Why WE Follow Best Practices

Audiology of Nassau County adheres to Best Practices
Audiology of Nassau County adheres to Best Practices

The landscape for hearing health care has changed dramatically over the past 35 years. This ever evolving profession has undergone legislative changes that prior to 1978 would not permit qualified audiologists to fit hearing aids for their patients, to laws, decades later, requiring that all audiologists entering the field hold a doctorate degree.  And while the profession has seen many positive changes that have augmented the professional scope of the practitioner resulting in better hearing and improved lifestyle for more patients, there is also a vagueness regarding hearing care standards that baffle both patients and some physicians.

One possible explanation for the confusion about hearing care and hearing health is a general lack of awareness about the auditory system, its effect on cerebral health, and the role of amplification and aural rehabilitation in the care of hearing impaired patients.  Another explanation for general befuddlement is the seeming overabundance of hearing care facilities.  Many facilities run aggressive advertisement campaigns that focus on “selling” and of course “discounting” hearing aids.  Sorting through the confusion of big box store proclamations, marketing gimmicks (see post Marketing Predators: The EAR-ie Truth), and too often hurried fittings by some audiologists both in private practice and those employed by otologists, often leaves patients vulnerable to making decisions that may not have the best outcomes for their hearing rehabilitation.

Hearing aids are prescribed to improve communication, increase brain stimulation and overall to improve quality of life. Yet, often hearing aids are not appropriately fit, verified nor measured for their success, nor accompanied by a systematic process to ensure that the fitting goals are met.  This logically can affect not only the patient’s satisfaction with the instruments, but with the quality of life improvement as well. It is therefore of critical importance that patients, and families who are ready to begin the journey toward better hearing, understand that there are industry standards in place to ensure best outcome.  These standards are called best practices, and by following best practices, there is a system available to ensure best outcomes both from an acoustic perspective but also from a quality of life perspective.

A recent article by Sergei Kochkin published earlier this year by the Hearing Review compares outcomes for hearing aids purchased by users through direct-mail hearing aids and those who opted for a more traditional route. The results indicate that patients are “significantly more satisfied if all best practices are employed by the hearing professional in the clinic or office. Satisfaction from direct-mail purchases exceeds that from offices where best practices are not followed.”  This study and others similar, and the organizations that guide our profession outline and emphasize the importance of the use of best practices as a tool to provide best care for patients.

For patients and their families looking for hearing care and for physicians seeking the best referrals for their patients, best practices format makes it easy. It demystifies so much of the hearing care process.  Indeed, hearing health care is a process, not a device.  Educate yourself, your patients, and your loved ones about the standards that should be expected for best hearing outcomes.

Download our best practices “shopping guide” (available soon) on our website that can be used to compare process and procedures from one facility to another.  Best practices are the gold standard for hearing health care and regardless of the location, these methods should be applied. The savvy patient will use this guide as a tool, and ask targeted questions when interviewing a practitioner. Better hearing health begins with knowledge. The power is yours.

Hears to better hearing and better health!

Stefanie Wolf, Au.D.

 

Doctor of Audiology

Audiology of Nassau County

165 North Village Avenue

Suite #114

Rockville Centre, NY 11570

(516) 764-2094

www.audiologyofnassau.com

 

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How to Select a Hearing Health Care Provider

female_audiologist_postcard-r2147302d1ca64d8bbfec49ea325d8ed6_vgbaq_8byvr_324You’ve finally decided to move ahead and try to improve your communication skills. You’re excited about wearing hearing aids but don’t know how to get started. Choosing an appropriate hearing health care provider is as important as your choice of physician. Your audiologist is the hearing professional trained to evaluate and manage your hearing disorders and your concerns….so where to begin????

While a recommendation is very useful, it’s important to understand that one person’s success may not translate into success for you. Each person’s hearing loss is different and requires individual attention, not only to your hearing disorder, but to your lifestyle and your hearing requirements. Your doctor may have the names of qualified audiologists and this may be a good place to start. Asking a friend or relative is also helpful in terms of knowing the style and personality of the practice.

