hearing aid fitting gus mueller

Cheers to 50 Years! Celebrating 50 Years of Hearing Aid Fittings with Gus Mueller, PhD

This Week in Hearing co-host, Bob Traynor, is joined by special guest, Dr. Gus Mueller, to celebrate 50 years since his first hearing aid fitting as an audiologist in the US Army stationed at Walter Reed Hospital in Washington, D.C.

The pair reflect on how the methods and techniques used to fit hearing aids 50 years ago have changed and evolved over the decades. Dr. Mueller offers his thoughts on the current state of hearing aid fittings and the potential benefits and drawbacks of self-fitting technology.

Full Episode Transcript

Bob Traynor 0:10
Welcome to This Week in Hearing where listeners find the latest in hearing care news from top individuals in our profession. Hello, I’m Bob Traynor, your host for my first episode of 2022. And I have a very special treat for all of my colleagues out there today. My guest is an audiologist among the top in our profession, and one of my oldest professional friends and colleagues, Dr. H. Gustav Mueller. Dr. Mueller’s topic for this week of for this week’s episode is celebrating 50 years of hearing aid fitting, we have changed the venue slightly from my usual study with all the books over here, wherever, wherever that is to our bars, because a celebration should actually take place in a bar rather than in a study. And after all, it’s five o’clock somewhere anyway. So I think, Dr. Mueller, I think we need to have a little champagne to begin the celebration of 50 years of hearing aid fitting.

Gus Mueller 1:30
Hey, that you know that that sounds fantastic. I was I was sort of guessing that that bottle you sent, which by the way is you know, it’s you know, you didn’t spare any cost on this. I was sort of thinking that that was for today. So and I’ve already opened it. That’s how convinced I was

Bob Traynor 1:47
Well that’s OK I popped mine to kind of be going well

Gus Mueller 1:51
I think that I will simply pour myself a glass. I’ve been waiting for half an hour for this. And as soon as you’re ready, we can have a good cheers of 50 years, because I’m thinking you probably got 50 years and you too I don’t know

Bob Traynor 2:06
Who me? me, I’d

Gus Mueller 2:07
Kind of a personal question. But cheers.

Bob Traynor 2:10
And here we go.

Gus Mueller 2:14
Now, I just have to ask, Will I be getting a bottle like this every week? Or was just a one time thing?

Bob Traynor 2:19
Would be nice, but I’m not sure our publisher could afford that. Okay.

Gus Mueller 2:24
All right.

Bob Traynor 2:24
Not sure if that’s in our This Week and Hearing budget.

Gus Mueller 2:27
All right, well, well, thank you. Thank you much.

Bob Traynor 2:30
So let me let me take a couple of minutes, Gus to do an introduction for, because because many people are younger, and they may not have an idea of the contributions that you have made to our profession over the last 50 years or so. And, uh, Dr. Mueller holds faculty positions at Vanderbilt University, the University of Northern Colorado and Rush University. He’s a consultant for WS Audiology, and a contributing editor for Audiology online where he has a very successful monthly column called 20Q with Gus, if you haven’t seen that, you need to take advantage of the CEUs offered by that particular column. Dr. Mueller is a founder of the American Academy of Audiology. A fellow of the American Speech and Hearing Association, serves on the editorial boards of several audiology journals and is a consulting editor for Plural Publishing. He’s an internationally known workshop lecture and has published over 200 articles and book chapters on diagnostic audiology and hearing aid applications. His co authored 12 books on hearing aids and hearing aid fitting including the recent three volume Modern Hearing Aids series, and I think you did that one with Todd Ricketts and Ruth Bentler.

Gus Mueller 4:01
Yep, absolutely.

Bob Traynor 4:02
And but also on the lighter side Gus house has it has been kind of a populist it with in audiology calls himself sometimes ‘Fun Gus’ which is an interesting nickname for some of us but

Gus Mueller 4:22
it’ll grow on you.

