We've Been Testing Hearing the Wrong Way!

[@sfrink1425]

I totally agree with your overall impression, that BOTH tests should be done, and we've been doing them at my practice for about 25 years. But I'll add some MORE suggestions... Another problem with the traditional standards for testing is to test word recognition at the patient's most comfortable listening level (MCL), i.e. turn up the volume until the patient likes it. The problem with this is that it only tests the patient's ability to hear when the volume is cranked up, not actually how impaired the person is. If a patient has a 20-45dB hearing loss and you test them at their MC, this is likely going to be around 50-75dBHL, which is actually LOUDER than normal conversational speech (which is traditionally around 40-50dB under headphones, 45dBHL average). So if you test them at a 50-75dBHL or louder, you're really just showing how well they'll do with amplification. Our practice, however, does an additional word recognition test if the patients speech reception thresholds (SRTs) OR their puretone average (PTA) is 45dBHL or better. We first test them at 45dBHL and see what the word recognition score (WRS) is. Since this is essentially testing them at normal conversational speech level, it demonstrates how bad they hear WITHOUT amplification, which is really what we need to know to determine if they'd be a good candidate for hearing aids. I've had many patients who have a mild loss and I test them at this level and they get 100% correct. These are the patients who, once fit with hearing aids, don't notice enough of a difference to justify the cost. This was part of our way to ensure that the cost / benefit ration makes sense. And sometimes if their WRS isn't 100% but still isn't that bad (i.e. 92%+) they still don't perceive enough benefit to justify the cost. If, however, they get less than 92% at 45dBHL, then you test at MCL and they get 100%, these are the patients who normally notice enough benefit to justify the cost. But then we take it a step further...with the QuickSIN test. Rules as written (RAW), the audiologist is supposed to administer the QuickSIN test with a 70dBHL presentation level OR LOUDER. But again, this is just demonstrating how well they'd likely do with amplification -- not with regular conversational speech level. People who haven't been fit with hearing aids don't complain about how well they hear with amplification because they don't have any. They complain about how poorly they hearing in background noise with their natural hearing. So, we defy the Rules As Written and again, for mild losses, first administer the test at 45dBHL. As you indicated in the video, a low score indicates someone who actually does well in background noise. A score of 2.5dB or less is considered "commensurate with normal hearing acuity." If you fit someone with such a low score with hearing aids, they'll again be the ones that don't keep them because they actually do just fine in background noise without the need of the devices. But if you test them at 45dBHL and the get a higher score (let's say 8.5) and then you test at MCL and it improves at least 4dB, it's a noticeable difference and they'll likely benefit from the hearing aids. After all, it's the people with mild hearing losses that are often the ones that say "I do fine in quiet and just have problems when there is background noise." Testing QuickSIN at 45dBHL is also a great way to catch "hidden hearing loss" and auditory processing disorders when every other test suggests the patient has normal hearing. So, my recommendation to audiologists and dispensers performing these tests is, when there is a milder loss, take your testing a step further and evaluate both WRS and QuickSIN at 45dBHL. It will help save you and the patient time and money to help determine if they are truly a good candidate for hearing aids -- or not.

[@sasha-gmail4370]

Thank you for excellent comment!

[@llucq1]

100 thumbs up!!!!! About time someone explains my #1 issue!! TEST hearing with background noise, NOT in a quiet environment . I have 3 grandsons, a daughter in law (who speaks low) and they have a home with high ceilings. SO.. with 3 boys chatting away, daughter in law wanting to know if I need another drink (hell yes!). I tune out at their home. Yes I have hearing aides (Oticon), which are great in a normal environment. It's so frustrating trying to explain this ...thank you. If you need a test subject CALL ME.

[@lauramaeda7214]

I was referred to an ENT in February due to an extremely dry ear issue. There was also a possible issue with the ossicles that one doctor wanted examined. My last speech in noise test made me feel broken. By the third sentence, i was in tears because i had no idea what was said. My word recognition scores are good but not great. It was a bit of a shock how different those two scores were. Granted, I could have had a bad hearing day as my tinnitus ramps up when i am anxious. It is great to know that i have a wonderful audiologist, Scot Frink, AuD that i selected from your Hearing Up Network that performs comprehensive testing.

[@glennfoote395]

Hi Lauren, I have the same issue. I have had to have ears cleaned each year. I started to take olive oil regularly. The ears are much more moist. Dry skin is wax is gone.

