An audiologist has either a master’s or doctorate degree. The master’s degree programs have closed, and the doctorate is the new standard. After completing a four year bachelor’s degree, most doctorate audiology programs require three more years of university study followed by a one year internship. In Indiana, you cannot be newly licensed as an audiologist unless you have a doctorate and pass the audiology license exam.
Audiologists are healthcare professionals who evaluate, diagnose, treat, and manage hearing loss, tinnitus, and balance disorders. Audiology evaluations are used for medical, educational, occupational, legal, and hearing aid fitting purposes.
Hearing aid dealers are only allowed to test hearing for the purpose of hearing aid selection, adaption, or sale (Indiana—IC 25-20-1-1)… or recommendations or service (Illinois—225 ILCS 50/1). To be licensed as a hearing aid dealer in Indiana, you need only have a high school diploma or equivalent and pass the hearing aid dealer’s exam. Usually, a student license is obtained first to help prepare for the exam through on-the-job training. Other states’ requirements may vary. Some state laws call hearing aid dealers by other titles, such as “hearing instrument dispenser” in Illinois. A “Board Certified Hearing Instrument Specialist” has passed a national exam. An audioprosthologist has completed a training course—the equivalent of about 4 hours college credit. Use of the term audioprosthologist has been banned in some states as deceptively infringing on the term audiologist.
How accurately do you want your hearing tested or hearing aids programmed? An accurate hearing test is essential. Not all dealers test hearing in a sound-treated room or know how to modify their testing for special needs individuals (the FDA essentially directs them to refer children to an audiologist for testing and rehabilitation). Indiana law doesn’t even specify how extensive their test must be. As they are only trained to test hearing for hearing aid purposes, they may miss subtle conditions that need medical attention. They aren’t trained in all the science behind the hearing aid programming algorithms, so they tend to rely on the manufacturer’s software to do most of the work for them. They aren’t trained in counseling or auditory rehabilitation techniques to help you through the process of adjusting to hearing well again. Very few do verification or outcome measurements, such as real ear measurement/speechmapping (recommended by Consumer Reports), aided functional gain, or pre- and post-fitting questionnaires. Yet many charge about the same or more for hearing aids as audiologists do (when product and service fees are combined). Why pay for care you won’t get?
Again, how accurately do you want your hearing aids programmed? Hearing aids are medical devices, not commodities. It’s not easy to fit hearing aids, even if you have an accurate hearing test (which is essential) and have chosen appropriate hearing aids. They have to fit the contours of your ears very well in a similar way that dentures fit your mouth. They are usually fit on ears with nerve damage, while eyeglasses are fit on eyes with normal nerves, so they won’t correct your hearing as well as glasses will correct your vision. It takes significantly longer to get used to wearing hearing aids than it does to get used to eyeglasses, so counseling about expectations is important. It takes an expert to get them ideally programmed.
Major manufacturers believe face-to-face care is the key to success and do not knowingly allow their products to be sold via the internet without local testing and fitting services.* It takes time for the brain to adjust to hearing well again, and follow-up fine-tuning adjustments will probably be needed (hard to do by mail). Verification and outcome measurements should be done to be sure that audibility is maximized and needs are met (most can only be done face to face). Don’t fall for one of those program-it-yourself devices, as what sounds good to you may be well below or well above the power levels you need to hear as well as possible without damaging the hearing you have left. Your impaired hearing has changed the way your brain perceives sound, so it’s hard for you to judge effectiveness without initial quality issues getting in the way (we can slowly change settings and counsel you through the first few weeks as the brain adapts to the new input—it’s a process, not a quick fix).
You also need to be taught how to insert, remove, use and care for your new hearing aids. They will need periodic cleaning. Some need periodic replacement of parts like tubing, domes or windscreens. They may need an occasional repair. Annual electroacoustic function checks are a good idea, along with annual hearing screening and re-programming for any changes in hearing or activities. (Choosing a longer Sound Care Plan with your hearing aids is your assurance of continuing to hear as well as possible thanks to follow-up care after the adjustment period.)
Why even consider buying hearing aids on the Internet? Just because it’s possible doesn’t mean it’s the smart thing to do. It may not even save money, since Internet prices are national, and prices in the Midwest tend to be lower than average. Plus, you will likely need to pay for local care at some point in the future.
Internet and mail-order sales are illegal in some states because professional care is that important.
* As of July 1, 2014, it is illegal to sell a hearing aid online or by mail to an Indiana resident unless it will be fit in person by an Indiana licensed dispenser.
The total price of getting hearing aids (products plus services) should include the verification and outcome measurements that audiologists do to insure that audibility is maximized and needs are met. Internet retailers and hearing aid dealers typically don’t or can’t include these important measurements but that may not result in lower prices. In fact, at one point we saw a website ad for a hearing aid with an $1800 price tag—the same hearing aid we had priced at less than $1300 including all the important services you need to succeed! Yet, they called audiologists “middlemen” for bundling in additional services. What are they charging $500 for? Websites like this generally rely on the manufacturer’s “quick fit” software to program the hearing aids for them. Research indicates that this method often results in the hearing aids being underpowered by 10-15 decibels.
