Close to despair after months of audiologists (note: PLURAL!) attempting recovery of music and speech

[user424]

The next episode has begun. The last week (ending May 14th) of the Sam’s Lucid/Liberty set is under way.

I rather expected to give them up today, but my audiologist had occasion to contact tech support on another matter yesterday, and revisited my case. As I no longer need protection from windy environments, but the Lucid/Liberty aids can only have 4 programs, she took “Windy” and made it “Music 2” - which, she thinks, not being the ‘normal’ music program, aimed at listening to recorded or even live music which might be damagingly loud, and with compression to reduce the sudden high-volume stuff, but, instead, permitting a “linear” tuning profile, should remove my piano notes’ distortion.

We’ll see on Sunday, unless I can find some other venue to listen to an acoustic piano; if it plays true, we’ll have solved that part of my demands. If I can sing along with a congregation around me, and hear my own voice, that will be a second part. And I’m going to find out about my ability to understand speech, and in particular my wife, pretty quickly just by wearing them.

However…

I also had an appointment with the ENT folks, who did a new audiogram. Which was orders of magnitude better than before, AND doesn’t generally (different numbers but similar shape) resemble other previous scans. I can’t imagine I suddenly got a great deal better acuity, particularly since the relatively recent Beltone scan by the more-experienced rep I was sent to in desperation pretty much matched the others in shape (minor differences in numbers, but the pattern looked the same). But, there it is.

And in looking back through the now-10 scans over the last two years, I see some wide variances in general. That disturbs me; I hate irregularity, as it’s suggestive that one or more of the previous scans is wrong, or this one is, or they all are. I have an appointment with the MD on the 23rd. I’ll raise the potential issue of an MRI with him at that time.

So, Sam’s will either be history or a solution by Monday. My next appointment with the Beltone lady, complete with my reportage of the couple-plus weeks of wearing them since the last adjustment’s issues, is in a week. Music is compromised but not terrible, and speech is fair. But both are a long way from issue-free, and we’ve been banging on these since I bought them 11-4-21, and even since my infection was cured by 1/22. I don’t know why these issues remain.

Sigh…

[Neville]

@user424

Which was orders of magnitude better than before

Out of curiosity, how does it compare to the one from ‘Advanced Hearing Aid Centre’?

[user424]

Good question.

Generally better, and not so matched up. I’m on a bit of a short leash currently, but if I get a chance a in a couple of hours, I’ll post a scan on it. There are very few overlaps of acuity marks, and the AHAC one was nearly identical for both ears, whatever the acuity, whereas the ENT has only a single point of same level of loss.

The curious thing to me is that it’s markedly better acuity in the range in which most speak; my functional illiteracy in things audiology makes me think that should mean that my speech comprehension should be improving - but whatever improvements there have been I think have been a product of chasing the right rainbow of sound settings…

Audiogram to follow once I won’t wake up the rest of the house

[billgem]

I find the Lucid hearing aids interesting. They don’t use compression the way that other hearing aids do, so I would think that might mean different results for music.

[user424]

@user424

Audiogram to follow once I won’t wake up the rest of the house:

Here’s Beltone, a month ago today:

Vero ENT a couple of days ago, a 05-09-23 reading:

That’s markedly better than the November '22 done by the same folks, and anywhere from markedly to marginally better than the best of them since late '21… (See comments at the top of the page)

Here’s the referenced earlier gram:

With the disparities, plural, among audiologists, I no longer have much faith in audiograms.

To the earlier question, here’s the Advanced 'gram:

@billgem

I find the Lucid hearing aids interesting. They don’t use compression the way that other hearing aids do, so I would think that might mean different results for music.

This last time (Tuesday) had the “Windy” program (of the 4 they’re capable of) changed to “Music2” and given a completely flat response. This Sunday (3 days) is the sole opportunity I’ll have to test the efficacy of the Sam’s music on that channel. We already know that the regular (with the aids as delivered) Music program doesn’t work (piano and xylophone, both percussion instruments, come across as tonally incorrect, and flat, to whatever degree, in all cases), so it will be a last-gasp chance for the Lucids, the extension technically expiring on Sunday, but having had no hard date (‘a month’) I’ve written assurance from the audiologist that Monday, if I have to surrender them, I’ll get a refund.

With the Beltones at least close, and with both of them (Beltone and Lucid) being quite close in speech, I’ll require perfect tonality on the Lucids or surrender them. Call me shortsighted, but I’m unwilling to risk $5000 on the chance that - if they’re not right this time - they MIGHT be massageable into a functional state. That said, the speech portions of both are very close, something not achieved with other than the Phonak (but only very close; same logic behind my very painful separation from them, as the audiologist and I had been making encouraging strides toward success). But if I can’t solidly solve the music, they’re not worth having, this “Music2” being as flat (and absent any automatic setting introducing compression or whatever is causing the discordance) or linear as it will get.

