Like many hearing aid wearers, I have never been 100% satisfied with any audiologist that I have used in the past. The reason being was because there were always the same longstanding issues that nobody ever seems to be able to resolve for me. In addition most audios only do a basic tone test which is not good enough. If you want the back story, you can read my other posts. This post is going to be an upcoming review on a new audiologist that I will be trying out next month.
About the new Audiologist
Their name is Farnham Hearing and the audiologist is called Charlene. They are based in Farnham, Hampshire, UK.
She does (which we know is essential). But in addition to that she does speech audiometry which I believe is and (which I have always wanted my audios to do because I believe it is necessary for me).
I am not really that familiar with what , ACT and are, but Chatgpt said that all of them would really help with different aspects of my hearing loss. I don’t think I have ever had a speech in noise test that I can recall. Just the white noise tone test.
While her reviews are all very positive, what really impresses me about her is the sheer battery of tests that she is doing, that virtually no other audiologists provide. Her process just seems far more scientific without guesswork. Chatgpt seems to think that this unaided and aided speech in quiet in the free field will help address my longstanding soft speech problem along with REM etc of course.
What I be receiving:
Healthy Hearing Assessment (90-minute appointment) incl. i.e.
Puretone Audiometry
Speech Audiometry
Speech-in-Noise
Acceptable Noise Level (ANL)
Audible Contrast Threshold (ACT)
Tympanometry
Identifying hearing and other difficulties with current instruments.
Maximise Your Hearing Program (several appointments):
Check your hearing aid fitting and settings (update firmware if needed) and make recommendations
Probe microphone measurements (rems) to validate the settings.
Unaided and Aided speech in quiet and in noise in the free field to assess functional improvement
Review in 6 months for final fine -tuning
Conclusion
I will be visiting her for the first time mid February. I will update with an assessment review then. I am interested in hearing your opinions on all the services that the new audiologist provides because I have never heard of some of them!
If she manages to solve my soft speech issue (which no-one else has ever been able to satisfactorily resolve) then she will become my go to audio in the future. To be clear, my soft speech issue is an intermittent one, where I am the only one that is struggling to hear someone who speaks softly and in certain frequencies voice - yet everyone else can hear that person! So it’s not a question of managing expectations as I have frequently been told.
What do you guys think of her services? I would like an experienced opinion from the forum.
You’re ignoring this member’s posts.
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I didn’t lnow any tests other than tone - air conduction and tone - bone conduction were availeable. With 2 NHS tests and 1 private consultation I have only had the air & bone conduction tests done. The NHS tests were carried out in a booth while that private consultation I was just sat in the room with a pair of headphone so not particularly good sound isolaton for that test.
Never had and only heard about it since joining the forum. I can kind of understand it not being done on the NHS but with hindsight I would have expected REM on the private consultation.
Don’t get me wrong, all visits ended up with better speech recognition but I’ve always thought it could be improved hence the reason I joined the forum to learn more and decided to go . I have the original programs for both sets of ’s and can go back to them If I totally screw things up.
Hopimg this new audio you are seeing will be able to come up with something for you after all the different tests.
Just completed my hearing exam last week. This is my fourth hearing exam and my second by an audiologist. I had to expand my search area by 50 miles (in a major US city) to find someone that does and accepts Truhearing insurance (Truhearing branded Signia hearing aids). I found two. So what was included
Included in Truhearing package $1100 (two premium rechargeable aids aids) and basic hearing test, bone conduction, speech. Unlimited visits the first year and 45 day trial. What was added on by the audiologist which I agreed to:
Ear wax removal both ears (needed it) - $60
Custom acrylic ear moulds (2) long overdue - $300
Speech in noise - $25
REM and validation - $100
Electroacoustic measurment (measures hearing aid performance) - $100
Also suggested I see and to check things out which I’ve never done before. I wonder if this is why was not included. My insurance will cover with a copay of $35.
I did some on my existing pair (signia) and was able to tweak some settings and made improvement. I suspect I would have not paid separately for REM and the electroacoustic measurement if I had just walked in and purchased hearing aids. Margins are thin for providers when they accept Truhearing. I get the sense from my previous two truhearing trips that providers are not thrilled but accept the business as some major insurances are headed in this direction. FYI - been happy with the Signia truhearing branded hearing aids (my first aid was phonak which was great as well).
Hearing aids will be here in a couple of weeks but so far so good. My appointment lasted 90 minutes
@storemanuk I was considering going down the route, but then I realised I am just doing the job that the audiologist is supposed to be doing. I think DIY should be used to optimise your hearing - like you want to tone down the noise of the crickets in the garden slightly (not that I ever hear them anyway). DIY should not be used to address shortcomings of the audiologists who are not providing (which is essential) and are not able to address those really difficult issues. People either have problems hearing in noise (I don’t) or they have problems with soft speech (which I do).
