Why do you need to wait days or weeks for an appointment if you have feedback? I had my current Quattros fitted in the morning, got home and had lots of feedback issues, emailed the audiologist and was given a special appointment late that afternoon. And it was a Friday.
A power dome is in between a custom mould and an open fit.
Best
David
Combination of factors between my availability and available appointments. She should be setting up telecare for Resound soon so hopefully quicker fixes in my future.
Got it. I tried the power domes in office and found the occlusion to be difficult but maybe the right custom mold would be doable.
With custom moulds it’s all about the vent. If your ear canals are big enough then they can give you a quite big vent which you then block with whatever size reducing plug. If they aren’t that large then normally they would settle for a small vent, maybe 0.5 or 1mm.
But whether you need custom moulds is a matter of the sort of loss you have. How big a loss is it and how does it vary with frequency.
I think occlusion is something you can get used to. I find it’s no problem now being almost totally occluded, but I do much prefer a small vent that just keeps the static pressure equalised.
Anyway good luck and I do hope the remote adjustment works for you.
Occlusion is not only venting but how the aids are set up.
Based on your hearing loss mold/dome venting is established to control gain/feedback.
Occlusion is then tuned to the clients likes.
I tried some other aids as I lost my Widex fitter and the new fitters didn’t set them up right. I couldn’t “better” my hearing from my Widex aids and to cut a long story short then found a fitter who followed Widex fitting software exactly and then it blew my old aids out the water. I now have Widex Evoke custom 440s, a family member has F2s. His stream direct to iPhone, I use a COM-DEX to stream. The slim tip with the F2 fits securely for him with excellent speech recognition. The aids can be adjusted whenever you like from home using the remote care app. Bloom support the remote care. I found Widex’s fitting support second to none so if you tried them and were having issues ask for the rep to get involved. I loved my Widex Minds but the Evokes (once set up correctly) are amazing for me.
This is classic from ex Widex wearers.
The answer is probably another pair of Widex, or possibly Oticon, with some of the adaptive features turned off.
The reason is, the Widex aids you’re leaving typically have a ‘soft’ (slow) release of the consonant function (this is fairly uncommon as most aids have fast release to improve the separation of different consonants). It can give the hearing aid sound a better quality as the output sounds less clipped.
The audiology practice I’m currently going to doesn’t carry Widex. Oticon was probably the closest fit next to the ReSound. I’ve considered trying to find another provider who carries Widex. I really want to make something workout for my cookie bite loss. I know it’s harder to program and takes patience on my part and the provider’s. The audiologist that I had found in February recently left and now 5 months into the process I’m under another audiologist’s care. I’m hoping we can make something work but not ruling out going back to Widex. I’d been under the impression that any brand could work for me and that most of it is personal preference. Phonak was completely out for me because I couldn’t deal with Autosense.
AutoSense can be disabled if you don’t want to use it.
Set up manual program or programs if desired.
The people I’ve successfully migrated off Widex have pretty much all gone to Oticon. Though one of them could only initially accept the music program.
If you’re waiting for the More, don’t discount the Ruby, the more basic WDRC might suit you well. The only caveat here is that Oticon limits the tunability of the (especially lower range) products through Genie2.
As a provider, do you have any advice on finding an audiologist to treat cookie-bite losses or more unusual hearing loss configurations? Every audiologist I’ve seen approaches it as if they’ve seen or treated my loss before but based on on low prevalence of this loss I find it hard to believe I’m a typical patient. Not to say that they don’t have the ability but is there a way to find a specialist for unusual audiogram configurations. Or is so much of it trial and error until one finds the best fit for the patient? Am I wrongfully assuming the average patient finds a great fit in a much shorter period of time?
