Fine tuning suggestion that helped me

Hearing Aids
#61

I really appreciate that you respond to our questions and address our concerns with good information and questioning Neville. Thank you.

You asked:
“But then you go out into your regular environments and it’s NOT experientially obvious to you that the hearing aids are any better than your previous set. . . do you keep them because of those tests even though you don’t notice any improvement? I wouldn’t. So I’m interested in what it is specifically that you are looking for? Just a wider range of ‘how does this sound now’ tests?”

I get what you mean about test results vs in day-to-day world experience. Thinking about your question, we’ve already discussed soundscapes so that’s not why I said I agree with MDB about the desire for objective evidence “unless the increased audibility was as experientially obvious to me” as the example I’d given of word understanding mistakes. I think I had brain adaptability more in mind. Your explanation to fbacher1 about not having good research on how long it takes to adapt seems to speak to the issue.

In very practical terms, if we don’t know if a particular hearing aid will alleviate a particular hearing problem and we don’t know how long it takes the brain to adapt in order to find out, yet we have a 30-day trial period to decide to buy or at best Costco’s 6 month trial period, then how are we to make the decision? If we trust and rely on our hearing experience coming up on decision time and changes we wanted haven’t happened, then I guess we give the aids back and start over. Or we keep them after a hearing professional tells us our brain still needs to adapt. But there’s no research that says how long that adaptation takes, for whom, or under what conditions.

I wish I could go to the fitter this weekend and he could look at the hearing issues I’m having with the aids and tell me, yes, this particular hearing aid can resolve that or no it can’t or it’s unlikely to and that’s based on evidence, not marketing materials. If that were possible, I wouldn’t be spending all this time reading, reading, trying to figure out what all this technical hearing info means and how to apply it so I can hear better.

#62

Should a boat yard lend you a boat for six months while you work out how to use it in lots of conditions, learn how to maintain it, cause wear and tear to it and make it unsaleable to another customer at their expense?

I agree it’s a bit of an obtuse example, but if you want to engage with the provider: surely they have a right to some recompense from the process?

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#63

I wasn’t suggesting an office soundscape. I was just stating that to me, there’s clearly a desire among a fair amount of people to have some objective demonstration that their hearing aids are doing something for them. I think that’s why we keep coming back to people doing tonal sweeps at home to see if their hearing aids are working properly.
One idea I had would be to look at the speech banana and show what sounds one is missing and then play words with those sounds with hearing aids off and then on. Also might be useful when people want highs turned down to show what they’ll be losing.
It really is a conundrum as I realize an audiolgist’s time is a limited resource. The forum is certainly a very skewed sample. (My Mom was an easy patient. Try them on. Yes, she could hear. Come back later and have them turned up a bit. Done.) In a way some kind of demonstration would be a bit like a vacuum cleaner demonstration. Likely no scientific validity, but it helps the client believe in the product. I think the alternative is either a lot more time spent with education or a dissatisfied client

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#64

The CI evaluation covered many things beyond the hearing loss.

I remember many questions about family, work, activities, life in general. This turned into how badly I wanted to hear. Will I put the effort in to learn how to listen and learn speech.
After that we talked about speech rehabilitation and expected times to understand speech. This conversation was all over the place time wise. It was made clear the CI might not work but success was a high percentage based on my effort put into rehabilitation.

When my high frequency hearing went really bad I learned more about frequency lowering technology. Don, the OP was the reason I pursued it. The reason I bring this up is learning to understand speech with aggressive frequency lowering is not far off from CI. It’s not as difficult as CI but it’s a learning thing.

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#65

I waited a long time until my hearing loss (due to loud noise at work) was bad enough and I qualified for Ministry of Labour help for hearing aids. I couldn’t afford to buy 2 hearing aids. I was told about “neural adapting” and thought, “yeah sure”. I regret waiting.

DaveL
Toronto

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#66

I find very interesting the idea that adapting to frequency lowering might share some similarities with adapting to CI!

