Expectations of Hearing Aids feat. Dr. Amit Gosalia | Part 2 of BHSM Series

In this episode, Blaise Delfino  speaks with Dr. Amit Gosalia about what to expect from amplification, more commonly known as hearing aids.

The Statistics

Dr. Gosalia explains that hearing loss is known as the invisible disease. The person experiencing it can’t feel or see it. Usually, family and friends notice and let the person know. 

Hearing loss is not uncommon. According to the NIH and the WHO, 15 percent of all Americans over 18, not only the elderly, suffer from some form of hearing loss. It can be caused by exposure to noise, genetics, or the environment, among other things. 

He adds that every year the Veteran’s Administration publishes a report on the disabilities suffered by veterans. Each year hearing loss is either number 2 or 3. Most people would guess that post-traumatic stress disorder would be at the top of the list for veterans returning from war. However, number one is almost always tinnitus, or ringing in the ears. 

Lost Wages

Each year there is a $1 billion loss in wages because of hearing loss. Dr. Gosalia explains that it is the result of misinterpretation and misinformation by people who can’t hear well. A recent market track survey demonstrated that among the thousands with hearing loss in the workplace, for every 10 decibels of hearing loss there is a reduction in salary. He explains that because a person’s brain has to go into overdrive to distinguish between the letter “t” and the letter “p,” for example, his/her cognitive energy is taken away from the ability to do other things. This is particularly difficult in meetings and when working with a team. 

The Types of Hearing Loss

There are four types of hearing loss. To understand the different types, Dr. Gosalia gives a basic anatomy lesson on the ear. The outer ear, which is on the outside of the head, funnels sound into the ear canal. At the end of the ear canal is the ear drum. Connected to that are three small bones commonly known as the hammer, anvil, and stirrup. Those bones are connected to the cochlea, which looks like a snail shell. Inside the cochlear are millions of hair cells that pick up the sound and send it to the auditory nerve. It is then sent to the brain for interpretation. 

The most common type of hearing loss is sensorineural. This is when a significant number of hair cells in the cochlea die off. They cannot be regenerated; however, a hearing aid provides extra energy to stimulate the remaining hair cells. This is considered hearing loss in the middle ear.

The second type of hearing loss is call conductive. This happens when the ear canal is clogged with debris and wax, or when there is a hole in the ear drum, and it cannot vibrate correctly. 

Often children suffer from fluid in the middle ear. This is treated by inserting tubes into the child’s eustachiantube. 

The third type of hearing loss is called mixed. This is a combination of conductive and neurosensory loss. 

The last type and least common is known as central hearing loss, which takes place in the brain.  

Fear of Hearing Aids 

Dr. Gosalia says people experiencing hearing loss wait an average of seven years to get help. They’re afraid of the cost, or fear that they’ll hear too much background noise. Others have heard stories of people who have had, say, five hearing aids in six years and none of them worked. About 99

Transcript

Blaise Delfino: 0:06

You're tuned into the Hearing Matters Podcast with Dr. Gregory Delfino, and Blaise Delfino of Audiology Services and Fader Plugs, the show that discusses hearing technology, best practices, and the growing national epidemic hearing loss. On this episode, we have Dr. Amit Gosalia, which if you tuned in last week, he joined us on the show as well. And we are so excited to have you back Dr. Gosalia because during this episode, we are going to be discussing the expectations of amplification, otherwise known as hearing aids. Dr. Gosalia, let's dive right into this. Can you share with us some statistics with regard to hearing loss because some of the stats that you're going to share with us are absolutely insane. I mean, in terms of how many people experience hearing loss, etc, etc.

