Special section co-editors Marshall Chasin, AuD, and Lawrence J. Revit, MA

As was demonstrated in the February special edition of The Hearing Review on music and hearing aids, musicians with hearing loss must cope with several significant obstacles. Many modern digital hearing aids—although better in many areas, including communication, than their analog counterparts of the 1990s—are actually worse for playing music. Many of the technical reasons were discussed in the February HR, but not all of the problems with playing music are technical. Some of the reasons derive from outdated societal views that people with hearing impairment are disabled and there are just some things that they cannot do. Some of the essays in this issue call attention to the unfair assumptions and views people may have that, although well meaning, actually limit the accessibility and enjoyment of music.

Some members of the Association of Adult Musicians with Hearing Loss (AAMHL) have written essays, published here about the hurdles (both technical and societal) that they had to navigate or avoid en route to learning to play and enjoy music. The AAMHL hosts an active Internet discussion where people can exchange what has worked for them (or not) with some very talented hearing and hard of hearing musicians, and can be accessed through their home page at www.aamhl.org. —Marshall Chasin, AuD, and Larry Revit, MA


A Musician’s Journey to Audiology and Professional Redemption

The early years. I first developed a hearing loss around age 4 that was believed to be caused by a severe case of measles. It initially started out as a fairly mild loss, then gradually got worse over time. At age 12, I took up playing drums (the very instrument not designed to preserve hearing!) and played my first professional gig at 14 with my college music teacher and others.

From there, I went on to have a very interesting and varied music career, performing and touring with a vast range of local bands and New Zealand icons including Hard to Handle, Hipshooters, Ritchie Picket, Suzanne Prentice, Ray Columbus, Suzanne Lynch, Tom Sharplin, and many others. As well as performing, I was involved in a number of recording studio and documentary projects, and won Producer of the Year and Album of the Year awards at the 1995 Bay of Plenty Music Awards.

Paul Higgins, MA, is an audiologist at Bay Audiology on the Bay of Plenty in Tauranga, New Zealand, and is a professional drummer who teaches, performs, and has been involved in recording music.

During my teenage years, I took up gliding and then went on to fly helicopters. Unfortunately, my hearing loss became worse and there came a point where I was unable to continue with my commercial helicopter license. I was absolutely devastated and became depressed, angry, and “lost” for a long time. I often turned to alcohol for solace, which eventually had dire consequences on my marriage and health.

One day while flying an American tourist over Mount Maunganui on the Bay of Plenty, he commented on what a great job I had. After explaining that flying gliders was only a hobby and giving him the sob story of my helicopter-career ending, he mentioned he had an audiologist friend in Florida and how it was an exciting and growing profession because of the digital revolution. By the time we landed, I knew this was what I was going to do with my life.

The next day I drove to Auckland to check out the Auckland University audiology department. I met with Professor Peter Thorne, who gave me the lowdown on what was required. I started my bachelor’s degree at Waikato University in 2003, majoring in psychology, with studies in physiology, screen and media, linguistics, history, and business and marketing studies at summer school.

Prior to this (about 1998), I had also studied hearing aid technology, running solo trials of various hearing aid settings in my own hearing aids, as I was very dissatisfied with the sound quality of hearing aids of that time—especially the early digital aids that did not have the same resolution capabilities they have today. However, I soon discovered that, no matter what the level of technology, sound quality could be maximized when set properly, just as one can set the graphic equalizer on a lower-quality stereo and get to a point where it sounds okay (even if it may not rival a 200-watt system).

Hearing aid prescriptive procedures are generally based on averages obtained in research trials. However, through experimentation, I discovered that I was consistently able to obtain better results for myself and others who were working with me; eventually I was able to pinpoint a set of averages based on a range of hearing loss types that, to me and the people who were trying these settings, sounded much better and had just as good (in many cases, superior) speech intelligibility than anything currently available.

In 2003, I met with the manager of Bernafon at that time (Ken Bozeman) who was very supportive of my pursuit and supplied me with a new technology of hearing aids called Symbio, which utilized a channel-free compression system. These aids were fantastic—far and away the cleanest and clearest signal reproduction I had heard in hearing aids to date (with the possible exception of the Etymotic K-Amp/Digi-K). Unfortunately, many audiologists just did not seem to be able to get their heads around the fact that there were no channels to contend with and did not embrace this technology fully.

It was around this time (2003) that my prescriptive procedure averages were becoming excitingly consistent. But my work was still in its infancy and there was a lot to learn. On top of this, I was now at university and trying to get my head around computer programs, statistics, and a lot of other scary things. My investigations slowed down quite a bit, but in 2006 when I started my master’s of audiology degree, my motivation for the hearing aid prescriptive procedures ignited again, and I was fortunate that year to win several scholarships, including being one of the winners of the AMP scholarship that recognizes excellence in projects that benefits others in a wide variety of settings.

