When fitting hearing aids, there are three guidelines that should always be followed by the dispenser:
restore audibility; so that the amplified sound is above the user's threshold,
limit the output; so that the amplified signal does not exceed the user's discomfort level, and
do no harm; so that the amplified signal is not unintentionally or undesirably altered by the hearing aid.
The first two of these three guidelines are obvious. The first is to present sounds above the user's threshold of hearing in order to create an acoustic environment with the maximum amount of audible speech cues. The second ensures that discomfort level is not exceeded, so that the user does not wince or remove the hearing aids when loud sounds are present.
The third guideline—do no harm—is less obvious. This indicates that it is important that the hearing aids produce no alteration of the signal other than that which the fitter intends. This is a subtle way of saying that, among other things, well-fitted hearing aids should not distort the desired sound. The topic of distortion is the subject of this issue of Trends in Amplification. The intention of this issue is to explain why distortion occurs in some hearing aids; to explain how distortion is measured; to summarize what can be done to prevent distortion; and to summarize the perception of distortion by the hearing aid wearer.
Distortion in hearing aids can be broadly defined as the generation of undesired audible components that are present in the output, but which are not present in the input. When distortion occurs, hearing aids produce undesired elements at the output through the interaction of the processed signal with some internal non-linear mechanism. These undesired components may interfere to some degree or other with the reception of sound by the listener. If these added elements are small compared to the overall signal level, they may effectively cause no interference at all. If they are large, they can be so disruptive to the listener that the desired sound becomes irritating or even incomprehensible.
All audio systems inevitably contain some amount of distortion. The practical problem for the listener is the type of distortion that is present and the level that is acceptable or tolerable in hearing aids before the distortion becomes disruptive to speech intelligibility and sound quality. It is known that highly distorted speech in quiet can remain intelligible (Licklider, 1946); however, as dispensers often experience, intelligibility is not the only measure of whether or not a user will accept and wear hearing aids. Gabrielsson and Sjogren (1979b) have shown that overall perceived sound quality is important to users when selecting a hearing aid. Punch (1978) has shown that listeners with mild to moderate sensorineural hearing losses retain the same ability to make distinctions in sound quality judgments as listeners with normal hearing. This implies that good sound quality is as equally important and desired by listeners with a hearing impairment as it is for listeners with normal hearing.
Three characteristics of distortion in hearing aids modify the sound delivered to the user:
the type of distortion,
the relative amount of distortion at different frequencies, and
the variation of distortion with different input levels.
Since the most important goal for fitting hearing aids is to restore or facilitate communication ability, undistorted sound is important for optimum speech intelligibility and sound quality. However, it is important to also recognize that there are other reasons to provide undistorted amplification of sound. For example, undistorted and pleasant reproduction of music may be an important sensory experience for some listeners.
This issue concentrates on different types of undesired modification to the waveshape of the sound, primarily by total harmonic distortion (THD) and intermodulation distortion (IMD). However, in a more general sense, any undesired component added to the sound by hearing aids is a form of distortion. Thus,
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Answer:
When fitting hearing aids, there are three guidelines that should always be followed by the dispenser:
restore audibility; so that the amplified sound is above the user's threshold,
limit the output; so that the amplified signal does not exceed the user's discomfort level, and
do no harm; so that the amplified signal is not unintentionally or undesirably altered by the hearing aid.
The first two of these three guidelines are obvious. The first is to present sounds above the user's threshold of hearing in order to create an acoustic environment with the maximum amount of audible speech cues. The second ensures that discomfort level is not exceeded, so that the user does not wince or remove the hearing aids when loud sounds are present.
The third guideline—do no harm—is less obvious. This indicates that it is important that the hearing aids produce no alteration of the signal other than that which the fitter intends. This is a subtle way of saying that, among other things, well-fitted hearing aids should not distort the desired sound. The topic of distortion is the subject of this issue of Trends in Amplification. The intention of this issue is to explain why distortion occurs in some hearing aids; to explain how distortion is measured; to summarize what can be done to prevent distortion; and to summarize the perception of distortion by the hearing aid wearer.
Distortion in hearing aids can be broadly defined as the generation of undesired audible components that are present in the output, but which are not present in the input. When distortion occurs, hearing aids produce undesired elements at the output through the interaction of the processed signal with some internal non-linear mechanism. These undesired components may interfere to some degree or other with the reception of sound by the listener. If these added elements are small compared to the overall signal level, they may effectively cause no interference at all. If they are large, they can be so disruptive to the listener that the desired sound becomes irritating or even incomprehensible.
All audio systems inevitably contain some amount of distortion. The practical problem for the listener is the type of distortion that is present and the level that is acceptable or tolerable in hearing aids before the distortion becomes disruptive to speech intelligibility and sound quality. It is known that highly distorted speech in quiet can remain intelligible (Licklider, 1946); however, as dispensers often experience, intelligibility is not the only measure of whether or not a user will accept and wear hearing aids. Gabrielsson and Sjogren (1979b) have shown that overall perceived sound quality is important to users when selecting a hearing aid. Punch (1978) has shown that listeners with mild to moderate sensorineural hearing losses retain the same ability to make distinctions in sound quality judgments as listeners with normal hearing. This implies that good sound quality is as equally important and desired by listeners with a hearing impairment as it is for listeners with normal hearing.
Three characteristics of distortion in hearing aids modify the sound delivered to the user:
the type of distortion,
the relative amount of distortion at different frequencies, and
the variation of distortion with different input levels.
Since the most important goal for fitting hearing aids is to restore or facilitate communication ability, undistorted sound is important for optimum speech intelligibility and sound quality. However, it is important to also recognize that there are other reasons to provide undistorted amplification of sound. For example, undistorted and pleasant reproduction of music may be an important sensory experience for some listeners.
This issue concentrates on different types of undesired modification to the waveshape of the sound, primarily by total harmonic distortion (THD) and intermodulation distortion (IMD). However, in a more general sense, any undesired component added to the sound by hearing aids is a form of distortion. Thus,
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