Bob Traynor 4:24
Haha. Okay, and but he also has a website called ear tunes.com. And if you younger audiologists haven’t been there. It’s an interesting place to be. Songs like ‘my old man’s an audiologist’ and on and on – you will find them there. And he resides currently in a tropic North Dakota Island which is nestled I think somewhere between the tundra and reality, but really just outside Bismarck. So with that, you know, I I’d like to start asking some real serious questions here, Gus. So

Gus Mueller 5:03
Let’s go for it, that’s why we’re here.

Bob Traynor 5:04
So where were you when you dispatched your first pair of hearing aids?

Gus Mueller 5:10
Good, good question. Indeed, it was almost exactly 50 years ago to the day, I’d gone into the Army. And they sent me to a little course to learn how to march and things like that. I was an audiologist at the time. And then they they knew Army audiologists at the time, Don Worthington was the Chief out at Walter Reed, they knew that most of us coming in, came from a pretty crappy master’s program and didn’t know what we were doing. So they sent us to a two week audiology boot camp at Walter Reed. And so I went out to in December of 1971, went out to Walter Reed, and we’re assigned eight patients a day or 10 patients a day, and they sort of evaluated our clinical skills and gave us remedial work. And of course, that was the military. So it was fine then to fit and dispense hearing aids, audiologists in private practice weren’t doing it for six or seven years later. So that’s where I actually dispense, fit, fitted, dispensed. My – although pair – you know, we know said ‘pair of hearing aids’, it took us it took us 50 years to get there. So in those days, you only fit monaurally. So that’s where I put my my fit fit my first patient, but with only one hearing aid. So that was the start,

Bob Traynor 6:30
of course, the techniques Gus were very, very critical at the time, and

Gus Mueller 6:35

Bob Traynor 6:36
scientific as well. So you know, I remember an article that you did with a, with a group from Walter Reed. And didn’t you do a study about the ‘hang-three method’. And I think this actually changed the way hearing aids were fit, I remember in the early 80s, or something like that. It really changed things.

Gus Mueller 7:02
Well, the what? Well, first of all, for for any young viewers who might be out there, the method of fitting hearing aids in that day called, which was called the Carhart method, which which which was no compliment to Carhart at all. Because it really wasn’t the way Carhart fit hearing aids. But anyway, it was to – we had on a wall, probably about 30 hearing aids that were on consignment, because every manufacturer would come into town take you to lunch and say, ‘Hey, would you like to take one of my aides on consignment?’ And of course we would you had a good lunch. So you had probably 30 different products on the wall. And then when you saw a patient, you would pick three of those why three? I don’t know. But it was always three, mainly because that was the time you had to do the testing. And you would do repeated speech measures. Actually, we often did do speech and quiet and word recognition and background noise. And we tested these three hearing aids. And that was the way we fit hearing aids in the early 70s. And actually into the late 70s. And anyway, my my doctoral dissertation had to do with comparative testing of hearing aids. And so when I finished that up in 1976, and I received an assignment out in San Francisco, I thought would be a really fun study is to do that traditional method, except embedded into it, we would, we would test the same hearing aids three times. So we really tested five hearing aids, but three of them were the same hearing aid. And this is the study that you probably remember Bob and what we found to surprise of hopefully nobody, that we saw the same differences among the same hearing aids, as we saw among different hearing aids. Now the study you were talking talking about. Coincidentally, I was then assigned to Walter Reed, when I got there, Dan Schwartz and Brian Walden had already started their own study, which was similar, but it was much more elaborate than the one I did. And and they found exactly the same thing, that this comparative approach didn’t work very well. In fact, it didn’t work at all. Given that the problem was the very, variability of the speech material was greater than the variability of the hearing aids, because we tended to pick hearing aids that were very similar. Also happening at that same time, I might add, was audiologists were starting to go into private practice. We’re now talking later in the 70s, Thorton and Raffin came up with their paper on when is a difference really a difference? And we saw that you needed to have 16% or so difference before it really was a difference. And we were struggling to fit custom hearing aids and you didn’t have three hearing aids to the test. So you put all that stuff together and you have a perfect storm not to do repeated speech testing, which had been the cornerstone of hearing aid sitting for 30 years, maybe

you know, and as I recall, one of the studies you guys did, where you were doing repeated speech measures and taking the same three hearing aids and each time, they always chose number two.

