1. A quick tidbit from a 2010 publication that was “dumped” by Catherine and her esteemed selection committee...

2. Working memory and hearing aid benefit: A direct relationship?

3. An example of how a reading span test might work Read each sentence out loud and then state—”Yes” or “No”—if the sentence makes sense. At the end of the five sentences, I will ask you to repeat either the first or the last word of each sentence. ARE YOU READY?

4. Go change your car color is red

5. Most men are going to the game.

6. Some flowers die in the fall of the year.

7. That neighbor found business at pink

8. Small boats can go under bridges

9. Okay... Name the LAST word of each sentence RED GAME YEAR PINK BRIDGES

10. Effects of noise and working memory processing of speech for hearing aid users Ng et al (2013) IJA, 52:433-441. Purpose: To evaluate the relationship between the benefits of noise reduction and individual’s working memory. Design: A sentence-final word identification and recall test was conducted in two noise backgrounds with and without noise reduction as well as in quiet. Working memory capacity was measured using a reading span test.

11. General findings of study: Noise impaired recall performance. Noise impaired recall performance. For late list items the disruptive effect of the competing speech background was virtually cancelled out by noise reduction for persons with high working memory capacity. For late list items the disruptive effect of the competing speech background was virtually cancelled out by noise reduction for persons with high working memory capacity. Conclusion: Noise reduction can reduce the adverse effect of noise on memory for speech, but only for persons with good working memory capacity.

12. Clinical Tips From This Article? The benefit of different hearing aid noise reduction features may be impacted by your patient’s working memory. The benefit of different hearing aid noise reduction features may be impacted by your patient’s working memory. Research data supporting feature benefit is probably from people with good working memory (participants screened as part of research protocol) Research data supporting feature benefit is probably from people with good working memory (participants screened as part of research protocol)

13. In general, we’ll talk about four important components of fitting hearing aids: Pre-fitting considerations Pre-fitting considerations Selection of technology Selection of technology Verification of the fitting Verification of the fitting Post-fitting follow-up and counseling Post-fitting follow-up and counseling

14. A quick mention of an article that indirectly relates to verification: Getting to know the ISTS Getting to know the ISTS

15. Development and analysis of an International Speech Test Signal (ISTS) Holube I, Fredelake S, Vlaming M, Kollmeier B. Int J Audiol. 2010 Dec;49(12)

16. A couple of abbreviations to know: The ISTS was developed as part of the ISMADHA project for the EHIMA. The ISTS was developed as part of the ISMADHA project for the EHIMA. ISMADHA=International Standards for Measuring Advanced Digital Hearing Aids ISMADHA=International Standards for Measuring Advanced Digital Hearing Aids EHIMA= European Hearing Instrument Manufacturer’s Association. EHIMA= European Hearing Instrument Manufacturer’s Association.

17. About the ISTS: The signal consists of concatenated speech of six female speakers; six different languages. The signal consists of concatenated speech of six female speakers; six different languages. The result is a non-intelligible real-speech signal that has all the most relevant properties of natural speech, yet it is not linked to a specific language. The result is a non-intelligible real-speech signal that has all the most relevant properties of natural speech, yet it is not linked to a specific language. A review of ISTS you might like: http://www.audiology.org/Documents/AN20 09Handouts/LM613_Fortune.pdf

18. Clinical Tip From This Article? There is a pretty good chance that you are going to be hearing about the ISTS more as years go by. There is a pretty good chance that you are going to be hearing about the ISTS more as years go by. The signal was well researched, and is an effective signal for your routine use (some manufacturers are using it already) The signal was well researched, and is an effective signal for your routine use (some manufacturers are using it already)

19. The importance of audibility in successful amplification of hearing loss Ron Leavitt and Carol Flexer Hearing Review, December, 2012

20. What they did... Selected the premier product from each of the “Big Six,” and programmed these hearing aids to each manufacturer's recommended fitting. All special features were activated. Selected the premier product from each of the “Big Six,” and programmed these hearing aids to each manufacturer's recommended fitting. All special features were activated. For benchmarking purposes, they added a 7 th hearing aid—a circa 2002 single-channel analog instrument, which they programmed to NAL-NL1. For benchmarking purposes, they added a 7 th hearing aid—a circa 2002 single-channel analog instrument, which they programmed to NAL-NL1.

21. What they did... The subjects were all experienced hearing aid users with typical downward sloping hearing losses. The subjects were all experienced hearing aid users with typical downward sloping hearing losses. The subjects, fitted bilaterally, were tested with all seven sets of instruments. The speech recognition test was the QuickSIN, presented at 57 dB SPL. The subjects, fitted bilaterally, were tested with all seven sets of instruments. The speech recognition test was the QuickSIN, presented at 57 dB SPL. Following the initial testing, all hearing aids were re-programmed to NAL-NL1 and QuickSIN testing was repeated Following the initial testing, all hearing aids were re-programmed to NAL-NL1 and QuickSIN testing was repeated

22. HA-1 HA-2 HA-3 HA-4 HA-5 HA-6 OLD Performance for the aided QuickSIN presented soundfield at 57 dB SPL. Bars indicate “SNR-Loss”: The average SNR disadvantage compared to individuals with normal hearing

23. Clinical Tip From This Article? If you want to help your patients understand speech in background noise, it is very risky to use the manufacturer’s proprietary fitting. If you want to help your patients understand speech in background noise, it is very risky to use the manufacturer’s proprietary fitting.

24. So what if you just push the “NAL Easy Button” in the fitting software? Will you then obtain a NAL fitting in the real ear? Siemens Phonak Starkey Hawaii Trip

25. The Accuracy of Matching Target Insertion Gains with Open-Fit Hearing Aids Aazh, H., Moore, B., Prasher, D. American Journal of Audiology, 2012, 21, 175-180

26. What they did... 30 people; 51 ears All open fittings NAL-NL1 selected in fitting software

27. What they found... 71% of fittings had a >10 dB mismatch from target at one or more frequency through 4000 Hz. 71% of fittings had a >10 dB mismatch from target at one or more frequency through 4000 Hz. After adjustment, 82% met target (majority could be met through 2000 Hz) After adjustment, 82% met target (majority could be met through 2000 Hz)

28. A 20Q article from earlier this year...

29. Maybe things have gotten better? Or the problem is only with one or two manufacturers? Data collected a few months ago: Selected the premier hearing aid from three of the leading manufacturers. Selected the premier hearing aid from three of the leading manufacturers. Selected “NAL-NL2” fit in the manufacturer’s software; programmed for typical downward sloping hearing loss Selected “NAL-NL2” fit in the manufacturer’s software; programmed for typical downward sloping hearing loss Matched all fitting and patient characteristics between software and probe-mic equipment. Matched all fitting and patient characteristics between software and probe-mic equipment. Conducted verification using speech mapping (male passage from the Verifit) Conducted verification using speech mapping (male passage from the Verifit)

30. Results for Manufacturer A

31. Results for Manufacturer B

32. Results for Manufacturer C

33. Clinical Tip From These Articles? If you believe that fitting to prescriptive target is a good thing, it is very risky to use the manufacturer’s fitting algorithm without real-ear verification. If you believe that fitting to prescriptive target is a good thing, it is very risky to use the manufacturer’s fitting algorithm without real-ear verification.

34. REMEMBER THESE ADS FOR VERIFIT?

35. That’s a bummer of a birthmark, Hal! While targets aren’t so good for Hal, what about hearing aid fittings?