Rem should be done by private, but unfortunately about 90% of audiologists don’t do it and claim that it is not necessary, when it really is! I think it’s because REM equipment costs a lot.
I abandoned the NHS after one appointment when it was clear to me that I knew more about hearing than the person who was supposed to be helping me. The NHS might be ok for people who have an age related hearing loss, but they are pointless for anything else in my opinion.
@stevek1959 Thanks for sharing your experience. Just for reference for other people posting, the point of this post is not really about prices or exactly what services each one provides etc as most provide moulds, wax removal etc. The purpose of the discussion is more to identify what services are actually important to help people who have challenging hearing loss (or even moderate) to ensure that they get the support that they need. For example, I already know that REM is really important, but not clued up on all the other services my new audio provides, so wanted discussion on them.
Ultimately, it would be helpful to have a complete list of what hearing tests and services are important for people who have complicated hearing issues and need a bit more support than common hearing losses.
Never had REM and only heard about it since joining the forum. I can kind of understand it not being done on the NHS but with hindsight I would have expected REM on the private consultation.
Yesterday I was at my local NHS audiology because of faulty aids. I was issued with new Danalogic Ambio Smart 77 aids with full .
DIY should not be used to address shortcomings of the audiologists who are not providing REM (which is essential) and are not able to address those really difficult issues.
Actually it’s the other way around, DIY should be used if you can’t get your clinic to “address” your issues, the reason is simply that the audiologist can’t hear what you hear and how you like things to sound, hearing is so subjective that even if you have the exact audogram in 2 people you will get differences in how they’d like things set up, hearing speech in noise is the “biggest” problem for people using , it’s number one priority for the manufacturers as well! but even people with normal hearing also suffer this while others have no problem, the “cocktail effect”
is just another tool in the toolbox,it’s not like its going to magically restore your hearing (unfortunately)
I’ve had another session with my Danalogic ’s and noticed that they hadn’t enabled tinnitus sound generator which I suffer badly from. Have enabled it and will see how it goes. I have also noticed that souns like clinking glasses and running water came with a horrible crackling noise so following the hints have slightly lowered the higher frequency gain. These HA’s were overly amplifying the higher frequencies to the point that I was losing sound volume and everything sounded tinny. My tinkering has been subtle but I notice an improvement.
It’s nigh on impossible to relate what you hear to another person and I’m pretty certain that these weren’t alterd from the auto settings based on the simply because the fitter said he had pre-programmed them to ‘save some time’ before I went in to be fitted.
I have the initial fit settings saved to the software database so if I totally make a mess I can revert to that.
How do the audiologists know there is not something wrong that could benefit from an ENT or specialized audiology consult?
Good question, I’d say once they look into your ears with their trusty otoscope, they’ll be able to see anything abnormal, plus question the patient about anything they suspected to be out of the ordinary.
@Baltazard around £1000 for the assessment and Maximise your hearing program. Not cheap, in fact she is considerably more expensive than my current audio. But he doesn’t do half the tests that she does. The problem is, he has to make educated guesses on what I am hearing, she is able to narrow that down considerably, although there will always be an element of guessing as people’s ears are different.
@tenkan I don’t want to argue what appears to be semantics. Yes the diy route does cut out the middleman. But that is not the point. The diy route should be used by people who want to cut out the middleman, not by people who despite having an audiologist still have to go down the diy route to address persistent shortcomings. My point is that because so many audiologist don’t even offer never mind all the other things this new audio does, it understandably results in a situation where the hearing aid setup is just not optimal at all. Will an audiologist (with the aid of all these tests provided by the new audio) get it absolutely 100% perfect? No, that is where diy tweaking comes in.
But when you have persistent “basic” problems like for example I don’t hear a phone alarm going off in another room - yet everyone else does or when people (with certain voice frequencies) speak at a lowish volume, I struggle to hear them, but everyone else clearly has no issues. These kind of problems should not require diy tweaking - they require rem (for verification because most hearing aid wearers are underfit) and require other tests to see what frequencies I am not hearing despite the fact that the aids are configured for them and REM verifies that my ears actually receive this. The problem could be more neural.
I understand exactly where you are coming from. tweaking does have it’s place, but it should not be used to address obvious shortcomings by the audiologists who far too often are relying on a simple basic tone test and nothing else. This new audio offers in my opinion a far more scientific approach which reduces the guesswork required. To me, I have long felt that the process most audio’s use is very unscientific and guesswork - how does this sound etc - why don’t they use tools like /REM etc as this is what these tools are for!
REM will not solve all the problems, but this is not the purpose of REM - REM does not fix your hearing. It is intended to verify the fit - i.e. confirm that your ears actually receiving what the hearing aids are programed for. If the fit is poor, REM won’t help much either. It is just a verification tool, but a necessary one.