USA 2006. My trip to the USA was a life-changing experience. I visited Mead Killion, PhD, president and founder of Etymotic research in Chicago. This man and his company have more than 80 worldwide patents for many technologies, including the K-Amp hearing aid and the ER insert tips that virtually every audiologist uses now when testing hearing. While we were sitting outside eating, a 747 flew overhead very low and very loud. I asked Mead and Etymotic Software Engineer Tim Munroe if that noise was close to being painful. They replied, “Yes, why?” From there, I explained my approach to the prescriptive procedure. First, I always used normal-hearing people for comparisons, and I always progressed from loud to soft. For example, when I was experimenting with the formula, I would ask normal-hearing people to tell me when a stereo became uncomfortable.

I discovered very often that people who wore hearing aids reached an uncomfortable loudness point much sooner wearing hearing aids than they did without them. For hearing care professionals, this may seem obvious. People with hearing impairment have a much smaller dynamic range from soft to loud sounds. However, at the more intense levels of 90-95 dB SPL, loudness judgment tends to be the same, although there are, of course, exceptions (eg, those with very severe/profound loss).

Mead and I discussed this, and we agreed that this is one of the reasons why the K-Amp hearing aid was so popular with sound enthusiasts and musicians; it reduced gain at loud levels in a manner that was vastly different from the majority of other compression-based hearing aids that often introduced distortion at higher input levels. As well as this, I personally found that many prescriptive procedures tended to provide inappropriate amounts of gain at not only loud levels, but at medium and soft levels too. I’m certainly not suggesting that other prescriptive methods are ineffective or invalid; indeed, I have tremendous respect for those who have produced these methods to date. But I (and others) have found that, with many of the procedures, sound quality and intelligibility do not always go hand in hand. This, in a nutshell, is the basis behind my formula: to provide amplification in a manner that is as close as possible to what people with normal hearing experience.

Patients often describe their hearing aids as “sharp and tinny,” or they comment that it sounds like Niagara Falls when using the toilet. There is definitely truth to the fact that people will take time to adjust to hearing sounds again (auditory deprivation and acclimatization), but my point is hearing aids do not need to sound tinny and sharp if the devices are set properly. Granted, patients can be given less amplification overall to begin with, and gain can then be increased as the listener becomes used to hearing sounds around them. But sharp and tinny at the outset? No! It’s all about proper frequency response shaping; the ratio of balance between soft, medium, and loud sounds (very important); and taking into account the small physical size of the microphones and receivers. Most hearing aids can be optimized to some degree, although they are certainly not all created equal, and my formula simply seeks to provide a rich, bright (but warm) environmental soundscape from the outset—or at least moves toward that if the “first fit” doesn’t quite achieve this. (Author’s note: remember these procedures are based on averages only. Also, there are many other ingredients to a successful hearing aid fitting outcome, which I won’t venture into here.)

I must also stress that I have a great respect for validation, something that was instilled strongly in me during my time at Auckland University, particularly by Dr Grant Searchfield. But people do need to keep in mind that research that results in a commercial offering may not always agree with another offering. Hearing technology, and all the things that go with it, including prescriptive formulae, is big business; manufacturers and researchers are scrambling for first place. Indeed, the DSL versus NAL prescriptive procedures debate is legendary, and they are vastly different from each other. My research at present has nowhere near the scientific validity of NAL-NL1, a common prescriptive procedure developed in Australia and used worldwide. But this doesn’t make my method any less effective in the real world. The proof is in the pudding, as they say, and whilst I had achieved very good and consistent results with many hearing aid users to date, it was the results I achieved with internationally acclaimed bass player Jerry Scheff (see sidebar) that really gained attention and further boosted my confidence in what I was doing.

Fitting a Legend: Jerry Scheff

Bassist Jerry Scheff onstage with Elvis Presley in 1976.

When I was in the USA, I flew to Memphis to visit Graceland and to jam with some blues bands on Beale Street. I then went on to Nashville via bus to visit legendary drummer Ronnie Tutt, whose credits include Elvis Presley, Jerry Garcia, Frank Sinatra, Sammy Davis Jr, Roy Orbison, Johnny Cash, Billy Joel, Neil Diamond, and hundreds of others. While sitting with his family on the 4th of July, Ronnie asked me if I thought I would be able to help Jerry Scheff with his hearing loss. I said I would give it a shot.

Jerry’s credits are also incredible and include Elvis Presley, Roy Orbison, Bob Dylan, The Doors, The Monkees’ soundtracks, John Denver, Johnny Cash, Elvis Costello, and again, hundreds of others. Incidentally, his son Jason is the lead singer and bass player for the band Chicago. Jerry and I met several months later in Sydney while he was doing the Virtual Elvis show, where Elvis is on the big screen and the band is playing live onstage reperforming the music. Before the show, we had dinner with the band, then I had a discussion with Jerry about his hearing loss. I could tell that it was pretty severe.

A year later, in December 2007, he flew to New Zealand to spend a week with me. I received some sponsorship from my workplace, Bay Audiology, and also had a special set of aids made by AmericaHears that contained ADRO (Adaptive Dynamic Range Optimization) technology, the topic of my dissertation at Auckland University. Bay Audiology also supplied two sets of aids from Siemens for Jerry’s everyday use, including the Nitro Power CICs and a BTE set. I applied my formula to all of these aids (a linear version was applied to the ADRO aids).

