The most critical appointment in your path to success with hearing aids is the hearing aid fitting. Unfortunately, the quality of a hearing aid fitting appointment can vary widely based on the hearing care professional that you go see. Hearing aid fittings done poorly or lacking attention to detail can actually slow your progress with your new hearing aids. It can also reduce your ability to make an evaluation whether or not they’re actually working right for you in your day to day situations, and ultimately it can lead to poor or unsuccessful treatment outcomes. This is why I have created a list of five things that you should expect when getting your hearing aids fit.
Number one is completing a subjective evaluation questionnaire. Basically, these questionnaires evaluate the subjective benefit that hearing aids are giving you. You fill out this questionnaire before you get your hearing aids, and then you fill it out again after you’re done with your fitting window, whether that’s 30, 45, 60 days, or whatever the hearing care professional’s fitting window is. This lets you and the hearing care provider know if you’re actually receiving subjective benefit in your day to day environments. My two favorite questionnaires are the Abbreviated Profile of Hearing Aid Benefit, or APHAB, and the Client Oriented Scale of Improvement, otherwise known as the COSI.
APHAB Questionnaire: The reason I like the APHAB questionnaire is that it has a series of 24 questions that are the same for anyone who takes it, and you basically score it as to how much difficulty or lack of difficulty you’re having in a variety of different situations. I like it so much because you can take those scores and compare them to everybody else who has taken that same questionnaire, and it will give you an idea of how much difficulty you’re having based on the rest of the general public with hearing loss. At the end of your hearing aid fitting trial, whether it is 30, 45, or 60 days, you’re able to compare how much more improvement that you’ve got based on those same questions, and how you compare to other hearing aid users.
The thing that I don’t like about the APHAB is that when you have very strict questions, sometimes people don’t experience those environments, so it’s really hard to give a score or a rating for someone who never goes to the theater, for instance. And so, even though you can get generalized scores and comparisons to other individuals, not everybody will experience those same environments.
COSI Questionnaire: The thing that’s great about the COSI is that it’s actually very specific to you, so you can actually create statements. For instance, if you have trouble hearing your spouse at the dinner table, you can use that in the COSI, and then at the end of your fitting period you can go back and rate how much improvement you’ve seen in that situation, and then what your final hearing ability is with the hearing devices. This is great, because you can have very specific things to you and see very precisely how much improvement you’re having in those important situations that speak directly to you. The negative is that you actually have to come up with very specific situations that you can use to gauge how much improvement you’re having. If your hearing care professional is doing a good job in the initial appointment, they’ll ask what your needs and wants are, and they’ll take some of that information and help you come up with ideas to fill in the COSI.
Number two is the physical fit of your hearing aids. This, in my opinion, is one of the most underrated
aspects of a good fitting appointment. This goes for hearing aids that are custom molded to your ears, but it also encompasses hearing aids that go behind your ears that either have a tube or a wire that goes down into your ear canal. The right fit is important for a couple of reasons. One is comfort – if you’re not wearing your hearing aids because they’re uncomfortable, then you’re not going to get the benefit of the hearing aids. You have to absolutely make sure during that during the fitting appointment, those ear molds, or domes, or whatever you’re using, are comfortable inside of your ears. If your hearing care professional identifies right off the bat that it’s not fitting in your ear properly or it’s creating soreness even inside of that fitting appointment, then it’s going to turn into a bigger problem. Discomfort needs to be identified right off the bat.
Aside from the comfort aspect, you need to make sure that the microphone orientation is right. This is something that not a lot of people understand. Hearing aids usually have multiple microphones on them, in order to allow the hearing aid to identify where noise and speech sources are coming from. If you have a wire that is too long on your ear, it’s going to tilt those microphones back and it’s going to think that the person you’re talking to is on the ceiling and that the noise is on the floor – when that’s not the case! So, you want to make sure that those hearing aids are oriented perfectly inside of your ears to where the microphones are directed in the direction they’re supposed to be going.
Another commonly overlooked aspect of the hearing aid fitting is the vent size. The vent size is critical to ensure success with both the sound that you’re getting and the sound of your own voice. You see, the larger the vent hole, the more sound you’re trying to amplify can escape. If that sound escapes, it’s not actually going to give you any perceived benefit. The other side is that if you have a vent hole that is too small, it can actually create the occlusion effect, in which the sound of your own voice feels boomy or loud, or like inside of a tunnel. If you have the occlusion effect, the only way to eliminate that is to actually increase the vent size. When you’re looking at the physical fit of a hearing aid with that vent size, you need to make sure that you have the exact right vent for you, to give you all the benefits of the amplification, but none of the negatives of the occlusion effect.
It’s really important that you understand that if the physical fit of a hearing aid is wrong, nothing else after that matters.
Real ear measures are the only way to ensure that your hearing aids are programmed correctly for your hearing loss prescription. If you’ve seen any of my other videos, you probably know I’m a firm believer that real ear measures are something that should absolutely be done with every single individual with hearing aids. In fact, I have another video completely dedicated to helping you understand the importance of real ear measures. I happen to believe that it is the single most important video that you could ever watch, and if you only watch one of my videos ever, that would probably be the one that I’d suggest.
If you’re new to hearing aids, you probably need someone to show you how to use them. This includes identifying the left from the right, turning the hearing aids on and off, getting them in your ear, and changing the batteries. All of these things are really important, and you need to be shown them during this fitting appointment. One thing I know for sure is that you’re not going to get any benefit from your hearing aids if you can’t get them in your ears and turn them on!
Success with hearing aids is a process, and this process should be discussed. You see, with hearing loss, your brain has gone for awhile without access to proper sound, and now that you’re giving it all back, it’s going to take time for your brain to adjust to it. I often tell my patients after their first fitting appointment that they’re going to go home for this next week and they’ll hear sounds
that they haven’t heard in a long time, and some of them they won’t like. However, it is important that your hearing care professional shares that information with you, so you can have some level of expectation on what you’re going to be hearing and how you’re going to react to it. That’ll make this whole process a whole lot easier for you, and for your hearing care professional.
These are the five things that you should expect during your hearing aid fitting. The journey to better hearing really requires a solid foundation, and the hearing aid fitting is that foundation. If you get that part wrong, or if you miss something, it’s really going to set you up for a more difficult time in the future. Different hearing care professionals will form this hearing aid fitting appointment differently. They may elaborate more on certain things, not so much on other things. I think that that’s one of the great things about hearing care professionals – they can take a style that they are most effective with. But, at the end of the day, you should make sure that they’re covering these five steps.
Dr. Cliff Olson from Applied Hearing Solutions in Anthem Arizona discusses the 5 things you should expect during a hearing aid fitting appointment. A great hearing aid fitting is critical for success with your new devices.
#1. Subjective Questionnaire - Pre and Post questionnaires are a great way to determine how much success you are having with your hearing aids in your natural environments.
#2. Physical Fit of your Hearing Aids - Get this part wrong and nothing else matters. Fit affects more than comfort. It can dictate how well a hearing aid can be programmed and functions.
#3. Real Ear Measures - REMs are the only way to ensure proper programming of your hearing aids. Watch my Real Ear Measurement Video by clicking this link: https://youtu.be/cHR0Oa6I-wY
#4. How to use your new hearing aids - It would probably be a good idea if you knew how to put them in your ears and turn them on.
#5. Realistic Expectations - Getting used to hearing aids takes time, and it isn't always easy. There will be some sounds that you hate, but it will get better. Your hearing care provider should discuss these with you so you know what to expect.