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Hearing aids for organ music

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JulianMoney-Kyrle

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Hearing aids for organ music

PostFri May 21, 2021 4:15 am

I have some high-frequency hearing loss resulting from a combination of noise exposure when I was younger (this gives a very characteristic loss at 4 KHZ and I think I can trace it from a single event when I was a teenager) and more recent damage resulting from chemotherapy, which has affected higher frequencies. There is also probably an age-related element as I am sixty now. It is rather ironic that I have been prescribing cisplatin (a chemotherapy drug) for many years during my career as an oncologist, taking great pains to minimise its serious toxicities (early and delayed vomiting, kidney failure and immunosuppression) while only being peripherally aware of its almost universal effects on hearing and taste, until I experienced these for myself. Unfortunately the hearing loss is delayed and often doesn't start until the chemotherapy is complete.

I have recently started wearing hearing aids. These were supplied free of charge by the NHS, and would have cost me about £3,000 - 3,500 were I to have bought them privately. They clearly perform some quite sophisticated digital processing, including suppression of background noise and directional preference (which can be controlled via an iPhone app) to enable me to concentrate on one speaker among several. They selectively amplify the frequencies that I am missing, and the audiologist took measurements inside my ear canals in order to tailor them more precisely to my own hearing.

There is no doubt that they do a very good job of improving the intelligibility of speech, which is, after all, what they are designed to do. However, they are less satisfactory when it comes to music, despite having a specific music setting. Prior to using them I would find it difficult to get a balance when choosing registration, and at times I would find it difficult to hear all the parts when I was playing polyphonic music. They help with that, and also they have restored the tinkling and almost percussive effect of upperwork stops such as the Cymbal, which brings back memories of hearing Peter Hurford play on the Mittenreiter-Flentrop organ in Eton School Hall when I was a student there (an interesting instrument rebuilt in 1974 after the original Dutch pipes were retrieved from a Hope-Jones monstrosity from the 1920's that had never worked properly and used to give the organist electric shocks).

However, there is one very strange and annoying effect, which I think must be an anti-feedback mechanism. When the hearing aids detect a sustained signal at a pitch close to the natural feedback frequency of the system (i.e. the whistling that I am sure you have all heard with other people's hearing aids), after about a second the amplified sound is shifted down in pitch by about 1% (with a bit of experimentation I found I could readily reporduce this by playing middle C with a 2-foot stop). This is very effective in breaking the feedback cycle, but the pitch-shifted sound mixes with the unprocessed sound coming into the ear canal and the result is beating in the notes. For most types of music this doesn't seem to be particularly intrusive, but it makes a piano sound out-of-tune, and the effect on an organ is a fluttering which resembles a problem with regulation of the wind supply.

I have gone back to Specsavers, who supplied the aids, and saw a technician there who is apparently some sort of musician himself, but he didn't seem to understand what I was talking about. I also found it rather frustrating that every time I have been there I have been rather talked down to - as a doctor with 30 years' clinical experience I am not used to being treated this way by other healthcare professionals, and although I don't have any training as a sound engineer I do have a certain amount of relevant technical knowledge.

One other lesser problem it that with the hearing aids I lose the sense of "presence" that has taken me a lot of trouble to get right when it comes to surround organs such as Groningen. I suspect that this is something to do with the audio processing aimed at maximising intelligibility of speech, though I suppose it might be that the microphone in these devices doesn't sit in the same position as the entrance to the ear canal and therefore isn't influenced in the same way by the shape of the pinna (external ear), which normally provides information about the direction of sounds (along with intensity for high frequencies and timing for lower frequencies up to about 1 KHz - I have always found it amazing that the human ear can detect timing differences in the range 1 - 5 ms in the arrival of sound between the two ears; when I was an undergraduate studying physiology we did a practical experiment involving clicks delivered via headphones with variable timing between the two ears - longer than 5 ms and they would be hears as two separate clicks, but for shorter delays the timing determined the perceived direction of the click down to 1 ms).

The hearing aids are made by Signia, and the model is Contrast S+. Rather frustratingly I can find very little technical information about them on the internet.

