Home Audiology Services is proud to announce that our fourth Open House, and only the second in our new office, has been nothing short of amazing. My new Audiology student, Mr. Michael Hammond, and I have been busy, busy, busy. 

Did I mention how incredibly busy we’ve been?

Patients have been flooding our office to learn more about the Intiga i, a new product from Oticon that we’re showcasing and to have their hearing screened…for free. Unlike the other products in the intiga line, the intiga i is even smaller- considered the smallest fully wireless hearing solution on the market.  It's a custom made hearing device that is invisible to others- almost like the lyric.   What it lacks in directional microphones and streamer capabilities it makes up for its discreetness.  I’ve never seen so many people waiting in our waiting room at one time.  It’s packed! 

So far we’ve been able to see a lot of patients and send them on their merry ways with two-week loaner, binaural hearing aids—also for free. It’s a blessing to see people immediately recognize a difference in their hearing and thus immediately improve their daily quality of life.  Since the intiga i is a custom made product, many of our patients are coming in and being fit with intiga 6's and 8's first before trying the intiga i.  Many times they find that their concerns about the aids being noticable are diminished and they can really benefit from directional microphones. Some of our patients are even walking out with a different brand of hearing aid all together.  That's the beauty of my practice- I use many different manufacturers and therefore I can recommend a hearing device that would better suited for a particular patient's needs.  

This is a real opportunity for a lot of these patients to take the next step into oral rehabilitation and see the opportunities that better hearing will provide them on a daily basis.

And for me personally, it’s nice to be able to provide this type of service. Typically, it’s natural to get patients who are hesitant to consider hearing aids with a simple word-of-mouth benefit. But with this type of promotional offer, it’s as simple as, “Give them a shot. Tell me what you think.”

This process has really allowed the cautious purchaser to experience the improvement in their normal settings. For me as a doctor, awesome!

Hearing Aids Styles and Stigmas: A Growing Industry

The following blog was written as a newspaper article that i recently submitted to some of our local newspapers:

If you think you know a lot about hearing aids, think again. The misconceptions surrounding these devices and those who suffer from hearing loss are numerous: hearing aids are bulky and unsightly, only older people have hearing impairments that require hearing aids, your social life will be affected negatively if you wear hearing aids, etc. False.

The truth is that hearing aids are not what they were even 10 years ago. The social stigma that has been walking hand-in-hand with hearing aids is finally losing its grip and it’s not a moment too soon. With the development of technology and the prevalent access to information, everybody should know the facts about hearing loss and the capabilities of hearing aids.

Hearing aids are sleeker, smaller, and in some cases virtually invisible.  Of the nearly 40 million people in the United States with hearing loss, around 70% are younger than 65. With the deafening concerts, use of in-the-ear headphones, and other lifestyles (including the workforce) that expose people to excessive noise, you can expect the numbers of younger and younger people suffering from a hearing loss to increase. Also, if you have hearing loss that requires hearing aids, your life is negatively affected socially without them.  To simplify it, it’s easier to notice someone who has untreated hearing loss than it is to notice someone wearing a hearing aid, because it’s difficult to live normally when your surroundings have been muffled.

One very important thing to note: all hearing loss is specific to each person who suffers from it. The good news? Hearing devices are rapidly minimizing their limitations. Users have more personalized options that can match their personal hearing loss and specific lifestyles. Since hearing loss is specific to each individual who has it, the expansion into customized aids with modern technology was seemingly inevitable. Think of the development of hearing aids the same way cell phones have developed over the past decade—exponentially and with no signs of slowing down.

            One of the major technological advances has been implementing Bluetooth features for hearing aid wearers. This aspect directly links users and their devices to other personal pieces of their individual worlds. By using a gateway device that receives audio signals, hard-of-hearing patients can link their hearing aids to multiple sources. iPod users who were once unable to wear headphones with their aids can now connect directly to their music. This is a phenomenal development for wearers who cannot fully rely on outside speakers to offer them clear sound with their favorite tunes.