1. Choose a practice that adheres to the industry’s standards of “best practice”

2. Choose a practice where you will be seen by the same individual practitioner so there is continuity of service

3. Choose a practice that is not corporate in design so that decisions can be made by the audiologist managing your needs, and not by corporate protocols

4. Choose an audiologist who will listen to your needs and your concerns

5. Choose an audiologist who has state of the art equipment

6. Choose an audiologist who adheres to infection control recommendations, using disposable items when indicated

7. Choose an audiologist who is willing to make changes and corrections to the recommended hearing aid if it is not satisfactory

8. Choose an audiologist who takes the time to survey your hearing problems before you make hearing aid decisions

9. Choose an audiologist who offers many manufacturers’ brands of hearing aids

10. Choose an audiologist who incorporates multiple follow up appointments in order to assure your success

11. Choose an audiologist with appropriate university degrees

12. Choose an audiologist who has outcome measures to validate the hearing aid fitting

13. Choose an audiologist who is state licensed and abides by the state rules and regulations, and explains the state’s law for the trial period.

14. Choose an audiologist with a helpful staff for making insurance claims and answering questions

15. Choose an audiologist who will forward reports to your primary care physician

16. Choose an audiologist who will refer you to an otologist if your tests indicate the need for medical intervention

17. Choose an audiologist who you LIKE…you will be spending hours with this person which makes it even more important to put your trust and your confidence in a professional who is pleasant and accommodating and makes you feel relaxed and comfortable.

When it comes to your hearing, which is an integral component of your overall health, choose a hearing care professional who is patient and caring and provides counseling and aural rehabilitation to facilitate the adjustment to hearing instruments. Hearing aids are a process, not a product, and the relationship you build with your audiologist should be meaningful and built on a foundation of trust.

Hears to happy hearing and healthy living!

Stefanie Wolf, Au.D.
Doctor of Audiology
Audiology of Nassau County
165 North Village Avenue
Suite #114
Rockville Centre, NY 11570
(516) 764-2094

What’s the Buzz About?

imagestinnitusAn estimated 37 million Americans suffer from ringing, buzzing, humming or hissing in the ear known as tinnitus. Tinnitus, by definition is the conscious perception of sound in the absence of an externally generated sound source. Tinnitus can be a combination of sounds and for many people may vary in tone, character and loudness. It may remain consistent and persist or may subside or at times seem to disappear. For some, stress and diet exacerbate it. Others have difficulty determining what makes it better or worse.

And while tinnitus is perceived in the ear, and may, in some cases be generated in the middle ear space, most scientists will agree that in most cases, the sound perceived in the ear is occurring in the brain. Yes, that’s right, tinnitus is perceived in the ear, but occurs in the brain. This explains why many patients with severed auditory nerves will lose all ability to hear from the severed nerve ear, but will still experience tinnitus.

Scientists disagree over the causes, origins and models for how tinnitus originates and becomes weaved into the neural pattern, but what they do agree about is the fact that many different types of tinnitus exist. A popular theory suggests that damage to the peripheral auditory structures send disrupted, abnormal neural signals to the brain which subsequently causes persistent abnormal activity in the central auditory pathway (Nageris, et al., 2010; Jastreboff & Hazell, 1993).

While tinnitus can occur for individuals with normal hearing, 85% of those with tinnitus do have some degree of hearing loss. (Simpson & Davies, 2000). This makes sense when we think about how damage to the ear can result in disrupted and abnormal signals to the brain.

For many patients, simply acknowledging the presence of the tinnitus and understanding that it is a result of damage to the auditory mechanism is enough for them to accept the noise intrusion. Others find their tinnitus more debilitating and seek other avenues for help.

For many tinnitus sufferers with hearing loss, a properly fit hearing aid will help to reduce the perception of tinnitus in over 60% of cases. Some find that use of amplification can suppress tinnitus. But for most, decreased awareness of tinnitus is either a result of a complete or partial masking of the sounds or a reduced contrast between silence and the tinnitus, or because of a more structured neural pattern, among other possible occurrences that contribute to diminished awareness of the presence of tinnitus.

For others, amplification alone will be insufficient to help deal with the effects of tinnitus. Stress management and counseling or cognitive behavioral therapy is often extremely useful when used alone or in conjunction with amplification therapies.

Certainly, one with tinnitus should know that there is help. An appointment with an audiologist can help identify whether there is hearing loss, need for medical referral and design an approach for dealing with tinnitus.

Hears to Healthy Living!

Stefanie Wolf, Au.D.

Doctor of Audiology
Audiology of Nassau County
165 North Village Avenue
Suite #114
Rockville Centre, NY 11570
(516) 764-2094
www.audiologyofnassau.com

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Sources

Jastreboff, P., & Hazell, J. (1993). A neurophysiological approach to tinnitus:
clinical implications. British Journal of Audiology, 27, 7-l7.

