Questions from an aging audio buff getting 1st HA's

[I created a sig with my audiogram but changes don’t stick and it isn’t showing up, so I put it at the bottom of this post.

Also I’m posting in this forum hoping that I’ll be able to find satisfactory digital HA’s]

If the below is too much to wade through, please just skip to question 4)

Background: I just turned 65 and have had some impairment for decades from loud power tools and motorcycles, but over the last several years it’s gotten progressively harder to understand people.

The last straw was when I recently played a CD track with nice and pronounced cymbals that I hadn’t listened to in awhile, and was shocked that I could barely even hear them.

Re audio sensibilities, I hesitate to call myself an audiophile, as I can’t hear differences between good quality amps or DAC’s, but I’ve been an audio buff since my teen years and believe I’m rather discerning about sound quality.

I’ve put in about 10 hr reading after googling “best hearing aids for audiophiles” and feel like I’m at the point where I can ask some reasonably informed questions.

  1. Do digital HA’s have A/D and D/A of sufficient quality that they’re not a weak link?

For me that would just be CD quality, or even less; some of the best and most realistic recorded sound I’ve heard has been on DVD’s, which have lossy compression; I think recording quality is a much larger factor.

  1. Regarding HA configuration, it seems to me that BTE would be a non-starter:

The pinnae collect and focus sound from the front, while attenuating the sound from behind (esp high freq), while the mic location in BTE HA’s would do the opposite.

Do I correctly conclude that BTE HA’s should be dismissed out of hand if sound quality is the top priority?

If so, that leaves CIC and RIC.

Or so I thought; from what I’ve read, the “receiver” in RIC refers to the speaker, whereas I’d have thought that would be the mic.

So that just leaves CIC.

Or does someone make a HA that has the mic inside the ear but the electronics behind?

I’m concerned about discomfort of CIC, difficulty of battery changes and insertion/removal, and life of the tiny batteries.

  1. It sounds like most (hopefully all) of the issues with digital HA’s are due to too much digital processing aimed at speech intelligibility in difficult situations, with predictable damage to natural sound quality.

And with CIC, why the heck would all that processing be necessary anyway, unless the aim is to increase speech intelligibility beyond that of natural hearing?

  1. Presuming I’m not alone in my sensibilities, has anyone tried the following strategy:

Limit processing to using EQ to flatten frequency response, combined with gain to correct sensitivity loss.

Regarding the former, I gather that this may not be as simple as one may think; I read that the audiograms we get only represent threshold sensitivity vs. frequency, not the frequency response at higher, more relevant levels.

Still, I expect experimentation would yield a satisfactory freq response result.

If the above has worked for some of you, please share which brands/models.

  1. Despite my impairment, it seems odd that I have the same distaste for bright sounding equipment and recordings and shrill sounds; I still wince when children squeal.

Perhaps something to do with my ears’ having freq response that changes w/SPL?

Thanks!


Noah’s audiogram (7/6/16)

Freq…L…R
0250…15…15
0500…25…20
1000…35…30
1500…45…50
2000…50…55
4000…65…65
6000…55…45
8000…55…45

Run, don’t walk, and try Opn’s with RIC. It will be a revelation (assuming a good fitting).

Marc

Hi,

it´s late at night here in germany, so just a short answer for now.

Seeing your audiogram, your outer hair cells are probably damaged. This results in problems hearing soft AND loud sounds. Read up on “recruitment”, that´s the problem you have.

And that is why you will not get away with using gain and EQ. You will need compression, too. And compression might (!) sound bad in some situations, but you need it.

The worst artifacts come from digital signal processing. There used to be input clipping from loud sounds (some aids still have that), but there are ways around that now.

If you don´t have artifacts and no distortion, hearing aids still are not high-end. But it will sound better with aids in than with aids out, you will be surprised how much you are missing right now.

I use Bernafon Juna 9 aids, Bernafon is a brand that it known to be good for musical ears.

You will get the best sound out of open domes. This way, you hear low frequencies directly , high frequencies amplified.

My hearing aids are Siemens Teneo S+ aids supplied by the NHS in England. Someone on this forum described them as entry level.
Each aid has two microphones. If you look at left hand aid in the photo just to the right of the mental fitting is a microphone when fitted on my ear this microphone will be pointing forwards. If you look at the right hand aid in the photo there is a microphone to the right of the button when fitted on my ear this microphone will point straight up.
I don’t think you should dismiss BTE aids.


Marc,

Thanks again for the Oticon tip.

Their web page says “Guided by Oticon’s BrainHearing™ audiological approach, Oticon Opn™ is engineered to better support how the brain processes sound. Oticon Opn™ allows the brain to follow and process multiple sound sources in noisy environments.”

