Phonak Marvel Occlusion / Dome sizes

Hi, I’m in the 2nd month with my Phonak Marvel M90s, and my first RIC experience after having CICs.
My Audi says that I need double closed power domes and I’ve been trying out the medium and small.
The mediums give me a lot of occlusion, make me feel like my ear is stuffed full, seem to generate a bit of moisture in my ears when wearing, and make my voice sound muffled. However the quality of sound is very rich and well balanced.
The small size give a lot less occlusion and I don’t have many of the issues I cited with the mediums when wearing those, however the quality of the sound is not as good at all - it lacks that richness and feels a bit tinny.
My audi says that I will in time get used to the mediums and it will become ‘normal’.

I have few questions really that perhaps people could help me with - how on earth the size of a dome can have so much effect on what you hear in the way i have described, what your view is on whether i should persist with mediums or go for smalls, and whether anyone out there has experienced similar.

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My suspicion would be that the small size domes are leaking. The idea of these domes when the loss is quite severe is to use a vent of a controlled size. Not sure if the double domes have a vent, but the effect of it in any case will be reduced with leakage around the dome.

You have a pretty significant loss. This is what my Rexton software shows for gains and feedback potential with double domes:

Phonak may have some tricks for feedback, or the fitter could be simply reducing gain to prevent feedback, or in other words compromising the required gain you should be getting. This suggest to me that you would be better to try custom molds. Here is what I get with molds Notice that the gains are now avoid the shaded red and blue feedback areas, and you are getting the full prescription. It is suggesting 1.3 mm vents which are small, but not totally occluded. Custom molds will fit your ear better than double domes off the shelf, and most seem to find them more comfortable. Costco will let you try them and if you don’t like them, they can be returned. Not sure about your provider. I tried them, but went back to closed click sleeves, which are probably more comfortable than double domes.

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I had these issue with my Costco K9- which are relabelled Phonak Marvels. The first time I went to the Audi I had the large power domes. They were uncomfortable with occlusion in my left ear. 2nd round we changed to medium power domes and the left ear was fine but the right ear was still occluded, and worse, as the fit was now very tight which made it difficult to remove from the ear. Third round we went with a vented dome in the right ear and maintained the left dome. Each time I had REM and the sound was balanced. The sound is also much better than my K6’s. For streaming the aids are incredible- great sound. But it did take awhile with patience to get to this point.

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I have the same experience as the OP. Had molds with a small vent for years now M90s with power domes. Sound so much better with mediam but feel the occlusion, sound less full and rich with the small size but more comfortable. Even had some pain in one ear at first with the mediam power domes so I switched to smaller. It took some time for me to adapt but I did. The larger size are far far better for me in every way except one. I still haven’t gotten used to the sound of my own voice. But, a small price to pay for hearing better.

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I too coped with dome fit issues for literally years. It was such a pain. To make matters worse my ear canals were kind of oily making keeping the domes in place a hassle. Finally went the custom mold route and am so much happier. The vast majority of people still don’t even realize I am wearing aids.

I never have understood why everyone doesn’t spend an extra 3-5% and get custom fitted molds.

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Seems like your audi is trying to compromise with you. You need custom molds. Stick a vent in them, and you’ll probably like them better than the double domes anyway. Stop trying to mess around with domes.

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I know why. I got three different pairs and hated them. Major occlusion and they made so much noise when I was chewing food that I could not hear a thing. The noise was there whether or not my aids were turned on. Fortunately I got them from Costco and returned them for a refund. They sure seem to work for some people, but not for me…

Because they don’t work as well for everyone- domes are better than molds for me and many others. Now do you understand?

My Audi thought custom domes would be good for me. Tight now I have closed domes to try and I hate it. My music streaming and phone calls are horrible. Very tinny sounding, as well as my own voice. I’m going back to my vented click domes. I tried frequency lowering and didn’t like that either. I started down this road of changes as I did not think I was hearing well. Sometimes change is not good.

