I was told that the trial aids were set to 100% adaptation. I know my new ones are at 100% - at least that’s what it says on the printout they gave me.
Interesting. I’ll try to find out tomorrow.
I was told yesterday that COSTCO (at least that one) never does REM on the trial HAs.
I think somebody is slaking off on the job. I had a quick in store trial of some ReSound aids at Costco, and the fitter took the time to do the REM. It only takes 5-10 minutes to do the REM. Seems to me that the only way one could make a comparison between aids is if they have both been REM adjusted to the same prescription target. If they are REM adjusted to two different prescription targets, then you are really comparing prescription methods not the aids.
My personal opinion on which fitting rationale to use is that unless one is already used to a particular fitting rationale that one was exposed to in the past from a previous set of hearing aids, one should use the proprietary rationale offered by the manufacturer of that hearing aid, because they’ve designed it to be best suited for their brand of hearing aids, and there may be functionalities offered that can only be set if their proprietary fitting rationale is used.
For example, it is said that Oticon did a lot of research on reverse slope loss and put this research result into their proprietary VAC+ fitting rationale. Some users with this type of hearing loss seek out Oticon hearing aids so they can benefit from this research. Imagine if their hearing care provider, unbeknownst to them, automatically fits them with NAL-NL2 instead, without telling the client up front. That would have defeated the client’s reason to go with Oticon hearing aids for the VAC+ rationale in the first place.
For Costco to force a certain fitting rationale on their users without letting them know, especially if because their REM equipment is limited to a particular fitting rationale, would be quite a bit of a turn-off to me.
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Your logic makes sense. The knock I have seen on proprietary fitting formulas is that they can be compromised to a “feel good” setting for the user, that may not be optimum for speech recovery, but minimizes call back fitting sessions. That may not be the case for all manufacturers. What I see in the Rexton Smart Fit compared to NAL-NL2 is that the Smart Fit can be more aggressive, especially when set to the Power level.
Yes, that may be a valid point. I think the optimum way that both the mfg and the provider can and should do is to enable the programming of different rationales on different programs if the user desires to do so, and most importantly, INFORM the user of the rationale options and choices so that the user is aware and has the chance to choose what they want to use. But the provider shouldn’t just “push” what they think is best for the user (or best for them), especially without telling user about it.
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Volusiano and Sierra,
Thanks for your thoughts on this. I think I’ll try to get my fitter to configure my HAs using the Philips “Fit4Speeech” rationale, so I can determine if it sounds any better.
Jack.
I don’t know about the Philips, but on my Oticon OPN, there are 4 programs and I can have 1 program use the VAC+, another use NAL-NL1, another use NAL-NL2, and another use DSL v5.0 Adult. Then I can switch back and forth between all these 4 rationales ON-THE-FLY for A/B/C/D comparison if I want to see which one I like the best. This way, you don’t have to rely on memory to see which one you like better.
Also, with this set up, you don’t have to choose one. If you like 2 or 3 out of the 4 for some reason, you can keep them all and select the one that works best for each situation. For example, I prefer the Oticon VAC+ most of the times, but I have NAL-NL1 in my second program for use when I need some extra help with sharper sounds in noise for better speech understanding.
Ask your fitter if this can be done on the Philips Hearlink or not.
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My first set of hearing aids were Oticon Agil Pro models, which were then state-of-the-art premium-level devices. I got them from a medical clinic that employed professional audiologists, where, with fitting, followups, and some accessories, they cost about $7,500. At that time I had insurance covering most of it.
Those Oticons served me well for seven years; but since they recently became in need of repair, I decided it was time to replace them with the latest technology. I no longer have any insurance covering hearing aids. Because of COSTCO’s very attractive pricing and the safety of their six month money back guarantee, I decided to give COSTCO a try. I tried out the Kirkland Signature 9’s and the Philips HearLink 9010’s. The person at COSTCO who did my hearing test seemed to favor the KS 9’s for me (I think only because she was more familiar with the Kirklands.) However I preferred the way the Philips sounded, so I bought those.
