Phonak Virto B Titanium for Severe Hearing Loss?

Hi everyone,

This is my first post. I’m 51 and after 6-7 years of struggling with hearing impairment in my left ear I finally saw an audiologist in March who diagnosed a severe loss (I’ve had an MRI scan and nothing sinister).

I’ve been fitted with my Phonak Virto B Titanium (M90) for two weeks now and I have to say results are somewhat underwhelming - I mainly struggle in noisy environments (pub, restaurant, walking beside a busy road etc.), and there is, so far, no improvement.

I’m beginning to despair a little, I wondered what people in a similar situation have made of the Phonak?

Thanks in advance!


It would be helpful if you posted your audiogram on here. If you search you can find instructions on how to do this.

In what way are you struggling? I assume you have one good ear. Does it sound tinny? Phonak are notorious for underestimating the gain required on a first fit. If this is out of sync, every other program on Autosense will be as well. I speak from experience. A REM fit is advisible - did you have REM?

Assuming you have a moderate/severe loss or even severe loss across the board, this aid should work for you. Do you have the SP receiver or UP receiver? For my loss I have the UP receiver, which was required as the SP receiver with only 60db of gain was not powerful enough. If you are not sure do you have the ITC MC aid or the ITC half shell or ITE?


Thanks for your reply, as I say I’m new to the world of hearing aids and I’m not familiar with a lot of the jargon, so I’ll try to answer what I can!

Firstly how would I find my audiogram, would I need to request or form my audiologist?

In terms of how I struggle, I can’t hear people talking to me in noisy places like pubs and restaurants - I hear very well out of my right (good) ear, so no problems with people sitting no/standing to my right, but anyone on my left hand side I just can’t hear, and the hearing aid hasn’t made any difference/improvement. In noisy places I’m just hearing a scratchy reverberations-type noise, I don’t hear the voice of the person speaking to me.

Apologies - what is REM and SP/UP receiver. Maybe I can ask my audiologist these questions?

Thank you so much for taking the time to reply, I’m very grateful.

You can request a copy of your audiogram from your audiologist. They can do a print out.

The fact that you cannot hear anyone at all on one side in my view is outrageous. Yes, there are people with severe enough loss where that will happen. But in your case, a hearing aid has been prescribed and it clearly does not work. Without jumping to conclusions, it is more likely to be the competence of the fitter. Can I please ask, what was the price or range of what you paid for the aid?

If you don’t know what REM is, that is another red flag. REM stands for real ear measurement. It is where the aids, once they have been programmed to fit your loss are hooked up to an instrument to test that the aids are delivering the required gain to fit your loss. Whilst it is not a panacea, I believe it is de facto best practice in the industry, and a lot of practitioners say it is vital.

With respect to SP/UP - this is the receiver power - the bit that does the amplifying. SP=Superpower. UP=Ultrapower. Both levels sound very powerful but the reason for asking for your audiogram is to determine if the aid meets your power requirements. If your loss exceeds 90db in a few frequencies or more it might be that an ITC aid is not recommended at all and you need a BTE or ultrapower RIC.


@jimarchbill: Welcome to the Forum!

I think @glucas is giving you some great insights and advice. I’ll add two things:

  1. Two weeks is no time at all when getting acclimated to hearing aids (especially if they’re your first), and

  2. If you use the Search function in the page header, you can get instant answers to what terms mean, what best fitting practices are, how speech comprehension in noise is the elusive Holy Grail for us HoH folks, etc etc.

The better you educate yourself, the better position you’re in to get optimal performance from your hearing devices.


Thanks again :+1:

I paid £1,695 via the website who introduced me to a local audiologist who tested my hearing, made the recommendation and fitted the hearing aid.

I’m seeing him on Tuesday so I can also ask about REM, when the aid was fitted he did hook it up to a small box which was attached to his laptop, not sure if this is what REM is?

Thank you👍

I guess I might be too impatient by the sounds, I just thought I might experience some modest improvement after a couple of weeks?

At the moment when I’m talking to someone one to one I get a lot of feedback in my left ear from their voice (same watching TV), whilst when I’m in noisy settings I’m hearing the background noise but not the person(s) I’m conversing with, just a bit frustrating!

Appreciate your help, thanks again.

@ It’s my pleasure if I can help you navigate this complex world of hearing aids. The members of this forum are great - you’re going to get lots of assistance.

The feedback issues you’re experiencing, coupled with your audiologist’s failure to explain essentials like REM, audiogram, acclimatization, etc, are suggesting to me that you may not be in the best hands. Experiencing feedback problems on the first fitting may not be such an unusual phenomenon, however. Others are more qualified than me to speak to that …

I suggest strongly that you watch some of DrCliff’s videos on YouTube, starting with the one on best practices. After you’re a bit better acquainted with what’s supposed to happen during a first fit, you can either go back to the same audi and get the treatment you’re entitled to, or decide to find a new one.

