Editor’s note: In the April 2001 issue of The Hearing Review, a special “Opinions from the Field” section was featured that included an article by Granville Y. Brady, Jr., MA, entitled “The Case Against a Trial Period” which questioned the usefulness of current mandatory trial periods for hearing instrument dispensing, particularly relative to clients’ acceptance of amplification. The following article, submitted by Mark Ross, PhD, offers another perspective on this subject.

In his article “The Case Against a Trial Period,” Brady1 makes some cogent points that few of us would disagree with. Certainly, the acquisition of hearing instruments is a time of great uncertainty for the affected individual and the family. After years of experiencing communication problems that may have had an impact upon all aspects of a person’s life, the decision to finally try hearing instruments is undoubtedly fraught with all kinds of fears and expectations, realistic or otherwise. Still, regardless of their significance for a particular person, these feelings and experiences are basically irrelevant insofar as a trial period is concerned. They occur because of the person’s hearing loss, not the hearing aids. What is relevant is whether the availability of a trial period will influence the next step: the decision to try and then actually purchase hearing aids.

Some hearing care professionals feel that a trial period is counterproductive, that it gives people who may not be really committed to wearing hearing instruments an “out,” and that this commitment would be enhanced if they were required to make a definite decision to purchase. Maybe. But it is equally, and I personally think it more likely, that the availability of a trial period will convince people who otherwise would not do so to try amplification. (Actually, neither Brady nor myself really knows the answer to this question. We’re both expressing personal opinions with no objective data to buttress either of our viewpoints.)

Flexibility Demands Follow-Ups
Brady points out that modern hearing instruments are capable of an enormous amount of electroacoustic flexibility; therefore, unlike the situation years ago, it is not usually necessary to try different hearing instrument models in order to achieve desired electroacoustic targets. Nothing to disagree with here either. Of course, modern hearing aids offer many more amplification possibilities than older ones. But I would interpret the consequences of this capability differently than he does. In my opinion, it is a good reason for the trial period, not an argument against it. It is because so much more can be done with modern hearing instruments than older ones that additional follow-ups are often necessary to ensure satisfaction and to improve performance. Given these follow-ups, the incidence of returns during a trial period should be markedly reduced. And, to be quite candid, it seems much more likely that such follow-ups would take place when trial periods are available than when they’re not. The realization that the sale of these expensive aids will not be finalized until after a successful trial period can’t help but add a further incentive for dispensers to respond to people’s problems and complaints during that period.

Where I would disagree with Brady is in the implication that a trial period necessarily reduces a client’s commitment to go through the hearing aid adjustment process. This assumes that it is the trial period, rather than the results obtained with amplification2, that is mainly responsible for people returning the hearing instruments for credit. The assumption is that if people understood that the sale was final, they would be more committed to working through adjustment problems than if they had the option of returning the aids for credit. On the contrary, it seems to me that without a trial period, the likelihood is that the hearing aids of many of these people would join previous generations of aids in dresser drawers.3

Reassuring the Wary
Additionally, a large percentage of those seen in our facilities are being dragged or nagged by loved ones into going there. If we waited for a commitment before we could fit hearing instruments on these people, we’d never see them. It is only a supervised and positive experience with amplification that converts them from skeptics into users. From this perspective, trial periods will increase rather than decrease the number of people who purchase hearing aids.

We should keep in mind that people don’t buy and then return hearing instruments casually. In order for them to have made the purchase in the first place, they (or their significant others) must have been experiencing a level of hearing difficulty that reached some critical threshold. Because of this, they then took the time and trouble to come into a hearing care center in order to see if hearing instruments could help them. When someone returns a hearing instrument that was purchased, and does not simply exchange it for another, it must signify some level of disappointment and disillusionment. Even the people who have been involuntarily dragged into the hearing care center must have harbored some unspoken hope that they could be helped with hearing instruments (thereby getting their loved ones off their backs).

The Heart of the Matter
As I read Brady’s article, however, I think the kernel of his argument lies in his belief that trial periods imply dispensing professionals cannot be trusted to make appropriate hearing aid choices for their clients. I can see where this attitude is coming from: of course, a “no sale is final” approach does imply that initial decisions can be flawed and that a person is not bound to make a final decision until sufficiently satisfied. So yes, I do agree that trial periods can be interpreted this way. Rather than implying any lack of skill or dedication on the part of hearing aid dispensers, however, I think that trial periods reflect the real uncertainties involved in fitting hearing instruments to human beings. It is no disparagement of dispensers to state that hearing aid fitting is still more of an art than a science; we don’t, we can’t, write prescriptions that can account for all possible electroacoustic and personal eventualities. Trial periods are the only method where a mutually satisfying decision can be reached between dispensers and clients.

In the last paragraph of his article, Brady recognizes that there are indeed certain “special cases” that may warrant the need for a trial period. Where I would differ is that I would expand the concept of “special case” to include just about everybody who is fit with hearing instruments. There are always uncertainties, always issues to work through, always unforeseen problems, always alternatives that may be useful, and almost always a large psycho-social element to deal with. Right now, only a serious and carefully supervised trial period can deal with the myriad possibilities that can, and often do, occur after hearing instruments are fit on clients.

Actually, at least from the viewpoint of an individual dispenser, the entire debate may be overdone. According to the latest industry statistics4, the actual return rate to dispensers in the year 2000 averaged only 7%. This figure reflects those people who returned hearing instruments during the trial period and who did not subsequently purchase another one from the same dispenser. This is the actual “lost-sale” figure. This percentage should be contrasted with the figure of approximately 20% that is often quoted. This latter percentage refers to hearing aids returned to the manufacturers and not the loss of a sale for an individual dispenser. Certainly, this is a major issue, and undoubtedly the expense of these returns to manufacturers are eventually reflected in unit cost figures—but it is not the same issue facing dispensing professionals.

New Questions
At any rate, no matter what we say in these pages, trial periods are here and they are going to stay. It would be a political impossibility to eliminate them now. I suggest that hearing aid dispensers think of trial periods as an opportunity and not a burden, a way to convince fence-sitters that the water’s fine, come jump right in. Indeed, isn’t this the rationale underlying the “starter” products now on the market? That, once clients get their feet wet, they will “graduate” to more refined products?

References
1. Brady Jr, GY: The case against a trial period. Hearing Review 2001; 8 (4): 54-57.
2. Ross M: When a hearing aid is not enough. Hearing Review 2000; 7 (9): 26-33.
3. Kochkin S: Why my hearing aids are in the drawer: The consumer’s perspective. Hear Jour 2000; 53 (2): 34-42.
4. Strom KE: The HR 2000 dispenser survey. Hearing Review 2001: 8 (6); 20-42.

The preparation of this article was supported in part by Grant #H133E980010 from the U.S. Department of Education, National Institute on Disability and Rehabilitation Research, to the Lexington Center. Correspondence can be addressed to HR or Mark Ross, PhD, Research Division, The Lexington School for the Deaf/ Center for the Deaf, 30th Ave. and 75th St., Jackson Heights, NY 11370.