I am very grateful to the NHS for supplying such sophisticated devices free of charge, as I am for all the other health care that I have needed recently. However, I know that there are other types of hearing aid available to purchase privately (at huge expense, of course) and of course I am wondering whether there are any that are designed specifically for music rather than speech. Given the widespread problem of occupational noise exposure among musicians I would have thought that there would be a significant demand for this sort of device, and for hearing services aimed at musicians.

I don't suppose I am the only HW user with hearing loss, and I would be very interested to know what other people's experience has been.
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Re: Hearing aids for organ music

PostFri May 21, 2021 9:49 am

I find the that older one gets, the more one is talked down to, sadly.

I wonder if something like this might be useful for feeding Hauptwerk output into the hearing aids?

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Doug S.

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Re: Hearing aids for organ music

PostFri May 21, 2021 10:44 am

I also have high frequency hearing loss along with tinnitus acquired during basic training. A number of years back I researched hearing aids for musicians. I discovered that a Canadian hearing aid manufacturer Unitron could make special aids featuring microphones which only responded to high frequencies. As explained to me, normal hearing aid mikes in a musicians environment would overload the internal preamp resulting in distortion.
I've been very satisfied with these modified Moda 1 units from Unitron.
I can post links to my by now quite dated research on this subject and if you message me I can send the email address of the engineer at Unitron who did mine and helped with some replacement case parts when mine were damaged by a heavy handed audiologist.
Doug
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JulianMoney-Kyrle

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Re: Hearing aids for organ music

PostFri May 21, 2021 11:03 am

Thank-you both for sharing your experiences. As I am fairly new to this I am keen to know what other people have found to be the strengths and weaknesses of their hearing aids and what solutions they have eventually settled on for playing the organ in particular.

mkc1,
I have ordered something similar that is compatible with my particular model, and I imagine that I will be able to use my hearing aids rather like Bluetooth earbuds once I have it set up. It should be reasonably straightforward to set up a Bluetooth transmitter with one of the outputs of my audio interface. However, I believe the Bluetooth system introduces a delay which makes playing difficult (which is why it isn't recommended that HW is used with wireless headphones). Also I currently have a set-up with six stereo channels plus sub-woofer, so ideally I would prefer not to lose all of that.

Doug,
I don't know what basic training is (perhaps it is a commonly-understood phrase in the US) but if it involved noise exposure I will hazard a guess that it had something to do with the Army. My exposure as a teenager was from a device for firing tin cans into the air, propelled by a .22 blank round, as a moving shotgun target, akin to clay pigeon shooting (I think you call it skeet). I was launching the tin cans and my brother was shooting them. At the end of the session I couldn't hear any of the notes of the top octave of the piano, and it took about a week to recover from that. However, my pure-tone audiogram has always shown a notch at 4KHz and I think this is the most likely reason. However, my difficulty following speech (and polyphonic music), didn't start until after having chemotherapy, and although my audiogram hasn't changed much there is clearly a change in how my hearing system is processing sounds. Pure-tone audiograms seem to me to be a very crude way of assessing hearing, though clearly they enable the audiologist to diagnose a problem and give some pointers as to how hearing aids should be adjusted.

I would be interested in your research, though I would think I would need to find a musician-friendly audiologist in the UK before considering ordering a bespoke device from Canada.

From what I have read, there are a number of important differences between speech and music, and on the whole hearing aid designers have prioritised speech. I believe that modern digital hearing aids have a number of independently configurable channels, corresponding to different frequency bands, so selectively boosting high frequencies is fairly standard with sensorineural hearing loss. However, there is also quite a lot of compression and also limiting of louder sounds (above 85 dB), which would prevent overloading the internal amplifiers but is problematic for music (I saw an account of a study where musicians were able to adjust the upper threshold of an experimental aid and tended to opt for 105 dB or thereabouts). I imagine this is where your high-level microphone comes into its own.
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mkc1

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Re: Hearing aids for organ music

PostFri May 21, 2021 11:40 am

JulianMoney-Kyrle wrote:It should be reasonably straightforward to set up a Bluetooth transmitter with one of the outputs of my audio interface. However, I believe the Bluetooth system introduces a delay which makes playing difficult (which is why it isn't recommended that HW is used with wireless headphones).

