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Questions about Live Speech Mapping

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Edited

For those who have not been following my progress with my new audiologist, a quick mini update before I get to my actual question. Otherwise, just go straight on to the question.

Mini update on my new audiologist

After two fitting/adjustment appointments with her she has accomplished the following improvements over the previous audiologist:

  • Done which the previous audio did not support
  • Configured programs for both and DSLv5 for me to trial. I ended up dumping DSLv5 at the second appointment in favour of NAL-NL2. I much prefer NAL.
  • Vowels are rounded properly and no longer sound thin or flat
  • Compression is no longer an issue as I don’t have problems with sound cutting out or distortion
  • My voice and some other sounds are no longer robotic sounding
  • Volume imbalance between ears (especially when watching tv using streamer), is almost totally gone (just a fraction at high frequencies). I have hyper acusis or something like that in the right ear.
  • I am now hearing real bass when watching tv using streamer almost as if I have a subwoofer now. I always felt like I had no subwoofer effect watching tv with Oticon hearing aids. No longer!
  • Apart from ambulance nothing is “too loud” for me. I wouldn’t even say the ambulance is uncomfortably loud just very loud. Might want that reduced by 2dB
  • I can tell where sound is coming from again
  • Birds sound more musical etc
  • I can hear things that I never really heard properly before such as laptop fan, I can hear the oven timer beep at the back of the garden, which everyone else could except me. In short, general audibility had improved
  • After the second appointment, where she boosted the soft input of low to medium frequencies I am now more aware of presence of sound such as water bubbling on stove, stove clicking and just general background noise that I heard before, but sometimes not immediately as the sound was probably slightly too soft. In short, I asked her to boost audibility (amongst other frequencies) slightly as REM clearly was not enough based on testing in real world environment. I have already noticed that one person I used to struggle with because his voice is not loud, I actually hear him quite well with no effort unlike before.
  • Music sounds vastly better than it did with previous audio
  • Accents on tv, such as Welsh accents, have now returned and are more distinct and noticeable
  • Hearing people speaking and understanding what they are saying in another room has improved a fair bit as well, which I think was a combination of audibility as well as clarity.
  • Even with increases in lower frequencies, I still hear speech very well in noise, which other audios failed to get right - address audibility and still retain excellent speech in noise.

I mention the above to highlight just how much this new audiologist has really helped me as previous audios all suffered from failing to address many of the above issues over many years. These issues might seem like niggles, but they are not trivial problems to live with long term. My new audio in two fitting appointments has managed to resolve all of the above. So, while I still have one remaining problem, I think she can solve it. I have found her to be fantastic and this is the best fit I have ever had in my life.

Someone on this forum, I can’t remember who, said that they had their hearing aids fitted to 115% of prescription and I have come to a very similar conclusion about my own hearing. She did REM and the moulds fit very well. But despite this, she still had to boost audibility and clarity a little bit (just for soft input) on the second appointment because I found under real world testing that I still had issues there. So, I am just wondering as a general rule, whether most people need to have their aids adjusted to more than what their prescription actually suggests they need. As in the computer, may be too conservative? Who knows.

I wear Oticon Intent 1 Hearing aids and they are brilliant.

Question: How does Live speech Mapping work? Is it effective?

My mother (and one or two other people) seem to have a voice that is difficult for me when they speak below a certain volume threshold. Even after both appointments with the new audiologist, I am still finding it difficult to understand my mother when she doesn’t project her voice or speaks below a certain volume. With the increase in lower frequencies, I don’t feel that audibility is a problem anymore with my mother. In the past it was audibility and clarity. Now, it’s just clarity at soft input. Once she speaks above a certain volume threshold (with or without hearing aids), I can understand what she is saying perfectly well and I think because when she speaks louder, her voice is naturally boosting the high frequencies which I seem to be struggling with for her voice. In short, I don’t think boosting the lower frequencies more is the answer because her voice is not soft anymore (when wearing aids) - just unclear at soft to moderate input volumes.

The audio has suggested that we can do live with my mother as my mother is a real world consistent issue that can be used in the test. What I would like to know is the following:

How effective is this at helping determine what frequencies I am not getting at soft and possibly moderate input volumes. I know it’s high frequency, but is that 2khz or 4khz? Do any audiologists on this forum use this technique or has anyone with aids tried it out and found it to work?

How does Live speech mapping work? I am not sure how we get my mother to speak at the problem volumes or inflections that seem to be the issue? How long does it take to do this test?

Will the test be able to determine whether the issue is only at soft input or moderate as well as I suspect the problem with my mother’s voice is that her voice constantly fluctuates on that border!

Do other people have this issue that I do, where in general you can hear most voices pretty well, but certain voices seem to be problem frequencies that my ears seem to struggle with and definitely need a lot more boosting than both the prescription and rem would suggest? Having said that, I only have this issue at below certain volume thresholds. Office and loud voice volume - no problems.

I am just keen to hear what other people think about live speech mapping as my only and single remaining issue is struggling with certain voices like my mother’s. Everything else has been fixed now. Thanks in advance.

3 people in this conversation10 min readJump to latest

LSM is a form of Real Ear Measurement: rather than just icra/speech sounds as stimulus you literally present speech and also speech over noise.

The input level of the speech is monitored per the V/U meter on the screen, so that it’s representative of real speech and the output is displayed as a series of peaks overlaying your inverted (into ) hearing loss.

