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Thursday, October 12, 2017

The best advocate for manufacturers  and consumers is the link between the two 

By Charlie Reese, MBA

Our family-owned audiology practice wasn't even a year old when I opened up the Wall Street Journal one day in 2006 and saw a most intriguing full-page ad. It was an advertisement for Stihl chainsaws, and it must be a first in marketing history for doing something no other manufacturer has ever done: it advertised where you could NOT buy their product!

In big, bold letters, the ad asked: "Why is the world's number one selling brand of chainsaw not sold at Lowe's or Home Depot? "

A sea of white space below that startling question gave this reader a moment to reflect on the possible answer, which was written in much smaller print than the question, under an image of their chainsaw: "We can give you 8,000 reasons, our legion of independent Stihl dealers nationwide."

It seemed counter-intuitive to brashly name two of the top retailers in the world, which don't sell your product, in such a huge advertising buy, but the strategy is focused. The folks at Stihl want the public to know that WHERE you can't (or, indirectly, can) buy their product is just as important as WHY you should buy it.

Our family-owned, independent audiology business has grown in the dozen-plus years since patient number one, and in those years we've seen and heard the growing concerns of others in the hearing aid industry express angst, surprise, shock and frustration at the various ways hearing aid manufacturers partner with distributors. Insurers have become distributors, big box stores continue in it, buying alliances have formed, online selling entities have teamed up with audiologists, and chain retail stores inside malls bloomed and faded. Every year someone comes up with a new, supposedly innovative way of marketing and delivering hearing aids to consumers. Perhaps it is time for the industry to step back and see if there is another way to cut through the jungle of overgrown marketing strategies. 

I know just the kind of chainsaw to use to help clear a swath, too.

When Stihl launched their advertising campaign, they were the largest selling manufacturer of chainsaws. Home Depot and Lowes were among the top retailers in the world.  Stihl is still the number one manufacturer of chainsaws, and Home Depot and Lowes are still at the top of the retail world.  The non-relationship among these businesses hasn't hurt either of them. And there are more than 8,000 independent businesses selling the best-selling chainsaw in the world. That makes this independent small business owner an optimist. 

I'm optimistic because I know that even though we can't capture every consumer—there will always be a number who will buy online or go to the big boxes—we will be fine with those consumers who know and value the link between product and service. And there are enough of those types of consumers to keep us in business as long as we continually stress our strengths. We appreciate, and let it show, that every person who walks through our door is a potential consumer for the only type of product we sell. Nothing else. Some consumers don't have an issue about buying an item that is one of thousands of other products sold in a membership establishment (or soon, perhaps, at your local drugstore), but here I think they know that their purchase was the main event for us the day they made it.

The folks at Stihl see it similarly. On their website, they repeat the point made in their advertising that their quality chainsaws are specifically not sold at Lowes or The Home Depot, underscoring that their product can be obtained only through servicing dealers. The manufacturer then lists ten strong reasons why their dealers are the right professionals to sell their product, with this preface: 

                 "STIHL products are ONLY sold through servicing STIHL Dealers.

                 People who are knowledgeable can match customers with the right piece of

                 equipment, and who service the equipment they sell. You just don't find all these

                 qualities at some of the larger stores. There's a STIHL Dealer near you – over 8,000 nationwide!" 

Now, I'm not going to tell a manufacturer how to sell their product, but just for fun, if you're a hearing aid manufacturer, take a few seconds to substitute your company's name in the three places above where the name Stihl appears. By the time you got to the second substitution, the brand is linked to the seller that creates a symbiotic loyalty certain to boost a consumer's confidence in their purchasing decision.

This is an insightful business philosophy that a manufacturer embraces with goods that require skillful adjustments and servicing. Chainsaws, by their very nature, endure a lot of wear and tear. Hearing aids do, too. Worn on active people in various climates and subject to perspiration (sweat, for men), wax, natural body oils and who knows how many variants of hair/skin/perfume (cologne, for men) products, these devices endure more abuse than any other consumer electronic device ever invented. They are set to individual levels of hearing loss and tuned to quite a variety of everyday lifestyle environments. They are far more complicated than chainsaws. But marketing hearing aids remains a mixed bag of ever-changing strategies. None as simple and effective as ads for the best-selling chainsaw.