It is misleading to suggest that hearing aids alone are all you need. It’s not likely to cost more to see a professional. It may cost less. Don’t pay more. Get more!
Real ear measurement with speech mapping is the initial fitting method we use. It involves using a very thin probe microphone tube to measure the sound levels in the ear canal with the hearing aids in place. The hearing aids are then adjusted until the power levels at each pitch match soft, average and loud targets based on the hearing loss, so that speech audibility can be maximized. The settings are further fine-tuned based on your comfort levels and comments on the day of fitting and at follow-up visits.
If you have hearing aids that are not helping you as much as you hoped they would, it’s possible that they can be reprogrammed using the “best practices” real ear measurement with speech mapping procedure described above. We charge a reprogramming fee and we will need a current hearing test done by an audiologist (or we can do the test for a fee, or maybe bill insurance). Sometimes we’ll need to charge for troubleshooting the hearing aids or replacing parts, and for follow-up visits. We can only reprogram hearing aids made by major manufacturers for which we have the correct software—- no proprietary franchise or cottage-industry brands, no relatively unknown brands, and no private label big box store brands (or most name brands purchased from big box stores, due to locked software). However, we can arrange for repair of any brand if the programming can be saved. While there may be costs involved, sometimes investing more in your current hearing aids is more cost-effective than replacing them, especially when they have been underutilized due to poor programming.
A common way of classifying hearing aid technology is into “best,” “better,” “good,” “economy” and “basic” categories. The prices vary accordingly. The “best” technology has all the top of the line features and usually turns the features on and off automatically as needed. Think of it like a really fancy computer. Features may include automatic multi-band adaptive directional microphone technology with binaural integration, motion, wind-noise and car-noise sensors, artificial intelligence, multi-level noise reduction, wireless connectivity, rechargeability, lots of frequency bands for fine-tuning, binaural synchronization of controls, feedback cancellation, and several others. “Better” technology has a few less features. Some features may be slightly less sophisticated and or may require you to push a button to activate them. “Good” technology often has several automatic features, but the features are even less sophisticated. “Economy” and “Basic” technology is sometimes from an older product line, with “Economy” having some automatic features that may not be very adjustable. “Basic” technology may be all manual with limited features but usually has a type of automatic directional microphones. Warranty length may vary by brand and technology level.
As technology improves, features are often added at the “best” level, and older features may trickle down to the other levels. Major changes seem to happen about every 18 months, but there is often something new introduced every six months. Sometimes one style of a product may cost more than another style even though the technology inside is the same. Digital technology is found in all price categories. Very few analog hearing aids are still being manufactured; when you see them, they are likely to be discontinued or reconditioned models or cottage-industry brands made specifically to be sold cheap.
Remember, prices may reflect more than just technology level or the length of the warranty. The type and amount of care you receive (or don’t receive) should in theory affect the total price, but it may not. Make sure you get the care you need as well as the right level of technology. Don’t pay for care you don’t get. Matching the technology level to the person requires more than just hearing test results and a budget. It also involves assessing occupational, educational, or recreational listening needs, or other lifestyle factors or disabilities, personality, and cosmetic concerns.
Local pricing varies widely, but midwest prices tend to be lower than the national average. Internet prices are national. Our prices may surprise you. You are not likely to pay more to see a professional. You are likely to receive more healthcare and technology expertise.
We offer products from eight manufacturers; prices and warranties vary. To avoid local price fixing concerns, we don’t put prices on our website. Our total prices include a combination of important professional services plus the products (at or near wholesale prices). The specific Sound Care Plan you choose for after care (care after the initial adjustment period) will affect the total, giving you the option of paying for some maintenance services either upfront or later as you need them.
You’ll see advertisements mentioning free tests, free trial and free aftercare services, but in reality, those “free” services are built into the product price. You’ll also see ads shouting about savings (for example) of up to 50%, or $1000 off a pair. They are referring to savings off of sky-high manufacturer’s suggested retail prices. Our normal prices and their sale prices are similar, but we give you the professional services you really need to succeed. That’s what we mean by dependable best value pricing.
Hearing aid dealers are only licensed and trained to do hearing tests for the purpose of selecting and fitting hearing aids. Their tests should not be used for medical purposes. Therefore, health insurance companies won’t pay for tests done by hearing aid dealers. They have little choice but to do them for free. State laws may dictate how extensive these tests should be (Illinois requires specific sub-tests, Indiana does not).