[@AG7SM]

I didn't have the QuickSIN test done, but I did get a test that made me repeat words that were being played to me over crowd noise. I also remember that test being one of the most emotionally difficult tests for me, because it put me in the situation I have the most trouble with. My audiologist has served me well and I am happy with my hearing aids.

[@FadeRunner13]

There are different types of hearing in noise tests

[@juliettesterkens721]

So agree. It’s absolutely needed to determine the patient’s SNR loss. Nothing new. Mead Killion, Robert Sweetow and many others have been beating this speech-in-noise drum FOR YEARS!!!

[@barryalanlevine]

Adjacent question, Doc. Why are none of the tests repeated while wearing your new aids? I realize that the Real Ear Measurement test is the gold standard and, assuming it's working well, provides the most objective assessment of how well your aids are performing relative to your hearing prescription, however it seems like running the word recognition test (either in quiet and/or background noise) while wearing aids would also provide a valuable comparison and potentially point to some fine tuning needed in the programming, no?

[@FadeRunner13]

You can… assuming the clinic is set up with the appropriate speaker set up. However, these tests are primarily more for validating the benefit than actually assessing an objective improvement. Just ask for an aided speech discrimination test or aided speech in noise test

[@DrCliffAuD]

You're talking about funtional gain testing and it provides little to no adjustment value. SIN testing does provide value, but not from a fine tuning perspective when programming.

[@BrentonHoyosHearingLife]

I'm proud to be part of the ~15% that performs the QuickSIN test (though, I really hope more Hearing Care Professionals will do it). It makes such a difference knowing how my patients will hear in noise. I'm also shocked when people come in and say they had their hearing tested somewhere else and it was only the pure tone testing. A truly comprehensive test should always include the QuickSIN!

[@sharonsuskin6859]

I use a ENT that is very experienced and the audiologist has a doctorate. The problem is my top hearing aids (most good hearing aides) can't do much to make speech louder without making everything louder. I have had it adjusted everyday possible. The technology has not caught up. Background noise is the problem for everyone with common hearing loss. Speech with noise and music on TV is the worse.

[@FadeRunner13]

It goes to show you how difficult the task is. Separating speech from noise in live situations is actually much more challenging than people give it credit for. some of the most advanced hearing aids, have the processing power comparable to a mid-tier smartphone so from a technological perspective, they are rather impressive for their size. Also, the biggest factor will be your ear/brain’s ability to interpret these sounds. I have had patients Who do very well in noise, and who do very poorly no matter how much adjusting we do. You may have to incorporate the use of an assistive listing device to help you close the gap and even then some patients still struggle. Really depends on your degree of hearing loss, speech discrimination, and speech-in- noise hearing ability. What is difficult for you might be loud and clear to others.

[@DonAlderOfficial]

which hearing aids do you have and whats your hearing loss

[@mattbusich]

Taking your recommendation a step further, Dr Douglas Beck was a speaker at our Costco managers CEU convention and discussed different methods for testing quicksin. He suggested presentation in soundfield to simulate noise behind and speech in front. Presenting speech in noise monaurally tends to make everyone perform very similar and SnR values are not truly assessed if the noise and sentences are presented with headphones in the same ear. Incidentally, I have to change this setting on my audiometer and it makes the test very time consuming because our company defaults to presentation of both speech snd noise in the sane channel. It's doable but not as good at indicating SnR loss.

[@howardjohnson3499]

You didn’t connect the dots. So you test for recognition with background noise. Please explain how knowing that helps you decide what hearing aid to get and how to program it. I don’t see how knowing that data makes a difference in either.

[@ahgflyguy]

Maybe it tells you that a simple amplifier hearing aid won’t help much at all, and that an aid that has voice detection or directional amplification (or both) would be necessary to see any useful improvement?

[@FadeRunner13]

It matters with instrument selection, feature set, microphone configuration, programming/fitting strategy aka your prescriptive targets, compression ratios, attack and release, syllabic or phonemic time constants, the need to incorporate assistive listening devices, etc. Even with all these considerations, it may not close the gap depending on how severe the loss is. Unfortunately a lot of people don’t understand that sensory hearing loss, which is the most common type of loss, is permanent, and the patient will never hear like a normal hearing person ever. They must learn to hear through the confines of their own hearing ability a.k.a. nerve function. The longer it is neglected or the more serious hearing loss, the more dubious the prognosis. Your hearing care provider can also use this information to give you realistic expectations of what your outcomes will be. For example, if you have a 0 dB SNR loss, you will do very well, if you have a 20 dB SNR loss you are cooked.

