jillio
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This woman hears worse in some aspects with CI over HA.
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rick48
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The bolded is the funniest thing I have seen posted on here recently, given that it seems to matter very little to you.
Gee and I would have thought it was your using an "honorary title" on this forum.
rick48
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Tell that to the Duke Lacrosse team and their parents.
Exactly. Exactly! I (and Deafdude) aren't nessarily against CI. I think the CI is AWESOME for those who obviously need it....I mean a high power HA isn't gonna cut it for someone who gets absolutly zero benifit from them.
However, it does seem like as the implantation criteria has gotten less strict, there has been really hardcore "selling" akin to Big Pharma practices or the "selling" of digital aids back in the 90's.
faire_jour
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:roll:
So if you get some benefit, you should stick with hearing enviromental sounds?
LadySekhmet
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That's what I keep arguing about. Some of us aren't "OBVIOUSLY NEED IT" type of implantees, like me for example, but I definitely will NOT be happy with "just hearing environmental sounds".
No matter how much benefit the HA gave me for environmental sounds, it does not give me the clarity that I desperately needed for music and speech. I could have gone ahead and really struggled for a couple years trying to find the perfect hearing aids, maximizing my gains, wasting thousands of dollars (since insurance companies do not pay for them), and I will never be happy with my HA's even though it will give me the environmental sounds.
Do I "obviously need" the CI's? No. I could have gone and just got top of the line HA's and be happy with hearing environmental sounds...but that's not me. I want to hear speech. I want to hear music better. The CIs gave me the clarity that I needed, even though I "don't need it if my life depended on it".
jillio
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I can't say that I disagree with your post, Lady. But, if you don't mind, I would like to clarify it from a different perspective.
You have made a decision that hearing music and speech, for you, improves your quality of life. It is wonderful that the technology is available to you that allows you to make that decision for yourself. It is your life, and only you can determine what will improve the quality. That is a very subjective measurement. Just as you feel the CI has improved your quality of life, there are those that also feel that hearing music and speech would not significantly improve their quality of life, and therefore, opt not to receive a CI. And that is as it should be. Only the individual can make that decision for themselves.
Where the topic becomes difficult, is the point that the attitude becomes that because the CI improves the quality of life for one, it is necessary to have one to improve the quality of life for another. One can not use their own subjective idea of life's quality to decide that, because it is true for them, it has to be true for everyone. I think that is the real issue behind the argument.
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LuciaDisturbed
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I have the same type of CI as Hear Again and I am able to hear bass quite well (although I have all the electrodes turned on). My fiance is Deaf and wears hearing aids and he listens to a lot of rap music and he would often play rap music in his truck when I am riding with him, and I hear it quite well. I can actually follow the bass and the beats quite well. I find rap music to be the easiest to follow due to its bass and beats although I tend to prefer to listen to a lot of rock and metal and Japanese techno music too as well. Music is not too much of an issue for me except for the lyrics, and I was not expecting to understand any lyrics at all when I got implanted anyway. I am happy with the way I am able to hear the music. That was something I had always wanted to hear all my life - music - and I got it. My surgeon, before he implanted me, he was quite frank and honest with me about the expectations and the possible outcome of the CI surgery and activation and told that even though he is agreeing to implant me that I should not really expect very much from it except maybe sound perception, and he made sure I understood that. I was implanted on October 11th, 2006 and was activated 5 days later (my clinic typically activates people the day after surgery but I asked them to hold off for a few days because I was not up for the long metro bus trip across town to get activated the day after surgery) and I was activated on October 16th, 2006. I could hear many different sounds right off the bat. I have a long list of different sounds that I heard in the first month after being activated. There were also a few sounds that I did not hear for the first couple of months after activation and one of them was cars. Then one day I was walking home on a busy street and all of a sudden, the cars was SO LOUD! O.O And I had to get a new map so that the cars wouldn't sound SO loud. I've since learned how to enjoy music and I enjoy music quite well even without understanding the lyrics, and am quite happy. I even have a mp3 player, tons of CDs of music laying all over my apartment, and before I reformatted my computer I had about 10 GB of music on it. Now I have 4 GB on the computer. I could add more but most of the music that was on my computer before the reformat are already on the CDs laying around the apartment, so no need to put them back on the computer unless I want to transfer them to my mp3 player. Six months after the surgery, I came back to see my surgeon for the final post-surgery check-up, and he asked me how have I been doing with my implant. I told him that I've been able to hear many different environmental sounds (even though I don't do so well at memorizing them - gotta work on that) and that I have been able to hear a lot of music. He was quite pleasantly impressed and surprised at that! He was NOT expecting much if at all to begin with. No, I cannot understand speech even though I can hear people speak but that is to be expected with my hearing history/background. I would of course like to understand speech just for convenience (writing back and forth with hearing people gets old sometimes and I lose pens or they run out of ink all the damn time!) but it is not something that is a huge deal to me. If I don't achieve understanding speech, that is okay with me. It's the music that is the biggest bonus for me really than it is to hear and understand speech.