During the initial fitting, my new hearing aids were configured using the NAL-NL2 fitting rationale, which I was told was the “COSTCO standard.” (Even though that wasn’t the fitting rationale recommended for me by the Philips Hearsuite setup program.) From the start, my new Philips HearLinks enabled me to hear speech better than did my old Oticon devices - especially when I was facing the speaker. But I still wasn’t hearing as well as I thought I should be. So during my followup visit I asked my fitter if it might be worth trying the Philips proprietary fitting rationale called “Fit4Speech”. She did make that change, and then performed new REM verification gain adjustments. That change to the “Fit4Speech” fitting rationale has further improved my speech recognition to the point where I am now quite satisfied.
Also at the first fitting, the “Directionality” was set to “Fixed”. With that configuration, I was having trouble hearing people who were speaking from my side or from behind me. So during the followup visit, the “Directionality” was changed to “True Ear.” I can now clearly hear people beside me as well as people talking behind me, e.g., in the back seat of the car when I am driving.
Feedback management with the Philips is excellent. Even with the volume pushed up a couple of clicks above the default level, I can have my ears pressed against the leather surface of a high back chair, with no squealing at all.
Compared to my previous hearing aids, the Philips have good battery life. Even with hours of TV streaming every day, a pair of 312 batteries last a full week.
At the initial fitting I asked that my new aids be set up with two manually-selectable programs, “Speech in Noise” and “Automobile”. So, including the automatic “General Settings” program, this gave me the ability to manually select from three different programs. The fitter left all three of these programs at their default settings. I frequently experimented with changing the three programs to compare how they sounded in a given situation. I did this in a variety of environments, e.g., around the house, while watching TV without a streamer, at a shopping mall, at an auto show in a large convention center, in restaurants, while driving my car, and as a passenger in other cars. It didn’t seem to make a significant difference which of the three programs I selected - they all sounded much the same in any given environment. This surprised me; but perhaps it means that the Phillips automatic program simply does very well in most environments, or perhaps it was because the two manually-selectable programs weren’t at all custom fine tuned for me. Because the automatic “General Settings” program seems to work well for me in a variety of environments, and because it was a nuisance to have to manually cycle through both of the special programs every time I wanted to use the “TV Adapter” program, I have had the two special programs removed.
The first Philips TV Adapter I received wouldn’t work at all. It paired up with my hearing aids, but produced no streaming sound; so COSTCO ordered me another one. The second one works extremely well. I am hearing sounds in streamed TV programs and movies that I could never hear with my previous Oticon TV Adapter. And the new Philips TV Adapter even streams in stereo; so for the first time ever watching TV, I hear different sounds on the left and right. Pairing up my hearing aids directly to the TV Adapter was quick and simple, and my aids have never lost connection with the TV Adapter. In fact, the other day I went out of the house to get the mail, and I was still getting good streamed sound from half way down the driveway.
From the start, when I switched to the TV Adapter the default volume was way too loud; so each time I needed to turn it down 4-5 clicks. At the followup visit I had the “TV-A Level” adjusted down a little, but it still needs more reduction in the default volume; so on my next visit, I’ll have it turned down some more. Also, initially the TV Adapter’s “Mic/TV Level” was set to 0 db (meaning no gain at all is applied to sounds from the surrounding room, and only the streamed TV sound is amplified). With that setting, and with my rather closed domes, I had trouble hearing my wife speak while I was using the TV Adapter. So on the followup visit, I had the “Mic/TV Level” increased a notch; and this now seems about right. The streamed sound from the TV Adapter is still clear and strong; but I can hear when my wife starts speaking, so I can then pause the TV and have a conversation.
Because my HearLinks are the miniRITE 312 version, there is only one button on each side. I had my devices configured so that a short press on the right hearing aid increases the volume, and a short press on the left aid decreases the volume. Also a medium duration press on the right hearing aid switches in and out of the TV Adapter program, and a long press on the left side mutes the aids. I like this particular configuration.
I am not interested in streaming music from my phone; but if you plan to stream music from an Android phone, be aware that the Philips HearLinks require you to use an intermediate device (which it is not required with an Apple phone).
I have not paired my hearing aids via Bluetooth to my Samsung phone, and I haven’t actually used the Philips Hearlink Android App. But from the instruction manual, it doesn’t look like that app has any real utility for me. It is easier for me to simply use the buttons on the hearing aids for what I need.
I’ve not experienced any annoying automatic changes in volume levels or programs, as was reported by someone else here.
