This expose reveals a number of issues relative to
the circumvention of professional diagnosis and care
when one purchases hearing aids through internet or
mail order. Reader inquiries may be directed to
digicarenet@aol.com or faxed to 719-676-6882.
Internet Hearing Aid Sales: Boon or Bane for the
Consumer?
by Max Stanley Chartrand, M.A.,
DigiCare Hearing Research & Rehabilitation
Fifteen years ago, this author published an article
titled “Mail Order Hearing Aids: Boon or Bane?”
(Hearing Journal/1988). The conclusion at that time
was, because of the enormous complexity of human
hearing and an elaborate regulatory system in place
to assure consumers of certain standards of care,
that hearing aids obtained by mail fell far short of
not only hearing health advancements, but also the
legal requirements set in place to protect
consumers.
And now, many years later, we find the issue needing
addressed, but this time around we find the rising
offender are sales of hearing aids via the Internet.
This, of course, frames the question in no less
crucial terms, but instead adds another dimension,
since Internet is a 24/7 access to an unsuspecting
public.
Invalid testing via Internet
At least this time around, there is some pretension
toward obtaining some kind of hearing test. Forget
calibration and a sound controlled environment.
However, making that leap of logic only exposes the
prognosticators to a host of other regulations:
ANSI, state licensing law, and scope of practice.
And what about otoscopy, middle ear assessment,
calibrated pure-tone and speech audiometry, a sound
controlled environment, and professional audiometric
interpretation? Experience tells us that it is
virtually impossible to obtain the necessary
information in any manner outside a properly
sound-controlled environment using calibrated
equipment by a professional who has demonstrated
appropriate levels of competence in the testing of
human hearing.
If this were not the case, consumers would be buying
hearing aids out of Radio Shack and K-Mart, where
mass production and one-size-fits-all takes
precedence over customization and calibration. For
this reason and much more, it is illegal to sell
hearing aids in all fifty states without observation
of many laws and regulations that are in place for
the express purpose of watching out for the
consumer’s best interests. Manner of delivery is
beside the point, although at least a half-dozen
states strictly forbid distance sales (and
purchases) of hearing aids. Internet sales are still
“mail order” regardless the more sophisticated
marketing façade.
What about the FDA Red Flags?
Moreover, there are good reasons why we have the
United States Food and Drug Administration Hearing
Aid Regulation, not the least of which is to assure
the public health and safety. For instance, under
the Red Flag conditions alone, there have been
identified hundreds of otopathological conditions
that require medical referral, including:
§ Tumors of all kinds, including cholesteatoma,
glomus, osteoma, ulcerated squamous carcinoma,
hematoma, acoustic neuroma, and vestibular
schwannoma.
§ Serious, insidious infections, such as
pseudomonas, candida, staphylococcus aureus,
otomycosis, meningitis, or neuritis statoacoustica.
§ Undetected trauma from past accidents, such as
temporal bone fracture, labyrinthine concussion,
acute acoustic trauma, or Caisson disease.
§ Undiagnosed inner ear conditions that could cause
sudden and complete hearing loss, such as Meniere’s
disease or syndrome, cochlear stroke, allergy, or
ototoxicity to medication.
The list of potential oto-related danger signals,
many of which get bypassed during routine physical
exams, is quite long. Detection and treatment often
requires the services of clinical audiologists and
otolaryngologists. Hearing instrument specialists
are also required to undergo extensive training to
detect the “Red Flag” conditions, and to make
immediate referral when any of these present during
the hearing test. To intentionally bypass these
consumer safeguards is not only unethical, but
clearly illegal under current state and federal
regulations. And that is precisely what is done
through internet sold instruments.
Do these devices pose a genuine threat?
Here is a small listing of dangers---some physical,
some financial, some practical---potentially
involved in such sales:
§ Overamplification or misapplied frequencies to the
cochlea can cause permanent tinnitus (ringing in the
ears) for life.
