Jabra Enhance: Committed to audiology

Frequently asked questions

• Doesn't the profession of audiology have concerns about remote hearing testing and fitting hearing aids without any direct patient contact?

  As a result of considerable tele-audiology research in recent years (Swanepoel et al, 2010; Krumm, 2016), remote hearing assessment and hearing aid fitting is now recognized as an evidence-based approach for providing hearing services to more people who need them. For proof of this positive change in professional opinion, you might want to read two editorials in the Journal of the American Academy of Audiology - one in the June 2016 issue entitled "Perceptions of Internet Delivery of Hearing aids (Jacobson, 2016) and the other, published in February 2017 entitled "Build a better assessment and patients will beat a path to your clinic (McCaslin, 2017).

• Are audiologists involved at all in the Jabra Enhance approach to delivery of hearing aids?

  Yes. Audiologists were involved from the outset in the development of the Jabra Enhance approach for hearing assessment and hearing aid fitting. These leaders in the profession still provide expert advice on the entire process. In addition, our licensed audiologists and hearing aid dispensers are in close contact with people who choose Jabra Enhance for their hearing aid needs, beginning with initial questions about Jabra Enhance and the initial online hearing assessment to the hearing aid fitting and throughout long-term follow up.

• How can Jabra Enhance begin the hearing aid process without an audiologist first inspecting the patient's ear canal without the results of otoscopy? Aren't you concerned about the possibility of excessive ear wax or ear disease?

  We understand the question because in-person audiologists and hearing aid dispensers typically perform an inspection of the patient's external ear canals before beginning hearing assessment. Perhaps someday technology will be readily available for adequate self-examination or online directed examination of the external ear canals. Until then, Jabra Enhance takes several steps to address the issue of ear canal status. Prospective customers are specifically asked about past problems with excessive cerumen. Persons with such a history are encouraged to seek medical consultation. In addition, customers are directed to complete the Consumer Ear Disease Risk Assessment, or CEDRA. The National Institutes of Health funded research on this validated 15-item consumer questionnaire to detect disease risk before a person purchases hearing aids. You can access CEDRA on the Jabra Enhance website.

  It's appropriate to also point out here that within the past few years we've witnessed a trend toward relaxation of Federal requirements for a medical examination prior to the purchase of hearing aids. The Over-the-Counter Hearing Aid Act of 2017 (see Section 709) is one example (implementing FDA regulations under it are still pending), as is the FDA's decision in December 2016 not to enforce the requirement that prospective hearing aid purchasers 18 and over first undergo or waive a medical evaluation.

• Is the Jabra Enhance system for hearing aids appropriate for children?

  No. Children or anyone under the age of 18 years should seek hearing health care directly from a licensed audiologist or other qualified provider. Jabra Enhance is for adults with hearing loss only.

• Are there any adult patients with hearing loss who should not get hearing aids from Jabra Enhance?

  We can anticipate that in a small proportion of adults hearing loss is a symptom of a disease requiring medical evaluation and possible treatment. Results of the online hearing test, responses on the CEDRA evaluation and interactions with our professional hearing specialists will usually identify those patients. Someone who contacts Jabra Enhance and reports problems such as sudden onset hearing loss, a unilateral hearing loss, or a progressive hearing loss are advised to seek medical attention. However, according to published research (Zapala et al, 2010), the majority of older adults with hearing impairment do not need medical services. Direct access for hearing problems poses little risk in this population.

• I have heard that diagnostic hearing testing should be performed with calibrated equipment and with the patient sitting in a sound-treated room meeting ANSI standards. Is it possible to get accurate test results over the telephone or via the internet?

  Yes. Research from around the world confirms that pure tone hearing screening and assessment conducted online, or even with a smart phone, yields results comparable to the conventional hearing assessment conducted by a hearing professional with the patient in a sound-treated room (Whitton et al. Validation of a self-administered audiometry application: An equivalence study. Laryngoscope, 126 (10), 2382 - 2388, 2016). You can find more information with a PubMed literature search at www.nlm.nih.gov. In fact, there is considerable research validating remote assessment of speech perception in quiet and noise (e.g., de Graaffe et al. 2018; Paplialonga et al. 2020).

• You hear a lot about best practices in audiology these days. How can Jabra Enhance follow best practices if the patient never sees a hearing professional audiologist in person?

  As we mentioned in the response to previous questions, strategies for hearing assessment and rehabilitation of hearing loss are rapidly changing. Tele-services are now a reality for much of hearing health care. Many hearing aid-related services a professional can perform in a traditional clinical setting can now be done just as well remotely using the kind of technology and techniques used by Jabra Enhance. Outcome research within the past decade confirms that hearing aid services delivered via technologically remote means can produce patient benefit equivalent to what we would expect for traditional face-to-face clinical services that are consistent with best practices.

• On the same topic, aren't real ear measurements part of best practices? How can Jabra Enhance be sure the hearing aid fitting is appropriate for a patient without a probe mic verification?

  While probe-microphone verification represents an in-person audiologic best practice, technological developments such adaptation algorithms, our frequent face-to-face follow-up schedule and our ability to remotely fine-tune the full suite of hearing aid features has yielded excellent client outcomes.

• What happens after a patient buys hearing aids from Jabra Enhance? Is there any follow up to confirm that they are actually using the hearing aids, and getting some benefit from them?

  As noted above, we schedule a series of face-to-face follow-up appointments after the hearing aid fitting, and clients have the ability to schedule further follow-ups with their included 3 years of hearing care. This allows us to identify problems requiring additional instruction, counseling and/or program modifications which we can implement remotely. Our protocol includes the use of the COSI to identify client-specific problems, establish client-specific goals and measure client-perceived outcomes.

• Does the Jabra Enhance model represent a threat to the audiology profession?

  Actually, the Jabra Enhance model expands and extends professional services to more patients, and reinforces our belief that the involvement of a qualified professional is critical to getting the best benefit, value, and performance from hearing aids. It's important to reiterate that licensed hearing professionals are involved in each step of the Jabra Enhance care process. People with hearing loss and difficulties with communication now have different options for seeking hearing health care. These people value, and in many cases require, convenience, access, and cost-effectiveness as they attempt to find a solution to their communication problems. The increased public interest in OTC products is evidence for this trend. Jabra Enhance offers an attractive professionally-focused option for adults who have hearing loss and who have decided it's time to do something about it or aren't well-served by a process requiring numerous in-person visits.