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.
I like to tell people that hearing loss isn’t only hearing less, it’s hearing differently. It doesn’t matter how loud the sounds are amplified. In my right ear, sounds above 4000 hz sound like hisses.
Hello .. thank you so much for this information … Most of people said to me that I have problem in my brain and not my ear because sometimes I can hear soft speech and sometimes I couldn’t get what they say even if they scream so they tell me this “your brain is or you are no concetrating to what we say” … I don’t know if there are a relationship between hearning problem and concetration .. eventhough I give all my all to concetrate trying to get what they are saying they say it out loud or in a soft way I don’t descriminate the speech … and in other times of two people speak in front of me I can’t keep up with them I dont know if I lose the energie or hearing problem :/ so I am always confused
Hi Rima:
It sounds like you are doing all you can–really concentrating to hear/understand people talking–yet you still can’t understand all you hear. This is perfectly normal when you have a hearing loss. And the worse your loss, the greater difficulty you’ll have. I’m in the same boat. I use my hearing aids and speechread and really concentrate and yet I still miss a lot depending on the situation.
Like you say, sometimes you can hear a whisper and other times you can’t hear a person yelling. It is all because of the exact environmental factors in play in any given situation. Hearing people just don’t understand how difficult it can be for us. It may be the tone of voice, the pitch of voice, the volume of speech, a person’s accent, the distance they are from you, any background noise, the number of people talking, etc., etc. that affects our ability to understand speech in a given situation.
It’s not your fault. It’s just the way damaged ears work.
Cordially,
Neil
Hi Neil, I searched your site and can’t seem to find info on when real ear testing became available.
Seems like the technology would have come along about the time of digital hearing aids and computers. But maybe there was some earlier technology?
My hard of hearing mom who’s 75 never benefited much from hearing aids until digital came along. I’m wondering if a real ear test was even an option before the 90’s or early 2000’s. Your thoughts would be much appreciated.
I may have found my answer on Wikipedia. Earliest version in the US in the mid 80s.
Hi Beth:
That’s because I haven’t written about it. Guess no one ever asked me that question before. Real Ear Measurements (REM) actually predated digital hearing aids by more than a decade. The first REM unit came out on or before 1984, yet the first truly digital hearing aid didn’t come out until 1996—12 years later.
Cordially,
Neil
Hello Dr Bauman
Thanks for your article. The information you provided about compression of sounds was very educational and helpful. However I have a question about new aids (Phonak, Resound and Oticon) versus one that a user us already wearing. I am profoundly deaf in my right ear (hearing aids don’t work) and severe to profound on my left ear. I’ve been wearing a BTE for most of my life. Whenever it was time to get a new aid, I just went to the audiologist, got fitted and walked away happy (more or less) I’m now very concerned though because I’ve been wearing an Oticon Chili for the past 5 years and seeking a replacement. I’ve been fitted (and I do believe real ear testing was used as the audiologist did insert something with the hearing aid during the fitting. However with the new Phonak, Resound and now trying new Oticon… I noticed speech is no longer “clear.” It almost sounds like people are muffled or talking to a tunnel… After wearing each of the new aids, I kept having to put my Oticon Chili back in to “hear better.” I’m worried because I think I’m coming across as a difficult client but the new aids just don’t sound right.
Would this be due to the compression? If it is, is it possible to ask the audiologist to not compress or what options do i have?
Catherine
Hi Catherine:
There could be several factors affecting your hearing.
1. Your brain needs time to get used to the new hearing aids. It can take up to 90 days. Since the new aids have different programming, you may just need to give your brain more time to get used to how speech now sounds. I don’t really think this is the case though–at least not to a great degree.
2. The hearing in a tunnel (or barrel) is called the occlusion effect. This can be “fixed” by having vented earmolds. I’m assuming you are wearing new earmolds with the new aids. If they don’t have vents (and they may not want to give you vents because of your severe loss so they don’t feedback), you experience this quality of sound. This is a good possibility in your case.
If you can wear your old earmolds with the new aids and still get this “tunnel” sound, then that is not the problem, but if it goes away when wearing your old earmolds on the new aids, then you know it is an earmold problem.
3. The compression may be set differently than you are used to. If your old hearing aid was set to linear compression (essentially no compression), then sound will be different if they use compression. You should have them see how your old aid was programmed and program your new aid to the same kind of compression and see if that fixes the problem.
4. To prove whether you understand speech as well with your new aid as with your old one, have them to the word recognition test first with your old aid, and then with your new aid, and also without wearing any aid.
Your word recognition score with no aid should be the baseline. If your old aid gives you the same or better scores, that is good. If your new aid doesn’t do as well as bare ears or your old aid, then you know they need to program it differently to increase your word recognition score to where it should be based on bare ear testing.
