February 22, 2018

Does One Size Fit All?

My husband and I recently went to a spa for a couple’s massage which we do once or twice a year when on a vacation. This spa day started out like any other; we checked in and were escorted to separate locker rooms where they gave us slippers and robes to change into before meeting up again in the relaxation room to wait on our masseuse. Those of you who know us know we have a slight height difference, and for those of you who don’t, I am 5’3” on a good day while he is 6’4”. Which meant the robe I was given was wrapped around me twice and covered me from neck to ankle while his was barely closing and stopped above his knees. While this was funny to me he was less amused. Obviously, with a big difference in body sizes, a nice spa should realize that one-size-fits-all robes are not a good idea. But, this got me to thinking. If something as obvious as clothing needs to be sized appropriately, why should people think a one-size-fits-all hearing aid would work?

The ads for these one-size-fits all hearing aids (commonly referred to as personal sound amplifiers or hearing amplifiers) are everywhere. If you’re not seeing them on the internet your definitely getting flyers about them in your mail. Most consumers shopping on the internet do not understand the importance of having a hearing instrument programmed to their prescription level, so they are easily drawn in by all the 5-star reviews. However, there are very few medical devices available where one size fits all. Even glasses need to be fit to your prescription level. Trust me, I was inappropriately fit for glasses once, and it resulted in a headache every time I wore them. To avoid overamplifying, internet hearing aids can only be sold with enough volume for someone with mild to moderate hearing loss. Yet, the 5-star reviews lead you to believe differently. For example, one reviewer with “severe to profound” loss stated he bought a pair and actually had to turn down the volume. Another reviewer claimed the hearing aids he bought were the “same ones being fit by the VA”. I’m not saying these reviews are made up, but they are definitely misleading, and the more I read the more I questioned their authenticity. First, the aids sold online do not have enough volume for someone with severe to profound loss, and based on personal experience with my father these are definitely not the hearing aids being fit by the VA.

I know internet hearing aids can be tempting as they promise great hearing at drastically reduced prices. But, do they live up to all their claims? The price of hearing aids on the internet range from about $200 to $1,999 per device depending on the site. There are many reasons why they are cheaper, ranging from design to technology to, most importantly, a lack of an audiologist.

Of course, if you are into vintage items internet hearing aids could be your thing as they are being housed in cases from about a decade ago. But a consumer will overlook this as they are convinced that all the external features like a wheel to adjust the volume, a button to change programs, and a switch to turn them on/off are necessary. Modern instruments have only one button that can be programmed to the user’s preference. Why? Because over the past 10-15 years manufacturers have learned that the more openings on the case of the hearing instrument the more moisture that will get inside which leads to corrosion and repeated repairs.

This knowledge of product, technology, and customized programming is exactly what is missing from the internet hearing aids. There have been several studies done comparing the electroacoustic performance and sound quality of both low-end and high-end internet hearing aids compared to the low and high-end hearing instruments fit by an audiologist. The studies consistently found the internet hearing aids were over amplifying low frequency sounds and produced more internal circuit noise than those that were fit by an audiologist. More importantly the studies looked at user preference when it came to sound quality and found hearing instruments fit by an audiologist were always preferred over internet hearing aids when it came to speech perception.

The value an audiologist adds to a hearing instrument fitting is irreplaceable. When I initially meet a client, my primary focus is finding out what each individual client’s needs are. I spend time talking about how their hearing loss is affecting them, where they struggle to hear, what concerns they have about wearing hearing instruments, and learning about what has lead them to pursue hearing instruments at this time? Once I have all this information I am able to help them select the best hearing instrument for them and then program it to their prescription level. When programming a hearing instrument, I am setting it to each client’s hearing loss. However, I am also taking into account the acoustics of their ear canal, their personal preference for sound, and the acoustics of the environment they live or work in. Having a hearing instrument fit to your prescription is the difference between participating in a conversation and struggling to hear it.
When it comes down to it, the concept of one-size-fits-all is not all it’s cracked up to be. Internet shopping is very convenient and generally can lead to deals. However, hearing loss is a permanent condition that needs to be treated appropriately by a professional. Attempting to treat hearing loss with a web-based deal will just end up like my husband in that robe…ill-fitting.