Ministry Health Care Audiology booklet

1. ministryhealth.org
AUDIOLOGY
Get the facts about:
Hearing professionals I Hearing evaluation I Hearing aids

2. Hearing Handicap Inventory
Screening Questionnaire
Instructions: Answer Yes, No, or Sometimes for each question. Do not skip a
question if you avoid a situation because of a hearing problem. If you use a
hearing aid, please answer according to the way you hear with the aid.
• Does a hearing problem cause you to feel embarrassed when you meet
new people?
• Does a hearing problem cause you to feel frustrated when talking to
members of your family?
• Do you have difficulty hearing when someone speaks in a whisper?
• Do you feel handicapped by a hearing problem?
• Does a hearing problem cause you difficulty when visiting friends,
relatives, or neighbors?
• Does a hearing problem cause you to attend religious services less often
than you would like?
• Does a hearing problem cause you to have arguments with family
members?
• Does a hearing problem cause you difficulty when listening to TV
or radio?
• Do you feel that any difficulty with your hearing limits or hampers your
personal or social life?
• Does a hearing problem cause you difficulty when in a restaurant with
relatives or friends?
Scoring: No = 0; Sometimes = 2; Yes = 4
Interpretation of total score:
0 – 8 = no handicap
10 – 24 = mild to moderate handicap
26 – 40 = severe handicap
Questionnaire adapted from Ventry 1, Weinstein B. Identification of elderly
people with hearing problems.
ASHA. 1983; 25:37-42

3. The first few steps…
Finding a hearing professional and
undergoing a hearing evaluation.
Help! I’m having trouble hearing! I may need a hearing aid.
What do I do? Who do I go to? How do I ensure that I make a smart decision?
How do I know I’m not being swindled? How do I know if a hearing aid is right for me?
Many factors need to be taken into consideration when choosing hearing aids. A
Hearing test should be the first step in your search for better hearing. Your hearing
health and hearing status should be the principal concern first; think of hearing aids
as a secondary concern. You should ensure that you are both comfortable and
satisfied with your hearing professional. If you do pursue hearing aids, you will be
spending quite a bit of time with this individual, so make sure he or she makes you
feel confident and at ease!
How do I choose a hearing professional?
There are two basic groups of individuals that test hearing: hearing instrument
specialists (also called dispenser) and audiologists.
What is the difference between a dispenser and an audiologist?
Dispenser
A dispenser must be at least 18 years of age, have a high school diploma, and pass
a written and practical exam by the Department of Regulation and Licensing. Most
training occurs in an office with another dispenser. Some dispensers do have advanced
degrees and training. Dispensers are required to earn continuing education credits to
maintain their license. The terms “dispenser” and “hearing instrument specialist” may
be used interchangeably.
Dispensers are typically found in private practice sales settings.
Great! I think I have a good idea of where to start!
Do you have any final tips for me?
The best thing you can do is to educate yourself. Make sure to research the
individual and site that you’ll be going to for your hearing evaluation. Before
choosing hearing aids, make sure to learn all you can about your hearing loss
and reasonable expectations for hearing aids. And most importantly, make sure
you are comfortable with the process. If you feel uncomfortable with any step
along the way, remember your rights as a consumer.
Good luck and happy hearing!

