This will be a game changer… Im surprised Dr Cliff hasn’t said a word
Is being implemented in Several equipment companies including MedRX.
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white paper…
Well, I’d sure SECOND that suggestion for a new kind of test to measure a person’s ability to comprehend SPEECH in LOUD surroundings. It’s almost a no-brainer, and hence the “Holy Grail” of which we’ve always struggled to attain.
Perhaps Dr Cliff hasn’t commented yet cuz it needs to be field tested. Ideally, each and every make and model of hearing aid should be compared to the person’s audiogram, word comprehension and now ACT score? Would HA makers be supportive?
The very fact that despite technological advances of AI, beam forming, open paradigms and speech comprehension improvements are being marketed by the major players, MOST of us still struggle to HEAR folks at a table in a NOISY place.
The problem is further complicated by hearing being a very nuanced thing. For instance, after my REMs & tests are used to set up the aids, they sound AWFUL - every single time! I have to go back 3-4 times to get the aids to sound the way I want my world to sound. Some HA makers assume that we are eager and our brains pliable enough to just LEARN how to hear all over again! But I am living proof that at my age of 68, I don’t want to struggle and stress with new open paradigms.
The audiologist’s time is precious. It may not make sense to have someone come in over and over for fine-tuning and trying this and that for a week or two in the real world before returning yet again for more refinement. On top of which, what if the aids in the person’s budget can NOT be adjusted to the optimum settings per the ACT test?
If ACT can clearly tell an audi in ONE appointment: set this frequency to THIS range, adjust MPO to that limit, etc., we’d be DONE! That, to me, would be way more useful than an AI program that tells me my BP or that I’ve fallen down. I don’t need that. I just want to hear speech in LOUD noise as good or better than someone with perfect hearing. That is the Holy Grail I strive for in this lifetime.
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I hear noise and siren as same sounds… 
We will know for sure, soon. Those who are fitted in the VA I suspect they will get their Reals, re fitted and therefore we will know if this test works or not some time early 2024. I seen Dr Cliff videos, he seem to be in the Natus (otometrics) ecosystem so It might take him a while as he probably will need change his aurical (audiometer) … Frankly, he is such a big advocate for REM I was surprised he uses otometrics when the industry standart is Audioscan
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Will it be a “game changer”? It’s a non-linguistic quickSIN. Providers already use their quickSIN values to support their prescriptions.
Nice that oticon has built in a system to prefit the ANR settings based on individual SNR differences. And yet, look at that graph–higher setting leads to better SNR comprehension for all users regardless of their ACT score.
Absolutely it is valuable to have a non-linguistic speech in noise measure. But I’m less convinced it will dramatically impact clinical outcomes across the board in English-speaking places that are already using speech in noise measure.
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Well said.
I saw my dispensing Audi over 10 times in 2 years
He didn’t know how to set up my hearing aids
They should just work.
After all the hearing practitioner took the same Audiogram and did a quick fit. I can hear after 2 years. Phonak Target with minor tweaks. Setup is so important.
I am so happy for the knowledge here.
edit:
I don’t know what’s truth anymore.
3 sets of Phonaks—always had “best practice” and REM.
Last two companies that provided hearing aids have had problems doing adequate setup. Last company took 2 years, then admitted it.
There must be a better way. Could this be it?
My 2 year old Phonak Audeo Paradise P90’s are finally set up so I can hear. I’m very very grateful.
It will be interesting to see how it plays out. I have seen many “new and improved” fitting and testing methods over the last 47 years. Many were a flash in the pan and then faded away. If it does really work and help the patients, then the providers have to be willing to spend the money to get it. There are still many offices that do not have real ear or even a test box because they feel it unnecessary and too expensive.
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Only 4 levels of noise intelligibility. It’s much easier and faster to estimate the level yourself. Moreover, in the settings of hearing aids there are also only 4 levels of noise reduction - sometimes even less. This test only inflates the price of specialists.
