Skip to content
Fuel COVID-19 Resource Center: Helping you get the answers you need. View Resources

Since the 1980s, audiology clinics have been offering hearing aids as the primary treatment for hearing loss. However, some patients with low communication difficulties don’t need the expense and sophisticated capabilities of hearing aids. Likewise, patients with high communication difficulties who don’t benefit from hearing aids could benefit significantly from cochlear implants. By limiting treatments to hearing aids, we are ignoring the needs of many patients with communication difficulties and do not offer students the professional training and experiences they need to serve this broad spectrum of patients.

The recent emphasis on accessible and affordable hearing health care has awakened those with communication difficulties to explore treatments that are lower cost than traditional audiologists’ provided bundled hearing aid services. Also, cochlear implants are now so widely accepted that implant companies want more widespread post-operative care and rehabilitation for implant patients, opening up opportunities for academic clinics’ participation. Academic audiology clinics should take the lead in providing a broader choice of treatments to serve all patients by taking advantages of these changes and opportunities. They also have the responsibility to train AuD students to help all possible patients with the broad spectrum of treatments now available. Let’s review what remedies we could be offering.


Personal Sound Amplifiers or PSAPs are non-medical devices that amplify sound but do not address other components of hearing loss. They improve audibility and enhance speech understanding in quiet environments and show limited improvement in noisy situations. They cannot be marketed as a treatment for hearing loss, but patients with mild hearing loss often benefit from simple amplification. Considering that 75% of people with hearing loss have mild to moderate hearing loss, and only 10% are being treated, this represents the largest category of potential patients for audiologists1-4. They should not be ignored or overtreated.  Simple amplification from the most basic hearing aid, first fit to the patient’s hearing loss, will offer an alternative to PSAPs at about the same affordable cost. With this strategy the clinic will:

  • Win a new patient at an earlier patient age
  • Create the opportunity for regular patient visits and frequent communication with the patient
  • Build trust that will draw that patient back to the clinic when additional, more sophisticated and profitable treatment is needed

This strategy allows you to fulfill your professional obligation to patients who do not want expensive hearing aids. It also taps into a large untapped market, and offers a more relevant and meaningful experience to your AuD students.


Over the Counter (OTC) hearing aids will formally exist in a few years. However, in fact, they are available now. These hearing aids are medical devices that will be permitted to be sold directly to consumers “without the supervision, prescription, or other order, involvement, or intervention of a licensed person, to consumers through in-person transactions, by mail, or online.” They are intended for people with “perceived mild to moderate hearing loss.” Audiologists will not be the primary source of these devices, but, as with PSAPs, this opportunity opens up a door to reach the large population of people, often younger, with mild to moderate hearing loss. These devices will be more sophisticated than PSAPs and will probably include self-fitting by the consumer. To the extent that these devices are imperfect, or self-fitting/other customization by the consumer is flawed, there is an opportunity for audiologists, for a fee, to resolve such issues and establish a relationship with the consumer. Academic audiology clinics should be prepared to serve disappointed or frustrated OTC customers and convert them to patients as their hearing difficulties increase and more sophisticated hearing aids are required. To be ready for the future of audiology, AuD students need to learn how to serve these consumers, recruit them as patients, and improve their treatments as hearing becomes more difficult.

Hearing Aids

Hearing aids are classified by the FDA as medical devices and are an appropriate consideration for most degrees of hearing loss. Hearing aid benefits are well established. They are at the core of today’s treatment for hearing loss. However, some patients cannot benefit from hearing aids and need to consider cochlear implants (see below). Also, hearables, with hearing aid capabilities, are quickly entering the market and will soon need to be added to hearing aid options to serve a wide range of patients best.

Hearing Systems

  • Hearing systems have tremendous benefits including:
  • Improved Ability in Noise
  • Listening to Music
  • Improved Comfort in Noise
  • Streaming TV Audio
  • Improved Speech Understanding in Noise
  • Streaming Directly from Phone
  • Localization of Sounds
  • Remote Companion Microphone
  • Telephone Use
  • Remote Adjustments and Programming

A wide variety of patients desire these hearing systems because of these wide-ranging benefits. They should be offered as an integral part of their treatment. Everybody from PSAP users to cochlear implant users can benefit from these devices. Students should be knowledgeable about them and gain experience explaining their benefits and use to patients.

Cochlear Implants

History – Cochlear implants (CIs) have advanced from being controversial devices implanted by a small select group of surgeons performing complicated surgeries on patients who met strict eligibility requirements. Today, more people meet new lower eligibility requirements for cochlear implants and risk/benefit ratios are much improved. Cochlear implants are now implanted during straightforward outpatient procedures, usually taking about two hours, with few complications. Recovery is typically quick. The procedure has been successfully performed on hundreds of thousands of patients worldwide. A wide variety of accessories are now available for CIs, increasing their use and convenience.

CI patients receive little or no benefit from hearing aids. However, with CIs results can be astounding for the patient, their family, friends, and co-workers. Historically, clinics without a physician could not offer cochlear implants, and when a patient was referred to a physician for implantation, the patient too often did not return to the clinic. This is no longer true. With Fuel’s involvement with Cochlear Corporation’s Cochlear Provider Network (CPN), patients can be referred for implantation and receive programming, rehabilitation and other care in your clinic, offering training opportunities for AuD students that were previously difficult to provide.

Why offer Cochlear Implants? – To adequately serve all patients, your academic clinic needs to offer qualified patients cochlear implants. Your students need to learn how CIs function and when to recommend them. Students must know how to program CIs and provide rehabilitation. They learn this best through experience. Cochlear implants require physician involvement and bring your clinic closer to the medical community, a natural relationship for academic clinics. Building on this relationship increases the likelihood of physician referrals. Offering cochlear implants makes your clinical and training approach a medical one, not one based on product or price. This medical approach will nicely differentiate your clinic from the competition. Most hearing implants are covered for Medicare beneficiaries who meet CMS criteria for coverage. Many insurance plans also include them.

How to Get Started Offering Cochlear Implant Services – Contact your Fuel representative to investigate your possible participation in the CPN and to avail your clinic of Fuel’s Cochlear support services such as: Getting started with the CPN; when to discuss CIs with patients; materials and strategies for marketing CIs; patient educational materials; information about scheduling the CI evaluation appointment, pre-surgery appointment materials, and more.

Academic audiology clinics should take the lead in understanding what treatments patients prefer and in providing a broader choice of treatments to serve all patients. They also have the responsibility to train AuD students to help all possible patients with the full spectrum of treatments now available.

If you are interested in broadening your treatment offerings, including possible participation in the CPN, contact your Fuel regional manager or account manager. If you are not a Fuel member yet, contact us today at or call (360) 210-5658.


  1. Nash SD, Cruickshanks KJ, Huang GH, et al. Unmet hearing health care needs: the Beaver Dam offspring study. Am J Public Health. 2013; 103(6):1134–1139
  2. Lin FR, Thorpe R, Gordon-Salant S, Ferrucci L. Hear ing loss prevalence and risk factors among older adults in the United States. J Gerontol A Biol Sci Med Sci. 2011; 66(5):582–590
  3. Lin FR, Niparko JK, Ferrucci L. Hearing loss prevalence in the United States. Arch Intern Med. 2011; 171(20):1851–1852
  4. Wallhagen MI, Pettengill E. Hearing impairment: significant but underassessed in primary care settings. J Gerontol Nurs. 2008; 34(2):36–42