Yes, that is true. The device I indicated has the option of using a wired connection to the sound source. The wireless connection between the device and the hearing aids themselves is not Bluetooth but e2e wireless, which supposedly does not have the delay inherent in Bluetooth. Just an option to consider.
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JulianMoney-Kyrle

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Re: Hearing aids for organ music

PostFri May 21, 2021 12:51 pm

I think there is a device available for my hearing aids to relay sound from a television. Since the aids themselves are not Bluetooth-enabled I suspect that it uses a similar technology to e2e. Something to think about then...
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Jan Loosman

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Re: Hearing aids for organ music

PostFri May 21, 2021 1:03 pm

Hello Julian.

Some of us use roomcorrection software to neutralise sonic humps and bumps to correct the acoustics of our organ playing room.
We measure the room and apply reversed equalisation to even out the room influences.

Can you obtain you hearing graph from your hearing care professional and use it to design a counteracting equalisation curve in reaper to compensate for your hearing problems?

The correction would be very personal and other people hearing you play will not like it but it could be a solution when you are alone playing your organ.

If you give a concert you have to use your hearing aids then.

Regards Jan
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Doug S.

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Re: Hearing aids for organ music

PostFri May 21, 2021 1:44 pm

Julian
Here's a few links

https://musicandhearingaids.org/2017/01 ... aring-loss

https://www.hearingreview.com/practice- ... -musicians

http://www.colinpykett.org.uk/

My experience and hearing aids are a bit dated, however I can email the engineer at unitron to find out what the current state of the art is regarding musicians aids.
Cheers,
Doug
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JulianMoney-Kyrle

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Re: Hearing aids for organ music

PostSat May 22, 2021 4:40 am

Jan,

I am planning to do something similar in the car, where I have a 32-channel graphic equaliser, a CD that generates white and pink noise, and a spectrum analysis app on my iPhone. Cars are a terrible environment for listening to music, but an equaliser can improve the sound no end. I haven't adjusted it for some years (I don't change my cars very often) but this is on my to-do list. Boosting the high frequencies in this way must surely be better than amplifying them with hearing aids, that would also amplify other sounds at the same frequencies or else reject the music as noise.

Unfortunately a pure-tone audiogram, which is what a standard hearing test is, simply measures the threshold for hearing specific frequencies and tells you little about how the hearing system is processing them - to regard hearing loss as an attenuation of specific frequencies is quite an oversimplification. However, boosting particular frequencies is a start, and is relatively straightforward. Depending on how I get on in the car I may try it for HW.

Doug,

Thank-you for the links. I am looking forward to studying them in detail.

With Best Wishes,
Julian
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Re: Hearing aids for organ music

PostSat May 22, 2021 8:46 am

When I got my hearing aids I noticed the same unpleasant effect when listening to music, especially organ music. It was like an effect stop on my old electronic organ which was called "Vibrato", a kind of frequency modulation.

First the audilogist has been clueless on my complaint. But he contacted the manufacturer who explained this effect being caused by the feedback cancellation mechanism.
As my hearing aids allow 4 different configurations (like HW :wink: ) they recommended a special configuration without feedback cancellation which cured the problem - without generating feedback.

Appart from this I prefer playing HW without hearing aids but with headphones. To do this I feed the HW sound into Reaper. In Reaper I boost the higher frequencies according to the correction diagramm of my hearing aids.

Rgds
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Doug S.

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Re: Hearing aids for organ music

PostSat May 22, 2021 10:41 am

Here's the piece specific to ARHL
http://www.colinpykett.org.uk/arhlandob.htm
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Re: Hearing aids for organ music

PostSun May 30, 2021 5:39 pm

Good evening, Juilan ....

