Tuesday, June 18, 2013

Describing Hearing Loss

Describing hearing loss can be a tad nebulous at times -- especially to those with normal hearing. I found this clip a year or two ago that very graphically shows the effect of hearing loss from normal hearing to severe loss. This is often an eye opener for those who hear normally.


Friday, November 4, 2011

How much brains do I really need?

Often one of the major quibbles I have run into when selecting a device for a patient is picking the level of technology needed. By level of technology, I don't mean size of the device, nor it's appearance. By level of technology, I'm referring to the device's capability to clean up one's ability to understand speech in noise in order to give them a fighting chance. In general, the more features that are implemented on a device, the easier a time somebody is going to have understanding speech in a noisy environment. Because if this, here is a guide, based on my own experience to help you have an informed conversation with your hearing care professional when it comes to decide what level of technology you need.

Premium (Price range: $6000-$8000 for a pair):
If you are still working or retired but still very active, you need premium devices. These devices do the best at squashing background noise and improving the speech signal so you have a chance at understanding people talk in noisy and active situations. This way, you aren't constantly making adjustments to your volume or constantly changing programs (groups of settings for different environments). All you have to do is put them on and let them run. That way, you can go to your job, be more productive because you can understand what's going on, and not have to worry about it. Same if you're retired and traveling. Airports can be hellacious when it comes to sound because you have people milling about constantly with announcements that aren't always clear being made, not to mention the sounds from a jet or turboprop aircraft in actual flight. If you're in those situations, you don't want to be constantly making adjustments because all it's going to do is call attention to the fact that you have a problem. You want something that will keep up with you automatically. Therefore, if you are working, retired but active in your community, or on your world tour/cruise, you want to wear premium devices because they will keep up with you automatically, giving you the fighting chance you need. Examples of premium devices include the Oticon Agil, Phonak Ambra/Audeo IX/Naida IX, and the Unitron Moxi/Quantum 20

Medium Level ( Price range: $5000-$6000 for a pair)
Medium level devices are for people who are largely still at home, yet still get out and participate from time to time. In more dynamic environments, they may require some user adjusting for clarity, but not that much, because they aren't quite as automated as premium level devices are. The type of person who would do well with medium level devices is somebody who largely stays at home in front of the television, but somewhat frequently gets taken out by their family or stays with family over the holidays. They don't need that much sophistication because their days are largely spent in a quiet room with very likely the television on. Therefore, they don't need a ton of sophisticated processing most of the time. The times they do get out though, they want to have that fighting chance and with a mid level product, they get that. Examples of Mid range devices include the Oticon Acto Pro, Phonak Solana/Audeo V/Naida V and the Unitron Moxi/Quantum 12.

Low End (Price range: $4000-$5000 for a pair)
Low end devices are generally for people who are either 24 hour care, homebound, or who really don't get out at all. They have the least sophistication and often require user adjustments in noisy situations. Most of the time, people who would use this kind of a device just need to be able to hear the television without it blasting and/or hear the doorbell when it rings. They may or may not use the telephone anymore. Because of this, they really don't need the sophistication of the high or mid range product. They just need a bit of a boost in quiet so they aren't blasting their neighbors. Examples of these devices include the Oticon Acto, Phonak Cassia/Audeo III/Naida III and the Unitron Moxi/Quantum 6

When talking with you hearing care professional, it's important to really look at yourself or at your parent if you're bringing them in to figure out what is really needed. Only your hearing care professional will know what exactly you need. All if this is only designed to help you have that intelligent conversation with your hearing care professional about what your processing and technology needs really are.

Sunday, October 9, 2011

Community Clinic, Costco, and Boutique

Let's face it, 2008 was a banner year for a lot of things. The main things of course most remember apart from the election of Barack Obama are close to $5 gasoline and the beginning of the Great Recession with the collapse of Lehman Brothers. The latter of these is important because we continue to feel the effects today. In the hearing care business, the the main thing we notice is not only the destruction of wealth, but the general fear and unease that resulted. The main change we noticed right away is that people who would normally buy premium hearing devices, now are buying mid range or cheap devices if they buy at all. Even then, they will buy only if they really and truly feel they are falling short with their current devices.

