What to Expect at Your Hearing Aid Fitting

Posted by Jhhearingaids @jhhearingaids, Oct 11, 2019

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.

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

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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.

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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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julieo4 and arrowshooter,

The one clinic audiologist told me that my aid purchased at Costco a year ago is new. It does have a telecoil, and the Costco fitter paired it with my smartphone when I acquired one several months later. She told me that she knew there would be a mic to pair with the aid, and that was correct. The other clinic audi (who only tests hearing to evaluate for possible CI) was totally dismissive of Costco on all counts. I scored 55% on the Ci test, 5 points above the level where Medicare would pay for a CI. She told me to spend $6,000 on two aids, wait six months, and come back to see if my hearing would have degraded enough for a CI for my ear that hasn't heard much for decades, and then a new aid for my other ear–a total cost in less than a year of $9,000!

Costco aids are about half the cost of the same aid elsewhere. There are several options, depending on amount and type of loss. The aid I bought has a two-year guarantee against everything, including loss and damage. There is no written statement about subsequent appts. for adjustments, and I've never been told that I can't have an appt. when I've asked for one. The nearest Costco is only 60 miles away…half the distance of the CI clinic. The only thing that I can complain about is that the Costco phone system isn't set up to take messages, so you have to call back if it's busy.

If I ever find a place in this little town where there's an induction loop (not likely!), I'll try that out. During weekly sessions of our lecture group, I sit in the front row and have my mic handy if the speaker tends to wander away from the podium while showing PowerPoints. If the speaker stays close to the podium, I generally don't need the mic. The first day I had it, I left it on, sitting on the table in front of me, during the break and was surprised to hear several people talking to the speaker while I was in the restroom about 75 feet away–surprise! I wasn't able to understand, because there were many voices, (I have a great deal of distortion at all times), but I could hear voices if not words. Because of the distortion, I rely on speech reading along with what I hear.

As for music, I quit playing when my right ear went south because the recruitment literally made me sick and I wasn't able to hear others playing around me. For years, I didn't listen to music, but about 10 years ago I began to listen to classical and jazz that I knew well, filling in the missing parts in my mind. Since I went bilateral, the distortion is so dreadful that all higher instruments (flutes, trumpets, etc.) sound like kazoos. I went to a concert with the Air Force quintet…kazoos! Imagine that! After several years, I'm hoping that the recruitment will taper off, as it did with my right ear after many years. So far, this recruitment isn't quite as bad as it was for my right ear, but the distortion is very hard to learn to live with. I hear sounds, but I don't know what they are–the car engine, the dishwasher or washer, microwave, a faucet running…all sound the same, just pulsating rumbling noise. Part of that is the new tinnitus in my left ear, so when I walk a quarter mile to the mailbox along our gravel road, it constantly sounds as though there might be a car coming even though there seldom is. When a car does approach, it isn't much louder than the T! Strange world out there!

Next trick will be to take a deep breath and start what is likely to be weeks of effort to get Charter to display captions on more than one channel on our TV. I'll work on that after I finish all the fall chores, esp. gutter cleaning. The ship has sailed as far as finishing exterior painting this year!

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This is another thing that's misunderstood. Many people prefer a 'T' only option, while others like an 'M/T' program that brings the sound in from the loop but also allows one to hear through the hearing aid microphone while using the loop or other device that relates to the telecoil. Some people I know refer to the M/T option as 'the marriage saver option'. Why? Because when one is using the T only option, all they hear is what is coming through the broadcasting system, meaning the microphone being used by the speaker or audio device. In many instances, that is the ONLY thing you want to hear. In others, perhaps in the family room with TV, you might want to hear your spouse ask a question. The M/T allows that. However, it also brings in the very background noise we are trying to eliminate. Not a problem in a quiet setting, but a big one in an arena setting. Most digital hearing aids have 4 programs that can be set by the 'fitter'. One can be used for T and another for M/T if that's preferable. Some hearing aids have remote controls that will allow adjustment in an M/T setting that determines which of the two is at a specific volume level. Those who fit hearing aids have an obligation to educate the people who buy them. It takes time, but should be expected.

