What to Expect at Your Hearing Aid Fitting

Posted by Jhhearingaids @jhhearingaids, Fri, Oct 11 2:27am

What to Expect at Your Hearing Aid Fitting

A successful hearing aid fitting is more than just selecting the correct device for your hearing needs. The hearing aids need to be properly fitted to your ears so that they provide the correct amount of amplification to maximize hearing aid benefit.

Prior to fitting the hearing aids, your audiologist will conduct a thorough hearing test to measure the softest sound you can hear at different pitches and record the volume of sound that is uncomfortably loud for you. Based on these tests, your audiologist will know how much gain the hearing aid needs to provide in order to amplify soft sounds so they are audible and how much to compress loud sounds so that they are not uncomfortable.

Different styles of hearing aids, levels of technology, and cost will all be discussed at your Hearing Aid Evaluation appointment. Your various listening environments and expectations of hearing aids will also be discussed. Your audiologist will discuss different features available in hearing aids and make recommendations based on your hearing evaluation and communication needs. You will select the hearing aids you want to order. Earmold impressions will be taken of your ears (if necessary) to order the hearing aids. About two weeks after you order the hearing aids, you will return for the hearing aid fitting.

At the hearing aid fitting appointment, your audiologist will verify that the hearing aids are providing the correct amount of amplification by doing Real Ear Measures. Real Ear Measures allow the audiologist to know how loud sounds are in your ear canal. First, a thin tube will be inserted into your ear canal. This tube is connected to a microphone that will measure the volume of sound near your eardrum without any hearing aid device in your ear.

Next, your hearing aid will be inserted in your ear taking care not to move the probe tube microphone already in your ear canal. Once the hearing aid is turned on, your audiologist will measure how loud the sound is at the output of your hearing aid in your ear. It is important for your audiologist to play different volumes of sound from soft to very loud in order to verify that soft sounds are amplified so you can hear them, that moderate-intensity sounds are amplified to a comfortable listening level, and that loud sounds are considered loud, but do not exceed your discomfort level.

Proper verification of your hearing aid settings is integral to a successful hearing aid fitting. If these measures are not completed, then the audiologist will not know whether your hearing aids are programmed properly. Real Ear Measures ensure that you are getting the appropriate amount of amplification in accordance with the severity of your hearing loss. Once the hearing aids are programmed, your audiologist will then review the care and maintenance of the hearing aids. Tasks, like inserting the hearing aids and changing the batteries, will be practiced in the office.

Liked by arrowshooter

Thank you, that's a good description of what SHOULD happen. But I don't see "real ear measures" being done by most audiologists.
Do others have different experiences?

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I've read that only about 30% of audiologists use real ear measures – most believe that this is not needed due to the programs provided by the hearing aid companies. My audiologist told me that she had used it and got a worse result than the Oticon programs. I kept pushing and now she has told me another audiologist in the office is using the real ear measurement and has the only device in the office to do so, so I'm going to that audiologist next time to see if it seems to make a difference for me.

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@maryjax

I've read that only about 30% of audiologists use real ear measures – most believe that this is not needed due to the programs provided by the hearing aid companies. My audiologist told me that she had used it and got a worse result than the Oticon programs. I kept pushing and now she has told me another audiologist in the office is using the real ear measurement and has the only device in the office to do so, so I'm going to that audiologist next time to see if it seems to make a difference for me.

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Yes, there is disagreement among the hearing professionals on the use of real ear measures.

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I wonder if we should do a bit more clarification of what a hearing aid 'fitter' is and/or can be. In Wisconsin, 'fitters' are required to pass a state exam to be licensed to sell hearing aids. Audiologists and hearing instrument specialists (HIS) take the same exam, and have the same privileges to fit and sell hearing aids. The difference is education. HIS need have no more than a high school diploma, and experience working under a licensed 'fitter', a short internship of sorts. Audiologists, for the most part have doctorate level degrees, that are indicated by the AuD initials following their name. Actually, many have a master's degree rather than an AuD degree, and are grandfathered in as clinical audiologists. They do not all have the same level of education, nor do they have the same quality of practice. And yet, some HIS seem to be better at fitting hearing aids than some AuDs, based on customer satisfaction. My personal opinion on REM is that 'more is better'. Why not get the full package when you're paying for the product? Even more important is what you do after you walk out of their office with the product(s) you just paid a fortune for. You have a mandatory trial period, according to the laws of your state. USE IT to try the products everywhere you ever plan to go or be. Don't get frustrated because things don't sound right. You only have 30 days to figure this out, so use them wisely. Go to a play, to the theater, to a social setting where background noise is present. Eat out. Don't simply test them in quiet.

