Health care from a big box store?

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By Dr. Nimet Adam

I recently had a patient come in for a diagnostic hearing evaluation.   She informed me that her Physician had suggested that she consider going to local big box store for hearing aids as they were “a lot less expensive and basically the same” as products being offered elsewhere. Fortunately, she felt it would be more appropriate to see a Doctor of Audiology for a diagnostic evaluation and consultation. Physicians referring patients to big box stores to save money is alarming so I thought I would take a little of your time to provide some information about the differences between BIG BOX STORES, ON-LINE Hearing aids and future OVER-THE-COUNTER (OTC) products.

Hearing tests provided by big box stores and other BIG BOX sites are NOT diagnostic evaluations.  They are not always conducted in an ANSI calibrated environment with calibrated equipment and they are not always provided by a licensed Audiologist.  It is illegal for HEARING AID SALES PERSONS to represent their testing as anything other than a ‘screening for the purpose of fitting a hearing aid’.  They take no medical history nor provide necessary diagnostic tests like otoadmittance, SIN, ANL, masked threshold, etc.  Recently, I evaluated an unhappy patient that had purchased his hearing devices from a local big box store. Upon inspection of his ear canal, he was completely impacted with wax. Not only was he tested with wax in his ears, he was also fitted. The sad part is that once we removed the wax, he did not need hearing aids.

Many ONLINE providers don’t even require a hearing test, leaving the hearing aid gain decisions up to the patients’ self-assessment of their hearing loss which is NOT typically accurate or predicative of their actual needs.  Over-the-counter hearing aids will be available in 3 years and at this time regulations do not require medical clearance, diagnostic hearing evaluation or even a hearing screening. They are designed for mild hearing loss and will not be appropriate for most individuals.

Hearing aids being purchased at BIG BOX companies are typically low-end technology and, in most cases, outdated technology.  They are also “locked” devices so you cannot seek help elsewhere. Hearing Aid pricing is often the same in private Audiology practices for comparable products so there really is no cost advantage.  These low-end hearing aids are appropriate for mild losses and for people who are in quiet environments most of the time. Consumer studies have found that often low-end technology hearing aids are only being used in select environments like watching TV or at the doctor’s office.  Patient satisfaction is usually good because the environment is not complicated and only a little volume is needed.  As the patient begins to wear the aid more often and in more demanding environments the technology falls short.   Having a physician send patients to a big box for hearing loss is like sending a patient to a vitamin store for a persistent cough; sometimes it works out but most of the time health issues should not be left in the hands of a retail sales clerk.

Technology needs to be explained to the consumer for them to make an informed decision about the cost/benefit options.  The person fitting the hearing aids must understand psychophysics, aural processing and acoustics as opposed to letting a computer generate the hearing aid fitting (method used by technicians and on-line fitters). This is important because the brain must acclimate to appropriate volume over time.  That is why it is also necessary to utilize aural rehabilitation counseling and auditory training instruction, that Audiologists are uniquely qualified to provide.

A typical patient will see their Audiologist 5-6 times for program adjustments the first year and 4 times a year in following years.  BIG BOX, ON-LINE and future OTC delivery models have minimal to no post-fitting support or follow-up.  A 2016 MarkeTrak independent study found that BIG BOX purchasers were replacing their hearing aids at 1 ½ to 2 years.  Hearing aids fit by Audiologists were being replaced at 4-6 years.  This is because of more appropriate initial product selection, fitting validation measures, aural rehabilitation, patient education, instructions and continued monitoring with adjustments.  These services are often bundled into the hearing aid price so patients will follow-up with the needed adjustment/appointments/cleanings.

In addition, on-going maintenance of the device is critical to ensure that the devices are performing at manufacturer specifications. Hearing aids tend to fail due to moisture, wax and debris clogging the receiver and microphones.

As a final note, research clearly shows that hearing loss over time can affect cognitive function and is a risk factor for dementia. Would you visit a Cardiologist or Neurologist at a warehouse or big box store? Probably not. You would search for the best. Why is your hearing healthcare any different?

I hope this has been useful information for you to share with your family, friends and colleagues. We care about our patient’s well-being and health and strongly believe that on-going audiological care and treatment lead to the best hearing aid outcomes and patient satisfaction.


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