Frequency Loss tipping point for tulip domes

What is typically the “tipping point” of frequency loss that results in movement from open domes to tulip domes? is there anybody out there that still goes with open domes, even though their frequency loss would dicate the tulip domes? How occlusive are they? If they are occlusive, are they LESS occlusive than comepletely in canal HA’s?

I have a 30-40 db loss in the low frequencies, and wear tulip domes with GN ReSound Pulse open fit thin tube BTEs and America Hears SIE receiver-in-canal aids.

When I tried Rexton Gem 12 receiver-in-canal aids, I wore 8 mm open domes.

The tulip domes are much less occluding than the in-the-ear Widex or America Hears aids I was wearing. Interestingly, the thin-tube tulip domes are less occluding than the receiver-in-canal with tulip domes. That small bit of hard material makes a difference.

With the GN ReSound and America Hears aids, I didn’t notice much difference between tulip and open domes with regard to the sound loudness or quality. With the Rexton Gems, I did notice that with the tulip domes the sound seemed louder.

I wish I knew more about all these “tip” options everyone is talking about. I just got widex mind 440s CIC and they are driving me crazy with that plugged up feeling. My audi said that open fit aids will not cover my loss and I can see that when she goes on the computer and inputs my readings. I am going to try the micro BTE mind 440-m-cb models next week. Overall I am very happy with the sound quality, etc on these aids. I’m just not thrilled with the comfort factor. The 440-m-cb will be fit with custom molds. I’m not sure what that means exactly but she said it will be more comfortable due to flexible material. I’m just wondering if there is any other tip I can use with these aids if these custom molds prove uncomfortable. We discussed passions also, but for now I want to stay with the mind 440s as I am very happy with the natural sound they seem to produce. Anyone know what the options are for these new aids I am getting next week? Any advice is appreciated as I am still in my trial period and I want to be sure my final decision is with the comfortable molds.

I have a low frequency loss. Reverse ski-slope, I guess.

I’m not sure what frequencies require tulip domes or open domes, but I had tulip domes about a week. My audiologist then switched to open domes with my receiver in canal aids.

The sound with the tulip domes was louder than the open domes, but the tulips didn’t let outside sounds “pass through” as well as open domes.

Both domes feel like there’s something in my ear, but neither gives me a stopped up feeling at all.

I think success with different ear fittings rest with 1. the amount and type of hearing loss, 2. the type and functionality of the device and 3. the skill of the fitter to properly fit the selected device. I’ve found the two following articles that really helped me form realistic expectations (since I had no idea what to expect after one miserable experience).

Article for anyone experiencing occlusion/ampclusion effect. This has an exercise you can do to demonstrate the potential ampclusion effect of a HA:
http://www.hearingreview.com/issues/articles/2002-09_05.asp

Article about particular challenges for fitting a low frequency loss:
http://www.hearingreview.com/issues/articles/2003-11_04.asp

The earpiece serves a practical function in some fittings: managing acoustics, preserving low sounds, mitigating feedback, etc. Try not to confuse an “open-fit” aid with an “open fitting”. An open-fitting is just like an earplug to hold the receiver/tube. Many of the folks on this site are wearing “open fit” HAs with custom molds. Some manufacturers will identify in their literature which tip is designed to work with their particular product at various amplifications.

The more amplification, the more sound that can escape the ear canal, the higher risk for feedback. For the majority of the Hi-freq slopes out there, tip selection is a matter of feedback management I think, and for the Low-freq losses, tip selection is a matter of amplification management (preventing sounds from escaping).

Anyway, I’ll be getting my HAs for a low freq loss in 5 weeks. I’m starting with a power dome, with the assumption that I’ll need a custom mold. I will be thrilled if my HAs sound even close to the potential ampclusion effect test in the article.

EnglishDispenser has written some really good explanations, as have some others, about occlusion, amplicusion and low freq losses (search topics) =)

Interesting post.

Your fitter is either skilled - or made a lucky mistake!

Theoretically an open fitting is not recommended for a reverse slope loss.

You need a blocked ear canal to create low frequency sounds in the canal.

However … in real life an open - or more likely a tulip - fitting will probably work well.

Speech is mid-frequency so losing low frequencies is not always a disaster. In fact, excessive low frequency boost can ‘close down’ the high frequency sensors in your ear!

You can see from this that fitting hearing aids is NOT straightforward … reality can sometimes defeat REM (Real Ear Measurements) and other sure-fire ‘silver bullets’!

I think I may be at the lower edge of the fitting range for open domes or tulips. I have 60db loss at 1000Hz and below.

I have no high frequency hearing and very little mid, yet I still understand some speech based on my lows. Back in 2005 I went to a hearing dispenser who spent 5 minutes programming my HAs, he couldn’t get it right. He tried several different configurations, one of them was maxing the gains. Another was reducing the lows while maxing the mids and when he reduced the lows, everything became nearly silent and I could not understand speech. He increased the lows and I could again hear and understand speech. I am having my current HAs(from a different audiologist) reprogrammed to max out the lows so I hear better, louder and understand more speech.

Not sure what that would be but one thing i notice is that the more open the fit perhaps the more prone your aids will be to feedback. I had open domes at first and then switched to Tulips to limit feedback. That was a help comparatively speaking but i did eventually go to a Custom RITE Mold for my left ear to improve feedback even more. I am very happy with the outcome. I wear a Tulip in my right ear.