I also noticed something a few weeks ago when my fiance got his RockBand 2. There was one song that both of us kept choosing (neither of us knew we were choosing the same song at the time). I would choose the song Rebel Girl "Bikini Kill" over and over and over and over and over when I was playing RockBand 2. Later, I noticed that my fiance was doing the same. He kept choosing it over and over and over again while he was playing RockBand 2 either with me or on his own. He then burned that song onto a CD and began playing it in his CD player in the truck often when we're out and about, and I found that this was the one song that we both enjoyed the most, despite the fact that my fiance isn't normally into that type of music. I'm not sure why this happened, but I thought it was interesting that this happened, and it also makes me smile.
I wanted to elaborate more about my decision to get a CI and stuff like that, but I will save it for another thread so I don't turn this into a novel. You may see some of this post in the thread that I am going to make.
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AlleyCat
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The first bolded part is exactly why I didn't get a CI. My CI audi felt I would *not* gain much benefit outside of gaining environmental sounds. I already get a good chunk of that with my hearing aids, so if I wasn't going to get the clarity I wanted, then I wasn't gonna do it.
I will try and shed some light on what is going on within the industry.
For the most part, audiologists make more money selling you a hearing aid than referring you to have an implant. The margins are much higher on hearing aids. In the case of some implants, audiologists receive no money (and loose a HA sale) by referring people.
There are 10, 16, and 22 electrode CIs. However, it takes a certain amount of electricity to stimulate the nerves. Below this energy, there is no stimulation. When you make a very small electrode, the energy density goes up significantly and can create significant problems. Electrical fields also contain over lap; they send a signal that radiates from a point. Think of them light a light bulb when the light goes out from a center point. They are not like a laser. What you get is electrodes that have cross-interference between adjacent electrodes. So think of a 10 electrode array as being able to turn on any one electrode at any given time. One the electrode density is doubled to 20 electrodes, it is not uncommon to not be able to turn on adjacent electrodes simultaneously or in quick succession. In effect, a 20 electrode array is two 10 electrode arrays spaced next to each other.
With sound processing sounds must be grouped. For example sounds from 1Hz to 500Hz will be combined to stimulate electrode #1. 500 to 1k will activate electrode #2 and so forth. The rules for banding are different than the linear example I gave, but it illustrates the concept.
Current CI electrode arrays are at the limits of manufacturing. In essence, to make a single electrode, it takes at least one man day of effort. That is very costly. There really is no-one who is able to mass produce these like computer chips or circuit boards are made. That makes the cost very high. You would be very surprised in the COGS (cost of goods sold) for a CI.
The issue is that there only seems to be 2.5 alternatives for hearing impaired people. Option #1 is a traditional HA. They have their limitations on sound amplification and aided thresholds but are a very attractive choice becase of everything is external and there are many choices. Once the lower limit for a traditional HA is crossed, people look at Option #2 which is CI. CI have inherent limitations with aspects of sound quality due to having large FFT (fast furrier transform) bin values due to limited number of electrodes. Option #2.5 is the hybrid of the two which are electro-mechanical implants (i.e. BAHA, SoundBridge, Carina, etc). They fill the gap between #1 and #2 and can many times treat conductive loss and mixed loss patients. However, they are typically expensive and not reimbursed like CIs.