[@ahgflyguy]

@@FadeRunner13 so now is the SNR loss something that happens in the middle/inner ear, or is it a brain thing? Or both, with the brain’s auditory processing degrading when there’s not high-quality signals for it to attune to?

[@Mudhen2020]

@@FadeRunner13 you absolutely nailed it. I dove into SNR a couple years ago and it is vital for the patient to understand how this will impact their experience with HA’s.

[@Gk2003m]

@howardj: I hear perfectly well in quiet scenarios, despite tinnitus. I can, for example, have TV audio near zero and hear virtually everything in the program. But in a noisy room, my ability to hear details - particularly conversation - dissipates. So testing against levels of background noise would, if I opted for hearing aids, be crucial to me getting the right ones.

[@bloodguard]

As a patient I'd really just love a knob that I can turn until I can just barely hear the frequency they're testing. The whole endless tones that I can't hear just make me feel like I'm failing a test I can never really pass. And the whole word recognition slog is just... dreadful. Makes me dread and put off going in for new HAs.

[@2009raindrop]

Indeed! Why don't they do this, if only for the psychological comfort of the patient? I wouldn't even mind if after turning the knob myself, they THEN do it the way they do it now. I would love to see a comparison of results.

[@FreshDrive]

I completely agreed with this. Am based in the UK with a private company and am profound deaf. The biggest problem was speech in noise, I can hearing everything but not the person itself, I always kept saying, I want that voice to be closer and/or louder toward me, to overcome the background noise. It’s the biggest failure in audiologist industry.

[@DavidEhrman-xr9gl]

Thanks!

[@JCh-oj3pv]

If the experts have been measuring wrong, have hearing aids been designed wrong also? Which hearing aids can correct a 20 dB sin loss?

[@FadeRunner13]

This video title is Clickbait. He could’ve easily relabeled this video to say “make sure your audiologist is incorporating this super important test”. By the way, no hearing aid will correct for a 20 dB speech in noise loss… it’s too much damage to the inner ear… not without the use of an assistive listening device.

[@DrCliffAuD]

I clickbait. You troll the comments. We're even. 😂

[@juliettesterkens721]

What a terrific topic to tackle! Yet I believe you don’t explain the SNR clearly enough for the viewers to understand. The SNR value that is obtained using the Q-SIN test determines the point where a hearing-impaired person requires the target speech to be “X” dB louder than the NOISE to achieve a 50% correct score (FIFTY % CORRECT SCORE - caps added for emphasis.) Note that 50% is NOT 100% or PB Max. The PB Max is determined by essentially doubling that SNR number. As you know, the speech recognition scores rise much less steeply for those with hearing loss versus those with normal hearing as seen in PI-PB graphs. Someone with a Q-SIN score of 8 could easily need speech to be 16 to 20dB louder in order to hear with ease, process the information and remember what was said. So even if you were to fit D-mic hearing aids on a client with an SNR of 5dB-and his D-mic were to deliver 5dB SNR improvement-that only gets him or her up to 50% effortful listening. To get him or her up to effortless listening, he or she needs 10-15 or even 20dB. This is the reason why consumers need accessories and assistive listening systems such as hearing loops and FM/IR systems with neckloops.

[@judyshugarts3532]

I know you are from Canada but I'm very frustrated with the Medicare eligibility guidelines. I had my Cochlear eval on Friday. At first, the audiologist said I qualified but I still had to see the Dr. After seeing the Dr I’m not eligible because my word recognition is 80% in right ear with the standard word recognition hearing test. Although with the SIN (speech in noise) test I only had 26% word recognition in my right ear. Since I am not single-sided deaf (I still have some hearing in my left ear) Medicare won’t cover the CI bc my word recognition in good ear would need to be less than 60% using the standard audiogram word recognition hearing test. Of course there are more specifics to my hearing loss and tests but I am frustrated that I am not eligible for a CI. I have BiCros and a Roger. The Roger Mic helps but not in every situation, especially if there is one background sound.

[@gordonquickstad]

The microphone placement on RIC hearing aids is not helping. The mic points UP and is most sensitive to noise reflected off of ceilings and also receives rearward noise better than the frontal speech that you're most interested in. There should be a forward facing mics that are most sensitive to the direction that your attention is directed to.

