Subject: Re: Inexpensive hearing aids From: "Richard H." <auditory(at)AUGMENTICS.COM> Date: Thu, 25 Mar 2004 19:29:25 -0000This is a multi-part message in MIME format. ------=_NextPart_000_0152_01C4129F.7B9244E0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Hi, A little story ... About a year ago I planned to make my fortune by starting a part-time = business selling OTC hearing aids. I contacted zillions of manufacturers and bought MANY aids for = evaluation. However just ONE manufacturer wrote me a letter explaining the errors of = my ways. My wife & I discussed this and realised he was right. I then gave up my very well paid senior role at a mobile comms company = and am now training as a dispensing audiologist. Having worked with patients for some weeks I can now confirm that you = simply should NOT sell aids OTC without a medical evaluation and proper = fitting. The health & social issues are simply too complex. You don't = take say 2 hours total for testing and fitting for no reason. Sure, you can question the pricing of the product & service ... but the = technology and method of delivery is the right one for most people. Don't forget that the average client is aged 74 .... with possible = cognitive issues, possible dexterity issues, possible unusual ear canal = shape due to age/surgery etc. Perhaps WE here can buy an OTC unit, twiddle with its controls and stuff = it in our ears with success - but these elderly and sometimes very hard = or hearing people simply couldn't do that. If I were to revisit the "instant millionaire" path, I would aim for a = slick, high speed, low cost, discounted service ... but it would still = be based on the current traditional practice structure. regards, Richard ----- Original Message -----=20 From: Barbara Reynolds=20 To: AUDITORY(at)lists.mcgill.ca=20 Sent: Thursday, March 25, 2004 6:48 PM Subject: Inexpensive hearing aids I just read the piece on Mead Killion's idea of inexpensive hearing = aids. Hearing aids are not just something to slap in your ears and off = you go. There are a myriad of considerations to take into account when = not only choosing the setting during the first fitting, but the follow = up care. This is largely due to the plasticity of the auditory system = and the absolute need for the Audiology, Dispensing, Manufacturing and = other related medical fields to go beyond hearing aids as a simple = correction. =20 Auditory neuroscience has been my specialty for the last 6 1/2 years. = It's taken me a long time to amass the amount of journal articles (3400) = among multidisciplinary fields of medical science to be able to fit = successfully those patients that range from mild to severe hearing = losses. Considerations such as their current and past medical or = developmental history is of utmost importance if I am to be successful = at fitting the hearing aids during the first 6 months that match the = initial auditory system capability and to keep pace with the = neurophysiological changes that occur through stimulation and = rehabilitation For example, if I have a patient with panic and anxiety disorders and = a patient who is a professional musician, even though they may have the = exact same audiogram, their settings on the hearing aids will be = completely different including the type of hearing aid. The P and A = will be drastically below the expected settings and the PM will be = above. This is due to their specific neurophsyiology makeup that give = substantial control over his system in the musician and the lack of = control in the P&A. The neuroanatomical differences in musicians vs. = non-musicians have been established numerous times. With a 25% greater = response to piano harmonics than pure tones, I need to try to match the = hearing aids to musical harmonics instead of the pure tones we use = during testing. Additionally, the counselling that would go into = encouraging and maintaining use of the hearing aid is also going to = markedly different. An Alzheimer's patient and a Parkinson's patient's rehabilitation time = is going to be significantly longer than a normal healthy control due to = the depletion of Acetylcholine through the degenerative process of AD = and the anticholinergic medication of the PD patient. Acetylcholine is = largely responsible for auditory system plasticity during = rehabilitation. A decreased availability will extend