The manufacturer to consumer cycle has a crucial link: the distributor.  In the hearing aid business, the distributor is the seller and the one providing service of the product. How important is this link?  Well, in addition to Stihl understanding its value, experts in consumer satisfaction have studied and confirmed its importance. Ronald Brensinger, Ph.D., did an exhaustive study on consumer satisfaction with automobile purchases, particularly with consumer perception of product and service quality. He noted the importance of service (the dealership, in particular) with relationship to the brand or manufacturer. His research showed that there is a halo effect between product and service; good product quality is associated with good service quality, and poor product quality is associated with poor service quality. In this respect, dispensers of hearing aids really shine when manufacturers produce top quality products to make them look good. However, it is more important for manufacturers and their brands to realize the stronger influence that dealership service quality has on consumers. Dr. Brensinger explains that as objective quality criteria in automobiles (avg number of defects per vehicle, for example) approaches an almost meaningless difference, "the competitive leverage will shift to the service side where greater variability still exists. As such, the manufacturer with a dealership network that delivers the highest level of service quality may well accumulate the greatest competitive gains in this post-product quality environment."[i] Let's change a few words near the beginning of this last sentence:  the hearing aid manufacturer whose dispensers deliver the highest level of service quality may well accumulate the greatest competitive gains in this post-product quality environment. 

This is where the private practice hearing dispenser can really shine. We'll always see consumers choose other options, whether it is Internet purchasing or retail outlets that count hearing aids among thousands of other products sold, but for something as personal as a hearing aid a consumer shouldn't have to go through a computer screen or a membership ID check to reach their hearing professional. My wife, Judith Reese, is our private practice audiologist who did her Ph.D. dissertation on the correlation between patients' cognitive functions with regard to hearing aid orientation and hearing aid use satisfaction.[ii]  As hearing aid use satisfaction should be the primary importance for all participants in the delivery of hearing aids—manufacturer, dispenser, consumer—the middle link of the dispenser takes on a significant role. Not only do they need to know the devices they sell, but they have to make assessments of the users' ability to understand the features and care of the devices, and adapt their instructions accordingly so that patient satisfaction becomes optimal. This critical relational link is highly individualized. Not an ideal process in bulk selling environments, and practically impossible over the internet. If manufacturers realized how important service quality and product orientation was to the consumer's perception of their product's quality, they would discount their costs to every private practice dispenser out there and not just to warehouses.  Currently, private practices aren't extended the same discounts that they provide large retailers. 

Manufacturers who sell the same product to hearing professionals with the same training at rates wildly different do so based on one criterion: volume of sales. That's their prerogative, and it is an acceptable business practice across many industries when the product is generally a one size fits all. Hearing professionals know that the product they sell has to meet an individual's listening needs with the help of their technical expertise and experience. There will always be consumers who don't want the bulk rate experience. The hope is that hearing aid manufacturers will embrace those middlemen who serve those consumers well. There is room for many sellers, and I suppose a few different price points, but the premium pricing by some manufacturers to dispensers without loading docks puts the emphasis on bulk sales above all else. Manufacturers who wish to place more of an emphasis on consumer satisfaction of their products shouldn't price those who serve them well out of the market. They risk severing a relationship to quality that will be as permanent as a chainsaw on the strongest oak.

[i]  Brensinger, Ron.  "An Empirical Investigation into Consumer Perceptions of Combined Product and Service Quality:  The Automobile." Pp. 176-7.  University of South Florida.  1993.

[ii] Reese, Judith.  "Cognitive Factors in Hearing Aid Delivery." University of South Florida. 2001.

Charlie Reese JC Audiology.jpg

Author information: 
Mr. Reese owns JC Audiology in Lutz, FL along with his wife, 

Judith L. Reese, AuD, PhDHe has served in corporate communications roles 
as well as editor and columnist for newspapers in Florida. 

Thursday, June 22, 2017

B​y Ben Gilham, AuD

Hearing aid evaluation is one of the most common type of appointment that a hearing health care provider encounters in daily clinical practice. The obvious reason for the visit is to select the most appropriate hearing aid for a patient based on case history, audiogram, and patient interview. How the hearing aid evaluation process is completed is highly variable in audiology; often, patients are not provided with other considerations when evaluating the hearing aid recommendation. However, it may be necessary to conduct a more thorough and patient-involved process in selecting amplification.