[@FadeRunner13]

Very likely the placement of your devices is not correct. Ideally a RIC hearing aid sits on top of your ear for this very reason. If it’s sitting too far behind the ear, you will hear the ceiling fan, wonderfully, but not the person talking to you. Go to your audiologist and shorten the receiver wire. That is how they are designed to sit and work wonderfully when this crucial fact is not overlooked.

[@juliettesterkens721]

Ask your audiologist to perform EAA - electro acoustic analysis on a large percentage of hearing aids d-mics are wired the wrong way.

[@DuffyF56]

AMAZING given when I asked for your help last year in trying to get the VA to change the way they determined hearing disability making the very same points you made in this video I got the brush off from your staff when I attempted contact. Disappointing given Dr. Cliff is a VETERAN. Currently the VA (by LAW) ONLY use two tests to determine if a Veteran is hearing disabled. The Pure Tone Audiometry and the Maryland CNC Test.

[@alspencer2794]

Why does a patient not get the same hearing test with their hearing aids in, or is this part of your best practice? Noisy environments are the worst. I have the Phonak Roger and it still picks up a lot of background noise. Not a lot of improvement.

[@DrCliffAuD]

I have Videos that explain that.

[@DuaneSmelser]

Very very old news. And providers dropping standard Word recognition test would be severe negligence since it is the most important indicator of how a client will comprehend conversations when not able to see the face of the speaker.

[@TK-zc5wu]

out of interest what country do you live in? if its old news to you its amazingly new to me i have been hearing imparired deaf whatever since d1983 and live in uk never heared of this

[@DaveG-qd6ug]

@@TK-zc5wu It is old news, even argentina tests with background noise. Really not helpful as hearing aids just amplifies the noise.

[@vicgeier3482]

Ran into bad background at work today, had to turn my aids off, thank God for your best practices that Dr Inman used to help

[@milledgehart8583]

I recently had a hearing test and was surprised that, in addition to the other tests, they also did a test of hearing in a noisy background. It was the first test I have had like that and after the test my hearing aids were adjusted and I noticed that I could hear better in noisy situations.

[@ralphw3]

Finally, you guys are getting closer to what you need to do. But this isn't the only thing the hearing industry is missing. Another is the quality of sound needs to be clear. Think hi-fi. I still think that the hearing aid industry has a long way to go on the technology side. AI has been around a long time. It is not new. Your "best practices" aren't cutting it. I hope the hi-fi audio industry gets into this in a big way. They are just dabbling right now. Am glad you are starting to see the errors of your ways. But there is a lot more to go. I think the hi-fi industry is closer to what needs to be done versus the current hearing aid makers. They are still thinking like they did for the past 30+ years. And the way audiologists do business needs to change major big time. Think publishing of prices. Your current reasons for not doing so are the wrong ones. Everything should be itemized like a car repair so the patient can pick and choose. This is one of the reasons why the government came in with the OTC stuff. They didn't go far enough as the current "best practices" need big changes and so far, I see nothing changing just yet.

[@MrTennc]

Once a SIN test has been completed, just what adjustments are made. The tone test has established the degree of amplification needed at each frequency. What changes will the audi make?

[@akf8783]

Agree. It's like trialling a self driving car on a straight road, with some but low level traffic, moving at a constant speed. The impressive tech works great, we are wowed and sold,,,then it doesn't seem to really works so well on real roads, and we just leave the car parked in the proverbial ’drawer'

[@WalkerFamilySports]

Thank you. So relevant to me. Despite a $6,000 price in 2023, my Phonak hearing aids do so, so little to help in background noise situations that I do better reading lips and filling in as best I can what I miss. Are there aids, is there technology already out there? Or is this just an overdue revelation that will hopefully lead to better noise filtering technology? Understanding is only the first step, right?

[@FadeRunner13]

There’s so many factors contributing to successful use of hearing instruments. It depends on how well the devices are fitted to you and how realistically your nerves and brain will allow you to hear. The challenges that hearing aids don’t necessarily need to filter, noise, but manage noise. It’s a significantly more difficult task than people give it credit for. It needs to allow you to hear your date at the restaurant, be aware of the waiter trying to get your attention, while managing, but not eliminating, the noise behind you, as you need to be aware in case someone is about to drop hot soup on you. Filtering and canceling noise is easy, managing it is difficult.

