First Time Experience

I went to get my first aid today and thought I would share my experience both with the fitting and the aid performance. Maybe the experienced out there can tell me if my experience is normal or if there is something I should think about.

My stats

47 yo with high-end loss, much more so in left ear.

Freq–L--R

250…30…10
500…25…10
1K…25…5
2K…40…10
3K…55…15
4K…70…45
8K…85…60

The Visit

I was disappointed in the amount of testing/adjustment at my first fitting - essentially none. I was there for 35 minutes

during which the audi ran the NOAH app for my Phonak Audeo V (one ear). The only adjustment was an automated feedback test.

I asked about REM and he said that it doesn’t work well with these aids (due to open fit I think). He said that he is going

to a seminar or training on a new system that works better. He said that only 10% of audi’s use it. I believe I remember

seeing 40% on this forum.

He set some sort of coarse level at 2 and said we would be shooting for 4 in the end (i.e. ramping up to give my ears/brain

a chance to adjust). Maybe this is why he didn’t do much testing. He said he would do the sound room test next time (2

weeks).

I asked about cleaning products, etc. and he said we would discuss that next time. I saw a Dry & Store Global in the

waiting area priced at $135. I’ve seen these online for $99, so I think this is a no-brainer.

The Aid

I just got it and have never had a hearing aid before, so obviously I don’t have any big revelations here, but so far, I am

very impressed with what I am hearing. Everything sounds “crisp” and I am hearing things I haven’t heard before. I looked

at the aid online at Phonak’s site but didn’t get a real appreciation for the small size until I saw it “in person”. It was

definitely smaller than I expected.

I thought that I would have more wind noise, but was pleased with the results. I would hear an occasional whisp of wind in

the mic, but not bad at all (even though the IX, not the V is advertized as having “Wind Noise Management”).

When I cupped my hand and put it up to my ear, I got feedback. I didn’t have to get to the point where I completely covered

my ear before it started. I guess this is normal?

When I went into an RF chamber at work with a lot of noisy fans in the equipment, I noticed that fan noise was amplified

pretty good (maybe too much). But then, it would fade completely out. The speech didn’t sound like it was being amplified

any longer either. I thought that the hearing aid had cut off, so I touched the top with my finger and got no sound. When I

did it again, the sound came back, including the fan noise. It seems like the aid is shutting on/off in this environment.

It would sometimes shut off and then come back on its own. I wonder what adjustment would fix this if any.

More to come …

it is posible to run rem test on open fittings…

some HI test box like the Frye comes with a open fit coupler

verification is a must… i have read about 40% people use rem…

While it is true that the most people dont use it, our obligation as

professionals is to provide the best care posible after all, we do charge

a reasonable premium for our service

Davew-

Thanks for sharing your experience. Absolutely REM can be performed with open fittings. I won’t say it is impossible to have a successful fitting with out REM, but certainly knowing what is really happening in the ear as opposed to what NOAH shows (the two are almost always very different) is of significant value both for fitting and trouble shooting.

The Audeo do really look great. Glad you like that.

With respect to the “cutting out”- the Audeo V has three programs that it chooses from based on the noise in the environment. It sounds like yours kicked into “comfort” mode which reduces steady noises considerably, but also reduces the overall gain.

This is adaptable with the programming- how sensitive the hearing aid is to noise and the degree to which it shuts down. I would talk to your Audiologist about adjusting that. Overall though, I’d be sure to get at least a week or two experience with the aid before making dramatic changes. It will take a little while to adapt to the sound and to understand how the aid is working across environments.

Thanks for the info guys. It sounds like the “comfort mode” may be attenuating too much. I guess this could also change once I’m up to level 4. Maybe the audi could have seen this if he had done some measurements.

Also, last night when I was watching TV, if I blocked sound from my good ear, I could not hear the TV well in the aided ear. I assume that this may improve with the increase in amplitude on later adjustments as well.

Does anyone know of a good site for learning about audiology and/or digital hearing aid technology? I’m an engineer who knows some basics about digital signal processing, so this is interesting to me.

Rem should be perform regardless the type of fitting done…
At the very least, a 2cc verification should be made…

Thanks xbulder. Tell my audi that. I tried. I’m going to give him a chance and see what he does when I return in 2 weeks, but I’m not happy with him so far.

I am happy with the Audeo so far though. I really don’t think I need the full 2 weeks. I feel like I’m ready for a bit more volume now, but I’ll be patient.

