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New Audiologist Review and thoughts so far

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Edited

I am doing a review on my new audiologist that will hopefully help people based in and around London UK to find an audiologist that can help with challenging hearing losses like mine. In addition, this will be a review based on whether all her extra audio services - that few to no other audiologists provide - actually make a difference.

I had, a few weeks back, created an upcoming review of the audiologist. However that topic has become too lengthy and went down several rabbit holes. So, I am creating a brand new topic for feedback on the new audio. I will also be creating a second topic, where I will upload the results of the tests so far and discuss the actual hearing results, as we have had some interesting findings.

First Appointment (90 minutes)

Tone hearing test - This was the standard one all audio’s do. I did notice that she seemed to place the thin headphones in more different positions than the previous one and this stage took a bit longer. In short, this test felt more thorough than the previous audio.

Speech Test - We also did a speech test, where I had to repeat words back to her for both ears. Virtually no other audio that I have been to see in the last 20 years has done this test. We found the results very informative.

Speech in noise test - Then we did another test, but with noise in the background. Again, no other audio seems to do this.

Audio Contrast Test - We also did the ACT, which produced some rather interesting results. This is where I had to tell her when I heard the siren noise amongst background noise. No other audio that I have ever been to has done this test.

Otoscopy and - She did the usual ear check, that other audio’s do. In addition, she did a new test where I felt pressure in the ear from the instrument. I am not sure that I have ever had that before, I simply don’t recall.

Test

She also performed an uncomfortable loudness test as she noticed I winced a couple of times during the Tone test.

Conclusion based on First Appointment

I am very pleased with my new audiologist. I felt her process was a lot more scientific and evidence based, more thorough and more detailed.

Tone Test - While, I felt it was more thorough, with more placements of the thin headphones, it is essentially the same as pretty much every audiologist. So, nothing important to add here, with one proviso. She tests more frequencies than other audios. We discovered a massive drop at 1500 hertz in the right ear, which then improved at 2khz. Because most audios only test 1khz and 2kzh, they miss this dramatic drop at 1500 hertz, which means that the hearing aid is not configured optimally. This kind of thoroughness makes a real difference to the results and I really value this.

UCL Test

I will concede that my previous audio and presumably the ones prior also did this test as it is well known that people with hearing difficulties have lower tolerance for high volume at certain frequencies. This was certainly the case with especially my right ear. I would consider this an essential test as well, particularly for me!

The speech tests (both quiet and noise) clearly showed how my ears comprehend speech at given volumes. I cannot for the life of me understand why 99% of audiologists do not do this test, just simply relying on the tone tests. The speech test makes it easy to see by how much we need to boost amplification for me to be able to understand speech well. In addition it also showed at what volumes speech discrimination started to deteriorate. I think the speech test is absolutely essential. I would not consider an audiologist that does not provide speech test services. Absolutely essential test. A tone test simply cannot tell you this information.

Otoscopy and Tympanometry - I know that most audio’s do the first test and I am not sure about the second one. Essentially eliminates all mechanical aspects and determines that my hearing loss is definitely sensorineural. The tests take about a minute each. Well worth doing to rule out mechanical issues. So, I would certainly recommend that your audio provide these tests as they are quick and easy wins.

Audio Contrast Test - I have never had any audio provide this service to me. There is dispute whether this service provides any useful benefit to audiologists. I am not qualified to say. The outcome of my test was that I could not hear the siren noise at all in the background noise. Not even faintly. I completely failed that test. I don’t know what that tells an audio about my hearing loss, but hopefully that provides useful information? I will ask the audiologist what she thinks this means for my hearing loss - in other words what this test tells her about my hearing.

On my , (which she has sent me), in addition to the O’s and X’s - which I am familiar with, she has also put in triangles, square brackets and what looks like L’s going forward and L’s going backward - or they could be < and > depending on which angle you are looking at them at.

According to Chatgpt, what she has done is masked and unmasked testing - isolating each ear etc. So, she has tested bone conduction and masking very carefully to eliminate artifact. My impression is that she just came across as a lot more thorough with this test.

My Audio Report

She also emailed me my audio report a few days later. This report includes my audiogram - with X’s O’s, Triangles etc. Then a pdf report with her examination findings, Clinical interpretation and Recommendations. I don’t think I have ever received an audio report from any audio that I have been to before. I feel that this elevates her to a new level above other audiologists, as her approach seems far more professional and scientific.

