Costco vs Audiologist

Hearing Aids
#63

I’m not sure I understand Neville’s use of the word cues in his comment re pinna effectiveness. But this paragraph from Scientific American is easy to understand. And of course I selected it because it reinforces my point that one with a very mild loss should think twice before selecting a HA that negates the functionality of the pinna:

“Pinnae are not randomly created. Take the human pinna, for example. Its twists and folds are such that they specifically enhance sounds with a pitch that is typical for a human voice, a sound humans care about. They enhance these sounds up to 100 times and leave other pitches untouched. In other words, it’s a handy built-in listening tool that reduces background noise. The human pinna also helps determine sound direction. Whereas sounds from the front and sides are enhanced by the pinna, those coming from the back are reduced.”

#64

I’ve worn CIC hearing aids for a couple of decades before switching over to the OPN 1 miniRITE and my personal experience is that I never notice any loss of the pinna effectiveness when I switched from CIC to BTE/RIC type hearing aids.

Combining the 4 mic-array notwithstanding, the OPN does do a lot of processing to compensate for and recreate the effectiveness of the pinna cues, quite effectively in my opinion. I can easily tell the origin/direction where any sound around me comes from. I can feel the 3 dimensional soundscape surrounding me.

To address the quote you used from Scientific American:

"Take the human pinna, for example, its twists and folds are such that they specifically enhance sounds with a pitch that is typical for a human voice, a sound that humans care about." -> most hearing aids focus on speech improvement and clairty. So I think they definitely try to address this aspect of the human pinna.

"The human pinna also helps determine sound direction. Wheras sounds from the front and sides are enhanced by the pinna, those coming from the back are reduced." -> The Spatial Sound LX technology in the OPN helps give a spatial awareness so users can identify where the sound is coming from. I’m sure other HA mfgs have similar technologies to help determine sound direction. It’s not that difficult to do this.

Where as the human pinna is shaped especially to help determine sound direction, remember that this is actually a LIMITATION BECAUSE OF the disadvantage of the ear canal being positioned in a certain fixed position, so the human pinna has to grow in a special way to WORK AROUND this limitation to get sound directionality,

But the RIC does NOT have this disadvantage that the CIC and/or the ear canal do. The mfgs can place multiple mics on each HA any way they want to, and array’ing the mics from both HAs to get the sense of the directionality of the sounds quite easily. So it’s not really losing any advantage of the pinna, because it’s not bound by the imitation of only being able to pick up the sound from the ear canal only in the first place.

Look at it another way, if the HA mfgs really want to take advantage of the human pinna, they can easily place a mic opposite to the receiver inside the canal on their RIC so that there’s a mic right there at the mouth of the canal, just like where the mic of the CIC is. But it’s not necessary, so they chose not to. It’s just as effective for them to place the mics on top and behind the ear and still be able to get the same sound directionality effect using their spatial sound processing technology, so that’s what they chose to do instead.

#65

Resound/Beltone has the mic in helix option that allegedly takes advantage of the pinna. Never tried it, but it looks interesting.


https://www.resoundpro.com/en-US/services/mih

#66

Uh, I’m going to fall somewhere in the middle here. The funneling properties of the pinna that amplify sound generally are easily replicated by hearing aids and so a bit immaterial. The pinna also helps to resolve the front-back confusion that we get along the midline from binaural cues, but hearing aids can do this with directionality, and many hearing aids aren’t ever truly omnidirectional anymore, they add in some mild directionality even in quiet to help with this front-back confusion. What we lose with hearing aids are the high frequency filtering of the pinna that acts as our monaural cue to localize sound. When sound moves into the ear, it bounces around those folds in a different way depending on its direction and you can think of this as adding a certain stamp or fingerprint to the sound which we use to determine its location. BTE HAs are not great at replicating this, although many of them list “pinna effect” of some sort in their features it is usually just a wide directionality. The only hearing aid I have seen so far that does a pretty nice job of recreating the filtering it is the Unitron Tempus Pro. That being said, monaural cues are not our strongest localization cues, and they are fairly adaptive. That is, if you take a replica of your pinna and flatten your real pinna down to your head and tape on the replicas so that your ears are backwards, you’ll mis-localize things for a little bit but then your brain will sort it out. But they are weak cues compared to interaural level difference and interaural time difference (binaural cues), and as I said before they are up above 5 kHz and so already compromised with most early hearing loss which tends to be high frequency.

