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Upcoming Review on Audiologist who does a sophisticated battery of tests beyond checkbox

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In reply to @Roberto

Is it possible to keep your posts to the point, who’s gonna read all your cut and pasteing, another good reason we should have a maximum count.

hi @Roberto i didn’t read 99% of your posts but i’d question whether all of those tests are necessary. ACT in particular is academic unless the fitting software allowed the clinician to input the score. only oticon allows this so far since it’s a proprietary test. otherwise the clinician is fumbling around trying to relate an abstract score of performance in noise with the settings of the hearing aids.

Edited

@tenkan Just do what I do when I see a post that is too long or even worse where the user has never been taught the benefit of paragraphs as opposed to a solid wall of text - just don’t read the post! Simple.

That one post was really long, but I was just frustrated that people keep talking about managing expectations when it is clear even from this forum alone - that hearing aid wearers are not getting the standard of care they need.

@choccybiccy69 I think that those are all the services that she offers, not necessarily what she does for every single fitting - probably depends on the hearing loss and patient’s requirements? I will update when I have been.

Fortunately my hearing aids are Oticon, so she can do that ACT test if it would benefit me. My main priority (once she has fixed the underfit issues) is to fix the soft speech problem. So, really the question boils down to what tests would help most with that given, that all previous audios have failed.

Edited

In reply to @user490

Pretty good although it varies with the hearing loss. I should really try to go through and do a more systematic comparison and get back to you.

But note that the isn’t the prediction. If you’re on the verifit, you click ON the SII and then it opens a different window with the aided speech predictions. I’m not sure exactly what you mean by “the SII estimate is off”, but my guess is that you were trying to directly compare it to WRS. Aided SII tells you what percentage of speech is audible, but people can fill in the blanks and predicted aided WRS is higher than aided SII. Verifi will account for the ear acoustics if you’ve measured an and/or are doing an on-ear unaided measurement. If you just put the in without an individual RECD it will still estimate unaided SII based on an average ear canal.

@Roberto said:

I use Chatgpt extensively for a lot of different things.

The thing I’m finding funny about ChatGPT, or about Google Gemini which I am using more often lately, is that when I am working in my area of expertise I see errors all the time and yet when I am talking to it outside of my area of expertise I sort of just accept its answers even though I rationally know that if it makes errors in my area it will make errors in other areas. It’s sort of a pragmatic decision in that a lot of things I ask it I don’t actually need a super precise answer to, just a general answer, so having a few details off feels fine. EXCEPT, those little errors are still going into my head, and a year from now they might just BE in my head and I won’t recall the source and just assume that they are correct. Dragons in the margins. It’s still interesting though. And it’s a very effective tool for writing very boring letters that you do not want to write.

@Roberto said:

I will be 50 in a couple of months. I only started wearing hearing aids when I was about 8 years old as somebody finally realised I couldn’t hear properly.

Ahh, so you were first fit with hearing aids during the pediatric fitting dark ages. Child prescriptive targets weren’t developed until the early 80s and weren’t released widely until maybe 13 years later, so you would have probably been fit to . . . adult half gain rules? And yes, soft speech would have been wildly underamplified for you by today’s standards. And then once better prescriptive targets came out you were probably transitioned into adult targets rather than child targets, whereas a child today would start out fit to child targets and never be moved out of them (with the result that they generally get more audibility across their entire lives than someone in adult targets). If you’ve been getting by without , soft speech is often simply inaudible. Especially in domes. She’ll probably get you fixed up there and that will go a long way. But man, hearing loss form birth and you are still relatively young. I’d be very tempted to see how you did in child targets. Yes, let her do her job. But do mention to her that your loss has been since childhood but that you suspect you were underfit in childhood too, so it’s not clear to you whether you should be in child or adult targets. Maybe she’ll experiment.

@tenkan said:

Is it possible to keep your posts to the point, who’s gonna read all your cut and pasteing, another good reason we should have a maximum count.

I read them. What a very millenial thing to say. :wink:

Why are we sure that more testing is going to yield a better result?

Looking at the actual loss, I’m reminded that this shape actually looks like the modelled results from the ISVR in respect of certain low frequency dead-spot configurations. They present differently than high frequency ones: especially due to adjacent hair cell transmission during testing.

That would also be consistent with the poor speech comprehension and other issues. There’s likely to be distortion with the fitting when you start driving lower frequencies especially with aids and fitting systems not designed to work with this kind of loss.

With these cases, fitting the person rather than the numbers is critical. And possibly incremented programmed levels with lots of control. Accumulating Auditory Fatigue is a potential downside of making everything clear all the time to the wearer.

I know I know, but I’m still trying to get hearingtracker’s to work..

In reply to @Neville

@Neville said:

If you’re on the verifit, you click ON the SII and then it opens a different window with the aided speech predictions. I’m not sure exactly what you mean by “the SII estimate is off”, but my guess is that you were trying to directly compare it to WRS.

When they run it shows an unaided estimate and an aided SII estimate without opening another window. Does clicking on SII provide additional details and if so what?

They did not enter and so it seems the estimate is off, not that the SII estimate really matters. I eventually got HA1-RECD values but even there I think one ear may be off as there’s a small valley 2-4K and deeper notch at about 6K. The other ear increases gradually as expected. Without a second reading it is hard to validate. The audiologist needed help as she doesn’t typically run this so possibly something wasn’t performed optimally.