Nageris, B., Attias, J., & Raveh, E. (2010). Test-retest tinnitus characteristics in patients with noise-induced hearing loss. American Journal of Otolaryngology–Head and Neck Medicine and Surgery, 31, 181-184.

Simpson, J., & Davies, E. (2000) A review of evidence in support of a role for 5-HT in theperception of tinnitus. Hearing Research, 145, 1-7.

I Can Hear but I Can’t Understand

images (1)The auditory mechanism is an astoundingly complex and brilliant design. It is truly amazing how sound waves or vibrations in the air, initiate a chain reaction that starts with vibrations to the eardrum and concludes with a neural signal to the cortex. Our physiological reaction, this delicate chain of vibration, pulsation, displacement, conduction, that occurs in response to sound is what allows us to communicate, participate and enjoy music, and the sounds of the world that surrounds us. This design is so fascinating, and so intricate that a slight interruption along this pathway, either occurring at the peripheral or central level, can result in tremendous difficulty with hearing, understanding, or both.
Hearing and understanding are not always codependent. One must be able to hear to capture a spoken message, but hearing alone does not necessitate that the message was understood. The ability to understand an auditory signal ultimately depends on the brain’s capacity to receive and interpret a complete and synchronously fired neural message.

For many older adults who suffer from sensorineural hearing loss, damage to the peripheral auditory system passes incomplete messages to the brain. More than 50% of adults over age 65 have some degree of presbycusis or hearing loss in the higher frequencies. These adults often have difficulty hearing certain higher pitch sounds such as a bird chirpings , certain phones ringing and particular letters of the English alphabet. Because our alphabet is comprised of a combination of vowels, which are lower in frequency, and consonants which are higher in frequency, an individual with high frequency hearing loss, might remark that they can hear, (because they can indeed hear ) but they didn’t understand because they didn’t quite receive all of the information due to the brain’s inability to receive a complete message. In English, consonants envelop vowels to give meaning to speech and hearing only vowels and limited consonant sounds offer opportunities for misunderstanding. “Fifty” and “sixty” sound somewhat alike for someone with presbycusis, especially in noise.

Hearing aids offer tremendous help for most individuals with hearing loss by bringing the inaudible sounds into the range of audibility and offering the brain complete messages. Yet, there are individuals who have difficulty understanding, despite being able to hear. For some, damage to the auditory nerve results in its inability to fire synchronously, delivering an unclear signal to the brain. Some listeners with auditory nerve damage may have normal hearing (when it comes to detecting tones) but cannot interpret speech because the signal sounds distorted or unclear. For many who suffer from a lack of clarity, assistive listening devices in conjunction with aural rehabilitation often result in tremendous improvements in listening.
If you or a loved one has difficulty hearing OR understanding , a hearing evaluation is a first step. There is help for most hearing loss. No one should suffer in silence. Schedule an appointment at an audiologist today.

Stefanie Wolf, Au.D.
 
Doctor of Audiology
Audiology of Nassau County
165 North Village Avenue
Suite #114
Rockville Centre, NY 11570
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Baby Boomer, Audiologist, Grandma, Hearing Aid User…

 

grandmareadingFor decades as a hospital based and later a private practice audiologist, I had been counseling my hearing impaired patients about the benefits of amplification. Most were receptive, but for a small group of resistive die-hard “denial-ers” I would attempt to motivate them to take steps toward better hearing by quoting scientific research, sharing success stories of the “non deniel-ers” and demonstrating the effectiveness of the latest in amplification technology.

And as a younger, normal hearing audiologist I was empathetic to the concerns of my hearing impaired patients, but on some level I couldn’t completely relate to their daily struggles of living with hearing loss. Until one day, I was one of them!! I too needed some hearing improvement and in 2006 I bit the bullet and fit myself with my first set of hearing devices. Suddenly, I had creds!

As a hearing instrument user, I was able to share my joy, not just my knowledge and professional experience, at hearing the birds chirping, listening to my classical music selections, enjoying movies and my favorite English TV programs that had previously eluded me. Hearing devices, I proclaimed, were giving me an improved quality of life that I was able to share with all of my patients, including the “denial-ers”. And they listened. Hurray!