Evaluation beyond the audiogram is critical when choosing the proper hearing aid. The first tool that can provide substantial initial information is a validation measure such as the Hearing Handicap Inventory for the Elderly or Adults screening version (HHIE/A-S). Having a patient complete this questionnaire prior to the appointment gives the clinician a basic idea of the patient's hearing challenges and opens discussions of specific listening situations that otherwise may not be examined. The HHIE/A-S can also be used as a basic pre- and post-hearing aid fitting measure, and provide a data point that can be tracked to determine any hearing improvement since the use of amplification.

The Client Oriented Scale of Improvement (COSI) is also a great way to discuss specific situations wherein patients experience hearing challenges. It also enables clinicians to learn what patients value in hearing aid function. This establishes a more personal connection and helps ensure successful hearing aid use.

Each outcome measure serves a different purpose. When used together, these can provide a great deal of information in a short period of time. Utilizing one outcome measure can already provide meaningful data that may serve as pre- and post-fitting metrics to determine if the goals of the hearing aid fitting were achieved.


These tests are useful prior to discussing amplification options: the most comfortable loudness level (MCL), loudness discomfort level (LDL), and speech-in-noise testing (SPIN). In many states, MCL and other forms of LDL measurement often need to be documented prior to hearing aid fitting. MCL has limited clinical utility for fitting hearing aids, but it may be required depending on the state of practice. Tone-specific LDL measurements are very important to obtain as they account for the individual variability of loudness discomfort to be applied on the maximum power output (MPO) setting of the hearing aids (JAAA. 2005; 16[7]:461). If frequency-specific LDL measurements are not obtained, the clinician can only rely on estimated MPO settings that can greatly impact the outcome of a fitting (JAAA, 2005). Speech LDL is not a useful measurement for programming hearing aids since the measurement cannot be applied to the specific programming of the MPO.

SPIN testing is very important to determine which style of amplification is most appropriate for the patient. There are several speech-in-noise tests available for clinical use, the most commonly used test is the QuickSin due to its efficiency and being widely available in many clinics. Testing speech understanding in noise allows the clinician to determine if directional microphones are required, whether an open or closed dome may be more appropriate, and whether a remote microphone or FM system may be necessary (Audiology Online, 2011). SPIN testing allows the clinician to provide an informed response to the question "What is the best hearing aid for me?" This further allows the clinician to utilize the data obtained to openly discuss the best amplification options given the patient's hearing profile and cosmetic preferences, i.e., RIC vs. CIC. SPIN testing also addresses common hearing difficulties in background noise, giving the provider an opportunity to explain how hearing aids can realistically assist patients in noisy environments.

To provide a thorough evaluation of assistive devices that will address specific patient issues, clinicians may discuss  most common areas of reported difficulty such as television and cell phone use, work accommodations (Bluetooth options for office and web based phones), alarm clocks, and even safety related to fire alarms (for patients with more severe-to-profound hearing profiles). Discussing telecoil and hearing loops is also pertinent as public awareness of loop systems appears to be increasing across the United States. Rechargeable hearing aid options are also becoming more durable and reliable, and are often asked about during consultations.

Many patients who come for a hearing aid evaluation have never worn hearing aids before. As such, giving an in-office demonstration during the consultation can help patients experience hearing with amplification. This gives the provider an opportunity to discuss the acclimatization process, set realistic expectations, and answer questions that the patient may not have thought of before trying on the hearing aids. A hearing aid demonstration is also beneficial primer for patients to determine if they note any hearing improvement. Patients tend to appreciate the opportunity to try hearing aids in the office as they understand more of how these devices may benefit them.

Hearing aid evaluation is an important part of the hearing aid process. Most often, hearing health care providers are under significant time constraint during appointments, but doing more homework prior to the fitting can help reduce hearing aid returns and follow-up visits, and help ensure satisfactory fitting and, ultimately, satisfied hearing aid users.

 ​ben bio photo.png​Dr. Gilham is an audiologist at the University of Washington Medical Center in Seattle, Washington.