Yeah, not not always. Um, that was that was that was my study 19 out of 24 times.

Bob Traynor 10:24

Gus Mueller 10:24
So I think what I used to say in – jokingly, of course – that of course, whatever whatever whatever company had the free trip to Hawaii, always test that one second, you’ll be you’ll be in good shape.

Bob Traynor 10:37
Oh, man, the ethical, people

Gus Mueller 10:38
just a joke. It was a little joke.

Bob Traynor 10:40
Ethical time with that.

Gus Mueller 10:42
Oh, no, no, no.

Bob Traynor 10:43
Well, wasn’t this also the time prescriptive hearing aids were coming out as well?

Gus Mueller 10:49
Well, to some extent, of course, you can go back to 1945, which was Sam Lybarger. But then we all got into this Carhart repeated speech thing. And we sort of forgot about prescriptive fittings, and there’d be methods that would come out. But the one that really made a difference was the one by Ken Berger. And I think he published that in 1976. But he started traveling around the country doing workshops on why this prescriptive method was better than the repeated speech testing. And and of course, this was, we were looking, I mean, if you’re going to dump repeated speech testing, you need to have something to hang your hat on. And so this was what we hung our hat on. Dennis Byrne, over in Australia, was publishing his the very first NAL procedure, also about that time, but for some reason, we didn’t really pick up on that very much. It was in Scandinavian Audiology. It was a little more complicated Berger’s method was pretty simple. But I have to say one interesting thing about Bergers method, because I used it for six, seven years, is that the way he collected the data, the way he determined targets, was he actually brought in a lot of people who were using hearing aids, and measured the game that they were using. Well, at that time, the hearing aids were BTEs, with big tonehooks, and they didn’t have dampers. in them. These tone hooks had a resonant frequency around 1500-1600Hz. So his data then showed that people were using hearing aids that had Max gain around 1500-1600 Hz. The only reason they were using it is because that’s what somebody fit them with. But then that then was his prescriptive method. And it was always puzzling. It’s like, Why do I want all this gain here, of course, it made it easy to fit the target, because that’s the hearing aids. But then a few years later, Telex and Maico were really the first two companies who started to put dampers in the tonehooks, and then you got a much smoother response. And to add one more thing on the prescriptive thing, then as we get into the 19… Well, let’s see, 1980s. Then we started to see the other prescriptive methods that maybe some people know about, like Pogo, Cye Libby thought Pogo had too much gain. So there was the Libby 1/3 gain, Pogo was basically one half gain. And then there was the revised NAL, which came out I believe, in around 1976. And so by that time, we had, we had a quite a family of prescriptive methods to choose from. The problem- and this might be your next question, but I’m going to answer it anyway. The only way we had to verify these was through functional gain, and functional game was just a mess. You know, I could, you know, you could write a bit well, people have written papers, of all the things wrong with functional game, but it was all we had. Because if you needed 25 dB of gain, you had to have a way to determine if you really had it. So we were all doing functional gain. Again, for the younger listeners, viewers. That means you go into the sound field, you test the person unaided, then you test them aided, you subtract the difference, and that would be their functional game, which by the way, is the same as insertion gain

Bob Traynor 14:20
And of course, you have to watch out for some compression kinds of issues.

Gus Mueller 14:24
Oh, that’s yeah, of course. And well, you got to

mask the non test ear, you have masking from the hearing aid you have, as you say, if you got a WDRC hearing aid, you’re not really testing. It goes on and on and on. It sounds like you’ve done some of that in your day to

Bob Traynor 14:41
ah well yes, after a number of years in practice, of course. And and by sitting in the audience for some of Dr. Mueller’s very fine lectures. A whole different way of doing things

Gus Mueller 14:54
hope I didn’t I didn’t say anything good about functional gain, but it was it was all we had. I knew we didn’t have a backup plan. So it was either a functional gain or ‘Gee Bob, how does that sound?

