Costco vs Audiologist

Hearing Aids
#83

I have done the testing scenario you described above myself many times. The only difference is that I don’t stand 10 feet away from it. I only sit a few feet in front of it on a rotating chair.

When you said you detect slight changes when you rotate 360 degrees from the noise source, were you expecting to detect volume changes, or directionality changes?

In my test scenario, I fully could tell when I rotate 360 from the noise source whether the noise source is in front of me, on my side, or behind me. So in terms of directionality, I always know where the noise source is coming from, easily. If you cannot tell where the noise source is when you rotate 360, I don’t know why.

But it doesn’t have anything to do with the Full Directionality setting in Genie 2. Regardless of whether I’m in Automatic or Full Directionality or Pinna Omni setting in the Genie 2 Directionality Setting value, I can always tell where my noise source is located. That’s an “always on” situation.

Setting the Genie 2 Directionality Setting to Full Directionality simply means is that you’ll hear sounds in front of you more than sounds on the side and behind you. But that’s only in terms of volume, It has nothing to do with being able to tell where the sound comes from (which is always on).

So when I rotate 360 from my noise source, while I can always tell where my noise source is, I also detect slight changes in volume as I rotate 360, with the volume being the lowest when the noise source is behind me, and the loudest when in front of me. But you’re right that it’s only slight volume changes. It’s not significantly different.

But then I think maybe it’s not designed to be significantly different in volume, because remember that with the OPN, their philosophy is to open up the soundscape and let you hear everything around you in the first place. So maybe there’s a bias to let more surrounding sounds come in than how the pinna would have done it. I think the traditional HAs might have been more aggressive in blocking surrounding sounds while the OPN is less aggressive (by design because of its open paradigm).

If the pinna (and maybe traditional HAs) is more aggressive in directionally blocking surrounding sound to help improve speech (not by making a distinction between what’s noise and what’s speech, but simply by favoring sounds coming from the front, assuming that it’s speech, which may not necessarily be so) , the OPN takes a different approach by having a rebalanced the soundscape that consists of a Voice Activity Detector to differentiate between the various sound sources in its soundscape to know what’s noise and what’s speech to rebalance accordingly. Maybe the picture below helps explain it better.

The point is that even though the OPN doesn’t behave in terms of affecting directional volume the way you expect, as with how the pinna does it, it doesn’t really matter because the end goal of preserving speech (and clarifying it), no matter where it comes from, and minimizing noise sources, is still achieved, even if in a different way than how the pinna does it.

Edit: actually I just remember that I did the same test with the Sonic Enchant 100, which uses the more traditional directionality approach of blocking surrounding sounds except in the front. With the Enchant, I did feel more volume change as I rotate 360 compared to the OPN in Full Directionality mode. But not significantly more volume change, just a little bit more. And like the OPN, with the Enchant, I can always tell where the direction of any sound comes from.

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#84

Not true! Friend just purchased one hearing from Costco.

“Costco of course only sells HA’s by the pair”

#85

Ah, yes, that’s an interesting trick that hearing aid researchers haven’t figured out yet. (Once again, it is morning coffee time.)

Generally the more damage to the auditory system the more temporal jitter you can expect, which certainly effects localization (my favourite bit) which impacts speech in noise, but also forward and backward masking and speech resolution itself. Essentially smearing the sound. (For further reading you would look for terms like gap-detection in normal and hearing impaired listeners, auditory temporal processing). The damaged auditory system also loses its frequency resolution (the analogy I like here is playing the piano with your elbows versus playing it with your fingers–further reading would look at frequency selectivity of cochlear neurons and the active versus passive response of the basilar membrane). However, in both cases it is not a tightly correllated relationship. So there are people with significant hearing loss who still do well on temporal and frequency resolution tasks, and those with less hearing loss who still do poorly. We do not generally test for these skills directly in the clinic, although we do some gross measures of speech in noise which help to get at it. Looking for best word recognition in quiet also helps give an idea, often referred to as ‘clarity’ but impacted by both of these auditory skills. (Sometimes we will do direct measures during central auditory processing tests, which are not completed on anyone with significant hearing loss because an auditory processing disorder is simply assumed at that point). These are very basic skills in the auditory system, but you can also have difficulty with more complex ones. I’ve seen patients with perfect hearing in quiet and no trouble in noise (mechanical and natural noise), good gap detection and frequency skills, but as soon as there is more than one speaker cannot make sense of what is being said. And there are wide variations in ‘normal’ listeners as well. Generally you can expect the temporal processing of trained musicians to be better than that of non-musicians, and there is some evidence now that older adults with hearing loss and musical training do better understanding speech in noise than their non-musician peers with no hearing loss. That’s cool. So you can see how two people with identical audiograms might have tremendously different experiences.

