13 ms·

I've long thought the problem with hearing aids is the calibration process. People (often old, confused, and less tech-familiar) try them on and spend half an h

I've long thought the problem with hearing aids is the calibration process. People (often old, confused, and less tech-familiar) try them on and spend half an hour answering questions about "does that sound better?" What if, instead, the calibration process worked constantly? Give the user a button to press when they don't hear something well, and another when they do. Let them have this for a month, let them try it in their kitchen, their bedroom, the local shop or bar, outdoors. Run some reinforcement learning algorithm to optimize for getting more "good" presses and fewer "bad" ones. Optionally, adapt separately to each environment. Is there a "smart" hearing aid calibrator that works like this? If not, but you think it's plausible, I'm interested in working on it.

jrace 5y ago
THere may be now, but not 5 years ago. I have many ideas about how the industry can be improved, especially with the use of a smart phone app and user interactions. Not only is it plausible, but would make the clinicians (fitter) job easier and lead to far more hearing aid sales.
- bane 5y ago
  What's really needed is a decoupling of the hearing test from the calibration activity. A basic hearing test takes a few minutes in an isolated box with headphones (the 'ol click a button if you hear the tone test). From that profile it should be trivial to build out the profile of what frequencies to boost and what not to and program the aids there.
  - kradeelav 5y ago
    I appreciate the optimism (and do think there's some room for efficiency improvements!), but each step is a little more complicated than that. a true audiometric room/booth to do the testing (eg fully soundproof) in is very rarely found outside of audiologist offices or specialized academic spaces, for starters, and I do believe those are required for paperwork (whether it be insurance related part of the process to getting the right device fitted). then there's also additional complications like types of hearing loss impacting calibration - some people react very negatively to higher (or lower) frequencies than others do, to the point facial stimulation can happen, and some people just have a frankly tricky profile that requires a trained audiologist on hand to work with them through several sessions, if not outright yearly on top of that, since the nerves and brain output can change by itself. (source: have a cochlear implant, been doing the described experience since I was ~ 3yrs old.)
    - dmi 5y ago
      To add to this — I suffer from Ménière's disease, which manifests for me as variable hearing loss. Some days are bad, and I can hardly hear/understand speech even when someone is right in front of me and I can lip-read. Some days are good, and my hearing aids are uncomfortably loud or make things sound "weird". But most days, my hearing aids do exactly what I need them to :-) I've had audiograms taken on moderate and bad days, and the difference in frequency response was significant (up to 30dBA difference across only the lower frequency bands).
- dmurray 5y ago
  I'd love to talk about this, could you email me at the address in my profile if you're interested?
- keithnz 5y ago
  my partners hearing aids has a smart phone app, but it seems to be built with the concept of someone else putting the calibration into it. They can then create profiles for the different situations, however it strikes me that the hearing test calibration could be done in the app as well. I would imagine for a lot of people, if you could just buy them online you wouldn't need the clinicians for many cases.
  - dmi 5y ago
    The app for my hearing aids allows my audiologist to make remote adjustments, so I don't even need to visit their office for straightforward changes. I really want to reverse-engineer it so that I can modify some of the details of the profiles myself.
- jessaustin 5y ago
  ...especially with the use of a smart phone app... Based on my observations of my father's struggles with various hearing aids, hearing aid smartphone apps are just as terrible as any other apps developed by hardware manufacturers. Don't expect the "clinicians" to help with this aspect either, because they were trained on a previous version of a different app and how could they be expected to figure out the apps that are used now?
EastOfTruth 5y ago
> What if, instead, the calibration process worked constantly? Give the user a button to press when they don't hear something well, and another when they do. On TVs, they call those buttons volume buttons, it is revolutionary.
- soylentnewsorg 5y ago
  ...which will simply make you more deaf. hearing aids do not simply amplify volume. you know, because they're not headphones and a microphone. but your idea is great too. if you can't hear one frequency, let's amplify all frequencies till the one you need gets loud enough, and go deaf to the other ones in a year. when you get old and need a hearing aid, you should stick with your method.
- RHSeeger 5y ago
  A lot of the time it's not absolute volume. If you can't hear certain frequency ranges well, boosting the volume of all ranges is just going to drown out the ones you can't hear well.
  - EastOfTruth 5y ago
    so a smart volume button
    - phkahler 5y ago
      That pays attention to the environment and changes the volume (part of the spectrum perhaps?) that is what you're likely to be listening to. This is of course a huge oversimplification, and aiming for it is probably what the industry is doing.
      - jrace 5y ago
        That is exactly what the tech does, automatically adjusts based on the amount of noise and speech in the environment. And going a step further, applying directional microphone control to better pick up sounds where the speech is.
FPGAhacker 5y ago
There are actually a good reasons not to do this. A very large part of your hearing is brain training...your brain learning how to interpret the new stimulus it is getting. You need to give your brain time to adapt to new stimulus before evaluating whether you are hearing better or not. If you are constantly fiddling with your hearing aids, you never get the benefit of training. This may not apply if your hearing loss was sudden, but many people get hearing aids only after years of decline. Your brain adapts to what it has available and you learn to hear as best you can with the limited stimulus. When you finally get hearing aids, it feels like your ears have been unblocked. When it comes to interpreting speech though, especially in noisy circumstances, you have to give it time. Your brain isn't used to using the extra stimulus to interpret speech. In fact, it may have gotten used to hearing loss filtering out background noise and you may initially find all the stimulus makes it harder to interpret speech because of all the background noise you now hear that you previously didn't. If you don't have patience and start immediately futzing with volume all the time, you never give your brain a chance to adapt, and will be very dissatisfied.
- unkeptbarista 5y ago
  I've been wearing hearing aids for almost 8 years. The brain training process is real and I'm glad the audiologist explained it.
- phreeza 5y ago
  Couldn't this brain training effect be included in a progressive algorithm like the one suggested? Such that the brain is gradually "guided" to the best performance by ramping up the hearing aid?
  - dmi 5y ago
    My (Phonak) hearing aids had a multi-week ramp-up to full power, in order to give my brain time to slowly adjust. Dealing with things like the occlusion effect (https://en.wikipedia.org/wiki/Occlusion_effect https://en.wikipedia.org/wiki/Occlusion_effect) just takes time, and getting used to something being in your ear for a large number of hours per day.
- 5y ago
rkagerer 5y ago
All audio devices used to have an instant-feedback feature like this. You could dial it in with zero latency. Early technosapiens called it the Volume knob :-).

