Choosing the best hearing aid for you can be a daunting process, especially if you are presented with a number of options, that you don't fully understand. To top it off, the hearing aid you select needs to deliver improved hearing and all the benefits that go with that, for years to come.
Many clinicians don't always strongly recommend a specific hearing aid, which leaves you in the "driver's seat" when it comes to making the final choice of device. The problem is when you don't know how to "drive".
It would be natural to expect that the hearing care professional you see should be making a strong recommendation. This is certainly the case when I see any medical specialist. Why then don't hearing care professionals always make strong recommendations?
I believe the problem lies in the way hearing aids have been selected for the last 20 or so years.
The way hearing aids are still selected to this day has not changed in the last 20 years or so. This is despite the fact that Hearing Aids have drastically changed in that time. Even the last 5 years have shown tremendous changes in hearing aid technology, which would have been unthinkable 20 years ago!
Surely something has to give with this mismatch between the outdated process to choose hearing aids and the modern hearing aids available today to choose from?
Looking at this process to choose a hearing aid in these steps looks quite acceptable and considers many important aspects.
So then what is the problem with the traditional selection process?
Even though aspects like the audiogram, personal preferences, ear health, dexterity, and even lifestyle considerations are very important in choosing the right hearing aid, there is a level of detail missing that may lead to average outcomes.
This outdated hearing aid selection methodology is actually great at helping the hearing care professional decide on the style, coupling to the ear, power, and size of the hearing aid. It is however extremely average at helping the clinician decide on which features and/or tech level to recommend. Some hearing aid features really make a difference and are well-researched but others, in my opinion, are simply marketing features to help sell the product.
The recommendation methodology of the "appropriate" hearing aid technology level for a client, I have heard, was apparently developed by hearing aid manufacturers. Talk about vested interest if this is true!
It is based on your lifestyle. Lifestyle situations may be broken into various groups of situations, with more "advanced" or for that matter expensive hearing aids getting more stars or are rated higher for noisier situations.
Another example with a different layout:
More advanced hearing aids certainly have more technologies, like better directional microphones, to support you better in noise.
It makes pretty good sense, right? There is a big problem here, however...
Having used this exact method for over the first decade or so of my career, I can tell you several stories where this method just did not work. For example there were several people over the years who chose the most expensive option, only to be disappointed that they could not hear well in social situations. Similarly, there were countless clients who could only afford the most basic options and they did very well, even in background noise. Others were in between, and it felt like a very small number of cases actually matched the lifestyle chart. Another effect of this selection method is that high-end (more expensive hearing aids) tend to get recommended more frequently. The simple reason for this is that most people spend at least some amount of time in noisy situations.
This certainly did not give me much confidence in my recommendations back then and I've heard other clinicians report the same.
What is going on?
The issue is that lifestyle needs have no relation to your ability to hear speech in noise.
The reason for this comes down to the fact that we actually hear and understand with our brains. Simply put, our ears are simply the microphone that provides the brain with the signal to process. With the most common types of hearing loss the ear is damaged, so what reaches the brain is diminished and often somewhat distorted. The amount of damage and distortion is normally measured by the traditional hearing test process that includes Pure Tone Audiometry and Speech discrimination testing.
What these normal tests don't show is how well each individual person can process the signal that enters the brain via the ears. This is where speech in background noise testing comes in. Tests like these normally involve a number of sentences played at a loud but comfortable level, which you need to repeat. With each sentence the volume of background chatter increases, making them progressively more difficult. We can then count the number of words per sentence you hear correctly and determine your individual Signal to Noise Hearing loss. This essentially tells us how much louder you need speech to be compared to the background noise, to be able to understand it.
The standard interpretation of these kinds of tests gives the professional some clues as to what kind of microphone technology you should consider. The problem with the standard interpretation guides is that it simply tells you whether you need an omni-directional hearing aid, which is typically a very basic aid, a directional microphone, which is anything above very basic hearing aids, or FM systems, which means you need a hearing aid and additional accessories called an FM system.
This does not resolve the detail as to what hearing aid will work best for you, so clinicians normally have little choice but to revert back to the lifestyle charts.
