Hearing Aids with Headphones - BTE vs ITE - Audio Engineer

Hearing Aids
#1

Hi,
I"m a musician and I mix my own music. I have a well treated mix room and have both speaker and headphone monitoring. When mixing, headphones are useful for checking certain aspects of a mix and are also handy when there are times that using speakers would disturb others in my environment.

I have hearing loss in my left ear (about 70 dB avg). I have had one Widex Beyond BTE hearing aid for about 7 years. My hearing has been degrading some over the years so tuning the hearing has been a bit of a moving target beyond the usual problems of tuning a hear aid for a critical listening environment. Since I have relatively good hearing in one ear, I can use my headphones (HD600 FWIW) to listen to music and by swapping sides (L/R ā†’ R/L), it is pretty easy to tell when the gain or EQ on the one hearing aid is off. I can use the Widex app to tune it in fairly well. I can also use EQ in my DAW (recording software) to more precisely tune it using the same methodology. Pink noise works particularly well for this as it has a wide frequency spectrum and is revealing of timbre deviations.

Iā€™m finding that a BTE hearing aid is causing a number of problems that are most obvious with headphones. (1) The gain is off (need to raise about 3 dB) with headphones (and maybe in general). (2) The timbre is off. Amusingly, Stairway to Heaven starts with just an acoustic guitar part panned to the left side and it is very obvious how badly it is impacted (sounds like itā€™s in a cave and mostly hearing the room reflections and not the direct sound of the guitar. (3) It is affecting the stereo field and doesnā€™t image very weil (harder to tell what direction a given instrument is coming from). On speakers, its probably less noticeable because the right hear is hearing some of the left channel, but I think overall the same problems exist.

My thinking is that because the BTE is behind the pinna, itā€™s blocking a lot of high frequency sound and giving me much more of the rear room reflections than the direct sound from the front. To test this, I moved the BTE off the pinna and let it hang in front of my ear (and then managed to stuff this into my headphone which are around the ear type). Things sound much better with it dangling. The gain is pretty much back to normal and the timbre and sound field are closer to normal (if I can remember what normal is these days).

Although this workaround is not bad, the positioning of the BTE hanging relative to the headphone might be a bit of a variable that Iā€™d probably rather eliminate, and with speakers, the dangling BTE is more likely to just fall off. So Iā€™m thinking some sort of ITE would be a better solution. Looking at the comsumer and pro web pages on Widex, I havenā€™t found a lot of details on the tech available in the Moment series (mostly marketing hype for the average consumer).

Iā€™ve found all of the ā€˜techyā€™ features on my HA to be generally causing more problems than not for music applications. I generally use the ā€˜musicā€™ program and have had my audiologist disable just about anything we could find in their programming GUI that does adaptive correction (noise reduction in particular is a problem - you need to hear all the stuff that they think is noise but is part of the music including sound effects like explosions for instance). From the programming interface, you can see the 15 frequency bands the hearing aid supports and there are gain coefficients for three loudness levels (something like Loud / Medium / Soft). And I understand that you need different gains for different levels of loudness because of the way ears work, but there are a number of problems here.
(1) Widex doesnā€™t seem to provide info on which SPLs apply to each loudness level - the idea would be to listen to a sound source at a certain SPL and know that your within the loudness band so you could tune that one. The high and low are probably easy enough to find (just use a really soft and a really loud source, but not sure when Iā€™m in the middle band). (2) The app on the phone only lets you correct for only 3 bands, but no frequency info on what the bands are (3) The loudness scales on the volume on the app goes from 1 to 9 and the EQ band levels from -6 to +6, but donā€™t have info on whether these are dB or something else. I can actually do some pretty precise tuning with EQs in my DAW (music recording software), but canā€™t exactly map that back into the HP without the programming GUI (4) I canā€™t access the programming functionality from my studio environment (need a special rig to do that). (5) My audiologist doesnā€™t have any usable audio gear in her office to play sources while programming the HA. I got some BT headphones that Iā€™ll bring next time so that will probably solve that problem and we can do some tuning in her office.

Iā€™ll also say have power domes on my BTE and I have problems with moisture inside my ear canal and sweat dripping on the BTE piece. The Widex Beyonds stop working when you sweat on them (I think moisture wicks into the BTE part and kills the battery connection (this stops the HA outright) and/or it gets on the receiver in the ear canal (this muffles the high end and drops the gain).