@storemanuk get REM done. It is worth it and does make a difference. I had it done on my last hearing aids by a previous not my current audio that I used for these aids, and admittedly the previous aids had a very poor fit. REM changed those old hearing aids from being useless to functional - not great but functional. My current audio has setup my current aids much better (better fit), but without REM I don’t know where I am underfit. So, get REM done. It is essential.
@user490 I don’t use Costco, so have no idea. However, I am not keen on Costco because it will depend entirely on whether you get a good audio or average one. So, this is too random. My new aduio - is just one person, so I know exactly what and who I am getting.
@Dule I intend to. Fortunately one of those people that I sometimes have problems with when they speak too softly is my mother. So she is being dragged out for lunch and my hearing appointment. PS welcome to the community.
It amazes me the lengths some of our fellow will go to, as we chase that perfect solution of our very individual hearing losses…And if anyone is like me, you will perhaps come out the other end knowing, perfect solutions do not exist, it’s all about compromise, nothing more, and nothing less…Acceptance of your loss, is the starting point, we grieve for what we had, and what we lost, you must accept it, in order to move on! Our hearing is damaged (and at present, beyond repair) as yet, there is no hearing aid available, that will offer a perfect solution to damaged nerves, it is impossible, if you have dead hair cells or nerve endings, they’re dead, and no amount of amplification is going to revive them! An Audiologist once told me how she tended to explain hearing loss, in the Cochlear, if you imagine a wheat field on a slightly breezy day, the breeze is sound, moving across the hearing hair cell endings creating a ripple effect, but with half our “Wheat field” missing, that ripple may stop dead, half way across, so the sound or word is lost, or we get it partially with key parts missing, and our brain interprets it, with limited information…Personally, many years ago now, I attended lip reading classes, I took up (British Sign Language) I became an excellent “Lip Reader” and a fairly competent signer? They say that, “necessity is the mother of invention” and sometimes we have to improve our skills, in order to compensate for other missing sensory perception, I am glad I did. Nowadays, I am fairly content, I can communicate fairly effectively, I am fortunate enough to have Phonak Naida Lumity 90’s, they are brilliant aids, my first fit, was my last fit, no adjustments from day one (November 2024) No whatsoever, it is not the Must have ingredient! I do have Target, Noahlink Wireless, but I have never felt the need to adjust them, my Audioligist is excellent… Cheers Kev
I think the test battery is very interesting. My god what a nerdy thing to say. But there are a lot of funny nuances that go into the test battery and a lot of the tests are quite a bit less useful than patients think, or at least useful in a very different way than they think. Our initial standard patient test battery is reasonably thorough: otoscopy of course, , acoustic reflexes, otoacoustic emissions, pure tone air and bone, speech reception threshold, word recognition, loudness discomfort levels, speech in noise testing. Some of these things are critical or at least important to pick out surgical/medical candidates, but a lot of them are actually pretty rarely useful and we do them either to have them on file, make the patient feel like we are doing more than our competitors (marketting!), or we simply have them in the line-up because some providers are better than others at critically deciding what tests are important at what times (sorry, but [not all HISs, but on average] are more likely to just do things by rote).
Speech reception threshold () for example, is just a cross-check that something isn’t off with your pure tone thresholds. In adults, 99% of the time it is consistent with pure tones and gives us no other useful information. It’s useful when it doesn’t line up to alert you to a technical difficulty, a potential medical concern, or a patient who is trying to fake it. It is regularly useful in children who sometimes struggle to understand/participate in behavioural testing or legitimately DO try to fake hearing loss at a much higher rate than adults (and apparently useful in at the American where people also try to fake it for some sort of financial compensation?). In typical adults, it is regularly a waste of our clinical time. If I do it once when I meet a patient and it is as expected, there aren’t a lot of reasons for me to do it regularly after that.
Word recognition is a very gross measure but does help with setting patient expectations surrounding limitations of hearing aid benefit and suggesting cochlear implant candidacy. Certain patterns of can be lightly diagnostic of retrocochlear lesions and initiate further investigations for the very rare patient who has that concern. Many clinicians don’t have a strong understanding of statistical variance and will attribute more meaning to WRS than it really has. Because of variance, live voice WRS is a completely meaningless test that is done to check a box but is essentially a waste of clinical time. Recorded WRS is still variable enough that a score of 60% is not meaningfully different from a score of 75%. Steeply sloping hearing losses can really disrupt WRS performance in a way that doesn’t necessarily mean that much. Particularly because WRS is time consuming, many clinicians are not taking the time to actually determine the level of best performance and the test is regularly presented at a level that is insufficient or with inappropriate masking. Very poor preformance on WRS can guide fitting decisions, good to excellent performance on WRS has very little impact on the hearing aid fit.
