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.
2 Likes
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.
3 Likes
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.
3 Likes
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!!
1 Like
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.
1 Like
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.
2 Likes
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.
1 Like
Great little article there, have a browse.
For me a cookie bite has to have three distinct levels of Hearing - Low, Mid, High. It’s also normally a sensorineural function, though you can get mixed chunks of Audiograms, having the middle part of the chart drop due to a conductive issue is less common in my book.
Essentially it looks like it might have been a fairly flat Audiogram to begin with but something has changed/pre-existed in the middle part of the cochlea neural pathology that has caused the distinct shape loss.
3 Likes
Trying to get used to the adjustments my audiologist made. She ended up taking down the feedback reduction since apparently that can actually cause feedback. Other than that we returned the hearing aids to previous settings from two visits ago. If the feedback is improved I’ll likely purchase the ReSound Ones. I’ll hope the the audiologist is right that Bluetooth will be better on the purchased device. I also tried out three different closed dome options. I found the power domes to be intolerable- I don’t think there’s any way I could get used to them. I tried one that looked like a tulip but that felt too big for my ear. The only one that seemed like it might work was a standard closed dome. We discussed trying silicone molds when I purchase hearing aids. Since I’d likely go with the top of the line plan since I need all the available channels to adjust my complex loss and that plan comes with the option to get molds made without additional expense.
Went in for another audiology visit today. I’m at approximately 20 visits (mixture of in office and telecare) since I started with a new practice back in July. This time we brought down the gain in the mid/high frequencies to reduce feedback in the ReSound Ones that I’ve been demoing since early October. The audiologist and I have come to the conclusion that open fit is still going to be my best option. So far, so good. Much less feedback even if it’s a little quieter. I’ll go in for final adjustments on Christmas Eve (if needed) and if all goes well finally end this chapter of trying to select a hearing aid.
3 Likes
Still dealing with some feedback with the ReSound Ones several setting adjustments later. On advice from ReSound, my audi maxed out feedback reduction and wind cancellation. Some of the feedback happens seemingly at random in conversation where there’s seemingly no change in volume or pitch. Also, my own voice with elicit an extended feedback. For example, an enthusiastic hellooo, yahoo, woohoo will create a long feedback response. This happens with other speakers too but is worse if it’s my own voice. This is all rather frustrating since in my earliest settings with these hearing aids there was absolutely no feedback. Out of curiosity, I may have her put these back on those first settings. I’m going into month 3 of the ReSound One trial. It’s my understanding I could try these without the additional in ear mic and maybe that would make a difference. Not sure exactly what we’ll do from here. I’ll be contacting my audiologist tomorrow to give her updates on the current settings.
1 Like
Figured I’d update my experience trialing the ReSound Ones. I’ve been trialing this pair of hearing aids since October 2020. Part of the reason for such a long experience trialing is that my audiologist left the practice mid trial and I needed to start fresh with a new audiologist. Also, I came to this trial after many two-three week trials of Signia, Phonak, and Oticon and it was the closest fit both physically and for sound. So my new audiologist has been working through many issues through adjustments. We recently got a brand new demo set because there was concern that feedback issues were caused by hearing aid. Unfortunately, with the new pair and programming adjustments I still had some feedback albeit considerably less. In my most recent visit, we decided to switch out the receiver that has the additional mic. This one is smaller and fits my ear canal better. In terms of comfort, it’s much better and so far I don’t notice a tremendous difference in sound. We’d kept the programming the same for comparison. I haven’t noticed any feedback with the new receiver.
2 Likes
Howdy, I am 6 weeks into trial of products. Started with Styletto3 which did not meet my needs. Thankfully, my AUD had Oticon MORE 1 available, they solved my issue but I still wanter to test ReSound ONE 7. This last week I was fitted with them. Issues with feedback and disconnect from iPhone. Tulip dome was used, but from what I read, there should have been setup with modified closed dome from ReSound. I am going back to AUD this coming week to try and get things fixed. If all else fails, the Oticon MORE 1 will be my choice.
At this point, I am frustrated and will ask AUD to order the premium ReSound ONE 9 and closed domes. I can’t tolerate Tulip domes.
My choice is Open dome, I will keep up with your progress as it may help me with own issues.
Regards,
1 Like
The feedback issue has been greatly reduced through using the One receivers that don’t have the extra mic. I’m wondering if my ear canals were too small for the other receivers that have the additional mic. The right aid frequently becomes unpaired to my iPhone. I’ll be trialing the Oticon More next.
Why test the premium version of More against the less premium version of ReSound One (the 7)? Since like all other HA OEM’s, ReSound “defeatures” the lower echelons of its models, I would think that a fair comparison of More vs. One would be the More 1’s (the most premium) against the One 9’s (the most premium ReSound version).
The comparison was against Signia Styletto X3. That did not solve the issue in auditorium – echoing which kept me from being able to ascertain speech. The reason for ReSound ONE 7 was audi mentioned that testing the midpoint level may solve the issue as I was going only one level up. This proved to be a false premise - try One 7 - and Monday I will be fitted with ONE9.
2 Likes
After nearly a year trialing hearing aids, I think I’ve finally found my set. Just started a trial of the Oticon Mores and I think I’m sold. Both the sound quality and physical fit are working for me. 
3 Likes