#67

Sure, charge me for an office visit. But not thousands of dollars for a piece of medical equipment that you can’t be sure will solve the problems. And the boat analogy indeed isn’t a good one.

#68

I thought it was a pretty good comparison.
Like test driving a new vehicle for a few months as a trial. Then saying no, I don’t like the way it looks and return it.

It’s a catch 22 situation sometimes.

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#69

It’s not about returning it for the way it looks but for the way it doesn’t function for the purpose you bought it. A boat is expected to float on water, it’s engine to start promptly and run continuously when switched on, and be capable of being steered. That’s all unless other selling points are touted. If it doesn’t do those things, yep return it (within some time period that’s usually specified by law, sales contract or warranty). There’s no expectation that it could be operated on land or any other environments by a specific driver.

And it’s an optional purchase (for most people) not a medical necessity. A hearing aid is necessary and expected to help us hear in all environments we’re in. If it can’t then yes, return it (within the specified timeframe).

Operating the boat under all conditions and it being an optional purchase are to me what make it a poor analogy to hearing aids. But I’ll repeat, of course hearing professionals should be paid for their time and expertise.

#70

Ah, but ALL hearing aids will support adaptation so long as they aren’t under-powered for the loss or the acoustic coupling to the ear is poor. You don’t need to worry about picking the wrong one for that, you just need to worry about engaging with your clinician and committing yourself to wear. You need to worry that they are physically comfortable so that you CAN wear them.

Have you told your fitter about what hearing problems you are having and asked them whether this particular hearing aid can resolve it? Because they can probably tell you.

Maybe the category of question is the issue. If you are asking, “is there a hearing aid that exists that will allow me to hear better than this one, given the limits of my individual hearing loss” and you presume whatever hearing aid you are already wearing is well-fit (i.e. no CICs for people who need UP BTEs, demonstrably providing the gain we want it to provide), at that point the differences between different devices are too small for our current objective tests to tell us. And yet, experience differs because humans are incredible machines for perception and pattern recognition–variability may be too large for us to identify small differences with a time-constrained, discrete test, but given constant iteration over time people may notice a difference. The comfort you can take from that is that you’re not libel to make a really WRONG choice when selecting hearing aids these days, unless you’re going against a firm audiological recommendation, which can be rare given the flexibility of modern hearing aids (again, this is usually happening when a patient demands a CIC and a CIC is inappropriate for their hearing loss). But I understand the decision paralysis, particularly on this forum full of optimizers who are super concerned about a 1% improvement in sound quality. But if there were one hearing aid that was obviously better than another, comparing similar tier devices from different manufacturers, all clinicians would just fit that one. Individual clinicians have their preferences, and I would hypothesize that in most cases these days those preferences are driven more by behind-the-scenes stuff than by the clinician having strong objective evidence, or even opinion, that the sound quality of one hearing aid was dramatically better than another. For example, if one patient has to have the top of his ear cut off due to skin cancer outside of the trial period but during the warranty, will this manufacturer switch his RIC to an ITC at no charge? Given two very similar hearing aids, if a clinician feels that they will get more support if they run into unusual trouble from one manufacturer than another, that’s probably the way they will lean. This doesn’t impact the patients who don’t happen to run into that problem at all, but on the aggregate it allows the clinician to provide better patient care. One of my manufacturers will swap out my pediatric hearing aids with higher-powered devices during the warranty period if the child ends up having progressive loss–absolutely I’m going to go with that one over a nearly identical device from another manufacturer that would require the family make an entirely new purchase 1 year after the initial fitting.

On the other hand, if your questions are more like, “Can a hearing aid resolve my /s/ /sh/ confusion given my loss?” or “Can a hearing aid help me hear better at the hockey arena, or do I need another device?” “Is this hissy sound something that I will adapt to or something that we can adjust out?” Those are all questions your provider can answer. They are probably not things that you can find an answer to in manufacturer marketing brochures comparing “speech enhancer pro” to “clear speech premium”.