Hearing aids also interfere with the binaural cues that I mentioned. Many modern hearing aids are trying to add algorithms to maintain interaural level difference with loose success. Most manfuactuers assume that interaural time differences are automatically maintained with symetrical hearing aid processing, but I think this is questionable. However, perhaps the bigger problem is this: The normal auditory system has impressively tight temporal processing compared to the rest of the nervous system (if you’re into this sort of thing, which I am, but I’m probably typing for myself at this point). There are neural structures in the auditory system that you see nowhere else whose specific structure promotes this tight temporal processing, which are critical in our ability to resolve 1 ms differences in sound. The temporal processing of a damaged auditory system has more jitter, and so perceptual skills that make use of this (sound localization for one) are impacted regardless of what hearing aids can do to maintain these cues.

Sound localization IS important for the brain to process speech in noise. Hearing aids are variably successful at maintaining this. Individuals have variable damage to the auditory system (even with normal audiograms) which may or may not impeed their localization anyway, so it’s difficult to suggest a general rule about avoiding amplification for mild losses. Which takes me back to my original advice: Try it and see.

(Which could all take me on another rant which is that people focus so much on the device because engineering is easier to understand. Hearing loss is more about the brain, and which device you pick probably isn’t as important as so many people trying to make comparisons between brands seem to think…)

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#67

This is interesting. Could you provide links for further reading?
Thanks.

#68

This is a good example of our overthinking a problem and making it more complex than it is. Not that it isn’t a complex issue but that a new users frame of reference leads to a fearful condition.

When I had the major loss due to Meniere’s, my life changed dramatically. A simple aging loss with high WRS went to what you see if you click on my audiogram/WRS. It brought me here to gain understanding and that is an ongoing process. Most of my original concerns were wrong or uninformed.

If you look at what good audiologist have just said here, you will see that we’re basically being told we are concentrating on the wrong topics – brand. Maybe we can also throw in style which is more cosmetic.

There is a lot of information and topics we talk about. I wonder how many of them really address fears more than facts. We turn it into a Ford - Chevy debate. Well, it does turn out we have to choose a brand and human nature says we’ll defend our choice. With aids there are nuanced choices we make. “It sounded better.” That’s OK but every brand has people saying it sounds better.

A couple of years ago, it wasn’t OPN1 as king. It was the Siemen’s/Signia that got the hype. One fellow was going on and on about how superior it was and every newbie was getting them. Then, one of the fitter got tired of the crap being spewed and went from passive to offensive. The poster got mad and left – probably to our benefit. Old timers here will recall that era.

What I am saying won’t go over well. But, it is something I thought needed to be said. I get some like or PM from time to time thanking me or whatever. It nice to be appreciated. But when a fitter points out something we need to understand our limits and read them closely. They’re sharing informed info is more important than everything I’ve ever said here. It is because they are so much more knowledgeable about what is truly important and they are sharing that with us without recompense. We are very lucky in that and need to listen closely when they explain and share knowledge.

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#69

Thank you Ken for your thoughts above. I appreciate the time you invested in this.
Thanks also to all the specialists that have added to this thread. I am appreciative and yes a bit overwhelmed by the outpouring of a considerable amount of information that I’m absorbing…albeit slowly.

Ironically this whole thing started when I went to Costco to pick up HA batteries for my mother in law and I finally decided that it couldn’t hurt to get a test done. I knew there was loss in the R ear, but did not know the L was on the fringe / marginal. I tried two HA’s there, the KS8 and the Phonak. From a sound perspective the Phonak (at least to me) seemed better, when I wore the pair around the store.

