I recently went with my son to the cinema to watch a movie when I started thinking that for some of my patients with hearing aids, this simple yet enjoyable activity can be a quite a struggle for them.
So why is hearing or rather following speech within a movie such a problem for some people who wear hearing aids and what can be done about? In a nutshell, most cinemas nowadays have what we call a room loop, infrared assistive technology or personal captioning devices available for hard of hearing patrons to make it easier for them. We will discuss the latter two options later in this post, but a room loop essentially is a metal rod with coiled wire around it which is located around the perimeter of a cinema. When current travels along the coiled wired, a magnetic signal is induced which can be picked up by a hearing aid that has a telecoil. A telecoil is a much smaller rod which also contains coiled wire found strategically placed inside a hearing aid. This allows the sound from the movie to be delivered directly to the hearing aid and is usually a much clearer and richer sound experience. Let us take a look at what a telecoil is in more detail and how to tell if your hearing aid has one.
What is a telecoil and does my hearing aid have one?
A telecoil also known as a t-coil (or T switch) is just a small component inside some hearing aids that is actually just a metal rod with a coil of wire around it. Its job is to pick up magnetic signals and convert them into an electrical signal that can be processed by the digital signal processing unit of the hearing aid. Unfortunately, not all hearing aids have this component due to space limitations or other technology such as bluetooth or wireless transceivers being prioritised.
With hearing aids getting smaller, the ability to physically house a t-coil is not always possible. The only way to know if your hearing aid has a telecoil is to ask your Audiologist. There are no identifiable marks on the hearing aid itself that can tell you if it has one or not. Your Audiologist should always give you the option of whether you would like a telecoil with your hearing aid as it has many more uses than just at the cinema.
A telecoil can make it easier to hear at the airport, bus terminal, train, art gallery, on the phone and can be used with some remote microphone devices. So I would argue that a telecoil is a feature that one should not simply disregard. Some of my experienced hearing aid patients who relocate over to our clinic having been seen elsewhere know nothing about telecoils and whether their hearing aid has one or not. They are surprised when I tell them about this feature and how they could have been benefiting from it for a while. What a shame.
I have a telecoil. How do I use it in the cinema?
A telecoil can be accessed by changing settings on your hearing aids. This can usually be done by physically pushing a button (either a rocker switch or a single switch) on your hearing aid or selecting the telecoil setting on your hearing aid remote control or smartphone app. Your hearing aids can be programmed to have different settings for different listening environments or situations. A telecoil setting can easily be programmed into you hearing aid by your Audiologist. If pushing the on-board hearing aid switch, you normally only need to do so on the one hearing aid as this will usually change the setting in both hearing aids simultaneously. You should hear 2 beeps to signify that you are now in the telecoil setting. If you are not sure, contact you Audiologist for specific instructions.
The telecoil can be programmed with either the microphones of the hearing aid switched off completely, dimmed or left on. You will get the best quality telecoil signal if you use it with the hearing aid microphones switched off. However, remember this will mean you may not be able to hear those sitting next to you which may or may not be a good thing 😊.
The next thing you need to consider is where the best place to sit at the cinema is. Although every effort is made by the sound engineers to ensure the room loop signal remains uniform in strength across the cinema, this is not actually possibly. What this means is that there will some seats where the signal will not be picked up as well by your hearing aid and hence the sound will be softer than it should. One way to get around this is to experiment yourself and sit in different positions around the cinema to find out which is giving you the best sound quality. Event Cinema (a Perth cinema chain) says that the best seats to access the room loop in their cinemas is in the middle section up the back. If you are not sure, it is always best to ask the staff at your cinema for help.
What if I don’t have a telecoil? What else can be done with my hearing aid?
Although most people with a hearing loss who wear hearing aids do just fine hearing at a cinema, this is not true for everyone. Cinemas are acoustically designed to enable the sound to be distributed evenly across the space with minimal reverberation to ensure a good quality sound regardless of where you sit. However, a good quality sound is not helpful for someone with a hearing loss if their hearing aids are amplifying it too much or not enough. If you are struggling at the cinema or have stopped going because you no longer enjoy yourself due to poor hearing, there are adjustments that can be made to your hearing aid even if you don’t have a telecoil.
One of the most important things to ensure when setting up a hearing aid for someone is to make sure that the MPO or maximum power output is set appropriately. The MPO is the maximum sound level a hearing aid can amplify too. As an Audiologist, this needs to be set high enough so that loud sounds don’t get clipped when they are amplified to reduce distortion. But we also want to make sure the MPO is set to a point that minimised loud sounds to getting painfully loud once amplified. This is always a balancing act. Chances are that if you are struggling at the cinema, the MPO of your hearing aid is set too low.
There are other tricks up our sleeve as Audiologists but this is a good place to start. Also, some hearing aids have a better dynamic range than others meaning they can amplify a greater range of sound levels without reduced sound quality. This is a feature that is being pushed now by some hearing aid manufacturers such as Signia (Motion P nx) and Phonak (Marvel platform) as they understand the importance of being able to maintain a good sound quality of amplified loud sound such as those experienced at a cinema or musical performance.