BUT, as the old infomercials would proclaim, “but wait… there’s more,” I soon unearthed my own amazing discoveries…..experiences I didn’t find in a text but rather from my daily exposure to the sounds around me. I detected the police sirens and ambulance sirens (not that I didn’t hear them before I became a user) when they were further away enabling me to make a maneuver in a timely fashion. I was now a safer driver! I burned fewer dinners because I heard the timer ringing when I was in an adjacent room. I had dryer window sills and floors because I heard the rain against panes and managed to close windows before the deluge. You can imagine how these little improvements reduced the number of spousal complaints.

AND then there was the BEST discovery of all. I have three grandchildren and I no longer protest that they talk too softly or mumble. Grandchildren are the dividends in life’s journey, and if you can’t share or connect with them, a whole segment of the wonderments they bring to the table are lost and never recaptured.

So to all you drivers, cooks, TV viewers, but especially you grandparents of any age, give yourself a gift that brings a whole other world to your doorstep….try to improve your hearing. Find an experienced, well regarded audiologist near your hometown and get started. It will be a journey you won’t regret!

Barbara Rosen, Au.D.

Director of Audiological Services
Audiology of Nassau County
165 North Village Avenue
Suite #114
Rockville Centre, NY 11570
(516) 764-2094
www.audiologyofnassau.com

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Marketing Predators: The EAR-ie Truth

I wish I had a nickel for every time a patient came to my office with a mailer they received promising a vacation, a kitchen appliance, or even a Thanksgiving turkey as a gift for trying a hearing aid. Mailers like these are nothing new. Such inducements have become common practice in condo time shares and car dealerships, but they have no place in health care.

 

These mailers are sent by hearing aid dispensers or audiologists who purchase a list of specific demographic targets in order to lure prospective patients to their offices with promises of gifts and discounts.  These practices expect that, in order to receive their “gifts”, the patients will book an appointment and splurge for hearing aids. The mailers will often arrive in an 8 x 10” envelope marked “urgent” with the appearance of an authorized document, with emboldened warnings such as “time sensitive information” and “for recipient only.” Others state that the recipient has been “selected to be part of a special test market.” These mailers are often outsourced and arrive from a third party marketing company to present the appearance that it is not the practice’s own marketing. Is it legal, yes. Is it ethical, who knows. Is it tasteful, definitely NO!

While there is nothing wrong with advertising a clinic – after all, how else will people be made aware of the practice – I have a particular distaste for letters and publicity designed to mislead people. What is particularly troubling is that most of those who are targeted for these mailers are over the age of 65. A December 2012 article published on NPR’s website entitled Why It’s Easier To Scam The Elderly reported findings from psychologist Shelley Taylor at UCLA. Her study suggested that older adults have decreased activity in the area of the brain that detects risk and danger, making them more susceptible to respond to unsavory types of marketing. The article also reports a finding from AARP that the average age of fraud victims is 69, and states that this age bracket is “most inclined to believe those too-good-to-be true promises.” A more recent article, entitled Psychological Vulnerable Older Adults Are More Susceptible to Fraud,  published by Science Daily in April 2013, suggests that psychologically vulnerable individuals, characterized by depression and ”low level of social needs fulfillment”, were most likely to become victims of fraud. Because hearing loss is so pronounced in this age demographic, and because untreated hearing loss leads to social isolation and depression, the inevitable obvious conclusion is that the target audience for the hearing aid gimmicks are those who are most psychologically vulnerable.

To our patients who are disgusted by these mailers, I want to say “Thank You” for reading between the lines. To our colleagues who remain committed to avoid this path, it’s wonderful to see so many taking the high road to preserve the caliber of our profession. To our professional organizations that have not yet sanctioned these tactics for being unethical, hopefully soon you will reach the same conclusion that I have and re-evaluate your ethics standards and guidelines.

Most importantly, to recipients of these mailings, please remember for yourself and for your loved ones – especially the elderly who may not be able to read the subtle cues or fine print – that there really isn’t a special prize, special discount or special test audience, as advertised. These are simply devices to get people intrigued. The gifts for valentines chocolates aren’t REALLY chocolate, rather a $15 online certificate where you have to spend a certain amount to activate the coupon. If a practice promises $500 off a price of a hearing aid, more often than not, the price is first INCREASED $500 so the spender can feel good about using their coupon. Or, my personal favorite is the 50% off the manufacturer’s suggested retail price, which of course is artificially doubled by the practice so that it can be cut in half. Read carefully, be smart, and advise those you care about to do the same.

