First pair of hearing aids but see no improvement

Hearing Aids
#64

I don’t know. It seems impossible for audiologists in North America not to have it. My clinic has had it for over 20 years. I’ve heard clinicians talk about working in places where their employers won’t get it? But there are affordable systems out there now, I think if I were in that situation I’d just buy one out of pocket.

But clinicians do things differently. I’m only eight years into this field; I’m not going to go out of my way to second guess someone with double my experience without greater cause.

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#65

Double your experience, but perhaps half your integrity. This simply isn’t a matter of opinion. Not performing REM is akin to shooting in the dark. Whether you’ve been shooting for 8 years or 8 minutes, anyone would tell you you’d be more accurate if you turned the lights on.

Without REM you’re flying blind - You are making assumptions about very important variables that can easily be illuminated with REM. You can argue how strictly an Aud must adhere to targets, whether they should encourage their client to adapt to the tone/gain or make adjustments away from target in the name of comfort, which prescriptions are most suited (NAL-NL2, DSL etc), and so on - but there is no justification for not performing REM at all.

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#66

Thanks for the feedback on REM. I don’t want to put this thread off on a tangent, but this is helpful. I live in a very rural area, which may account for it, but this forum has been instructional on how to advocate for myself.

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#67

All the best @joanhawsey - you hit the nail on the head! You’ll be a lot more successful if you do advocate for yourself.

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#68

@Rain.Drop

I had real trouble with my previous audiologist. They sold me hearing aids that got worse and worse with each visit. Then it would take a bunch of visits to get word recognition back. Along the way I went through a number of styles of domes. They became really uncomfortable.

When I changed audiologists and got new hearing aids things improved a lot. However, it took quite a while, and that was frustrating.

Dr Cliff talked about domes. Saying that the little 50 cent contraption affects the way we hear, and how the hearing aids perform. Someone here talked about the “fingers in the ear” test. I did that and darned if my hearing aids weren’t a lot louder! So no matter what the Signal to Noise ration was, my hearing aids were ineffective with those domes.My new audiologist listens! He tried different sizes in each ear. Closed domes…and I have much improved hearing with the hearing aids he supplied.

I’ve been critical of Phonak’s choice of wax guards since the beginning. I’ve put so many of them in crooked. That seems to block the sound from my hearing aids. I usually discover when I figure it’s been a while, and should change them. Phonak audeo P90 R’s.

That’s why I talked about these two suggestions. I simply wanted to pass on what worked for me, in case you didn’t know they could affect your hearing aid’s performance.

DaveL

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#69

Interesting comments about REM. I did ask her about it on first visit and she said she typically doesn’t do it on first visits. So I was like oh ok. I am new to this journey and not informed on a lot of things. I remember asking why some providers don’t perform the REM and she said maybe because the machine is expensive.

I will ask to come in sooner to get REM because my second appointment is next week and that would mark total of 3 weeks since I have the aids. My trial period is 30 days so if my aids are under target I won’t have the needed experience to decide if I want to get these aids or not.

How long does the REM usually take? My next appointment is 30 mins. First appointment was 1 hour

#70

Thank you for sharing your experience. Audi gave me two sizes of open domes. I tried both and they make no difference for me. I remember asking her about closed domes and she said those are for people with a more severe loss. So I just went with what was given to me. I will bring this up on my second appointment. I’m just a bit disappointed since I see no improvement at all at this point considered these are quite expensive.

#71

Looking at your audiogram I tend to disagree with your fitter, maybe.
Power domes or even custom ear molds just might improve your hearing. The power domes are an easy cheap thing to try. The aids have to be set up for whichever done you do decide to use.

#72

The LF is the usual guide; at the level shown, you’d usually want this fitting to be open as humanly possible.

Though as you say, more occluded domes cost nothing to try.