So after all this - here are somethings Iā€™m trying to figure out:

  1. Does anyone have experience with HA and over the ear headphones that can confirm my impressions of the BTE causing an issue and the ITE fixing it?
  2. Are there differences in the functionality of the different ITE HA that Widex makes. Are they all 15 band with the loudness still? Do the still have 24 bit DACs (extended dynamic range)? Do the all have ways to turn off the noise suppression and any other dynamic compensation. Do they have different battery lengths? I also saw some mention of zero delay function on some Widex HAs - to any of the ITEs have it? Are they all removable by the consumer? Do they all charge wirelessly? Do they all have switches? Are they all accessible via Bluetooth to use the programming app?
  3. Are the Moment series sealed so that they are not affected by moisture? Do they leak through any switches?
  4. Is there a more detailed version of the app that gives access to the 15 bands - and yes youā€™ll have to trust me that I know what Iā€™m doing.

I havenā€™t talked to Widex yet (not sure the will connect me with someone that could answer my questions), and I havenā€™t tried my audiologist yet (and I suspect she will be need to call Widex and it will be another version of the man in the middle passing the message). So Iā€™m asking here to get as much info as I can before going down those channels.

Thanks in advance for any responses.

1 Like
Guidance for a first time hearing aid shopper
#2

Welcome Ric !

Yeah, the behind the ear can present challenges for headphones, Iā€™ve found flat face/open back to be least problematic - while okay for at home in the quiet, but not ideal for professional mixing. I will steal your solution of moving the BTE into the ear shell, :grin:!

I use the RIC Widex Moments w/tulip dome and for now, prefer the PureSound over Music for various reasons with live/playback music. The Zero Delay (okay, 0.5ms) means I donā€™t have any slurred sibilants like I get with the Music programā€™s 2.5ms delay, and to a far lesser extent, comb filtering. Closed domes or ITC would make these moot, and a well tuned Music program

Iā€™ve been having my audi ease back the Music programs compression bit by bit and it really is shaping up to be useful, if not my preference. As a music professional, the biggest favor you can do yourself is find an audi that works with musicians. IME - music and tinnitus are not anything most audis want to get intoā€¦ Iā€™m just persistent with mine.

FWIW - When my adui has to call Widex support, Widex pickup and get things resolved immediately. So thatā€™s not a bad way to approach this.

Accessing more than the appsā€™ 3-bands is going to put you into DIY territory. Instead, I rely on mixer/routers in phones and PCs to achieve any additional equalization.

Yep, Moments still have full dynamic range and 32KHz sampling that are ideal for critical hearing needs.

For product into, I suggest investigating at https://www.widexpro.com/en-us/products/

Good luck, and stay in touch!

#3

Hi Ric,

You are being very thorough with your research! Very interesting.
Iā€™m afraid I can only react to question 1 as I have no experience with Widex:
After having used BTE aids for several years I decided to switch to ITE (in my case Signia Insio Charge&Go AX). The main reason was being able to monitor sound when filming. In that situation I have to be able to work switching between with and without monitoring headphones and be able to function in both situations.

This functions quite well, combined with a music program that has been tuned slightly less aggressive, meaning flatter than the other HA programs. I have a ā€˜ski slopeā€™. Compression is minimised almost completely, and no directionality, active noise and feedback suppression dialed in. All DIY with the back-up of my audiologist.
Although this works well for monitoring interviews and background sounds, Iā€™m still not completely confident using this set-up for mixing and sound sweetening. I do the work, but with the help of a proof-listener in different phases of the project.
To keep improving I will gladly follow your research further, and do my own of course.

Good luck!

#4

Hi user715, thanks for the response. Youā€™re just the type of person I was hoping to get some feed back from.

