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I have reverse slope hearing loss. I have a pair of Oticon OPN 1 hearing aids. My audiologist does not seem to know how best to program them. I still have problems with speech in noise. Any suggestions?

Inventor, MBA-TM, BSET in Albuquerque

04 May 2017 - 4.2K Views

Noise is inherently low frequency.  If you have reverse slope loss and your hearing aid is programmed with too much low frequencies, that would interfere with your clarity for speech understanding, especially in noisy situation.  I would try to increase the mid frequencies and lower the low frequencies, as you probably would have enough high frequencies already.  A discrimination test with the hearing aids in the ears would probably help to determine the effectiveness of the hearing aids after they had been programmed. 

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Member
Member 04 May 2017
Hi Thank you for reply and your comments are appreciated. So far my audiologist has lowered the low frequency and upped the high frequency but still no good in speech in noise situations. In that situation all the background noise comes through as high frequency but the speech I am trying to hear comes out in low frequency so the background noise overwhelm what I am trying to hear
Keith Lam
Keith Lam 04 May 2017 Replied to Member
If you can email me your audiogram, I may come up with a better educated guess as to where it should be set. Please notice that low frequency is different from low volume.
Member
Member 04 May 2017 Replied to Keith Lam
I am seeing my audiologist tomorrow and will ask for a copy of my audiogram. If I lower the volume in the situation I described. the sound I hear from people I am sitting with is muffled and mixed in with the noise if that makes sense

Hearing Aid and Assistive Device Engineer and Dispenser

04 May 2017 - 4.19K Views

1) Your audiologist must rule out Auditory Neuropathy Spectrum Disorder (ANSD), and low frequency cochlear dead zones, which is a form of ANSD. The screening test is measuring the acoustic reflex thresholds across the speech range, and if they are above 90dB or missing, dead zones/ANSD is in play. The Threshold Equivalent Noise (TEN) test is available from Prof Brian CJ Moore at Cambridge; or from Frye at a slightly higher price (they also have a better explanation of it on their web page). You can read more here;

2) Refer your audiologist to the Reverse Slope Hearing Loss group on Facebook, where she can read the pinned post and the comment thread, which includes curated comments on pertinent subjects as cochlear dead zones and upward spread of masking;

3) Although both Neil Bauman & I have been doing it manually for years, instruct your audiologist to use Oticon's VAC+ fitting formula, which is the "least worst" of any of the formulas.