the rehabilitation = time and potentially reduce the final recovery of function. I could go on and on about the different parameters that make hearing = aid fittings difficult for so called "easy" mild hearing losses. But I = won't. Suffice it to say, if more University programs would concentrate = on the neuroscience end of central auditory processing and the = degenerative processes as a result of a hearing loss (which can begin at = 20dBHL with the loss of GABA receptors creating more spontaneous = activity, less temporal resolution, less frequency resolution, less = spatial acoustics, etc.) Mr. Killion, with all due respect to his = position in Audiology would not be so quick to relegate hearing aids to = the "over the counter reading glasses" genre. Barbara Reynolds, M.S. Clinical Audiologist -------------------------------------------------------------------------= ----- FREE pop-up blocking with the new MSN Toolbar - get it now!=20 --- Outgoing mail is certified Virus Free. Checked by AVG anti-virus system (http://www.grisoft.com). Version: 6.0.631 / Virus Database: 404 - Release Date: 17/03/04 ------=_NextPart_000_0152_01C4129F.7B9244E0 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"> <HTML><HEAD> <META http-equiv=3DContent-Type content=3D"text/html; = charset=3Diso-8859-1"> <META content=3D"MSHTML 6.00.2800.1400" name=3DGENERATOR> <STYLE></STYLE> </HEAD> <BODY bgColor=3D#ffffff> <DIV><FONT face=3DArial size=3D2>Hi,</FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2>A little story ...</FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2>About a year ago I planned to make my = fortune by=20 starting a part-time business selling OTC hearing aids.</FONT></DIV> <DIV><FONT face=3DArial size=3D2>I contacted zillions of manufacturers = and bought=20 MANY aids for evaluation.</FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2>However just ONE manufacturer wrote me = a letter=20 explaining the errors of my ways. My wife & I discussed this and = realised he=20 was right.</FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2>I then gave up my very well paid senior = role at a=20 mobile comms company and am now training as a dispensing=20 audiologist.</FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2>Having worked with patients for some = weeks I can=20 now confirm that you simply should NOT sell aids OTC without a medical=20 evaluation and proper fitting. The health & social issues are simply = too=20 complex. You don't take say 2 hours total for testing and fitting for no = reason.</FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2>Sure, you can question the pricing of = the product=20 & service ... but the technology and method of delivery is the right = one for=20 most people.</FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2>Don't forget that the average client is = aged 74=20 .... with possible cognitive issues, possible dexterity issues, possible = unusual=20 ear canal shape due to age/surgery etc.</FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2>Perhaps WE here can buy an OTC unit, = twiddle with=20 its controls and stuff it in our ears with success - but these elderly = and=20 sometimes very hard or hearing people simply couldn't do = that.</FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2>If I were to revisit the "instant = millionaire"=20 path, I would aim for a slick, high speed, low cost, discounted service = ... but=20 it would still be based on the current traditional practice=20 structure.</FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2>regards,</FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2>Richard</FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <BLOCKQUOTE=20 style=3D"PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; = BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px"> <DIV style=3D"FONT: 10pt arial">----- Original Message ----- </DIV> <DIV=20 style=3D"BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: = black"><B>From:</B>=20 <A title=3Dbr_auditory(at)HOTMAIL.COM = href=3D"mailto:br_auditory(at)HOTMAIL.COM">Barbara=20 Reynolds</A> </DIV> <DIV style=3D"FONT: 10pt arial"><B>To:</B> <A = title=3DAUDITORY(at)lists.mcgill.ca=20 href=3D"mailto:AUDITORY(at)lists.mcgill.ca">AUDITORY(at)lists.mcgill.ca</A> = </DIV> <DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Thursday, March 25, 2004 = 6:48=20 