Bob Traynor 15:05
Well, you know,

it’s almost like that’s kind of how we started. “Hey, Hey Gus, how’s that sound?” Yeah. Okay, now we have a lot of people doing that even with all the things we have today, they’re still saying, ‘Hey, Gus, how does that sound?’

Gus Mueller 15:19
Well, that does happen. It does happen.

Bob Traynor 15:22
So well, about the same time the probe microphone verification was coming out. And I know you were really active in in the not only using the probe mic systems, but also in some of the developmental kinds of things regarding these products.

Gus Mueller 15:40
Well, you know, as I mentioned, in 1979, I was assigned to Walter Reed, and I was very fortunate because they an early adopter there as early as you could get was an audiologist, Dan Schwartz and Dan had worked, some worked around way to get one of the first big Frye units. And at the same time, he was able to get a hold of a device that Dave Preves had put together, that coupled to this Frye system that you could actually measure ear canal SPL. So we were doing that in the fall of 1979. One of the downsides is the way you measured it was you actually put a hearing aid microphone down in the ear canal. And you can only guess what that was like in a gooey ear. We tried, we came up with everything we could think of the good news was we collected a lot of measures. And by the first of April, we had enough to submit for an ASHA paper that was back when audiologists went to ASHA and so we submitted an ASHA paper which we presented then in 1980, which I think was that was 40 years ago. I think that could have been one of the first probe mic papers, if not the first presented at a at a national meeting. Rastronics then came up with their system a few years later, after Rastronix. We had who else? Madsen the course was big. The Igo. B&K had a system Bosch had system. There was one from South Africa that you bet I don’t you know, bomba the Acoustamed, Charlie Anderson, rep that Chris Sweitzer did some work with them. So by 1986 I’d say we had five or six different probemic systems to use. I know we were at Walter Reed, and I still remember putting in the order to buy six of them. Because we wanted one in every fitting room.

Bob Traynor 17:40
I remember buying a Rastronics, this date several dates us as well. But I remember heck buying it having a Rastronics at the practice, and then when that thing wore out, kind of wore out or couldn’t find stuff for it anymore. Then I did the Igo system. And now the others. I think the Igo lasted quite a long time. And then I had to upgrade for to get some of the other formulas and those kinds of things. But

Gus Mueller 18:09
yeah, and you might say, Well, why didn’t I mention Verifit? And that’s because I’m sort of doing it decade by decade. Yeah. Verifit didn’t come out -the black suitcase version – I believe then called Audioscan didn’t come out until I think 1991 or so. So all of this and that was talking about now all happened in the 1980s

Bob Traynor 18:30
Well, you know, with all of this, this stuff that’s going on with all this fabulous equipment and being invented and upgraded and modified. We thought that, I mean most all of us thought that everyone would be doing pro mic measurements. And and it would be part of training programs, which is part of training programs. But even after the training programs, a lot of the people are not doing verification. So we thought there’d be a lot of that going on and and and I I really not sure what happened with that. Maybe you can enlighten us on that.

Gus Mueller 19:06
Geez, ya know, that’s the million dollar question. I actually that’s an old saying isn’t? I guess it shouldn’t be the billion dollar question today. I’m definitely I mean, to me that this isn’t. This isn’t rocket science. I mean, imagine if you were you were in construction and you’re building houses. And you would had to pace off the dimensions by walking. And all of a sudden somebody walked up to you and said, Guess what, buddy? I have a tape measure. Why would you not use the tape measure? It’s crazy. It’s crazy. Yeah, I don’t get it. Yeah, we assumed everybody assumed that that audiologists would use probe mic equipment, like cardiologists use a stethoscope.

It’s part of your practice.

Bob Traynor 19:58
I’m just gonna say well, why Why do you think people haven’t done probe mic measures?