I could go on indidivually for each element in the test battery, but I have to go out into the snow in a few minutes. Tests that are useful for the actual hearing aid fit are air- and bone-conduction pure tone testing and loudness discomfort levels. is critical, of course. Speech in noise testing can be lightly useful for the fitting (more useful for device selection and setting patient expectations) but not always more useful than patient report.
Aided testing is rarely useful for the hearing aid fit in my experience, or at least rarely actually being used in that way . . . I’m still waiting for providers who do it regularly to tell me what they are getting from it to direct the actual fit that they can’t get from REM. It can definitely be good for patient education/marketting/counselling/warm feelings.
It amazes me the lengths some of our fellow HOH will go to, as we chase that perfect solution of our very individual hearing losses…And if anyone is like me, you will perhaps come out the other end knowing, perfect solutions do not exist, it’s all about compromise, nothing more, and nothing less…Acceptance of your loss, is the starting point, we grieve for what we had, and what we lost, you must accept it, in order to move on!
Initially I was not going to respond as you are not the first person on this forum or first audiologist who has said to me that people with a hearing loss must manage their expectations! However, I have decided to make a reasoned case for why I no longer believe that this is acceptable. Note I also used to believe the same as you that I had to be realistic about the fact that a hearing aid could never replace a human ear.
About me in a business context
I used to run a small business. One valuable lesson that I learnt from running that business and specifically dealing with clients who are difficult is the importance of ensuring that my clients are “managing expectations” because some people have very unrealistic expectations for their budget. In addition, many do not understand the difficulties of certain things they are asking. So, I fully understand why people keep saying I must be realistic.
When I used to accept and manage my expectations in the old days
Years ago, I used to wear Resound hearing aids and another brand, name unknown before that. I used to work in very noisy environments as I had to go into schools a lot and there is nothing noisier than kids shrieking. I used to come home and rip out my hearing aids, because hearing was exhausting. It was too loud, too much sensory stimulation etc and it just drained me. I was frankly delighted to rip my hearing aids out the moment I got home from work. In addition, despite the fact that everything was too loud, I never heard very well in noisy environments because the background noise was competing so much. Speech in noise was at best ok, but I did struggle to hear, it was not that great.
The beginning of the change for me
When I lost those hearing aids (not deliberately I can assure you), I went to a high street chain in the UK to get a new hearing aid. They prescribed me Oticon, not because they determined it was best for my ears, but because that was the product that they preferred to sell. They are Oticon dispensers.
I had a lot of problems with those Oticons initially and they were never satisfactory for reasons I will come to later. But, and the massive big but is this. After many long months with the high street audios with many changes and eventually asking them to do an I got to a point where the hearing aids were usable - not brilliant, but actually quite usable.
But Oticon changed two things for me. Firstly, I no longer ever suffered auditory fatigue anymore unlike I did with Resound and even with the recent Widex hearing aids that I trialed last year. Auditory fatigue had vanished. In addition, I discovered with Oticon I could actually hear very well in noisy environments - but I did have to adjust the left hearing aid volume up 1 click in noisy environments or when walking around outside like going down the high street etc. The hearing aids were not perfect, but I was shocked how much of a difference moving to Oticon was. I no longer suffered from everything being too loud and I could actually hear surprisingly well in noisy environments and my auditory fatigue had vanished. I could now pop my hearing aids into my ears first thing in the morning and take them out just before bed.
Moving beyond that audiologist and when things started to click for me where the problem was
My mother needed to get hearing aids as she was starting to suffer age related hearing loss - losing high frequencies. So she went to the same high street audio that I went to. However, she only ever wears the hearing aids for tv using a streamer and for nothing else. The reason is because she said she couldn’t notice any difference wearing the hearing aids and one mould in particular, but both moulds are loose in her ears.
Bottom line, she has had a very poor experience with the high street audio and her hearing aids sit in a drawer most of the time! That was when I realised that all the problems that I had with the same audio getting my hearing aids to work was actually an issue with the high street audio, not with my hearing being particularly challenging although it is. Apparently the number of elderly people who have bought hearing aids that are now sitting in a drawer is a shocking statistic - something like 40%
My new hearing aids and new (current) audiologist - same longstanding problems persisted
I had to replace my old Oticon hearing aids and I realised that I needed to find a good quality audiologist as it was clear high street chains were to be avoided.
He trialed me with Widex because that is what he prefers, but also with the Oticon Intent1 as I said I was happy with Oticon (for reasons mentioned above), but was not happy with the old audiologist where the fit was not good.
I only wore Widex for 24 hours and realised it had all the problems that I used to have with Resound, so that was returned pretty damn promptly. I wore the Oticon for a few days and found that they were similar to my old hearing aids, but I heard slightly better with the new aids.
Now I will get to the crux of the matter here, why I now do not accept the argument that I must manage expectations.