4. Do hearing aids ever have to go back to the manufacturer?
Yes. It is not uncommon for hearing aids to require periodic reconditioning/repair
at the manufacturer over the life of the aids. Hearing aids are very sensitive to wax,
moisture, and heat. Considering that the hearing aids are in your ears many hours a
day (in a moist environment at a temperature of about 98.6 degrees), it is reasonable
to expect a few repairs. If the aids require repair and are out of warranty, there will be
a charge associated with that repair. Check to make sure you are given an additional
repair warranty if you pay for a hearing aid repair.
I’m hearing a lot lately about Bluetooth technology. What is this and
how does it relate to hearing aids?
As time goes on, hearing aid technology gets more and more sophisticated. In the
audiology field, current research and development is focusing not only on hearing
aids themselves but also additional accessories to make hearing aids more functional
in today’s world. Many hearing aids are now Bluetooth and/or wireless compatible.
The term “Bluetooth” refers to wireless technology that can send information via short
wave radio transmission. Hearing aids that are Bluetooth compatible can be paired
with additional devices (such as wireless microphones, personal computers or even
cellphones) that enhance the functionality of the hearing aids.
Example #1: Hearing aid user having difficulty hearing in the car.
This situation has historically been hard, even with well-fitting hearing aids
because of the additional noise offered by the road and the car itself. With the
addition of Bluetooth, we can now couple an external microphone to some
hearing aids. This microphone will wirelessly transmit directly to the hearing aid(s).
So, the microphone would simply be clipped to the speaker’s shirt and that
information goes directly to the listener’s ears. As a result, listening and
understanding become much, much easier.
Example #2: Hearing aid user having difficulty enjoying television
at a level comfortable for others
For several reasons, many hearing impaired individuals have difficulty understanding
television. To compensate for this, they often turn the volume up louder than others
around them are comfortable with. A wireless microphone can be coupled to a
television which would then stream directly to the hearing aids. The volume, then,
can be adjusted through the hearing aids, maintaining a comfortable volume for
others in the room.
There are numerous other ways in which Bluetooth can connect hearing aids to
other forms of technology…it can enhance use of cell phones, computers, MP3
players, and so on. If you are interested in any of these possibilities, make sure
to ask if your future hearing aids have Bluetooth capability.
Audiologist
An audiologist is a professional that has extensive training on the anatomy, function
and disorders of the ear and hearing. Audiologists are also trained
in communication, rehabilitation and communication counseling. In addition
to evaluating hearing and fitting hearing aids, audiologists perform many
advanced brainstem and vestibular (balance) tests. Audiologists are also the only
professionals legally allowed to test individuals with cognitive problems and/or
dementia. Audiology has now transitioned to a doctoral profession.
This means that audiologists must graduate with doctorates to enter the field.
Professionals that have been working with Master’s levels degrees may continue to do
so, but the majority are obtaining their clinical or research doctorates. Audiologists
must obtain continuing education credits to maintain their license.
Audiologists can be found in a medical setting, such as a clinic or hospital,
or in a private practice setting.
I’ve looked around and it seems like every hearing professional has
different credentials. Everyone has lots of letters behind their names,
seems like the more letters the better, right?
Well, more letters can certainly look more impressive, but they don’t necessarily mean
much. Here’s a listing of the possible credentials you’ll find on your hearing
professional’s business card and a description of what those letters mean.
Potential credentials granted to Hearing Instrument Dispensers:
• BC-HIS
This stands for Board Certified Hearing Instrument Specialist.
This is a designation of certification of licensed hearing instrument
dispensers. To become board certified, the dispenser must pass a
national exam and have at least two years experience in the field.
This designation does not indicate any specific college-level
education, but does indicate a certain amount of extra training time.
• Audioprosthologist
This is the highest designation given to hearing instrument dispensers.
This indicates further studies beyond the standard BC-HIS requirements.
Though they look similar, make sure not to confuse the term
“Audioprosthologist” with “Audiologist.” The education levels between
the two are vastly different. Because of the confusion that this term can
create, some states prohibit the use of the Audioprosthologist title.
Potential credentials granted to Audiologists:
• MA or MS
These letters indicate an education level of “Master’s of Arts,” or
“Master’s of Science.” All audiologists practicing are required to have
a minimum of a Master’s degree (2 years post Bachelor’s degree). Since
the field has transitioned to a doctoral profession, audiologists can no
longer graduate with a Master’s degree, but must graduate with an
AuD or PhD.