Wednesday, June 21, 2017

​​The Hearing Journal recently completed an online readership survey on the impact of two critical reports on hearing health care: the 2015 PCAST report and the 2016 NASEM report. Our July 2017 cover story breaks down the survey findings and explores the tapestry of insights into how these reports affect the future of audiology. Here, author Valerie Neff Newitt further​ explores ways for hearing professionals to acclimate to the PCAST and NASEM recommendations. ​ 

Since passage of the OTC Act, and adoption of at least some of PCAST's and NASEM's recommendations seem to pave the path to the future, how can hearing professionals best acclimate?

"We must try to turn a negative into a positive," said Kenneth Henry, PhD, associate professor and clinical program director, Department of Hearing, Speech and Language Sciences, Gallaudet University, Washington, DC. "The positive is we can decrease our focus on the commercial aspect of audiology–selling devices–and instead concentrate on rehabilitative aspects which are the foundation of audiology."

Cover story.jpgJackie L. Clark, PhD, president-elect of the American Academy of Audiology, also summed up a need for a greater public recognition of the totality of audiology's value. "As a dispensing audiologist serving exceedingly low-income hard of hearing individuals both in the U.S. and abroad, I am painfully sensitive to and aware of the lack of equity in access to hearing health care and assistance. It is unfortunate that policy makers believe there are easy and inexpensive hearing solutions for such disparities in access.  I firmly believe that OTCs provide the profession of audiology an opportunity to demonstrate to consumers the value of our professional services. We know that the auditory system is a complex mechanism and there is immeasurable value in clinical audiologists identifying, diagnosing and remediating a disordered human auditory system with professional finesse, commitment and technology through extensive experience, education and knowledge."

Research, too, offers a perspective on the role of audiology in an OTC environment. In March of this year the American Journal of Audiology published an article, "The Effects of Service-Delivery Model and Purchase Price on Hearing-Aid Outcomes in Older Adults: A Randomized Double-Blind Placebo-Controlled Clinical Trial" in which the authors determined efficacy of hearing aids in older adults using audiology best practices, to evaluate the efficacy of an alternative OTC intervention, and to examine the influence of purchase price on outcomes for both service-delivery models (Am J Audiol.2017;26[1]:53).

At the study's end investigators concluded that their "… single-site, double-blind, placebo-controlled, randomized clinical trial was the first to demonstrate that hearing aids are efficacious in older adults for an audiology-based best-practices (AB) service-delivery model. The efficacy of an alternative OTC approach [consumer directed (CD)] in which the consumer selected pre-programmed devices was also established. Overall, the consumer directed model of OTC service delivery yielded only slightly poorer outcomes than the AB model. Nonetheless, outcomes for CD participants improved significantly following a four-week AB-based follow-up trial. Purchase price, $600 versus $3,600 per pair of hearing aids, had no effect on outcomes, but a high percentage (85%) of those who rejected hearing aids paid the higher of the two prices for their devices…"

A survey respondent helped to sum up the way forward: "As audiologists, we should be treating our patients like any other medical specialist, making sure our patients understand that hearing loss will be a condition they have for the rest of their life. The loss will change over time, as will the condition of the devices themselves, which requires regular follow up -- just like monitoring blood pressure, blood sugar, etc." So while a piece of assistive hardware may soon be purchased through various retail outlets, the heart of true hearing healthcare will continue to beat within the collective body of hearing professionals.

Wednesday, June 7, 2017

​By Jennifer Groth, MA; Maulik Bhatt, MBA; Peter Elsig Raun, M Econ; and Andreas Jahn, MSc

It is sometimes said that if you have seen one hearing aid clinic, you have seen one hearing aid clinic. The implication of this statement is that each hearing aid dispensing practice is so unique that observations made of one site cannot be broadly generalized to others. There are certainly differences among practices. For example, a hospital-based audiology clinic will likely be quite different from a small private practice in terms of staffing, caseload, location, management, facilities, and more. However, regardless of setting, the actual procedures that are carried out to fit, follow-up and manage adult hearing aid wearers will mostly be similar. Hearing care professionals (HCPs) are trained to follow best practice guidelines that are intended to lead to reliably positive outcomes (1-3) and these guidelines do not differ substantially from one another depending on clinical setting. Hearing aid users visit practices for the same reasons: for assessment and guidance regarding their hearing, to have hearing aids fit, to have hearing aids fine-tuned, for service of their hearing aids, etc. In all likelihood, the time spent on these different activities will be similar across practices. Thus, if a large sample analyzing the breakdown of appointments for different activities related to hearing aid dispensing were available, the results should be applicable to a large cross-section of practices throughout the world.

