BMN Blog

DEC 22

Every year, new hearing aid technology is introduced to the market. New technology in hearing aids boasts updates and changes in directional microphones,  sound processing algorithms, noise reduction features, amplitude and frequency compression, and audio data transfer between hearing aids, just to mention a few.  What is often forgotten however, is that the primary objective of a traditional hearing aid fitting is to ensure that the patient is receiving the appropriate amount of amplification for their hearing loss at each frequency. This maximizes the patient’s potential for understanding speech, and therefore addresses the foremost complaint of hearing aid users: speech understanding. Updates in technology and convenience features are then subsequently meaningless if the hearing aid’s basic gain and output programming are not sufficient for the patient’s type and degree of hearing loss. In other words, updates in technology aren’t helpful if the patient’s primary concern of understanding speech is not addressed. The ability to understand speech, is for the most part, determined by the frequency-specific gain programmed into the patient’s hearing instruments. This means that if the patient’s hearing aid gain and output are not appropriately programmed across the frequency range for his/her hearing loss, he/she will be missing out on important auditory information which is crucial for understanding speech.

How then as audiologists do we ensure that hearing aids are appropriately programmed for each unique, individual patient and their hearing loss? The use of a probe-microphone, or real-ear measurement system is the only way to objectively verify and measure the appropriateness of hearing

aid gain and the resulting output across frequencies, ensuring audibility of the speech signal. The American Speech-Language-Hearing Association (ASHA) and the American Academy of Audiology (AAA) have created guidelines recommending the use of real-ear measurements as the best-practice for verifying hearing aid fittings. Despite the numerous documented benefits of conducting real real-ear measurements during hearing aid fittings, nearly 70-80% of audiologists do not routinely use real-ear measurements when fitting hearing aids. Reasons include lack of time, financial difficulties and/or space constraints. Instead, many routinely rely on the hearing aid manufacturer’s first-fit settings. The problem with this approach is that many manufacturers’ first fit settings fall short of the patient’s needs when it comes to hearing aid gain and output. Essential auditory information is then being missed, and speech cannot be well understood by the patient.

Excel ENT of Alabama values and complies with best practice guidelines for hearing aid fittings. Time, space, and financial challenges are not a valid excuse for failing to provide the highest quality of care to our patients. Excel ENT of Alabama is now one of the only clinics in the Birmingham and the surrounding areas utilizing the Auricle probe-microphone real-ear measurement system during all hearing aid fittings. Our audiologist understands the importance of providing quality hearing devices as well as verifying that those devices meet each patient’s needs for audibility according to their type and degree of hearing loss.

In order to take a real-ear measurement, the patient can first expect a probe tube microphone to be placed in their ear canal. This probe tube is thin, soft and flexible and many times is felt as no more than a tickle in the patient’s ear canal. The hearing aid is then turned on and inserted into the ear canal with the probe tube remaining in place. Once the probe tube and hearing aid are in place within the patient’s ear, the next step is to compare the hearing aid output to patient targets. Targets are defined as the necessary gain to obtain audibility of speech at each frequency relative to the patient’s hearing loss.  To obtain the measurement of hearing aid output in comparison to patient’s targets, a soft, moderate, and loud speech signal are presented via loud speaker.  The system then produces a visual read-out displaying a graph with decibel sound pressure level on the Y-axis, and frequency measured in Hertz, on the X-axis. Within the plane of this graph are the measurements of hearing aid output displayed as a solid line, and patient’s targets displayed as a dashed line. The goal of appropriate fitting would be to ensure that the hearing aid gain matches the patient’s targets as closely as possible. In other words, ideally, the dashed line and solid line should match. This confirms that the patient’s hearing aids are producing the necessary gain to achieve speech audibility and therefore addresses patient concerns regarding speech understanding.

Although there is much more to a hearing aid fitting than real-ear measurements, the importance of real-ear measurements in hearing aid fittings cannot be overstated. Research suggests that completing these measurements as a part of routine clinical care improves patient satisfaction and reduces the number of return visits as well as the number of hearing aid returns for credit. Utilization of real-ear measurements is the current industry guideline for best-practices when it comes to hearing aid fittings. By providing patients with hearing aids that are customized to their hearing loss needs using verification, the hearing aid provider is ensuring the value of both their expertise and the hearing aids for addressing patient concerns regarding speech understanding.

*References available upon request

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