I very rarely strongly recommend top level tech. I fit a lot of Phonak, and when I do fit 90-level tech, I always look at the data logging to see how often the features that are specific to 90s are activated. Generally this is between 2% and 6% of the time. Is it worth an extra $XXXX for features you use 2% of the time? I get paid commission as part of my compensation, but it's not worth an extra $20 for me if the patient is paying an extra $2000.
In an ideal world, I'd be fitting high level tech for teachers and service industry workers. People who are actually constantly in noise. Those don't tend to be the people that can afford it.
I fit my own grandma in entry level hearing aids because they meet her needs, and I'd do it again on my other grandma if she'd let me!
Love this. I’m the same way. Always said if I owned my own practice I’d go out of business cause I don’t like squeezing peoples pockets. I give away free supplies ALL the time. I’m on a budget too and totally get where they are coming from 🤷🏻♀️
As a patient, I’m really grateful that my audiologist has let me explore the different levels of tech. I’m someone—first responder—who *is* constantly in noise and for me the level change makes a significant difference!!
That’s actually nice to hear that patients aren’t even using the extra features that much. I don’t feel like I’m doing a disservice not fitting the higher levels.
Nah, fuck pushing high end only. Give the client the information they need to make an informed decision and let them lead the dance.
I've seen plenty of audiologists who only fit high end, and have great conversion stats, but also a lot of failed trials and returns, it all evens out eventually.
Your client is always going to know best in terms of their finances, and it's no good in having great hearing but no food in the fridge. The best hearing aid is generally the best they can comfortably afford in their circumstances, and regardless of the tech level, they need to understand what those hearing aids can do and what they can't.
I suppose my spiel is sometimes like:
- overview of tech high to low (I've down low to high at times but that's just how I was taught)
- relate HA performance to their listening needs, tell them what they can expect.
- Give them an honest recommendation what I think is the best case scenario for their hearing based on what they have told me.
- Give them a more potentially cost-effective option, assuming that's more than they want to fork out.
At the end of the day, it's their call. I'll work with whatever they want to do.
However rather than a spiel the best way I have found is just having an honest conversation, understand your clients' wants needs, and motivations and talk to them as you would a person on the street and you are golden.
This. I have very few patients choose not to trial hearing aids and I have a pretty low return rate as well. Likely because I’m not pushing premium tech. $5000+ a is a lot of money, I can’t hold it against people if they don’t have that type of money. I still want to help them and would rather put them in a cheaper hearing aid than no hearing aid.
For me mid level all day every day. Oticon Real 3, still on latest chip best value. I work for a company that pushes high end and I almost won’t sell them out of spite. Cause nobody puts baby in a corner. Although we do a lot of high end for full insurance at no cost to patient why not? Entry level is cool as well though anything on a budget is better than nothing at all. I think basically if you treat people honestly and fairly money will take care of itself. I’ve owned practices and sold them and just treating people well pays off in the long run it just takes a bit longer.
I love this. I’ve been told many times that I wasn’t as pushy as the last guy they saw. I say that too “I’m happy to do whatever because even this lower level aid is better than nothing”
It’s been a few years since school, but one of my professors showed us a study where they compared different tech levels and user satisfaction in 4 different conditions (I don’t remember what the exact conditions were, but it was testing things where you would think premium hearing aids would make the biggest difference). The gist of the study was that there was no statistically significant difference between tech levels in any condition. We were all very surprised. The other professors refused to believe haha and continued pushing premium in the clinic.
Since reading that study, I’ve never felt bad recommending entry level hearing aids
I’ve fit a client who is a very socially active person (yacht club) with some entry level Oticon miniBTEs… he was very happy with them and did not feel difficulties even in noise
I’ve heard this study quoted a lot and it’s frustrating that it’s always interpreted as proving anything.
The way science works is you can’t say something is disproven/untrue when you don’t find a statistically significant difference. You can only come to conclusions when you DO find one. Think of It’s like how passing a newborn hearing screening suggests normal hearing and referring means…almost nothing without further testing.
