Simulating Real World Sound Helps Patients Trust Their Hearing Aids

You can hit targets, run the tests, and still hear the same question at the end of a fitting: “What will it sound like when I leave your office?” That one line exposes the biggest challenge in hearing healthcare right now, turning great clinical data into real-world confidence.

I’m Blaise Delfino, M.S. - HIS, and I recorded a different kind of listen this week: a narrated reading of an interview I co-authored with Dr. Dave Fabry and Madison Levine, BC-HIS on AudiologyOnline. We dig into ecological momentary assessment (EMA), a method that captures patient behaviors, emotions, and listening challenges in real time out in the world, and Symphonia, a tool that brings realistic listening scenarios into the clinic through simulated environments. They’re not competing ideas. They’re complementary ways to close the loop between what patients report in restaurants, meetings, church, and the car, and what we can demonstrate and adjust during an appointment.

We also get specific about evidence-based hearing aid fitting. Real ear measurement and probe microphone verification remain essential for audibility and comfort, but they don’t replicate the messy dynamics of daily listening. That’s where speech-in-noise testing, expectation setting, and hands-on counseling matter. We talk about why two patients with similar audiograms can need very different personalization, and how demonstrating programs, noise management, directionality, and comfort settings in a simulated soundscape can make those choices finally “click,” especially for first-time users.

If you care about audiology, hearing technology, patient-centered care, and better hearing aid outcomes, queue this up and listen through. Subscribe to Hearing Matters, share this with a colleague, and leave a review with your biggest real-world listening challenge.

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Transcript

Welcome And Sponsor Thanks

Blaise M. Delfino, M.S. - HIS 0:06

Welcome back to the Hearing Matters Podcast, where we explore hearing technology, communication science, and the people and ideas shaping the future of hearing health care and hearing loss around the world. Before we kick things off, a special thank you to our partners. Care Credit. Here today to help more people here tomorrow. Inventis. Inventis is innovation. Blueprint Solutions. Clinic management made easy for hearing care professionals. Now with Blueprint AI. And Fader Plugs, the world's first custom adjustable earplug. Welcome back to another episode of the Hearing Matters Podcast. I'm your founder and host, Blaise Delfino. And as a friendly reminder, this podcast is separate from my work at Starkey. Now, let's get into the conversation. Welcome

Why We Recorded This Reading

Blaise M. Delfino, M.S. - HIS 1:00

back to the Hearing Matters Podcast. I'm your host, Blaise Delfino. I cannot believe it is already the middle of July. What a year it has been. I'm actually gearing up to attend Starkey University, so I'll be in Minneapolis, but I wanted to record this segment before I hop on a plane in a couple of hours because it's a new article that I co-authored with Dr. Dave Fabry, Chief Hearing Health Officer at Starkey, and Madison Levine. She is the founder and clinician at Levine Hearing in Charlotte, North Carolina. And a couple of months ago, Inventus had reached out to the Hearing Matters podcast, and we've collaborated with them a decent amount of times throughout the last 18 to 24 months on different content. And I just appreciate their pragmatic approach to audiological equipment. So we had the chance to write about Symphonia and Ecological Momentary Assessment. Now, this episode will be a little bit different because if you do like audiobooks, you'll love this episode. And if you do like podcasts, you'll really love this episode. So I'm a big fan of audiobooks when I've whenever I travel. You know, I'm always tuned into Audible and uh just love it. So, what I'm actually going to do is read our interview that was released on Audiology Online. If you go to audiologyonline.com, you go to journal and then scroll down to interviews, you'll be able to read this interview. So here it is Symphonia and Ecological Momentary Assessment by Dr. Dave Fabry, Madison Levine, Board Certified Hearing Instrument Specialist, and Blaise Delfino.

EMA Versus Symphonia Basics

Blaise M. Delfino, M.S. - HIS 2:55

In hearing healthcare, one of the ongoing challenges is helping clinicians connect what is measured and demonstrated in the clinic with what patients actually experience in their everyday listening environments. In this interview, Dr. Dave Fabry, Madison Levine, and Blaise Delfino discuss how Symphonia can complement ecological momentary assessment by recreating realistic listening scenarios within the clinic and supporting counseling, personalization, and patient-centered care. Question one. Ecological Momentary Assessment, or EMA, captures a patient's behaviors, emotions, listening challenges, and experiences in real time within their natural environment. It helps us understand what patients are experiencing in the real world, whether at restaurants, family gatherings, places of worship, meetings, or other complex listening environments. EMA has also been described in hearing research as a valuable way to better understand real-world listening experiences and the potential future clinical applications of real-time patient feedback. Symphonia approaches this from a different but complementary angle. Rather than measuring the patient and their natural environment, Symphonia allows the clinician to simulate real-world listening environments inside the clinic. That distinction matters. Ecological momentary assessment evaluates the patient's lived experience outside the clinic, while Symphonia helps recreate realistic listening scenarios in a controlled clinical setting. This creates an important bridge. We can verify hearing aid performance with real ear measurement, conduct speech and noise testing, and counsel the patient based on their goals. However, when the patient asks, what will the sound like when I leave your office? Symphonia gives us a way to demonstrate that experience before they walk out the door.

