It’s not an unrealistic boost given the sort of boosting we often have to do to meet proper prescriptive targets. I think it’s unlikely that it’s too high.
But that’s the value of real-ear measures, you’re not just guessing what the hearing aids are doing on the ear.
I have almost no feedback. It’s not a concern
That’s with closed domes (large with 2 tiny holes)
DaveL
Point is—I hear well with this and it’s 8dB higher than what he programmed. He wasn’t even close
Thanks!
It seems so simple to me. Use the quick fit at the beginning.
What isn’t simple to me is the amount that the gain has to be incrreased.I’m sitting at 4 right now…that’s 8dB! That’s huge.
Frankly I feel that there must be a reason, and a mistake has been made setting the quick fit setting.
After all i have almost no feedback. And that’s with closed domes (with 2 little holes, in case I have the name wrong.)
If I heard this well when the hearing aids were handed to me I would have been a happy customer, provided good practices were used in the setup.
DaveL
Toronto (Mississauga)
It’s likely that he did use the quick fit at the beginning. What happened from there, only you and he know, or maybe no one. Maybe the start point was 80% and open domes instead of 110% and closed domes. What this would have meant for audibility, without it actually being measured, is anyone’s guess.
There’s no feedback because he ran the feedback manager with the current domes you’ve settled on and the software has limited the gain to stop feedback.
The “something wrong” is no real ear measures. Increasing that amount from the manufacturer’s first fit is not uncommon. Maybe your ear canals are just a bit on the larger side. Or maybe you’re turning them up much too high and we just don’t know it (but I doubt it).
He had the 2 year old Phonaks that Peel Audiology had sold me. He may have matched the settings from them. I was their client 8 years
I had discussed whether he could fix that setup. He didn’t tell me what he had done. I trusted him completely. I’m happy I have the hearing aids he got for me.
Setup is the most important part.
DaveL
Well Mike sent me names of three audiologists names suggesting I might pick one as his replacement
I’m grateful he did.
@Neville
When I was with Peel Audiology they regularly turned up volume and changed domes as required. They didn’t change the dome setting in software. I used to ask, and they would say “next time”. I ended up with Power Domes but they were extremely uncomfortable. I stopped using them; they offered no other solution.
Now with Mike I’m using the closed domes with two small vent holes. With 3 notch increase in volume I have no feedback. Over the weekend I increase to 4 notches by early afternoon. I can hear much better than I could with the last setup that Mike has erased. He had used REM with that. During our last conversation in his office he said, “perhaps I should have used ??? with large vent holes. Perhaps in one ear, but not the other…”
I appreciate your comments about ENTs. I thought they would dispense and setup hearing aids too.
Now I get to figure whether I want to use one of the audiologists he recommended or find one myself…
So far I’ve lost the audiologist lottery but I keep buying tickets. What a mess.
DaveL
Toronto
Closed domes might be fine, depending on your ears. If not, then custom tips would be the next step given that power domes have already failed for you.
Re-adjusting for different acoustic coupling matters to varying degrees depending on the coupling and the ear. I know that I am beating a dead horse with this, but I don’t know how a clinician would ever get a feel for how much and when this would matter without seeing how it impacts the gain output with. . . real ear measures.
Thanks. I appreciate your advice about custom tips.
Now I don’t have an audiologist. We did part on good terms
It’s really hard and I don’t know what to do to find the good audiologist I need
Sincerely
DaveL
key question–how do I find an excellent audiologist who knows the Phonak Audeo Paradise P90R’s setup inside-out in Brampton/Mississauga/Oakville?
And I’m a WSIB client.
DaveL
Mississauga
He set up autosense and other programs for the period from August /22 until that visit. He always used REM. That Friday he scrubbed the programs and they’re gone. I’m interpreting that he used quick fit. He said he restored the PHONAK programs, and set volume at 110%. He didn’t use REM. So I had 2 programs; rest were gone completely. autosense and a “calm” program which mirrors the settings of autosense.
When I got home, I couldn’t hear at all. So I turned the volume up, a notch at a time. In the 10 days since, it’s almost always been +3; sometimes +4. Based on those settings I hear better than I have the entire time I’ve used these hearing aids.
He says he knows PHONAK, and talks to them regularly on a first name basis. I’ve found him very helpful, polite and generous; however, the experience has been terrible. He is an audiologist.
I’ve followed his advice and used the APP. and passed on what i learned to him. I had a program from this forum which truly helped. It was intended to be used when talking with people wearing masks. I wish I had that when I was in hospital overnight for a heart procedure. I couldn’t understand doctors and staff at all. I posted about that. That “mask” program was scrubbed.
While we parted on good terms I feel he sent me out the door with hearing aids that didn’t work. If I was a new hearing aid user I wouldn’t be able to hear with them in use now. I know how to use the APP. In the old days the only tool I had was to increase volume until distortion occurred. (These are my third set of Phonaks and are coming up on 2 years old end of August.) Phonak Audeo Paradise P90R’s.)
Thanks for talking to me about audiologists and your suggestion.
JordanK was helpful and told me who set up his lumity hearing aids so well. Thanks Jordan.
My used-to-be audiologist provided me with a list of 2 too. He didn’t emphasize private clinics as I wish he had, and you did. I had horrible experiences with Listen Up Canada, and the company that bought Peel Audiology where I was a client for 8 years too long.
DaveL
Mississauga
ps Thanks for your suggestions! They truly help. I believe that it’s important to select fitters and audiologists very carefully. I
I hope one of the places I suggested works out, or that you are able to find a good fitter through word of mouth, which I think is usually the best way when it comes to medical providers.
