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Best Practices in Audiology

Find out more about the industry standards we strive to meet in order to give you the best quality care.


Hi, I’m Jim Cuddy. And this is Ask The Hearing Doctors. And I’m joined today by Dr. Adriana Martineau, Dr. Ashly Wilcox, doctors of audiology with Hearing Doctors. The Washington DC area’s highest-rated audiology practice with over 1,500, five-star reviews. Adriana, Ashly as always great to see you both. Thank you.


So today, well, let me start things off. Obviously, most industries have standards that are the results of years of research and, and practice. Who sets the standards for the profession of audiology?


So that is set by the American Academy of Audiology. And the reason why we have standards is, um, for, it’s kind of for us to govern ourselves as audiologists as a whole. So regardless of what state or city you’re in, we’re always providing the best quality care for each person. Um, so it’s just really important that we’re all on the same page.


So everybody has the same level to live up to and as far as that goes? Yes. All right. So now let’s talk 10 best practice guidelines for audiology. I love lists like this. I think it’s a lot of fun to do it this way. Um, it starts with assessment. What are we talking about in assessment? I imagine that’s right walking in the door.


Yes. So you’ll walk in the door. Uh, well, you know, see how everything’s going. We’ll start off with the case history. So we want a thorough case history. We want to know your otologic history. So have you had a hearing test in the past? Do you suspect you have a hearing loss? Do you know you have a hearing loss? After, we do a thorough case history we’ll move on to otoscopy. So we’ll make sure there’s not any, uh, earwax or cerumen buildup in the ear. And if there is, we’ll, take it out for you. Um, we also have been running a cognitive screening on all of our patients. It just gives us another piece to add to the puzzle to better help suit your needs. Um, after that, we’ll do the hearing test and we walk you through the whole step of exactly what you need to do. So you’re not wondering, you know, if you’re doing something right. And then we’ll go over the results with you and see what we can do to help you.


All right. And now treatment planning, what’s involved with treatment planning?


So we want to know what your goals are. What you’re having difficulties with. What you’re looking to get out from us. Um, what we can do to help meet those goals. So we have questionnaires that we’ll have you fill out and will help kind of gear, um, the direction for the appointment to better suit your needs because each person is different. So each person is going to have different goals. Uh, so we just really need to know, and we’ll write it down exactly what those goals are and try to meet them.


And go from there. Yeah. All right. Now, technical components to treatment. What are we talking about there?


Yeah. So following up from Dr. Wilcox, um, with talking about the treatment plan, you, you go into talking about hearing aid selection. So we have assessed that now you have a hearing loss. Um, now we know what your goals are, so how can we treat that hearing loss? So that’s when we talk about the hearing aids. So do you have hearing loss in one ear? Do you have it in two ears? If you have it in two ears, we recommend two hearing aids. Um, and we can talk about different styles. So some people are, um, pretty worried about vanity. So we have ones that fit directly into your ear canal, and they’re invisible. We also have ones that fit behind the ear, which can also be very discrete depending on hairstyles and, um, things like that. So that’s usually the next step that we discuss with the patient.


And you know, that, that the discreteness to even the behind-the-ears, they’re not the big, bulky, boxy things that they once were either?


No, not at all. And typically they’ll blend in with any hair and they sit directly right behind your pinna, your, your ear. So, um, they’re pretty well hidden.


The hair wouldn’t work for me, but I do understand what you mean. All right. Now, next on the list. Quality control.


Yes. So hearing aids are a kind of like a little computer behind your ears. What I like to say to my patients. So sometimes we have to send them out for repair, and if that’s necessary, when they come back from repair, we want to make sure that they’re working as they should be before we give them back to you. So we have a, it’s called a test box or hit box where we can run some verification measurements to make sure that they’re working up to par as they should be. Um, and it’s just, it’s a really useful tool that we can use to make sure everything’s going okay.


And this even I know is very important because we’ve talked about this a lot, fitting. Crucial for somebody that’s getting hearing aids, you don’t just go and try and plug a hearing aid into your own ear. You really need to be fitted correctly. Tell us some more about that.