Overall Conclusionn at this point in time

I have only been for the first appointment where my ears have been tested and received her report. My next appointment will be where my hearing aids are configured with whatever changes are necessary and the will follow at some point.

So, this review is obviously incomplete. But, so far I have been very impressed with her. I found real value in her speech tests and the thoroughness of her tone tests (where we picked up an unexpected drop at 1500 hertz). Her report reflects professionalism and a feeling of an evidence based approach rather than guessing or using - “how does this sound” kind of mentality.

She even says and I quote - “Given the complexity of your dynamic range differences between ears, this evidence-based verification approach is particularly important in your case.”

I will update after the next appointment. I hope that this review helps fellow hearing aid wearers who are not happy with their current audio. So far, I am encouraged with my new audiologist!

13 people in this conversation40 min readJump to latest

It pretty much sounds like what my , Veterans Administration, audiologist has done on my hearing loss exams over the last 8 years. Now due to the limited time allowed per appointment the testing helped over a few different appointments. My first 2 years with my audiologist I had 15 appointments to find the right settings, the right ear molds, and the correct venting. My hearing loss is a complex combination of genetic and military service related hearing loss. I have a cookie bite hearing loss complicated by loud firearms, jet engines, and loud equipment noise from cooling fans ot transmitters and later computer servers. Then there were the loud exhaust of motorcycles, and race cars. I have always been an active person that loves the excitement of life.

I can’t wait for the next appointment. While I think her testing regime is far superior to anything I have had before, the proof will be in whether it results in my hearing better. My next appointment is Thursday. I think the will take place on the 3rd appointment if I recall.

My audiologist does the any time there is a change to my aids, ear molds. Which could be firmware updates, new ear molds, vent size adjustments, or repairs. In the past my biggest issue was feedback, but that was figured out about 5 years ago.

I think the US/Canada are pretty much the same as the UK. Almost no audios in America, UK etc do and many of the other tests. CVKemp uses an army audiologist and they are probably providing a better service because they are funded better and are not reliant on trying to be cheap and cheerful for the general public who want good service, but don’t want to pay for it. That would be my guess as even people on this forum who are in the US have said that they struggle to find an audio that does REM etc.

I don’t know where you are getting your information for this blanket statement, but my audiologists have always done all these tests and (when it became available, I have been using hearing aids for over 50 years). I do not go to the or Costco, but a private audiologist.

I don’t know if your post is addressed to me or one of the other users, but I assume it’s me.

I am pleased that your audio does and all these other tests. You have a good audio.

However based on this forum - you will see any number of users posting saying that their audio does not provide REM and it’s not just limited to the UK. There are some audiologists that do provide REM, but they seem to be far and few in between. There are any number of topics on this forum with this exact complaint that their audio does not provide or believe in REM.

@Roberto just one thing i don;t know if i’ve failed to notice or if you haven’t mentioned is your audiologist private or nhs as out of all the nhs audiologists i’ve been to none have been that much in detail as they just don’t have the time

In reply to @Roberto

It was addressed to you. Yes, there are posts in this forum saying this and that, but those are anecdotes, not data. I don’t mean to belittle anyone’s experience, but you can’t generalize from such. People who are content with their practitioners will not complain about them. They may even not find much reason to come to a forum.

In reply to @LRav

My audiologist is private as has been my last few audiologists. I went to the NHS in 2009 for an appointment and didn’t go back when it was clear that I (with my very limited knowledge) knew more about audiology and hearing than the NHS person that was supposed to be helping me.

Unfortunately the NHS service for audiology and dentistry is pretty poor in the UK. The NHS is great for trauma care, cancer etc, but not audiology sadly. You need to go private, but you also need to find a private audio that actually does etc.

I have been told that the NHS does do REM - because they are required by law to do it, but then they simply ignore the REM tests and program the aids without using the REM. I am not sure where I read that, but I have been told that while the NHS do actually do REM, they don’t actually use the information from REM - so what’s the point.

In reply to @Roberto

@Roberto said:

Almost no audios in America, UK etc do REM

This is not accurate for the US. Many don’t, maybe half or so at this point by practice not by volume. Every Costco does and they are the highest volume seller (not counting the which also does REM). Multiple small practices I have gone do REM.

Whether they do REM or not there’s lots of testing that doesn’t need that machine. Pure tone only is barely a screening and not a full hearing evaluation.

In reply to @Hildegard

Noted. I don’t want to derail the topic by debating how many audios provide , but I believe that the problem is more widespread than would appear as there have been youtube videos by reknowned audiologist lambasting the fact that audios still do not provide REM. I am sure that there is a statistic somewhere. The problem with REM is the equipment is expensive so a lot of audios simply won’t spend the money on it.

