Offer tuning in realistic circumstances, legalize and support self-tuning

This is the 8th part of my wishlist to audiologists and accousticians, hearing aid manufacturers, and the health care system. If you like to add something, share your experiences, or provide more information, I encourage you to submit a comment.

In order for hearing aids to improve a patient’s life, they have to be tuned correctly. The tuning is done in many meetings with an audiologist. The process of tuning hearing aids takes months and still after that most patients are not entirely happy with the result.

From my own experience I guess that one reason for this is that the tuning never takes place in a realistic hearing setting, but in the audiologist’s soundproof cabin. The only information he has is what I describe about that situation where I was not able to understand my friend at that party last week. In comparison, if you bring your car to a car repair shop and describe in what situations it makes problems, they for sure will try to reproduce the situation in order to examine it and fix the problem. The only thing audiologists do sometimes is taking you out on the street for a minute or two [1].

So getting your hearing aids tuned is a frustrating and time-consuming experience. As a patient you are totally dependent on your audiologist and spend a lot of your valuable time in his office without being happy about the result afterwards. It is no surprise that there are quite a number of people who started to tune their hearing aids themselves.

The problem with self-tuning is: you need special hard- and software and you need the knowledge. The knowledge is out there, although it might not be too easy, it is possible to teach yourself the required audiology.

The hardware and software on the other hand is hard to get. Officially it is only sold to audiologists and doctors [2]. There is no way to buy it on the free market like on ebay etc., because those hardware is classified as medical devices and as such not obtainable by patients.But for every market, there is a black market and when people are frustrated, they find a way. So, there are quite some people out there which tune their hearing aids, because they can do that wherever and whenever they want and not just when their audiologist is willing to give them an appointment and willing to do the tuning outside his office. So the situation is that there are people self-tuning, but because they have to do it inofficially, they don’t get any support for that. Support means software updates, manuals, maintenance material for the hardware, trainings for the software, warranty for the tuning hardware and their hearing aids etc.

What I want here is that interested and skilled patients are allowed to get a “hearing aid tuning license”. Similar to a driving license, I imagine that you take some classes and maybe have to do a test and in the end you are allowed to tune your own hearing aids. Most hearing conditions are permanent, which means as a young person, you are facing several decades of having to wear hearing aids. In that situation you might as well spend some weeks on learning how to tune your hearing aids yourself in order to be more independent.

Also, it would great, if the software would comply to common standards, meaning that it has open APIs which everyone can use to extend its functionality. The hardware should comply to open standards and be legally purchasable by patients. It would be even better if you don’t need special hardware at all but can use consumer hardware. Why do you need a special device when you hearing aids can talk bluetooth in the near future? So, why can’t I just tune my hearing aids using my smart phone or my tablet PC while I am sitting in the subway?

[1] I heart rumors, that some audiologists come home to people and adjust the hearing aids there. Of the four audiologists that I have seen so far, none of them offered that.

[2]  There is one exception in the U.S:

See also the next point on my wishlist: Legal certainty for situation related to broken hearing aids. Or the previous one: Open hardware and software standards.

7 thoughts on “Offer tuning in realistic circumstances, legalize and support self-tuning

  1. I would go one step back to keep it simple.
    Audiology is a complex field, you’re able to do plenty things wrong. Even some ‘experts’ proof that every day.

    Let’s assume you are able to say based on a hearing test, what is the perfect volume for every band in your HA (called ‘first fit’), and only the adaptive parameters are unclear. So the ‘expert’ do the first setting and let you go in a trial mode. During this time you are able to test different feedback cancellation strategy (dynamic and static), some kind of focus (depending on HA maybe 180°, 90° and 30°) and a little sound adjustments in tone and right/left-balance.

    You can say ‘the tools are there’, for example ‘data logging’ or other systems. But honestly, who has time to:
    – advice customer about the function and the purpose
    – check if the customer got it
    – take a look in the logs
    – understand what the customer did and WHY he use 3dB less in program 2 …

    The customer also can’t understand what his smart phone do. But he can choose and use apps.
    Apps got a description, what they (should) do and he decide if he need this cool feature to live better.
    And he is aware, that he can’t have it all. He has to decide what is more important.

