Week 5, Fall 2007

During clinic this week, I encountered a recruit who had previously been very dissatisfied with his hearing aid. Prior to his visit, I did not know what type or configuration of hearing loss he had, and I knew very little background information about him.

The case history proved to be greatly important and revealed a significant amount of information about the client. The client noted significant unprotected noise exposure during his service in the military, which he described as the source of his hearing loss and his bilateral tinnitus. He reported that he had experienced difficulty hearing and has had persistent low-frequency tinnitus since that time. He also mentioned that he had chemotherapy treatments two years ago; however, he denied any additional hearing loss, tinnitus, or dizziness subsequent to his treatments. He was unsure of the date of his last hearing evaluation, but he believed that it had been approximately 5 years. At that time, he was fitted with one hearing aid in his left ear, which he described as his worst ear.

Otoscopy and tympanometry were normal bilaterally. Acoustic reflex threshold testing indicated that the client may have possible recruitment because he complained that the input levels were too loud, and at some frequencies, his ARTs were present at low input levels.

Pure tone air conduction and bone conduction testing revealed normal hearing to mild hearing loss in the low-frequencies, and a sharply sloping drop, beginning at 2000Hz, to a severe SNHL Hz. Thresholds and SRTs were substantially worse in the left ear. Significantly, word recognition testing was poor in the left ear and good in the right ear.

Previously, the client had been fit with a BTE in the left ear, and he reported little to no benefit. In fact, he had not worn his hearing aid for over a year because he didn't feel that it was helping him.

My supervisor and I decided to recommend a mini-BTE for his RIGHT ear. During WR testing, he reported that he liked the way the words sounded in his right ear and stated that they sounded "muffled" in his left ear. In my opinion, without viewing his old audiograms, I still feel that it is very likely that this patient was fit inappropriately, which led to his great dissatisfaction. The client was very excited to try something that may give him more benefit. We also talked with him about possibly trying bilaterally amplification on a trial basis, if he was pleased with the benefits from aiding his right ear. Hopefully, we can get him happier with amplification.

The article linked below, Rehabilitation Approaches to Promote Successful Unilateral and Bilateral Fittings and Avoid Inappropriate Prescription by Hickman, (2006), describes factors associated with client dissatisfaction and non-use of hearing aids. It also provides tips about how to promote successful fittings. The article cites a statistic from Dillion, et al. (1999) that indicates that only 10-20% of first-time adult users actually continue wearing their hearing aids for more than 3 months post-fit. That statistic was alarming to me.

The author of the article also completed an independent study that involved 6 males and 15 females with a mean age of 75 years. All 21 participants were contacted by telephone and asked about the amount of time they use their aid(s), their feelings about having one or two aids, their decision-making process for purchasing amplification, and any problems that they have faced. From these questions, participants were classified as successful or unsucessful users. Four unsuccessful users were found, and they reported several reasons for not liking their hearing aids. Overall, the author found that clients with better initial attitudes were more successful. The author also found that individuals reported greater satisfaction when initially fit with one hearing aid and then fit bilaterally IF the client was successful with one hearing aid.

http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=2009306852&site=ehost-live