Revisiting the Perennial Question: What is the "Best"
Hearing Aid? - Part Two
By Mark Ross
Editor: Such a simple question. Such a complex answer! Here's Mark Ross
with his thoughts on the best hearing aid.. This article was originally published in
the January/February Issue of Hearing Loss magazine, and is reprinted with
the author's kind permission.
This is part two of two parts.
Here's Part One
About all we can say that people with hearing losses have in common is
that they all have hearing losses! I don't mean this to be a facetious
comment, but sometimes we seem to overlook this basic fact. In reality, it
is not just a question of someone falling into the generic category of
having a "hearing loss," but the type, nature, and severity of the
auditory disorder displayed by the specific person. This will have major
implications in determining what kind of hearing aid the individual should
use and how well he or she does with it. We're all somewhat to very
familiar with the basic dimensions of a hearing loss, as visualized in an
audiogram. From this chart, we can see how much of a hearing loss a person
has across the frequency (pitch) range. The pattern displayed by an
audiogram can very considerably between people, with probable significant
behavioral implications for the larger variations. Generally, for example,
a person with a severe high frequency hearing loss will not function in
the aided condition as well as someone with a moderate flat hearing loss
(equal hearing loss at the different frequencies). In other words, the
same hearing aid will not result in equal performance for these two
people. This occurs because the upper limit of possible performance is set
by the nature of the auditory disorder and not the hearing aids; because
people differ in the severity and nature of their hearing loss, so will
their hearing aid performance.
The information provided by an audiogram, as crucial as it is, presents
us with only the most superficial information we have about the components
of an auditory disorder. Two people with exactly the same audiogram may,
and often do, demonstrate completely different listening performance in
other auditory tasks, such as their loudness discomfort thresholds and
speech comprehension in noise. For example, one such person may find the
limits of acceptable loudness to be 80 dB, while the other person with a
similar audiogram finds that sounds of 100 dB are easily tolerable. These
different tolerance limits will affect the how a hearing aid is fit and
how successfully a person performs with it. Such individuals may also
differ considerably in how well they understand speech in the presence of
noise, though there may be little difference in their speech perception
scores in quiet. In other words, auditory disorders and their observable
consequences encompass more than what is displayed on the audiogram. These
would include, among other dimensions, the ability to detect small time
differences within and between speech sounds (temporal resolution) as well
as their ability to separate out the individual components in a complex
sound (frequency resolution).
Differences in these dimensions explain why hearing aid users with the
same audiogram and the same hearing aid may perform differently. But the
question still remains; given the nature of some specific individual's
auditory disorder, is there a best hearing aid (or amplification pattern)
for that particular person? Certainly, we know from experiences garnered
by consumers and professionals over the years, people do perform better,
or worse, with one amplification system over another. But is the hearing
aid a particular person is now wearing, or contemplating purchasing, the
absolute best for that person? I don't know and furthermore I don't think
the question is answerable at this time, for this reason: we have no way
now of determining what a person's potential speech perception
capabilities are to which we can compare his or her actual performance.
How do we know when we've reached the best possible performance?
Additionally, given the awesome flexibility now incorporated in modern
hearing aids is it possible that the consumer would do even somewhat
better if one or more of the hearing aid's electroacoustic dimensions were
varied in some fashion? I'd say the possibility exists, but there is no
way at the present time that we can be certain.
It seems to me that rather than focus on the best hearing aid,
potential hearing aid purchasers could more fruitfully spend their time
and energy looking for a well-trained audiologist, one who is competent,
caring, and conscientious. This is the person whose job it is to select
the "best" possible amplification system for a hearing aid user, one who
can maneuver between the myriad possibilities now offered by modern
hearing aids. Such a person will not only keep up with new developments,
but also not limit their efforts to the device itself but will also
consider and respond to the totality of a person's communication problems.
The hearing aids these people recommend should ensure that their client's
performance falls into the best possible "zone" of performance, one
consistent with the person's hearing loss, the audiologist's personal
experiences and the research evidence.
So now how do we find this paragon? I don't have a specific answer to
that; I wish I did. . The experiences of other hearing aid users are one
major source, as are the recommendations from other professionals (Otologists,
etc.). A good place to start would be looking at the professional members
of HLAA. You can find one by clicking on the "Finding Your Hearing Health
Care Professional" box on the opening page of the HLAA website (hearingloss.org).
Obviously, I can't vouch for the technical proficiency of any of the
audiologists on the list, but I can say that their membership in HLAA
suggests a consumer orientation that would put them on my personal short
list. Someone who functions more like a professional and less like someone
simply selling a product. One who recognizes that the implications of a
hearing loss can be pervasive and profound and that the search for the
"best" hearing aid can best be viewed as just one step, albeit a crucial
one, in the effective overall management of a hearing loss.