Recently, I saw two patients in the same day with different problems, but one thing in common: It is very difficult for them to put into words what bothers them about their hearing aids. I’ve known both patients for more than 20 years. They have both been struggling with the sound quality of their new hearing aids. Both were fit with probe-microphone verification and follow-up coupler measures to look at how their older aids compare to the newer aids. The differences that I can measure are minimal, but something about the sound that they perceive is notably different—and unacceptable to them.

Dennis Van Vliet, AuD, has been a prominent clinician, columnist, educator, and leader in the hearing healthcare field for nearly 40 years, and his professional experience includes working as an educational audiologist, a private-practice owner, and VP of audiology for a large dispensing network. He currently serves as the senior director of professional relations for Starkey Technologies, Eden Prairie, Minn.

Of course, we frequently see patients who have difficulty adjusting to a new sound quality when we change hearing aids, and expect some period of adaptation. These two patients were well beyond that; they had persistent quality complaints that I couldn’t properly measure, and they couldn’t easily express what it was that bothered them.

My approach was to listen more than talk, and to encourage them to say more about what they were experiencing. One of the two patients is an engineer and musician. (He’s actually a great patient, and very easy to work with.) Fortunately, he responded well to the “listen and encourage to say more” method. I was able to get enough additional information from him to proceed to A/B comparisons with recorded speech and music stimuli. Almost by accident, I started making adjustments in compression and bandwidth monaurally, and was able to come up with different settings that together sounded much better to him than the original settings. It was rewarding to see him respond so favorably to the changes. Relatively small changes yielded some large perceptual differences that I wouldn’t have predicted.

The other patient is a very alert 90-year-old woman with severe hearing loss in both ears. One ear is much better with speech recognition, but she relies on input from both ears so much that she hardly notices the big difference between the ears. Her comments center around vague complaints of “…not clear” or “Something isn’t connecting.”

A wide range of changes in the response of the hearing aids did not improve her perception of the quality of speech. In the process, I noted that she was relying on her perception of her own voice as much as external stimuli as she evaluated and sampled each adjustment trial. I experimented with some earmold fit changes and determined that she was likely responding to earmold acoustic effects from either canal depth, or direction of the sound path rather than anything I could change with programming adjustments. I took impressions to make new molds, and we’ll continue the process once the molds come in.

Going the Extra Mile for a Sound Quality Solution

Both of these patients are experienced users and very dependent upon their hearing aids. They know what sounds normal to them, and both tried earnestly to adapt to a new sound quality without success. I couldn’t pat them on the back and encourage them to “get used to it” because it was doubtful that they ever would. It would be up to me to keep working with the limited feedback they could give me so that we could find a solution if one exists.

The talk and tweak method I deployed has been around for a long time—well before probe-mic measures. It has limitations because the process depends upon patient subjective responses that may not be consistent or precise. Yet, it is easy enough to use with many patients, and can bring them into the process so that they have an investment in the final adjustments. The experimentation may allow them additional information to comment upon and get us closer to a solution.

The Final Word? Standard of care measure and match fittings appeal to our sense of precision and orderly process, but may not offer an outcome that meets patients’ needs, especially when subjective reactions are very important to a user. The ability to encourage the user to describe in detail what it is about the sound that is pleasant or objectionable and to offer meaningful comparative samples can lead to personalized fittings that may offer the patient a better outcome.

The final trick is to recognize when we are close enough, THEN pat them on the back and encourage them to “Get used to it.”

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