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Member
Member 04 May 2017
Hi Thank you so much for replying this sounds very helpful. I will take these details to my appointment tomorrow
Shanna M Mortensen-Dewsnup
Shanna M Mortensen-Dewsnup 04 May 2017 Replied to Member
The person replying to your comment is not an audiologist. Many reverse slope hearing losses are hereditary. Make sure your audiologist is performing real ear verification when doing the fittings and they have the appropriate power and venting whether it is with a dome or mold attached to the receiver wire. I'm not sure how old you are, but this is usually diagnosed at an early age and usually with an MRI. Audiologists go to school for approximately 8 years for a doctorate degree specifically in hearing loss. Hearing Instrument Specialists are not required to go to school for anything hearing related and usually require minimum hours for basic education in hearing aid fittings. If you are questioning your audiologist, ask if they do Real Ear Verification Testing. If you are now freaking out because the person replying to this post said it may be ANSD, an ENT can order an MRI and quickly rule that out along with an ABR. An ABR screening tool won't work. It sounds like the person fitting your hearing loss may not have a lot of experience fitting reverse slope hearing loss.
Member
Member 04 May 2017 Replied to Shanna M Mortensen-Dewsnup
Hi That is very helpful. I am not sure if the lady I am dealing with is actually an audiologist. So you are saying if she is not I would be best to actually find an audiologist
Shanna M Mortensen-Dewsnup
Shanna M Mortensen-Dewsnup 04 May 2017 Replied to Shanna M Mortensen-Dewsnup
Yes. Everyone's ear canals are different sizes. Some are nice and straight and large, others are very small and bendy. Hearing aid software uses a generic target based on age and gender to decide what to set the hearing aid to for your loss. It doesn't take into account "your" anatomy. If you are being fit to target in the software, but have small ear canals, it will sound way too loud. If you are being fit to software, and have bendy ear canals, you could be getting what is called 'resonant peaks' that may be over amplifying certain frequencies and making things very uncomfortable or distorted. All of this can be seen when doing real ear verification testing. Unfortunately, there are still many audiologists who don't do this testing because the equipment is expensive, and then there are hearing instrument specialists who are salesman.. So if your provider isn't doing that type of test with the hearing aid in your ear, I would find an audiologist who can do that testing for you and it will solve the problems you are having. The dome on the end of the hearing aid can make a big difference too. Make sure they are venting the domes, but not putting you in an open dome.
Member
Member 04 May 2017 Replied to Shanna M Mortensen-Dewsnup
Hi I have just checked on line my audiologist is listed as audiologist RHAD. Thank you ever so much for your replies they are really really helpful
Dan Schwartz
Dan Schwartz 04 May 2017 Replied to Shanna M Mortensen-Dewsnup
Actually, I'm a hearing aid and assistive device engineer & dispenser for over 30 years; and I also have had reverse slope SNHL for 37 years, as I was accidentally deafened at age 19 in the loudspeaker lab (prompting an electrical engineering career refocus). And Yes, I know the limitations of probe mic ("real ear") measurements, as I built my own probe mic test equipment in 1993, first using an Apple Macintosh Quadra 840AV & Rastronics probe mic kit, and writing my own software to run on the AT&T DSP3210 co-processor for the number-crunching. [I demonstrated this setup in a workshop at the 1994 Pennsy Hearing Aid Alliance (PHAA) convention, and my friend (the late) Sam Lybarger (the father of the modern hearing aid) was suitably impressed, as was Cy Libby,] This statement by Mortensen-Dewsnup is patently false — And I don't remember seeing her at the last worldwide ANSD conference hosted by Chuck Berlin & Linda Hood in March 2012: "If you are now freaking out because the person replying to this post said it may be ANSD, an ENT can order an MRI and quickly rule that out." The screening test for ANSD is abnormally elevated or missing ipsilateral (same-sided) stapedial (acoustic) reflexes across the speech range (500-4k); and the confirmation test uses high level click ABR using both compression & rarefaction clicks to cancel out the cochlear microphonic artifact. Use of an auditory nerve MRI will not tell you anything clinically significant, as it is only a proxy for what is there; and if you have (or have had) normal thresholds, then it will return normal. The only way to *verify* auditory nerve functionality is with an electrical ABR (eABR), though for adults the promontory stimulation ("prom stim") test is adequate, and is used as a pre-op test for cochlear implants (CI's) in borderline cases. Also, if cochlear dead zones (which is part of the ANSD spectrum) is suspected, the electrocochleogram (ECochG) can be used to help isolate the site of the lesion.
Shanna M Mortensen-Dewsnup
Shanna M Mortensen-Dewsnup 04 May 2017 Replied to Shanna M Mortensen-Dewsnup
So you have an engineering degree specifically in assistive hearing devices? I have never heard of such a degree. Can I ask where you obtained it? Was it a degree to make hearing aids? I know that is definitely not an Audiology degree and as far as I am aware, the audiology degree is the only one along with an actual medical doctor that is available that focuses specifically in diseases of the ear and treatment and takes 8 years + to obtain. Where did you get the 'assistive device engineer' title? Being a dispenser for over 30 years, does not qualify one to say they are an assistive hearing device engineer and can be very misleading to people seeking treatment for their hearing problems. An engineer is completely different than a hearing doctor. Having a hearing loss yourself may give you first hand experience with your own hearing loss, but does not make you in expert in what everyone else can experience. My son was born with severe hearing loss and is legally blind. I would not claim to be an expert in vision loss. I did however spent 8 years in school to learn as much as I could about his hearing loss and get an audiology degree so I could help my son and others like him. I would not have become a dispenser and then claimed that I knew the most when it came to treating hearing loss because I was my own expert. Where did you obtain your assistive device engineering degree?
Dan Schwartz
Dan Schwartz 05 May 2017 Replied to Shanna M Mortensen-Dewsnup
B.E.E. (co-op) at Georgia Tech with a focus in audio, acoustic, & communications systems engineering. We're the people who design and build the tools audiologists use (or often, misuse); and we're the ones who originally developed many of the theories used in audiology today. Unfortunately, AuD (and many PhD) audiologists lack the rigorous calculus-based physics, fluid dynamics, and electronics training, which is necessary to fully understand and interpret the results observed in electrodiagnostics, CI's, hearing aids, and assistive devices… And this is why I'm called in to troubleshoot problems audiologists have created, especially regarding ANSD & CI's. Oh, And By The Way, I was trained in ANSD by my longtime friend Chuck Berlin, along with Kirsty Gardner-Berry & Linda Hood.
Shanna M Mortensen-Dewsnup
Shanna M Mortensen-Dewsnup 05 May 2017 Replied to Shanna M Mortensen-Dewsnup
I see, but you are not a doctor of audiology correct? Engineers are different than health care providers so I'm still failing to see where you have the credentials to counsel patients on things that are not taught in engineering school for healthcare practice. They are two completely different fields. Name dropping may make you feel like you are a big name in the field, but you are not.
Dan Schwartz
Dan Schwartz 05 May 2017 Replied to Shanna M Mortensen-Dewsnup
And you're not a real doctor, either, as you did not attend medical or osteopathic school, so stop calling yourself "Doctor." In addition, you do not have formal training to deal with electronic devices, so you should not be programming hearing aids or (especially) MAP CI's. Stick to auditory rehab, which is in the scope of your practice.
Shanna M Mortensen-Dewsnup
Shanna M Mortensen-Dewsnup 05 May 2017 Replied to Shanna M Mortensen-Dewsnup
So the doctoral degree I spent over 8 years working on does not qualify me to be a doctor? So just to be clear, you are saying that if you designed prosthetics and your education was specifically for that, that would qualify you to be a surgeon? Or if you designed the anesthesia drugs, that would qualify you to inject them into people? I'm failing to see the comparison for an engineering degree making you a healthcare provider?? Creating a title that confuses the public and consumers and being vocal and argumentative on different blogs saying you know more than people who have spent years in school studying for the field they are healthcare professionals in, especially counseling parents on CI and other devices, which you are not qualified to do, is very misleading and damaging to the people getting the misinformation. I'm sorry if you feel you are above people who have dedicated their life and education to help others because you decided you wanted to dispense hearing aids without a degree in what you are doing. I'm not going to keep beating a dead horse because I know from other blogs you are on what you do and what you are like. I just feel bad for those that buy into the BS that comes from your blog and your comments who may not know any better.

