> We don't have to scream but if we don't speak 'clearly', she misses a lot, especially when we are with a larger group (say 10 people at a dinner). She says she has some friends that she understands very clearly, in contrast to others (admittedly, me and one of my sisters are not the best examples of how to speak crystal clear).

This is where my normal hearing is now. My assumption is the "some I understand clearly" is base very much on what frequency their speech is in.

I'm meeting with a hearing aid doctor this week, actually.

Just as a tip, shouting or even just speaking more loudly is rarely necessary if someone has (properly configured) hearing aids. Just speak clearly. Ensuring proper enunciation so they can read lips is usually more important. Hearing aids will make it "loud enough" but they won't clean up the information.

Does she have primarily high frequency loss? High frequency loss is the most typical in the elderly and also from damage from noise exposure.

Different people have different voices. I usually find it easier to understand men because I hear the lower frequencies better, especially without my hearing aids but also with them. And it's always easier to understand people you know well compared to strangers.

I find small speakers to be awful. The high frequencies are distorted and tinny. Scratchy is a good way to put it. I have a very hard time understanding anything played through a smartphone or tablet speaker. The speaker is too small to reproduce the bass frequencies I can hear the best, and so it's just TSSST TSSSSSZZT sounds through my hearing aids.

I cannot wear my hearing aids at full volume at the dinner table or while working in the kitchen for this reason. Metal, plastic and paper are also common offenders. CLINK. CLINK. CRSZZST. It's almost painful and headache inducing if I'm tired.

Unfortunately those high frequencies are what carry speech sounds like sh, t, ch and so on. Without those it's like the adults talking in the Charlie Brown cartoons. "wah-womp-wah-wah-mhuh??"

Hearing aids can do two things for this: one is to take some of that high frequency information and remap it to lower frequencies. This is part of why they say you won't like wearing your hearing aids when you first get them. They're systematically distorting what you hear -- but in a way you might eventually learn to interpret.

The other is just to make it loud enough that it can be heard. And as you suggest that may be the limit of the hearing capacity if there's very little at the high frequencies the only way to make something high frequency to be perceived, is to hammer the ear with a 90 or 100 dB level of sound.

It's absolutely worth having them adjusted a bit. Also every manufacturer uses a different algorithm for speech frequency remapping. Some people have strong preferences by brand as to the hearing aid sound. (Phonak and Oticon certainly have different "feels" in my experience.)

Almost all hearing aids allow multiple "configuration profiles" where you can switch through them with the app or buttons. I have four: general, lecture, comfort, music. Comfort mode just nukes the high end and cranks up the noise reduction. That's what I use if I'm just reading alone in the living room, or when out at the grocery store, etc.

As to large groups, personally I've simply conceded I can't do large groups. If I try I will feel left out and get depressed over it. If people want to see me at a family reunion, for example, after I do a brief tour to say hi to everyone, they'll have to join me for a small group chat in the den or whatnot.

I use Bluetooth with my phone and sometimes my laptop. My current hearing aids can stream directly from devices with Bluetooth LE audio; no relay dongle necessary.

But at home I often use telecoil. It's one of the killer features for hearing aids that no one seems to know about. Short-range (inches to a few feet) baseband analog radio.

I have a transmitter set up in the living room. If I come within a few feet of the couch I'll hear the television. Got another at my desktop computer in the office. I also have a loop I put around my neck when I play my electric guitar. Telecoil transmitters will plug into any standard line audio source.

My son is 14 and has a moderate to severe loss. During his younger years we had a big clunky behind the ear type of aid and it was fine for a while. But tech progressed and we started noticing that he was having trouble hearing "s" sounds. I researched and got him the Oticon Real and it's been amazing and his speech dramatically improved with the new tech. There have been a lot fewer problems with wind noise and he can talk and pay attention in loud environments like school or a restaurant. His grades shot up.

The newer tech is definitely worth it but spendy. There are times though when I'm a bit jealous, too! He can turn them off when he doesn't want to hear and can listen to anything on his phone over bluetooth, as well as take calls. And he never wakes up at night because of noise :)