Hello everybody,
this is my first post here, and pardon my English, I had to use DeepL several times as I am not a native speaker but this thread got me to get involved.
Let me briefly introduce myself. I am a hearing care professional from Germany and at the moment I am also a student at the Technical University of Luebeck in the field of hearing science and acoustics. I started my apprenticeship as a hearing aid acoustician in 2016 in a well-known and highly regarded company in Southern Germany and became a journeyman at the beginning of 2020 (my CV is anything but normal and I am definitely an absolute late bloomer - I was born in 1984).
My username DRMLFL (pronounced Drummel-fell) is a german-english wordplay. I started playing the drums 2 years ago and "Trommel" means drum, "Trommelfell" means tympanic membrane or eardrum. The logo I am using shall represent the right ear drum, the little triangle on the lower right side is the cone of light, or light reflex. My passion is the sense of hearing and everything that is related to sound.
So, I have been a silent reader of this forum the last few weeks because I want to learn more about audio/speaker placement/room modes etc. I´ve been making music for over 20 years and since then I became a passionate hobbyist in audio enginee(a)ring (pun intended) and music production. Right now, I want to improve the acoustics of my room in order to become more efficient in producing. There are so many helpful information on this site, thanks for that!
I had the opportunity to test and to try lots of hearing aids in the past and I can tell it is a "complete" different hearing than your "normal" perception. But in general, they all have more or less the same sound - it is like with telephones, there is no real difference between them because of the limited frequency band (around 300 Hz to 3.5 kHz). Ok, smartphones sound a bit better, but still. I hope you get what I mean by that analogy.
An hearing implant sounds - depending on how many channels it provides - similar to a vocoder.
You can find some sound examples of hearing implants on YT:
This is in german language:
I will also try to emulate the sound of hearing aids in the near future if anybody is interested.
I had a client (aged 48) who underwent a cochlear implantation at the beginning of 2023 (monaural), he said that after a few weeks he has already got used to it well and started to "understand" what his implant is "saying". Before his surgery we tried a masker for one or two weeks because he had severe tinnitus which almost drove him insane and severe to profound hearing loss on one side (80 dB HL in average) and he was wearing the hearing device over 12-16 hours per day. He would sometimes raise the volume of the masker to 80 db SPL! I assume he was just feeling the sensory and tactile threshold of the affected side and had the impression this could help him to suppress the tinnitus, but it was the transitional hearing that happened to his better ear. He confirmed this after I explained him some things about the hearing process in general. I could hear the noise of the tinnitus masker although he was 2 meters away from me and we even used a custom ear mould. But I could no longer take responsibility for it and he had a profound hearing loss and I think he had been suffering from hearing loss the last 2-3 years, so I told him to look into cochlear implants and to talk to a specialist in our town. He was very open to this topic from the start. At an appointment he described the sound of his implant as very robotic and not human-like at all, but the severe tinnitus he suffered from was almost inaudible and you could really see the relief he felt. This was the most moving moment in my career as a hearing care professional. Unfortunately, I have had no contact to him for some time now because of my relocation but I will send him a mail in the next time to see how things are going for him now.
But like with everything, there is no specific timeframe in which you will get used to the new sound your brain has to interpret. Maybe a few months, maybe years, maybe never. So many things come together, like your age, your experience in life, your expectations, how fit you are (mentally, physically), whether you constantly train your hearing or not. I think the biggest aspect is the psychological one (are you afraid or are you excited to see what will happen etc. and also, do you consider yourself a cyborg after the surgery could be one reason, for example). A defensive posture is certainly not beneficial.
I also know several people with implants, but they all had surgery when they were very young, so they can´t remember how "it" was before. So wearing these devices is totally normal to them. They cannot imagine being without, of course.
There are different solutions in hearing aids like a masker or a noiser to treat tinnitus but there is no guarantee that it will work because there is no general cure as I am writing this. For most of the clients/patients I worked with who suffered from hearing impairment + tinnitus it didn´t really work and it was more disruptive and annoying. Most of the time the pure amplification of hearing aids was/is sufficient enough in order to push the tinnitus more in the background, simply because hearing aids produce a natural hiss sound (white noise-ish) at around 23 dB which embeds the in most cases "whistling" tinnitus noise (somewhere between 4-8 kHz).