            This capability extends to Bluetooth-capable cellular phones, too. Owners can link their gateway device from their phone and stream directly to their hearing aids. This maximizes their conversing abilities with others and simplifies a rampant issue between hearing aids and cellular devices. Driving hands-free is simpler than ever and basically unavoidable. Those who have difficulty hearing their television at normal volume levels are now able to use an adapter that streams the audio signals directly to the devices in their ears. Not exactly the bulky beige device most people picture, huh?

            Although I don’t suffer from hearing loss, I have been utilizing hearing aid technology for multiple years in order to understand the benefits of the products and to keep up with their widening capabilities. On a near daily basis I wear hearing aids with a gateway device to give me hands-free driving, couple music to my computer, to watch TV when my wife is sleeping, and for wireless headphones for when I am at the gym. Volume adjustments with the gateway device are as simple as using an in-hand remote. It’s also been an effective way to evaluate the connectivity and effectiveness of multiple hearing aid product lines. I am able to connect to other users who also have these devices and have concerns because I own and wear them, too.

            An incredible advancement in hearing devices has been in processing complex sounds such as speech while filtering out background noise and other undesired sounds. Sounds that cannot be electronically streamed to the aids, such as simple conversations and everyday interactions, can be maximized. And this personal touch on aids is heavily increasing. Concert and theater goers, social diners and people who just want to sit at home with their family can have their aids programmed to best suit the environments they are in.

            A lot of modern hearing devices have multiple adaptive directional microphones that allow them to minimize background noise and enhance the desired sounds such as speech. This feature is becoming less and less limited—just ask those driving convertibles who want better hear their passengers speak rather than the noisy wind.

            The cosmetic approach to hearing aids is not what it was years ago either. For years, hearing devices have existed as simply purpose over appearance. Now, hearing aid designers are considering a very simple question: Why can’t wearers have both? The goal: take hearing aids from the realm of social stigma to fashion statement. Where users were once limited with few options and sometimes hulking, eye-catching aids, wearers now have alternatives and choices to give their devices flair and a personal taste, right down from the size, the color and the style.

            As previously stated, all hearing loss is specific to each person. It’s important to know that the use of hearing aids can exponentially improve but never fully restore hearing to perfect capacity. However, with improved hearing comes improved quality of daily life. Remove the muffled world and re-establish the best hearing quality. It is impossible to say what type of hearing aid would be most beneficial to someone with hearing loss or if it is even necessary. The only way to find out is to have a hearing test conducted by an audiologist or a hearing health care professional. 

So...what do you think?  That picture is wild!  Rock your gauges and treat your hearing loss!

We recently had a telephone call from someone who purchased their hearing aids off of HearingPlanet.com.  He was "Satisfied with their tuning" but felt that we could adjust them more precisely.  While he had no problem in paying our cost to reprogram his hearing aids since "they were so expensive anyway," one has to pause and consider: is purchasing hearing aids online or from a mega corporation a good idea?

The answer is going to be, for most people, a no.

Why?  Well... there are a number of reasons.  I'll address online hearing aids first.

Buying hearing aids online is simply just a poor choice.  While at first it may seem like a simple solution- it isn't.  Regardless if you send in an audiogram and test results that have been obtained from an Audiologist, it would be very difficult for the company to program the instrument EXACTLY for your loss.  There is a lot more that goes into fitting a hearing aid than hooking up a hearing aid to a computer and dropping some settings into the device.  First, an audiologist is going to verify the physical fit of the device in or on your ears.  While technical savvy people can probably find information on youtube regarding how to insert and remove devices, many people still continue to have problems inserting them to the proper depth.  An audiologist will show you the best way to insert and remove the hearing aids.  In addition to making sure the aid is properly inserted, they'll make sure the device is comfortable.  Many types of hearing aids come with different tube lengths and dome sizes.  Othertimes, the audiologist finds that an ear mold would better suit a patients need and will seal the ear canal better than a dome.  A good physical fit of the hearing aid is key in getting the best results.  

