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doi: 10.1097/01.HJ.0000293289.94627.6c
Hj Report
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The Consumers Report newsletter onhealth dedicated four pages in its May 2002 issue to hearing aids. Entitled “Time to deal with hearing loss,” the article is unusually comprehensive and accurate, and extremely positive about hearing aids.

The story, which is not bylined, begins by emphasizing how insidious hearing loss can be (“Hearing loss can start so slowly that you barely notice it at first”). It goes on to cite findings from the 1999 National Council on the Aging study (sponsored by the Hearing Industries Association) indicating that “individuals who don't get hearing aids or other assistance for their loss may be more susceptible to depression, worry, anxiety, paranoia, lower social activity, and emotional security than those who get help.”

While noting that “even those who try hearing aids can find the experience frustrating” (and costly), the article encourages readers to try amplification. It states, “New technology and new options could make…[hearing] aids more satisfying than before. More sophisticated systems help you screen out background noise and locate sounds. Less expensive ‘starter’ aids are available. And mandatory trial periods in most states let you return aids and get most of your money back if you're dissatisfied.”

The article says that some hearing losses can be treated by surgery or simply by removal of wax, but adds, “Hearing aids are appropriate for the majority of people with sensorineural hearing loss.”

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Getting treatment

The report in onhealth goes on to offer readers very practical guidance on how to get help for a hearing loss. It advises, “Selecting the device should not be your first consideration. More crucial is finding a dispenser—an audiologist or licensed hearing instrument specialist—qualified to evaluate your hearing loss, recommend appropriate devices, provide an aid that fits your ear canal and hearing needs, and offer strong follow-up.”

As a first choice, Consumer Reports recommends seeking out an audiologist (preferably one certified by the American Speech-Language-Hearing Association or American Academy of Audiology). However, it adds that licensed specialists, while having less formal education than audiologists, “may have a great deal of practical experience and can be qualified to fit hearing aids.” If one goes to a specialist, the article says to choose one with Board Certification in Hearing Instrument Sciences.

About half of the article deals with hearings aids, explaining the different types of technology and styles and giving their pluses and minuses and typical retail costs. Regarding digital devices, it notes their superior flexibility and cites anecdotal reports of greater patient satisfaction with them. However, it reports that some skeptics contend that there is little objective evidence that the benefits of the technology justify their higher price. The article also describes various non-conventional products, including the Songbird disposable aid, low-price entry-level devices, instant-fit hearing aids, and implantable hearing aids.

Among the hearing aid features and add-ons cited as useful are volume controls, directional microphones, telecoils, and audio-input options.

In a list of “shopping don'ts,” onhealth urges, “Don't buy hearing aids by mail or Internet from makers who claim you don't need direct contact with a dispenser.”

The article closes with a caution to “temper your expectations. Make sure you discuss expected benefits in detail with the dispenser. No matter how good and well fitted, no hearing aid can restore your hearing completely.”

Although one may disagree with some specifics in the article, given its generally positive tone and Consumer Reports' reputation for providing objective, non-commercial information, it seems likely that many dispensers will want to share the article with their clients.

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Recently, a team of audiologists in Durham, NC, helped program a recently implanted Med-El cochlear implant. What made this unique was that the patient was thousands of miles away, in Bogota, Colombia.

The Food and Drug Administration (FDA) recently agreed to the exploration of employing telemedicine for the treatment of implant recipients. This first application of Med El's Remote Support Project linked Carol Gilmer, a clinical audiologist at the University of North Carolina, and Suzanne Hasenspab, PhD, director of audiology at the Medical College of Virginia, with audiologist Adrianna Rivas, who was with the patient in a clinic in Bogota.

While telemedicine offers numerous potential uses in hearing care, cochlear implantation is an especially promising area, said Chris Bertrand, CEO of Med-El North America, in Durham. Centers where cochlear implant surgery is performed and where there are experts in the technology on staff are few and far between, especially in less advanced nations. Therefore, patients often live a long distance from where they were implanted. Since repeated programming is required for months post-surgery to maximize the benefit of the device, patients who do not live near a center may be denied the follow-up they need because they cannot keep returning to the center and there is no audiologist nearby with the experience and expertise required.

During the procedure involving the Med El patient, digital cameras allowed the audiologists in this country to see how the patient responded to the programming, which helped them make sure the level of amplification was correct.

