examples of ethical hearing dilemmas. case 1 the client bought a pair hearing aids 6 months ago,...

EXAMPLES OF ETHICAL

HEARING DILEMMAS

CASE 1

The client bought a pair hearing aids 6 months ago, from a different practice.

Basic 3 channel ITEs and still in warranty.

Omni-direction, very basic noise suppression & feedback systems;

Lindsey-Henderson, S. (2013, January). Ethics in hearing healthcare – the basics. AudiologyOnline, Article #11568. Retrieved from http://www.audiologyonline.com.

http://www.audiologyonline.com/

CASE 1b

Binaural speech discrimination, under earphones was 72%;

She is very disappointed in her “poor hearing” ability, even in quiet situations.

She thought they were the “best” hearing aids available & spent her life savings on them;

CASE 1c

Do you have all of the facts, or just the patient’s perception of the facts?If true, LEGAL? …….ETHICAL?

CASE 2

Purchased the hearing aids a month ago, in Florida, their winter location;

Budget CICsPaid over $6000He bought a 3 year warranty & believes that

he can go to any HA place (that carries this model) for service;



CASE 2b

Called customer service & discovered only a 12 month warranty.

Normal hearing to 1500Hz, then a steeply sloping mild to severe loss;Complained that the hear aids echo and feedback.

CASE 2c

If true, LEGAL……ETHICAL?

Contact the original dispenser.Is there a return or exchange policy?

CASE 3

A long time, healthy, 50 year old patient wants to know about getting stronger hearing aids;3 years ago he had a moderately-severe to severe hearing loss.Now he has a profound hearing loss with a best aided discrimination score of 16%. No FDA red flags. The patient has misgivings about the surgery

associated with a cochlear implant.



CASE 3bRecommend that he consider CI as the only real choice; Provide / loan assistive devices; Work on coping strategies; Demonstrate power hearing aids to show

low benefit;Be aware that over-amplification can cause further cochlear damage;In writing (with the patient signature) explain the low benefit of hearing aids vs CI.

CASE 4

A 70 year old prospect tests with a long-standing bilateral moderate to severe HF hear loss;No FDA red flags;Speech discrimination scores at MCL are:

L: 56%, R: 52% and BOTH: 92%.He tried an hearing aid 3 years ago,

“Heard just fine.”

Chartrand, M (2004,January-February). Ethical Dilemmas in Dispensing Practice. Membership Matters, Article #70, Retrieved from http://ihsinfo.org/IhsV2/hearing professional.

CASE 4b

He will only accept a hearing aid for the right ear.

He will “not pay a penny until he is completely satisfied”.

CASE 4cAlways try to ensure that a spouse or other

can be there too.Demonstrate the benefit of two hearing aids

over one; Indicate that it is not possible to do what he

is asking.LEGAL to pursue a doomed rehabilitative strategy?.....ETHICAL?If you do work with this patient, be sure he

signs a form explaining the situation.

CASE 5

A 50 year old lady had been referred by her physician 7 months ago for a hearing aid;At that time she had a moderate, sloping sensory loss in one ear;Six months ago you dispensed a RIC hearing aid for that ear, with a 30 day return policy.

Chartrand, M (2004,January-February). Ethical Dilemmas in Dispensing Practice. Membership Matters, Article #70, Retrieved from http://ihsinfo.org/IhsV2/hearing professional.

CASE 5b

The patient did very well with hear hearing aid until recently. Now she hears better and does not need a hearing aid.After 6 months of treatment for her hyperlipidemia, the hearing improved to near normal; She wanted a refund on her hearing aid.

CASE 5c

Do a hearing evaluation. Consider past ototoxicity, hyperlipidemia, hyperlipoproteinemia,

cochlear stroke, allergy as possible reasons for the improvement.

Dispenser’s obligations?If can’t refund….LEGAL…..ETHICAL?

CASE 6

A 45 year old “has not heard well through her right ear for the past 10+ years.”

For her job situation she wants to hear through the right ear.Audiometrics found: LEFT: normal hearing

RIGHT: a severe sensory loss.The speech recognition scores were

LEFT: 100% RIGHT: 48% BOTH: 78%.

