Thank you so much. I never thought of downloading a tone generator to my iPhone! I did it and now I have something to to see my hearing aid specialist about. I need to get some high tone adjustment to the left ear and low tone adjustment to my right ear.
I had previously tried using my computers speakers to test this but wasn’t successful. Now I can readily see where adjustments are necessary!
Yes; this with bells on.
Pure tone stimulus is going to cause massive issues with any aid recognising it as feedback.
I can’t think of a worse system to use.
Aids should be tested with speech and speech with noise.
7 Likes
I’ve been wondering, why don’t hearing booths include ways to add background noise and other sounds outside of the hearing tests? I’m asking for fitting purposes. To put on a new pair of aids in a no-noise little office and have the audi/fitter ask how they sound seems almost pointless. I did try a pair that reverberated so badly and made my voice so loud and grating that I said no way to those. So maybe not totally pointless, but almost. And yes, REM is supposed to get us started with a close fit, but wouldn’t it likely lessen the need for follow-up tweaking sessions if there were some sound simulations we could then listen to? Like whizzing down a mountain slope on skis or a bike, being at a music concert with crowd noise plus music, outside in the natural world as the sun’s setting and birds, frogs and crickets are doing their thing.
This is pitch shifting (lowering)?
In Phonak Target it actually works very well for tuning Sound Recover 2 especially if you also enable Client View so you can actually see what’s happening with the different frequencies.
With SoundRecover2 tuning my understanding is that all programs and audio processing are disabled anyway.
It enabled me to fix a problem which wasn’t possible to properly diagnose with the built-in media so for me at least it has given me an immediate benefit.
I haven’t had it trigger any feedback management at all in testing but that could be specific to the detection algorithm in Autosense 4 and I agree that it could well do that in other aids.
Don thanks for your suggestion.
Did you do this test using your hearing aids. Would there be any point in doing the test without hearing aids?
DaveL
Toronto
Ok, dealing with a frequency compression issue is one aspect.
Convention hearing aid tuning is the application of gain to different channels within the aid. When you throughput a Pure-Tone any sine-wave inversion is going to subtract from the output. If you’re using this to ‘measure’ how well the aid is performing you’d get a false result. More worrying is that this result is likely to be significantly lower than the actual output of the aid in the same channel. Therefore this method is highly likely to result in an overprescribed output.
Like I said above, (aside from frequency compression tweaks), Don’t use Pure Tones!
Use Speech.
2 Likes
Preferred practice is to verify frequency lowering with an /s/ stimulus during REM.
Assuming you’re talking about adding various realistic soundscapes beyond the basic speech in noise testing we already do.
Two issues jump to mind. The first is that we’ve tried a bunch of stuff and it’s always still pretty artificial relative to the real world. Unless you’re getting into some expensive multi speaker arrays. The second is that there is some expected neural adaptation that occurs over time to newly audible sound, so to a certain extent clinicians may not WANT a quick follow up to adjust sound to you preference–they want you to live with it for a while first even if it doesn’t sound perfect right off the bat.
But it’s not the case that audiologists have never thought of doing this, is just… Not as practically/clinically useful as you might like.
2 Likes
Yes, some realistic soundscapes is what I meant. As realistic as possible of course given that they’re not the actual environment. I’m surprised to hear that this is already happening. I’ve been to several audiologists (in the U.S.) and never experienced it.
I can see where cost might be an issue. The neural adapting, yes I’m aware of this but it’s an issue I sometimes think gets thrown out too often when hearing aid wearers complain about something and get told “your brain has to adapt.” Maybe there’s some difference in this for first time hearing aid wearers and long-time wearers who are getting a new pair of aids?
1 Like
I certainly harp on neural adaptation a lot. I am absolutely biased towards audibility. My bias comes both from my heavy background in auditory neuroscience as well as patient outcomes I see day to day. It’s also the thing that new patients often don’t really understand right away, so you have to talk about it a lot to support that. My preference is definitely that a patient live with sound for a while before I take it away from them at their request because it is so frequently the case that they will adjust and will stop wanting me to remove audibility. Absolutely new users are different from experienced users, although you are often still able to wedge in more audibility for experienced users with a hearing aid change if they have been living under target because of preference with initial set, changes in hearing, or a slowly degrading device. Or the limitations of the devices themselves change and allow you to give more.
4 Likes
I think what users would like is some clear objective demonstration that the hearing aids are helping as much as they can. REM comes off as "this is what you need, and this test guarantees that you’re getting it. There’s kind of an implied: “This is the best we can do, get used to it.” That may very well be the case but I think if the industry could put more effort into showing the difference hearing aids make, there would be a lot more satisfied customers.
