Active vs. Passive Follow Up : The Hearing Journal

Journal Logo


Active vs. Passive Follow Up

Kozelsky, Joseph D.

Author Information
doi: 10.1097/01.HJ.0000899324.84375.5b
  • Free

When I opened my practice after 20 years of working in a 501(c)(3) agency, I had several operating assumptions in mind. The primary one, however, was the idea that many people are reluctant to purchase hearing aids because they are expensive and because they are afraid hearing aids don’t work.

F1 Viewpoint, passive follow up, active follow up, call, survey.

Everyone knows many stories to this effect. Yet, we know that hearing aids do indeed work. So why does this fear still exist for consumers?

My answer is simple: lack of follow up on the part of both the users who expect to have problems and who don’t realize that most problems are easy and inexpensive to resolve; and the providers who have instructed the users to call if they are having any difficulties. If the provider does not receive a call, the assumption is things are okay.


Users expect problems, but without a reference they don’t know if their problem is self-induced, due to the nature of their hearing loss, or if they picked the wrong hearing aid style, and so on through all the reasons imaginable, including the fear of more costs, the fear that they just wasted their money, that they don’t want to bother their provider, that it’s hard to get in for an appointment, or that this is just the way hearing aids are. There are so many reasons. But providers know that most of the time the problems are simple to remedy.


Providers across many disciplines typically engage in passive follow up. (I.e., if the user or patient has a problem, they are instructed to call for an appointment and it will be taken care of.) The reality is often users don’t call. Sometimes, it’s not easy to get an appointment right away—especially in an institution, or if there is reliance on a third party for transportation. So, the path of least resistance may predominate. (I.e., do nothing because hearing aids don’t work.)

Quoting from a report by Larry Humes in the March 2017 American Journal of Audiology, “only about 50–70% are satisfied with them [hearing aids] and use them regularly.” 1 His references included five original source documents, four from the MarkeTrak Surveys by Sergei Kochkin of 1993, 2000, 2005, 2009 and another by Perez and Edmonds in 2012. More recently, Erin Picou reported in February 2020 that results from the MarkeTrak 10 survey, indicated that “roughly eight out of 10 hearing aid owners are satisfied.” 2 Although better than the earlier findings, it could be said that still about 20% of hearing aid owners are not satisfied with their hearing aids. This supports the continuing assumption by some people that hearing aids don’t work.


Since we assume that many users don’t know what to expect and what’s normal and what isn’t, my practice incorporated a fine-tooth comb questionnaire of our design for use at the final hearing aid fitting appointment to make sure we had covered all the bases and things that might be on people’s minds. No one was discharged until we were satisfied that we had maximized their hearing aid fitting.

Additionally, we engaged in active follow up largely based on the findings at the final dispensing visit. That is, we virtually always followed up actively either by establishing a follow-up appointment before users left the office if the problem(s) seemed complex, or by telephone, or email. We strove to be sure difficulties were resolved and that we knew of their outcome. Knowing the outcome was the key. Outcomes are unknown unless they are verified.

Realizing also that problems can develop over time, we scheduled a six-month quick check and annual re-evaluations and hearing aid checks to be sure that users were still on track.

A fair question would be, “How well did our active follow-up model work for our long-term users in comparison with national statistics?” We defined long-term users as people who had had their hearing aids for at least 12 months, but no longer than 36 months.


In order to find out, we sent out a version of our own four-page satisfaction survey to 100 randomly selected long-term users every two or three years. This survey form utilized an eleven-point scale of zero to 10 and was based on a fine-tooth comb questionnaire we developed for use at the final hearing aid fitting visit. The average of the satisfaction ratings for multiple satisfaction surveys, once even including a MarkeTrak Survey form, was 94%, ranging from a low of 88% for a single survey to a high of 96%.

In 2008, we engaged a law firm to conduct our satisfaction survey. Forty-three of the 100 survey questionnaires were returned. This time the rating for Overall Satisfaction was 93%. The midpoint was 5, and only ratings of 7 or higher were counted as being satisfied.

We can’t conclude what the actual contribution of the fine-tooth comb questionnaire was to the final results, and the unknown contribution of this procedure shouldn’t be ignored. However, based on our operating assumption that users often expect problems and simply don’t know how to go about managing them, it is our sense that the active follow-up protocol was a major contributor to our high rates of satisfaction.

Given the many intrusions into the traditional hearing aid dispensing model in today’s marketplace, perhaps incorporation of an active follow-up protocol might give the provider a stronger competitive advantage. After all, it’s the provider, rather than the product that can make the difference.


1. Humes LE, Herring C, Kinney DL, Main AK, Quigley TM, Rogers SE 2017 The effectiveness of hearing aids and two service-delivery models in older adults: a randomized double-blind, placebo-controlled clinical trial American Journal of Audiology 26 53 79
2. Picou EM 2020 MarkeTrak 10 (MT10) Survey Results Demonstrate High Satisfaction with and Benefit from Hearing Aids Seminars in Hearing 41 21 36
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.