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If you would like to know what your child or adult loved one is experiencing with their hearing loss, the first step is to understand more about their hearing loss. The audiogram below contains drawings depicting typical sounds and where they fall on the audiogram.  Jet planes, for instance, are loud, high decibel, high frequency, sounds while wind rustling leaves is a much lower decibel sound. Show your friends and family what sounds you have difficulty distinguishing between and hearing on the below audiogram with the speech banana.  This can help them learn to say certain sounds a little louder, or speak into your better hearing ear or to speak directly in front of you so that you can help determine what they are saying. This site is not designed to and does not provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual. Frequency lowering strategies are generally used in the hearing industry as an alternative for patients who do not benefit from traditional amplification in the high frequencies. Jennifer Groth, AuD, is Director of Audiology Communications at GN ReSound Global Audiology in Glenview, Ill. The clinical challenge for this feature resides in identifying which individuals will receive benefit from frequency lowering, and which would be fitted more successfully with traditional amplification, as no definitive candidacy criteria for frequency lowering have been established to date. Hearing loss that slopes to greater degrees of severity for the high frequencies is commonly encountered in hearing clinics. For the patient, many consonant sounds important for accurate speech discrimination are located in the high frequency region. The inaudibility of certain phonemes produced at typical speech levels may present significant problems for the patient. In the real-world scenario of continuous discourse, people can often decipher messages even when not all the acoustic information is present.
The relative importance of different types of redundancy in speech and communication shifts, depending on both acoustic and intrinsic factors. The need for and desirability of adequate high-frequency audibility extends beyond the realm of speech to environmental sounds. Traditional amplification using wide dynamic range compression (WDRC) will provide greater audibility for low-level sounds in the necessary frequency regions, in an attempt to raise the level of speech and other environmental sounds to an audible level per the individual’s hearing loss. Aside from the technical issues in providing these significant high-frequency gains, a physiological issue has also been suggested in the literature.
If adequate gain cannot be provided by the compressor, or if the patient does not receive benefit in speech understanding from this degree of high-frequency amplification, an effective alternative to provide audibility may be a frequency lowering approach. In some frequency lowering approaches, this also results in reducing the bandwidth of the device to a lower frequency.
Current research has revealed some interesting patient characteristics that would contraindicate the use of frequency lowering for certain individuals.
At the other end of the age spectrum, children fitted with nonlinear frequency compression (NLFC) may perform better in some areas but poorer in others, as compared to their traditionally fitted peers.5 Poorer consonant articulation scores were revealed in this study for children fitted with frequency compression.
The configuration or slope of the hearing loss may also be an important factor to consider. Finally, certain cost-benefit decisions are involved when enabling frequency lowering for a patient. In the absence of the patient considerations outlined above, and when judicious use of the feature is employed, frequency lowering may be an appropriate tool to use for individual patients who do not receive adequate benefits from traditional amplification.
In addition to the shared goal of audibility, ReSound Sound Shaper employs much of the same terminology as amplitude compression.
Verification of the audibility of these compressed signals is important, since a frequency-lowered signal that is still inaudible to the patient defeats the purpose of turning the feature on. All frequency-lowering techniques introduce a compromise between audibility and sound quality. As previously stated, there are no defined guidelines about which individual patients will be the best candidates for frequency lowering. To this end, Sound Shaper is incorporated in Aventa 3 with a limited number of settings, which were found through internal testing to provide the greatest audibility benefit while also minimizing deleterious effects on the sound quality.
The effects of frequency compression on sound quality are not easily generalized to all users. To provide the greatest listening benefits with minimal signal distortion, Sound Shaper was developed as a proportional frequency compression strategy. The main benefit of a proportional frequency compression technique is that there is less distortion as compared to a nonlinear compression strategy. The results for both devices show that the frequency of the hearing aid output is lowered, and to approximately the same degree. Sound quality for music was also evaluated for proportional and non-proportional frequency compression via a predictive model. Identical 10-second segments of pop music presented at 60 dB SPL (RMS) were recorded through each hearing instrument for each of these hearing losses. Results for all three types of hearing losses showed the same trends, so for simplicity, the averages of these results for each frequency compression setting are depicted in Figure 6.
This indicates that stronger frequency compression settings are predictive of poorer sound quality regardless of which method of frequency compression is used. Sound Shaper provides hearing care professionals with another tool to improve high-frequency audibility, especially for individuals who do not receive optimal results with traditional amplification. Wearing hearing aids has been such a positive experience for Marie Redfern, she wants to encourage others with hearing loss to try them, too. Your experience can provide helpful information to someone looking for a great hearing care provider, reward a clinic for taking good care of their patients and create a sense of community where you live. Studies indicate that 1 in 4 Americans who recognize their own hearing loss actually do something about it by adopting amplification. If you noticed that you couldn’t read the newspaper over coffee, you’d go see a vision specialist, right? A full hearing evaluation (more than just a quick screening) is usually performed by an audiologist or licensed hearing instrument dispenser. An audiologist is a highly-trained professional in the prevention, identification, assessment and non-medical treatment of hearing disorders. A licensed hearing instrument dispenser’s qualifications vary state by state as state laws dictate the level of education and training that is required to become a licensed hearing instrument dispenser.
