legends · 4 min read ·
Calibration Notes
An audiologist's fitting notes record a patient whose hearing aids pick up a second voice, slightly slower than his own.
**Ashwood Audiology · Hearing Aid Fitting Record**
**Patient:** Mr. Leonard Gale, 67 · **Device:** Bilateral BTE, programme 2 · **Audiologist:** Dr. R. Quint
**Audiogram (right / left):** Mild to moderate sensorineural loss, high-frequency. Speech discrimination 62% / 58%.
· · ·
**Fitting session 1 (3 Oct)**
Devices programmed. Patient reports good clarity at conversational level. Patient asked whether there is a second voice in the room. Audiologist replied that the room has no speakers, only the test equipment.
Patient reports he can hear "a faint humming, like someone under a sheet". Audiologist checked the device gain. Gain nominal. No external signal present in the test booth.
· · ·
**Patient questionnaire (completed 3 Oct, self-reported)**
*Q: Do you hear sounds that others do not?*
Yes. A voice, always just behind my left shoulder. Not loud. It repeats things I've said, slightly slower.
*Q: When did this start?*
Around the time I lost my hearing in the high range. It's easier to hear the voice than the people I speak to now.
*Q: Does the voice say anything else?*
Only my name. And a number.
· · ·
**Fitting session 2 (10 Oct)**
Patient reports the voice is louder with the aids in. He says it now comes through the devices directly, speaking in a close, intimate tone, and that it is counting, slowly, in a steady rhythm.
Audiologist ran a sound-field test. Patient correctly identified tones at all frequencies. Patient then reported a second tone, lower than anything in the test set, and asked whether it was normal to hear a heartbeat through the aids.
*Clinical note (R. Quint): patient reports a second pulse, faintly, in the left aid. Not present in the test signal. Possible feedback. Adjusted the gain.*
· · ·
**Fitting session 3 (17 Oct)**
Patient was distressed. Reports that the counting has reached a number he doesn't recognise, and that the voice has started to ask him to turn the aids up.
He said, "It's not in my ear, doctor. It's in the room. It's right behind the chair, and it's been there the whole time, and every time you lean forward to adjust the devices, it leans forward too."
Audiologist checked the booth. The chair is at the centre of the room. There is no one behind it.
· · ·
**Audiologist's notes (R. Quint, 18 Oct, personal)**
I've been sitting with Mr. Gale's file for a week. The numbers don't add up. His audiogram shows a loss in the high frequencies, but the discrimination scores are better than they should be for someone who can't hear the consonants. He's reading lips. He's reading mine, and he's responding to words I haven't said yet.
When I checked the recording from the last session, the device logged a second speaker, quiet, at a distance behind the patient's chair. The waveform is almost identical to the patient's voice, but a fraction slower. It says the same things he says, and then it adds a number.
· · ·
**Fitting session 4 (24 Oct)**
Patient did not attend. Clinic called the home address. Phone answered by a woman's voice, repeating the patient's name, slowly, several times.
*Clinical note: call logged. Patient's wife deceased 2019, per records.*
· · ·
**Home visit record (24 Oct, 16:30)**
Patient found in the armchair, looking towards the window. The hearing aids are in, both sides, switched on at maximum gain. The room is quiet except for a faint, steady sound, like breath being held and let out, very slowly, behind the chair.
Patient says the voice is with him all the time now. He says it's been counting to the number he heard last week, and that when it reaches it, he'll be able to hear it properly, without the aids.
· · ·
**Letter from Dr. R. Quint to the Clinical Governance Lead (27 Oct)**
Dear Dr. Ashe,
I'm sorry to write this so late. I should have stopped the fittings after session two. I didn't, because I wanted to know what he was hearing.
Mr. Gale has now stopped responding to the clinic. I went to his house on Sunday and let myself in with the spare key. He was sitting in the armchair with the devices switched on at full gain. The room was empty apart from him. He was leaning forward, and he had his head tilted to the side, as if he were listening to someone speaking very close to his ear.
I asked him whether he could hear me. He said yes. Then he said, in my voice, a little slower than I'd spoken: "Doctor, I can hear you through the wall now. You're in the room with me. You've been in the room all along, behind the chair, and you're counting too."
I checked my own aids. They were switched off. I hadn't worn them since the last session.