"I don't hear perfectly still. If I have to wear these d**m things, I want them to work!"

High expectations? I think so! I saw a client today that came in for a hearing evaluation and hearing aid consultation. The man looked to be in his fifties. After careful look at his previous audiogram, the man had a moderate sloping sensorineural loss bilaterally. He is currently wearing Oticon Deltas in both ears.
The clinician asked the client what he noticed to be an issue with his aids. The client responded that it had been a while since he had everything checked, and he still wasn't hearing "the same that everyone else is hearing." He complained of missing some voices and having issues with watching television. He also mentioned that he had 10mm domes and would rather have 8mm.
First, the clinician listened to the aids to see if anything seemed to be off. The clinician stated that the aids sounded fine. The clinician also noticed that the domes had been altered. After asking the client about the domes, he responded that he wanted them to be smaller so he cut them himself.
The clinician then perfomed otoscopy on the client. The right ear was fine, but the left ear was almost if not completely occluded with wax. The clinician and supervisor informed the client that the wax would need to be removed, preferably by a professional, before any further testing could be performed. The clinician instructed the client to make another appointment after the wax was removed. I found an article from ASHA that has some really great information on cerumen management and it's importance for audiologists to be familiar with the issue (Rosser & Roland, 1992). I thought it was odd, but the client stated that he heard better in his left ear which wouldn't make sense with the wax occlusion unless his hearing had significantly changed elsewhere in the audiologic system.
The clinician also informed the client that the 8mm domes would be ordered for him. After inspection of the client's file, it was determined that the client was actually wearing 8mm domes which would need to be addressed during his next appointment. The next step is to wait for the client to return to get more information from the hearing evaluation.
I thought it was important to note that it is the clinicians job to be sure that clients have realistic expecations for their aids. This client was not satisfied, I believe, because he expected the aids to allow him to have normal hearing. The following website gives some great information on hearing aid fittings for adults. http://www.asha.org/docs/html/GL1998-00012.html

Roeser, R. & Roland, P. (1992, November). What audiologists must know about cerumen and cerumen management. American Journal of Audiology, 1, 27-35.