New Fitting question and recommendations

First time hearing aid wearer and the first couple weeks were great, but after the tweaks, feeling frustrated! Fitted with Phonak B90 direct.

The first week I was fit with closed domes and only had adjustments based on my hearing loss. The default programming seemed to work very well. Then came the followup appointment.

The adjustments I asked for were as follows: Better clarity for speech when talking with another person directly across from me in a noisy environment, restaurant for example. High frequencies sounded fake and needed to be turned down, maybe shrill is a good description. The program for Bluetooth streaming while taking calls seemed to increased all background noises, which didn’t make sense. I also asked to try open domes since my hearing loss is mild in mid frequencies and mid to severe in high. I read in other places where using open domes would allow for the sounds i can hear well (bass for example) would sound more natural. I also inquired about a dedicated music program i could select in the phone app just to try out.

The results, the program for music to music is now very tinny with no base, and highs were very distorted. The default music program was much better. No change to call streaming, i think it might be worse actually and i was told the program for loud environment was already maxed out for more front sensing.

I have another appt on the 15th and may ask for a complete reset to the the initial fitting. Really frustrated since it was better before she made the tweaks.

Also, should the domes always have a seal inside the ear? My initial fitting with the closed dome, where both were size small and I don’t think they sealed all the way. With the open tips (med in size) they fit tighter in my ear and produce a lot more occlusion as compared to the closed domes which seem backwards. But overall, i had much more bass, less distorted highs, and much less occlusion with the smaller closed domes.

Couple things… First, the B90 Directs may not be right for you; there are noise-handling and directionality features MISSING from these aids (compared to the regular B90’s)- why did you get these? (If just because you like Android phones, let me suggest that it’s not the best reason to pick HA’s). Next, I’d say your fitter doesn’t seem very competent, which is a pretty common thing.

Open domes should NOT be occluding at all; sounds like they might be too large for your canal? Domes should be neither too loose (no seal at all around the sides) but not tight (i.e. if they are too large, the vents in the open domes will get compressed, potentially occluding the canal). Any competent fitter should get you the right thing.

Thanks for the feedback. My audiologist suggested either Widex Beyond or Phonak B90 direct since i wanted call connectivity to my cell. I didn’t like the intermediary device in the middle so I choose the Phonaks. Overall, I was very happy with more of the default settings. I have watched a few training videos and read a few PDF doc on programming with Phonak Target software and it looks like even with the B90 directs there are a lot of tweaks that can me made, even with directional pickup. So i think it more of knowing how to program to get what i want. The next time i go in i may surprise the Audiologist with asking for specific changes using the terms the target software uses to see if that helps.

Hmm, that makes no sense to me. The B-Directs are the ONLY HA’s that talk directly to ANDROID phones; pretty much ALL HA’s talk to iPhones directly (Siemens, Widex, Oticon, Resound, Sonic, etc.)

So if you have Android and your audi mentioned Widex, he’s mistaken. If you don’t have Android, then I can only think he’s pushing you to brands he generally likes.

I’ve been most impressed with streaming on the Signa Nx’s, FWIW.

Do you have an audiogram to post? If yes, see Tip#2/Hearing Tracker Tips/ Forun Support category.

It’s difficult to get the right advice without your audiogram. Yes the click domes should fill/fit your ear canals. Especially closed domes, because the point to to not let the low frequency bass sounds escape. When low frequency bass escapes it generally results in tinny sounds.

Here is a copy of my audiogram.

That was my experience with my v90’s too. The default settings worked pretty good. It seemed any change was accompanied by a loss or annoyance someplace else.

Bump up the setting on the comfort in noise program then find it was suppressing sound when I went into the kitchen. Works better in the factory default.

My opinion: Open domes let sound leak in and leak out. It is the entire point of them; sound is very natural. Use open domes with premium aids and much of that fancy program shifting leaks right out. Some form of closed domes make more sense with premium aids.

There is no “factory default” in any meaningful sense.

News to me. Put in your age and audiogram and Target sets it up in a very satisfactory manner. That’s what I’d call a default.

Say what… what’s that? :slight_smile: (He perks up.) What does age do? Isn’t it just about the audiogram? I know with Connexx there’s an adult or child and then experienced or new. I know one could put in age somewhere for the client. But does age affect fitting?

If you look in the “preferences” for the various fitting applications, you’ll see that there are some options that figure into the “default” (for example, the default fitting prescription (e.g. manufacturer’s, DSL, NAL-NL2, etc.) So yes, it’s POSSIBLE that there’s a true default, but I doubt many fitters use what comes “out of the box”.

Also, you say that the “default” is set up in “a very satisfactory manner”. That may indeed be true for you, but that’s certainly not true for everyone.

Be a bit careful what you ask for when going for adjustments. All hearing aids will sound like too much high frequencies to you at first. If you turn down the highs so it sounds “normal” ( your normal is not normal like people with no hearing loss or you before hearing loss ) then you lose clarity. It is a trade off that you make when you reduce the highs instead of letting yourself get used to them. The same for noise reduction. Increasing the hearing aid noise reduction can work against your understanding speech in noisy environments. Make changes slowly and one at a time. Try to give the aids some time also. Many fitters will set the initial gain to about 75-85% of target levels then set the aids to automatically increase the gain over several weeks to months. You do not get the full benefit until targets are reached.