Further, if your 'fitter' doesn't demonstrate the options available to you, and merely tells you about them, you are getting short changed. I don't know anyone who would not choose to have the telecoil option if they were able to plug in to a radio, ipod, laptop, etc. with a neckloop, or better yet to use with a loop installed in the 'fitter's office with a TV. You have to try it to know what it does. Merely having someone who is selling you something tell you that this 'option' might help you in some places, isn't good enough. And, some 'fitters' will tell you it's not important. Wrong! It is important IF you really want to hear in all settings, even those you may have abandoned because of your hearing loss. Some will tell you they don't want to add cost to the product by selling their customers on options. Don't swallow that. A quality telecoil in a hearing aid will add less than $20 to the cost of the product. It is not an added expense. So, when you go to your HIS, audiologist or 'fitter', be armed with questions and have some ideas about the answers, which are why you are asking those questions in the first place. You are paying for service and should expect the best available. Bluetooth technology is wonderful, but it does NOT replace the telecoil feature, so don't swallow that one either. Seriously, your approach to buying a hearing aid should be a consumer approach. Do some research. Talk to people who use hearing aids successfully. Read. Find some HLAA folks who are willing to openly discuss their hearing loss journeys. You won't regret it. (Sorry so long, but this is such an important topic!)

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I'm wondering if anyone knows if VA uses REM. I have been seen by 7+ VA audiologist and never had a REM taken. I don't know of any veteran who has had an REM taken. I have been to 4+ private practice audiologists and got the same answer – "we don't do that". Private practice audiologists can do what the want, but I'm wondering if VA audiologists are constrained by VA policy we don't know about and they don't talk about. I'm not critical of VA care. All the audiologists I've seen have been caring people and seem competent. I did have to request t-coils in my hearing aids and received them with no argument.

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@arrowshooter

Yes, there is disagreement among the hearing professionals on the use of real ear measures.

Jump to this post

I’ve only see the PRI argument. I’d be interested in hearing the against argument.

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@julieo4

I wonder if we should do a bit more clarification of what a hearing aid 'fitter' is and/or can be. In Wisconsin, 'fitters' are required to pass a state exam to be licensed to sell hearing aids. Audiologists and hearing instrument specialists (HIS) take the same exam, and have the same privileges to fit and sell hearing aids. The difference is education. HIS need have no more than a high school diploma, and experience working under a licensed 'fitter', a short internship of sorts. Audiologists, for the most part have doctorate level degrees, that are indicated by the AuD initials following their name. Actually, many have a master's degree rather than an AuD degree, and are grandfathered in as clinical audiologists. They do not all have the same level of education, nor do they have the same quality of practice. And yet, some HIS seem to be better at fitting hearing aids than some AuDs, based on customer satisfaction. My personal opinion on REM is that 'more is better'. Why not get the full package when you're paying for the product? Even more important is what you do after you walk out of their office with the product(s) you just paid a fortune for. You have a mandatory trial period, according to the laws of your state. USE IT to try the products everywhere you ever plan to go or be. Don't get frustrated because things don't sound right. You only have 30 days to figure this out, so use them wisely. Go to a play, to the theater, to a social setting where background noise is present. Eat out. Don't simply test them in quiet.