5. • AuD
This designates a clinical doctorate in audiology, much like the “OD” is
a clinical doctorate in optometry. A doctoral level degree (i.e. AuD or PhD)
is now required for all new practitioners entering the field of audiology.
• PhD
This designates a research-based doctorate. Most PhD audiologists
work in education or research, though some do work in clinical settings.
• CCC-A
This stands for “Certificate of Clinical Competence – Audiology.” The
American Speech-Language-Hearing Association (ASHA) grants the
CCC-A. Many states require that audiologists hold the CCC-A in order
for them to practice. Simply put, the CCC-A is a statement that ASHA
believes the audiologist has the required skills to practice audiology.
• FAAA
This stands for “Fellow in the American Academy of Audiology.” This
designation is given only to audiologists and indicates that the
audiologist has the required skills to be certified and recommended
to the public by the American Academy of Audiology.
• Board Certified in Audiology
Board Certification is granted by the American Board of Audiology
(ABA) Only audiologists that have met the criteria (including prior
education, test scores and hours of professional practice) and continuing
education requirements (three times those from other credentialing
boards) can be board certified. The ABA credential “demonstrates a
commitment to a quest for excellence through lifelong learning”.
FYI
Not all audiologists will list all their credentials. For example, those
individuals who have earned their AuD may simply list their doctoral
credentials, but may hold other certifications as well. If you have any
questions regarding your hearing professional’s credentials, just ask!
On a positive note, at the follow-up visit, you should also discuss:
• Improvements in hearing with the aids
• Improvements in communication with the aids
• Sounds that were once inaudible (birds, for example) that you can now hear
• Comments from family/friends about hearing improvement
From your comments, both positive and negative, your hearing professional will
be able to discern what further adjustments are necessary.
What happens after the trial period is over?
You will still need to periodically visit your hearing professional for routine hearing
evaluations (every 1-3 years depending upon your personal hearing situation), and
routine hearing aid checks/maintenance (several times per year). Your hearing
professional should encourage you to come in with any questions or concerns.
Generally, quick hearing aid checks and/or maintenance done within the hearing
aid office (i.e. not sent to the manufacturer) are provided either free or for a
minimal charge.

6. Once my new hearing aids arrive, how will I know how to use them?
You’ll need to set up an appointment to be fit with the hearing aids. The fitting is the
beginning of your trial period. The hearing aids will be set based upon your hearing
loss. At that appointment, you will learn to insert and remove your hearing aids and
batteries. You’ll also learn about basic hearing aid maintenance.
• Your hearing professional should be willing to take time to sit with you
and any family members or friends you would like. Often, it is beneficial
to have an extra set of ears at the initial visit, as a lot if information will
be provided in a short amount of time.
What happens after the fitting?
Remember, you’ll be spending quite a bit of time initially with your hearing professional.
You should be asked to set up a follow-up appointment about 1-2 weeks after the
initial hearing aid fitting. At this follow-up visit, you should bring up any concerns
you have regarding your now hearing aids.
Hearing aids can be adjusted based upon your hearing experiences and comfort with
sounds. Objective testing, such as “Speechmapping” (also called Real Ear testing)
should be performed to verify that the hearing aids are providing you with the
appropriate amount of sound for your hearing loss.”
What kinds of concerns should I look out for?
Here are some things to look out for and discuss at your follow-up visit:
• Physical discomfort from the aids
• Discomfort with the loudness of the aids
• Feedback (i.e. whistling) from the aids
• Sounds that are still inaudible with the aids
Wow, there’s a lot to look for: How do I choose my hearing professional?
Our best advice is to go to the environment that makes you the most comfortable
and stick with the professional that you feel can provide you with the best
diagnosis and advice about hearing loss.
Ok, what’s involved with a hearing test?
A hearing test typically takes about half an hour. You will undergo pure tone
(beep) testing as well as speech discrimination testing. Depending upon those results,
further testing may be warranted. Also, a referral to an otolaryngologist (ear, nose,
and throat physician) may be recommended.
How much does a hearing test cost?
Cost is based upon several factors, including the tests performed and your insurance
coverage. Many insurance companies will cover hearing tests, though they may
require a physician’s order. The best advice is to call your insurance company and see
if your plan covers hearing tests. There may be some other requirements from your
insurance company as well. For example, there are several insurance companies that
will only cover hearing tests if performed by an audiologist. If paid out-of-pocket,
typically hearing tests average from about $150 – $250.
Why then are hearing tests offered as “free” at certain hearing aid
shops?
Good question! Hearing tests are typically offered as “free” in sites where there are no
audiologists present. Hearing instrument specialists (dispensers) cannot bill insurance
companies and therefore must find other means for hearing test coverage. Typically, in
situations such as these, the cost of the test is bundled into the cost of the hearing
aids.
FYI
Medicare Law and other insurance statutes mandate that audiologists
currently billing insurance MUST bill for the hearing test in all circumstances.
How important is a sound booth?
A hearing test should ALWAYS be performed in an appropriate sound-treated booth.
Tests performed without a booth are subject to effects from ambient room noise. This
can “inflate” your hearing loss and make it look as though
you need a hearing aid when you don’t.

