What the HELL is Going on With VA Audiology?

Honestly, what the hell is going on at VA audiology clinics when it comes to dispensing hearing aids?

Hey guys, welcome back to the Dr. Cliff AuD vlog. This is vlog number 280, and today I'm talking all about VA audiology when they're dispensing hearing aids.

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So I do not want this video to come across as that I do not have respect for the VA, or for VA audiologists. I have the utmost respect. I did clinical rotations through the VA when I was an audiology student, and I have a lot of friends who are audiologists who work at VA audiology clinics and dispense hearing aids.

But here's the thing, guys, I will say this. In defense of the VA audiology departments, they are incredibly swamped with veterans. Now, I served in the military, as you guys know, there was a ton of hearing loss that is a result from serving in the military, both hearing loss and tinnitus. And these audiologists have to deal with all of it, and they have jam packed schedules with very limited amount of time to get veterans treated.

Now, with that being said, I draw the line when it comes down to veterans not receiving a high quality of care. Now veterans get the best hearing aids. So if you have a hearing loss and you're a veteran and you're honorably discharged, then you can go to the VA and get hearing aids. I'm sure there's some stipulations around that. Like if you make too much money, you don't get free hearing aids from the VA, whatever. Okay? But this comes down to the treatment side of things.

So you get great hearing aids at the VA, but why do I constantly have veterans coming into my clinics with their amazing top tier technology hearing aids, and they still can't hear very well?

Well, I have, I don't know. I don't know how many veterans I see on a monthly basis. It's at least a couple who either come to me to get treatment because they refuse to go to the VA anymore, or they come to me with their VA hearing aids and they're like, Hey, Cliff, I'm not really sure why I am not doing good with my hearing aids. I was told that these were the best hearing aids I even saw on your YouTube channel. You talking amazing things about these devices. So what the heck is going on?

Well, I get these individuals in and I'm basically giving them a second opinion. They go through my applied 360 review process where I can essentially identify exactly what is causing their lack of benefit with their hearing treatment. Every single time I identify that either individuals were given the wrong hearing aids or they were fit the wrong way, it's one of the two, and sometimes it's a combination of the two.

So this recent case that I had, which is pretty much what's prompting this video today, is this gentleman had come in, he served in the United States Navy, you know, he is in his sixties at this point, don't really think he had any noise induced hearing loss, but nevertheless, he was able to get hearing aids from the VA.

Now, he had previously had Oticon hearing aids, and he ended up transitioning to Phonak hearing aids because he heard that Phonak hearing aids were the best. And while I don't disagree with him, I, I don't think that Phonak hearing aids are perfect for everybody. Nevertheless, you can pretty much make any hearing aid work for everybody unless there's an extreme circumstance.

Well, in his particular case, he comes in and he brings in his audiogram that he had done at the VA very recently, within the past two months. And he's like, you know, I got an updated hearing test. I got these new hearing aids, it took a couple months to get the hearing aids, but I got them and I'm still not hearing very well. And I'm like, okay, well that's interesting. Let me look at your audiogram.

And what I identify is that this individual has a steeply sloping high frequency hearing loss, and he's been fit with open rubber domes on his phac hearing aids. Now, if you have heard me say anything negative about Phonak, you would've heard me say that from a high frequency amplification standpoint using rubber domes, phac is really not that good. They end up limiting the amount of high frequency amplification you can get. So you don't actually restore any of the missing high frequency speech information that you need to get clarity out of speech. And that is exactly what was happening with this individual.

But you know, on top of that, I was like, you know, I know that these hearing aids are not going to be hitting your prescriptive targets. Let me go ahead and do a verification measure using real ear measurement to see how closely are to hitting your prescription and real measurement, just in case you don't know, it's a way that we can verify how much amplification you're getting at certain frequency ranges relative to your hearing loss prescription, and we can plot it on a screen to see how far off you are. And then ultimately, if we go in and reprogram the hearing aids, we want to adjust the amplification settings to match your prescriptive targets as a part of our applied 360 review process.

That is exactly what I did with this individual. And you wanna know what I found? Well, he was significantly off of his prescription with these hearing aids. So it is not a surprise that this individual got some of the best hearing aids that literally exist on the planet, and he still can't hear very well.

In fact, he reported that he heard better with his 6-year-old Oticon hearing aids. And guess what I found? I measured those too. He was actually closer to his hearing loss prescription with his 6-year-old hearing aids than he was with his brand new hearing aids, which is why he was getting more benefit from his old technology.

So this is like, I mean, this happens everywhere. It's not just VA individuals who come in. I get people from Costco all of the time. I get people from other private practice clinics. I get people from ENT clinics who all come in reporting virtually the same exact thing this individual did. And every single time I find an egregious missed recommendation from a hearing aid technology standpoint or a missprogramming by the hearing care professional who set the individual up with those hearing aids.

But here's my issue with the VA, like if they're not going to allow enough time for the veterans to have hearing aids programmed properly, then you're not really doing that much good for a veteran. I mean, yeah, it's great. You can give them a pair of $7,000 hearing aids, which is what they would typically pay on the priVAte market. But if those $7,000 hearing aids that are brand new don't perform as well as hearing aids that you could buy used on eBay that are properly programmed, then what the hell is the freaking point?

So this is really not a knock on VA audiologist. It's really more of a knock on the veterans administration in general, give your audiologist enough time to follow best practices, and in a minimum, at least perform real air measurement to make sure they're, they're hitting their prescriptive targets. This is an absolutely crazy thing that the VA is not regulating here.

Now, I've been told that each VA department from an audiology perspective runs its itself, okay? So there's not like a universal standard that every single VA clinic has to follow when it comes to dispensing hearing aids. Now, in my mind, that seems absolutely crazy. I mean, serving in the military and having anything that, well, I guess it is government run, so you really can't expect it to be that great. But it's just crazy to me that there's no standard that has the minimum standard of performing real or measurement on veterans hearing aids.

You essentially have these individuals who gave their lives in service of their country, and one of the benefits of doing so is getting healthcare at the Veterans Administration. And they've done such a bad job of supporting these veterans that they are choosing to literally go outside of the VA to get the problem solved.

I mean, this individual could have gone back to the the VA clinic that he went to to get the hearing aids, but he no longer trusts them. And so I had to basically say, Hey, listen, I know that you got these great hearing aids, but you need to go back to the VA. You need to tell them like, listen, I just, I'm not doing good with these hearing aids. Can you just get me the new Oticon hearing aids and just upload my old settings because those worked better?

And you know what they're gonna do? They're gonna say, yeah, let's just go ahead and get 'em. We'll upload your settings, come by and pick 'em up. That's probably what they're gonna do.

Now I'll give you guys an update to let you know if they're like, oh, you know what? Come back in. So like if they, instead of just giving him a different pair of hearing aids, if they say, you know what? Come back in. Let's figure out why those hearing aids are not working for you. And then hopefully they do the right thing and perform verification measures because it literally takes 10 minutes to identify the problem with real measurement, and then it takes another 10 minutes to solve the problem with better programming.

Now, to be fair, if they're gonna solve this problem with these photic hearing aids, they had better get him custom ear molds. 'cause without custom ear molds, he's still gonna be leaking out all of his high frequencies.

But let me know, guys, down, am I going overboard here? I know I've had a couple of rants here in the past couple months, and I don't mean to hurt any feelings with this, but again, when it comes to individuals with hearing loss and especially veterans with hearing loss, I take that personally. If you're not going to provide them with the high quality of care and ensure that they're actually hearing their best, then what the heck are you doing?

Let me know down in the comment section, guys, really interested to hear what you have to say about this entire situation with VA audiology.