Newbie with “Reverse Slope” Hearing Loss-- Just got HA


I’m new at this forum :slight_smile:

I have “Reverse Slope” Hearing Loss. For the most part I can hear fine, it’s just people with deep voices that I do not understand. Also, I can’t hear well in noisy environments or when people have soft voices.

I just got hearing aids for the first time. I have been wearing them on and off for the last six days. Sadly, I dot not see a difference, instead I hear better without them. I got the Starkey 3 series i30 CIC for $1800 for the pair.

Is there a hearing aid that anyone can recommend for my type of hearing loss? I don’t have my audiogram with me, but I will post it later tonight.

Thanks in advance for any help anyone can provide.

  • Vanessa

Hi Vanessa,

the problem might be not the hearing aid but the way it is connected to your ear.

Most people have hearing loss in the high frequencies. They can - if the loss is not too big - use open domes, this way they hear the low frequencies natural, the high ones amplified.

In your case, this is not possible, because low frequencies cannot be amplified with open domes. You need closed domes (power domes or custom molds) to amplify the low frequencies.

Alas, the high frequencies don´t come through closed domes, so even though you can still hear well in the high frequencies, you will have to hear those through the hearing aid. Hearing aids provide high frequencies up to 10 kHz, but most stop at about 8 kHz or even lower. While this doesn´t matter much to people with high-frequency-loss (those very high frequencies are not extremely important for speech, and most of us are used to not hearing them for some years), it actually takes away some hearing for you.

Please post your audiogram, maybe then someone can add useful information.

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Reverse slope losses are hard to dial in since all the HA companies gear their programming toward the more common ski slope type of loss. You need to find someone who really knows what they are doing when programming a reverse loss and that is the hard part. Good luck!

I’ll just remark that the info you’ve received is spot on. I want to emphasize what Seb said. Finding a hearing aid fitter that is good at your type of loss is crucial. The fitter is half the battle.

Thank you so much for your replies! :smiley: I will share them with my audiologist. I have my audiogram with me, but do not how to post it. :confused: I have attached pictures of them though.

With an audiogram like that you better find someone who really knows how to set up HA’s for a reverse slope loss. You might want to look up
The Bizarre World of Extreme Reverse-Slope Hearing Loss (or Low Frequency) Hearing Loss

by Neil Bauman, PH.D

You biggest issue is likely to be the audibility of mic/circuit noise due to your relatively normal higher pitch sounds.

Try a few different manufacturers to see what sounds best in a RIC format, then change the body style if you prefer a different type of aid.

Even when you feel comfortable with your choice it’s quite possible that you might need a few tuning visits to settle the final product down - bear in mind that you have a good ‘noise filter’ in place at the moment and you will be removing a good deal of that comfort.

Thanks for you input. I had read that article before and it’s very interesting. I will share it with my audiologist, hopefully it will help him so he can program my hearing aids better.

And I do live in a “peaceful world” right now. I live close to a major street where there is constant traffic during the day. It does not bother me at all, but my family can barely live with the noise. :frowning:

I will keep these HA up to the last week of the 45 day trial. If they don’t work, I will try different ones. I’m definitely making an appt with my audi for adjustments.

I happen to know a guy with a lot (relatively) of reverse slope hearing loss patients.

He happens to strongly believe Starkeys are not a good fit for reverse slop losses. In his estimation, the best devices for reverse slope loss are Oticons and Phonaks.

And you will definitely need an ear mold with a very small vent… think .7mm to .8mm. Depending on your results with thatm you may even end up opening the vent somewhat toward the lateral end.

And you will definitely get MUCH better results with better devices. An entry level device like a Phonak V30 or an Oticon Ria2 will not do a great job. You will want to get closer to the V90 or Alta2 product lines…

If you are stuck with Starkey, bare minimum you will want is a Z series i110. Thats not great, but definitely a better fit than a 3 series i30.

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What about Siemens Binax in your opinion?

There’s a great article about how to fit non standard losses. It spells it out a bit better than other articles.

The article is written by the VP of audiology at oticon. He has specific adjustments that are recommended for low frequency losses. For less than 2000hz, no more than 15-20db insertion gain. For 2000 and above, even if hearing is normal, add 10-15db gain. This is because when you add gain to the low frequencies, you get the upward spread of masking which is basically the low frequencies masking the ability to hear the higher frequencies where speech is. This is why most people with low frequency losses cannot get help from aids. It’s not the aid, but the programming. Since most audis have no experience fitting reverse slope, you have to direct them on where they can get helpful hints and tips. I’ve talked to Dan Scwartz who himself had reverse slope loss. He has been fitting hearing aids since the 80s and says reverse slope losses are actually the easiest loss to fit if you have experience fitting them. You need an open dome as well.

if for reverse slop is it true if use custom mould then suppose we have loss of 20-30db in high then above 20-30 ie 30-80 will not be enter in to our ear or only not emplified still we proved gain for 65 level since its not covered by our audiogram.for (our deafness) HTL?

Sorry, I’m not sure what you’re asking there?

suppose i have 60 HL low frequency loss with 30 HL db high frequency loss right. now in audiogram i will plot this then we will amplify via three stage 50 65 and 80 but in high i do not have loss above 30. so my question is if fitting software providing dain at 65 and 80 some like 5-8 db will those level amplified with gain though my loss is only upto 30??? or above 30 will not enter if used closed mould custom without venting?

I think you’re confusing gain and output. In the LF you’d get about 20dB of gain for speech at around 65dB which would result in 85dB of output - audible to you. In the HF you’d get about 10dB of gain, making the input 65dB of speech a bit more audible at 75dB Output.

This isn’t necessarily the ‘right’ prescription for your loss - you might want a flatter application of the gain so it doesn’t sound like the lower frequencies are masking over the upper ones.

hence we have to plot audiogram as it is and just provide gain for 65 low as well as high frequency input ok??? the also 65 high will be amplified at more 10db if gain provided and i do not have deafness at 65 at high frequency? because my audi asked if i agree to increase HTL for high though i have normal limit in high hence asked.

No, you don’t plot the Audiogram any differently, you do a REM and measure what the actual gain is being provided at all levels, then adjust the gain using the appropriate channel levels in the fitting software.

The manufacturer software will not let you see the actual gain being applied, just their suggestion of what it might be - this is unlikely to be accurate in the lower frequencies due to poor canal size matching and venting differences.