I’m cautiously optimistic.

But Sunday will be revealing; I’ve had a Sunday with the Beltones, and they were only close; whether I could learn to work around that, should that be the limits of the gear remains to be seen. My next appointment is Tuesday, and we can continue to tweak theirs for the music portion (well, and speech as well, as the restaurant last night was VERY challenging).

Sigh…

[Neville]

So, random stranger across the internet with very limited information. But this looks like an error to me:

And aside from that the tests look fairly similar.

In regards to the Beltone audio, the transducers are not indicated on the test, but do you remember whether they used inserts? My first guess remains that your ear canals are tall ovals and that this low frequency loss is actually venting from a poor foam insert fit. If your hearing aids are being fit with that audiogram it could be causing problems, although if you are using round closed domes that are an equally poor fit in your ear canals, maybe not. Just a guess.

As per the rest looking similar, note that your response variability on a hearing test is about 5 dB on either side of your “true” threshold if all clinic variables are being managed well (so, 10 dB overall). When you compare them with that in mind:

One can reduce audiogram variability by averaging repeated tests over time. So you could knock out obvious outliars at the high and low ends where there can be more transducer placement error and come up with an average. However, fluctuating loss in the left would confound this–I recall you mentioning a bad infection with lasting effects.

[user424]

@Neville

In regards to the Beltone audio, the transducers are not indicated on the test, but do you remember whether they used inserts?

I believe (not absolutely positive) that they were foam.
And for sure, the ENT was a hard earphone, not a cupped soft over-the-ear; I recall thinking that likely more accurate due to the physiology of the ear. And, yes, my molds are essentially ovals in profile.

As to the infection, that was now long ago, and as that eardrum had previous damage (5 perforations over 40 or so years, then another due to the infection in November 2021), the acuity has always been somewhat worse in the left ear.

I don’t believe there’s (aside from the basic acuity issue) other damage, but I’m close to asking for an MRI if it can be of any benefit. I have an MD appointment at the ENT shop on the 23rd, so I’ll ask about that then. The Beltone above was preceded by a de-waxing (irrigation and then a tiny grabber), so it appears that my left ear is hampered there as well. Occasional H2O2 and at other times, some steroid drops the MD there prescribed the last time, he having suctioned a serious chunk from that canal before that earlier audiogram.

What’s so amazing to me is that I seem to have improved, but intermediate (audiograms done after the ENT/22 and before the ENT/23) ones are all over the map (see the very earliest posts for reference) - and I certainly can’t find any reason (based on how difficult speech STILL is) to believe that. Yet, HOW do I achieve lower numbers if not hearing better? Is there some medical (vs auditory) reason I should be exploring?

Thanks for the feedback.

[Neville]

@user424

I believe (not absolutely positive) that they were foam.
And for sure, the ENT was a hard earphone, not a cupped soft over-the-ear; I recall thinking that likely more accurate due to the physiology of the ear. And, yes, my molds are essentially ovals in profile.

Foam inserts can be more accurate than supra-aural with a good seal, but are subject to leakage which creates a false elevation in low frequency thresholds. Supra-aural can have their own placement problems and can cause canal collapse that will artificially elevate high frequencies, so it’s a pick-your-poison situation. Clinicians should be able to identify and correct problems by adjusting placement or changing transducers; however, clinical time is always a factor. And available equipment. Water or wax on the eardrum can artificially elevate high frequency thresholds as well.

Honestly, I don’t see a lot of improvement. To me it looks like your hearing has been a relatively stable bilateral slope from ~45 to ~75 dB HL and every test where your hearing appears to be elevated in the lows is likely instead a consequence of bad transducer placement, in particular for your left ear which is probably a slightly more difficult shape than the right. That pattern where someone seems to have worse thresholds at 250 and 500 Hz that rise and then fall again is not particularly common absent some particular etiology (e.g. meniere’s, neuritis) as low frequency cells tend to be more robust versus noise damage. That configuration is always suspect to me, even with matching bone conduction scores as 500 Hz bone can frequently be elevated due to placement or anatomy.

An MRI seems like an expensive waste of time, but I’m not a medical doctor.

[user424]

Brief update:

My Beltone rep, it turns out, is a multi-line rep, meaning she still handles all the independent lines.