I was pretty amazed how much moving the BTE out made. Let me know what you think if you try it. When I go in to see my audiologists (two over the long term), I usually go in with a set of corrections I wanted on the 15 ch x 3 level inputs. They seem happy to let me drive the GUI. So yeah, Iā€™m very much into DIY, but itā€™s been difficult because I just have the 3 band app where I can test , have to extrapolate to the 15 band and update where I canā€™t test, and then terate as needed. That being said, the changes Iā€™ve made have been rather general - full spectrum gain changes or maybe a few dB boost/cut in lows/mids/highs on a given loudness level. I did do some minor cuts at 6K to damp out some feedback issues I was having - especially when I had the HA inside a HP

Iā€™ll share a bit about my experiences. Originally, I started out with no hearing aid and just used my HPs. I set up a session where I could control the L and R earā€™s channel separately, and as I said, then tried to match the sound of L and R ears with pink noise. With some tweaking, I got to where I felt things were sounding right - surprisingly right. The one problem I ran into though with some of the high gains, I couldnā€™t turn the HPs up very loud without hitting some sort of distortion issues (clipping/limiting/overdriving the HP). All in all, I think the HP were probably loud enough to be usable like that, but then that didnā€™t solve my listening problem with speakers. So I proceeded to get a hearing aid. At the time, WIdexā€™s and Oticonā€™s literature seemed to be paying the most attention to things I thought would be important for a musicianā€™s problems (dynamic range, multiple band EQ, three loudness bands, etc.), so I ended up with a Widex.

The initial programming based on my measured hearing was awful. I had a band practice that evening (just vocals and two acoustic guitars), but there was so much bass it was unusable when playing. I eventually found that by turning the app bass response all the way off, I could stand to use it. So since then itā€™s been a iterative process to get them dialed in. I think along the way, the algorithm they used may have been tweaked some because I found their default setting at some point had changed a lot from the prior itereations. At any rate, the last iteration, I just started with their ā€˜newā€™ default settings. It was actually not bad. I think I had the feeling I might need to increase the gain a bit on the low and medium loudness, but the loud setting seemed close to right. One thing that impressed me along the way was that hearing tests only try to measure to the nearest 5 dB (so maybe +/- 2.5 dB at best). As a mixer, you can see where this would rise some eyebrows.

Anyway, have been getting back into working with a new pair of HP, and after some more listening came to the conclusions I described I in the original post. The BTE was causing a lot of grief. Iā€™ll probably pass back through my audiologist before I do anything else and make some tuning adjustments with the benefit of some BT headphones in her office. Like I said, Iā€™m almost happy with the workaround I have (if I can keep the HA from falling out - but since Iā€™m sitting in a studio and not jumping around on a stage - itā€™s probably not a problem). I"ll trying to swing back here with updates as things progress.

#5

Yikes, that bass heavy bad fitting/setup wasnā€™t a good start! I do get boom city if my domes clog and I get occlusion (as itā€™s called in HA speak).

Yep, the 5dB range accuracy is industry standard - from everything Iā€™ve read. I really do appreciate the difficulty of itā€¦ starting from the accuracy of hearing test to the HA is a driver in the ear canal, ported or not. For speech comprehension a few dB is no thang, but thatā€™s a very different goal than mixing.

#6

If you are unaware of this web site, then you might find it helpful.

https://musicandhearingaids.org/

#7

So I called Widex Customer Support, selected their option 2 (Audiology), explained my problems (they were expecting me to be an audiologist I think), and a nice person talked to me for a very long time.

Short version: The WIdex Moment series has the same audio technology across their line (BTE, RIC, ITE, ITC), but the in-the-ear models do not support Blue Tooth - so no App and no streaming. The Moment 440 has the same 15 channel setup (as best I can tell from the conversation and the spec sheet) as the Beyond 440, but the ā€˜techā€™ has been much improved over the years.

Itā€™s kind of a bummer that the ITE doesnā€™t have BT. I tend to play with the app quite a bit in different situations (particularly in trying to figure out how to adjust the programmed tuning). The Widex person suggest two other brands, one being Signia, as having an ITE with BT and had heard from someone (professional) that the Signiaā€™s were ā€œpretty good HAsā€.

Both the Widex Moment and the Signia spec sheets show latency < 15ms, but the Moment ā€œZero-Delayā€ touts 0.5 ms delay which is pretty amazing. I was thinking about trying to tune in a Haas effect (5-40ms delay) to get the effect to sound right with a 15 ms delay in one ear. Sigh.