So depending on the style that you get, if it’s a custom one, that’s fit custom to your ear, or if it’s the style behind-the-ear. The little wire that runs down the front and the little rubber piece that goes down into your ear canal come in all different sizes and shapes and different lengths. So we will make sure that it’s fitting appropriately. And if it’s not, we have a lot of things we can do to help make sure it’s comfortable and fitting appropriately. Because if it’s not fitting correctly, it’s not going to sound the best. And there’s potential it could work its way out of your ear or even fall off.


You know, we often talk about no two people have the same hearing issues. No two people are the same. Well, obviously nobody has the same ears either. So that just makes perfect sense that you would want that custom fit to your ears. All right. Verification, what is verification here?


Yeah. So there’s something called real ear measurements and that’s a machine that each office has at their location. And what it does is it verifies, um, the amount of gain or amplification that we’re providing that patient based upon their hearing loss. So, um, what it is is it’s a little probe tube, um, that goes into your ear canal, not too far. Um, and then we place the hearing aid on top of that as well. And the patient will listen to a story and their job is to just listen. And the real ear measurement equipment does its job. And then us as audiologists, we can adjust it from the hearing aid itself, from that point, based on the different frequency responses that we’re seeing,


That’s phenomenal. I mean, I just the advantages for somebody and how much better they will be able to hear. And again, rather than going in and just grabbing one off the shelf at some big box store, the importance of getting everything just right is crucial.


Hearing assistive technology. Yes. I would think the hearing assistive technology, is that not just the hearing aid?


Yeah. So that’s something that a lot of people kind of forget about, or don’t really know. Um, hearing aids are able to connect to other devices such as a remote microphone or even a TV streamer that would plug right into the back of your TV. So what that does is just help improve the signal to noise ratio. So improve the speech over the noise to provide the best sound quality. Um, some people really need that assistive device and some people don’t really need it. And some people like it because they can hear the TV directly into their ears. Uh, so it just, it reduces a distance between us and really improves that speech.


I have had my ears tested here at Hearing Doctors and it’s in pretty decent shape, but I could really go for something that plugs right into the TV and right into my ears that is for sure. Um, orientation and counseling. That seems to me to be pretty important.


Yes. So orientation, we bring you in for the fitting. We run the real ear measurements at that time to ensure that everything is fit appropriately. Um, and then we really teach you how to put them in your ears, how to take them out. If they’re rechargeable, or if they’re battery operated, how to change the battery, how to use the charging device? Um, the maintenance. So hearing aids are typically pretty low maintenance, but it does require some to keep the, um, the sound quality up. So we go over all of that with you at that orientation fitting. And we really, really make sure that, you know, and feel comfortable with your hearing aids when you’re, when you’re leaving that appointment,


Follow-up care? Obviously this is important too.


Yeah. So after you have an orientation appointment, we’ll see you in about two weeks to a month after that appointment. That time period gives you, uh, uh, plenty of time to go out and experience the world with your hearing aids. So, um, different environments, probably environments that you originally came into the door and are having, you know, issues or difficulties with. So kind of circling back to what Dr. Wilcox said about your goals. So what were your goals with these hearing aids? So we’re following up to see, have we met those goals? Are we close to meeting those goals? And how can we adjust the hearing aids to meet those goals better for you?


And then finally on our list validation, what are we talking about here?


So we like to give out a questionnaire, um, it’s after the follow-up appointment. Typically at that follow-up appointment, if everything’s going really well and you feel very comfortable, we set the timeline out for about six months for a general hearing aid clean and check. And at that time we’ll give you a questionnaire based on the different situations you’ve been in typically within the past two weeks. And we’ll see, how have the hearing aids been helping you? Are your goals being met? What are we, um, lacking in the hearing aids and what do we need to help improve your goals or improve your experience?


It’s very thorough. It’s obviously very important to use best practices and audiology. Thank you for sharing your knowledge with us today. Thank you. Of course.


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Dr. Ana Anzola, CCC-A, FAAA, ABA Principal

Dr. Anzola received her Doctorate degree in Audiology (AuD) from the Arizona School of Health Sciences, and her Master’s Degree in Audiology and her Bachelor's Degree in Speech Language Pathology and Audiology from Towson University. She has been a fellow of the American Academy of Audiology (AAA) since 1995, board-certified by the American Board of Audiology (ABA), and certified by the American Speech-Language-Hearing Association (ASHA).


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