Hearing tests revisited

All, I’ve asked this question before but I am going to ask again. Background: I’ve been wearing hearing aids for 40 years now and have been assisted by various audiologists, all of whom have had excellent credentials and have been highly rated. I have a moderately severe hearing loss. I have always purchased top of the line hearing aids because I must be able to hear to continue doing my work. At least part of the evaluation conducted by my audiologist is a series of hearing tests. I understand that, at least to some extent (and maybe to a fairly significant extent), the results of those hearing tests are utilized to program my hearing aids. I also understand that the programming is based on an algorithm and I understand that the algorithm is developed, at least in part, based on the thousands of people who have taken those same hearing tests. Here is my hypothesis: If the algorithms that are developed are based, at least in part, on the thousands of people who have taken those hearing tests, most likely some sort of an “average” or “likelihood” is determined. That may not be the correct terminology. What I am getting at is similar to the “bell-shaped curve.” The problem I have with that is we all know that different people use different amounts of energy, focus and concentration when taking tests. What if a particular person uses more energy and more concentration and maintains 100% focus throughout when taking those tests and that is not typical of most people who take those tests? I am not saying that the “average person” isn’t trying to pay complete attention when being tested, but if you have worked with thousands of clients (like I have), you know that not everyone gives the same fully focused level of attention to everything they do. Wouldn’t applying the algorithm to the person who takes the hearing test and is using an above average level of focus, energy and concentration be “over-stating” that person’s hearing ability? The reason I ask is that neither my current hearing aids (Phonak Audeo) nor my prior hearing aids (Resound One) are or were able to get me above an average hearing rate of about 85%. Maybe no hearing aids can get me higher than that based on my level of hearing impairment. If any audiologists have ever been involved in a situation with a client like the one I am describing, let me know what “extra steps” were helpful in programming the hearing aids of those particular patients. Thanks.

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Well interesting questions, but I don’t think there really relevant, averages or not, each person’s hearing is different, as are the algorithms offered, NAL1, NL2, DSL etc, so this is why depending on ones hearing, everyone gets a different outcome, your audiologist makes adjustments within the manufacturer’s software to suit your hearing loss etc. Remember HAs are an aid, they don’t restore your hearing.

Can you post your audiogram, as I’m sure this would be helpful for everyone.

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So, there’s about a 5 dB test-retest variability and patient signal detection criteria plays into that. So let’s imagine that you are super focussed and therefore all of your thresholds are 5 dB less than they might be if you were having a lazier day. But the type and configuration of your hearing loss is the same. So overall, your hearing aids end up being about 2-3 dB softer than they should be for you in this less focussed state.

This is a bit of a simplistic response but. . . knock your volume up 1-2 steps. How’s that sound?


The algorithms and hearing test is the science part of the fitting. Having a professional that will really listen to you and make the different adjustments is the magic in fitting. Depending on the degree of hearing loss different amounts of magic can be performed. Bottom line is we can only work with what you have left to work with.


I don’t understand. If you’ve asked this question before are you expecting a different response this time?

Different people will answer, so of course the responses will be different.

I would agree if something had changed. But I’ll make a quick contribution. An audiogram is just a starting point when it comes to hearing aid settings and adjustments.

I think the main failure of hearing tests is too few data points. We have many audio spectrum bands available for tuning, many frequency detecting “hairs” in our ears, but only a few frequencies are tested. Plus the theory goes that our sensitivity to a frequency (versus other frequencies) changes depending on loudness. I think there should first be way more frequencies tested. Sure this will take more time. Ever done a medical test that takes a long time? Probably. Then, equal loudness tests might be done at a few different volume levels. Our aids have compression that at minimum accounts for loud, medium and soft levels, but these are guestimations based on patient feedback.

Interestingly, in my latest test at Duke University the fairly recent audiology graduate tested the midpoints between the normally displayed audiogram values.

She knew that test would be evaluated by a medical specialist though.