Limited options for first hearing aid in Thailand, need help

[Jack_K]

Hi all! I am in Thailand so a lot of things that others get (like newer models, in depth adjustments and at home trials) are just not available here. And the fitting guys are basically just reps, not audiologists.

I have moderate hearing loss in one ear and normal in the other. The one that has hearing loss has a 52% speech understanding score. Graph at the end.

I tried Oticon More1 today. Disappointing. I could tell they were doing…something…but in terms of filtering out noise and making speech understandable…meh. We walked outside to the parking lot and he would talk to me…it was a slight difference. Maybe. They didn’t do any adjustments, other than running some automated program to fix the initial settings. They also have Starkey but he didn’t recommend them for my hearing loss situation.

Streamed some YouTube and it worked fine but I couldn’t understand the words coming out of the streaming in the one ear so it’s not a useful feature for me. But that’s ok, not a priority.

Tried Widex the other day and it couldn’t connect to the app. Going to try that again since she didn’t reset the phone. These 3 brands are the only ones they have available in this area.

So…questions…

1. Am I expecting too much from my HAs? Should I be able to notice a big difference at the hospital? or is the fact that my right ear more or less ok going to mean I don’t get a lot of speech understanding boost in the left?
2. 90 minutes away, they have more brands (Phonak, ReSound, etc.) but they will still be older models. Would switching brands make much difference?
3. Are their settings I can tell them to try? I messed with the equalizer and I didn’t notice much difference. I am trying to understand speech in a loud setting, like a bar with music and people talking. The fitting guy just ran the auto program and didn’t try to adjust them.
4. About 90 minutes away, I can try some other brands, like Phonak. But they will still be 1-2 generations back. Think it’s worth it, given my chart?

[1Bluejay]

Wow Jack_K, you have my empathy!!! I just don’t understand how a tourist capital like Thailand can do so poorly in providing hearing solutions for its citizens. My in-laws had the same issue living in Chandigarh, India tho!

I don’t know where to begin, but I’ll start by saying since this is your FIRST pair of aids, YES, brands and models make a difference. Even more important is who is fitting these aids, and how skilled they are at making adjustments based on what you’re telling them. A good fitter can make or break a hearing aid’s acceptance with a user.

I’ve tried Oticon and Phonak over the many years I’ve worn aids. My own brain seems to do better in the Phonak camp. My hearing is FAR worse than yours, so ideally, you’d be able to try 2-3 brands and see what kind of sound experience you prefer. Even models 2 generations ago (4-6 yrs) are not abysmal. But for me, aids have to have great sound quality, STABLE Bluetooth connectivity and accessories that actually work for streaming TV and other situations.

I’d check out the offerings in the location 90 min away. Perhaps you could take 2 weeks (work remotely?) and actually stay there to trial the brands and have adjustments made.

That said, I’m wearing Phonak Lumity Life aids, and use their myPhonak phone app to tinker with some of the program settings. I don’t think you can second-guess what programs or settings you want without meeting with the fitter and doing this TOGETHER. As you’ve already experienced, if the fitter doesn’t even figure out how to optimize speech in LOUD places, what are the odds you can do this on your own?

You are not expecting too much from your aids so much as you are limited by the quality of hearing care professionals in your area. That’s the frustrating reality for many of us - no matter what country we live in.

Best of luck in your journey. You’re lucky that you don’t have profound loss, but still - you’ll want to work on word comprehension. And if that requires a hearing aid, that’s what you’ll need to work with. Keep us posted on your options there.

[Alex_D1]

Hi Jack, looking at your test results unfortunately your hearing loss is a very challenging one for us clinicians to fit and get really good results with.

This is because generally most “noise or Background noise” is a low frequency sound - and this is where your loss is, so trying to give you volume / clarity in speech without raising the level of background noise can be a very delicate balance to overcome. It would take some time for your brain to get used to filtering out background noise from speech . You’re issue is volume on that left side - not clarity of speech which is generally high frequencies.
Patients with low-frequency hearing loss may find it harder to adapt to hearing aids because of the perceived unnaturalness of amplified low-frequency sounds.

So yes while I agree that your location and lack of Audiological support may not be assisting you as well as it could , there needs to be some more counselling and time taken with you to adjust to your hearing loss.

Based on your speech result as well - yes expectations need to be kept in mind, this means if we raise the volume of that ear how much are you going to hear - basically how well will you do with hearing aids . To give you some context , some of my clients who have a moderately severe hearing loss can still have a speech understanding of 100% if amplified to correct levels- so its not necessarily the degree of loss, but a combination of type of loss, what cause the loss, any other protentional retroocular pathologies happening etc .

Are you experiencing any dizziness or vertigo as well, as I would look into Meniere’s disease as well as your audiogram has signs of Meniere’s disease , If you also had Meniere’s disease this also contributes to trouble understanding speech, if you also experience tinnitus on one side , I would ask them to write a report to a Doctor and get an MRI.