Gus Mueller 20:03
I think, I think because you can get by. And you can make a very decent living without doing probe mic. You know, I mean, if if you don’t use your you don’t lose your license if you don’t do it. You don’t go to jail

Bob Traynor 20:20
unless you’re at Costco you can lose your Costco job by not

Gus Mueller 20:26
And guess what they do probe like, I have to mention, there is a difference between doing probe mic and verifying hearing performance with probe mic. I know many clinics that get audited by their supervisor or traveling supervisor. And so what they do is they fit to the manufacturer’s first fit, don’t change the thing, but then do probe mic. So when they go out to their state meeting, they can say, Well, I do probe mic on every patient. But that’s not the point. The point is you fit to a validated target, using probe mic as your tape measure. Right? Yeah. So why people don’t embrace it, I don’t know.

Bob Traynor 21:10
What, you know, some people probably assume that if you click on the NAL target inside the software, no matter whose software it is, you get a fit to an NAL 1 or NAL 2, or some sort of a specific fitting. And I’m not so sure that that’s true.

Gus Mueller 21:32
Well, I am, it’s not,

Bob Traynor 21:34
you would know!

Gus Mueller 21:36
unless it changed in the past year, you know, you’re right, it could be that I guess you could just have this belief that somehow this could magically know, the volume of the ear canal and all the other characteristics of that particular patient. And you could assume that the manufacturer didn’t purposely tweak the NAL a little bit, just to make it more pleasing to sound. But there is no shortage of literature, independent literature on this particular topic that shows that with a manufacture, with the default NAL of any manufacturer, and again, this if things could things change, and this might not be true in the past year, people usually do a study most every year comparing in all the Big Six. But almost all the research has been published shows that you will under fit for average, by around 6 to 8dB. And remember, many of these algorithms today are more linear than I think they should be. So if you’re missing average by that much for soft, which is some could argue that that’s more important than average, for soft sounds, you’re going to be missing targets, maybe by 12 dB or so that’s a lot of audibility to not give your patients, I encourage any of you to sit down in front of your TV and turn it to where you’re just barely hearing sounds, and then turn it down another 12 dB. And it’s going to be inaudible, you know, and that’s what we’re doing. That’s what we’re doing to our patients. Ya know, I might toss it right there that Louise Hickson did a really interesting study a few years back, maybe it’s been back 2014-2015, something, she looked at all these attributes over 50, I believe, of what could determine hearing aid satisfaction, and then came up with the ones that were more significant factors. And the first couple probably wouldn’t surprise us. One of the factors was you had to have a great attitude to using hearing aids. Secondly, you had to have, you had to have a good support system with the third factor was matched the target for soft sounds. That that was the third factor. And I think that we totally dismiss the importance. I know some clinics that don’t even try to match targets for soft. They match targets for average and on their way. And let me add one more thing about how we’re doing out there. Ron Leavitt, I’m sure you know Ron, Bob, he has a practice over in Oregon. He he published something Oh, three, four years ago. He runs some aural rehab classes over the weekends. And people come in from all over Oregon. And so over the span of a couple years, he had tested Around 100 people who had been fitted somewhere else, but before he enrolled them into rehab, he of course wanted to make sure they’re fitted correctly, because what’s the point really? So anyway, he um, I remember his data showed that of the group that he had 98% of them were 5dB or below target. But this is for average, on four or 98%, I think 97-98% were below or 5 dB or more below target. And the sad thing was 70%, some percent were over 10 dB below target. When they showed up at his clinic, this is, you know, this isn’t right.

Bob Traynor 25:23
So, so what do you think about these? These, now manufacturers I think are beginning to put some automatic probe mic fitting within to their software? Yeah. Now, are those, I mean, are they kind of like nothing? Or are they kind of a little better than nothing? Or are they similar to other pro mic systems like a verifit or something like that?