... I too have hearing aids, and they too are from the NHS.
I have suffered with poor hearing in my left ear since I had a labyrinthitis when I was 12 (unsurprisingly, it also damaged my balance). Until I was in my late 50s, my hearing in my right ear was very good, and enabled me to get by without any artificial support to my hearing. However, as the years went by, slowly, my incipient high-frequency losses in my right ear necessitated hearing aids in both ears.
I think that my aids are much simpler than yours - Oticon Synergy - and they took a little getting used to. I play the piano and guitar as well as the organ and the very worst effects of the aids were with the piano - they made many note sound as though the three strings of the treble side notes were slightly out of tune with each other - but if that same note was played again, the degree of detuning would change, and sometimes disappear!
Although they improve my sensitivity to volume when playing the organ I prefer the sound without the aids, but that wouldn't suit many listeners (nor a congregation) because I then play much more loudly!
However, the effect on acoustic guitar (I play acoustic and electric guitars) is a really significant improvement in sensitivity, and I would ony play acoustic guitar now with hearing aids in situ.
After I had had my hearing for a while (I now have had them for about 5 years) I asked the Audiologyu department to see whether they could improve music processing, as I suspected that the digital processing used wasn't good at keeping up with the demands of processing music, and they made some adjustments - but they still are nowhere near perfect.
I have taken the view for a number of years now that modern hearing aids are not a good deal for musicians. Many of my organist friends remove their hearing aids when playing - I would do that too if I wasn't concerned about the fact that I tend to play more loudly!
Anyway best wishes, and I wish you a speedy and successful recovery ...

Kenneth Spencer
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Re: Hearing aids for organ music

PostMon May 31, 2021 9:24 am

kaspencer wrote:Many of my organist friends remove their hearing aids when playing - I would do that too if I wasn't concerned about the fact that I tend to play more loudly!


Interesting observations all around. Question, Kenneth, have you thought of or tried listening to the organ via a headset as Heau mentioned esp when accompanying a congregation? Mixing in a slight amount of live (what we refer lo as nat sound)?

It might be a little fiddly, but if done "correctly" could give more precise control of what you hear. During live performances, you sometimes may notice a performer(s) wear an earpiece which is fed a mix of live sound(s) referred to in the sound biz as foldback.

https://www.mediacollege.com/audio/sound-reinforcement/foldback.html

https://www.fullcompass.com/prod/186500-alto-professional-zmx862-6-channel-compact-mixer-with-3-band-eq-and-2-microphone-inputs

Sometimes this sound "mix" is made by the "sound guy" but more often this (custom) mix is made by the performer (him or herself). The option to an earpiece are wedge speakers you may see along the front edge of the stage.

Rgds,
Ed
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JulianMoney-Kyrle

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Re: Hearing aids for organ music

PostMon May 31, 2021 6:18 pm

An update:

Further to Jan's suggestion that I could try using acoustic correction software based on my pure tone audiogram, I decided to have a go with my car HiFi, which I spent quite a bit of money on a few years ago and which included a graphic equalizer with three channels per octave, and which could introduce variable delays into each audio channel (I have four) to correct for listening position, as well as high- and low-pass filters to feed different sets of frequencies into each channel. I had previously set it up some years ago, using a CD with white-noise ad other test signals, and an app on my iPhone for frequency analysis (it was calibrated for a generic iPhone microphone, not my specific one). When I first set it up it improved the sound no end, but my hearing has changed since then.

My pure-tone audiogram shows a sharp notch of about -60 dB at 4 KHz, rising again to -10 dB on the right and -40 dB on the left. However, the equalizer doesn't allow anything like that degree of adjustment. Nevertheless, I tried to boost 4 KHz as much as I could, and the frequencies above that to a lesser extent. The result sounded terrible, with or without my hearing aids, and I restored it to what it was before.

Oddly, I have had a number of audiograms over the years, dating back to over thirty years ago when I was a junior doctor in an ENT department. They have all looked almost identical, and my recent changes in perception of high frequencies leading to problems understanding speech aren't reflected in the tests, which measure the threshold at which particular frequencies can be perceived. I have been advised repeatedly that the 4 KHz notch is characteristic of hearing loss caused by noise exposure, and I think it probably dates back to an afternoon spent shooting when I was a teenager, following which I was unable to hear the top octave of our piano for about a week. Since that occasion I have always tried to avoid loud noises.

It seems to me that a standard audiogram test, while useful in diagnosis and management of hearing loss, is nevertheless very crude, and provides very little information about how the sound is processed. One thing that I have come to realise is that hearing loss does not really take the form of a simple attenuation of particular frequencies. For instance there is the phenomenon of recruitment, very common in sensorineural deafness, where a tone has to be moderately loud to be perceived at all, but does not have to be a great deal louder than the threshold before it becomes uncomfortably loud. I suspect this has something to do with why many deaf people don't find it helpful when others raise their voices.

