Hearing Fitting Standards: Why are they important?

We believe that fitting a hearing aid/s correctly is so important that we’re dedicating the first podcast series to it.

We’ll ask why we are still having the conversation about Hearing Aid fitting standards in 2022? We will reflect on the Audiology profession’s commitment to providing evidence-based clinical practises that lead to optimal patient outcomes.

Standard of practice documents outline basic services that audiologists are expected to include in the provision of quality healthcare. They reflect the values and priorities of the profession, providing direction for professional practice and a framework for the evaluation of practice. Standards of practice are prepared by subject matter experts, based on available evidence, peer-reviewed and subject to periodic updating.  The UK currently has Audiology protocols in place, which has recommendations, leaving room for interpretation from time to time.

To discuss Audiology Hearing Aid fitting standards, Julia van Huyssteen is joined by Dr. Gus Mueller who has extensive expertise in the sector: He is a consultant for WSAudiology and Contributing Editor for AudiologyOnline. He is also a Founder of the American Academy of Audiology and co-author of 12 books on hearing aids and hearing aid fitting, including the recent three-volume Modern Hearing Aids series, and the clinical text on Speech Mapping and Probe Microphone Measures.

Gus is the co-founder of the popular website www.earTunes.com

www.gusmueller.net

In this first episode Julia and Gus talk about the relevance of hearing fitting standards and how it differs from recommendations.

Sounding It Out has been produced by Annie Day. A Fresh Air Production for Signia. 

See omnystudio.com/listener for privacy information.

Episode Transcript

Julia Van Huyssteen (00:09):
Welcome to the first episode of Signing It Out, brought
to you by Signia, UK and Ireland. I'm Julia Van
Huyssteen, the Head of Audiology at Signia, and I'm so
excited to be hosting this new series. Hearing health is
something I'm really passionate about, as I've seen firsthand the
impact of giving back the gift of hearing. And believe
me, it is rewarding. Consequently, I can't wait to share

(00:32):
this project with you all. We wanted to launch this
series because we want to educate, we want anybody and
everybody to benefit, regardless of whether you use our technology.
We're starting this series talking about an important but often
undervalued topic, hearing aid fitting standards. Our first guest is
legendary audiology expert Dr. Gus Mueller, and he is an

(00:53):
author many times over, and Founder of the American Academy
of Audiology, amongst many, many other things. He's come to
the UK all the way over from tropical Bismark in
North Dakota. Dr. Mueller, welcome to our inaugural episode, and
thank you for joining us.

Dr. Gus Mueller (01:10):
Hey, I should be the one saying thanks. So thank
you for the invite. I don't know what makes one
legendary, being old helps. Also, just to be clear to
our listening audience, the city of Bismark is not an
island. I happen to live on a little island on
the Missouri River in the great state of North Dakota
in the US. But yes, great to be here.

Julia Van Huyssteen (01:30):
Lovely, thank you very much. So for the series, we
are delighted to say that we are joined by a
live audience. Welcome to you all, and we'd of course
love to hear any questions from you. Dr. Mueller, I'm
going to open up the floor to you with a
question that some here in the UK may think I'm
pushing the boundaries with. In the UK we have a
few overarching professional bodies that are in charge of developing

(01:52):
and maintaining our audiological protocols, and they do a great
job. But I can't help noticing that the protocols state
that they contain guidelines. Can you please tell us your
view on the difference between guidelines and standards and why the audiology
profession needs to aim for standards?

Dr. Gus Mueller (02:11):
Some of it is semantics, but I'm guessing you're referring
to the fact that I was involved with some standards
that we developed in the US. If you think about
the big picture, let's say you were having a new
house being built and it was in an area that
was prone to earthquakes. I think most of us would
like our house being built according to a standard, not

(02:31):
according to a guideline. Like it maybe sort of shouldn't
fall down, or how about a standard that just says
it will be built to these specifications. What I've seen,
what's been done in the profession of audiology, is that
we've sort of done things backwards. And that is not
only in the US but in other countries, including as

(02:52):
you mentioned here, people have developed guidelines before there ever
was a standard, which is really backwards. The notion would
be to have a standard, then you sit back and say, "
Okay, here's the standard. This is what's minimally acceptable for
us to do. Based on this standard. Now let's have

(03:13):
guidelines to how we comply with the standard." So this
is something that I was fortunate enough to help work
on a year or so ago, and there was a
group of people, I wasn't one of them, but decided
that we really should have an audiology standards organization. And
the goal of that organization then is to put forth

(03:33):
standards on a variety of topics. And one of them
is hearing aids.