Whether Obamacare is ultimately upheld or not, the hearing care industry, like everything else is changing. It used to be that your local audiologist or dispenser is where you went to get your hearing needs attended to and you didn't generally shop it. These days, with the proliferation of the internet and the general destruction of wealth and earning power caused by the Great Recession, that's less and less true. The internet in this case is a double edged sword because you have people using it to learn about hearing loss with no way of knowing whether the information they are receiving is accurate or not. They further use this information to pair off one care provider against another in terms of not only price, but also in terms of plan of treatment. Further, some companies post prices and offer to sell hearing devices direct to the patients. This is dangerous because it can really make a relatively moderate problem a lot worse.

Because of this, the industry is moving, slowly but surely to a three tier model for care delivery. The first tier is the Community Clinic. The second tier is Costco and other discounters, and the third tier is the Boutique clinic.

The Community Clinic tier is the one that will serve MediCaid patients. These patients are generally poor and MediCaid reimbursement is generally a pittance to the point where most providers across all specialties of medicine cannot generally afford to care for them in private practice due to overhead and administrative costs. In a Community Clinic setting, the overhead and administrative costs are pooled, allowing care to be rendered in a cost-effective manner consistent with what the providers can hope to get from all of their services. In this kind of setting, you have a couple of primary care doctors along with specialties like gynecology, orthopedics, vision care, ear nose and throat and audiology and dispensing all in the same building. This is largely not accepted among providers now because they would make a lot less than they can on a cash basis in private practice. However, with the destruction of wealth among retirees who did the right thing and ended up getting hoisted for it, this is likely to be their only option since they will likely to be covered by both MediCare and MediCaid and most independent providers will stop taking MediCaid because any money they do realize on top of their costs of goods dispensed will be eaten up in necessary administrative overhead, leaving no incentive to treat MediCaid patients.

Costco and other discounters will form the middle tier of the new hearing care delivery system. This will serve people who either can't afford nor want the attention that a value boutique gives, yet are not poor enough to qualify for MediCaid, nor have a loss severe enough to qualify under MediCaid. This is key because with the destruction of wealth and retirement funds among baby boomers who did the right thing is leaving them scared, making steep discounts for devices a major priority. They will get a solid set of devices, very often digital, at this level for a deep discount. They will not get the same attention or necessarily the hyper customization that somebody at a value boutique will get, but their problem will be tended to. This is likely where most of the baby boom will start, due to either not saving enough, having to get help to keep a job due to not saving enough, or loosing their retirement funds and having to do this to have enough to live on -- likely where most of the population of the United States is going to be for the forseeable future.

The highest end devices are going to be found in the Value Boutique clinics. These clinics will generally have a small to medium sized patient load. This allows them supply hyper customized solutions for their patients and charge a premium for it, as everybody gets the attention they need. This will serve not so much the rich, as they tend to price shop everything, but rather those who want and desire the boutique experience as well as truly want and value a hands on professional to take care of their hearing. This could include not just on-call or house call services, but also the environment of the office, which would be very homey and not as clinical, except in some areas such as the laboratory. The whole idea is to help put patients at ease and make the experience of getting help for a hearing problem as relaxed and as customized as possible. The idea here again, is not necessarily to sell everybody amplification, but rather finding a solution that works for their lifestyle -- something most will pay a premium for.

In a lot of ways, this is similar to what happened when supermarkets started selling meat. It used to be that if you wanted meat, you went to the butcher to get it. In addition to cutting and weighing your meat for you, he would give you some recipes and tips on how to best prepare it. Now, if you want meat, you can get it in the cooler at the supermarket with a limited selection at the meat counter. The butchers that have survived are generally boutique or specialty outfits that charge a premium that a certain niche of the market is happy to pay for either the advice, or certain cuts or kinds of meat they can't get anywhere else.