Other Cinema Assistive Listening Devices.
If you would like to know if your hearing aid has a telecoil or would simply like us to have a closer look at your hearing aids to optimise them for you, please give us a call on 08 6336 7170 today. You will speak to an Audiologist who can advise you on your next step. If you can’t come to us or are happy where you are, please ask your Audiologist to show you all that your hearing aids can do. You may be missing out on very helpful features to make your day to day communication easier and improve your quality of life.
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As a patient, it is easy to just accept the recommendations of a health professional without much thought. Sometimes this is not the best thing to do especially when it comes to Audiologists recommending hearing aids. This article is designed to inform you about what to ask your Audiologist so that you can be more confident that their recommendation is made with your best interest in mind. Below is the 5 questions I would encourage you to ask any Audiologist before investing money into a new pair of hearing aids. If your Audiologist cannot answer these questions, I would get a second opinion.
1. Ask your Audiologist to disclose to you any sales commissions or incentives they operate under.
By asking your Audiologist to disclose any incentive arrangements they have will go a long way to ensuring they only recommend what is clinically appropriate for you in your situation. Their readiness and willingness to divulge this information will tell you if their advice and recommendations is something to trust or be mindful of.
2. If your Audiologist recommends a higher level technology hearing aid, ask them what test results or other clinical information have they used to arrive at their recommendation.
Your Audiologist should be able to explain to you in layman's terms how they arrived at their recommendation and why cheaper hearing aids are not appropriate for you. They should be able to demonstrate or highlight the specific hearing aid features in their recommended device that are designed to help you achieve a specific communication goal of yours. If they cannot, I would be doubtful whether their recommendation is grounded in valid and defensible clinical or scientific reasoning.
3. Ask you Audiologist to explain why the hearing aid they have recommended you is more appropriate than say a similar one from a different brand and whether they have any business agreements in place with their preferred manufacturer.
While it is common for Audiologists and Audiology clinics to have a preferred manufacturer, a lot of Audiology Clinics out there are actually owned and run by a hearing aid manufacturer. This means that your choice of hearing aids is limited to their specific brand. You are entitled to request information about all options available to ensure your investment is both informative and the best for your needs. How unfortunate would it be to spend all this money on a specific hearing aid only to find out that another brand would have been more appropriate.
4. Ask your Audiologist for a trial of the recommended technology before purchasing it.
Trying before you buy can be a great way of determining the potential benefit of the recommended hearing aid. I would recommend trialling at home or in the environments you are having difficulty in. If this is not possible, I would at least ask your Audiologist to simulate these situations and measure your speech perception with the hearing aids in. Ideally it would be good to compare your performance with more basic hearing aids if possible. Although trialling a hearing aid over a day or a week is good, performance can improve over time as your brain gets better at using and extracting meaning from the sounds it hears.
5. Ask you Audiologist for examples or testimonials of patients they have seen to demonstrate to you the outcomes they can achieve.
Although every patient is different, it would build confidence in you to see examples of patients from a variety of background who have purchased basic hearing aids as well as more sophisticated hearing aids to see how they have fared. It would be good to see that your Audiologist is able to help patients obtain good results no matter what hearing aid they choose and that these patients are happy with their results. Sometimes this information is not readily available but most clinics conduct patient satisfaction surveys which can be shared.
Commission Based Hearing Aid Sales - Why This Should Stop
It has been well documented over the last few years of the exploitative behaviour of some in the hearing aid industry who pray on vulnerable seniors and anyone for that matter who require hearing aids (ACCC enquiry, ABC report).
More recently this was again highlighted on Radio National and ABC Perth (1 hr 34 minutes into the drive program). This article will examine the nature of commission based hearing aid sales incentives and 5 ways you as a patient can mitigate it.
See also: How Pristine Hearing goes about helping you choose the right hearing aid
As an Audiologist who has been in the industry for many years now, I have seen sales incentives for Audiologists provided in a few ways. Generally speaking, the most common way to incentivise an Audiologist is to provide them commission in the form of money when a patient purchases a hearing aid they have recommended. This is quite common among the large hearing aid clinic chains who are owned by hearing aid manufacturers. Instead of paying their Audiologists a fixed remuneration like Independent Audiology clinics do, commission from hearing aid sales is added.
Companies will usually use a sliding scale meaning the more expensive hearing aids attract a higher commission compared to the less expensive ones. Below is a table that highlights how much money an Audiologist may make from commissions they receive from hearing aid sales. The commission rate is based on word of mouth and personal experience.
So as can be seen in the table above, these sales incentives are like waiving a carrot in front of a rabbit. You would be crazy to think such a model would not cloud the judgement of some Audiologists recommending hearing aids to their patients.