As such she’s knowledgeable about them, and confirms that I have a top-of-the-line set, and that I had had (before they declined to continue my journey to my 3 metrics) the next-to-top Phonak. The Sam’s went back Monday due to their not managing my metrics and THEIR (like Phonak, earlier) unwillingness to extend the trial period…

But…

The Beltone/also-independents rep is very knowledgeable, and has further tweaked my already pretty-good app and profile numbers. We’ll see just HOW well that was on Sunday, when the music part is again available to me, but around my home, and (with the aid of the MyPalPro external mic set in the center of the table) at a relatively-empty pizza joint without a great number of folks contributing to the ambient noise last night, I largely understood the conversation.

The rep also commented that she wasn’t allowed to give me the Solus app, and what I’d download from the net was a very lightweight version of what she used. She agreed with my reticence, as well, so at least for now, as we seem to be advancing on diminishing issues, I’ll not think of that actively.

As well, she doesn’t recommend MRI unless my loss was monaural (very different - much more sizeable than mine) vs binaural, or with indications of Meniere’s disease, so we’ll put that on the shelf for now.

And, finally, she reviewed all of my audiograms since before my current aids (bought very close to but before my infection seen above), including the most recent ENT which seemed to show an improvement in acuity; she wasn’t concerned about the variances due to the various possibilities, some discussed earlier in this thread. We also discussed domes vs molds (I wore my domes to my surrender of the Sam’s on Monday, as the molds I’d been using were snitched to see if they’d work, after they clearly would not hold the Sam’s receivers securely), and the likelihood that my noted apparent greater volume with the domes was a product of their being further into my canal. If we go with a new mold, she prefers a much deeper penetration than any (Miracle Ear - hard, Phonak - soft, and Sam’s - both soft and hard) I’ve had so far.

Next appointment is again on Tuesday, and we’ll keep at it on a weekly basis until we get it solved, whereupon I may return to my local office (only a 40-minute round trip, rather than a 140 minute round trip).

For those in similar circumstance, my journey has been extensive, and I threw all the resources (4 different suppliers) I could think of at it. But, in the end, I remain convinced that it’s not the hardware, but the audiologist, which will solve the problem. That the same hardware I started with, previously sounding like total discord in musical terms, and a completely verklempt voice clarity, is now very close to as I need it verifies my thoughts.

What a journey. More next week.

[philbob57]

I’ve been told that the setup for molds is different from that for domes; therefore, the aids would be far from optimal if they were set up for domes, and I switched to molds (and vice versa). If that’s the case, I doubt your switching between them is useful. In fact, if you regularly switch between domes and molds without changing the settings, you’re probably collecting bad data.

That is: if 1) the settings are different, and 2) you switch between domes and molds without changing the settings…

[tenkan]

@philbob57

If that’s the case

Yes your right, it’s definitely the case, if you change the acoustics you “should” always recalculate the fitting including feedback.

[user424]

Update - I believe we’ve turned the corner, and are now on the homestretch.

My exhaustive detail collection and transfer for the audiologist, with her appreciation and use of same, seems to be working.

The first meaningful changes happened a week ago (next appointment tomorrow), and the difference is night and day.

To refresh those who may not have read the full thread, and those with fatigue, I wanted 3 things only from the 4 different vendors I tried, when the Beltone factory rep and any prior attempts were failing:

Accurate tonality presentation to my ears from Piano (percussive issues leading to compression and alteration of tone, apparently) and any other music source
The ability to hear my own voice while singing to match those proper pitches, including while in a group
The ability to hear and understand speakers, particularly my wife, without the need for external assistance such as the MyPalPro microphone

When I started, listening to a piano was akin to a shaken galvanized bucket with assorted sized rocks in it. If I couldn’t hear the tonality, I couldn’t match it - and didn’t. I took myself out of a choral dress rehearsal when a ringer brought in from a local college told me that I was singing the wrong notes. He was right. Yesterday in church, while not absolutely bang-on, there was no question as to the note intended, and its variance from pure was minimal.

Various attempts at the above have led to my not being able to hear my own voice very well; that still needs work, but at least I’m able to match the tones when I sing.

And finally, all week, it’s been very rare that I have needed to ask my wife to repeat - and everyone else is even better.

So, there’s some further tweaking which will happen tomorrow afternoon in my appointment with my audiologist. But my premise that the audiologist, and not the equipment (I went through top-of-the-line gear from 6 different not-Beltone manufacturers over the last 4 months before either dumping 2 audiologists, or being timed out of the other two, the Lucid/Sam’s gear being unable-to-resolve, and the Phonak being corporately ‘done’ with me) was the issue seems proven.