What is 2cc verification?

sometimes, you can not preform a probe microfone verification for what ever reason you could think… for example, i had a client with down sindrome which will not sit still… to make the story short you can check what the instrumet is amplifing using a hearing aid test box. The coupler that simulates a normal adult ear canal is a 2cc coupler… I use a Modified swislosky coupler which provides better results… Often times which children you perform a RECD

for more info please refer to
http://www.dslio.com/protocols/recd.html

Doesn’t sound too impressive to me. It sounds like the audi did the least they could to (ie run the feedback routine) and sent you out the door without bothering to answer your questions about cleaning. To me this is a deal breaker. Accepting factory defaults in an aid is what you do if you suck at programming a hearing aid.

Yeah, I agree ZCT. But I thought I would give him one more chance since it is only set at level 2. We’ll see what he does after turning it up and getting feedback from my experience.

I’ll report on my next visit and you guys can give me an opinion on whether I should bail or not.

often times, it is best to program the aid at the factory settings at least at the beggining. However, some conceling and verification should always be done…

Maybe, maybe not. Personally, I program each hearing aid I fit from scratch. That way I know exactly what my patient started with. Then I work from there.

Remember, the factory has not met your patient. They just loaded a default prescription based on the audiogram (which they may not have even entered accurately). Their thought process was producing a quality working aid, not the intricacies of what your specific patient may like.

For example, there are usually various mathematical formulas to go from test results to prescription. While there may be 8 or more available there are typically 2-3 that you will use often. But some of these formulas are better suited to a new user, versus an existing user.

These kinds of things are typically ignored by the factory, who are more concerned with putting the right amplifier in place, and making sure the aid works perfectly.

So this is why I personally start from scratch on every fitting. It may explain why my revert rate is less than 2.5% in the past couple of years.

Seems like most Audie’s and Dispensers just use the mfg’s first fit (mfg’s best guess) on their new customers. Then they ask “How does that sound?”.

Probably not too bad an approach for mild losses.

But with severe/profound losses this time saving method is a loser. The problem is that the Audiogram curve is only a broad approximation of what the patient really hears. REM and other similar procedures are almost useless because they only tell what the aid is doing…not what the patient hears.

In my opinion, the only simple way to fit the severe/profound is by trial and error. If a setting works use it …if it doesn’t try a different value up or down while the patient listens to speech material.
Ed

Yesterday, I had the chance to see how the Phonak Audeo V worked in a meeting environment that is very challenging for my hearing. Prior to getting the HA, there were two persons in this meeting that I could not understand at all when sitting across the room from them. There is a projector fan that makes a small amount of noise.

I sat across the room from them with my HA and I could hear about 70% of what one said and about 40% of what the other said. A definite improvement. However, my HA is only set to level 2 out of 4 and I believe I will get a marked improvement when this is increased.

The audi had scheduled me to come back in 2 weeks. I rescheduled my next appt for Thu, Feb 7 (only one week) because I feel like I have been in enough different environments during this time to evaluate the HA and I am used to the volume level.

I will post after my visit to relate what the audi did this time and later on how my speech comprehension is affected by the changes.

Today, I had chance to test the Phonak Audeo V in a VERY noisy restaurant. It was the most noisy restaurant I have ever been in and I was able to understand probably about 80% of what was said. I had to ask for a repeat a few times, but others had to do this as well.

I’m looking forward to the increased volume!

Thanks for all your posts and research on the AudeoV. I have enjoyed reading your questions AND the responses of others.

I am also headed for my first aids and considering the audeo V’s. Please keep the updates coming. Especially ones regarding performance in different enviroments.

In the noisy resteraunt, you said you were hearing at about a self estimated 80% with the aid. What do you think you would have heard without it? Any idea?

That’s a great question Jake, and one that I thought about. However, I can only attempt a guess since I did not remove the aid and try it.

I have somewhat of a comparison though. I was at a very noisy restaurant about a year ago (no aid). The restaurant was not as noisy as the one I was at yesterday. However, I felt like I was not part of the group because I couldn’t hear most of the people at the table at all. My wife sat to my left and had to relay most of what was said to me. I had trouble hearing the person across from me and the person to my right as well. I would guess that I heard about 50% of what was said from these two. Others who were further away, I could not hear at all.

I can tell that the high frequency gain provided by the aid is a big factor in the improvement I experienced yesterday. I wonder if I would experience further improvements from the Audeo IX, but this one seems to work well for me. I am looking forward to my audi visit tomorrow when he increases the gain further toward my target level.

