- In this video, I'm gonna show you the difference
between hearing aids that are programmed
using Real Ear Measurement vs. hearing aids
that are programmed using the auto-program button.
Coming up.
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Hi, it's Cliff Olson, Doctor of Audiology
and founder of Applied Hearing Solutions
and Anthem Arizona.
And on this channel I cover a bunch
of hearing related information,
to help make you a better informed consumer,
so if you're into that make sure
you hit that subscribe button,
and don't forget to click the notification bell
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All right guys, I wanna give you a little heads up
this video might be a little complex for some viewers,
so if you don't know what Real Ear Measurement is yet
then I highly recommend you watch my video
that I will link in the card up here
and in the description below,
and then come back to watch this video.
All hearing aids sold today have the capability
to be auto programmed, otherwise known as First Fit.
First Fit is basically,
when you take the hearing loss of an individual
you enter it into the manufacture software
and it provides an estimate for how much amplification
that individual should receive.
All hearing aid manufacturers
have their own proprietary First Fit algorithms
to provide a certain amount of amplification
that they believe is best from their devices.
The problem with this is,
is that you cannot verify a prescription
that is proprietary to these manufacturers
because third-party verification equipment
can only verify certain validated prescriptive methods.
You see even individuals with identical hearing losses
will require different amounts of amplification
at different frequency ranges,
based on different ear canal size and shapes
of those individuals, because no two ears are alike.
To understand why hearing aid verification is so critical
you have to understand what a prescription is.
A prescription is basically the amount of amplification
that an individual with the hearing loss
would require at each individual frequency
to ensure that sounds are comfortable and audible for them.
Prescriptions take into account
a variety of factors from individuals including their age,
their gender and how long they've been wearing hearing aids.
Based on years of research,
we know that verifying hearing aid prescriptions
using Real Ear Measurement,
will improve the way that someone can hear
in nearly all situations including background noise
which results in a better
overall listening experience for a user.
In fact, this research continues to happen,
we just had a research study come out not too long ago
by Washington University where they did a double-blind study
that indicates that users prefer
hearing devices that have been fit
using Real Ear Verification
versus hearing devices that haven't.
If you wanna go ahead and see that research
I went ahead and linked that in the description.
The two most common validated hearing aid
prescriptive methods are NAL and DSL.
NAL is derived
from the National Acoustics Laboratory in Australia,
they had the NAL-R for linear hearing aids,
the NAL-NL1 for nonlinear hearing aids
that use compression,
and they also have the updated version of the NAL-NL1
which is the NAL-NL2.
The DSL prescriptive method
stands for Desired Sensation Level,
this one was derived out of the necessity
to have a verifiable prescription for children.
You see adults and children both require
different levels of amplification,
and they are now on the fifth generation of the DSL.
Verifying hearing aid programming
using one of these validated prescriptive methods
will ensure that you're receiving
the proper amount of amplification,
for your hearing loss and your individual characteristics
like your ear canal size and shape.
Of course, Real Ear Measurement is the gold standard method
of verifying these hearing aid prescriptions.
How this process works, is your hearing care provider
will place probe microphone tubes inside of your ear canals
along with the hearing aids that they are programming.
These microphone tubes will record
the level of amplification coming out of the hearing aids.
By playing a known calibrated signal
from a loud speaker in front of you,
we can measure to see if the amplification coming out
of the hearing aids is meeting your prescriptive targets.
When we look at these measurements on a screen
we see the prescriptive targets for sound
indicated by the purple hash mark line.
The solid purple line indicates
the sound coming out of the hearing aid
after it has been amplified.
The goal is to have these lines overlap
as closely as possible.
On the left hand side of the screen
you're looking at a hearing aid that has been fit
using manufacturer First Fit settings,
and the screen on the right is the same hearing aid
after has been programmed to the prescriptive target
using Real Ear Measurement.
When you are at your prescriptive targets,
that is where you will hear your best.
If you had to pick between fitting in the left
and the fitting on the right,
which one would you pick?
The problem is, the majority of hearing care professionals
use manufacturer First Fit method
instead of using Real Ear Measurement.
You see hearing aid manufacturers are not stupid
they know that two out of every three hearing care providers
is not going to use Real Ear Measurement
to verify that a hearing it is fit appropriately
to a patient's hearing loss prescription.
So, what do they do?
They reduce the amount of amplification
particularly in the high frequencies
to make that amplification more comfortable
for a patient, thereby reducing
the likelihood that that patient
will return those hearing aids
because they don't like the way that they sound.
I wanna show you some evidence
to illustrate what I'm talking about.
So, I'm gonna actually show you some screenshots
of First Fit measures that I've done on hearing aids
that are programmed by the manufacturer of software,
and then I'm gonna show you
what I actually adjust them to,
to make sure that they're meeting a prescription.
In this screenshot the pink line illustrates
the manufacturers First Fit estimate of amplification
and the purple line shows the programming
after adjustments made using Real Ear Measurement.
After verifying the amplification using Real Ear Measurement
we now know that this patient is getting
the correct amount of amplification
to accommodate their hearing loss,
again different hearing loss but same result.
It isn't as bad as the previous example that I showed you
but he was still significantly under amplified
in the high frequencies.
Now, there is a chance that this patient
would have been somewhat satisfied
with this hearing ability,
but he wouldn't perform at his best based on research
and he likely wouldn't perform as well
in a background noise situation.
Here is a third example
of a poor manufacturer First Fit estimate.
Again, pink is the manufacturer estimate,
the purple is after making adjustments
using Real Ear Measurement.
See how close we get
to the purple hash mark prescriptive targets
when using Real Ear Measurement?
I'm sure this patient appreciated
not going with the First Fit settings because if we did,
they would be missing a significant amount of speech clarity
by under amplifying the high frequencies.
The point is if you don't have
your hearing loss prescription verified
using Real Ear Measurement,
you really have no idea whether or not
you're meeting your prescription or not.
Actually, you know you're not meeting your prescription
because I've done this a million times,
and never have I ever seen a First Fit estimate
even come close to matching a prescriptive target.
And this is from some of the most high-tech hearing aids,
top-of-the-line hearing aids
that exist on the market today.
You guys, I am not making this stuff up
there are tens of thousands of individuals
walking around out there with hearing aids
that are not programmed correctly
to their hearing loss prescription,
because they've never had
Real Ear Measurement performed on them.
Now, I know that there's some of you out there
that are getting sick of me
talking about Real Ear Measurement
and how important it is,
but the simple fact of the matter is
is that I'm not gonna stop talking about it
until 100% of hearing care providers do it
on a regular basis.
Hopefully this video has opened your eyes
to the importance of hearing aid verification.
Even if it costs you significantly more money,
which it usually doesn't
you should demand that Real Ear Measurement
be performed at your fitting appointment.
If you don't have Real Ear Measurement performed
and you rely on manufacturer First Fit settings,
then you are setting yourself up for a poor fit
of your hearing devices
which will ultimately result in poor performance.
That's it for this video, if you have any questions
leave them in the comments section below.
If you like the video please share it,
and if you wanna see other videos just like this one
go ahead and hit that subscribe button.
I'll see you next time.
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