Despite my understanding what was being done electronically (and I couldn’t properly present it, anyway, given the level of technical fiddling done in the various portions of the MyBeltone app), I’ll save you the detail of how we got there other than to say that we’re now very close to my metrics. I would guess that we might hit it tomorrow, or perhaps with another visit after that.

And, in the event that my left-ear infection of November '21 is in any way relevant today, I have an ENT appointment tomorrow before going to my audiologist.

Wow. Whatta ride.

L8R

Skip

[michael1]

If you can find the time I would be really interested in your solutions.

[user424]

LOL Lotsa time.

Not sure what you mean by “solutions” - so won’t try just yet.

But the simple answer (albeit over a long time and lots of effort) was to record every issue you find, so the audiologist can address them. My case was unusual in that I’m a musician; anything out of tune is instantly apparent, and, as I’m a singer (also instrumentalist, but that’s a different issue), I need to be able to hear the notes I’m to match/harmonize or otherwise generate, as well as myself.

My wife’s speech was another issue, and more general.

In both (music in/out and speech clarity) cases, giving situational detail to a very experienced audiologist was what won the day.

I’m happy to discuss particulars in more detail than shown in this very long thread; it might help you and someone else. But that’s the essence of my solutions, which are, as yet, close, but not perfect…

And, if it could be useful, I could post one of my logs in more detail than the brief segments appearing upstream/upthread (#27, for Phonak, #55 for Beltone). But that’s how it was accomplished…

[michael1]

I was wondering if you found the cure to be in the complex gain settings or the program options eg whistle block, wind block etc which are usually turned off for music.

[user424]

Hi, again…

It was (and still is; we’re not fully there yet) a very complex tweaking of several of the Beltone HearMax app segments, as well as an addition of one ("Ultra Focus) not standardly there, but replacing “Wind Noise”.

The music accuracy part was mostly a complex tweak of compression time (linear or other approaches) and severity, signal-noise ratio (SNR) and likely some other tweaks I forget (discussed as they were happening, but I wasn’t taking notes).

The speech was mostly shaping of what got amplified to what extent. The "ultra focus’ replaced the “windy” protection, as I no longer live on a sailboat. As well, there are two different (dunno why as they appear the same whenever I’ve used it/them) sections for the remote mic “MyPalPro” A or C; they appear to function the same way, though I suppose one mic may not have the tabletop or the lavalier function (one or the other missing; speculation, so I could be mistaken).

My particular aids have the typical bluetooth functionality, and, significantly, when functioning in Bluetooth, there are no intonation issues. And, my expectation, after all this time, is that my musical intonation issues are related to percussive sounds, as when there’s an orchestra (such as the Cantata performance) over the piano, masking the percussive sound waves, there isn’t an intonation issue. That premise was reinforced in a segment where it was just piano accompaniment and minimal other instruments, with a xylophone which also was slightly off-pitch, to my surprise - but on reflection confirmed my assessment of my intonation difficulties’ sources.

So, to your question, it’s not yet finished, but, in general, I believe it to be a complex gain setting, enhanced by tweaking the individual sub-programs (everything other than the “all around” main program) AND their button-activated alterations.

E.g.:
All around: Noise filter and Speech clarity
UltraFocus: same
Restaurant: Noise filter, Speech focus and Hear everyone
Music: Bass boost and Treble boost
Both MyPalPro: same as music.

My current log (a week’s worth) runs to 2 pages, about half of which is the regular Sunday church service in which I tested EACH subsection (main, plus subsets of the above) during piano-inclusive stuff, and various speech-related periods, either amplified or acoustic examples, both in large-group listening or individual back-and-forth conversations.

I wrote to my audiologist before last week’s, and again yesterday for today’s, adjustment, later this afternoon, a summary of the significant findings. From those (and some minor questions for clarity), she did the various wizardry with the components of the app.

Eventually, it’s my presumption that we’ll arrive at an All-Around status which will have me understanding speech clearly, and perhaps music without the atonality generated by the tweaks in the linear/compression adjustments. At that point I’ll be freed from my dependence on my phone, as, other than unusual circumstance, I’ll be able to merely use the buttons on the aids to move from one program to another without the need for fine tuning.

I hope that’s informative; please come back again if not.

[michael1]

Thank you for taking the time to reply.
Not knowing the Bernafon software I’m not sure if you have discovered a brilliant audi or one prepared to do trial and error.
From a diy point of view I don’t think I could reproduce that in Phonak Target!.
Pleased you are nearly there, I’ve followed your thread from the start and understand your frustration.

[user424]

I had a quick lookup, and Phonak Target was, I believe, what my audiologist there used.

