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I still cannot understand speech properly

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Hi all. I have recently changed from domes to custom moulds but, I am still noticing that I am not able to understand speech clearly, despite the audiologist saying that speech clarity should be improved as I did tell him that I want to be able to hear speech properly and block background noise which he also did and I have the app on my phone to do that. I can hear high frequency sounds like the microwave, washing machine beeping etc but I am still finding that I am asking people to repeat themselves several times and their voices sound staticky and distorted, but without my hearing aids, I can SOMETIMES make out what they are saying (If I am upstairs and my husband is downstairs for example), whereas I would not be able to with my hearing aids in. I am quite worried that my word recognition score is really bad… what is the point me wearing them I still cannot understand what people are saying? As that is mainly why I want to, to be able to talk to others without repetitively asking them to repeat 2 or 3 times. As most of you know, NHS does not do it but I have read on here how important it is. How do I test to see how bad it is? I am betting absolutely terrible… if I see the audiologist it will be the 4th adjustment and I am still not satisfied.

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You don’t say what brand and model of ’s you’re wearing. That might help other folks here make suggestions. Also, if you know what fitting algorithm the audi used, that’s useful information.

YMMV, but I prefer the fitting algorithm, for example, over ReSound’s proprietary + algorithm because NAL-NL2 amplifies high frequencies more, and that helps me to hear and understand what my very soft-spoken wife is saying.

Similarly, ReSound’s smartphone app has a settings button available called Speech Clarity. Tapping that will increase mid-tone and treble amplification and decrease bass slightly. I find that helpful to better hear speech sounds in situations where a person has a gravelly or raspy voice, or there is a lot of background noise in the environment.

So perhaps whatever model of HA’s you’re wearing, there are similar fitting adjustments or different fitting algorithms you could try to see if you can get better results. As you say, for your hearing loss, maybe, unfortunately, you are at the limits of what can be done. I don’t know much about but looking at your audiogram and the profundity of your high-frequency loss, I wonder if you are a candidate for frequency lowering, whereby the hearing aid reproduces the very high-frequency sounds that might be ~impossible for you to hear at their original frequencies and instead shifts them for you to hear at a lower frequency. And the frequencies you can hear get shifted down a bit to make room in the range of frequencies you can hear for downshifted, otherwise inaudible high frequencies (sorry if this is an unclear, terribly long-winded explanation!).

What I’m about to say is pure conjecture, so keep that in mind. I’m guessing you’re getting a lot of gain to high frequencies that you can’t make use of. You can hear the microwave, but it doesn’t help with speech because your brain can’t make use of it. All I can suggest is returning to the audiologist and sharing the problems you’re having.

Have you happened to get word understanding test done? At what db?
Testing before molds and after might tell you something.

Seems I remember you saying you went many years with hearing loss and didn’t wear hearing aids. This can really affect word understanding if it goes too long. But you just might get some word understanding back with properly fit ads that are worn everyday.

In my experience it can take some time for the brain to learn how to interpret sounds. If the audiologist thinks the are adjusted correctly, I would keep using them,

As much as possible, I would concentrate on speech in quiet environments to give the brain a chance to learn how to interpret the sounds.

Are these your new hearing aids, or are they still your old ones with new moulds?

Why would they do that?

They aren’t particularly on the clock - assessments have long enough allocated time slots. All the audiometry is PC based and written back through medical DB like Audit Base. There’s no profit motivation to worsen or skew the results and the staff are fully trained. Also there’s large soundproof rooms on tap.

The NHS might lack the budget to buy and fit top end product in the form factor that people would find most cosmetically appealing, plus there’s some long waiting times kicking around, but suggesting that they’d deliberately manipulate a test is just bonkers.

There’s likely to be some issues with the downward spread of masking from your fitting.

This is one of those occasions when fitting ‘to target’ simply doesn’t provide the best results due to the 5000x sensitivity difference between the the high and low frequencies.

If you have a look at the search function, you might find something about the management of steeply sloping losses like yours. The options are broadly:

1, Seal up the ears, make the output very punchy in the HF, cue distortion, poor resolution,
feedback, auditory fatigue etc.

  1. Pick the usable LF, use a bit of frequency compression/transposition, amplify more gently and accept you probably have a dead-spot around 6-8Khz anyway. Your results are possibly from adjacent hair cell stimulation. Accept the gain doesn’t hit the target above 2KHz and set the response the same as the 2KHz across all of the upper frequencies to avoid feedback and other gain artefacts. Provide you with a usable/accessible volume control and noise management programming to access more power as needed.

In reply to @Um_bongo

@Um_bongo said:

suggesting that they’d deliberately manipulate a test is just bonkers.

@jUm_bongo: I do wish that you’d take the trouble to read my posts carefully before you go off.

