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Complaining clients that wear hearing aids
#3030567 09/30/20 12:06 PM
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I always ask a new client who was the last tuner and why they are not working with them anymore. I've been noticing a pattern with older clients. If they are unhappy with the last tuner and say they did a bad job the first question I ask older clients is if they wear hearing aids. I then explain to them about harmonics and how the hearing aids amplify harmonics and can make a piano sound out of tune. I suggest contacting their doctor to try adjusting them or to try a different kind of aid. I just tell them to try not wearing them when they are playing the piano.

Do other people do this? Sometimes I wonder if I am being offensive asking if they wear hearing aids or even if I am providing them correct information about them.

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Re: Complaining clients that wear hearing aids
TimM_980 #3030622 09/30/20 03:01 PM
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My experience, as a person who wears hearing aids, is that the digital aids will "warble" when listening to any pure tone like an in-tune piano. I can play one note and hear it. I can also just whistle and hear it. The hearing aid identifies that pure tone as feedback and tries to suppress it, and the result is a warble. I have a second program on my hearing aids with the feedback turned off. That eliminates the warble entirely. Of course, that may not work for everyone.

I tune my own piano, hearing aids in, with the help of CyberTuner.

If I complained to a tuner, and he asked me if I had hearing aids, I would probably think he was looking for some excuse for his poor tuning.

Sam

Re: Complaining clients that wear hearing aids
TimM_980 #3030649 09/30/20 03:53 PM
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There used to be an extremely deaf person on the same floor as me in my apartment building. I invited him over one day to show him my new Mason BB. Uninvited, he sat down at the piano and played a few notes, looked at me, and said "It's not so good!".

We had the following conversation many times...Me: saying something Him: What? Me: Louder Him: What? Me: Even Louder Him(smiling):You don't have to shout!
It was funny the first few times only.

Re: Complaining clients that wear hearing aids
TimM_980 #3030796 10/01/20 03:04 AM
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Deafness is a sensitive thing. I’ve learned a few things from my wife’s hearing loss, into full deafness and back to the hearing world with a cochlear implant.

The first thing we hearing people do is talk louder. But hearing loss doesn’t mean it’s only quieter, it means distortion. So don’t talk louder, talk clearer. Also, choose different words. “I’m going to the store” might not register so try, “do you need anything at the market?”. Simply repeating the same thing they couldn’t understand the first time, but louder and louder leads to frustration for both parties.

Lastly I would say it could be considered offensive or invasive to outright ask if the person wears hearing aids. Better to ask what they hear and why they thought the piano sounds bad.


-Bill L. - former tuner-technician
Re: Complaining clients that wear hearing aids
TimM_980 #3030958 10/01/20 12:08 PM
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As I understand it, in much hearing loss, it's the cilia responsible for higher frequencies that die off first, and with human speech, the higher frequencies give clarity, and the lower frequencies give warmth. It's the clarity/intelligibility that suffers, rather than overall volume. Which ties in with what you say, Bill.

Re: Complaining clients that wear hearing aids
TimM_980 #3030966 10/01/20 12:22 PM
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I have several clients with hearing loss and it seems there are many different types of it. I had a long chat with a hearing aid manufacturer as some complain of odd distortions and others of odd pitches, harmonics etc.
The hearing aid man said to me that whilst digital aids were massively better than analogue ones, he went on to say that no aid can give you back what is lost. So the new digital aids analyse what's coming in and transfer it to a pitch where the wearer can hear it. Thus it completely mangles a complex sound like a chord on a piano as it is actually shifting the incoming harmonic structure of the sound. In this way they can be worse than the old analogue which just boosted the frequencies the wearer lacked (which also didn't really work in many cases as you can't make the brain hear what the body has lost).
Although they can adjust these digital aids very finely, he did say that the best thing a player could do would be to turn off the aid when playing!
So that's what I tell my clients now.

There are some new headphones that work against the bones behind the ear. One client has told me that by connecting a set of these to a pocket amp connected to a microphone, he bypasses the failing ear mechanism and gets a reasonable result.

Nick

Last edited by N W; 10/01/20 12:22 PM.

