Delivering the Highest Levels of Hearing Healthcare in Visalia and The Tulare County Communities

Setting Benchmarks of Audiological Excellence

Why Choose Us?
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A Personal Message From Dr. Dan Finnegan

In today’s world, there is no shortage of places to have your hearing checked, whether it’s through an online test or a “free assessment” at your nearby hearing aid store.

However, just as you wouldn’t rely on the internet or a medical professional offering “no-cost appointments” for a complex medical diagnosis, the same careful approach should apply to your hearing health.

Since launching Visalia Hearing Center, my team and I have proudly helped hundreds of local people and their families to improve their quality of life by delivering a methodical process of audiological best practices. Each step of the patient journey, from the initial consultation through the preventive maintenance and optimization care protocol, is well defined and executed to ensure that each patient is reaching their full hearing potential.

By combining over 15 years of experience, an astute attention to detail, and a long-term view of each patient’s hearing health, with great technology and a big heart & soul, our team has developed a reputation for helping local people optimize their hearing.

If you or someone you care about is worried about their hearing and would like to work with a team that prioritizes your long-term hearing health, we’d love the opportunity to meet you.

Q: Why would someone choose a private hearing care practice over Costco?

A: Costco offers attractive pricing and convenience – and for some people, that might be enough. But hearing care is more than just buying a device off the shelf. Private practices like Visalia Hearing Center provide something Costco simply can’t: personalized care, time, and long-term support. You’re not rushed through a transaction.

Instead, you receive a detailed hearing evaluation and a treatment plan built around your hearing loss with ongoing adjustments to keep your hearing at its best. The goal isn’t just to sell a hearing aid – it’s to help you hear confidently, now and in the future. If outcomes matter more than quick savings, that’s where a private practice shines.

Services For You

Diagnostic Hearing Evaluations

Complete Analysis of your Auditory System

Most hearing tests simply aren’t very good. Either only the bare minimum to sell a hearing aid is done, or highly insightful measurements aren’t performed because insurance won’t cover them. Our approach is different.

Whatever data is needed to achieve the desired outcome will be collected. We routinely spend over 40 minutes in the sound booth and are often told that our approach to patient care is the most thorough they’ve ever experienced. Other places only do a hearing test. Visalia Hearing Center provides a complete analysis of your auditory system.

Concierge Based Service

Hearing Care Done Correctly

This isn’t like other places. There’s not a long wait list to book your appointment, you don’t sit in a waiting room waiting on delays and you don’t have rushed appointments where your questions don’t get answered.

This is hands-on concierge style care that ensures that every appointment is scheduled within 2 weeks, over 90% of patients are seen within 5 minutes of their scheduled time, and we often hear that “this is the most time any doctor has spent with me”.

Read what some of your fellow patients share about their experience by clicking here.

Continued Care and Coverage

Partners On The Journey

Many people believe that the solution to a hearing loss is a hearing aid. Yet anybody that has successfully achieved better hearing will tell you that the most important component is a partnership with an experienced team of hearing care professionals.

Hearing loss is something that will impact you for life, making treatment for hearing loss a journey, not a destination. As your trusted partner, we promise to be alongside you on this journey, helping to navigate the bumps in the road, so that you can gain all the benefits of reconnecting with what matters to you.

Real Stories, Real Results

“They were my third pair of premium hearing aids… and I still wasn’t hearing clearly.”
That’s what one of our newest patients said before coming to Visalia Hearing Center. He had nearly given up on hearing aids after multiple failed attempts – until a friend told him about our unique approach.

We didn’t sell him new devices. Instead, we reprogrammed the ones he already had using advanced testing, precision fitting, and real-ear verification. The result? Speech understanding dramatically improved, usage doubled, and for the first time, he actually wanted to wear his hearing aids.

Read the full story of how we turned “lousy” into life-changing.

Explore the Case Study

Request a Callback

With numerous myths, misconceptions, and conflicting information surrounding hearing loss, hearing care, and hearing aids, it can feel overwhelming.

That’s why our team is here to help. Simply complete the form, and a member of our team will reach out for a friendly, no-obligation conversation.

We’re ready to answer any questions you may have and provide professional guidance tailored to your needs. Remember, there’s no such thing as a silly question—our goal is to support you!

