New User - Questions

Hello,
I am a complete newbie with hearing aids. I am trying the ks9. I have been wearing them for two weeks. I still haven’t figured out if I’m hearing the people I struggle to hear.

Anyway, is it normal to have a constant static noise happening? It’s just very subtle, but it’s there? I was wondering if this is something I just have to deal with?

Thank you.

I can think of a couple of different possibilities. One is simply that you have become used to not hearing the lower frequencies, due to your somewhat less common hearing loss. This will just take some time to get used to. Does the static noise seem like high or low frequency?

If it is higher frequency another possibility is that the relative gain at the high frequencies is too much. There are different fitting formulas that can be used to prescribe the gain vs the frequency. Phonak probably have their own proprietary one, and there are a couple of other industry standard ones used like DSL v5, and NAL-NL2. The latter still provides some gain at higher frequencies where you hear well, while the DSL v5 provides no gain at higher frequencies. My hearing loss is very different from yours, but I would think the DSL v5 would sound a lot softer than NAL-NL2.

Not sure about the KS9 Phonak aids, but some can use different programs in the aids to use the different formulas. For example you could ask the fitter to put the Phonak prescription in one, the NAL-NL2 in another, and the DSL v5 in a third. Then you could compare each over an extended time to see which one you like. They are all valid formulas, and it comes down to what you like to hear, and how well you can hear speech if that is your main concern. If the aids cannot handle multiple programs with different formulas then you would have to have each one put in at the office and try each to see what you like. Here is what a DSL v5 prescription would look like for your loss. Note that it gives more gain at low frequencies and none at high frequencies.

It is definitely a higher frequency noise. Thank you for this. It is helpful. I had to read it a few times to start getting it, as this is all new, but I am understanding, and it is something I can bring to my fitter.

I saw him yesterday, and I asked him about it, but then I think we veered into another topic, and we didn’t get back to this, but it is something I’d like to sort out since I am constantly hearing it, and maybe I don’t have to be constantly hearing it.

The graph below is what the NAL-NL2 curve looks like. It is also probably quite similar to the Phonak proprietary formula. Notice that it gives more gain in the higher frequencies. The other thing it does is use more compression in the higher frequencies. Compression is when quieter sounds are amplified more than normal level sounds. The lighter colored upper curve in these graphs is the gain applied to softer sounds. The normal sound is the heavier gain curve in the middle. While the lowest gain curve is for loud sounds. The more spread there is between the top and bottom curves the more compression is being used. What this could be doing is picking up higher frequency quiet (to someone without hearing loss) sounds and amplifying them too much. The DSL v5 prescription only uses compression for the lower frequencies where you have much larger hearing loss. It uses no compression above 1500 Hz. All the gains are the same.

So, I might do well in asking for the DSL v5 version and try that out? I am in the reverse slope hearing loss facebook group, and someone is having the exact issue with their hearing aids. I am wondering if this is common since many fitters don’t have a lot of experience with this type of loss. I am trying to be an advocate for myself without stepping on toes.

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Yes, that would be the least complicated way to go. Just ask to try the DSL v5 and give it a go for a couple of weeks. Just make sure they do the Real Ear Measurement over again, and adjust to it. On a quick look at the RSHL issue, one article claimed that it is very rare and only 3,000 or so people in america actually have it?? If so, fitters are not going to see it very often. The cause of it is apparently hereditary or due to medical conditions. It may be something seen more often in younger people or youth, as the much for frequent ski slope loss is usually caused by age and noise exposure over time. The history of DSL is that it was initially developed for children, who may have RSHL more often. But, it has been revised to now include adults. It was developed in Canada. The NAL-NL2 comes from Australia.

Your other option would be to just ask to have the highs cut back. But, I think it would be better to get the best prescription formula first, before making willy-nilly manual adjustments. DSL not only cuts gain, it reduces compression.