I have read the comments about this being about money. Yes. It is. Just as General Motors wants to make money and pay the people that work for them, hearing companies, whether traditional HA or implants, have the intention of making money. Also, just like all other industries, they are constantly improving products. They take products and perform spiral designs on them. This means they have a Generation 1 CI that they learn from. Then they make a Gen 2 followed by a Gen 3. However, if they do not make money, they have nothing left to spend on new R&D.
Contrary to what may be believed hearing companies are not comprised of hearing impaired employees wanting to make a difference their own lives. The majority of the people doing the R&D are normal hearing people that typically have the following goals: 1) Do something the find interesting 2) Work in a profession where their product helps people and 3) make a living doing the first two. In fact, most people that work in the entire operation of these companies do these three things.
You are just seeing the infancy of the technology. The new trend will be implants because traditional hearing aids are about at their limit. They really can’t put out 150dB without damaging the ear canal and tympanic membrane. Hearing implants have been dominated by small companies with limited resources. Look for that trend to be changing.
C1
For the most part, audiologists make more money selling you a hearing aid than referring you to have an implant. The margins are much higher on hearing aids. In the case of some implants, audiologists receive no money (and loose a HA sale) by referring people.
There are 10, 16, and 22 electrode CIs. However, it takes a certain amount of electricity to stimulate the nerves. Below this energy, there is no stimulation. When you make a very small electrode, the energy density goes up significantly and can create significant problems. Electrical fields also contain over lap; they send a signal that radiates from a point. Think of them light a light bulb when the light goes out from a center point. They are not like a laser. What you get is electrodes that have cross-interference between adjacent electrodes. So think of a 10 electrode array as being able to turn on any one electrode at any given time. One the electrode density is doubled to 20 electrodes, it is not uncommon to not be able to turn on adjacent electrodes simultaneously or in quick succession. In effect, a 20 electrode array is two 10 electrode arrays spaced next to each other.
With sound processing sounds must be grouped. For example sounds from 1Hz to 500Hz will be combined to stimulate electrode #1. 500 to 1k will activate electrode #2 and so forth. The rules for banding are different than the linear example I gave, but it illustrates the concept.
Current CI electrode arrays are at the limits of manufacturing. In essence, to make a single electrode, it takes at least one man day of effort. That is very costly. There really is no-one who is able to mass produce these like computer chips or circuit boards are made. That makes the cost very high. You would be very surprised in the COGS (cost of goods sold) for a CI.
The issue is that there only seems to be 2.5 alternatives for hearing impaired people. Option #1 is a traditional HA. They have their limitations on sound amplification and aided thresholds but are a very attractive choice becase of everything is external and there are many choices. Once the lower limit for a traditional HA is crossed, people look at Option #2 which is CI. CI have inherent limitations with aspects of sound quality due to having large FFT (fast furrier transform) bin values due to limited number of electrodes. Option #2.5 is the hybrid of the two which are electro-mechanical implants (i.e. BAHA, SoundBridge, Carina, etc). They fill the gap between #1 and #2 and can many times treat conductive loss and mixed loss patients. However, they are typically expensive and not reimbursed like CIs.
I have read the comments about this being about money. Yes. It is. Just as General Motors wants to make money and pay the people that work for them, hearing companies, whether traditional HA or implants, have the intention of making money. Also, just like all other industries, they are constantly improving products. They take products and perform spiral designs on them. This means they have a Generation 1 CI that they learn from. Then they make a Gen 2 followed by a Gen 3. However, if they do not make money, they have nothing left to spend on new R&D.
Contrary to what may be believed hearing companies are not comprised of hearing impaired employees wanting to make a difference their own lives. The majority of the people doing the R&D are normal hearing people that typically have the following goals: 1) Do something the find interesting 2) Work in a profession where their product helps people and 3) make a living doing the first two. In fact, most people that work in the entire operation of these companies do these three things.
You are just seeing the infancy of the technology. The new trend will be implants because traditional hearing aids are about at their limit. They really can’t put out 150dB without damaging the ear canal and tympanic membrane. Hearing implants have been dominated by small companies with limited resources. Look for that trend to be changing.
C1
LadySekhmet
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Awesome post CrazyOne! I def learned a lot...
Just to go out that CI companies are not out there JUST to make money..they're out there to help us do something that we could never achieve...and that is to hear.
