Hearing aid fitting: In desperate need of improvements?

Hearing Aids
#1

I need to rant a bit about this subject because I’m currently super-frustrated that after 5 years fine tuning and enjoying my Phonak Marvels when it comes to having a new hearing aid fitted (yes, the famous Spheres), it seems everything goes backwards and you are forced to start again from scratch with no end in sight.
First up, you get to retest your hearing via the usual process of listening to some tones through headphones in a sound isolation booth and pressing a button accordingly. Maybe its just me that literally hallucinates sounds I don’t know, but I find the whole experience a nightmare never quite sure if i have heard something or not. The audiogram output serves a purpose but I do think that it is a blunt instrument and with all the technology we have at our disposal nowadays there should be a better means of finding out what the attributes of your hearing are for the express purpose of fitting hearing aids well rather than spitting out a set of data points about tones that may or may not be accurate.

Then, you get the new aids and apply the configuration acquired in (1) to them. Unsurprisingly its a car crash because modern aids having several programmes are more than just the sum of an audiogram, and the profiling is affected by things like your ability to comprehend speech, the noise suppression applied, all sorts. Oh and by the way, why after investing 5 years in fine tuning my Marvels is it not as simple as migrating settings / configuration from one aid to the other? They are from the same maufacturer for goodness sake - Phonak should be providing a migration path which understands the attributes of both aids and converts settings between them for an optimal first fit. But no, the faulty audigram in step (1) is what we use.

And lastly, you attempt to reconfigure the aids in a small quiet room with a single person saying “how does that sound” after twiddling more buttons on a screen. Honesty, I have no idea because I am rarely in a quiet room with a middle aged male addressing me face on and unless I get a place on Mastermind I am unlikely to ever be in that situation ever again. So out into the wide world we go and as soon as you set foot outside the shop or go to your office you know in 2 seconds that you will need to go back. Why oh why in 2024 with technology at our disposal can’t they invent some sort of simulation booth with surround sound speakers simulating different environments or something so that you can test in a real world situation in an audiologists office on a more objective basis, and come out more confident that at least you are getting the solid foundation for your hearing aid config? As it is, you are back on the phone yet again “yes sir we will try to squeeze you in 2 days time” and the new aids rot away in their shiny case unused.

I’m now on my 3rd appointment and completely fed up. Hearing aid manufacturers - what you are doing technology wise in your hearing aids is nothing short of amazing. But if we as customers can’t walk out of the first appointment with a good fit ultimately you have failed on your customer experience. Goodness knows if anyone reads this, but manufacturers could easily choose to use their clout and position to force radical improvements in this area.

Anyway if you have made it to the end well done… on a practical note if anyone has upgraded to Spheres from the phonak line and moved their settings across from Marvels or similar - I am keen to hear your experiences. And indeed, for anyone who shares any of my frustations feel free to have a rant yourself!

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#2

@Matt2962
Great post here. I had to LOL as I’m also a rational thinker now and then. I can imagine your frustration as a long time wearer.
Actually I did transfer old settings to new HA, but I forgot if I also did it on my Spheres and what the outcome was. I like experimenting with my HA so as a DIY I have a nice hobby.

But what about asking your HCP to put over your old settings and look how it sounds.
You’ll get some nice additional futures in your new aids as setting up two devices at the same time for BT. A better connection on your devices because of the newest BT protocol with bigger range and faster handshake. The amazingly better sound in noise suppression feature. Etc.

So my advice, just ask to do as you would like and see if it works for you. I mean you pay for the service also don’t you.

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#3

Yes, the process is frustrating, but due to our individual hearing issues, one setting doesn’t fit all. Think of how we used to have stereo systems and play with the bass, treble, brightness, etc to get music to sound to our liking - and the next person comes along and wants something completely different - and that’s with good hearing. There indeed are other ways to booth test in more depth, I learned that when I had my two hour CI booth testing with noise, etc. to see if I was a candidate and it was - borderline. But for HAs it may not change the outcome.

My only suggestion is to accept that this is process that changes over time - the settings you had for your prior HAs would not work with the hearing levels you have today…and so it goes. And each HA system works a little differently. There is currently no way around it - to happy acceptance is the best way to remain sane.

As for booth testing - if you just “think you heard is” because you anticipated it, likely you didn’t. You don’t get any points or change your hearing reality by having a better audiogram result. It just means your HAs don’t get set appropriately and you have to go back for more adjustments. So, it’s “OK” to fail the test if that is our hearing reality. It was folks on this forum who helped me see that. And then for the CI tests, that was one I didn’t mind “failing” because in knew the CI was the way to go forward - for me.

Good on you for keeping up with the changing technology and getting new HAs. Keep moving forward even as the hearing declines. Keep venting - it helps with the frustration.

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#4

Matt, you hit the nail on the head!

My experience in the booth is the same as yours. Hallucinate sounds? Maybe. But I certainly can anticipate sounds when I know they’re coming on a more or less fixed schedule.

And your comment about the ability to comprehend speech is dead on. Especially when there are male and female voices, adults and children, low talkers and loud talkers, soft speakers and shrill speakers. I want to buy a puffy shirt (Seinfeld) just to get the message across to low talkers that it is torture to listen to them.

In the past year I have trialed Rextons both AX and IX, Phonak Lumity L90, Philips 9040, and Oticon Intent 2. They vary in their ability to handle background noise and loud noise - Intenrs are amazing in this regard - but my problem remains the same with all. Clarity of speech in normal, everyday situations from quiet to moderate background noise.