7 Likes
Personally, I’ll be interested to see if any of those possibilities you mentioned for experienced hearing aid wearers show up for me as we modify the Philips I now have. But, I’m not sure how I would know if that’s happening. I can think of one example that happened immediately in my brief trial of Phonak’s Paradise.
I’d gone to an audiologist wanting my hearing tested and/or aids adjusted because I felt like my hearing had worsened over a period of years. I was mistaking lots of words, like being unable to distinguish between wood and hood. But, somehow she got hung up on the fact that my hearing aids were old and on how often I wore them and the issues became trying to sell me new hearing aids and scaring the bejeebers out of me making me think dementia was right around the corner.
I’d never heard of this association between hearing loss and dementia at the time. (It was so astonishing to me I looked into the studies and wrote an article about it–I’m a freelance journalist/writer and researcher). Almost two years later and living in a different state, I finally went to another audiologist. She tested my hearing and indeed there had been additional loss but in the high frequencies (when the majority of my loss has been in low). Immediately, when I put on the Phonaks I could tell the difference between wood and hood and made almost zero word understanding mistakes in conversation. So, an instance of additional untreated hearing loss and under-powered aids due to tech changes. But, it didn’t take my brain any adapting time to recognize and understand the sounds.
This is an example where the increased audibility was evident to me but unless it’s always this experientially obvious I agree with @MDB about the desire for some objective evidence (aside from an algorithmic target).
I’m guessing that there must be a lot variability in how long neural adaptation can take among patients, especially first time HA users like me. I went 2 months with my BiCores and never felt I adapted very much. They always sounded tinny and distorted to me, directionality was non-existent as was noise reduction for me. My Philips 9030’s sound a lot better but I’m still not used to the volume and don’t see much if any adaptation going on with my brain. And they are still a bit tinny sounding to me (this is a common new user complaint I know) but not distorted. Maybe that will always be the case with open domes? I have the open bass domes. My fitter, who has been at this for over 30 years, tells me it can take a lot longer than I’ve been led to believe…6-12 months for some people while other seem to adapt in weeks. She started me off at 80% of the REM target and it’s only been about 2 1/2 weeks with these new HA and will have my first adjustment in a couple of days. I had to lower the volume right away in the app and I keep trying to increase it but I think it’s a bit too soon. Have to be patient and work with my fitter. I believe each volume increment is 2.5 dB which is a lot for my ears and trying to learn to tolerate “zero”. I’m thinking some lowering of the high frequencies will help with that because it’s mostly sharp sounds I’m having issues with right now.
I’m not a hearing professional so what I say is based on an N of 1. That said, the idea of 6-12 months adaptation is one of the kinds of things that makes me suspicious of the brain needs to adapt explanation. I’ve never adapted such that sharp sounds don’t startle me, grating sounds don’t irritate, and that the world isn’t generally too loud for me and hearing aids exacerbate it. 30 years. Still experience sound that way. Presumably that part of me just isn’t adaptable and I increasingly think that’s because some of us have an innate hypersensitivity to sound that just isn’t accounted for.
You mentioned directionality and I realized that’s another thing that returned immediately for me with the Phonaks. I’d been without that for many years.
I do have some difficulty identifying what some sounds are sometimes-- I think it’s one thing and it’s really another. So far I still have that with the Philips and didn’t trial the Phonaks long enough to find out perhaps.
I wish you the best of luck getting the right aids and the right calibration to help you the most.
Just curious. Is there a reason your fitter doesn’t just go with custom molds? Seems like a way to rule out your question about the possible effect of open domes but maybe there’s some reason not to go that route.
It’s probably my fault since i was concerned about feeling like I was talking in a well like I did with my airpod pros. It’s always a future option to look into. I’m sure it would improve music a lot and maybe make my guitar sound better (warbly and unnatural at any note above an open g string). The HearSuite program did not even suggest open bass domes for me but the double bass domes, double referring to two vents and a more closed dome I think. Even with the open bass domes my voice sounds artificial and hollow at times and will talk to her about this. I think with hearing loss many like me have loud noise sensitivity which makes amplifying sound to hear better more difficult, just my theory, lol.
I took them on a mtn bike ride last night and the guy in front of me had a bell that made it sound like either my bike or his bike was coming apart, shrill and annoying whenever I was in back of him. And wind noise was there since I had my hair cut too short recently but mostly ignored that. I was using the speech in noise program with the volume down to -4. I think the pure noise program would have been quieter but then speech suffers a lot.