As for hearing aids mitigating these effects–one of the reasons skills like these are NOT regularly tested in the clinic is that knowledge of results would not necessarily lead to different treatment recommendations. Hearing aids are pretty good now at making things loud enough, but you can see that a loss of volume isn’t the only problem. Hearing aid researchers are working hard at speech in noise and their results are impressive from one angle and very disappointing another angle. They are doing so much, and yet for many users the results are still underwhelming. It’s still a hard problem. To my knowledge, no one has a solution for the temporal jitter problem yet. Well. Maybe music lessons. :wink:

I was trying to think of a good analogy for this the other day, and I’ll say in advance that I am a brain person not a music person so I don’t know if this is quite right. But I was imagining a speaker that was damaged to various degrees, and the trick for the hearing aid researchers is to figure out how to process sound in such a way that when they put it through that damaged speaker it is still intelligibile, or even great-sounding.

I suppose this also plays into why hearing aids can be so expensive, too. It’s certainly not the cost of the physical parts. The auditory system is fascinating and complex (much more so, I would argue, than the visual system, but I have a particular bias.)

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#86

Volusiano, your suspicions are correct. When I do the 360-degree test, I’m focusing entirely on volume changes. I never thought about this much, but I suspect that this might still be a reasonable test relative to my objectives. Explanation: First, my overarching objective is to be able to understand what somebody is saying, especially if there are other sounds around me (i.e., the classic speech-in-noise issue). I find it pretty easy to face the person I’m trying to hear in almost all situations. So it seems to me that if my HAs could amplify sounds directly in front of me and reduce sounds in back and on the sides, that would go a long way toward fulfilling my objective. I realize that that Oticon claims they have gone way beyond this simple-minded strategy with OSN and MAST; more on that below. Second, for me, having my HAs help me detect the direction of incoming sounds is a relatively low priority. Third, I think it’s quite difficult to carry out a good-quality test of directionality effectiveness for addressing speech-in-noise… particularly if you are trying to compare two HAs. The 360-degree test we have both mentioned doesn’t have any “side” noise competing with the white noise from computer speakers. Probably, with some effort, this could be set up. We all know that running this test in a real environment (e.g., going to a restaurant with friends and telling them, “Everyone keep talking just the same while I put my other hearing aids in”) is easier said than done.

I’ve read the Oticon semi-scholarly blurb explaining their Open System Navigator (OSN), which includes the diagram that you reproduced. While I don’t understand every detail, I think I do understand the basic strategy. And the “a little bit of knowledge can be dangerous” adage applies to me. That said, based on the popularity of their OPN HAs, I’m sure that Oticon’s Analyze -> Balance -> Noise Removal OSN technology works well for some people. But I suspect that the simpler old-school Directionality -> Noise Reduction strategy works better for some other people with different loss characteristics.

#87

One of the tricky things about Oticon’s “user friendly” programming software is that it is very opaque and makes it difficult to know exactly what the hearing aid is doing at any one time. All of those personality profile questions change things (other than just the gain), and it would certainly be nice to know what.

The thing I did want to mention, however, is that 16% of directional microphones fail within the first 6 months of use. And the user generally does not notice because amplification is fine. (Once in a while the d-mic isn’t even installed correctly from the get-go, but this is more of a problem in customs.) If they are lucky, it would be caught at their yearly appointment (what yearly appointment?).

Although Oticon’s HA button design is nicer than, for example, Phonak’s has historically been–basically asking users to mash debris from their fingers into the microphones every time they press the button.

#88

Uh oh. I take it that doesn’t mean just Oticon? RIC / CIC / BTE?

#89

The study I’m thinking of was pediatric, I’m pretty sure, so likely primarily Oticon and Phonak BTEs.

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#90

Day 1. Single OPN1. - I’d call it a success. Wore the HA for 8 hrs in different environments and noticed the improvement immediately. I was able to have a conversation with my wife in a noisy resturaunt tonight without asking her to repeat or raise her voice. I also realized that in that environment there would be a benefit to having the second one for my left ear as well. I was able to sit in two different spots at the table to test how it operates a bit and noticed that I had more trouble when my left ear was a few feet from a wall as I faced my wife, When I sat next to her with my right ear facing her I was pleasantly surprised at the result and quality. Now here is the strange part of today. The only thing that sounded odd was when I was starting my car (Prius) It beeps during this process with a solid tone, With the one HA in I experienced a fluttering of that tone. If I covered my right ear I could not hear it and if I lowered or raised the volume the fluttering was still present. I imagine that if I had the second HA it would also produce that effect, The only comparison I can make to what this sounds like is an effect on the Hammond Organ called Chorus I. It’s not terribly annoying and not a deal breaker, maybe just a limitation of how the HA programming works with certain tones.

