Online Hearing Aid Purchasing Deal or No Deal

Online Hearing Aid Purchasing: Deal or No Deal? Suzanne H. Kimball, Au. D, CCC-A Assistant Professor Illinois State University Normal, IL

Internet Purchases n What types of things do you purchase over the Internet? q q q Apparel Toys Medications Books, DVDs Travel Etc.

Online Purchasing n According to e. Paynews. com, total amounts of online purchases for 2004 may be about 65 billion dollars. Estimates for 2008 are in the area of 117 billion dollars. By 2008, about 50% of Internet users are expected to purchase products online.

Bottom Line n Questions and debate about the ethics and issues of online hearing aid dispensing has become of increasing importance as the prevalence of general online purchases of goods rises.

Did You Know? n n Numerous Internet sites are available where consumers are given the opportunity to purchase hearing aids over the internet without any human contact. These are not necessarily “hearing amplifiers” which have been on the market for years, but rather name-brand, leading manufacturer devices that are the same as those sold in our private practices and clinics.

What is required to purchase a hearing aid online? n For some sites: q q An online hearing test A “homemade” earmold impression Medical waiver $$$$

Online Hearing Test Study n n Many internet sites that offer online hearing testing stand by the reliability and accuracy of their test. One site claims that their “test delivers results that are typically within a 5 d. B variance of a professionally administered test”.

History n The sale of hearing aids over the Internet is a fairly recent phenomenon, but consumers looking for a great deal, is not. According to Schillinger (2003), online purchasing represents the latest way for bargain hunters to get door-to-door delivery of hearing aids without the expense and hassle of an office visit to a doctor or to a hearing healthcare professional.

How much of a problem is it anyway? n According to Schillinger (2003), Internet hearing aid sales are growing rapidly. In 1997, “distance” purchasing had less than 1% of the market share, whereas guesstimates based on 2002 consumer polling were that approximately 185, 000 hearing aid shoppers in the U. S. were interested in purchasing a hearing aid online. Given the vast usage of the Internet in 2007, more recent numbers may be even higher.

Research Purpose n n The purpose of the first study was to challenge the claims of one online company that the hearing test taken via their website was comparable to traditional audiological testing. Subjects in three age groups took an online and a professional hearing test. Results were compared across age groups and overall.

Hearing Test Study n 3 subject groups (81 total participants) q q q Group 1: Less than 30 years of age (N=26) Group 2: 30 -64 years of age (N=26) Group 3: over 65 years of age (N=29)

Study n n All subjects were asked to take an online hearing test as prescribed by the website. Subjects were asked to follow the directions as stated on the website which included plugging in headphones and adjusting the computer volume.

Study n After the completion of the online test, subjects then received a hearing test in a sound-treated room using standard test procedures and calibrated audiometric equipment. The test was completed by a licensed/certified audiologist or a secondsemester Au. D student.

Study n Approximately one-half of the subjects began the computer test first, whereas the other half began with the test suite hearing test first.

Results n Results, obtained at the. 05 confidence level, indicated statistically significant differences between the online and professional testing conditions across all groups and by individual age groups.

Mean Differences in d. B Right Ear

Mean Differences in d. B Left Ear

Discussion n n Results of this study suggest that the outcomes of online hearing tests are significantly different from the outcomes of traditional audiometric testing. Additionally, participants among all age groups, but more predominately in the elderly group, displayed difficulty in performing the online test procedure, especially in the setup portion. In some instances, the participants had to receive computer help to complete the online test.

Discussion n What is the clinical impact? q q Misrepresentation of severity of hearing loss Prescription for hearing aid settings in question Ethical practices Lack of professional service

Phase II/Earmold Study n n Data from 83 subjects Three age groups q q q 18 -30 (N=35) 31 -59 (N=26) 60 and over (N=22)

Earmold Study n n First, we contacted an online company and obtained a “kit” for the purpose of making an impression at home (anonymously). We then replicated the kit for use in the project.

Earmold Study n The kit included: q q q a polyethylene syringe one pack of silicone earmold impression material (to make 2 impressions) a medium cotton otoblock a cotton swab (which you were to obtain from your own home, but we including in our kits) two sets of instruction

Earmold Study n n n Each subject was asked to pair with a partner (either a friend, family member or spouse) Each person was given a kit Each subject pair was asked to follow the instructions and make an impression on one ear of their partner, and then switch places and have the partner make on them.

Earmold Study n Research team was present in the room the whole time q n IRB insisted Team consisted of one licensed and certified audiologist and 2 third-semester Au. D students

Earmold Study n n When the subject pair finished, they then had an impression made on the same ear by a member of the research team. The research team used: q q q an otoscope a polyethylene syringe differing sizes of foam otoblocks silicone impression material an ‘earlite’ to place the otoblock in the ear canal.