Hearing Healthcare Provider in Champaign

04 May 2017 - 4.2K Views

Reverse slope hearing losses are difficult to program for, and keeping realistic expectations is important. 

A couple of questions - Do you have custom earmolds or do you have earbuds?  Custom earmolds can help emphasize the low tones and achieve better control over noise.  This might be something to try.

Have you been doing any auditory rehabilitation along with wearing hearing aids?  Brain training excercises can help us maximize the hearing we have.  If you are not doing auditory rehabilitation, I highly recommend trying it.  Ask your Audiologist about how auditory rehab can help you improve your speech understanding in noise.

Is there another audiologist in the clinic who can help?  Sometimes getting a second opinion can help.  That is not to say your first audiologist is not good, however sometimes a second specialist can see something that the first person didn't think of that may help.  There are also audiologists on demand for most manufacturers, and perhaps it would be worth asking about getting expert assistance from the manufacturer. 

Do you have auditory deprivation?  Was your hearing loss left untreated for many years before you got treatment?  Unfortunately, when a hearing loss is left untreated for a very long time, sometimes there is only so much we can get back even with the very best hearing aids and very best programming done on those aids.  Having realistic expectations is very important when treating hearing loss.  While the technology available today is the best it has ever been, we still cannot get back the lost speech understanding that is caused by deterioration in our brains from leaving hearing loss untreated for many years.  This is why it is so important to get help for our hearing early, as soon as we first notice symptoms of hearing loss creeping up in our lives rather than waiting until the problem is "bad enough" to do something about it.  Like all health conditions, early detection and treatment produces the best outcomes over the longest period of time.  If auditory deprivation is present, auditory rehabilitation is even more important. 

I hope this helps!

