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Hearing Aid Fitting Strategies--WARNING: ADULT HUMOR

tapeworm tapeworm at bellatlantic.net
Fri Oct 31 05:58:39 EST 1997

Hearing Aid Terminology and Fitting Theory

There has been a great deal of  work and applied theory to achieving
satisfactory hearing aid fittings.  Hearing aid dispensers need to
remember that the aids are being fit to individuals, and not static,
rigid ears.  It is important that the dispenser and the patient consider
and declare themselves life-long partners in hearing health care.  This
partnership is best when the patient and dispenser work together for
long-term satisfaction, but it must be recognized that many patients
will have a number of partners throughout their lifetime.  The quality
of the fitting often depends on the bonds of the partnership.

In the past few years, a great deal of attention has been paid to Real
Ear Aided Response (REAR) as the measure of partner satisfaction with
hearing aids.   In the new world of Digital Signal Processing (DSP)
hearing aids, simple linear response measures of the REAR are
insufficient to properly assess and fit amplification.  A new method of
insertion testing, the Variable Algorithm-Generating  Input -Normalized
Assessment (VAGINA) has been proposed.  For most, the VAGINA is a more
preferable avenue than the REAR.  In fact, many partners insist that the
REAR not be used at all.

Standard methods of insertion testing are insufficient for the VAGINA.
Although substitute or artificial means of insertion may be used, the
Portable Electronic Noah Insertion System (PENIS) remains the method of
favor amongst most partners.  Note:  If discharge is present, PENIS
insertion should not be attempted.

By simply applying the PENIS to the VAGINA, many partners derive a great
deal of satisfaction, and nothing further is necessary.   It is
important to remember, however, that partners are not always truthful
when expressing satisfaction.  They often believe that the partner may
feel inadequate as a dispenser, so they tell the partner that they are
satisfied, and the best partner they’ve ever had.  So, to ensure true
mutual satisfaction, other methods of assessment and measurement are

Because most hearing aid fittings are no longer monaural, the Binaural
Insertion Gain (BIG) measures and the Binaural Aided Loudness Level
Sensation (BALLS) become important.  While many use warble tone stimuli,
other partners prefer to assess the Binaural Output Of Broadband Signal
(BOOBS).  To illustrate the wide variety of choices amongst partners,
some eschew suprathreshold measurements and perform tests of Target
Insertion, Threshold Signal (TITS).  In the case of asymmetrical losses,
a Weaker Ear Threshold (WET) may be useful, obtained with Natural Ear
Stimuli Signals (NESS). PENIS testing of the VAGINA can easily determine
if the WET-NESS is sufficient.

When using real-ear testing, unaided measures must first be taken, most
popularly the Narrowband Unaided Threshold Shift (NUTS) and the Unaided
Gain LinearitY (UGLY).

In the age of digital hearing aids, the use of compression has become
almost universal in hearing aid fitting.  Specialized testing for these
instruments have been developed, including the High Output Threshold
(HOT) which is used to set the Compression Output/Compression Kneepoint
(COCK).  Binaural fittings benefit from setting the Dual Insertion
Compression Kneepoint (DICK).  All measurements should include the Aided
Saturation SPL (ASS).

So, with all of these methods intended to derive both partners’
satisfaction, what is the best method?  Obviously, there is no one way
to do it. Do not be concerned if the BIG, UGLY ASS does not look as nice
as you may wish.  A great deal of attention should be paid to the DICK.
However, many partners ignore the BALLS when manipulating the DICK,
which results in less satisfaction.  Conversely, the attention BIG BOOBS
demand can distract the partner from the task at hand.  If you don’t
think the BOOBS are important, consider this possibility: your NUTS.
Many partners believe there’s nothing better than HOT WET COCK and BIG
TITS. It is always important to remember, however, that the PENIS and
the VAGINA are key.

Even though the partner tries his best, the other partner often simply
does not perform properly and blames the other.  These people are often
BUTTS (Basically Unaided, Turned-on Telephone Switch).  The hearing aid
dispenser should be patient with these BUTTS, even though they can be a
pain.  Gentle treatment of BUTTS often works.  In fact, if dispensers
kiss enough BUTTS, they will probably sell a lot of hearing aids and be
very successful indeed.


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