Devices

devicesHealthy Hearing & Balance Care offers a complete range of technology for the prevention and rehabilitation of hearing loss and tinnitus. Our audiologists are qualified and accredited to provide the best hearing solution by selecting, fitting, programming and maintaining the following devices of all available manufacturers in Australia.

When considering hearing rehabilitation the first step is to visit an independent audiologist who will provide unbiased advice. There are more than 300 hearing aids from different manufacturers available in Australia. They come in different sizes, shapes, colours and prices. It should however be kept in mind that hearing aids are medical devices and not fashion items. Although important to consider the cosmetics characteristics of a device, the most important is the suitability for one’s hearing profile.

Hearing Aids

At Healthy Hearing & Balance Care we provide hearing aids as part of the hearing rehabilitation of patients who are interested in fully engaging in the process with our audiologists. We believe in a customised approach where everyone is an individual with specific hearing needs.

Unlike many other practices, we are not a retail hearing aid outlet.  We are a tertiary referral source and specialise in helping patients with complex hearing needs. A hearing aid is one of the instruments we use as part of the hearing and communication rehabilitation process.

These days, hearing aids are readily available even over the internet. There are a range of hearing aid retailers in Australia either owned by hearing aid manufacturers or by large corporations such as pharmacies and supermarkets.   At these establishments hearing aids are sold at a variety of prices ranging from very cheap to extremely expensive. These places usually advertise a range of services including hearing tests, “free of charge”. Those offering “free-services” tend to overcharge for hearing aids. Those offering cheap hearing aids are likely to offer unauthentic inferior products. Their ongoing services are more often than not questionable and unreliable. We know this because many unhappy people end up at our clinic after dissatisfaction and disappointment with such services.

Fees for hearing rehabilitation services in Australia are most commonly bundled into one package where a large sum is charged to cover the hearing aids and all the assessments, fitting, programming and ongoing services for a period varying from 6 months up to 3 years. This approach is misleading because it gives the impression that you are paying for the hearing aid only and all the other services and procedures, fundamental for a hearing aid to work, are offered for free. This common pricing strategy also means that those who acquire a hearing aid and are less dependent of the audiologist for their ongoing hearing health will pay far more than those who need more frequent visits to the clinic to be able to manage their hearing loss.

Since 2011 Healthy Hearing & Balance Care has adopted an unbundled structure of fees. This means that all the services required for a successful hearing rehabilitation program have been itemised and charged according to its provision to each individual patient. This also means that the price of the actual hearing aid is lower as the services and costs are no longer bundled together. Patients are only charged for the procedures they require and pay for each service as they receive. While we try to keep our prices as low as possible we also need to generate a margin of profit which will ensure we remain in business to provide much needed audiological services to our community.

Hearing aids in Australia are commonly offered on a return for credit basis with a trial period of around 4 weeks. We also follow a 4 weeks hearing aid trial policy although we do not fully agree with this principle. The reason we do not agree is because, as highly qualified and experienced professionals, our audiologists are capable of guiding our patients to make the appropriate decision regarding the most suitable device for their needs. Successful results do not rely solely on the technology of a hearing instrument but more so in the professional expertise used to select the appropriate device, to program the aid, verify the results and rehabilitation protocols.

At Healthy Hearing & Balance Care we expect that a patient who engages in the hearing rehabilitation process with us is someone who is experiencing real difficulties with a hearing loss and who is serious and ready to take this step. This person comes to our clinic based on trust in our expertise and is committed to work with us towards achieving his or her goals.

If you choose to engage in the hearing rehabilitation process at our clinic you will undertake a series of diagnostic hearing and ear function tests to ascertain the origin, characteristics and prognosis of your hearing loss so that your rehabilitation plan can be customized for your profile. The appropriate hearing instrument, when required, will be selected according to your needs and budget.