Gus Mueller 25:48
I think they’re something nothing, there’s something they, it requires a little bit of thought. But yeah, what we know about this, there’s been six or seven studies that have been done. Relative to this, I should mention that essentially, all pro microphone manufacturers are affiliated with one or two companies, they might not be, have, they might be not linked to all companies, but but they are linked to at least one or two companies. So you, you know, if you know your favorite company, then you can easily find out what probe mic equipment partners with that particular company. And I believe all companies have this particular system, which I’m going to call auto REM fit, because every company has their own way of doing it. Here’s what we know, it will be faster. Um, but it probably takes about half the time that a careful clinician fit would take. So it’s going to be faster, some people think that’s important. So this would help. We also know that for fitting to average, they probably will deliver a fit that is close to what a careful clinician would get probably better than what a careless clinician will get. And so we do know that this is forever. Now, here’s the two things to consider. Number one, is, as I just mentioned, I’m talking about average, there are some of these systems that only fit the average. So you could have a very nice fit to average, but you might be off by 10 dB for Soft. Well, if you if you go back then and match to soft, you just screwed up average, and you’re gonna have to go back and refit average, which means you ruin the whole that destroyed the whole purpose of doing it in the first place. Because you’ve gone back to a clinician fit, that’s one thing. The second thing, which is even more important is I just mentioned a little bit ago that most if not all manufacturers have modified the NL2 to to their liking, which means if the manufacturer software is the Boss, and is controlling the probe mic system, it possibly could fit to the targets that in the manufacturer software, not the true NAL. So you might have a beautiful curve on the screen, but it’s not the real NAL, I happen to know one company Verifit will not partner with a manufacturer, unless they’re allowed to use Verifit targets, which are the true NAL targets. So if you’re using the Verifit, you know, then you’re really fitting to true NAL. I would recommend for those of you who are doing this, that the first couple of times after you finish and you got this beautiful fit, then run another curve your traditional way, where you’re using the ISTS and just your typical way of fitting hearing aids, if it truly is fitting to the correct NAL target, then then that should be a match. So yes, it’s good, but you have to think a little bit be a little careful.

Bob Traynor 29:05
So um, so that has some promise. It sounds like maybe you over time, that’ll get even better.

Gus Mueller 29:16
Yeah, I think that things do. I mean, if I worked for a probe microphone manufacturer, I one of the things and I was sitting in a sales meeting, one of the things you’d say is, we have this fantastic thing. It works perfectly. It’s been around for 30 years, why are only 30% of audiologists using it and you you collect all the reasons, all the reasons people give you a no. And then you try to counter those reasons. Okay. So one of the reasons two of the reasons would be some people say it’s too complicated to learn, which is bullcrap. But people say that and some people say it takes too long. So this should solve two of those two those things. I don’t know if it’s gonna move the needle or not, but it’s certainly it’s, I think it’s a useful advance.

Bob Traynor 30:08
Super. Well, you know, moving just a little bit ahead now from 1990s 1980s 1970s. It’s not going to be too long before we’re going to have a lot of self fitting products.

Gus Mueller 30:24
I suspect that’ll be true.

Bob Traynor 30:26
And I think are some of them that are already out there. What kind of, what kind of thoughts do you have on this self fitting instrumentation? That kind of goes against all of our, of our formula fits in and probe mic measures? And some of those kinds of kinds of things?

