Audiogram vs Real life

Deafdude,

I learned something at JTC I thought I would share with you.

audiogram.jpg


Do you see that triangle at the top of the audiogram? You hearing aids should be programmed inside that triangle for speech perception. If they aren't able to reach that high, they need to be, at least, shaped like the triangle. Low frequency sounds like "ahh" and "b" are much louder when produced than sounds like "th" and "f", so they need to be amplifed LESS than the high frequency sounds. If they are louder, they will overpower even more. Your audiogram should ALWAYS slope UP, even if that means that you need to amplify the lows less.

Also, the line at the bottom represents the WORST your hearing can be and still be aided into the speech banana.

Caution: This is only true if you are seeking the ability to understand speech through audition.
 
First of all, I am VERY glad you're doing a split placement! That ROCKS!
That way she'll be able to get the content of stuff in her bi-bi classroom, and ALSO get oral training from a teacher who knows how to teach oral skills. I think that was what your barrier was......the speech therapist really wasn't trained in how to teach oral skills. It wasn't the bi-bi program....it was more the "skill" of the speech therapist.
She is doing great now, so maybe we leave it alone, OR maybe it could help even more....tough choice.
Well since she's getting 20% with HA, it's helping her, and she is doing great with a bimodal approach, right? I wouldn't worry about a second CI possibly "helping more" I know that there's a lot of "bilateral CI is the next BIG development" but I have heard of kids who got bilaterals, no longer using the second one. Since she's getting some obvious benifit from her hearing aid (and has no problems with recruitment or tintintas) I would wait til she's a bit older and can make the decision along with you guys. It really doesn't seem to be an urgent matter right now. She's doing awesome with the bimodal. Keep the possibilty of bilateral implants as a possibilty....
She doesn't really have an opinion about bilaterals right now. I have asked and sometimes she says yes, other times no. She is having a lot of trouble in noise right now and I would hope that is where she would get more benefit as well
Well the thing is, that virtually ALL hoh folks (including unilaterally dhh) folks have difficulty in noise.
 
OR maybe it could help even more....tough choice
Well.....the thing is.....it might be the bilateral implant, (that's helping)or it might be that the type of family that would get bilaterals is the kind that has good insurance and can really invest time and money into things like therapy, moving to oral schools etc.
I do know that some bilateral kids have stopped using the second one.
Since, Kat is still getting some speech percpetion benifit (and doesn't have tinituas or recruitment) from an aid I'd wait til she's a bit older to decide.
 
She loved it. It was interesting to see her blossom in that area. She made obvious, visable progress in just 3 weeks.
Excellent!!! That actually proves what I've been saying. I know one of your fears has been that "the clock's ticking" BUT most dhh kids still have language therapies in elementary school.
As long as Kat gets decent spoken language therapy, she'll really do well.
It's awesome that you're fighting for a split placement. I think that would be the perfect placement, so she gets speech therapy and spoken language instruction, and she ALSO gets the "meat and potatos" of "just learning.
 
Excellent!!! That actually proves what I've been saying. I know one of your fears has been that "the clock's ticking" BUT most dhh kids still have language therapies in elementary school.
As long as Kat gets decent spoken language therapy, she'll really do well.It's awesome that you're fighting for a split placement. I think that would be the perfect placement, so she gets speech therapy and spoken language instruction, and she ALSO gets the "meat and potatos" of "just learning.

Well, at the bi-bi school, she isn't getting that. The therapy is inappropriate. The SLP doesn't even do formal assessments. It is very bad. Plus, she is not given the opportunity to use or learn spoken language.
 
Well, at the bi-bi school, she isn't getting that. The therapy is inappropriate. The SLP doesn't even do formal assessments. It is very bad.
And that's understandable. You just needed a way to try to supplement her speech and language therapy. You know....you prolly would have encountered the same sitution at a public school. You really do need the specialization of people who have qualified experiance with oral language.
I don't think she needs VERY intense speech therapy. Don't fall for that at ALL....It sounds like she just needs it as an added supplement.
 
Deafdude,

I learned something at JTC I thought I would share with you.

(you showed me the image)

Do you see that triangle at the top of the audiogram? You hearing aids should be programmed inside that triangle for speech perception. If they aren't able to reach that high, they need to be, at least, shaped like the triangle. Low frequency sounds like "ahh" and "b" are much louder when produced than sounds like "th" and "f", so they need to be amplifed LESS than the high frequency sounds. If they are louder, they will overpower even more. Your audiogram should ALWAYS slope UP, even if that means that you need to amplify the lows less.

Also, the line at the bottom represents the WORST your hearing can be and still be aided into the speech banana.

Caution: This is only true if you are seeking the ability to understand speech through audition.