I would describe the sound of hearing aids as a "cheap" pocket radio, they have a poor resolution (speaking as an audiophile) with a fake stereo image which is much wider than reality. One "problem" (and there are many imho, like delay time between direct and processed sound) with hearing aids is that they cannot reproduce frequencies over 10 kHz (and lower than approximetaly 120 Hz) because they run with a bit-depth of 18-Bit and the sample rate is only 33 kHz. The sound can get shrill, squeaky and whining very quickly even with broadband amplification (I think of "aliasing" due to Nyquist frequency), and I assume there are some phase cancellation issues and slow release time of the (often) multiband compression, hence the hollow sound at times. Also the microphones and receivers are very small, so there is already a physical limitation of what is possible.
Depending on how it was build the fitting room at the hearing care professional store could also suffer from a very poor acoustic where flutter echos, heavy comb filtering and poor RT60 occur/come together and the fitting of the hearing aids alone can become a real hassle because of this. In more than one situation I had to explain the normal and audible reverberation of every room (anechoic chambers excluded) to the clients once the hearing aids were fitted appropriate to their hearing loss. By the way, the perception of room reverberation with hearing aids is much more audible than without, mainly because of the "poor" quality of the microphone used in hearing aids, in most cases electret microphones, and the diminished dynamic and frequency range . Plus, the patient has forgotten that every room and every surface creates reverberation/reflection and how that sounds - and many other things - the so called hearing withdrawal or hearing dehabituation. In 99% cases (at least in Germany) they just hang up carpet/rug on the wall of the fitting room, which sounds horrible (boxy, dull and muffled) and very often with interference noise coming from outside the room, louder than 40 dB. And they seriously call this a hearing booth...
Streaming music in hearing aids via bluetooth is absolutely not a pleasure due to the lack of bass frequency response, and also the audio distorts very quickly.
Don´t get me wrong - despite my criticism -
these devices are very important and most of the clients I worked with had great results and a much better speech intelligibility in speech tests with and without background noise, often 30-50% (sometimes even more) better than without hearing aids, dependent on the degree of hearing loss and the hearing withdrawal or dehabituation and their general condition.
The benefits of a better hearing are much greater than my complains about these devices!
And sometimes the problem is more than simple "hearing impairment", i.e. communication disorder or auditory perception disorder. The problem with mild or moderate hearing loss is, you need a positive signal-to-noise-ratio of around +5 dB (of course, depending on the degree of hearing loss) for an acceptable speech intelligibility (50% comprehension of monosyllabic words) whereas "normal" hearing persons can compensate sometimes a negative SNR up to -8 or -9 dB.
Still, from my point of view, the hearing aid business should be taken with a grain of salt and with utmost caution. Not every ENT, audiologist or hearing care professional understands what he/she is doing and I have seen the wildest things, I had to shake my head more than once.
All companies have financial interests in the first place, always keep that in mind! TIME IS MONEY! They (your boss/company you work for) will put the hearing care professional under pressure because appointments lasting more than one hour are not financially viable/profitable. And you (hopefully not) will put your client under pressure in order not to exceed 3 appointments per client and come to a "conclusion" very soon. Otherwise, you will not be considered a "good" hearing care professional! I did not care about my boss and he luckily did not put this pressure on me because he benefited from me in other ways.
I am also very critical towards the so called "over-the-counter" and "self-fitting hearing aids" market in the United States, which (I assume) will finally also come to the german market in a few years. I am just waiting for companies like Ap*le and others to sell hearing aids and to promote them as lifestyle devices, which they are NOT. These are medical devices/products in the first place, regulated by the U.S Food and Drug Administration (FDA). But to be honest, I have the impression they are the same *
word of your choice* like the people from WHO!
If you ask me you should
ALWAYS test the fitting/amplification of your hearing aids with a speech test in order to see if the devices really work for your favor.
The one question to clients I hate the most from my colleagues during fitting of hearing aids: "Does it sound better now???" Click (*cough - or fake it - *cough) on a few buttons in order to adjust the fitting of the hearing aids and ask this question your client a few times. At a certain point he will automatically say yes because a) he cannot remember the overall sound 30 seconds ago (mainly because there was just silence and no test signal for example for him/her to listen to) or b) he is very annoyed and irritated. I have seen this tactic many times, either because the colleagues did not know which buttons to click in the software matrix in order to get a "better" sound quality or because they simply did not want to spend any more time on this particular case. And in so many cases no speech test after the fitting... smh!