So there are 4 things you need to try/consider. Go over them with your audiologist and see whether any of these make things sound more normal to you.
Cordially,
Neil
The speech is loud enough but for each word spoken in a conversation there is a buzz on top of the word which almost drowns out the word.
I try, in my brain, to filter out the buzz to make out the underlying words but like I said the completion between the buzz and the word is very profound (pronounced). Loud if not louder than the spokenword itself.
In a casual small round table conversation each word spoken by others is accompanied by that same buzz . Interestingly the buzz is monotone and of one pitch. So you can imagine my difficulty trying to concentrate on the underlying word spoken to me during a one on one conversation.
One other point. When I speak I have the same buzzing note attached to my word(s).
I feel there is something wrong in my ear canal, Eustachian tube or sinuses. I can no longer distiquish pitch in music because of the interference of that annoying buzz sound.
Let me make it clear: the buzz sound is heard word for word and is not a steady sound like tetanus is.
This just happened out of the blue overnight.
I do have hearing aids but they don’t help at all to eliminate the buzz sound all it does is amplify everything. Almost to say it is worse.
Hi Bill:
Let me get this straight. One day you woke up and now you hear a buzz attached to each word you hear and sometimes to your voice as well, correct? This is wihout wearing hearing aids, correct?
But if you wear your new hearing aids, it just makes it worse, correct?
If this is the case, then it has nothing to do with your hearing aids so they are off the hook, and thus, there is something gone wrong in your auditory system.
Why do you think the problem is in your ear canal, Eustachian tubes or sinuses and not something wrong in your inner ears.
Another question. Is this in both ears or only one ear?
How long ago did this happen?
Were you on any medications or drugs in the weeks before this happened, or did you change the dose on any drugs before this happened?
I’ve never heard of a buzz attached to words before–apart from people who are being mapped for cochlear implants. But I do know that a number of drugs can mess up your pitch perception. That is why I suspect it may be a drug side effect problem.
The more you can tell me about this, the more chances I’ll have of figuring out what may be going on.
Cordially,
Neil
Thank you for responding to my hearing issue. I appreciate it very much.
Yes to both questions in the first paragraph.using hearing aids the speech and the buzzing is just louder.Yes I believe it is auditory but what I think must be weird is that I get the same sensation when I’m speaking. Just guessing about E.T and sinuses but why and where in my head is causing this effect must be physical I think.This happened about 2 years ago after I was on an 8 hour rail trip with lots of wheel and rail banging that was very very loud, I thought nothing of it went to bed that evening and next morning there was a new world of awareness out there.i am on 2 drugs for a long time Tamsulosin and Valsartan. I had perfect pitch before and now I have none.Take common songs like the National Anthem or Happy Birthday I cannot appreciate pitch in hearing nor can I create or distinguish pitch when I sing them.If I can rid myself of the buzzing I think I would be able to engage conversation successfully. Can you imagine my understanding of conversation one on one when others are engaged in their own exchanged and i am getting buzz from them too.Thank you
Thank you for responding to my hearing issue. I appreciate it very much.
Yes to both questions in the first paragraph.
using hearing aids the speech and the buzzing is just louder.
Yes I believe it is auditory but what I think must be weird is that I get the same sensation when I’m speaking. Maybe its because I am hearing myself speaking.
Just guessing about E.T and sinuses but why and where in my head is causing this effect must be physical I think.
This happened about 2 years ago this coming August after I was on an 2 hour rail trip with lots of wheel and rail banging that was very very loud, then a 3 hr pro noisy ball game then 2 hrs on the rail again to home and bed. I thought nothing of it went to bed that night and next morning there was a new world of awareness out there. I wore my hearing aids the whole time and I think that’s when the damaged happened.
i am on 2 drugs for a long time Tamsulosin and Valsartan.
I had perfect pitch before and now I have none.
Take common songs like the National Anthem or Happy Birthday I cannot appreciate pitch in hearing nor can I create or distinguish pitch when I sing them.
If I can rid myself of the buzzing I think I would be able to engage conversation successfully.
Can you imagine my understanding of conversation one on one when others of the group are engaged in their own exchanges and i am getting buzz from them too.
Thank you
Hi Bill:
I’ve never come across a person with symptoms just like yours, but it seems to have started after you exposed your ears to loud sounds for some hours. Noise trauma can certainly mess up your ears and make you sensitive to sounds in general so they all sound too loud. It can also mess up your pitch perception–especially since you already have some hearing loss.
Does this buzzing happen at all levels of speech, etc. or is it only when speech goes over a certain level? If that is the case, and the buzzing starts as the volume increases, it almost sounds like reactive tinnitus kicking in. Reactive tinnitus is basically a combination of both tinnitus and hyperacusis. Read my comprehensive article on reactive tinnitus and see whether that may be what you have. You can read it at http://hearinglosshelp.com/blog/reactive-tinnitus/ .
