Manufacturers build a lot of “help” for us into their hearing aid fitting software. This includes many suggestions for helping our patients hear in a wide variety of listening conditions. But sometimes, you can find a better fitting—a really excellent fitting–by doing a little trial-and-error rather than depending on the manufacturer’s suggestions.
Many years ago I was trying to help a patient, Joe, who loved to bowl. This was back when Widex had come out with a programmable BTE hearing aid called the Quattro. I loved that hearing aid and the remote control that came with it (each program had a separate button). I see remote controls as the greatest research tool ever developed for hearing aids.
AN EXPERIMENT INTO THE UNKNOWN
Joe wanted new hearing aids and was willing to pay whatever they cost if he could wear them in the bowling alley and have a conversation with his friends. When I started this experiment, I really didn’t expect to be successful.
I first fitted Joe with hearing aids and gave him several listening programs to try at home and at restaurants. I also called the factory and talked to their expert. He told me that I could program two different remote controls to operate the same set of hearing aids. He suggested that I use one remote for the “standard” programs, and the other remote for my experimental programs.
The patient loved taking part in this experiment. He had two remote controls and many different programs – five different bowling alley programs in all. He went to his regular bowling lanes, tried all five programs, and took notes about what worked and what didn’t.
It quickly became obvious that none of the “standard” programs were suitable. There was simply too much sound in a program that matched an NAL real-ear target.
I could not think of five different “experimental” programs, so I arbitrarily set Program 5 so that all controls were at the minimum position: maximum low cut, maximum noise filter, maximum high cut, minimum output, etc.
To my absolute amazement, Joe loved Program five, the one that had very little amplification. He was comfortable using this program.
I ran a few real-ear curves on the hearing aids set to the experimental Program Five. They showed that the patient was getting a little useful gain in the higher frequencies, especially the zone of 1000 to 4000 Hz. There was little gain in the lower frequencies.
After fitting Joe, I tested this approach on many other patients and learned a simple, basic fact. We design hearing aid fittings on the theory that we are trying to restore hearing back toward normal. We try to do this by amplifying broad-spectrum sound. This works when the world is quiet. However, this does not work in a bowling alley or in any listening environment that is very noisy. Sometimes, less is better.
A LESSON FOR THE AGES
It has been many years since I worked with the Widex Quattro. In many respects, hearing aids have improved markedly since then. But I will always remember the success of fitting my first “bowling alley” patient.
The technological improvement built into the Widex Quattro remote control dramatically advanced my ability to fit hearing aids. The impossible became possible. Today I still use many of the concepts that I worked out using the Quattro.