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@joyces

julieo4 and arrowshooter,

The one clinic audiologist told me that my aid purchased at Costco a year ago is new. It does have a telecoil, and the Costco fitter paired it with my smartphone when I acquired one several months later. She told me that she knew there would be a mic to pair with the aid, and that was correct. The other clinic audi (who only tests hearing to evaluate for possible CI) was totally dismissive of Costco on all counts. I scored 55% on the Ci test, 5 points above the level where Medicare would pay for a CI. She told me to spend $6,000 on two aids, wait six months, and come back to see if my hearing would have degraded enough for a CI for my ear that hasn't heard much for decades, and then a new aid for my other ear–a total cost in less than a year of $9,000!

Costco aids are about half the cost of the same aid elsewhere. There are several options, depending on amount and type of loss. The aid I bought has a two-year guarantee against everything, including loss and damage. There is no written statement about subsequent appts. for adjustments, and I've never been told that I can't have an appt. when I've asked for one. The nearest Costco is only 60 miles away…half the distance of the CI clinic. The only thing that I can complain about is that the Costco phone system isn't set up to take messages, so you have to call back if it's busy.

If I ever find a place in this little town where there's an induction loop (not likely!), I'll try that out. During weekly sessions of our lecture group, I sit in the front row and have my mic handy if the speaker tends to wander away from the podium while showing PowerPoints. If the speaker stays close to the podium, I generally don't need the mic. The first day I had it, I left it on, sitting on the table in front of me, during the break and was surprised to hear several people talking to the speaker while I was in the restroom about 75 feet away–surprise! I wasn't able to understand, because there were many voices, (I have a great deal of distortion at all times), but I could hear voices if not words. Because of the distortion, I rely on speech reading along with what I hear.

As for music, I quit playing when my right ear went south because the recruitment literally made me sick and I wasn't able to hear others playing around me. For years, I didn't listen to music, but about 10 years ago I began to listen to classical and jazz that I knew well, filling in the missing parts in my mind. Since I went bilateral, the distortion is so dreadful that all higher instruments (flutes, trumpets, etc.) sound like kazoos. I went to a concert with the Air Force quintet…kazoos! Imagine that! After several years, I'm hoping that the recruitment will taper off, as it did with my right ear after many years. So far, this recruitment isn't quite as bad as it was for my right ear, but the distortion is very hard to learn to live with. I hear sounds, but I don't know what they are–the car engine, the dishwasher or washer, microwave, a faucet running…all sound the same, just pulsating rumbling noise. Part of that is the new tinnitus in my left ear, so when I walk a quarter mile to the mailbox along our gravel road, it constantly sounds as though there might be a car coming even though there seldom is. When a car does approach, it isn't much louder than the T! Strange world out there!

Next trick will be to take a deep breath and start what is likely to be weeks of effort to get Charter to display captions on more than one channel on our TV. I'll work on that after I finish all the fall chores, esp. gutter cleaning. The ship has sailed as far as finishing exterior painting this year!

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Joyces, your experiences are interesting and also quite typical, yet everyone's hearing loss is unique. Most of us have trouble identifying sounds, knowing where they are coming from, etc. Some are distorted. Most of us who enjoy music, and many do, prefer music they enjoyed prior to their hearing loss becoming severe, or that which is clear and easier to understand than some of the rap, rock, etc. that is so popular today. I hope you own a neckloop that you can try with personal audio devices. Getting loops installed in outside places takes education. You sound like an educator. You sound like someone who attends educational events. Be an educator and tell people how much loops matter. If you can get one installed in your small community it can multiply, but someone has to start the process. A library is a good place to begin, as is a church. Libraries tend to be interested in ideas, churches want to be helpful and inclusive. Good luck with the TV captioning. That too is a matter of education for local programming. National programs are captioned by law. One problem seems to be finding and employing people who are able to provide the subtitles/captions. Again, this is called 'communication access', and it is just as much a right for us as curb cuts are for people with mobility issues. Hearing loss is at a disadvantage because it is invisible. Invisibility to some means non existent and easy to ignore. That's especially problematic because so many people spend more energy trying to hide their hearing loss than they do trying to manage it.