Julia Van Huyssteen (03:38):
Thank you very much, and we will actually be doing
a deep dive into those standards within the next few
episodes. So thanks for alluding to that. Now, you did
make several very valid and vital points. We need to
have standards that tell us what is the right thing
to do. Now with guidelines, there are room for interpretation
and therefore also making mistakes, which individuals can then often

(03:59):
be oblivious off. They may not know. Now, we've recently
had a whistle blowing incident in the UK where a
series of mistakes made by a certain trust led to
several children with severe to profound hearing loss being undiagnosed
until a much later age. Now, upon investigation, it was
clear that there was room for interpretation with some of
the protocol recommendations. Now my question to you is, how

(04:22):
specific and direct do we have to be with our
audiological standards?

Dr. Gus Mueller (04:27):
Yeah, well again that goes back to the difference between
a standard and a guideline and best practice. So here
would be an example. I think that in the standard
you keep things short and you pick key areas. In
our standard, we pick 15 key areas related to fitting
hearing aids. So here's an example. I'm a firm believer

(04:49):
that when you're fitting hearing aids, you have to verify
to a validated prescriptive fitting method, ear canal SPL. Well,
that's what would be stated in the standard. That's it.
It has to be verified to a validated prescriptive method.
Then you would have the fitting guidelines. Then the guidelines
would tell what signal to use, where to position the

(05:12):
patient, where to put the probe tube, what input signal
to use, what intensity levels to use, and on and
on. And then you could still have, after that, you
could still have best practice. Best practice might then say
that you also should do an RECD as part of
all this so that you correct the person's HL hearing

(05:34):
loss correctly when you convert it to ear canal SPL.
You start with the standard and then you would go
to guidelines. Then you would maybe have a best practice
document. To more specifically answer your question, I don't know
that standards have to be... They should just state the
fact of what should be done and not go into
a lot of detail as that's what guidelines are for.

(05:56):
Unfortunately, as I said before, most places we started off
with guidelines and we don't have a standard. And so
I could see that an attorney would say, " You don't
even have a standard for that. How could this person
be wrong when you don't even have a standard?"

Julia Van Huyssteen (06:12):
That makes sense to me. So it almost seems that
our standards are our foundation. And as per your example with
the building, you need to have your foundation to build
on from there. Now, to me it seems to get
to a point where we have a widely accepted and
used standard, we need to come together as a profession.
And I know you've just said earlier that you've been

(06:33):
very heavily involved in the hearing aid fitting standards for
adults and geriatric patients over in the States. Now it's
not always easy when there isn't a hundred percent agreement,
because some experts will say, " Well, I'm not happy to
concede on something that I feel is both correct and
critical for a standard." So how did you pull together
different bodies and subject matter experts to come to this

(06:55):
agreement on the standards?

Dr. Gus Mueller (06:57):
Well, you're absolutely correct that there can be some disagreement
and like a lot of things in the field of
audiology, you can find some evidence supporting one issue and
other evidence supporting something else. I personally didn't pull this
group together. The person who is the Chair of this
standards organization invited what he termed 'subject matter experts'. And

(07:20):
I think he did a nice job of pulling in
a few people who have done a lot of writing
and talking on the issues. Simply because if you do
that, you probably have a pretty good idea of what
the research evidence is. We had one person from industry,
so we have the viewpoint of industry. We had two
people actually who were in large clinics. We had one

(07:44):
person who's primarily a researcher with hearing aids and a
person involved in a large private practice. And so I
think you need, if you have people coming from all
these directions, I think then everybody has to listen to
everybody else and you get the different perspectives. And we
really had very few disagreements because most of it is

(08:07):
just the right thing to do. When it's the right
thing to do, it's hard to argue about it.

Julia Van Huyssteen (08:13):
And I think what I'm hearing from what you're saying
is, a key to this as good representation across the
field of audiology.