Cordially,
Neil
I just got my first hearing aids- Oticon Opns. I think I am adjusting well, except for irritating feedback when I touch my hair in the area of my ears. I really dislike the sensation of occlusion, so we have gone with larger vented tips. The feedback issue is better but not gone. Is this something I have to accept if I don’t want occlusion ? Do you find that most people, if they give it time, adjust to occlusion? It makes me feel like I’m in a tunnel and very removed from my environment.
Hi Sally:
Feedback used to be a serious problem and you learned to keep your hands away from your ears so your hearing aids wouldn’t squeal. However, modern hearing aids have anti-feedback circuits built into them so feedback isn’t the problem it used to be–but you can still make your aids feedback–especially if you need lots of power in order to hear.
Occlusion is another common problem if you don’t have vented earmolds. I know. I wore unvented earmolds for many years. Vented earmolds cut down on the occlusion, but increase the chances of feedback. Thus, the trick is to use the largest size vent (to cut down occlusion) that will not allow feedback. I used to have earmolds that had a large vent hole and then a number of plugs with different sized vent holes in them so I could select the exact size of vent hole that worked for me.
Over time you do get used to occlusion so you no longer notice it. At least that was my experience. Currently, I wear unvented domes and really like them. I only “feel” the occlusion effect when I first put them on–especially if I push them in without letting the air escape. You don’t want to build up pressure in your ear canal because that makes the occlusion worse. But once I’m wearing them for 5 minutes, everything sounds normal to me again. So I think you can get used to them too.
You might want your audiologist to cut down on the low frequency amplification a bit and see if that reduces the occlusion effect as it is caused mostly by the lower frequencies.
Cordially,
Neil
Will stem cell therapy eventually be a reality? I have ringing in one ear from swimming and allergies. I can hear OK in conversation, but not with certain people with husky ex-smokers. I will get hearing aids, especially as a birder, I want to hear the high-pitched birds. I do take supplements which might be helping. I think diet plays a role and of course anit-biotics. Yes, I did take Cipro once. Are the EMFs an issue in hearing aids?
Hi Anne:
I think stem cell therapy will become a reality in a few years. How well it will work is still open to question. I doubt it will ever give people totally normal hearing–but it should improve hearing significantly. Who knows–you may still have to wear hearing aids to get closer to normal hearing.
At this point, I haven’t heard of any definitive research that proves or disproves that EMF from the new hearing aids is a health problem or not.
On the one hand, the power output is very low (so that is a good thing), but on the other had, they the EMF is generated right at your head (and that’s a bad thing). I think in practical terms, unless you are very sensitive to EMF, it probably won’t be a problem–at least in the short term.
It’s going to take time to study the long-term effects of low-power EMF signals generated right a a person’s head (brain).
Cordially,
Neil
I have reverse curve hearing loss in both of my ears and the loss is almost identical in them. I didn’t notice hearing problems until I was in my 50s. I am wondering what the most likely cause could be and is it worth finding out why it happened. I didn’t get hearing aids until several years later and they do help with some things but I am having a hard time understanding men in particular. Is there something you think my audiologists could program differently?
Hi Candace:
Have you read my comprehensive article on reverse slope hearing loss. I’d highly recommend you do so. It’s at http://hearinglosshelp.com/blog/the-bizarre-world-of-extreme-reverse-slope-hearing-loss/ .
The only reason to find out what caused your hearing loss (apart from curiosity) is if you are going to do something different once you know. So, personally, I don’t see any benefit since you are still going to be wearing hearing aids.
In my experience, most cases of significant reverse slope losses are hereditary and typically they are non-syndromic–meaning there are no other conditions attached to this kind of hearing loss.
In the above-mentioned article, near the end is a section with guidelines on how to properly program hearing aids for people with a reverse slope loss.
Cordially,
Neil
I’ve been wearing a pair of Phonak aids for about 11 years. My hearing loss is progressive and a few weeks ago I went in for reprogramming. I could hear most sounds at a moderte level but was losing speech even when standing close to the speaker and concentrating. The audiologist felt he could help my situation. However, after programming I am worse off than before. Every noise is loudly multiplied and strangely distorted. For instance, my wife is a pianist at church. She plays a fine grand piano. The sound of the piano was previously rich and musical. Now it is distorted and almost painful. Every chord she plays sounds like someone hitting a piece of sheet metal with a hammer. And the worst thing is – despite all this extra volume – I still cannot understand most speech.
Hi Bill:
You need to go back to your audiologist or hearing aid dispenser and tell them they made things worse and to give you back your previous program that at least worked properly some of the time.
