by Ross Cushing, Au.D.,Live Better Hearing

More and more, hearing aids are being sold online, through catalogs, and directly to the consumer, bypassing the hearing healthcare provider. If your mailbox is like mine around Christmas time, it is getting filled with ton of catalogs. And if you like gadgets, like I do, you undoubtedly saw some of the same advertising for hearing aids in many of the catalogs from gadget distributors (like Hammacher Schlemmer). This is just one of the many ways hearing aids are now being sold directly to consumers as an over-the-counter product.

For the sake of discussion, let’s act as if it were legal to distribute hearing aids in any way (many companies are doing it illegally but that’ a topic for a different article) what method of distribution is best for the consumer of hearing aids: going through an audiologist or buying direct? As you can probably tell from the title, I am against the direct-to-consumer hearing aid model. The primary argument I have heard for this model is that buying direct will provide greater access to more products making the hearing aid manufacturers compete to the ultimate end of providing a less expensive, higher quality product to the average consumer. And to the average consumer, this probably seems like a reasonable train of thought.

Here’s the problem. Although it is true that the distributers of these products can almost always provide hearing aids at lower costs to the consumers, the purchase and use of a hearing aid without a proper examination, diagnosis, fitting, programming, and counseling is a recipe for poor treatment outcomes and increased risks. One of the main risks of omitting an evaluation and treatment by an audiologist include the missed diagnosis of a serious underlying health condition that requires medical intervention and subsequent hearing loss as a result of improper fitting or programming of hearing aids.

There are a lot of different causes for hearing loss including: aging, blockages in the outer ear, ear infections, fistulas, head injury, medication, Meniere’s disease, noise damage, otosclerosis, and tumors. Many of these conditions cannot be treated with a hearing aid, and several require immediate medical intervention for treatment. How will the consumer know when to get a hearing aid and when to seek medical attention if they buy online? They won’t.

Here’s an interesting fact to consider – most hearing aid manufacturers will not allow their hearing aids to be sold or purchased without a face-to-face consultation with a licensed practitioner, because they too recognize the inherent risks associated with the purchase and use of hearing aids without the proper counseling and fitting that only a licensed hearing healthcare professional can provide.

For a moment, let’s move away from the risks associated with the direct to consumer model, and look at patient satisfaction with this model. Research (Hearing Industries Association research and MarkeTrak data from Sergei Kotchin, Ph.D) has shown that the top reasons for patient satisfaction with hearing aids are directly attributable to the patient’s experience with a trained hearing instrument professional. I think those of us who understand what patients need for best hearing healthcare are committed to the principle that hearing aid technology is successful only when a trained professional has evaluated the hearing loss and fit a hearing solution that meets the patient’s individualized needs.

There are three important components inherent in the audiology model that are necessary and absent from the direct-to-consumer model:

1) PROPER EVALUATION – There has to be a good evaluation of your hearing for two primary reasons: to evaluate if medical treatment is needed or to see if a hearing aid is needed. An audiology test battery will be able to give insight into the problem and ultimately lead to the best treatment.

2) INDIVIDUALIZED DEVICE SET-UP – A hearing aid has to have the right hardware and software for the needs of the individual. It has to physically fit correctly on the individual. It has to be tuned right – it has to be configured to the individual’s dynamic range of hearing. And finally, it has to be used correctly.

3) PSYCHOLOGICAL CONSIDERATIONS & COUNSELING – A hearing aid not a normal consumer product. It’s a medical device and it has stigmas. On average, people know they have a hearing problem for 7 years before they do something about it.

Why? There are cosmetic concerns: ‘what will other people think about me if they know I have a hearing aid?’ There are communication issues that need to be addressed with loved ones. There is often a fear of having to rely on an artificial device. I try to put myself in the shoes of someone who has never gone through the process of getting hearing aids. From this perspective, the person may feel they could get something in a catalog or online, without having to make a big deal about it or talk to anyone. They could try it in their own time and see if it works.

In theory this sounds attractive, especially for those new users who aren’t ready to confront their own negative perceptions of wearing hearing aids or because they want to keep their costs low. But does this approach work? It’s like trying to put a band-aid on a broken arm. It just doesn’t make sense – a healthcare provider is needed to do it right. It is the knowledge and care of an audiologist that allows for success of amplification. Although, on the surface, better hearing seems like it could be more accessible if provided in a direct to consumer way, in reality, it is not practical or effective, and in many cases, not safe. Fitting hearing aids is an art, guided by science and delivered by the experience of an audiologist.

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