I understand that people are against CI's or whatever...it's because they're undereducated or never have the desire to hear sound. That's okay...that's the way they are.
Just to go out that CI companies are not out there JUST to make money..they're out there to help us do something that we could never achieve...and that is to hear.
I understand that people are against CI's or whatever...it's because they're undereducated or never have the desire to hear sound. That's okay...that's the way they are.
Thanks.
I have read quite a few posts on this site. I find them interesting. You may be able to tell that I know quite a bit about the technology that is used so if you have technical questions, I will try my best to respond but I cannot respond much to lifestyle questions.
However, I will post what I understand about hearing impairment. I was at surgery to implant a hear device. After seeing the whole thing from start to finish, I couldn't understand why anyone would do that to themselves. What I was told by the surgeon, is something that I will paraphrase.
They told me when a person looses eyesight, they are disconnected from the physical world. When they loose hearing, they are disconnected from the human world.
That has stuck with me.
C1
I have read quite a few posts on this site. I find them interesting. You may be able to tell that I know quite a bit about the technology that is used so if you have technical questions, I will try my best to respond but I cannot respond much to lifestyle questions.
However, I will post what I understand about hearing impairment. I was at surgery to implant a hear device. After seeing the whole thing from start to finish, I couldn't understand why anyone would do that to themselves. What I was told by the surgeon, is something that I will paraphrase.
They told me when a person looses eyesight, they are disconnected from the physical world. When they loose hearing, they are disconnected from the human world.
That has stuck with me.
C1
Hey, I have some questions:
Is everything nowdays measured in db(A) SPL using the A weighing? I am curious if the gains and SPL of HAs is A weigh or C weigh. I am doing some math to objectivately calculate what possible settings my HA can be programmed at and I am working with my audie to have my HAs reprogrammed for it's best.
I was also wondering if audiometers are calibrated in dbA or dbC? Ive read on how to convert db SPL to db HL but I need to know if they always use dbA or if they use dbC. One source said at 1000Hz, 0db HL corresponds to 7db SPL, yet the minimum audability curve shows "normal" hearing at some frequencies(mid-high) to be about -5db SPL!
I will post a longer reply in the next post.
Is everything nowdays measured in db(A) SPL using the A weighing? I am curious if the gains and SPL of HAs is A weigh or C weigh. I am doing some math to objectivately calculate what possible settings my HA can be programmed at and I am working with my audie to have my HAs reprogrammed for it's best.
I was also wondering if audiometers are calibrated in dbA or dbC? Ive read on how to convert db SPL to db HL but I need to know if they always use dbA or if they use dbC. One source said at 1000Hz, 0db HL corresponds to 7db SPL, yet the minimum audability curve shows "normal" hearing at some frequencies(mid-high) to be about -5db SPL!
I will post a longer reply in the next post.
So why refer? Unless the comissions are more than what the audie would make in profits selling the HA, it's pointless. Also alot of deaf people get angry when CIs are pushed on them.
so 22 electrodes is the limit? Are results better with 22 than with less? What ever happened to the 48, 64, 128 electrodes I read about in an article? So if I understand, how well you hear with CIs(threshold levels) have many factors, one of them being how viable your nerves are. I am still trying to find out why some people get much better thresholds than others. One of my worries is ill hear worse than with HAs, one of the reasons is perhaps not being able to get better than 50db thresholds. Then CIs usually destroy residual hearing so I have no plan B to go back to my HA if CI happens not to work. I posted that this lady hears worse with CI than HA.
That is why fiber optic laser CI is an exciting prospect. Youd be stimulating the nerves with a different type of energy that's much more precise. You could have 128 or more electrodes this way and be able to hear 128 different pitches/frequencies instead of only a few. Id like music to be smooth and hear all the sweeps/transititions between each few Hz instead of hearing abrupt changes from 500Hz...1000Hz...2000Hz...4000Hz with nothing in between.
Any idea when CIs will be able to be mass produced?
HAs are the best option for anyone getting benefit from them. Ive always said that CIs should be a last resort. I am reading on the limitations of HAs and the more I know, the more I can work with my audiologist to reprogram my HAs with sophiscated programs that are a workaround to some of the limitations. Transposition is one such example and there are many more. As long as a person has enough residual hearing, HAs can amplify that. I am reading on what degree of loss becomes unaidable. I know it's 120db for sure but not sure how much below that and at what frequencies.