[@charliejg]

The practice I went to did do a test that introduced noise while listening to speech, but it wasn't sentences it was just words like the quiet test. I remember that on my follow-up visit the did another hearing evaluation and my speech in quiet improved. I still swear I have something going on in my eustachian tubes or sinuses or both because I get changes in pressure feeling all the time. I did have an MRI, but it just seems odd that I am experiencing this feeling of pressure in my head. Question 1: If you have a poor SIN test, are there specific brands that have better background noise reduction? Question 2: What are your thoughts about the ClearCast product? Thanks, have a great day!

[@FadeRunner13]

There is no single brand that is definitively better or worse for background noise. All hearing and manufactures work towards the holy Grail of hearing in noisy settings. They just have different methodologies and philosophies of how to get there. Signia IX is pretty impressive with their sound architecture. The most important thing is how well the devices are fitted to you, and how realistically your brain and nerves allow you to hear in crowds.

[@Diggers5]

Very useful video -well done!

[@randallgoff3689]

Yes, thank you. Between tinnitus and background noise and slowdown of transmission to my brain. I need hearing aids I cannot afford

[@suzannelefrancois5343]

Excellent information. Thank you

[@MiguelBenavides-cc7nt]

I was wondering if you had any experience with the ACT test from Interacoustics? As far as I can see it has not been addressed?

[@registromalplena2514]

It really reminds me of the color blind test. You can see colors and name them (or not). But separately from that you could have a hard time distinguishing the colors from similar shades and colors.

[@patsample5479]

Ok, this video made complete sense to me, however it raises my question. Now that you agree with the issue raised here, how will all of the other providers in your HearingUp service fall in the same line? Provided you have a process in place to address this I would be willing to leave my existing provider for a HearingUp provider. I understand that all doctors in your service are personally vetted at time of joining, but what keeps my local provider in Missouri up to your "New" best practices? How often are the providers "revetted"?

[@DonAlderOfficial]

Dear Dr Cliff Im curious if you know the answer to this . Im told that normal ears can endure 85 for a specific time and not take damage however what about damaged ears say -30 -35 on the right and left ears and - 40 down on both ears to - 80 on the higher frequencies. Question being will damaged ears like that take more damage with less than 85 db based on that they are all ready damaged or does the same threshold for damage remain the same as normal hearing. This leads to the next question if you get hearing aids setup for hearing people talk in loud restaurants running 85 to 95 db does that mean one should avoid these settings thx

[@petersrosenthal]

Given this how well are you able to address speech recognition in Background noise? This is always my primary issue.

[@peterpappas620]

Even if we are tested for this to understand how much louder someone's voice need to be to hear that in noise, what can really be done to help it? My experience with even the latest generation of hearing aids, is that they still have difficulty isolating the desired speech from the rest of the noise in the environment. This is particularly true in restaurants where most of the background noise is other people talking. Until hearing aids can truly identify the speech we actually want to hear, knowing how much louder that speech needs to be, isn't of great value.

[@DrCliffAuD]

It is a HUGE value as a hearing care professional.

[@TiborWeisz-j2g]

What can be done to fix the problem of background noise..?

[@mitchellschoenbrun]

I have significant difficulty understanding speech in noisy environments. I have noticed something that seems to temporarily improve this and I'm wondering if this is typical or not. The magic ingrediant is alcohol. Does this suggest some type of therapy other than going around drunk?

[@ChangesOneTim]

That only works when all your interlocutors are also under the influence - inhibitions fall away to the point where conversations aren't about serious topics, you then all end up talking shite at or near the tops of your voices and no one cares if you mishear anything because others probably do too😜

[@iancoulson8171]

4m 08s "a 10db increase... is a doubling in volume". In my hi-fi world a 3db increase is a doubling in volume. Which is correct?

[@sprezzaturarrd]

From my speaker design day's, if I double the electrical power to the speaker, that would be +3db increase. On the other side of the speaker is the perceived loudness. If your speaker was outputting +80db and you increased it by 10db to +90db, you would have a perceived doubling in loudness. I hope that makes sense.

[@DrCliffAuD]

You're using a different scale. There are 3 scales for dBs. Intensity, pressure, & perception. 3dB, 6dB, and 10dB respectively.

[@peterspencerdavies6894]

Current audiogram tests are fine for sensorineural (cochlear hearing loss They do not work for hearing loss caused by loss of auditory processing by the brain, which is commonly associated with ageing. Lets give more publicity to Auditory Processing /Disorder APD (or Central Auditory Processing Disorder (CAPD) in the USA)

[@williamrieger9904]

If your word recognition score in one ear is at 14% like mine is, I can’t imagine noise being introduced into the mix with a positive outcome

[@gregstuder6495]

After the Quicksin test and other tests are done, how are the hearing aids adjusted to take into consideration all of the results????