There is no shortage of recommendations and proposals for specific procedures HCPs should follow in the hearing aid fitting process. These recommendations are sometimes related to products and services offered by vendors, or they may be scientifically validated tools for assessing or improving some aspect of hearing aid fitting. Regardless, they often come with the encouragement that implementation will add just minutes to whatever procedures are already carried out at the HCP’s practice. In some instances, the tool or procedure is intended to replace a more lengthy, existing practice and therefore represents time savings. It is fairly easy to estimate how much time is required to carry out a particular task. But is the total of the time for all tasks a good estimate of the time for an appointment? HCPs know how much time an individual would be scheduled for particular activities at their own practice and may have some experience with other practices. It is probable that some practices also track and analyze how time is spent to identify opportunities for increased efficiencies. However, to our knowledge, data of this nature has not been made publicly available.

In this article, we present data covering a more than a 9-year period from a large hearing aid dispensing practice with multiple offices serving an adult population. All offices in this practice follow similar procedures, and they keep track of client contact and other data in their practice management software. Examination of the clinical contact time on a large scale can afford valuable insights to other HCPs in regards to their own practices. It can provide a new perspective on how a practice operates, which can be especially helpful for HCPs who may be considering different pricing models. It can also serve as a benchmark for HCPs who may wish to evaluate how time is spent in their own practices.

The data reported here is anonymized, meaning that no information that identified individual clients or HCPs at the practice was made available to GN Hearing. The information that was uploaded included demographic data describing gender, age and audiometric results from clients of the practice, appointments, hearing aid purchase data, and hearing aid fitting data. The data covers full-year periods extending from 2008 to 2015, as well as the first 10 months of 2016. In all, more than 80,000 unique clients accounting for approximately 500,000 appointments are included.

fig 1.jpg
Figure 1. Gender split of clients by year. There are more men than women served by this practice, and the trend is stable over the years covered in the study.

The practice served more than 80,000 individual clients in the period covered. The client base contains 58 percent male and 42 percent female clients (Fig.1). The higher percentage of male clients is consistent with reports that prevalence of hearing loss in men is greater than in women. Therefore, it is not surprising that this practice has more male than female clients (4,5). However, the gender ratio of clients is lower than the prevalence of hearing loss by gender in the general population. Although the reason for this is not known, it may be that a greater proportion of females with hearing loss perceive a need for and seek hearing help than males with hearing loss. There is some evidence to support this idea, as women with hearing loss have been reported to have greater awareness of hearing issues and to be more likely to accept their hearing loss than men (6). In addition, increased motivation to obtain a hearing aid as well as higher expectations to treatment with hearing aids has been reported for women relative to men (7). Also, once hearing aids have been acquired, there is evidence that women exhibit more regular use patterns than men (8). In further analysis including fitting data, it will be possible to explore gender differences in use patterns based on datalogging of actual use.

fig 2.jpg
Figure 2. Number of persons purchasing a hearing aid for the first time at this practice by gender and age. More men purchase hearing aids at an earlier age than women.

Further insight on gender patterns can be gained by examining first-time hearing aid purchases per age and gender (Fig. 2). Note that this data is for first-time purchases made at this practice. Therefore, some clients must be assumed to already have been hearing aid owners prior to becoming patrons of this practice. For the period covered in this dataset, more than 200,000 hearing aids were sold with an average of 2.5 hearing aids per client; 20 percent were repeat purchases at this practice and the rest were first-time purchases. The largest number of male first-time purchasers occurs at an age approximately 15 years younger than female first-time purchasers. The number of male and female first-time purchasers is equal at the age of approximately 83 years. Above this age, there are more female than male first-time purchasers at this practice. This pattern is consistent with the fact that women have a life expectancy that exceeds that of men by approximately four years in the country where this practice is located. It is also consistent with cross-sectional studies that reported greater prevalence of hearing loss in males than females (9) and that a greater proportion of males acquire hearing loss at an earlier age than females (10).

The average audiogram per gender across all ages is shown in Figure 3. Unsurprisingly, the audiogram for males is slightly less severe in the low frequencies, and significantly more severe in the higher frequencies than the audiogram for females. This is also consistent with other reports (11).  In all, the clients of this practice appear to be generally representative in terms of age, hearing loss and gender for a typical practice serving adults.

