I am frequently asked by my musician clients if they can have control over my software programming tools when fitting and adjusting their hearing aid. At this point I usually look over my glasses frame and, with my best paternalistic look, I say “no”. At this point they get impatient with me until I explain in a calm and professorial voice, “You are too stupid to understand what you will be doing.” And for some unexplained reason, they either storm out of my office, or more often, hurl some really colorful words in my general direction.
But now after years of having this happen to me, I wonder, was I wrong? Perhaps musicians (and indeed the hard-of-hearing public in general) do know about some things that I don’t. Perhaps they can do as good a job as I can in adjusting their hearing aids. This has implications, not only for musicians, but for anyone who has access to Internet-based software tools and can find a way to program their hearing aids (or Smart phones).
We are already in an era where Internet-based software can enable people to adjust their personal amplifiers, or even Personal Sound Amplification Products (PSAPs), using some mode of coupling, possibly via their Smart Phone with Blue Tooth-enabled PSAPs.
Short of abrogating all of my responsibilities as an audiologist, what are some electro-acoustic parameters that I wouldn’t mind giving up control over–perhaps something patients could experiment with at home and while playing music… but that would not allow the aided musician to experience any “harm”.
The one parameter I would not give up control over is the maximum output of the hearing aids (OSPL90). This parameter has to be fit according to an individual’s frequency-specific tolerance levels and this is something that only a hearing health care professional can fit.
As far as the other parameters are concerned- compression characteristics, frequency response, and gain settings, I am a bit more casual about them. After all, the worst case scenario is that the hard-of-hearing musician comes back to my office with his tail between his legs.
Setting gain is really no different from setting the volume control on a radio. Setting the compression characteristics- albeit more complex than gain- is also something that hard-of-hearing musicians can “play” with in various listening environments. If they did, indeed, have control over the amount of gain for soft, medium, and loud sounds, they could experiment for hours- something that a typical clinician would not have time for. We could make it really easy by just giving them control over the compression ratio, which given the gain, and pre-selected output, they could play with in various frequency bands. And we could suggest some “guiding principles for music,” such as never let the compression ratio exceed 3.0; use similar attack and release settings for both speech and music; set the gain and the maximum output for the music program about 5-6 dB lower than that chosen for the speech-in-quiet program.
Frequency response is even simpler and virtually every single musician, or audiophile, I have ever seen has played extensively with the settings on their home MIDI system. The reason it’s a simple setting is that there is no inherent reason for the frequency response of a “music program” to be set any differently from that for any of the various speech programs. The frequency response has more to do with the audiometric features than with the nature of the input to the hearing aids.
I would even offer to give them a quick summary based on the work of Doctors Todd Ricketts and Brian Moore: for milder losses, and losses with gradually sloping audiometric configurations, set the frequency response settings as wide as possible (i.e., more is better). For more severe losses (> 60 dB HL) or if the audiometric configuration is steeply sloping, then a frequency response that has limited high end would be better (i.e., less is better). This has nothing to do with the nature of the speech or music entering the hearing aid.
If, indeed, a complete audiometric assessment was performed, the resulting frequency response for a speech program could be set, and then the musician would be free to play with the frequency response for the music program. I would be willing to wager that the ultimate frequency response (given the limitations of modern hearing aids) for the music program would be similar to that of the yet-to-be-programmed music setting.
So, to allow a musician to set up their own music program, really all an audiologist need do is:
- Educate the musician in some general audiological principles
- Pre-set the OSPL90
- And maybe set the parameters for the speech-in-quiet program.
I know that some of you out there find this heretical and my gut tells me that this is also the case for me, but I think that a discussion of these issues is worthwhile before too many more clients walk into our offices demanding more control over some aspect of their hearing aid fittings.
I ask my self-program patients to leave the adjustments of the “Everyday” and “”Restaurant” settings up to me as adjusted in the office or remotely via Telehealth; while I give them free reign (except as you do for MPO) over their music setting. Generally, I uncompress the gain on the “Music” program (i.e. set the gains at 50, 65 & 80 dB input closer together) to enhance the dynamic range.
However, in my own experience, as part of my admonishment to leave the speech and speech-in-noise settings alone, I counsel the patient that “the settings that deliver the best speech perception are almost always NOT the settings that deliver the best sound quality, as your ears prefer too much low frequency gain to sound ‘good,’ but that mucks up your speech perception, especially when it’s noisy.”
We do this now at Blamey Saunders – musicians love it. But we also have a robust tele-audiology service to support anyone who wants a bit of help. And we provide self monitoring tools.
By the way, I use your book all the time.
I have been a musician for over 60 years. I have experience working in a major music studio. I have been working in digital audio production since its inception and I had one of the first DA systems (Sound Designer – pre Sound tools). I have a progressive loss that is now at the profound stage. I have been adjusting my aids through 5 pairs – beginning with Siemens Signia to my Resound Verso 9. Most of my knowledge on this is gained through educated guesses, applied audio engineering principles, and trail and error.
I think the article leaves out a huge part of the qualifications, and this is a practical knowledge of audio production and engineering, and equipment to accurately produce real world sounds at real world sound and dynamic levels. You can’t expect a musician who has a great ear and skill, to have a grasp the principles of audio engineering. It is very easy to tweak something at home and think it is “it”, then go out and find, on stage, that what I thought was right just made a mess that I have to deal with through a performance. I have a process that I use to set my aids at home, but I have a small scale music production studio, with a sound system that I have EQ’d to be flat in the room up to 102db. I have hardware 24 band EQ’s and a hand held db meter, a software Real time analyzer, a lot of music and uncompressed sound samples. Further, my HA software is on a laptop, so I can go out to places with difficult sound environments, and adjust in the field. It is not an easy task, and it must be approached very methodically. I do not advise self adjustment unless the person knows audio production techniques, and has the proper gear. Being an accomplished musician does not equate being an accomplished audio engineer.
I really wish that musicians did not have to resort to self adjustment, but with the state of things it is a “rock and a hard place” decision. IOW, which is worse? You can’t expect an audiologist to play back compressed orchestral passages through 4″ speakers in a sound boot at conversation levels and call that acceptable. I believe that setting aids for musicians can be done with accuracy in office by an audiologist, but the whole process needs to be revamped from bottom to top, to make that work.