- Hi guys, welcome back to the Dr. Cliff AuD vlog.
This is vlog number 108.
And today I wanna talk about the art and science
that goes into providing audiologic care,
particularly when fitting and programming hearing aids.
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With that out of the way, let's go ahead and get into it.
So the reason that I wanna talk
about this particular topic today
is that it's a highly debated topic,
really inside of probably every profession,
but it is also highly debated
inside of the profession of audiology.
And what I mean is that there are certain individuals
who believe that either the science is more important,
or that the art of fitting a hearing aid is more important.
And, you know, I have my own opinions on it,
but let me kind of expand upon this a little bit further.
I used to be a massage therapist.
I don't know how many of you know of that,
but when I got out of the military,
I went through massage therapy school,
started my own practice doing massage therapy,
while I was going through undergraduate university.
And, you know, that was something
that really helped me kind of understand
this difference between the art of something
and the science of something.
And so, as it relates to massage therapy,
when you think about the science of massage therapy,
it's really important to have a deep understanding
of musculature, right, and how the body moves,
and how different medical conditions
can influence how the human body reacts to something.
And if you don't have a good understanding
of the science behind human anatomy and all of that,
and physiology, then you're not gonna be
a very good massage therapist, right?
And I just think, you know,
I've had a million massages, I don't know,
I've had a lot of massages from a lot of different people.
And you can always tell
who does not have a good foundational understanding
from the science side of like human anatomy and physiology.
For instance, if you're going to be massaging someone's leg,
right, like their thigh,
it's technically called your quads, your quadriceps muscles.
And it's called the quadriceps,
because you have four muscles, quad, four muscles
inside of your leg, of the quadriceps group, right?
And if you're a massage therapist,
and you are unaware of that,
and you only end up massaging two of those muscles
inside of that muscle group,
then you are missing two of the muscles.
And massaging all four of them is typically very important
when you're providing massage therapy care,
especially if you're working with an athlete,
or someone who has a medical condition,
or something like that.
And so, I've been to massage therapists,
who like they hit every single muscle, and it's perfect.
And then I go to some that they're like,
they hit half of 'em, and they don't, you know,
they just don't have an understanding
of what they're actually doing.
And then on the other side of that,
there's an art form that goes along with it.
So like knowing how to apply a certain amount of pressure,
or if there's a knot or contracture inside of a muscle,
techniques that you can use to alleviate that,
and being able to kind of like feel that out
as you go along.
And there's some massage therapists
who have like no understanding of that,
and some who have a deep understanding of that.
And you can technically go to someone
who's like really good at the art behind massage therapy,
and someone who's really good at the science
behind massage therapy,
and then someone who's really good at both of them.
And you can totally tell who those people are.
Now, I know that it seems like
I'm getting off on a tangent here,
but I explained that to make a point,
when it comes down to audiologic care,
there is a certain science or understanding of the science
behind the ear anatomy, the ear physiology,
psychoacoustics, acoustics, all of that stuff.
It's important to have a detailed understanding
of the science behind what we're doing.
And that include doing certain fundamental procedures,
like test box measures, and real ear measurement,
and validation outcome measures,
like all of these different things
that need to be done that are backed by science,
and how you do them, right?
And then there's the art form side of it.
So when you're applying all of the amplification
with hearing aids and all that,
being able to listen to patient feedback,
and understanding how they're articulating something
might mean that you need to adjust
the hearing aid programming in one way or another.
And if you don't have a understanding of the art
of applying amplification, you're not going to achieve
a really, really high level outcome.
And so kind of the way I equate it is
is that you can have someone
who has a really deep understanding
of the science behind audiology,
and they will probably get you a good outcome, right?
And then you can go to someone
who conversely doesn't have a good understanding
of the science behind it.
They might have a really good understanding
of like being able to understand
what patients are trying to tell them,
and manipulating devices that way.
And you'll get a good outcome with that.
But the problem is
is that we're not looking for good outcomes,
we're looking for great outcomes.
And the only way to get a great outcome
with amplification, with hearing aids,
is to have a really good understanding and application
of the science behind amplification,
and a really good ability to apply your craft,
or your art form to doing amplification.
Now, a lot of people get irritated with me,
because I'm such a, like a stickler
for real ear measurement, right?
I mean, real ear measurement for everybody, you know?
Except in very, very few cases, where you can't do it.