Audiologists can bill Medicare, Medicaid, and private health insurance for hearing tests (after the audiologist undergoes a credentialing process—similar to a reference and background check— done by each insurance company for which they provide in-network services). It is considered Medicare fraud to charge a Medicare patient more than another patient, so if the audiologist does “comprehensive” hearing tests for medical reasons as a Medicare provider, they have little choice but to charge everyone for hearing tests of this quality. They sometimes offer free “screenings” so that patients can find out if they have a hearing loss, but the “comprehensive” test is the standard of care. Audiologists consider it unethical to base hearing aid fittings on a lesser test (unless the patient’s age or disability limits their ability to complete a comprehensive test).
The good news is that health insurance will usually pay for the first hearing test and for any “medically necessary” follow-up hearing tests. However, Medicare and Medicaid patients need a physician referral due to Audiology being in a diagnostics only category like lab or x-ray. We’re trying to change that, but it will take an act of Congress!
Will the test be done by a licensed audiologist? Will it be done in a sound treated room? Has the equipment been calibrated in the past year? Was the person who calibrated the equipment NASED certified? Does the office meet nationally recognized infection control standards? Is it wheelchair accessible (if applicable)? If you call Sound Care Audiology, the answers will all be yes!
The other “yes” answer is that yes, we charge for our hearing tests. We will do free screenings, but a screening is only a starting point (learning that there is or is not a problem). Screenings are not sufficient for diagnosis or hearing aid programming. Because Indiana law doesn’t specify how extensive hearing aid dealer tests have to be, we consider them to be screenings and will not use them for hearing aid programming. We will accept recent tests done by audiologists.
Only about ten percent of adult hearing loss is due to factors like earwax, infection, or other medically or surgically treatable disorders. Audiologists are trained to identify these cases and refer them to an appropriate physician, as necessary (sometimes we can remove earwax ourselves). We do have a video-otoscope if you want to see inside your own ears.
Most adults have sensorineural hearing loss, which is damage to some of the 15,000 nerve cells in the sense organ, the cochlea, or to the auditory nerve itself. Ninety to ninety-five percent of sensorineural hearing loss can be helped with hearing aids, at least to some degree. We can’t make the damaged cells work again, but we can work the undamaged cells a little harder, if we’re careful. Most people get a 30 to 60 percent* improvement in the ability to hear soft sounds and are able to understand words as well or hopefully better than without hearing aids, but at a much more normal volume level.
*Percent as used here means unaided hearing level minus aided hearing level divided by unaided hearing level. Percent is not an accurate way to describe hearing loss, as the deciBel scale is logarithmic and larger than 100.
Please don’t feel that “Wow, I must be twice as bad as I thought if they are recommending two hearing aids!” If that is our recommendation, it’s based on decades of clinical research on how our bodies work. About eighty percent of hearing aid users wear two hearing aids. If you have a hearing loss in both ears, and if both ears can be helped by hearing aids, wearing two of them is probably the best thing to do. We really hear with our brains. If the hearing aids can be balanced to send equal input to each ear, the brain can better tell where the sound is coming from. You will need slightly less volume from each aid when you wear two, as you gain 3 decibels when the brain adds the two ears together. After you get used to them, the brain can also learn to “squelch” one ear, tune in to the other ear, then switch as necessary when trying to sort out speech from noise.
Everyone has different needs, and new technology comes out at least twice a year. We can offer the latest best hearing aid technology in the world, and it still might not be right for everyone’s hearing, cosmetic concerns, lifestyle, dexterity, or personality. Several of the largest hearing aid manufacturers claim to have the best hearing aid. They spend millions on research and development, and some of the products are truly amazing, but the real question is, “Best for whom?” Let a professional guide your choice. A doctor of audiology can evaluate your hearing, help you select the most effective type of hearing aids for your hearing loss and the best model of hearing aids for you, custom fit them for comfort, and precisely program them for maximum performance. The knowledge and expertise of the person programming your hearing aids is just as important as selecting the right hearing aids. It is misleading of manufacturers or retailers to suggest that a pair of the best hearing aids is all you need (when they may be useless to you if not chosen, fit, and programmed correctly).
Hearing aids are fit on a thirty day return basis, minus professional fees (for our time), to allow for an adjustment period. We do evidence-based procedures and invest several hours in helping you succeed. It’s really about retraining the brain to listen again. It can take time to adjust to the new sound, and follow-up visits for fine-tuning and instruction are advisable. Don’t give up too soon!
A doctor of audiology (Au .D.) specializes in the diagnosis and treatment of hearing and balance disorders but does not prescribe medicine or perform surgery. While they could be called “ear doctors,” similar to the way that doctors of optometry (O.D.) who specialize in vision are often called “eye doctors,” many doctors of audiology feel that the term “hearing doctor” is more appropriate.
The term “ear doctor” is usually used to describe a physician, a doctor of medicine (M.D.) or a doctor of osteopathic medicine (D.O.), who specializes in the surgical or medical treatment of the ears (also called an otologist), or of the ears, nose, and throat (also called an otolaryngologist or an ENT).