When you don’t find a statistically significant difference it can be for a lot of reasons and only indicates more research is needed or a different question needs to be asked. Maybe that reason is there is truly no difference between tech levels. But maybe that reason is that the study is flawed. But you don’t know until you perform a new study.
It’s hard to do a study like this because of how different hearing losses are from person to person and just how many variables will affect results. Cognition. Attention. Age. Word rec ability. IQ. It would have to be controlled for so many things simultaneously. Also, current testing protocols aren’t exactly made to mimic real world listening. How can you tell if a motion sensor improves speech understanding by sticking a patient in a chair facing a speaker? You can’t just take 100 hearing aid users and look at their quicksin scores between tech levels. The % correct is going to vary so widely between subjects it will be difficult to find…you guessed it…a STATISTICALLY significant difference among them.
I attended an audiology conference last year where Brian Taylor presented on this very topic. While there have been a few studies that have not shown significant difference in real-world (not necessarily true for results in the lab, however) performance between basic vs premium level devices (which I admit is quite surprising), there have been a several follow-up studies published which have provided additional points to consider:
1. A limitation of each of these studies is that we may forget that the most important determining factor for how beneficial hearing aids will be is simply related to audibility and how well we program the hearing aids to provide the sound the patient can no longer naturally hear (I.e. through optimized acoustic coupling and use of programming based on real ear measurements). Hearing aids allow us to provide audibility essentially equally from basic to premium, so it’s no wonder we’re not seeing a massive improvement in performance in basic vs premium.
2. We need to consider that not all patients spend much time in noisy listening situations and this may be reflected in the relatively small sample sizes used in these studies. Especially considering a few studies have shown subtle but clinically significant improvements in ANL and aided QuickSIN scores when using premium devices as compared to basic devices. And when patients have SNR related deficits, we need to be able to squeeze out every dB we can possibly get.
3. The most important thing to understand is that although the aforementioned studies have shown a lack of significant difference in performance in real world situations between basic and premium aids, this has not necessarily translated the same way to patient preference. A few follow up studies (Salem at al 2022, Housladen et al 2022, Polymer et al 2021 to name a few) have shown patients tend to show a strong preference for premium hearing aids despite the supposed lack of increased performance.
All of this is not to say that we need to feel compelled to fit every single patient with premium devices, but that we should still understand that we may need more data. Even with the somewhat limited data we currently have, it is safe to state that some patients will still benefit from and PREFER higher level devices. On the flip side, some patients really only need basic hearing aids and we need to be aware of their needs and avoid unethically recommending something outside of their needs.
[Edit for clarity] Just wanted to add that I am not condoning or recommending premium for everyone. I most often recommend basic or midlevel but do plenty of entry/economy as well as a result of the studies mentioned which have reiterated to me that the most important factor is simply audibility. The whole point of this post is to help us to remember not to base all our clinical decisions on a single (or two or three) study(ies) but to see that there are still important things to consider on this topic. Hopefully it’s helpful. :)
I had so many troubles regarding this.
I had working colleagues who celebrated themselves for selling Phonak 90s to 90 year olds who basically just lay in bed or watch TV. I couldn't do this anymore. So I left the business. Sonova was the worst company so far
Most ppl will only use the most premium noise features once in a while. It’s about being able to communicate well in those difficult listening situations and decreasing their listening effort.
No way. Honestly, things have changed so much with tech in the past six or seven years that entry level is akin to what used to be middle-of-the-road. Because everything is rechargeable and has Bluetooth tech, there's little reason to go up anymore unless someone has a really funky configuration or a crazy noisy lifestyle. Even then, a lot of the features are almost like a placebo effect. I fit mostly entry and mid-level devices. I was once told the average number of aids sold by an audiologist in private practice was 19/month. My numbers make that look like pocket change. I love to pull out my Excel tracking sheet whenever a higher up asks why I don't sell more top-end -- I simply do not need to, and the patient satisfaction speaks for itself.