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#73

What is the rule of thumb for hearing loss to start thinking occlusive acoustics?
I had thought it was around 2000 hertz with 40 db loss.
Thanks

#74

No, usually at 250 and 500Hz, you tend to need different venting 0-20dB (maximum), 20-40dB (moderate) and 40-60dB (small). 60+dB and you’re basically only talking a pressure vent for comfort.

These can vary depending on the client, but as you can see, the lower the LF is, the bigger the vent potentially needs to be.

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#75

I completely agree with @Um_bongo. You should be fitted with open domes.

I’m confident you’ll have a much better result after REM. I know that Oticon’s estimated first-fit (particularly if set to the VAC+ prescription) is often severely under target. Here’s an example of a fitting I had recently. The 3 dotted red/blue lines are the first-fit estimations (at 3 different input levels). The solid red/blue lines were the final settings required to meet REM targets. There is a massive difference between the two! Had I not performed REM, this client would also be saying that they don’t notice any differences with their aids in.

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#76

Thanks.
I have always appreciated help from the pros.
I am bilateral CI now so no more self fittings.
Trying to help.

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#77

@Um_bongo not meaning to detrail the thread but talking of venting, my earmould vent size is 1mm (my audiologist told me she told them to put a 1mm vent so I do not feel occluded and to let in some natural sound), but my previous moulds I still have, got a larger vent size. Is there any way they are able to give me slightly bigger vent size? They are comfortable but I do feel a bit of occlusion. I was told I have good low frequency sound but does not look like it is a lot because of how steep my audiogram is.

#78

@craftycrocheter

With a bigger vent, you might struggle more in background noise as you have good lows.

Lows would come in more naturally and could overpower the highs which are amplified.

#79

Ideally you would need at least 2-4mm, bit it also depends on how good your aids are at managing feedback: steeply sloping losses always present more problems in this regard (the trade-off between gain and venting).

We (using the latest aids and very fast feedback control) would normally try to keep the fitting as open as possible and offer something like single closed power domes, then vented canal moulds. Other audiologists might choose a more closed mould and deal with the occlusion in other ways.

If I had to fit a proper mould/tubing I’d ask for a Select-a-Vent option on a 3-4mm through vent. If there’s space. You could then play with the acoustics to get the right balance. (There’s also a load of theory about shortened/stepped/collection vents too, but that’s way more in depth than this site.)

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#80

Is that the option to have a bigger vent hole in the mold and chose a varying option of different plugs with their own hole size inside so you can select the desired vent size from larger to smaller?

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#81

Hi Rain.Drop!

So sorry you’ve having issues! I know you have a lot of replies here, but I’ll put in my .02 cents as I was also fitted with new hearing aids recently, Rexton BiCores from Costco. Like you, I was very excited to get them, but noticed very little improvement. I had two issues: they were simply not loud enough and lots of feedback.

I was very disappointed to say the least. Like @DaveL said below, I noticed that everything got louder when I put my fingers in my ears, so strange!

BUT.

I went back and the audiologist and he put me in larger, closed domes. That 100% took care of the feedback issues! There is zero feedback anymore, no matter how closely I cup my ears. And he adjusted the gain 4-5 notches.

And wow, what an incredible difference! The world came to life, and I could suddenly hear EVERYTHING! In fact, it’s nearly overwhelming and I have to take breaks now and then, lol.

So I’m guessing you need more gain, and that you’re in the wrong domes. You possibly need to go larger, and possibly closed domes. Not everyone needs or can tolerate them, but it’s worth a try!

(Adding… I’m no expert, this is just what worked for me)

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#82

In the old days==I thought the only way to hear better was to turn up the volume.

My hearing aids are so much better than the ones I had before. It’s the setup. I’ve fought hard to make improvements. We have to advocate for ourselves.

DaveL

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#83

My partner has perfect hearing, 1-10 straight across all the frequencies. Yet, she has trouble understanding certain people some of the time, e.g. the mumblers, the people who almost chew their words, soft spoken people, a range of others. Have you tried to identify what type of speech is most difficult for you to understand. Also, I may have missed it in this long thread but did you have a word recognition test? Results?