Dispensing audiologists: about 50% would probably offer PSAPs and OTC hearing aids

As an audiologist who used to dispense hearing instruments, I often wonder how I would logistically react to the disruption currently taking place in the hearing industry.  If I were still in clinical practice, would I offer PSAPs and/or OTC hearing instruments as an option to some of my patients? Out of my own curiosity, a short survey was created to gather responses from audiologists currently dispensing hearing instruments to adults.  There were a total of nine questions; eight multiple choice with the last question offering participants the option to provide feedback.

The survey was posted on Facebook (FB).  Specifically, it appeared on my professional FB account (private) where my friends are mainly audiologists or hearing industry colleagues. It was also posted on four closed group FB Pages with advertised memberships comprised either solely or primarily of audiologists.  In less than 24 hours, 331 responses were collected.

Before anyone asks the University of Cincinnati to take my PhD back, I am well aware of the survey’s informal nature and familiar with all the inherent threats to its internal and external validity. For whatever its worth, here are the results of this informal survey.


A total of 331 individuals responded to the survey with all 331 complete. The terminal degree of most respondents (85.28%) was the AuD with the majority employed in one of the following four primary work settings:

  1. Private Practice/owner or partner (29.14%),
  2. ENT Practice (21.78%),
  3. Hospital/Medical Center (15.03%),
  4. Private Practice/employee (14.11%).

As indicated in the bar graph below, about half (44.47%) reported 1 to 10 years dispensing experience; the other half (55.21%) reported 11 to 25+ years experience. The majority were involved in offering traditional ALDs to their patient base (amplified telephone, TV listening device, PockeTalker, etc.) either directly (70.86%) or via referral to an ALD source (26.69%).


As illustrated in the pie chart below, only a small percentage of respondents (7.36%) currently offer PSAPs in their primary work setting.  While the majority (87.73%) did not offer PSAPs, of those that answered “NO”, about half indicated that their primary work setting is considering offering this kind of technology.

Survey participants were also asked the following question:

“If it were up to you and you only, assuming acceptable quality and appropriate gain for mild to moderate hearing loss, would your current primary work setting offer PSAPs to patients meeting necessary hearing loss criteria who may not be ready for hearing aids?”

The pie chart below shows survey results to that particular question.  As indicated by the two green areas, 56.5% answered YES.  Of those that responded YES, about a third indicated “definitely” whereas the remaining two-thirds indicated probably. Approximately one-quarter of the participants (23.87%) answered “NO, probably not” while 6.34% answered “NO, absolutely not”.  The remaining 13.29% answered “I don’t know”.

When participants were asked the very same question about OTC hearing aids, the results were essentially the same (see pie chart below).

Assuming the Senate passes the pending OTC Hearing Aid bill this year, about 50% of the participants answered that they DO anticipate changes in their primary work setting’s business practices as a direct result of the legislation. A little more than one-third indicated that they DO NOT anticipate much change with the remaining 10-11% not sure. It will be interesting to see how this all plays out in the next few years. Thank you to those who participated in the informal survey and I look forward to continued discussion.

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Dear Esteemed Consumer with Hearing Loss – A Letter From an Audiologist

On November 7, 2016 U.S. Senators Elizabeth Warren (D-Mass) and Chuck Grassley (R-Iowa) introduced the Over-the-Counter Hearing Aid Act of 2016, legislation that would make certain types of hearing aids that compensate for mild to moderate hearing loss available over-the-counter (OTC) , eliminate the current requirement for medical evaluation or the need for patients to sign a waiver, and allow personal sound amplification products (PSAPs) to be sold as a treatment for hearing loss. On-going discussions have been taking place between my audiology colleagues at meetings, conferences, and numerous channels online including the American Academy of Audiology’s listserv AudiologyCommunity and Facebook groups Audiology Happy Hour and SOUNDing Board. Regardless of how you feel about the legislation, our patients’ well-being (along with the potential pool of patients we currently do not serve) is at stake. Yesterday, I came across a post on Facebook by a colleague who expressed what she would like to say to every hearing impaired consumer if she had the chance. With her permission, the following is the letter she would write to adults with hearing loss:

Dear Esteemed Consumer with Hearing Loss,

I am an audiologist and have been involved in this industry for over 25 years.  I am very supportive of your initiatives to change the hearing aid delivery model and industry.  I support the Hearing Aid Tax Credit and the Over the Counter Hearing Aid Acts.

