As an audiology consultant, I’ve seen firsthand that having difficult conversations with patients is often the key to providing truly exceptional care. You’ve built a practice dedicated to helping people hear better, and for many patients, that journey begins and ends with hearing aids. But what about the patients who are “getting by” with hearing aids but could be thriving with something more?
This is where the conversation about cochlear implants (CIs) comes in. It’s a tough topic to introduce. You may worry about scaring a patient or losing a hearing aid sale. Yet, avoiding this discussion means you could be leaving a patient with a frustrating and limited listening experience. Having the courage to initiate this conversation isn’t just a matter of good practice, it’s an ethical obligation to give patients the best possible care.
The Problem of “Good Enough”
Patients with severe-to-profound hearing loss are often the ones who are just getting by. They can hear with their hearing aids, but they struggle with word understanding, especially in noisy environments. Their word recognition scores might be low, and they’re expending significant mental energy just to follow a conversation. From a business perspective, they might come back for an upgrade every few years, but their quality of life isn’t dramatically improving.
The longer this continues, the more a patient’s brain health is at risk. Untreated or under-treated hearing loss is a major risk factor for cognitive decline and dementia. A hearing aid can help, but it doesn’t always provide the brain with the rich, clear auditory input it needs to stay sharp. This is where a CI can offer a life-changing solution.
Beyond Hearing Aids: The Full Spectrum of Hearing Devices
To have this conversation with confidence, you and your staff must be experts on all available technologies. This includes:
- Prescription Hearing Aids: The bread and butter of your practice, these devices are essential for many patients. You’re an expert at fitting and programming them to a patient’s unique hearing loss profile.
- Over-the-Counter (OTC) Hearing Aids: While they have a place in the market, it’s critical to understand their limitations. They are not a suitable solution for most patients who need professional care. If a patient walks in with one of these devices don’t just turn them away, take the time to show them what they are missing and educate them.
- Bone-Anchored Hearing Aids (BAHAs): These are a specific solution for conductive hearing loss, mixed hearing loss, or single-sided deafness. They’re part of the conversation for patients with these specific needs. Make yourself comfortable explaining why this is or is not an option.
- Cochlear Implants (CIs): Unlike hearing aids that amplify sound, CIs bypass damaged parts of the inner ear and directly stimulate the auditory nerve. This offers a level of clarity and sound understanding that hearing aids simply cannot provide for a patient with profound hearing loss. Even if your practice does not work with Cis you need to have the difficult conversation and make sure your patients are educated on all options even if it means loosing a hearing aid sale.
The key is to not think of these as competing technologies but as a continuum of care. For some patients, the journey begins with hearing aids and progresses to a CI as their hearing loss worsens. For others, a CI might be the best option from the start.
The CI Conversation: When and How to Have It
The right time to bring up CIs is when you see a patient who is a borderline candidate. They have poor word understanding even with powerful hearing aids. Their audiogram shows significant loss, and they express frustration with their current devices. This is not a conversation about selling a device, it’s about presenting all options.
It’s crucial to set realistic expectations. A CI doesn’t sound like a hearing aid, and the initial experience can be jarring. It requires patience and a significant commitment to aural rehabilitation. However, the long-term benefits are incredible. I’ve seen countless stories of patients who went from struggling to understand a single word to having vibrant, engaging conversations with their family and friends.
A CI is an investment in a patient’s long-term cognitive health and overall well-being. By having this conversation, you’re not just selling them a device, you’re offering them a pathway back to a richer, more connected life.
Your Next Steps as an Audiologist
- Train your team: Ensure every audiologist and / or hearing instrument specialist in your practice is comfortable discussing CI candidacy and the patient journey. This includes understanding the latest criteria and being able to explain the process clearly.
- Establish a referral network: If you don’t already have one, build a strong relationship with a local CI surgeon and aural rehabilitation specialists. This ensures a seamless continuum of care for your patients.
- Reframe the conversation: Instead of framing CIs as an extreme option, position them as a powerful tool for patients who have exhausted the benefits of traditional amplification.
By embracing this conversation, you will not only grow your practice but, more importantly, you will become a true partner in your patients’ hearing healthcare journey.