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#91

Nice update Waynetc. I had something similar with microwave long tones and such. I believe it’s the noise algorithms trying to figure out “is it noise?..is it music?..keep natural?..process it?” and so it waffles back and forth indecisively. From all my fiddling self-programming I haven’t heard that in a while.
But of course…I’m no expert.

#92

It isn’t really “Costco vs. Audiologist”. This is a false dichotomy. I got treated, at Costco, by an audiologist. I got treated, at a private clinic, by a dispenser. Both were great, BTW. I got treated at a government clinic by an audiologist. Who was terrible. I got treated, at a different private clinic, by an audiologist who was excellent. It comes down to technical skill, yes, but this is a threshold test for most of us, those without seriously complicated clinical profiles. After that, it’s mainly down to the sensitivity and caring that one is offered in the clinical setting.

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#93

Do you have the feedback manager enabled? If so, I think it might be a side effect of the 10 Hz frequency shift which is one of the 3 strategies employed to help eliminate feedback. The other two strategies are phase change and headroom gain reduction.

This side effect usually happens is usually prominent on a single tone sound so it’s consistent with what you described.

If it’s really an issue then you may have to disable the feedback manager, otherwise it’s a small price to pay to be able to enjoy the feedback manager functionality.

#94

I have found this to be true also. I first insisted that due to test results, I needed a HA in one ear only. However, the audiologist suggested I try it both ways and let me use a loaner pair, programmed to my hearing loss. He was right, and I ended up buying a pair.

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#95

latest update - going back next week with my single OPN1 to the AUD. I’ve been in at least half a dozen noisy situations and always have to manually raise the volume from ‘0’ on the app, sometimes to 100%
At work where it is relatively quiet, always have to raise it up around 12%. If the HA is designed to adjust automatically then imo it is not happening, They never did a real ear test during the fitting. I’ve decided that having a second HA for my left ‘good’ ear will be best. I’m hoping that I can do a trial on a pair of Resound 3D and a pair of OPN1’s and have both pairs for a few weeks. Right now I’d rate the OPN1 a B- a bit discouraged. They told me that they do have the equipment for the real ear test, but did not have the software to do this with Oticon… we’ll see how this progresses…

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#96

if they have REM (Real Ear Measurment) equipment and software they should be able to do this with any brand - the REM equipment runs separately to the hearing aid manufacturer software and the clinician runs both applications at the same time. The OPN is making ‘automatic’ changes all of the time, as does any other digital hearing aid on the market - However sometime the automatic changes may not seem like enough. The clinican has the ability to fine tune the hearing aids automatic feature-set. However plenty of hearing aid users still like to have their own ability to control the hearing aid volume so regardless of hearing aid brand you try you may still get a better result if you retain some control over volume etc.

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#97

Most hearing aids, not just the OPN, starts out with an underpower fitting on purpose as not to overwhelm the patient on the first days. It can be scheduled to ramp up to full volume potential over a period of time (as determined by your hearing professional). So it is designed to adjust automatically, but not because of some smart sensor that does it on the fly or anything like that. It’s simply a 3 phase schedule, with phase 1 being the lowest power fitting, phase 2 medium power, and phase 3 full power. But the interval between these phases are programmed in by your hearing professional. People who adapt better and faster may notice this underpower issue sooner than others.

Just ask your hearing professional to do a REM test for you, and accelerate the fitting schedule for you sooner rather than later. In the mean time, just use your volume button to compensate until then, and just remember that this is definitely a fixable issue on your next visit.

You can also go the other way, ask your hearing professional to give you full power right now, and if it’s too overwhelming for you, then just use the volume button to manually dial back the loudness.

#98

It was only after I learned about this feature that I asked my fitter and she said she doesn’t use the acclimatization feature.

#99

I rarely use it either.

#100

thank you for this information - I had no idea a ramp up could be added to the programming. Very interesting indeed. More to come after the next visit…

#101

This has me thinking - what adjustments / features are in the OPN1? (and probably the other higher end mfg’s offerings) Since I’m new to all of this please be gentle. I did learn that the Oticon tinitus app on the iphone, though a free standing app has to be activated in order to use it , blend those sounds into the HA. Is there a document of ‘feature set’ / options that can be activated, adjusted or deactivated? Thank you.

#102

To really get a feel for this, I’d suggest going to the DIY part of the forum and download the Genie2 software. Looking at the fitting software is the only way I know of to get an idea of the full range of adjustments available. It won’t allow you to make the adjustments unless you also purchase necessary hardware, but it will let you know the possibilities.

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