Dr. Amit Gosalia: 1:05

Yeah, thanks for having me on. Again, Blaise, I really appreciate it. And I think this is a very important topic because people don't realize that hearing loss, which is commonly known as the invisible disease, because we don't see it, and we don't feel it. It's usually the friends or family who notice the hearing loss before the actual patient notices it. And when you when I go over these statistics, I know you won't be blown away, because I know you know this, but I think your audience may be blown away at how prevalent hearing loss is. So the first thing is when we look at the data from the National Institutes of Health, the World Health Organization, we actually know that over 15% of American adults over the age of 18 have some form of hearing loss. Now, I said 15% over the age of 18, that is not just over the age of 60. Okay, where a lot of people think hearing loss is age related only. The reality is that there's a very, very strong predictor of hearing loss with all adults. So the idea is that it's not just age related. It's actually noise related, environmental factor related genetics related. In fact, the Veterans Administration, the VA, which is the organization that helps our respected servicemen and women, they put out a benefit report every year, and every single year, the number two or number three, most common service connected disability is hearing loss. Well, so you imagine these men and women who are coming back from wars, you may think that PTSD has got to be number one or two. The reality it's usually number two is hearing loss, followed by knee injuries or PTSD later on. So if you think of number two, what's number one? Well, number one, believe it or not, is tinnitus. Tinnitus is the ringing in our ears or in our head, the number one service connected disability for the VA is something related to hearing. So if you look at additional statistics, almost two to three out of every 1000 kids in the US are born with some form of hearing loss as well. So it's extremely, extremely common, probably more common than what most people would realize.

Blaise Delfino: 3:30

Dr. Gosalia there is a statistic that Starkey Hearing technologies shared that there is 1 billion lost us earnings every single year due to hearing loss, untreated hearing loss.

Dr. Amit Gosalia: 3:45

Absolutely.

Blaise Delfino: 3:46

Why is that?

Dr. Amit Gosalia: 3:47

You know, the and I want to be very careful here because I know that we have a lot of people who are deaf, okay, and I say Deaf a little bit more pronounced because we're using quotes, or capital D or lowercase D, where these are functional human beings, they don't feel that hearing loss is a disability. So the next thing I say is is going to be separate from those individuals. When we look at hard of hearing or folks with hearing loss. There was a there was a market track survey done back in 2005. By a very famous PhD, his name is Sergei Koch. And he actually took 1000s of people with hearing loss. And what we found is that every extra 10 decibels of hearing loss that we see we are seeing a significant reduction in salaries and take home pay. And it was almost It was almost this diagonal line going from the top left to the bottom right. And it's one of those things that you look at you wonder well why would hearing loss lead to loss of money or income or sales? Well, the misinterpretations, the miscommunications that can happen. I used this example yesterday that if you're talking about baseball, and somebody suddenly said, cap C A P. Well, our brains have a certain amount of words that we're going to associate with baseball, right? Catch, pitch, bases, homeruns, whatever. When I say cap C A P, will baseball cap actually makes sense, right? It's a very common thing to say. Now, if I had said cat C A T, well, the person may have misinterpreted and her cap C A P. And that distinction of a T versus a P, this example, is a very common mistake. And now the person who's hearing that word, their brains go into overdrive thinking, wait a second was that C A P or C A T, but it must be ca p, because we're talking about baseball. So that amount of cognitive energy that we put into trying to figure out what that word or that sound was, takes away from some of the abilities that we need, cognitively to do other tasks. So when we're working with a team, in a group or board meetings, for example, and you're putting so much energy into trying to hear or understand what the other person is saying, that you may not even be able to process what it really means. And that can lead to all kinds of detrimental effects, income wise as well.

Blaise Delfino: 6:31

Dr. Gosalia, there are different types of hearing loss, can you share with our listeners, the different types of hearing loss and when the audiologist or hearing healthcare professional reviews your your type of hearing loss with you, what does that even mean?

Dr. Amit Gosalia: 6:45

That's a great question. And most, most providers do a very good job of explaining this. And sometimes we spend too much time talking about the hearing test results