My custom molds are vented. I can’t tolerate that being in a well, closed in feeling. Also occlusion when body generated sounds like chewing, talking, footsteps sound exceptionally loud. That’s the primary reason they made custom molds for me a long time ago.
The Speech in Noise program I just don’t seem to be able to use. It just floods me. I’ll try turning it way down next time and see if that helps. Noise works better but then it tamps down everything so I have to listen more intently to hear speech. The Airplane program seems to work better in that situation-- probably because the mic direction is fixed. The other modifiable settings differences between it and Speech in Noise are Sound Map Noise Control which is High in Airplane and Very High in SIN, Comfort Control which is maximum in Airplane and Medium in SIN, and Transient Noise Reduction High in Airplane and Medium in SIN. Now that I see this typed out maybe the higher Comfort Control is helping in Airplane too. I’ve read about these features/settings but I don’t yet understand them all or how they work together, independently or clash. Sure seems like a lot of features related to noise.
And how would an in-office soundscape DO this?
I mean, this just sucks though. Using dementia as a scare tactic is abhorent.
But give me more details on the objective evidence that you are looking for that is better than your own experience. Audiologists frequently do amplified speech in noise testing, and then they can say “Look, the hearing aids help you hear with a signal-to-noise ratio of 2 rather than needing a signal-to-noise ratio of 6 in this very specific test situation” and maybe they do some amplified word recognition as well and see your score go up (which they can also predict from the REM fit, but they can demonstrate it to you that way for marketting purposes). But then you go out into your regular environments and it’s NOT experientially obvious to you that the hearing aids are any better than your previous set. . . do you keep them because of those tests even though you don’t notice any improvement? I wouldn’t. So I’m interested in what it is specifically that you are looking for? Just a wider range of ‘how does this sound now’ tests?
Absolutely. We don’t have good research on this, so I can only give clinical experience/anecdote. There seem to be some correlates, but they don’t always track very well. The longer the person has lived with a hearing loss, the slower the adaptation, typically but not always. The older the individual the slower the adaptation, typically but not always. There seem to be personality correlates (i.e. how willing are they to just put the hearing aids in and wear them all day–the laid-back or the determined seem to do well). Various medical comorbitities seem to slow it (concussion, anxiety/depression, fibromyalgia). Some people are bothered by sharp noise their whole lives even prior to their hearing loss, and I wouldn’t expect someone like that to end up in a better spot than they were before the hearing loss.
The trouble is, we don’t currently have a way to predict in advance how long adaptation will take, nor whether certain categories of ‘imperfect’ or ‘unpleasant’ sound will adapt. But the brain cannot use what it cannot hear, so adaptation is desireable if it will result in better overall functional access to sound. For example, in other threads people have asked about the functional importance of high-frequencies, which tend to be what a lot of individuals have trouble adapting to–pushing bandwidth out to 5/6 kHz reduces letter confusion for /z/, /f/, /th/, /p/. That seems very worthwhile to some, but others don’t care so much. So, how long do you keep pushing for adaptation before giving up and adjusting to preference? It can be work, and individual patient tolerance is different, and their tolerance and motivation is impacted by how effective a teacher the clinician is. I think at the end of the day, the approach just needs to be patient-centred. A lot of clinicians set low and work up. There’s some minor evidence saying that you end up in a better place if you start with full gain and work backwards after a trial period if necessary, so I tend to do that but with a lot of variability for individual patient tolerance. I frequently push my patients towards better audibility at their routine annual or semi-annual appointments, assuming they show up.
But, adaptation aside, sometimes hearing aids sound tinny because of high frequency gain and sometimes they sound tinny because of a lack of low frequency gain. You might prefer a more closed fit.
4 Likes
So we’ll described, thanks for taking the time to explain.
Your description falls into CI as well. The CI evaluation has a lot of questions about the person’s life and why they want a CI. This session weeds out those that won’t have the drive or want to do CI with good results. Maybe something similar to this CI evaluation could be brought into hearing aids. We rarely see CI failures due to the person failing.
I think when people are falling towards, ‘well how much can things really adapt’, it’s worth considering CIs. That is a dramatically different input, and can start out sounding very strange, and yet become normal-sounding over time as the brain learns to use the input. At the end of the day, the auditory cortext doesn’t know whether its information was originally acoustic or electrical–it just works with the input it gets. I don’t work with CIs, but I imagine there’s tremendous variability in adaptation over time, too. Did they talk much about the expected trajectory? It is surely much more dramatic, but perhaps still similar to adapting to hearing aids.