When it comes to your hearing, which is an integral component of your overall health, choose a hearing care professional who is patient and caring and provides counseling and aural rehabilitation to facilitate the adjustment to hearing instruments. Hearing aids are a process, not a product, and the relationship you build with your audiologist should be meaningful and built on a foundation of trust. Certainly professionals who use tricks to get you to their door could be initiating a relationship that prays on your vulnerabilities. Don’t let yourself or your loved ones fall victim to marketing predators. Isn’t it better to find honest professionals and buy your own Thanksgiving turkey?

Stefanie Wolf, Au.D.

Doctor of Audiology
Audiology of Nassau County
165 North Village Avenue
Suite #114
Rockville Centre, NY 11570
(516) 764-2094
www.audiologyofnassau.com

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http://www.npr.org/blogs/health/2012/12/06/166609270/why-its-easier-to-scam-the-elderly
http://www.sciencedaily.com/releases/2013/04/130425132441.htm

When Louder isn’t Always Better: Tips for communicating with someone who is hearing impaired

 

Communicating with someone with hearing loss is often very frustrating for all parties.   The inability to hear normally and effectively communicate leads to emotional consequences such as a loss of self-esteem, social isolation and a lack of participation in social settings. While there is currently no cure for sensorineural hearing loss, hearing devices prove a powerful and life changing tool.

While I (and most of my colleagues and patients) regard hearing instruments as “tiny little miracles”, simply wearing hearing aids alone may not be enough to maximize communication.   Both the listener and speaker should understand that in order to receive the most benefit from hearing aids, there are additional strategies that can be employed concomitantly.

The Hearing Loss Association of America (HLAA) recommends three core points to maximize communication with a person who is hard of hearing: set the stage, get the point across, and establish empathy with the audience.

When setting the stage, the HLAA recommends facing the listener directly, spotlight your face (avoiding backlighting), avoid noisy backgrounds, get the listener’s attention before initiating speech, and ask how you can facilitate conversation (often the listener knows just what to recommend!).  When the acoustics are poor, emphasize visual cues.

The HLAA outlines several pointers on how to best “get the point across”.  First, don’t shout. Speaking louder doesn’t necessarily result in a clearer acoustic signal.  The ideal way to deliver your message is by speaking at a moderate pace, clearly, without overemphasizing words. Use facial expressions or gestures when appropriate and don’t hesitate to rephrase if you are not understood. Finally, remember the hearing impaired rely heavily on visual cues. Chewing, facial hair such as a heavy beard or mustache, or turning your head while speaking may not result in communication breakdowns for someone with normal hearing but may cause interruptions for a hard of hearing listener.

To establish empathy with your audience the HLAA recommends being patient.  Speak directly to the hard of hearing individual (not about him or her to another person), show respect and maintain a sense of humor, stay positive and relaxed.

Even with the best intentions however, communication breakdowns are bound to occur.  If your listener did not appropriately understand what you said, try repeating the message noting your delivery speed. If your message was still not understood try rephrasing the message. If “that’s right” was not understood try, “that is correct.” Another approach is to repeat a key word to indicate the topic of conversation. If “Sue came home” was not recognized try, “Sue. Sue is home.” Simple alterations in word choice and order often have a significant impact on your intelligibility.

In summary, when communicating with individuals with hearing loss , share in the responsibility of effective communications.  While there are certainly strategies for the hearing impaired listener to maximize communications (a topic for a later post), exercising some of these strategies can yield a positive impact on your relationships.

 

Stefanie Wolf, Au.D.

Doctor of Audiology
Audiology of Nassau County
165 North Village Avenue
Suite #114
Rockville Centre, NY 11570
(516) 764-2094
www.audiologyofnassau.com

“Like” us on Facebook!
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Johnson, C., Danhauer, Guidebook for Support Programs in Aural Rehabilitation. Singular Publishing Group, San Diego,1999.
Montano, JJ. and Spitzer, J.B. (Eds.) Adult Audiologic Rehabilitation Plural: San Diego (2009).
Tye-Murray, N.: Foundations of Aural Rehabilitation Singular: San Diego (1998).
http://www.asha.org/public/hearing/disorders/types.htm
http://www.earaudiology.com/hhie.pdf
http://www.hearingloss.org/LEARN/index.asp#50
http://www.isu.edu/csed/profile/sac.shtml#