SWC March 2008 Newsletter

Question: What is the best way to determine if an audiologist is competent?

Michael: Well, we can interpret the word "competent" in many ways. In fact, one national certifying body for audiologists, ASHA (The American Speech Language Hearing Association), grants the "Certificate of Clinical Competence" to those who graduate from an accredited university program, pass a national examination and who obtain the requisite continuing education hours to maintain certification. Another national body, the American Academy of Audiology, offers a similar credential through its ABA (American Board of Audiology) Board Certification. In order to practice legally, however, these credentials may not be enough. Most states have regulations requiring a license of audiology. One can contact these various agencies to determine whether an individual practitioner is certified and/or licensed. Some states have websites which allow the consumer to search whether a practitioner is licensed, when the license expires, and whether the licensee has had his or her license suspended or revoked for any reason. However, just because a particular person has all of the training and credentials (in ANY profession) does not guarantee competence. Reputation and word-of-mouth referrals can be very important in helping you to find the right audiologist for you.

Question: What questions should one ask in order to become very familiar with their hearing loss? I have seen many an audiologist since my early 20s (I am currently approaching 49), and am only now realizing that I probably was too trusting and should have been more of my own advocate over the years. After all, who has my best interest at heart, if not me? I have tried several brands of hearing aids (Phonak, Oticon, Siemens) trusting that my audiologist was steering me toward those most likely to enhance for my specific hearing scenario, but I am beginning to wonder if that was the case, as the last hearing aids I tried (over 5 years ago) came at a price of more than $3,000.00 each. No success. I have recently moved [DELETE? to Duluth, MN] and am trying to establish myself with a new audiologist in order to see what's new, and I want to be armed will all the ammunition I need to become as good of an advocate as some of the other members of SWC seem to be.

Michael: An excellent question. You are right, as a consumer you can be your own best advocate. This doesn't mean, of course, that the lack of perceived success in the past is the result of being "too trusting." I find that some people, at different stages of life, are more or less open or curious about the specifics of their hearing loss. When providing educational counseling to those with hearing loss, I am always tempted to provide a mini-course on all of the characteristics of hearing, from anatomy and physiology to the source of the pathology, to the nitty-gritty about intensity of sound, implications of hearing loss, and so on. Of course, my more inquisitive patients want to hear it all, and I will always make sure to provide as much as needed to answer the questions. However, consider that each person is quite different from one another, and as such, there are some who are curious, and some who have no desire at all to know any more than the recommendation. Whether I agree with that or not is irrelevant. The successful counselor is not one who will try to change the patient. S/he can work to be sure that the consumer has enough information to make an informed decision, but to provide lengthy specifics for one who does not wish it is overkill and, in fact, may be detrimental (patients can get bored and may even opt to not return or pursue amplification due to a perception that the process is too complicated, as a result).

And so, while it is not going to be beneficial to consider what may have been (indeed, the audiologist you saw quite possibly had your best interests in mind, yet it may not have proceeded according to expectations for other reasons, such as technological limitations, degree of hearing loss, etc.).You clearly have the right frame of mind moving forward. Whether that is spurred by simple reflection, by a lifestyle change (the move, etc.), by an outside source (friends, family), or just simply because you are now "ready to learn about it," I personally think it wise to want to seek information. Any audiologist should be able to answer questions about all of those things I mentioned above (anatomical changes, impact on communication, etc.) and that, in turn, can help you to be in the best position as an informed consumer. You need not memorize specific questions. Quite simply, I would begin by asking the audiologist to tell you a bit about what s/he knows about your hearing loss, and see what questions that elicits from you. I would strongly advise you to not worry so much about any particular brand or model of hearing aid, as they change over time, and since most manufacturers have very similar products. Rather, I would consider what features are important to you. As you've tried amplification in the past, your experiences (even if very minimal, and even if they occurred a few years ago) can help you and the audiologist learn about what to try next (or, what NOT to try next). For example, the hearing aid trial period can help reveal that a particular size is too small to handle, a particular style is easier (or more difficult) to allow for battery-changing, that a volume wheel is advised or not, that a telecoil is warranted (or not), whether programmable memories would be helpful. Today's devices have a growing number of features. Some hearing aids now use rechargeable batteries; some are Blue-tooth compatible. On the other hand, some of the newer features come at an added expense, and you want to be sure to not fall into the trap of wanting the "newest" simply because you equate that to "best." I think it important to consider features and needs, and try to match those things up. Of course, with the answers to the questions you will pose to your audiologist, you will be able to make the most informed decisions about your rehabilitation plan, and will not have to be as reliant upon others' opinions as to what would most likely suit you best.

Question: Having slowly lost my hearing in both ears over a period of 30 years, I still remember what things should sound like. I just came from a visit to my audi. I am trying out 2 new Phonaks. No matter what she did, I still got voice distortion. How will I know if I have ever gotten the best sound with that program? Is it a matter of getting used to just about anything?