I am still trying to find out if HA gains/SPL are "A" or "C" weighed. Is the audability threshold curve "A" weighed like I suspect? Also are audiometers giving "A" weighed SPL that is shown as db HL rather than db SPL? I know that the pain threshold is 130db(again, is this A or C weighed)
SPL(dbc) for 0db HL:
125Hz=47.5(45)
250Hz=26.5(25.5)(27)
500Hz=13.5(11.5)
750Hz=8.5(8)
1000Hz=7.5(7)
1500Hz=7.5(6.5)
2000Hz=11(9)
3000Hz=9.5(10)(11.5)
4000Hz=10.5(9)(9.5)(12)
6000Hz=13.5(10.5)(15.5)(16)
8000Hz=13(13)(15.5)
This is what I was able to find on the internet(slightly different answers). I assume it's C weighed. This doesn't agree with the minimum audability curve however, not even when I convert to A weighing.
Neither. dBA and dBC are weighted scales to "approxiamte" human hearing perception. An audiogram picks specific points to test your hearing. An audiogram will likely pick 250, 500, 750 (sometimes) 1K 2k, 3k, 4k, and 5k. They are done in dB HL.
Converting to dB SPL is frequency dependant. There are very complicated formulas for this but I will give you the simplified values. These are all in 1/3 octave frequency bands.
250Hz -13db
500Hz- 6db
750hz -5 db
1000hz - 4db
1.5k - 2.5db
2k -0.5
3k - -4
4k- -4.5
6k- 4.5
C1
Converting to dB SPL is frequency dependant. There are very complicated formulas for this but I will give you the simplified values. These are all in 1/3 octave frequency bands.
250Hz -13db
500Hz- 6db
750hz -5 db
1000hz - 4db
1.5k - 2.5db
2k -0.5
3k - -4
4k- -4.5
6k- 4.5
C1
I will say that I am not an audiologist so with that in mind, I don’t know their exact business model. I do know a portion of the hearing industry well. One of the issues with the newer technologies is that audiologists will not refer and will try and fit patients with the inappropriate device. Basically, what ever audiologist you walk into will say what they sell is the best thing. It doesn’t matter if it is a HA or a CI. That said, many really want to help the patient. Also, many are interested in new treatments.
Most audiologists really don’t make that much money. It is not really a highly paid profession.
CIs often destroy hearing because they drill a hole in the cochlea and replace a volume of cochlear fluid with an electrode. This electrode impedes fluid movement and depending upon where its placed can also impede hair cell movement.
Around 25 is the practical limit at the moment. It is no secret that for each wire that comes out of a CI you must pass from a sealed titanium can to the outside world while preventing fluid ingress into the electronics . This is done with a feedthrough. Making 48 feedthrough pins in a reasonable size is hard. Each one must be electrically isolated from one another. This is don’t by using platinum wire going through either glass, ceramic or ruby.
Next, the electrode must be made. Each electrode must have a wire welded to it. The wire must be platinum and electrically isolated from every other wire. This is no simple task. Right now, about 25-30 is the practical limit.
I know of nothing in works from anyone working of fiber optic in any commercial venue. Other methods are being explored (that’s all I can say).
Competition in the CI market is heating up. The first to do this will do well.
In general, 80-85db HL is where a HA is no longer really viable. At 90db HL, you mist remember there is only 30db dynamic range to work with. That takes a lot of compression (that means 4:1 compression ratio).
One thing that must be realized is that hearing market is growing. Unfortunately, most of the products are geared toward sensory neural HL. The reason for this is the baby boomer population has a lot of money and is loosing hearing. The boomers want it fixed. That is the business model that works for making hearing solutions. I suspect they will be the first to get Has reimbursed too. Don’t get discouraged. Many companies are working on new solutions.
My prediction. The next 5 years will see tremendous growth.
C1
Howcome when I search the internet, it gives different values for converting? For example it gives a value of 7db SPL at 1000Hz. None of the values are below 7db SPL from what someone tested the audiometer with a db SPL meter. For example at 1000Hz hearing at 77db SPL puts your loss at 70db HL.