What I’m suggesting is that a beleaguered employee who - because of the tremendous pressure they’re under due to constraints of resources and time - were to accidentally lose data for one ear might remember that this patient was symmetrical in their loss, and simply plug the data they did have into the blanks for the other ear, considering them to be the best proxy for the lost data.

No intentional manipulation of the data beyond that necessary to cover some unfortunate employee’s ass was suggested or implied.

You literally said they could ‘cook’ some results; that’s a colloquialism for manipulation.

Nobody’s gone off on one. You’ve made another completely unsupported claim (this time) about the veracity of hearing tests in an organisation you’ve got limited or no experience of.

My original point stands: NHS Hearing services, might be criminally underfunded by our current government, but why would the well qualified, experienced and equipped staff ‘cook’ a result that’s of no benefit to them, the patient, the supervising consultant or the delivery of hearing aids within the system?

I don’t work with or for them; if you’d questioned the veracity if a particular bit of test kit, a weakness in the 4KHz response of the B-71 bone-conduction transducer or something in the prescribed practice of the BAA, you could have made sone form of argument. Otherwise like I said, it’s a pointless and spurious thing to suggest.

Edited

In reply to @MDB

@MDB said:

you can hear the microwave, but it doesn’t help with speech because your brain can’t make use of it

I am sorry to jump into the discussion, but if that were the case, and you were hearing far more decent environmental sounds than speech while having fitted as maximum gain in-put on high frequencies, in your experience, in which direction should a new regulation move? Why would such regulation hinder speech recognition?

@MDB said:

your brain can’t make use of it

That’s interesting, I’d like to read some more about this…

Edited

Here’s a quote from Um bongo, an experienced audiologist from (edit) Wales.

@Um_bongo said:

Pick the usable LF, use a bit of frequency compression/transposition, amplify more gently and accept you probably have a dead-spot around 6-8Khz anyway. Your results are possibly from adjacent hair cell stimulation. Accept the gain doesn’t hit the target above 2KHz and set the response the same as the 2KHz across all of the upper frequencies to avoid feedback and other gain artefacts. Provide you with a usable/accessible volume control and noise management programming to access more power as needed.

My loss is a little similar to yours. What Um bongo says is what has been most helpful to me.

For sure I have dead zones, due to the genetics of the loss. I use less amplification on the highs. I use a some frequency compression (via Phonak’s algorithms for SoundRecover 2). And I use earmolds that are either more open (for quieter environments where noise isn’t an issue) or 2mm vented ones (for noiser places where noise would make it harder to understand speech). My Roger pen helps a lot for zoom business meetings (less in person, unfortunately). I use captions, Live Transcribe, and other visual guidance as well. To me seeing is an important part of how I gain speech comprehension in some settings. I hope this is helpful to you and good luck!

Edited

@buiononsense:,This is a very simplistic account of my experience with speech lowering.

My audiologist at the time that I first took delivery of my More1 hearing aids, told me that because of my hearing deficiency in the very high frequencies, my brain was not receiving any valuable information from those frequencies above 4-5k Hz. So he suggested that I turn on the speech lowering feature of my More hearing aids.

I took his advice, and I can’t really describe what I heard: it seemed to be “fuller”, but on the other hand, my word comprehension diminished.

After trying speech lowering for a couple of months (Addendum::and by “trying”, I mean returning for adjustments and tweaks when it wasn’t working for me), I went back to my audiologist and asked him to turn that feature off, meaning that I was now receiving input from the high frequencies that I couldn’t hear before. With the additional input, even though I was not able to perceive the high frequencies, my brain must have been able to make use of the imperceptible information it was receiving way up there, because my word comprehension improved dramatically.

So the audiologist and I both concluded that, even though I was unable to perceive, or hear these very high frequencies, my brain must be receiving some useful information therefrom, based on my improvement in comprehension . My wife said she noticed a big improvement, too.

So, I realize that this is a very simplistic story - I have no science to back up what I’m telling you, nor do I need to have it because it’s just an account of my subjective experience. But I would say, do not discount what your brain may be receiving from those very high frequencies that you can’t perceive as tones. It may be more significant than you think.

In reply to @buiononsense

To me what Um bongo said clarifies a lot of this, but if you’ve got more questions, do chime in.
Regarding the brain not being able to make use of it. There can be multiple reasons. The highs can be so loud that they mask (drown out) the lower frequency sounds so the brain ends up getting less info even though it got the highs. If brain hasn’t been getting high frequency speech information for some time, it loses the ability to make sense of it. Sometimes the sound is distorted because the cochlear region that deals with a specific frequency is damaged and another nearby region that still works is getting stimulated. This stuff can be complicated. My suggestions are to read and ask questions (or on the other hand, find a good audiologist or hearing aid specialist and don’t worry about it! :>)

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