Michael: Some research suggests that it can take 16 weeks to acclimate to the sound of a hearing aid. Emerging evidence of the plasticity of the brain, suggests that the auditory system can "re-wire" itself to maximize audibility as time proceeds. This is not to say that someone with a severely compromised word recognition ability (in which words sound very unclear) should be expected to hear like someone who has normal hearing, but it DOES suggest that ears that we previously thought of as "unaidable" can show improved functioning when aided. Additionally, this information makes a strong case that new users should be encouraged to stay with amplification longer than the limitations that some "trial periods" impose. This is a Catch-22, of course, in that if someone perceives the sound of a particular new device to be lousy, s/he is far less likely to stay with it. However, the more we learn about brain plasticity, the more evidence points to providing stimulation to the ears when possible.

Question: My speech perception is dismal. I still need to look at the speaker. If I get an FM attachment for my aids, I still need to see the person. Is it worth it? I tried the PocketTalker (lost it on vacation). I liked it but still had to look at the speaker.

Michael: FM systems do something the traditional hearing aid typically cannot, and they do it much more effectively in those rare cases when the traditional device can provide this advantage. Specifically, FM systems improve the existing "signal-to-noise ratio," which is more or less like having the speaker's lips come closer to the listener's ear without the actual physical space changing. An FM involves a remote microphone, which would typically be placed on or near the person speaking, and a receiver worn by the listener.

There are many factors that can cause communication to break down. Noise and distance are two important factors (as are the degree of hearing loss, intelligibility of the speaker, etc.) If someone spends most of his/her communicative time in a quiet environment which is in close quarters, then the impact an FM system will make will be limited. However, as the noise levels in the room, and or the distance increases, then an FM system can provide assistance like no other existing product can today. Whether or not you will benefit from FM technology is based on a number of characteristics, such as the degree of your hearing loss, lifestyle, etc.; however, from what you write above I would advise you to consider trying it.

Question: Audiologists always say to keep a hearing aid on a deaf ear to keep the nerve stimulated. If there is only cochlear damage, why would one need to amplify sound to stimulate the nerve? In fact, why is one told to wear their hearing aids as much as possible for the same reason?

Michael: Someone with profound hearing loss, while perhaps functionally "deaf," may have measurable hearing ability, however limited. The ear is wired to the brain, as far as sound is concerned. From the cochlea is the portion of the ear (inner ear) in which a neural response to sound is generated. This electrical firing of neurons results in a transmission of"sound" (albeit in electrical form) from the cochlea to cranial nerve number 8, also known as the Acoustic (or Hearing) Nerve. The energy further propagates to the brainstem and then to higher levels of the brain before being processed in the cortex of the temporal lobe. Although this may sound somewhat technical, it may help you to see that it is important to stimulate the ear to have sound reach the cochlea. It is important to stimulate the cochlea to allow for sound to travel to the hearing nerve. And the hearing nerve must be stimulated to allow sound to travel beyond it, eventually culminating in comprehension in most people.

There is an increasing body of research suggesting that plasticity evident in the brain also translates to similar results in the neural components of the auditory system. When one realizes that the cochlea is infused with neural parts, notably the hair cells of the Organ of Corti, it becomes clearer how important the role of the cochlea is. The reasons that people are suggested to wear there hearing aids routinely are many and varied. However, some reasons include that there is evidence of a deprivation effect: a "use-it-or-lose-it" phenomenon that can occur with lack of use, an "acclimatization effect" with regular use, and the fact that as creatures of habit, we are more likely to stop using a device completely if we limit (i.e. pick and choose) the times of use. All of these factors suggest that routine use is an excellent recommendation for many people.

Question: I was wondering if one day a person will be able to make their own adjustments with the home computer. I have a new digital CIC aid called the Nitro from Siemens, which is for severe hearing loss. My hearing changes constantly and I have to go back to have adjustments quite a bit. Sometimes I have to wait 2 weeks for an appointment. If I could do it myself, I could make the changes that I need. Do you see anything like this on the horizon?

Michael: Currently this is not possible. Undoubtedly the technology will someday allow for this. However, there may be other barriers. Most states have licensure laws for hearing-aid dispensing, and for those types of changes, the consumer may actually be violating law by practicing without a license. There may be other governmental legal issues to making those changes by Internet.

While it may be tempting to cut out the "middle man" in the process, please realize that there is a science to dispensing and someone without the proper training can wind up setting the patient's (own) devices to a level that can be dangerous and cause a noise-induced hearing loss. Perhaps this will someday be worked out in a way in which the audiologist dispenser will be able to legally make adjustments to a patient's hearing aids via a remote location. This would not be unique to audiology; in fact telehealth is gaining momentum in other disciplines such as health and nutrition, and speech-language pathology. It's quite possible that this or some similar modification of remote practice will be a significant part of the future of audiology. At this time, the commercial technology does not allow for it, and there are potential legal hurdles to conquer.

Michael Bergen is the Director of Brooklyn College's Speech and Hearing Center and is on the faculty of the Doctor of Audiology (AuD) Program at the CUNY Graduate Center. Michael is a NYS licensed, ASHA certified audiologist. As Director, Michael oversees daily operations, supervising clinical sessions and teaching doctoral, masters and undergraduate students. He was recently honored with the "Distinquished Service Award 2008" by NYSSLHA and named Favorite Teacher" of the Dept. of Speech & Communication Arts & Sciences by Brooklyn College for 2007 and 2008.

Michael was elected NYSSLHA VP of Audiology 2006-07, 2008-09 and has chaired or
served on committees at the university, local, state and national levels, including for NYSSLHA, ASHA, AAA, CAPCSD and the Metro Council.