jrace 5y ago

THere may be now, but not 5 years ago. I have many ideas about how the industry can be improved, especially with the use of a smart phone app and user interactions. Not only is it plausible, but would make the clinicians (fitter) job easier and lead to far more hearing aid sales.

bane 5y ago
What's really needed is a decoupling of the hearing test from the calibration activity. A basic hearing test takes a few minutes in an isolated box with headphones (the 'ol click a button if you hear the tone test). From that profile it should be trivial to build out the profile of what frequencies to boost and what not to and program the aids there.
- kradeelav 5y ago
  I appreciate the optimism (and do think there's some room for efficiency improvements!), but each step is a little more complicated than that. a true audiometric room/booth to do the testing (eg fully soundproof) in is very rarely found outside of audiologist offices or specialized academic spaces, for starters, and I do believe those are required for paperwork (whether it be insurance related part of the process to getting the right device fitted). then there's also additional complications like types of hearing loss impacting calibration - some people react very negatively to higher (or lower) frequencies than others do, to the point facial stimulation can happen, and some people just have a frankly tricky profile that requires a trained audiologist on hand to work with them through several sessions, if not outright yearly on top of that, since the nerves and brain output can change by itself. (source: have a cochlear implant, been doing the described experience since I was ~ 3yrs old.)
  - dmi 5y ago
    To add to this — I suffer from Ménière's disease, which manifests for me as variable hearing loss. Some days are bad, and I can hardly hear/understand speech even when someone is right in front of me and I can lip-read. Some days are good, and my hearing aids are uncomfortably loud or make things sound "weird". But most days, my hearing aids do exactly what I need them to :-) I've had audiograms taken on moderate and bad days, and the difference in frequency response was significant (up to 30dBA difference across only the lower frequency bands).
dmurray 5y ago
I'd love to talk about this, could you email me at the address in my profile if you're interested?
keithnz 5y ago
my partners hearing aids has a smart phone app, but it seems to be built with the concept of someone else putting the calibration into it. They can then create profiles for the different situations, however it strikes me that the hearing test calibration could be done in the app as well. I would imagine for a lot of people, if you could just buy them online you wouldn't need the clinicians for many cases.
- dmi 5y ago
  The app for my hearing aids allows my audiologist to make remote adjustments, so I don't even need to visit their office for straightforward changes. I really want to reverse-engineer it so that I can modify some of the details of the profiles myself.
jessaustin 5y ago
...especially with the use of a smart phone app... Based on my observations of my father's struggles with various hearing aids, hearing aid smartphone apps are just as terrible as any other apps developed by hardware manufacturers. Don't expect the "clinicians" to help with this aspect either, because they were trained on a previous version of a different app and how could they be expected to figure out the apps that are used now?

