Hi 1Bluejay,
Sorry, I deleted the post as there was a section of it where I was not explaining myself very well and I wasn’t sure whether you had been down the same road anyway, and it was late - lol.
OK. It’s morning and my boss isn’t looking… lol. So I will rewrite the post. This is going to be a very long post so apologies (and apologies to the other members), but I thought it might be worth putting it all out there, as there could be mutual benefit. I am going to say a lot of things, they may not seem relevant at first, but I think the relevance will become clearer.
Phonak and Oticon
As I said, your posts are of interest because you have a similar audiogram to me and you wear predominantly, Phonak aids. You had an unsuccessful trial with the Oticon OPN. I too wear Phonak aids predominantly (since 1994) but have also worn Oticon on 3 other occasions (since 1989), but I have never worn the OPN. However, 2 years ago I was fitted with superpower hearing aids, the Oticon Dynamo 8 and this was one of the aids where “Brainhearing” for speech cues was first mentioned. As you may know, here in the UK we have the NHS. This is a mixed experience. Generally there is an upgrade every 3 years, but it depends on the post code (zip code) lottery and people get various levels of service from bad to excellent. I was not upgraded for 6 years, but this time around they upgraded me. This is the thing, as you say in America, at first, being reasonably technology savvy, I was a bit sniffy about these aids. I was unimpressed. It was 2022 and here I was being fitted with something I thought was from the stone age. It was a 2015 model, no direct bluetooth and BTE hearing aids to boot, which were obviously not as discreet as my KS10s.
Oticon Dynamo - the superpower aid - and realisations
OK. So they are BTE hearing aids. I put them on at home, I listen to music. It sounds poor, but otherwise the sound is clear. They were programmed with REM and NAL-NL2. They sound similar to my KS10s and they get relegated as a back up for my private KS10s. They go into the draw. In the summer of 2022 I go on a bike tour and put them in my panniers. I have a problem with my KS10s and I have to switch to them, and I start wearing them. They are OK, but I got home and put them back in the draw for 6 months.
After Xmas around 2023, I am thinking about music and hearing issues and I remembered long ago that the NHS adjusted the gain in one of my reassessment sessions of a previous Oticon hearing aid. I contact my NHS audiology department and ask them do this. They increase the gain, something like 6dB to 10dB. I go home and listen to music and I realise that it sounds fantastic. OK - just to give some background here, with the KS10s (even after REM), music sounds rubbish - this has always been an issue for me. It sounds good streaming, but not in the car or listening to loud music. However, with the Oticon, it sounds fantastic. I almost have tears in my eyes. I have not heard music as good as this for 25 years. It reminds me of my younger days with analogue hearing aids. Why is this? Well - I conclude, as it’s a super power aid, it’s the power (this is only partly correct - see later).
Music
OK. Let me stop at this point in the story and talk about the relevance. Well - I have been fit with REM from two providers, and in one aspect, both failed - enjoyment of music. Why did they fail? And why did I not realise it after my fitting. A few possible reasons, firstly, there was no test of my loudness perception. I am used to wearing analogue hearing aids, so I can tolerate loud sounds. However, the programmer limits the MPO and makes sure the output is not at dangerous levels. That is possibly one reason. Another reason, I did not think digital hearing aids were capable of delivering music. The chief audiologist at the NHS told me that the fitting strategies were at odds with music and it was not likely they could program it so I could enjoy it. However, the music on the Oticon Dynamo was unbelievable. The music sounded good quiet, in noise conditions and loud. How could this be? I have only just realised the main reason (through some playing around on Target and understanding the effects with my Phonaks). The reason for me was that the Mids were not loud enough.
Oticon Dynamo - The Car
When we travel as a family, we take my wife’s car and I get relegated by my eldest daughter to the back seat. It’s winter 2023. I decide to take my Oticon Dynamos to listen to music in the car as I know it sounds better (fantastic in fact). Whilst listening to music, I discover that I am hearing my wife and daughter talking in the front. What? I am enjoying the music and I can hear my wife and daughter talking. I cannot hear them with my KS10s, despite the “car program” or any other program. Their voices are reasonably clear. How can this be? When I am wearing KS10s (which are a 2020 model), programmed with REM and NAL-NL2 I do not understand them. The Oticon Dynamos are also programmed with REM and NAL-NL2 and the technology is 5 years older and I am understanding them in the car, with the noise. The reason? In hindsight, is the Mids. The mids were too low on the KS10s. Again, the relevance?
The relevance is that, for me, is that the problems with Music were interconnected with problems elsewhere. The lack of gain in the Mids had a knock on effect of my understanding of speech in noise.
The Unitron Vivantes and the Oticon Dynamo - The Conference
I start to wear the Oticon Dynamo more. They are not my mainstay as they do not have the direct bluetooth and I have a lot of Skype and Zoom meetings, so I have to wear the KS10s, or more recently I underwent a trial of Unitron Vivantes, as I want to upgrade to the Lumity equivalent. This is a RIC.