Nick, ageing piano technician
Re: Complaining clients that wear hearing aids
TimM_980 #3031882 10/04/20 07:32 AM
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One effect is the time difference for the brain to respond to sound between a good ear and a bad ear, or one that has a hearing aid fitted. For those with two good ears try aural tuning when one of your ears has wax build-up! Its horrible experience as I have found out.
Ian


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Re: Complaining clients that wear hearing aids
Beemer #3031905 10/04/20 08:59 AM
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Originally Posted by Beemer
One effect is the time difference for the brain to respond to sound between a good ear and a bad ear, or one that has a hearing aid fitted. For those with two good ears try aural tuning when one of your ears has wax build-up! Its horrible experience as I have found out.
Ian
That's very interesting, I've never heard about that before.
Nick


Nick, ageing piano technician
Re: Complaining clients that wear hearing aids
N W #3032217 10/05/20 04:18 AM
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Originally Posted by N W
Originally Posted by Beemer
One effect is the time difference for the brain to respond to sound between a good ear and a bad ear, or one that has a hearing aid fitted. For those with two good ears try aural tuning when one of your ears has wax build-up! Its horrible experience as I have found out.
Ian
That's very interesting, I've never heard about that before.
Nick
Nick,
I have read it is similar to why some aural tuners turn their head to a different angle to verify a fine tuning.
Ian


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Re: Complaining clients that wear hearing aids
Beemer #3032227 10/05/20 04:50 AM
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Originally Posted by Beemer
Originally Posted by N W
Originally Posted by Beemer
One effect is the time difference for the brain to respond to sound between a good ear and a bad ear, or one that has a hearing aid fitted. For those with two good ears try aural tuning when one of your ears has wax build-up! Its horrible experience as I have found out.
Ian
That's very interesting, I've never heard about that before.
Nick
Nick,
I have read it is similar to why some aural tuners turn their head to a different angle to verify a fine tuning.
Ian
That's also interesting as I have found myself doing that on occasion. It can be very revealing.But I've never wondered why!
Nick

Last edited by N W; 10/05/20 04:51 AM.

Nick, ageing piano technician
Re: Complaining clients that wear hearing aids
WBLynch #3032264 10/05/20 07:54 AM
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Originally Posted by WBLynch
Deafness is a sensitive thing. I’ve learned a few things from my wife’s hearing loss, into full deafness and back to the hearing world with a cochlear implant.
That's fascinating, Bill. I've always wanted to ask somebody who was once able to hear normally, what the difference is with a cochlear implant. Is it similar in sound to human hearing, or does it have a sort of robotic quality to it? Or perhaps is it like wearing a hearing aid? Is your wife able to hear normal things clearly? Is it distorted? Can she still enjoy music? Sorry if I'm being nosey, it's just really interesting. Cochlear implants are a marvellous invention.

Re: Complaining clients that wear hearing aids
ando #3032422 10/05/20 07:00 PM
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Originally Posted by ando
That's fascinating, Bill. I've always wanted to ask somebody who was once able to hear normally, what the difference is with a cochlear implant. Is it similar in sound to human hearing, or does it have a sort of robotic quality to it? Or perhaps is it like wearing a hearing aid? Is your wife able to hear normal things clearly? Is it distorted? Can she still enjoy music? Sorry if I'm being nosey, it's just really interesting. Cochlear implants are a marvellous invention.

Since I am not the one with the device I can’t give the perfect description. But I can tell you several things.

First of all CI’s have made great improvements over the years. At first they were very robotic and monotone sounding with frequency response limited to a narrow range optimized to the human voice. Over time they improved both the implant array and the processor capabilities.

If you look at the cochlea it’s like a snail shell. If you were to unwind it into a straight line the deeper you go the more bass or low frequencies are detected. The closer to the opening is the higher frequencies. Kind of like a piano keyboard.

The cilia are hair like fibers that extend up from the wall, into a viscous fluid. Vibrations from the ear drum excite the cilia which are connected to nerves inside the cochlea wall. These cilia shrink over time and can eventually shrink so short that they become ineffective. The ones nearest he opening go first and that’s why people lose their high frequency hearing, even if they don’t go deaf.

So, the implant works with electronic emitters along a strip that excite the nerves with electric shocks. Depending on how long the strip is, how many emitters there are, and the skill of the surgeon in placement, it can determine which frequencies will be heard.

Also the processor and microphones have their impact.

Then there is an audiologist who “maps” the system to the patient, kind of like setting an equalizer.

Now, add in that there are 3 major device makers in the US, with a few more internationally, and you can imagine all the variables. (Not to mention the variations between human recipients). These makers balance all the parameters based on their goals. Battery life, cost, ease of implant, etc. So not all give the same results.

Whew! I’m sorry this is so long but I hope many might read it and learn more about CI’s.

Now, the last major factor is, if one has residual hearing in their non-implanted ear or if they are implanted in two ears or one.

So...

In my wife’s case she is implanted in only one side and completely deaf in the other. Her maker is Advanced Bionics which we chose because they are the best in the world for music and they place their microphone in the ear opening for normal type hearing. She can hear voices normally, the robots and chipmunks went away in a few days. She can hear music very well but doesn’t get the lower bass she loves as much as with her natural hearing. She can’t understand speaking behind her but overall it is a tremendous gift.

