Hearing aid gain and frequency response requirements for the severely/profoundly hearing impaired

The optimal frequency response slope, from the low frequencies (250 or 500 Hz) to 2000 Hz, was estimated for each of 46 severely or profoundly hearing-impaired adults. The estimates were derived from paired comparison judgments of speech filtered to simulate different frequency response conditions, from home trials and ratings of different tone settings of high-powered, behind-the-ear hearing aids, and for 28 subjects, from speech recognition testing. The estimated optimal response, expressed as the slope from 250 to 2000 Hz and as the slope from 500 to 2000 Hz, was compared with the response prescribed by the National Acoustic Laboratories (NAL) procedure and its relationship to audiometric variables was analyzed. Insertion gain was measured for the preferred volume setting with the best frequency response. Preferred gain was typically about 10 dB higher than the NAL prescribed gain. Considering these results in relation to other data, it appears that the "half-gain" rule ceases to apply when HTL exceeds about 70 dB. The estimated optimal frequency response agreed with the NAL response for some subjects but relatively more low frequencies were required for between a third and half of the subjects, depending upon how frequency response is expressed. Generally, more low frequencies were required if HTL at 2000 Hz exceeded 95 dB, whereas the NAL response was usually appropriate for other cases.