                          fi 3.jpg

Figure 3. The average audiogram by gender for all the clients served at this practice. Consistent with the literature, men have slightly less severe hearing loss in the low frequencies, and more severe hearing loss in the high frequencies than women.

fig 4.jpgFigure 4. The percentage of different appointment types (columns) and average time spent for each appointment type (red circles).

A unique feature of this dataset is that it provides a breakdown of how time was spent in the practice. Figure 4 illustrates the average percentages of 12 appointment types as well as the average number of minutes spent on each. Year-by-year comparison did not reveal large changes in these patterns, although it is known that the practice has changed their protocols in recent years. This could have affected the method of logging the appointments to some extent. A decrease in the time for fine-tuning was observed along with an increase in other service-oriented appointments, suggesting that other service-oriented appointments may sometimes include fine-tuning. Because this detail is unknown and the observed trends were not large, the data shown in Figure 4 is combined for the entire period.

Evaluation, hearing aid fitting, and follow-up accounts for approximately half of all appointments while service-related appointments comprise the other half. Examples of service-related appointments are fine-tuning of hearing aids, exchange of hearing aids and repair/service of hearing aids. Appointments for fine-tuning are the most frequently occurring, comprising 28 percent of the total appointments. Further detail to fine-tuning appointments is that, for those who have purchased hearing aids at the practice, fine-tuning appointments make up 34 percent of the total appointments. For those trialing, but ultimately not purchasing hearing aids, 11 percent of the appointments are for fine-tuning. However, like most of the service-related appointments, fine-tuning visits take relatively little time. The average length of a fine-tuning appointment is 30 minutes, compared to nearly an hour for appointments for hearing aid evaluations and fittings.

As is common in many practices, appointments for follow-up are a planned part of the hearing aid dispensing protocol. Thus, it would be expected that the percentages of appointments for hearing aid fittings and follow-ups would be similar. This is indeed the case for initial follow-up appointments; hearing aid fittings account for 18 percent of the appointments and first follow-up visits for 16 percent. However, fewer than half of clients fit with hearing aids return for a second follow-up appointment. Considering the much higher percentage of appointments for fine-tuning, this could be an indication that clients might prioritize a need for an adjustment over a regularly scheduled follow-up. In other words, after the first follow-up they might consider follow-up to be pursued on an as-needed basis rather than scheduled. It may also be the case that the practice does not encourage second follow-ups as a regular part of their protocol, and thus fine-tuning appointments occur as needed.

​                                           fig 5.jpg

Figure 5. Distribution of time intervals spent for each appointment type. Most appointment types are consistent in the amount of time spent. 

To gain more insight on how time is used at appointments, Figure 5 breaks down each appointment type into time intervals. Interestingly, most appointment types do not vary a lot in the amount of time they take. Repair/Service, Re-test, and HA exchange are the only appointment types where the great majority of appointments do not fall into one time interval. This observation makes sense in that the reasons for, and thus the time needed to deal with, these types of appointments are less predictable than other types. Knowing which appointment types can vary the most in length and which types do not tend to vary much can be helpful in planning staffing and scheduling so as to provide the best service to clients.

Because it is the most common type of appointment, fine-tuning appointments merit further discussion. Eighty-four percent of visits for fine-tuning take 16 to 30 minutes, and 11 percent take 15 minutes or less. Thus, 96 percent of appointments for fine-tuning are less than 30 minutes. This time considers only the actual contact time between the HCP and client, during which relatively little is likely to be spent adjusting and programming the hearing aids. Much of the appointment is spent on waiting, polite conversation, getting situated in the fitting room, discussion of the issue, and trying to assess the success of any adjustments. The actual time used by the HCP, practice staff, and client to make the appointment happen can go far beyond 30 minutes. Bearing in mind that fine-tuning appointments are motivated by experiences that clients have in their daily environments, this might be an area where newer technologies, such as teleaudiology, might improve efficiency and satisfaction for both the HCP and, more importantly, the client. 

fig 6.jpg
Figure 6. Percentage of hearing aid purchasers as a function of how many fine-tunings are required. The vast majority of purchasers have 3 or fewer fine-tuning appointments.

