"Antiquated" hearing test

#30

Correct me if I’m wrong but the tone test is used to determine the level of amplification required at the frequency of the tone being generated. It is not which sounds are heard and which are not, but the amplification required to bring a deficiency at that frequency up to normal levels. When a tone is increased or decreased as the case may be it is the same frequency tone that is used, the result recorded and then on to the next frequency.

The difficulty ISTM, especially for speech in noise, lies in pulling speech out from surrounding sounds, some of which are at the same frequency as speech, and make it distinct enough so one can separate it from and hear it above the noise. Of course I’m not a lawyer so I might be wrong.

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#31

The pure tone test is not a speech in noise test. It is just a hearing threshold test.

There is a separate word recognition test but it is not used to make adjustments.

I think there should be an aided word recognition procedure and use it to increase speech in noise recognition.

It could also be used as a sales tool. If I have 10 year old aids, and you do an aided word recognition test, and I’m at 80, and you want to sell me new aids, set them up and do the aided word recognition test. If I’m at 95 on the new ones, sold!

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#32

It is not just hearing the speech, but to be able to recognize & process the words. The other evening I walked int a room with the TV news playing using the TV speakers. I heard the female voice and some of her tones rung my aids, but, for some reason, I could not understand a word she was saying. :hot_face:

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#33

The whole point in pulling speech out of noise is so that one can understand it.

#34

Essentially, yes. But that’s not to say that one couldn’t build amplification prescriptions from ‘most comfortable level’ tones rather than ‘threshold of hearing tones’, and it has been done. But the majority of the research leading to modern prescriptive targets have been based on threshold measures. To get to where we are now using most comfortable tones, we’d have to re-do everything. ‘Most comfortable’ and ‘uncomfortably loud’ levels are also more malleable.

Unsurprising. Your audiologist was measuring your thresholds and because of the different context and criteria you were measuring something else that doesn’t match the standard definition of what we usually measure, and then underfitting your hearing aids. (Also, in the booth, you get multiple beeps presented at and around threshold, not one.)

Aided tests used to be standard for verification and still are for devices that cannot be verified in other ways (e.g. most audiologists don’t have the verification device for bone conduction hearing aids yet, and cochlear implants still need to be verified in the booth).

#35

Isn’t that something that can be done after the initial fitting with user input? Wouldn’t that actually be preferable?

#36

I mean build generally applicable prescriptive targets.

But yeah, comfort checks are generally done with user input.

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#37

I agree with you completely and also believe that when tested I may sometimes acknowledge a weak beep in one ear and then miss it in the other ear, it is a judgement call on my part that does not give an accurate picture of my hearing loss. Yes, the beep testing needs to be replaced with another method. I also think that the word pronunciation should be made from a professional speaker, not be made by my audiologist.

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#38

The word test I get is always a recorded voice of what seems to be a professional. But how to do the hearing test of beeps better is something I do not believe is possible. Hearing is completely subjective there is no way around it. What we hear, and how we relate to noise of all types depends in lots of way to the environments we are use to being in.
it is even hard to take a person that has normal hearing and is use to being in a quiet environment and moving them to a loud noisy environment with out them having problems with hearing. And to be honest that is normally the beginning of their hearing issues is that move.
I grew up on the farm and lived way out in the country where is was really quiet most of the times. Then I went in the service and sent to large loud and noisy cities that really hurt my ears and gave me headaches. But I guess now that I am wearing hearing aids that I have adjusted to them because I am someone that has lived in the very quiet and the very noisy environments.

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#39

On my hearing tests before Costco the hearing dispenser read the words themselves I was in a sound proof room wearing headphones.

#40

The following is the procedure for the tone test at the clinic where I get my aids.

  1. Prior to the start I am reminded that if the sound level at the start is not comfortable to let her know.
  2. The tone is generated and then reduced until it is no longer audible.
  3. The volume is then increased until I once again hear the tone.
  4. It is then reduced again until not audible
  5. It is once more increased until I again hear it.

That is repeated for each frequency tested. The repeatability of the test reduces the error from guesses or from the chance of missing a tone altogether with the “only one shot at it” method described above. Which, if that is one’s experience they need to find an audiologist who (a) knows what they are doing or (b) is not a lazy ass.

