Is it possible to recommend the right hearing aid based on the hearing test (audiogram) alone?

Rivka Strom, AuD

Audiologist in Brooklyn

10 January 2019 - 1.16K Views

The audiogram can provide a lot of information; however, it is not enough to make a decision for an appropriate hearing aid. It is important to consider the lifestyle of the individual as well as physical characteristics of the ear, manual dexterity, and the overall hearing needs of the individual. All of this and more can be obtained at the hearing aid evaluation so I would encourage you to make that appointment for your benefit. 
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Matthew Pearson

Audiologist in Greater London

10 January 2019 - 1.13K Views

Quite simply no.

Quite often in forums an audiogram will be posted & the question will come up "What would you fit for this loss"?

It is simply a starting point.

ie What us the person's view about cosmetics?

What is their budget?

Have they worn hearing aids before?

Can their ear accommodate all types of aid? For example is their canal very narrow is their any kind of deformity to their ear? Do they have any kind of sensitivity to any materials? 

Are they a current analogue aid user?

If they are a digital aid user what brand?

What support systems do the person with the loss have in place?

Would speech testing indicate assistive devices where required?

There are more questions/tests validations/verification but you get the point!

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John Coverstone, AuD

Board Certified in Audiology in New Brighton

10 January 2019 - 1.16K Views

This is a loaded question. The question asks whether it is "possible" - meaning is there any way in the universe - to recommend the "right" hearing aid based on the hearing test alone. I would argue that it is possible to recommend "a" hearing aid based on the hearing test only. Whether it is possible to recommend the "right" hearing aid (versus the left?) is another matter. In my practice, the "right" hearing aid is one that will allow my patient to hear and communicate as well as they possibly can in the environments and situations that are important to them - and hopeful some which are not important also. This is well beyond the hearing test and takes into account, lifestyle, communication preferences, work demands, family interactions, and many other factors. Rechargeable devices have been a fantastic solution over the past few years for patients with limited dexterity. Patients who use their cell phone a great deal LOVE devices which can stream audio. Patients who frequently need to socialize or work in noisy environments need higher level technology and directional microphones. People who perform poorly on speech in noise testing (not routinely done, unfortunately, and not part of the audiogram) are in even greater need of those types of features. None of these needs can be met by looking only at the test, which is why no reputable provider would look only at the hearing test. If anyone tells you that they can recommend a device based solely on a hearing test - or, even worse, without even looking at a hearing test, stop the conversation immediately and seek help elsewhere. This is healthcare, not an electronic purchase.
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Scot F
Scot F 11 January 2019 Replied to Abram Bailey, AuD
Knew that was coming from someone.  Leave it to John.

Sarah Curtis, AuD

Audiologist in Concord Township

10 January 2019 - 1.19K Views

Simply looking at an audiogram does not provide enough information to select a hearing aid. Many patient-related factors must be considered. For example, the shape or texture of a person's ear(s) may dictate best style, as may the rate and degree of earwax production in the ear canals. Poor vision and/or dexterity will also limit choices/steer selection - for example, a rechargeable hearing aid may be best for someone who has a very difficult time changing hearing aid batteries. Lifestyle factors will also influence choice - if the person is often outside, frequently uses mobile phones, watches a lot of television, is a musician or listens to a lot of music, or works in a noisy environment, all may require different hearing aid features. 

At fitting, real ear measures should be performed to determine if the aids can provide appropriate, rehabilitative gain for the person being fit. Despite what the selection software may present, ear canal size, shape and resonances will affect the frequency response of the aids. This further confirmation, provided only at an in-person fitting with a practitioner who utilizes real ear measures in fittings, is the only way to ensure that the aid is fit properly. If the appropriate gain cannot be achieved, it is possible that a different aid be chosen.

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Margaret ("Peggy") Tomko

Professional Member

10 January 2019 - 1.2K Views

I would argue that it is not possible to recommend the right hearing aid based on the audiogram alone.

When I recommend a hearing aid, I take into account not only the results of the hearing evaluation, but also the patient's dexterity, ear size and shape, cognitive state, vanity, and lifestyle (just to name a few!). I would not have any of that information if I had only seen an audiogram.

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Christopher S. Frink, AuD

Audiologist in Salem

11 January 2019 - 1.11K Views

Absolutely not.  This is akin to saying "I have a driver's license, so all cars are alike and I'll be just as happy with one as another."Hearing aids vary significant in styles, features, and performance.  The greatest variance which has a direct impact on the price is the level of technology the hearing aid has, but whether someone benefits from that technology cannot be determined by the audiogram alone.  Certain features will be irrelevant to some users and crucial to others.  