Audiologists also make sure that the amount of sound that is going into your ears is correct.  This is very important as we don't want to over-amplfy your loss nor under-amplify it.  Every person's ear canal is a different shape and size and therefore the way each person's ear responds to sound is unique just to them.  

That's just the fitting.  

While I understand that oftentimes the price is more attractive, what benefits are you relinquishing for that price?  The first time your hearing aid doesn't work and you need it taken care of immediately, your local audiologist will charge you up to several hundred dollars per aid to service them because you didn't buy them from him or her, and why should they give away their expertise for free?  Dr. Slifer said it best with "You wouldn't expect a car mechanic to do a diagnostic on your engine for free, would you?"  No, of course not.  Adjustments, repairs and mostly any out of pocket expenses can quickly add up if you don't have a service contract with that audiologist.

It is unlikely that your hearing aids will be perfect the very first day you wear them.  More often than not, our patients come back for at least 1 or 2 adjustments to make sure the hearing aids are tuned specifically to their loss.  In fact, we purposefully start with under-amplifying a hearing aid because it takes time for your brain to adapt to sounds you may not have heard in many years.  When our patients come back for their adjustments, we increase their gain slowly to make sure they comfortably retrain their brain to hear.  And remember, just like I said each person's ear responds to sound differently, the same can be said with processing sound- no two people hear exacrly the same thing.

As far as purchasing hearing aids through a company like HearingPlanet...

When a consumer contacts HearingPlanet they aren't dealing directly with an audiologist.  More often than not they are dealing directly with a salesperson who has been trained in aggressive sales tactics.  First and foremost they are a retail operation- not a doctors office.  And with most retail operations, once they obtain your contact information they will relentlessly contact you to schedule a hearing test appointment.  

HearingPlanet also does nothing for the local economy.  While it's true that HearingPlanet has negotiated with a hearing professional in a local area, they receive a small stipend for performing their work.  Most of the money that someone will spend at HearingPlanet goes back to their corporate headquarters in Tennessee.  In fact, you don't pay your provider at all- you pay HearingPlanet directly.

The warranty given by HearingPlanet is pretty abysmal.  Their warranties and service contracts are only for one year while the life of a hearing aid is anywhere between 5 to 7 years, based on how yout ake care of your devices.  Like I stated above, out of pocket expenses can quickly add up and anytime you need to reprogram your aids (many times, after a repair hearing aids need to be reprogramed) you can spend a couple hundred dollars per aid.  Having a service contract with an Audiologist can save you money in the long run.

And that leads me to my last point-  when you purchase a hearing aid with through an Audiologist, many perks come bundled into the price you pay.  When all is said and done, we find patients actually end up spending more with HearingPlanet than they would if they chose to go to their local audiologist.  

Ultimately, I feel that Dr. DuBrey asked it best when he said "Are you comfortable sending thousands of dollars out of a town to a stranger or would you prefer to save money and receive better service locally?"

I’ve noticed something recently-  When I call to have my patients come in for a routine hearing test, many of them ask why or indicate that they don’t want to come in because they think their hearing hasn’t changed. 

Hearing loss is like any other important health-related issue.  It should not be neglected.  Even a mild hearing problem can cause you to retreat from the world around you and studies have shown that untreated hearing loss can have a negative effect on your health and attitude, even resulting in stress, depression, isolation and reduced earning power.

Hearing problems are also harder to detect than vision problems, so it’s even more important to come in for an exam.  We wouldn’t want to miss something that could be cause for concern. 

I recommend the following guide for check-ups:

If you are between the ages of:

18-45 –every five years

45-60 –every  three years

60+ –every two years

This may differ based on what I find in your audiogram.  If I find something that needs monitoring, I may want to see you more often to ensure that you’re receiving the best attention for your hearing.  Also, anyone exposed to hazardous noise should have an annual hearing test- we want to make sure your hearing is protected!

If you’re a patient that is using hearing devices, it’s also important that your hearing aids are matched to your loss- so coming in to have it checked will also increase the benefit from your devices!

