Chalfont Hearing Centre joins the UK Elite for Audiology and Hearing Aids

Chalfont Hearing Centre and Henley Hearing Centre are proud to announce that as of September 2015, we have satisfied the criteria to be considered as one of the UK’s Elite Hearing Centres. (more…)

Verification of digital hearing aid fittings; Real Ear Measurements (REMs) versus In-Situ fitting

This has been a subject that I have had strong views on. However, overtime I have changed my position slightly. But I have taken some research from several recent journals including https://www.ihsinfo.org/ihsv2/Ceus/pdf/2008_July_Aug_Sept_THP.pdf to help clarify my current stance.

Hearing aid fitting software has a built- in audiometer to obtain hearing levels with the hearing aid in the ear. This procedure is called in situ audiometry. “In situ” is a Latin phrase meaning “in place” . In the case of hearing instruments, it refers to measurements taken with the hearing aid in its natural location: correctly fitted in the ear.   The procedure also accounts for the effects of the depth of the instrument in the ear canal, the effectiveness of the seal in the ear canal, the effects of venting, and the specific receiver in that instrument. When we are using the fitting software to set the target and perform the initial adjustments we rely exclusively on the hearing levels (HTLs) obtained during the audiologic evaluation. The fitting formulas used to set the target gain contain the proper algorithms to compute the gain targets based on the desired input levels and hearing instrument style. However, these algorithms are all based on average data. By including data obtained for your specific patient and his or her specific hearing instrument, we are adding a level of customization that patients expect from the sophisticated digital technology used today.

Once the HTLs are corrected for the hearing aid insertion effects, the hearing aid must be calibrated so that its gain response matches the gain targets.  Real-ear measurements as a technique for objectively verifying the performance characteristics of a hearing aid are recommended as a best practice in hearing aid fittings (Valente, 2006). However, it is not widely used for reasons such as expense, time limitations, and the need for cumbersome equipment. As a result, about 60% of hearing professionals do not use real-ear measurements (Kirkwood, 2006).  Differences in the acoustic characteristics of the ear canals are quite apparent and speak to the need for individual measures to add precision to the fitting rather than relying on average data. The target match will be inaccurate for the individual ear to the extent that the average RECD is different for the ear under test.

It is essential when achieving fitting success that the hearing aid prescription is verified. Without verification you do not know how the hearing aid is performing and therefore whether the patient is benefiting. I would estimate that at least 75% of private hearing centres still DO NOT verify their fittings, in comparison to 95% of NHS departments that DO verify their fittings. What this means is that ‘potentially’ most premium and advanced hearing aids fitted privately, ‘maybe’ under performing in comparison to more basic hearing aids fitted by the NHS. National hearing aid companies do not verify their fittings generally and often fit the aid to the manufacturers settings. When adjustments are made they are often made blindly without knowing the effect they have on output.  The research indicates that verification is still needed to ensure (http://www.ncbi.nlm.nih.gov/pubmed/21376007) prescription is met and that in situ measures are not enough on their own, a stand alone verification device provides the best option. I used to feel that in situ measurements, would sufficiently tailor hearing aid gain to accommodate different ear canal properties. I naively used to make that assumption based on the patients first fit satisfaction and acceptance, as patients who were fitted to REM targets were often less satisfied than patients who were fitted using in situ.  After reviewing many of my fittings using real ear measurements I have found that some manufacturers match to target better than others, but that there is still room for improvement in 7 out of 10 patients. Using data obtained directly from your patient will ensure the most accurate initial fitting and will help deliver high patient satisfaction. Therefore, I feel that a combination of both will result in a more precise fitting that is more representative of the individual rather than average data. If a centre is doing neither then you should really consider whether you should use them.

If you feel that your hearing aid is not performing properly or that it is not programmed correctly, then contact us on 01494 765144.

How to buy your hearing aid?

As a hearing professional who has sat in front of NHS patients, one of the most common questions I was asked was, how do I go about getting a better hearing aid? However, owing to departmental impartially little advice or assistance was advised. These patients were largely left to their own devices to source more satisfactory solutions. Now sat in front of my private patients it is apparent that they are still ill informed and unaware of the vastly different options available to them. Leaving me to be the primary person answering their questions, which can be difficult to fit into a 90 minute consultation. After visiting several different health professionals, typically their G.P., NHS audiology, a national hearing aid company and doing internet research the patient arrives not knowing typical price structures, difference in clinical qualifications (competence) for achieving optimum outcomes, the importance of technology level and service packages in achieving satisfaction. Therefore I thought I would offer some advice based on the Which Magazine report.

