Why Not Word Recognition Tests After Fitting With Hearing Aids

#21

Everything else about the process, Audiogram, PTA, WRS, BC, is quantified, in order to express the level of loss and to assist in setting up the hearing aids. So quantify the benefits.

I’m sensing there is some reluctance on the pro side, and I understand that. It moves the decision point to a currently unfamiliar area. But, if it was done right it would result in very defensible evidence that the hearing aids you are fitting would have the prescribed benefit.

Maybe we need a new metric to measure the benefit?

#22

The metric for the hearing loss is easier to quantify, like with the audiogram. But even the ability to hear pure tones is very different than the ability to hear more complex, real life sounds. Pure tones rarely exist in real life.

Even the WRS is still a rather pretty crude metric to measure the degree of the hearing loss, because perception plays a big factor in it, and even between two people who hypothetically have the same hearing loss, one may have the ability to guess the words better than the other person. Many other factors are involved, their ages, brain acuity, mental sharpness, etc.

So if the metrics to measure the hearing loss is already pretty rudimentary to come up with, the metrics to measure the benefit are probably even harder to standardize.

On top of it, listening environments vary greatly. While it may be easy to standardize and simulate a simple listening environment at an audiologist office (if the pros are even so inclined to do), the much more important thing to measure is how well a patient does with a particular hearing aids in THEIR OWN REAL listening environments. How do you standardize and simulate that? It’s just way too broad and subjective and personal. There’s no guarantee that a person doing better in the WRS with hearing aid A compared to hearing aid B in a sound-proof audio booth will do better with hearing aid A in their own real live listening environment. They may be surprised to find that hearing aid B still actually outperforms hearing aid A in real life. The WRS test is so rudimentary that in no way it can or should affect the decision to select one hearing aid over another.

This is an inherent issue that’s already well implied by many patients’ acceptance that they simply need to go try out the hearing aid in their own real world to see if it works out for them or not, simply because there are just way too many personal variables involved.

I’m an engineer and I consider myself disciplined and logical in my trade and thinking as well, but I wouldn’t want to waste time asking my provider to rerun the WRS test for me after I’ve been fitted with a hearing aid. I won’t allow the WRS after-fitting result to be the judge of how well I think a hearing aid performs. The real judge to me is how well it does in my own personal and subjective listening environments. That’s the ultimate test that can’t be standardized and implemented in any professional’s office.

#23

I’m reminded of a current struggle in medicine regarding imaging. A lot of patients want expensive imaging tests (MRIs and CAT scans) if they have a problem. Evidence shows that in a lot of cases the images really don’t provide any help for the patient and that the patient is better off going with conservative therapy. Even though research supports the more conservative approach, many patients feel like their insurance is trying to “cheap out,” and they don’t realize the potential downsides of imaging tests and testing in general.

#24

I think sometimes also in the case of word recognition tests etc they often don’t like to make to many adjustments from the get go as they like to give you a chance to get to know in certain situations if you are not understanding certain words more than others like say in noisy environments etc that’s what my audiologist has been doing with me.

#25

It is interesting to hear pros and those associated with a brand argue against improvement in the hearing aid process. Currently when we are fitted it is much too oriented around not having a return. I understand that. You have to make a living. But, if there was objective evidence of the improvement that hearing aids make, it would make that part of your job easier.

If I was presented with objective evidence showing very good results, I would fight through any other problem in order to keep them.

Right now we are asked, how do those sound. In a booth? Seriously? I want to say, I don’t know, you tell me.

#26

I don’t think anybody is arguing against improving the process, but people are against doing things that don’t help. Unfortunately hearing is subjective and it can’t be “fixed.” Hopefully it can be improved upon and only the user can know that.

#27

I’ve been critical of pros (all the ones I’ve been working with, from Costco HIS to private audiologist in their own practice) not having anything equipped to simulate various listening environments in their office. Perhaps an audio set up with multiple surround sound speakers and sound tracks that simulate anywhere from simple to complex listening environment, outdoors, concert halls, car driving, lecture, simple one on one conversations, meetings, restaurants, etc.

Of course most of them just crumple a piece of paper in front of me and ask me “How does that sound?” after they’ve made some adjustment on the hearing aid for me, no matter what kind of adjustment it is.