I had never had my hearing diagnosed by a musician and I believe that the combination of the ADRO, Paul’s formulas, and his musical sensibilities, combined to create a career-saving experience for me. I have been playing my usual touring and recording schedule as well as fronting my own group in Europe. We play songs that I am associated with as a bass player, such as The Doors’ LA Woman, Riders on The Storm, some Bob Dylan songs I played on, and of course Elvis Presley songs. I tell stories between songs and even participate in the vocals here and there. Two years ago none of this would have entered my mind. —Jerry Scheff

Although I was confident in my fitting formula, I was nervous when Jerry arrived. He had been to audiologists around the world, and he was still unhappy with the sound he was getting. Now he had flown all the way from Scotland, and it was my turn—yikes! When we got to the airport car park, I handed him the Siemens canal aids and explained this was just a first-fit to get us started and to be able to at least converse. He put them in and said, “Oh, wow, man, what a sound! This is what I’ve been looking for, man!” Knowing how much I had left to fine-tune, if needed, I was relieved and ecstatic at the same time. For the record (and with his permission), his hearing loss was severe/profound, with 95-105 dBHL from 1.5 kHz onwards.

A few days later we performed together in Tauranga at a private gathering to test the ADRO aids. They were ITE aids too, but bigger than the Siemens aids. The day started with a couple of guitar players jamming while Jerry watched, and he gave me the thumbs-up for the sound. Then more players were added, and finally the whole band with a rhythm section played at a fairly high volume. Still, clear sound with no distortion in his aids.

Then came the moment I had waited for all my musical life: Jerry got up to play with us. Words cannot describe the feeling I was experiencing, jamming with my bass hero and seeing his face light up when he started to play. He told me later he had not heard so clearly for years, and had never been able to wear hearing aids onstage. He made a speech at the end of the jam acknowledging how this visit had changed his life. It was surely my proudest moment. The next day his wife Natalie (an accomplished film producer) rang me from Scotland and she was ecstatic. She said she had just had a conversation with Jerry on the phone, and it was apparently the first truly successful phone conversation they had ever had.

When Jerry and I were driving back to Auckland, he suddenly turned to me and said “Do you realize what you have done for me, man? You’ve given me my life back.” Again I was stunned. On the way to Auckland, before I picked him up, I was listening to him on the car stereo playing with Elvis live at Madison Square Garden, marveling at his beautiful playing. Now, a week later, he was sitting in my car telling me I had just changed his life. It was the most surreal and emotional week of my life. — Paul Higgins


Rick Ledbetter is a bassist, composer, and music producer who lives in Williamsburg, Va.

A Musician’s Story … An Appeal for More Personal Control of Fitting Parameters

My name is Rick Ledbetter. I have an inherited hearing loss, complicated with use of asthma medications and a jaw injury. I have been playing music for more than 50 years, starting at age 7. I began on clarinet and moved to electric bass in my teens. I have played professionally in all types of situations from small clubs to arenas, live and in recording studios, from coast to coast. While living in Los Angeles, I worked at a major recording studio, and had the opportunity to learn audio engineering and production from some of the greats; I learned how to use hardware EQs, compressors, limiters, and expanders, and later moved to software versions for computer music production. I have my own computer-based music studio.

Around 1989, I noticed I couldn’t hear high frequency sounds well. Although this didn’t interfere with performing or recording, it was a minor annoyance in day-to-day life. About a year later, at a recording session, the engineer told me that he had my headphones up loud, and suggested I get my hearing tested. Since I was doing a series of sessions, I thought this was just hearing fatigue, but I made an appointment to get my hearing tested. The test revealed my worst fear: I was losing my hearing, and subsequent tests showed a progressive loss.

I bought my first pair of analog ITE aids, and they were awful. The sound quality was tinny and harsh, unusable for music and barely good for conversations, especially in noisy places. I talked with an audiologist about improving the sound, but her advice was “get used to it” and “that’s the best you can get.” But knowing what I knew about audio recording, I was convinced that there had to be something better. The aids went unused, and my life got more difficult as my loss progressed. I began to lose work. It was hard for me to hear conversation in rehearsals, and some musicians got upset with me when I could not hear what they were saying. My pitch perception faded, too. But I could still work with headphones, and I was able to work by writing music for commercial videos using my computer.

While looking for help and advice, I found HEAR (Hearing Education and Awareness for Rockers) and Kathy Peck, a musician who had a hearing loss. Kathy was gracious enough to talk with me and give me the support and encouragement I needed. She convinced me to continue looking for better sounding hearing aids. Kathy’s hands-on activist approach gave me a sense of optimism and kept me going.

I heard about hearing aids with K-Amp circuitry, and bought a pair. The sound quality was much better than my old aids, but just tolerable for performance. They had weak bass and OK top end (eg, cymbal crashes would overcompress and disappear). But the mid range was a big improvement over my previous aids, and I could hear well enough onstage to perform, as long as it wasn’t too loud. They also worked well enough in conversations for me to wear them most of the time.

Later, I bought my first pair of digital aids. My new audiologist, Dr Eric Hecker in Williamsburg, Va, helped me choose a pair of digital CIC aids, a big improvement over my K-Amps. He tried to help me find a setting for live performance—a very time-consuming and inaccurate process. With my background in music production and ability to focus on a particular sound, I could better describe what I heard, and this made his chore of solving the problems a bit easier, but it was still a lot of trial and error. At each visit, I would watch him operate the software, and I saw how this was much like my own studio software compressors and EQs, only simplified. And I wondered why I couldn’t do this myself in my own studio.