As for what happened in your case that has left you where you are, I don’t know. It might call for an interested interogation of the historical data that exists, if your fitter had the time or proclivity for that. REM is the gold standard, but it does take some skill. I recall a clinician on these boards saying that he didn’t use REM because “you never get the same results twice”. This is untrue–I thought of him just the other day while looking at an REM measure that was identical 2 years after fitting. There are a lot of points of variability in hearing tests and hearing aid fits, and one needs to be sensitive to them. I can see how a clinician trying ernestly to implement REM but who works alone in a clinic with no mentorship/support might reject REM because they lacked the skills to troubleshoot it. If you cannot recognize that the gain response looks a bit funny at a certain frequency because of issues with probe tube placement, acoustic coupling, hearing aid positioning, and other various and sundry, then the approach would be to correct the gain at that point in the software even though correction is not required, and that can lead to some funny results. I would say, looking back, that my schooling on these issues was probably a bit lacking. So how does one come to a good place in this? Good mentorship, a particular curiosity, experience.
The other place where things can get weird is in how clinicians respond to patient requests. The part where a patient comes back and says, “I don’t like hearing [this thing that I am currently describing in a way that no other patient has described it]” and the clinician attempts to interpret that complaint and apply it to making changes in the software really is the “art” part of a fitting. There are no specific, 100%-agreed-upon ways to address each of these issues, just a general clinical consensus that is stronger in some cases and weaker in others presuming you can correctly interpret what the patient is describing. Users of this forum seem to put a high regard on their fitter “calling the manufacturer” about their problems, but the person on the other end of the call is also an audiologist providing their expert clinical opinion rather than some sort of magical manufacturer oracle. That expertise will vary just as anywhere else; manufacturer audiologists generally do have a strong training on the particulars of the individual software, but sometimes they have weaker clinical experience. This process of patient report and fitter adjustment can be magical sometimes, but I have also seen it get to some very weird places, particularly with young colleagues who are bending over backwards to try to make a patient happy. It’s one of the things I worry about when some users on this forum counsel others to go back to their fitter a dozen times to get things “perfect”.
So that’s just a long way of saying that there are a lot of points of failure and I cannot guess where things went off the rails for you.
My first Phonak Hearing Aids were perfect because my audiologist was absolutely incredible.
My last audiologist said he was 59 as I was leaving. He’s been in business a long time.
I taught 2 summers in a community college in London Ontario Skilled technologists know procedures and follow them. Their goal is reproducible results.
It’s time to move on. I’ve did go to the internet to start making a decision. I truly prefer independent audiologists. One is a Dr. and she works with the WSIB according to her site. She’s the first I’ll question and see if there’s a fit there. Thank you so much!
I truly appreciate your comments and assistance. Thank you so much.
DaveL
Mississauga
Hi Dave, I am just west of you in the “belle Province” here we can’t go to those big box store since the Audi’s control who can deal with Ha’s, I don’t have issues with this, having just upgraded to the Paradise P70, fitting was everything, took her 2 hrs to do the first fine tuning, having experienced 2 months ago trying the Resound model, she did the REM again, unlike last time, I asked her to show me her computer screen, last time she used the hearing test as a basis, it was so loud I stopped wearing the Ha’s after 1 day, this time we balanced the frequencies according to the test but toned down quite a bit to match what I was actually hearing, and keep the gain t a level that I was comfortable with, what a difference, my next appointment in a few weeks will be to just fine tune the alternate modes as the Autosence seems to be doing a great job. I opted for the 13T type since connecting with my house portables phones was no longer possible, with the T-coils it works great, I did add a 20mm dia. x 3mm thick earth magnet to each unit to enlarge the connecting area in that mode. Being a Ham radio op. dabbling in things comes as second nature. All this to say, yes I did have my reservations on my Audi to get it right (almost the first time) and she did a great job with me, suggesting adjustments all along, working as a team is probably the most important part just after knowing how to do it, having spent a small fortune on the new Ha’s (no gov. support for them this time around) it was vital to get it right. Good luck on your quest.
P.S. the connectivity of the Phonak’s is great, the Resound ones was like going back 10years, at least for me is was a no brainer.
Thanks so much!
I appreciate your comments and recommendations very much.
I haven’t chosen a new audiologist yet. I’ve spent time looking. I need to talk to some of them now…I want an independent audiologist as you recommended.
DaveL
I love your image…have a Springer Spaniel Pup that thinks he’s a big dog and fully grown.That’s after 2 Westies, then 5 Goldens spaced through about 35 years.
I’ve known from the beginning that my issue is setup. My audiologist was very helpful, and a gentleman. Two weeks ago he scrubbed the programs as we had set them up over almost 2 years of trial. He also setup my very first Phonaks that i got about 10 years ago. They sound better than my Paradise P90’s! I told him so. That caused the split. He advised me politely to find someone that would be able to help me more. He didn’t do REM. He always did before. I think he used the PHONAK quick fit program. I crank the volume up 3 notches and hear better than I have for the last 2 years.
So…I need to win the audiologist lottery. There’s no excuse for it to have taken so long.
DaveL
Her name is Jenna, she’s 11 now, our 3rd Rotty, she has issues like most dogs by now, all under control, still feels like a 2 year old most of the time and just loves everybody.
My hearing is also under control, someone posted “I can hear my wife in the other room” and other stuff like that, I have decided for bat’s replaceable for many reasons, these new ones have improved hearing people on the street 100%, great at cutting out those loud leaf blowers among other thing.
Cheers K.