I believe that you, the hearing aid consumer, have the following rights:

  • You have the right to control your hearing healthcare and amplification journey.
  • You have the right to have access to a wide range of amplification options, including over-the-counter options, provider delivered amplification, personal sound amplification products, assistive listening devices, FM systems, and implantable devices. These devices should have technologic and manufacturing specifications to reduce the risks of over-amplification, as well as ensure the quality and integrity of the product.
  • There should be clear labels on all products that explain the intended use of each class of product and provide warnings of the risks of improper use.
  • If you seek an evaluation from an audiologist, you should receive a copy of your diagnostic audiologic evaluation and a copy of your plan of care.
  • If you purchase hearing aids from a provider, those hearing aids should not be proprietarily locked. In other words, those devices are yours and you should be able to go to any provider for those aids to be adjusted or modified.  At the very least, you should be informed that your devices are proprietarily locked prior to purchase.
  • Prices should be transparent and they should reflect the costs of the device as well as the costs of the evaluation, treatment and follow-up services. Long-term service should be an optional purchase.
  • You have the right to see any provider and pay for the services they have rendered, yet not purchase a product from them. You should never be pressured to purchase.
  • Every patient does not require premium technology. Their communication needs may not warrant them. Providers have a responsibility to assess you and your listening and communicative situations and to find you the aid that best meets your listening needs at the most affordable price.
  • Provider driven care should be readily available and accessible. Providers should offer evening and weekend hours as well as telehealth services, when possible.
  • Providers should consistently provide evidence based care and treatment. You, as the consumer, have the right to demand that level of care.
  • Providers should utilize all available treatment options and delivery modalities, including telecoils, assistive listening devices, FM systems, over-the-counter products, and aural rehabilitation.

I, personally, support these patient rights and will advocate with you for commonsense industry regulations that minimize risk, ensure quality and safety, and allow for increased access and affordability.

But, with rights also come responsibilities. Providers need hearing impaired consumers to acknowledge and accept their roles.  Consumer responsibilities include:

  • Hearing aids, regardless of their cost, do not cure hearing loss. They maximize your communication and listening abilities. Your expectations of amplification should be realistic for the type and degree of hearing loss you exhibit. You have as much influence on the outcome and performance of amplification as does the provider and the devices themselves.
  • There are significant differences in the providers in this industry. Consumers should educate themselves on the differences between hearing aid dispensers, audiologists and physicians, their different roles in the delivery process, and their different motivations.
  • The evidence suggests that patients have better performance and outcomes if they receive an evidence based audiologic evaluation. In other words, you would, if possible, be best served to be evaluated by an audiologist prior to any purchase. Many payers pay for this initial evaluation or an evaluation to determine the cause of hearing loss.
  • If you experience tinnitus, dizziness, drainage from your ear, earwax buildup, a sudden or rapidly changing hearing loss, a hearing loss where one ear is poorer than the other, an ear deformity, or ear pain, please seek an audiologic evaluation and medical intervention prior to any over-the-counter, mail order or internet purchase. Otherwise, you could be wasting your money or missing a treatable or serious medical condition.
  • Over the counter hearing aids are NOT appropriate for every hearing loss. They are appropriate for mild hearing losses to moderate flat hearing losses.  You may experience insufficient gain/volume, difficulties in noise, and feedback if your hearing loss is more significant. This will lead to poor performance and satisfaction.  No one wants to see you waste your money on an inappropriate option.
  • Over the counter hearing aids are NOT appropriate for children. Children have unique audiologic and communicative needs that require professional intervention and engagement.
  • There are pros and cons of purchasing hearing aids over the counter. If you purchase hearing aids over the counter, please understand that audiologists cannot adjust or modify all of these products.  Also, it is important that you understand that providers will charge you for the care, treatment, and guidance we provide.  We cannot provide care at no charge.
  • There are costs, which you will be financially responsible for, when you seek the evaluation and guidance of a provider. Many consumers currently demand free hearing tests and hearing aid evaluations and consultation. “Free” though was never really free.  This has only worked so far because of bundled pricing and provider driven care.  The patient who purchases the products pays for the evaluations of themselves and every other patient who opted to not purchase products. When hearing aids are unbundled or itemized, the patient will now need to pay for the hearing test and pay for the hearing aid evaluation/consultation, even if they opt not to proceed with a purchase. Providers cannot be expected to provide their expertise at no charge.
  • The evidence also suggests that patients have better performance and outcomes when they receive evidence based care and treatment. This includes inventories, verification, speech in noise testing, and aural rehabilitation. Many providers, as a result, have a non-negotiable, no exceptions standard of care.  It is our right as providers to practice in a manner which we know benefits the patient.
  • Insurance cannot and does not pay for everything and you cannot expect that it will. The allowable rates within provider contracts with the third-party payers often indicate the level of technology that we can provide and not take a loss from fitting the device.  Insurance often does not cover our costs of premium technology and many payers do not allow us to allow you to pay the difference between basic and premium technology.  Payers often do not cover long-term follow-up or service. They do not cover batteries, earmold, or wax filters. They do not typically cover rehabilitation. Remember, insurance coverage is an agreement between you and your insurer.  The provider is just executing that agreement, to the best of their ability, within the confines of their own contracts.  Sometimes, you, the patient, are just financially responsible.
  • If you want to minimize your out-of-pocket provider costs, you should take on as much of the daily care of the device as is possible. You should clean your hearing aids every day.  You should keep them dry and free of hair products, perfumes, and sprays.  You should change your own batteries.  You should replace your own wax guards and clean your own earmolds.  You should follow the instructions outlined by your provider.