How am I seeing a percentage of people that were able to preserve some or even all of their hearing? Did they get special electrodes placed in the right positions that don't interfer with the hair cells? Some of those people got full electrodes, not the shortened ones used in hybrid CI/HA clinical trials.
University of Michigan
What happened to that 128 electrode CI being developed since 2006?
Google laser or fiber optic cochlear implant. Plenty of articles that discuss this new technology. Maybe it's being developed in secret but could be several years away.
How much would this cut down on the cost? Current CI costs $50,000 but those getting CI usually pay much less or nothing at all due to insurance. So really it's the insurance companies that will benefit from the savings.
Ive been wondering why some of us still benefit from HAs despite being profoundly deaf(90-110+ db losses) As for dynamic ranges, doesn't CI also have a small dynamic range? Im still wondering if the gain/SPL manufactors list on their HA specs are A or C weighed? In another thread, I said:
I was wondering the same thing to be honest. I will have to ask my audiologist(s) this. Those reading my post can offer their own theories as well. Let me share my experience what it's like. The results are with the speaker volume cranked up.
250Hz(75db HL) and 500Hz(90db HL): I hear low frequencies up to 500Hz very loud. I can still hear those from the other side of the house!
750Hz(105db HL): I still hear this tone very loud but notice it's half as loud as the 500Hz tone. I can hear this tone from the other room!
1000Hz(110db HL): Much softer than 750Hz, about half as loud and about a quarter as loud as 500Hz. I can still hear 1000Hz from the other end of my room!
1250Hz(115db HL): Less than half as loud as 1000Hz, this tone is quite hard to hear even if I put my ear to the speaker. I can't hear it from more than about 3 feet away.
1500Hz and 2000Hz+(115db-120db+ HL): Most of the time, 1500Hz is inaudible. On a good day, I hear it from a few inches away at threshold levels.
I am personally surprised by that disparity, once I reach 110db HL, each few db above that quickly fades into nothing. But I hear sounds very loud and well at levels below 110db HL, even the 750Hz tone I can hear very well! I have a piano when when I play it, there is a small difference in loudness between the low(first set) and mid frequency keys(second set). It's when I get to the high frequency keys(third set) that I can tell a noticable volume decrease between each key. My parents do not experience this however for any keys. My dad only experiences this for the last few highest keys since he has a moderate high frequency loss. But for me, the last dozen keys are silent, and the keys before that are very faint.
Some possibilities and theories:
1. Perhaps the dynamics of the ear changes at 110db and up. Below 110db HL, there still is enough functioning hair cells that can be stimulated/amplified. Once you get to 110db and up, there is so few, if any hair cells. Ive read into cochlear dead regions where a very loud sound actually stimulates adjacant hair cells and this does give the person a perception of hearing. The sound may be noiselike, very distorted, off-frequency, felt as a woosh, or simply very faint.
2. I wonder if it's a limitation of HAs but after trying my old HAs from 1998 and comparing my new HAs from 2008 with neither giving me hearing above 1250Hz, but the new HAs making sounds at 1250Hz and below 2-4x louder, yet still not being able to give me anything usable at 1500Hz, I suspect it's my ears.
3. I am able to get a response on the audiometer at 1500Hz, 2000Hz and sometimes even 3000Hz in the 115db to 120db range. But I don't recall hearing any shrill tones or whistles. It's likley I heard a low frequency distortion that came from the audiometer and/or due to the cochlear dead region phenomenon. I also hear the same distortion comming from my speakers at 1500Hz, 2000Hz, 3000Hz, 4000Hz, etc. It sounds like "ehhhh" like humming or static.
4. I will find out more when I ask my audie about this and when he reprograms my HAs. He did say that at 120db, HAs cease to become useful. I can ask him what about at 110db, 115db and in between 110db and 120db.
5. I do know that the pain threshold as well as UCL(uncomfortable level) occurs at or around 120db. Thus even if you could attempt to amplify a 120db loss with an insane amount of gain/SPL, it won't be pratical as there's zero dynamic range, would not be comfortable and might even cause damage to adjacant functioning hair cells.