Sometimes programming hearing aids involves treading a fine line between making things loud enough to hear, and making sounds clear enough to understand. So you may find you have to compromise a bit–but what you describe is totally ridiculous. You need to find someone that knows how to properly fit hearing aids.
Cordially,
Neil
I have fairly new octicon rechargeable aids. I still miss a lot if people have accents or if they seem to mumble or have certain pitch/tone to their voice also listening to talk on T.V.
Wearing face masks inhibits as well. I now find I’m anxious because I can’t hear all that is said and I can’t keep asking people to repeat. Would most audiologists have the real ear measurement equipment?
Hi Ellen:
Just phone your favorite audiologist and ask her if she does. If she doesn’t, just phone another one. If I remember correctly more than half do have the necessary equipment. Whether they regularly use it is another matter.
Cordially,
Neil
Hi Ellen:
Many hard of hearing people have a lot of trouble understanding people with accents. Hearing aids aren’t perfect so you will still have problems with accents.
However, you want your hearing aids adjusted to help you understand speech as well as possible and real ear measurements really help you get the best settings. I’d hazard a guess that at least 50% of audiologists have real ear measuring equipment. Whether they use it or not is another matter. Just phone them up and ask. You’ll soon find one that has it and uses it.
Cordially,
Neil
Dear Dr,
I am from London, UK.
I have a cookie bite hearing loss, 40-70(moderate?), both ears. I am waiting for my new hearing aids as the hearing loss has progressed. My concern is even with hearing aids, I can’t understand speech. I can hear the person’s voice clearly but the speech is muffled. Audiologist said I need a more powerful hearing aids. She didn’t bother listening to my concerns. Amplifying the volume won’t help. The unwanted loud sounds have given me migraine and dizziness (which I never had before). I have stopped wearing them and have started speechread. I feel more comfortable without them. I’m worried that the new hearing aids will make more harm than good. Your advice is very much appreciated. Thank you.
Hi Jamela:
It’s not the hearing aids themselves that are the problem, but not fitting them properly to your hearing loss AND the way your brain processes sound. Since the vast majority of people have ski-slope losses of some kind, hearing aid manufacturers and audiologists make and fit hearing aids to this kind of loss and know how to do a pretty good job of it.
However, when encountering people with cookie-bite, reverse cookie-bite and reverse slope losses, they basically treat them mole like they do ski-slope losses, and that just doesn’t work. In your case with a cookie-bite loss, and mine with a reverse slope loss, they typically put too much amplification in the wrong frequencies and that can give us headaches and sometimes balance problems too.
You could also have other underlying hearing loss (hidden hearing loss) issues that mess up your understanding of speech. When you say you can’t understand people talking when the volume is adequate to clearly hear their voices, is this true in quite situations where you are talking to one person, or is it true when you are in groups and trying to understand one person amongst the “party babble” around you? Or all the time? If you understand well in quiet and not in noise, you could have hidden hearing loss and it is hard for hearing aids to correct this.
You also have some recruitment kicking in due to your sensorineural hearing loss, plus you may have some degree of loudness hyperacusis. Both of these conditions make certain sounds seem unbearably loud, when in actual fact, they are not near as loud as you perceive them to be.
Rather than you audiologist fitting your hearing aids to your specific hearing loss (which they are trained to do), you need your hearing aids fitted to how you brain wants to receive sound–and that may not be the optimal level as shown on your target for your hearing loss.
Furthermore, you probably need more compression at certain frequencies than is being provided. Proper compression by frequency lets you hear softer sounds at that frequency, while limiting louder sounds to fall within your comfortable listening level.
Since your audiologist won’t listen to your concerns, probably you need to find another one who does and is willing to work with you to make sounds clear, but at the same time not to loud for you to stand. You should NOT get headaches from wearing properly-fitted hearing aids.
Cordially,
Neil
Thank you for replying to my hearing concerns.
Even with adequate volume, I can’t understand speech, all the time. I struggle a lot with and avoid social interactions. I can’t understand my husband and 2 sons. I hear what they are saying but the speech is all mixed up. I can’t hold a conversation. I also find some words difficult to pronounce. I don’t know who I should ask for help. I also have allergies and wonder if the allergies are also factors contributing towards the hearing loss? I’m very grateful to have found your blog. It has answered some questions.
Hi Jamela:
There are two possibilities that come to mind.
First, you could have an auditory processing disorder. This can make it difficult to understand speech as you are finding.
Second, you could have a hidden hearing loss that makes it difficult to understand speech if there is any competing noise around. This is often caused by exposing your ears to loud sounds in the past.
I doubt that your allergies are causing this from what you have described.
You need to find either an audiologist or ENT doctor that is knowledgeable about auditory neuropathy and auditory processing disorders. They are the people that should be able to help you the most.
Cordially,
Neil