I think I’ve gone way off topic, but I’m out of time. I’ll have to edit later to try to make this more concise and relevant.

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#71

With a boat or car the research you do about it can be a lot more useful. And just about anyone can learn how to operate a boat or car, maintain it or pay someone to do that for you. After you’ve poured over the reviews and specs the rest is just person preference. But with HA and the huge variable of the human brain involved I would say the boat and car analogies are a pretty big stretch. It seems like the sound quality individual perception of the various HA vary a lot depending on your hearing loss and human sensory variable that can’t be quantified in a very accurate way. For instance why would someone with a similar hearing loss to mine fine the Rexton BiCore utterly fantastic and use descriptions like clear and rich sounding while I found them so tinny and distorted as well?

Given the lack of discrimination in the simplistic audiogram relative to complexity of the process of hearing and understanding, it’s no wonder many of us would demand a “test ride or two” before committing to such a large sum of money and time. I was only able to demo out the Philips and Jabra inside the CostCo warehouse and while I chose the Philips over the Jabra I’m not even sure now if it was the best choice for me but so far a lot better than the BiCores at least. I am committed to working with my fitter and trying to give these Philips HA a chance though. It’s only been about 3 weeks but right away I knew that sounds like my feet shuffling on the floor, water hitting a plate, the sliding of my fingers on my guitar strings, dishes/utensils in the nearby kitchen were all very uncomfortable to me (think cringing uncomfort) and I needed further adjustment. It didn’t take more than a day or so. The process of waiting 2-3 weeks every time for a minor tweak is so inefficient in my mind and frustrating. It may in fact take 6 months before these every get sorted out for me. I can see why many of us resort to DIY at some point because no one can hear what I’m hearing the way I’m hearing it and words sometimes fall way sort of describing the issues. When I tell my fitter it sounds distorted she is confused because she explained that means something different to her than to me a guitar player for instance. Better to say garbled, tinny and sharp I guess… anything but clear and rich, lol.

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#72

Scratch the ‘boat’; say Whitewater kayak. Or at least the kind of craft you need to develop a skill set to use properly.

I can tell you you’ll probably prefer a Jackson Zen over a Dagger Code: I can set-up the outfitting for you, I can fix you up with the correct length Werner Powerhouse paddles, dry-suit, Buoyancy Aid and Spray deck….etc. I can even get you launched.

Does this mean you can float? Yes.

Does this mean that you can run a a G3/4 set of rapids or surf a river wave off the bat without lots of practice, adaptation and development? Should I lend you the few thousands worth of gear while you’re getting your practice in?

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#73

If you’re a kayak dealer, I guess not. If you’re a whitewater training and solutions and support center, charging a price that’s well above that of a bare, unsupported kayak, then perhaps so.

Analogies on this forum always seem to hit the rocks, in my judgment, once you scratch the surface at all.

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#74

Still a lousy analogy. Hearing aids are to be able to hear. Period. No one should have to be a sound engineer to be able to use a medical device. Last I’ll say about it.

#75

In New Zealand my audiologist offers a HA trial for RICs but at a cost of $400 if I am not satisfied. The $ pay for discarding the HA receivers (in ear canal speakers) on health grounds and sanitising the HA bodies so she can resell the HAs. Seems fair to me.

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#76

I still see it as part of the topic because as you say any of today’s hearing aids can do the basic work, but then we need the fine tuning–improving what can be improved. How to know what can be improved, I agree no marketing materials get anywhere near the kinds of specificity we need. Again, thank you for taking the time and typing to explain. I think I’ll just leave the discussion here at this point.