The trial started in December 2023. Initially it was good. The Vivantes have the Sword chip and I am impressed by the bluetooth handling and the car program and the general clarity. One disadvantage of these aids, is that they are Specsavers (an international opticians here in the UK) and are locked. I cannot program them. However, I trial them for 3 months. They are very good, but there are a couple of experiences that prove to be deal breakers. I have a bad experience in noise when I go to a really noisy pub with my brother and his wife at Xmas. I play around with the App settings and believe that I may be able to resolve these issues the next time with the App. In early March I go to an open day for students who have been accepted at University, with my daughter and wife. The experience is harrowing. There are over 100 people there and I have one of the worst experiences in noise in 25 years. People are talking to me directly and I cannot hear their voices. The voices are just lost in the noise. We go into a canteen and it continues. An excruciating, embarrassing experience. I go home and immediately contact the Specsavers audiologist and decide to upgrade to the Phonak Lumity Naida SP BTE. I do not know why the Unitron Vivantes performed so badly. I believe the Mids may not have been loud enough. But I decided to upgrade to the BTE because I also believed that music would sound better.
In the meantime, the following week, I go to a Cambridge conference, which is a talk by Brian Cox, a cosmologist. I take the Oticon Dynamos. They are wonderful. I can hear him and the people around me in the noisy interval.
Phonak Lumity Naida SP BTE
I switch to the Phonak Lumity Naida SP. This is a BTE, less discreet but about the same size as the Oticon Dynamo, which is impressive, for it’s power. The audiologist starts me off with the fitting formula APD (Adaptive Phonak Digital) 2.0. I am initially impressed with the music but experience a couple of false dawns regarding their performance in noise. A simple trip with my wife to a restaurant reveals they are quite good. But a subsequent experience in French class reveals a lot of problems. I decide to ask to switch back to NAL-NL2. This seems a lot better and I am currently still evaluating it.
Fitting Process and severe to profound loss
Personally, and I know the industry are trying to take steps to redress this, a lot of problems are rooted in a lack of testing to see if the hearing aids are optimally set up to work in all of the various environments that we have to undergo. The walk around the warehouse test in Costco is woefully inadequate. There is quiet, hearing in noise, hearing in loud noise, hearing in the car, listening to music. We all want our hearing aids to be optimised in every one of those situations, but there does not seem to be a scientific, deterministic way of seeing if they are.
I can see your problems in noise, and I mentioned last night that as you seem like a person of means, I would recommend that you find a real expert, who is experienced with dealing with severe to profound loss. Some of my problems have been rooted in a poor fit caused by a lack of gain in the Mids. It could be that there is too much gain in the Mids in your case, but that is idle speculation. But along those lines, there could be room for adjustments that may optimise your hearing in noise.
There is also the BTE V RIC argument. In hindsight I am now unconvinced that the RIC form factor is best for my loss, but in saying that, I may have had, by chance, a better programming experience, as explained above, with my Oticon Dynamo than with the RICS. However I think it’s true that BTE superpower hearing aids are specifically optimised for our loss, regardless of the fact they employ more gain and output. I have read white papers from both Oticon and Phonak where they claim this. They say super power aids employ fitting formulas and strategies designed for people in the severe to profound category. One strategy is less compression and more linear gain when presented with loud sounds, which means we have a chance to understand more voices above the noise floor. The Naida Lumity SP and UP has 2 receivers in each aid. Other makes may have other features optimised for severe to profound loss. For this reason it might be worth trailing one. On the other hand I have seen one person who had a flat loss of 90dB who was successfully fit with a RIC Oticon Real, so who knows? The issue is also that, as you probably know, the most current releases of hearing aids are always featured in RICS, and they always claim to have more benefits e.g. the Oticon Intent with their improvements claimed in improved signal to noise ratios. However, one has to decide if these benefits outweigh those of wearing an SP or UP aid.
With respect to the questions about Roger, if you look at the following under the RogerDirect + mic tab:
You can see options for Adaptive Microphone Behaviour, SoundRelax, NoiseBlock and Soft noise reduction. I found that changing the Microphone Behaviour to dual my help, as it just uses the Roger mic and cuts out the hearing aid mics. NoiseBlock may help as it will reduce noise by up to 10dB. You could try mentioning this to the Audiologist.
I hope that helps, sorry for the long post again. The post is not meant to present any solutions. The only real conclusion I can come to is that this is a process that takes a long time to resolve, because of the complexity of our losses. It may be, that in the case of speech in noise, and multiple, dynamic talkers, we are shooting for the moon. It is a problem that is maybe beyond the capabilities of these aids. However, the reason for the long post was to demonstrate, in some small way, that persistent alterations do make a difference and it may be that there is room for more improvement once the set up is optimised further.