I spoke to my wife about it and like any expense these days is an expense that needs to be considered carefully. She mentioned that she thought part of the benefit plan included audio exams, ENT, HA’s and looked into it. When she told me what the benefits were (50% off any HA up to 3500 per ear, 50% off any extras, free exams, free fittings, free followup, free annual) well it was a no brainer. So off I went to the hospital audiology dept (they have 5 locations - as mentioned it’s a big hospital system - and I chose the closest to home)

So I went into test #2 with some knowledge (and a test result in my back pocket) and decided to take it from the top and not disclose test #1. The new test result was in essence the same graph - a bit more flat lined than peaks and valleys. Was I wrong in not telling them I had a test done 10 days prior - I don’t know - I just wanted to gather more info and see what they had to say.

I was almost elated when they told me I could get by with one for now vs two and given the reading I’ve done in the past two weeks was pleased with what I tried. With a single aid in a limited area to test in (I was not in Costco this time) all I could do was have a conversation with the aud and do my own little directionality test - tapping on things, snapping fingers etc to see if I could locate the sound. I could and that impressed me.

So I chose the OPN1 and bumped it to the rechargable version - my cost for one is 1250 plus a bump of 125 for the rechargeable version - probably a wash over the battery version, but my thought was less wear and tear on the battery door - so that made sense.

My hearing loss I believe is part heredity and part self inflicted. My Dad had tinnitus and I’ve had it for a while. It’s becoming more noticeable and annoying especially when I am tired. My mom is practically deaf now - refused to wear hearing aids and with the progression of her dementia - no need to force that now.

So am I concerned as to how this will turn out - yes - I need to fix as best as possible my ability to hear speech, especially in noisy environments. I’ll update once I adjust to wearing it.

Fortunately I still hear music well - not as well as I used to but well… As an audio guy (who has designed some pretty interesting headsets for the call centers I support) it’s a passion. I’ve no idea if anyone here has a parametric equalizer tied into their stereo - but I do.

As also a hobbyist musician / former p/t recording engineer ( I do have some very high end mics to sell too, which will more than cover this cost!) it’s going to be really interesting when I spin up the Leslie attached to the (clone) Hammond organ and see how it handles that - That could be a fun topic itself (doppler effect)

All I can do in retrospect is continue to advise my kids to wear hearing protection when they attend concerts. I should have known better, but nearly two years ago ‘the worlds most dangerous synth’ got me good - that’s a story for another day.

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#70

Well you’ve got a good attitude and that may be the most important thing in adjusting to hearing aids. It’s always a shock for a while. You’ll know about that shortly. :slight_smile:

With your loss, you should get good benefit in noisy situations. Remember that the OPN1 has a different approach to noise than others. So decide on that during the trial period – normally a month.

#71

That’s a really nice benefit your wife’s employer has.

On other topics you mention now you’ve got me curious :slight_smile: . And hey it’s your thread…say whatever you want.

#72

Nah. This is fascinating!

#73

Indeed. And many of us, of course, don’t have the time / money / interest / possibility to try out different brands.

To say nothing of the fact that even when it is possible to trial a particular brand / model, the experience is going to depend in a very large way on how the aids have been set up.

1 Like
#74

Neville and Volusiano: Thank you very much for your expert posts regarding the pinna. Also thank you for taking the time to make them detailed; I read every word. And to others following this thread: please excuse me for getting this thread somewhat off topic relative to the OP’s first posting.

