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20.09.2013
Previous research and current movement in the endeavor to provide the most natural, binaural auditory experience for hearing instrument users will be discussed, in addition to the technological developments that have made these advances possible. The benefits of bilateral hearing aid fitting—that is, the real-world advantages provided when a hearing instrument is fitted for each ear in the common case of aidable hearing loss diagnosed for both ears—are generally well accepted. But, as we know, the complete answer to this question extends far beyond this 5-second response. Although much of these benefits are findings from older studies, new research in bilateral versus unilateral fittings continues to emerge.
Of course, as with any broad-stroke recommendation involving humans, there are a few patient considerations that may preclude successful use of binaural amplification as compared to unilateral.
It is important to note that just fitting two wide dynamic range compression (WDRC) hearing instruments for a patient is not a surefire way to provide each benefit listed above.
The digital technology that we enjoy today in hearing instruments performs impressive calculations and manipulations of the input signal, to such noble ends as radically suppressing feedback and reducing environmental noise for the listening.
This means there is no reference to what is happening for the other hearing instrument in a fitted pair. But for other features, such as directionality and acoustic noise reduction, this automatic processing can have undesirable results for the user in the very environments where they are designed to provide user benefits.
To address this problem, new features using wireless device-to-device communication were introduced.
For example, one such feature chooses a bilateral omnidirectional, bilateral reverse directional, or bilateral adaptive directional response, based on the environmental inputs provided by detectors on each hearing instrument.
In fact, perhaps due in part to the recent emergence of academic research focusing on cognitive effects of amplification (eg, Arehart et al, 201317), the very label “binaural” has become a catchphrase in itself, as it is becoming the new vogue term to market newly developed, wirelessly communicating hearing instruments. But the term “binaural” can extend so much farther than the basic act of fitting two hearing instruments for a patient, or even the two hearing instruments working together toward a common goal. Further, this directed beamwidth is not a natural listening pattern; unaided listeners are used to being able to choose and focus on important signals at different azimuths in their environment (ie, a binaural hearing process), because surrounding sounds are largely audible. Developing technology that supports the natural processes of human hearing is a key goal of ReSound. These processes include auditory scene analysis,18 which involves the ability to detect new and novel sounds in the environment (such as a television commercial), and the option to choose which sounds to focus on (for example, a grandchild asking a question). Binaural Directionality is the current premier directional option when fitting two ReSound hearing instruments for a patient.
Based on academic published research on user preferences for directionality in different listening environments,19,20 as well as lab testing to determine the microphone responses yielding the best speech intelligibility in noise21-26 and ease of listening22 in these complex listening situations, Binaural Directionality offers patients four bilateral microphone responses. Each of these four possible bilateral microphone responses is selected based on the classification of the environment by the Environmental Classifier. Binaural Directionality, like all ReSound directional options, includes bandsplit processing, termed Directional Mix.
This is especially true for closed fittings, which receive amplified sound in the low frequencies. Additionally, providing omnidirectional processing for low frequencies restores audibility due to the inherent low-cut response of directional microphone functionality, without the artificial noise induced by low frequency equalization features (ie, “bass boost”). Bandsplit processing also affords wind noise reduction, as compared to a hearing instrument with a full directional response and bass boost, because wind noise has been found to be more problematic when processed through a full-spectrum equalized dual-microphone directional response.27,28 Further, low-frequency longer-wavelength sounds naturally produce an omnidirectional-like response as they move around the head. Directional Mix is preset for the hearing instruments in one of four levels, ranging from “very low” to “high,” depending on the patient’s low frequency hearing thresholds and the hearing instrument model fitted.


