“Not being able to see

isolates you from objects.

Not being able to hear

isolates you from people”

Immanuel Kant
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RESIDUAL HEARING
 Overview
• HISTORY
• TYPES
• TECHNOLOGY
• PROGRAMMERS
• SELECTION CRITERIA
HISTORICAL PROSPECTIVE OF
HEARING AIDS ….
 Hearing Aid Types
• Body Aids
• Behind-the-ear (BTE)
• In-the-ear(ITE)
• In-the-canal(ITC)
• Completely-in-canal(CIC)
INDIVIDUAL HEARING AIDS

Body level BTE

IN THE EAR HEARING AIDS

 Technology

 Analog

 Digital
 Linear amplification
• Oldest type of hearing aid amplification
• Amplifies all inputs same amount
• Does not address nonlinear nature of loudness
growth in SNHL
• Uses peak clipping to prevent reaching LDL
• Causes substantial distortion at high input
levels
• Non-linear techonology:

• Compression Threshold (CT)

• Compression Ratio (CR)
• CR = 2:1
– For every 10 dB increase in input level, output
increases by 5 dB
 Analog and Analog hearing aid
digitally-programmable microphone
block diagrams receiver
Signal path

Programmable hearing aid

Signal
path

Digital
controller and programmer
programmer
memory interface
interface

Source: Dillon (2001): programmer

programmer
Hearing Aids unit
unit

Figure 3.2 Block diagram of an analog

hearing aid (top) and a digitally
programmable hearing aid (bottom).
 Compression limiting versus peak clipping

To prevent excessive loudness:

• Peak clipping: chops the tops off

sounds
• Compression limiting: rapidly turns
the volume down
 Compression
• Control of hearing aid output to within
dynamic range
• Weak intensity inputs are amplified more than
high intensity
• Nonlinear relationship
• Cuts down on distortion and uncomfortable
output levels
Peak clipping versus compression limiting

Original Clipped Compressed

 Compression
100
Reduces Amplificaton
80
when it’s Noisy.
Amplification

60 Helps you hear more

when it’s Quieter.
40
Keeps it from being
20 Painful when it’s Noisy
Adjustable (manual and
0
quiet loud
automatic).
Different settings in
Amount of Noise
multiple frequency bands.
• Channel” versus “Band”
In a channel, can change gain, CR, CT, etc.

–Band typically refers to ability to change gain only

–Can have multiple bands in one channel

• Example: In a particular hearing aid, channel one goes from

250 to 1500 Hz. There are three bands within the channel
centered at 500, 750, and 1000 Hz.
• Changing the CR or CR in channel one will
affect all frequencies from 250 to 1500 Hz.

• Also would have the flexibility to adjust the

gain independently using the three bands (at
500, 750, and 1000 Hz) within channel 1
 Microphones
• Directional versus omnidirectional
• Using Directional can be helpful in noisy
situations.
• The best hearing aids can switch between the
two.
 Telecoil
• Converts magnetic energy to electrical signal
• Telecoil option only available on certain styles
• Telecoil automatically activated or manual
Push button .
 Advantages
• Feedback Management

• Noise Management

• Automatic adjustment between programs

 Programming Hardware and Software

• Hi-Pro Box
– Hearing Instrument Programmer
– Interface between computer/fitting software and the
hearing aid
– Can be a standalone unit or built within the probe mic.
system
• NOAH
– Software platform that facilitates data storage and
transfer
– Information such as audiometric data can be used with
any manufacturer that has adopted this standard
• NATIONAL ACOUSTIC LABORATORIES –NON LINEAR
PROCEDURE (AUSTRALIA)

• NAL –NL
Hi pro
• NOAHlink’s wireless Bluetooth connection
allows for
• easy fittings up to 16 feet away from your
computer
• without the hassle of programming cables
Noah link
• Dynamic Range

• Range in dB between threshold and loudness

discomfort level
• With normal hearing, speech sounds fall
within the dynamic range
 Conductive Hearing Loss

Normal Hearing 120 dB

Uncomfortably Loud 100 dB 110 dB

Loud, But OK 90 dB 100 dB

Comfortably, but 80 dB
Slightly Loud 85 dB

Comfortable 65 dB 60 dB

Comfortably, 40 dB 45 dB
But slightly soft

Soft 25 dB 30 dB

Very Soft 10 dB

Dynamic Range = 100-10 = 90 dB 120-30 = 90 dB

Indicates need for Linear Processing

 Conductive Hearing Loss

• Loss of sensitivity for all sounds

• No reduction in dynamic range

• Need gain, once sounds are audible should do well

 Sensorineural Hearing Loss
• Loss of sensitivity for low-mid intensity sounds
• Complete or partial recruitment
• Reduction in dynamic range
• Deficits in Frequency and temporal resolution
• Need increased audibility and improved SNR to
function at normal levels
 Sensorineural Hearing Loss

Normal Hearing

Uncomfortably Loud 100 dB 100 dB

95 dB
Loud, But OK 90 dB
87 dB
Comfortably, but 80 dB
Slightly Loud 73 dB

Comfortable 65 dB 57 dB

Comfortably, 40 dB 43 dB
But slightly soft
30 dB
Soft 25 dB

Very Soft 10 dB

Dynamic Range = 100-10 = 90 dB 100-30 = 70 dB

Indicates need for Non-linear processing

 WHAT IS SPEECH BANANA?
 It has been found that when speech is presented
from about 1mt distance at a conversational
level, each speech sound has a different
intensity and frequency pattern though the
overall intensity of speech is 60-65dBSPL.
 The speech sounds lie in a sort of cluster. If the
border of this cluster are defined, a shape not
unlike a banana emerges. This is called as
“speech banana”.
 USES OF SPEECH BANANA
 speech banana is very useful for hearing aid
fitting.
 Speech banana is useful for the selection of
hearing aid.
 It is very important in interpreting aided
audiogram.
 Speech banana shows acoustic
characteristics of different sounds that is
consonants and vowels in the language.
 It is useful for parental counseling.
 Single versus Multichannel
• With sloping hearing loss, single channel
compression may lead to inappropriate degree
of compression in certain frequency regions.
• Most advanced circuits are multichannel.

• Most individuals will benefit from multiple

channels because different compression values
are needed in different frequency regions
 Button, switch, or Remote
Hearing aid need the capability to automatically
switch between memories depending on
environment.
• Depending on number of options, may have one
switch, one memory button, or both.

• Need to consider dexterity and cognitive functioning

of patient.
Main contributors to earmold acoustics:

• Venting

• Dampers

• Soundbore/horn effect
 Styles

Standard: Shell Half Shell

Skeleton Semi Skeleton

Semi Canal

Canal Tip
 Binaural Advantage I
• Improved signal clarity in many
contexts due to combination of
–Binaural summation
–Binaural interaction (“squelch”)

Minimize the Head shadow effect