Problems and solutions for fitting amplification to patients with Menière's disease

Fitting amplification to a patient with Ménière's disease (MD) can present several challenges to the dispensing audiologist. These challenges include the presence of fluctuating hearing loss, a rising audiometric configuration, unilateral or asymmetrical hearing loss, reduced dynamic range, and reduced word-recognition scores. The presence of any one of these characteristics could create obstacles for a successful hearing aid fit. The presence of most if not all of these characteristics in a single patient can readily challenge the skills of even the most experienced dispensing audiologist. In addition to the audiometric challenges, this patient population has the added psychological problems associated with feeling ill due to the nausea secondary to vertiginous attacks and the anxiety associated with the unpredictable nature of the course of these attacks. This paper summarizes numerous strategies and technologies that could be implemented by the audiologist to address these unique challenges and provide a greater opportunity for a successful hearing aid fit. These suggestions include (1) advantages offered by digital signal processing; (2) using directional microphones and assistive listening devices to improve speech recognition in noise; (3) using wireless hearing aids as well as the bone anchored hearing aid; (4) counseling patients on the realistic expectations from amplification in noisy listening situations and for those with poor speech recognition; (5) using multiple programs for patients with fluctuating hearing loss; and (6) offering suggestions on programming the frequency-gain/output response for a rising configuration.