Unfortunately for us (he cuz he made nothing from me, and me cuz I didn’t solve the remaining minor issues and get a working set), Phonak declined to further extend the trial period. But watching his screen as he adjusted my aids, I believe he could have gotten to my nirvana.

I just got back from this week’s adjustment of the Beltones, and learned more about the app I’ve been using. My audiologist, using my summaries (the entire log is mostly chaff in terms of stuff which is meaningful to my specific needs, so I’d sent her the significant events regarding my week’s experience with the previous setting), went through EACH of the 4 major adjusting/environmental parts (All-Around, Ultra Focus, Restaurant, Music).

So, it’s far more than mere tweaking of amplifications. For example, my “music” setting is as linear as the software will allow - meaning there’s a very long compression period, which minimizes clipping (the issue with the intonation irregularity in the usual setup) and therefore minimally affects the intonation I hear from a percussive instrument with specific pitches (piano, xylophone, chimes, e.g.). And, for my being able to hear myself when I sing in a group (so that the others don’t drown me out), adjustment of the high and low frequencies, and, perhaps, some mucking about with the vent in my molds. At your level of loss, likely (if you’re not already there), molds would be a significant step up from domes, albeit likely that domes could be pushed further than the usual mold shape, bringing the receiver output closer to your eardrum.

In my case, my canals are large, and the mold is further enhancing that seal even though they don’t penetrate all that far by comparison to my previous domes. If you’ve followed the entire thread, you know that the molds are castoffs from Sam’s due to their inability to retain their receivers. I’ve not had any such issue with the Beltone receivers, despite their being square vs rectangular in cross section and thus smaller. My audiologist also put in a plug with a tiny vent in the mold vents; we may revisit that in my ‘own-voice’ issues, but it also minimizes the potential for feedback (no sound is getting out).

But, for now, having just returned home, and in the All-Around, I’m a bit dismayed at my wife’s speech clarity. On the other hand, in all of last week’s testing, my best speech recognition was in the Ultra Focus program, with the Speech Clarity enabler. So before I get nervous about the speech clarity, I’m going to try the UF/SC pair.

As I typed that she walked by, and I made the change; my voice is tinny, and hers isn’t all that clear, so we may not have enhanced speech much. A week of working the programs will tell more of the story…

And, I won’t be able to find out about the intonation tweaks until Sunday; no choir practice (we’re in South FL, which is a very seasonal population, so choir is out until the fall), and no easy access to someone who plays a piano for testing that part.

I hope this is helpful in some way; if you’re facing anything similar to what I was, it’s a long struggle. But based on how we (the Phonak guy and I) were progressing, particularly if you have the ability to muck around in it yourself, I’d expect there’s hope for your situation…

[michael1]

Thanks for the reply. Sorry I mixed up Beltone with Bernafon! As an aside Costco sell Jabra aids which is part of GN that I believe makes Beltone, may be a consideration for the future.
The music solutions fits what most members on here have found.
As for me I am going private after many years of nhs due to long waiting lists. Here in UK Boots the chemist have hearing centres partly owned by Sonova. They offer a reasonable service but are also very busy after covid.
I do wear moulds and I’m going to try soft silicon. I’m sure my audiogram will be worse than the one on my profile so likely will need Up this time.

[user424]

I have soft moulds but had two instances of hard moulds along the way; Miracle Ear and Phonak’s were both hard.

I dunno for sure, but I speculate that the soft moulds give more tolerance for movement (my jaw movement of any sort impacts my ear canal; it’s what caused the Sam’s soft molds that I snitched to eject their receivers), as well as perhaps being slightly more comfortable.

As to NHS, social media has many arguments about “free” health care, but you’re similar to my MIL, RIP, who spent a VERY large pile on private insurance whilst living in UK (married a Brit, expatriated in '61, lived there for over 40 years before returning to the US) so as to have access to better and faster care. Her ears got bad enough in the period she lived near us that her RICs became Starkey BTE and went through the 50/60/70 receivers before going to an audio-tube BTE. Her RICs became over-the-ear and full moulds, as she was profoundly deaf.

Now that I’ve had the most recent tweaks, I’m finding the voice side not quite as good as it was. It remains to be seen whether or not my music metric (both incoming and own-voice) has been met, which won’t happen until Sunday. Meanwhile, dinner out with friends will be a good test for the voice part.

Good luck with your continued search, and please let us know how the private sector works out for you. In the case of wait times, my change of offices was due to just that - and that the one I’m using now has a VERY experienced and skilled software manipulator. As well, she was allowed to continue to be a multiline provider, so she has a very broad experience with how things work in general (vs Beltone specific).