Blaise Delfino: 6:55

Absolutely

Dr. Amit Gosalia: 6:56

Thank you! Back to the original question, and not so much about what it really means out in the real world. Similar to if I had an EKG done and the physician comes in and goes over every single plot on that graph, I as the patient, I'm going to glaze over half of that, and then have more questions later on. However, patient education is extremely important. And whatever I'm talking to my patients, I want to make it very conversational, and make sure it's applicable for that patient's issues. So there are three to four main the types of hearing loss and now we have three sections of types of hearing loss. So the most common one, which we'll start with is something called sensory neural hearing loss. And I think we probably need to take a moment to discuss the anatomy of the auditory system as well, because I think that'll make you know this piece together. So, when we talk about sensory neural hearing loss, well, when we hear sounds, you all have seen ears that are on the sides of our heads. Well, those ears are shaped in a certain way that you know what it's facing more to the front. And we're trying to cut out a little bit of what's behind us. It's a natural way that our bodies were built. And it's a it's a fight or flight response and almost a warning system that you know, caveman used to use, excuse me caveman and cavewoman used to use for survival techniques. The idea is that we have these curves. So the next time you look at someone's ear, you'll see there's these curves, those curves, essentially funnel sounds into our ear canal, where we find ear wax, debris, unfortunately, even bugs and insects which get trapped in there, but at the very end of the canal. And of course, this looks like a cave, and at the very end, we see an eardrum, and that eardrum is basically just a layer of skin, that eardrum is attached to a bone. And that bone is attached to a second bone and a third bone. Those bones if you were in elementary school in the United States, you probably remember these as the hammer, Anvil, and Stirrup. And if you do, congratulations, you must be over the age of 35 or 40. We, we don't use that anymore. But the idea is that these are the smallest bones in the human body. So they're very fragile. Well, the third bone which actually these bones are called the Malleus, Incus, and Stapes that third bone, the Stapes is attached to the cochlea, the cochlea is what we commonly refer to as the inner ear. And if you look at a picture, it looks like a snail. And that snail, if we open it up has a membrane and there's 10s of 1000s of little cells that our ear, right? So we have from the outside of our ear to the are attached to this membrane. And every time we hear a sound, this membrane moves like an ocean wave. And the respective cells pick up the sound. They send it to the nerve, the nerve sends it to the brain and your brain decides what did I just hear. Now, for the doctors who are listening. I know this is a eardrum, we're going to call that the outer ear, from the very simplified description about how we hear. But I think in general, this makes most sense to my patients when I'm explaining it, and hopefully you guys will give me a pass on that. So the idea is that back of the eardrum to that cochlea, we're going to call that the middle ear, and the cochlea and beyond, we're going to call that the inner ear, and or the brain, right? So the idea is that when we have a sensory neural hearing loss, generally, the outer and middle ear are in fairly good health, it's the inner ear, the cochlea, where some of those cells if you remember, I talked about those cells, which are commonly known as hair cells, they look like hair, it looks like a field of hair. Okay, so those hair cells, some of them die off. And in the human body, we actually cannot regenerate those dead cells. Now fish, reptiles, birds, they can, but we can't. And I know the joke as well, let's try Well, we might end up with gills or feathers, who knows. So the idea is that we still cannot regenerate those cells, it will happen. There are companies that are working very hard to see how we can do that. When those cells have died off, we need extra energy to stimulate the surrounding cells to pick up those cells. So sensory neural hearing loss in general, is that a summary I just gave you. However, sensory neural hearing loss can also be when the nerve has been affected, or if the brain has been affected. So we group all of these potential areas of damage into what we call sensory neural hearing loss. Now, the second most common type of hearing loss is called conductive hearing loss. Now, if your ears were plugged up with ear wax, obviously, you're not going to hear as well. Well, that's what we call a conductive hearing loss. The issue is not in the cochlea, nerves or the brain, the issue is in the outer ear, naturally, that's something we can treat, we can go and we can pull that wax out. We can wash the wax out, you cannot candle the wax out, I will argue successfully with anybody.

Blaise Delfino: 11:59

Do not use candles.

Dr. Amit Gosalia: 12:01

Candles don't work.

Blaise Delfino: 12:02

Do not do that.

