"Antiquated" hearing test

Sorry mate, but that’s not the case on two counts.

1, Siemens and Resound didn’t invent the MCL and UCL or the BCL.

2, Apart from the threshold measurement/BCL which although can be tricked are fairly objective with a cooperative patient, the MCL and UCL are hugely subjective.

The wiki article is clearly written by someone with an agenda - probably selling word-lists or something.

The repeatability of any test method is key, while the test doesn’t show resolution issues it’s a valid year on year analysis of the decline of the system.

I agree about doing your own insitu testing. When I did that with Target, it indicated my high frequency loss was less than my audiogram indicated. I used that as the basis for setting my aids. Unfortunately, it didn’t help my speech recognition. My issue with the standard, booth type testing is that you get one chance to respond, and then on to the next tone. While the test Target does has its limitations, I could vary the level as much as I wanted to find my true threshold. The next time I do the test, I think I will put headphones on over the aids. The microphones in the aids are cut off during the test, so feedback shouldn’t be a problem, and the headphones should cut down on environmental noise.

@Um_bongo said:

The repeatability of any test method is key, while the test doesn’t show resolution issues it’s a valid year on year analysis of the decline of the system.

Costco here uses a recorded voice for speech recognition tests. I think that has 3 advantages.

1. The test is repeatable
2. Since the dispenser did not need to be trained on perfect enunciation, the hearing results talking to the dispenser are closer to real world situations.
3. You do not need to have the same dispenser perform the test for repeatability.

@karen1 said:

I know I have put audiologists on the defensive with my post, but I stand by my criticism of the “beep” test. If all positive answers (i.e., affirmations of beeps) are used as the “baseline,” hearing ability is being grossly overstated because the faint beeps that are remotely heard (which would never translate into understandable speech)

I think it is a good test. If you indicate to the machine, assuming it is run by computer, and after some trial and error, that the faintest sound you can hear at, for example, 2000hz, is 60db, then what needs to happen for you to understand soft speech coming in at 50 db? It needs to be boosted 20 to 25 db, right? It needs to get the sound over the 60db threshhold by some margin.
That’s the purpose of the test, to help get to that conclusion.

Now, is 20 to 25 db right for you, for soft speech? Maybe you need 30db?

I’ve heard Um Bongo mention that the gain guideline is a third to half your loss, so 20 to 25 gain in our example would fit the example 60db loss.

But 30 would also fit so after the PTA test results are applied to a first fit, there may still be some adjustments needed. It doesn’t mean the test is flawed. It just means more adjustments may be needed because all our flawed ears are not the same.

I have problem with women’s and foreigners. Normally men’s speakers are great for me. My Audi uses the recorded word test to and gives me both men’s and women’s voices. And I believe it has really helped my Audi to find due my aids so I can understand speech better.

What people also forget due to the logarithmic nature of the increments in dB HL, every 3dB or so is a doubling of power of the signal - so every 5dB test increment is observably louder. That means you could potentially (with a missed value) be out by 5dB but never more than that as the sound differential at 10dB would be eight times as powerful.

So I understand why people think it’s a blunt tool and are quick to suggest that ‘other things’ are better, dBHL has the longevity and broad acceptance to be considered for legal settlements in addition to the general audiology usage.

BTW 1/3 gain rules are a very rough basis for most fillings, though most modern strategies are far more dynamic. The half gain rule only really apples to conductive losses.

I need more than a third but not quite half to have good understanding.

Sometimes just bumping up soft speech one decibel makes things clearer. I can understand medium speech and loud speech with my Phonaks set to 110% of target (on the basic tab) and then bumping up soft speech a little on the fine tuning tab makes it good!

I don’t do anything different with the very soft speech (35db input) because I’m afraid it will just bump up machine hum.

It is not just hearing the speech, but to be able to recognize & process the words. The other evening I walked int a room with the TV news playing using the TV speakers. I heard the female voice and some of her tones rung my aids, but, for some reason, I could not understand a word she was saying.

@prodigyplace said:

It is not just hearing the speech, but to be able to recognize & process the words.

The whole point in pulling speech out of noise is so that one can understand it.

@Mark_Chambers said:

Correct me if I’m wrong but the tone test is used to determine the level of amplification required at the frequency of the tone being generated.

Essentially, yes. But that’s not to say that one couldn’t build amplification prescriptions from ‘most comfortable level’ tones rather than ‘threshold of hearing tones’, and it has been done. But the majority of the research leading to modern prescriptive targets have been based on threshold measures. To get to where we are now using most comfortable tones, we’d have to re-do everything. ‘Most comfortable’ and ‘uncomfortably loud’ levels are also more malleable.

@John_Green said:

When I did that with Target, it indicated my high frequency loss was less than my audiogram indicated. I used that as the basis for setting my aids. Unfortunately, it didn’t help my speech recognition.

Unsurprising. Your audiologist was measuring your thresholds and because of the different context and criteria you were measuring something else that doesn’t match the standard definition of what we usually measure, and then underfitting your hearing aids. (Also, in the booth, you get multiple beeps presented at and around threshold, not one.)

@Don said:

I think there should be an aided word recognition procedure and use it to increase speech in noise recognition.

Aided tests used to be standard for verification and still are for devices that cannot be verified in other ways (e.g. most audiologists don’t have the verification device for bone conduction hearing aids yet, and cochlear implants still need to be verified in the booth).

I agree with you completely and also believe that when tested I may sometimes acknowledge a weak beep in one ear and then miss it in the other ear, it is a judgement call on my part that does not give an accurate picture of my hearing loss. Yes, the beep testing needs to be replaced with another method. I also think that the word pronunciation should be made from a professional speaker, not be made by my audiologist.

The word test I get is always a recorded voice of what seems to be a professional. But how to do the hearing test of beeps better is something I do not believe is possible. Hearing is completely subjective there is no way around it. What we hear, and how we relate to noise of all types depends in lots of way to the environments we are use to being in.
it is even hard to take a person that has normal hearing and is use to being in a quiet environment and moving them to a loud noisy environment with out them having problems with hearing. And to be honest that is normally the beginning of their hearing issues is that move.
I grew up on the farm and lived way out in the country where is was really quiet most of the times. Then I went in the service and sent to large loud and noisy cities that really hurt my ears and gave me headaches. But I guess now that I am wearing hearing aids that I have adjusted to them because I am someone that has lived in the very quiet and the very noisy environments.

On my hearing tests before Costco the hearing dispenser read the words themselves I was in a sound proof room wearing headphones.

The following is the procedure for the tone test at the clinic where I get my aids.

1. Prior to the start I am reminded that if the sound level at the start is not comfortable to let her know.
2. The tone is generated and then reduced until it is no longer audible.
3. The volume is then increased until I once again hear the tone.
4. It is then reduced again until not audible
5. It is once more increased until I again hear it.

That is repeated for each frequency tested. The repeatability of the test reduces the error from guesses or from the chance of missing a tone altogether with the “only one shot at it” method described above. Which, if that is one’s experience they need to find an audiologist who (a) knows what they are doing or (b) is not a lazy ass.