The purpose of this is to improve the dialogue between the audiologsts and consumers. Speaking for my audiology colleagues, we want to help each of you maximize their hearing, listening and communicative abilities.  We want to be partners in your success. We want to be available to evaluate, educate, manage and treat. But we both have to realize and appreciate our roles in this journey and be understanding and respectful of each other. I want our relationship to be a win-win for both of us. I feel as though if you are successful, I will also be successful.


Kim Cavitt, AuD
Audiology Resources, Inc.
Chicago, IL

NOTE: The Federal Trade Commission (FTC) is hosting a workshop in Washington D.C. on April 17, 2017 to examine competition, innovation, and consumer protection issues raised by hearing health technology, particularly hearing aids and devices with similar functions. The FTC is inviting comments from the public (COMMENT FORM).

Dr. Cavitt is an audiologist and owner of Audiology Resources, Inc, an Audiology consulting firm that provides comprehensive operational and reimbursement consulting services to hearing healthcare providers. She served as President of the  Academy of Doctors of Audiology (ADA) in 2015, a representative to the Audiology Quality Consortium (AQC) and as a member of the State of Illinois Speech Pathology and Audiology Licensure Board. She also serves on committees through ADA and ASHA and is an Adjunct Lecturer at Northwestern University.

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Even Mild Hearing Loss Can Kill You

Good Morning America ran a story this morning warning parents that more than 80% of children between the ages of 2 and 13 did not wake up to an active smoke detector.  As I watched, I nodded my head because that information has been available for a long time. Today’s report remains consistent with findings previously reported by Bruck (1998) who found that 77% of children with normal hearing slept through a smoke detector alarm that was active for 3 minutes.  When you take into consideration that most experts say you have no more than 2-3 minutes to escape a residential fire once the smoke detector has been triggered, when you do the math, things don’t add up favorably. Of course, the fall back plan in the mind of most is that the adult will wake up.. While adults with normal hearing successfully wake up to an active smoke detector within the first 32 seconds of signal activation, things significantly change in the presence of even a mild hearing loss.

In a comprehensive study by Dorothy Bruck and Ian Thomas, approximately 50% of adults with mild to moderately-severe sensorineural hearing loss did not wake up to a standard residential smoke detector even when the intensity level of the signal met Federal Fire Codes. More specifically, the mean pure tone average of air conduction thresholds at 500 Hz, 1 KHz  and 2 KHz for the adults participating in the study was 40.82 dB and 42.15 dB in the left and right ears respectively. If you are still reading this, you appreciate how vulnerable adults are to potentially sleeping through an activate smoke detector in the presence of even a mild hearing loss.  What is an audiologist to do?  Here are some informative links for you and your patients:

From the Altering Systems resource section of the Oaktree Products Website

  1. Residential Fire Facts
  2. Residential Smoke Detector Signal Requirements
  3. Research Summary of Smoke Detectors & Hearing Loss
  4. Smoke Detector Facts for Patients

Informational Articles:

  1. Alarming Facts Audiologists Must Know (Audiology Today)
  2. Alarming Facts About Smoke Detectors (AudiologyOnline article with eligible CEUs)
  3. Hard of Hearing More Likely to Awaken from Sounding Alarms

Research Articles or Abstracts:

  1. How Does the Pitch and Pattern of a Signal Affect Auditory Arousal Thresholds?
  2. Smoke Alarms for Sleeping Adults who are Hard-of-Hearing: Comparison of Auditory, Visual, and Tactile Signals
  3. Towards a Better Smoke Alarm Signal – an Evidence Based Approach
  4. Waking Effectiveness of Alarms for Adults Who Are Hard of Hearing
  5. Waking Effectiveness of Visual Alerting Signals (spoiler alert:  they are NOT effective)

Solutions for Individuals with Hearing Loss:

  1. 50% Chance of Sleeping Through Working Smoke Detector
  2. Alarming Facts about Hearing Smoke Detectors
  3. Bedside Smoke Detector Options
  4. Product Designed to Alert Patients of Emergency Signals


  1. NBC Today Show: Children and Smoke Alarms
  2. GMA: Warning for Parents on Children and Smoke Detectors
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New CS-QConnect Makes Landline Phones Bluetooth Enabled!

