Fine tuning suggestion that helped me

Hearing Aids
#81

No, this wasn’t insurance at all. It was cost for new hardware and transferring my licenses.

If you lose aids, you can’t get such replacement. It’s only for hardware damage. That’s why you have to bring all parts.

Actually I was offered insurance and was asking more questions, that’s how we (fitter and I) found out about this ‘bring pieces, pay for hardware only’ option. So I concluded that I don’t need to pay premium for insurance (would be half price of new aid), since I was only concerned with heavy damage and not losing them. So 200 eur per piece sounded perfectly ok sum.

I used that just because that’s how I found about price for hardware itself. Aids were 3k a piece.

So if for month trial my fitter returns aids, and they probably just destroy it as opposed to detail cleaning and testing, I don’t see the difference in cost for doing 3-6-12 months trial. It’s still the same hardware and same trash bin.

And he didn’t pay a thing for such returns. I’d knew because he’d tell me, he was very open and transparent.

#82

Did you pay it before or after you damaged them beyond repair? If before, it’s insurance. If after, that’s VERY different from how it works where I am.

#83

It would be paid after. I didn’t break them, I was just gathering information about my options. As I said, basically just shell replacement, directly from the manufacturer. Germany. Info directly from Phonak through my fitter. Maybe if you’re buying through some reseller they don’t want to bother with that.

I also asked about changing battery in select and on, and they confirmed it would be possible.

That’s one of reasons why I didn’t took the insurance.

#84

I read this comment with interest (and your others in this thread). I can’t speak for others, but I have had similar questions.

I have been wearing hearing aids for ~22 years. In that time I have had several pair, and due to long distance moves and retirements, I have seen 5 or 6 or 7 different audiologists. In every case, they do an un-aided tone test and an un-aided speech recognition test, and tell me that “based on these objective criteria, you would benefit from (new) hearing aids”.

I buy the new aids, the audiologist loads up their programming software and sets them up, and then says (in a quiet and often echo-y room) “how does that sound, good?”.

Everything that comes before the sale is presented as objective, scientific. After the sale it’s objective, and about whether I like the results.

Why is there no tone test with the aids? Why is there no speech recognition with the aids? Whether I LIKE them or not is far less important than whether I hear better with them.

What I, and I think others, are asking is why there is not some kind of before/after validation that gives some empirical evidence that the money was well-spent.

That’s what I wish for.

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#85

I asked my fitter to do it. Ok, he has only words / wrs test (Germany), but we did several tests.

I’ll try to remember the results. But the difference is important.

I have loss just on right side. So, we did in quiet with right aid, and with two. Same. I think wrs was around 90-100. No wonder, I have good ear, I don’t need aids in quiet (I need aid in right so that my brain doesn’t forget there’s an ear). I think my result on test for right ear with headphones was 70.

We added white noise from behind (he doesn’t have other sounds unfortunately). One vs two aids. Same shit, poor results. Like 60 or even lower. Paradise P90 aids, so top of the line at that moment. And simplest noise to detect.

Then I put select microphone under the speaker in front. Two aids. White noise from behind. 90-100 wrs.

That was what I felt through my experience, but having it measured and repeatable, definitely convinced him as well why I want microphone. We did it to convince insurance I need microphone, but they didn’t ask for such details, they wanted something that wouldn’t show the difference at all. So we went above and beyond. They rejected the claim :joy: after half a year of back and forth, after my husband quit the job, they magically approved. No clue is that was what triggered them. But they definitely wasted more money on specialst reviewing the papers than what’s the price of the mic.

My fitter is one that aims for cheapest solution that solves the problem, so he wasn’t keen on selling me 90s nor microphone. For 90s he had to trust me that I feel the difference when autosense kicks in for echoey environments, for microphone he saw clear difference.

Not to mention that this tests took like half an hour to an hour with all discussions. And convinced both of us what’s really best solution for us both. And it’s dummy test, no sentences at all, no hard noise. But it should be available with any fitter. And doable. And you could check on the spot if some setup really makes a difference or not.

Going forward, that’s the minimum I’ll ask to be tested with every new aid. (I’ve moved countries, so unless I travel 1000km to this great fitter, I will have to find someone here, so far no one says they’re doing REM :confused: )

Because inventing testing situations at home is harder, plus, I want to engage in conversations, not testing the equipment all the time :joy:

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#86

I can only confirm this @Blacky .
I bought my Paradises online in another country. Paid extra for a 5-year warranty extension.
However, I was concerned about long periods without HA in case of repair.
Then I found a local provider willing to send it to Phonak for repair for me. Even though I had not purchased them from him. For a small fee for his trouble.
He explained to me the following:
Phonak charges 200 CHF (equivalent to about US$200) for any repair - even non-repairable ones.
So the hardware cost must be well below that.
Maybe some providers have a different agreement.

