**1. Introduction**

By most standards, audiology is a relatively young profession, burgeoning in North America and Western Europe following World War II. Cutting its teeth by managing the needs of soldiers returning from the war, audiology centered on two distinct practices: (1) Diagnostics, particularly the identification of ear diseases using an evolving battery of site of lesion testing. This battery of tests included, air and bone conduction pure tone threshold testing, speech audiometry, tympanometry, and acoustic reflex thresholds. Eventually, electrophysiologic assessment of the auditory and balance system including auditory brainstem response (ABR) and otoacoustic emissions (OAE) assessment were added to armamentarium of audiologists involved in diagnostic assessments. (2) Treatment and rehabilitation, specifically the selection and fitting of hearing aids for individuals with

benign forms of hearing loss. Aural rehabilitation, with its emphasis on exercises to improve communication skills, should remain an important part of the second pillar. Beyond these traditional components of Audiology, changes in the market are likely to provide opportunities to provide different types of services to individuals with hearing loss.

Managing adults with hearing loss is by far the most fundamental aspect of audiology practice making this the bread and butter of our profession. Both pillars of clinical audiology, diagnostics and treatment/rehabilitation, will remain integral components of care for persons with hearing loss, however, technological progress, driven mainly by Moore's Law and the evolving consumer demands of the Baby-boomer generation are expected to change how Audiology is practiced. Over the next decade, self-fitting hearing aids and other amplification devices purchased over the counter, without the assistance of a licensed professional, will likely enable persons with hearing loss to self-direct or self-manage their own care. The availability of self-directed care, which includes self-administered hearing testing and self-fitting hearing aids, will enable persons with hearing loss to select and fit hearing aids without intervention of an audiologist. The ability of persons with hearing loss to self-direct their care warrants the development of a third pillar in Audiology. One devoted to comprehensive care and well-being of the person with hearing loss that is not dependent on the purchase of hearing aids directly from a licensed professional.

**Self-directed or self-managed care** is defined as a patient's or customer's ability to identify and treat a perceived condition without the assistance, guidance or input of a credentialed expert. The purchase of medication, such as pain relievers for a headache is perhaps the simplest type of self-directed care. Smartphone-enabled apps that collect and analyze bodily functions are allowing more opportunities for people to self-direct their own care. Self-fitting hearing aids may soon be a viable option for individuals opting to self-direct their hearing care. If these types of devices are purchased on-line, a growing number of individuals could seek services from an audiologist *after* they have purchased hearing aids elsewhere.

### **2. Self-fitted hybrid hearing devices**

Hearing aid technology has never been better, yet a surprisingly large number of persons with hearing loss fail to embrace it. Fortunately, as smartphoneenabled apps, Bluetooth streaming and voice-activated algorithms find their way into traditional hearing aids, it increased the chances that this technology can be successfully selected and fitted without the guidance of an audiologist. Exactly who can benefit from this newer technology has not been firmly established, nevertheless, audiologists must be ready to practice in a future where some people can self-fit their hearing aids, referred to in this chapter as self-fitted, hybrid devices.

The combination of changing demands within the market, led by an aging Babyboomer population and rapidly evolving hearing aid technology, has paved the way for new ear worn products. These products combine the advantages of traditional hearing aids, such as stable gain without feedback and sophisticated noise reduction technology with consumer audio products that interface with smartphone-enabled apps and allow their users to easily adjust them, often with voice-activated technology. Commonly referred to as hybrid hearing devices, there are a range of products that exist on a continuum. Some of these products are classified as traditional hearing aids, while others are conventional consumer audio products that happen to provide some nominal amount of amplification.

