If we want to understand the needs and wishes of an individual, we need to determine his individual experiences in different auditory situations.Ī transition from the “average” patient fitting towards a more individual fitting requires several stages, which include: This hearing history depends on an interplay of many factors. Hearing loss is a dynamic process that changes with time, and how one hears depends on the hearing history of the individual.
With regard to hearing aid fittings, it is clear that there is no simple solution that would allow us to perform a consistently perfect customized fitting by even adding one additional variable to audiogram data.
The factors just listed serve to highlight the high complexity of hearing loss pathology. The search for additional measures, which could enable us to move beyond audiogram-based fittings towards more individual fitting, have included research on age (Dubno, Dirks, & Morgan,1984, Gordon-Salant, 2005), audiogram type (Dubno, Eckert, Lee, Matthews, & Schmiedt, 2013), acceptable noise level and loudness tolerance (Nabelek, Freyaldenhoven, Tampas, Burchfield, & Muenchen, 2006 Mueller & Bentler, 2005), personality (Hutchinson, Duffy, & Kelly, 2005 Cox, 2006), cognition (Pichora‐Fuller, Schneider, & Daneman, 1995 Lunner, 2003 Lunner & Sundewall-Thorén, 2007) and various psychoacoustic measures such as frequency selectivity, temporal fine structure sensitivity and modulation thresholds (Hopkins & Moore, 2011 Bernstein et al., 2014). This implies that there are other patient-specific factors that influence speech understanding, and in particular speech understanding in background noise. It has long been known that pure tone audiogram (PTA) measurements cannot fully account for the variation in speech intelligibility scores measured from hearing impaired listeners (Smoorenburg, 1992).
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These average settings are offered in the fitting software as the best starting point for the majority of patients, however they will not be suitable for all, as few people are precisely “average.” Additionally, the adaptive parameters in the fitting software are optimized based on patient-averaged satisfaction ratings. The term “hearing loss” describes a myriad of diagnoses and symptoms, not all of which are necessarily reflected in the audiogram (i.e. As a first fit, this works very well for many patients, but not for all. Accordingly, the fitting software applies default settings of adaptive algorithms that are optimized to provide an ideal balance between speech understanding and sound quality. This is the most individualized part of the fitting process. The usual practice when fitting a hearing aid (HA) is to adjust gain and output according to the patient’s audiogram.
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