What I personally find problematic are, in general, doctors/ENTs/audiologists, hearing care professionals on YT promoting brands and companies. Never forget,
they get sponsored by them!
I was just reading the
clinical trials of Lenire company, and this is what I find strange, among other things:
Tinnitus is
always a chronic issue, because THE MAIN criteria is the duration in which the sound was perceived (at least 3 month). This circumstance should be more than clear, no need to specify this. But otherwise, there are many people with false assumption regarding tinnitus/hearing loss and maybe this is/was their way of sorting people out.
Another exclusion criteria, which I find not serious/reputable is that only patients with a mild hearing loss of less than 40 dB HL were tested. And what about people with moderate or even without hearing loss having tinnitus? In case you are wondering, yes, they do exist. I am one of them (but I have a theory for this), and I have other things concerning my hearing that nobody was able to answer up to now.
I didn´t know about this device and maybe it can help, but my complain is the number of test participants, 326 in total, which is literally nothing if you ask me. It could be just a placebo effect.
An estimated 1,5 billion! people worldwide suffer from hearing loss (
source). Of course, among them, many will also have tinnitus. I can imagine the number is even higher and will increase in the future because music/media consumption is constantly increasing and so many people wear earbuds these days - and we have not even talked about the affect of wireless radiation, which could potentially be an amplifier for the cause. We are surrounded by ten thousands of mobile phones and antennas within a radius of 5 kilometers. The signal strength has increased (5G) the last few years.
But, in general, tinnitus is a "very complex" phenomena and "experts" still don´t fully understand it.
Please let me know if anybody tested this product and please do share your experience!
There are other exclusion criteria of trial persons/test subjects (ugly word) which I find doubtable, but I do not want to make this a complete rant, so I will stop here.
Very interesting to read the comments here, I will try to make my contribution to the education of hearing aids, tinnitus and hearing loss in the future.
If you have not tested your hearing as an adult yet, I highly recommend
EVERYBODY to visit an ENT or hearing care professional nearby you so that you have clarity. There are also apps for smartphones, which are of course not so reliable like a calibrated audiometer but they can give you an indication. In most cases the higher frequencies are affected and the hearing loss is sloping, from 3-4 kHz upwards in the audiogram - or it is a noise notch at 4 kHz. I would say half of the clients/patients I have met did not know about it or were not aware of their hearing loss because it is a deterioration over time. In some cases, family members have brought this to their attention.
This is a diagram/audiogram (the english version) I made for my clients for a better assessment of their hearing loss. I hope this helps a bit!
View attachment 334389
Please, don´t get me wrong, I don´t want to spread neither panic and fear nor a bad vibe and I am certainly not a pessimist. I just have seen so many things from the hearing aid industry and sometimes I ask myself if they even know what they are doing. The hearing aid industry take so many things for granted and expect their
customers (
this is what you are in their eyes) to spend a lot of money with them not knowing what they are paying for and - more important - what to expect after they bought them. You don´t get many informations about hearing aids in general, and from my own experience you won´t find many acousticians with a deeper knowledge about the technical things inside hearing aids, which I find very disappointing. Not one single person I met in this industry has ever understood what I was talking about...
I wish more audiophiles, musicians, technicians, mixing/mastering enginee(a)rs would enter this industry, the society as a whole would benefit from.
I repeat, an estimated 1,5 billion people worldwide suffer in some form of hearing impairment, most of them not even knowing!
In Germany hearing care professionals are regarded as craftsmen but most of them are just sales and business men.
One last thing:
There is this german saying: "Wer nicht hören will, muss fühlen"
He that will not hear must feel!
Hearing impairment can increase the risk of dementia. It shows how deep the sense of hearing is connected to the brain.
Did you know? The sense of hearing is the first of our 6 senses to be developed. Do not let it be something that withers away as if it were nothing. It is more precious than most can imagine!
Stay focused!
PS: if you read this text upon to this point it shows that you have some interest concerning the hearing process and I will answer every question you have as good as I can.
PPS: please let me know if you find any grammatical/linguistic mistakes, it was a real challenge to me.
www.oxygenmag.com
3dB? 6dB? 20db? ...and beyond?