    The expert has to create apps, that the customer can use and change by his own. Predefined little feature sets.
    I tried a couple of times with up to 5 programs via fitting for younger people. But there was nothing the customer are able to grab, it was too abstract. They need little pictures and better names than ‘Program [n]’.

    This is my little crazy idea 🙂 I hope it was not too hard to understand.

  2. Thanks for your comment. I deeply hope, that future augmented reality devices might help with that. I also get confused which program to choose sometimes. So it would be totally cool, if my smart phone would tell me “You are now in program X, it is designed for your office / the metro / your favorite concert hall”. Future, I am counting on you 🙂

  3. Thank you for posting this. I learned a lot. Sounds like the technology that audiologists are using is still very primitive. Secretive, too. For as much as hearing aids cost, the user SHOULD be able to fine tune them himself. And here’s a novel idea. Why can’t you just TELL your hearing aids which program to use. You know, like this: “Crowded restaurant”, or “cell phone”, or whatever. Certainly not just by numbers, but with an identifier that means something.

  4. I am an audiologist with normal hearing.

    It’s very easy for you to get your own ‘tuning licence’ – go to university for at least five years and graduate as an Audiologist.

    You can’t set your own medication prescription, you can’t set your own optical prescription why would you want to tune your own hearing aids?

    If you get the hearing aid settings wrong, too loud for example, you will end up damaging your hearing more. Your audiologist should be using researched, tested and peer-reviewed prescription methods to make sure your hearing aids are not damaging your residual hearing, and these prescription methods have been tested on large groups of people with hearing loss to determine what is comfortable for most but more importantly what will make speech it’s clearest (NAL) or what will normalise loudness (DSL). (Note. If you go to an audiologist and all they do is First Fit and do not complete any ear measurements, go to another audioligist.)

    Most hearing aids come with program control features so you can turn the hearing aid up and down, change features of the hearing aid and even tonal qualities, so in effect an audiologist will give a user quite a bit of control provided the user is willing to change controls (most of my clientele just want an automatic hearing aid because they don’t want to fiddle around). I’m sorry to say this but if a person cannot remember what each program does based on the number of beeps assigned to it, or could not be bothered writing these things down during the appointment, I’m not sure you should be trusted with the responsibility of setting up your own hearing aids.

    I agree wholly on the wish for tuning in actual acoustic environments – my favourite part about visiting clients at their homes is that I can verify my settings in their day to day environment. Currently the provider I work for only does this for sick or hospitalised clients.

  5. I have meniere’s and my hearing loss fluctuates from mild to severe at different wavelengths. Sometimes the change can occur within a day. By the time I get an appointment with doctor to test my hearing, again, and then get to the audi, it is too late to have the setting I needed that day.

  6. Have you heard of Blamey Saunders hears? It’s like they read your wishlist! They sell hearing aids with bionic ear technology you can tune yourself with just their software and your smart phone. No need for audiologists, and they’re relatively inexpensive, too: Worth a look.

  7. Seriously this “Hearing aids are medical devices” nonsense needs to end!

    They are not medical devices, they are not implanted under the skin, they don’t effect my metabolism or control my heart rate. If they malfunction I just take them off.

    I can still function without my hearing aids, but I’m totally lost without my glasses (which can be had for less than £100 not £20000-30000)

    Expensive hearing Aids do nothing that the clever iPhone app that will one day succeed the likes BioAid of will do.

    A well set up mixing desk and some decent headphones will do what my NHS aids can do.

    Hearing aids are smaller, and can remember multiple settings without twiddling equaliser knobs and dynamic gain controls that’s all! They are not rocket science.

    I can buy a loop amplifier for my living room for £15 on EBay (which just needed one >£1 component to fix it) and a £10 new neck loop that works perfectly stream my iPhone to my Tcoils. That the bits to stick in my ears cost so much is just daft.

    I’m 47, I hopefully, have 40+ years of hearing aid wearing ahead of me, so I don’t mind investing a bit of effort in learning to program them.

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