[@FadeRunner13]

It’s most crucial in the initial testing; instrument selection, feature set, microphone configuration, programming/fitting strategy aka your prescriptive targets, compression ratios, attack and release, syllabic or phonemic time constants, the need to incorporate assistive listening devices, noise management settings, sound processing behavior, etc. all this is adjusted when a fitting is performed. Luckily, some of these things are already done automatically by the software. Have a competent audiologist, they can ensure the settings are where they need to be in tweak them if necessary. The more advanced your hearing aids are, the more flexibilityYour audiologist has. Also, if speechin noise testing results are poor. There’s not much an audiologist can do even with the best hearing aids.

[@bluesman0903]

I went to a hearing aid provider not long ago, I took their "free test", and for the beep test she had me stick a finger in my ear and close my eyes, and I'm thinking "there selling hearing aids for up to $7000 and I'm sticking a finger in my ear" really?

[@christopheriansiti4465]

For 25 years with 4 different otologist offices I’ve always had background noise testing. In addition to the pure tone, word and bone conduction. So this video and finding seems odd to me. Guess it’s good you are making it.

[@RainArchiver]

To Doctor Cliff, AuD., How would you test ward recognition hearing loss for learning disabled people who struggle with word recognition? Like F, V sounds and other fricative consonants in speech.

[@patriciapennell5505]

For years, everyone I know with hearing loss says the same thing: "If only life could be lived in a testing booth where we can actually hear." And when you tell an audiologist you can't hear well with your new hearing aids, they have no actual reason to care, because their only goal is to sell you hearing aids. Baseball, cowboy, mushroom, ice cream, good bye.

[@paulksacco]

I have friends with hearing aids who complain about background noise problems AFTER they get hearing aids. I'm guessing they had this problem before hearing aids, too. What can be done for their issue? Can hearing aids be modified? Is there a new high-tech solution around the corner?

[@tonyp8034]

One aspect of traditional testing that is ignored by professional testers is the firing of pure tones into each ear and expecting a meaningful result. The patient must be trained to DO THEIR OWN TESTING. In this way "meaningless" i.e. white/pink noise sounds can be discounted and the appropriate region of the aural spectrum discounted for reinforcement. This has to be done by sweep testing and where the ear fails to track the changing pitch, then that region of hearing should be written off. Difficult to achieve ----- but how else could it be done?

[@KevinK38]

Thank you. Here's my question: you make reference to the Hearing Up list of audiologists in the United States, but is there an equivalent resource for Europe. I live in Spain, and am about ready to retest and upgrade my hearing aids. I would like to avoid the laborious process of going from provider to provider and asking about this.

[@DrCliffAuD]

No, I have not expanded into Europe yet.

[@KevinK38]

@@DrCliffAuD I will look for audiologists who follow the same practices, and let you know what I find.

[@MarlaFeinberg]

@@KevinK38 hi I live in Portugal and have not had experiences here with three different audiologists here. I am thinking of going to London- I read about a good audiologist there- don’t have name right now. Germany might also be worth checking out.

[@lionelschmidt4127]

"Is it worth it?" question has more parameters. Does insurance think it is worth it? How much more will it cost me? How is treatment different with more information? Different HA? Cost? Maybe patient is only in a noisy environment 1 hour a week. Of course every patient is different. But sometimes more information just muddies the water.

[@_SYDNA_]

There's a definite disconnect between the profile & amplification suggested by testing and how well HA's work in the real world.

[@marymaryquitecontrary]

So ,,, is this test something you've been doing, or are doing now? (I haven't paid a lot of attention to the components of my evaluations, my bad I guess.) And what adjustments do you make on the basis of the outcome?

[@ruihmartins]

I have been telling my audiologist precisely this. The tests are a joke. The moment I walk out the door - poof - I wonder what a waist of time all those adjustments are.

[@TK-zc5wu]

i live in uk i dont ever remember having a test of this sort or anything like it !

[@TK-zc5wu]

if i turn up my hearing aids the sound seems less clear for some reason

[@MrTennc]

Has anyone ever made hearing aids that have large forward looking directional mics so the sound in front is very much more emphasized than all around? Would be ugly, but might work better.

