Professional opinion

Audiologists and Hearing Aid Dispensers
#1

I have a reverse slope hearing loss as I’ve stated before. I’ve subscribed to the theory and research about using open domes to allow the high frequencies to come in to my ears naturally. Also minimal amplification on the lows (around 10 dB) to avoid the lows overpowering the mids and highs where most speech is present. The dispensers I’ve worked with also seem to subscribe to that theory. Essentially I’m getting minimal low frequency amplification and some amplification at 2000hz and above (10-15 db).

I’m struggling immensely in background noise and oftentimes on the phone despite streaming. I’m essentially deaf at a store or restaurant unless the person is right next to me and speaks up. I don’t notice any benefit with hearing aids unless I’m in a quiet environment despite multiple adjustments.

I’m looking for opinions. Should I try boosting the lows a bit more and go for a more closed fit like a power dome or mold without venting?

Here’s some of the articles I believe apply to my circumstances.

http://www.hearingreview.com/2003/11/changing-with-the-times-managing-low-frequency-hearing-loss/

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#2

In all honesty, I wouldn’t turn the low frequencies down AND vent the fitting to that extent - you do need ambient sounds at the lower pitches and all they seem to have succeeded in doing is fitting a hearing aid designed for high frequencies to a low frequency loss with inadequate compensation.

It would appear that the theory of what’s being suggested is being taken to the nth level rather than trying to conventionally fit AND THEN IF IT DOESN’T YIELD THE CORRECT RESULT make subtle changes in the direction of what is being suggested.

I’ve used REAR/Speech Verification with a fitting like this and we found the optimum setting to be a flattish response at about the 2/3rds of the average level for a 65dB speech input. Looking at your loss that would result in a flat 10-15 dB of gain on the left (turn off above 6khz) and around 12-17 dB on the right (tapered off from 2KHz and up)

Get it done on a speech REM rather than using the manufacturer settings as you are trying to get a result that runs counter to the manufacturers algorithm/historical gain rules AND your actual ear dynamics.

#3

I tried to look up on google what’s defined as low, mid and high frequency range and there are a tons of different opinions on this. I saw that mid-range speakers generally amplifies from 250 Hz to 2KHz. But that’s a very wide spectrum.

My question for our pros on this forum is what is an audiologist’s definition of low, mid and high frequency range?

#4

This makes so much common sense!

Also, if the current approach hasn’t been working for you, I wonder why your dispenser hasn’t tried to open up the lows a bit more? Or at least try a close dome. It only seems like the natural thing to try out next.

I’m no professional here, but I always thought that open domes are for people with high frequency hearing loss to allow the natural lows to come in, and also to benefit from occlusion. I also thought that open domes will let the amplification of the lows escape too much, and that’s why people with low frequency hearing loss need more occlusion to keep the low amplification contained inside the ear canal either with power domes or custom mold. So fitting a reverse-slope patient with an open dome AND limit amplification of the low frequencies doesn’t seem to make any sense to me in the first place.

I notice that 1Bluejay, a frequent poster on this forum, has pretty heavy low frequency loss (although not a reverse slope like yours), and she uses a power dome with her Oticon OPN and has had success with it. She recently tried a Comply foam tip (which is a pretty snug seal with no vent at all) and likes it a lot, too, except for when she’s on the phone. But that’s only because she doesn’t have an iPhone to enjoy direct streaming to her OPN when on the phone.

#5

Thank you Um bongo. I will definitely raise that suggestion at my next fitting. Would you also suggest using a power dome/closed mold without venting or small venting ~ 1mm? Also would you consider the OPNs to be a good aid for a low frequency loss considering it seems speech in noise is our major issue.

#6

I can’t fathom why you wouldn’t have been given at least a closed dome in the first instance with your lower frequency loss. A Power dome may be unnecessary, but go that way if you still aren’t getting the retention of the low frequencies evidenced on REM. I reckon the Genie 2 software actually thinks you’ve got a better sealed fitting (up to the Audiologist to change the default acoustics) so it’s actually put your LF lower from the point of view that the fitting is already occluded.

The amount of recent complaints on the forum recently about HF/LF variation across brands seems to support the fact that the ‘fitters’ aren’t actually looking at the pre-condition of the set-up prior to the fit. That recent one about the Widex/Opn showed it up too - Widex’s fitting wizard sensogram makes the changes to the fitting, but the Oticon one had clearly been done ‘blind’.

#7

Thanks again

#8

I actually am using bass domes with a single vent. Much better sound quality. The aids were reprogrammed on account for the new domes and the settings are working out much better for me.

#9

I’m no professional, but just a cranky, opinionated, long-time wearer of aids for 30+ years! I’d also say: try a CLOSED DOME on your aids! I had always thought these were strictly for profound hearing loss, to lock the sound in the canal? But perhaps they can help with other loss curves such as Abarsanti’s reverse loss hearing curve.

Volusiano is correct: “I notice that 1Bluejay, a frequent poster on this forum, has pretty heavy low frequency loss (although not a reverse slope like yours), and she uses a power dome with her Oticon OPN and has had success with it. She recently tried a Comply foam tip (which is a pretty snug seal with no vent at all) and likes it a lot, too, except for when she’s on the phone. But that’s only because she doesn’t have an iPhone to enjoy direct streaming to her OPN when on the phone.”

I did indeed LOVE the Comply foam domes, and had even contemplated getting back in to my aud-guy to have him re-calibrate my aids with these on. However … WEEKS of biblical snowfall have kept me a virtual prisoner, unable to make any kind of app’t and actually keep it! I’m probably not alone with the unbelievable winter we’ve had in many parts of the U.S., but some fine, fine day, I’ll take those Comply domes in to my aud-guy. Meanwhile, I’m totally used to the Widex power domes. It’s just that they lack the comfort when stuck on the rock-hard receiver with its razor sharp tip.

I also hear better on the phone with the Widex dome (and AutoPhone mode when it kicks in) than with my wonderful Comply foam domes. Maybe it was a simple re-calibration issue, but I haven’t had the opportunity to get to the bottom of that.

#10

Ah, that is GOOD news! Trial and error is the way to discovering the optimal combination for anyone with aids. You are lucky to have that single vent, too, as that will make the sound quality more natural, and your own voice less occluded.

#11

Glad to hear! That’s what I wear, too, bass domes with single vent. It’s enough to keep occlusion in check, yet still keep the sound in, which also helps with feedback control. If I hadn’t been happy with the single vent bass dome, my audi would have wanted to try to make custom molds for me.

I tried the Comply foam tip and like the comfort but it has way more occlusion than I can tolerate. But people who are used to custom molds or power domes will probably feel more at home with the Comply foam tip.

Please come back and share with us if you’re having better luck in understanding speech in noisy places now.

I take it also that your repaired OPNs have been returned to you from that direct streaming static noise issue? Did they say anything about what went wrong and how they fixed it?

#12

Suprisingly I’m still using the demo aids as they had a delay in shipping the aids to Oticon. But I’m fine with the demos since they’re the same aids as mine. I’ve had the bass domes and reprogramming for only 5 days so I’ll save a further review to get some more real world experience, but I can say my own voice is sounding much more natural, the phone is sounding much better when streaming and the limited experience I have had in truly noisy places has been definitely better than the open domes with the prior programming. So I’m feeling much more positive about the OPNs these past few days.