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Julieo4, listening to music, now that it is so hopelessly distorted by my enemy, the Meniere's monster, is far down the list. Right now, my great effort is to learn how to hear in small groups–meetings about environmental issues, lunches during lecture days. Next would be figuring out how to hear at least some of what each speaker is saying in auditorium settings where (a) it's impossible to sit near the speaker due to setup of the room, (b) the A/V equipment is often of low quality, and (c) the audience is encouraged to participate in formally at all times. I am fortunate because the lecture series has good A/V; by sitting in the front row, I can understand most of what the speakers say.

As for captions for television, I often see that there's a logo and "closed captioning provided by" message, but no closed captions appear on our TV. I've set it to use captions, but only one channel provides them. Since it took us months and FOUR separate numbers to get phone service from Charter, I just haven't had the time and willingness to go to battle once again. Seems as though the $180/mo we pay doesn't get us much, but I do appreciate the fact that I have access to the internet. We've given up on attempting to have continuous television and expect that the picture will pixilate and all sound disappear frequently…but not often during commercial breaks. <g> Charter is Charter, and that's the one service available to us, living in an isolated area near a very small town.

Loops are definitely classified as a luxury by this town and the slightly larger one 40 miles away because it takes all the tax dollars they collect to provide infrastructure to enable the tens of thousands of tourists every weekend to "have a nice time." Basic services like water are very expensive to provide in a community that has few roads and large undeveloped areas–long runs of pipe for few customers. The tourist economy also means that the homeless problem is extreme every winter. There's no way minimum-wage workers can "save for the winter" when they're paying elevated prices for rentals during the summer while they work two or three part-time jobs (20 hours of less means the employer doesn't pay benefits). Relying 100% on tourism definitely has a downside. Having a tribal casino that doesn't contribute to unemployment only makes matters worse.

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Well, it's obvious that you live in a very remote area. Where? I spend considerable time in a tourist area, but don't seem to have the issues you are describing. As far as loops go, we've been using a loop at our HLAA meetings since 1984. We built the original loop we used for 20 years out of telephone wire, an amplifier and a hard wired microphone. While professionally installed loops have some new standards, a loop can be built fairly easy if one has even minimum understanding of how they work. Cost: A few hundred bucks. You might also consider purchasing a personal FM system to use in those social settings you describe. There are numerous products that can work like FM does. That could also be used in venues with speakers if you are willing to ask the speaker to use a microphone that you provide.

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Julieo4, I live in Lincoln City in Lincoln County, on the central Oregon Coast–even though Pres. Lincoln was never anywhere near here. Until 1965, there were five separate tiny towns strung along several miles of the coast; they were consolidated, but each couldn't keep their own name, so someone elected to follow the name of the county. Oceanlake would make the most sense, as there's a very large lake east of the narrow strip of "downtown" called Devil's Lake. I live a bit north, in Roads End, much of which was recently annexed. Although we have very serious issues with the town's reliance on tourism, I'm sure that visitors aren't aware of the problem. Infrastructure is unusually expensive here: sandy soils, most population within two blocks of the Pacific Ocean, no road except US 101 goes north-south for any distance, entire area very hilly, breezes of 60 mph aren't unusual. Cities are ordinarily laid out with a grid radiating from the center, rather than this narrow strip along the cliffs above the water. The county seat is larger (10,000 pop.) and has lots of scientific jobs (NOAA, NMFS, UofO Oceangraphic Studies), fish processing, and a large brewery with much less reliance on tourism. What they do have is two failing water supply dams that must be replaced at a cost of $75 million. That said, this is truly God's country, one breath-taking vista after another. We live with wild creatures for neighbors. The spruce forest on much of our acreage has never, ever been harvested…true old growth.

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Sounds beautiful and fascinating. I get some of the same in northern WI and MN, but am glad I have internet! The choices we make have much to do with the lives we live. I hope you write a book about your experiences there, and with hearing loss. It's therapeutic! Good luck to you.

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Jhhearingaids, May I post your reply on our HLAA website, http://www.hearinglosskentucky.org . Each month we add new information and links for our viewers. We average 600 to 1000 real persons viewing information on our site. Your response will be helpful to others. ed@hearinglosskentucky.org

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@joyces

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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Thanks for the shout out for the Costco experience and product. I’ve heard the same from several friends who’ve gotten their aids through a Costco.
Joyce what state do you live in?
Thanks , Margot

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