Not sure what kind you have, but I know that Phonak completely drops the ball (and the audi was little help) when it came to proper frequency adjustment for streaming. If it sounded tinny, it was because they didn’t amplify the full range of sound.

But with closed domes, I would have through they would have had to turn up the gain on the lower frequencies to equalize the sound. Did you get REM adjustment with the closed domes?

So your audi is not necessarily up to snuff on a couple of issues.

They may have started you on closed domes for simplicity. And yes they may make your voice sound muffled at first.

  1. Did your audi do a REM adjustment (with the little tubes in the ears snaking behind the domes and the machine projecting sounds at you)? This should equalize the frequencies so that your voice sounds normal.

  2. You had molds before with your CICs. How did that work in terms of fit and sound? You’re in a unique position to choose between domes and molds because you’ve had the mold experience.

With everyone using their own terminology for what we stick in our ears, including me, it’s getting very, very confusing. By definition, domes are symmetrical half-spheres, aren’t they? So how can there be such a thing as a “custom dome?”
If one has something made to precisely fit the size and shape of their canal, isn’t that a “mold” or a “custom mold” or as Phonak seems to call it, a “SlimTip” or a “cShell”?


And what exactly is the difference between the SlimTip and the cShell?
When I first had “custom molds” made years ago for my then Phonaks, they looked like these “SlimTips” and they felt like perfect little jewels, so that’s what I thought I was getting with my next pair of hearing aids ordered through Costco from some co. called Westone, but they were nothing like those and looked and felt awful.
Now I am considering getting custom molds for my poor guy’s version of the Marvels - the new KS9s from Costco and feel unsure as to what I need to specify. I assume or hope they will come from Phonak, which explains my interest in this thread and hope I am not considered to be “butting in.”
I wish there was some standard point of reference we could all refer to when talking about these things, especially in my case for high frequency loss.

I recall you have Signia aids. The software is saying open domes would be trouble for feedback. The soft sounds go right into the shaded feedback zones.

Have you tried the closed sleeves? They tend to be more comfortable than domes and also give better isolation from feedback. I have tried both closed and open sleeves and don’t find much difference in terms of occlusion. See below:

One thing you have to be careful with when the fitter is switching domes and sleeves is that they go to the Audio Streaming Tab and set up the boost. Whenever they change fittings in the software the Streaming equalization goes to a default, which I have found is very lacking in bass. Here is what the default equalization looks like for closed sleeves. I find I need at least 10 dB more bass boost for it to sound good to me. If you take your phone with iTunes to the office you should be able to get them to adjust it, and then you can listen to see how it sounds to you.

And last make sure they are setting up the Own Voice Processing and actually turning it on. Right below the First Fit tab there is an Own Voice tab. It should have a check mark beside it when it has been set up. It also has three levels and defaults to the middle one. I asked for the Maximum setting. You can also tell from your myControl app whether or not Own Voice has been set up. If you tap on the Sound Exposure icon in the middle at the bottom it brings up the exposure screen, In the bottom right of that there is another icon that you can tap on to show a graph which displays the amount of talking you have done. If the OVP is not set up it cannot track that you have been talking.

Hope that helps some,

I did not get REM w/ the closed domes. She just made a computer adjustment - like reprogrammed. Should I have had REM again?

I am not Haggis, but for sure you should get REM redone when any fitting change is made, even if it is just a change in the size of the fitting. It will fit differently in your ear and change the volume of the ear canal behind the fitting. And, as I mentioned every time you change the fitting type in the computer, it will also change the equalization for streaming. If you want it different than default, it has to be reset as well.