Good Luck, the best advise I can give you , is take your time , be very patient and also don’t have expectations too high, not everyone’s hearing loss is the same and not everyone’s experience of hearing aids is the same. Hopefully you can find a clinician that is able to work with you and give you more guidance and a specific rehabilitation program for you.

[Jack_K]

Thanks 1Bluejay.

The good news is that I am retired and I don’t mind making the trip. However…everywhere I have talked to does not have ‘trialing’. You can wear them on the premises. Go out to the parking lot maybe. But not leave the area. The only advantage of going up there is that they have Phonak and Resound. Where I am at now, they only have Starkey, Oticon and Widex.

I asked the rep why they can’t order newer models and he said it was Thai law. He guessed it might be due to the expense of the newer models. But that’s…weird. Because they seem like they are overcharging for the hearing aid, anyway. Oticon More1 is like $4400 for a single hearing aid and charger which. Seems high from my research.

I am covered by my insurance, though, so I am not at danger of wasting money…but whatever I choose, I will have to live with for a couple years.

The other option I have is to try to find another nearby country I can go to (Japan, maybe?). Obviously, this is a lot more involved and I would have to wait and make a proper vacation out of it. And of course that is a cost that won’t be covered by insurance. But…if it will make a big difference in my hearing, maybe it’s worth it…but no guarantees the audiologists there will be any better.

[1Bluejay]

I think your lowest cost option is to just go to the 90-mi away place. You really NEED a fitter who’s in the general area cuz there may be changes you want made OR the instrument may fail in some way down the line. I don’t know how many languages you speak, but Japan may be a challenge! Even taking a train there can be daunting unless you have some kind of translation app - or ask someone under the age of 30.

That’s been my experience traveling in Japan on a few occasions.

As for the trial, what if you were to put 50% down as a “good faith” deposit. Wear the aids for even TWO weeks - while in the same city. Have them copy your driver’s license. Is it the case that these hearing aid dispensaries have ONLY ONE SINGLE set of aids for folks to try out? That’s like a car lot with a single Mercedez that folks can LOOK at, not touch, and then go plunk down thousands of dollars to buy without even a test drive.

[dankailo]

How about Malaysia? Buy your own and service/tuning at the Audi office. About USD12 per hour. USD 60 for REM.
Oticon & Phonak, Resound & Rexton models can be fine tuned.

[Jack_K]

That’s some really great information @Alex_D1. Thank you.
I have Tinnitus in that ear but I don’t think I have vertigo or dizziness. The doctor I saw recently did suggest an MRI but she seemed more interested in Acoustic Neuroma possibility. She didn’t seem overly worried but said it was an option. She didn’t have any more information than the audiogram, though, so…who knows.

You mentioned a rehabilitation program. What all is involved with that? If I buy a hearing aid here, I believe the only after-support is that I can come back and they will make adjustments (although I don’t know how they will make adjustments since they are not in the noisy environment that needs to be tested) and one provider said they offer a cleaning very 2-3 months for a year… Sounds like there is something beyond that?

@1Bluejay I am used to getting around with translation apps. Ironically, since I have hearing issues, they often work better than someone trying to talk to me in a foreign language with a foreign accent hehe The upside is they do have Costco in Japan (but no idea if they have the newest models there).

They said it’s hospital policy so I don’t think they can change it. I can search around for a different provider but it gets a little complicated with my insurance (probably be looking at reimbursement instead of direct bill).

So the way it works (at least at this hospital that will direct bill for me) is each company has a rep that is there a different day of the week. So if you want to fit Oticon, you come this day and a guy who works for Oticon fits you. If you want to try out Widex, you come another day and try Widex that day. But they only have reps from Oticon, Starkey and Widex at this hospital. If I go to the capital, they should have all, or most, of the brands there.

I saw the Widex lady today. Their most current model is the Moment, series 1 through 4. I guess that’s not too old. Looks like it came out in 2020. The Oticon has the More1, which looks like 2021.

[Jack_K]

I could go to Malaysia if need be. I would need to find out if they carry the most current models first, of course. I don’t actually know if other countries in the region are any better, or not. Any particular reason you mentioned Malaysia, though? Can you expound on the self-service option a bit? They have Oticon here and one of the things I didn’t like was that the program didn’t let me do much fine tuning with it. The Widex was better in that regard.

[dankailo]

I am from Malaysia. Bought Oticon More from Holland (online), Xceed & P70 Naida thru forum members. Service by local Audi and pay a fees. Quite happy with their service. Did not see Widex in their webpage.
Important is to try it out until you satisfied. In Asis, the Audi only let you try for 1 week and a small fees. Costco USA trial is 6 months.

[Alex_D1]

I would definitely look into the Acoustic Neuroma and MRI to clear that first. Especially if you have the tinnitus only in one side. Generally a rehabilitation program is centered around how we are going to give you the best possible hearing out of your hearing loss.
For example we do this with appointments ,adjustments, counselling, education, FM devices, support mics. It just depends on your type of loss. if you require say 4 - 5 sessions over a period of a year to reach your target prescription that would be in your rehab program , if it was suggest you learn lip reading to help or have appointments for education on communication tactics, where to sit in certain situations, how to read peoples facial ques . You generally cant fit in all this information in 1 - 2 appointments, its a process, it also takes trial and error and adjustments.