Posting your audiogram and particulars about your hearing aid and acoustic coupling (type and size of dome/mould, etc) would go a long way to helping you obtain the best response from this Forum.

Good luck!

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Ok. Thanks. It looks like from your audiogram that you have a moderate to severe loss. Any of the custom instruments from Phonak should be able to handle this loss. However I am unsure what the advice is regarding a unilateral loss such as yours. A cros hearing aid is sometimes used, which enables transmission of sound to your good ear. Why that has not been done in your case, I do not know. I am only a hearing wearer so I would wait to see if any audiologists can comment on here.

Regarding hearing in noise, yes, it can be difficult but the technology should allow you to hear somebody in front of you, or to your side. This is because your aids will have a beamforming capability - even if there is only one aid, which will enable you to zoom in. More difficult is to pick out one talker in a group. This is a holy grail of hearing aid technology. What complicates the matter is that it’s not just whether you require amplification, but some people are able to perceive speech in noise better than others, with less amplification required.

I would personally go back to your audiologist, ask about REM, explain these issues and try to get your aids re-programmed.

One additional thought is to contact the NHS. I would personally do it because of their expertise. Even if they prescribed you a RIC, or you never know, a cros, generally the care and provision is professional.

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Thanks again, I have a follow up appointment on Tuesday so I’ll ask about REM. Following @SpudGunner advice I’ve watched a couple of videos on REM and I definitely didn’t go through that process when my hearing aid was fitted. I have zero experience of course but my audiologist has been established over 20 tans has excellent reviews, so I’d be surprised if he was unreliable after all that time do you think? Appreciate the support guys, I didn’t realise how much I didn’t know!

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If you didn’t get REM, the fitting process was hit and miss.


Looking at your audiogram, seems odd that they would offer a ITC for your left ear, as your just 10dB off profound hearing loss in a few frequencies, on your right a completely open fitting would be perfect, just 20 - 25dB at the tail end, RIC would have been a really good choice, something like Marvel M90 312 or P90.
Are you on a trial, you could at least try this option.

The Phonak ITC easily reaches those frequencies with an SP or UP receiver. The same goes for Oticon custom or Signia aids. I assume he has the 312 in a half shell configuration. I am not an audiologist but I think his hearing is normal in his right ear.

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Yeah they have the power, but my point was that not a completely open fit, which would be perfect for the right,

Yeah again I was thinking do you really need one here! but just outside the “normal” at 25dB at those higher frequencys, unless there’s something else involved a RIC’s working together would be something to try.

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Thanks. Just to clarify I don’t have a hearing aid in my right ear, only in my left.

This is the hearing aid - it’s a Phonak Virto B90 Titanium

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Thanks again. I don’t have a hearing aid in my right ear, just my left. I don’t think it’s a half shell, it’s an in the ear I think?.

It’s a CIC - Completely in the canal. This may explain why you are getting less benefit in noise than an MC (Mini canal) or ITC (In the canal) aid. Although wearing a CIC will allow the benefit of the pinna to give you some natural directionality, it only has one microphone. An ITC aid - whether mini canal or half shell, has 2 microphones. I am unsure of the increase in directionality, but I believe there would be added benefit using these aids in noise.

To explain, the more directional the aid is, the less amplification you would need in noise to understand speech. The measurement I believe is called the directivity index. A directivity index of 5db would mean that the aid is providing an additional benefit of 5db i.e.
that otherwise would require amplification of 5db to hear in noise. ITC hearing aids in a binaural setting are highly directional, 7db+. In a monaural setting - less so, but still highly directional. A monaural CIC on the other hand, which is omnidirectional with just the use of the pinna, will not provide much directionality and will have a low directivity index. This is a really complex area. I can only go with my experience. I used to wear CIC aids - they were certainly not as directional and I struggled to comprehend speech in noise, but background noise was dampened effectively.

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Thanks again, I must say everyone has been so helpful, I’m very grateful. On the basis of what I’ve told you about my situation, is there a make and model of hearing aid you think I should consider if things don’t improve with my Phonak Virto B Titanium? Apologies in advance if this is an unfair question.

All good to know, the B belong is a few platform’s ago as well, so no wireless with the size 10 battery ether.

You could try Marvel (M90) or the latest Paradise (P90) go RIC to compare, you’ll get much better results, two HAs work better together, so if you can, try this plus you’ll get
bluetooth streaming, hands free calls always good ( safety, local laws)

Good luck