Gus Mueller 30:47
Well, you know, instead of us asking the patient, how does it sound? They’re, they’re asking themselves, how does that sound? Right? Yeah, you know, it’s, you can look at it in two ways, you can say, there are people out there who are never never going to use hearing aids, or they won’t use them for 10 years, if you give them a model – a way to obtain hearing aids, that that’s lower priced, and that they can fit themselves. That’s better than not using hearing aids at all. And I think that’s probably true. But then you can look at it the other way, is, what if a lot of these people would have gone into an audiology clinic anyway, and they would have been fitted, hopefully, correctly, to validated prescriptive targets, would they then be better off? I think the answer is yes, if they were fitted, if they were fitted correctly. You know, I’ve over the years, back in my military days, you know, we of course, saw tons of hearing aids, and you learned a lot about and also through research projects, how people select what they believe is best for them. And so I think one of the things that we have to ask is, how good is a patient at really choosing what is the best for them? I mean, anybody out there fitting hearing aids today knows that they’re not very good at picking the best audibility for high frequencies, because they say it sounds tinny, and they want you to turn it down. And then you have to make a decision. What do I do? Do I? Do I turn it down to make them happy and put a smile on their face? Or do I leave it where it is? And tell them I’m the doctor, you’re going to get used to it? Or do you do some kind of compromise? And you know, this is what people face every day when they’re fitting hearing aids. But if the patient is in charge, and doing all this, and so there’s no compromise, you know, nobody’s telling them that these high frequencies are good for them. And now, you know, you might say, Well, wait a minute, they’ll go in someplace, and and turn it up, turn up the highs, and they’ll go, Oh, my God, this is fantastic. And maybe that’ll happen. But you know I have to say here’s, here’s… well let me give you a couple examples. Um, we did a study several years ago. This was actually a capstone project, and I’m sorry, but I don’t remember the name. Remember the name of the fellow who did it. But anyway,

Bob Traynor 33:17
if they’re listening, I bet they’ll remember.

Gus Mueller 33:21
I know. I’m getting an email the next morning, I bet it. Anyway, he’s from Michigan, I can say that. Anyway, what we did in this study was fit everybody to wide dynamic range compression, very carefully matched targets, to soft, average and loud. And then what we did is we had this scale that Catherine Palmer and I developed called the PAL, the Profile of Aided Loudness, Find yourself a pal for tomorrow. And what this is, is patients do subjective ratings. We had the norms on there were collected from normal hearing people. So we had four different environmental sounds that normal appearing people rank soft for that they rate average, and for that they rank loud. And so the the if you believe in loudness, normalization, your patient should go out. And when they hear those sounds, now, we didn’t deliver him to them. They were sounds that you’d normally hear in the environment, like yourself breathing was rated number two, on average. Okay, soft. Okay. So anyway, our concern was soft sounds because pick, if you recall that most people don’t like soft sounds. They hear themselves walking on carpet, they hear rustling of paper, they hear this they are themselves breathing. I don’t know what all they hear. They don’t like it. And it’s common for some audiologists to simply turn down soft sounds. But that wasn’t possible in this study. There was no adjustments necessary, and we followed them for eight weeks, well after one week. These people rated soft sounds number four, which is average sounds, so they thought that soft sound sounded like number four After two weeks, they rated them. Number four, after six weeks, they rated them number four. And it wasn’t until eight weeks that they rated soft sounds 2.5. My point being is, if you’re fitting yourself, you’re not going to, you’re not going to wait eight weeks, you’re going to wait a couple minutes and turn it down, you’re not going to go through acclimatization, there won’t be acclimatization. And acclimatization is so critical for for the brain to do its thing. A second point along those same lines, Bob, I’m sure you remember. Larry Hume’s study, the one that got a lot of press and a lot of discussion from AJA back in 2017, I’m going to say, which was Larry had the Consumer Decide model, the the Audiology Fit model, and another group called the Placebo group. And in the Placebo group, they went through the same motions, except when they were fitted, they were fitted with hearing aids that had zero dB gain. And then the people went out and they use their hearing aids for two months, I think it was, and they did all kinds of ratings on the APHAB and all these different scores and all that. And as you would hope and expect the people on the Placebo group did not do as well as the other two groups. But the point I want to make is these people paid for their hearing aids, and at the end, they had a chance to either keep the hearing aids and get a refund or keep the hearing aids or get a refund. Of the placebo group. These are people with zero dB of gain 32% chose to keep their hearing aids. They have no gain! So you know, then that makes me wonder when people are out fitting themselves? How many of them will be walking around with no gain? You know, I guess

Bob Traynor 36:57
that’s a that’s a really doesn’t work very well, at all. You know, that kind of thing?