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Member
Member 04 May 2017
Hi Thank you very much for taking the time to reply. You give some useful advice which I will discuss with my audiologist. The aids are fitted with ear buds (thin tube) my hearing loss was a gradual thing over a few years. These hearing aids are great in quiet situations. It is in the noise of say a restaurant I get overwhelmed by the high frequency noise of people talking at the other tables. I can't understand what they are saying of course I don't want to be able to. But the voices of people I am with come through as a low frequency sound and I can't follow or take much part in conversation. What I would like is that background noise to be filtered out and my hearing of people I am conversing with to stay higher frequency. Or is that just a dream
Alina Phoenix
Alina Phoenix 04 May 2017 Replied to Member
It sounds like there are some adjustments that could be done to help, and it is also dependent on the level of technology you are wearing how robust the background noise filters are. Lower level technology have fewer lower quality noise filters, higher level technology have more and better noise filters. It also sounds like you could try some custom earmolds to help get better sound. Other folks in this thread also have some great advice for you. I wish you the very best of luck!
Member
Member 04 May 2017 Replied to Alina Phoenix
Thank you I feel more impowered now for my appointment tomorrow
Dan Schwartz
Dan Schwartz 04 May 2017
"Do you have custom earmolds or do you have earbuds? Custom earmolds can help emphasize the low tones and achieve better control over noise. This might be something to try." Sorry, this is the wrong direction: Unamplified environmental noise isn't a problem; and in fact using sealed or pinhole-vented earmolds not only exacerbates the upward spread of masking problems, it also cuts off the high frequencies which are processed unaided. Back about 25 years ago, Mead Killion at Etymotic developed the K-Hook earhook series to address this for reverse slope, cookie-bite, reverse cookie-bite, and ski-slope losses, the latter a variant on (the late) Sam Lybarger's design.
Dan Schwartz
Dan Schwartz 05 May 2017
I need to clarify my response yesterday: Although open fit eartips will work, I try to avoid them on my patients (unless they specifically demand them) as they do not secure the hearing aid against falling off, especially in sports. Instead, I always provide custom eartips specifically for retention.

Audiologist in Oshkosh

04 May 2017 - 4.21K Views

Member
Member 04 May 2017
Thank you for your reply very helpful
Dan Schwartz
Dan Schwartz 04 May 2017
Juliette, that's an excellent suggestion to visit Neil Bauman's article on RSHL! As it turns out, Neil & I had both been chasing RSHL since about 1985, as we both have it; and when in 2009 we "found" each other first online & then in person and compared notes, our methods — although derived slightly differently — were surprisingly close. As It Turns Out, Neil heuristically discovered that you don't amplify the audio in cochlear dead zones: He didn't know what they were, but he figured "something is amiss." I just looked at the "Amplification" section of his "Bizarre World" article for the first time in a few years, and saw he updated it two years ago (and I'm glad he did!). Here's the URL: link [I just discovered there's no online archived copy of "Bizarre World" so I shot an e-mail to Neil.]

Doctor of Audiology in Franklin

04 May 2017 - 4.22K Views

I read a research article about programming hearing aids for reverse slope audiograms. I don't remember the title because it was a few years ago, but it talked about how you program the hearing aids for more gain in the high frequencies and less in the low frequencies than you would expect from just looking at the audiogram.  I don't know if this has been tried yet. A reverse slope can be a hard hearing loss to fit. 

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Member
Member 04 May 2017
Thanks for your reply which is helpful. What you suggest is what my audiologist is attempting after I showed her an article that was the same as your suggestion. The hearing aids are fine in quiet and slight noise but in a restaurant situation I get all the noise from everybody else at other tables the hearing aids don't isolate the voice of someone talking to me so very difficult for me
Danielle Gorsky
Danielle Gorsky 04 May 2017 Replied to Member
Do you have hearing aids that can connect to an IPhone to give you some control in those situations? In this article the patients had the ability to adjust their hearing aids how they liked.
Member
Member 04 May 2017 Replied to Danielle Gorsky
Yes I have an iPhone and the remote for them but that only adjusts the volume and programs. If I turn the hearing aids right down in noise there is not enough high frequency to hear the people I am with
Dan Schwartz
Dan Schwartz 19 May 2017
@Danielle, there's not much on reverse slope SNHL in the peer reviewed literature; but indeed you're on the right track. Some quick keys, as I'm short on time today: 1) Watch out for ANSD, including apical (low frequency) cochlear dead zones (which is in the ANSD "spectrum"). Screen for this via abnormally high or missing ipsi acoustic reflexes across the speech spectrum (>90dB HL **compensated for canal volume**); 2) Upward spread of masking will kill any RSHL fitting, especially around 3kHz: We believe this is exacerbated by fluid turbulence caused at the first principle bend of the cochlea, approximately 6mm from the oval window. At present, there are still no good computational fluid dynamics (CFD) finite element analysis (FEA) models of the cochlea, as it appears there is too much variation (ask any CI surgeon!); 3) Don't be afraid to refer for a formal CI evaluation.