In testing a teleaudiology model, Angley et al (12) reported that participants said timesavings was the most frequently cited reason they were interested in the​concept. The current dataset also shows that more than 70 percent of clients have at least three fine-tuning appointments (Fig. 6). If the fine-tuning could be carried out at their convenience and quickly trialed in their daily environment, this could have a significant impact both for the client and the practice. Even if one physical appointment fine-tuning could be done with the client in their own environment, this would drastically reduce their time investment and inconvenience. Trends in hearing healthcare, such as teleaudiology, and how they might be used to improve efficiency and satisfaction in hearing aid dispensing practices are discussed in more detail elsewhere (13,14).


It is probable that not many HCPs have analyzed their practices in terms of how time is distributed among the different types of services they provide. This article presented a large set of data characterizing the appointments of a large practice over more than nine years. The clients of this practice appear to be broadly representative based on studies of hearing loss prevalence by age and gender. An analysis of appointments suggested that fine-tuning appointments may present an opportunity where emerging technologies could increase efficiency and satisfaction for both the HCP and clients. The data from this practice could help inform HCPs regarding their own practices.

Ms. Groth is the director of Global Medical Affairs at ReSound, Glenview, IL. Mr. Elsig Raun is senior director of insights and analytics at the Global Marketing and Business Development of GN Hearing in Ballerup, Denmark, where Mr. Bhatt is a global value management and price analyst, and Mr. Jahn is a graduate candidate.

  1. American Academy of Audiology (2006). Guideline for the Audiologic Management of Adult Hearing Impairment.
  2. Good practice guidance for adult hearing aid fittings and services, 2004.
  3. American Academy of Audiology Clinical Practice Guidelines: Pediatric Amplification,. 2013.
  4. Gopinath B, Rochtchina E, Wang JJ, Schneider J, Leeder SR, Mitchell P. Prevalence of Age-Related Hearing Loss in Older Adults: Blue Mountains Study. Arch Intern Med. 2009;169(4):415-418.
  5. Agrawal Y, Platz EA, Niparko JK. Prevalence of hearing loss and differences by demographic characteristics among US adults: data from the National Health and Nutrition Examination Survey, 1999-2004. Arch Intern Med. 2008; 168(14):1522-1530.
  6. Garsteki D, Erler S. Older adult performance on the Communication Profile for the Hearing Impaired: Gender difference. J Speech Lang Hear Res. 1999; 42:785-796.
  7. Jacobsen G, Newman C, Fabry D, et al. Development of the Three-Clinic Hearing Aid Selection Profile (HASP). J Am Acad Audiol. 2001; 128-141.
  8. Staehelin K, Bertoli S, Probst R, Schindler C, Dratva J, Stutz EZ. Gender and hearing aids: Patterns of use and determinants of non-use. Ear & Hear. 2011; 32:e26-e37.
  9. Moscicki EK, Elkins EF, Baum HM, McNamara PM. Hearing loss in the elderly: An epidemiologic study of the Framingham Heart Study cohort. Ear and Hearing. 1985; 6(4): 184-190.
  10. Akeroyd MA, Foreman K, Holman JA. Estimates of the number of adults in England, Wales and Scotland with a hearing loss. International Journal of Audiology. 2014; 53:60-61.
  11. Lawton BW. Typical hearing thresholds: a baseline for the assessment of noise-induced hearing loss. ISVR Technical Report No. 272. University of Southampton Institute of Sound and Vibration Research. 1998.
  12. Angley GP, Schnittker JA, Tharpe AM. Remote hearing aid support: The next frontier. J Am Acad Audiol. 2017; 00:1-8.
  13. Fabry D, Groth J. Teleaudiology: Friend or foe in the consumerism of hearing healthcare. Hearing Review. 2017.
  14. Stender T, Groth J, Fabry D. Teleaudiology: Promoting better fit-to-preference and efficiency. Hearing Review. 2017; in press.

Wednesday, April 19, 2017

​By Raymond H. Hull, PhD

The critical nature of communication influences the success of any work environment, whether it be an audiology clinic, a hospital, or any business venture. Since the 1990s, companies have become dependent on e-mail as their primary connection with colleagues and patients. Even employees sitting a cubicle apart are sending e-mails instead of talking to each other. Effective communication is critical to an organization’s success; what follows are suggestions on how we can improve communication in the workplace.