Hello there.

My response isn’t specific to your model or exact issue, but know you will undoubtedly have many more to come. Your post caught my attention and I wish there were someone to tell me some of this when I started wearing HAs. I have moderate to severe hearing loss and wear Widex Beyond with a custom receiver. I have been through and still go through what you do today.

I thought I would chime in and offer some advice based on my experience wearing hearing aids now for over 20 years. I’ve gone through several audiologists, several types (ITC, ITE, BTE), models, and manufacturers (Phonak, Siemens, Widex). As a new recipient of hearing aids, I would warn you that you will be in for a lot of frustration as the hearing aids will be high maintenance. You will be making several adjustments and there are factors to consider. New features to make adjustments for, environmental issues; moisture, wax build up, dust, physical changes such as weight loss can impact your hearing as well, etc etc etc. Then having finally adjusted your HAs, you have to overcome learning to “listen” to people all over again. You literally need to learn to process the information again. I had learned to tune people out, even today with my own HAs, I still maybe tuning people out. It’s behavioral. Understandable for you, but not always for others.

Dealing with all this can be overwhelming and I would completely understand if you were to just give up.

Don’t. All that said, if you understand all this and have the patience to work with your audiologist, it can be a life changer.

HAs aren’t like getting fitted for glasses. It’s not as easy as getting a prescription and new frames and lenses. it’s much more complicated. A few takeaways from my years of experience wearing hearing aids.

  1. Have patience. HAs are high maintenance. Even after getting through the challenges of making tweaks and appropriate adjustments there will always be something that may set you back. HAs are not cheap, and often are not covered if at all by insurance. You will have down time and even if you were to afford a spare pair, they will likely not give you an identical experience. You’ll finally get to a place where you’ve got the tweaks down and it’s time to replace your HAs and new technology and features to tweak. It still frustrates me even today and I struggle daily, but would not be able to live or work well without my HAs.

  2. Find a great audiologist. This is the most important person you will need to rely on during your struggles. This is very subjective and can be intimidating, but do some research and find someone you feel comfortable with. I moved from Chicago to NYC and found one that I’ve stayed with for the past 12 years. I found someone I can trust and someone who got to know me and my profile, needs, quirks.

  3. Do you own research and homework. Learn as much as you can and push your audiologist. Technology can be challenging and frustrating. There’s a lot out there that’s useful and some not so much. If it seems to good to be true, it likely is. I have experience with Widex, Phonak, and Siemens, but Starkey, ReSound, and Oticon are other reputable brands. It all depends on what you need and what your preferences are.

It’s going to be challenging and frustrating at times. Don’t give up and give it a chance. It will change your life for the better. I believe it was Helen Keller who said “Blindness separates people from things; deafness separates people from people.”

I hope this helps put things into perspective.



I’ll have a pound on whether the feedback manager/gain compensation wasn’t re-run after the new domes were fitted. It’s a classic fitting error - you don’t just add a massive amount of venting without modifying the inductance of the output signal.

I’m not sure why this was ever a discussion about different brands.

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I have been wearing hearing aids for 50 years. I have worn Phonaks, like yours for the last 4 years and went through a similar series of problems that you describe, when I first got them. The VA has just supplied me with a new set of Phonaks about a week ago and the first week was very difficult. Fortunately I am in control and am not waiting for an appointment in 30 to 60 days to address the problems. The Domes are round, but the canals are oval. Both were uncomfortable. Instead, I make and modify my ear molds to suit my perceived problems. My ear molds fit exactly with comfort. I do not worry that they are too large or too small. I experiment with venting, until it is just right. My process is to file a portion of the outside of the mold. I prefer using a finger nail emery board and just file a small path along the bottom side, from front to back. I file a little and use it for hours or days. If I think more venting might be helpful, I file a little more. At some point, I stop the vent/filing when I am satisfied. No one knows this but me. No audiologist knows what the experience is. They guess, drill holes and wait for your experience and response. Instead I go to this website and buy a cheap kit with printed instructions for $19.88. They also have a deluxe 24 mold version for $29.77, which I prefer, so I can make many re-makes.

There is some useful information and advice that has been given. It is true that there is a learning curve when getting a new set of hearing aids, but especially a first time user. If you ever learned a foreign language and haven’t used it , you must re-learn and retrain your memory. Hearing is the same when you have gradually lost some hearing, like you. Your memory of those high frequency speech sounds will be strange and may be perceived as noise, at first. My advice based on my personal experience is to read aloud until you are comfortable with your own voice. This speeds up the adjustment period and re-trains my brain to recognize the new experience.
My final word is be patient. When I first started wearing hearing aids, no audiologists were dispensing them. They learned from a book, professors and listening to their customers. Many really try to help you get the best hearing experience. Be patient…

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I use Widex 440 beyond and am an android user. I have a device that I wear around my neck that is unobtrusive that streams to my hearing aids with great sound. The hearing aids themselves have given me the best sound I’ve had in over 25 years. I had used phonac and demoed Oticon OPN and Starkey as well.