CASE 6b

She does not want to wear a device in the left ear.There were no FDA red flags.

CASE 6c

Demonstrate a hearing aid in the right ear; Discuss / demonstrate / loan a CROS unit;Discuss a BAHA.LEGAL ……ETHICAL ……to dispense a standard

HA in the right (bad) ear?

CASE 7

A 65 year old lady was dispensed a canal hearing aid in one ear 2 years ago. Got only one hearing aid because she could

not afford two; She never felt that she could hear very well

with the device. Testing found a symmetric, moderately-severe

sensory loss in either ear, except….

CASE 7b

Speech Recognition using W22 words was: Left: 74% Right: 72% Both 70%, &Sp Recog using SENTENCE STIMULI was: Left: 10% Right: 75% Both: 70%.No wonder she could not hear with the HA.

(poor auditory memory?)

CASE 7cWas the original fitting LEGAL…..ETHICAL?

Remember, you probably don’t know the whole story (faulty patient memory?)Possible safeguards against this:

Critical HA follow-up visits;Return privilege on HA;If BTE HA could be switched to RIGHT

ear;

CASE 8A 50 year old man has a pair of 5 year old

BTE hearing aids that “DON’T WORK”.The hearing aids are out of warranty.He thinks that he needs new hearing aids.Had been “hearing perfectly” with the HAs

before they quit.

CASE 8b

Upon inspection the dispenser finds that they would work for the patient after service or repair is performed.

But this is also an opportunity to sell another set of hearing aids.

CASE 8c

If problem was a bad tube, filter or windscreen, recommending new HAs would be....

LEGAL?.......ETHICAL?

If the HAs need to go in for service, recommending new HAs would be....

LEGAL?.......ETHICAL?

CASE 8d

If the dispenser does explain the need for service,

Yet the patient decides to order new hearing aids……Be sure to describe the explanation & the decision on paper, then Have the patient sign it.Should explain the cost differences and

benefits of repair vs new HAs.

CASE 8e

The signed paper documents the information.Protects you, the dispenser.Goes a long ways towards promoting your practice’s honesty in the community.

CASE 9

After testing the a new patient with bilateral sensory-neural hearing loss,

A pair of HAs is ordered, then dispensed.During the fitting process, only the

manufacturer’s first-fit settings are used.No measure of the HA’s output in the

patient’s ear canal is made.

Palmer, C: (2009, Sep-Oct). Best Practice: It’s a Matter of Ethics. Audiology Online. Retrieved from http://acaeaccred.org/wp-content/uploads/2013/12/PalmerAT-21.5.pdf

CASE 9bUsing the FIRST FIT implies that the dispenser

BELIEVES that the MANUFACTURERsettings are appropriate & there is no need to verify.

This also suggests that a patient could orderthe HAs online with the software

then program them him or herself.

CASE 9c

Hearing aids need to be fit by individuals knowledgeable about their features, able to manipulate the various parameters & equipped to measure the output of the in the ear canal.

CASE 9d

Studies show that various manufacturer algorithms provide different amounts of gain for the same hearing loss on “First fittings”.

Verification through real-ear probe microphone measures is more efficient & less time than asking patients about the loudness of a sound that they cannot accurately judge.

CASE 9e

Dispensing most of your hearing aids withoutelectroacoustic verification within the canal:

LEGAL?................ETHICAL?.........

Some lines from (hearing) Codes of Ethics….…. maintain high standards … in rendering services….

…..maintain professional competence… …..shall provide only services & products that are in the best interest of those served……..shall honor their responsibility to achieve & maintain the highest level of

professional competence.

CASE 9f ANOTHER WAY TO LOOK AT REAL EAR MEASURE

WHY should people come through OUR DOORS for us to ORDER & FIT them with Hearing Aids?

By using REAL EAR PROBE MIC / LIVE SPEECH MEASURE we demonstrate our professionalism & expertise.

We show we can do a better job than they could themselves in fitting their ears!!

examples of ethical hearing dilemmas. case 1 the client bought a pair hearing aids 6 months ago,...

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