My colleagues and I have been discussing some ‘sharp practice’ we’ve encountered, prompting me to write about this topic. Please seek advice from your own hearing care provider, as everyone’s circumstances are different. Please then ask for a second opinion if you feel you have been misled.
It is a fact that hearing aids have different lifespans due to a number of issues:
1) Style of aid. In the ear (ITE) generally don’t last as long as receiver in canal (RIC). This is because, once manufactured, they cannot have more powerful components added in.
2) Capacity of aids. RIC aids can be limited to a certain power level of receiver (audiology term for the speaker). The smallest, battery-operates ones on the market are most likely to be affected as these only tend to take up to a ‘moderate’ receiver, but it also varies between manufacturer.
3) Hearing changes in the end user. If your hearing suffers a dramatic change, you might find the aids are not capable of producing enough power for your new audiogram (hearing test results). If this happens early on in the life of your aid, it can lead to a disappointing lifespan.
4) Wear and tear. Someone who makes a lot of wax or works in a dusty environment may find they get fewer years/months of wear than someone who doesn’t. This can be mitigated by sending the aids for a clean/service at the manufacturer, usually under warranty.
5) Obsolescence of the aids. When parts are no longer available and the electronics inside aren’t supported by the manufacturer.
6) A combination of these issues, e.g. above average changes in hearing along with an aid that won’t take a higher power receiver renders them ineffective. They still work but audiologists can’t get that same excellent performance out of them.
Obsolescence is not something that is relevant to customers very often. Firstly, manufacturers usually have an agreement to supply parts for 5 years after the aid is discontinued. In practice, this can mean 8-9 years as the previous models are still manufactured for some time after newer versions come out. Most people will change their aids for other reasons long before it actually becomes an issue. Often the parts manufacturers use are still kept on for future models, for instance receiver styles don’t always change when the new aid comes out. Once an aid is genuinely obsolete, it will still work until it breaks (obviously!). There’s no need to worry about this, as new hearing aids can be ordered quickly, and old receivers can often be located for you even if the manufacturer no longer sells them.
How to get the most out of your hearing aids.
Carefully choosing the aids at the outset can limit your disappointment in the future. Along with the suitability for your hearing profile, I counsel those who choose the small RICs or ITE styles that their choice will not have the same longevity of the larger RICs (not very large, I might add!) such as I wear. As part of my prescribing technique I help patients work through their needs and desires, asking them to prioritise:
Hearing ability/sound quality
Cost
Aesthetics (size/style)
Ease of handling (for dexterity issues)
Features, such as:
I would then advise which make/model best fits the needs and priorities of the individual. I advise that if it would be unacceptable to replace an aid within 4 years, you should choose x style. If a patient is near the top of the output band for a receiver (speaker) I will choose a higher powered one to build in more capacity/lifespan for the aid, rather than allowing the manufacturer to produce something that will be out of power in a few years with normal hearing decline. I also check when fitting that the aids have ‘headroom’ for future loss, and advise my customer if it is unlikely that the aids will last out the warranty period.
I do these things because I have had an experience whereby I had to replace private aids 2 years after purchase because ‘no one could have foreseen my hearing deteriorating so fast’. This was incorrect as we have family history showing the exact same deterioration. My hearing history/cause was never taken into consideration. This was before I studied to be an audiologist, unfortunately. The longevity of my hearing aids was never considered, least of all the fact that I could not afford to replace them as I was being supported by my employer.
I have since met customers who dealt with other audiologists, who’ve been told they “need a more powerful aid now” (after just 3 years) and variations on “he said my aids were out of date” (what does this even mean?) after 4 years. Probing tends to reveal that when they asked for the “tiny invisible aids” they were not shown other options or told that they might not last longer than a few years.
Although we may all want the latest model, one single generation change (new model) is unlikely to provide you with a material difference, so although you might notice a clarity boost from brand new aids, and they might be a bit more refined, they’re probably not going to make a huge difference to your life.
Not all audiologists ask regarding priorities, and advise you on lifespan unless asked. We are not trained to do so and aren’t required to do so, specifically. Our remit is to find you a pair of aids that suits you today. After that it’s down to individual audiologists and their own style. This is not best for customers, but even that is not the most problematic aspect.
Dispensers are not all trained to the same qualification, and they have different company priorities. Some are even expected to make x% of new sales to old customers (upgrades). They have sales targets, and different reasons for what they prescribe. They may have ties to a particular manufacturer, and will not consider other ones for you, even though they might be better for you.
That’s not good, but during your aftercare, your appointment can be used as a ‘sales opportunity’. When we should be concentrating on re-testing your hearing, finding out if you have new challenges or lifestyle requirements and updating the programming of your aids, someone who is targeted to sell 30% of aids to existing customers might be tempted to mislead you. That might be saying “there’s a new version out, yours is obsolete now”.
Is it obsolete? No, it’s just been superseded. In the same way that a facelifted version of your car being available makes no difference to your own car’s suitability, performance or longevity, a new hearing aid is not relevant to your current situation. Taking the analogy further, the face lifted version of your two-seater car may not be right for you since you’ve had three children in the meantime!
The question audiologists ask themselves when providing follow up care should always be, “what performance can I get out of these aids for my customer today, and is it still meeting their needs?”. If the aids are no longer able to meet their needs, it’s time to talk about either new aids or add-on accessories for the situations where the customer is struggling. Depending on your hearing, personality, lifestyle and budget, that conversation might be 3-8 years after your initial purchase.
In case you’re interested, I tend to think two generations is worth changing for. I don’t update my own aids every time a new model comes out (~18-24 months) but I would like new ones every 2 generations/4 years ideally. I still check the whole market to see what’s available from other manufacturers, even though I have my personal favourite.
If you have ended up with an audiologist who makes comments on your aids being ‘old’ at 2 or 3 years, you can see where they’re going with that. Embedding an idea that aids should be unnecessarily replaced at 3-4 years is not good practice. Question what you’re told. If you hear the term obsolete, you should ask for clarification of what is meant. Have they really sold you something that is only good for 2-3 years?!
I also like to rehab previous models, and encourage pre-loved aids being reused by others less fortunate. A pair of 2-generations old high-tech aids will make a huge difference to someone on NHS tech. My mother is wearing my previous hearing aids very happily.
The bottom line is that audiologists are clinicians, not salespeople. Sales figures or targets should not make a difference to what we recommend.
So, do you need to upgrade your hearing aids? Probably not, but you might want to. If you do, well that’s a different conversation and I’m sure I have some fun technology to show you! But if it’s just that your warranty has ended, or your payment plan, or there’s a new gimmick available, then no.