Becoming an activist. Around this time, I became an hard-of-hearing activist. I joined the board of an advocacy group and began to ask questions and share my experiences. I learned quickly that I was not the only person who was dissatisfied with the sound quality of their aids; there were plenty of people who also wanted, but could not get, better sound from their devices.

I wrote articles on what I knew about sound using words that people could understand, so they could take the information to their hearing care professional and help them fit their aids. I wrote an article on how to use a piano and common household sounds as reference points that a dispensing professional could relate to. I followed this with two other articles: how limiters, compressors, and expanders affect the sound of the hearing aids, how to listen to your hearing aids, and an article on how to choose a good dispenser. I came to realize that a large number of dispensers didn’t know the theory of how digital hearing aids process and amplify sound and how to adjust them. Dispensers had little more than a quick lesson on the software, and most called the factory when they got into trouble; quite a few never did a probe-tube test to see how the aids were performing in situ. The majority did not have a sound system to test the aids at real-world sound levels, relying instead on a “try this and come back” method of adjustment.

The discussions on the board evolved into a few central questions: Why do we have to deal with trips to the office to get the aids set right? Why all the problems of hit-or-miss adjustments? Why can’t we adjust our aids ourselves? Who makes a hearing aid that we can adjust at home? And the bottom-line question: Why can’t the aids come from the factory properly adjusted for my hearing loss? In my opinion, this was, and is, the heart of the matter. Many frustrated hearing aid wearers, including performing musicians like myself, think “the way things are, what is there to lose? I’ll risk it.” Other musicians told me their aids were not doing the job, stressing them out, costing them work and careers. In my view, there was an industrywide lack of concern for quality sound reproduction in digital hearing aids, and the probe-tube test was rarely being run on patients to ensure the aids were doing what they should be doing.

Then an American hearing aid maker began offering hearing aids with everything needed to self-adjust hearing aids (the software, wires, etc) plus a way to adjust via the Internet. I got a pair, and this was the solution to a lot of my problems. I could be in my studio and test my aids, and make the proper adjustments without having to endure an endless loop of appointments and adjustments. Now I can try out the aids in my world, as I need to, when I need to.

Real-life performing. I am going to describe my last jazz jam playing in a small nightclub. Jam sessions are more than just a chance to play; they also serve as informal auditions where you go to meet other players and maybe find work. Most of all, they are places to show others in the music business what you can do. This is critical; a musician’s reputation is at stake here, and he or she has to be on top of the game and make a good impression personally and professionally.

This club has a high ceiling and medium reverberation. There is a stage at one end with a good sound system, and it is just big enough for a grand piano, upright bass, drums, and one horn player. In front of the stage on the floor is a vibes player, with usually one or two horn players standing to the side. Everything is miked and the sound system is top quality throughout the room. The sound level is not loud, but what I would call “strong.”

I arrived and started a three-way conversation, literally in the middle of a conversation between two musicians and a bartender facing me. The house band began the first set. I could hear the band clearly, all instruments well separated and clear. However, now conversation was difficult. Eventually, I was called to play. I went on stage, and we decided what song to play.

I stand between the drums 3 feet away on my right, a grand piano 2 feet away on the left, with the vibes 6 feet in front, and the sax player about 10 feet away from me at front stage right. A knee-high bass amp is behind me (note: for those who wonder why not use directional mics, there are two reasons: 360° sound and voice, and directional mics don’t have enough bass). I am talking to the sax player, while the drummer is tapping on a cymbal right by my ear. While the tune is being played, we are talking over the music about who solos first. I can still hear most of the music, although the hearing aid compressors have reduced the highs. I can just hear the cymbals and the piano is dull sounding. Sax, vibes, and bass are fine. We finished the song, and I leave the stage. Sitting about 20 feet from the stage at a table with three other people, it is very hard for me to hear them speak as they talk over the music. Next set, I go back up to play a fast jazz tune. My aids do not distort, I am not overloading the input stage, as has happened to me in louder situations, like concerts.

This scenario is typical of many musicians. Those who play rock have a harder time, because their instruments are louder and they have to hear guitars, which are distorted to begin with. Musicians need hearing aids that can take louder sounds without distorting and have a wider dynamic range. I can’t speak for all musicians, but I can say that I will gladly sacrifice size and battery life for a pair of aids that sound as good as an iPod. Musicians in rehearsals need to be able to hear speech as well as music. We cannot switch from a “speech” program to a “music” program while we are working on a piece of music with other musicians. Whether in rehearsal, performance, or recording, a musician must concentrate on the music, not on the operation of their listening device.

Sometimes in-the-ear monitors are suggested, and this works fine once the music and show are perfected, there is little need to talk on stage, and the musician is performing with the same group daily. However, this does not describe most musicians. Most musicians work with different groups and need to hear on stage. Taking an in-the-ear monitor system from one group or venue to another is inviting a disaster.