So hopefully I’ll see you for your check-up this year!

For years, Home Audiology Services was located at 250 Montauk Highway in East Moriches, NY.

It was a great place to get our office started, we could afford the rent, we had a nice flow of patients and our Landlady, Ms. Patricia Gillard of The Law Offices of Patricia Gillard was wonderful.  The office was built only in the early 21^st century, but all our patients felt the building was built back at the turn of the 20^th. 

However, last March our office made the tough decision to move away from our small office and take on bigger endeavors at 201 Montauk Highway in Westhampton Beach.  While our employees and our patients loved the convenience of the office to the Moriches and Riverhead area, we were expanding and needed the space to accommodate that growth.

Our office is now located on the ground floor of a beautiful, cedar shingled office with plenty of parking, with three designated handicap spaces.  We continue to have a handicap ramp and a handicap accessible bathroom but now we have a comfortable waiting room for our patients to relax in before their appointment; complete with complimentary coffee, tea or hot chocolate.

The one office space has now expanded into five individual spaces, including a testing room, counseling room, conference space, back-area and waiting/reception area.  It definitely has given our employees some space to move about in, which they are definitely happy about- no more sharing desks!

Ms. Hillary Bieling did a fantastic job decorating the office as well, pulling in a beach theme to match our proximity to one of the best beaches on Long island!  The move, though tough because of the pressure to transition quickly, was made easier by the help of my employees—all of which I am lucky to have.

We have heard of the saying “behind every great man is an equally great woman.”  Well, behind every great practice, there are great employees.  Have a great new year, ladies and gentlemen, you deserve it!

Today was Martin Luther King day; however Dr. Hersh (as well as most Doctor’s offices) had hours today.  The pace of the day was very good; the first four patients that I tested were right after the other!  After I finished with one test, another patient was coming out of Dr. Hersh’s consultation room with an audio request.  I tested one patient who I had seen last year.  Stanley had a high frequency sensorineural hearing loss starting at 1500 Hz in both ears, and the loss was worse in the right ear.  He remembered me from last year and asked about what can be done to make speech more clear.  I recommended open ear hearing aids like the ones I was wearing, as his low frequency hearing is very good.  He did acknowledge that they were expensive, and asked about other means for making speech more clear.  I showed him some personal amplifiers on the internet, but indicated that the clarity of speech probably wouldn’t improve much.  He was encouraged (as was I) that his hearing sensitivity had not changed much from the previous year.  I even offered him a 2 week no-obligation trial with an open ear hearing aid, however he said he would think about it and follow up if things got worse.  Research does show that people wait an average of 5 years after being diagnosed with hearing loss before obtaining hearing aids.  Dr. Hersh finished early today around 5:20pm.  I was waiting for a patient’s daughter to show up and pick up her mom’s repaired hearing aid, luckily she was on foot and she met me near my car on 112^th Street.  I made excellent time driving home to Shelter Island, as the traffic was much lighter than usual because of the holiday.

