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Author: admin, 13.03.2014. Category: Tinnitus Causes And Cures

Traditionally, hearing aids have been unable to provide sufficient amplification for sounds beyond 4,000 to 6,000 Hz.
Recently, several manufacturers have introduced “extended bandwidth” hearing aids, which promote improved receivers that sufficiently amplify sounds to 8,000 Hz and beyond. Rather than attempting to extend the limits of the hearing aid's frequency response, some manufacturers have developed hearing aids with frequency-lowering technology.
Non-linear frequency compression (NLFC) (Figure 2C) takes high-frequency information above a designated frequency range, referred to as the crossover frequency, and compresses it into a lower range as determined by a pre-set frequency compression ratio. Spectral envelope warping (SEW) (Figure 2D) is designed to capture a high-frequency sound information and replicate it at a lower frequency. All of the aforementioned frequency-lowering strategies possess potential advantages and limitations, and there are no published research studies showing one approach to be superior to another. Ask your audiologistAs previously mentioned, there can be disadvantages associated with frequency-lowering technology. One of the most pressing difficulties of persons with hearing loss is an inability to effectively understand speech in the presence of noise. Directional microphone technology typically employs two or more microphones to amplify sounds coming in from the front as prescribed, while limiting or reducing amplification for sounds coming from the sides and back. Although directional microphones may improve speech recognition in noise, it is probably prudent to refrain from their use until a child is old enough to consistently orient toward the signal of interest and provide verbal feedback about the potential perceived advantages and limitations of directional amplification.
Digital noise reduction (DNR) is another hearing aid noise technology designed to improve performance in noisy environments.
As with directional hearing aids, we are still examining the appropriateness of DNR for young children. However, it is important to remember that not all hearing aids work alike, and it is possible that some DNR algorithms may reduce gain for speech. Almost every major hearing aid manufacturer now has a way to wirelessly link your hearing aids with your personal technology (from phones to computers to TVs). Personal remote microphone radio frequency (RF) systems have been around for a long time, and have long been recognized as the most effective means to improve speech recognition in noisy places. Perhaps it’s just icing on the cake, but besides all of the great technology that allows individuals to hear better in a variety of settings, several hearing aid companies have now made some of their products water-resistant. In summary, hearing aid technology has improved significantly over the past few years.  Although it is not perfect, contemporary technology can improve the communication abilities of most everyone with hearing difficulties. When you're a family member coping with the hearing loss of a loved one, you may encounter frustration, the feeling of being ignored, separation from the relationship and isolation from daily family life.
When a family member has a hearing loss, treated or untreated, the loss impacts the entire family and communication skills are put to the test.
DiMarco uses the universal language of dance to change the hearing world’s perception of what it means to be Deaf – and he just might win the Mirrorball trophy in the process. 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. 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. Today, some advanced technology features, which were formerly only available in expensive, high-end hearing aids, are now available in economy-level hearing aids.

The ability to hear high-frequency speech sounds is crucial for understanding speech as well as the rules underlying language and grammar, such as plurality, possessives and subject-verb agreement. The speech sounds on the audiogram are placed in the pitch and intensity range at which the sounds are typically heard.
This constraint was primarily attributed to a limitation of the hearing aid receiver (the term used to refer to the miniature speaker of the hearing aid), which simply could not provide adequate amplification of high-frequency sounds. Although this technology is promising, there is a paucity of studies showing significant improvements in speech recognition with the use of extended bandwidth amplification.
Frequency lowering can be achieved by linear frequency transposition (LFT), non-linear frequency compression (NLFC), or spectral envelope warping (SEW). Similar to LFT, the bandwidth of the high-frequency sound information is not altered, SEW moves the high-frequency of sound to a lower frequency range, where the low-frequency and high-frequency sounds are overlaid on one another. In particular, if the frequency-lowering is too aggressive, then speech and environmental sounds may become distorted resulting in poor sound quality and a reduction in speech understanding. Studies have shown that around 40% of adult wearers continue to be unsatisfied with their ability to hear in noise after being fitted with hearing aids (Kochkin, 2010).
This approach assumes that the wearer will face the signal of interest in a noisy environment, and consequently, the speech will be enhanced and the surrounding noise will be reduced.
In fact, some hearing aids even go a step further and remain in omni-directional mode if the primary signal arriving from behind the user is speech. Hopefully, ongoing research and development will clarify the question of whether young children should use adaptive directional amplification and possibly even result in a hearing aid that limits the potential disadvantages of directional amplification for children. DNR analyzes the sound arriving to the hearing aid, determines whether it is speech or noise, and reduces the aided gain when background noise is the dominant input. It is imperative that the audiologist verify that gain is not reduced when speech is present. In people with typical hearing, the ears work together to better understand speech in noisy environments as well as to determine the direction from which a sound originates.
Directionality with Binaural Processing.Furthermore, some hearing aids work together so that a wearer may adjust the volume or a program on one hearing aid and the change automatically happens at the other hearing aid.
Some companies use “streamers” (a device you wear around your neck to allow you to interface between the hearing aids and the accessory) to wirelessly connect to your personal products, while other manufacturers have developed hearing aids that allow you to wirelessly connect without an interface device. Recently, manufacturers have started introducing digitally-modulated RF systems, which are similar to Bluetooth® technology used in several recreational and business applications. Some even claim you can swim with them.  It is important to consider how the warranty works if you do choose to participate in water activities with the hearing aids on.
If you are struggling with your hearing, you should consult your audiologist to determine whether new technology may alleviate your communication difficulties.
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? 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. This article discusses several new hearing aid technologies and suggests questions that you may want to ask your hearing health providers when you select your next set of hearing aids. Furthermore, research has shown that when children with hearing loss cannot adequately hear sounds above 4,000 Hz, they will have to be exposed to three times as many words as children with typical hearing to learn new vocabulary and concepts due to the reduced acoustic bandwidth caused by the hearing loss (Pittman, 2008). Audiologists should properly select good candidates for frequency-lowering technologies, program this technology appropriately for the individual’s needs, and verify the benefit the wearer receives through the use of probe microphone measures (ask your audiologist about probe microphone measures if you are unaware of this important hearing aid assessment tool). Numerous research studies have shown that directional microphones improve speech understanding in noise more than any other technology currently built into hearing aids (although directional microphones do not provide as much improvement in speech understanding in noise as remote microphone radio frequency systems—also commonly known as FM systems—which are an assistive technology that may be used with hearing aids to provide the most improvement in speech recognition in noise (Schafer & Thibodeau, 2004)). With this approach, the risk of missing out on important speech signals arriving from behind or from the side of a hearing aid wearer is limited.