As you see, the demands for a hearing aid for a performing musician are great. There must be no added distortion from front end or receiver overload at performance levels up to 105 dBSPL. The device must be independent of any other input or output needs—and the system has to be stand-alone and work without a lot of fuss. Although most people think “loud rock band,” an orchestra or jazz big band can also get to 105 dBSPL.

Over the years, Larry Revit and I have had many conversations about applying knowledge gained from audio production and engineering to improving fidelity in hearing aids. Here are a few ideas for improvement, resulting in part from these conversations:

  • Upgrade the input stage. The input A/D converter and inputs microphones should be designed to handle input to 105 dB, from at least 100 Hz to 16 kHz.
  • More control in the 100 Hz to 800 Hz area, using two parametric equalizers with narrow bandwidths. Even adding just one narrow EQ band between 400 and 150 Hz will help.
  • Re-center the EQ band more evenly throughout the hearing range. Base the frequencies on the musical octave so there are at least two bands per octave. Most hearing aid software EQ bands are at 250, 500, 750, and 1000 Hz, a base-10 log. This does not address the tonal character of most musical instruments. Musical instruments—such as the cello, bass, trombone, flugelhorn, and bassoon—have their sonic character in that area, so this must be accurate. Further, most human voices have their distinctive characteristics in the lower range, and doing this will help a hearing aid wearer to better identify a speaker by his or her voice.
  • Add a low-end compressor/expander for the range of 250 Hz and under, as well as improve on the algorithm to make it respond faster and cleaner.
  • Use a quality output device—a speaker with as little coloration as possible.

These improvements should work hand in hand with the option to self-adjust. It should be apparent in this essay that it is difficult for any dispensing professional to meet the hearing needs of musicians. Our ears are sensitive to the nuances of sound and are trained to pick out a single note and follow one instrument in a composition. I have spent hours tweaking my hearing aids, and I doubt that any dispensing professional would want to spend that amount of time with a person who needs this degree of fidelity—especially when that person’s livelihood depends on it. Musicians need to have available to them a means to adjust their aids; I believe that without being able to adjust my aids, I would not have been able to achieve the degree of fidelity I now experience.

Larry Revit emphasizes, and I agree with him, that all aids should be tested and adjusted in real time, in the ear, with a probe tube. And tested at all three standardized gain levels, plus one more above 100 dBSPL. As you know, the programming software graphs are only approximations and should not be relied upon as fact. Tests should include:

  • A test of the aid to make sure it is performing according to specifications;
  • A real-time probe-tube test, performed with the aids connected to the programmer so adjustments can be verified in situ.
  • A real-world sound test that lets the wearer hear sounds as they will hear them in the real world, at real-world levels. It isn’t reasonable to expect that an MP3 clip of an orchestra played back through 3-inch computer speakers will suffice.


by Cherisse Miller

Music has always been a major part of my life since the day I was born to parents who were professional musicians. Practicing, going to concerts, and singing in church, music was all around me. Today, I too am a professional musician – only I have a binaural sensorineural hearing loss. I teach piano in my studio at home, I am a church organist in a large Baptist church, and I enjoy accompanying choirs, vocalists, instrumentalists, collaborating with other musicians and pedagogues throughout the state and community. I recently earned a Master of Music in Piano Performance in 2005 and I’m currently completing a Doctor of Musical Arts in Piano Pedagogy from the University of SC. I love what I do despite my hearing loss and accept the challenges and frustrations as a musician with hearing loss as who I am and try to make the best of it.

I only discovered the nature of my hearing loss by pure luck and my inquisitive nature during a rare visit to the ENT office about twenty-five years ago. Until then, my parents thought my hearing loss was hereditary and were unaware of how or when my hearing loss occurred, which I naturally accepted. I was told by this “new” doctor, after reviewing records from old hearing tests from elementary school, that my hearing was normal prior to 1962. He then suspected that something happened to me in 1962. That “something” was pneumonia when I was eight years old. Further investigation from medical records and with my pharmacist confirmed Chloramycetin, as the probable cause.

My most recent audiogram in August 2008 showed a 10-20 dB loss over the past four years. I have poor speech discrimination scores of 60% in both ears. Hearing loss in my “good” left ear is mild to moderately severe sloping to profound and my right ear is moderately severe sloping to profound. I have worn the Widex Senso Diva’s Mini #9 digital hearing aids for the past six years. I’m also very much aware of recruitment issues now, which have not been a problem until recent months and now interferes significantly with the volume levels in speech, music and everyday sounds in general, even after a few professional adjustments. I find anything I do not want to hear as unwanted noise and find myself not wanting to wear my hearing aids when I’m working and need to concentrate. It is time for new hearing aids, but my audiologist suggested that I try to wait for the new music technology expected to be available within two years.

My story begins with sharing personal experiences over the past 45 years as a piano teacher, church musician, and graduate student with progressive hearing loss. Despite my hearing loss, I never questioned that hearing loss would keep me from making music or teaching music. I learned to speak, acquired a basic vocabulary, became familiar with everyday sounds and was already playing the piano before my hearing loss became severe. My love of music was already in my heart long before I knew or understood my hearing loss. My parents reminded me every year on the first day of school to sit at the front of the class, which was always demeaning and embarrassing for me. I am sure I did not always do this, causing my grades and self esteem to suffer. I assume my hearing loss was mild to moderate, since I made it through my senior year in high school in 1970 without hearing aids. I earned a BA in music wearing one BTE hearing aid and not telling a soul about my hearing loss, which remained a “secret” until almost twenty years ago. Without realizing, I developed many basic survival techniques for reading lips, watching people’s gestures, facial expressions, and any other visual clues that would help me connect words and meaning when I could not hear effectively.