Dr. Amit Gosalia: 12:03

Yeah. So the reality is that if there's something medically that we can treat in the outer ear, we call it a conductive hearing loss. What about the eardrum? We have a lot of children who and adults excuse me, we also have adults, where we get a hole in our eardrum, well, that hole the eardrum now that your drum is not 100% intact, that can also lead to what we call a conductive hearing loss. What about when I have a cold or I feel congested or stuffed up? Well Believe it or not, there's fluid that's in that middle ear cavity. Remember earlier the hammer, anvil, stirrup area, that's what we call the middle ear. It's actually the size of an m&m, which I just learned at a trivia contest. So that area is the size of an m&m. So you can imagine how small the area really is, a drop of snot in that area is going to fill it up. And now you're not going to hear as well. So that whole area, we call all of those potential issues a conductive hearing loss, most of the time, we can actually go in there medically and treat it, am I going in there surgically and medically treating it absolutely not, we will send our patients out to an ear, nose and throat specialists, who are also known as otolaryngologist and let them work on the medical side of things. The final one is what we call a mixed hearing loss. The mixed hearing loss is when you have a conductive component, and you have a sensory neural component. So you mix those two things together. So somebody, you know, I'll use a very high level example, you have a veteran who has been in, you know, wars or a lot of noise, they have this sensory neural hearing loss. But now they also have a cold and their ears are plugged up well, you have two things going on that are really causing the issue. One, probably the least common one, which hopefully we don't see a lot of, or we don't want to see a lot of is what's called central hearing loss when it's more up in the brain area. So those are the three, four major types of hearing loss.

Blaise Delfino: 13:51

Dr. Gosalia, you had mentioned that there are different treatments for hearing loss. So there might be medical treatment or you know, surgical treatments. What are some of the medical and surgical treatments that are available for individuals with hearing loss?

Dr. Amit Gosalia: 14:10

Yeah, that's a great question. So sometimes when we see patients that come in, we get to a point where I have to tell the patient listen, this is now outside of my scope of not only knowledge, but also expertise and licensure, to be honest with you. So as an audiologist, I'm limited in what I may or may not be able to do. There are other specialties that can get into the medical and surgical side. So let's talk about the treatments. So some folks that may have a hole in their eardrum, we may go in there and patch the eardrum. So some of the physicians will use a patch of skin, sometimes from behind the pinna or the behind the ear itself and then they put it onto the eardrum. I'm definitely generalizing this but essentially that skin will mold together and you've patched the hole. Sometimes we have so much middle ear fluid built up that the surgeon will go in there and put what's called a tube. So we call it a pressure equalizing tube or a p tube. So a lot of children, because children and I skip this, I apologize when I gave the anatomy but there's something called the Eustachian tube. And I'm going to quiz you on this later. So that you station to basically allows us to equalize pressure from outside of our heads to behind the eardrum. So when you go up and down an altitude your ears plugged up, because the pressure out here, outside of your changes, but the pressure behind the eardrum has not yet changed. So we do funny things, we chew gum, we yawn we move our jaws around, some folks even plugged their nose and blow to force air to go up the Eustachian Tube and pop that ear drum open. Now, please be very careful, here's my one little warning, if you are going up in altitude, do not plug your nose and blow because that's actually doing double the impact in that middle ear and then you risk the the rupturing of the eardrum. So sometimes we'll put a PE tube in there and help release that pressure because as I was saying, children or babies for you know, all the way up to adulthood, the Eustachian Tube is not vertical, it's horizontal. So they don't have gravity on their side to help bring that fluid back down. So that's why we have a lot of children who have fluid built up in their ears. Another type of surgical treatment is called a cochlear implant. So we are a provider for cochlear implants here in our clinic. So when we have somebody who comes into our office, and their hearing is so severe to profound, and their ability to understand some of the testing we do we we want to find out how well they're understanding speech. And those scores can be so low, and if they're if they're low enough, and their hearing loss is severe enough, we will refer them out to a surgeon to have an implant done. And then when the patients come back to us, after a few weeks, we will actually activate. And now we're not using the natural hearing aid anymore, we're using a device that looks like a hearing aid on their head, and it sends a signal to that nerve almost directly. And then the brain adapts. So those are probably the most common ones. Blaise, there are many, many, many other ones. But I think these are probably the most common medical and surgical treatments for hearing loss.

Blaise Delfino: 17:11

Now, Dr. Gosalia, about 95% of hearing loss is treatable. And that's phenomenal. That is wonderful to hear. And you just touched upon medical and surgical options are treatment options for individuals who do present with hearing loss. Now, what are some of the treatments for hearing loss that are non medical?