Another issue is that when there is damage to the auditory nerve, hearing is affected (as fewer signals are able to reach the brain) but the hair cells in the cochlea (the actual hearing organ in the ear - the rest of the apparatus is essentially a mechanical amplifier to match the impedance of air to that of the fluid within the cochlea in order to maximise enrgy transmission from one to the other) remain just as sensitive to quiet sounds. I suspect that I have an element of this, which would explain the deterioration in my hearing which is not reflected by changes in the audiogram.

Coming back to my hearing aids: They amplify multiple frequency channels which can be adjusted by the audiologist, who used my audiogram as a starting point but also took measurements inside my ear canals to see how their individual shape modified sound waves before they reach the ear drum (this is also affected by the shape of the internal ear and is directional, forming part of our perception of direction, along with intensity for high frequencies and timing / phase for 1 KHz and below). However, they are designed primarily to boost the frequencies necessary for understanding speech, specifically consonents, and to suppress extraneous sounds. The two devices (one in each ear) work together, selectively amplifying sounds from directly ahead, which makes it easier to follow a conversation when several people are talking (there is an app they provide which allows you to vary the preferred direction).

I find they do the job that they are intended for very well, and I can understand speech much more easily, particularly TV and radio (with the pandemic I haven't tried following a conversation in a crowd). However, music has a much wider range of frequencies and suppressing most of them is unhelpful; furthermore the directionality function interferes with the sense of space in a surround (or stereo) recording. But the one thing that I find particularly irritating is the anti-feedback system, which works by shifting pitch, so that the amplified sound waves and the directly-transmitted sound waves interfere with each other, producing beats and simulating an out-of-tune piano or an organ with serious wind issues.

Although my audiologist hasn't been particularly helpful, I have spoken to the technical department of Signia, who make the hearing aids. They tell me that the anti-feedback pitch-shifting can be disabled, and as the aids are switchable between different preset programmes, this can be done specifically for a music programme, leaving it in place for general use. The music programme also doesn't have so much suppression of "extraneous sounds" and allows a wider range of frequencies to be perceived. They also advised me about an additional gadget I could buy which acts as a Bluetooth interface, effectively turning the hearing aids into earbuds for use with an iPhone or other devices. I have ordered one, and if necessary I could set up HW to work with it, though I think I am likely primarily to use it for listening to music. Now I need to get back to Specsavers, who supplied the aids, and try to explain to them how I want them reprogrammed.

I believe that there are private hearing clinics which specialise in musicians, and I may end up going down that route, but it would probably be very expensive. However, I would be interested if anybody has had experience with one of these in the UK.
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Re: Hearing aids for organ music

PostTue Jun 01, 2021 4:22 am

Thanks, Ed.

I do occasionally listen to my Hauptwerk organ via headphones, and that is broadly fine, most of the time.

As far as playing the pipe organ is concerned, I have a setting on my hearing aids which mixes live with the induction loop which does work reasonably well. Luckily I have continued playing during the pandemic as in the two or three lockdown relaxations, weekly non-singing services have been allowed - I play hymns before and at two points during the service, and have played during communion and after the blessing - all very helpful for keeping in touch!

I encountered the practice of "Foldback" during my time playing guitar in a few bands. I hold some drummers responsible for some of my hearing loss - somewhat akin to Julian's "gunshot" event.

With regard to these single-event effects on the cochlear, years & years ago I worked at the old Royal Free Hospital in Gray's Inn Road (London). I encountered the eminent Otorhinolaringologist, Dr John Ballantyne, having been asked to help with one very tiny paragraph of the imaging section of his famous "ENT Bible" - I remember him telling me that sometimes the very restricted nature of a "notch filter" appearance of a detailed audiological response plot leads to the conclusion that these loud sonds actually break a small set of the cochlear's nerve fibres, leaving an almost total absence of response to those frequencies, and quite a "tuned", or at least, a very "pink" tinnitus in their place.

Anyway, it seems that the only real conclusion is that there is a very lonmg way to go yet in the development of all aspects of diagnoses and treatments for deafness.

Best wishes

Kenneth Spencer
Kenneth Spencer
Music Site: http://www.my-music.mywire.org
Project Page: http://www.my-music.mywire.org/opus_ii.htm
Books on Hauptwerk and Computing; Novation Launchpad overlays: http://www.lulu.com/spotlight/kaspencer
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