Hearing Providers attitude towards frequency lowering

Thanks, but I’ve got lots of sources on frequency lowering and happy to overwhelm anybody who’s interested with them. Your first source does somewhat address my first question and I would fully agree that frequency lowering is not for everyone.

The last article lists a number of currently available HA’s with frequency lowering built in.

I self tune on Phonak and use it since I have no hearing at high frequency. It does require a little playing around to get it right and the first stab usually has your wife sounding drunk or something. Once right, the birds chirp. I think fitters don’t like to play around with it because of having to guess how to set it.

That said, I have a music channel for the piano and turn it off.

Yeah it’s hard to avoid music even if you wanted to. So you should probably try and stick with ratios that are musical (like dropping an octave or something). I haven’t played with frequency lowering at all, but I wince at the thought of having to go that route. Perhaps unfounded, I don’t know…

@MDB said:

I have yet to find a hearing care provider who regularly used frequency lowering. Most are willing to do what I say (keep the customer happy) but offer no guidance other than they don’t recommend it.

My speculation on the frequency lowering part of your post. Briefly there isn’t pay off (financial; self esteem; etc.) in a provider bringing up or getting good at frequency lowering as an option. These factors might be in play …

1. If??? say 10% of clients are candidates for frequency lowering and I bring it up as possibility and all want to try it and say that for < 1/3rd does it make a clear + difference, even if I am paid for my time as provider, I probably won’t feel that much more professional & successful than adopting the stance … well if client brings it up, I’ll recommend against it and have distance from the outcome. Since my hunch is that for more people it does not work or is a very mixed bag, then while I might loose out on feeling good about trying everything for client and enjoy their hearing improvement I avoid at least some of the downside of trying and failing as I have distanced myself from the procedure. I protect my self esteem in believing that I am a good provider.
2. It seems like freq lowering (which I have read quite a bit about as I think I might have interest in it) even for a given mfg is far more art form as well as trial and error, why would invest time in getting good at it if it might only be potentially useful to a minority of my clients? If there are so many factors involved of what might work for someone and it might be hard to generalize and apply such experience to someone else, it could be (unconsciously) de-motivating to pursue it.
3. It seems that some client for whom freq lowering might be worthwhile might already be in the more to very more challenging “to fit” client. While some professionals like a challenge, many??? might prefer things that are more routine or where likelihood of having a pleased client (leading to recommendations to others) is higher.
4. While our society looks at failures as potentially teachable moments, some recent research indicates that we might actually lean more from our successes than failures. {https://news.uchicago.edu/story/why-you-may-learn-less-failure-success#:~:text=New%20research%20from%20the%20University,from%20failure%20than%20from%20success.&text=%E2%80%9CWe%20are%20taught%20to%20learn,on%20motivation%20and%20decision%20making.}
5. Even in settings (Costco; VA??) where fitter is not paid on basis of how many clients are seen, and client does not pay for each visit, there still might be a personal or organizational “hidden” bias toward keeping it simple and tending to avoid freq lowering.

As I said I am purely speculating, but it seems that there might be numerous dis-incentives for provider to bringing up freq lowering and to get good at it. To the extent the phenomena I am alluding to is “real” I don’t think that it is limited to audiologists/fitters; whether we are aware of it or not to some extent clients gradually shape the behavior of professionals. You as a nurse probably have seen many examples of this (and I expect its opposite - consistent requests of clients that a professional change in some way and their resistance/failure to do so). Attempting to understand the dynamics of “professional attitude-behavior” is complex.

On a more practical note, if you have not found someone to work with in a satisfactory way for freq lowering perhaps you should consider DIY; or perhaps one of those members can offer you software suggestions for HA tweaking.

My experience in dealing with several manufacturer’s versions of this is roughly as follows.

1. It’s been around long enough for a good sample of clientele to try.
2. Despite trying the step with many suitable cases, the longer term preference towards it is probably around 20% (self-programmers will be on a completely different ratio here)
3. The systems are proprietary in their implementation, which isn’t necessarily the best for your client going forward.
4. The actual A:B comparison seems to work for intelligibility, but is often reversed for perceived sound quality.
5. As has been pointed out elsewhere, music can sound awful; even if you just listen to talk radio, the jingles and advertising contain music clips.
6. Also; over processed sound isn’t great to listen to, introducing another layer in that isn’t always helpful.
7. Some people also object to it on a fairly solid clarity/purity basis; I’m not 100% if this is down to confusion/lack of resolution in the area the sound is being moved to or just the dislike that someone is messing with their tonal gamut.

However, it sometimes produces excellent results. I wonder if it was presented in the Apps on a separate page with an analogue style dial, so you could dial in your own level of preference over time (or back it off if the ‘quality’ was diminished), some people would do better with it.

Definitely your points 5 and 6 would be the main reasons, introducing artefacts into the processed sound is what a lot here have mentioned as the reason they didn’t like using frequency lowering.

Wow, a long post that I completely agree with! Frequency lowering can for sure make things worse on both a clarity and sound quality basis. Here’s a pretty in depth look at the impact on speech acoustics. https://www.audiologyonline.com/audiology-ceus/course/speech-acoustics-and-frequency-lowering-3692211

I think the idea of having it be adjustable by app makes a lot of sense

Sounds like some adjusting would have been beneficial. It’s not an on or off thing (which is how audiologists often treat it. )The idea is to get just enough lowering to help make the “s” audible, but not enough to make it sound like “sh.”

@mike_g said:

She said that it can take a while to get used to it, some people never get used to it, and some find it quite helpful.

In my opinion this is one of those things where if your hearing loss gets bad enough and you really want to do something about it, frequency lowering is fantastic.

Cochlear implants fall into this area as well.

I DIY, so I did try adjusting it down, but still found it more annoying than useful as it still affected perception of pitch. I’m a musician and spend much more time listening to music than I do to speech. If that was reversed it may have swayed me to keep trying to get used to it.
Although, I don’t hear much at all above 3K and it falls off steeply after that, I can hear music just fine without them and quite a bit clearer with them. So, I’m fine with music. It’s just speech that I have difficulty with and definitely need to have the HAs and crank them up a bit for conversations.
Maybe I’ll give it another try on one of the programs and use it only for speech. It really makes things sound weird, though, even turned down.

I agree. Someday if my hearing gets worse I may have to decide between speech and everything else.