I made really good time getting to Dr. Hersh’s office in Forest Hills from Shelter Island.  After being on the first ferry leaving the island at 5:40am, I was on 108^th Street by 7:35am.  It gave me enough time to go to TD bank before going to his office.  Normally I have to park about a half mile from the office, but I was thrilled to find a parking spot right on 72^nd Ave!  It was a light day at his office; I did a total of 4 hearing tests.  Unfortunately, the last patient didn’t show until 12:07pm, and consequently I was not able to leave until 12:30pm.  Luckily, I made great time going back out east.  I had time to stop at Bank of America in Shirley to deposit my secretary’s checks for her (she was recovering from tonsil surgery on 1/11).  I just made it back to the office by 2:01pm for my 2:00pm patient.  Maria was back into the office because her hearing aid was set too high.  Thankfully she told me to set it where I thought it should be.  I reset the fitting to acclimization level 1 (she wears an Oticon Dual M5 receiver-in-the ear hearing device in her right ear) and enabled the automatic adaptation controller.  The hearing device will gradually increase the output until it reaches level 2 in 30 days.  I informed Maria this would be the best way to gradually increase the gain without her getting an adverse reaction.  After Maria left, I did some clerical work (Maggie was working from home and my secretary was out), then set up Persona Medical’s hearing aid software in my ‘house call laptop’.  I invested in their Speech Pro package which was really an excellent one.  Persona gets you a MedRx Avant real ear system (which only works with Persona Medical hearing aids unless you purchase a firmware upgrade from MedRx) and a pair of powered Logitech speakers.  The best part about the Avant system is it’s binaural real ear measurement and the probe microphone setup is far superior to the system I purchased from MedRx back in 2006 (Digital Speech Mapping).  What I like about the Avant system is that you have binaural probe microphone assemblies. Unfortunately, there was a problem with the sound card on the laptop but I was relieved when I learned that the MedRx box has its own separate sound drivers.   I also purchased a pair of Persona Medical’s Evok 900 behind-the-ear hearing aids.  These aids are their top of the line model, and I had a chance to have their software demonstrated to me by allowing Michael Steinman (inside sales) remote access to my computer.  He had me actually put the probe tubes in both ears and couple the BTEs to foam molds.  I remember just how uncomfortable having the real ear probe hit your tympanic membrane is!  I programmed a moderate flat loss and Steinman fit the hearing aids with Speech Pro.  This is a revolutionary system where you can use either composite speech waited noise or real live speech as a stimulus and you can have the software automatically program the hearing aid to within 3dB of target!  Steinman was also able to demonstrate the difference in sound quality of real ear verified versus predictive.  It’s amazing that there was a clear difference.  The real ear verified was more natural; the predicted was tinnier.  This entire process took a little longer than expected, but I’m really excited about being able to fit their product on some of my prospective patients.  I am really looking forward to when they are able to introduce connectivity to BlueTooth devices as a feature of their product.  In the meantime, I look forward to using their amazing software on some of my patients to see what they think.

My first patient, Joseph, found me from the phone book.  He saw the Nurse Practitioner at his primary physician’s office.  During the examination the NP saw his right ear canal to be completely occluded with wax; consequently he recommended having the ear irrigated.  Unfortunately, the NP did not make a direct recommendation so Joseph found me in the Yellow Pages.  This will be a good opportunity to market my services to that office!  Joseph was indeed completely occluded in the right ear and had a moderate cerumen buildup in the left ear.  I irrigated his right ear about 10 times before the block of wax had egressed to the point where I could remove it with a curved buck curette.  After the large block of wax removed, there was some residual wax located near the eardrum, so one more irrigation was all that was needed to remove it.  The left ear was irrigated just once, and the canal was clear.  As is customary, a hearing test was performed after the wax was completely removed.  He had a high frequency sloping sensorineural hearing loss typical of presbycusis (age related hearing loss).  He reported being able to hear much better after the wax was removed, and did not feel his measured hearing loss affected his quality of life.  He felt that he was in pretty god shape for a 91 year old man.  I agreed with him.  I recommended to have him come back in 6 months so I could look in his ear and see if there was buildup occurring again.  The second patient was another Joseph (it must have been the day for Josephs).  He had been approved for two hearing aids from Medicaid after a long application process (about 5 months to be exact), and came in to be fit.  I had given him a loaner BTE for his left ear and he had an old ITE for the right ear (but it was insufficient for his loss); after today he had a brand new set of non-programmable digital BTE hearing aids from Personal Medical.  After an initial hiccup with the telecoil inadvertently being activated in the right ear, it was determined that both were operating quite well and he was very pleased with having both ears working together again.  I left for Dr. Hersh’s office