To find a hearing professional one place to begin is by asking your family physician for a referral. The more information you collect in finding a hearing professional, the better equipped you are to serve as your own advocate for better hearing. This will provide the hearing professional with an overview of your medical situation and will help them in assessing the hearing test results as well as assist in determining the necessity of a medical referral following the hearing test. Next the hearing professional will examine your ear canals and eardrum with a specialized ear light called an otoscope. The lowest levels of the test signals you can hear at least half of the time are called your hearing thresholds.
The thresholds are plotted on an audiogram (see below) which provides a visual representation of your hearing loss. The degree of hearing loss is based on the thresholds obtained during the hearing test, and ranges from least to most severity in this order: mild, moderate, moderately-severe, severe and profound.
The most common type of hearing loss is high-frequency hearing loss and an example is shown on the audiogram below. During the hearing evaluation the hearing professional will look for any red flags of underlying medical conditions that may require treatment by an otolaryngologist, or ear nose and throat specialist. Hearing loss can be categorized as conductive, sensorineural or a combination of the two factors which is referred to as a mixed hearing loss. This is the bottom line and why you underwent a hearing evaluation in the first place – recommendations.

And you can almost be certain that your hearing professional is going to make lifestyle recommendations – especially in cases of mild hearing loss. And of course, the hearing professional will discuss with you if you are in fact a hearing aid candidate. Hearing loss is often a progressive condition and rarely does hearing return all on its own. According to recent research carried out by the Better Hearing Institute persons with hearing loss on average wait 7 years before purchasing a hearing aid after learning they have hearing loss. Early diagnosis along with early treatment of hearing loss has been proven to result in the most successful outcomes. A child may be able to hear certain low frequency sounds such as [m] but not hear higher frequency sounds such as [s] and [sh] even with the use of hearing aids.  Missing those sounds may change their understanding of what is being said. Through this site and linkages to other sites, we provide general information for educational purposes only. However, all of these strategies introduce distortion and potentially do more harm than good. A review of the literature reveals many studies with conflicting results and recommendations. It is for these reasons that frequency lowering strategies are typically regarded as alternatives to consider for patients who do not receive the expected benefits from traditional amplification in the high frequencies.
This hearing loss configuration, however, presents its own challenges, both for the patient and for the hearing care professional.
Steeply sloping high-frequency hearing loss, with the speech banana and English phonemes superimposed to indicate areas of audibility and inaudibility for the patient. A speech banana is superimposed on the audiogram, which indicates the common distribution of speech sounds in the frequency-intensity realm over time. This is due to the linguistic and acoustic redundancy of speech communication; speech contains more information than is needed to decode it. One-third octave band importance functions for nonsense syllables and continuous discourse. This is illustrated by the band importance functions for different types of speech material in calculating the Speech Intelligibility Index2 (Figure 2).
As shown in Figure 1, a hearing loss of this configuration and degree affects the audibility for environmental sounds, such as birdsong.
Steeply sloping high-frequency hearing loss, with typical environmental sounds superimposed to indicate areas of audibility and inaudibility for the patient. The success of this approach often depends on the severity of the hearing loss in the high frequencies; for greater degrees of high-frequency hearing loss, traditional amplification may have limited success in providing audibility for these high-frequency sounds.
For some individuals, it has been suggested that providing traditional high-frequency amplification for severe high-frequency hearing losses may not be beneficial if the corresponding high-frequency areas on the cochlear basilar membrane represent a “dead region.” A dead region is generally characterized by non-functioning inner hair cells.
Frequency lowering strategies work through the displacement of signals from higher frequencies to lower frequencies, where beneficial amplification may be achieved. Although all frequency lowering approaches introduce some degree of distortion due to the artificial movement of some frequencies to a different region, the benefit in audibility may result in a favorable compromise for some individuals. For example, older patients who have a known working memory or cognitive deficit may be more susceptible to distortion created by certain hearing aid features.4 As frequency lowering is known to create distortion to some extent through artificial alteration of the high frequencies, these patients may receive greater benefit from traditional amplification. Overall, the study revealed insufficient evidence to suggest global language ability differences between the children fitted with NLFC and those fitted traditionally.
A recent study indicated that, while NLFC was beneficial for high-frequency consonant recognition, it was not as beneficial for speech recognition in noise.12 Further, the methodology and care taken when fitting this feature was highlighted as a factor in the benefit it can provide.