Seems like a lot of words that don’t inform much, but seem to land on the side of more, not less, processing.

So are you enjoying them with a lot of processing in effect?

You say they’re RIC; is my concern about the mic’s being in the ear canal unfounded?

Edit: Oops, that should have been “is my concern about the mic’s not being in the ear canal unfounded”

I tend to ignore marketing babble. There are lots of adjustments possible in the fitting software, though arguably fewer than in older aids (like the Agil’s I had from 2010 until recently). As far as RIC, I think your concerns are largely unfounded. Your experience with music will be so insanely better than without HA’s, that I doubt you’ll spend much time wondering whether they could be even better. When I first got HA’s, I had a smile on my face any time I listened to music; I’d practically given up listening because it sounded so “flat”.

Marc

p.s. I’m 61, very similar audiogram, also something of a lapsed audiophile (dumb expensive cables, tube amps, horn speakers, etc.)

Noah,

Someone else mentioned “recruitment”. I just wanted to elaborate on that.
To a normal hearing person, a 20 db SPL tone is soft but audible and a 100 db is very loud. The range of loudness is 20 to 100.
To a hearing impaired person, you may not hear the 20db tone, and a 40db tone is soft BUT the same 100 db tone is very loud. The range is 40 to 100.
In other words, the ceiling of loudness has not change whether you have normal or impaired hearing, BUT the floor has raised when you have a hearing loss. Your dynamic range (the sensation of very soft and very loud) of hearing has reduced, and that’s why hearing aid used compression when they amplify sound, so as to fit the dynamic range of a normal hearing person to the one with hearing loss. Different gain level at different input level.

Now on the topic of music, I don’t know if you have read this article already, it is from a manufacturer but the principles are the same:
http://www.hearingreview.com/2009/03/ensuring-high-fidelity-in-hearing-aid-sound-processing/

I hope you will know what to look for after reading it. CL

— Updated —

Noah,

Someone else mentioned “recruitment”. I just wanted to elaborate on that.
To a normal hearing person, a 20 db SPL tone is soft but audible and a 100 db is very loud. The range of loudness is 20 to 100.
To a hearing impaired person, you may not hear the 20db tone, and a 40db tone is soft BUT the same 100 db tone is very loud. The range is 40 to 100.
In other words, the ceiling of loudness has not change whether you have normal or impaired hearing, BUT the floor has raised when you have a hearing loss. Your dynamic range (the sensation of very soft and very loud) of hearing has reduced, and that’s why hearing aid used compression when they amplify sound, so as to fit the dynamic range of a normal hearing person to the one with hearing loss. Different gain level at different input level.

Now on the topic of music, I don’t know if you have read this article already, it is from a manufacturer but the principles are the same:
http://www.hearingreview.com/2009/03/ensuring-high-fidelity-in-hearing-aid-sound-processing/

I hope you will know what to look for after reading it. CL

Thanks, that’s very encouraging!

Cool :slight_smile:

Pat, that’s interesting, thanks, and agrees with what Marc just said.

Musician, thanks for bringing in the issue of recruitment; very interesting!

“The theory of recruitment is that as the]hair cells in your cochlea become ineffective, they “recruit” their (still working) neighbor hair cells to “hear” the frequency the damaged hair cell was supposed to hear, in addition to the frequency the still working hair cell was supposed to hear. This increases the signal from the still working hair cells.”

So if the missing frequencies are restored with EQ, wouldn’t recruitment no longer be necessary and perhaps diminish (allowing time for adaptation of course)?

CL, thanks for the great link; I’m familiar with most of the concepts from my audio background (also from vibrations analysis work as a mechanical engineer).

That info is now 7 yr old; is the described tech still unique to Widex (if it ever was)?

Here’s my complete audiogram if that’s useful

Hi,

for hearing aids and music there are some important areas where they sound bad.

  1. Distortion: This is worst. Some aids just clip at the input stage when it gets louder than 94 dB, the microphones can distort, the output can distort. For an in-depth discussion, see Marshall Chasins Blog http://hearinghealthmatters.org/hearthemusic/

Much has been done on this topic in the last few years. Bernafon just shifts the dynamic range from 0 - 94 dB up to 20 - 114 dB for the live-music-program. Widex uses a similar approach. Resound puts an analog compressor befor the AD stage. The newer aids with more bit just enhance the dynamic range and avoid input distortion very well (the latest aids from phonak and oticon certainly fall in this domain).

You will still get problems with distortion when visiting loud rock concerts or sit in the front row for a symphony. Use earplugs for very loud concerts.

