The Causes and Effects of Distortion and Internal Noise in Hearing Aids (1998)

When fitting hearing aids, there are three guidelines that should always be followed by the dispenser:


restore audibility; so that the amplified sound is above the user's threshold,


limit the output; so that the amplified signal does not exceed the user's discomfort level, and


do no harm; so that the amplified signal is not unintentionally or undesirably altered by the hearing aid.



The first two of these three guidelines are obvious. The first is to present sounds above the user's threshold of hearing in order to create an acoustic environment with the maximum amount of audible speech cues. The second ensures that discomfort level is not exceeded, so that the user does not wince or remove the hearing aids when loud sounds are present.

The third guideline—do no harm—is less obvious. This indicates that it is important that the hearing aids produce no alteration of the signal other than that which the fitter intends. This is a subtle way of saying that, among other things, well-fitted hearing aids should not distort the desired sound. The topic of distortion is the subject of this issue of Trends in Amplification. The intention of this issue is to explain why distortion occurs in some hearing aids; to explain how distortion is measured; to summarize what can be done to prevent distortion; and to summarize the perception of distortion by the hearing aid wearer.

Distortion in hearing aids can be broadly defined as the generation of undesired audible components that are present in the output, but which are not present in the input. When distortion occurs, hearing aids produce undesired elements at the output through the interaction of the processed signal with some internal non-linear mechanism. These undesired components may interfere to some degree or other with the reception of sound by the listener. If these added elements are small compared to the overall signal level, they may effectively cause no interference at all. If they are large, they can be so disruptive to the listener that the desired sound becomes irritating or even incomprehensible.

All audio systems inevitably contain some amount of distortion. The practical problem for the listener is the type of distortion that is present and the level that is acceptable or tolerable in hearing aids before the distortion becomes disruptive to speech intelligibility and sound quality. It is known that highly distorted speech in quiet can remain intelligible (Licklider, 1946); however, as dispensers often experience, intelligibility is not the only measure of whether or not a user will accept and wear hearing aids. Gabrielsson and Sjogren (1979b) have shown that overall perceived sound quality is important to users when selecting a hearing aid. Punch (1978) has shown that listeners with mild to moderate sensorineural hearing losses retain the same ability to make distinctions in sound quality judgments as listeners with normal hearing. This implies that good sound quality is as equally important and desired by listeners with a hearing impairment as it is for listeners with normal hearing.

Three characteristics of distortion in hearing aids modify the sound delivered to the user:


the type of distortion,


the relative amount of distortion at different frequencies, and


the variation of distortion with different input levels.



Since the most important goal for fitting hearing aids is to restore or facilitate communication ability, undistorted sound is important for optimum speech intelligibility and sound quality. However, it is important to also recognize that there are other reasons to provide undistorted amplification of sound. For example, undistorted and pleasant reproduction of music may be an important sensory experience for some listeners.

This issue concentrates on different types of undesired modification to the waveshape of the sound, primarily by total harmonic distortion (THD) and intermodulation distortion (IMD). However, in a more general sense, any undesired component added to the sound by hearing aids is a form of distortion. Thus, this issue also discusses sound generated by hearing aids with no signal present at the microphone. This artifact is more commonly called internal noise. Internal noise fits within the definition of distortion given earlier, since internal noise is an undesired product generated in the output of hearing aids that is not present at the input. In some cases, distortion and internal noise are so closely linked that they cannot always be separated into discrete entities. For example, instability in the frequency and shape of the clock pulses in a Class D output stage (often loosely called clock jitter) results in distortion of the signal. However, this artifact may be audibly revealed in the output sound primarily as noise, rather than as distortion of the waveform.

According to this broad definition of distortion, undesired noises such as “motorboating” and other acoustic feedback oscillations can also be considered to be forms of distortion. However, acoustic feedback and other similar audible artifacts occurring within hearing aids will not be discussed here. These types of distortion have been discussed in detail by Agnew (1996b) in a previous issue of Trends in Amplification.

In this issue distortion is discussed in two general categories:


Undesired modification of the waveform of the incoming sound by some mechanism occurring within the hearing aids. The severity of this effect may or may not vary with the acoustic level of the incoming sound. This type of audible artifact is generally what most dispensers refer to as “distortion”. This will be the subject of Part I of this issue, and will follow the definition used for distortion in this text.


The production of undesired audible components in the output sound, regardless of whether or not there is any acoustic input to the hearing aid. This is generally called “noise”. This will be the subject of Part II of this issue.



The first part of this issue discusses the causes and effect of distortion. First, different types of distortion are described, followed by an explanation of how they are measured. This is followed by a discussion of the sources of distortion that may be present in hearing aids and the various mechanisms by which distortion is created. The final section of Part I discusses the effects of distortion on the hearing aid wearer. For the reader having difficulty understanding the technical concepts in the first part of this tutorial, a good overview from a different perspective has been presented by Kuk (1996).

The second part of this issue discusses the causes and effects of internal noise in hearing aids. This part starts with a discussion of sources of internal noise and continues with a description of methods for the measurement of internal noise. This part concludes with a discussion of the perception of internal noise and its effects on the user of hearing aids.

At the end of the text is an intentionally long list of references, which is intended to serve as a reasonably comprehensive resource for the reader seeking further information on distortion and noise in hearing aids.