Lively: Committed to Audiology
At Lively, our commitment to audiology and professional service runs deep: Not only are we advised by some of the top audiologists in the world, but we make sure each and every Lively client meets face-to-face with a licensed audiologist or hearing specialist.
However, we realize there are bound to be questions about us and our use of technology for hearing assessments and remote face-to-face care. We've created this page to help provide clarification and background to the professional community.
The Science of Online Hearing Tests
Thanks to significant technological advancements and research
1 over the past few years, online hearing tests can now be used to safely and effectively fit hearing aids. 2
Building on this work, we've done a considerable amount of research on a wide-range of devices and headphones, and have developed our own online hearing assessment based on what we've learned. Given our testing across different transducers and operating systems, we're confident that when augmented with face-to-face professional support and ongoing remote tunings by a licensed Lively hearing specialist our test enables us to effectively fit a hearing aid and improve a client's hearing. So far, our approach has proven well-founded, as we've consistently received excellent clinical outcomes and customer satisfaction scores.
Of course, providing effective hearing care extends beyond a customer's online hearing test and initial fitting. Lively customers are monitored for improvement, and our Audiology team uses the Client Oriented Scale of Improvement (COSI) to ensure we address their specific hearing needs and goals.
Focusing On Accessibility
Hearing care has an accessibility problem. In fact, 70-85% of adults 50+ with hearing loss do not receive the care they need.
We're committed to changing this. At Lively, we use video and other telehealth technologies including online hearing assessments to make custom-tuned and professionally-reviewed hearing aids available to anyone who meets our requirements. Recent studies have shown that approaches like ours are effective at making hearing care more accessible.
While Lively can help increase the accessibility of hearing care, there will always be a need for traditional audiology practices. Some clients will opt for in-person care, or will need access to procedures such as otoscopy, probe-microphone measures, and advanced diagnostic testing. For these reasons, Lively will never replace the traditional model, only augment it - and we will always let you know if we believe it is important that you be seen in person by another qualified professional.
The Highest Standards
We're committed to complying with all applicable laws and regulations related to online hearing aid dispensing and our legal team works closely with our Board of Advisors and company executives to ensure Lively always upholds the highest standards of the industry.
Come Grow With Us
If you're a licensed audiologist or hearing aid dispenser and want to help Lively make hearing aids and professional care more accessible, let us know. We are always looking to add qualified, caring, and passionate professionals to our team!
Frequently asked questions
As a result of considerable tele-audiology research in recent years (Swanepoel et al, 2010; Krumm, 2016), remote hearing assessment and hearing aid fitting is now recognized as an evidence-based approach for providing hearing services to more people who need them. For proof of this positive change in professional opinion, you might want to read two editorials in the Journal of the American Academy of Audiology - one in the June 2016 issue entitled "Perceptions of Internet Delivery of Hearing aids (Jacobson, 2016) and the other, published in February 2017 entitled "Build a better assessment and patients will beat a path to your clinic (McCaslin, 2017).
Yes. Audiologists were involved from the outset in the development of the Lively approach for hearing assessment and hearing aid fitting. These leaders in the profession still provide expert advice on the entire process. In addition, our licensed audiologists and hearing aid dispensers are in close contact with people who choose Lively for their hearing aid needs, beginning with initial questions about Lively and the initial online hearing assessment to the hearing aid fitting and throughout long-term follow up.
We understand the question because in-person audiologists and hearing aid dispensers typically perform an inspection of the patient's external ear canals before beginning hearing assessment. Perhaps someday technology will be readily available for adequate self-examination or online directed examination of the external ear canals. Until then, Lively takes several steps to address the issue of ear canal status. Prospective Lively users are specifically asked about past problems with excessive cerumen. Persons with such a history are encouraged to seek medical consultation. In addition, Lively customers are directed to complete the Consumer Ear Disease Risk Assessment, or CEDRA. The National Institutes of Health funded research on this validated 15-item consumer questionnaire to detect disease risk before a person purchases hearing aids. You can access CEDRA on the Lively website.
It's appropriate to also point out here that within the past few years we've witnessed a trend toward relaxation of Federal requirements for a medical examination prior to the purchase of hearing aids. The Over-the-Counter Hearing Aid Act of 2017 (see Section 709) is one example (implementing FDA regulations under it are still pending), as is the FDA's decision in December 2016 not to enforce the requirement that prospective hearing aid purchasers 18 and over first undergo or waive a medical evaluation.
No. Children or anyone under the age of 18 years should seek hearing health care directly from a licensed audiologist or other qualified provider. Lively is for adults with hearing loss only.
We can anticipate that in a small proportion of adults hearing loss is a symptom of a disease requiring medical evaluation and possible treatment. Results of the online hearing test, responses on the CEDRA evaluation and interactions with our professional hearing specialists will usually identify those patients. Someone who contacts Lively and reports problems such as sudden onset hearing loss, a unilateral hearing loss, or a progressive hearing loss are advised to seek medical attention. However, according to published research (Zapala et al, 2010), the majority of older adults with hearing impairment do not need medical services. Direct access for hearing problems poses little risk in this population.
Yes. Research from around the world confirms that pure tone hearing screening and assessment conducted online, or even with a smart phone, yields results comparable to the conventional hearing assessment conducted by a hearing professional with the patient in a sound-treated room (Whitton et al. Validation of a self-administered audiometry application: An equivalence study. Laryngoscope, 126 (10), 2382-2388, 2016). You can find more information with a PubMed literature search at www.nlm.nih.gov. In fact, there is considerable research validating remote assessment of speech perception in quiet and noise (e.g., de Graaffe et al. 2018; Paplialonga et al. 2020).
As we mentioned in the response to previous questions, strategies for hearing assessment and rehabilitation of hearing loss are rapidly changing. Tele-services are now a reality for much of hearing health care. Many hearing aid-related services a professional can perform in a traditional clinical setting can now be done just as well remotely using the kind of technology and techniques used by Lively. Outcome research within the past decade confirms that hearing aid services delivered via technologically remote means can produce patient benefit equivalent to what we would expect for traditional face-to-face clinical services that are consistent with best practices.
While probe-microphone verification represents an in-person audiologic best practice, technological developments such adaptation algorithms, Lively's frequent face-to-face follow-up schedule and our ability to remotely fine-tune the full suite of hearing aid features has yielded excellent client outcomes.
As noted above, we schedule a series of face-to-face follow-up appointments after the hearing aid fitting, and clients have the ability to schedule further follow-ups with their included 3 years of hearing care. This allows us to identify problems requiring additional instruction, counseling and/or program modifications which we can implement remotely. Our protocol includes the use of the COSI to identify client-specific problems, establish client-specific goals and measure client-perceived outcomes.
Actually, the Lively model expands and extends professional services to more patients, and reinforces Lively's belief that the involvement of a qualified professional is critical to getting the best benefit, value, and performance from hearing aids. It's important to reiterate that licensed hearing professionals are involved in each step of the Lively care process. People with hearing loss and difficulties with communication now have different options for seeking hearing health care. These people value, and in many cases require, convenience, access, and cost-effectiveness as they attempt to find a solution to their communication problems. The increased public interest in OTC products is evidence for this trend. Lively offers an attractive professionally-focused option for adults who have hearing loss and who have decided it's time to do something about it or aren't well-served by a process requiring numerous in-person visits.