I would evaluate my years of experience using hearing aids as sufficient. I do not recall the quality of sound being that much better each time I got new ones; except for regaining sounds lost when the old aids began losing power. My first experience with digital hearing aids during the mid 1990s was the most frustrating endured in trying a new hearing device, only to finally realize they were not made to hear music. The audiologist worked patiently with me for a couple of months, and I remember thinking I must be her first patient who was a musician. I was very disappointed, since for the first time in my life I could eavesdrop and understand people talking around me, behind me and across the room with clarity and seldom heard consonants. Yet the sounds of music I also wanted to hear were consumed by the same condensers that enabled me to understand speech. While waiting for technology that offered both speech and music, another audiologist introduced me to programmable hearing aids. They did not have the clarity as the digitals, yet offered three different programs: normal speech, the T-switch, and a party/restaurant mode for cutting down on background noise. Only after wearing two hearing aids, did I hear a few additional higher pitches on the piano and a gain a better balance between both ears. Only after binaural digital hearing aids, did I hear clarity and crisp consonants.

In 1990 after being fitted with an ITE hearing aid in the left ear, used in combination with the BTE in the right ear, I remember playing the 8 foot Yamaha grand piano at my church. I could hear at least 8-10 new pitches in the top two octave range of the keyboard. This was exciting because at one time I actually didn’t think anyone could hear the highest pitches on the piano. The organist and I played piano-organ duets every Sunday. Both instruments were fairly new and of excellent quality. The organ amplification was also excellent for the sanctuary. Although we were face to face on opposite sides of the sanctuary, a mini Peavey amp close by allowed me to hear myself as well as hear the speaker from the platform. Fortunately, the organist had great listening capabilities and listened musically. He let me lead in tempos and any fluctuations in tempo. When I got out of sync with him in tempo or playing expressively, he was able to follow my musical leading. This was fortunate for me and I realize that not all situations have this kind of flexibility. In similar situations problems occur in staying together because it is difficult to hear both instruments simultaneously, especially when a partner does not have equal musical abilities or keen listening skills. I cannot hear them well enough above my playing to make the musical adjustments necessary for a unified performance.

Up until 2001 I had never given my hearing loss much thought as to the specifics of my coping skills, strategies, understanding my audiogram, and a how hearing loss affected my life as a musician. I have always adapted and tried to do the best I could. Over time as my hearing loss progressed, I gradually began avoiding situations where it would be difficult to hear, unless accompanied by a family member or good friend. In a sense, I created a world where I did not have to be involved with groups of people on a daily or even weekly basis. I taught piano privately, since I could manage one-on-one conversations, played in churches, directed children’s choirs, which were difficult at times when I could not understand the children. These part-time activities enabled me to have periods of quiet time during my days to rest my ears, instead of working a full-time job, where I would constantly have to listen. I worked with children’s choirs over twenty years ago and would not be able to do that today because of the noise levels and my inability to multitask, all at the same time trying to remember my plans for teaching. I find it very frustrating and difficult to think and talk at the same time when one or more people are talking.

In my work as a piano teacher and church choir accompanist, communication problems usually outweigh any problems of hearing the music. Beginners and intermediate level students for the most part play a 3 to 3 _ octave range in the middle of the piano keyboard and sound textures are fairly thin (single or two lines, melody with simple accompaniment). I am quite capable of hearing all of the pitches used in playing this level repertoire. I can match pitches, hear wrong notes away from the piano and tell which key is wrong within a chord. I am very sensitive to pianos being out of tune or performing on an unfamiliar piano with sound and tuning issues when playing from memory (which is not often). In choir rehearsals, I can identify the voice part singing the wrong notes. I am able to hear when choirs and vocalists sing off pitch. The piano accompaniments are not so difficult or complex for the majority of church choral music that cause any specific problems. As long as I am consistently focused on the director and learn to anticipate his actions, I am competent in doing a good job musically. I always explain my specific needs to a new director prior to rehearsals which are – to speak in my direction and to avoid talking before the choir stops singing. Most everyone I have worked with has been supportive and patient while adapting to my hearing loss. It does become difficult when a director speaks too fast in rehearsals, causing hesitation in my response while processing what I thought he said and finding the correct measure in the music. I am constantly looking for visual cues to help me anticipate his every move.

Serving as the organist in a moderately large Baptist church for 14 years is gradually becoming more difficult as amplified contemporary praise bands are becoming the more accepted musical accompaniment. I no longer participate in contemporary praise band due to the dangerous sound levels and the difficulty of not being able to keep up in following the beat without a traditional music director leading.