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Oh Sierra thank you for this information. I dont understand it all, but it is encouraging that something can be done and it tells me that my Audi is only doing what computer says. I do not think she is adjust manually anything. Before these changes in the last week I had told her I did not think I was hearing all that well and that I was t sure if the HAs were adjusted to full efficiency for my hearing loss. She said that they were adjusted correctly and that I could try closed domes. I was using Click Sleeve S Vented. I used them for a about 5 days prior to my appt to get them adjusted for the different domes, as she mentioned I’d need to come in. (She is 1.75 hrs away). She made the adjustment for the closed domes and then I asked about frequency lowering. She said it was not enabled but she could. She had not discussed with me as she said most of her patients dint like. I tried for a week and didn’t like it. This last Friday she removed it. It was just a click on her computer. On/off. I’m now thinking she isn’t working with me properly. No REMs after these changed. She just clicks on her computer. That’s it. I’m frustrated as I think I that these HAs are good but the fitting is what is the limiting factor.
Sorry about length of this and I appreciate your information. I’m saving these so I have it for the future. Thank you. I dint know what to do. :crazy_face:

The frequency compression is just an on-off switch like you say. The frequency ranges can be tweaked, but the computer makes a default choice. I don’t think it would benefit you a lot because your loss is pretty constant over the higher frequency range. In other words the very high frequencies would be switched to a range that you do not really hear much better in, so no gain.

If you have not tried the closed sleeves, I would give them a try. Also make sure the Own Voice Processing is turned on. Based on what you hear, don’t be afraid to ask to have it turned to the higher step. If you change the sleeves make sure you get the REM done again, and also ask to have the streaming bass boosted.

When I go to a fitting session I take a list of what I want done, and then review it part way through the session to make sure it all gets done.

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Thanks again. That a good idea about taking a list. It’s like pulling teeth to get her to recommend or clarify what I might need. I don’t want to insult her to make her think I’m telling her how to fit me. I right now have closed sleeves. Connex Click Sleeve S Closed. I’ve had them since Fri 11/22. She adjusted them. My music, phone calls and TV isn’t good. I think speech understanding is somewhat better. Tomorrow night -Thanksgiving w/ 8 ppl - will give me a good feel. I do love my music streaming though, TV and phone calls. Prior to having these Signia HAs I didn’t talk on phone. Again Sierra thank you for your time and input.

My own 35-cents’ worth here … well, I’ve worn aids that many years, so a penny per year isn’t too outlandish.

I found I probably heard sound the most natural and rich with the flesh-colored, plastic, custom molds with a pretty narrow vent hole to prevent occlusion. It seems that style has gone the way of the dodo. What I liked about them was that they sat in the natural cup of the ear - not behind the ear with a mic that points through rustling hair to some point on the ceiling. However, they looked like old-lady fuddy dud, and I had a couple audis tell me I should not even be fit with them any more. :face_with_raised_eyebrow:

Flash forward to 4 years ago when I started wearing RIE aids with some kind of soft, silicone dome on them. I’ve tried tulip domes, foam/sponge comfort domes, double power domes for old Phonak aids, custom molded silicone tips and now the newer, flatter-style double power dome for the Marvels I have on.

I kid you NOT when I say the style of dome matters a LOT in terms of sound quality. The tulips didn’t give me enough seal for my loss, so I had the same leakage and tinny sound quality. The foam/sponge comfort domes felt DIVINE, but I couldn’t understand anyone talking on the phone. The old double dome power domes I have on my Audeo B’s work super on them, but the sound quality is about 18% less when put on my Marvel aids. The custom molded silicone tips had a vent hole that was first too big, then too small. They also caused compression sores in my ear canals.

To me, there are 4 basic “ends” to a pair of aids: 1.) custom mold will tend to be HARD material or slightly softer silicone, typically either clear, tinted pink or flesh colored, 2.) domes will tend to be made of soft silicone and come in clear or smoke topaz; these can do the job for mild/moderate loss if vented or closed, placed on a receiver that goes IN the ear canal, 3.) double dome "power" domes, which are also made from the softer silicone in clear or smoke topaz, either vented or closed, and are good for moderate/severe loss, and go IN the ear canal, and 4.) custom-molded “tips” which are made big enough to fill the opening of the ear canal with an acorn-sized molded tip that is likely vented to prevent occlusion.

Hope this monograph helps! :slightly_smiling_face:

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