I think that’s a really interesting question. I’m guessing that very few do go that deep.
I’d be inclined to say that some audiologists are probably gifted enough to get these settings right on the basis of one or a few appointments. However, I also get the impression that the technology changes so often, and the professionals are expected to fit so many different brands and models of aids, that it’s unlikely that they get the chance to become that familiar with the ultra-fine-tuning of one type of aid before it gets superseded by another.
These two know way more than I do, and I’m also guessing that in the large majority of clinical cases, the fitting and adjustment decisions are made on the basis of a very few sessions.
There’s also the huge (IMO) problem of simulating actual listening environments in the clinic. This question has been raised slightly elsewhere, but I think it’s more important than it gets credit for being. I’ve definitely been there – you have some problem in a real-world environment. You go for an appointment, the clinician plays an audio file, through speakers in the examination room (or whatever you call it), you say that’s great, and then leave and find out nothing’s changed much. There’s so much you can’t simulate this way – at the very least, sound in reverberant spaces, or sound from a source 20m away, or your boss’s voice.
So, maybe if the clinician knew the aid and its features inside-out, and had lots of direct experience with it; if the patient could come in as often, and for as long, as needed; if the patient could very accurately and completely describe her experience and needs; if the clinical environment allowed for simulation of the difficulties and possible solutions; and if everybody involved had the patience to stick with all of this – yeah maybe you could hear these things. Maybe.
I really believe – again, without any professional anything to back it up – that given at least similar technological possibilities, it’s the quality of the fitting and adjustment that makes the difference between an adequate hearing-aid experience and a fully satisfactory one. And this hand-wringing about insanely complicated, quasi-magical features and micro-tunings that only a few people could detect, in ideal situations, has more to do with marketing than anything else.
And in fairness, there is a thing called “pride of ownership.” You do have these things stuck to your body all day, and you do depend on them for your livelihood and your engagement with life. If you can afford it, and if it matters to you, then buy a Mercedes. Seriously: if I could afford it, I’d probably go for Oticon OPNs or something, even for that reason alone.
I worked in pro audio for decades. So I was working with – including designing and evaluating – equipment and systems that met the highest measurable technical standards. I’d have the most mystifying conversations with audiophiles, who would justify spending ten or twenty times more for a piece of gear than it would cost to buy the super-pro industry equivalent because they said they could hear things that I couldn’t hear, and that couldn’t be measured.
Another side to this professional experience was discovering that people really are not very discriminating in how they evaluate what they hear. A lot of it really is about unquantifiables like how the equipment looks, or how much it cost, or what a magazine said about it. Silly me – I ride the bus wearing a pair of Sony MDR7506 headphones.