My old hearing aids and audio and my new (current) hearing aids and audio still had the same longstanding problems, which was disappointing as I had hoped that the new audio would be able to resolve these issues.
Volume imbalance mismatch between left and right ear. Everything, but particularly high frequencies always sounded louder in right ear than the left.
I still could not hear people in the back seat sitting behind me in the car, yet other people clearly managed well, including people on this forum.
While I could hear well in noisy environments and in general conversations at work etc, I found that I still seemed to have issues hearing people at certain “low” volumes, particularly certain voices (frequencies). This was consistent whether sitting around the table, or in a noisy restaurant or in a supermarket if they were a few feet away. Now apparently hearing in noise is the real challenge, which I don’t seem to have a problem with. So, why is it so difficult to adjust my hearing aids to boost softly spoken people loud enough so that I can hear them properly - without increasing the volume for everything else! I did mention that I have issues hearing phone alarms etc in another room - but this is more to highlight my belief that soft sounds are too soft for my hearing, not because I really care about hearing the phone in another room.
My current audiologist is significantly better than the previous high street chain audiologist, but despite being much better - several longstanding issues remained that he had no explanation for.
Where I am today with my hearing journey
I am sure that many people, audios and in this forum will say I have to manage my expectations and be realistic about resolving those three problems above. But due to my own efforts, research and investigations I have already solved two of these problems or rather more accurately solved one problem and dramatically improved the second problem!
I asked my audiologist to change my prescription from Vac+ to . This immediately resolved my years long problem with Oticon hearing aids where there was a volume imbalance between the two ears. It’s not 100% eliminated - I would say 98% eliminated. But to all intents and purpose this years longstanding issue with volume imbalance is gone! But I had to tell the audio to change the prescription. Why did neither of the audios that prescribed me Oticon think of that?
Changing to NAL-NL2 massively improved my ability to hear people in the back seat (when I am in the front). According to another poster, he said that increasing the high frequencies substantially did the trick for him (as he was having the same problem) and effectively this is what NAL-NL2 does compared to Vac+. I have since learnt that Vac+ is pretty meh for increasing high frequencies and to a large extent Vac+ is suitable for people who have never worn a hearing aid their whole life (unlike me) and is designed for acceptance offering natural sound. Whereas I was born with a hearing loss and my hearing loss is extremely rare and unusual. Bottom line is Vac+ is not suitable for my hearing loss based on all the research that I have done because they don’t boost the high frequencies enough.
However, while moving to NAL-NL2 has removed the volume imbalance and I can hear much better (still not perfect, but considerably better) in the car, I still struggle sometimes to hear people who are very softly spoken and I am positive the reason is because I am currently underfit in a number of frequencies because my new audio doesn’t provide REM, so he cannot verify the fit. I know from the previous audio, that REM made a massive difference (changed those old hearing aids from useless to something that I could actually use). In addition, I am mishearing words more frequently now with NAL-NL2 than I was with Vac+ because NAL-NL2 does not raise the lower frequencies as much as Vac+ does and obviously it is now too low because the vowels are no longer fully rounded and accents are no longer distinct like they used to be with Vac+. The problem is not with NAL-NL2, but with the fact that my audio doesn’t provide REM so I am underfit in some/many frequencies and this has become more noticeable with NAL-NL2 and the vowel roundness.
My questions that I will put to you today are these:
Why don’t 90% of Audiologists (including my current one) provide REM, which almost every hearing aid wearer (including me) has said has made a difference. REM is not a magic solution, but it is a necessary tool. So why do most audios not provide this?
Why do most audios provide and trial you with only one hearing aid manufacturer and you as the patient have to specifically know a lot more about hearing aids etc to know to ask to trial other hearing aids. It was pure luck that I got given Oticon hearing aids 8 years ago that changed my hearing for me as explained above. I have always been provided with one manufacturer choice of hearing aids by every audio I have used in my life and audios are still doing it now. Why don’t audios understand that different hearing aids work differently for different people. Why are we still automatically not given this choice even today!
My current audio I have to say set these hearing aids up far better than the previous audio did, but I still had to be the one to tell him to try NAL-NL2. Why did he not try this? It should not be up to the patient - these are the problems I have and this is the solution to the problem! Why do most audios just stick with the default prescription provided by the hearing aid manufacturer. This is not acceptable when a patient tells you that they are having issues a,b,c and d and tweaking doesn’t seem to make a difference. Most audios stick with the default fitting profile.
My current issues with NAL-NL2 (which I believe that REM would fix) demonstrates the value (in my opinion) of word speech recognition at soft volumes because I am now currently mishearing words with similar vowels such as autumn vs alton for example when sound is slightly too soft. This is also a problem I used to have with my old Resound hearing aids. Surely this is where word speech recognition is effective to determine what letters/frequencies/sounds I struggle with. Granted REM would fix this because I didn’t have this current issue with Vac+ prescription and it feels like an underfit issue. But seems like a really useful service to provide for this exact problem. So, why does virtually nobody provide this service?