#87

If you haven’t been getting those follow-up assessments, you just haven’t been getting gold standard care. Aided testing in the booth used to be common standard prior to the introduction of real-ear measurement (REM) which gives you the same information and more quickly, and aided tests are still used alongside REM or in cases where REM doesn’t work (cochlear implants, BAHA for a bit longer). Modern hearing aids don’t do well with pure tone testing in the booth because of feedback management and compression algorithms so REM is preferred. But if REM is NOT being used, then yes the clinician should still be validating with aided speech tests. One or the other, at least. REM has been around for longer than you’ve been wearing hearing aids. Modern REM will also estimate aided word recognition reliably, so the clinican already has that information once REM is completed. REM or simulated REM can validate directional microphone and noise reduction functions, but many still validate using speech-in-babble tests in the booth–although in a lot of cases the clinician already knows from unaided SNR to what degree the hearing aids will (or will not) help in noise.

So, it’s not that those assessments don’t happen, it just sounds like you haven’t been getting them? But I actually don’t have a strong idea about how access to different levels of clinical care differs from North America to Europe. What I was more interested in was what people were looking for in addition to REM or aided speech tests that they felt would help them more, and then thinking about whether what they are asking for actually gives the clinician much more valuable information or is just more of an artificial marketting demo that I might argue is not necessarily more useful than simply wearing the hearing aids in one’s own environments. And then the additional confounder of allowing for adaptation rather than adjusting everything to patient preference immediately. I cannot count the patients who come back after four weeks and say, “everything sounded sharp and intrusive at first, but now it sounds fine.”

I can’t say I love that your clinicians do a hearing test and look at it and say “this means you would benefit from new hearing aids” if that’s really how it usually proceeds. That’s not rational unless your hearing loss has progressed beyond what your current hearing aids can support, or your hearing aids are malfunctioning. If your existing hearing aids are functioning well and adjusted appropriately to whatever change in your hearing loss has occurred, the clinician is just guessing that you’d benefit significantly from new hearing aids–and what degree of benefit is of value to you, personally, anyway? Certainly a clinician might say “in my experience, patients notice improvements with new technology at the 5-year point” or “new hearing aids are now able to do X, which you may find beneficial relative to your old hearing aids” and a patient may hear it as “you need new hearing aids”. There are also some practical considerations about how long you want to keep putting money into assessing and adjusting old hearing aids rather than putting it towards new ones.

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#88

Absent from the original post is whether there had been an audiologist involved in testing him and then first setting up the H/As. If so, this is a case of malpractice. If not, why not?

#89

@Neville your posts are excellent and help me so much. I learn from every post Thank you!

DaveL
Toronto

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#90

I went back to this tone generator last night to test it without my hearing aids because I know some sounds are loud to me even without those devices and with them there was the distortion (that Neville explained the reason for).

I know sounds in our daily environment are more complicated than hearing a single tone. But, It really makes me wonder why I can hear all the standard frequency intervals from 500 to 8000 at 5 percent volume but lose so much of speech in day-to-day settings. (I probably could have heard with less volume but didn’t test that.) I can even hear 10,000 at 45 percent volume. 250 I couldn’t hear even at 100 percent volume.

Looking at my audiograms since 2008 (had already been wearing aids more than a decade), the amount of loss at 1500 and below hasn’t changed. Higher ranges have dropped from normal to around 50 or so during the most recent 8 years. Just adding this info in case it helps make sense of the difference in my hearing pure tones and day-to-day environmental sounds

#91

@Blacky: I find this to be an extremely astute observation → and well-put, too . (FWIW)

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#92

I had an an adjustment today on my 9030’s. I had anticipated that my fitter would lower the high frequencies for me based on the fact that I had to lower the volume right after the last appointment by -2 to -3 steps, each step being -2.5 dB. I also told her things like running water, my feet on a hard tile floor, kitchen noises and shaking pills in a bottle for instance were harsh and sharp to my ears. I figured lower high frequencies based also on what the HearSuite program suggested with these complaints. But instead she said the NAL2 fitment raised high frequencies too much for some people and instead used the fit4speed fitting. Having gone thru that now I can see that it does lower the high frequencies from 3k to 8k by -1, -5, -9 and -11 at 3k, 4k, 6k and 8k respectively and raises the mid frequencies by 2-4 dB compared to NAL2. And I am still at “80%”.