Now this sounds really complicated, but actually, graphically it’s quite simple on the screen. You’ll see an area (usually in grey) which corresponds to the long term average for speech superimposed into your remaining dynamic range of hearing. Practically, you want the output the aid to sit roughly at the top of the grey area under normal, well presented speech conditions.

You can also see the effects of background noise, see if you’re likely to get feedback and see if other people/sounds over your Mother’s voice cause a problem for you.

Thanks for the explanation. We did the live and we were able to see where my ears were not hearing my mother’s voice. To our surprise, a lot of the time, it was actually the lower frequencies, which surprised even the audiologist as my mother does not have a deep voice. However, the audio did not make any changes as from her point of view, she was using the live speech mapping to show me what my ears (with hearing aids) could actually hear.

Further real world experience with different people has led me to the conclusion that the problem is not actually specific frequencies or specific voices (although that is a factor as it’s obviously not all frequencies that are an issue) but rather it seems to be a specific volume threshold (for various frequencies) where my ears either don’t hear or can’t understand speech below that volume. I base this on the fact that I discovered that I still had problems with both men and women are various timbres when they are speaking in a very low volume. The problem with my ears seem to be that my hearing (clarity wise) is just not functional below a certain volume threshold and even though my hearing aids have boosted things quite a lot and I now hear things that I never heard before, I must obviously be at the limit of what my ears and hearing aids can achieve - without boosting soft input volume too much that sound just becomes invasive.

So far, it seems that the best solution (although not always perfect) is simply to bump up the volume one click on my hearing aids when I am finding a person is too softly spoken, but I have very often have to reduce the volume when noise picks up. I probably need the audio to consider bumping up just the left ear, and not the right ear, but only for certain frequencies because the right ear has that hyper acusis problem. That might help. But other than this irritating low volume problem, she has achieved an incredible fit where I really enjoy wearing my hearing aids. So, despite my disappointment that I am still struggling with this soft input volume threshold issue, I am very happy with what we have managed to achieve. Of course, I won’t stop trying to see if I can somehow find the magic tweaking to address my last remaining problem.

Thank you

Perhaps suggest boosting the G50 or soft speech gain a bit. Technically you’d get a bit more compression, but that’s not necessarily an issue if you arrive at a bit more audibility without hitting the ’s/distortion.

Thank you. When I next go in, I will ask her about this although I suspect that she has probably done this already. I will be going back for one final appointment as I would like to adjust the right hearing aid down slightly as I still get feedback too often. In addition, I would like to bump up the left ear slightly - more with medium higher frequencies as I have discovered certain broadband noises such as running water into a pool sounds louder and more present in right ear even when the sound is coming from the left hand side of me!

I will ask the audiologist if she has any test that she can run where I can determine where the sound is coming from as hopefully this will help to balance out my hyper acusis problem. It seems to be only with medium to high frequencies.

Edited

In reply to @Um_bongo

@Um_bongo said:

Perhaps suggest boosting the G50 or soft speech gain a bit. Technically you’d get a bit more compression, but that’s not necessarily an issue if you arrive at a bit more audibility without hitting the MPO’s/distortion.

That was my thinking also, however I don’t know which receiver power is used by @Roberto, so increasing G50 may require stepping up like from P to UP or 85 to 105 receiver power.

For me UP gives much improvement compared to P, thanks to 5 – a dozen more gain over 2 kHz…

I speak under correction, but I believe that I am using the 105 receiver power. On my previous hearing aids, I was I believe initially prescribed the 85 receiver and kept blowing the receivers until they replaced it with a 105dB. I am not sure whether I have a P or UP? I will ask the audio regarding this, but I would only need this for the left ear as I have some feedback already on the right, so I need to reduce the high frequencies that have been boosted to remove the feedback that I get when my head gets too close to a wall, door jamb etc.

@Roberto said:

I have some feedback already on the right, so I need to reduce the high frequencies that have been boosted to remove the feedback that I get when my head gets too close to a wall, door jamb etc

The solution to this problem (feedback) should be an earmold with less ventilation in the first place, not to limit the amplification of high tones, which can be crucial for speech understanding, especially in noise.

In my case that requires deep placed canal earmold with no vent and UP receiver (Phonak’s 105 “equivalent”).

I will ask my audio about that. I currently wear moulds (as domes are useless for me). I think, but speak under correction that the vents I have are 0.5 or 0.25mm for both ears. I am not sure. I do have deep placed canal earmoulds though.

I think when I have time, I will buy the Noah device and connect my hearing aids up to Genie so I can see exactly what receivers, vents etc my hearing aids actually have and many other questions that I don’t know the answers to because I lack access to Genie for my aids. Thanks

@Roberto said:

I currently wear moulds (as domes are useless for me). I think, but speak under correction that the vents I have are 0.5 or 0.25mm for both ears. I am not sure. I do have deep placed canal earmoulds though.

From my experience:
no vent vs. even 1mm diameter vent make difference in feedback threshold and more effective antinoise technology. I think this applies also for 0.5 mm (I am skeptical about that 0.25mm).

Try this app (you can activate ongoin translation in your web browser):

https://xavierdelerce.shinyapps.io/VentsFeedForward/3

That app is from that article:

Occlusion : quel gain ? quelles pertes ?

Nous avons l’habitude en Audiologie prothétique de nous intéresser beaucoup plus à ce qui pourrait « fuir » de l’oreille lors d’un appareillage (il s’agit du phénomène de Fe…

Thank you. I will ask the audio about this, when I go in for my last appointment.

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