Having said that, I do realize that even an elaborate surround sound system in their office with simulated sound tracks is still not the real thing, although it’s better than nothing. I’ve come to a conclusion that a much more effective way to solve this issue is for the hearing aid manufacturer to educate and give the patient the ability to make changes on their own if they choose to do so that way. This way, they can make their own change, maybe under the guidance of their provider, or have it done by their provider remotely without having to make an appointment and wait to come into the office, so they can quickly just test it out for themselves in their own environments, rather than depending on some kind of defacto standardized testing environment at the audi’s office. I’d rather see the effort be made to enable some type of DIY effort, and if needed, under the guidance of the provider, than to push providers to come up with some kind of standard validation setup.

#28

Yes, this is certainly true. But it is more difficult in practice because of the hazy measures we have. Even the audiogram isn’t terribly precise. We cannot reliably detect a statistically meaningful drop in hearing of less than ~15 dB between two tests, for example. We could improve a lot of the variability with time and repetition, but clinical time is limited. And patient tolerance for lengthy measurement is limited.

Additionally, a huge element of variability that patients often miss is the wetworks side. Your brain changes over time in response to hearing aids. It’s not simply an engineering problem.

I’m on your side though. I do believe that we need to get better, and I agree that we are too slow to change (although implementing change when your days are already packed with appointments and you are booking two months out can be glacier slow.)

And I agree with you that there are many practitioners out there who care very strongly about returns and profits. But there are also some who care about helping people hear better. Say you get one of those, it’s still always a battle between access to sound and acceptance. Getting a new user to get some benefit and accept hearing aids is better for the user than to aim straight at maximum possible benefit right off the bat and have them reject the hearing aids immediately. That’s why they ask you how it sounds to you. I prefer to take the angle of “this is where I’d like you to be, at minimum, but they still need to sound comfortable enough that you won’t be tearing them out of your ears. So we may need to turn them down for now and work back up later.” Some users are like you and want to power through from the beginning. But then, my clinical expeirence is more limited than others, so I aim for the maximum from the get-go. Maybe after years of people coming back telling me to turn things down I’ll be more conservative from the start. :wink:

I also agree with Volusiano; I like the idea of guided self-fitting (my boss will probably never let me do it in quite the way I’d like). I haven’t gotten deeply into the new Widex app, but it does try to address things from that angle of getting into your real environments and then helping you to adjust the sound. So it is something the manufacturers are responding to, and practitioners will probably have to move along with them.

But please, develop better metrics! Please please. I’ll use whatever I can to help cut through the manufacturer marketting bs.

#29

Thanks, Neville. Good thoughts.

#30

I have been very, very fortunate in that I developed an excellent relationship with my audiologist over the past four years. Unfortunately, my most recent appointment with her was my last I believe today was her last day of work; she has now retired.

I think my relationship with my audiologist and her skills, maturity, willingness to listen, and willingness to learn new things (my Starkey’s were the first she saw) were all key to my satisfaction with my hearing aids. I know that when I choose a new audiologist, I will be looking for someone I can learn to trust and work with.

I have what I consider to be very realistic expectations of my hearing aids, especially after wearing them for a few years. I know my hearing is better than without HAs, but is never going to be “good.”

#31

I have heard many people say that the skill of your audiologist is much more important that the hearing aid they choose for you. You were very fortunate!

#32

You’ve just described the Widex Evoke 440.

#33

I have been wearing Has for fifteen years or so. My hearing loss is now in the profound range. A year ago I got a new set of HAs. The fitting visit included a Word Recognition Test at a 50 dB level (normal conversation) with my old HAs. Score was 10% - 20% or so. Without HAs my score is basically 0%. The new HAs are much more powerful. After a couple of tuning visits, there was another Word Recognition Test. At the same 50 dB level, I scored 76%. The tests were given in a sound booth with no background noises so it is not a real world situation. But the marked improvement shown by the scores does carry over to real life. Just ask my wife!