Returning to graduate school in 2002 was an endeavor that took me completely outside of my small quiet world of controlled listening to many hours a day of constant music, talking and other environmental noises. I quickly realized the programmable aids were not working for me anymore. My audiologist informed me of the music program now available on the Widex Senso Divas and let me try them over the course of the semester. I doubt that I would have been able to continue past that first semester without these new digitals. They worked so well and contributed to my self confidence and satisfaction as a teacher, performer, and in my newfound ability of making mostly A’s, which was not something I achieved as a teenager. My piano teacher was eager to learn from me as a hearing impaired student, as his special interests included teaching young students with learning disabilities who were blind and/or autistic. He quickly adapted by not talking while he modeled correct technique at his piano and waited for the sound to decay before talking. As a piano major my music was much more advanced than what I played at church or taught. I soon realized, as far as sound was concerned, that Baroque and classical literature (Bach, Mozart) were not as difficult to hear due to the smaller range of the pianoforte, as some of the Romantic music (Chopin, Brahms) and especially the 20th Century piano literature, because of the thicker textures and the extreme use of the upper and lower ranges of the piano. I constantly doubted myself when very low pitches were distorted because of volume and/or overtones, and in the extreme upper register I only heard thuds. I learned to practice small sections of music in a comfortable hearing range to learn the correct sounds and finger memory. While practicing without my hearing aids one day I discovered I could hear the clarity and clean even sounds in my playing from feeling and hearing the action of the keys. All of the resonance was gone which sometimes overlapped which I believe affected my perception of how I sounded. It was a good way to check my memory, but lacked the warmth and fullness I prefer when listening to myself play the piano with my hearing aids. Octaves are not as difficult even though I usually do not hear the top note in the upper register, but audiate it from the lower note. I learned to appreciate 20th century music, but found abstract music when lacking tonality and music with too much dissonance to be very difficult and even more tedious to learn. I made an effort to work on minimalist John Adam’s China Gates, with constant repetitious melodic patterns changing on irregular beats. It was hard to spend long periods of time practicing it, even though I did like the music, because repeated key patterns in the upper range produced bell-like oscillating sounds that did not sound like the piano. It was not comfortable to my ears as well.

These past six years as a graduate student have been a rewarding musical and personal journey. It was a constant challenge to cultivate new listening skills while adapting to the rigorous schedule of classes, practicing, performing and teaching, not to mention family time. The bad news is – my hearing will continue to get worse. The good news is – new technology will continue to improve. My only hope is my story will offer inspiration and a realization of the growing need for quality sound technology for hearing music through hearing aids for musicians and anyone with hearing loss.


by Janice Rosen

I am an amateur musician taking piano and clarinet lessons. I also sing regularly with a choir.

I was born with normal hearing – and malformed middle ear bones that did not grow properly and I started slowly losing my hearing as a toddler. By age 6 even though my hearing loss was mild, it was severe enough that I needed to wear hearing aids to function normally.

I began learning to sing at age 3 or earlier from my Dad, who was not a professional musician, but just someone who loved music and had a good voice.

It was a fun way to get me to learn to speak better, too. Plus I also loved to listen to the Saturday afternoon Metropolitan Opera broadcasts on the radio. I didn’t understand what the singers were singing about but I was fascinated by the beautiful sounds of the music coming from the radio. I would sing along with them and match my voice with theirs and attempt to harmonize with the opera singers event though I was off key. I know I will never sing like my favorite – Joan Sutherland – but just hearing her sing and the fact that I was able to hear her full range and that beautiful effortless coloratura voice filled (and still fills) me with delight.

I sang in my synagogue youth choir and had a very supportive choir director / music teacher who would train all of us youngsters how to sing properly, with breathing exercises and scales. My hearing aids helped me hear but my problem was knowing how loud I would be in comparison the other singers in the choir. I had to listen carefully to everyone else and watch the choir director. It helped that she would sing along mouthing the words and I would lip-read in order to make sure I was keeping proper time and keeping up with everyone. I sang alto and most of the time the altos would sing very softly, too softly. I could hear the sopranos better – maybe because they were louder.

Voice was my first instrument. My second instrument was an organ, the kind with the regular keyboard for the right hand and the left hand has buttons for chords. Due to poor neuromuscular coordination at that young age I was able to play only one hand at a time. I tried the guitar but did not have the strength or coordination to handle strumming with one hand while pressing strings with the other hand – I gave that up after a while.

Piano was frustrating when I was younger not because of hearing but because of poor coordination. I did not take formal piano lessons when I was a child even though I wanted to very much. There were no programs or teachers in my area that would accept a child with a hearing loss, much less one with other physical disabilities. I taught myself how to read music and enjoyed playing melodies with just the right hand on my family’s organ. When my family would visit friends who had grand pianos it was a delight to sit and invent melodies.

My main problem was not knowing how I sounded to everyone. I would have an idea in my head on how I would sound but others did not share the same feelings. My hearing aids were the inexpensive analog hearing aids that amplified sound in general, to 40-50 dB.

I found it easier to learn to play the clarinet and recorder as it was not necessary to have good hand coordination (at least not as much so as a piano) but my problem was hearing tone. I played clarinet in my high school band and also some clarinet and recorder solos in programs at my synagogue when I was a teenager.