Lastly I would like to add that they are working on an implant now that works with light instead of shock. It promises much better frequency response and lower power requirements which will allow smaller and lighter batteries as well.


-Bill L. - former tuner-technician
Re: Complaining clients that wear hearing aids
WBLynch #3032466 10/05/20 09:09 PM
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Originally Posted by WBLynch
Originally Posted by ando
That's fascinating, Bill. I've always wanted to ask somebody who was once able to hear normally, what the difference is with a cochlear implant. Is it similar in sound to human hearing, or does it have a sort of robotic quality to it? Or perhaps is it like wearing a hearing aid? Is your wife able to hear normal things clearly? Is it distorted? Can she still enjoy music? Sorry if I'm being nosey, it's just really interesting. Cochlear implants are a marvellous invention.

Since I am not the one with the device I can’t give the perfect description. But I can tell you several things.

First of all CI’s have made great improvements over the years. At first they were very robotic and monotone sounding with frequency response limited to a narrow range optimized to the human voice. Over time they improved both the implant array and the processor capabilities.

If you look at the cochlea it’s like a snail shell. If you were to unwind it into a straight line the deeper you go the more bass or low frequencies are detected. The closer to the opening is the higher frequencies. Kind of like a piano keyboard.

The cilia are hair like fibers that extend up from the wall, into a viscous fluid. Vibrations from the ear drum excite the cilia which are connected to nerves inside the cochlea wall. These cilia shrink over time and can eventually shrink so short that they become ineffective. The ones nearest he opening go first and that’s why people lose their high frequency hearing, even if they don’t go deaf.

So, the implant works with electronic emitters along a strip that excite the nerves with electric shocks. Depending on how long the strip is, how many emitters there are, and the skill of the surgeon in placement, it can determine which frequencies will be heard.

Also the processor and microphones have their impact.

Then there is an audiologist who “maps” the system to the patient, kind of like setting an equalizer.

Now, add in that there are 3 major device makers in the US, with a few more internationally, and you can imagine all the variables. (Not to mention the variations between human recipients). These makers balance all the parameters based on their goals. Battery life, cost, ease of implant, etc. So not all give the same results.

Whew! I’m sorry this is so long but I hope many might read it and learn more about CI’s.

Now, the last major factor is, if one has residual hearing in their non-implanted ear or if they are implanted in two ears or one.

So...

In my wife’s case she is implanted in only one side and completely deaf in the other. Her maker is Advanced Bionics which we chose because they are the best in the world for music and they place their microphone in the ear opening for normal type hearing. She can hear voices normally, the robots and chipmunks went away in a few days. She can hear music very well but doesn’t get the lower bass she loves as much as with her natural hearing. She can’t understand speaking behind her but overall it is a tremendous gift.

Lastly I would like to add that they are working on an implant now that works with light instead of shock. It promises much better frequency response and lower power requirements which will allow smaller and lighter batteries as well.
Thank-you very much for your detailed reply - not too long at all! It's a brilliant technology and I'm sure it's made your home life immeasurably better too. Just getting music and conversation back in her life is an incredible blessing.

Re: Complaining clients that wear hearing aids
TimM_980 #3032617 10/06/20 10:15 AM
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Originally Posted by TimM_980
I always ask a new client who was the last tuner and why they are not working with them anymore. I've been noticing a pattern with older clients. If they are unhappy with the last tuner and say they did a bad job the first question I ask older clients is if they wear hearing aids. I then explain to them about harmonics and how the hearing aids amplify harmonics and can make a piano sound out of tune. I suggest contacting their doctor to try adjusting them or to try a different kind of aid. I just tell them to try not wearing them when they are playing the piano.

Do other people do this? Sometimes I wonder if I am being offensive asking if they wear hearing aids or even if I am providing them correct information about them.

It's important to understand that the purpose of hearing aids is not to restore hearing back to "normal" -- whatever that may have been. They are to achieve a very defined target: hearing speech clearly. That's what they're for and that's what they do -- to greater or lesser extent, depending on variables that others have discussed. Digital hearing aids in particular -- and all hearing aids in general -- can actually make music sound worse.
If you do an internet search for "hearing aids and musicians" there are many articles like this which discuss the challenges in achieving anything like useful tonal response from a hearing device:
https://musicandhearingaids.org/2017/01/03/musician-hearing-loss/

So, yes, it is appropriate to address the issue calmly and politely but head-on with someone who uses a hearing aid. You simply have to say what's so and work in the arena of reality. Otherwise, everyone is in a no-win situation.