So, why can’t manufacturers zero in on this in the original diagnosis and fitting? If the can use AI in the processing, why not in the diagnostic phase instead of a piece of equipment which was invented more than a century ago?

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#5

But the instructions are “to click the button if you think you hear something even if you’re not sure.”

Your points are all well taken and your advice is sound. Thank you.

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#6

Valid point on the instructions…but as pm you point out our minds start to play tricks! I tend to overthink but when I go with the gut it works better.

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#7

I tend to overthink it too. :joy: :face_with_raised_eyebrow:

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#8

You mean something such as Real Ear Measurement (REM)?

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#9

Hey, yes - and no. Phonak did a white paper that is good at placing the value of REM into its context for fitting.
However whilst REM can help its not the whole solution. In the UK Specsavers and Boots have basically succeeded in land grabbing the aids market and as part of that I think in order to maximise their profit margins try to get away with the bare minimum standard of fitting.It is so hard to find a good experienced available audiologist outside of these settings.

It is interesting that customer satisfaction with hearing aids has fallen year on year for about 5 years in a row now (I saw this industry data somewhere but can’t find it to reference now, sorry) and I think fitting issues is a large part of this given the aids themselves have only got better and better!

I think this is where the manufacturers should be more active at pushing best practice to get the best outcome for their customers.

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#10

People want cheap pricing and good service.

They’ll forgo using a service which is more expensive because they’ve forgotten/don’t understand/don’t appreciate the quality of what they’re getting.

Providing decent quality knowledgeable care costs money. The big suppliers know this, but squeeze the centre ground.

The general public of this board seem happy to seek the lowest pricing, by regarding hearing aids as commodities and buying online. The manufacturers are at least partially happy to endorse this while pretending to save face with their conventional supply channels.

This drives the aggregate market into the floor, while dispensing has to front load the charges and not invest as much as possible because tomorrow you might be able to buy your hearing aids for £500 in Asda.

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#11

Yeah totally agree, situation is sad really, a race to the bottom.
Do you think there is room for a national provider to make excellent fitting its USP as a differentiator to the market, or do you think that will only happen in pockets of small independents?

#12

It’s practically guaranteed only to happen in pockets; simply because as soon as you separate ownership from work activity the motivations change on both sides. The dispenser becomes concerned with earning their pay/bonus, while the owner/shareholders sees everything in terms of cost.

This yields a system where the dispenser wants to see as many people as possible, to fit as much FAF (fire and forget) product and the owner is happy. Why should anyone devote extra expensive clinic time to more ‘awkward’ cases, when you get the same £50 bonus as you did when you fitted Mrs Jones in ten minutes on Monday?

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#13

Do you think it’s feasible through regulation to make it so every dispenser can get the product at the same price? To me that would really even the playing field. Somebody providing excellent service would still need to charge for their time but at least the huge discrepancies in “wholesale” prices would disappear.

#14

The system is flawed
“to click the button if you think you hear something even if you’re not sure” is a crock of you know what…

Why am I reporting that I hear better than I do when everyone of us using hearing aids has trouble understanding words in noise? and everyone of us can’t hear music and enjoy it?

Why am I encouraged to report my hearing is better than it is? It’s like a Mother saying, “There there. It’ll get better.”

I hope that artificial intelligence leads to significant improvement.

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#15

:slightly_smiling_face:

But so true. Going from a fitting in clinical space to the outside world is night and day, but it what there is. I can also appreciate the time it would take to fine tune settings in modes using simulated environments could be probative for providers, and may not even cut down on the follow ups - even if it condensed what would be months of feedback and multiple visits into a single session.

Back to the original complaint what can’t the old fitting be plugged into the new models… that is definitely an opportunity for an enterprising manufacturer to develop a translation utility for exactly that. The payoff of brand loyalty will follow!

#16

I have some older relatives that have HAs but both cheaped-out and one won’t wear them because they don’t help, and the other will but only socially and still doesn’t get much benefit from them. A 3rd with 50% comprehension and severe loss won’t spend the money on entry level models.

All in their 80s, it’s not only about the money. There’s the stigma, value on personal happiness, etc., they grew up with. The one that does wear won’t go back for fine tuning. :man_shrugging:

#17

All REM can do is match a reciprocal to a audiogram.
But the question is does that audiogram represent real world hearing.

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#18

A tonal audiogram is a subjective test, but it is retaken under the same conditions and is repeatable, which makes it more objective and credible if performed correctly and the patient is informed about what exactly he/she must do.

IIRC, there are more objective tests, such as ABR/BERA, but with cooperative adults they are rather no better and are not more accurate than a correctly performed and repeated tonal audiogram.

Not to mention the WRS in quiet (and possibly QuickSIN) to create a proper picture of expectations from HA technology.

#19

That sounds like communism……. :joy:

It would help, but firms would still have workarounds - they own the whole supply chain, so they can choose to take profits at whatever level in whatever tax jurisdiction they like.

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#20

Mine didn’t.

My dispensing audi announced my hearing was better, and my hearing aids would be quieter as he erased my programs and then did a quick fit without REM. That was after a year and a half of attempted setups. Then he said I should find someone that could help me more than he could; shook hands. I thought it was a friendly good by until we parted. .

It actually was good news. My setup with a new person is working better than his ever did.

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