Conclusion
I work in IT. I am a very details orientated sort of person. You have to be to do my job. I am very logical and process driven in my thought process. I quite frankly find the way most audiologists work where they don’t offer you a choice of hearing aids (by default); they don’t try different prescription profiles such as NAL-NL2 versus Vac+ when the patient clearly indicates issues; they don’t provide REM despite it being the gold standard and last but not least they don’t provide WRS - it just seems that the way they do things is very unscientific and largely based on guesswork using just the tone test as the starting point.
I am the kind of person when something is not working properly, I investigate to find out why. Audiologists on the other hand come out with that tired old phrase - “Manage your expectations sir!”
However, as explained above, I have personally myself fixed several issues with my hearing, by doing the research myself and telling the audio what to do and lucked into fixing other issues by the high street chain fortunately preferring Oticon hearings (which work for me).
This is why I am keen on the new audiologist that I am going to try next month. Because I think her process is far more scientific and process driven, not relying on guesswork - how does this sound, how does that sound! Getting REM alone from her I believe will fix my current vowel rounding issues that I did not have with Vac+. But I am especially keen to try the WRS, because it just makes sense to me to test speech at low volumes to see if we can identify why I still struggle with it across audios, hearing aid brands, sound profiles etc. I believe I am underfit in very specific frequencies - possibly mid frequencies.
I do apologise for this incredibly lengthy response. I actually plan to use this response to point other people to in future when they complain that I am not being realistic and managing my expectations. So, this is not just for you. I wanted to explain why I don’t believe that I am being unrealistic.
The reality is that I have come to believe that most audiologists are not providing a good service to patients for the reasons I mentioned above. Patients need to trial different hearing aid manufacturers, trial different hearing prescriptions and we definitely need REM. But none of this is offered by default leaving especially elderly people with hearing aids sitting in a drawer unused! This paragraph alone justifies my complaints.
If you read all that - thank you for your patience, you have earned it as this a long post!
Thank you for your very helpful post. It is really good to get an unbiased opinion of what this new audiologist is offering.
I guess I am a nerd lol - battery of tests is exactly the right term in my mind lol.
I fully agree with you that some tests may be more about marketing fluff than anything really useful.
For reference,my mother had scarlett fever when she was pregnant with me, so I was born with my unusual hearing loss. This is why I believe that I need more in depth investigation than say someone who is over 80 and has age related hearing loss as this is a very much simpler hearing loss to treat. I think and would be helpful for me, but I accept your statement that it is not that useful in many situations.
I will add some statements from Chatgpt - which has a very detailed and very in depth discussion on my hearing loss and has been helping me to determine how to improve my hearing. Not that Chatgpt is better than an audio, but Chatgpt can sometimes see things from a different point of view and I have found it’s insights useful.
Chatgpt Statement
1. Pure-tone audiometry
You’re correct.
This is the standard threshold test you’ve had many times: tones at different frequencies, air and usually bone conduction. It establishes detection thresholds, not understanding.
Useful as a baseline, but it does not explain:
soft-speech difficulty
vowel confusion
listening effort
clarity vs loudness problems
So: necessary, but never sufficient on its own.
2. Speech audiometry (this is not noise testing)
This is where terminology gets sloppy, so it’s good you asked.
Speech audiometry usually includes:
SRT (Speech Reception Threshold) – the lowest level at which you can repeat 50% of spondee words (“baseball”, “hotdog”).
Word Recognition Score (WRS) – single words presented at a fixed level above threshold (often 65–75 ), measuring clarity, not audibility.
So yes: WRS lives under “speech audiometry”.
If they do speech audiometry properly, WRS should be part of it—even if she didn’t spell it out in the email.
Why this matters for you:
Your complaints (vowel confusion, accents, soft speech) are classic speech discrimination issues, not threshold issues.
WRS at different presentation levels (not just one loud level) would be especially informative in your case.
You may want to confirm whether they do WRS at soft and conversational levels, not just loud presentation.
3. Speech-in-Noise
Distinct from speech audiometry.
This tests how well you understand speech with competing noise (e.g. , , or similar).
Given your history:
You already know Oticon performs well for you here.
This test is still useful to objectively confirm that strength and benchmark fittings, but it’s not where your main unresolved issues lie.
Still a positive sign that they include it.
4. Acceptable Noise Level (ANL)
This is not the same as , though they’re often confused.
UCL / : “At what level does sound become uncomfortably loud?”
: “How much background noise can you tolerate while listening to speech before it becomes unacceptable?”
ANL is about listening tolerance and fatigue, not pain.