I’m not sure that this solved my issues and didn’t create others (my voice sounds like I’m talking in a well sometimes) and I’m still lowering the volume to -2 or 5 db lower to feel comfortable. I’ll have to test this out some more but I can see I’m far from where I would say…wow this is really perfect. I have my NoahLink now but I’m resisting a DIY move right now until I understand more. If only the app did a lot more than just volume I could really try more things out easily on my own, right on the spot when I’m experiencing the issues. I do realize that with so many variable I could easily screw things up too, lol. At some point these HA will be like over the counter HA in that I will be making my own changes as I learn more about what makes things sound better to me. Oh there’s also a fitment called fit4comfort and from the numbers I’ve looked at the corrections that one makes are extremely conservative compared to the others.

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#93

Hearing loss isn’t just everything being too soft. It’s also a loss of frequency specificity (1000 Hz and 1001 Hz no longer sound different) and temporal specificity (small gaps in sound are no long detectable). This frequency and temporal smearing leads to decreased clarity and it impacts your brain’s ability to differentiate target sound from background sound, including not just obvious background sounds but also the sorts of secondary echoes that we don’t typically think about but that a normal hearing person uses to perceive things like, “how big a room am I in and what is it made of?” Two people with seemingly similar audiograms can have different degrees of these sorts of losses. In particular, reverse slope loss is correlated with different types of cochlear damage on autopsy (more supporting cell/stria vascularis involvement; ack, I can’t find the paper I want) and, anecdotally, they tend to be worse off when it comes to clarity and speech-in-noise processing.

And then there’s audibility. Hearing aids do not return full audibility because adult users find it loud and unpleasant (and because there are limits to what we can give while avoiding damage when the dynamic range is reduced, but this is often secondary to patient comfort). But the brain cannot use what it can’t hear. So when, for example, fbacher is having his clinician turn all of his high frequencies down, he is giving up audibility at those frequencies where he has hearing loss. At two and a half weeks it seems a bit premature, but if he cannot tolerate them enough to push consistent wear, he could consider turning them down to comfort and then actively work on turning them back up to prescriptive targets over time with the understanding that he will not have optimal benefit while they are underfit. (Although often what happens is that patients turn down to comfort and then never try to increase again.) With reverse slope, patients are often even less able to tolerate low frequencies because of the bothersome self-noises and upwards spread of masking and it is very typical for individuals with progressive reverse slope loss to be lacking low frequency audibility for this reason (as opposed to individuals born with reverse slope loss and fit early, who simply adapt to low frequency gain during development).

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#94

I have about 3 months now if you include the 2 months I had trying to get the BiCores to work. Same issues but also a lot of distortion with the BiCores and one HA failed on me as well. I wore the BiCores 14 hrs a day as I’m doing with these Philips 9030’s. With my hearing loss has also come loud noise sensitivity. Loud concerts are painful and over the years I’ve worn my hifi ear plugs to protect myself a bit. I’m either telling my wife speak quieter or saying huh or what even with the HA. And while I’m not deaf like a few others in my family I know I struggle in noisy situations and the world in muffled without the HA. So I appreciate what they are doing for me even at 80% and with the fit4speech reductions which might not optimal yet. No substitute for the real thing and after 3 months at this I’m a bit more realistic with my expectations. I have actively tried to bring the volume up back to zero and probably need to renew that effort with this latest adjustment.

The difficulty I have of course is describing to my fitter in a way that she can relate that to some frequency range that needs adjustment. Shrill, sharp, hollow, artificial, well like, distorted all seem to describe the same thing and maybe not necessarily a high frequency issue. Looking at some of curves and gain applied I see no gain added below 1k due for NAL2 due to the fact that we are only at 80% insertion gain right now. Fit4speech does add some gain from 500 hz to 1kz even at 80% and of course much less at 4-8 kz.

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#95

Looking at what fit4speech change did relative to NAL2, it lowered the high frequencies way more than I was doing with the volume control and it raised the low frequencies to the point where my voice is very hollow and annoying where that was OK with the NAL2 settings. I think I want my fitter to go back to the NAL2 fitting and just lower the high frequencies 2-4 db and not the 5-11 db like the fit4speech fitting did. My voice is too annoying and giving up 11 db at some high frequencies was too much. I think just 4 db at 3-8 kz might allow me to set my volume back up to zero and then go from there.

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#96

This is fascinating. Finally an answer to my lack of clarity with speech that makes sense to me. I checked the tone generator for 1000 and 1001, 1002, etc. You may not have really meant that degree of precision but I couldn’t distinguish a difference. I could tell a difference between 1000 and 1100, I think. And I’m going to listen for those gaps. I know I experience a lack of them–now that you mention it.

If two people with similar audiograms have different degrees of these kinds of losses, then presumably the fitting algorithm may not match very well for a particular individual, right? I guess that’s why it takes a lot of trial and error for us.