Another model that is used by some clinics is to provide the same commission rate regardless of the hearing aid purchased. So for example a rate of 6% maybe used across all hearing technologies. Although on face value this seems better, in reality it still serves as a way to interfere with Audiology hearing aid recommendations as a more expensive hearing aid will still attract a higher commission. In other words, 6% of a larger number is still more than 6% of a smaller number so the incentive is their to recommend a more costly hearing aid.
Let's look at an example. Let's say John, a 68 year old gentleman, goes to an Audiologist for help searching for hearing aids. His Audiologist performs the standard hearing tests and asks John about his background to get a feel for his situation. When it come to discussing hearing aids, John is told that he needs one of the better hearing aids available. John, not being the questioning type, accepts this recommendation. Being a more expensive hearing aid, John's Audiologist is set to pocket a larger commission compared to the lesser amount had more basic hearing aids been recommended.
The question here is has this carrot waiving sales incentive in the form of a commission clouded the judgement and device recommendation made by the Audiologist? I recently had a patient who told me his brother had purchased hearing aids from a national audiology chain 4 years ago. His brother paid a lot of money for these hearing aids but was told by his Audiologist not long ago that he needed better hearing aids already. There was no clear justification provided for this which I was aghast at. Such blatant mistreatment of patients is something our industry needs to stamp out.
Coming back to other sales incentive programs that have been used in the industry include providing trips for staff who "sell" the most hearing aids as well as other competitions. Companies I have worked for in the past would run competitions between clinics to push the selling of higher level technology hearing aids and assistive listening devices. I found this kind of environment counter productive and did not highlight or acknowledge Audiologists who would simply recommend devices based on defensible clinical reasoning and who consistently obtained great outcomes for their clients irrespective of the devices they had chosen.
I'm not saying that all Audiologists who work with these kind of sales incentives are compromised. All I am saying is why take the risk. Audiology as a profession needs to move away from any kind of sales incentive model and rather focus solely on better patient outcomes. Hearing aids are a medical device and should be recommended or prescribed based on need and specific clinical and medical factors. As soon as our profession bans sales incentives of any kind, the sooner ALL patients can feel like their Audiologists have their best interest in mind.
To this end, Audiology Australia recently put out a public statement relating to their position around commission based hearing aid sales. This can be read here but a summary is provided below.
Audiology Australia, in our response, has called for commissions linked to sales of hearing aids to end...Audiology Australia continues to support the ACCC’s 2017 recommendation that the industry needs to prioritise remuneration structures that reward service and quality advice ahead of sales."
I am very pleased with Audiology Australia's position on this which is far more definitive than any of their positions in the past. I do however, welcome stronger regulation from them in this regard. Audiology Australia also has a complaints handling system that patients can access if they feel they have been given questionable advice from an Audiologist.
Independent Audiologist Australia (IAA) is an organisation that represents the owners of Independent Audiology Clinics in Australia of which I am one. Their position is similar to Audiology Australia and go on to say that "commissions or bonuses contribute to high hearing device costs, create conflicts of interest and are not usually transparent to patients or their referring doctors." For more details about IAA's position as well as other negative factors associated with commission based hearing aid sales, visit the link here. IAA also placed an advertorial in the online Seniors Newspaper recently which comes down hard on those clinics who still use these incentive schemes and promotes that patients only go to Independent Audiology Clinics for unbiased ethical advice regarding their hearing. I recommend you reading this article here.
If you are patient needing help with your hearing and are likely to need a hearing aid I would recommend you go to an Independent Audiology Clinic like Pristine Hearing who unashamedly promotes their clinic as a SALES COMMISSION or SALE INCENTIVE free zone. I know I would feel more comfortable in that kind of clinic as well as feel more confident in any recommendations made to me by their Audiologist.
If for whatever reason you can not be seen by an Audiologist from an Independent Audiology Clinic, the above list of 5 questions you should ask your Audiologist should keep you in good stead.
Not one to pump up our own tyres but Pristine Hearing is a proud Independent Audiology Clinic that does not have any sale commissions or incentives which could cloud our hearing aid recommendations or any device for that matter. Our only incentive is good patient outcomes. This means our recommendations are usually made in conjunction with the individual and/or family and have clear clinical reasoning behind it. We will usually educate our patients about hearing devices from multiple brands and highlight the key features that are relevant and are connected to a communication goal the patient is trying to achieve. We conduct clinical tests that are necessary for building a picture of the patient's physical hearing abilities to determine likely outcome with basic versus more sophisticated hearing aids. Lastly, Pristine Hearing offers FREE trials and a 60 day MONEY BACK guarantee to give our patients piece of mind.
If you would like the privilege of being seen at Pristine Hearing to achieve the hearing results you deserve, call 08 6336 7170 or book online today.
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Michael is a very thorough and experienced Audiologist who takes pride in ensuring his patients are listened to, valued, respected and achieve the best results possible. He has worked as a Senior Audiologist seeing a broad case load from young infants right up to complex adults who require more specialised audiological care and management. Apart from Audiology, Michael has a Bachelor in Electrical Engineering and Applied Mathematics from The University of Melbourne. When you see Michael for a consultation, you will wonder why you never saw him sooner.