I have some clients that don’t need a rehab program , we fit them check them and follow up and they are really happy and feel their hearing has been fixed with great results. Other clients I have with either single sided deafness, poor speech or poor speech in background noise, low frequency hearing loss, Meiners disease, excessive tinnitus, profound hearing loss - these people generally need a rehab program outlining the steps we are going to take in order to give them the best possible environment and tools to get good results.

It is important though to find a product and a clinician that you are happy with , especially when you can have really good hearing aids and they just aren’t set up properly by a good clinician.

[Deaf_piper]

@Jack_K if you’re going to travel to Japan, Malaysia or even Singapore to get a more up to date HA. Check out the company to see if that company offers remote care.

The other option is to look at the DIY section here on the forum. If DIY is something you could do yourself this might solve some of your problems looking forward.

I found this clinic in Singapore that offers “remote care”? Well they advertise that’s what they offer. They also offer more up to date hearing aids.

Hearing Aid Prices & Subsidies in Singapore | Hearing Partners?

Good Luck.

[Raudrive]

How long have you had this hearing loss?
Have you worn a hearing aid on that ear for a long time?
Your low 52% word understanding could mean a few different things but properly aided and time should get that understanding score up higher. Unless there are other issues.

[Jack_K]

Tinnitus is only on one side, I think. Sometimes I think I hear it a little on the other briefly but not sure. Definitely not like the one side that’s constant, though.

Your rehab program sounds very advanced and thorough. I am definitely not aware of anything like that here. I don’t think there’s much in the way of options here to find more than I have. The fitting reps are nice enough and I am sure they know their product but I don’t feel there is any advanced knowledge on how to make it work in my situation. The two I have seen more or less said not to expect too much. One said because my hearing loss is low freq. The other said because my speech understanding is 52%.

Question…having tried on the Oticon More1 and Widex Moment and not being too impressed with them so far…could that be because I am not “used to them”? I am sure there would be some improvement if I got used to them but how much is that likely to be? I ask because I basically have to make a choice if I want to get them without wearing them any more than I have (no trials).

[Jack_K]

Many years, not even sure how many. More than 5 is safe to say. On the upside, I don’t think it’s gotten any worse.
Never worn a hearing aid.
Any suggestions on how to get that score up there? Any particular brands or models that work well for low frequency hearing loss, such as mine?

[Raudrive]

@Jack_K

Never worn a hearing aid.

This is probably the reason your word understanding score is low. Your brain has slowly acclimated to the hearing loss.
You have a good chance of getting some or most of that understanding back by using a properly fit hearing aid. It will take some time, won’t be an immediate fix. It takes the brain time to relearn sounds.
Hang in there and good luck.

[Jack_K]

To be clear, my one ear functions normally with full understanding. It’s only the one ear that is so poor. Not sure if that impacts what you said?

I certainly hope you are right. You think it’s worth getting a hearing aid for one ear, even if it doesn’t seem to have any effect?

I have local access to the Oticon More1 and Widex Moment (both 5 year old models).

[Neville]

That’s a difficult hearing loss. Even with the best hearing aid on the market fitted approrpiately with a good custom tip, benefits will be moderate and speech in noise will still be bad. I do think it’s worth trying to aid that ear, but for speech in noise situations you may be better off picking up a Roger On and a Roger Focus to wear on the right ear. In your situation where there is limited access, you might be able to find something on ebay–the Roger Focus doesn’t require much in the way of adjustment, it’s pretty plug-and-play.

[Alex_D1]

Hi Jack,

Just as another option you could also look at Trialing a CROS Hearing Aid . Due to your poor speech on the one side , if you place a mic hearing aid on this side it will transfer all the sound to your good ear and you will be able to hear what is being said on your bad side. This would be my last option though before also looking at CI at very very last.
You would still be better aiding both sides in my opinion and then giving yourself time to get used to how amplification sounds but it will be challenging to completely understand .

A Cros system may assist. I could imagine it would be quite frustrating not having a clinic close by that you can trial devices with. considering your challenging hearing loss.

[Jack_K]

Thank you for your reply, @Alex_D1

Not only no trials but worse, maybe, the limitation on newer models (the Oticon More1 is 2 generations old, I think, and it’s their newest model). I will have to research and see if they have a CROS system available

The only upside is that my insurance will pay for it. So I get one shot at trying something and if that doesn’t work, I have to wait a few years, maybe, to try something else.

@Neville Thank you for your reply. I haven’t heard of the Roger series. I will have to research that one.

In general, would custom molds be of any benefit to me? Like with the Oticon, they have them but the fitter seemed to think they wouldn’t help my situation at all, due to the low speech score on the one side.

[Zebras]

@Jack_K

Like with the Oticon, they have them but the fitter seemed to think they wouldn’t help my situation at all, due to the low speech score on the one side.

So with low speech scores and your low frequency being quite severe, you definitely need an ear mould. I would suspect with just small vent as well to reduce feedback issues.