The best determining factor for what the "right" hearing aid is for each individual is their lifestyle and communication demands.  For someone with a quiet, socially sedentary lifestyle, and entry-level product is not only adequate, but probably more appropriate since they won't be spending money of features they will likely never use.  At the other end of the spectrum, however, is someone with a very active, dynamic lifestyle--someone in meetings a lot, background noise, on their cell phone, etc.  They will benefit from the additional features to help their hearing keep up with the demands of that lifestyle.  Two patients with similar audiograms but very different lifestyles will each have a different "right" hearing aid to best suit their needs.

The primary impact the audiogram has on what is the "right" hearing aid is simply how much amplification--in decibels--are needed to meet the user's hearing loss.  But the choosing the "right" hearing aid depends on a lot of other criteria besides just the audiogram, which is why purchasing a hearing aid without the benefit of a licensed hearing professional to assist your needs would be tantamount to picking a car based solely on its color.

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Carly Jean Girard, AuD

Doctor of Audiology in Libertyville

10 January 2019 - 1.18K Views

This is a great question.  No, you cannot accurately prescribe or recommend the correct hearing aid for a patient without a physical examination and patient interview/consultation.  There are so many factors that impact the appropriateness of a hearing aid for an individual.  These factors include but are not limited to size and shape of the ear/ear canal, amount of ear wax production, dexterity, cognition, and communicative needs/desires.  The proper hearing aid and earmold selection is essential for the success of a the hearing aid user as it lays the foundation for which all programming and customization is based off of.    
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Lori Esposito

Hearing Healthcare Provider in Huntington Beach

10 January 2019 - 1.18K Views

This is a great question and my answer would be no.  Not if you want to be fit properly and have a continued positive experience with your hearing instruments.  There are a lot of factors that go into a hearing aid recommendation.  For example, I have a patient that is blind, we chose a hearing aid that was physically the easiest for her to work with.  I have another patient with Parkinson's Disease.  Trying to put a hearing aid behind his ear as well as the ear mold on the inside was too difficult, we chose a larger in the ear style for ease of insertion.  I have a gentleman with very large fingers, there was no way one of the tiny hearing aids was going to work. Some people have difficulties changing the tiny batteries so rechargeable might be the answer for them.  Looking at things like the ear shape and size, the person's dexterity, mental state, lifestyle, drainage from ear, are they interested in blue tooth features, buttons on the aids, volume control, apps for the cell phone, budget... there is much more that goes into a hearing aid recommendation than simply looking at the audiogram.  
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Melissa Wikoff, AuD

Doctor of Audiology in Marietta

10 January 2019 - 1.2K Views

I completely agree with the points stated by Dr. Tomko above. You must consider the patient as an individual person. The way we perceive sound, the sound environments we are in, our listening needs, cognitive ability, sight, dexterity, cosmetics and budget should all be taken into account.

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Sheri Gostomelsky, AuD

Doctor of Audiology in Deerfield

10 January 2019 - 1.17K Views

Yes it is possible to choose a hearing aid based on a hearing test.  Fitting hearing aids on the basis of a hearing test alone is done routinely on mission trips when we see hundreds of people in need of help each day.  I assume in writing this that your ears were examined and found to be free of wax and that the hearing test was not self administered.  That being said, in my practice, using a hearing test alone would not be a recommendation for most of the patients that walk through our door.    Doing it right the first time saves both time and money and makes for happier patients.   Anatomical structure, dexterity, or how much time an individual spends in noise and  hears in noise are only a few examples of what is taken into consideration in making a decision.   The way we purchase products is rapidly changing.  To assure your success with the product that you choose, make sure that real ear measurements or speech mapping is used in the fitting process.   

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Matt Watson, HIS

Hearing Instrument Specialist in Kitchener

10 January 2019 - 1.19K Views

The audiogram is only one small part of the hearing aid recommendation.  This would almost be like purchasing a car knowing nothing but the person's address and work address.  We would have no way of knowing what environments you are in, and how often which would dictate the different features and accessories needed to provide the best possible results.
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Charles Darby PhD, MA, BC-HIS, BC-HIS

Hearing Healthcare Provider in Little Rock

01 February 2019 - 894 Views

I will make the assumption you are referring to the standard hearing screening results ... a graph showing the levels of how each ear responds to various sound intensities.  The answer is both yes and no!  Yes, there is information sufficient to set hearing aids to proper levels to amplify sound.  However, this is a blatantly incorrect way to fit hearing aids.  There is so much more that has to be considered.  First and most important is the cause of the hearing loss.  There are medically treatable issues that can restore hearing without hearing aids.  There are also medical issues causing hearing loss that can lead to permanent loss or even death if not discovered and treated properly.  Any reputable provider will not fit hearing aids without proper and THOROUGH testing.  To do otherwise is simply malpractice.  