This dilemma got me thinking when I started my own hearing care business back in 2009 and I started using Speech-in-noise testing with every new client.
I had always been a bit of a technology geek. After having an almost obsessive level of interest in the technical details of hearing aids, I soon discovered that every hearing aid has its own unique ability to improve signal-to-noise ratio loss.
That got me wondering if one could match up an individual person's signal-to-noise ratio loss (measured in dB) with a specific hearing aid's ability to improve the signal-to-noise ratio (also measured in dB).
I started paying attention to how different clients with their individual SNR losses, fared with their selected hearing aids, providing specific SNR improvements. I noticed that there did indeed seem to be a correlation and the first iteration of CogniMatch was borne.
Using a rather complicated excel sheet, with lists of hearing aids and their SNR ratios calculated based on a variety of characteristics, I was able to match a hearing aid to an individual and produce a star rating as to how well this device will function in noise for a specific person.
As the years went by I tweaked the algorithm to deliver more accurate predictions. Arguably this lead to a high number of very satisfied clients and gave me and my clinicians a high level of confidence when recommending specific hearing aids. I even ended up building a comprehensive Cloud-based application that automatically imports lists of hearing aids and allows us to calculate their correction factors.
Recently we started to notice that some people who were initially recommended more basic hearing aids, but still chose to purchase high-end hearing aids, were reporting difficulty hearing in noise. These people all did well with their hearing aids initially but over time they felt their performance dropped. When I retested their SNR loss, they had all deteriorated significantly. Their scores were so low that even their high-end hearing aid, which has been optimised for them, was unable to help them as much in background noise. The evidence is definitely anecdotal, but it is a concern that I do not wish to ignore.
What I believe might be happening in these worrying, although isolated cases, may relate to how the brain works. We understand that the brain, like the rest of the body, needs a challenge in order to form or strengthen connections. Too much of a challenge and you tire and might give up as the listening effort is too great. This leads to an inability to understand speech in background noise. Too little of a challenge, making hearing in noise effortless, and the connections dealing with the signal might start disconnecting to conserve energy.
I suspect, that inadvertently and significantly over-supporting a person's brain with a hearing aid that does too much of the work could in effect make the brain "lazy". The brain disconnects those underused pathways, leading to a drop in performance in noise to match what the hearing aid is providing or possibly less.
This appears to happen over a period of years and a multitude of other factors could be at play. We also don't currently understand if this effect is reversible. It does however suggest that over-prescription, when a more advanced hearing aid is fitted, than what is really needed, may be something professionals need to keep in mind.
Note: This does not relate to the hearing aid being too loud, but rather doing too much to clean up the sound before putting it into the client's ear. Much more data and peer-reviewed research is needed to confirm this effect.
Based on over a decade of experience in using this new methodology as well as in-house research, we continually improved this unique and beneficial hearing aid selection methodology.
This gave birth to CogniMatch, which rather than simply using your lifestyle as a way to choose hearing aids, takes into account your brain's unique requirements for support in order to get the best hearing possible, without under- or over-prescribing. The algorithm then allows the clinician to see at a glance whether the hearing aid style and technology, they have in mind for you based on your goals, medical considerations, preferences, audiogram, and more will support your brain optimally. They can compare these factors on the fly for any hearing aid available in Australia.
This provides the professional with a clear understanding of how the hearing aid can be expected to work for you in a variety of situations before they even put it on your ear.
From my experience with CogniMatch and the responses from clients fitted with hearing aids that have been selected in this way, I would have to say I wouldn't feel comfortable fitting a hearing aid unless it has been vetted by CogniMatch. We are planning to release this tool to the rest of the industry in 2023 so that as many clients as possible can benefit.
One thing to keep in mind is that a hearing aid is just a small step in your journey to better hearing. If it hasn't been fitted and real-world optimised using gold standard processes and supported and tweak as time goes by, this method alone means very little. It is however a foundational step in your journey to the best hearing possible for you as getting the right hearing aid is critically important to your success.
Value Hearing's Hearing Aid Assessment appointment includes the OptiMatch selection methodology as standard (CogniMatch currently requires a conversational level of English competency from the client to complete speech in noise testing).
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