1. Is the hearing aid always to blame when things get really noisy? Gitte Keidser 1, Elizabeth Convery 1, Jürgen Kiessling 2, and Ruth Bentler 3 1 National Acoustic Laboratories (Australia) 2 University of Giessen (Germany) 3 University of Iowa (USA) ASA meeting May 2010, Sydney

2. National Acoustic Laboratories, Sydney, Australia ASA 2010, Sydney Background Of 56 randomly selected hearing aid users, 82% reported experiencing loudness discomfort in real life Mean: -4.9 dB re NAL-NL1 @ 65 Mean: -10.7 dB re NALSSPL

3. National Acoustic Laboratories, Sydney, Australia ASA 2010, Sydney Is the hearing aid to blame or has our world become ‘uncomfortably’ noisy? Question

4. National Acoustic Laboratories, Sydney, Australia ASA 2010, Sydney Normally hearing mature adults Of 20 participants who passed the Telscreen hearing test, 85% reported experiencing loudness discomfort  11 F/9 M  60 years [50,67]

5. National Acoustic Laboratories, Sydney, Australia ASA 2010, Sydney Reportedly loud sounds Sound categoryHI (N = 46)NH (N = 17) People/groups (large gathering, crowds, screaming children) Entertainment (music, TV, movies) Transportation vehicles (traffic, engines) Tools/machines (road work, lawnmower) HF and/or sudden sounds (sirens, screeching birds) Wind noise Aircraft 50% 46% 30% 24% 26% 7% 29% 41% 29% 35% 12% -

6. National Acoustic Laboratories, Sydney, Australia ASA 2010, Sydney Some variation People/group (discussions with several people, specific voices)  Other negative aspects than loudness discomfort Sudden transient sounds (door slamming, rustling, cutlery)  Could be the hearing aid – try noise reduction that target transient non-speech sounds

7. National Acoustic Laboratories, Sydney, Australia ASA 2010, Sydney Reportedly loud sounds Sound categoryHI (N = 46)NH (N = 17) People/groups (large gathering, crowds, screaming children) Entertainment (music, TV, movies) Transportation vehicles (traffic, engines) Tools/machines (road work, lawnmower) HF and/or sudden sounds (sirens, screeching birds) Wind noise Aircraft 50% 46% 30% 24% 26% 7% 29% 41% 29% 35% 12% -

8. Loudness tests suggest that LDL > 90 dB SPL

9. National Acoustic Laboratories, Sydney, Australia ASA 2010, Sydney Clinical implications Don’t just reduce the output level  Too low output levels can distort speech  A narrow range of output levels likely unacceptable Understand the client’s complaints  Definition of loudness discomfort may be holistic  Reaction can depend on activity at the time of exposure, attitude toward the noise source, noise sensitivity, and controllability of the stressor (Berglund et al., 1996) Counsel/educate your client  Normal hearing listeners rate the same sounds too loud  Use VC, change program, turn HA off, use ear plugs

10. National Acoustic Laboratories, Sydney, Australia ASA 2010, Sydney Acknowledgement The study was partly funded by HörTech, Germany www.nal.gov.au