As far as I know, at this point Philips are only sold in the United States by COSTCO; so that could be a downside for those who don’t happen to have a nearby COSTCO with hearing instrument specialists who are good at fine tuning the Philips devices. However, given COSTCO’s outstanding price for these premium level hearing aids (compared to say top level Oticons which use the same hardware), my recommendation would be to buy the Philips anyway. Because they are NOT locked to COSTCO, if necessary you could go somewhere else to have them properly configured. You’d still be way ahead cost-wise (compared to say similarly-featured Oticons), even if you had to pay several hundred dollars to a skilled third party provider for a series of unbundled fitting-service appointments.
All in all, my impressions of the Philips Hearlink 9010s are very positive. They should be especially attractive to anyone wanting rechargeables and/or a telecoil (although neither of those two features were important to me).
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Hearing aid fitters, audiologists and medical professionals in general are trained to do what they think is best for the patient. Although I agree that patient preference should be taken into account, I think it’s pretty unrealistic to involve patient in such matters of detail as fitting formula. If the patient asks, fine, but there are tons of decisions that are made in every medical appointment. To consult the patient on every decision would be overwhelming. Hopefully you go to a professional who you have some trust in. You shouldn’t be afraid to ask questions, but if you’re going to second guess every decision, you might question why you’re even there in the first place.
Costco is doing REM tests and adjustments to at least 5 different brands of hearing aids. That means just as many different fitting software systems. Each has to be connected up to their REM equipment and the REM software, as well as the Audiogram equipment. My fitter stepped out of the office for a few minutes at my last appointment and while I was sitting there getting bored, I looked at the REM (Aurical) speaker/microphone equipment. While much of this stuff is wireless there is obviously a limit to that. There was a bundle of cables going into that Aurical device that was nearly the size of a fire hose. In other words the overall hardware setup required is complex.
From discussions with my fitter, they basically seem to leave the software setup and I suspect to some degree the hardware setup to the hearing aid factory representatives. When I was first fitted I wanted to try the proprietary Rexton SmartFit prescription formula, and she said that was what she would normally do. However, she said she had to do it manually as the software was not connected up in such a way that she could do it directly from the Rexton Connexx software. She has to go into the Aurical software, and it does not have the SmartFit in it. Long story, but essentially she does it “manually”, by using the NAL-NL2 formula, and then tweaking it to match the gains in the SmartFit. Your fitter may not have preferred to do it that way, as it obviously takes more time.
One has to have some respect for the computer abilities of these fitters in having to learn all the tricks and traps of 5 different software systems. I suspect that may be why some small shops only deal in a more limited number of brands. Simplifies things on the software/hardware fitting side.
I think you totally missed the point I was trying to make. It’s not about patient preference. Of course most patients don’t know diddly squat what fitting rationale is, let alone choosing which one they want.
My point is about the manufacturer’s preference. They know their hearing aids better than anyone else and they’ve gone through considerable research to come up with a proprietary fitting rationale that they think works best for their own brand and model of hearing aids. If they think the standard fitting rationales work better than their own proprietary fitting rationales, they wouldn’t bother making the time and effort to come up with their own for their specific brand and model of hearing aids.
For a hearing care professional to just summarily dismiss it and choose a defacto fitting rationale just because they’re used to dealing with it AND THAT"S WHAT THEY USE is not necessarily best for their patients. It’s another story if they knew the history of a particular patient well and knew if this patient has been used to a certain fitting rationale so they decide to fit this patient with the same fitting rationale this time around, or because due this patient’s type of hearing loss, this particular rationale should work best for them, etc.
But what I’m hearing here, if it’s true, is that Costco doesn’t care what your hearing aid history is or what your type of hearing loss is, THEY do NAL-NL2 NO MATTER WHAT, PERIOD, meaning they don’t really care to consider what’s best for their patient like you’re saying they do.
Unless a provider has a particularly preferred rationale for a patient due to a good reason, I still maintain that the hearing care provider should default to the proprietary fitting rationale that the manufacturer has painstakingly developed and chosen for their own brand and model of hearing aids they designed and sell. From the case of Costco that I’m hearing about here sticking with NAL-NL2 just because that’s what they use, period, no matter whether it’s best for the patient or not, that’s a practice far from what you’re basing for your argument here.
Now I would contend further that if the hearing care provider wants to push a particular fitting rationale for no reason other than that’s because what they use on all their patients, and it’s not the manufacturer’s own fitting rational, THEN at least inform the patient of this and give the patient a chance to try both out and choose for themselves. Sure, the patient may not know what a fitting rationale is, but if you give them A to B comparison options, they can still choose easily what their preference would be.