Healthy Hearing & Balance Care’s audiologists have access to all hearing instruments available worldwide. Professional audiologists have hearing instruments distribution rights and buy directly from the manufacturers.  Our preference is to select the most reliable, efficient and economical for each of our patient’s needs regardless of brand.  If you have a preference we are happy to oblige as long as it is suitable for your audiological profile.

You may also choose to buy your hearing aid elsewhere and we will be happy to include the device in your rehabilitation plan. However we will not be able to honour the warranty, the authenticity and reliability of a product which was not sourced by us.

If you are serious about your hearing and want a successful result we will be happy to provide our itemized list of procedures and fees involved in this process.

You may also wish to browse the internet to become familiar with available hearing aid technology to help you make an informed decision prior to your first consultation with our audiologists.

We provide below a list of reliable websites of reputable hearing aid manufacturers:

  • www.bernafon.com
  • www.evertone.com.au
  • www.oticon.com
  • www.phonak.com
  • www.resound.com
  • www.siemens.com
  • www.sonici.com.au
  • www.starkey.com
  • www.unitron.com
  • www.widex.com

 

Hearing Aid News – Is invisible better?

Hearing aids have become smaller again, and this time inserted even deeper in the ear canal. Our audiologists have long been advocates of completely in the canal hearing aids (CIC). This style is our first choice whenever suitable for an individual’s hearing loss and ear canal size. They provide a more natural perception of sound due to microphone placed right inside the ear canal mimicking normal hearing physiology. This style facilitates sound localisation and is straightforward to use on the telephone and with headphones.

There are currently two new styles of even smaller completely-in-the ear canal hearing aids: “disposable extended wear” and “reusable self-insertion”.

Disposable extended wear style, brand name Lyric by Phonak, is inserted by the audiologist in the clinic under a microscope and remains in the ear 24/7. At the end of its battery life, which lasts for up to 4 months, the hearing aid is removed by the audiologist in the clinic, totally disposed and replaced with a completely new unit. It offers an advantage for those with dexterity problems who have difficulties handling the insertion and removal of a small hearing aids and battery replacements. The disadvantages are the extremely high ongoing costs, increased risk of ear infection and the possibility of the battery running out before you made an appointment with your audiologist to acquire a replacement unit.

Reusable self-insertion styles are currently made by all manufacturers marketed with different names such as such “Soundlens” by Starkey, “Nano” by Phonak, “Invisible-in-the canal (IIC)” by Bernafon, Oticon, Siemens and Widex, and “Micro-CIC” by Unitron.

Just as small as the Lyric, these non-disposable hearing aids are first fitted by the audiologist in the clinic and subsequently inserted and removed by the user every day. The battery is also replaced by the user but only lasts for about 3 to 5 days. At the end of the battery life the user disposes the old cell and replaces with a new one – no need to buy a new hearing aids – just ensure you stock lots of size 10 batteries.

Water resistant: Both “extended wear” and “self-insertion” styles are not fully water proof but can be used in the shower and while swimming on the surface, providing a swimming cap or an ear plug is used to protect the hearing aid.

Limitations: Either style is not suitable for everyone, as deeper insertion requires a fairly wide ear canal. Both styles are contra-indicated for ears with a perforated tympanic membrane and recurrent ear infections.

Implantable Hearing Devices:

Healthy Hearing & Balance Care director Dr Celene McNeill has been working with implantable hearing technology since 1995. Celene fitted the first BAHA and the first Medel cochlear implant in Sydney and has published several scientific articles and presented at international conferences on the topic of cochlear implants and bone anchored hearing aids.

As technology advances more adults with acquired and congenital hearing losses are taking advantage of implanted hearing technology, as there is no age restriction. One can be as young as 3 months or as old as 99 to benefit from an implant.

There are currently different options available to address a variety of hearing disorders.

Cochlear implants electrically stimulate the hearing nerve directly via electrodes implanted in the cochlea and connected to an external sound processor via a magnet placed under the skin behind the ear. It is suitable for those with more severe sensorineural hearing impairments with an intact auditory nerve.