PM</DIV> <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> Inexpensive hearing = aids</DIV> <DIV><BR></DIV> <DIV> <DIV class=3DRTE>I just read the piece on Mead Killion's idea of = inexpensive=20 hearing aids. Hearing aids are not just something to slap in = your ears=20 and off you go. There are a myriad of considerations to take = into=20 account when not only choosing the setting during the first fitting, = but the=20 follow up care. This is largely due to the plasticity of the = auditory=20 system and the absolute need for the Audiology, Dispensing, = Manufacturing and=20 other related medical fields to go beyond hearing aids as a simple=20 correction. </DIV> <DIV class=3DRTE> </DIV> <DIV class=3DRTE>Auditory neuroscience has been my specialty for the = last 6 1/2=20 years. It's taken me a long time to amass the amount of journal = articles=20 (3400) among multidisciplinary fields of medical science to be able to = fit=20 successfully those patients that range from mild to severe hearing=20 losses. Considerations such as their current and past medical or = developmental history is of utmost importance if I am to be successful = at=20 fitting the hearing aids during the first 6 months that match the = initial=20 auditory system capability and to keep pace with the = neurophysiological=20 changes that occur through stimulation and rehabilitation</DIV> <DIV class=3DRTE> </DIV> <DIV class=3DRTE>For example, if I have a patient with panic and = anxiety=20 disorders and a patient who is a professional musician, even though = they may=20 have the exact same audiogram, their settings on the hearing aids will = be=20 completely different including the type of hearing aid. The P = and A will=20 be drastically below the expected settings and the PM will be = above. =20 This is due to their specific neurophsyiology makeup that give=20 substantial control over his system in the musician and the lack of = control in=20 the P&A. The neuroanatomical differences in musicians vs.=20 non-musicians have been established numerous times. With a=20 25% greater response to piano harmonics than pure tones, I need = to try to=20 match the hearing aids to musical harmonics instead of the pure tones=20 we use during testing. Additionally, the counselling that = would go=20 into encouraging and maintaining use of the hearing aid is also going = to=20 markedly different.</DIV> <DIV class=3DRTE> </DIV> <DIV class=3DRTE>An Alzheimer's patient and a Parkinson's patient's=20 rehabilitation time is going to be significantly longer than a normal = healthy=20 control due to the depletion of Acetylcholine through the degenerative = process=20 of AD and the anticholinergic medication of the PD patient. =20 Acetylcholine is largely responsible for auditory system plasticity = during=20 rehabilitation. A decreased availability will extend the = rehabilitation=20 time and potentially reduce the final recovery of function.</DIV> <DIV class=3DRTE> </DIV> <DIV class=3DRTE>I could go on and on about the different parameters = that make=20 hearing aid fittings difficult for so called "easy" mild hearing = losses. =20 But I won't. Suffice it to say, if more University programs = would=20 concentrate on the neuroscience end of central auditory processing and = the=20 degenerative processes as a result of a hearing loss (which can begin = at=20 20dBHL with the loss of GABA receptors creating more spontaneous = activity,=20 less temporal resolution, less frequency resolution, less spatial = acoustics,=20 etc.) Mr. Killion, with all due respect to his position in Audiology = would not=20 be so quick to relegate hearing aids to the "over the counter reading = glasses"=20 genre.</DIV> <DIV class=3DRTE> </DIV> <DIV class=3DRTE>Barbara Reynolds, M.S.</DIV> <DIV class=3DRTE>Clinical Audiologist</DIV></DIV> <DIV><BR clear=3Dall></DIV> <DIV> <HR> </DIV> <DIV><A href=3D"http://g.msn.com/8HMBENUS/2728??PS=3D">FREE pop-up = blocking with=20 the new MSN Toolbar =96 get it now!</A> <FONT face=3DArial = size=3D2></FONT></DIV> <DIV> </DIV> <DIV><FONT face=3DArial size=3D2><BR>---<BR>Outgoing mail is certified = Virus=20 Free.<BR>Checked by AVG anti-virus system (<A=20 = href=3D"http://www.grisoft.com">http://www.grisoft.com</A>).<BR>Version: = 6.0.631=20 / Virus Database: 404 - Release Date:=20 17/03/04</FONT></DIV></BLOCKQUOTE></BODY></HTML> ------=_NextPart_000_0152_01C4129F.7B9244E0--