But in general, the reason I'm such an advocate
for real ear measurement is because if you don't know,
if you don't have a foundational understanding
of the science behind what's actually happening
inside of someone's ear canal
when you're applying amplification,
it's really hard to make an educated decision
on what to do next, from the art form perspective.
Now, I truly believe that there are clinicians out there,
and they're successful hearing aid practices out there,
who don't follow best practices at all,
because they're really good at the art form,
and at least they can get patients happy enough
to keep their hearing aids, right?
On the other side, I think that there's clinics out there
who follow a lot of best practices,
but they're horrible at the art form side of it,
and they can usually get good outcomes,
and their patients will wanna keep their hearing aids,
and they continue to exist, right?
But the really good clinics are the ones,
and the really good clinicians are the ones
who've developed this ability to incorporate
the art form with the science.
Let me give you an example of art versus science here.
So if you are going to be
treating someone with hearing aids,
and doing real ear measurement,
you want to make sure
that what you're going to be doing with that device
is capable of meeting
their hearing loss prescriptive targets, all right.
So we do this with real ear measurement.
And based off of that,
typically individuals cannot accept
the full level of amplification right off the bat.
So what do you have to do?
You have to back down their levels of amplification
to essentially some level of comfort for that patient.
But it doesn't stop there, right?
You have to then, over the course of time,
as their brain adapts,
you have to gradually build them back up
to their full prescription.
That is the art form behind it.
So you have the science,
which is like let's make sure that we can measure,
and actually get them up
to their full level of prescription,
and then understanding
that you can't just send 'em out your door
with them wincing at every sound.
You have to back it down,
and then gradually build them up into it,
and explain to them and help them understand
why you're taking that approach.
That ends up resulting in someone
who has their hearing aids
eventually fit up to their full prescriptive targets.
They may have been giving other feedback along the way,
where you have to increase noise reduction
in certain situations,
or you might have to taper off some high frequencies,
or reduce low frequency, or increase low frequency,
or whatever above and below their prescriptive targets.
But it doesn't change the fact
that you can't get the optimal outcome
until you set the baseline properly,
with the science behind providing audiologic care.
Now, the argument against doing real ear measurement
in this particular scenario
is that no one can accept their full level of prescription.
So why do real ear measurement?
And I would understand where that's coming from.
That's coming from the standpoint of, at the beginning,
people typically cannot take
the full level of amplification.
So there's two approaches.
It's either you do it, and then you back them down,
and gradually build them back up into it.
Or you just don't do real ear measurement,
you do first fit on a hearing aid,
it significantly under amplifies
typically a variety of different frequencies.
I don't care what people tell you,
that like, "Oh, every time I do it, it seems to come close."
Let me tell you, I've probably done
more real ear measurement on more devices,
both prescriptive and non prescriptive devices,
than anybody on this planet right now,
and I can tell you that it is very, very rare
to see a hearing aid hit 90%
of a prescriptive target with first fit.
So I just do not buy that.
So now let's wrap this up, so if you were to ask me
if I would prefer to go to someone
who is really good
at the science behind fitting a hearing aid,
or if I'd rather go with someone
who's just got a ton of experience with the art,
but they don't follow any of the science,
to be honest with you, I'd have to take the one
who understands the science behind what they're doing,
even if they are not developed enough yet
to understand the art that goes behind it.
I know that everybody has a different preference
when it comes to this.
Some people are like, "Nope,
I'd take the dude with experience all day long,
or the lady with experience all day long,"
and I totally get it.
You know, you do what's comfortable for you.
But really what you're looking for
is you're looking for someone who employs best practices,
the foundational science behind fitting a hearing aid,
with the art of doing it as well.
And so if you can find that unicorn that's out there,
you need to go to that provider,
because that is gonna be the individual
who takes whatever hearing aid you go with it,
and gets the most out of it, all right?
So there you go, hopefully that made some cohesive sense.
Don't ask me for a massage,
I don't do massage therapy anymore.
I barely ever give my wife a massage anymore.
So that being said, guys,
I really appreciate you hanging out with me this morning.
Who you got in the Super Bowl?
I'm thinking I'm probably gonna have to go with Bengals,
so Erica Fleck Person, if you're hearing me in this vlog
giving you a little shout out,
hopefully Joe Burrow pulls it out for you guys.
But as always, guys, have a great weekend,
and I'll see you next week.
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