[@BillyGoatGruff57]

Does this background noise also include severe tinnitus as I have trouble hearing the TV over the sounds of a million crickets rubbing their legs together inside my head.

[@FadeRunner13]

Looks like you need some sort of tinnitus therapy. Consider notch therapy or sound masking. Depending on the characteristics of your tinnitus, notch therapy can be rather effective.

[@DuaneSmelser]

FYI I’ve been following Best Practices AND providing Comprehensive Hearing Evaluations for FREE for 23 years. So, stop saying “Free” means lousy. Also, I’m curious why despite several attempts to sign up for your program, no one has responded.

[@iluvj50]

Seems so obvious. Wish this type of testing had been industry standard all along. Better late than never!

[@WalkerFamilySports]

The technology, including design, including other contributors, like tinnitus is really the rest of the solution that doesn't seem to exist yet.

[@ronaldmiller8792]

The person talking the sentence to you also affects how well one hears the sentence or words.

[@dondgc2298]

I’m not sure how this is “news.” It would be news if there was a hearing aid that adequately addressed the issue.

[@FadeRunner13]

It’s not news.

[@lindsaylawlor635]

What happens if your hearing is normal but you have a bad SNL score?

[@richalexander525]

It doesn't do any good to determine that my speech in nose recognition is bad if the hearing aid doesn't have a way to correct it

[@FadeRunner13]

You’re both correct and wrong. There is no single “ speech in noise” setting on the hearing aid. It’s a multitude of adjustments that must be adjusted to compensate.

[@billhohmann2653]

Doctor of Audiology.... what medical school did you go to?

[@FadeRunner13]

The doctor of audiology is similar to a doctor of optometry. it’s not a medical doctor per se, but it is a doctorate level degree

[@jackturner6266]

Anecdotally, although I generally see a positive relationship between word recognition and quicksin, I've seen plenty of exceptions and perform both routinely. I think it's slightly unfair to tar practitioners offering free tests with the same brush in saying that all free test providers will rush and cut corners. Your viewership extends worldwide and in the UK, the majority of private hearing care providers offer free testing as it is the norm. If I was part of the one company which charged a fee, I wouldn't see nearly as many patients and would only be pushing people away from accessing my care.

[@WalkerFamilySports]

Location really isn't an excuse for less than a Best Practices approach is it?

[@jackturner6266]

@@WalkerFamilySports why does a hearing test being free lead to the assumption I wouldn't follow best practices?

[@WalkerFamilySports]

@@jackturner6266 Hello Jack, I beg your pardon. I see (and saw) you do both. I wasn't speaking of you, but I think mistakenly understood that it was excusable when the exam was free. My bad. Thanks for bringing me back to read your post again. My point was merely anything worth doing, is worth doing as right and best it can be done. Best wishes to you.

[@twilawalker-w6j]

Have severe vertigo Meniere's disease tinnitus in both ears what's the different sound in each ear. Drives me crazy totally deaf and left ear from Meniere's 20% hearing in right ear with acoustic neuroma when the audiologist fits me with hearing aids I am in a soundproof room she will say can you understand me? Yes she opens and slams a file cabinet drawer can you hear that ? Yes I can hear that. Great she says we're all set. Then I walk out into the world of noise and I can't hear anything but noise I can't understand anything that anyone says to me. It's a horrible feeling very discouraging wouldn't wish it on anyone my doctor says I have the best most expensive hearing aids which I consider a piece of junk. Will consider a cochlear implant possibly in the fall when the rest of my hearing is gone

[@samwyz69]

Free hearing test = to sell you a very expensive unless hearing aid.

[@bastiaan.1108]

guy, you repeating the same point 5 or 6 times 😂

[@DaveG-qd6ug]

Useless, hearing aids do not improve SNR

[@joeamerican2611]

If the test was wrong then the prescription was wrong. No wonder people struggle when they get their hearing aids.

[@WalkerFamilySports]

Good point. But the script is "goes to" inadequate technology, doesn't it? Technology and it's design just seems so antiquated. When the aids are behind the ear and the mics are pointed in a direction that picks up as much "back"ground noise as what's forward in the target zone, what can we expect. (A lot more based on the prices we pay. But that's just me)

[@FadeRunner13]

The title is Clickbait. Speech in noise testing is important, but he’s implicating you need to throw the baby out with the bathwater when all you need to do is go back and have your audiologist perform that test.