Why Simulations Matter In Fittings

Blaise M. Delfino, M.S. - HIS 5:25

Interview question number two: why do simulated listening environments matter? Dr. Dave Fabry answers, for decades, clinicians have looked for ways to make hearing aid technology more tangible for patients. Years ago, this may have meant using a speaker, an iPad, or restaurant noise in the office to demonstrate the benefit of amplification, directional microphones, or noise reduction. The goal was simple. Help the patient hear and feel the difference. Symphonia brings that concept into a more refined and repeatable format. Instead of only telling a patient that their hearing aids can adapt to background noise, prioritize speech, or improve comfort in complex environments, the clinician can demonstrate those features in real time. This is especially important as today's hearing aids include increasingly sophisticated tools such as automatic environmental classification, noise management, machine learning, deep neural network processing, and patient-controlled sound adjustments. This type of demonstration is valuable because hearing aid fittings are not just about meeting prescriptive targets. Real year measurement remains essential because it verifies audibility, comfort, and output across input levels. Research supports the importance of probe microphone verification as part of evidence-based hearing aid fitting, but verification alone does not fully represent the dynamic environments patients encounter after leaving the clinic. Speech and noise testing helps add another important layer. Speech and noise ability is often more closely related to the listening challenges patients report in daily life than traditional speech testing in quiet. A systematic review found that speech and noise measures had some of the strongest associations with hearing aid satisfaction, suggesting that these tests deserve a greater role in auditory rehabilitation. Similarly, Billings and colleagues emphasize that speech and noise testing can provide individualized information that may not be captured by the audiogram or word recognition testing in quiet. Once the patient leaves the clinic, they enter a much more dynamic listening world. Symphonia gives the clinician another tool to help the patient understand how their devices may respond in that world.

Counseling And Personalization In Action

Blaise M. Delfino, M.S. - HIS 8:06

Question number three: How can Symphonia be used as a counseling and personalization tool? Madison Levine answers, one of the most powerful uses of Symphonia is counseling. Patients often struggle to understand what hearing aid features are doing, especially when those features are automatic or operating in the background. By placing the patient in a simulated listening environment, the clinician can demonstrate how different programs, noise management settings, comfort settings, or clarity-focused adjustments may affect the listening experience. This is where the research becomes clinically relevant. Davidson, Marone, and Souza found wide variability in Qicksin performance among adult hearing aid users and reported that advanced hearing aid features were not always set in a way that aligned with the patient's speech and noise abilities. In other words, two patients may have similar audiograms, but very different needs when it comes to background noise, directionality, hearing assistive technology, and counseling. Simulated listening environments can also help clinicians evaluate and demonstrate these differences more meaningfully. Beston colleagues measured speech reception thresholds in a simulated reverberant cafeteria and found that performance and hearing aid benefit could differ from results obtained in a more traditional laboratory noise condition. Wallravens, Keitzer, and Hickson also found that listener preferences for hearing aid settings, including intensity, gain frequency slope, and directionality, varied across simulated real-world environments. These findings support the idea that realistic listening simulations can provide useful information for counseling, personalization, and expectation setting. This is especially helpful for first-time hearing aid users. If environmental sounds are too sharp, too loud, or too overwhelming, the patient may quickly lose confidence. By combining real ear measurement, loudness discomfort levels, speech and noise testing, experience management, and simulated listening environments, hearing care professionals can better prepare patients for the sounds they will encounter outside the clinic.

Keeping Clinicians In Control

Blaise M. Delfino, M.S. - HIS 10:39

Question number four How does Symphonia keep the hearing care professional in the driver's seat? Blaze Delfino answers: Technology continues to advance, but the role of the hearing care professional remains central. Tools like Symphonia do not replace clinical expertise, they enhance it. The clinician is still responsible for interpreting the audiogram, verifying the fitting, understanding the patient's communication goals, counseling the patient and family, and making appropriate adjustments. In many ways, Symphonia fits naturally into the larger orchestra of audiological tools. Real ear measurement verifies audibility and comfort. Speech noise testing provides insight into real-world listening difficulty. Symphonia adds another layer by allowing patients to experience simulated real-world environments in the clinic. This matters because patients do not judge hearing aid success based only on how they perform in a quiet treatment room. They judge success at dinner with family, in a busy restaurant, during a meeting, at church, or in the car with a road noise. Symphonia gives the clinician a way to bring some of those listening environments into the appointment, creating a more meaningful conversation around benefit, limitations, and personalization. In conclusion, Symphonia is not intended to replace real-world validation or ecological momentary assessment. Rather, it helps bridge the gap between the controlled clinical setting and the complex listening environments patients face every single day. As hearing technology becomes more advanced, patients still need a clinician who can translate technology into real-world benefits. Symphonia gives hearing care professionals another way to create that experience.

Wrap Up And Listener Check In

Blaise M. Delfino, M.S. - HIS 12:37

And that's the end of the article. So that was one of my first jabs at, you know, reading an audiobook. Y'all have to let me know on social or LinkedIn how I did, but all jokes aside, I want to extend my gratitude and thank Dr. Dave Fabry, Chief Hearing Health Officer at Starkey, and Madison Levine, founder of Levine Hearing in Charlotte, North Carolina, for their collaboration. I don't want to speak for the group and all of us, the co-authors on this piece, but I will tell you that this was one of those pieces that really stretched me as a clinician to continue to think outside the box. Because when I was in private practice, whenever I would demonstrate the noise reduction, the digital noise reduction, I was one of those clinicians who was using a speaker and I would go to YouTube and look up restaurant background noise. Now, while that helped the patient, I wish nine years ago I had a system like this in the clinic because how amazing is it for you to simulate these real world environments in the clinic. Again, it's not replacing that ecological momentary assessment, but it really is enhancing the overall patient experience. I want to thank you all for the continued support. I hope you have a wonderful rest of your week. I'm your host, Blaze Delfino. You're tuned into the Hearing Matters podcast. Keep hearing and listening well. And until next time, hear life story.