If you decide to buy hearing aids rather than go to the NHS the price of the hearing aids is bundled with the service and follow up. In order to compare hearing aid prices it is important to compare like for like only. So make sure you know what is included. You are buying a whole on-going package not just a one off purchase. Independent hearing aid centres tend to be cheaper and have more flexibility when offering products because they are not generally tied to manufacturers. National companies tend to offer older technologies at lower price points, have higher overheads and therefore premium products are often more expensive and often they do not verify the fitting of the hearing aid which is important to ensure correct prescription. Hearing aid devices last on average 3 to 5 years, so you will need to build in the cost of replacing them. Manufacturer’s guarantees are attached to service packages to a maximum of 5 years, manufacturer’s guarantees are essential as you are buying an electronic device that can go wrong. Lifetime aftercare is a gimmick term used by companies to give you a false perception of the life of the hearing aid and the ongoing costs, it is a valueless term, as any quality independent hearing aid centre will always look after you and your hearing aid once you have purchased a hearing aid on an ongoing basis.

Ongoing costs can include batteries, domes and wax guards which can total an average spend of £50 to £100 per year. With some independents this cost is included in their premium packages. Batteries can be purchased for between £2 and £4 a pack (6 batteries).

There are 7 main manufacturers who all have four current ranges and therefore four price points. The four ranges are a basic, mid-level, advanced and premium level, with the performance and cost increasing as you go up the range. Average prices are from £500 to £3500 per hearing aid. The average spend in the UK is £3k for a pair of hearing aids. At Chalfont Hearing are prices range from £750 to £2000 per hearing aid with a basic service package. If you buy mid-level hearing aids from high street hearing centres you are likely to get older or lesser quality technology than obtainable from independent hearing centres. If you buy premium hearing aids (from high street hearing centres, like Boots, Specsavers, Hidden Hearing) you will often pay an unnecessary premium for exactly the same product. Hearing aids supplied by the NHS (such as the Oticon Zest) are mid-level technology and were released to the private market in 2008, they have since been super-seeded by 2 generations. We would advise against going for cheap hearing aids especially those under £500-£600 pounds as they are often old or extremely basic technology, these hearing aids maybe ‘OK’ for housebound elderly patients who can not get to the hospital but will offer limited benefit.

However getting value for money is about more than just the cost of the instruments. Actually the price is fairly trivial, its about service and therefore the difference of whether the hearing aids work or not. The amount you pay should reflect the quality of the instrument, the service and your lifestyle requirements. If your lifestyle is fairly relaxed and you rarely leave the house a more basic hearing aid is perfect, if you are still working and socially active then you will need something more premium.

Key questions to ask if you are buying a hearing aid:

1. Have you been offered a choice, have you reviewed the pro’s and con’s of different hearing aid styles and features?

2. Have you trialled them to see if they actually benefit you?

3. What is the warranty period (repairs and replacement)?

4. What level and quality will the fitting be done to?

5. How will the aftercare be delivered?

Five things to watch out for:

1. Some companies offer free guides on hearing aids and follow these up with home visits. They are often lead generation companies who operate in a sales based way.

2. Do not buy hearing aids online without a full hearing assessment, the hearing aid is only as good as the programming.

3. If you are shopping around, only compare ‘like for like’. That includes make, manufacturer, warranty, aftercare, additional extras, qualification of clinician and quality of premises and equipment.

4. Some companies have tie ins with manufacturers, this includes the NHS and therefore options will be limited if this is the case.

5. You should not need to replace hearing aids more than once every 3 years.

For your piece of mind Chalfont hearing Centre have considered and incorporated all of this information into our service delivery model to ensure our patients get the best advice on hearing aids possible. To have a hearing test and get informed and impartial information contact 01494 765144.

http://www.which.co.uk/home-and-garden/bathroom-and-personal-care/guides/how-to-get-the-best-hearing-aid/how-to-buy-your-hearing-aids/

Which Magazine Report on Hearing Aid 'Shops'

In October 2010 a Which? investigation revealed serious problems at ‘shops’ selling hearing aids to the public.  In an undercover inquiry they sent researchers with hearing loss to branches of the biggest five high street companies, plus some independent shops.  They found some ‘shops’ failed to ask basic medical questions or properly carry out hearing tests, and missed potentially serious problems. The report detailed below explains the shortcomings found across the industry.

http://www.which.co.uk/documents/pdf/p66-68_hearing_r3-231245.pdf

Is your hearing aid fitted correctly? Are you hearing properly? Can we help?

In the UK there is no standardised way of fitting hearing aids, there are also various different qualifications that practictioner’s may possess in order to fit hearing aids. The outcome and fitting success can vary wildly depending on where you go. Some people may have had negative experiences with private hearing aids, some may have had negative experiences with the NHS. The main factor in the successful fitting of a hearing aid is the audiologist or hearing aid dispenser that is fitting the hearing aid. A hearing aid is only as good as the audiologist fitting it. When choosing a hearing aid it is important not to choose an aid based on price but on the competency of the audiologist.  If the hearing is not fitted using some form of verification you may not achieve optimum hearing levels. Verification typically refers to the process of real ear measurement, insitu audiometry and speech mapping. If you hearing aids have not been fitted using this method they may not be working to their optimum. Under amplification may lead to a lack of clarity and over amplification may lead to feedback, noise, distortion and even further damage to your hearing.

To find out if your hearing aid is performing correctly contact us via email chalfonthearingcentre@live.co.uk or call 01494 765144.

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