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Fitting hearing aids on non-wearers can be a challenge. By a non-wearer, we mean a patient with a hearing loss who has never previously tried hearing aids or has tried and rejected them. Many of these patients do not have enough communication difficulty to require them to seek professional help. Also, because of their milder degree of hearing loss, they are less likely than other patients to agree to wear hearing aids in a style (e.g., behind-the-ear [BTE], in-the-ear [ITE]) that they object to on cosmetic grounds. On the other hand, when they are fitted, previous non-wearers often expect their chosen hearing aids to enable them to understand speech in noise perfectly without any negative hearing aid effects such as occlusion and acoustic feedback. Like everyone with a hearing loss, non-wearers also have difficulty understanding speech in noise. Although hearing aids with directional microphones have proven effective in enhancing the signal-to-noise ratio (SNR) of listening environments, most come in BTE and ITE styles that may be unacceptable to these patients. Furthermore, most, if not all, published research in this area has used experienced hearing aid wearers as test subjects. Published reports supporting the benefit of such a feature for new wearers are almost non-existent. One may assume that the same benefits seen in experienced hearing aid wearers can be generalized to all people with a hearing impairment. This is a reasonable assumption considering that the improvement in SNR is correlated to the directivity index (DI) of the directional microphone.1 Current hearing aid fitting practice may obscure the benefit of directional hearing aids for previous non-wearers (and experienced wearers with a mild degree of hearing loss). Because of their milder degree of hearing loss, these patients often require an open fitting or the use of a large vent to minimize the perception of ampclusion (“occlusion” complaints due to a combination of amplifier gain and shell occlusion2) with hearing aid use. However, Ricketts has shown that vents decrease the DI of a directional hearing aid below 1000 Hz.3 Indeed, the larger the vent size, the greater the decrease in DI. This finding suggests that when former non-wearers are fitted with conventional directional hearing aids, the use of a large vent to minimize potential ampclusion may compromise the perceived benefit of the directional microphone, resulting in more reluctance to use hearing aids. On the other hand, the hearing healthcare profession needs to focus on the non-wearer population if more people are to benefit from amplification. Recently, Widex introduced Senso Diva, the first digital in-the-canal (ITC) hearing aid with an adaptive directional microphone (LocatorTM). Along with its directional-microphone feature, this hearing aid was designed to minimize the perception of ampclusion through the use of multiple channels of compression with steep, narrow filters. A filter design with short group delays, an active feedback-cancellation algorithm, and an Occlusion Manager are other components of this occlusion-management design. In-house evaluation and anecdotal reports from the field indicate a significant reduction in ampclusion complaints by wearers of this instrument. This suggests that the same or a smaller size of vent can be used in fitting the device in order to preserve the benefits of a directional microphone while at the same time minimizing the perception of ampclusion. The present investigation compares the magnitude of the objective benefits of the adaptive directional-microphone system used in the Senso Diva between a group of new wearers and a group of experienced hearing aid wearers when ampclusion is controlled.

Preserving directional benefits for new users wearing smaller hearing aids