Know any patients who wish their home phones were Bluetooth enabled so they could wirelessly chit-chat with friends and family using their landline phone? The ClearSounds QConnect (CS-QConnect) is a great solution to consider for optimizing communication. This new Bluetooth audio accessory works both as a transmitter and a receiver, providing two-way communication between corded/cordless phones and compatible Bluetooth receiving devices. Simply plug the CS-QConnect into the headset jack of any phone and then pair it to a Bluetooth neckloop, hearing instrument streamer, or Bluetooth headset. The nifty, rechargeable device offers up to 6 hours of use time and maintains functionality when recharging.  For more information contact Oaktree Products toll-free at 800.347.1960 and ask for customer service, or place your order online at OaktreeProducts.com.

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Oaktree Products’ 2017 Silver Anniversary Catalog

The 2017 Oaktree Products catalog is now available and hitting your clinic’s doorstep during the month of January.  The artwork adorning this year’s cover was created by Nicole Borg, a company employee since 2013 with an incredible artistic talent. The silver oak tree symbolizes the company’s 25 years of business within the hearing industry. Inscriptions appearing above most of the silver oak tree’s limbs or branches represent some of the different product lines offered to practicing audiologists and range from otoscopes and clinical tools to cerumen management and infection control.  If you have not received your 2017 Oaktree Products catalog, request a catalog online via the company’s website or contact customer service toll-free at 800.347.1960 to have a copy immediately sent out to you.

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AudBling’s Celebrating Five Year Anniversary – guest post by Noël Crosby

cochlea-necklaceAs I was window shopping one day, a jewelry display caught my eye.  I went a little closer and was delighted at what I saw, in particular the sterling silver and shell jewelry. I had never see such a beautiful combination that symbolized audiology, a profession I love dearly.  And then it hit me! This unique jewelry, with it natural shape of a human cochlea, was the perfect symbol to promote hearing loss awareness and encourage dialogue about its treatment. Audiologists could embrace it as a symbol of a profession we all love and our patients could adopt it as a symbol of their first step in accepting their own unique hearing loss.  I decided at that moment that I had to find a way to introduce this beautiful “cochlea” jewelry to the audiology and hearing impaired communities.  I contacted the artisans, became a distributor and introduced it at the annual Florida Academy of Audiology meeting.  The response was overwhelming and AuDBling was born!

heart-necklaceSince that time, I have spread the message to thousands by attending conventions and by building my own website AuDBling.com.  I have been able to have countless conversations with people in all sorts of places that I feel have impacted individuals in a positive way, all by simply wearing AuDBling jewelry.  For example, one typical conversation I often engage in goes something like this:

Individual: “That is a beautiful necklace!”

Me: “Thank you! I am an audiologist and I wear it because it’s shaped like the cochlea of the ear.”

Individual: “Oh, my grandfather doesn’t hear very well and I can’t get him to pursue hearing aids because they are so expensive.”

Me: “Is he a veteran?”

Individual: “Yes.”

Me: “Well, I have some great news for you……”

audbling-mixAgain, this is just one example of how a conversation can begin. And this is such an opportune time to make your AuDBling purchase count! I recently have partnered with Entheos Audiology Cooperative to help give the gift of hearing to those who would otherwise go without.  Entheos is comprised of private practice audiologists who offer their skills and talents to not only assist patients within their practice, but to assist those in need worldwide including Zambia, Jordan, and Guatemala.  During the month of December, AuDBling will not only donate 10% of your purchase price to support the mission of this Audiology Cooperative, but additionally match the donation. By purchasing beautiful jewelry for yourself, staff, friends and family, you will support a great cause and help spread the word about hearing loss and all its available treatments.

noel-crosbyNoël Crosby is owner of Advanced Hearing Solutions, Inc. in Englewood Florida and owner of AuDBling. She earned her MS in Audiology from Florida State University in 1986 and her AuD from the University of Florida in 2000. Dr. Crosby served as Audiology Director for the Ear Research Foundation from 1986-1988. Noël has served as President of the Florida Academy of Audiology two time; her first term was in 2000 and her second term was in 2009. Dr. Crosby is a member of the Academy of Doctors of Audiology and the American Academy of Audiology.

