The secret to better hearing

In this article, Andrew Holmes chats with Adam Bostock, senior audiologist and director of Alto Hearing & Tinnitus Specialists, about hearing tests, hearing aids, and the audiology industry in general.

AB: Time to listen. The more time we have with people, to truly understand the challenges they face as individuals, to find out where they are looking to gain improvements, and what kind of situations they encounter on a regular basis, the better we can make a recommendation for a solution.

One of the biggest benefits for me, opening our own practice, is that I can take as much time as necessary. This might be over two appointments, if that’s what is needed, as we want to get to know our customers really well to be able to find something that completely fits their needs. We have a pretty thorough consultation before we even start looking in any ears.

It doesn’t just inform what solution we might recommend; it also informs how we might support that individual moving forward with their ongoing care.

AB: Very good indeed, there is more choice than ever. Especially for us, as an independent provider we can choose from all the different solutions available. There has been such an improvement in technology over my time. Back when I started, digital hearing aids were in their relative infancy. A lot of the time with patients was spent stopping the hearing aids whistling to be honest! Now, with the options available, the sound quality and features, as well as digital wireless accessories, it’s remarkable really and client feedback evidences this.

As for which hearing aids we recommend, as well as what we learn about the patient’s lifestyle and areas of difficulty, we will take into account the severity of their hearing loss, any conductive element or asymmetry, alongside their brains ability to process speech, which influences things like directional microphones and background noise reduction. On top of that, dexterity and personal preferences are also important.

All hearing aid manufacturers tend to offer excellent devices, but some are more suited than others to individuals. There are some that have better connections with apps, some that are better for music lovers, some that we would recommend for severe hearing losses, and so on. Plus, each manufacturer will have varying levels of technology within their platform. There really is quite a lot to take into account when finding the right solution.

AB: That’s a difficult thing to keep to just one bit of advice, but I guess the main thing for me would be to manage your expectations realistically.

When I’ve spoken to people in the past about hearing aids and they’ve told me that they’ve been sat in a drawer for years or that they had some but then returned them, it has nearly always been down to the poor management of expectations.

Hearing aids are incredible, they really are, but when you first get them you get all this sound back that you haven’t heard for a long time. Your brain responds to this by making you overly aware of these sounds and, as such, it can be quite an overwhelming experience. It might sound echoey, tinny, and you will definitely hear your own voice.

To help with this, we would initially set the hearing aids a bit quieter than your full prescription and turn it up over a period of weeks or months. This means that you get improved comfort, allowing you to wear them, but it also means that you don’t get the full benefit straight away. If expectations aren’t managed properly around this then people can give up before they get to a place where they can truly experience better hearing.

AB: Whilst hearing devices have improved, and perhaps there is less concern around wearing devices, many of the challenges remain the same. People still wait a long time to do something about their hearing loss, and getting regular hearing checks isn’t common place.

We now understand even better the importance of your brain receiving the speech signals it needs, but far too often people wait until hearing becomes a really significant problem, when it can be more difficult for the brain to adapt to hearing again.

AB: It’s up to us as an industry, and individuals within the audiology profession, to help raise awareness, encourage people to get their hearing checked regularly, making it convenient and easy for them to do so. We also need to be collaborating with and working with other healthcare professionals to raise awareness of the importance of hearing checks and hearing health. We’ve made strides here, but there’s always room for improvement.

At the moment there are a few different routes to getting your hearing checked. You can go to your GP and get a referral to NHS audiology services, you can go to a private audiology provider like us, or you can go online or through an app and check it that way.

Sometimes if you want to go the private route, you have to book a hearing test for an hour or more. It looks and feels like a hearing aid assessment, as that’s pretty much what it is for many private providers. If you just want to get your hearing checked, it’s not exactly convenient to book an appointment for that amount of time.

I’m a big fan of the screening test, and that’s exactly what we offer at Alto for free. Our AltoScreen takes fifteen to twenty minutes, and we check the health of your ears and conduct a screening test. If we find hearing loss, we will recommend further investigation, or refer you to your GP, if this is required. It’s quick, easy to book in, and convenient for people to just pop in and get it done. I truly believe this is so important if we are going to help more people with their hearing.

AB: Overall, my belief is that we have to embrace the industry having more of an online presence, it certainly doesn’t worry me. We are always looking at new ways to support even more people to hear better, and our AltoConnect service does just that. If people want to have their hearing aids adjusted remotely via a Zoom or Teams meeting, and this works for them, I think that’s great, and the technology supports this really well. They would need to have their initial assessment and fitting in person though, we don’t sell hearing solutions over the internet, just provide adjustments and support.

It depends which online providers you are talking about though. Hearing aids are only one part of an overall hearing solution. It is the support, counselling, and care audiologists provide, alongside the testing and possible referrals required, that is absolutely key to a good outcome. So, whilst hearing aids might be much cheaper online, if it doesn’t include a proper hearing test and the right follow ups, verification and support, it might not be as good a deal as it sounds.

As for hearables, or self-programmable hearing aids that don’t necessarily require an audiogram, they have their place. Remember that a very small percentage of people who would benefit from hearing aids actually wear them. Well, if hearables can help improve this, and provide benefit to people, then I’m all for it. Again, I would encourage people to do their due diligence before purchasing a device, manage their expectations, and perhaps consult with a hearing care professional beforehand to get some advice.

AB: For us, we will continue as we’ve started and aim to provide completely bespoke, premium level care for our customers.

We will, no doubt, see further improvements in technology and testing. I think there will be more cognitive testing in the future, we’ve seen this happen already, and this is going to benefit patient outcomes. These things will be embraced, but what I don’t think is going to change is the need to get to know our customers’ requirements inside out to be able to make a valid recommendation.

I think, and I hope, we can reduce the gap of people who need hearing aids actually wearing them. We will see different solutions enter the market, and the routes to provision will change, plus, audiologists, including ourselves, will adapt and perhaps adopt different ways of doing things as we have been doing as a healthcare field for some time. At the end of the day, customers will determine the market, it’s up to us as care providers to offer what people are looking for.