Feature -Communication image.jpg


Communication specialists have observed that people have become so dependent on computers and cellphones that we have neglected, or even lost, the art of conversation—of actually talking to one another. The problem is that up to 70 percent of the meaning of what we say comes from our facial expression and body language. If we take smiles and gestures out of the picture and only interact online, the recipient of our messages may get the wrong idea, especially if the sender is not an articulate writer. Some ways to overcome this is to pick up the phone and make a call once in a while, or walk down the hallway to talk to colleagues or employees face-to-face.


A common barrier to communication in the workplace is poor listening skills. How does this manifest? We may be distracted with other thoughts. We may be listening but appear not to be because we’re not directly attending to the person talking to us. We may be constantly glancing at our watch or a clock on the wall instead of paying attention. There are various circumstances where people show poor listening skills.

To correct this, make sure to face the person you are speaking with and reflect on what he or she is saying by responding with attentive nods and thoughtful remarks like “Let me see if I understand what you are saying,” then repeat portions of what you’ve heard.​


Having different perception is a constant challenge in the workplace. But people look at the world differently. Don’t let varied perceptions become a barrier to communication by recognizing that there are always many viewpoints and opinions among those with whom we work. By listening to these diverse perceptions, we may actually get new ideas or approaches to problem-solving.


Everyone has encountered at least one micromanager in their career. Micromanagers are like shadows lurking in the background, making sure everyone is doing his or her job. They appear to feel as though they’ve hired incompetent employees. However, micromanaging may have adverse effects on employees’ morale and productivity.

When employees feel they have control of their responsibilities, they tend to feel a sense of purpose and become more invested in doing an excellent job. Employees are notably encouraged when managers provide them with the tools and freedom to accomplish their tasks. Managers need to remember this if they want the most productive workforce.​


The atmosphere of communication is another critical aspect leading to the success of an audiology practice. Many of our day- to-day interactions with patients and employees involve different forms of communication. But interpersonal communication goes beyond just talking; it is the creation of an "atmosphere" of communication that results in a positive and constructive work environment. It enables an environment that promotes productivity and creativity. And the better we are at creating such an environment, the more successful our organization will become.

People are usually drawn to others who make them feel most comfortable, those with whom they are able to communicate in a positive and supportive manner. In the work environment, successful interpersonal communication depends on not only what we say but also what we do when interacting with others. What we do may involve our body language, gestures, eye contact, and more importantly, the manner in which we listen to the person talking to us. Good listeners become good leaders.

I usually tell my audience, "Whether we like it or not, we live in a world full of people who do not communicate well. We live in a world with people who may not possess the knowledge or skill to be good communicators. It is simply that many people, including many bosses, may possess communication habits that are less than desirable."

Several factors may make it difficult to create a good atmosphere for successful communication. For example, some people may be poor listeners. Listening is a skill that is learned. Good listeners do the following:

- They give the speaker (the one to whom they are listening) cues to note that they are listening.

- They tend to act empathetic and responsive to what another person is saying by, for example, making eye contact with no side glances.

- They offer verbal expressions of feeling, such as, "That must have made you very angry."

​Some people may have poor body language when communicating—they put their hands in their pockets, constantly shuffle their feet, make poor eye contact, and hunch their shoulders. These gestures usually indicate disinterest in what another person is saying.

Another undesirable habit that makes communication un- successful is interrupting. Some people tend to interject their opinion even when the person speaking is not done. On the other side of the spectrum, there are people who are not responsive at all and fail to respond to missed calls, voicemails, or emails. Either way, these show an uncaring attitude and poor communication skills that can negatively affect the interactive dynamics in the workplace.


The art of public relations and image development is another component of successful communication in the workplace, though understood from a slightly different angle. The ability of an audiology practice to satisfy patients can make or break a business. The practice must demonstrate high-quality services, with sincere efforts that assures long-term assistance. If the professional services being provided are of the highest quality, the practice should do well, right?

Not necessarily. Many medical practices and businesses run by people with the knowledge and skills to be successful do not achieve higher levels of success because of their poor public image. Enhancing your professional image through the art of public relations involves high-level communication that is critical to the success of your practice. 

For more tips to develop the image and public relations of an audiology practice, see the full version of this article in The Hearing Journal's May 2017 issue.