Bertrand believes that remote support represents a major advance in the effectiveness of cochlear implantation. He said, “Until now refining the programming of a cochlear implant could be a tedious process that could take a year or more before patients could hear clearly. Refining the program by using a software system in real time can speed the process for the audiologist. The days when audiologists were forced to program the implant without support are over.”

In the Med El program, an audiologist works with the interactive software program over several weeks or months with the patient's help, fine-tuning and tailoring it to produce the clearest sound for the patient. If problems occur, the primary audiologist can use the software system to dial up an expert who can see the patient in real time.

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Future benefits

Bertrand and Kim Jackson, an audiologist with Med El North America, foresee additional applications of remote support, including long-distance training of audiologists to treat implant patients and of surgeons to perform the implant surgery. Eventually, Bertrand said, teleaudiology might even be used to help patients program their own implants.

While Bertrand said that Med El is the first cochlear implant manufacturer to provide remote care, he anticipates that other companies will do so as well.

Based in Innsbruck, Austria, Med-El has been making cochlear implants for nearly 25 years. Its hybrid multi-channel cochlear implant received FDA approval in August 2001.

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Last month, this column reported on a new law in Louisiana that will provide hearing aids (up to a maximum manufacturer's single-unit price of $400) at no charge to residents who meet specified audiologic, age, and income criteria. While the benefit is perhaps the most generous offered by any state in the U.S., a look at a new law in Denmark provides a perspective on the great differences between the U.S. and some other advanced countries when it comes to coverage of hearing care.

Like several countries in Western Europe, Denmark has long provided free hearing aids to citizens who get them through the state-funded national health service. However, those who apply for hearing aids through the health service face a long wait, ranging from 10 weeks to as long as a year and a half, depending on the location. As a result, about 10% of Danes opt to go to private dispensers, where there is no wait and where they can be fitted with the hearing aids of their choice instead of those selected by the state clinic.

These hearing aid purchasers also receive help from the government in the form of a subsidy, which, until recently, was 3000 Danish kroner (about $400). However, effective June 1, the Danish parliament raised the subsidy to 5000 kroner, or nearly $700. In addition, persons covered by the main Danish health insurance company receive a supplementary grant of 1000 kroner (about $135) if they purchase hearing aids privately. Since retail hearing aid prices are much lower in Denmark than in the U.S. (a high-end digital typically goes for $1600 or $1700), the new subsidy and insurance grant are expected to cover most of the cost of purchasing aids in the private market.

The government anticipates that the increased subsidy will induce more consumers to go to private dispensers, thus relieving the burden on the state hearing care clinics and cutting the waiting time. However, some manufacturers predict that increasing the subsidy for private purchase of hearing aids will be too effective. They warn that so many people will be diverted into the private market that they will overwhelm the supply of private dispensers. The resulting demand for more dispensers will lead audiologists currently employed by the state to switch to private practice, which may leave the state clinics understaffed again.

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In its continuing effort to build a market for its disposable hearing aids, Songbird Hearing, Inc., is trying a new strategy. Fred Fritz, president of the company, said that Songbird will use a mobile audiology center on a trial basis in the Dallas area. A Songbird van, staffed by an audiologist, will go to parking lots of major shopping centers. There, the licensed professional will conduct testing and dispense Songbirds. The first van was scheduled to begin operating sometime this summer.

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Sue Thomas, F.B.Eye, the first weekly television series whose main character is deaf, will debut Sunday, October 13, from 9 to 11 pm, on the Pax network. Playing the title character will be Deanne Bray, the first deaf actor to win a starring role in a TV series.

In the action drama, Bray portrays a young deaf woman whose ability to read lips and her powers of observation land her a job in surveillance with the Federal Bureau of Investigation. The real Sue Thomas has been deaf since age 18 months and worked for the FBI before entering a seminary and then moving on to her current career in motivational speaking.

Deanne Bray has a similarly varied range of talents and interests. Along with being active in the Deaf West Theater Group, she teaches science and math to hearing-impaired high school students in East Los Angeles. She recently established a literacy program for deaf children and is close to earning her master's degree in education.

Bray won the role over hearing and deaf actresses from across the country. Severely deaf since infancy, the attractive blonde actress and teacher wears hearing aids some of the time to take advantage of her small amount of residual hearing. She communicates in several ways, including signing, lipreading, and speaking, the last with a clarity that belies her deafness.

After its 2-hour launch, Sue Thomas: F.B.Eye will be aired every Sunday from 9 to 10 pm on Pax, a self-described “family-friendly” network that reaches 86% of U.S. television households.

Copyright © 2002 Wolters Kluwer Health, Inc. All rights reserved.