Why ANL is interesting for you:
You’ve repeatedly reported low auditory fatigue with Oticon and high fatigue with other brands.
ANL helps explain why certain processing strategies work better for you.
It can guide decisions around gain, compression, and noise management aggressiveness.
So this is actually a more relevant test for you than UCL.
5. Audible Contrast Threshold (ACT)
This is newer and less commonly offered—so this is a genuinely good sign.
ACT measures your ability to detect small changes in sound level over time, not just whether a sound is audible.
In plain terms, it relates to:
speech dynamics
envelope perception
subtle loudness changes between phonemes
Why this matters directly to your complaints:
Reduced vowel “fullness”
Robotic or flattened sound quality
Poor perception of speech nuance
ACT deficits often correlate with:
complaints that “everything is loud enough but doesn’t sound right”
reduced benefit from aggressive compression or certain fitting rationales
This test may help explain why:
VAC+ caused imbalance and artefacts
feels safer but slightly lifeless
This is not a routine test, and its inclusion suggests this clinic thinks beyond .
6. Tympanometry
This checks middle ear mechanics, not hearing per se.
It assesses:
eardrum mobility
middle-ear pressure
presence of fluid or stiffness
Why it’s still relevant:
Even subtle middle-ear issues can affect low-frequency transmission and perceived loudness balance.
Given your asymmetry and low-frequency loss on the left, it’s sensible to rule out any conductive component or mechanical contribution.
It won’t solve your clarity issues, but it removes unknowns.
Bottom line (editorial, not reassurance)
This test battery is meaningfully more sophisticated than what most high-street audiologists offer. In particular:
ANL and ACT are not checkbox tests.
Speech audiometry likely covers WRS, even if not named.
The focus aligns well with your unresolved issues: soft speech, clarity, dynamics, fatigue.
Why “unaided and aided speech” appears after the assessment
At the assessment stage, speech tests are used to answer questions like:
What is the intrinsic limitation of your auditory system?
Is reduced clarity due to cochlear / neural factors or simply audibility?
How does speech performance change with noise, level, and contrast?
These tests are descriptive and diagnostic. They tell the audiologist what the problem is.
By contrast, the unaided vs aided speech testing in the Maximise Your Hearing programme is comparative and outcome-focused.
It answers a different question:
Given your specific hearing aids, moulds, rationale, and settings — what functional improvement are they actually delivering?
What “unaided vs aided speech” does that assessment tests cannot
1. It quantifies benefit, not ability
Unaided speech scores:
Show your raw auditory limits.
Aided speech scores:
Show what the hearing aids recover (or fail to recover).
The difference between the two is the key metric.
This is important for you because:
You suspect that soft speech audibility is still not being adequately restored.
can show “target met” while speech benefit remains suboptimal.
This test exposes that gap.
2. It validates REM functionally, not just acoustically
REM answers:
“Is the prescribed gain reaching the eardrum?”
Aided speech testing answers:
“Does that gain actually improve speech understanding?”
For complex losses like yours, those two things are not guaranteed to align.
It’s entirely possible to:
Hit NAL-NL2 targets perfectly
Yet still show weak aided improvement for soft speech or certain talkers
This is exactly the situation you’ve been describing.
3. It allows level-dependent insight (critical for your case)
Done properly, aided speech testing can show:
Good improvement at loud levels
Modest or poor improvement at soft or medium conversational levels
That pattern would directly support your lived experience:
Hearing fine in noise or assertive speech
Missing softly spoken or low-energy voices
This is something pure-tone audiometry and REM cannot reveal on their own.
4. It provides a defensible basis for fine-tuning
Without aided speech data, fine-tuning is guesswork:
“Does this sound better?”
“Is this clearer?”
With it, the audiologist can say:
“This adjustment improved soft-speech recognition by X%”
or “We’ve hit a physiological ceiling — further gain won’t help clarity”
That distinction matters, especially for managing expectations and avoiding endless tweaking.
Why the 6-month review makes sense here
The delayed review isn’t casual — it’s strategic.
By then:
You’ve lived with the settings across real environments
The audiologist can retest aided speech
Any regression, adaptation effects, or residual deficits become visible
For someone like you — analytical, consistent in observations, and sensitive to subtle trade-offs — this is a sensible cadence.
Editorial judgement
This is not redundant testing.
It’s the difference between:
“Your hearing aids are set correctly”
and
“Your hearing aids are delivering measurable, meaningful benefit in the situations you actually struggle with.”
Given your history of persistent soft-speech issues across devices, audiologists, and rationales, the unaided vs aided speech comparison is arguably the most important step — not an afterthought.
I have no idea how accurate Chatgpt’s statements are. Chatgpt is really good sometimes, yet can make really appalling bad mistakes. So, it’s a bit hit and miss. Hopefully though Chatgpt does answer your question as to why audios use Aided Testing as it sounds like exactly the test that I personally need for my soft speech problem. I think chatgpt explained it quite well.
