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Adjustment to aids - getting it right

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I have had by a professional audiologist in 2022, 2023, 2024, and 2026. In 2023, I got my first aids, Oticon Real 1. This week, after the 2026 audiogram, they adjusted my aids. My audiologist added 10dB in the bass and 5dB in the treble.

I looked at the four audiograms and noticed that everything was in increments of 5dB. Isn't that very coarse resolution?

I also compared the four audiograms, and didn't see much difference at all in the bass and just a bit of difference over time in treble. To my eye, variations from year to year could be in part measurement error.

The audiogram has points for air & bone conduction, which were quite similar, and one test of masking at 2kHz.

I'm not sure why the audiologist thought I needed 10dB more bass.

Now, one day later, I'm trying to adapt to the new program and finding the extra treble annoying. I assume that I'll get used to it. Is a 5dB gain step a lot or is that considered subtle?

Here's a bit of data pulled from the various audiograms:

Some data from audiogramsIf the testing uses 5dB increments, can we really trust a 5dB difference from year to year?

Is this all subjective or is there really a correct aid profile to match each audiogram?

What are your thoughts?

I welcome any comments at all, professional, subjective, personal experience, and off-the cuff.

Thank you.

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Edited

1.- During a hearing test, the margin of error is 5dB (standard error of measurement). 20dB is 20dB +- 5dB (15 to 25). It's the same with glasses (margin of error is 0.25 diopters, this is why prescriptions jump in 0.25 increments).

2.- In a typical setting, 1 or 2dB change is barely noticeable to most people. 5dB is a difference that the person can identify clearly as louder or softer. You also have to consider the variables: How "concentrated" are you during the test, the booth conditions, etc.
3.- If you are not seeing any significant differences: Good, hearing loss is stable.

@user1115 said:

why the audiologist thought I needed 10dB more bass

He/She could be using a different fitting formula. Or he/she used and adjusted the values to ensure the needed gains are reaching the eardrum. Or maybe you are using different domes. Specialists use their training to determine what is optimal for you, not just enter the number in a computer and get a result.

People worry when their hearing loss gets worse. Yours is stable :-)

@user1115 said:

Is a 5dB gain step a lot or is that considered subtle?

It is the minimum increase/decrease that can be done -- See # 2.

Don't worry about those 5dB -- Are they aids working for you? That's what matters. If not, go back for an adjustment

In reply to @user1115

Do you happen to have your word understanding scores for each ear separately. Maybe your audiologist/fitter saw a reason to bump up gains on other data than the .

If gain verification was being done maybe prescription gains were not being met.

Maybe those old Oticons are getting tired.

Lots of possibilities to bump gains up. Lots of threads on this forum about the 5 db increments used in audiograms.

In reply to @user1115

@user1115 said:

My audiologist added 10dB in the bass and 5dB in the treble.

What do you base this comment on? Was it simply that they were pressing buttons on their computer, or were they actually measuring the output of the hearing aids using and finding they needed to increase the gain by this much in order to meet prescription targets?

Thank you all for the comments. That helps a lot.

@OcramSagev : OK, I'll accept that 5dB is the resolution step. I'm not sure what you meant by "If you are not seeing any significant differences..." If you're saying that I haven't noticed my hearing getting worse, yes. But I don't trust myself as an analytical instrument with the ability to compare my hearing 3 years ago from my hearing now.

I've never had , not at original fitting and not this time.

As a side point, in addition to changing settings, the audiologist changed my domes from open to "double vent" which is less open. She said that allowed her to get more sound out of the aid without increasing the gain as much.

"Are they aids working for you?" Yes, they work fine, but the treble is annoyingly loud. I'm hoping that I adapt to it.

@Raudrive : Yes, I have the word understanding scores.

Word recognition dbHL@Hearing_Potential : Good question. I'm not really sure what adjustments were made in the program. I don't have software to query the aids. I'm just going based on what the audiologist told me ("I'm boosting your low frequency by 10dB and your high frequency by 5dB").

Next time I visit the audiologist, I'm going to insist on real ear measurement. But without a baseline, I'm not sure how that will help.

What do you mean by "prescription targets"? I haven't heard that term before. I just did a web search of the term and it suggests that prescription target is related to real ear measurement...which was never done. Is that what you mean?

BOTTOM LINE: I'm having no trouble understanding people using these aids and the new parameters. But treble is annoying. Typing on this keyboard is annoying. Listening to the car radio is harsh. Normal conversation is OK until someone speaks a bit louder. I adjusted the volume -1 unit on the Oticon Companion cell-phone app and that's much better. Is that a 1dB step? But I'm still running at 0 and hoping that my ears/brain adapt. I'm scheduled for a hearing check in 6 months and will get real-ear at that time.