Another example of this happened to me not long ago. I'm a recreational archer and had purchased some arrows at a generic sporting goods store. The arrows flew ok, but had some issues with loosing their heads in targets. On the recommendation of one of my fellow archers, I went to a local archery store to get some more arrows. When I got there, the owner asked what kind of bow I was shooting, what kind of shooting I was doing (target, hunting, etc.) as well as analyzed my release and stance. He then recommended some arrows for me that were not cheap, but allowed me to shoot much more accurately. Further, he was able to pick a bow for me that when I decide I'm ready to hunt, will serve me well. The arrows were not cheap, nor was the bow he recommended for me, but I was happy to pay a premium for the arrows because he knew what he was doing and it showed.

This is a classic example of a value boutique. You do pay a premium, but you are taken care of by a trusted professional who takes the whole you into account. He can do this because he doesn't see that many people, allowing him to take the time to figure out exactly what you need and what you value, whether it be understanding the priest, being able to understand somebody at a party, or a quick and easy solution for understanding somebody on the phone as well as having a fighting chance at understanding small grand or great grandchildren.

Because of the economic and personal realities, the market niche for a value boutique is quite small. Therefore, not every currently existing clinic or office is going to be able to embrace this model, meaning most will fail, with their providers being forced to join either the community clinics or the deep discounters. They will still make money but it will not be what it was before. A sales guru friend of mine wrote a book entitled "The Market Has Changed, Have You?" Our market has changed due to a number of large forces and we need to adapt to this new reality or else get run over into oblivion.



For more sales strategies, techniques and ideas and insight for how to change in the climate we're in, visit pauldsouza.com

Monday, December 13, 2010

I don't think I have a problem. Why should I buy now?

This is something I hear a lot in the office, especially from people who have a moderate high frequency loss. The reason you should treat a hearing loss early is because it will help you keep your ability to understand speech as you get older. Hearing loss is one of those things that creeps up on you in a very subtle and insidious way -- almost to the point where you don't know you have a problem until a lot of damage has been done that you don't even realize it until you have a major problem and incredibly isolated. Catching and treating it early will save you a lot of grief further on down the road as well as increase your overall earning power if you are still working.

With aids costing around $6500-$7000 per pair at the high end, it's no wonder people in the early stages of a hearing loss don't get help -- the price and bother of using them is simply too high compared to the value. Yet before you drive a stake of holly through your hearing care professional's heart when he tells you about your problem, keep this in mind: he's only trying to spare you worse pain further on down the line as well as help you get a leg up on life. If your doctor said that you were in the early stages of a treatable cancer or that he saw a precancerous lesion, wouldn't you want that treated?

It's a similar story with hearing loss. Very often the first areas of hearing that are affected are the soft middle to high frequencies. This is important because those frequencies carry the consonant sounds that give definition to our language. To hear what that sounds like, try listening to an mp3, CD, etc. through a stereo system with the treble turned down a bit and the bass and mid set at the middle. Odds are, the sound will be muddy without a ton of definition. Your average person with a hearing loss hears like this every day and doesn't even know it. This loss of definition costs relationships, jobs and a whole bunch of other things as without this definition, there is little to no understanding of speech.

That's not the only dimension to this either. This is because of the neurological component to this as well because the nerves in the brain that handled the consonants get lazy the longer they don't get used. Like muscles, they atrophy and retask. As the cochlea looses its ability to process those frequencies, more nerves fall offline. Further, as we get older, our brains get more and more brittle and less able to adapt to new situations, allowing a hearing loss to get worse and worse and worse without the victim even knowing it. Then when they don amplification for the first time, they end up overwhelmed and start cursing their aids and considering their hearing care professional to be Beelzebub himself.