I think the audi’s on here would caution that not everyone is alike. I believe I have moderate loss, mainly in one ear and I only have one aid. Someone who has more profound loss or other circumstances may perceive things differently.

I’ll continue posting my experiences until I’ve reached my target gain and reported on that.

By the way, the Audeo looks cool too. :cool:

Yeah it does(look cool). I have tried one on but not ‘trialed’ one yet. Hope to do that soon. I will need two. The first Audi I went to quoted a pretty good price I thought, 25% off off msrp. That put a pair around 4300 w/ the remote.

I have a ski slope loss, normal at 250Hz, then linear drop to 70db at 8000Hz.

Completely missing high freqencies in both ears.

I do ok on the phone though, and most of my business is done one on one so I do ok there.

But I really struggle in a large group. The one thing I hate even worse than a NOISY restaurant, is a QUIET one, especially if you have a group around a large table. Then everyone wants to talk softly so that the people at the next table don’t hear - well then the conversation falls completely off my radar and I am forced to switch to puppy dog smile mode - not the best!

The other thing I REALLY struggle with is distance. If someone is 30’ away from me- forget it, even if they are practically yelling. But if they talk at a normal level at 5-10’ I do fine, why is that?

My wife and I can at least joke about me giving completely wrong answers to things. She compares me to an older neighbor who must also have a hearing problem. My wife was out walking with our two little girls and a pack of coyotes crossed the street less than 20’ in front of her. They are non agressive, just scrounging for food. Well she turned around and started heading home and ran into this neighbor a few doors down. She told him you won’t believe it - I just saw a pack of coyotes - well, she he he just gave her the biggestest smile and said - ‘that’s good!’

She had to explain again, but we still laugh about that…when I miss stuff, I’m now becoming like ‘the coyote man’.

I got one for $2000 and the remote would be $250 if I got it, so this is pretty close to your price.

I know what you mean about the puppy dog smile and the coyote. Sometimes I just get tired of asking someone to repeat themselves, so it’s easier that way. But that’s what the hearing aid will help with … I hope.

It “sounds” like your hearing is a bit different from mine. I’m sure one of the audi’s on here can answer your questions about soft versus loud and near versus far. Audi’s? Are you reading?

Yes I am pretty good about asking people to repeat themselves, but if I don’t get it the second time, it starts stressing me out.

When a neighbor talks to me from across the street, I just have to go over there, it’s really frusterating. If you have time for a conversation, that is great and neighborly, but sometimes I don’t have time and I’m sure they don’t either, they might ask the simplest of questions and I don’t get it.

I am curious as to why this is. I mean, I have very little trouble face to face, with the person speaking normal, but from far away, I really struggle, even if the person is speaking LOUD. Maybe the higher frequencies have a harder time going distance than lower frequencies? Maybe I’m relying on lip reading more than I think.

When I’m on the phone, I can hear a lot of stuff in my office background (like when I’m on hold or something and there is no converstaion going on) that I can’t without the phone. Clicking of the keyboard, rustleing of papers etc.

But not a phone ringing -! One time I was one the phone and the person said ‘hey do you need to get that?’ I was like ‘what?" They said isn’t that your other phone ringing?’ I was like nope, not here. Sure enough, I hang up and start thinking about it and go check they caller id on the other line and I did get a call. sigh I wonder what the perfect hearing world think when they get wacky responses like that. I guess there are enough wacky people out there they just lump me in with that crowd…?

My next appointment is coming up, so I am looking forward to my trial.

I went back for my first adjustment yesterday. I told the audi that they were working fine, but needed more volume. He turned up the overall level and then we went to the sound booth for a tone test with the aid in. He determined which freqs he needed to turn up. I watched and he mainly turned up the lower freqs - from the upper 300 Hz up to somewhere below 1KHz.

We went back to the chamber and he wanted to turn the same ones up some more and give me some more highs around 3K or 4K. I noticed that we were bumping up against a gain limit at the higher frequencies even though the graph had a limit line that was higher. He said this was due to feedback being possible with the open molds.

Also, I asked about the higher freqs (above 4K) since these were trailing off like a ski slope. He indicated that it’s not good to give these too much gain because the sound quality can be bad. He said people don’t like what they hear when these are too high. Any audi’s want to comment on this?

I can tell that it is definitely louder after the adjustment. I’ll comment on how they do with speech in noisy restaurants and in meetings after I find out.

jake, on your issue with not being able to hear when people are yelling at a distance. You may have to create a separate thread to get the audi’s to respond. You are right about the higher frequencies being attenuated more when traversing the distance.