Dr. Gus Mueller (08:20):
Absolutely. You wouldn't want a group of people, and this
does sometimes tend to happen. You wouldn't want a group
of people who don't even see patients sit down and
write a standard of how people seeing patients should perform.
You know, want somebody who at least sometime in their
life probably was in doing clinical hearing aid fitting so
that they have a sense of what this is really

(08:41):
like. Because you have to be practical too.

Julia Van Huyssteen (08:44):
Some really good tips there, thank you very much. And
if you can do it over the pond, so can we.

Dr. Gus Mueller (08:49):
Well, we're just getting started, so don't get ahead of things here.

Julia Van Huyssteen (08:53):
So my next question is, what should we consider to
be our selection criteria, for what needs to be a
standard versus what should be a recommendation? Now, you already
mentioned the right thing to do as your standard, as
your foundation, but thinking about it a little bit more, what
goes into a standard? Do we think about what we
can offer as clinicians, our expertise from a clinical perspective?

(09:16):
Or do we think about our patient, what would be
best for them?

Dr. Gus Mueller (09:19):
Yeah, I don't really see those as two different things.
I think that when we develop the standard, we are
actually looking at what could be best for the patients.
I mean, an example is speech recognition testing and noise,
which not everybody does. But who could argue that that's
not best for the patient? Because if we're armed with

(09:40):
that information, our counseling skills improve tremendously. So of course
it's best for the patient that we know more about
them because we will then be delivering better counseling skills.
So I can't think of anything in the standard that
isn't based on the notion that the patient's long term
benefit and satisfaction with hearing aids will be enhanced if

(10:04):
somebody follows that standard. I can't imagine that, that's just
the way it has to turn out.

Julia Van Huyssteen (10:09):
No, I completely agree with you. If we think about
what's right for our patients, why wouldn't we have as
much clinical information available to us to set the hearing
aids up, but also to counsel our patients?

Dr. Gus Mueller (10:19):
Sure, exactly.

Julia Van Huyssteen (10:20):
So the last question then is going to help setting
up for our next two episodes where we will be
doing a bit more of a deep dive into those
hearing aids fitting standards that you mentioned. And that is,
do you think the phrase 'hearing aid fitting standards' is
encompassing enough? Because when I look at those standards, they
talk about pre fitting assessments, they talk about the hearing
fitting itself. It talks about short term and long term

(10:42):
follow ups. So do we do it injustice just by
saying hearing aid fitting standards?

Dr. Gus Mueller (10:47):
Yeah, I guess that hadn't even occurred to me until you
just now mentioned it. I guess it depends on how
you define a fitting and the title of the standard
can only be so long. So in my definition, a
hearing aid fitting while really it starts with your air
conduction testing and it goes through the whole process until
you do your post fitting counseling. And as part of

(11:10):
our standard, it goes into long term adjustments. So it's
the journey, going from the very beginning to the life
of the hearing aid basically, if you continue to buy
service. For simplicity, we're just calling it the fitting, but
it's everything. There could be a better word for it
or words, but that's what we're calling it.

Julia Van Huyssteen (11:31):
No, that's fine-

Dr. Gus Mueller (11:31):
And it's public, so it's too late now. You can't change it.

Julia Van Huyssteen (11:35):
I'm going to change the world. No, that makes sense.
And for me as an audiologist, I don't think you
can see any or isolate any part of that journey
in itself.

Dr. Gus Mueller (11:45):
Sure.

Julia Van Huyssteen (11:45):
We can't just talk about the hearing aid fitting without the pre-
assessments and without the follow up.

Dr. Gus Mueller (11:49):
Exactly.

Julia Van Huyssteen (11:49):
So its really that pathway. So let's call it hearing
aid fitting standards.

Dr. Gus Mueller (11:53):
All right, well we did that.

Julia Van Huyssteen (12:00):
Thank you, Dr. Mueller, for a very insightful introduction into
our first episode in our series on hearing aid fitting
standards. Today we talked about why fitting standards are important
and how they differ from recommendations. Let's keep the conversation
going here in the UK but also globally. And feel
free to send us your comments. Please join us for
our second episode about hearing aid fitting standards. And in

(12:21):
the meantime, you can find out more information about Signia
and also Dr. Gus Mueller's work on the episode page.
If you found this episode helpful, we'd love it if
you could share it with your friends and colleagues, so
as many people as possible benefit from Dr. Mueller's expertise.