Electro- Acoustic stimulation (EAS) or Hybrid is a combination of a cochlear implant and a conventional hearing aid in the same device. The indication is for those with reasonably good low frequency hearing and no hearing in the high frequencies. The cochlear implant portion of the device provides the high frequencies electrically and the low frequencies are acoustically supplied by a hearing aid.

 Bone anchored devices also known as BAHA  provides hearing via bone conduction stimulating the cochlea through vibration of the skull. The implant is placed on the mastoid bone and connected to an external speech processor via an abutment implanted on the skull  or magnet under the skin, depending on the model.  They are suitable for those who have a hearing loss due to external or middle ear disorder such as malformation of the external ear, chronic ear discharge and allergic reactions to plastic which prevent wearing conventional hearing aids. Another application is for those with one normal hearing ear and one totally deaf ear due who do not want to wear a CROS hearing aid and cannot receive a cochlear implant due to a damaged auditory nerve.

Middle ear implants also have 2 different applications. It can be implanted on the incus (one of the little bones in the middle ear) or directly on the round window (membrane that separates the middle ear from the cochlea). The incus approach is indicated for hearing losses that affect the cochlea or the hearing nerve (sensorineural hearing losses) with an intact middle ear. The round window approach is indicated for those with sensorineural or mixed (middle ear and inner ear) hearing losses.

Are implantable devices invisible?

All implantable hearing devices are comprised of an internal component which is surgically implanted by an ear surgeon and an external processor worn behind the ear which is fitted, programmed and maintained by an audiologist. They all operate on batteries. To date there is still no commercially available device totally implanted and invisible. Interestingly, conventional hearing aids are still far less visible than any implant available.

What about the different hearing implant manufacturers?

Advances in technology brought many different options  to reduce the impact of hearing loss in a hearing society. At the same time commercial interests are running high, as hearing impairment becomes a profitable market target.

There are different brands of implantable hearing technology available in Australia manufactured and supplied by different companies.

Cochlear Ltd is an Australian company leader in cochlear implant technology. It manufacturers and supply cochlear implants and hybrid devices. It has also produces the bone anchored hearing implants trade marked as BAHA, since the purchase of the Swedish company Entific Medical Systems.

Medel, an Austrian hearing implant company, has been in Australia since 2004 distributing cochlear implants, electric acoustic stimulation hearing systems (EAS) and also the middle ear implant trade marked as Vibrant Sound Bridge (VSB) with which they became involved since the acquisition of the original manufacturing company Symphonix, and more recently the bone conduction implantable device Bonebridge.

Oticon Medical is a Danish company who has recently released a bone anchored implantable device in Australia. Their sound processor Ponto is also compatible with bone implants of other manufacturer.

How do we know these devices are safe?

It is reassuring to know that these companies need to follow a very strict protocol before an implantable device can become commercially available in this country. The organ responsible is the Therapeutic Goods Administration (TGA).

In principle, an implant is indicated only when a conventional hearing aid is not enough to provide adequate hearing. The question is how is adequate hearing defined? What is adequate for some may not be satisfactory for others.

How are the results measured?

Manufacturers fund clinical trials and research to compare results and performances usually based on the final ability to recognise speech with their latest devices. Such research can be biased and used for marketing purposes.

Healthy Hearing & Balance Care Audiologists have a scientific background which allows them to critically analyse research methods and results  to help patients make an informed unbiased decision.

It is important to remember that as implantable technology progresses so does conventional hearing aids. The same end result maybe obtained with either conventional or implantable hearing devices depending on the characteristics of each individual case.

How are hearing devices funded in Australia?

Implantable hearing devices are fully covered by private health funds as they are part of the surgical prosthesis schedule of fees.

Private health funds only reimburse a minimal amount for conventional hearing aids while they are fully subsidised by the government for children up to 26 and over 65s on an age pension.

