Clinical Practice

Make a plan

How HCP’s can effectively address their clients’ hearing needs in both the near and far fields.

I sometimes hear that offering a Roger™ system to a client a couple of weeks after they’ve purchased a pair of premium hearing aids is difficult. To be honest, I don’t find this surprising. If you have selected and fitted premium hearing aids, and the client is still reporting significant difficulties in noise and over distance, it is indeed tough to now convince them that a Roger system is THE solution for their remaining hearing and understanding challenges — even if we all know it is the perfect solution. At that moment, it is not easy to admit to your client that the hearing aids you first recommended are not the complete solution and the initial price tag is not the final cost.

Of course, instead of offering a Roger system, you could say that what the hearing aids deliver is the best that can be done for them. Indeed most clients are not given any information on advanced microphones. Research has shown this. And yes, there are limitations to what technology can do. Hearing loss is tough. Physics is tough as well. But physics is also the key to the solution. Physics allows us to predict a few things.

It is often predictable what the listening experience with hearing aids will be. For instance, if the client has a loss in critical signal-to-noise ratio (SNR) of about 10 dB and there is a need to understand speech at 2 meters or more distance in 65 dB noise levels, it is very likely that hearing aids are not going to solve this. Not because the hearing aids have poor technology (on the contrary, they are marvels of technology) but room acoustics make it impossible to deliver a SNR to the client that allows them to deliver auditory signals at that noise level and at that distance. For example, a speech level of about 70 dB at 1 meter is about 67 dB at 2 meters.

Beyond the critical distance, the improvement in SNR of directional microphones is negligible. That leaves a SNR of + 2B, which may be 3 dB below the critical SNR of the client (+5 dB), assuming normal hearing listeners have a critical SNR ratio of about -5 dB. At 3 dB below the critical SNR, no one will understand any speech. And this is perfectly predictable. The bad news is that 65 dB noise levels (or more) are more the rule than the exception, and a loss of 10 dB in critical SNR is also very common, definitely for losses of more than 60 dB.

To help hearing care professionals, we have developed a needs assessment that includes questions for the near field and the far field. Based on that needs assessment and the audiological diagnostic findings, the audiologist can recommend a complete solution that comprises products for both the near and far fields. When the overall hearing solution effectively improves as many listening situations as possible, client satisfaction increases significantly.

In my mind, it would be ideal if hearing care professionals make an individual treatment plan for each client, based on their needs in near and far field, especially for losses greater than 60 dB, and explain the entire plan to clients and their family member(s). If the plan involves hearing aids for the near field and a Roger system for the far field, it is not necessary to explain details about Roger at the beginning. A live demo however might be worthwhile, to give clients and their significant others a first taste of what will be offered later.

By doing so, you can start with the selection and fitting of the hearing aids. The client will be aware that with this first step some important hearing needs will be addressed — but not all needs. Their expectations from the hearing aids will be realistic, as they will understand that hearing aids are the first offering in the complete hearing solution. Clients will much better understand what to expect and what not to expect

The Roger system comes later, after the hearing aid fitting has been successfully completed. Of course, every client is different. It may take a while before some clients are ready to take the next step in their hearing journey.

What can you do to ensure a smooth process? First, make sure you do not fit your clients with Roger incompatible hearing aids in the beginning. Second, make sure you know the reimbursement options available for Roger systems, especially for the workplace. Quite often reimbursement is possible which is separate from medical coverage. Phonak can help.

When your audiological treatment plan comes together and you effectively address your clients’ needs in both the near and far fields….life is on!

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