Gus Mueller 37:02
No, I might say there, there are published studies from respected researchers that say that people are pretty good at fitting themselves that they come within a few dB of the now. So I could be wrong on this. But my experience has has been that people like their hearing aid to not sound like a hearing aid. And they tend to pick a response, that’s the same as there are a you are because that’s what they’ve been listening to all their life, you know, they take whatever the insertion loss was, and compensate that with game to make it sound back what it sounded like with an open year, but maybe this whole thing’s gonna work. You know, if it gets more people using hearing aids, that’s good. My concern is, it’s also then going to have a whole group of people that will simply think hearing aids don’t work very well, but it’s here and and we’re we’re gonna live with that. It’s not like it’s not going to be here.

Bob Traynor 37:56
I also think it’s a it’s a good, good reason for people to begin on bundling some of their fees. So when these people come in with no game, then they can refit their hearing aids and set them up with some sort of a some sort of a program to facilitate that, rather than trying to sell them something else. Yeah. Anyways,

Gus Mueller 38:15
there’s a lot of I’m just happy. I’m not a young person sitting in private practice right now. Because that well, in some cases, I wish I were but I don’t because there’s a lot of decisions to make of how to how to tackle all this. And of course, you know, I read the different opinions and, and I read one and go, Yeah, that sounds okay. And then I read another one. Yeah, well, that sort of sounds okay, too. And fortunately, I don’t have to make that decision. But

Bob Traynor 38:45
well, you know, I guess we could do this all night. And we could interact and banter and so on. But I think we should have one last toast to that first set of hearing aids that you fit 50 years. And so here’s here’s to the our Dr. Gus Mueller, fitting his first hearing aid. January of what a year would that be? That’d be

Gus Mueller 39:14
December, December of 1971, December 1970. Over 50 years and a week ago or something like that. So yeah, very good way to go. Thanks. Thanks for the invite Bob, and thanks for the champagne and that’s, that’s the history as Gus knows it. And I might have got a few dates wrong, but I think most things are pretty close.

Bob Traynor 39:37
Well, to to our colleagues that are out there and put up with our banter and our interactive skills today. I want to thank you for being part of this weekend hearing and our tribute to Dr. H Gustaf Bueller’s first hearing aid fitting.

Gus Mueller 39:57
Very good. Thanks

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About the Panel

Dr. H. Gustav “Gus” Mueller holds faculty positions with Vanderbilt University, the University of Northern Colorado and Rush University. He is a consultant for WSAudiology and Contributing Editor for AudiologyOnline, where he has the monthly column “20Q With Gus.” Dr. Mueller is a Founder of the American Academy of Audiology, a Fellow of the American Speech and Hearing Association, serves on the Editorial Boards of several audiology journals, and is a Consulting Editor for Plural Publishing. He is an internationally known workshop lecturer, and has published over 200 articles and book chapters on diagnostic audiology and hearing aid applications. He has co-authored 12 books on hearing aids and hearing aid fitting, including the recent three-volume Modern Hearing Aids series, and the clinical text on Speech Mapping and Probe Microphone Measures. Gus is the co-founder of the popular website www.earTunes.com, and resides on a tropic North Dakota island, nestled between the tundra and reality, just outside the city of Bismarck.  


Robert M. Traynor, Ed.D., is a hearing industry consultant, trainer, professor, conference speaker, practice manager and author.  He has decades of experience teaching courses and training clinicians within the field of audiology with specific emphasis in hearing and tinnitus rehabilitation. He serves as Adjunct Faculty in Audiology at the University of Florida, University of Northern Colorado, University of Colorado and The University of Arkansas for Medical Sciences.



About HHTM

HHTM's mission is to bridge the knowledge gaps in treating hearing loss by providing timely information and lively insights to anyone who cares about hearing loss. Our contributors and readers are drawn from many sectors of the hearing field, including practitioners, researchers, manufacturers, educators, and, importantly, consumers with hearing loss and those who love them.

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