CASE STUDY INVESTIGATION | You Only Have One Chance to Make a Good First Impression

By David Fabry

This article is a part of the May/June 2017, Volume 29, Number 3, Audiology Today issue.

Case History

The patient presented to the clinic as a blind 45-year-old male with bilateral, symmetric severe sensorineural hearing loss. He was currently wearing binaural full-shell, custom, in-the-ear (ITE) hearing aids that were approximately eight years old. Despite numerous attempts to discuss new devices, the patient had been resistant to consider new technology, despite the fact that third-party pay would offset the majority of the cost. In addition, the patient had suffered panic attacks during the previous two clinic visits when discussing the need for replacement.

First Impressions

The patient was already quite anxious and agitated by the time I saw him, as he had been waiting for some time to be seen. Further, his service dog was restless, lending to the sense of urgency. Audiometric findings revealed no change since his previous examination two years ago (FIGURE 1), but once again, the patient was extremely resistant to discussion of new devices, despite the fact that the current ones were in need of replacement. Monosyllabic word recognition was bilaterally symmetric, at approximately 50 percent for recorded stimuli. Immittance showed no evidence of middle-ear or retrocochlear pathology.

Electroacoustic evaluation and real-ear measurements revealed that the patient’s ITE aids were providing appropriate gain and output for his hearing loss, and the patient was generally satisfied with their performance. Physical inspection of the devices, however, revealed them to be in poor working order, with apparent visual wear-and-tear on the rotary volume controls, plus cerumen impaction in both receiver ports. Review of the patient’s insurance indicated that he was eligible for new hearing aids at no cost to him through state third-party insurance programs. When this was discussed, however, the patient immediately became quite agitated, instead insisting that we clean and repair these devices.