In high school I took the Seashore Test of Musical Ability and did very well but both my high school band teacher and my guidance counselor were very negative and didn’t want me playing in the high school marching band and said that I should not think about a career in music due to my hearing loss. This was before my hearing got much worse.

My college years were spent at Gallaudet, where there were no music courses and no musical instruments. I was too busy as a college student and the dormitory rooms were too small for me to bring an instrument from home. So I put playing an instrument on hold for a while.

I did get to enjoy music at Gallaudet as the Gallaudet students would get together on a regular basis in the Rathskellar to sign and sing and it was fun. My major concern was the level of noise as the music was turned up too loud. No one knew or cared about ear protection in those days.

In 2001, the Association of Adult Musicians with Hearing Loss (AAMHL) was founded and that opened up a whole new world for me as an amateur musician and music lover. AAMHL is a nonprofit organization of musicians with hearing loss, music lovers with hearing loss, hearing health care professionals, and anyone else (including both people with normal hearing and people with hearing loss) who is interested in the AAMHL mission. The AAMHL mission is to open up possibilities for adults with hearing loss to discuss the challenges we face in making and listening to music; create opportunities for public performance for those of us who might not otherwise have access to these opportunities; provide ongoing feedback to hearing health care professionals, researchers, manufacturers of hearing assistive technology, and music educators; and provide educational opportunities to enable hard of hearing and deaf adults to appreciate and make music in ways not previously available

One of the things I learned about through AAMHL resources is the Note Frequency Conversion Chart which indicates how many frequencies each note on a piano keyboard is. It was what I needed in assisting me in choosing my first digital hearing aids in 2002. I showed the chart to my hearing aid dealer / audiologist and told him I wanted to be able to hear all the frequencies on a piano as well as the full range of the human singing voice – assuming that I have the auditory nerves to allow me to do this. There are no musical instruments or music testing equipment in the hearing aid dealers office so he tested my hearing, programmed the hearing aids based on my audiogram and the Note Frequency Conversion Chart. As I live only a short distance away from his office, I went home and tried listening to the notes on my piano and CD’s of singers I enjoy in order to determine if the sound is in fact “just right”. I also tested the hearing aids by listening to my favorite opera singers at the Washington Opera. Was I getting the full tone, full power of the singers’ voices? Was I hearing every note? This was an especially useful environmental test with the bel canto and the flourishing coloratura that I know so well. However, this is not a very scientific test and I know that even with the best hearing aids I am not hearing music the same way someone with normal hearing does.

Currently I am an avid attendee at opera and classical music concerts and attend almost weekly at the Kennedy Center for the Performing Arts in Washington, DC, taking formal lessons in piano and clarinet and sing in a choir once a week.

The emphasis of my piano and clarinet teachers is that you don’t have to physically “hear” so much to judge tone quality as you have to feel the musicles in your fingers or the wind of your breath and chest muscles or lip position as you blow a wind instrument.

Thanks to the AAMHL and the many fine people and resources I have come in contact with, I have been able to revitalize my love and pursuit of music as an avocation and when I retire from my job in a few years, I hope to pursue a degree in an appropriate area of music.

Membership in AAMHL is free and open to anyone interested in the areas of music and hearing loss. AAMHL members are located all over the world and communicate mostly online via a listserv on the Big Tent web site. For information on AAMHL and how to join, visit www.aamhl.org or send an email to.

Janice Rosen, Treasurer
Association of Adult Musicians with Hearing Loss
2130 P Street, NW #221
Washington, DC 20037

Home phone: 202.296.6220
Work phone: 202.727.2145
(November 30, 2008)

In Conclusion

• Performing musicians need a place to turn to for our special needs and capabilities. Our needs and knowledge of sound and our finely tuned sense of sound should be addressed with respect. The office that deals with musicians and audiophiles should be equipped with proper testing equipment and sound amplification. No graph test can substitute for the real thing.

• There is need for a way for a qualified person to adjust their aids at home safely. I know there is a lot of resistance to this, but for people like me, this is the only way to achieve quality sound. Given the opportunity, musicians are both willing and capable to try. I believe that hearing aid manufacturers and dispensing professionals should work with people who want to self-adjust their settings not as an adversary but as a partner. And I believe the hearing industry and professionals, as a whole, would benefit from this arrangement.

• Hearing aids must be able to produce quality sound at real-world levels. The improvements made in hearing aids for performing musicians will result in better hearing aids for everyone.

Citation for this article: Higgins P, Ledbetter R, Chasin M, Revit L. Experiences and perspectives of performing musicians. Hearing Review. 2009; 16(3):44-50.

Index for this special February-March 2009 special feature package:

Revit LJ. What’s so special about music? Hearing Review. 2009;16(2):12-19.

Killion MC. What special hearing aid properties do performing musicians require? Hearing Review. 2009;16(2):20-31.

Chasin M, Schmidt M. The use of a high frequency emphasis microphone for musicians. Hearing Review. 2009;16(2):32-37.

Ryan J, Tewari S. A digital signal processor for musicians and audiophiles. Hearing Review. 2009;16(2):38-41.

Higgins P, Ledbetter R, Chasin M, Revit L. Experiences and perspectives of performing musicians. Hearing Review. 2009; 16(3):44-50.