Most people are familiar with the eye and vision care hierarchy, and it is similar in ear and hearing care. There is the medical physician: Ophthalmologist for eyes, Otolaryngologist for ears. Then there is the specialist in the sensory function: Optometrist for eyes and Audiologist for ear. Lastly, there is the dispenser of assistive devices: Optician for eyes and Hearing Aid Dispenser or Hearing Instrument Specialist for ears.
• The physician has an M.D. or D.O. degree and has done their specialty schooling and residency. They treat medical issues with surgery and medications.
• The sensory specialist has a Clinical Doctorate (O.D. for eyes and Au.D. for ears), although Audiology just transitioned into an entry-level Doctorate, so many of us still have Masters Degrees and several years’ experience; after school there are national tests to pass and clinical fellowships to complete. The sensory specialist evaluates and treats they function of the sense, and is involved in counseling the patients through their diagnosis and rehabilitating their function.
• The Hearing Aid Dispenser has a high school diploma and an apprenticeship, and has to pass a state-licensure test. There are Associates Degree programs for Hearing Instrument Specialists. They are trained and licensed in the fitting of the devices, and have some basic test skills needed in order to fit those devices. I do not know the specifics of the Optician requirements, but they are likely to be about the same as for hearing.
It the rare physician that will perform sensory tests or fit assistive devices. They often employ sensory specialists and/or assistive device dispensers to serve their patients. However, that does not mean that as a patient of that physician that you cannot go elsewhere.
If there are no suspected medical causes of the hearing loss, it is not necessary to see an Otolaryngologist (a.k.a. Ear, Nose and Throat or ENT doctor). Although the ENT Evaluation and medical clearance to wear hearing aids is recommended by the FDA, the patient can sign a Waiver of Medical Clearance. However, if the patient has never worn hearing aids before, or if there are any symptoms other than a gradual decline in hearing acuity that is about equal in both ears, the patent should start with an ENT evaluation – especially if they have insurance to cover the visit.
As for choosing whom to see for hearing care, I generally recommend the Audiologist – and not just because that is my vocation. Because of the extensive education and training, the Audiologist is better able to address the individual patient’s needs, beyond just plugging the numbers in the computer and sticking the device on the ear. With that being said, I have known Audiologists to whom I would not refer anyone, and I have known Hearing Aid Dispensers who were very motivated and caring, and who provide exceptional care.
Therefore, I recommend talking to people you know about their experiences as well as talking with other medical professionals who might have some knowledge of professionals in the area. It is important that you find a care provider whom you like and trust. Ideally, start with the ENT who has an Audiologist on staff, and schedule the Audiological and ENT Evaluations for the same visit. Ask if they dispense hearing aids and whether they have an initial consultation that is free of obligations (no co-pay, no deposit required), which should be the case. If you like the person who tested the hearing and they are also licensed to dispense hearing aids, schedule the Hearing Aid Evaluation with them. Also ask for a copy of the hearing test results to take with you for your records, along with a prescription or note on letterhead signed by the physician that states that the patient is medically cleared for hearing aid use, so that you can bring that elsewhere in your search.
For patients with complex ear histories or even if they’re just someone who builds up a lot of ear wax, it is convenient getting the hearing aid services in the same office as the ENT physician. Also, this is a rehabilitation service – you want a place that is convenient to you and that offers low- or no-cost follow-up. Many of my patients have gone through the V.A. for free hearing aids, but then they have to deal with the V.A. for service, which is inconvenient as there are usually waiting times for appointments and the locations are not always close by. It’s not just about the price of the devices, but the overall value of the care and services you’ll receive over the life of those devices (~5 years).
If your insurance has a hearing aid benefit (most don’t), ask if the providers are “in network” and whether they will bill the insurance, or if you have to pay out-of-pocket first and then apply for reimbursement at the end of the trial-period (which is usually the case, since most practices have a 30-day or longer period during which the devices and be returned for refund, with the exception of a deposit). If the providers are not “in-network” or do not participate with a discount program that your insurer offers, ask if the provider has an offer to compete with that benefit you might get elsewhere. Top-of-the-line hearing instruments exceed $3000.00 each, so if you can save a couple hundred dollars, every little bit helps. Also ask about financing options, such as CareCredit, which is a revolving credit line for non-covered medical expenses and often has interest-free options.
As for styles of hearing aids or technology options, that depends on the individual patient’s hearing levels, physical abilities, and preferences. If I could, I would put the state-of-the-art technology on every patient, because they are pretty amazing at getting the best sound quality to the ear, and doing a lot of the sound processing that our brains are not as good at doing as we get older and especially after we’ve been hearing impaired for a few years. However, many people are reluctant to invest $6–7000.00 on hearing technology for their first set. I find that when they are ready to upgrade, 4–6 years later, they better understand the benefits of hearing and are very pleased with the outcome of having the best devices for them.
In cases where patients simply can’t afford the premium technology, I consider their lifestyle and the environments where they spend most of their time, and choose the devices that might not have all the best features, but at least have some features to fit their needs. I explain that lower priced devices are less automatic and won’t filter ambient and background noises as well. Most of my patients still appreciate that they are hearing better, and accept that they will have more difficulty in noisy environments that’s they would with the better systems.
The biggest factor in hearing aid success is patient motivation. It takes commitment to learning to hear all the little sounds around us, and giving the brain the opportunity to relearn how to use what it hears – like a two-year-old. Ideally, the hearing devices should be worn all day, every day. There are now water-resistant models for folks who are outdoors, near or in the water, or who perspire a lot. Giving the brain the most consistent sound stimulation (which means hearing every little thing all the time like when we have good hearing) is the best way to adapt to hearing through the devices and having the most natural hearing experience going forward.
If you have any more specific questions relating to this process, feel free to send me a private message and I will gladly address your concerns.
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