Perceptions and Prescriptions

I’m currently 24 years old and have worn hearing aids for the majority of my life. I still wear them with pediatric DSL prescriptive targets.

(For the non-audiologists out there, the quick and dirty explanation of hearing aid prescriptions is that these prescriptions represent different mathematical formulas used to determine how much amplification a hearing device should give to the user at each frequency range based on their hearing loss. Historically these approaches have differed, but in recent years they’ve converged somewhat – though methods for children, like what I’ve worn, still give a significant boost to ensure learning brains get all the information they need. The prescriptive methods “DSLv5” and “NAL-NL2” are today’s empirical, quantifiable standards that hearing care professionals use to ensure that those with hearing impairments are able to benefit from their devices as much as possible.)

Now I’ve tried to change. At the advice of one audiologist who couldn’t believe how loud my hearing aids were relative to my loss and age, I used NAL-NL2 for a few months. I got to the point where I was fully adapted to the change in sound and specifically the overall reduction of sound. I felt I was doing as well as I ever had in everyday circumstances and even in busy environments. I didn’t think I was missing any words or sounds that I hadn’t before. Objectively, I was hearing as well as I was with my previous settings, and quiet environments actually felt more comfortable.

But I still switched back.

When you’ve trained your brain to hear things a certain way for 20 years its hard to change. I was personally surprised at how well my sensory system could adapt to the reduced inputs of NAL-NL2, but I couldn’t get the rest of my brain to adapt the same way.

For example, imagine you’re in a busy restaurant and you’re trying to participate in an important conversation. Challenging, but not impossible. Now imagine you have to do the same but with a pair of ear plugs. The impact of this new challenge affects you before anyone says anything. Your heart-rate rises, your eyes get darty as they look for visual cues, you just feel on-alert the whole time. It doesn’t matter what you’re actually hearing; all that matters is that you feel that you’re going to have a difficult time hearing.

Communication challenges are anxiety-inducing. In fact, I’ve realized that even perceived communication challenges are anxiety-inducing. When I switched from my familiar DSLv5-child prescription to NAL-NL2 I wasn’t missing anything – but, I couldn’t get over the fear that I might be missing things. 

What have your experiences been as users trying other fitting methods, or as professionals attempting to transition young people to more adult targets?


  1. Sarah · January 26, 2018

    Are there any drawbacks to sticking with the pediatric targets? I’d also be interested to hear how the targets are different (maybe a topic for another post).


    • Hearington · March 3, 2018

      I don’t think there are any drawbacks per, I’d like to find out more for myself too!


  2. snegugogor · January 26, 2018

    Are there any drawbacks to using the pediatric targets? I’d also be interested to learn how the targets are different (maybe a topic for a different post).


  3. Colette Vossler-Welch · March 11, 2018

    Personally, unless the DSL fitting is intolerable to the user – I don’t see the value in reducing the usable audibility. I am a DSL user all the way- and then some. I have noticed each percentage increase of audibility make a difference for me in terms of my communication abilities. This has only been achieved by defying the norms in terms of fitting formulas. The “formula” I use, while unique, has been used by others. For me, it is audibility that makes a difference along with where that audibility is provided. For example, I am currently using a WDRC fitting formula which has provided me with more gain for soft-level sounds than ever before. It’s louder and clearer than any of my other hearing aids. When I switched to even my usual as linear as possible fitting method, I noticed that this method did not allow for as much headroom as when in the WDRC formula. I would say, that unless someone is doing better as confirmed by speech-in-noise tests, than leave them with the louder fitting formula. These should be providing more audibility and in my experience, more audibility usually means they will be performing better. Of course, it is up to us to investigate the best fitting formula for our patients.


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