On the Science of Audiology from a Client’s Perspective- part 2

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 algorithms and to speed up technology so that modern hearing aids can take advantage of apps have hotly been 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 an optimal hearing aid for him and his musician colleagues.

Part 1 can be found by clicking this hyperlink.  Part 2 is more applied.  And, speaking of applied, Dr. Doug Beck and I will be co-guest editing the August 2014 issue of Hearing Review and … and wait for it…. it is all about musicians.  There are two very practically oriented articles in it by Richard Einhorn and Larry Revit.  Be sure to catch that issue.

In a classic scientific environment, only one variable is changed at a time and the same experiment is performed so the effect of that change can be carefully gauged.  But this doesn’t always work in the audiologist’s office, and it often makes little sense to effect one subtle change and ask a client to go out into the world (hopefully to that exact same seashore where he or she heard that whistling sound) and see if it stops now. It’s just not feasible. I think it makes sense to tweak various programs in one visit, because these should not affect the others.  Like the sound of program 3, the audiologist simply rolls back the programming to the earlier date.  But what was performed, what change was made then may or may not be noted.

The roll back will also necessarily remove the change I would like to keep. This is an untenable situation in any other scientific environment. This inability to program in a more granular fashion is clearly not systematic and leaves plenty of room for improvement. I am well aware of other companies that are allowing patients to do their own programming, but at this point, that is quite rare and means responsibility for liability, user education and live technical support that many companies may not be ready to accept at this time.

Allowing patients to tweak via their hand-held phones is a step in the right direction and long overdue. I predict that the days of carrying around an external volume control will soon be over. As the hand-held devices become more and more sophisticated, there is every reason to use them for this role as well. Hearing aids will just have to be manufactured to be compatible with phone apps.

As technology marches on, we users of sophisticated amplification are sure to be the beneficiaries, provided that hearing aid manufacturers and audiologists are quick to assimilate and assess the needs of the patient. This also means realizing that listening to music at high fidelity is not just an add-on; for some of us it is a crucial aspect of our lives. If ever there was a time for user interface acceptance testing via actual hard of hearing users, it is right now.

About Marshall Chasin

Marshall Chasin, AuD, is a clinical and research audiologist who has a special interest in the prevention of hearing loss for musicians, as well as the treatment of those who have hearing loss. I have other special interests such as clarinet and karate, but those may come out in the blog over time.

1 Comment

  1. Hello from California.

    Unfortunately I have not been able to try Widex Dreams. As many have already noted the other brands don’t cut it due to clipping/distortion etc. or problems due to internal electronics failing.

    I still wonder why audiologists don’t have a graphic equalizer sound machine to create a test frequency mix that works rather than sending the audiogram to the aid company for them to approximate. So I tried another sort of common sense approach. I used the full piano key board and mapped where I could hear notes and could not hear them. This method worked as good or better than the audiogram up to the limit of the pianos highest note. So I could ask the audiologist to turn up the gain between 1k-2k and down slightly between 2k-3k etc. based on my own hearing perception. This at least made a little difference with aids that I am now using but they still have some distortion issues.

    The clipping/distortion issues have had a real impact on my ability to play in public so I seldom perform or even jam anymore. I noticed that one company still makes class D programable analog aids- I just wondered if any musicians out there have tried this approach.

    Best Wishes-Banjo

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