7. The hearing aid trial and beyond…
Learning about hearing aids and your rights as a consumer.
I have made the decision to purchase hearing aids. What’s next?
Great! Next you’ll need to meet with your hearing professional to determine which
style and circuit you would like to pursue. Depending upon style, you may need either
measurements of your ears or impressions of your ears taken to customize your fitting.
This information is then passed along to the hearing aid manufacturer. At this point,
you should be provided with a fee estimate as well as a list of the terms of your
hearing aid trial. Typically, from the date you’ve placed the order, your hearing aids
will be available in one to two weeks.
Summary: Steps for finding a hearing care professional
• Find names of local hearing professionals (word of mouth, phone book, and
web are great sources of information).
• Check the education/certification levels of the individual doing the
testing (i.e. audiologist or hearing instrument specialist).
• Make sure the testing site is appropriate for accurate hearing tests. There
should be a sound booth available for testing.
• Make sure you are comfortable with the person treating you. You are the
most important person in this equation!
• When being presented with hearing aid choices, make sure you are
given a wide range of choices and technology.
• Some hearing professionals are part of a franchise for a specific brand
of hearing aid and will only offer that particular option. Most audiologic
private practices or medical centers are not associated with one
particular manufacturer and will have many options to choose from.
• If you are not comfortable with the recommendations,
get a second opinion.

8. Are there laws regulating the sale of hearing aids?
Yes. There are laws set in place to protect you. Both the Federal Government and
the State of Wisconsin regulate the sale of hearing aids. A summary of these laws is
provided below.
Both the Federal and State governments require that:
• Hearing aid(s) be sold by a licensed audiologist or hearing
instrument specialist.
• You as the consumer must be provided with a trial period of at
least 30 days.
• At the time of the hearing aid fitting (when you get the aids), a purchase
agreement must be provided to you. This must list the purchase
information containing all fees, warranties, etc.
• You must be given the option of seeing a physician regarding the
purchase of the hearing aids. In cases where there is evidence of disease
or unusual findings with the hearing test, consulting with a physician is
in your best interest. If, however, no unusual findings are present, and
you are over the age of 18, you have the option of signing a waiver
verifying that you do not wish to see a physician. YOU SHOULD ALWAYS
BE PRESENTED WITH BOTH OF THESE OPTIONS PRIOR TO SIGNING
A WAIVER.
• You must be given all the warranties provided by the manufacturer.
What about ordering hearing aids through the mail or over the Internet?
Good question. Several years ago, there was an increase in the number of hearing
aids sold off-site, particularly over the Internet. Many problems arose from this and
several leading manufacturers have discontinued internet sales. It seems to be the
trend among hearing aid manufactures to require that their aids be sold in a reputable
manner. For those individuals who are still interested in ordering aids on their own,
consider this:
• Hearing aids should not be offered without a valid hearing test.
How else would you know what aid is right for you?
• Hearing aids cannot be customized without impressions of your ears.
It is unsafe to take impressions of your own ears.
• You will not have the tools available to set the hearing aids yourself. This
means you will still have to take the hearing aids to a qualified individual
to set the aids. Typically, you will pay large sums of money to a hearing
professional for programming fees if you did not purchase the hearing
aids through that professional.
The next few steps…
Learning about hearing aids and your rights as a consumer.
Ok. I’ve had my hearing test and I need hearing aids.
What’s next?
Next you will begin your education into the different types (technology/circuitry) and
different models (size and style) of hearing aids. Simply put, you will need to decide:
• What type of technology to pursue
• What type of style to pursue
I’m already confused. What do you mean by technology?
By technology (i.e. circuitry), we’re talking about the actual circuit inside the hearing
aid. The circuit inside the hearing aid is what helps you hear. You may be surprised to
learn that the hearing aid’s appearance has very little to do with helping you hear. It’s
all in the processing of sound. The circuit determines the type of processing. Nearly
100% of hearing aids sold are now digital, but there are many variants within digital
hearing aids. To simplify, most aids are labeled as “entry level, mid-level, or high-end
(premium)” technology. The higher end you go, the more flexible the aid is at
adjusting to the environment around you. Higher end aids also have more
adjustments available to shape the sound to your hearing loss.

