More closed fitting for better speech in noise?

I’m hoping for some feedback from audiologists. I’ve seen several on the forum recommend a less open fitting for those with normal low frequency hearing to better deal with speech in noise. Essentially a closed dome with a small vent. I understand the rationale to block out the outside noise directly and let the hearing aid do all the processing, but it’s also counterintuitive to interfere with one’s essentially normal hearing. Other’s welcome to comment, but I’m especially interested in professional’s opinion. Thanks

The argument is that you ‘manage’ all the sound rather than just let it mix with the HF improvement you get from more open fittings.

As with lots of this stuff, the answer is more ‘it depends’ rather than a straight YES/NO. Looking at the long term success of RIC fittings you have to examine why this type of fit has dominated the market in recent years vs. the more occluded styles if fitting. It’s not just about the looks and slimmer wires, there’s a good deal of subjective improvement in first fit ‘sound quality’. Whilst RIC fittings definitely sound different from your normal hearing they seek to improve and ease the auditory resolution issues you’re experiencing. This by and large results in greater fit satisfaction, happier clients and fewer returns.

So the World turns, and it becomes fairly obvious that although RIC are great for the majority of cases, there’s some real issues:

Reverse sloping losses - Not a great fit as the resonance of the whole hearing aid is designed to provide lots of oomph at 3Khz and above.
Flat 40-50dB Conductive losses - Typical middle ear failures - All they really need is flat power and the wearers may be teenagers/young adults who prefer an IIC to be out of sight - see also cultural reasons and 70 year old men…
Power Losses/Leaky ears - fiddly moulds and receivers that don’t like body fluids.
People with very limited manual dexterity/historical preference - The body of an ITE is easier to fit than a RIC, especially if you’ve been doing it for 30 years.

In terms of straight sound delivery, if you control the entire response of the aid from 50Hz to 10Khz, you can manage the noise by channel and turn down/manipulate the sound in the lower pitches as needed if they contain little in the way of speech information - you simply can’t do that in a RIC. If there’s a sound in the lower tones that ‘masks’ over the upper frequencies due to it’s intensity - the RIC user has to live with it - the occluded user doesn’t. However, this ‘positive’ in itself creates a portion of the ‘artificial’ sound associated with occluded fits before you even consider the occlusion effects from one’s own skeletal sounds/voice. Rehabilitating a user requires much longer and more adjustment to obtain a satisfactory outcome that might never be as good as the RIC version of the fitting.

Full habituation with a RIC might be the ‘cheap’ and dirty answer - but there are some trade-offs as noted above. Making the correct decision on those trade-offs is why perhaps self-diagnosis isn’t always the best answer AND turning hearing aid purchasing to a web delivery model is a bit of a can of worms.

Thanks for the thoughtful answer. Yeah, I guess RICs have been sold as curealls. Didn’t quite get the “cultural reasons and 70 year old men” reference ( a search didn’t turn anything up) but I’m guessing some people just don’t like RICs for whatever reason. So I guess it comes down to what kind of hearing problems one is trying to solve and how hard one is willing to work at it. Speech in noise may benefit from a more occluded fit, but may sacrifice some sound quality. If one is frequently in that situation, probably worth it. If not, probably best to just avoid the situation. And yes, I can definitely see the advantage of dealing with an experienced professional.

Some cultures perceive wearing any type of aid as a sign of weakness or at least there is a perception that they will further degrade the hearing.

Men of a certain age (not universally 70, but that’s a good average) perceive wearing a visible hearing aid as an intrusion on their person - younger guys don’t seem to suffer with this as much and women usually are aware of the benefits of conversation outweighing the visual aspect. It’s a marker for them that they aren’t at the top of their tree any more. I guess that’s why other issues go undiagnosed in that bracket too.

I don’t understand your words on RIC limitations. I have a RIC, but the receiver is put into a full hard shell custom mold, non-vented, so why do you say you can’t fully control the sound environment in a RIC?

He was taking about the frequency profile. BTE have larger speakers which allows “louder” profiles than with the smaller RIC. If you have speakers, look at the size difference between base and treble components.

For RIC read ‘open fitting’ - full canal moulds are certainly an option, but in reality of most of these fittings won’t be done on that basis, even if the loss would suggest it was the best method. My general point was that they aren’t always the panacea that they are made out to be.

Do they? I haven’t seen a BTE with tube since the early 80’s. I can’t imagine that much of a “speaker” size difference

Yes, there are people who need to be fit with a BTE. It has gotten close with the Ultra Power Receiver. Close <> Horseshoes. :slight_smile:

I’ve been interested in this topic, for years. While I generally have such poor hearing that I barely function without the aids on, I seem at times to understand better with no aids. Currently I have the molded ear canal with the receiver embedded in the mold, but, have often wondered if I had a less-closed device. I’ve asked the audi (VA), but, she thinks that my hearing is so poor, that I can’t use anything less than a mold.

Bill

^^^ Your audiogram is not so different than mine - altho my hearing is a bit worse! For YEARS my aud-guy fit me with ITC aids. A few years back, he tried the BTE + tube, but I was allergic to the custom mold in my ear. I think that at our level of hearing loss, a BTE would be ideal! It’s just that cosmetically it looks cludgey, even if it offers the best POWER to address our level of hearing loss. My new Oticon Opn miniRITE aids may not deliver much more power than my older Agil Pro ITCs, but they offer a crisper speech. Plus, the soft, silicone power dome can fit into my swollen ear canals at the beginning of the day. I’m guessing that a BTE would provide the optimum power for me, but I’ve had to make a trade-off with physical limitations that require a more flexible receiver in my ear. My power dome is not vented, so that is another way in which I try to get the best device that meets other criteria. You might ask your audi about trying out one of the newer RIE aids to see if you can also enjoy adequate hearing without complete occlusion. My guess is: you CAN!

Because of your hearing loss in your low frequencies, you need the earmolds.