**35**

*Audiology's Third Pillar: Comprehensive Follow-Up Care and Counseling for Those Who Choose…*

Importantly, both hearing aid manufacturers and consumer electronics companies are bringing products to market today that are considered, multi-tasking hybrid devices. Some, of course, have as their core function amplification with direct audio streaming via Bluetooth or biometrics as a secondary function. On the other hand, consumer electronics companies are bringing a wide range of ear worn devices to market that have customizable amplification as one of many features for the wearer to use. As technology continues to evolve, especially in the emerging era of voice activated algorithms (e.g., Siri and Alexa), these hybrid devices are likely to

As we move into this brave new world of multi-tasking audio gadgets, here are a few key points to remember about these hybrid devices: (1) These are true multi-tasking products that provide the wearer with a core function, which could be amplification, phone and music streaming, language translation or biometrics, and whatever feature from this list not deemed by the wearer as the core feature becomes a secondary function for the wearer. (2) Many of these devices are selffitting in nature. This, in theory, enables their wearer to purchase the device, finetune and wear it without ever seeing an audiologist. (3) Some, yet to be determined number of individuals, who are interested in these hybrid devices will need help navigating the myriad choices, or after they have purchased a hybrid device will need some expert help and attention on maximizing their use—this final point is

**3. The third pillar: comprehensive follow-up care and counseling**

The ability to self-direct hearing care means that a potentially large number of individuals with hearing loss may not have to see an audiologist for care until *after* they have purchased hearing device. Given that most hearing aid purchases today are completed in a bundled manner (hearing aids and services are sold together as one "package"), the advent of self-fitting hearing devices will present Audiologists with the challenges of offering more unbundled professional services to individuals with hearing loss that purchased devices elsewhere, but now need counseling or

Some Audiologists are already offering "unbundled" or "itemized" hearing care services. This may be to cope with the constantly changing needs of individuals with hearing loss and to differentiate themselves in an evolving healthcare marketplace. Such an approach may bring opportunities for Audiologists to increase market share by assisting persons who may have purchased hearing devices online without the audiological services or support. However, little has been written about the ways in which Audiologists can effectively offer decoupled audiological services. The purpose of this chapter is to provide guidance and insights on how a third pillar of Audiology, one firmly centered on comprehensive follow-up care and counseling, unbundled from the sale of hearing aids, can be used to better serve the community and generate revenue for practice owners. Before offering specific comprehensive follow-up care and counseling strategies, let us take a closer look at how audiological services have been customarily delivered and how that is likely to change.

For more than 30 years, regardless of practice setting, most audiologists have generated much of their practice revenue from the dispensing of hearing aids. The generation of this revenue is predicated on the number of hearing aid units sold over any given time frame. Given the large profit margins historically associated

*DOI: http://dx.doi.org/10.5772/intechopen.88224*

the third pillar of Audiology.

device management support.

**3.1 Units based versus time-based business models**

become easier to use for a wider range of the population.

#### *Audiology's Third Pillar: Comprehensive Follow-Up Care and Counseling for Those Who Choose… DOI: http://dx.doi.org/10.5772/intechopen.88224*

Importantly, both hearing aid manufacturers and consumer electronics companies are bringing products to market today that are considered, multi-tasking hybrid devices. Some, of course, have as their core function amplification with direct audio streaming via Bluetooth or biometrics as a secondary function. On the other hand, consumer electronics companies are bringing a wide range of ear worn devices to market that have customizable amplification as one of many features for the wearer to use. As technology continues to evolve, especially in the emerging era of voice activated algorithms (e.g., Siri and Alexa), these hybrid devices are likely to become easier to use for a wider range of the population.

As we move into this brave new world of multi-tasking audio gadgets, here are a few key points to remember about these hybrid devices: (1) These are true multi-tasking products that provide the wearer with a core function, which could be amplification, phone and music streaming, language translation or biometrics, and whatever feature from this list not deemed by the wearer as the core feature becomes a secondary function for the wearer. (2) Many of these devices are selffitting in nature. This, in theory, enables their wearer to purchase the device, finetune and wear it without ever seeing an audiologist. (3) Some, yet to be determined number of individuals, who are interested in these hybrid devices will need help navigating the myriad choices, or after they have purchased a hybrid device will need some expert help and attention on maximizing their use—this final point is the third pillar of Audiology.