I think we agree that one’s experiences and perceptions regarding their hearing disability and HA effectiveness depends very much on their particular disability characteristics. In that regard, as I’ve posted elsewhere, I have otosclerosis, I’ve had four stapedotomys, so I have metal and plastic prostheses instead of middle ear bones, and I believe that my word discrimination capability is much worse than the WRS scores on my audiogram would suggest. Perhaps that accounts for the fact that my experiences are somewhat different from those articulated by Volusiano. For example, going back to my Oticon Syncros, through my Agils, and now with these OPN 1 miniRITE1s — I’m perceive very little directionality and speech-in-noise effectiveness. For example (probably not perfectly scientific here) if I broadcast white noise through my computer speakers (only about 8 inches apart), stand back about 10 feet, adjust volume to medium comfort, set OPN program to max directionality, and slowly turn through 360 degrees, I detect only slight changes depending on angle. If I remove HAs, adjust volume to medium comfort, and repeat experiment, I detect significant changes depending on angle. So that’s one thing that makes me suspect that my pinnas work better than Oticon’s algorithms.

One other comment re “they can easily place a mic opposite to the receiver inside the canal”: My understanding is that one reason that BTE & RITE HAs rather than ITC or ITE HAs are usually prescribed for folks (like me) with substantial loss is because the resultant microphone-to-speaker separation makes feedback management more straightforward. So if they tried to locate the microphone at the pinna focal point with a high-gain BTE or RITE, even with closed domes or molds, wouldn’t feedback be nearly impossible to avoid?

#75

Agreed and frustrating. We, up here, don’t have the luxury of brands in stock and are limited to a 90 day trial.

In my case, test and purchase was 4 weeks before the fitting so my trial is reduced to 60 days.
KS8 better get here soon.
:fearful:

#76

@whahuh: Read your purchase contract. It’s 90 days from dispensing date. Not purchasing date. Turns out in my case that they didn’t put a dang date in that box. But that’s what the wording says.

#77

Thank you Z, mine, like yours, only has purchase date. I’ll argue it if I have to, plus I did them a favour by moving my test date up by 6 weeks, to fill a cancellation.

#78

I was been fitted with Starkey Halo 2’s by my audiologist a year ago but have not been to happy with them and have read quite a few positive comments about Costco and their KS8’s. Yesterday I had a hearing test at Costco and the result was Costco’s wouldn’t be any better help than my Halo 2’s.
After hearing this at first I was a little disappointed but it did speak well of Costco.

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#79

Uhm. Yeah, maybe. That’s just me synthesizing on the fly during morning coffee time. Which bit did you want to follow-up specifically, and what is your tolerance for dry neuroscience? I’ve been away from the academy for just long enough that they have finally revoked my journal access, so getting full papers is harder than it used to be.
I had in mind the Calyx of Held, which you can wiki, and which can transfer action potentials at a rate of up to ~1 kHz, hence my 1 ms comment. However, the human auditory system can resolve interaural time differences of 10 um (!). It is difficult to imagine an individual neuron having this sort of resolution, so the brain is probably looking at groups of neurons or sampling rates over time.

Oh yes, definitely. I was going off on a tangent in reponse to a different poster. I hope the OP understood that.

And Waynetc, all the choices you’ve made so far have been totally fine. The important part is simply that you are noticing a significant benefit in your day-to-day life. Hearing aid or no hearing aid for your good ear is a close enough argument that practitioners disagree, which means you shouldn’t stress over which way you decide to go at this point.

As I’ve mentioned before in regards to listening to music–consider that many musician/composers end up with significant hearing loss. The music they are composing is done through the filter of their own ears. So in some ways, you might be able to consider your music listening more true, not less. :wink:

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#80

@Neville, @aggie60: I was wandering around and stumbled across this editorial/column/opinion/educational piece and thought oh hey that’s being talked about around these parts. There seem to three parts to it.

#81

“The temporal processing of a damaged auditory system has more jitter, and so perceptual skills that make use of this (sound localization for one) are impacted regardless of what hearing aids can do to maintain these cues.”

I was interested mainly how my AIED condition might be affecting these skills and whether hearing aids can actually mitigate these impacts. I found the article for Calyx of Held which led me to this article on the auditory system. Interesting reading.
Thanks for the lead.

#82

This looks interesting too. Thanks.