Of the frequency lowering approaches used today by the hearing industry, the most commonly fitted strategy is frequency compression.
To this end, ReSound has introduced Sound Shaper, available in Aventa 3.6 fitting software, as a tool to be used by the fitter to meet the needs of the individual patient. Frequency compression changes the input to a more amenable output above a cut-off threshold, or kneepoint.
Audioscan Verifit Speechmap display showing verification measurements with Sound Shaper “Off” (blue) and Sound Shaper set to “Moderate” (green).
Figure 4 illustrates one possible method of ensuring audibility for a previously inaudible stimulus.
Some users will benefit greatly from the increased audibility of high-frequency sounds, while others may be bothered by the feature’s inherent distortion and perceptual sound quality. In addition, consideration was taken to ensure that different settings provided distinctly different results, to simplify the process of setting Sound Shaper. This means that the relationships between frequency-compressed inputs are constant; in other words, the frequency compression ratio is constant for all input frequencies. Spectrograms for a swept pure-tone were measured unprocessed (upper- and lower-left panels), and with both amplitude and frequency compression activated (upper- and lower-right panels). To illustrate the differences in the processing of a signal, a pure-tone sweep was processed through ReSound’s proportional frequency compression and another manufacturer’s non-proportional frequency compression to create spectrograms (Figure 5).
The difference is that, for the non-proportional method (lower-right panel), there is more distortion in the output than with the proportional method (upper-right panel) used in Sound Shaper.
In this comparison, each hearing instrument was programmed for three hearing losses: mild flat, mild sloping to moderately severe, and mild sloping to profound.
The recordings were then analyzed through the Hearing Aid Speech Quality Index (HASQI),16 which is based on coherence  between the input and output signals of the hearing aid, and yields a score on a linear scale from 0 to 100%. Better sound quality for music is suggested by the HASQI for Sound Shaper than for a non-proportional frequency compression (FC) strategy with similar kneepoints and compression ratios. The highest HASQI scores relative to the input signal were obtained when frequency compression was deactivated (the “Off” setting). These results are also in agreement with other research regarding sound quality for music with frequency lowering.15 However, the HASQI results overall predicted better sound quality for the proportional frequency compression technique (Sound Shaper) than for the non-proportional frequency compression strategy.
Ching TYC, Day J, Zhang V, Dillon H, Van Buynder P, Seeto M, Hou S, Marnane V, Thomson J, Street L, Wong A, Burns L, Flynn C. Yet with so many different causes of hearing loss and so many solutions to solving the problem of hearing loss, why don’t more of us do something about it? Audiologists hold either a master’s degree or doctorate degree in Audiology and are licensed in most states. In other words, a well-educated patient collaborates with the hearing professional to deliver the best hearing experience possible. You’ve more than likely been through a case history process before at other medical visits. This is necessary to check for issues such as wax in your ear canal or infection of the middle ear. These thresholds assist in determining type and degree of hearing loss, potential causes of your hearing loss as well as your treatment plan (i.e. It is represented on the vertical axis of the audiogram, from approximately 0 dB HL (very soft) to 110 dB HL (very loud). It is represented on the horizontal axis of the audiogram, from 250Hz (very low pitch) to 8000 Hz (very high pitch). As you can see in the low frequencies hearing thresholds for both ears are within normal range; however around 2000 Hz (a mid pitch) hearing begins to slope and worsen in the higher frequencies. Audiologists and licensed hearing instrument dispensers typically refer patients to ENT specialists when they suspect that disease, trauma or some other factor has caused the hearing loss.
The type of hearing loss can be determined by comparing testing done with earphones and testing done with a special bone oscillator headband. The hearing professional may refer you to a medical doctor if the hearing loss is suspect to be caused by a medical issue that may be treatable.

A pro-active approach is your best solution so we’re talking about getting fitted with a pair of hearing aids. Would you wait 7 years to get eyeglasses after finding out you have significant vision loss? Not to mention that treating hearing loss will have a direct positive impact on quality of life, relationships, earning power, need we say more?
The information provided in this site, or through linkages to other sites, is not a substitute for medical or professional care, and you should not use the information in place of a visit, call consultation or the advice of your physician or other healthcare provider.
This article outlines considerations when fitting a patient with frequency lowering, as well as current research suggesting when this type of feature may not be as beneficial.
There appears to be no general consensus on benefit for groups of people fitted with this feature versus those fitted without it. Individual phonemes indicate on the audiogram their specific frequency and intensity ranges in everyday speech. Vowel formant transitions, which indicate place of articulation for the consonants that precede and follow them, provide acoustic cues to help identify those consonants correctly. High-frequency acoustic information is more important for correct identification of nonsense syllables (red curve) than continuous discourse (black curve), in which knowledge of the language assists in correct identification of speech.
