Your Most Challenging Patient – The Musician?

By Steve Hallenbeck

Over the past few months, I have worked with some musicians in field trials, remote fittings and with Resound customers.  As a musician, I found these fittings both challenging and rewarding.  One of the best things that I can share is that they have all been successful fittings. These successes prompted a desire to share some of my experiences.

First, keep it simple. I am unsure if my luck with these musician patients was related to the sound quality improvements with the Verso, a sense of confidence in the sound quality on my part, or some combination of both, but I have found that the fittings were relatively automatic and did not elicit immediate complaints.  Speaking both as an audiologist and a musician, I am apt to find myself over-analyzing what needs to be done to ensure a good music listening experience. I did not even realize to what extreme I was taking it until a patient asked “are you expecting something to be wrong?” after I had repeatedly asked if his violin sounded accurate through the hearing aids. In doubting the settings, I was a little overzealous in looking to do something which actually could have done more harm than good.  So the idea is set and forget, and let it rip.

I have taken note of a few technical tips that might be helpful when fitting musicians and music lovers:

1. Reset the Environmental Optimizer to zero in the Music program or whichever program they will use when performing or listening to music.  I have heard from patients that the gain and noise reduction changes made by this feature can be triggered by music performances. The result is fluctuations in the tone quality which can throw off their performance.
2. Music Mode DFS will be “on” by default in the Music program. This setting differs from DFS Ultra II in that it reacts more slowly and it is not allowed to adapt as much. This means it is less capable of cancelling feedback in the daily situations where we talk about feedback cancellation being advantageous such as getting a hug, or fixing your hair, and so forth. Music Mode DFS is a lot less likely to try to “cancel” musical sounds and is absolutely a great option. One advantage that ReSound has for all DFS settings in the Verso is that the input dynamic range for the feedback cancellation specifically extends to 118 dB SPL. Feedback cancellation systems do not do well if the information they are trying to extract from the input is tainted by distortion, so the upper boundary of the input dynamic range needs to be as high as possible. This is especially important for performers, who may be exposed to even higher input levels than music listeners. However, if the fitting is stable without DFS, consider turning DFS off completely in the program the patient uses when performing music. Although ReSound is industry leading with the high input dynamic range for DFS, and Music Mode significantly reduces the tendency of feedback cancellation to react to non-feedback sounds, no manufacturer has yet discovered the silver bullet for this.
3. The Music program makes the gain settings more linear and a few dB softer relative to the settings for speech programs.  If adjustments are needed, I have made the instruments even more linear and with less gain. To be more specific, I lower the G50 gains and up the G80 gains a couple dB.
4. This is perhaps a controversial statement, but if a need for adjustments arises, consider explaining the software screen and let musician patients drive their own adjustments. My experience in doing this is that it does not diminish your expertise as the audiologist, but rather engages the patient in a way that is beneficial to both. Musicians recognize that they are not representative of your typical patients, both in terms of the acoustic environments they will be in as well as what they need the hearing instruments to do for them. They appreciate that you are willing to experiment with them.
5. Have fun!! As you know, fitting hearing aids to musicians is arguably more challenging than fitting engineers! But when it’s right, it’s really great.

These ideas just scratch the surface, but I hope they will increase your comfort when working with musicians and help bring more success when fitting these patients.