There are several types of hearing loss and each must be treated correctly.  Hearing aids are not always the answer.  This can only be known by complete testing, not simply tones played in the ear.  As an example, if a fitting increases sound but the loss is resultant of a tumor on the auditory nerve ... there is almost certain longer term and very serious issues in store for that patient.  Practitioners that are licensed to provide hearing healthcare services have extensive training to find the many maladies that can lead to hearing loss.  The majority of online sellers (some even offering online hearing screening) are just that, online sellers only interested in selling hearing aids.  Don't fall for that!  Your health is far too important.  Find a professional you trust that has impeccable references.  So no, if done correctly and safely, there is not enough information to recommend the right hearing aids!     

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Jeffrey Cline

Board Certified Hearing Instrument Specialist in Hickory

11 January 2019 - 1.08K Views

We use several test when making recommendations but it could be done as long as you have air and bone. It would how ever be nice to have speech discrimination and a few other helpful results. Most patients would be fit with binaural hearing instruments unless there is no hearing loss in the other ear. In which case a unilateral hearing loss would demand more than an audiogram to determine recommendation. We want as much information and case history as we can get when making hearing instrument recommendations. 

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Amy Swain, AuD

Hearing Healthcare Provider in Rochester

11 January 2019 - 1.09K Views

No, I need to know more about the person.   People don't go see the eye doctor and have them select their frames.  The patient needs to know what all of their choices are and what are the differences from one brand to another.

Other considerations are dexterity, cosmetics, and whether or not they are frequently in noisy places.

Audiologists look at the whole person.

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Chris Wahl, AuD

Audiologist in Tucson

11 January 2019 - 1.13K Views

No. Please do not buy hearing aids based off the audiogram alone. Go to a doctor you trust, who will help you find the best match for your needs as a person. I utilize data collected from multiple assessments in addition to the audiogram, such as otoscopy, Real Ear Measures, needs inventories and interviews to make hearing aid recommendations.
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Michael Rametta

Clinical Audiologist in Tarentum

10 January 2019 - 1.15K Views

Absolutely not!  An audiogram does nothing but give you an estimate of the amount of power you need from a hearing aid.  What do YOU need the hearing aid to do? Simply allow yourself to turn down the TV?  Enjoy music at a Jazz club?  Understand your co-workers around a conference table?  These are just a few questions to ask.  The speed and technology on the chip inside the hearing aid allow the instrument to be programmed and to react to your environments at a speed appropriate for your lifestyle.  Cost and appearance are also factors to take into account.
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Erin Burns

Professional Member

10 January 2019 - 1.19K Views

This is a difficult question. On the whole, hearing aids are all pretty good, and they all provide relatively the same function-they process sound to make soft things loud enough to hear without making loud things uncomfortably loud and without causing "too much" spectral distortion. Basically, the hearing aids are usually trying to take the place of the cochlea which isn't functioning the way it ought to.

So inasmuch as the basics are there, you can choose a hearing aid that will provide the appropriate gain or amount of loudness for a given hearing loss based on just the audiogram...just like you could choose an appropriate car for someone just on the basis of knowing they want to drive and they want to use gasoline over diesel or electric. Anything chosen would be at least right enough to provide the service needed.

However, the devil is in the details, and without knowing all the features and details a person wants and needs, you are very unlikely to pick the most right hearing aid for a person.

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Discussion

Julie N
Julie N 10 January 2019
The audiogram offers a good starting point, allowing us as providers to assess which devices are capable of accommodating hearing needs, but that is only part of the equation. Other factors that contribute to choosing which hearing aids would be appropriate include age, lifestyle, user preference for style and size, dexterity (if that is a concern), resistance to moisture, dirt and debris, accessibility to other devices such as FM systems (for students and classroom use) and remote controls, connectivity to Bluetooth (iPhone versus Android streaming), and battery preference (disposable versus rechargeable and battery pills versus encased lithium ion batteries). Most of these factors, as well as many others will and should influence the selection process.
Rachel B
Rachel B 10 January 2019

I agree with those statements above regarding why this is not the best way to prescribe the best hearing aid for an individual.

The first question I ask of every patient is, "What 3 specific situations can you name right now in which you want hearing aids to help you hear better?" The answers to that question is just as important to me as the audiogram due to the variety of features available in the various technology levels amongst the 7 major manufacturers of hearing aids. All of the other considerations listed above are also a part of the equation. I could have two patients with the exact same audiogram that will prefer and function best with two totally different devices.

I hope this helps!

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