Can most audiologists properly do an initial fitting and ongoing adjustment of Oticon OPN S HA's?

Personal bias, but I would not consider Beltone. For your hearing loss (not dissimilar to mine), I’d certainly consider Oticon, but would also seriously look at Phonak and would consider Signia. Be patient with the hearing aids. Things are going to sound a lot different and improvements in understanding people will be subtle.

MDB, Thank you again. I don’t plan to consider Beltone and will keep an open mind about the other two.

I plan to be patient about getting used to the HA’s because my main reason for getting them is not so much to be able to hear better in crowds. I intend to wear them because of the studies that indicate they MAY help delay dementia. I think that if they really did delay dementia and alzheimers, then the federal government/medicare would be providing them for free or a very small cost.

That’s a great point about medical issues and Medicare. We can only hope.
Your high frequency lose is a possible candidate for frequency lowering technology. Modern aids can lower the higher frequencies into lower frequencies that you can hear better. Some manufacturers are better at it than others. Phonak tends to be know for the best frequency lowering but Oticon does well too.
The aids that tend to have the better reputation here on this forum are Phonak, Oticon, Resound, Starkey, Widex and Signia. These are all good aids along with others I have not mentioned.
The important part is finding a hearing aid fitter you are happy with, that makes all the difference in the world.
Good luck.

That’s certainly the main message I have picked up on this forum. Thanks for reinforcing it.

My Medicare Advantage plan reduces my cost for Oticon OPN S down to $1000 each. If your other requirements for selecting your Advantage plan are not too confining, you might want to consider different plan or adding hearing aid coverage.

Your timing is excellent, as we are in the middle of open enrollment.

BTW - I am a strong believer in hearing well enough to engage with others in significant conversations as a method of delaying dementia. Of course there is no clinical study backing that assumption, but when I see older people who cannot communicate easily, I see rapid decline. JMO

The basic process for fitting hearing aids is the same for all aids. I’m sure the local audi will know the process. However, each manufacturer has different software to do the fitting, as it is all computer driven today. The question would be as to how familiar the local audi is in using the Oticon software, and how familiar they are with the various bells and whistles that Oticon offers. You may want to start a new thread ask about what features work the best with the Oticon OPN S, and how they should be set up. That will arm you with a bit of information on what questions to ask the Audi (to see if they know what they are doing).

Another thought is a smart phone. The smart phone you use can influence which hearing aids may be the best suited to you. A smart phone that can stream wirelessly to the aids is a real help in phone conversations.

Thank you, Sierra. I do have an iphone 5s. I have been laughing to myself since I learned that the HA’s act as bluetooth receivers. I have been too cheap to spent $100 on a bluetooth earpiece and now I will be spending $ thousands for one.
And good idea for me to learn more about the OPN S models and maybe more about Phonak.

Apple gives some information on MFi Made for iPhone, hearing aids at this link. You may want to look for hearing aids that are MFi compatible. Phonak is not MFi, but their latest Marvel models have a work around that allows them to work with both Android and Apple phones.

I have a 5s phone and a 7. They both work with MFi. The 5s is limited to iOS 12, which is not a bad thing. It avoids all the issues involved with the new iOS 13 operating system.

It certainly is a pleasure to talk on the phone with audio going direct to your ears, compared to a regular land line phone. My aids can be set to attenuated the background noise (currently set to 70%) when you are talking on the phone. That helps too.

Your loss is not an easy one to fit satisfactorily. Some patients with your loss would not be without their hearing aids, others do not notice enough difference to make the expenditure worth while. Make sure whom ever you choose uses speech mapping and speech in noise testing. Also make sure you have a trial period, if you happen to be one of the “not enough difference to be worth while” group you do not want to spend a bunch of money and let them sit in the dresser drawer. It will not be perfect, but with the proper fitting and adjustments you should notice a nice positive improvement.