For this patient, these environmental sounds will be inaudible without some form of high-frequency amplification (Figure 3). This study suggested that some manufacturer default settings of NLFC for a patient may still fail to provide audibility for the compressed signal, especially in the case of more severe hearing losses.
Just as WDRC and other types of amplitude compression “move” low-intensity sounds to higher intensity levels for the individual, frequency compression “moves” high-frequency sounds to a lower, more aidable region. The degree of frequency compression applied can be expressed as the frequency compression ratio. For instance, two individuals with similar hearing losses may derive the greatest benefit from different frequency compression kneepoints and ratios, or from no frequency lowering at all. This is in contrast to a non-proportional or nonlinear frequency compression strategy, in which the relationship between compressed inputs (ie, the ratio) changes as the frequency increases.
The lower-right panel shows the results for another manufacturer’s non-proportional frequency compression, while the upper-right panel shows the results for Sound Shaper. Gains were set according to the default prescriptive targets in the respective manufacturer’s fitting software.
A higher HASQI score predicts better sound quality, as the output sound will be more similar to the input sound, with less added noise and distortion relative to the original input sound. For both frequency compression techniques, the HASQI score was inversely related to the aggressiveness of the algorithm.
ReSound Sound Shaper is designed as an option that enables hearing care professionals to better accommodate the needs of their individual patients. A randomized controlled trial of nonlinear frequency compression versus conventional processing in hearing aids: Speech and language of children at three years of age. Effects of low pass filtering on the intelligibility of speech in noise for people with and without dead regions at high frequencies. Effects of low-pass filtering on the intelligibility of speech in quiet for people with and without dead regions at high frequencies.
Implications of high-frequency cochlear dead regions for fitting hearing aids to adults with mild to moderately severe hearing loss. Determination of preferred parameters for multichannel compression using individually fitted simulated hearing aids and paired comparisons. High-frequency amplification and sound quality in listeners with normal through moderate hearing loss.
Benefits from non-linear frequency compression hearing aids in a clinical setting: The effects of duration of experience and severity of high-frequency hearing loss.
Many audiologists specialize in their field; for example, some specialize in hearing aid technology, pediatric hearing loss, geriatric hearing loss, tinnitus therapies, vestibular (balance) testing, etc.
Some states do require hearing instrument dispensers to obtain further education in the study of hearing loss and hearing aid technology. Finding the right hearing professional is an important first step towards healthy hearing and success with hearing aids.
On your first visit to your hearing professional you’ll be asked about your medical history, current medical issues, medications, hearing loss symptoms, family history of hearing loss, history of noise exposure, your hearing concerns, etc. During the hearing test, a series of tones of different frequencies (also known as pitches) as well as speech signals will be presented to each ear separately through earphones. This particular example would be called a mild to moderately-severe high frequency hearing loss. So is mowing the lawn without wearing some kind of hearing protection so expect to receive good advice you can use to lessen the degree of hearing loss, or the rate at which you’re actually losing the ability to hear. Your hearing professional may fit you with the type of hearing aid to best address your type of hearing loss, wearing preferences, lifestyles and degree of hearing loss. However, research suggests that it can be highly beneficial for certain individuals, when fitted appropriately. Sounds below the hearing thresholds on the figure are audible to the patient, and sounds above the thresholds are inaudible.
The physical properties of larger receivers, which are used in high-power hearing instruments, result in a high-frequency roll-off that is at a lower frequency than what is observed for lower-power hearing instruments.
Sound Shaper compresses the frequencies above the kneepoint, effectively moving them closer together. For these reasons, the best approach to applying and fitting frequency compression is often a conservative one. These spectrograms show that less distortion is generated by the Sound Shaper proportional frequency compression strategy than by the non-proportional frequency compression approach. Colors indicate the intensity of the signal, with red indicating the most intense and blue indicating the least intense.
This pattern is similar to what was observed by Parsa and colleagues14 in their investigation on the effect of nonlinear frequency compression on sound quality. Maybe things are a little muffled, or maybe you’ve seen the TV volume notch up over the past months. You will respond to test signals either by a hand raise, pushing a button, or in the case of speech signals, repeating what was heard. Sound Shaper is a proportional frequency compression approach that can provide high frequency audibility for individuals who do not receive it through traditional amplification, and was developed with the goal of preserving sound quality and minimizing distortion to the extent that is currently possible.
This provides the input frequencies in a smaller region that is more usable to the hearing instrument user. Both hearing instruments were programmed with amplitude compression for a mild-to-moderate hearing loss, with similar frequency compression kneepoints and ratios.
The “Strong” setting had a frequency compression kneepoint as close to 2 kHz as possible, with the same 2:1 compression ratio as used by the “Moderate” setting.
In fact, recent data suggests 34.25 million Americans experience some degree of hearing loss.

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10.12.2013 admin

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