The End of Audiology—Maybe After seeing a cell-phone application that adjusts the slope and gain for high frequencies, I thought to myself, “The end of audiology is near.” Soon the cell phone will test your hearing and send you hearing aids. I read in the newspaper that “free invisible hearing aids are here,” and ... From My Perspective
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From My Perspective  |   March 01, 2011
The End of Audiology—Maybe
Author Notes
  • Richard S. Tyler, PhD, CCC-A, is a professor at the University of Iowa in the departments of otolaryngology-head and neck surgery and of communication sciences and disorders. His areas of interest include tinnitus and cochlear implants.
    Richard S. Tyler, PhD, CCC-A, is a professor at the University of Iowa in the departments of otolaryngology-head and neck surgery and of communication sciences and disorders. His areas of interest include tinnitus and cochlear implants.×
Article Information
Hearing Disorders / From My Perspective
From My Perspective   |   March 01, 2011
The End of Audiology—Maybe
The ASHA Leader, March 2011, Vol. 16, 26. doi:10.1044/leader.FMP.16032011.26
The ASHA Leader, March 2011, Vol. 16, 26. doi:10.1044/leader.FMP.16032011.26
After seeing a cell-phone application that adjusts the slope and gain for high frequencies, I thought to myself, “The end of audiology is near.” Soon the cell phone will test your hearing and send you hearing aids.
I read in the newspaper that “free invisible hearing aids are here,” and that this is a revolutionary FDA-approved approach. It would be necessary, however, to get a “free hearing screening” to “evaluate” my hearing loss. This screening would be performed by a “hearing professional” who would ask some “medical questions.”
How important is your hearing? If you heard only 40% of spoken words and were mailed hearing aids that improved your hearing to 50%, you would be happy. If you had seen an audiologist and been properly evaluated, fit, and counseled, however, you would hear even better.
The profession of audiology is in danger of extinction and consumer safety and well-being will be compromised. The following steps will ensure the best possible hearing health care: fit patients based on their individual needs, not average audiograms; change legislation nationwide so that hearing must be tested and hearing aids dispensed by a licensed audiologist; change the definition of hearing aids nationwide to include all devices that adjust sound to improve hearing; and change legislation nationwide so that audiologists are independently reimbursed for their health care services.
Take Time to Fit Properly
I was taught to stimulate an individual’s hearing from near threshold to the uncomfortable loudness level, using the broadest frequency response possible. There are exceptions, but generally the best fit utilizes the entire dynamic range. For example, I proposed that hearing aids be fit based on amplifying 1/3 narrow-band noises at speech levels to the most comfortable listening level (Tyler, 1986, 1991). Such an approach requires a change from current fitting approaches that are based on the average patient. Even a cell phone could measure hearing and prescribe hearing aids based on averages. It requires skill and time to adjust hearing aids for an individual.
Provide Full Service
Patients will hear better if we take the time to use an individualized approach. Many hearing aid signal processing options, such as compression, noise reduction algorithms, and highly directional microphones, would benefit from individual fitting practices. Paired comparison tests (e.g., Studebaker et al., 1980) and field trials (e.g., Tyler et al., 2008) might be required to determine the best parameters for individual patients.
Match Device Options to the Patient
A patient leaving your clinic should have the most-likely best fit, the hearing aid options that match the person’s lifestyle, and the knowledge to evaluate these options. Professional one-on-one contact is far more likely to meet the needs of an individual. Could a cell-phone app accomplish this?
Establish Reimbursement
The most important issue in the future of audiology is reimbursement. If we take more time to provide our patients with the best possible hearing, who will pay for it? Audiologists provide services not typucally covered by payers that should be reimbursed, including determination of hearing aid candidacy, hearing aid fitting and follow-up adjustments, aural rehabilitation, tinnitus treatment, intraoperative monitoring, and vestibular rehabilitation.
We need to help consumers and legislators appreciate the value of hearing and communicating and demonstrate that audiologists can provide the best hearing health care. Soon there will be hearing, balance, and tinnitus “coaches” who will not be subject to licensure. In some states a high school diploma is not needed to dispense hearing aids. Audiologists can improve efficiency and provide the most cost-effective management—and society will need to agree for us to achieve appropriate reimbursement.
Act Now
These thoughts are not new, but there has not yet been enough action. Three changes are needed:
  • Audiologists need to develop their own reimbursement system, defining services and negotiating reimbursement values.

  • Clear standards need to be established nationwide regarding which professionals should be permitted to dispense hearing aids.

  • Devices that amplify sound, such as those for hunters and cell-phone users, should be regulated and require fitting by an audiologist.

Cell phone companies have the potential to end the profession of audiology. Hearing is one of the most important aspects of people’s lives, and we all deserve to hear the best we possibly can.
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March 2011
Volume 16, Issue 3