The 8 Reasons to Choose Visalia Hearing Center

Identifying the right hearing care partner is a challenging decision. You’re not just looking for someone to assist you today, but for a team who can support you for years to come—someone committed to delivering on promises for decades ahead.

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#1 - Focus on Audiological Best Practices

We continually strive to deliver the highest standards of hearing healthcare. Our Director of Audiology, Dr. Dan Finnegan, has been helping people to optimize their hearing for the past 15 years.

From voluntary Board Certification, a commitment to obtaining double the recommended continuing education units per year, having the latest in diagnostic equipment, and incorporating real ear verification and an aural rehabilitation program as part of their treatment plans, Visalia Hearing Center does not cut corner’s when it comes to patient care.

This means that you’ll not just be partnering with a local hearing professional, you’ll be partnering with a Board Certified Doctor of Audiology that is committed to excellence.

#2 - An Independent Business

Visiting a local independent restaurant offers a different experience than dining at a chain, and the distinction is even more pronounced in hearing healthcare.

Most chain hearing aid stores focus on a model that prioritizes the quantity of patients seen, applying ‘one-size-fits-all’ rules for their providers and limiting time with the people they’re trying to help—all aimed at growing the pockets of shareholders based thousands of miles away.

Our approach is very different: we only win when you win. Our independence ensures we can make the right decision in the moment, always in your best interest, with your investment reinvested locally.

#3 – Warm, Friendly and Accessible Location

We’ve all visited locations where the parking is a nightmare, you have to walk 100+ yards in 100-degree heat and finally be met with a flight of stairs to climb.

This isn’t the case with us. With convenient parking, easy access, comfortable seating and a warm yet professional atmosphere, your experience with us will be enjoyable from start to finish. This is hearing healthcare with a big heart and soul.

#4 – Here for the Long Haul

Hearing care is a lifelong journey. Once you find the right partner, you want assurance that they’ll remain by your side. As an independent practice who is planning for decades, not years, you can trust that our team is committed to fulfilling our long-term promises and always prioritizing your best interests.

#5 – Helping You to Choose The Right Hearing Technology

If you go to a Honda dealership, you can bet they’ll tell you a Honda is exactly what you need—Honda makes the best cars, after all.

The same is often true of franchised hearing aid locations; they usually work with just one manufacturer, meaning everyone receives the same solution, regardless of whether it’s the best choice for their individual needs. But as a true independent practice, Visalia Hearing Center takes pride in providing solutions across all six major hearing aid brands.

Very few clinics can say the same. Success with hearing aids requires both a skilled Doctor of Audiology and the right tool for the job. Current patients at Visalia Hearing Center know, and future patients can rest assured, that you’ll get exactly that here.

#6 – The Ear-Brain Connection: Taking Action

There’s been a lot of recent discussion around untreated hearing loss and its impact on cognition. The rumors are true, and that’s why Visalia Hearing Center has integrated state-of-the-art Cognivue Cognitive Screenings into our process.

Many hearing aid providers talk about the importance of hearing for cognitive health but fail to measure, assess, or monitor this connection—or to make an appropriate referral if changes occur, we do.

#7 – Timing is Everything

Three of the biggest frustrations with today’s insurance-based healthcare are: the long wait to book an appointment, extended waiting room times, and, after all that waiting, a rushed provider visit that barely lasts 10 minutes. Our approach is the opposite. Every appointment is scheduled within two weeks, over 90% of Dr. Finnegan’s patients are seen within five minutes of their scheduled time, and we often hear from patients, “This is the most time any doctor has ever spent with me.”

#8 – Qualifications Matter

Patient choice is important. In hearing care, you can take a do-it-yourself, over-the-counter (OTC) approach, work with a licensed hearing aid retailer, or choose to see a Doctor of Audiology. If education and training matter to you, a Doctor of Audiology is the choice you want. Since the person fitting your hearing aid plays a more significant role in your success than the device itself, it’s crucial to work with the most qualified team. At Visalia Hearing Center, a Doctor of Audiology will oversee your care every step of the way.

From Frustration to Freedom

You’ve tried hearing aids before. They didn’t work. That doesn’t mean you can’t hear better.
Many of our patients come to us after disappointing results elsewhere. One patient, on his third pair of name-brand devices, described them as “lousy” – until we showed him what real audiologic care looks like.

We performed a comprehensive analysis using tools most clinics don’t offer: QuickSIN, ACT, Speech Mapping, and Real Ear Measures. We didn’t recommend new devices. We optimized what he already had. Now he’s hearing his spouse again, enjoying TV with clarity, and wearing his aids all day, every day.

It’s not about the hearing aids. It’s about who’s programming them.

See How Our Approach Made All the Difference

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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Insurance Questions? Kim Has the Answers!

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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.