Anyway, the point of my topic is simply to make others around London aware of what audio services to consider when looking for an audiologist if they are not happy with their current one. How many audios do and don’t provide the service is outside the scope of this topic. Thanks.

In reply to @Roberto

@Roberto I have always found that my nhs audiologist at uclh in london is great and always know’s exactly what i mean when i describe an issue i’m having to them so i am in the belief that it is down to the area you are in and if you are sent to a audiologist in a hospital or a small clinic that is part of a gp surgery that is where the problems start. For me private is an unaffordable option

Perhaps things have improved since 2009. I was shocked at how poor the audiologist that I went to see at the NHS was. I was explaining to her what xyz meant and she was supposed to be the professional.

Your point does highlight something that has been repeatedly made in this forum. The most important thing that makes the biggest difference to how well one hears is not the hearing aid (with some provisos on that point), nor or any other test - but the expertise of the audiologist which is paramount.

A brilliant audiologist can make a cheap hearing aid sound really good whereas a poor audiologist can make a top of the range hearing aid sound absolutely crap. How good your audio is, is the most critical factor. However, if they don’t do services like REM or speech testing - it doesn’t matter how good they are if they are not using all the tools to optimise the hearing aids. The speech test makes a huge difference for my hearing loss, yet I can’t recall when I last had an audio that did that test!

PS - the hearing aid does make a difference. With oticon I can hear in noisy environments. With Resound, Widex ext I can hear everything except what I am trying to hear. So, the aids do make a difference.

Edited

In reply to @Roberto

every nhs audiologist i’ve encountered did , you can’t really “ignore the information” the point of doing it is to match the volume to the prescribed formula. I’m sorry, but you don’t know what you’re talking about.

i know you’re desperate to prove your private audiologist who you’ve paid a gargantuan fee to is providing a better service than the NHS (which is in no doubt) but you shouldn’t make false statements about it either.

i also have a private audiologist after using the NHS for 20 years. not because the clinicians were bad or the service was particularly poor but because i couldn’t access them easily anymore. with my hearing loss one day without a working aid can be catastrophic so i made the choice to pay.

In reply to @user490

@user490 said:

Whether they do REM or not there’s lots of testing that doesn’t need that machine. Pure tone only is barely a screening and not a full hearing evaluation.

Tell me some more about this……interested to hear how you understand the testing process better than the BAA?

What’s your thoughts on the massive subjectivity in methods or the near impossibility of accurately repeating the other tests out there?

Whether is done and whether it is useful are different issues. There was already a comment by @Neville in another thread with this OP about how WRS is of limited use. An exception might be to evaluate for cochlear implants?

Still, Costco does some WRS. Many audiologists in the US do that as well as other testing OP is discussing and more such as acoustic reflexes.

Perhaps US organizations and BAA disagree or one set of guidelines is more outdated or more minimal than another. I’ve not checked. WRS in crude form is pretty quick so it’s hard to see why not to do it and observe any changes over time. Test-retest and other limitations are not alone a reason not to test. Over time better tests may be developed.

I am the person who has been complaining about the lack of good audiologists in Portugal and I decided to try my luck in London. For whatever reason your review has attracted several defensive comments about their great experiences when clearly yours has not been good until now. I am looking forward to your next review and to hearing about what she is able to do with your Intents, which I also have.
To those who are happy with the level of service they are receiving, just because an has been performed doesn’t mean it was done correctly. I feel like my first REM “broke” my aids, and they have never worked well since then. The second test was done by a different person and was very painful to the point where I wanted to stop. The aids seem to have deteriorated since then, so the importance of finding a Competant audie is paramount.

In reply to @user490

@user490 said:

Whether WRS is done and whether it is useful are different issues. There was already a comment by @Neville in another thread with this OP about how WRS is of limited use. An exception might be to evaluate for cochlear implants?

I am confused. Are you talking about the speech test where you have to repeat back the words. I have to say, I found that test extremely useful, because the audiologist was able to tell me that at this volume, my speech comprehension is like so and at that volume, my speech comprehension is at that percentage. To me, the test seems incredibly useful - although admittedly it doesn’t take into account how well you hear once you have hearing aids in and necessary frequencies boosted. But she will be doing another speech test (aided and unaided) once the hearing aids have been setup.

All I can say is that I personally found the tests very illuminating.

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