1. An Update on Hearing Aid Testing
Reading Speech-Maps or SPLograms
Niki Timar, Audiologist
Vancouver Island Health Authority – South Island

2. Background
Audiologists used to routinely test hearing aids in the booth, using aided audiograms

4. Background
Research has shown aided audiograms are not a good way to test modern hearing aids
BC Public Health is switching over to the newer way of testing, using Real-Ear or simulated Real-Ear measures
This is why you might not be receiving aided audiograms recently

5. What is a SpeechMap or SPLogram?
A graph showing hearing thresholds, maximum safe or acceptable levels, and the performance of the hearing aid
“Speechmap” is the proprietary term Audioscan uses for their software
“SPLogram” is a term coined by Richard Seewald and his group, from the University of Western Ontario, for use with the Desired Sensation Level (DSL) hearing aid prescription formula

6. Audiogram on Speechmap Screen
In dB Hearing Level (HL)
Normal Hearing
“Speech Banana”
Hearing Thresholds

7. Speechmap or SPL-o-gram
In dB Sound Pressure Level (SPL)
Hearing Thresholds
“Speech Banana”
Normal Hearing

8. Difference Between Speechmap and Audiogram
Loud
In dB
Sound Pressure Level
NOT Hearing Level
Soft

9. Too Loud
Aided “Speech Banana”
Inaudible

10. Why Not Aided Audiograms?
Aided audiograms only show one thing: the response of the hearing aid to very soft sounds
Aided audiograms do not tell anything about how loud the hearing aid is, and whether it is potentially damaging to a child’s hearing

12. Real-Ear Testing
Instead of Aided testing in the booth, we now rely on Real-Ear Testing as our main hearing aid test

13. What is Real-Ear Testing?
Real-Ear testing is objective testing with the hearing aid in the ear.
Basically, we place a microphone in the ear just past the hearing aid, and measure what the actual output of the hearing aid is, close to the eardrum
                                                         
                                                 

15. Why the Changes in Methodology?
A Short Lesson on Hearing Aid Technology

16. Hearing Aids Hearing aids are now digital
Hearing Aids are no longer linear, they use COMPRESSION

17. Dynamic Range
One important concept for understanding compression and hearing aid function is DYNAMIC RANGE
This is the range of usable hearing for a given individual – between the quietest sounds they can hear (hearing thresholds) and the loudest sounds they can tolerate (loudness discomfort levels)

18. HL
Hearing Thresholds
Dynamic Range
Maximum Output

19. SPL
Maximum Output
Dynamic Range
Hearing Thresholds

20. Linear Hearing Aids Until the 1980’s, hearing aids were linear
They added the same amount of amplification, no matter how loud the input sound

21. Linear Amplification
140
120
100 80 60 40 20

22. Peak Clipping 140 dB is dangerously loud for most people
To keep the sound levels safe, hearing aids used Peak Clipping – they just stopped at a given level – for example, they wouldn’t make anything louder than 120 dB
This caused DISTORTION in the hearing aids

23. Peak Clipping
140
120
100 80 60 40 20

24. Compression
In the 1980s, as a way to keep sounds comfortable but undistorted, manufacturers started using compression limiting
Instead of amplifying the same amount no matter what the input, for sounds approaching the limit, less amplification would be used

25. Compression
140
120
100 80 60 40 20

26. Even Newer Advances
As technology advanced, it became possible to have different compression levels for different frequency ranges, and for different intensities
This is where digital hearing aids shine, as more capability can be added in these functions, without adding size or battery drain

27. So What Does This Have to Do With Speechmap?
Testing just quiet sounds in the booth does not tell us about what the hearing aid does to speech
Digital hearing aids often have noise suppression, which makes quiet, non-speech-like sounds even quieter, to avoid amplifying annoying sounds like fridges humming
Aided audiograms are tested using quiet, non-speech-like sounds (tones)

29. Limitation of Aided Audiogram
This slide shows the hearing aid’s response to quiet non-speech tones
We can infer how much speech the child can hear, but it does not show differing performance for soft, versus loud, speech
It does not tell us if the hearing aid is too loud, or if there is distortion
There are no targets, so we don’t know if this is a “good” fitting

31. The Speechmap shows soft speech, loud speech and very loud sounds, showing, in this case, that they all give acceptable responses
It also shows Speech Intelligibility Index (SII), which predicts how much of the speech signal is audible for a given input

32. You may also see Speechmap tables, depending how your local audiologist likes to look at things:

34. The Speechmap shows clearly the limitations of what can be achieved with hearing aids for difficult fittings
This keeps us from trying to increase the volume where it does not help, and would only cause feedback problems

36. The End