The key is to keep going back for adjustments on a monthly bases until you can hear the best you can possibly hear with the aids. I got my aids in December of 2018 and I was taking notes and going back to the Audi monthly until August of this year but it paid off and I can not just put my aids in my ears and forget them all day long. Am I say it will work for you? Maybe, maybe not, it depends on your hearing issues, it also depends on your patients and attitude. You have to be very positive that you are going to get them the best possible for your issues. You have to be very much into getting them right by talking to your Audi and explaining what is working and what isn’t working. You also have to remember to only make one change at a time. That makes it easier to remember what was changed last. Each appointment as to build on the last one. And yes you have to have an Audi that is willing to learn with you what you need to make your hearing experience work the very best it can.
You have to keep your feet to the fire to get it correct, and at the same time keep the feet of your Audi to the fire to get it correct. You have to build that partnership to get it done.

Sierra, George & EV, thank you for the very valuable information.

So I will not seek out the Phonak but will consider it if it becomes the best choice for hearing.

I do not know if my first Audi used speech mapping and/or speech in noise testing but below I pasted the rest of the one page she gave me. The rest of the page is the audiogram chart. I will ask my second audi about speech mapping and speech in noise testing.

Your loss is a real ski jump type. Here is what the gain curves would look like with an M receiver, and closed click sleeves in a Rexton or Signia aid. You have very little gain, and then a really steep climb in gain. For most people having a high number of channels to fit is not necessary, but with your steep loss having more channels may be of some benefit. It looks like with closed sleeves you could avoid feedback - the shaded red and blue zones in the 2-4kHz range. The software is however suggesting you would benefit from frequency compression. This is something that can be adjusted but as a first cut the software is suggesting that the 5-12 kHz frequencies should be squashed down into the 5-7 kHz range. This should help you recover some of the higher frequencies that cannot be amplified enough to be of benefit. So you may want to look for aids that do frequency compression well.

I now think I MAY understand the charts/simulation.
Please tell where any of the following that is not correct.

  • Emerald S 80 *C is brand/model HA
  • the graphs show how the HA can be set to provide little or no amplification in up to 2k Hz because my hearing in both ears is in (or close to) the normal range up to 2k Hz.
  • over 2k hz, the HA’s provide up to 20 db’s of amplification.
  • But my HL is 55 db (75-20), so the HA’s will help me regain less than 50% of my HL.

Not sure I understand enough of the feed back (red and blue shaded) comments to make guess. But I read them to say that the shaded ares represent feed back and IF that feed back can be compressed, I would gain additional HL above the gain of 20.

Thanks for any comments (maybe some of you will get a laugh from my lack of knowledge. :slight_smile:

That’s actually “normal prescription”. In the earliest days of tests and aids, best results were had with a rule: “Provide gain to cover about half the HL”. This was just an approximation, but worked OK. Even with better testing and much improved aids (which can match a target better), the best fittings deviate only slightly from “about half the HL”, guided by decades of experience biasing “half” one way or the other.

Why “half”? First: if you stuck 50dB (a LOT) at 4kHz in your ear, after years of not hearing 4kHz, you would freak out, overwhelmed by all the squeaks in the world. Even 15dB@4kHz really surprised me walking across the wood floor or hearing the dryer squeal.

Second: it is mostly not necessary to boost the world to 0dB or even 15dB HL level. “Threshold” of HL is well below the sounds we really want to hear. 20dB HL is not a significant loss. If you got close to 30dB HL you’d hear far better than you have in years.

Third: most (not all) hearing loss involves “recruitment”, a bad name for the fact that there is loss at threshold but relatively less loss at higher sound levels. I tested my equal-loudness for soft, medium, and loud tones.

When soft I can’t hear highs well. But at “pretty loud” I hear highs pretty good. When I turn up music in my car it does not sound muffled. But when my housemate speaks soft, it is muffled. Simply getting “halfway” from soft to medium would make me hear her better.

And articulation tests show that just a 10dB boost from soft speech to medium in my ear makes me understand very well.