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Hearing Aids Gave Me My Youth Back – guest blog post by Anne Walker

my-story-2My name is Anne Walker and I have been employed at Oaktree Products as a customer service representative since January 2008. Getting hearing aids was one of the best things I ever did for myself and I wanted to share my story. About a year ago I had my hearing tested because I felt more and more like I wasn’t hearing exactly what someone was saying to me. When I was watching TV with other people it was hard for me to hear what seemed to be a sufficient volume level for everyone else and I was uncomfortable always asking for the TV to be turned up. When I finally had my hearing tested, I learned that I had a gradually sloping, moderate to severe high frequency hearing loss in both ears.  Although I was surprised at the degree of my hearing loss, I continued to put off doing anything about it for a while.

appointmentLast October while at a family wedding, my brother-in-law showed my husband and I his new and first pair of hearing aids. I was so intrigued; you couldn’t see them even with his short hair! They were nothing like I remembered my grandmother having years ago.  He was so excited about having them, mentioning that he wasn’t sure why he waited so long. Honestly, I was envious of how happy he was and, about two months after that weekend, I finally made an appointment with an Audiologist to talk about amplification options. My brother-in-law definitely served as my inspiration.

resound-linx2During my consultation, my Audiologist asked me about all the things that I like to do and places I frequent on a regular basis to get a better idea of my lifestyle.  Going into this appointment, one of the hearing aid features I really wanted was a t-coil. Several technology levels were discussed and the most appealing option to me was the made for iPhone hearing aids. I made the decision to invest in a pair of Resound LinX2 and so began my hearing aid journey.  My Audiologist counseled me that things would seem really loud at first but after a few days or so it would sound more normal.  She explained that I would be hearing things I have not heard for a while and that may brain needed some time to learn how to process this information again.

pennyOnce fitted with my new hearing aids, I was amazed at the little things I was able to hear like the sound of papers being moved around my desk, a penny dropped on the floor, or my cell phone ringing in my purse and no longer having to rely on someone to tell me my phone was ringing. While driving home from my initial fitting, I actually heard the blinker in my car! When I came home, I heard water running out of the gutters! Ever
csr-all-green-2-annesince that day, I hear something new and think to myself, “Oh my heavens! It’s been a long time since I have heard that sound!” When I am conversing with customers over the phone or socializing with friends outside of work, I am not longer afraid that I will have a hard time hearing what someone is saying. My hearing aids have taken away a crutch and have game me my youth back! When I get up every morning, I do not feel complete and ready-to-go until I have put my hearing aids on. Anyone considering hearing aids should do so and not wait. Your quality of life will change so much for the better.  You will be amazed!

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The Hassle-Free VDC Loupe System

qualityAny audiologist involved in cerumen management and/or other procedures necessitating high-depth of field resolution of the external ear canal needs a high-quality loupe system. One of the initial drawbacks of trying out a new loupe is the perceived amount of effort in making necessary adjustments to achieve a clear image. This is particularly evident when a practice with multiple clinicians is pursuing a loupe system that they intended to share between several colleagues. If this is or has been a frustration or concern, try the no-hassle, no-adjustment VDC Loupe System.

98-1805Designed for visualization of the ear canal, the VDC Loupe System attains an extremely high depth of field with excellent edge acuity, and retains focus even when the patient moves. What makes this system hassle-free is the fact that the loupes reside within the actual glasses and, therefore, do not come equipped with a knob to adjust for interocular distance.  The relative loupe location is based on average adult Pupillary Distance (PD). PD refers to the distance between the pupils of the eyes, center to center, measured in millimeters.  The VDC Loupe System (item# 98-1805) is specifically designed for PD measuring 30mm which will be suitable and appropriate in more than 90% of adults.

pdEven though the VDC Loupe System above will work for the majority of health care professionals, additional versions are available, each identical with the exception of how far apart the left and right loupes are positioned from one another.  If you wear eyeglasses or contact lenses, obtain your PD from your ophthalmologist, optometrist or optician to customize your VDC Loupe system. If you do not wear glasses or contact lenses and want to know your PD to ensure the most appropriate version is ordered, measure your own PD using How To Measure PD instructions. Learn more from the Oaktree Products VDC Loupe Resource page that addresses Which VDC Loupe System Is Right For You? For more information, contact customers service at Oaktree Products toll-free 800.347.1960 or via email at otp@oaktreeproducts.com

Posted in Audiology, Otoscopes, Headlamps & Earlights | 1 Comment