1248488634069663300.jpg


It's impossible to get to the triangle(25db HL) in the high frequencies. For that ill need the transposition cutoff to be closer to 500Hz than 1500Hz. Maybe Phonak will design a new HA where the transposition has more programmable options. With a 1500Hz cutoff, I pretty much don't benefit from transposition since I have 120db loss at that frequency.

When my HAs were reprogrammed, different aided results were tried and with the gain on the lows reduced, I heard less. My parents said I begin to talk too loud and they had to shout at me so I could hear them. My ability to understand speech dropped as well. I also was missing out on some environmental sounds with less gains. So yea it's always good to give as much gain as possible, why hear less?

As for the bottom line(black dots) that's not true! Look at the 750Hz, 1000Hz and 1500Hz results. It's a matter of getting the most powerful HA and correctly programming it for the best possible aided hearing. I am sad when I see people with better unaided hearing than me hear worse than me aided. They need better HAs and more amplification!
 
1248488634069663300.jpg


It's impossible to get to the triangle(25db HL) in the high frequencies. For that ill need the transposition cutoff to be closer to 500Hz than 1500Hz. Maybe Phonak will design a new HA where the transposition has more programmable options. With a 1500Hz cutoff, I pretty much don't benefit from transposition since I have 120db loss at that frequency.

When my HAs were reprogrammed, different aided results were tried and with the gain on the lows reduced, I heard less. My parents said I begin to talk too loud and they had to shout at me so I could hear them. My ability to understand speech dropped as well. I also was missing out on some environmental sounds with less gains. So yea it's always good to give as much gain as possible, why hear less?

As for the bottom line(black dots) that's not true! Look at the 750Hz, 1000Hz and 1500Hz results. It's a matter of getting the most powerful HA and correctly programming it for the best possible aided hearing. I am sad when I see people with better unaided hearing than me hear worse than me aided. They need better HAs and more amplification!


No, you missed the whole point. If you can't reach the triangle in all frequencies, you need to at least have your results shaped like the triangle. That would mean that you would need to turn down the lower frequencies, so they match the high frequencies. The lowest frequency sounds have more power behind them, so if you have them overamplifies they will completely overpower the soft sounds. The low frequencies need to be NO louder than 2000 and 3000 HZ.
 
Also, show me a single audiogran that has unaided results WORSE than the black line, and is aided into the triangle. It is impossible.
 
The Audiogram: Explanation and... | Healthy Hearing

Here is a link with a little better explanation. Training also plays a big part.

You should understand if you have only done sign with a hard of hearing kid from birth, she won't have developed the ability to take advantage of cues.

I am talking about being aided well enough to hear all sounds in the English language. It is not possible if you are not aided inside the shaded triangle. And, you can not be aided into the triangle if your loss is worse than that black line.

This is not me saying this, this is coming from Mary McGinnis and Daniel Ling. They wrote the auditory skills curruculim that this graph was taken from.

I'm not talking about lipreading or understanding cues and clues, I'm talking about hearing.
 
I am talking about being aided well enough to hear all sounds in the English language. It is not possible if you are not aided inside the shaded triangle. And, you can not be aided into the triangle if your loss is worse than that black line.

This is not me saying this, this is coming from Mary McGinnis and Daniel Ling. They wrote the auditory skills curruculim that this graph was taken from.

I'm not talking about lipreading or understanding cues and clues, I'm talking about hearing.

Oh, I see. In that case I am sure you are correct about not hearing all sounds in the English language.
 
No, you missed the whole point. If you can't reach the triangle in all frequencies, you need to at least have your results shaped like the triangle. That would mean that you would need to turn down the lower frequencies, so they match the high frequencies. The lowest frequency sounds have more power behind them, so if you have them overamplifies they will completely overpower the soft sounds. The low frequencies need to be NO louder than 2000 and 3000 HZ.


It is simply impossible for some types of hearing loss/audiograms to have results shaped like the triangle or even reach the triangle. Since nearly all my residual hearing is in the low frequencies(left corner audiogram) reducing the gains in the lows causes me to be unable to hear. Normal converstation becomes too quiet to be audible and I also don't hear alot of sounds as well. When my HAs were reprogrammed, my current aided audiogram in my sig is the best.

Why should I hear less at any frequency, especially the lows when it's clearly helping me big time? By the way, my speech % is higher with just the lows on max without the mids than with the mids on the max and the lows reduced.

This also means if I were to lose what little hearing I have at 750Hz and 1000Hz, as long as I keep all the lows, my speech % won't drop much. If I were to lose several db in the lows, yet not lose any in the mids, my speech would get alot worse.