I agree with Sephratusi that being able to change between HP and speakers with ease is important. Iā€™m also thinking that the ā€˜dangling BTEā€™ might take a bit more fussing about when setting and removing HP but not insurmountable.

One other experiment. Was setting listening to TV (and the audio is playing through good stereo speakers). The couch is in front of a wall and the speakers are about 10 ft away. Tried playing with the BTE - behind the ear, dangling, and turned forward (opposite normal position). Noticed gain boost from rear to dangling most, some more going to forward. Timbre from rear to dangling noticeable - rear getting mostly reflections off the wall behind (like cupping your hands to the rear over your ear) and dangling sounding much better. Turned forward, the sound got a bit more ā€˜aggressiveā€™ - maybe boost on treble. Dangling is maybe a nice combination of direct and indirect. The micā€™s on the WIdex BTE are on the top and rear. Definitely noticing the effect of the orientation of the BTE.

Sephratusi, your comment about ā€˜decompressingā€™. Iā€™m not sure I know what is right here, but my impression of my hearing is as follows. It seems that Iā€™ve lost more dynamic range at low loudness (e.g. canā€™t hear soft sounds), than Iā€™ve lost dynamic range at the loud end. Occasionally seem to notice when I crank up the levels that some transients seem to peg the channel - like maybe some limiter is kicking in - donā€™t know if thatā€™s my hearing or something in the HA. Anyway, I think of it as needing to ā€˜switchā€™ from the normal dynamic range available into a reduced window that is more closed on the low side. So, the gains I have on the low loudness band are much bigger than the gains on the high loudness band (i.e compression) - this is how Widex defaults in my experience (gains like 30 on low and maybe 10 on high).

Also, whatā€™s your experience with Signiaā€™s app? Is it like a 3 band EQ with a volume control or something else? Whatā€™s your experience with your audiologist being able to turn off all the ā€˜dynamic compensationā€™ stuff?

Aside: I told the Widex person that their noise reduction is a problem for me. If you have a transient (bang something), the transient goes through unattenuated. About 500 ms later, the treble shuts down and about 1500 ms later, the treble opens. Like slow attack, long release compressor. So you get three audible transients out of one. Told them that the ā€˜noiseā€™ in music (cymbals, drums, amplified instruments, just about everything) needs to be heard. Mix a sound track with an explosion, you need to hear how loud the explosion is to decide where to set the loudness level. She said that ā€˜Iā€™m not the typical userā€™. To each their ownā€¦ But she was VERY helpful.

My next step here is to check out a headphone (DT-900 Pro X) on my phone with the dangling HA. Itā€™s only 48 ohm so the phone should be able to drive it (with the Lightning to TRS adapter) unlike the 300 ohm HD600. The cheap Blue Tooth HP I have would probably work, but itā€™s on the ear which might be more of a thing with the dangling HA. Iā€™ll make a pass at seeing if I can EQ to get L/R sides to sound the same in that configuration before swinging back to the audiologist. I think she is entertained by my efforts. :slightly_smiling_face:

#8

One more thing - the Moment BTEā€™s have rechargeable version that are water resistant. The ITEā€™s are battery only (not rechargeable and not so water resistant).

#9

Signiaā€™s app is a disaster. Apart from the often failing bluetooth functionionality (connection between aids and iPone is stable) it is quite simplistic. There is only a one slider EQ labeled sharp on the high end and soft on the low end. Any dialed in setting is reset after switching to another hearing program. There is no way to store a setting. Coming from Resound this was quite a disappointment.

I do that myself in the Connexx fitting software, the dedicated music program defaults to not doing any dynamic attenuation or noise reduction if I remember well. Leaving wind noise reduction and feedback control to be turned off completely by me (if gain and venting allows).
My audiologist would do this for me as well if I asked.
Btw Signia even has 3 Music presets to choose from: for listening over speakers, for playing an instrument and for live music. I have not discovered what the difference between the first two is and never tried the live music one yet.

That sounds logical. I also need more gain for the soft sounds so I keep some compression dialed in specifically on that side. In the end itā€™s about your personal preference.

#10

Thanks, I wasnā€™t aware of this site. Itā€™s great they are doing this. I read the 2021 paper - it was less specific than Iā€™d hoped, but they seem at least to have some general recommendations that fit with my experience.

