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A “Goldilocks” Approach to Hearing Aid Self-Fitting

Ear-Canal Output and Speech Intelligibility Index

Mackersie, Carol1; Boothroyd, Arthur1,2; Lithgow, Alexandra1

doi: 10.1097/AUD.0000000000000617
Research Article

Objectives: The objective was to determine self-adjusted output response and speech intelligibility index (SII) in individuals with mild to moderate hearing loss and to measure the effects of prior hearing aid experience.

Design: Thirteen hearing aid users and 13 nonusers, with similar group-mean pure-tone thresholds, listened to prerecorded and preprocessed sentences spoken by a man. Starting with a generic level and spectrum, participants adjusted (1) overall level, (2) high-frequency boost, and (3) low-frequency cut. Participants took a speech perception test after an initial adjustment before making a final adjustment. The three self-selected parameters, along with individual thresholds and real-ear-to-coupler differences, were used to compute output levels and SIIs for the starting and two self-adjusted conditions. The values were compared with an NAL second nonlinear threshold-based prescription (NAL-NL2) and, for the hearing aid users, performance of their existing hearing aids.

Results: All participants were able to complete the self-adjustment process. The generic starting condition provided outputs (between 2 and 8 kHz) and SIIs that were significantly below those prescribed by NAL-NL2. Both groups increased SII to values that were not significantly different from prescription. The hearing aid users, but not the nonusers, increased high-frequency output and SII significantly after taking the speech perception test. Seventeen of the 26 participants (65%) met an SII criterion of 60% under the generic starting condition. The proportion increased to 23 out of 26 (88%) after the final self-adjustment. Of the 13 hearing aid users, 8 (62%) met the 60% criterion with their existing hearing aids. With the final self-adjustment, 12 out of 13 (92%) met this criterion.

Conclusions: The findings support the conclusion that user self-adjustment of basic amplification characteristics can be both feasible and effective with or without prior hearing aid experience.

1Audiology Division, School of Speech, Language and Hearing Sciences, San Diego State University, San Diego, California, USA

2Qualcomm Institute, University of California in San Diego, San Diego, California, USA.

Received December 5, 2017; accepted April 11, 2018.

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal’s Web site (

Address for correspondence: Carol Mackersie, School of Speech, Language, and Hearing Sciences, San Diego State University, 5500 Campanile Drive, MC-1518, San Diego, CA 92182, USA. E-mail:

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