  1. Artifacts from digital signal processing. Feedback canceller is worst, gives a wah-wah-effect to music. Noise reduction is bad, cancels out the cymbals, for instance. Those can be switched off easily and usually are switched off by default in a music program.

More difficult are artifacts that are produced by separating the signal into channels. Most aids (all with the exception of bernafon) split the signal into channels and process each channel separately. Amplification and compression can be set indivudually for each channel - a multiband compressor. This can produce artifacts. For instance, for a note on a piano, the overtones might lie in a different channnel than the base frequency. This can sound strange. Manufacturers try to link the channels and avoid those artifacts, the only manufacturer that consequently avoids them is bernafon by not using channels (channel free). Those artifacts are difficult to hear and occur seldomly, so you might ignore this problem.

  1. Problem: Hearing aids are not high-end. This problem still remains. If you compare the frequency response of a hearing aid with that of a good speaker or headphone, you will be shocked. In my opinion, if you have
    a) good hearing in the low frequencies and
    b) still remember how the real thing should sound
    the only way of getting a HiFi-Sound from hearing aids is to use open domes. This way you can hear the low frequencies naturally, while the high ones are amplified. Note that you will have to find a sweet spot where it sounds good: If you turn up the volume too much, the aids will start to compress. As only the highs are amplified, the lows will become louder and louder, the highs not, the sound becomes unbalanced. But if you find that sweet spot, it sounds (in my opinion) really good.

If you have the right aid set up correctly, music from a good HiFi or at a live classical concert will sound much better with the aids in than without - which is a big plus after all this criticism!

— Updated —

Hi,

for hearing aids and music there are some important areas where they sound bad.

  1. Distortion: This is worst. Some aids just clip at the input stage when it gets louder than 94 dB, the microphones can distort, the output can distort. For an in-depth discussion, see Marshall Chasins Blog http://hearinghealthmatters.org/hearthemusic/

Much has been done on this topic in the last few years. Bernafon just shifts the dynamic range from 0 - 94 dB up to 20 - 114 dB for the live-music-program. Widex uses a similar approach. Resound puts an analog compressor befor the AD stage. The newer aids with more bit just enhance the dynamic range and avoid input distortion very well (the latest aids from phonak and oticon certainly fall in this domain).

You will still get problems with distortion when visiting loud rock concerts or sit in the front row for a symphony. Use earplugs for very loud concerts.

  1. Artifacts from digital signal processing. Feedback canceller is worst, gives a wah-wah-effect to music. Noise reduction is bad, cancels out the cymbals, for instance. Those can be switched off easily and usually are switched off by default in a music program.

More difficult are artifacts that are produced by separating the signal into channels. Most aids (all with the exception of bernafon) split the signal into channels and process each channel separately. Amplification and compression can be set indivudually for each channel - a multiband compressor. This can produce artifacts. For instance, for a note on a piano, the overtones might lie in a different channnel than the base frequency. This can sound strange. Manufacturers try to link the channels and avoid those artifacts, the only manufacturer that consequently avoids them is bernafon by not using channels (channel free). Those artifacts are difficult to hear and occur seldomly, so you might ignore this problem.

  1. Problem: Hearing aids are not high-end. This problem still remains. If you compare the frequency response of a hearing aid with that of a good speaker or headphone, you will be shocked. In my opinion, if you have
    a) good hearing in the low frequencies and
    b) still remember how the real thing should sound
    the only way of getting a HiFi-Sound from hearing aids is to use open domes. This way you can hear the low frequencies naturally, while the high ones are amplified. Note that you will have to find a sweet spot where it sounds good: If you turn up the volume too much, the aids will start to compress. As only the highs are amplified, the lows will become louder and louder, the highs not, the sound becomes unbalanced. But if you find that sweet spot, it sounds (in my opinion) really good.

If you have the right aid set up correctly, music from a good HiFi or at a live classical concert will sound much better with the aids in than without - which is a big plus after all this criticism!

Musician_ 72…Great information! As always, all your Posts and insights are greatly appreciated by me. Thanks for taking the time to help so many as you have.

You´re welcome!
I forgot one thing: I was explaining that in my opinion, open domes give the best sound for music (as long as your hearing of low frequencies is still good).

That is why I think that ITE-aids might be a bad idea for music. They usually are closed, or at least more closed than open domes. There might be cases when you have a big ear canal and a very good custom mold for the ITE-aid where this combination will give you an open sound, too, but usually it´s more “closed”.

What you say about the pinna is true. With a BTE-style aid you will need a pinna simulation to reproduce that, whereas with a ITE-aid you won´t need this kind of processing.