Today was a light day at Dr. Hersh’s office.  I believe I performed a total of 4 hearing tests when I typically perform about 6.  He has hours from 9am-12pm.  Afterwards I went to Avalon Gardens Nursing Home in Smithtown to deliver two hearing aids.  The first was to Maureen; her story has a happy ending but the entire process took 6 weeks to complete.  6 weeks ago on one of my previous visits, her hearing aid had a broken battery door.  I took it with me to Dr. Hersh’s office, since there were extra battery doors there from several different types of hearing aids.  Unfortunately, none of them fit.  The same thing happened at my office.  So I called Starkey to order battery doors for her specific ITE.  A follow up call a week later by my secretary revealed that nobody had acted on my request.  So I placed a call myself to Starkey and explained that I had already ordered these doors and nobody acted upon the request.  The representative stated that since I didn’t hold an account with Starkey, the request could not be fulfilled because the computer system they use does not allow them to place an order without an account number.  I stated my growing frustration with the situation and that if I needed to, I would have my colleague order the doors for me since he held an account.  The rep sympathized with my situation and somehow got the doors shipped out to me.  Unfortunately, after I got the door replaced, the hearing aid was completely non-functional.  It took me 2 weeks to get in contact with my local repair guy, as he was alternating being sick with his wife and kids.  I got the hearing aid out to him and asked him to ship it directly to Avalon Gardens after it was fixed.  He was able to comply with my request, however it was lost at Avalon upon delivery (note to self, no more shipping hearing aids to Avalon) on December 10!  I was there on December 16 and the situation was not good, as this patient has a severe to profound hearing loss and cannot function without a hearing aid.  I took a new earmold impression, raced back to the office, got a DVS approval from Medicaid for a new digital ITE, completed an order form for a Phonak Certena Power ITE and JUST made the 5pm FedEx pickup.  I got a call from the Ombudsman from Avalon Gardens on December 17, who informed me that Maureen called the State to complain about the situation.  I informed him of my extraordinary efforts and that if the hearing aid arrives before I go on vacation on December 23, it will be programmed and dropped off at the facility by my secretary while I was on vacation.  I was thrilled when I stopped at the office on December 22 and the hearing aid had arrived already.  I was crushed when I discovered the volume wheel popped out of the faceplate and I couldn’t program it.  So, it was sent right back to Phonak to be fixed.  It came back while I was on vacation and my secretary informed me that there were a number of problems with the hearing aid that was sent in to be serviced; Phonak made a brand new aid and put the same serial number on it.  I installed the latest version of their software and this solved the problem of programming.  I programmed it in the morning on January 8 at Dr. Hersh’s office and dispensed it that afternoon.  Marueen was thrilled with the quality of sound and very grateful to receive a new hearing aid.  The other patient was Barbara who received a replacement hearing aid (her previous one was lost).

I went to two nursing homes today; the first being Hampton Care Center.  The first patient was Paula.  She had a mild to moderate high frequency SNHL and did not meet the MMIS requirements for a hearing aid through the Medicaid program.  She was counseled as such, and did not feel that she needed a hearing aid in particular.  The second patient was.  Her main concern was wax which was affecting her hearing adversely.  I removed two significant pieces of wax from her ears using a curved buck curette.  She immediately voiced improvement in her hearing.  She had a mild to moderate high frequency SNHL with asymmetry at 3000 Hz, but did not feel she needed a hearing aid.  The next patient was Menika; she was a simple check for wax in the ears.  I removed a small piece of wax with a curette from her left ear.  The forth patient was Helen.  I did not actually see her, just replaced the oto-clips on her ITE hearing aids.  The fifth patient was Antoinnete; she was completely unresponsive to all forms of testing and not a suitable candidate for amplification.  The last patient was Margaret; whose hearing aid was completely non-functional and taken for repair.  The next stop was Riverhead Care Center.  There were only two patients for earmold impressions Fred and Mary.  While I was at Riverhead Care Center I chatted with a lawyer who has an 8 year old daughter that wears Phonak hearing aids, and he was inquiring about a connection to a cell phone.  I informed him that I would be in touch with him via email and give him information about the iCom so he could investigate whether this would be a feasible option for his daughter.  The day was complete after that.