Provider removed

This provider is no longer listed.

08 May 2017 - 4.03K Views

I would say look over this article there is a lot of great information regarding reverse slope hearing loss. 

http://www.hearingreview.com/2003/11/changing-with-the-times-managing-low-frequency-hearing-loss/

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Doctor of Audiology in Peoria

04 May 2017 - 4.19K Views

Reverse slope hearing loss is impossible to fit without performing real ear verification testing. The generic fitting algorithms in most manufacturers software is based off an average and not typically the best for reverse slope hearing loss. Make sure your audiologist is following best practices and performing real ear verification testing while the hearing aids are in your ear. 

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Dan Schwartz
Dan Schwartz 04 May 2017
Patently false: Real ear measurement simply insures you "hit the target" of the fitting formulas, of which NONE are designed to handle them (although Oticon's VAC+ is the least worst). Scroll up and see what I wrote about cochlear dead zones, upward spread of masking, and ANSD.
Shanna M Mortensen-Dewsnup
Shanna M Mortensen-Dewsnup 04 May 2017 Replied to Dan Schwartz
Considering we have programmed multiple reverse slope loss and the only accuracy and happy outcomes come from those with real ear measurements performed, I would say you do not know what you are talking about. If this is false, why is it required for pediatric fittings to ensure they are fit appropriately to learn speech? I'm assuming by your response, you are not an audiologist?
Dan Schwartz
Dan Schwartz 04 May 2017 Replied to Shanna M Mortensen-Dewsnup
As I wrote above, And Yes, I know the limitations of probe mic ("real ear") measurements, as I built my own probe mic test equipment in 1993, first using an Apple Macintosh Quadra 840AV & Rastronics probe mic kit, and writing my own software to run on the AT&T DSP3210 co-processor for the number-crunching. [I demonstrated this setup in a workshop at the 1994 Pennsy Hearing Aid Alliance (PHAA) convention, and my friend (the late) Sam Lybarger (the father of the modern hearing aid) was suitably impressed, as was Cy Libby,]
Shanna M Mortensen-Dewsnup
Shanna M Mortensen-Dewsnup 04 May 2017 Replied to Shanna M Mortensen-Dewsnup
I have seen you on other forums. I'm sorry, but I am in complete disagreement with you. Do you make your own hearing aids as well?
Dan Schwartz
Dan Schwartz 05 May 2017 Replied to Shanna M Mortensen-Dewsnup
In fact, I have indeed designed & built by hand custom hearing aids & earmolds for challenging patients, including reverse slope, back in the Bad Old Analog Days, using Etymotic Research K-AMP & LTI/Gennum (now ON Semiconductor) chipsets.
Shanna M Mortensen-Dewsnup
Shanna M Mortensen-Dewsnup 05 May 2017 Replied to Shanna M Mortensen-Dewsnup
Interesting.. I wonder why they are not on the market if they were such good devices.
Erin Burns
Erin Burns 19 May 2017 Replied to Dan Schwartz
Not so, just because there ARE targets, doesn't mean we are required to hit those targets. The benefits of using real ear measures go far beyond simply being a button clicker to hit "target". We also use it to make sure amplification at least exceeds threshold and does not exceed UCL. For the trickiest of patients I use the Contour Test and a semi IHAFF type of fit. But like I tell my students, manufacturers lie, and the only way to know by how much is to test for it, you can't know what the actual hearing aid output is with various inputs without testing for it.