Ask for a pinna simulation for your aid.

By the way, those are not purely theoretical assumptions: I use power domes for my backup-aids whenever I suspect that it might get loud but I still need to understand people. With the power domes, one can simply turn down the volume and has a kind of ear plug. But this combination doesn´t sound nearly as good for music as my standard one with open domes. There might be good in-between solutions, though, like vented custom molds. I don´t know how much low-frequency sound comes in through vents and if they allow for natural hearing for lower frequencies (say, up to 1000 Hz or so).

Yes, RIC (and I presume BTE) work just fine. RIC seems to be the preferred style right now. With your fairly good low frequency hearing the CIC style will probably not be comfortable due to occlusion. I have a custom soft mold for my RIC style hearing aids, and the mold was fit very deep. If it is deep enough, and maybe the pros can weigh in and tell us exactly why, it reduces occlusion. Apparently mine hit that spot. Mine have the adjust-a-vent with the smallest vent and I still don’t have occlusion. CIC hearing aids do not fit deep enough and can’t have the vent large enough to eliminate occlusion.

Why is occlusion bad? You know how, when talking to someone, or in a group, people talk over each other a little and start a sentence as someone else is finishing, or comment, or agree when someone is talking? If you are saying anything you can’t hear anything anyone else says. It is like using a two-way radio. When you are talking you can’t hear anything else. Also, you can chew or hear, pick one. Plus, for me, just the physical feeling of a CIC is uncomfortable.

Noah,

You’re probably already aware that most popular recordings are already heavily compressed, the exceptions being some symphonic and jazz recordings captured with a binaural mic, and the occasional rock CD, like the Cowboy Junkies - Trinity Sessions. When listening to recordings that are already compressed, you probably want to continue to have your HAs do EQ boost on the high frequencies, but dial back the compression, and just turn up the volume of your sound system a bit.

I believe most digital HAs have 16 bit DAC/ADCs (96 db of dynamic range) and a few high end ones (not sure which) go to 24 db. That said, the converters are not going to be of the best quality simply because the entire power budget of a typical HA is around 2 mw, about half of which is dissipated in the receivers (speakers). The batteries are 1.4 volts so the HAs are dealing with really low signal levels and the condenser mics are polarized at lower levels. Short answer - HAs are not audiophile gear and you should set your expectations accordingly. That’s not to say HAs won’t improve you music listening experience, but you won’t get back to those virgin 12 year old ears.

Musician, many thanks for your very helpful explanations!

OK, but I really don’t need that, right?

The hard part for a tiny speaker is bass, and my loss isn’t severe there, so it would seem that I just need the HA to boost the midrange and treble.

Can HA’s not be EQ’d to do that?

Good point!

Oh, and can you comment on my question about recruiting perhaps diminishing after using HA’s?

Don,

Oops, what I meant to say was “is my concern about the not mic’s being in the ear canal unfounded?”

Not sure that changes your or anyone else’s answers.

Thanks for the other good info.

TK,

Yes, I’m aware, and don’t listen much to pop; my listening consists of the streamed local jazz radio station on my (quite good) computer speakers, and movie soundtracks on my HT system.

Thanks for the info on the state of HA electronics, that was exactly what I wanted to know.

Given the inverse square law (or perhaps inverse linear in the ear canal), obviously the closer the speaker (still having trouble with it being called receiver) is to the eardrum, the better.

Has anyone noted a correlation between HA’s that get the <straining> receiver closer to the eardrum with greater freedom from overload distortion?</straining><straining>
</straining>

Yes, aids can do exactly that. But in order to hear the lower frequencies well, it is necessary that the aids are open and let the natural sound in.

Good point!

Oh, and can you comment on my question about recruiting perhaps diminishing after using HA’s?

I can only tell my own experience: For me, it got a little better. I went to an ENT in the first place because of hyperacusis. I had really bad problems with loud sounds. Now, with the aids, my hearing is more relaxed (I no longer need to put an effort into understanding everyone) and my sensitivity to loud sound has lessened a bit. I explain it like that: If you are standing in the bright sunlight and then someone takes a photo of you with a flashlight, it won´t matter much. But if you are in the dark and are trying to see something and then suddenly someone produces a flash, it will really hurt you. So, in a constant state of struggling to hear, it´s more difficult to handle loud sounds.

On the other hand: The outer hair-cells are damaged, and they won´t recover. The underlying problem will not go away. I can´t predict what it will be like for you.

