Question
I work in a large hospital setting with multiple outpatient clinics, and it seems as if there is quite a bit of variability between audiologists in the way hearing aids are fit and programmed. What are some fundamental guidelines to achieving a consistent, accurate process to minimize risks and achieve best outcomes?
Answer
With the introduction of programmable and digital hearing aids, we were introduced to a new world of flexibility and possibilities. With this came the added complexity of the continuously evolving features and algorithms, as well as multi memories, wireless connectivity and Bluetooth technologies. The implementation or use of digital amplification will not necessarily result in an improved patient outcome, however. We need to employ the skills and the techniques to result in the patient realizing those benefits.
One of the most common mistakes is the overreliance on the first fit algorithms. One online survey showed that 70% of the responding audiologists program hearing aids using the manufacturer's first-fit settings. Another report said that less than 12% of the targets on the manufacturer's fitting software screen actually match what is measured in the patient's ear. Softwares vary considerably among manufacturers, and we can't assume that the norms performed in research facilities are going to apply to our individual patients in real life situations. Using first-fit as a routine procedure leads to repeat visits, unrealized expectations, and creates anxiety.
All audiometric data, including bone conduction, has to be entered into the fitting software;we know that conductive and mixed hearing losses often require more gain than sensorineural hearing losses. Furthermore, up to 80% of providers don't perform objective verification of fittings afterwards, but they rather rely solely on patient feedback to make adjustments. An important part of a best practices protocol is objective verification of the fitting with probe-microphone measurements taken from the ear (or using a validated coupler method with infants and others for whom real-ear measures can't be obtained) compared to prescriptive targets. We need to ensure that we're using soft, medium and loud calibrated speech inputs that yield acceptable outputs within the patient's dynamic range.
Other pitfalls include not saving the program into the hearing aid, and handing back factory repairs that have not been programmed appropriately or verified upon return.
Overall, it is important to have standardized validation measures in place for the initial fit, probe microphone measures for in-situ verification and adjustments, and verification measures once the patient returns for follow-up.
Implementing and documenting a standard procedure that includes these components across all practice settings will help to minimize risks and achieve best outcomes with your hearing aid fittings.
Editor's Note: This Ask the Expert was taken from the eSeminar Preventing Medical Errors for Audiologists - 2011 Update published on 6/23/2011. To access the recorded course, please go here.
Dr. Cindy Beyer has a master's degree from West Virginia University and an Au.D. from PCO School of Audiology. She has over 20 years of experience working as a clinical audiologist, supervisor and manager. She is currently the Senior Vice President of Professional Services at HearUSA. For more information about HearUSA, visit the HearUSA web channel on AudiologyOnline.