It just occurred to me that my statement could be wrong. It could be that the audiologist changed my treble by 10dB (not 5dB). She could have mis-spoke or I could have mis-heard. I'm going to follow-up with a phone call.

Edited

In reply to @user1115

IMO, the treble difference you are noticing more is likely due to the change of dome types rather than a change in the . The explanation you got from the is aligned with this

(….She said that allowed her to get more sound out of the aid without increasing the gain as much).

you should ask for .

Domes: That's an experiment I can easily do myself. I used shaking a bottle of pills and typing on this old keyboard as standard sounds. I swapped out the new domes (double vent) for old ones (open) and the boosted treble is still annoying. I know it's not a scientific measurement like real ear.

I still plan to go back to the audiologist and have real ear measurements.

If a clinician doesn't do and you have no complaints and your hearing is stable, then the why of them making a change is a wild mystery. You'd have to ask them. Maybe you were under fit to begin with? Except that if they don't do REM then they can't know and they also clearly aren't worried about leaving their patients under fit.

Edited

I have been wearing hearing aids 21 years. My hearing loss started out as a mild to moderate cookie bite hearing loss. Meaning my worse hearing loss is in speech. I am almost 79 and I have lost a good bit of my high frequencies. My hearing loss is now severe. I have used several brands of aids over the years. My present primary aids are the Phonak Spheres, a awesome set of aids for someone like me that struggles to understand speech. My backup set of aids are the Oticon INTENT1 aids, they are great in less noisy environments. You are asking why to sets of aids. I can't understand speech without my aids. I am a veteran that gets my aids from the Veterans Administration, as my hearing loss is a combination of genetics and military service. My present audiologist insisted on me always having a backup set of sids. If you are doing good with your hearing aid settings then praise God. By the way I get my hearing checked up to twice a year. My hearing varies by what time of day it is, what the weather is like, and believe it or not by what I eat. I have had tinnitus for about 51 years, and tinnitus varies and make my hearing results vary by as much as 10db.

In reply to @Psych2

Well I suppose that's good that they do for children, as there is a direct relationship between ensuring a child's hearing aids are meeting prescriptive targets closely and good speech and language outcomes. Whereas with adults we don't need to try to optimize their hearing because... I'm not sure why, actually.

Edited

I'm new to all this stuff, in fact I don't even own a HA yet as I want to learn as much as I can before I spend what seems to me to be a fortune on something that may just annoy me.

So.....why do you all have to go back to an audiologist to have your HA's configured? Isn't there a bit of software that allows me to do this myself? I'm a retired... kind of...IT guy so I'm sure I could work it out.

I have seen cheap Oticon HA's in Sam's Club in China, so I'm contemplating buying a pair to see what theyre like. I'm a 60 year old male who's had tinnitus for about a decade. Over the last year I can't understand conversation in noisy environments so that's why I'm investigating HA's.

My mum is 91 and had NHS hearing aids for many years. All I know is that she is always having something done to them and she gets very frustrated. I am starting my 'HA journey' as the young people say, but I want to be fully informed first. Any feedback from you seasoned HA users would be appreciated. Thanks

Get tested so you know whether or Rx aids are necessary. If you buy an OTC pair of aids to experiment, you may be buying something not powerful enough to fit your loss. Conversely, you might be able to get by with good OTC if you have mild or moderate loss. OTC aids will generally not be as configurable as Rx aids. You can get the SW & HW to configure most Rx aids yourself as long as you avoid places that lock them, and avoid a certain model from a brand that is only configurable with cloud based SW with a provider’s login. Any of the aids you get at a Costco will be self configurable if you wish. See the category on these forums for more info.

WH

Thank you WH. Really appreciate that. I live in Hong Kong where 's are expensive like most places, but I do nip across the border to sams club in Shenzhen (China) to buy stuff cheap and they have a free hearing test place and oticon HA's. I will continue my investigation on this topic... Thank you.

Olly

I've never had to adjust my aids. Each ear has a very different hearing loss profile and I have fairly loud tinnitus ringing which makes hearing test sounds confusing, so I don't understand how I would even be able to figure out what to reconfigure. I bought them from an audiologist who tested me and ordered them; my understanding was the factory configuration was done by studying my hearing profile and would never need resetting. I don't even understand why anyone would be able to configure them. They are 6 years old, and were top of the line Phonaks when I bought them. The tech improves every year or so, which made a repair costly 1.5 years ago because so many parts changed, requiring replacement in order for the new part to be compatible. He said aids have a 5 year life because of the continuous upgrades that the factory does in order to be competitive. I'm going to keep these until a catastrophic failure occurs that makes repair too costly.

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