I definitely experience that masking you’re talking about with reverse slope. I’ve been wondering over the last couple of days if I could learn to live with the bothersome self-noises, but I’m not sure even if I could whether it would help with my other hearing in part because of that masking. I should have my custom molds in a month and I’m looking forward to seeing what difference that makes with the Philips. The fitting software recommended much smaller venting (0.8 and 1.4) than you’d said (2 mm) and in the molds I’ve worn for a long time the vents must surely be at least 2 mm. Tough to measure a small hole with a ruler. :wink: The fitter said he’d submit special instructions to maybe get both to 1.8. I figured, close enough and if not hopefully Costco will just make them again. Presumably the smaller ones are more likely to give me those bothersome self-noises and closed in feeling.

I’m thinking about musical training. For that to help my hearing (which it very well may not unless it can diminish all these reverse slope issues), does it matter if the sound comes through headphones rather than out into the open air? Trying to spare my spouse! :slight_smile:

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#97

Our hearing is so weird. I find this happening too. Sometimes my spouse’s voice is so loud (to me with hearing aids) that I turn them down a notch, but at the same time–even at default volume–I can still miss some words. I too am trying to learn to keep from hitting the down button though and see if that makes any difference eventually. I’m starting to wonder about the Philips because with the Phonak P70, I never mistook a word nor was her voice too loud. I think too I liked the Phonak sound better–more natural and “alive” as I’ve heard someone refer to it but never knew really what that meant until I popped in those P70s and now have the Philips sound for comparison. Hopefully we can get the kinks worked out with the Philips though and even if it doesn’t sound as alive, it’ll make hearing easier and more reliable.

“The difficulty I have of course is describing to my fitter in a way that she can relate that to some frequency range that needs adjustment.”
This is what I’m wondering too, which is why I’m trying to come up to speed on terminology and how the technical aspects of hearing and hearing aids work as quickly as possible, but I don’t even know yet what some of the things you’re saying here mean. I wish there was a crash course for this instead of the hunt and peck. I surely, surely am grateful for people on this forum.

#98

Um_Bongo, I’m not leaving it on one single tone. I’m cycling through a range until I find a dead “spot”. If I stop on any frequency the feedback processor does kick in.

Just guessing each frequency would get .1 second. When I find a dead spot I cycle through it back and forth, well into the good range (well, better) to get a good idea the size of the dead spot. A dead spot is not just one frequency. It is a small range. It varies.

I have no way of using speech to test for dead spots. Also, I don’t think I can use the Audiogram feature of Target. I’m not sure what the precision is or if you can set that, but I would need to test 4100, 4200, 4300, 4400, etc.

Cycling through by turning a wheel gives me a quick picture of my dead spots and it doesn’t trigger feedback.

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#99

Yes! Phonak brands call it Sound Recover.

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#100

I did. The typically-hearing human ear has a just-noticeable-difference for frequency of about 1 Hz and gaps of about 1 ms. These would be measured in lab conditions, mind you–I certainly cannot tell the difference between 1000 and 1001 off my random computer speakers pulling youtube recordings of those frequencies.

Fitting algorithms are more about returning audibility vs loudness comfort to an individual with a reduced dynamic range. The functional effects of these losses in discriminative ability tend to be losses in the speech-in-noise domain which, as we have seen, hearing aids try to help support but are still limited. Although, I’ve mentioned elsewhere that I think there’s a gap in research to support measuring individual tolerance for compression and applying that to fitting algorithms. The low hanging fruit for speech in noise, at this point, when one has a loss for which no premium hearing aid on the market can return effortless listening in complex situations, is accessories, acoustics, and communication strategies.

That all said, for reverse slope specifically, you are not wrong to think that your fitting algorithm may not be generally optimized. The reverse slope population is smaller. Modern hearing aid fitting algorithms were largely developed for flat and sloping hearing losses. We are a relatively small field and so research is slow–there is definitely work to be done defining the specific needs of these smaller hearing loss populations like reverse slope, meniere’s, SSCD, sudden loss, and so on.

Smaller vents are better for low frequency gain and feedback management, and worse for occlusion, so you’re basically trying to find the smallest vent that is comfortable for you. Some people can adapt to those self-noises while others struggle more. I am probably less sympathetic to people sometimes about this than I really should be, as I have a low frequency conductive loss that basically causes a mild, permanent sort of occlusion that is just my normal.

For music lessons, headphones don’t matter, what matters is that you are making the music. It’s that iterative feedback process of producing sound, listening to it, and adjusting to match to what you are trying to play/sing in a focussed way that seems to be important.

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