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Two different audiograms - which one to fit?

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Hello everyone!

This is my first time posting, but I have been an avid reader every since I started considering getting hearing aids. I am 48 years old, first noticed my hearing loss at around 34, ever since it has been a very gradual decline, mostly in the upper frequencies. I went to see an in my home country 1.5 years ago and was diagnosed with sensorineural hearing loss, was clear. About one year ago, I went to see a local audiologist and was fitted with Signia 7ax hearing aids. The audiologist tested my hearing again, and, surprise, my hearing had suddenly improved significantly - on paper, that is. In real life, it felt the same. My hearing aids were fitted according to the audiologist’s (the better) . I will attach both of them for you to see the difference.

Ever since, I have been wondering if I am really getting the best out of the hearing aids. While I certainly do feel that they make a difference, especially in quiet surroundings, I still find that some people do not sound clear, my mother for instance. With these people, I mostly have a hard time hearing the letters ‘s’ and ‘f’, sometimes ‘z’. In other people, I hear them perfectly fine. I also have a hard time in noisy surroundings - restaurants, airports, planes. I found that if I activate the ‘mask mode’, it helps quite a bit (the mask mode in Signia aids supposedly boosts the 2000-6000 frequencies). The noise mode does not make any difference at all.

My audiologist seems to be competent - she is the only one far and wide that does . She also said that her equipment is regularly tested. She made several adjustments, but they seem to have made things louder rather than clearer. Last time, she adjusted what she called the “master volume” (I believe?) by a couple of decibels. But I can’t help feeling that all these adjustments, including REM, may be useless if based on an inaccurate audiogram.

My main questions are:
(a) If my first and worse audiogram were the “correct” one, would this be a significant difference in terms of my problems described above (lack of speech clarity)?
(b) With my hearing not being all that bad, is it still unrealistic to expect to hear this high frequency sounds more clearly? I realise that hearing aids cannot restore natural hearing, so I’m wondering if this is just a case of unrealistic expectations…
(c) Should I ask her set up a new program based on my older, worse audiogram, just to try and see if this would actually make a difference? I am afraid that if she re-tests me in her booth, the outcome will be too good again.

My better audiogram:
IMG_7204.pdf (5.3 MB)

My worse audiogram:
IMG_8729.pdf (3.6 MB)

9 people in this conversation12 min readJump to latest

Hi @val_ley

Was the 2nd taken using the same equipment as the first, or was it taken with the new hearing aids in your ears?

Do you wear domes or molds?

Either way, with your loss, you should be able to distinguish speech. Increasing the overall volume, will increase those frequencies, but will also increase the lower frequencies which could drown out the higher frequencies (upwards masking).

Peter

@val_ley said:

Ever since, I have been wondering if I am really getting the best out of the hearing aids. While I certainly do feel that they make a difference, especially in quiet surroundings, I still find that some people do not sound clear, my mother for instance. With these people, I mostly have a hard time hearing the letters ‘s’ and ‘f’, sometimes ‘z’. In other people, I hear them perfectly fine. I also have a hard time in noisy surroundings - restaurants, airports, planes. I found that if I activate the ‘mask mode’, it helps quite a bit (the mask mode in Signia aids supposedly boosts the 2000-6000 frequencies). The noise mode does not make any difference at all.

It seems like you have an acoustic problem. You should ask the audiologist to swap out the dome type (be sure to try everything available). If it is mold, you should check the occlusion and vent, ask the audiologist about this. Vent plays quite a role in how you perceive the sound. Too small a vent, you may perceive larger sound (louder and occlude). Too big a vent, you may perceive too thin sound, not enough amplification.

Make sure acoustic is not issue first.

And about the test. I probably just go with the newest test. Because its more current and now.

I don’t think it matters a great deal which you use. Aids should enable you to hear high frequencies, but nowhere near “normal.”
It sounds like you have narrowed your issue to wanting more high frequency gain. You could ask for that.

In reply to @val_ley

@val_ley said:

I wear open domes, tried tulip ones as well, no big difference for me.

Open domes will restrict the amount of available gain in the higher frequencies, so the Audiologist will have less room to increase those frequencies. Tulip, or (2 little vents). Just changing dome types probably won’t make a noticable difference as the fitting remains as it was. Your Audiologist would have to change the dome type in the software to recalibrate. Generally, going from open to closed would increase the amount of available gain, so the high frequencies could get the boost you need

Peter

Thank you for the replies. That already helps - I think the general direction for me would be to go for more , recalibrate the fitting accordingly and ask for more high frequency gain. If anyone has more tips, I would love to hear!

Although definitely true that open domes can limit how much high frequency gain can be added without getting feedback, I doubt you’re close to that limit currently.

Depends on the ear, but I agree. It sounds like the mask program gives her more high frequency gain, so we know there’s room for it.

In reply to @val_ley

@val_ley said:

If anyone has more tips, I would love to hear!

There are 3 possibilities why your 2 are different:

  1. The 2 setups for the audiometry equipments are different, although in ideal conditions they should be the same if they’re calibrated properly to established standards.

  2. Your hearing might have changed for the better for some reason, resulting in the difference. If you don’t think your hearing loss has really changed at all, it can be as simple as maybe in the first test you have a slight cold that plugs up your ears a little more than the second time around, hence the worse result.

  3. Your personal bias on your second audiometry test. Maybe you never experienced with the audiometry test before the first time around so you didn’t trigger the button until you were sure that you heard the tones. But the second time around, you have gone through that test once already, so you knew what to expect, and maybe your anticipation is more trigger-prone and you unconsciously decided to trigger the button earlier as soon as you heard a faint-enough tone, instead of making sure you heard it loud enough before your trigger the button.