EastOfTruth 5y ago

> What if, instead, the calibration process worked constantly? Give the user a button to press when they don't hear something well, and another when they do. On TVs, they call those buttons volume buttons, it is revolutionary.

soylentnewsorg 5y ago
...which will simply make you more deaf. hearing aids do not simply amplify volume. you know, because they're not headphones and a microphone. but your idea is great too. if you can't hear one frequency, let's amplify all frequencies till the one you need gets loud enough, and go deaf to the other ones in a year. when you get old and need a hearing aid, you should stick with your method.
RHSeeger 5y ago
A lot of the time it's not absolute volume. If you can't hear certain frequency ranges well, boosting the volume of all ranges is just going to drown out the ones you can't hear well.
- EastOfTruth 5y ago
  so a smart volume button
  - phkahler 5y ago
    That pays attention to the environment and changes the volume (part of the spectrum perhaps?) that is what you're likely to be listening to. This is of course a huge oversimplification, and aiming for it is probably what the industry is doing.
    - jrace 5y ago
      That is exactly what the tech does, automatically adjusts based on the amount of noise and speech in the environment. And going a step further, applying directional microphone control to better pick up sounds where the speech is.

FPGAhacker 5y ago

There are actually a good reasons not to do this. A very large part of your hearing is brain training...your brain learning how to interpret the new stimulus it is getting. You need to give your brain time to adapt to new stimulus before evaluating whether you are hearing better or not. If you are constantly fiddling with your hearing aids, you never get the benefit of training. This may not apply if your hearing loss was sudden, but many people get hearing aids only after years of decline. Your brain adapts to what it has available and you learn to hear as best you can with the limited stimulus. When you finally get hearing aids, it feels like your ears have been unblocked. When it comes to interpreting speech though, especially in noisy circumstances, you have to give it time. Your brain isn't used to using the extra stimulus to interpret speech. In fact, it may have gotten used to hearing loss filtering out background noise and you may initially find all the stimulus makes it harder to interpret speech because of all the background noise you now hear that you previously didn't. If you don't have patience and start immediately futzing with volume all the time, you never give your brain a chance to adapt, and will be very dissatisfied.

unkeptbarista 5y ago
I've been wearing hearing aids for almost 8 years. The brain training process is real and I'm glad the audiologist explained it.
phreeza 5y ago
Couldn't this brain training effect be included in a progressive algorithm like the one suggested? Such that the brain is gradually "guided" to the best performance by ramping up the hearing aid?
- dmi 5y ago
  My (Phonak) hearing aids had a multi-week ramp-up to full power, in order to give my brain time to slowly adjust. Dealing with things like the occlusion effect (https://en.wikipedia.org/wiki/Occlusion_effect https://en.wikipedia.org/wiki/Occlusion_effect) just takes time, and getting used to something being in your ear for a large number of hours per day.
5y ago

rkagerer 5y ago

All audio devices used to have an instant-feedback feature like this. You could dial it in with zero latency. Early technosapiens called it the Volume knob :-).