So a “half LH fit” works, for no single reason, but because of a lot of factors that on the whole lead to “half” as a good goal.

That can still be a shock to a disused ear so the audiologist might start from 40% or less, with plan to increase the gain as you learn those high sounds again.

BTW, it is not just “can you hear 4kHz tone?” I have found other tests which show I can no longer differentiate music boosts at 1k 2k or 4kHz, something I used to do for a living (sound-guy). I still know 250 from 500Hz instantly. Damaged then disused ear-nerves forget what things sound like, and the re-learning takes time, months.

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The Emerald S 80 is a Rexton hearing aid. The M at the end is the power of the receiver. I only have software for Rexton aids, as I have a KS8 which is essentially the Emerald 80 C.

Yes, the gain prescribed is based on your loss vs frequency.

The gain at the higher frequencies is actually three levels. The quieter sounds are amplified the most, at a little over 20 dB. The normal sounds are amplified a little less and max out at about 20 dB. The loud sounds are amplified the least at just over 10 dB. This is done because most people lose their hearing for soft sounds more than loud sounds.

Yes, that is what they are called hearing aids. They only partly recover your loss. Another formula used is called one third gain. It applies a gain equal to 1/3 your loss.

The shaded areas at the top are areas of potential feedback. It the gain levels go up into those areas, you have a high potential for feedback. In the scenerio presented the feedback zones are not limiting your gain. The feedback has been suppressed to some degree by using closed sleeves in the simulation.

Hope that helps some,

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Thank you paul! Very helpful to learn that 50% is “normal prescription” and for reminding me that hearing and understanding all spoken words and sounds is not a simple “straight line”.

Sierra, Thank you very much for taking your time and effort to put my info into the program to develop the simulation charts! And for your ongoing education. You have explained how HA’s could improve my hearing.

I found a page which talks all around the “half-gain rule”.

Lybarger 1944 observed that HA users tended to choose gain about half their HL. The NAL formula 1976 gives the number 0.46. Data from the 1980s relates HL to average UCL and MCL (Upper and Most Comfort Levels). When graphed we see that UCL does not change as much as threshold(HL), and that MCL tends to sit mid-way between UCL and HL. Third-gain has also been mentioned. These are meant as starter-goals, and in days of linear aid the user would turn the dial up/down from there to find an optimum. Wide-range automatic gain systems are not so simple. But very often we wind up with half-HL or a little more gain for soft sounds where you need gain, less for loud sounds where you don’t need much gain, and the change of gain with level (compression ratio) is “2:1” (1.6:1 to 2.3:1 for fine tuning). Which for middle loudnesses does indeed come near the old “half HL rule”.

The “about half HL” rule happens to work good for many many people. When HL is over 60 the UCL may rise or drop and other goals may be better. Very steep HL curves are hard to match and some compromise must be found.

This book is older and there has been much refinement in prescription, now mostly built into the HA fitting software. But a half-gain first-fit is still a good start and a significant improvement in hearing.

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1/3 gain is a common formula available in fitting software today. I believe it is mainly used for those who are trying to transition from old analog hearing aids. This is what a 1/3 gain correction for your loss would look like. Note that there is only one curve as 1/3 gain (and most older analogs) were not capable of compression.

This is NAL-NL2 which uses lots of compression. Soft sounds get more gain, and loud ones less.

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And history shows that when “half-gain” was proposed, most HAs had truly ratty response, frequency response not smooth, so gain was an uncertain thing. “Half” may have raised the dips in the curves, the missing tones where speech sounds were weak; the excess gain on peaks was tolerated for better intelligibility in the dips.

Also a good flat high-output HA in loud sounds could be intolerably loud. The older HAs usually clipped too-loud sounds. Nasty but didn’t blow your eardrums away.

Sure, 1/3rd-HL is probably a much better plan today. Anyway it it less annoying to new users and leaves room to turn-it-up as the ear acclimates to sounds it has forgotten. (Though I see you have turned a “acclimatization” knob full-up.)