April 2014 Hearing Review

Van Vliet By Dennis Van Vliet, AuD

In March of this year, I joined a few hundred participants at the American Auditory Society (AAS) annual meeting in Scottsdale, Ariz. This meeting has always been excellent, and was especially so this year. The topics addressed gave a glimpse at the future of treatment of hearing loss, such as stem cell treatments, and direct delivery of drugs to the cochlea for “rescue” of critical structures after noise trauma, ototoxicity, or other damage.

Closer to present-day capability is integration of smart phones with our lives by using GPS to tag locations where our iPhone-connected hearing aids may switch to a user-optimized adjustment or by looking at listening demand by analyzing clusters of activity detected by GPS capability. These topics, along with many other emerging ideas and research presented in the 3-day meeting, fueled my imagination on what lies ahead for the industry and the professionals working to provide care for individuals with hearing loss.

Changing Roles

As providers of care, we are likely going to need to adapt to a changing landscape by giving up some of our role as the exclusive source of information for individuals, and work more as guides to help them through the jungle of good and bad advice offered by online sources, print and televised media, and word of mouth.

We will also need to be prepared for the fact that generic consumer devices will begin to cross over into the space we now fill with professionally fitted hearing aids and accessories. I recently had a patient with a severe loss tell me about using cheap old-fashioned Walkman-style headphones as couplers for listening to podcasts and music via telecoils. She had learned that the electromagnetic fields produced by the coil-driven diaphragms in the headphones are excellent for stereo listening. An accessory that I might have researched and provided for her would undoubtedly have been more expensive, yet not necessarily more effective. I felt pretty good about the fact that she had been resourceful enough to come up with a good solution on her own. I won’t mind passing the tip on to other similar patients either.

Let’s imagine, however, that next year a generic Low Energy Bluetooth accessory becomes available that allows anyone to use their phone as a remote microphone as needed. Will we adapt so that we can embrace developments like such an accessory and allow them to be part of the options we offer to patients?

I think so. We are interested in building the value of our services to the population we serve. When we see patients younger than the typical new user, they often aren’t excited about jumping into a full function set of hearing aids if their areas of difficulty are limited. If we can adopt test batteries that define specific performance limitations, and offer clear guidelines on how the difficulties can be avoided or compensated for with training, or by using products other than hearing aids, we have provided good value, as well as established ourselves as a provider of services that have high value to the patient, increasing the chances that they may return when their needs are greater.

The presence of “gateway” wireless products in the marketplace may actually help us gain access to the potential hearing aid consumer when they are much earlier in the awareness and contemplation stage of the hearing aid acquisition process.

We do need to look at our standard of care test battery if we are going to have success in this endeavor. Speech-in-noise tests, such as the QuickSin, that do not take too much time have been available for more than a decade. Similarly, there are simple screening tests that can assess working memory without the patient thinking we are looking for dementia, scaring them off. With knowledge about recognizing speech information in noise, and some hint about the patient’s ability to compensate for a difficult environment, we are much better equipped to counsel the patient and their significant others about the best course of action.

Think about the last patient you saw with a minimal or high frequency loss that didn’t meet your gut criteria for amplification. Rather than giving them the advice of returning in a year or so, with the proper diagnostics, you could be very specific about what they can do now to start to remedy their complaints. It might be rehabilitation training, a consumer device, or a sophisticated hearing aid fit in an unconventional manner that matches their needs.

The Final Word? There is an ongoing discussion today about impending changes in the hearing aid delivery system we are familiar with. We can start to adapt by embracing some of the changes in the marketplace and looking carefully at how we can change our current practices to improve the value we provide. Looking at changing our test battery a little to learn more about the ability of our patients to function will help.

Dennis Van Vliet, AuD, has been a prominent clinician, columnist, educator, and leader in the hearing healthcare field for nearly 40 years, and his professional experience includes working as an educational audiologist, a private-practice owner, and VP of audiology for a large dispensing network. He currently serves as the senior director of professional relations for Starkey Technologies, Eden Prairie, Minn. Correspondence can be addressed to HR or [email protected].

Original citation for this article: Van Vliet, D. Our changing roles in patient management. Hearing Review. 2014;21(4): 50.