I still have problems with loud situations, for instance big crowds in big halls. At the moment I am pondering about whether I should try custom molds with a small vent (see this blog article: http://hearinghealthmatters.org/hearthemusic/2016/3080/ ). I would then get rid of the problem with louder situations (with the exception of very loud ones like rock-concerts), but I really like the sound of open domes so much …

By the way, one important thing to remember: Aids take a little getting used to. Your brain must accept the new sound as “normal”. Until that happened, the aids won´t sound “good”, especially not for music.

Good luck!

— Updated —

Yes, aids can do exactly that. But in order to hear the lower frequencies well, it is necessary that the aids are open and let the natural sound in.

Good point!

Oh, and can you comment on my question about recruiting perhaps diminishing after using HA’s?

I can only tell my own experience: For me, it got a little better. I went to an ENT in the first place because of hyperacusis. I had really bad problems with loud sounds. Now, with the aids, my hearing is more relaxed (I no longer need to put an effort into understanding everyone) and my sensitivity to loud sound has lessened a bit. I explain it like that: If you are standing in the bright sunlight and then someone takes a photo of you with a flashlight, it won´t matter much. But if you are in the dark and are trying to see something and then suddenly someone produces a flash, it will really hurt you. So, in a constant state of struggling to hear, it´s more difficult to handle loud sounds.

On the other hand: The outer hair-cells are damaged, and they won´t recover. The underlying problem will not go away. I can´t predict what it will be like for you.

I still have problems with loud situations, for instance big crowds in big halls. At the moment I am pondering about whether I should try custom molds with a small vent (see this blog article: http://hearinghealthmatters.org/hearthemusic/2016/3080/ ). I would then get rid of the problem with louder situations (with the exception of very loud ones like rock-concerts), but I really like the sound of open domes so much …

By the way, one important thing to remember: Aids take a little getting used to. Your brain must accept the new sound as “normal”. Until that happened, the aids won´t sound “good”, especially not for music.

Good luck!

You have great hearing in the low frequencies so the last thing you want is CIC hearing aids, which will plug your ear canal and force the low tones through the hearing aid, creating occlusion and an artificial sound quality. You want to wear Open-Fit hearing aids, available in both RIC or OE design. Most brands come with multiple programs available, which allows the hearing aids to be set for prescription on one setting- and let’s say “music” on another setting.

When we program hearing aids to a music setting we increase the frequency response range and boost the intensity in the upper frequencies, often appreciated by music buffs, however this same setting while worn in a busy restaurant would end up making the sounds of forks and knives on porcelain plates sound extremely piercing.

The benefit of Open-Fit hearing aids for your hearing loss is that the low tones will remain being heard naturally while the middle and high frequency sounds will be boosted the appropriate amount based on your prescription.

If you decide to order from my company please contact me directly and let me know that you want one of the four programs available specifically programmed for music, I can be reached at jeff@clearlyhearing.com.

The product I recommend for your hearing loss can be viewed by following the link below:

You make some great points and I appreciate that you experience recruitment with UCL levels well below the norm, however the posters audiogram and write up is not indicative of someone living with recruitment, which can be defined as abnormal loudness growth. The poster has slowly lost sensitivity in the high frequency range for many years, the fact that he finds high frequency sounds “shrill” is much more likely based on lack of stimulation than recruitment. When hearing aids are introduced these high frequency sounds may be heard sharp and somewhat unnatural for a time, however as the brain becomes reacquainted with normal listening levels and the frequency information that has been slowly starved for many years the posters sense of “shrill” will be replaced with more clarity and a normalized interpretation of the high frequency spectrum.

People with no hearing aid experience should not enter into hearing aids with a set idea of what they need hearing aids to sound like. In the posters case he doesn’t even hear stimulation at 4000Hz naturally until it reaches 65 dB. Once this frequency is properly stimulated it will not sound natural (at the beginning), but that’s okay, the posters sense of normal is sku’d to living with hearing loss for many years.

Anyone who lives with high frequency hearing loss for years before purchasing hearing aids should expect a 2-6 month habilitation period where the brain gets reacquainted with normal listening levels and begins re-guage what sounds normal and natural.

The normal range of hearing isn’t subjective, however the type of music we like and the volume we like to listen to our music at is subjective. Hearing aids should be programmed to prescriptive levels to promote the best possible communication today and reduce or retard future deterioration of speech clarity based on improper stimulation of the high frequency sounds. Optimizing music on the other hand can be optimized by factoring in the individuals preferences, but requires a stand alone music program.

[quote=Noah Katz;140728]Oops, what I meant to say was “is my concern about the not mic’s being in the ear canal unfounded?”

darn, I still didn’t get it right; should be “is my concern about the mic’s not being in the ear canal unfounded?”