Further, if your 'fitter' doesn't demonstrate the options available to you, and merely tells you about them, you are getting short changed. I don't know anyone who would not choose to have the telecoil option if they were able to plug in to a radio, ipod, laptop, etc. with a neckloop, or better yet to use with a loop installed in the 'fitter's office with a TV. You have to try it to know what it does. Merely having someone who is selling you something tell you that this 'option' might help you in some places, isn't good enough. And, some 'fitters' will tell you it's not important. Wrong! It is important IF you really want to hear in all settings, even those you may have abandoned because of your hearing loss. Some will tell you they don't want to add cost to the product by selling their customers on options. Don't swallow that. A quality telecoil in a hearing aid will add less than $20 to the cost of the product. It is not an added expense. So, when you go to your HIS, audiologist or 'fitter', be armed with questions and have some ideas about the answers, which are why you are asking those questions in the first place. You are paying for service and should expect the best available. Bluetooth technology is wonderful, but it does NOT replace the telecoil feature, so don't swallow that one either. Seriously, your approach to buying a hearing aid should be a consumer approach. Do some research. Talk to people who use hearing aids successfully. Read. Find some HLAA folks who are willing to openly discuss their hearing loss journeys. You won't regret it. (Sorry so long, but this is such an important topic!)

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@julieo4 You make some good points. I do not know how Michigan differentiates between AuD's and HIS's. Thanks for explaining how WI handles them. Secondly, we are fortunate to have resources available to us. I'd like to say that ALL of those people that are members of HLAA are knowledgeable on telecoils but I have to imagine that some (most likely those that do not attend meetings or conventions), would not know how to handle a hearing aid fitting and bring up the benefits of that technology. Perhaps this is the reason that hearing aid manufacturers are pushing to make the technology obsolete. We need more people to request telecoils. Thirdly, we are used to the "bundling of services" when we buy our hearing aids. It takes longer for an audiologist to fit if a customer has a telecoil. It's would have its own "program" with its own parameters. The same would be true if you wanted a remote microphone. There is a separate program, and maybe even two or more programs. It would seem that a bundled cost should include the cost of fitting regardless of which accessories one may want. People SHOULD do research before a product is purchased.
Tony in Michigan

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Interesting discussion! I bought my aid a year ago from Costco, because it cost far less. The person who has worked with me is not an audiologist, but appears to have done all of the things that one could want or expect, including activating the telecoil several months later after I acquired a smartphone and, recently, pairing the aid with a microphone designed to work with it. For a while, I was afraid that I was somehow getting less because she is not an audi, but the audiologist I consulted, part of the clinic that does CIs in this part of the country, gave Costco very high marks for the most part. In fact, she was not aware of Live Transcribe, although the Costco person was. Go figure!

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That is what makes the process so complex. Technology isn't all that difficult to understand if one is willing to learn. Many of the HIS are very tuned in to the various components in hearing aids. Some 'fitters' at all levels listen to their clients; some do not because they consider themselves the experts. I am sure that Costco and other 'big box' providers have a variety of levels of professionals in this area. Costco sells good quality hearing aids made by reputable manufacturers. I don't know this for fact, but have been told that many of the hearing instruments they sell are less expensive because they are models that are slightly outdated; perhaps a model or two behind what is currently being promoted by the manufacturers and audiologists. That doesn't mean they are not quality hearing aids. You educated your Costco provider because you knew what you wanted. That will also help other people who buy hearing aids from the provider(s) you taught. 🙂

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reply to Julieo4
One thing I've seen is that there doesn't seem to be a limit on how much the Costco fitter is willing to work with me. There's been no talk of too many appts. or waiting because I had one not long previously. The audiologist at the CI clinic told me that my Costco aid is actually an Oticon under another name and that it was up to date (not an older model) when I bought it a year ago. Interestingly, the person who did the hearing test at the clinic told me I should give up the $1,600 Costco aid and spend $6,000 to buy two "better" aids. A week later, during my appt. with the audiologist, she said that was totally wrong, that the aid I have should last another five years or so before something much better should replace it. She also confirmed that I wasn't fitted with an aid in my useless ear due to the recruitment and felt that it probably wouldn't be successful. How's that for two vastly different opinions from the same clinic?

