My trial Phonak Sphere I70 has significant occlusion with closed domes, more so with large Power 4.0 domes than medium. Long story short, this Friday I am trying the Oticon Intent 1 with I assume Oticon closed domes. Will Oticon releive my stress and discomfort with the occlusion effect?
Occlusion is physical. Power domes will always have more occlusion than closed, large more than medium, regardless of the manufacturer. Whatâs your hearing loss?
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I would think that if you test drive a few different domes you will find one that serves you well. I ultimately ended up using 6mm double vent bass domes and find them so comfortable I forget Iâm wearing hearing aids. Zero occlusion or discomfort. I use Oticon Intent 1s.
Moderately-Severe/Severe in high frequencies.
Great feedback. I will share your domes with my Audiologist. Thanks.
If you turn the hearing aids off and put them in your ears, occlusion will still be there. If it is not, then you are not dealing with occlusion but rather something in the gain. Itâs worth double checking, but with that loss I wouldnât be surprised if getting around occlusion is an issue. A custom tip might allow for better venting control to try to balance occlusion with feedback control.
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I tried it. The occlusion is still there. In fact, it is worse (like sticking a finger in each ear)! To minimize the occlusion, my audiologist reduced the gain to prevent feedback but that also affects speech clarity (and the main reason why I choose Phonak Sphere technology). Frankly, my 7-year old Phonak aids have the least occlusion with the same power 4,0 medium domes and better speech clarity. Unfortunely, they are on their last legs and near end of life. I am thinking the undesireable level of occlusion may be a programming issue that I intend to explore with my audi on Friday. Absent that, custom molds with proper venting may be the solution (albeit my experience with them many years ago with ITC Widex aids was unacceptable). Thank you for your feedback.
Feedback is something completely different than occlusion. Usually patients need more occluded fitting to prevent feedback.
True occlusion is generally due to a physical cause, not programming, although I heard rumors about overcoming it with proper low-frequency gain; I donât know if it works.
Try carefully and slowly, without force, to push the receiver with the dome deeper into the ear canal. Sometimes this reduces occlusion.
Ear molds/slim tips/cShell are surely a possible solution.
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Thank you for your feedback.
Yeah, Iâm not 100% sure what you are talking about is occlusion. Occlusion is typically a boomy, echoy effect on your own voice and internal noises. If you could wear old phonak aids with medium power domes and not have whatever this effect is you are describing, you should be able to wear the new ones. Its possible this is actually an insufficient gain issue if you are actually feeling plugged (which would also get worse if the hearing aids were muted). You may be confusing your clinician if you are using the word âocclusionâ and it is, in fact, not.
If your old hearing aids are working, they can compare REM measures from those against the new ones, as a start.
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Your definition of occlusion is exactly what I am experiencing. I agree perhaps there may be a gain issue (or programming issue). My old aids are still working. Your suggestion to compare REM between the old and new aids is excellent. I will discuss REM comparison with my Audi and let you know the outcome Friday.
Hi Neville. Attached are two REM views (hope links are viewable!). One of my old Phonak B90 HA with an acceptable level of occlusion and the other a REM of my new Oticon Intent 1 HA with a comparable level of occlusion. I feel like I can live with this level of occlusion. Apparently, with the current gain and medium domes I was over amplified in the LFâs particularly in the left ear. I must admit my left ear did feel more louder and boomy than the right ear. So, I agreed my audi should setup the new HAs as shown in the Oticon Intent 1 view. All of this REM stuff is above my head I must admit. Maybe you can provide me a laymanâs explanation that makes sense to me?
Meanwhile, I am giving this Oticon a try. So far, I am very pleased with my experience to date (albeit only a couple of days). But, first impression is I like them and they are very comfortable!
Your thoughts would be appreciated.
Links follow:
Theyâre not vievable. Theyâre link do login page to Kaiser Permamente. Try export them to PDF or make a screenshot.
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Hi Bimodal. I replaced the prior two attachments with links to the Photos. Hope this works for you and Neville. Thanks for expert advice/tips!
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Update: I replaced the prior two attachments with links to the Photos. Thanks for expert advice/tips!
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Yup. X-axis is frequency going from low pitches to high pitches (left to right). Y-axis is volume going from quiet at the bottom to loud on top (in dB SPL). Letâs look at the left for the Phonak B90 as an example. The blue Xs are the softest sounds that you can hear at each frequency. The grey dotted line that forms a gentle scoop along the bottom of the graph is average normal hearing. Everything under the blue line with the Xs you cannot hear and everything above you can (for the right ear, everything below the red circles you cannot hear and everything above you can). The asterisks at the top are the uncomfortable loudness limit and the yellow line is the maximum output of the hearing aids. Green, pink, and blue lines are the measured speech spectrum at soft (55), medium (65) and loud (75) volumes. The little âcrossesâ in each of those colours are the NAL-NL2 prescriptive targets that are recommended based on your hearing loss.
So if you look at those green, pink and blue lines on the Phonak REM, you were meeting prescriptive targets at the high frequencies, but you were way above prescriptive targets in the low frequencies. This is what I might expect if hearing aids had been initially set up using closed domes and then a patient had moved to power domes without the hearing aids being re-adjusted. It could also happen if whomever completed REM originally, assuming it was done, didnât get the hearing aids all the way into the ears resulting in low frequency leakage and then cranked the low frequency gain to compensateâlooking at the settings would probably give the answer to that. Itâs possible that you also werenât actually wearing them like that if you typically do not insert them fully. I find that patients will often adjust their own low frequencies with variable insertion strategies, for better or for worse. You can probably tell us whether you tend to really push the hearing aids all the way into your ears so that the wire is nice and flush against your head, or whether you will pull them out a bit to make them âsound betterâ.
The oticons are a nice fit to prescriptive targets right now, presuming that you are inserting them as deeply as the clinician did when they did REM. If you are pleased, then great! Your clinician has done well by you. It would have been interesting to see what the REM on the Spheres was.
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Wow! I appreciate your excellent explanation, in terms that I can understand. Thank you.
I attached the REM for the Phonak Sphere I70 you were curious about.
Regarding your hunch (variable insertion strategies), I believe over the years I have done a little of both (push in too far, pull out a bit). My left earâs canal anatomy is not as straight as the right. Domes tend to slip out frequently so I am always reinserting/adjusting. I am hoping the Oticon domes I am testing now wonât be as finicky (so far, so good - Oticon domes are 8mm, in between small and medium size Phonak dome). If need be, I will consider molds in the future since I am told their creation process is significantly improved from many years ago when I tried them with Widex ITC HAs (at that time, the popping sound was very annoying and I stopped using them). I suspect the popping was related to the vent hole not be positioned correctly within my canal with it closing/opening randomly in my left ear only. Anyhow, I remain open to trying them again if recommended by my current Audi.
Lastly, I canât speak accurately to the use of REMs over the years with my Phonak B90s. There was opportunity when my domes changed to power domes and my receivers changed to power receivers and dome sizing changed at times as well. But, to be honest, I felt REM was NOT done every opportnity that arose. I could be mistaken!
Thank you again for your time and responses. It is genuinely appreciated.
Thatâs a shocking response if thatâs how theyâre working: almost nothing above 2KHz is even over threshold, never mind on target.
@Um_bongo
Can I ask then is the gap between audiogram and targets at HF a result of NAL prescription or some kind of error?
Oticon also has the grip tip option, which is sort of a dome with more of a custom tip shape. Hopefully your current dome will keep working well for you. All manufacturers fit a little bit differently, and sometimes one just physically fits an ear better than another.