On the Science of Audiology from a Client Perspective – Part 1

Charles on guitar

For this two part blog entry, I have asked Charles Mokotoff to chime in.   Charles holds Bachelor’s and Master’s degrees in guitar performance from Syracuse University and Ithaca College, respectively. He has served on the faculties of numerous colleges and universities in New York and the New England area as a lecturer in classical guitar and lute. Prior to settling in the Washington, DC area in 1991, Mr. Mokotoff made his home in New England where he was widely recognized as an active guitarist and lutenist. During that period his career culminated with two Far East tours and a well-received New York City debut at Carnegie Hall in 1987. Solo and ensemble recitals over the past few seasons have centered around the Mid-Atlantic states, but include performances in Chicago, Boston, and most recently two performances at the Lincoln Center Performing Arts Library in New York City. Charles Mokotoff is an audiologist’s worst nightmare and an audiologist’s greatest teacher.  Charles is a hard of hearing musician who is as at home with computers as he is with his six-stringed classical guitar.  The points that Charles makes with respect to changes in fitting algorithm and to speed up technology so that modern hearing aids can take advantage of apps have been hotly debated by the hearing aid industry and clinical audiologists. I have invited Charles to submit this two-part blog about his experiences and his opinions of what might constitute a more optimal hearing aid for him and his musician colleagues.

I have been a hearing aid user for the past 44 years, which puts me in the small minority of those requiring amplification to get around in the hearing world. When you combine that long experience with my background in software programming and my former profession as a touring classical guitarist, you end up with an atypical audiology client who requires a great deal of care. I understand this; in fact I am well aware of the fact that a “typical” client in an audiology office would be someone probably over the age of 70 who is being fitted for the first time. This patient will be given a much more sophisticated instrument for their first go-around with amplification than I ever had. I vividly recall my first aid, only one–for some reason two aids were not recommended for me in 1970. It was a large behind the ear analog aid and the controls were simply volume and on/off. Today’s patient will require several office visits to treat them effectively, but after the initial fitting and follow up, their visits should trickle off.

My story is anything but typical. I have been wearing a pair of “high tech” hearing instruments for the past two years and I would estimate the number of visits to my audiologist to be in the neighborhood of 30 since getting this set of aids. The first 10 or so were in the very beginning as many changes were required during my first few weeks. Things stabilized but now, two years later, I am still going to the office to straighten out and correct issues. For example, the automatic program, the first on the hearing aid which contains a suite of other programs automatically called based on external stimuli, is fixed; it can be altered but not removed. I found that the aid was switching too frequently between the programs within it. Even with the sensitivity set to the lowest possible option. I have asked my audiologist to create a new program that is identical to the first setting in the automatic program but does not switch. So at that point there became two programs. Despite the fact that that the automatic program contains “speech in noise” and “music” settings that are brought up automatically, I have to be able to get to these on demand, not when the automatic program “thinks” the time is right.

For my lifestyle I need to be able to manually switch to these when I am in a noisy place, or listening to music, so that makes for two more stand-alone programs which, including the program for my phone, makes a total of five.  That’s a lot of switching around. To be completely fair, I know of a few audiology patients who have only the automatic program. The aids switch for them as needed (including going into phone mode directly when a handset is placed nearby) and they are perfectly happy. But as a musician and long-time user of hearing aids with a very substantial loss, this just doesn’t work for me, I have never felt the programs were called up correctly at the right times.