Discussion

Shanna M Mortensen-Dewsnup
Shanna M Mortensen-Dewsnup 04 May 2017
We have programmed multiple reverse slope loss and the only accuracy and happy outcomes come from those with real ear measurements performed. If fitting with real ear measurements are false, why is it required for pediatric fittings to ensure they are fit appropriately to learn speech? There are multiple articles out there with proof that real ear measurement testing increases patient satisfaction with hearing aids and in some states, it is starting to be required by law due to the number of people who are not fit appropriately.
Member
Member 04 May 2017 Replied to Shanna M Mortensen-Dewsnup
Hi No not an audiologist just a very frustrated consumer. I just feel the audiologist I see does not fully understand how to overcome this. She has spoken to Oticon for advice but has not improved things it is so frustrating not to be able to follow and take part in conversation in noisy situations. What I feel I need the hearing aids to do in noise is cut out the high frequency background noise but keep my hearing at a high frequency for conversing with people I am with. Is that an impossible dream do you think?
Shanna M Mortensen-Dewsnup
Shanna M Mortensen-Dewsnup 04 May 2017 Replied to Member
I wasn't referring to you, I was referring to the person who posted the response. It sounds like your provider may not have a lot of experience programming reverse slope hearing loss. We see a lot of reverse slope hearing loss. It's a tricky fit because you need low frequency to hear speech, but too much high frequency makes everything really sharp and piercing to the ears. There are ways to vent the domes to give you the best of both worlds, but I promise, if they do real ear verification testing with a little probe microphone in your ear, it will sound much much better. I would ask them if they perform these types of fittings or maybe go to an audiologist who does.
Member
Member 04 May 2017 Replied to Member
Hi I looked on line it says she is Audiologist RHAD whatever that means. I can't thank you enough for your advice which I am going to follow. I know the practise I go to does not have the equipment for live ear measurement so I need to find one that does.
Member
Member 06 May 2017 Replied to Shanna M Mortensen-Dewsnup
I have bilateral RSHL and have seen 9 different audiologists for fittings in less than 2 years. Fittings where real ear measurement was used as the baseline, proved to be unsuccessful for me resultung in discomfort an unused pair of very expensive hearing aids. There are varying degrees of challenge with RSHL. I have seen the most progress with settings, for me, when following guidlines set by Neil Bauman with further assistance from Dan Schwartz. From what I see your attacks to discredit advice, from someone who has personal experience with the needs of RSHL, are emotionally driven and biased. Everyone has room for growth, always. I would be more inclined to trust one who embraces a a new idea or approach especially when considering the variants.
Shanna M Mortensen-Dewsnup
Shanna M Mortensen-Dewsnup 06 May 2017 Replied to Member
If you read the past posts, you will find that I was not attacking anyone, however, the contrary from Dan. It sounds like you are either "Dan" with a different account, or one of his friends. This does not sound like it is written by someone who is a consumer with RSHL. I'm sorry, but I see Dan on other blogs and know he is a 'pot stirrer' and someone who claims to be an expert in everything without any education to back it up. Just because someone has a hearing loss themselves does not make them an expert or a hearing 'healthcare' professional. How is that even possible without having any form of education in in any form of healthcare? We stay current on all the research and follow best practices. There are limitations to REM if someone has surgical ears, however, we have programmed enough reverse slope hearing loss to know that it works and they have very successful outcomes. My son has lived with hearing loss for 18 years and I have been his main advocate, and I would never become a dispenser and then claimed to be an expert in hearing healthcare based on just that without getting a degree in it. The minimum education necessary in most states to dispense hearing aids is a high school diploma or GED. We can agree to disagree. I know Dan's reputation is not someone of expert knowledge, but someone who causes a lot of drama and arguments on blogs and is trying to make a big name for himself. Unfortunately, for those that don't know better and are coming to blogs to get help or expert advice, they get misinformation and a lot of negativity toward audiology and those that have spent years in school to specialize in just that. And believe it or not, there are audiologists with first hand experience with hearing loss, and they went to school to learn as much as they could to help others as well.
Dan Schwartz
Dan Schwartz 19 May 2017 Replied to Member
You can climb off your high horse, as there are other professions besides audiology which contribute to the hearing care profession, including engineers (of which without, there wouldn't even be the audiology profession!), neurobiologists, physicists, real doctors physicians & surgeons), and so forth. You say you stay up on the research: I doubt it, as you haven't mentioned the CAM2 (CAMEQ-2HF) prescriptive fitting method, which comes closer than VAC+ for audiologists who "chimp it," as it takes into account cochlear dead zones. Also, I sign all of my posts.
Dan Schwartz
Dan Schwartz 04 May 2017
@Danielle, you're going in the right direction as (unlike another commenter), you recognize the Upward Spread of Masking bugbear (but only after ANSD has been ruled out!). The articles to which you refer can be found in the comments of the pinned post here: link
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