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Feedback on narrowband Volume Test for speech comprehension

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Edited

I am not sure which category to put this in, as its more feedback for audiologists on this forum and not related to a hearing aid or my specific hearing loss.

My hearing loss is such that when wearing hearing aids, the right ear is/was louder than the left ear. This has been resolved, but I would like to provide feedback on the findings.

The second issue that my hearing loss struggles with is with what I call an audibility threshold problem where if people don't project their voice (too little energy) or speak a bit softer, I can struggle to hear/understand what they are saying. However, I have no issues hearing in noisy environments (providing they speak above this audibility threshold).

My audiologist did the and then . At the following appointment, she adjusted the left hearing aid upwards (by guesswork and her experience knowing what to change) as I said there was still a slight volume imbalance between ears and I had said that I had experienced some audibility issues, such as not being aware that the waiter was speaking to me etc.

Yesterday, we did a narrowband volume test, where I sat on a chair and she had a speaker on my left and another on my right and we played narrowband sound at 500hertz, 1khz, 2khz, 4khz and 8khz at 50dB and same at 75dB.

For all frequencies the right ear was louder than the left at 50dB. For 2khz (for some reason), the right was louder than the left at 75dB, but all other frequencies were as far as I could tell the same. It was very interesting that at moderate volumes almost everything was the same, but the left was softer for all frequencies at 50dB (particularly with high frequencies).

The difference in volume (bearing in mind, that she had already boosted the left ear after REM on the previous appointment) was sufficient that I could actually hear the difference, but it was not a massive difference in volume, so probably only a few 's.

The end result is that after the changes, nothing sounds louder, but I think the shape of sounds has very subtly altered and improved my speech comprehension (as the left is my better ear). For example, it seems like I am not missing (or nowhere near as much) the first word when an actor on tv starts speaking. When a person starts to speak, they don't start at a loud volume, but their voice increases as the sentence goes on and I often found that I sometimes missed the first word on tv. It's early days yet, but what we have done seems to have have improved this massively.

The second thing, is when my mother (for example) says something and she doesn't project her voice or is speaking at a volume which is fractionally below my audibility threshold, I have noticed an improvement. The problem is not resolved, but her speech at the non-projected volume seems a bit clearer, more intelligible and I can make out more of what she is saying. I am going to go back to the audio and ask if we can do 250hertz as well and possibly 3khz and 6khz.

I appreciate that I have an incredibly rare and unusual hearing loss, but I hope that my feedback helps audiologists on this forum who may have equally challenging hearing patients. In addition, we only did this test yesterday, so it's really too early to conclusively state that this was successful in improving my issue with audibility threshold. But so far, the results are promising. I will update when I have had more experience.

Hopefully people on this forum might find the experiment interesting to consider as it was the first time that my audio has ever done this test and she has worked in the field for close to thirty years. Maybe other patients would benefit?

If you have any questions, please do ask.

PS - I have confirmed that I have the smallest vents in my moulds and am using 100dB receivers as this was a question raised by others in other topics.

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@Roberto said:

Yesterday, we did a narrowband volume test, where I sat on a chair and she had a speaker on my left and another on my right and we played narrowband sound at 500hertz, 1khz, 2khz, 4khz and 8khz at 50dB and same at 75dB.

Was your audiologist using a special program or verification mode in the aids while performing this testing?

It seems to me that your audiologist has boosted the gain for soft sounds in your left ear which will of course boost the audibility of soft speech and resolve the issue you were having hearing sub-threshold speech. Which hearing aids are you using?

I am using Oticon Intent 1 aids with . I don't know if she was using any verification program, but I think not. Basically I told her, right ear is louder, she adjusted left ear upwards and I said need's more or it now sounds balanced. The whole point of the test was not to rely on what the computer says, but rather what my ears perceive. I can find out if you want?

You are correct of course, that boosting the gain for soft speech would improve audibility and help address that audibility threshold, but for my hearing loss it's not as simple as that, because my ears differ massively and if simply boosting the volume would address the issue, I would be on - which did not work either I might add. My left ear has something like 85% speech comprehension, whereas my right only has about 47% speech comprehension. But because my right ear was always louder than the left, I think speech comprehension suffered slightly because the poorer ear was always dominant.

I also think the problem is my left ear, my and say boost by this much - but we have determined that my left ear needs to go way beyond what the computer says. In short, my left ear I think has always been underfit for decades because we listened to the computer and not on what my ears actually perceived. She said that she had to boost the higher frequencies a lot more than she expected, as well as the lower frequencies of course. But only for the left ear.

Sorry, I should have been more clear that this test is very useful when you have one ear that is much better than the other ear. Essentially what we have done is brought the volume of the left ear up to the volume of the right ear, so I don't have a situation where the poorer ear is dominant for sound. Now I am (in theory) hearing equally between both ears, rather than favouring the right which is a problem with only 47% speech comprehension.

I was also told it was not possible to address this audibility threshold because of limitations of my hearing and technology. But this experiment suggests that I can improve speech comprehension and audibility by balancing ears. Once we have done 250 hertz and other missing frequencies, I will update how that further affects audibility, which I think has improved without causing issues in noisy restaurants, which I went to straight after the hearing appointment.

