This study examined the effect that signal processing strategies used in modern hearing aids, such as multi-channel WDRC, noise reduction, and directional microphones have on interaural difference cues and horizontal localization performance relative to linear, time-invariant amplification. Twelve participants were bilaterally fitted with BTE devices. Horizontal localization testing using a 360 degrees loudspeaker array and broadband pulsed pink noise was performed two weeks, and two months, post-fitting. The effect of noise reduction was measured with a constant noise present at 80 degrees azimuth. Data were analysed independently in the left/right and front/back dimension and showed that of the three signal processing strategies, directional microphones had the most significant effect on horizontal localization performance and over time. Specifically, a cardioid microphone could decrease front/back errors over time, whereas left/right errors increased when different microphones were fitted to left and right ears. Front/back confusions were generally prominent. Objective measurements of interaural differences on KEMAR explained significant shifts in left/right errors. In conclusion, there is scope for improving the sense of localization in hearing aid users.

Client-based adjustments of hearing aid gain provide a reliable method of individual fine-tuning. The results also showed that a biased correction of amplification is reached via self-adjustment within one session, which reduces the effectiveness of fine-tuning in a traditional clinical setting.

Self-adjustments of variable hearing aid parameters are essential for trainable hearing aids to provide customized amplification for different listening environments. Prompted by a finding of Dreschler et al. [Ear Hear. 29, 214-227 (2008)], this study investigates the effect of the base line (starting) response on self-adjustments of gain in different frequency bands. In a laboratory test, 24 hearing-impaired listeners adjusted the bass, treble, and overall gain to reach their preferred responses from two different base line responses for 12 different listening situations. The adjustments were repeated five times using the preferred response after each adjustment as base line response for the next adjustment. Half of the listeners further compared three different response shapes, within the range of preferred responses, pairwise ten times for preferential and perceptual discrimination. The results revealed that base line response biases were more pronounced at low frequencies and for listeners with a flat hearing loss configuration. While 83% of listeners reliably discriminated between the average selected biased responses, only 25% demonstrated reliable preferences for one response over the other. Listeners who showed preferential discrimination ability were those who were less biased by the base line response. The clinical implication is that self-adjustments should begin from an appropriately prescribed starting response.

The need for reliable access to hearing health care services is growing globally, particularly in developing countries and in remotely located, underserved regions in many parts of the developed world. Individuals with hearing loss in these areas are at a significant disadvantage due to the scarcity of local hearing health care professionals and the high cost of hearing aids. Current approaches to making hearing rehabilitation services more readily available to underserved populations include teleaudiology and the provision of amplification devices outside of the traditional provider-client relationship. Both strategies require access to such resources as dedicated equipment and/or specially trained staff. Another possible strategy is a self-fitting hearing aid, a personal amplification device that is equipped with an onboard tone generator to enable user-controlled, automated, in situ audiometry; an onboard prescription to determine the initial hearing aid settings; and a trainable algorithm to enable user-controlled fine-tuning. The device is thus assembled, fitted, and managed by the user without the need for audiological or computer support. This article details the self-fitting concept and its potential application in both developing and developed countries. Potential advantages and disadvantages of such a device are discussed, and considerations for further investigations into the concept are presented. Overall, the concept is considered technologically viable with the main challenges anticipated to be development of clear, simple user instructions and a delivery model that ensures reliable supplies of instant-fit ear tips and batteries.