Thank you. I appreciate your time with this. Mine is definitely hereditary. It comes from my mom’s side of the family. Everyone on that side of the family is known for not being able to hear, yet nobody does anything except my aunt who is profound in all frequencies and has two cochlear implants. I don’t want to be my family. I feel like technology has come to a point where I can get some relief from always struggling to hear people.

Again, I very much appreciate this. I feel like I have a solid base to go with now.

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Scastill, there is a great piece on the internet by Dr. Don Schum, a VP at Oticon. He talks about fitting special populations–low frequency loss, ski slope loss, etc. And he mentioned how it can be counterintuitive. From that I took away the need to try different types of tweaks.

Here is his material, I hope it’s helpful–I don’t know if it’s possible to log in to it without a free account with Audiology Online, so I’ll summarize what he said after the link. If you do set up an account at Audiology Online, Dr. Schum’s talk is Course #33147.
https://www.audiologyonline.com/articles/complex-versus-standard-fittings-part-21836-21836

He said some folks with rising audiograms prefer amplification in the region where they have pretty good hearing, much like a Hearing person in the car might turn up the radio to hear something of interest better. So, as with ski slope losses, it’s not about fitting the most lossy areas every time. It’s what Dr. Schum called, “fitting residual capabilities.” Hope this is helpful.

Thank you. It is asking me to sign-up and pay. but it also providing me with the report. I will definitely read it.

You don’t need to pay!

You can get it free if you don’t want CEU (continuing education unit) credit.

I can find the article for you if you want, probably, and copy at least the text part of it.

I’ve been listening free for years.

I was able to get the article. Thank you for pointing it out to me.

Costco just told me the don’t use the DSL v5. I am going to go in for an adjustment next Wednesday.

I would be surprised if the Target software that Phonak uses is not capable of DSL v5. Perhaps one of those that have it could comment. DSL v5 could work well for you.

Edit: I think the Costco fitter is misleading you. The Costco I go to uses Aurical FreeFit for doing REM. A quote from their info:

“Aurical Freefit is wireless – giving you more freedom and flexibility to perform probe microphone measurements. OpenREM supports open fittings. You can verify fittings against NAL and DSL prescriptive targets. Or you can incorporate your own targets and stimuli to suit the way you work.”

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Target, selected instruments M90312, here are the options.

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I went for an adjustment today. I am cautiously optimistic, as it was the high frequency that is causing the white noise, but put me in open domes and adjusted mid and high-frequencies like that article states. We didn’t get into the DSL bit. I didn’t want to step on toes. I really want to build a relationship with him, and I was super happy he made these adjustments without me saying much about what I had read. I did tell him I’ve been reading up on reverse slope hearing loss, and I asked him to tell me exactly what he was doing.

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If you want to go along with the suggestions in that article, you may want to consider a NAL-NL1 prescription, but with a 10 dB or so boost in the higher frequencies where you hear quite well - the yellow highlight area. The NAL-NL1 already limits gains in the low frequencies, and has a reasonable boost in the mid frequencies. BUT, that might bring back the high frequency hiss… A starting point would be to try NAL-NL1 and see what it sounds like with no fine tuning of the highs.

i wish I had written down what prescription he has me on. I guess it’s the NAL NL2. When I came out of Costco the sound was so different. I will see how this works out. He told me give it a month. I have diligently made sure I am wearing them for 12 hour per day. I will give the month, and will definitely keep the idea of increasing the highs a bit more. I feel like I’m going to have to deal with the white noise if I want to benefit from the aids.

I would call the NAL-NL2 more like what they call a Broadband Gain in that article posted above. It gives a lot more bass and less of a midrange peak. I don’t think it is all bad if you can handle the bass. That article seems to dis the use of bass correction.

The broadband setting was the one that stood out to me when I was reading the article. I guess that’s a start. I was reading about just having high frequencies and no low frequencies, and I also read about people sounding like Mickey Mouse, and that didn’t sound appealing for me at all. But, I also want to be able to hear my husband.