I would highlight that the underlying basis for this experiment has been my belief that I needed to see what frequencies my left ear was weak in, rather than simply boosting soft input volume for all frequencies. I have long felt that it was specific frequencies that needed to be looked at. My audio said she found the experiment interesting and revealing. I have a feeling she might use it with other patients with similar problems to me.

@Roberto said:

My left ear has something like 85% speech comprehension, whereas my right only has about 47% speech comprehension.

I don't pushing that option, but be aware of fact that right ear is eligible for at least evaluation. Is quite below 60/60 rule (that's is rought criterion, but has some evidence). With most probability, that 47% will be not improved by even the best hearing aid and fitting.

We actually discussed yesterday, not seriously, but the question did come up. She doesn't think I would be eligible and to be honest, I don't feel the risks of surgery would outweigh the benefits.

For a deaf person, I hear very well in noisy places like restaurants and other environments, with different people etc. So to me, CI is not a viable solution as I cope very well. I quite agree, I am very limited in what I can do with the right ear. I am now really only focusing on the left ear, which has always historically been softer than the right over different hearing aids, audiologists, Vac+, and .

My only single remaining issue is this volume threshold and I am very pleased with this latest experiment because it has shown some benefit in both audibility and speech comprehension. There is potential for further improvement with the frequencies we have not done yet which is great news. Ultimately I don't think I will eliminate the soft speech volume threshold issue, but I believe we can drastically reduce the impact.

In reply to @Roberto

@Roberto said:

I am using Oticon Intent 1 aids with NAL-NL2. I don't know if she was using any verification program, but I think not.

The reason that I ask is that performing aided testing using narrowband noise is not recommended as the noise reduction in hearing aids can also reduce your perception of narrowband noise artificially, resulting in elevated thresholds. Testing using modified speech phonemes or ling sounds is preferred because a hearing aid will treat them as speech and the results will be indicative of true hearing thresholds.

Looking at your your hearing thresholds are very asymmetrical. Do you know the cause of your hearing loss? Has auditory neuropathy spectrum disorder () been ruled out using acoustic reflex testing? I ask only because of your imbalanced loudness perception that favours the right ear which could be indicative that your hearing thresholds may not be truly reflective of how you're hearing with that ear. I get the impression that you are also performing better than expected in noise given the significant asymmetry in your hearing. It is something that you'd want to exclude as a cause of your hearing loss.

In reply to @Roberto

@Roberto said:

I don't feel the risks of surgery would outweigh the benefits.

Despite I'm not necessarily convinced if you indeed need , I think same evaluation may be useful given your asymmetry.

I must to point out - that surgery isn't considered high-risk, especially compared to stomach surgery, gynaecological, etc. I write that particularly for new forum users, who may need CI and be unnecessarily scared.

@Roberto said:

PS - I have confirmed that I have the smallest vents in my moulds and am using 100dB receivers as this was a question raised by others in other topics.

If finance isn't a problem and you like to experiment - you can try 105 receivers with no vent to test if their G50 will be better.

In reply to @Hearing_Potential

@Hearing_Potential said:

The reason that I ask is that performing aided testing using narrowband noise is not recommended as the noise reduction in hearing aids can also reduce your perception of narrowband noise artificially, resulting in elevated thresholds

Normally I would agree with you 100%. One should never use artificial sounds that the hearing aid would regard as noise because of noise reduction and other sound processing. But we are not doing speech aided testing or determining how well I hear a sound. All we were doing is using my right ear as the yardstick and altering my left ear so that the sound was the same volume as the right ear. Using speech for this ear balancing test would not work as well as speech is not one frequency, which would make it impossible to know which frequency to adjust. In principle I agree with what you are saying, but not relevant for this test.

I have updated my profile to indicate details about my hearing loss. In short, my mother had Scarlett Fever when she was pregnant with me.

We are considering get a lacquer film for the right mould as there is very slight movement which is enough to cause feedback when I pass close to objects like a door jamb. She has mentioned the possibility of going with 105 receivers, presumably for the right ear. Not sure how much bandwidth I have left, so can't tell whether it would make any difference or not?

Edited
@Roberto said:

Using speech for this ear balancing test would not work as well as speech is not one frequency, which would make it impossible to know which frequency to adjust.

Modified speech phones have a limited frequency range which makes them more frequency specific than narrowband noise, making them more suitable for this purpose. But accessing these may not be easy for your audiologist. They are widely used where I am based.

I see no problems arising with the use of narrowband noise if you're testing with the hearing aids in verification mode where noise reduction algorithms are disabled. If this isn't done, you run the risk of not getting a fair between ear comparison as noise reduction is often a feature that is not binaurally coordinated, which could potentially result in measurement error.

Aah thank you. Now I understand what you mean.

I will pass this onto her as I intend to go back and do the other frequencies because I think the experiment has been a success. I will say that she probably did the test in verification mode because I have consistently found her to be far better than any other audio I have ever been to, so I seriously doubt that she would have made such a rookie mistake of not turning off noise reduction. She has programmed my ears so well that a whole litany of problems that I used to have no longer exist and she did that on the very first fit!

But she did say that this is the first time she has ever performed this specific test, so I will pass on the information so she has all options at her disposal. Thank you.

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