Dr. Amit Gosalia: 18:20

That's great that this is my favorite question. Because the reality is that people end up waiting, on average seven years to do something about a non medical treatment option for hearing loss. Right. So somebody notices they have this issue, it can be a mild issue, it can be a major issue that everyone's starting to, you know bogged down on the patient, Hey, you got to do something. The short answer is hearing devices, such as hearing aids, are going to be the best option for treating those types of hearing loss. Now, people have a lot of fear about hearing aids, because they they've heard horror stories. They've heard about costs, they've heard about, oh, I hear too much background noise or it wasn't done right, or somebody bought six hearing aids in the last five years. And none of them work for them. So it's not going to work for me. The reality is that if somebody has a treatable hearing loss with the use of hearing aids, and if it's done the right way, following best practices, verifying that what we've done is going to it falls within what we call our target range. 99.9% of our patients do fantastic so much so that we always enjoy those patients who come in, and they tell me, you know, at first I didn't want anyone to see him. And now I want everyone to know that I have hearing aids because I'm showing them off. That is awesome. And we get you know, I've had a young man, he was an executive working, I won't say too much about where he works, but he works in the fashion industry around a lot of young women. And he didn't want to be the quote unquote, old man. You remember earlier we talked about it's not just age related, but he had a genetic hearing issue. So we got these tiny hearing aids that went so deep in his ears, even though it was questionable if it was the most appropriate option he end up doing very well. So great for him. The funniest thing is about six months later, you know, after some follow ups, we let her patients loose and he came in for six months. He goes, yeah, I keep telling everybody, can you see my hearing aids and I thought, wait, I thought the point was not to let anyone see them. And he's like, Oh, no, it's like people know that I can hear better. They actually feel like I'm engaging more. The reality is that hearing there's nothing to fear about hearing aids. If you go to a professional who knows what they're doing, who specializes in hearing aids, again follows best practices. I know that Blaise you guys have have been preaching about best practices on this podcast for a long time. And the reality is that's why that's why your clinic is so successful with your patients. I think that's why our clinic is very successful with our patients. And there's a reason when people go and buy hearing aids from some of these franchises or national chains or over the counter or direct to consumer type devices, that they're not happy, because there's a human professional component that's missing in some of those places. And I think we have to not to keep repeating the same phrase. But again, they don't care how much you know, until they know how much you care. And that care aspect really comes into play. And again, 99.9% of our patients do fantastic with hearing aids.

Blaise Delfino: 21:23

Dr. Gosalia, out of curiosity, what should patients expect with amplification? Now, to further that, what should patients expect with amplification when they visit a hearing healthcare provider that implements best practices?