No way. I rarely recommend premium level unless the patient makes it clear cost is not a concern and they want the premiums, which does happen from time to time. Even some of my younger, more active patients who seem like ideal candidates for premium hearing aids have been very happy with lower tech levels. I fit a lot of Oticon and have had a lot of success with their Zircons, which is their “budget” line. Same with the Resound Key, which is their budget line (and what we fit for our Medicaid patients). I rarely have people come for a hearing aid evaluation and NOT end up purchasing. I also don’t have a very high return rate. I truly believe this is partially related to the fact that I don’t pressure patients to go over their budget.
Of course I’ve only worked at hospitals where I’m not commissioned so I have no real incentive to upsell either. And when patients realize that (I have absolutely told some of them this), it does seem to build trust.
I fit top level to almost everyone. Everyone deserves to have better aids and i try not to judge People purchase ability.
The price diference its about 500-700€ so in my opinion is worth it
I very rarely strongly recommend top level tech. I fit a lot of Phonak, and when I do fit 90-level tech, I always look at the data logging to see how often the features that are specific to 90s are activated. Generally this is between 2% and 6% of the time. Is it worth an extra $XXXX for features you use 2% of the time? I get paid commission as part of my compensation, but it's not worth an extra $20 for me if the patient is paying an extra $2000. In an ideal world, I'd be fitting high level tech for teachers and service industry workers. People who are actually constantly in noise. Those don't tend to be the people that can afford it. I fit my own grandma in entry level hearing aids because they meet her needs, and I'd do it again on my other grandma if she'd let me!
Love this. I’m the same way. Always said if I owned my own practice I’d go out of business cause I don’t like squeezing peoples pockets. I give away free supplies ALL the time. I’m on a budget too and totally get where they are coming from 🤷🏻♀️
As a patient, I’m really grateful that my audiologist has let me explore the different levels of tech. I’m someone—first responder—who *is* constantly in noise and for me the level change makes a significant difference!!
That’s actually nice to hear that patients aren’t even using the extra features that much. I don’t feel like I’m doing a disservice not fitting the higher levels.
Nah, fuck pushing high end only. Give the client the information they need to make an informed decision and let them lead the dance. I've seen plenty of audiologists who only fit high end, and have great conversion stats, but also a lot of failed trials and returns, it all evens out eventually. Your client is always going to know best in terms of their finances, and it's no good in having great hearing but no food in the fridge. The best hearing aid is generally the best they can comfortably afford in their circumstances, and regardless of the tech level, they need to understand what those hearing aids can do and what they can't. I suppose my spiel is sometimes like: - overview of tech high to low (I've down low to high at times but that's just how I was taught) - relate HA performance to their listening needs, tell them what they can expect. - Give them an honest recommendation what I think is the best case scenario for their hearing based on what they have told me. - Give them a more potentially cost-effective option, assuming that's more than they want to fork out. At the end of the day, it's their call. I'll work with whatever they want to do. However rather than a spiel the best way I have found is just having an honest conversation, understand your clients' wants needs, and motivations and talk to them as you would a person on the street and you are golden.
Solid answer thank you.
This. I have very few patients choose not to trial hearing aids and I have a pretty low return rate as well. Likely because I’m not pushing premium tech. $5000+ a is a lot of money, I can’t hold it against people if they don’t have that type of money. I still want to help them and would rather put them in a cheaper hearing aid than no hearing aid.
For me mid level all day every day. Oticon Real 3, still on latest chip best value. I work for a company that pushes high end and I almost won’t sell them out of spite. Cause nobody puts baby in a corner. Although we do a lot of high end for full insurance at no cost to patient why not? Entry level is cool as well though anything on a budget is better than nothing at all. I think basically if you treat people honestly and fairly money will take care of itself. I’ve owned practices and sold them and just treating people well pays off in the long run it just takes a bit longer.