The fitting software do not use data from quicksin, it is useful as a reference or perhaps to set the HI with a more aggressive beam forming for the Speech in noise program.
The value for the ACT will be used to determine how to set the More sound intellingence, so it could in theory lead to a better first fit.
Again, most hospitals use GSI, so I assume it will be done on regular basis- we will see if this really works well.
True, but if you read the white paper all the fitting software is doing is taking it into account to adjust the initial settings on the ANR. Which a provider would do themselves in three clicks in response to a quickSIN result.
Now, maybe in the future it could lead to oticon making more fine adjustments. I wonder whether they have considered making the test a bit more frequency specific.
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I’m not actually sure there’s a demonstrable benefit to be had.
Sure it gives you graph, but it’s just a noise over noise test: I’m not sure it identifies how well your brain will decode speech over speech babble in a real world situation. Why not just put a restaurant track on in the background and ask questions over the top, aided or unaided.
a) that would take a lot longer. b) It will be language specific.
No different That Quicksin.
The difference being REM/LSM provides a meaningful result in terms of (potentially multiple) speech situations; whereas ACT doesn’t.
It’s difficult for MedRx to make the case for BOTH LSM and ACT within the same software package, when for years their argument has been based on objective and verifiable speech levels, over background noise/babble as necessary.
This looks like an interpolated test step for someone who doesn’t want to do a full REM, but wants an indication to set up the power of the dynamic speech functions of the aid, but without ANY information on how well the actual individual’s binaural processing works for speech.
I can see why it would work as a sales justification tool for an aid claiming better SNR pre-sale, but I don’t see the veracity thereafter. Or, that’s basically it, isn’t it: you have Scored X, therefore you ‘need’ a Real 2. Whether the client understands and can uses the test properly or not……
Nope, you will be using REM just to see if the the instruments are matching targets. To be fair, what you really want to use is speech mapping to optimize for SII (speech intelligibility index). Matching target is matching target SII would be a better predictor.
The ACT test would allow you predict how to fine tune more sound intelligence, specifically the neural more suppression. Not meant ta a presale, other than customers who score poorly would be better off using remote mics , etc.
In my mind it might work to do better first fit … I would tell you next year if it works or it isn’t . time will tell
WOOO. Lucky you! Do let us know the results. I’d take any test - or even stand on my head! - if that led to settings enabling me to comprehend SPEECH in noisy places.
Your SAGA is proof that hearing is a nuanced thing, and that some miracle of practitioner competence meets with user’s desired outcome. When it happens, it’s like finding gold at the end of a rainbow. But during the long, stressful journey, it can really eat away at one’s self-esteem and even sanity. We doubt that we actually NEED to hear the way we want to. In time, we say, we’re not even ABLE to hear the way we darn well should be as per the “expert’s” tests and setup. That was my singular experience with the Oticon OPN.
When you’ve worn aids for as many decades as me, you no longer fear pushing back and articulating exactly what’s wrong with the “perfect” setting. I’ve had audis gasp, drop jaws, roll eyes, but then make the changes and here I am, feeling like I’ve never heard better once the aids are set up the way I want to hear my world. I guess that’s another proof that the brain-ear connection is strong. We can actually train our brain to hear better with sub-optimal settings. Works for me!
LOL!!! Isn’t that the crux of it all? I’ve often wondered why my audis don’t even get me back in the booth with my aids ON, (set to how I want to hear the world) - no headphone needed - and repeat the tone test and word comprehension test. I’ve never had that done. So that final closure, or gestalt, is simply not provided after plunking down $7K for a pair of aids.
I think a medical device as critical as hearing aids (especially for us cinderblock-eared folks) deserves that follow-up test to see if the aids really deliver, especially in the very SPEECH in LOUD noise you refer to. 
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I AGREE. Particularly when my problem is isolating the “speech” I want to hear in a room with a lot of people talking (other speech). It is one thing to isolate speech from “noise” but something else altogether to isolate speech from “other speech!”