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People Travel To Us From

Exeter

Hanford

Lindsay

Porterville

Tulare

Woodlake

Visalia Hearing Center Inc, 2316 W Whitendale Ave., Suite A, 
Visalia, CA 93277

Meet Your Team

Dan Finnegan, AuD.

Owner/Audiologist

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Jonathon Kalama, M.S.

Clinical Audiologist

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Stacy Patterson, MA, CCC-SLP.

Speech-Language Pathologist

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Kim Covarrubias, LVN

Patient Care Coordinator

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Angelica Castellon (Spanish Speaking)

Patient Care Coordinator

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Your Questions Answered

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Case Study #1. If I’ve already failed 3Xs with Hearing Aids, does that mean Hearing Aids won’t work for me?

Like a broken record, you'll hear us say over and over again that the person you're working with plays a larger role in hearing care success than the hearing aids. Or put another way, hearing care is more important that hearing aids. We believe this in our core. Here is an in-depth case study that will help demonstrate what we mean when we say this. We'll begin by giving you a little back story on the patient's journey when they arrived at our office:

  • Wearing bilateral, name brand, Premium hearing aids, still within the manufacturer’s parts warranty.
  • Receiver-in-canal (RIC) style devices, with Encased/Embedded custom ear molds with 3 mm vents.
  • Fit by an Audiologist at a large hospital setting.
  • On their third pair of name-brand, premium devices, all three pairs described as “lousy” – that is, until Visalia Hearing Center demonstrated what real audiological care looks like.
  • Current set fit in March 2023; besides the new rechargeable and TV streaming features (new devices have, old devices did not), no improvement over previous sets. While the patient acknowledged that current hearing aids are helping, even more help is needed. The patient's specific concerns were:
    o Hearing aids seem to amplify the background noise more than speech
    o Hears spouse's voice but more often than not doesn't understand what is said
    o Hears TV but more often than not often doesn't understand what is said
  • Patient scored a 40 on pre-optimization HHI-E. Please click here to see the form.
  • Was referred to our office by a friend who is very impressed with us, and the patient is hoping for the same type of hearing care outcome.

As a refresher, patient dissatisfaction with prescriptive hearing aids usually comes down to one of these four areas:

  1. The damage to a person’s auditory system is so great that it limits their potential with hearing aids.
  2. There’s a large mismatch in expectations between what the patient wants and what prescriptive hearing technology can actually do (unrealistic expectations). Yes, the above bullet point is the leading cause of this but it is by no means the only cause.
  3. Damaged/Defective/Dirty or Audiologically inappropriate hearing aid hardware.
  4. Poor/ineffective programming/software of the hearing aid.

In this patient’s case, as in any case for that matter, in order to determine if we can help, we needed an assessment of those four areas.

  • The first order of business was to understand what exactly this individual’s potential with prescriptive amplification is. How much damage has their auditory system sustained and what are the impacts of it on their speech clarity?
    • [It is a common misconception that simply putting on hearing aids makes speech clear like when you put on glasses. That is far from the truth. Hearing aids won’t make you better than you are. The goal of prescriptive amplification is to help each person reach their full potential, whatever that potential may be. Some of us have A+ potential with our auditory system, others are a C-. If your auditory system is at a C- minus, that’s all you’re going to get from hearing aids. Of course, some complain why would they get hearing aids if they’re only going to get a C- outcome? The answer is because that person’s auditory system is an F without them].
  • A basic Medicare hearing test does not answer these questions.
    • [The goal of insurance-based testing is only to determine the type and severity of hearing loss and if there is any medical condition present that a physician needs to treat, they are not meant to evaluate for hearing aids. In fact, Medicare prohibits reimbursement for hearing tests done for the sole purpose of fitting, dispensing or programming hearing aids].
  • What was needed was a detailed analysis of the potential of this individual’s auditory system to process amplified speech. Measurements such as a PIPB function, binaural WRS, the Quick Speech in Noise (QuickSIN), Audible Contrast Test (ACT), the Acceptable Noise Level (ANL) and/or the Threshold Equalizing Noise (TEN) to name a few are utilized. As an FYI, none of these tests are covered by insurance.
    • [For those who are health insurance aficionados, attempts to use CPT Code 92700 have been made but even with pages of documentation and justification, Medicare denies this code > 99% of the time. Again, that’s because these tests do not aid in medical diagnosis. These tests aid greatly in evaluating for hearing aid performance, which is expressly excluded from coverage by Medicare].
  • In addition to monaural WRS from the basic hearing test, for this case, we looked at binaural WRS, the ACT and the QuickSIN.
  • To briefly summarize the patient’s results, there was 92% binaural speech clarity of amplified sound in quiet environments (was 80-88% monaurally), an 11.2 dB nCL on the ACT and a 6.17 dB SNR Loss on the QuickSIN.
  • This means with optimized prescriptive amplification, expectations can be set quite high for speech clarity in quiet and expectations have to be lowered a bit for speech clarity in noise. Overall, though, there was a lot of residual hearing to work with and this auditory system has a lot of potential for prescriptive amplification. What this means is the patient should be benefitting much more from prescriptive hearing aids than what is being reported.