Bentler and colleagues (2010) did show that DNR may improve listening comfort for children in noisy situations. For instance, we can tell that a sound originates from our right side, because it is a little louder and arrives a little earlier at the right ear than the left. Some hearing aids also have the capability of allowing the user to hear the sound from a telephone in both ears simultaneously when the phone is placed next to one of the hearing aids. Here, a directional hearing aid provides amplification for sounds arriving from directly in front of the wearer, while reducing the volume for sounds arriving from other directions. Here, a listener is using hearing aids with directional microphones enhanced by binaural processing.
Some manufacturers also offer a wireless microphone accessory, which can pick up an important voice and wirelessly send it to the hearing aids directly or via the streamer. Because the microphone is positioned closely to the mouth of a parent or teacher, the speech signal captured by the system’s microphone is typically much higher in volume level than the surrounding background noise. Digital RF systems are able to provide a higher level of analysis and control over the signal that is captured by the microphone and eventually delivered to the receiver. Some are not “water-resistant” per se, but have a special coating inside the electronics that helps repel moisture—especially good if you (or your child) are susceptible to excessive sweating or have wax problems. 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. 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. The “Familiar Sounds Audiogram” shown in Figure 1 illustrates the large number of consonants that reside in the high frequencies. Further, the benefits of frequency-lowering technology should be validated with behavioral testing and feedback from parents, speech therapists, and teachers. Hearing aid manufacturers have developed numerous technologies to improve performance in noise, including directional microphones, digital noise reduction (DNR), wind noise reduction, and dereverberation algorithms. We know that incidental listening, the term used to describe a child’s tendency to listen to speech that is not directed specifically to him or her, is responsible for a great deal of a child’s vocabulary and social development.
It is likely that there are differences in adaptive directional algorithms from one manufacturer to another, and consequently, there is not enough evidence to determine whether they are suitable for children. Other studies have indicated that DNR provides at most a modest improvement, and in many cases, no change in speech understanding in noise (Bentler, 2005; Peeters 2009). They also showed that children’s novel word learning abilities were improved with the use of DNR, a fact they attributed to a decrease in the cognitive processing load afforded by improved listening comfort associated with DNR. The interested audiologist is referred to an excellent review by McCreery and colleagues on electroacoustic assessment of hearing aids with DNR (McCreery, Gustafson, & Stelmachowicz, 2010). Note how the binaural directional response is more focused on the sounds arriving from the front than the directional response achieved by the hearing aids in Figure 3B. Furthermore, these systems typically use a carrier frequency that “hops” from frequency to frequency many hundred times per second, a characteristic that makes digital RF systems less susceptible to interference from nearby RF devices (Wolfe et al., in press). Additionally, make certain you see a licensed audiologist who is experienced with providing new technology for patients in your age range (or the range of your child). 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. 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. Most studies have shown no degradation in speech recognition in noise for adults using DNR. The best technology in the world can be worthless if it is not selected and fitted appropriately to meet the wearer’s needs. 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.
More recently, Wolfe and colleagues (submitted, 2013) compared aided thresholds and speech recognition for a group of children who had mild hearing loss and used hearing aids with NLFC and extended bandwidth.
Carol Flexer has estimated that as much as 90% of what a child learns during the first few years of life comes from incidental listening (Cole & Flexer, 2010). In fact, recent data suggests 34.25 million Americans experience some degree of hearing loss. NLFC provided better access to low-level high-frequency sounds as well as better recognition of high-frequency speech sounds when compared to hearing aids with extended bandwidth. Could directional microphones, which inherently limit access to sounds arriving from behind a child, interfere with incidental listening?

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