What to Expect at Your First Hearing Aid Check
~This post is really meant for people who are transferring their services to me, i.e. they have hearing aids from another practice but really can apply to any hearing aid check appointment.~
If you’ve read any of my blog posts or anything on social media, you’ll notice I repeatedly mention BEST PRACTICES! As a profession, we have standards of care that we are to employ in our clinical practices. Not every hearing healthcare provider follows the standards.
I firmly believe in using best practices. One of these is called probe microphone measurements or real ear measurements (REM) or live speech mapping (LSM). Unfortunately, only 30% of hearing healthcare providers use this measurement. I was fortunate to be taught about REM/LSM in graduate school and used it regularly when I was employed at the VA. I worked at a large medical group for a few years before I opened my practice. When I joined this group, I was shocked that best practices were not being used. I asked to have a REM machine in the clinic, but I was told no because of the cost. I was shocked…. how can I fit hearing aids to patients without this verification? Shortly after joining this medical group, I knew I would not stay there long. Fast forward about 3 years, I left that place and started my business plan and one of the first pieces of equipment I purchased was my REM!!
Okay, so enough about the why. Let’s get back to the hearing aid check appointment. Maybe you are coming to see me for a second opinion, maybe you have hearing aids, but you barely wear them, or maybe you want to hear better with your hearing aids. I start this appointment by talking to you about your needs and what has been happening with your current hearing aids. I will then check and clean the hearing aids. And, look in your ears!
The next step is to perform an electroacoustic analysis of the hearing aids. This equipment is also part of best practices and I am happy to have it. This analysis involves placing your hearing aid in a hearing instrument test chamber and running it through many tests to verify that it meets manufacturer specifications. A simple listening check is not enough to thoroughly test how well a hearing aid is functioning. With this data, I can determine if the hearing aid needs repair, needs a new receiver, or is working “up to specs.”
Next, I will connect the hearing aids to the hearing aid manufacturer software and read the current settings. It’s always a good idea to save the settings in case you prefer the “old” settings. Usually, I can download the most recent hearing test that is saved into the hearing aids. What I like to point out is this limited information only provides me about 1/5 of the info I would like to have, but it’s a good starting point. I can tell from the settings if real ear measurements were performed and in almost every case, they are not.
Now, we have reached my favorite part. It’s time to perform real ear measurements and live speech mapping. At this time, I will place a tiny probe microphone in your ear canals and then place the hearing aids. Using the REM equipment, I will measure what the hearing aid is actually doing in your ear based on your hearing test. Often, the hearing aid is under-performing and not providing enough gain (i.e. volume). The gains prescribed in the fitting software are a starting point, but it is imperative to use the patient’s ear canal properties to perform the best fit. Following this measurement, I start running more tests and making changes to the gain of the hearing aid. In addition, I may also change out the acoustic coupling on the hearing aid to a more appropriate coupling. The changes I make in this appointment are usually significant and more often than not, the patient will report everything is too loud. This is the time to have the discussion about brain adaptation and how the brain has become very accustomed to hearing improperly. Another great part of this is live speech mapping. Typically, I use recorded speech, but we can use your spouse or your child’s speech as well. It’s a wonderful tool.
Lastly, we chat about the changes made. Typically, I will decrease the overall gains by 20-30% from the measured gains because as I mentioned above, your brain must acclimate. Fortunately, most software programs have a way to program the hearing aid to automatically increase over a time period set by us.
Writing this makes me think of a patient who came to me for a second opinion. She purchased hearing aids from another practice but was wearing them only a couple times a week. I ran REM on the current settings and the hearing aids were doing nothing for her. She even mentioned she didn’t notice a difference with them in or out. After changing the settings to match targets, she was in awe. She only had the hearing aids for about a year when I met her. She said I have missed out on so much for this last year, but I am so happy I found you now!
I look forward to helping you hearing better and improving your quality of life!