Is “Mediocrity” the New Standard Protocol?

Is “Mediocrity” the New Standard Protocol?

May 22, 2015 In the News

Based on returned surveys from 1,141 experienced hearing aid users and 884 new users, Kochkin et al (2010) reported that "quality control at the point of dispensing has not kept pace with technological improvements…there is great variability in the hearing aid fitting process, and it appears that critical aspects of the fitting protocol are not followed, despite general consensus among all the professional societies…." 

The authors noted the top 10 key mistakes made by dispensing professionals included:

  • Lack of verification via probe-mic (i.e., lack of real ear measures)
  • Misunderstandings about the efficacy of open fits 
  • Assuming the manufacturers first fit defaults are correct
  • Not accounting for the patient's manual dexterity
  • Not performing appropriate validation measures
  • Not performing appropriate counseling
  • Not adjusting gain over time
  • Fitting amplification without "patient buy-in"
  • Assuming the automatics work properly (without testing/verification)
  • Failing to use modern tests to select, fit, and counsel

Beck and Nilsson (2013) report that the single most common complaint of all people with hearing loss and all people with hearing aids is speech-in-noise (SIN)—and to not measure it (SIN) is crazy—as there is no correlation between an audiogram (mild-moderate, SNHL) and a SIN score. That is, SIN cannot be predicted, it must be measured. They reported that "the only way to know we have defined and improved the single most common complaint (speech-in-noise, SIN) is to measure it at two moments in time: pre-treatment and post-treatment."  Therefore, to address the patients concerns, and to document that those concerns have been addressed through amplification, one must measure SIN pre and post-fitting.  

Taylor (2015) reports that "no frills solutions" may meet the needs of the consumer. That is, sometimes products that are "good enough" suffice from the end-users viewpoint. Taylor notes Cox et al reported that higher cost, premium amplification products did not provide statistically of clinically superior outcomes (fitted to best practice protocols) across a limited (two basic products and two premium products), carefully designed study of 25 patients. He reports the study by Cox et al indicates that regardless of price or technology, hearing aid amplification provides patients with favorable lab-based and real-world outcomes. Taylor reports "hearing aids with basic technology fitted…using a standardized approach (i.e., best practices) are likely to outperform premium products taken straight out of the box and placed onto a patient's ears using a minimalist protocol." 

Taylor reports the sky is apparently NOT falling. Rather, the potential new "just good enough" market may allow professionals to "broaden the scale and scope of patient offerings; the ability to provide truly patient-centric care that revolves around the behaviors and attitudes of the individual, rather than a single device…." Taylor says hearing care professionals serve about one-fourth of the people with hearing loss, primarily composed of people with moderate-severe-profound hearing loss. However, for the other 75 percent of people with mild hearing loss, our protocols "predicated on numerous office visits and incremental improvements in hearing aid features" and the services and products we offer are not valued "by the vast majority of patients in the bottom 75 percent (people with mild-moderate hearing loss). He notes that even though technology is being commoditized, human skills (such as guidance and support through excellent science and audiology) cannot be delivered (yet!) by machines. Nonetheless, we must change to meet the needs of the consumer and their preferences in 2015 and beyond!

For More Information, References, and Recommendations

Beck DL, Nilsson M. (2013) Speech-in-Noise Testing: A Pragmatic Addendum to Hearing Aid Fittings. Hearing Review. May 6.

Kochkin S, Beck DL, Christense LA, Compton-Conley C, Kricos PB, Fligor BJ, Mueller HG, Nilsson, MJ., Northern JL, Powers YA, Sweetow RW, Taylor B, Tyrner RG. (2010) MarkeTrak VIII: The Impact of the Hearing Healthcare Professional on Hearing Aid User Success. Hearing Review17(4):12-34.

Taylor B. (2015) The "Good Enough" Era and Hearing Healthcare. Hearing Review. May:10,48. 

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