You can settle which audiogram is better for you by not using either one of them, but instead ask your audi to perform an in-situ audiometry test for you using your own hearing aids and fitting (probably wait until you get the that you want first), and have your gain curve be prescribed based on your new in-situ audiometry result. This way, you don’t need to care about which of the 2 original audiogram results is more accurate because the in-situ result should be the latest and most accurate because it uses your own hearing aids and your own fitting, so both factors are taken into account there as well, on top of it being the most current audiometry test you will have taken.

Ok, there are some interesting points there! Thank you. I definitely don’t believe my hearing loss has changed for the better. But yes, perhaps I reacted differently to the two test situations - this is possible. Your solution is also an interesting one - I will ask my audiologist about testing with my hearing aids. Is that something commonly done?

Yes, you should be able to have more high frequency gain with those domes. They typically run a feedback test which sets the upper limit of gain you can use without feedback. The programming software will show the curve with how much gain you should get and a feedback curve limit. If the gain curve is going beyond the feedback curve, then you need more occlusive domes to be able to use the gain without feedback. This isn’t precise. Sometimes going over a little is ok and even if you get a little feedback if you cup your ear, it’s not a problem for most people.

In reply to @val_ley

@val_ley said:

I will ask my audiologist about testing with my hearing aids. Is that something commonly done?

Usually the done by the is the one used as input into the hearing aid software programming and in-situ is not commonly done as a replacement for the audiogram. But that’s because usually it’s assumed that the audiogram was done properly and with properly calibrated equipment, so there’s usually no ambiguity about the accuracy of the result like you have in your case with it being done twice with different results.

Verification of the proper performance of the hearing aids and the fittings, as well as taking into account the shape of your ear canals which may change things, is usually done by already, so in-situ audiometry testing is optional and usually not done because it’s probably overkill and its return on investment may be questionable.

But it’s a handy tool to have if you think that your hearing might have become worse but you already have your hearing aids with the fittings in place. In this case, the HCP may prefer to opt for doing the in-situ audiometry test with your hearing aids and fittings in place, instead of sending you back into the booth to do the standard in-booth testing again sans hearing aids again, only to have to revise your audiogram input with the new result and re-prescribe the gain again. Basically it saves a few steps, and it also has the advantage that the testing is done using the actual hearing aids you wear. So if the hearing aids and fittings underperform or over perform, this would already be factored into the in-situ audiogram result.

Valerie, have you tried using the Signia Assistant inside the Signia App? Personally, I think the app is weak in the options it provides, but you can modify your response with the Signia Assistant. Unfortunately, it does not allow the changes to be saved as a separate program, but the changes can be discarded if not to your liking. I have used it to boost my ability to understand speech, and it does seem to work. I have also used it to modify the overall response to high and low frequencies as well as overall volume. The big problem, as I see it with the app, is that after modification there is no way for the user to determine how the response curve has been changed. However, according to the literature, your Audiologist is able to see the changes and that, in theory, should allow her to better assist you in making changes to your liking. But who knows? Anyway, you might try it. As I said, the Signia Assistant modifications can be removed if not to your liking.
By the way, yes, you should expect to be able to hear high frequency sounds better. My is similar to yours and when I got my 7AX’s the higher frequency sounds I hadn’t heard for a long time were shockingly intrusive. My first response was that they were much too loud. However, now, after about a year, I am quite used to and comfortable with them.
Best of luck to you.

Hello Jay, thanks for your reply! Yes, I do actually play with the Signia Assistant. But as you mention, there is no way of knowing what each option actually changes in terms of gain or compression. I don’t know a lot about these things, but I would appreciate being able to see the response curve. Also, I’m not quite sure what the difference is between making changes to ‘sound’ vs. ‘speech’? Have you been able to figure this out? I just read up on the Signia Assistant and realised that the assistant makes the changes in the context of the environment you find yourself in at that moment. So changes will differ in a noisy environment / quiet environment.

In reply to @val_ley

@val_ley said:

Hello Jay, thanks for your reply! Yes, I do actually play with the Signia Assistant. But as you mention, there is no way of knowing what each option actually changes in terms of gain or compression. I don’t know a lot about these things, but I would appreciate being able to see the response curve. Also, I’m not quite sure what the difference is between making changes to ‘sound’ vs. ‘speech’? Have you been able to figure this out? I just read up on the Signia Assistant and realised that the assistant makes the changes in the context of the environment you find yourself in at that moment. So changes will differ in a noisy environment / quiet environment.

Yes, as I understand it, the Assistant makes changes based on the current environment, which seems reasonable, but rather impractical. Dragging out the phone to make changes while having a conversation or otherwise engaged hasn’t worked for me. Although, I suppose one could put themselves in a particular environment for that express purpose. When I’ve made changes, I’ve just affirmed the result was better to keep it, without actually knowing. I assume the changes are cumulative, so one could keep asking to “improve” the same quality to account for differences in environment.
As far as sound vs speech, again I assume, changes made to speech are more or less limited to the frequencies of speech while those to “sound” are rather broad spectrum, maybe similar to adjustments of bass, treble, and volume. It is also possible the programming is “aware” of the typical difficulties in understanding speech and applies particular algorithms when trying to improve that quality.
I do hate not knowing what changes are being made by the Assistant. I am seriously considering buying a Noahlink and getting the software so I can see what is going on. I really don’t want to get that deeply involved, but it’s a consideration :grinning:

I’m in agreement that the two aren’t dramatically different. Also, stay with open domes to preserve 100% natural hearing at all lower frequencies. High-frequency gain can be increased as others have said and your audiologist will be able to increase it. That’s what really sharpens definition of speech. Excess gain at low frequencies is not helpful, so don’t just increase the global gain (i.e. volume control) except in moments of desperation :slight_smile: We work like mad to get high frequencies emphasized in radio communications, even for people with normal hearing…

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