I know that peopleā€™s hearing can be compromised in many different ways and to different degrees, and at some point, just being able to hear and understand conversation must be the focus. But itā€™s curious that they seem to think that musicians and sound engineers are a special case that needs to be handled differently, rather than the musicians and sound engineers are probably about the best audience they have for figuring out what sounds right for the general population. They have the tools and the terminology to communicate about what they are hearing, and generally have strong opinions about how it should sound vs how it does or doesnā€™tā€¦

#11

Well thatā€™s also unfortunate. I suppose until my hearing aid dies, I have the option of waiting until an ITE with BT and a working app comes along. Iā€™ve been generally impressed with Widex - their app has volume and a 3 band EQ and Iā€™ve found itā€™s quite reliable connection-wise. My impression is they also seem to be leading edge on dynamic range and latency. To program their HAs requires their software (which I have downloaded in the past), but also a special tool that I think is harder to get and a bit expensive. Itā€™s probably better not to unleash too much capability on untrained and unsupervised users, but I wish they gave you a bit more of an assist (like access to all the bands gains within some limits) in the app as a way for the client to help the audiologist (e.g. this setting sounds better). Perhaps one app for all, but an Advanced Tab option for those who are more apt at using the additional capability.

#12

So probably wrapping up here with a few commentsā€¦

In some more listening, Iā€™m again noticing that the pickups on the HA are rather directional. The ā€œdanglingā€ HA in the headphone is an improvement over behind the ear but it is still rather sensitive to the positioning of the pickups. So basically the off axis response of the pickups rolls off (not surprised) - probably a bit like a cardioid mic. Iā€™m almost surprised it picks up frontal sound very well in the normal BTE position. In the dangling HA in the headphone case, the dangle can be in just about any direction, but it seems to sound most natural when it is pointing at the HP speaker (at least as best as I can tell with my fingers holding it while the HP is mostly over my ear).

So Iā€™m definitely thinking Iā€™ll want to get an ITE HA at some point - maybe sooner than later. Right now, Iā€™m considereing Widex Moment 440 XP ITE. It works with their Tonelink app but not their Evoke app (more on this below). It is not rechargeable like the BTEs and uses a 312 battery. This model is the most visible ITE (like maybe a half shell). No of the ITEs are rechargeable, but I believe the others have smaller batteries so Iā€™m guessing less battery life.

So my point is not so much to plug Widex, but there are several reasons Iā€™m considering this model:

  1. I have Widex experience with my existing HA and I think itā€™s pretty good (at least when itā€™s not inside a HP).
  2. It has upgraded electronics and even better latency specs.
  3. Itā€™s an ITE and probably should work well with headphones.
  4. It has an app that runs on a smart phone. From what I saw, the app that it works with has volume and mute and the ability to change programs. It does not have a 3 band EQ, the ability for the user to store user defined presets, or their newer AI user tuning assist functions that are in the other app that works on their BTEs.

Iā€™ve typically used the app on my HAs for two cases:

  1. To experement with different volumes/EQs to make tuning recommendations to my audiologist.
  2. To adjust volume/EQ in specific situations such as conversation in a noisy environment. I suspect some of my need to adjust in this case will go away with the ITE because I believe the problem is that Iā€™m hear much more of whatā€™s behind me (ā€œnoiseā€ and other conversations) than whatā€™s in front of me (the people Iā€™m talking to).

To perhaps compensate or even improve on the fact that I would be loosing access to the EQ presets on the phone, I also looked into Widexā€™s programming tool. Seemingly, I see them on eBay for on the order of $200. Its a unit (USB? Blue Tooth) that attaches to a cable that you put around your neck and it communicates with the HA program on a computer to allow someone to program the HA. Thatā€™s not much expense given the cost of HAs and might be something Iā€™ll explore at some point. I think it would be a lot quicker to tune it in with music environment I have at home than iterating with my audiologist. I donā€™t know if there are any ā€˜rulesā€™ about who can buy it. Iā€™ll be in discussions with my audiologist about the feasibility of doing this.

Iā€™ll try to remember to report back here if I actually go forward on the new HA and if I end up getting the ProLink tool. Anyway, thanks for all the comments. Itā€™s been a fun an interesting discussion.