Another interesting phenomenon taking place in Australia is that hearing aid manufacturers themselves have acquired hearing aid clinics in order to guarantee the sale of their products in a very competitive market. Consumer must be aware that when walking into a hearing aid clinic they may be in fact entering into a hearing aid manufacturer’s retail shop. This situation in many instances compromises an unbiased recommendation.

Who sets the guidelines for device recommendation?

Usually the manufacturers of the device themselves set the criteria of individual’s suitability for their products. They usually have charts and tables showing the audiogram (hearing test results) of people who would benefit from their hearing devices. Surely no one knows a product better than those who make them. Their candidacy recommendations are usually correct.

There are however several overlaps in the candidacy amongst many of the devices available. It means that a person with a given hearing profile may benefit from several different technology options.

How to choose? Who to trust?

  • It is inevitable that each one will preach what they know best.
  • The manufacturers may tell that their own products are the best…
  • The surgeons may tell that implantable devices are the best…
  • Audiologists who fit hearing aids only may tell that hearing aids are the best…
  • Audiologists who do implants only may tell that implants are the best…
  • Consumers who are happy with their own devices will also tell that theirs is the best…

Implantable and conventional hearing aid technology are advancing very rapidly. Unfortunately for the implant companies, their devices require much longer clinical trials and more strict approval protocols before their release. For this reason conventional hearing aid technology available is always ahead of implantable.

This is not to say that conventional hearing aids are any better than implantable technology. There is definitively an important place for implantable devices but candidates must be aware that selection criteria overlap. Ideally, before considering surgery, an implant candidate should exhaust all the possibilities of a conventional device.

Who are the candidates for a hearing implant device?

Those with a profound sensorineural hearing loss who have very little or non-recordable hearing measured through a diagnostic audiometer are straightforward candidates for a cochlear implant, providing they have an intact auditory nerve.

Those with chronic ear discharge, malformed external ears and or chronic skin allergies, which prevent the use of a hearing aid plastic mould in the ear canal, are definite appropriate candidates for a bone anchored device.

 What about everybody else in between?

As a rule of thumb, all the others will qualify for more than one technology and may benefit equally from many of them. It is a matter of choosing which is more adequate for an individual needs.

What about choosing the correct model?

Some people believe that a device which provides benefit to a friend will automatically be suitable for them. This is usually not the case. To compare results one needs to consider causes, degree, progression and duration of hearing loss by detailed audiological assessment including life style and communication needs. Even when these factors are identical we may still not obtain the same outcome with the same device due to other individual differences.

 Who should make the choice?

Before proceeding with an implant, choose a university qualified audiologist of your trust. Have a comprehensive audiological assessment. Explore the latest advances in conventional hearing aid technology. Try the best available for your needs and undergo some auditory training if appropriate. If an implant is then recommended for your individual needs, do not hesitate. Current surgical techniques and implantable technology are safer than ever.

The following websites will help you to further understand implantable hearing technology available in Australia:

  • www.cochlear.com.au
  • www.medel.com
  • www.oticonmedical.com
  • www.sonova.com

 Assistive Listening Devices:

Healthy Hearing & Balance Care also offers a range of complementary devices to help to improve hearing capacity in  more challenging situations such as in the presence of background noise, in large auditoriums and on the telephone.

These assistive listening devices are used in conjunction with either conventional or implantable hearing instruments and can be wired or wireless connected using blue-tooth, infra-red and FM technology.

Many hearing aid models offer the option to wirelessly connect to smart phones, tablets and personal music players.

Telecoil to connect to public and personal loop systems are also available in most conventional and implantable hearing aids.

Custom- made Hearing and Ear Protection:

Hearing loss and tinnitus prevention is a core part of our services. Exposure to loud noises is one of the main causes of hearing loss and tinnitus in our society.

Our Audiologists are very skilled at taking precise ear impressions and selecting the appropriate custom made product such as:

  • Noise ear plugs
  • Musician ear plugs
  • In-ear monitors
  • Ear pieces for mobile phones and MP3 players
  • Swimmers plug
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