title: An examination of the practicality of the simplex procedure.
abstract: OBJECTIVE
  The practical importance of the simplex procedure, a subjective technique used to refine the frequency gain characteristic (FGC) of a hearing aid according to listener preference, was determined for individual listeners by measuring hearing aid benefit using both laboratory studies and field studies.
  
  
  METHODS
  A digital research hearing aid with two memories was used as the test hearing aid. The modified simplex procedure was used to select the FGC judged to yield the best speech clarity in the presence of low-level vent noise and again in higher-level cafeteria noise by 10 experienced hearing aid users. The FGCs assessed by the listeners varied systematically from The National Acoustic Laboratories Revised (NAL-R) response in the amount of low-frequency or high-frequency amplification. The benefit obtained with these two simplex-selected settings was compared with that obtained using the NAL-R FGC. Measures of benefit included speech recognition testing in the laboratory and ratings of speech intelligibility in the field. In the first field study, the two simplex settings were compared. In the second field study, the simplex-selected setting for higher level noise and the NAL-R setting were compared.
  
  
  RESULTS
  In the laboratory, the majority of listeners selected an increase in the low-frequency channel gain compared with the NAL-R. Desired high-frequency channel gain was correlated with degree of hearing loss and type of background noise. The benefit as measured using nonsense syllables did not differ significantly among the three fittings, but differences in benefit were measurable with the rating procedure. Five of eight participants noticed a significant difference in their speech understanding in the real world for the FGCs selected in different background noises. Two of seven participants reported significantly better speech intelligibility with a simplex-selected FGC compared with the NAL-R FGC in the real world. The remaining subjects reported similar speech understanding capabilities with both hearing aid settings.
  
  
  CONCLUSIONS
  The majority of subjects included in this study selected an FGC with real ear insertion gain different than the NAL-R prescription to improve subjective speech understanding in the laboratory. A small number of these listeners rated the selected FGC as providing improved speech intelligibility over the NAL-R FGC in the real world. This finding indicates that the simplex procedure should be used selectively to modify the NAL-R prescription. A screening technique would be useful in selecting those who might benefit from a modified fitting. The simplex procedure may also prove to be useful in selecting listeners who would benefit from multiple memory hearing aids.
authors.affiliation: Rehabilitation Engineering Research Center on Hearing Enhancement and Assistive Devices, Graduate School, City University of New York, New York, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Preminger
authors.forename: A C
authors.initials: AC
authors.lastname: Neuman
authors.forename: M H
authors.initials: MH
authors.lastname: Bakke
authors.forename: D
authors.initials: D
authors.lastname: Walters
authors.forename: H
authors.initials: H
authors.lastname: Levitt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001309:Auditory Threshold / Q000502:physiology; D006310:Hearing Aids; D006319:Hearing Loss, Sensorineural / Q000534:rehabilitation*; D006801:Humans; D008875:Middle Aged; D010700:Phonetics; D017755:Prosthesis Fitting; D012720:Severity of Illness Index; D013067:Speech Perception / Q000502:physiology*