Monza Adventure

Boungiorno!  Greetings from Monza Italy!  I can’t believe that I am really here.  I want to learn and absorb everything about this beautiful city.  Although best known for its famous racing course, Monza, Italy is also a prosperous industrial city. 

The main streets combine old world charm with upscale storefronts.  I rise early, excited to start my adventure only to find that very little happens along the main streets until after two in the afternoon.  The narrow brick streets accommodate pedestrians, bicyclists, and delivery trucks. People stop and visit, chat and continue.

I am having fun window shopping the upscale fashion stores, leather boutiques, small businesses, and food establishments, when I happen upon the attractive Amplifon hearing instrument storefront.  I can’t resist looking at the appealing window display of earplugs and hearing instruments and finally go inside to say hello. Greeted warmly in Italian by friendly staff in crisp white lab coats, the staff are not sure what to make of this American visitor. 

Cautiously, but cordially, they ask me to wait for the return of Stephanie Deutsch, a staff member who speaks some English. So, I have a seat in the waiting area and have fun watching people come and go. I find that the language of customer satisfaction is universal -- a smile—a knowing nod – a laugh and a smile when hearing soft sounds for the first time.  It is amazing to be able to follow the conversations playing out on the faces of the customers without even knowing the language. 

When Stephanie Deutsch returns from lunch, she listens to my halting French-Italian explanation of who I am and why I want to spend my vacation meeting the owner of Amplifon-Monza. (I am wondering that myself, but who ever heard of an audiologist relaxing on vacation?).  I explain who I am, make an appointment to return the next afternoon, and leave my card.

As I leave, my mind fills with questions.  How are hearing instrument dispensers in Italy trained?  Do customers express the same concerns about cosmetics and performance that are expressed in the US?  Have the staff at Amplifon found any magic solutions to perfect hearing aid fitting?  Are all their customers happy?  Do any ever complain about cost?  Tomorrow I will find out.

Fabio Donati, the owner of the Amplifon office in Monza, greets me warmly the next day.  He gives me a tour of his office and we sit down to talk shop. Joined by his staff, we spend the next hour comparing notes.  I find that they share a common interest in accurate assessment and fitting validation.  They are eager to learn my magic formula for hearing aid fitting.  They share their struggles to find answers to the same questions all those involved in fitting hearing instruments face: “How do we know when we have optimally fit this person with amplification?”  Do we use scientific methods to quantify performance or validate success through patient reports?  Do we use measurements such as real ear analysis, sound field testing, and word recognition testing in noise? What about patient and family reports of use and comfort? 

Mr. Donati tells me that in Italy there are Audioprostologists (Audioprotonsta) and Audiometrista.  He explains that an Audioprotonsta is trained for three years at the University level before s/he can practice.  They can test hearing and fit hearing instruments.  An Audiometrista is also University trained and is typically found practicing in the hospital or clinics performing diagnostic evaluations including ABR, ENG, and OAE.  In addition to the testing of hearing, an Audiometrista may also prescribe treatments including medications for the ears.   Ear surgeons receive referrals for patients who surgery for ear problems.

Anyone who has seen a recent issue of  Vogue magazine, knows that the Italians are very focused on image.  In a country where appearance and fashion are an important statement of success, many Amplifon clients express concerns about the appearance (or disappearance) of hearing instruments.  Eyeglass bone conduction instruments are presented as options for those with normal bone conduction thresholds.  Amplifon markets an earring with a hearing aid inside as well as BTE, ITE, Canal and CIC instruments.  Although the Italian government health care program will cover hearing aids for patients with moderately severe hearing loss, there are many patients who have mild to moderate loss who purchase hearing instruments privately.  Mr. Donati says that people are motivated to pursue hearing instrument when their hearing loss interferes with their ability to communicate on the job and with their families.  And, yes, even in Italy, it doesn’t matter how much, … it is always too much.

Mr. Donati reports that in his office they try to get as much test information as possible to evaluate and document the successful fitting of the hearing instruments.  They rely heavily on sound field measurements and speech in noise measurements supplemented with real ear measurements.  They also make adjustments to the fittings based on customer concerns about the physical fit and performance problems.

What types of circuits are being used at this Amplifon office?  Programmable instruments are just beginning to be introduced.  Linear amplification is very commonly used, and compression circuits are used sometimes, but not routinely. We talked about the use of computers in office management, hearing instrument fitting and in communication.

One major obstacle to the introduction of new technology is the lack of technical information that has been translated into Italian. After spending a week trying to communicate basic needs and wants in halting Italian, I can only imagine the challenge of tackling my pile of technical  journals or calling a manufacturer’s customer support number in Italian. We laughed together as I tried to communicate my experiences with the K-AMP and Fig.6 in the Heide version of Italian technical language.  (Anyone out there know how to say FIG.6 in Italian?)