Hearing aid advice for someone with microtia and profound hearing loss

[Marco_v_B]

Hello everyone! I’ve been reading for some time now and would like to introduce myself. My name is Marco, and I come from the Netherlands. I’m in my early fifties. Born with microtia with a closed ear canal on the right side. A BAHA screw is also attached to this side. I have an operative and sensitive ear canal on the left side.

Unfortunately, my hearing has continued to deteriorate in recent years. My hearing is unstable and changes very frequently. One moment I hear quite shrill and the other moment quite dull. I never really got clarity from the hospital or a hearing care professional about how much hearing loss I really have.

My current hearing aid (Phonak Bolero V50) needs to be replaced. This also does not have Bluetooth, so making telephone calls is not possible for me at the moment. Furthermore, a noisy environment is a big challenge, because I can’t really hear anyone well.

Right now I’m trying to figure out which hearing aid is best for me. I recently switched from Android to iPhone for better hearing aid support. What’s especially important to me is that I can hear a person properly outside and in a noisy environment and get through the day less tired (because it’s very taxing), and that I can adjust the high and low tones while streaming, since I stream quite actively.

Now, following the advice of a hearing care professional, I tried the Phonak Naída L90 UP and PR (30-day trial). Unfortunately, I clearly miss the clarity (high frequencies) with this hearing aid. The biggest loss is being able to adjust the high and low tones during streaming. So the search continues to find the right hearing aid. One option I’ve been looking at is the ReSound Nexia 88 PBTE.

Do you have any advice on which one to get for my use case?

[Neville]

Are you still using a baha on the right? Is the cochlea on that side hearing at normal levels?

[Marco_v_B]

No, because it’s been placed incorrectly, such that the vibrations aren’t being transfered properly. And yes, the cochlea on the right side hears at normal levels.

[Marco_v_B]

Here are some audiograms from the last few months.

[Deaf_piper]

Marco welcome to the forum.
I’m just wondering if a cochlear implant on the R side could be the way to go. Specifically the Kanso 2, the K2 doesn’t sit on the ear at all. It’s Bluetooth enabled, so it streams to your hearing devices. Marco this is something for you to discuss with your audiologist.
Good luck to you.

[Raudrive]

So you have a BAHA that does not work on your right side.
The older Phonak is on your left side.
Is this correct?

Has a cochlear implant been mentioned for your right side by your audiologist?

Your left ear could be aided with many different hearing aids looking at your audiogram. It doesn’t appear to have a severe/profound hearing loss. I am not sure why your audiologist tried the Nadia UP.

As far as being able to adjust the upper frequencies with your phones app the Resound hearing aids have the better app compared to most hearing aid brands.

[Marco_v_B]

Hello @Deaf_piper, thank you!

Unfortunately, I’m unable to have a cochlear implant because my ear is closed off.
I have an auricle reconstructed from my rib bones and an ear canal, but the external auditory canal is missing (born with microtia type 3).

[Marco_v_B]

Hello @Raudrive,

Yes, that’s correct.

Yes, a cochlear implant was discussed, but because of the type of microtia I have (type 3, as described above), they deemed it unsafe to do any surgeries at this time because my ear has always been closed off.

As for why they chose the Nadia UP, it’s because they weren’t sure if the Nadia PR would suffice, so they let me try both of them at the same time. Since yesterday I stopped using them because it doesn’t feel right for me and I’ve asked to try the ReSound Nexia, to which they agreed. I’ll receive them next month and I am very curious.

[MDB]

Just wanted to clarify for my own edification. If the cochlea on the right side is functional, wouldn’t that make a cochlear implant kind of pointless? I’d think another attempt at inserting a bone conduction device would be more appropriate, IF the surgery seemed advisable.
The left ear seems like it might be challenging to get enough gain at 750-1500 Hz and 3KHz and not mask the very important 2000 Hz range.

[Neville]

If there was something to be done to get the BAHA working that would be better, but if it can’t be done a CI would be reasonable if it were an option (sounds like it’s not). Outcomes in patients with reasonable cochlear function but big conductive loss where the combination of a milder SNHL and a big CHL put them outside of a BAHA range tend to do well with the CI.

[Neville]

Can you try a bone anchored hearing aid on a soft band on either ear? Do you use bone conduction headsets for music listening/streaming (e.g. Aftershokz)?

[Neville]

I suspect the limit that you are probably up against with your reconstructed ear canal is not just the necessary power of the hearing aid to overcome the big conductive hearing loss, but the much more reflective ear canal wall compared to a typical eardrum which is probably dramatically increasing the chance of feedback and that is in turn limiting the gain.

If you can’t get any sort on bone conduction solution working, and Phonak didn’t work, maybe give Oticon a try.

[Marco_v_B]

Hello @MDB,

To correct my previous statement, I wasn’t aware of the current technologies regarding cochlear implants.
I got two things mixed up. With my reconstruction ear, the ear canal cannot be opened. They always said what is stable must be kept stable and nothing can fit behind my ear (like with a hearing aid), because there is no room for it. At the ENT, they still work with the old form of CI, i.e., a device behind the auricle. That is impossible for me, but with the Kanso 2, this isn’t the case anymore, which might make it a viable option, so I’ll discuss it again with the ENT doctor and look at the available options.

As for the BAHA, I’ve already discussed with my ENT doctor to replace it.
The current issue is that my skin has grown “over” the screw, which causes the vibrations not to transfer correctly.

Hello @Neville,

Regarding the limit and reconstructed ear canal, what you say is correct. This is what I have been struggling with for years.

In the time that I have been here on the forum, I have come to understand my hearing loss and associated issues much better than I have heard from the audiologist and ENT doctor in the hospital in recent years, which I’m really thankful for.

As for the Aftershokz, I have tried them and really liked them (especially being able to hear from both sides for the first time), however, due to the way the auricle was reconstructed, there’s not enough room for the clamp to be mounted (because there’s no space behind the auricle), which causes it to fall off again. I tried using it with a headband, but that didn’t work either. Hence, I had to return it. I did ask Aftershokz if there was a way they could provide a different mounting solution, but they responded that they weren’t able to. Currently, I’m using the B&W Px7 S2e when calling and streaming, which can go loud enough and has a proper EQ, of course with the only downside that I can only hear it on the left.

Next month I have another appointment with the hearing care professional and doctor at the hospital to discuss the BAHA again. I’ll also ask him about a cochlear implant (such as the Kanso 2, as described above). If the ReSound doesn’t work out, I’ll definitely keep the Oticon in mind.

[Raudrive]

Something interesting would be a Cochlear CI with the off the ear Kanso2 processor and the Resound compatible hearing aid on the other ear,
bimodal.

The other choice would be the (Auto Bionics)AB CI with the Rondo3 processor with the compatible Phonak hearing aid.

[Neville]

It might also be worth looking into whether the adhear could be an option for you:

ADHEAR Bone Conduction System

And you said a bone conduction hearing aid on a soft band didn’t work for you–ever try the original oldstyle band? I’m not even sure who might make them anymore but they might be somewhere:

[DrakeEspinoza]

Given your needs for improved audio clarity, Bluetooth support, and stability in noisy environments, it’s also worth considering models from other manufacturers such as Oticon and Widex. It’s important to pay attention to hearing adaptation features, noise settings, and device connectivity. Purchasing a hearing aid is an individual process, and the best choice will depend on your specific needs and preferences.