  •  

  • The second order of business is to understand the patient’s expectations/goals for hearing aids. Since this was the patient’s third set of hearing aids, the patient knew all too well that it would never be perfect. The patient stated the hearing aids "don't need to be perfect...just better than what they currently are." Additionally, the patient's hearing goals were improved spousal conversations and better clarity of TV, which both primarily take place in a quieter home environment. Since the patient's potential for amplified speech clarity in a quieter environment is so high (92% speech clarity to be exact), prescriptive hearing devices should be quite effective in helping the patient achieve these hearing goals (at least if the devices were programmed and optimized correctly by someone who knows what they're doing). The bottom line here was that patient had a good idea of what prescriptive hearing aids can do and was not expecting them to do things they can't.
  • The third order of business was to determine if any hardware defects were present and if the hardware was Audiologically appropriate for the patient. Essentially was the patient’s poor performance related to a hardware issues with the hearing aids? This can be determined by performing Electro Acoustic Analysis (EAA). We did this with the VeriFit2 test box. As seen in Figure 1, both of the devices were performing within the manufacturer’s specifications, which means no hardware defects were detected. However, 3 mm ear mold venting is quite large for this degree of hearing loss (thresholds of 30 dB at 750 Hz & 50-55 dB at 1kHz). Venting should be around 1.5 mm but no larger than 2 mm.

 

Figure 1: Electro Acoustic Analysis (EAA) results. Both devices are within the manufacturer's specifications.

  • The fourth and final step was to assess the programming/software of the hearing aids. Essentially, how effective are the patient’s current programming settings?

    This can most easily be accomplished with real ear verification/probe microphone measures.

    First, we measured the patient’s real ear to coupler difference (RECD), as seen in Figure 2. This is an often overlooked step, but critical in optimizing hearing aids. In a nutshell, it measures the resonance of your ear canal and incorporates your resonance, instead of the average adult ear canal resonance, into the programming of your devices. It’s the way to most precisely customize, personalize, and enhance the accuracy of hearing aid fittings.

  • Expert Tip: If your hearing aid provider is performing this, they absolutely know what they’re doing. Kudos to them, and please tell them to keep up the good work.

Figure 2: The patient’s real ear to coupler difference (RECD).

  • Now the real meat and potatoes of assessing hearing aid programming was done by performing Speech Mapping with VeriFit 2, as seen in Figure 3. A quick overview is we want as much of the green to be ABOVE the red and blue curves. For a more detailed step-by-step, on Speech mapping, click here.
  • Results were fair for the right ear as the SII improved by 23 percentage points (from 27 to 50) and quite poor for the left ear as the SII only improved 9 percentage points (from 29 to 38).

Figure 3: Speech Mapping results with the Verifit 2, prior to working with Visalia Hearing Center

  • Additionally, after an exploration of the program settings, I found a lot of room for improvement. Essentially, the patient’s hearing aids were set to the generic, “out-of-the-box” settings with minimal personalization done (the manufacturer’s 1st fit algorithm).
  • That approach would be acceptable if the patient was raving about their performance but since the patient was stating the exact opposite, generic settings were inadequate. Most telling was the usage time (or lack their of), as seen in Figure 4: 6 hours a day for the right device and 2 hours a day for the left device. No one will reach peak performance with their hearing aids without a full-time commitment to utilization.
    • NOTE: For hearing aids, VHC defines full-time usage as at least 8 hours a day.

    Conversely, why would anyone wear hearing aids if there’s no benefit derived from their usage?

    Figure 4: The patient’s usage time with hearing aids, prior to working with Visalia Hearing Center.