It shows the unaided and aided number and Audibar as shown here: Understanding the Speech Intelligibility Index (SII) | e3 Diagnostics4 . I happened to catch the curser hovering on an Audibar and it says the number is “Aided SII - click for details” so the number is the Aided SII but there are more details to view. Isn’t SII just a number? That link does not show the more details screen or what is displayed there.

Yes, you click for more details to get the predicted aided .

This isn’t that exciting. :joy: I’m just saying that the verifit can predict it for you and given the variability of WRS the prediction is going to be close enough as to give you what want but way faster.

In reply to @tenkan

I will try and keep my posts shorter. My problem is being details orientated is what makes me really good at my job, but it is also the same thing that makes it very hard for me to provide big picture overview information rather than minutia detail.

Edited

In reply to @choccybiccy69

@choccybiccy69 said:

real ear measures, along with aided speech and speech in noise will be the most useful tests. otherwise i believe it’s simply a case of trial and error with the settings.

This directly contradicts what @Neville says - that he has not yet seen the value in aided speech. However chatgpt does agree with you! I will ask her about this because Chatgpt said it would help, so it will be very interesting to hear what she says.

@Neville The problem with Chatgpt is garbage in, garbage out. A program is only as good as it’s data. That is why it is very good at something like explaining what or aided speech is - because it is describing a fact which in general everyone can agree on. But when it comes to judgement it is relying on everything it has read good and bad on the Internet. So, it gets things wrongs because it is repeating the mistakes of millions of other users. Use Chatgpt for facts - what is this and you will do well. Never ask it to troubleshoot or diagnose anything unless it has been trained only accurate data.

I am not understanding your recommendations about child/adult targets. My understanding from Chatgpt tells me two main points. I don’t like Widex, Resound etc because too much noise, too loud etc and I always suffered auditory fatigue until Oticon. Chatgpt said I would have the exact same problem with adult and I would be better off on . In addition, it said that DSL is meant more for teaching children audible cues such as fricatives, consonants etc - whereas this is unnecessary in adults. Or words to that effect.

I can’t say that I was underfit when I was younger, because I did not think about my hearing as a kid. Hearing aids were a lot louder back then. In addition, children and teenagers all tend to speak much louder than adults, so I don’t really recall having a problem with soft voices when I was younger although actually now that I think of it I do remember one guy being hard to hear because he was softly spoken. I will ask her to to advise on NAL-NL2 vs Adult DSL.

@Um_bongo and @Neville I will raise a point to both of you as I think you may be misunderstanding me about my soft speech problem. I don’t know how to read my , so it is basically greek to me what the results mean bar the very obvious drops in volume at different frequencies. In short I know that low frequencies is bad in my left ear and high frequencies are bad in my right ear. But that is about it.

When I say that I have problems with soft speech - it is not the case that I struggle as in I can’t hear audibly. It is more that I can’t understand (if the volume drops below some kind of threshold) and there seem to be two issues - actual volume as in listening effort and secondly the frequencies of some voices are a problem at low volumes. Distance, objects blocking etc all affect volume which explains the car problem a lot in hindsight because while it appeared to be a problem with the noise of the car, I realise now it is actually a soft speech issue which manifests in shops, the car, around the dinner table or calling out from a distance - like do you want coffee.

Bottom line - I am not saying that more tests are better. The problem is my current audio does not do REM or any other test, so he is unable to diagnose why I have a problem with soft speech and whether the issue is audibility (threshold), or whether it is discrimination, masking or underfit in some frequencies or some other problem. I chose the new audio because she does REM. She just happens to do all these other tests.

All I want is for somebody to be able to scientifically explain why I have this volume imbalance with Vac+, why I have difficulty hearing soft speech (when obviously my hearing aids are boosting volumes) because I don’t struggle to hear speech in noise (with Oticon) which apparently is the difficult one. So, this is why I am pleased she does more tests than other audios - maybe she can answer these questions.

Edited
@Roberto said:

In short I know that low frequencies is bad in my left ear and high frequencies are bad in my right ear. But that is about it.

No, all frequencies are have a significant loss. You’ve got slighly better values one side vs the other, but those differences also mean that you don’t have any stereo summation for speech in noise. Looking at that - you’d struggle to hear even with my voice (Welsh Tenor) in most situations.

However, aided and with properly occluding moulds you ‘should’ be getting a better result. Like I also noted you don’t really ‘fit’ what modern aids do. I agree that with a real speech input would be beneficial, especially in figuring out what speech you are actually capable of receiving.

You might have a greater secondary issue of trying to eliminate low frequency noise while trying to hear sharper high frequency sounds - I’d suggest that you’re used to your ‘quiet world’ and have some form of acoustic deprivation going on - rehabilitating that is long and sometimes quite loud process.

I’m not telling you what you should or shouldn’t do, but I’m going to suggest that there’s a good chance that if you get your aids fitted to the full REM target, you’ll probably not like the result.

Edit: Vac+ is notorious for applying different weighting(before you add values) to LF and HF sounds when it does its gain averaging - the other thing is you tend to judge loudness from the lowest two points on the chart - if these are assymetric, then the subsequent gain applied is going to be (potentially) significantly different, so you might be getting a bass boost that is also noticeably assymetric.

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