I finished reading an article of someone who has a ski slope audiogram where she hears(both ears almost identical) 10db at 250Hz, 50db at 500Hz, 100db at 750Hz, cochlear dead regions above that and her speech score is 58% and she can even use the phone with varying success in her slightly better ear. I read about another person who also has a ski slope audiogram with near normal hearing up to 750Hz, poor hearing at 1000Hz and no hearing above 1500Hz. That person's audiogram was "unaidable" but he made do just fine without HAs and yes he can even hear phones.

I wonder if those two people hear better(even unaided) than I hear aided? Yea I can get down to "normal" hearing in the lows but that's just for quantity, not quality. I am going to read more on this but my impression is that someone who hears 10db unaided, even at a maximum of 250Hz still has normal, good quality hearing that's way better than my aided hearing at the same low frequencies.

One can also conclude that the low frequencies hold the most speech information from the above results and how well those people can still understand speech despite having normal hearing only in the lows with a very steep drop down to nothing around 1000Hz. This is called a ski slope audiogram. I am currently reading more about this and learning. My own aided hearing seems remarkably good even at 1000Hz but drops rapidly down to nothing above 1500Hz. On a piano thud test, I may hear all the keys up to 900Hz loud and clear then 1000Hz is much fainter, 1100Hz is very faint and 1200Hz can't be heard.

Also, show me a single audiogran that has unaided results WORSE than the black line, and is aided into the triangle. It is impossible.

The most powerful HAs have a gain as high as 80db or so(depends on many factors) A loss of up to 105db will be aided to 25db. So yea you are correct. However there's always transposition. Also most of the speech letters/words are in the low frequencies. I hear every letter and if my dad says the F and S 6" from my ear, I hear and differnate those as well. The F and S have alot of energy at 4000Hz but some of the energy of those letters does extend to the mids and lows. I don't hear those letters loud enough at "normal" distance so they appear silent.

My audiologist says what's between your ears is more important than what's in your ears. He says I simply need to train my brain to understand speech and ill achieve big improvements. He says those, even with "alot" of hearing who never train lose their ability to understand speech and that includes those with CIs too.
 
There is a reply, but it is still missing the point. If you want to hear speech, you have to get the triangle. If you can't, and you want to hear speech, get a CI!

How do you explain my dad who has presbycusis and a 50db+ hearing loss at 3000Hz and up is able to understand 90% speech and can hear the difference between "S" and "F"? Is it because frequencies above 2000Hz is of very little importance to speech as my dad says? Even HearAgain who had 6 high frequency electrodes on her CI disabled understands speech just as well without the highs!

Ill agree that if you can get to the triangle and be hearing at 10db across, you can get 100% access to speech. If you can get to part of the triangle(2000Hz) like my dad, you can still get 90% access. If you can't get to any of the triangle, then your speech score will probably be 50% maximum. Transposition can help those who can get to the triangle in the lower frequencies but not in the highs.

No one in my family has ever needed HAs to my knowlege, not even my grandparents(now deceased) and it's a fact that the eldery have some degree of hearing loss. HAs probably wouldn't be much help, if any when you are already scoring 90% speech unaided!
 
How do you explain my dad who has presbycusis and a 50db+ hearing loss at 3000Hz and up is able to understand 90% speech and can hear the difference between "S" and "F"? Is it because frequencies above 2000Hz is of very little importance to speech as my dad says? Even HearAgain who had 6 high frequency electrodes on her CI disabled understands speech just as well without the highs!

Ill agree that if you can get to the triangle and be hearing at 10db across, you can get 100% access to speech. If you can get to part of the triangle(2000Hz) like my dad, you can still get 90% access. If you can't get to any of the triangle, then your speech score will probably be 50% maximum. Transposition can help those who can get to the triangle in the lower frequencies but not in the highs.

No one in my family has ever needed HAs to my knowlege, not even my grandparents(now deceased) and it's a fact that the eldery have some degree of hearing loss. HAs probably wouldn't be much help, if any when you are already scoring 90% speech unaided!

When you have a CI, you can turn off electrodes and the sounds are just transfered to different electrodes, you don't just not hear them.

As for your dad (who is apparently an audiologist :roll:) do you have an audiogram with a speech test? What was his score again? Oh wait, you don't have one, do you?
 
deafdude,

I wanted to clarify that the reason I had 6 high frequency electrodes turned off is because they were causing dizziness and nausea. As FJ has pointed out, the high frequency electrodes that were disabled were shifted to other electrodes. My audi told me that turning off electrodes *could* result in poorer hearing, but this isn't always the case. Thanks to the electrodes that were deactivated, I'm able to hear/understand speech (in background noise and on the phone) as well as music better than I could when all of my electrodes were activated.
 
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