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That's really interesting. Some Costco's have audiologists on staff; some do not. I'm sure they vary a great deal. I have profound hearing loss, and am bimodal with a CI and a HA that work very well together. I would not risk short changing myself by not going to an audiologist whom I know to be excellent. However, I would not discourage others with less serious hearing loss to try Costco. This also goes back to that trial period issue. If the aid(s) you are trying don't work, take the back and either go elsewhere or ask to try something else. That trial period is vital. I would also recommend asking whether or not a hearing purchased at Costco or other 'big box' provider, can be reprogrammed by a provider outside of Costco. I've heard that some of the aids they sell are 'locked' in a way that they cannot be programmed outside of Costco. This is may not be a big issue for some, but for those who travel it could be.

Liked by arrowshooter

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@julieo4

That is what makes the process so complex. Technology isn't all that difficult to understand if one is willing to learn. Many of the HIS are very tuned in to the various components in hearing aids. Some 'fitters' at all levels listen to their clients; some do not because they consider themselves the experts. I am sure that Costco and other 'big box' providers have a variety of levels of professionals in this area. Costco sells good quality hearing aids made by reputable manufacturers. I don't know this for fact, but have been told that many of the hearing instruments they sell are less expensive because they are models that are slightly outdated; perhaps a model or two behind what is currently being promoted by the manufacturers and audiologists. That doesn't mean they are not quality hearing aids. You educated your Costco provider because you knew what you wanted. That will also help other people who buy hearing aids from the provider(s) you taught. 🙂

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I think you're right about the Costco being the older model of some manufacturers products but it may not always be the case. If anything, we may be able to get a new model but it may not have a telecoil option, a rechargeable option, or have tinnitus masking, etc.
Tony in Michigan

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I have no experience at Costco. But, in general, it appears to me that most decisions made by the big stores are made by the marketing department with the objective of making a profit for the company. I don't doubt they have some caring and competent people who want to server their patients (customers) well, but they have to operate within the constrains of store policy – determined by the marketing department. With the advent of OTC hearing aids this would be a huge consideration for me. There is no guarantee that a patient will get better care at a private practice audiologist either. But I agree with julieo4 about wanting to see someone I know is best positioned to help me.

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@tonyinmi

I think you're right about the Costco being the older model of some manufacturers products but it may not always be the case. If anything, we may be able to get a new model but it may not have a telecoil option, a rechargeable option, or have tinnitus masking, etc.
Tony in Michigan

Jump to this post

That goes right back to the importance of being an informed buyer/consumer. Do some research on hearing aids. Talk to people who use them successfully. Use HLAA as a resource if possible. This is a unique area as we consider hearing instruments to be medical devices. They are, but since they are rarely insured so they are more like a 'consumer product'. You don't go out and buy a car, a TV or a refrigerator without knowing what options are available. Your lifestyle matters. If you don't enjoy social events, movies, plays, etc. you may not need all the options. On the other hand, if the reason you don't enjoy those things is because of your hearing loss, the options may be the incentive you need to get back in the swing. As I've said before: The telecoil is extremely important to me, and still would be if I didn't use it outside of my own home. home I use it on my laptop, and to listen to music on a variety of audio devices. I use it with my cell phone. Elsewhere I use it at our performing arts center, and in church. I turn to BlueTooth when we are out for dinner or in cocktail party settings. A hearing aid without a telecoil is like a car without air conditioning….you don't need it all the time, but when you do you are sure glad you have it! BT takes things a step further, but it does not replace the value of the telecoil. Lastly, it's up to the hard of hearing population to educate their communities about the value of hearing loops in public venues. They don't get there without that education. It's time we all stopped accepting that hearing loss is simply ignored when it comes to access. Communication access is a right but we have to claim it.

Liked by arrowshooter

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All true and well said. I, too, use my Connect Clip to listen to my computer and I have found music worth listening to only since t-coil and BT.

But I recently talked to a member of our church (equipped with a hearing loop) who told me he can't use the loop because he can't hear anything but the loop. I was the one who encouraged him to get t-coils in his hearing aids. I found out his programs do not include a program that activates the induction loop AND his hearing aid microphones at the same time. I told him to go back and tell his audi that he needs such a program. Another example of audiologists who don't understand our needs.

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