OTC Hearing Aids?

You may have seen that the Over-The-Counter Hearing Aid Bill was recently passed as a part of the FDA Reauthorization Act. This is exciting news for the hearing care industry, as around 80% of individuals who would benefit from amplification do not currently utilize any form of hearing care.

Much is still to be determined as the FDA has three years to create regulations and distinctions for this new category of devices.  Eliminating the current marketing and use of unregulated Personal Sound Amplification Devices as an alternative will greatly improve public safety.

I anticipate widely available amplifiers with treble/bass and overall volume control and a built in gain limiter so that the devices are not capable of creating further hearing loss in their users.  Most will be digital with feedback controls and the ability to adjust sound level and quality through a computer or phone or onboard controls.  These will be very similar to our hearing aid technology of the early 1990’s. These will be a great option for individuals with mild hearing loss that has not impacted auditory processing in a significant way.  Aiding hearing loss at an earlier stage will slow the process of auditory deprivation hopefully resulting in less loss of auditory processing as well as improving overall health goals such as cognition, social engagement, and physical activity levels.

My hope is that traditional hearing aids will be designated as Class 2 medical devices.  These will remain the appropriate treatment option for individuals with hearing thresholds greater than 40 dB, sharply sloping hearing losses, or auditory processing difficulty such as difficulty understanding speech in nose.

Our current hearing aid technology has 12-32 channels of frequency control and 3-4 loudness levels with additional algorithms for different types of noise reduction, special shaping, frequency compression, and tinnitus management.  In my practice, all devices are fit with a small microphone tube located 3-4 mm from the tympanic membrane to calibrate the sound very precisely.  The hearing loss levels and acoustics of the ear canal are taken into account, and sound levels are set to match an independent, Evidence-Based prescription for ideal speech understanding.  Sometimes additional settings are created for sound quality of music, or specific environments.  Accessories can be connected to aid with processing difficulties, for individuals with difficulty managing competing noise due to cognitive decline.  The recommendation and selection of these hearing systems is based on concrete test results.

Hearing care has been a field of rapid change for over 20 years now, and the changes will certainly continue!  I hope to be a resource to you and your family as we navigate expanded access and changing technologies.  Please call or message the office to find out more information about hearing care resources, changing regulations, and our practice.

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What to Expect (Part 5)

Most of our patients who wear hearing aids come see us 2-3 times a year for routine maintenance to keep their devices working as well as possible.  Our climate in North Carolina is brutal to tiny electronics and computer chips worn on the body all day!  Routine care helps the hearing aids work well all the time, and stay working longer.  This helps you get the maximum benefit from your investment!


Hearing aids are able to give you the most help if you wear them the whole time you are awake.

Eyes Open = Ears On


The average adult takes 4-6 weeks of wearing hearing aids for at least 1 hours a day to reach maximum benefit and best understanding in noise.  The brain has to relearn what to do with all those sounds in the world.

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What to Expect (Part 4)

We do dispense hearing aids through our office, as well as fit appropriate amplification devices purchased through insurances or reputable outside sources.  We are preferred providers for TruHearing and Amplifon.


Hearing Aids available range from made for iPhone and Bluetooth enhanced options, to 24/7 invisible solutions, to traditional devices optimized for limited dexterity and vision.  We use your hearing ability data in the hearing aid selection process, basing our recommendations on your lifestyle needs, degree of hearing loss, and your speech understanding scores.


A hearing aid fitting, refitting, or amplification assessment involves very precise measurements of the sound level at your eardrum through a process called Real Ear Measures.  This allows the Audiologist to make sure that the devices are working in the best possible way to meet your needs. The sound is lined up to match a prescription – to ensure the best possible speech understanding.

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What to Expect (Part 3)

A comprehensive hearing evaluation assesses how loud sound needs to be for you to be aware of it across a range of different types of sounds, or pitches, as well as how well you are able to understand speech when it is quiet and when it is loud.  If additional information might be helpful, we may also assess your loudness reactivity, speech understanding in background noise, and/or measure your tinnitus.


We like to review the results and implications of the hearing test at the same visit, and an evaluation with us means that you and, if you wish, your primary care provider will get a written report explaining the results. If management or treatment options are suggested, we can discuss them at that time as well.


Hearing aids are NOT the only treatment that we have to offer!  Some individuals with hearing difficulties may be better treated with auditory rehabilitation through computer-based retraining programs, or assistive listening devices.


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What to Expect (Part 2)

Did you know that we are in-network providers for Medicare, Blue Cross Blue Shield, and Cigna?  We are also preferred providers for TruHearing and Amplifon.  Carlisa, our Financial Coordinator, is here to help communicate with insurance companies and make sure that you know what to expect.


New patients typically begin with a consultation – just a sit down visit with Dr. Cristobal to discuss what experiences and goals you may have.  Bringing a family member or the person you talk to the most can be very helpful, as he or she may understand what you are missing even more than you do!


Once we have an understanding of your goals for the visit, we often proceed to an evaluation of the ears.  We will look in the ear canals for wax that may interfere, appearance of the eardrum, and any notable anatomy. We see many different ears on a daily basis, and your anatomy contributes to how you hear!

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What to Expect

Have you ever wondered what to expect at a visit to the audiologist?  Stay tuned to see what to expect!


When you call into the office, you will likely talk to Rachel.  Rachel has been with HHCS since August 2015. She is our cheerful Patient Care Coordinator and Audiology Assistant.  She will ask you several questions to help figure out what type of appointment will be best to meet your needs.


Our office is located on Highway 54 between Durham and Chapel Hill.  We are on the first floor of our building – park and walk right into our front door!  We are suite 100, farthest from the road.


Our waiting area has coffee, bottled water, and candy to make you feel at home.  We may gather some information from you to help us make sure we offer the best care and utilize any insurance assistance possible.

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