9. What does digital mean?
Digital hearing aids are computerized—sound is converted to a signal that can be
manipulated based upon your hearing loss. The hearing aids are set (by your
audiologist/dispenser) via a computer and can be reset (to a degree) if your hearing
changes. The digital nature of the aids allows greater flexibility in setting the hearing
aid for you. Digital circuits can also identify noise sources and amplify speech over
noise, making it easier to hear in difficult listening situations. These aids are a huge
improvement over hearing aids of the past.
All digitals are not created equal!
Digital hearing aids are computerized—sound is converted to a signal that can
be manipulated based upon your hearing loss. The hearing aids are set (by your
audiologist/dispenser) via a computer and can be reset (to a degree) if your hearing
changes. The digital nature of the aids allows greater flexibility in setting the hearing
aid for you. Digital circuits can also identify noise sources and amplify speech over
noise, making it easier to hear in difficult listening situations. These aids are a huge
improvement over hearing aids of the past.
Here’s an example of how someone may be misled when purchasing
a digital aid…
John Doe shows up at a hearing aid office. He has a hearing evaluation and
requests a quote on the most economical hearing aid. He is given a quote of
$700 on an entry-level digital aid. “Great,” he thinks, “I can get a digital aid
and not spend too much money!” John Doe then goes to another hearing aid
office, has an other hearing test and requests a quote on a digital hearing aid.
He is quoted $1700. He sees this as a simple decision, saving $1000! But the
truth is, he may have been quoted for a much more advanced aid which may
actually serve his needs better.
The moral here is…always compare apples to apples.
If you want to compare costs, you MUST compare:
• Same manufacturer
• Same style
• Same circuit
• If you’re unsure about your hearing aid circuit or style,
ask your hearing professional to write it down for you.
You said, “in most cases” you would recommend two aids.
When would you recommend one?
There are several situations that would warrant a recommendation of one aid.
Some examples of these situations include:
• One ear with normal hearing
• One ear with hearing that is too poor to effectively utilize amplification
• One ear with a physical deformity that precludes hearing aid use
• Monetary constraints
How about cost? What should the cost of a hearing aid(s) include?
In most cases, the cost of the hearing aid includes the hearing aid, a warranty period
from the manufacturer (usually 1-2 years), at least a 30 day trial period, office visits
through at least the trial period, and your initial pack of batteries.

10. Isn’t one hearing aid enough?
One is not necessarily enough. In fact, in most cases where hearing loss is present in
both ears, your hearing professional will recommend two hearing aids.
Why is having a hearing aid in each ear important?
Research has shown that wearing two hearing aids can help with localization (knowing
where sounds are coming from), sound detection (hearing soft sounds), and improve
overall speech understanding (understanding what you are hearing). Additionally,
research has shown us that ears follow the principle of “use it or lose it.” That is, the
more you deprive your system (i.e. your ear and its connections to the brain) of sound,
the harder it will be in the future to make use of that system.
What if I don’t like using two aids?
Trying two allows you to try each ear separately, and then together so you can make
an educated decision on how you do best. You’re right, not everyone can tolerate
wearing two hearing aids. In this case, you may return the second aid at the end or
during the trial period.
Behind-the-Ear Open Behind-the-Ear In-the-Ear
Half-Shell In-the-Canal Completely
In-the-Canal
How do I choose what size or style hearing aid to get?
Hearing aids come in a variety of sizes and styles’, ranging from one that sits behind
your ear to a tiny, completely-in-the-canal hearing aid. The size you ultimately try will
depend upon:
• The type and degree of your hearing loss
• The size and shape of your outer ear
• Vision or dexterity issues
• Your personal preference
Here’s a listing of the different size designations:
• BTE – behind-the-ear
• Open BTE – a behind-the-ear hearing aid fit with a “slim tube”
(smaller, less noticeable that traditional BTEs)
• Receiver-in-the-ear – a BTE hearing aid with speaker placement
in the ear (similar in appearance to Open BTEs)
• ITE – in-the-ear (the largest of the custom hearing aids)
• ½ SHELL- half-shell (about half the size of the ITE)
• ITC – in-the-canal (a bit smaller than the ½ Shell)
• CIC – completely-in-the-canal (the smallest of the custom aids)