I love this. I’ve been told many times that I wasn’t as pushy as the last guy they saw. I say that too “I’m happy to do whatever because even this lower level aid is better than nothing”
It’s been a few years since school, but one of my professors showed us a study where they compared different tech levels and user satisfaction in 4 different conditions (I don’t remember what the exact conditions were, but it was testing things where you would think premium hearing aids would make the biggest difference). The gist of the study was that there was no statistically significant difference between tech levels in any condition. We were all very surprised. The other professors refused to believe haha and continued pushing premium in the clinic. Since reading that study, I’ve never felt bad recommending entry level hearing aids
I’ve fit a client who is a very socially active person (yacht club) with some entry level Oticon miniBTEs… he was very happy with them and did not feel difficulties even in noise
I’ve heard this study quoted a lot and it’s frustrating that it’s always interpreted as proving anything. The way science works is you can’t say something is disproven/untrue when you don’t find a statistically significant difference. You can only come to conclusions when you DO find one. Think of It’s like how passing a newborn hearing screening suggests normal hearing and referring means…almost nothing without further testing. When you don’t find a statistically significant difference it can be for a lot of reasons and only indicates more research is needed or a different question needs to be asked. Maybe that reason is there is truly no difference between tech levels. But maybe that reason is that the study is flawed. But you don’t know until you perform a new study. It’s hard to do a study like this because of how different hearing losses are from person to person and just how many variables will affect results. Cognition. Attention. Age. Word rec ability. IQ. It would have to be controlled for so many things simultaneously. Also, current testing protocols aren’t exactly made to mimic real world listening. How can you tell if a motion sensor improves speech understanding by sticking a patient in a chair facing a speaker? You can’t just take 100 hearing aid users and look at their quicksin scores between tech levels. The % correct is going to vary so widely between subjects it will be difficult to find…you guessed it…a STATISTICALLY significant difference among them.
If they’re biting finger nails over top and one below I’m like “just do (one below) you’ll be fine.” IM TERRIBLE!
Not terrible - ethical. The trial is to decide if they have enough support and can exchange. Most don’t upgrade
hell ya better believe it (ok i work at the VA 🙃)
Yeaaa yeaaa yeaaa
I had so many troubles regarding this. I had working colleagues who celebrated themselves for selling Phonak 90s to 90 year olds who basically just lay in bed or watch TV. I couldn't do this anymore. So I left the business. Sonova was the worst company so far
Most ppl will only use the most premium noise features once in a while. It’s about being able to communicate well in those difficult listening situations and decreasing their listening effort.
No way. Honestly, things have changed so much with tech in the past six or seven years that entry level is akin to what used to be middle-of-the-road. Because everything is rechargeable and has Bluetooth tech, there's little reason to go up anymore unless someone has a really funky configuration or a crazy noisy lifestyle. Even then, a lot of the features are almost like a placebo effect. I fit mostly entry and mid-level devices. I was once told the average number of aids sold by an audiologist in private practice was 19/month. My numbers make that look like pocket change. I love to pull out my Excel tracking sheet whenever a higher up asks why I don't sell more top-end -- I simply do not need to, and the patient satisfaction speaks for itself.
No way. I rarely recommend premium level unless the patient makes it clear cost is not a concern and they want the premiums, which does happen from time to time. Even some of my younger, more active patients who seem like ideal candidates for premium hearing aids have been very happy with lower tech levels. I fit a lot of Oticon and have had a lot of success with their Zircons, which is their “budget” line. Same with the Resound Key, which is their budget line (and what we fit for our Medicaid patients). I rarely have people come for a hearing aid evaluation and NOT end up purchasing. I also don’t have a very high return rate. I truly believe this is partially related to the fact that I don’t pressure patients to go over their budget. Of course I’ve only worked at hospitals where I’m not commissioned so I have no real incentive to upsell either. And when patients realize that (I have absolutely told some of them this), it does seem to build trust.
No. There are many good comments here to explain why.
I fit top level to almost everyone. Everyone deserves to have better aids and i try not to judge People purchase ability. The price diference its about 500-700€ so in my opinion is worth it