My appointment with the fitter is tomorrow. I’ll ask him about the issues I’m experiencing of course and hopefully he can adjust the aids to remedy them. I’ve been doing so much research on my own because the initial fitter is so fresh out of school that she didn’t even know how to set up a program in my aids or answer any question I had. The fitter I see tomorrow is experienced, but he’s the only other fitter they have right now. So my confidence isn’t very high. Hopefully it’ll work out fine.

But like @fbacher1 keeps saying, weeks of waiting to be able to get changes made that “maybe” will work is kind of ridiculous. My brain may or may not be adapting during that time, but we may be adapting to just living with sub-standard hearing aids or dropping them into a drawer if we can find a way to manage without them. Likely none of us involved in this forum would be able to do that but many, many people do.

#77

To add more oil to the fire, for phonak paradises I was quoted something like 200 eur per aid, in case I need full hardware replacement, if for example I smash it with a hammer but bring all pieces. That was the condition, I have to bring everything back, and I’ll get new shells with same internal ID and my roger licences inside.

Show me boat where whole hardware cost is such fraction of a price :slight_smile:

What we’re paying in aids is software research and development and fitter time and expertise. Hardware is cheap.

So trial period of several months and us paying for the used hardware, I see no problem.

If it can be a month with us, it can be six, in both cases it will be destroyed on return probably. Since they probably cost just 20 to produce anyway.

Hygiene reasons are the same, if I wear it for a day, or for a year.

So, I think only reason of them not doing long trials is because that you can’t go all over the providers and basically have aids for free, doing trials, with or without us paying for hardware only. Can’t see any other reason at the moment.

If we’d have unbundled prices, and pay fitters per hour, then such usage wouldn’t be possible. But people wouldn’t want to pay for many fitting sessions if paying directly. Or they’d expect miracles from each fitting.

Basically knowing as much as we know here is kinda curse - other folks just live with 3-5 k price a piece and getting free unlimited fittings and maybe even batteries and yearly checkups. Deal and a half :slight_smile:

That’s the same illusion as so many in European countries being convinced that their healthcare is free. It is not, it just more or less directly paid form taxes. And some immigrants in Switzerland are kinda dumb, because they see bills and ‘everything is expensive’ (we have yearly max cap, premiums, deductable and co-pay included), and they don’t realise how much transparent system is actually.

Or any other ‘service included’ package. That just means that you were billed some average amount of hours times price per hour immediately when buying a product.

That being said, even bundled is better than subscription model. I dread the moment when some hearing aid manufacturer will come to this great idea of eternal monthly payments argh…

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#78

Because of the fit.
But also, looking at your audiogram, if this is your first set you’re up against. . . what, 20 years of creeping hearing loss? It’s going to take some time.

Eh, that’s tough. Reverse slope loss can be tricky.

#79

That’s insurance. The price is spread across all the people who also get it but don’t lose their hearing aid. So, sort of like saying if your car gets smashed, you’re only paying $1200 a year for insurance therefore the car must only cost $1200.

That said, I see what you are saying. Know that there ARE clinics that are leasing out hearing aids. I think they are still hard to find. The benefit of this, of course, is that you are not committed, you can move whenever (likely with a penalty), you can always move to the most advanced device as it comes available. There’s certainly a premium on the pricing structure. Is this something that interests you?

#80

No in the case of your example I would be willing to rent the gear to evaluate or take some lessons first using the gear I’m thinking about buying… Like someone said analogies sometimes fall short. I’m not into Kayaking but I bet like mtn biking it can take a lot of practice to improve and of course desire to get better. I have all kinds of desire to hear better but if I’ve got a less optimal HA for me then my desire won’t produce results. Sure I would be willing to pay to rent a HA. But I was happy that my fitter at least let me demo two of them for a time. But I had to pick one with what I thought was very minimal information. You can read the marketing hype and specs all day long and not really learn much. And given the variability of biology, it’s easy to find haters and lovers for all models online. It almost came down to a coin toss in the end. At any rate I’m hoping some fine tuning will improve things for me so they are not going in a drawer or back to Costco…not even close at this point.