by Neil Bauman, Ph.D.
January 21, 2017
A man wrote,
I am disappointed with my ability to understand speech with my new hearing aids. My hearing aid dispenser gave me the word recognition test. I scored only 50 – 60% which I don’t think is much of an improvement over my old aids.
Naturally, you always want your new hearing aids to help you hear even better than your old hearing aids did. At the same time, you need to have realistic expectations regarding what your new hearing aids can and cannot do in helping you to hear better.
Hearing aids typically perform three main tasks.
- They make sounds louder.
- They filter out some background sounds so it is easier to pick out speech from background noise.
- They compress sounds so they better fit your dynamic range. This means they make the soft parts of speech louder while at the same time, they keep the loud parts from becoming too loud and hurting.
When you have less than perfect discrimination, such as you have, you cannot understand everything people say. You may hear the sounds with the help of your hearing aids, but your ears/brain can’t always figure out what the word was. Sometimes you hear gibberish, or what sounds like a different word from what was said.
When you get new hearing aids, you hope your discrimination scores will be higher than they were with your old hearing aids. But that is not a given. At the very least, your new hearing aids should give you the same level of understanding as did your old hearing aids.
If they don’t, you can assume that your audiologist/dispenser has not programmed them properly for your hearing. This happens much more often than you might suspect.
One way this can happen is if you need speech compression so the louder parts of words don’t become too loud while still amplifying the softer parts so you can understand what people are saying. Unfortunately, compression distorts speech to some degree and this can mean you don’t understand as well as you should.
This happened to me with one set of hearing aids. I needed a fair bit of compression so the louder parts of speech wouldn’t recruit and hurt. At the same time I needed the softer parts of speech amplified so I could hear them.
When the compression was set so that louder parts of speech didn’t hurt, my speech discrimination went down because of the additional distortion. In like manner, when the volume was set softer so sounds wouldn’t recruit I didn’t need as much compression, but the sound level was now too soft for me to hear speech well, so again, my speech discrimination went down. Thus there was a fine line I had to tread—find the balance between compression and volume. Either way, I had trouble with understanding speech.
For those hearing aids, the best compromise resulted in a 12% reduction in my speech discrimination. Not a win-win situation to be sure, but still better than not wearing hearing aids at all. Thus, no matter which way I had them adjusted, I still needed to do a lot of speechreading to completely understand what people said.
Another reason for not having better discrimination with your new hearing aids is that your hearing aids were not set to fit your hearing prescription. Your hearing prescription is the amount of gain you need by frequency in order to bring your hearing up to where you hear and understand best.
The hearing aid manufacturer’s software selects your prescription based on the results of your hearing tests. It then programs your new hearing aids with this prescription.
What typically happens next is that your audiologist/hearing aid dispenser sends you on your merry way, assuming you are hearing wonderfully well with your new aids. After all, they programmed your hearing aids according to the hearing prescription you need.
This begs the question, “Why are so many people disappointed with their new hearing aids”?
The answer is because your audiologist/dispenser did not check and verify that the hearing prescription you need is what your hearing aids are actually sending down your ear canals to your eardrums. You see, because of a number of factors such as the length, size and shape of your ear canals, what you need and what your hearing aids send down your ear canals are two different things and that makes all the difference.
The only way your audiologist/dispenser can verify that your hearing aids are meeting your hearing prescription is by inserting tiny probe microphones way down your ear canals to “listen” to what your hearing aids are sending down them. This is called real ear testing.
Real ear testing really does make a difference in how satisfied you will be with your new hearing aids. It’s that important. In fact, it is so important that it is one of the “best practices” listed for fitting hearing aids. Even so, less than half of audiologists and hearing aid dispensers actually take the time to do it.
Thus, if you are not satisfied with your new hearing aids, go back and find out if your dispenser did real ear testing or not. If he didn’t, insist that he does. If she doesn’t have the real ear testing equipment, then ask for your money back and go to an audiologist or hearing aid dispenser that regularly does real ear testing. This will give you the best chance of understanding the best you can with your new hearing aids.
Having said that, you have to be realistic about what your hearing aids can do to fix your lack of discrimination. No matter how good your new hearing aids are, and in spite of proper real ear testing, you’ll never hear better than how well your damaged auditory system can process speech. Thus, if your unaided speech discrimination is 50%, don’t expect your new hearing aids to give you 100% discrimination. It just doesn’t work that way. That would take a miracle! Let me explain.
I’m using a visual analogy to help you understand why this is so. Pretend you are looking through a window into another room. Your side of the window is the “hearing aid” side and the other side is your “brain and auditory processing” side. In this analogy, the window is very dirty on both sides so you cannot clearly see (hear) what is on the other side. You and your audiologist/dispenser only have access to your side of the window, so you do what you can. You clean and polish the glass on your side until it is spotless (adjust your hearing aids properly, verify with real ear measurements, etc., etc.). That lets you see (hear and understand) a bit better.
At this point, you have done all you can do, but because the other side of the glass is still very dirty (50% discrimination), you still can’t clearly see (hear) what is in the other room. And since the other side of the glass is in your brain, there is nothing anyone can do about cleaning it either. That is why your new, properly-adjusted hearing aids don’t permit you to see (hear) clearly like you want to. This is just the way it is.
Therefore, you have to have realistic expectations. You need to do everything you can to keep your side of the window clean. The rest is beyond your control. Instead, use your other senses to help fill in what you are missing. For example, use speechreading, writing things down and other visible ways of communicating to help make up for the “dirty window”. You’ll be surprised how well you can do, when you do this.
One final word of advice. Don’t fret about those things that are beyond your control. It will just make you miserable. Instead, rejoice that your new hearing aids help you as much as they do.