Bilateral fittings, where two hearing instruments are programmed for a patient, may fall short in providing the brain the support it needs to conduct binaural processes.
Well, he is known more commonly for chasing dragons rather than chasing after voters for votes, yet the actor of Hobbit trilogy for the upcoming General Election is supporting the Labour. Amy Lou Adams is famous as an American actress and singer who made her debut in feature film Drop Dead Gorgeous. Hearing loss is sometimes sudden, but often it's gradual and you may not notice it at first.
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A study published in 2014 concluded that patients fitted with both hearing instruments at the same time were more compliant with their usage than those who were fitted with one hearing instrument initially and the other a month later.14 In fact, sequentially fitting one hearing aid after the other was already fitted resulted in reduction of use for both hearing instruments. One such consideration is binaural interference due to the coexistence of hearing loss and certain auditory processing disorders (for a review, see Holmes 200316).
But in many ways, this technology is performed in a vacuum, at the level of each device individually. For some features, this individual hearing instrument control can be advantageous; for example, problems such as feedback and wind noise are often best controlled when each hearing instrument is allowed to process and control the problem for each ear.
One hearing instrument might switch audibly to a directional mode, while the other might be slower to make the change. But, regardless of the goal of the feature, both hearing instruments provide input into the final response at each hearing instrument.
Often, the end result of such processing is a response that makes sense only in certain situations. Thus, it is important that these wireless features that are purported to be “binaural” actually have the true binaural benefits they are represented to possess. It is only when the brain receives a true representation of the sound environment, provided by the inputs at the ears, that it can do its work well. It steers the microphone response of both devices to support patients’ awareness of the auditory environment, and to allow them to choose what is most salient in that environment.
The four bilateral microphone responses of ReSound Binaural Directionality, from left to right: bilateral omnidirectional, directional-right and omnidirectional-left, directional-left and omnidirectional-right, and bilateral directional. Users can employ their brains’ binaural processing powers because they can hear the sounds in the environment via the omnidirectional response, and choose for themselves the signal of interest since there is no “tunnel hearing” to the directional beamwidth only. Low frequency sounds are processed in an omnidirectional fashion, while high frequency sounds are provided with a directional response when it is selected (such as in a bilateral directional or an asymmetric directional response via Binaural Directionality). For certain open fittings, where much of the low frequency sound escapes through the ear canal, the effects of Directional Mix Processing may not be apparent. This also minimizes the audible switching that may be heard when the hearing aid switches between omnidirectional and directional patterns. Polar pattern showing the response per frequency for the open ear (left panel) and with ReSound Directional Mix Processing (right panel). This setting is inversely related to the crossover frequency between omnidirectional and directional processing (eg, a “very low” Directional Mix setting will have a higher crossover frequency than a “high” setting). But, as Holmes also asserts, the benefits of fitting hearing instruments for both ears far outweigh the costs, in nearly all cases—and especially as patients age and as hearing loss progresses.
By virtue of the audibility benefits provided by compression, where soft sounds above a kneepoint are amplified to a greater degree than loud sounds, a high-frequency sound approaching from one side of a listener will be assigned lower gain, due to its higher sound level, than the same sound at the far, opposite ear, due in part to head-shadow effects.


Or one hearing instrument could in fact have a strong level of noise reduction activated, while the other one might remain in a neutral, noise-reduction-off setting, based on the environmental classification at each ear. And because both hearing instruments are involved, the term “binaural” is used in the marketing and advertising material. In the case of some of the current coordinated directionality features, the hearing instruments work together to find a signal to focus on (typically the loudest speech signal), and force the listener to attend to that by making other signals less audible. This feature truly incorporates the principle that the ears should be providing inputs to the brain so that the person can choose to focus on what is important. This means that, even if Binaural Directionality automatically selects a bilateral directional response, there will be some environmental awareness via the omnidirectional processing in the low frequencies.
However, in an open fitting, the user also receives direct, unamplified sound inputs, including low frequency sound, which aids in environmental awareness. Provision of directional benefit in conjunction with auditory environmental awareness allows hearing instrument users to detect and choose the signal of interest. Effects of long-term binaural and unilateral fitting of different hearing aid types on the ability to locate sounds.
Unilateral and bilateral hearing aids, spatial release from masking and auditory acclimatization.
Plasticity of binaural hearing and some possible mechanisms following late-onset deprivation. Better together: reduced compliance after sequential versus simultaneous bilateral hearing aids fitting.
Effects of noise configuration and noise type on binaural benefit with asymmetric directional fittings. The effects of asymmetric directional microphone fittings on acceptance of background noise. Effects of noise source configuration on directional benefit using symmetric and asymmetric directional hearing aid fittings. The effect of frequency-dependent microphone directionality on horizontal localization performance in hearing-aid users. This can effectively reduce the interaural level difference that the brain uses in its natural binaural processing to deduce localization information.
In general, these advanced features could possibly detract from the binaural benefits and natural sound quality the patient should receive. While the loudest speech signal may be what the user would sometimes choose, this is not true in every case. Bandsplit directionality affords users with additional support for better binaural hearing instrument. Bilateral fittings in and of themselves do not provide support for the brain to produce its important, inherent binaural processing advantages.
The user may not detect another softer speech signal in the environment if it is outside of the directional beam, and in some cases, this user may have preferred to listen to the softer speaker rather than the louder speaker. Handbook of Hearing Aid Amplification: Vol 11 Clinical Considerations and Fitting Practices.



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