Getting help for a hearing loss early saves most of if not all of that. When a developing hearing loss is treated early, it keeps the nerves that process the consonants active. This in turn will make sure you hear speech clearly for years to come. This will further improve your relationships with people and give you a much happier life. One person I've fitted wears both glasses and hearing aids and he's in his early 30s. He technically only needs the glasses for reading and using the computer, but he wears them all the time because he sees that much better with them on. Likewise, his hearing loss is mild to moderate. He does fine without his hearing aids. When he wears them however, he finds himself much better able to function in life. those around him notice that he doesn't have to shout or have things repeated quite as much and does better at his job. With that kind of quality of life improvement possible, along with the fact that to my knowledge, hearing aids are considered by the IRS to be a medical expense and therefore are tax deductible, why not get a mild to moderate loss treated? The benefits even in the short term well outweigh the cost. Further, styles are so discreet these days that barely anybody is going to notice that you're wearing hearing aids unless they are looking entirely too closely at you. We spend our lives these days with Bluetooth earpieces on and tunes coming to us in our earbuds, which are far more noticeable than a pair of properly tuned hearing aids that help you not only survive today's hyper competitive business and social environment.

Tuesday, July 6, 2010

Hearing Aid Maintinence 101

These days, with hearing aids costing what they do, basic maintenance more important now than it ever was in the past. This is because Hearing Aids spend most of their time in an environment that is utterly hostile to them. As electronic devices, even though they are coated and treated to take moisture, they much prefer a cool, dry environment and the human ear is the opposite of that. Because of this, it's very important that hearing aid users and their caregivers know the basics of how to take care of hearing aids, so if you either use hearing aids or help somebody who does, this is for you.

Rule Number One: Keep them as clean and dry as possible.
This means brushing them off before you go to bed, keeping as much wax out of the receiver and tube as possible, and keeping them in their open case -- unless you have cats, dogs or other pets, then keep the case closed. The reason for this is it lets them dry out after spending 10+ hours in the warm moisture of your ear canal. This is probably the most important thing you can do to make sure your investment lasts its full life, as it gives the electronics a break so that things like contact corrosion and fouling don't happen as often if at all. Also, please check your ears before you step into the shower, the tub or go swimming to make sure you aren't wearing your hearing aids -- they really don't like water. If for any reason they do get wet, dry them off with a blow dryer set on cool air only -- the hot setting will damage the electronics and you don't want to do that to something you spent $3000+ each on.

Rule Number Two: Keep your clean and check appointments.
You wouldn't expect your car to last if you didn't take it in for it's oil change every 3000 miles, yet people seem to expect the same of their hearing aids. A clean and check appointment is like going to get your car's oil changed, except it usually takes less time. In this appointment, your hearing aids and molds are taken into the lab and intensively cleaned. Since the tubes on traditional Behind The Ear hearing aids very often get brittle, they are usually changed as well. After that the hearing aids are dried out and put back on you. If the tube was changed, your hearing care professional may refit the tube on you to make sure it fits right. This intensive cleaning again, helps maintain the electronics and other components of the two (or one) computers you are wearing that are helping you stay connected to the outside world.

Both of these rules are related because the main thing you need to do to maintain hearing aids is above all to keep them clean and dry. The clean and check appointment allows your hearing care professional to assist you in doing this. With your car, they recommend that you check your oil level whenever you fill your gas tank and that you go in for an oil change every 3000 miles. Your dentist recommends that you brush your teeth twice a day, change your toothbrush every 3 months and get a professional cleaning every 6 months to keep your teeth in good shape. The same applies for your hearing aids. Therefore, why not take the small amount of time it takes to maintain them, since they are an investment in your health?

Friday, June 11, 2010

Hearing Well, Being Well

Welcome to Hearing Well, Being Well. This blog is about hearing health care and related issues. This covers not just hearing aids, for those of us who need them, but also hearing protection and common sense. Hearing is one of our most important senses as it does the most to connect us to others, yet it's not that well understood by the public at large. By posting here, I hope to be able to help educate people about this very important sense of ours.

As a Hearing Aid Specialist, I deal with these issues on a day to day basis and look forward to helping us learn more broadly about hearing health, what this sense does for us, and the benefits and limitations of hearing aids for those who need them.

Until next time,

Auditor Maximus.