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#41

It should 100% be done with recorded voice.

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#42

A bad side effect of the dispenser reading is they train themselves to pronounce words precisely which carries over into their conversation.

When trying Hearing Aid settings we usually talk to the dispenser to evaluate the settings. Carefully pronounced speech is not real world.

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#43

Oh, we definitely train, and are trained by our patients, to speak clearly. That’s not just about doing live voice speech.

Now if only we could train friends and family members to also speak that way. :wink:

#44

I think it would be easier to train the hearing professionals to mumble … :frowning:

#45

Even with HA’s, I’m still accusing my wife of mumbling upon occasion! We also need to train the hearing professionals to look away or look down (doing something else at the same time) when they speak to us hearing-impaired individuals with imperfect recovery devices.

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#46

Turn their backs to us too.
I had my HIS do that when we were standing outside the booth.

#47

OK - that is a NEW one! I’ve never had that one done … but then I can just envision the outcome: sound is SO LOUD the entire floor evacuates, mistaking it for the fire alarm. Sigh.

I have a tough time on the warbled tones, and while I’m sure an audiologist would find value in them, for ME, the one with the wooden ears, the only REAL test is understanding speech in all scenarios: with background music, in noisy place, quiet, at a party with lots of blather, etc.

That kind of test can only be done on a trial basis or after purchase when the aids are really put through their paces. Boggles my mind why audis don’t have their exam room set up with more practical, real-life things for testing aids:

  • have the patient use their cell phone AND your landline phone. Can they hear? Is the streaming set up right if bluetooth-enabled?
  • turn on some background noise and have the patient give you the jist of the conversation.
  • set to LOTS of blather and have the patient repeat the conversational sentences spoken word for word.
  • turn the TV on and see if patient can understand dialogue; again, test any streaming devices if they are part of the purchase.

Now, maybe these kinds of tests can be done by an assistant, but they should be done! So many of us creep out of the audi’s office only to find myriad things that need fixing, adjusting, changing and connecting with our new $SIX THOU aids.

When I buy a car, I typically get a good hour spent with the sales person going over the features (till I’m dizzy from the info overload). But with aids, we’re often sent on our merry way only to learn about features HERE at this very forum.

Case in point: I just learned last week that I can turn my TV streaming volume DOWN and still hear the TV absolutely fine, but also my hubs speaking to me on one side. Never knew it before!

#48

I’m very sorry to say you don’t understand the testing. Is this the fault of whomever is performing the test? I’m not sure. To hear and UNDERSTAND within a NORMAL range, you need to BARELY BEGIN to hear the BEEPS with no more than 20 dB needed. If that’s the case, you will easily hear and UNDERSTAND a voice at the usual dB of about 40-45 dB. Does that make sense? If you BARELY hear each of the frequencies of speech by at least 20dB, you will hear and understand a spoken voice. The test in no way indicates YOUR PERSONAL experience in the REAL WORLD. It is a REPEATABLE, VERAFIABLE test. It’s a jumping off point. It’s a starting point. Because we don’t know where you could hear when you were a baby and learned speech, we don’t know for sure where you need to be able to hear and understand. We can approximate it from this test though. Because we don’t know the REAL WORLD situations or VOICES you need to hear, we can approximate. This test with “beeps” you are talking about is just ONE of a complete evaluation that should include at LEAST 7 different tests. Some of those are performed with each ear (monaural) and some also with both ears (binaural). I won’t post separate comments to each post that addresses these issues. I just really want to help you to understand the purpose of the test you seem to reference. I sure hope this helps!

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Audiogram comparison
#49

I for one as a troubleshooter by trade and training would love to be able to hear all sounds again. Our brains are able to filter out unwanted sounds and noise. I have been getting my hearing tested this way since forever and it works. But you have to have the correct frame of mind. You can’t automatically say it is wrong or bad. And for the life of me I cannot understand how else it can be done.
For me I use to be able to set outside and be able to tell you what bird it was that was singing without seeing it, the same was true for most other animals and insects. Now I can’t even hear the AC without my hearing aids. I want to hear the way I once did, yes I know that isn’t possible now but maybe some day they will figure it out.

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