    Summary of Findings:

    From the data collected at this assessment, the culprits for the patient’s dissatisfaction with hearing aids was roughly 85% the fault of the hearing aid programming/software and 15% from the ear mold vents being too large (a hardware issue).

    The programming was essentially set to the manufacturer’s generic default settings, and those settings, quite frankly, weren’t getting the job done (FYI, the generic default settings rarely get the job done for anyone).

    Since these were name brand hearing aids, Visalia Hearing Center had the capability to reprogram and optimize them. I expressed confidence to the patient that we could take their current devices and make them perform at a much higher level.

    Based off our findings and that we really helped a friend with similar hearing challenges, the patient wanted to immediately sign up for a Visalia Hearing Center adoption program (and was thrilled new hearing aids didn’t need to be purchased!).

    Action Plan:

    • Modified the ear molds: Partially occluded the ear mold vents. Re-ran feedback calibration and achieved more access to gain.
    • Performed Speech Mapping with VeriFit 2: As seen in Figure 5 we obtained much better aided audibility scores. The aided SII is now 57 in the left ear and 68 in the right ear.

    Figure 5: Speech Mapping with the Verifit 2, after implementing the patient’s action plan.

    • In addition to gain adjustments/frequency shaping, we made programming adjustments to multiple hearing aid features including the MPO, Environmental Optimizer 2, Noise Tracker 2, microphone modes and the directional mix. As an FYI, knowing where to set these features is one of the key reasons why we performed such a detailed analysis of the patient’s auditory system. This information just does not come from the basic insurance-based hearing test. We were even able to complete a Firmware update for the devices!
    • The patient’s first visit with Visalia Hearing Center lasted a little over 2 hours.
    • First follow-up 2 weeks later (45-minute appointment). Usage increased to 12 Hr/day. We needed to modify the left ear mold for comfort. Synched TV streamer and remote microphone to devices. Provided Audiologic counseling on proper care for devices and troubleshooting tips when problems arise.
    • Second follow-up 3 weeks after last visit (30-minute appointment): As seen in Figure 6, usage is holding at 12 hours a day, which is more than double the amount of usage the patient used to do. Here are some of the comments that were made at the second follow-up visit:

    “Hearing isn't perfect, still thinks some things are too loud but there's no doubt I’m hearing better. For the first time with three sets of hearing aids, I’m actually wearing the hearing aids… certainly wearing them more than ever before… no ear mold comfort issues since last visit, TV streamer is working great, conversation with spouse is much improved.”

    Figure 6: The patient’s hearing aid usage after implementing the action plan.

    At the second follow-up visit, the patient expressed satisfaction with the hearing care and an understanding of the steps necessary to keep the devices functioning at this level. The patient is now ready to graduate to Visalia Hearing Center’s preventative maintenance program.

    On the patient’s post optimization HHI-E, the scores showed a twelve-point improvement/reduction in self-reported hearing challenges (from 40 down to 28).

    • Summary of before and after data:

    Table 1: A summary of the patient’s before and after data.

    Take Home Message:

    Visalia Hearing Center took the same exact hearing aids that were deemed “lousy” and rarely worn and turned them into hearing aids that the patient actually wanted to wear (because they were actually making a difference). Both objective (SII scores) and subjective measures (HHI-E) show a substantial improvement with our approach compared to the previous approach.

    Visalia Hearing Center sees cases like this on an almost weekly basis. In fact, patients like this, those who purchased hearing aids elsewhere and failed, and then are successful with our approach, are the most loyal and satisfied patients we have. These patients had the opportunity to experience what else is out there, which makes them appreciate what we do for them that much more.

    If you’re not doing as well with prescriptive hearing aids as you think you should, please reach out to us to see if we can make the same type of improvement for you.

    It does not take rocket science or secret sauce to achieve these goals. We simply applied a methodical approach to following Audiologic Best practices. Every day, Visalia Hearing Center chooses to do things the right way, not the quick or lazy way. The reality is, however, that this methodical approach that works so well takes time and most hearing aid centers do not want or do not have the time to things the right way. Which is probably the biggest contributor why hearing aids have such a poor reputation. To be clear, this is not an issue with the hearing aids, it's an issue with the people fitting the devices. Here comes that broken record again. The people you chose to work with are absolutely more important to your hearing care success than the hearing aids.