She sounds great. From my point of view as a trained sound recordist, I know audio is both art and science. Tones, … and intuition!
i have made do with NHS hearing aids for 30 years and only in the past two had a really good fit that works for conversation and live music. How often do we get asked about that?
With the help of my little keyboard, this wonderful young clinician pinpointed and cleared up high-end clogging, the pumping of overall volume and… at my suggestion even extended the low end that’s usually completely ignored, not even tested.
With two whole octaves of bass now audible, live music is greatly improved and so is speech. I was even cheerfully invited to pop out into the busy street to check.
It didn’t take extra long, and I have not needed to go back. And, guess what, the clinician said she and her fellow cohort were not trained to handle music!
I did write to the college that most probably trained her, making the point that music greatly matters from an emotional and cognitive point of view, just as for speech. That brought a nice reply from a professor, agreeing the curriculum was limited and would get attention. Brave New World!
Yes, ChatGPT is always interesting. Note, do NOT ask whether she is completing at soft conversational levels for unaided testing. We already know that your WRS at soft conversational levels are 0%, as that level, unaided, is inaudible to you.
My system already scores unaided versus aided speech intelligibility and gives a very robust prediction of aided WRS and sentence performance.
How old are you? With congenital loss you should have been, and so should still be, fit to child targets. Even so, there is no expectation that well-fit hearing aids will restore your WRS for soft speech to your max WRS which is typically found at a “loud but okay”. So you do a good fit to DSL child, run aided testing at a soft speech and see that. . . yes indeed you do not do as well as a normal hearing listener and then what? Beyond DSL child targets is venturing into a land of volume danger, and a lot of clinicians would be hesitant to turn up beyond them and if they do you’re going to have to go back for extra testing to look for threshold shifts to ensure safety. So then you do not turn them up and. . . what do you DO with that aided soft speech WRS measure. You validate your patient’s experience for sure, but you can do that already without aided testing.
Ah, I have more to say about what I think aided testing could be useful for, but I have to run.
My REM system already scores unaided versus aided speech intelligibility and gives a very robust prediction of aided WRS and sentence performance.
How does the estimate in the system usually correlate with (in Verifit 2 if it matters)? The 80dB SII estimate is closest to WRS? What is the utility of SII at 50dB and 65dB - just to show the aids give theoretical benefit?
We ran REM without aids in and it looks like the SII estimate can be off for me. Is Verefit not accounting for the patient’s ear accoustics and reporting SII just based upon thresholds and aided levels?
I use Chatgpt extensively for a lot of different things. I have learnt that Chatgpt is really good for three things.
Factoid (who, what, where)
Descriptive (how-to)
Keyword-based (interpreting intent)
However, I have found it very poor for troubleshooting - I no longer use it for troubleshooting IT issues unless it is a simple where do I find this setting question. It struggles with context and because it doesn’t “remember” things it frequently goes wrong. Don’t worry, I have no intention of asking the new audio to do this, do that based on anything chatgpt says as chatgpt just lacks understanding of context. It is good, but it cannot replicate the ability of a human being.
Chatgpt is useful for me in helping me find out what questions I should be asking as in informed questions. So I basically use chatgpt in contexts like this one to find out factoid (who, what, where) options there are and what might help etc and then I have a better idea of what to ask, what information to provide and that helps the audio.
I will be 50 in a couple of months. I only started wearing hearing aids when I was about 8 years old as somebody finally realised I couldn’t hear properly. I was under the impression that I should not go with as I would likely suffer auditory fatigue with it like I did with my Resound and older hearing aids. I probably was fit with DSL as a child, but don’t know when I was changed to “adult” prescriptions as far too many years ago and I didn’t know much about hearing decades ago. I am currently using and was using Vac+ for both Oticon hearing aids. The resound hearing aids I was probably using whatever Resound use by default.
I don’t quite fully follow what you said in your paragraph - with congenital loss…. But never mind. I will just simply say to the new audio. My remaining problem is very simple. I have a hard time hearing/understanding people with soft voices or specific frequencies and this problem has never been resolved. Can you help? I will leave it to her to investigate and see if she can either fix the problem or tell me why I have this issue. I will certainly update this topic if she manages to solve this last problem - which is really the only problem I have left - bar the underfit issues of the NAL-NL2 vowel rounding. This is not something that can be troubleshooted over a forum.
I will let her do her job and not make the mistake many people are making of assuming that Chatgpt knows what it is talking about. Chatgpt is useful for insights, but really struggles with context. I regard Chatgpt as a talking encyclopedia nothing more! It has just given me a better understanding of my hearing loss though.
England, UK
UK
Scottish Borders