#34

Neville (and/or others who wish to respond) : My audiologist once gave me a speech-in-noise test while in the booth. A recording (roughly 5 to 10 seconds duration) was played for me (without HAs) at different volume settings to establish the volume I was most comfortable with. The recording consisted of a woman saying a simple sentence with some background multiple voices similar to the restaurant scenario. In the first recording, the woman’s voice volume was significantly higher than the background voices, and I was asked to repeat the simple sentence that the woman said. In the next recording, the woman said a different simple sentence and (as you are anticipating) the background voices were a bit louder. Additional recordings in this sequence were played until I said that I had no idea what the woman said. Unlike a WRS, I was given no quantitative score following this test, and the test was not repeated with HAs.

Q #!: Is this test common?

Q#2: Why can’t this sort of test be given before and after fitting a client with HAs? While it obviously isn’t anywhere near perfect, telling the patient, “Go to a restaurant with a group of your friends, or go to your grandkid’s birthday party, and report back to me on how these HAs are handling speech-in-noise environments”, isn’t anywhere near perfect either.

#35

Sounds like the Quick SIN (speech in noise ). It is scored and the results are usually given as a signal to noise ratio for each ear. I’m only aware of it being given without hearing aids. My impression is that the test is widely known, but not used all that much. I’ve had it when I asked for it and at an academic center. I’m not sure how useful it would be in showing how hearing aids help in that all the systems that I know of rely on directionality in some way and having everything come from one speaker wouldn’t let that work. Brieftly the two systems for reducing noise: 1) Narrow the focus of the mikes on the source of the speech 2) Subtract the noise sound coming from behind the listener from the sound that is more speech intense in front of the speaker.

#36

Thanks MDB. I read a bit about the Quick SIN test. Understanding speech with other or background noises (I.E., SIN) is my overarching problem and complaint.

As I understand it, HA manufactures use directionality to address SIN (as you point out), but about all HA manufactures claim to also employ supposedly sophisticated algorithms, which are independent of directionality, to enhance SIN understanding. So it seems that at least the HA directionality-independent SIN algorithm effectiveness should be able to be assessed with a Quick SIN test. And as suggested in a prior post in this thread, if the Quick SIN test were expanded to include something like a surround sound system in the booth with mainly noise going to some speakers and mainly speech going to other speakers, why couldn’t such a test assess both the directionality and algorithm SIN effectiveness of HA options for a particular HA customer?

To recap, I think telling the HA customer to go to a restaurant or a birthday party doesn’t provide a very objective or quantifiable HA SIN effectiveness assessment.

#37

I’ve had word-recognition tests when I picked up the last two pairs of aids. One was with the audiologist in an ENT’s office and the last was at Costco.

#38

[quote=“Overoaked, post:34, topic:36765”]
Q #!: Is this test common?

Q#2: Why can’t this sort of test be given before and after fitting a client with HAs? [/quote]

I do it on every new patient, ideally. Time constraints can be a problem. It probably isn’t as common as one would like. At higher-level presentations (i.e. loud enough that the hearing loss isn’t necessarily much of an issue) it gives a gross measure of speech in noise processing, which can be an important counselling tool (e.g., hearing aids can improve speech in noise ratio(SNR) by ~3 dB with directional microphones, if you have an SNR loss of 14 dB hearing aids aren’t going to improve your function in noise at all.)

It can be given before and after a hearing aid fitting and it can be given with the noise displaced from the target speech if there is a two-speaker soundfield available (all pediatric offices would have this, but not all exclusively adult offices would). It is not sensitive enough to find differences between two well fit hearing aids, so its use would be to say, “look, you do better with hearing aids than without.” This doesn’t actually give us much extra information, as depending on your hearing loss we already knew you’d do better with hearing aids.

Tangentially, as a past researcher I would be jazzed to put willing patients through ALL the tests. I could pack an 8-hour day FULL of fun tests for a tireless patient. We’d get the most complete picture of their hearing abilities ever, with a nice break for lunch in the middle. We could go on field trips! We could try multiple aids in multiple environments with mobile adjustments. If someone called in and requested an 8-hour appointment and was open to paying my hourly for it I’d be thrilled. Sometimes I think if I win the lottery I would open my own not-for-profit clinic where I would only see 2-4 patients a day and would have basically unlimited time. It wouldn’t be for rich patients or poor patients, it would be for nitpicky optimizers like me.