I am not a provider but-mine has been described as cookie bite. I am in mid forties and when I lost my very experienced fitter and went to the high street my hearing was much worse with all the new aids. And this was being fitted by several different dispensers. I knew it couldn’t be right. One dispenser could set it up and we make many adjustments but it never got anywhere near where it should be. I spent over 2 years going through this and it ended up being purely about following the right procedures. I was fitted with the Evokes by doing the sensogram, feedback calibration, vent size and aid type. I could instantly hear incredibly well and then only made some fine tuning adjustments but my hearing was instantly excellent. It took the normal few months to get my custom moulds as good as they could be but I was really supported with this with the right person. I think if you have worn hearing aids for a while and have a well fitted pair of aids along with liking the sound, it is extremely obvious when new ones aren’t set up as well as they can be. At least that’s how it was for me. I think it’s very difficult persevering as you can wonder what the issue is, but mine ended up being purely about the dispenser needing to follow the set up exactly right. Some dispensers dilute the fitting using methods used for other aids and it really affects the results. As mentioned, the Widex Sound can be hard to move away from. For me, the Evokes were worth waiting for as my hearing is the best it’s ever been now.
The way I’ve tended to approach them is to rather ignore the prescription from the manufacturer.
The problem is that not all cookie bites are alike, some are basic SN losses, some are congenital issues, some are mixed losses and others are due to dead-spots.
Ideally you need to split the loss into 3parts. To start with, a flat prescription to begin with using the two ‘shoulders’ of the loss as the start point, somewhere near 1/3gain. Then consider the actual cookie bite section and apply the 1/3 gain average again. This effectively gives you a Low/Mid/High setting.
If you look at a speech mapped REM, this bubble (inverse cookie bite for output) shape is fairly apparent.
Now, up you can futz about with levels, but broadly speaking, you need to preserve the general shape to maintain the amplification across the board, but the transition frequencies at either edge of the cookie-bite might be pitched somewhere between the two gain levels. Loudness is a massive problem though, people struggle with the amount of energy in the signal.
My historical approach is to follow the steps above, then give multiple programs and volume control refine what works best for the client. Usually you’ll find what’s working best after a couple of steps, make this P1 and put derivative programs in the other slots. Leave the volume control still with the maximum range and cut the MPO’s down to 105 maximum, even where the dynamic range of the loss would demand higher output. This step ensures that you limit the over amplification of adjacent frequencies.
That’s not a ‘cookie-bite’, that’s basically a flat loss with a better LF.
There’s no step change in sensitivity over adjacent frequencies.
Thank you, I appreciate the detailed information you’ve provided. The past two days I’ve really been feeling at a low point in attempting to treat my loss. Trying to remain optimistic that my audiologist and I will fix whatever caused the feedback on the left side and the Bluetooth issues. Fine tuning the cookie bite programming has always been difficult because I often feel like we’ve fixed an issue only to create another problem.
It’s suspected that my cookie bite loss was present at birth but at the time of diagnosis it wasn’t at the point it could be treated. My cookie bite was progressive but has been relatively stable since my mid twenties. My first Widex was purchased at age 20 and was CIC and did nothing to help me. My second Widex (Passion, open fit), purchased at age 31, did give me noticeable hearing improvement. The devices I’m currently trialing at age 41 are similar with the added benefit of Bluetooth and that they’re rechargeable.
YES, it can be ear anatomy!! I have to use a size larger dome in my right ear than in my left. Found this out relatively recently and it completely solved my feedback issues!!
I started with ear molds before open fit became available and HATED them.
Switched to open fit when it became available and LOVED it, but did have some feedback issues.
I am demoing various aids right now and just found “power domes” and LOVE them. They do not give the occlusion effect that ear molds always gave me, but they have eliminated my feed back issues.
Tomorrow I plan to ask for a closed dome or power dome to try on the left side that has feedback issues at the current settings. I hadn’t had feedback in the earlier programming so hoping between programming and dome experimentation I can get it figured out. Oh what fun. 
My audiologist returned my message today to say that she thinks she’ll be able to resolve the feedback issue at today’s appointment. I’m crossing my fingers that’s the case. I’m actually bringing one of my kid’s toys to the office that routinely causes feedback to test the feedback adjustments in office. Sometimes knowing how the adjustments will play out in my real environment is so hard.
And as far as the BT problem, she said that demo hearing aids from ReSound sometimes have more issues than the actual purchased hearing aids. But that we can contact ReSound at the appointment to communicate issues directly to them.
I have been wearing hearing aids for 3 years. I have problems optimizing the audio gram as I get tinny static when I talk louder and from most women and children. The sound is overwhelming if the aids are set to the audio gram.
Could you tell me what is meant by cookie-bite. I’ve never heard that term except on this site.