Keith Akins, RPT
Piano Technologist
USA Distributor for Isaac Cadenza hammers and Profundo Bass Strings
Supporting Piano Owners D-I-Y piano tuning and repair
editor emeritus of Piano Technicians Journal
Re: Complaining clients that wear hearing aids
TimM_980 #3058405 12/18/20 01:18 PM
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Here is some technical background on digital hearing aids and how they can mess up music (not for the faint of heart). There are 4 main algorithms that run in a hearing aid: amplification/compression, noise reduction, feedback cancellation and directionality.

Amplification/compression - this is a multiband amplifier and compressor (similar to music compressors). The number of bands depends on the hearing aid. Each band has amplification and compression settings based on a person's hearing loss. This is unique to each hearing aid wearer. The 3 problems here are:

1) Hearing aid amplification is geared towards speech, amplifying higher frequencies (where there is more speech information) more than lower frequencies. Also, most hearing aids amplify up to 8kHz. This is above B8 but it affects the harmonics. There are "wide band" hearing aids, but that is not the standard.

2) The compression system is designed to take a full range of human hearing, let's say 0dB to 120dB into smaller range - for instance 40dB to 120dB. This is part of what is meant when people say that hearing aids are not designed to "restore" hearing. When your hearing range is shortened, you won't get the nuances that you get with your full range of hearing.

3) Also, because hearing aids are geared towards speech, the amplification doesn't necessarily match the loss. Usually it is 1/3 to 1/2 of the loss. Again, it does not "restore" hearing fully.

Noise reduction - this is exactly as it sounds. It is designed either to detect noise in multiple bands and lowering amplification in those bands, or to subtract out "stationary" sound - sound that doesn't change or changes slowly AKA background noise. This is also a speech optimization because speech is dynamic - constantly changing. For music, longer notes could be considered "stationary" by hearing aid standards, so the noise reduction would kick in and try to remove that sound.

Feedback cancellation- amplification can cause whistling/feedback, which happens with sound from the speaker gets back to the microphone. With microphones so close to the speaker and with loosely fit hearing aids, hearing aids have to detect the whistling and knock it out ASAP. However, the whistling is a pure tone so hearing aids often mistake tones coming from musical instruments as whistling/feedback. There are several ways to knock out the whistling, including producing the negative tone cancel out the original and notching out the frequency of the whistling. Each one has issues with music because they could cause "ghost" tones or knock out some of the harmonics of what you are listening to.

Finally, directionality is using 2 (or more) microphones to filter out sound from certain directions and enhance the sound from the direction of speech, or straight ahead, depending on the algorithm. With music, this should be off. Generally, a hearing aid has multiple programs/settings and directionality is only on in some programs. So, it should be easy to bypass the effects of this feature.

In summary, a musician is not going to like hearing aids that are optimized for speech. Some audiologists may have the musical understanding to fine tune one of the programs to make it better for music, but most don't. If you made it through this response, I hope that it gives you some background to help someone with hearing aids understand why the piano might not sound right even after you have tuned it properly.


Wayne Bayever
Hearing Instrument Specialist
VP Engineering, Sound World Solutions
Re: Complaining clients that wear hearing aids
Wayne Bayever #3058443 12/18/20 02:47 PM
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Originally Posted by Wayne Bayever
Finally, directionality is using 2 (or more) microphones to filter out sound from certain directions and enhance the sound from the direction of speech, or straight ahead, depending on the algorithm. With music, this should be off. Generally, a hearing aid has multiple programs/settings and directionality is only on in some programs. So, it should be easy to bypass the effects of this feature.

In summary, a musician is not going to like hearing aids that are optimized for speech. Some audiologists may have the musical understanding to fine tune one of the programs to make it better for music, but most don't. If you made it through this response, I hope that it gives you some background to help someone with hearing aids understand why the piano might not sound right even after you have tuned it properly.
I have had a NHS hearing aid (UK) for the past 10 years and as far as speech is concerned it is been pretty poor despite attempts by audiologists to rectify matters. Basically as the volume increases so does the distortion and I often find myself taking it and hearing better, especially in noisy situations. I have asked them and the manufacturers could I please just have an aid which increase the volume without anything else, but they say sorry, our devices don't to that. Does anyone know of simple, easy to use, wearable ear trumpets?

My aid has three settings, allegedly, one of them being one for music, but I am not alone in saying that there is actually no difference between any of them. And the idea that directionality is possible with such a small device - it is just ridiculous. As for the piano, I never wear it.

Last edited by Colin Miles; 12/18/20 02:49 PM. Reason: additional comments

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Re: Complaining clients that wear hearing aids
TimM_980 #3058502 12/18/20 05:53 PM
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I would just let them read this post. That should help them understand better. Thank you.

Peter Grey Piano Doctor


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