Earmold Study n After the impressions were completed, subjects then were asked to complete a survey about their overall experience both when they made their own impression and when they had one made by the researchers.

Judgment of Impressions n Once the impressions were all completed, they were sent to a leading hearing aid manufacturer for evaluation.

Judgment of Impressions n Two audiologists employed at the manufacturer evaluated each impression as to how complete the impression was (study was blind). The following criteria where utilized: q q q 1) Is the impression smooth and complete? 2) Is the canal long enough to show the beginning of the canal’s second bend? 3) Is the helix portion of the impression clearly defined? 4) Is the tragus portion of the ear clearly defined? 5) Is the concha complete?

Scoring n n These criteria were used because they are considered the most important factors in making an earmold impression according to the earmold lab industry. One point was given for each category for a total of 5 points. q q A score of 0 meant none of the criteria were met A score of a 5 meant that all of the criteria had been me

Results n n Ratings values were averaged for both judges’ for each impression (A [amateur] and B [professional]). A two-sample T-test was utilized to determine significance.

Results n Results at the. 05 confidence level indicated that a high level of significance (P = 0. 000) existed between the two groups of impressions.

Results n To determine if age was a factor in the subjects’ ability to make an impression, a regression analysis was performed.

Survey Results n 83 subjects completed the survey: q q q Question #1: How comfortable were you with the process from the beginning? Question #2: How comfortable were you with your partner making the impression? Question #3: How comfortable with the researchers? Question #4: Was the “feel” different and how? Question #5: How likely are you to make an impression at home for the purposes of purchasing a hearing aid?

Survey Results n n n #1: The average score was a 3. 301. #2: Making themselves: mean score 2. 77 #3: Research team: mean score 4. 48 #4: 66 out of 83 participants described the impression taken by the research team as being either firmer, deeper in the canal, tighter, fuller, more uncomfortable or having more pressure #5: 58 subjects answered that they were “not willing” to make one at home, whereas 17 said they were “possibly willing” and 8 said that they were “very likely”

Discussion n n The results of this study suggest that having average consumers make earmold impressions without professional assistance is a difficult task at best. Approximately 50% of the participants selfproduced earmold impressions that received a score of 2 or lower (0, 1 or 2) and almost 80% received a score of 3 or lower. Only 20. 5 % of the “amateur” impressions were rated with an average score of 3. 5 or higher.

Discussion n n In contrast, over 97% of the impressions produced by the research team received a score of 3. 5 or higher, with only. 02% of the “professional” impressions scoring a 3. Almost 93% of the impressions made by the research teams rated at a 4. 0 or higher, with 25. 3% scoring an average rating of a perfect 5. There were 0 impressions produced by the research team that received a score lower than a 3.

Discussion n Think safety first! q q q In the January 2002 issue of The Hearing Journal, Dr. Robert Martin writes an article about how to avoid injuries while making earmold impressions. One point from that article indicates that, “proper lighting, a good view of the ear canal, proper equipment, and the amount of pressure used in squeezing the syringe” are important issues in impression making. None of these are available with the homemade version!

Discussion n Think fit second! q The Hearing Review (May 2006) Pirzanski states that “with a shallow otoblock position, the impression material will not stretch the cartilage within the seal area, and the resulting earmold may fit loosely, have retention problems, and be susceptible to acoustic feedback”

Discussion n What does it mean clinically? What “point value” would cause an impression to need to be remade? q q Depends…on the style of hearing aid purchased. Example: CIC needs canal length, but less important for concha

Liability? ? n Think liability third! n Should patients sign waivers regarding to indicate that they are “taking their own risk” when making impressions at home? Is it the liability of the online company? n

November 5, 2007 Update n n Oticon sent a letter to all distributors stating that their hearing aids must be dispensed face to face and cannot be dispensed via a catalog, mail order or over the Internet. Ebay states: “ATTN: Important notice to our loyal EBay customers. Due to changes in Oticon policy, we will not be re-listing this product after the current listing expires. This affects all internet sellers of Oticon products. We apologize for the inconvenience”.

Clinical Questions n n n Is online hearing aid dispensing legal/ethical? Is online hearing aid dispensing feasible? Is online hearing aid dispensing governed? Can online hearing aid dispensing be regulated? Is online hearing aid dispensing the future of the profession, particularly for use with the “baby boomer” generation?

Thank-you…. . n Siemens Hearing Corporation q q n Dr. Thomas Powers Nina Atchley and Linda Di. Camillo Illinois State University q q Dr. Joseph Smaldino, Department Chair Mike Sharp, B. A. , Graduate Assistant

Do You Have…. n Questions?

Contact Information n Suzanne H. Kimball, Au. D, CCC-A Assistant Professor Illinois State University Department of Communication Sciences and Disorders Campus Box 4720 Normal, IL 61790 -4720 Phone: 309 -438 -5707 Email: skimball@ilstu. edu