Dr. Amit Gosalia: 21:43

Excellent. So first of all, we have to go back to the anatomy, right. So when we talk about a sensory neural hearing loss, which is the most common type of hearing loss that I see, and that's where we talk about hearing aids, we have to remember that we are not curing the problem, we are not regenerating those cells that have been damaged. So those cells that have died off or damaged, they're gone. If you have a field of grass in your backyard, and you got a dirt patch, and there's no seeds, and you just add water to it, there's nothing that's going to grow in that dirt. All you're going to do is create mud. So the reality is that when we look at what are we going to expect, we are not expecting normal hearing. We're not some people think, Okay, well, let me buy more expensive hearing aids so I can hear normally, that's actually not true. The reality is that we set the bar appropriately for our patients. So we set that expectation that listen, the damage has been done, our job is to try to fix what we can and help you with your quality of life moving forward. So we want to set that bar appropriately. Most of our patients do very well in a speech understanding test. So maybe the bar can be set a little bit higher than somebody who doesn't do very well on a speech understanding test. So the bottom line is that a patient should hear better, they will not understand clearer. Okay. And I think that's a very careful thing that we have to be careful on how we approach that clarity is a very subjective term, and, and understanding we know what the brain can do and what it can't do. We've done some trainings with our patients and sure, their their ability to understand people seems better when they come in some of them, you know, they have 20 and 30%, speech understanding. And then we put hearing aids on and it sounds like there, it seems like they are actually engaging in the conversation. But they're providing relief to their brain, yes, by giving it the signal needs. So it can do an easier job of filling in the blanks. So it's not that we're telling, you know, we're getting these hearing aids, and we're retraining your brain to say, Okay, now you can understand 100%, when you're only understanding 25 or 30%. So the expectations again, just to kind of close this loop is not normal hearing, but better hearing. Now, when you go to see a, an audiologist for your hearing needs, right, so one of the first things we do, of course, is a detailed case history. We want to find out exactly what's happening. And we ask a lot of questions. Okay. And so the reality is, we want to get to the bottom of what's happening when it started. Is it something that just happened? Or has this been long standing, genetics, you know, parents, noise exposure, things like that, then we go into a full evaluation, which can take anywhere from 15 to 30 minutes, believe it or not. And once we're done with that evaluation, we go back out and really go over the results. Now that's on the diagnostic side, when somebody comes in for their hearing aids, which I think it was a question you would ask me when they come in for the hearing aids, the very first thing I do is before they come in, is I'm going to test those hearing aids to make sure they are working right. So we have what's called specifications on hearing aids, and we have a box in our clinic. Most people do, it's called a hearing instrument test box, we will run the hearing aids on there doesn't match up to what the hearing aid manufacturer says it's supposed to do. If you buy a car off the lot, the car actually also has specifications that need to meet the national standards that they've already preset. So we're trying to do that as well. Could you imagine if you go and buy the car and the engine doesn't work, right? Of course, that would suck. Same thing with hearing aids, you get your hearing aids or the side of the mic isn't working? Well, why didn't I check that ahead of time, of course we do that. So that's number one, then the patient comes in, we're going to do what's called a verification test. Now that's either live speech mapping real ear, there are many different versions of this. So we do that. That means we do a test with the hearing aids in and basically we're trying to see how well part of the hearing aids doing to help you hear better so we want to make sure that those sounds fall within a target range. After that, we go back into my office and We started adjusting the volume a little bit based off the data that we just found. Sometimes we go back and do another verification, if we do too many adjustments, we go through the whole process, teaching our patients how to put the hearing aids and how to take them out, go over all the schwag that comes in with the hearing aid bags and boxes and stuff. And then at the very end, of course, we want to set them up for follow up. So at least in our office, we always set them up for two or three follow ups, one at one week, a couple weeks later, a couple weeks later. And then we keep going until they're doing well. Good. Because again, my focus is the patient. So once that's done, then we let them lose, we see him twice a year. And I always joke that I'm going to see you twice a year for the rest of your life. Right. So that's that's kind of the expectations. I hope that's very similar to what most other doctors are doing.

Blaise Delfino: 26:28

Absolutely. And you know what, Dr. Gosalia? Again, I have to commend you and your team because of course, implementing best practice. And best practice is not only real ear measurement, and it's not only speech mapping, well, it's counseling, abbreviated profile of hearing benefit IOI-HA, there's so many of these elements that that encompass best practices. And again, you know, as a friend and mentor of mine, thank you for continuing to preach best practice and help all of your patients on the road to better hearing. admit this is a question we get almost on a weekly, definitely monthly basis. How much do hearing aids cost?

Dr. Amit Gosalia: 27:13

Well, that's always a tough question to answer. And the reality is that it varies greatly. So hearing aids can cost anywhere from a few $100 each, to a few $1,000 each. Why is there a great variance in the pricing the great variances, because there are two schools of thoughts on hearing aid pricing. The first which is still by far the most common is what we call bundled pricing. And what that means is you pay a fee, that includes the hearing aids and all of your services. And you know, the warranties, which of course are always there. But those services can last you the warranty period, it can last lifetime of the hearing aids. So when you're paying for a bundled cost on hearing aids, you're not just paying for the hearing aids, you're paying for all the services, you're paying for the doctor you're paying for everything else that is included. It's a nice model. I've been using that model for many, many years. However, at some point, we realized, you know what, there has to be a way to separate and itemize everything out. So versus the bundled. Now we also have the unbundled approach. And I'm not saying now as an as new, it's been around for a long, long, long time, where you pay for the hearing aids and those that cost can be a bit lower. And then you pay for the fitting, you've paid for the follow ups, you pay for all the services, all the appointments. You know, patients have to realize that certain clinics are bundled clinics, some clinics are unbundled. So if somebody says, Hey, hearing aid x is going to cost you$5,000 for both ears. That's a lot of money. Well, clinic B says, Well, yeah, well, we have hearing aid x, and it's going to cost you $2,000 for the pair. Well, you have to compare what's involved in that cost.