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This is not the case with my wife and I at Costco in San Antonio. When I did my KS9 trial around the store the aids were set up with Phonaks proprietary algorithm as were my wife’s. She bought hers and they are still set up with Phonaks proprietary algorithm.
The knock I have heard on the proprietary prescription methods is that they can “softball” pitch correction so the user is not put off by a more aggressive speech recognition correction. That said I can’t say I have seen that in the Rexton SmartFit prescription at least at the “Experienced” setting. Both it and the Phonak proprietary prescriptions look quite similar to NAL-NL2. Fair bit of gain, and lots of compression.
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I’m glad to hear that not all Costco do this. This should be more like it. I think most hearing aids automatically default to the manufacturer’s proprietary fitting rationale by design, and it usually takes a conscious effort to change it from the default. At least that’s how my Oticon OPN hearing aids are set up.
Thanks for clarifying. I’d agree that there seems to be some evidence to prefer VAC+ with Oticon. We can agree to disagree that other manufacturers “know best” with regard to their proprietary fitting formula. My own take is that they’re designed for maximum acceptance, not optimal speech recognition.
Yeah, I guess we have to agree to disagree.
I think that because the fitting rationales by manufacturers are proprietary by nature, one cannot really judge in general what they’re designed for unless one has first hand experience with using it oneself, and comparing it to other standard fitting rationales.
Even if they were designed for maximum acceptance and not optimal speech recognition, maximum acceptance is not necessarily a bad thing compared to optimal speech recognition, because maximum acceptance can still mean very good speech recognition, just not optimal. But if there’s a price to pay for optimal speech recognition (like the sound being too sharp to your liking and you have to live with it for the 95% of the times you don’t need it), then maximum acceptance may even be the preferred rationale.
Like in my personal situation with the OPN, having tried out the Oticon VAC+ against the other standard rationales like DSL V5.0 Adult, NAL-NL1 and NAL-NL2, I still prefer the VAC+ sound over the other standard sounds because it sounds the most natural and not too sharp to me. I use it 95% of the times, and the 5% of the times that I need an edge for speech recognition, I resort to the DSL Adult rationale. If my hearing care provider is competent, then they should be able to give me BOTH options in separate programs and let me have the ability to choose the right program when the situation is appropriate.
For me personally, if I didn’t have a choice and had to choose between a maximum acceptance proprietary rationale which is still very good for speech recognition, but not optimum like a standard rationale can give me, I’d take the maximum acceptance proprietary rationale any time. But then again, I should be able to have both options if my provider is competent.
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This is an update to my previous “First Impressions” post. My Philips Hearlink 9010s continue to perform well in my usual, relatively non-challenging, environments. One thing that’s changed is that battery life is now down to 5-6 days, instead of the 7 days mentioned in my earlier post. Perhaps I am spending more time streaming with the Philips TV adapter than I did initially (lately 5 hours per day or so).
My one significant new discovery is this. We recently attended a basketball game in a large middle school gymnasium. This was the first time I’ve been in an extremely noisy environment with my new hearing aids. When we arrived, there was already a game in progress with perhaps 200-300 spectators present. While still standing in the entryway before I even got way into the main part of the gym itself, the general level of sound from my hearing aids was incredibly deafening. And the shrill sound of a referee’s whistle 50 feet away bordered on being painful. I had to turn the volume on my hearing aids down 5 clicks to make the volume level comfortable. I was then able to recognize my daughter’s speech when she was shouting at me about 12 inches away, but I couldn’t understand cheerleaders shouting only about 8 feet away from me. To be fair, this was of course a very challenging environment even for someone with perfect hearing. Never-the-less I think my hearing aids should have performed much better.
As I mentioned in my earlier post, I previously had the “speech in noise” program disabled; so I don’t know if that setting would have helped. I have an appointment scheduled for later this week; so I hope something can be done to improve things before my grandson’s next basketball game.
My KS8’s have a Noise/Party program that I would use in that situation. I do that first, and if that is not enough I turn volume down. That is a very rare occurrence for me though. Since I have switched to a DSL v5 fitting formula I have been much less likely to get overwhelmed with noisy environments. I think having less compression which means less amplification of soft sounds helps a lot with those situations…