Audiogram Test-Retest Results

I have been wondering about the degree to which my hearing thresholds have changed for each frequency since I have been wearing my new HAs. My initial audiogram was done by an audiologist in my ENT doctor’s office in the usual sound proof room. This was done immediately after he cleaned my ears.

As some of you know I have purchased Phonak P90 RT aids online and therefore the testing is done in my aids via the myPhonak app. I did not ask my online audi about the first test results she did but plan to next week.

I would like to know your experiences in trying to determine how your audiograms have changed since wearing your aids. I know that test-retest variability happens because of different levels of concentration and response time on any given day. However, that can’t really be more than about 5 dB for each frequency. But, if you have a test-retest done by two different means how reliable are the results? I suppose I could go back to my physician and have another test done but I’d like to know your opinions first.

So I cannot comment directly on change because my loss is related to a tumor so not a general age related. However, I have had tests done in an ENT office in a booth, at Costco, which is a booth but they are in the booth as well (the office is the booth) and I’ve done it myself with my aids. I have found that the costco and ENT are comparable. Doing it myself is challenging as I know when I hit the button. The biggest issue with using the aids, from my perspective, is what kind of dome you have. If it doesn’t seal completely then outside noise can have an impact. I have done a self test with a pair of over the ear headphones over my ears, which blocks noise pretty well, and my self test is fairly close to the others…

Long story short I suspect the both can be effective if done properly.

I would think they wouldn’t match but they should be reasonably close. My question is why are you concerning yourself with this. The best test is how you feel you are hearing with them. My experience is that test results are just a starting point and when I get my aids tuned based on what I’m comfortable with they may not match the test results

The first few days I had them I “thought” I could hear conversations and the TV better but then after a while I wasn’t sure. I began to say “what” more to my wife and I wondered if the initial excitement I felt was perhaps a classic placebo effect. Right now I feel that nothing has changed with my hearing. If I had some type of more objective measure then I could make a decision as to whether I am benefitting at all from wearing them. I’ll discuss it further at my next tuneup.

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I have done that as well and the audiogram from the self tests (I did them about 4 times) are no different than my original audiogram done in the doctor’s office. I’ll look into whether I have the correct domes. Thanks.

You might find this interesting:https://www.phonakpro.com/content/dam/phonakpro/gc_hq/en/resources/evidence/field_studies/documents/PH_FSN_Audiogram_and_Audiogram_Direct_comparison_of_in-clinic_assessments_297x210_EN_V1.00.pdf

This suggests that variation can be way more than 5 dB.

If I am reading the conclusion of the study correctly it states that for individual frequencies the difference is less than ±5 dB HL but the differences between both methods lies within an interval of ±24 dB HL for 95% of the data, across all frequencies. I am interested in knowing whether my hearing is helped at the individual higher frequencies where my hearing loss is severe in my left ear and moderate to severe in my right ear.

This study was conducted using pure tone frequencies and I found an online website run by an audio engineer (he’s not selling anything) that uses this methodology and prints an audiogram. I’m going to do a series of tests over the next few days comparing my hearing with and without my aids and see what I come up with. I’ll post the results if anyone is interested.

I’m not seeing anything in the conclusion regarding the first claim (+ or - 5 dB) but even that is still a potential variation of 10 dB. For the second, I think they claim + or - 15 dB, but looking at the specifics one could tighten it up to + or - 13.5 dB or a potential 27 dB difference. On average, the two methods are remarkably close.

It is in the Conclusion Appendix 2 at the very end of the paper.

“For the individual frequencies, hearing thresholds obtained
through standard audiometry and AudiogramDirect are
highly correlated (all Pearson correlation coefficients > .80).
The mean difference between the two audiometric methods
is smaller than ±5 dB HL for all individual frequencies.”

I conducted a series of tests this morning to see if I could detect a difference in my hearing with and without hearing aids. I find the results disappointing but will discuss them with my audiologist next week. Hearing Test Results.pdf (74.5 KB)

My personal experience is:
The audiogram measured by the ENT was always “worse” than the one I performed myself in Phonak Target’s “Audiogram Direct” (that is the SW your audi used for the remote fitting session).
I see differences of up to 15db in some frequencies.
I have two recent ENT audiograms, one taken in December 2020 and one taken in September 2021. They are more or less identical. So no, I don’t think the daily use of the HA did cause any degeneration of my hearing. Even if I compare with my earlier diagrams taken over the last 15 years when I got my first set of HAs. I found only what’s to be expected due to my aging. A worsening of about 5dB dot max. 10dB.

Do you think your aids were better before your first online session?
It is possible that the new remote-session-audiogram caused a reduction of gain (amplification) in some frequencies.
Still, it does not mean that this new audiogram is less accurate. It takes the chain of the system better into account: Mics, amplifier, receivers, domes, etc.

There is a feature in the fitting-sw called “auto-acclimatization”.
This allows a slow increase of the gains in several weeks to the final target. For example: start with 60%, go to 100% within 3 weeks. New HA users often complain at the beginning that the HA are too loud.
Since you are a new HA user, your audio might have programmed this feature. Ask her at your next appointment. It might be ok to go to 100% straight away.

Finally: Did you check your domes? They might require cleaning. Maybe also change the filters.

Hope this helps!

EDIT:
When you conducted the self-tests this mordnig: Is it possible that the HA’s mics were not inside the headphones. But covered by the headphones cushions?

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Yes. It appeared to me that after the first online session my understanding of other people’s speech was not as good. I think she was trying to reduce the “walking on glass” sound that was so loud.

I’ll ask her about it.

I clean them every morning.

No, the phones have very large soft coverings and the mics are definitely inside.

Many thanks for the info and advice. I’ll follow up after next Wednesday.

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Thanks. I didn’t see that. Those are average differences.

They have to be of course, but the Pearson coefficient of 0.8 and above tells us that strong positive correlation among the results.

One more thing occurred to me. I’m sure she also made a feedback test in the first session (loud white noise in one ear and then in the other). This might have led to too much gain reduction in frequencies important to you. You should discuss this with her. Maybe it makes sense to repeat the test, make sure the domes are tight in your ear canals during the test. If your canals are not sore anymore it might even be reasonable to change for lager domes to prevent reduction due to feedback risk-

I just finished my 2nd session and she did increase the gain in the higher frequencies. However, the feedback is “back” when I cover my ears. But, as before I don’t experience it when I don’t cover my ears. If it stays like this it will be okay as long as I can hear speech better.

I did ask her about the domes and she felt that the size I have now fit well and a larger size may be too uncomfortable given the size of my ear canals which they measured in 3D when I ordered the aids.

She also installed 3 additional programs: Speech in noise, Speech in car and Speech in 360 degrees. I have not tested these yet.

I also had her activate the T-coil but my first test was a failure. I’ll have to do more reading about it or maybe I didn’t activate the program properly when the phone rang. I find holding or clicking the top of the rocker control very difficult.

Thanks again for the suggestions.

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