Understand speech - yes. Sounds good - no

@Electroniker, Neville did not write out of malice. However, we see that you do not benefit much from hearing aids. This is because, for incomprehensible reasons, you can’t admit that it may be worth trusting specialists and doing some work on your own hearing.

The methods of sound measurement you describe are not validated in any way, so they cannot be a reliable source of knowledge about hearing for us.

Having seen my wife for many years struggle getting hearing aids that would work for her substantial hearing loss and reading about all the other problems folks are having I think that “trusting specialists” is a bit optimistic. With a PhD in electrical engineering, many years of experience with audio systems and now my own efforts to get hearing aids I have encountered very few “specialists” who are all that knowledgeable about the more technical aspects of audio. I have, however, had a good technical relationship with the person in charge of hearing aid development at a major manufacturer. I do understand the complexity of trying to match technology to the human hearing/brain system. So perhaps my reasons for exploring and suggesting other approaches may not be so “incomprehensible”. As I mentioned in an earlier note I was finally able to find a specialist who had many years of experience and who had the knowledge and interest to work with me instead of just sitting in front of the computer and telling me to “get used to it” because the Audiogram said so. The Audogram is a useful tool but only measures hearing threshold and does not tell the complete story of how we hear under more normal levels. Perhaps in the future we will see some new developments that can improve upon the testing methods currently in use.

Loudness growth testing has been available for 30 years or more.

Unfortunately it’s massively subjective and if people feel they need more or less ‘help’ with their hearing they skew the results that way: irrespective of whether that yields a better fitting or not. People with ‘sound engineering’ experience tend to have the most subjective opinions on the matter.

Your residual dynamic range can be effectively tested and then stimulus reproduction can be measured using REM, this is the preferred model. Now, if you have a particular loudness growth bias, it can be superimposed into the reproduction: however, despite your subjective view, it doesn’t mean that this setting isn’t correct for your hearing simply because your brain has habituated to unamplified levels of sound. Or to put it another way: you’re not always the best person to judge the performance of the hearing aids, because you can’t hear what you can’t hear.

@Electroniker said:

The Audogram is a useful tool but only measures hearing threshold and does not tell the complete story of how we hear under more normal levels. Perhaps in the future we will see some new developments that can improve upon the testing methods currently in use.

I agree. It’s good for hearing threshold. A long time ago, “aided threshold testing” and “functional gain” was used to set up HA. This has many drawbacks, one of them was just it’s rely on the thresholds and has also much subjective component.

For your requirements, REM is needed, in which a validated recorded speech sample is played at 50, 65, and 80 dB input (or 55, 65, 75, IIRC, as a second option). Based on those measurements, the proper gain for every speech input (quiet, normal, loud) can be set.

The only thing you need is accurate, reliable tonal audiogram (bony + air) measured with validated audiometer, not oscilloscope and decibel meter.

I do appreciate your audio engineering PhD, but this is still a different field area than audiology. Just because an anesthesiologist is a physician like a surgeon doesn’t mean that the former can perform surgery, even though anesthesiologists do some invasive procedures.

@Electroniker said:

I think that “trusting specialists” is a bit optimistic

I agree, based on my experience as well. Long ago, when I tried an acrylic earmold with a 0.6mm vent, I felt so isolated from the world, but I didn’t perceive an occlusion effect, like a boomy own voice or loud chewing. However, the young HIS wasn’t proactive and made the assumption that this was an occlusion effect because of my good low-frequency hearing. It wasn’t, because in fact, this was insertion loss, but I know that only now.

Like “Electroniker”, I’m a long retired broadcast and audio engineer. Over the years, I have noticed that Audiologists and ENT’s speak a different language from audio people. They also have differnt goals. An audiogram does not always represent real world hearing and a reciprocal of a audiogram is not always the best solution.

@Speedskater said:

An audiogram does not always represent real world hearing and a reciprocal of a audiogram is not always the best solution.

Yes, and that’s why I wrote the second-to-last post about the old fitting method, which is based directly on the audiogram, and the newer method, REM.

My understanding of REM is that it improves the accuracy of the sound being sent to the eardrum. It cannot do anything to measure or assess what the ear/brain system interprets that sound to be. The user has to provide that feedback.

If you’re a parent of any number of the teens in question, and they’re planning to have a party at your house while you’re not home, you may not want to know - but you need to know!

@Electroniker said:

It cannot do anything to measure or assess what the ear/brain system interprets that sound to be. The user has to provide that feedback.

If you’ve already provided that loudness information at different frequencies it gets baked in to the determination of the REM.

You are correct that people do have different levels of retro-cochlear function - some people don’t have otoacoustic emissions at all. However, the aids attempt to provide the best clarity they can for all users - sound engineers aren’t an obscure subset of clients: they just have the same types of hangups as the people who review HDMI cables by ‘quality’.

@Electroniker said:

My understanding of REM is that it improves the accuracy of the sound being sent to the eardrum. It cannot do anything to measure or assess what the ear/brain system interprets that sound to be. The user has to provide that feedback.

Yes and that’s why REM is very good point to start, regarding much possible combinations of gains, when you try fit HA without any starting point.

Some fitting algorithms, like DSL 5.0 and probably future NAL-NL3, incorporates MCLs (Maximum Comfort Level) or LDLs (Loudness Discomfort Levels) to be more accurate in compression calculation between thresholds and MCLs.

The proper order of management should be (as a possible example):

1. Performing REM-based fitting of HA, setting gain targets and if they are too loud - setting with e.g. 80%

2. Using HA at least 8-10h per day for 2-4 weeks.

3. Next HCP appointment - setting 90% target gain.

4. Repeat point 2.

5. HCP appointment- setting 100% gain

6. Repeat point 2. After getting used to 100% gain, making notes what is good and what is poor.

7. The probably MOST IMPORTANT (in your case) HCP appointment - making small adjustments based on your notes from that good starting point like REM-based targets.
   It’s less random, less time- and energy-consuming, and more systematic than fitting hearing aids out of the fog.

@coastal_california said:

Sound engineers have “analog” ears and yes have a lot of experience

‘Most damaged’…..

I’m not saying they aren’t discerning. I’m saying they find adaptation to their new ‘normal’ more difficult than the general population primarily because they enter the situation with pre-determined ideas of how things ‘should’ sound.

The HDMI point was general levity (not a digital vs. analogue) , but there will definitely be a bright shirted individual who will attempt to sell you a better ‘quality’ one in certain stores.

I think often also because they are so focused on the hardware that they don’t think about/trust/believe in the brain’s ability to adjust.

@Neville

That’s me.

I thought the key was to turn up volume to hear better.

Yeah. Definitely that, they don’t have a movable feast concept.