§ Like wearing eyeglasses that are not suited to
one’s visual needs, the physioacoustic
characteristics of an improperly fitted ear can
change with the distortions and mismatches of these
devices. Some changes are permanent.
§ Since they purchased these devices without benefit
of the proper examinations, life-threatening
conditions continue undetected and untreated,
including more benign conditions, such as impacted
wax, middle ear fluid, etc.
Other reasons why hearing aids obtained outside
legal channels can be a detriment for the consumer
are:
§ Unnecessary hearing aid purchases ostensibly to
correct a loss that may be a result of a medically
treatable condition.
§If hearing aids were “tried” by the consumer in
this manner, and found to be wanting (which is
usually the case), it would serve to delay getting
the needed help for one’s hearing loss.
§ It is virtually impossible to make and fit a
proper earmold without a professionally administered
ear impression, including accommodation for
individual neurophysiological characteristics. Every
ear is different, and being off slightly can cause
discomfort, loss of natural ear canal resonance, and
failure to fit.
§ ANSI and FDA-required quality controls cannot be
assured, making the quality of such purchases
questionable at best, and substandard at worst.
Under this reasoning, if one were to spend just $100
for their Internet hearing aid, they would have
spent $100 too much!
§ Auditory rehabilitation is a complex and
customized process. It requires the guidance of
those who trained and equipped to do this on a
one-on-one basis. It cannot be done at a distance,
as some would suppose. Below, are listed some
references to help the reader get a better picture
of the vast body of considerations when designing an
effective counseling and rehabilitative program for
the hearing instrument patient.
§ This form of marketing requires no up-to-date,
specialized training on the part of the
merchandisers. All one needs to do is attend any of
the thousands of seminars and workshops at the
American Academy of Audiology, International Hearing
Society, American Academy of Otolarynoglogy-Head &
Neck Surgeons, and many other professional
organizations to find out why it is important that
one’s hearing professional stay on the cutting edge
of the profession. To offer any less is an
abrogation of professional responsibility.
In sum, Internet and mail order hearing aids are not
the bargain they pretend to be. For their proponents
cannot build and market a one-size fits all hearing
instrument for any less than the legitimate system
does, yet they often claim they can in their
marketing materials.
However, the biggest difference is what is being
left off: Consumer protections, professional
services, and the part that is most important, an
auditory rehabilitation program that helps consumers
make the most of their hearing health investment.
These added-value services are nothing to sniff at,
and certainly, if leaving them off was a feasible
method of marketing hearing aids there would be no
need for the myriad regulations and well-defined
protocols that were put in place to protect the
consumer.
For a better picture of what true auditory
rehabilitation entails, I direct readers to the
website of the DigiCare Hearing Health Network at
www.digicare,org. There, they’ll find many more
reasons why the best bargain in health care are the
quality services and products of provided by
America’s Hearing Healthcare Team!
Dr. Chartrand serves as director of research at
DigiCare Hearing Research & Rehabilitation in
Colorado City, Colorado. Correspondence:
chartrandmax@aol.com or by faxing to 719-676-6882.
Editors note: Parts of this article are also
included in a multiple-authored version published by
Audiologyonline and HealthHearing newsletter.
Reprinting is granted only by keeping credits and
references in tact, and that it is used for
educational purposes only.
Suggested readings
1. Durrant, J.D., and Lovrinic, J.H., Bases of
Hearing Science, 2dn edition, Baltimore: Williams &
Wilkins, pp. 248-250 (1984).
2. Chartrand, M.S., “Video Otoscopy Observation &
Referral: The FDA Red Flags”, Hearing Professional,
Jan.-Feb. (2003).
3. Chartrand, M.S., and Chartrand, G.A., The Nuts &
Bolts in Solving Problem Fitting Cases, a 12-hour
continuing education course, Livonia, MI:
International Institute for Hearing Instruments
Studies, (2002).
4. Chartrand, M.S., Hearing Instrument Counseling:
Practical Applications in Counseling the Hearing
Impaired, Livonia, MI: International Institute for
Hearing Instruments Studies, pp. , (1999).
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