[Value of in situ measurement for evaluating effective hearing aid amplification at high sound pressure levels].

A careful hearing aid fitting requires consideration of various characteristics of inner ear pathology. The recruitment phenomenon restricts the dynamic range of the impaired hearing and this increase the demands on the hearing aids for a satisfactory correction of the frequency characteristics as well as for an intensity reduction at higher sound pressure level SPL. For years data from coupler or KEMAR (Knowles Electronics Manikin of Acoustical Research) have served to estimate the real ear gain of a hearing aid at higher input levels. In previous papers we reported on some of the differences between coupler measurement and probe tube measurement. The object of this study was to investigate the differences between these two methods at higher input SPL. Therefore, we measured the real ear insertion gain as well as the output characteristics with a 2 cm3 coupler in 80 patients at input levels of 60 dB, 80 dB and 100 dB. The results show differences between the two methods up to 30 dB in both directions in the single patient. Furthermore, the highest compression rate was found in the middle and high frequency range which are crucial for speech discrimination. Consequently, probe tube measurement should be used not only to adjust the frequency characteristics of the hearing aid but also to characterise the real effect of Automatic Gain Control AGC and Peak Clipping PC on insertion gain at higher input SPL. Multichannel hearing aids should be used whenever possible to reduce the disturbances to speech discrimination at low frequencies.