Blaise Delfino: 29:00

What are you getting right?

Dr. Amit Gosalia: 29:01

What are you getting? right? Exactly? Are you getting, you know, all your services included? Probably not in the $2,000 for the pair using this example. There's no Model X, of course, I'm using a hypothetical, but the reality is that you have to make that determination. So in our clinic, we have a hybrid approach, of course, we have to meet both worlds. So in general, probably easily 60 to 70% of our patients still use the bundled approach, whereas the remaining will use an unbundled approach. Excuse me. So we use the unbundled approach where finances are an issue. We say, listen, let's at least get you hearing. And then as time goes on, we really want you to come in twice a year, and at least it helps with your cash flow. So yeah, so both work.

Blaise Delfino: 29:44

And Dr. Gosalia, we we encompass that same model, or I should say we implement that same model, we definitely have that hybrid approach for sure. Now, Dr. Gosalia? How do I know which hearing aids are best for me? You know, I just went through this extensive hearing test 15 to 30 minutes, I heard the tones, I let you know, when I heard the tones, I repeated back all these words to you there might have been noise. And now I know which type of degree of hearing loss I have, because you've done such a great job explaining it to me. How do I know which hearing aids are best for me?

Dr. Amit Gosalia: 30:17

That's a fantastic question. It's a question that we hear a lot because the reality is that there are hundreds of hearing aids on the market. Hundreds. There are five big manufacturers of hearing aids. They're all very good. So there's no there's no one hearing aid is extremely much, much much better than another company's hearing aid. At the same level. The reality is the data that we've seen as most of these hearing aids perform fairly, fairly well. The differences Of course, are in the features, right? So we have to look at you as the patient. What are your needs? Do you have an iPhone and you want to be able to connect to your iPhone? Or do you have an Android and you want to connect to your Android with your hearing aids? Do you need an FM system? Do you need a telecoil? Do you have an ear that can support something going over your ears? So we have to go in the ear? There are many, many factors in the determination. So I spend as much time as I can with our patients, deciding what is the right solution. But I rarely sit there and say, Okay, here's Company A, and here's all of their options. Here's Company B, here's all their options. You tell me which one you like best. That's That's not what I get paid for. Right?

Blaise Delfino: 31:30

You're not going to the candy store. And i's not you know, alright, I'll t ke this. Ab

Dr. Amit Gosalia: 31:36

When you when you I'll pick on the cardiologists again, because my dad was a cardiologist when you go in and they say, Hey, we got to get you a pacemaker. Are you saying no, I went to Medtronic. And that's the only one I want. The reality is that you rely on the physician, you rely on your doctor to help make that decision with you. And what works for Betty or Joe down the street may not work for you. This is a very common phrase. I'm not the first to make that up. I've heard that from hundreds of other doctors. The reality is that what works for one person may not work for you. Living in Los Angeles, I see Rolls Royces and Ferraris every single day. That doesn't work for me, because I can't afford it. So the reality is, I can't I also can't drive stick. So you know, if somebody gave me a Ferrari, we're all in trouble. The idea is that we have to look at a patient and really let the doctors or the providers help you, you know, mold that decision with you, keep you engaged and part of that decision making process. But the reality is that when we finally get down to it, sometimes very rarely patients say hey, what's the what's the company and model? Then I'll tell them this is what I think is gonna work best for you. And if they say, Hey, I saw this one online, I saw an ad. Okay, we'll talk about it. And why didn't I choose that for you? Because it's not right for you. In my opinion.

Blaise Delfino: 32:55

You're tuned in to the Hearing Matters Podcast with Dr. Gregory Delfino, and Blaise Delfino of Audiology Services and Fader Plugs. On this episode, we had Dr. Amit Gosalia from West Valley Hearing Center in Los Angeles, California, discuss the expectations of amplification. Dr. Gosalia you will be joining us next week on another Hearing Matters Podcast episode and we will be discussing philanthropy in hearing healthcare. Until next time, hear life's story.