Question for those with good audiologists

Audiologists and Hearing Aid Dispensers
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First off, the question is genuine. I have huge respect for all of the audiologists who post on here, and I’m not trying to upset anyone. For years I’ve been seeing comments here and on other forums along similar lines. “Choose your audiologist before you choose your aids” sums up the kind of comment I’m talking about- the idea that a good audiologist can make the difference between success and not. My personal experience is that I’ve been given my aids, asked back for a few visits for form’s sake (nothing meaningful changed) and that’s it. Comments from me that I’m not really following speech out in the real world have been met with quizzical looks, and I’ve been left with the understanding that this, baby, is as good as it gets.

So, my question is this: That audiologist who really helped you along your hearing journey… what did they actually do? What kind of interactions led to positive outcomes? I’d like to understand what I’ve been missing out on.

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Well I did end up giving up on them and going the DIY path for good reasons, but it wasn’t only because all the audiologist’s that I used over the years getting poor results, it’s was the constant nagging for more money every time I set foot in the dam place! It just got out of hand, I haven’t looked back and never will, sorry I couldn’t actually answer your questions.

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Following the correct set up for the brand of hearing aids. As a (very happy) Widex user, some dispensers wouldn’t follow the Widex set up (hearing aid type/vent size/Widex algorithm/sensogram/feedback calibration). Missing any part of this means it’s not scientifically calculating the perfect set up that takes a lot of research to get right. Also rerunning the sensogram & feedback calibration & any changes in aid type (including exact vent size) after every change in mould/custom tip/aid etc. I think in summary, someone who fits that particular brand a lot, cares about it & is willing to seek advice from technical support if required.

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I have that audiologist that can make the deal. To answer your question It is a two-way street, the audiologist has to be willing to listen and sometimes make adjustments the audiologist doesn’t think is correct. The patient has to be able to explain what is really going on good and bad. Both have got to have that give and take attitude. Getting the aids just right is a delicate dance between audiologist and patient. I for one being a trained researcher and troubleshooter I taught myself everything I can about my hearing loss and hearing aids. I have also done the same about my health issues. I can and do rub doctors wrong in the doctor’s minds.
I am off all prescription drugs and I am better off without the drugs. But I can’t fix my hearing loss or bad eyes so I go for the best results I can get.

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@tinkyp. I guess taking care in setup and initial fit is something good audiologists do. But unless they’re a sophisticated user like you seem to be, people wouldn’t know if their disappointing experience is because of the aid, the fit, or that’s just the way it is.

I’m interested in what happens at the point where the client tells the pracitioner that he or she was hoping for better. I’ve seen people say that they’ve “worked with” the audi for their positive outcomes. Implies ongoing collaboration, multiple appointments, a pretty commited audiologist I guess. I’m wondering what that might look like. What kind of back-and-forth would you get with a vanilla high frequency hearing loss?

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@cvkemp Thanks Chuck. So perhaps a user with some skill in analysing what they are hearing and describing it to the audiologist. Also a user who isn’t prepared to settle maybe. Still, you’d think the audiologist would start the conversation by asking some very specific questions.

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My hearing loss is similar to yours, so could be relevant. I have high frequency Tinnitus as well.

I have UK NHS funded Marvel M70’s and the Audiologist basically did ‘first fit’ and sent me on my way. I strugged with speech, and returned twice, getting quizzical looks, and very minor adjustments. Word recognition. I just knew I wasn’t getting the best out of these excellent hearing aids. I had custom moulds too!

I decided to go private this year, and bought P90s. They arrived with domes, and were only a very slight improvement. My Audiologist used to be a Phonak partner. He stated that the biggest problem with Phonak is “their aggressive feedback management”. He did everything he could to disable it. Firstly, he got me custom slimtips. These took a couple of weeks to arrive, so I lived with the domes and initial setup until they arrived.

From what I remember, on fitting the slimtips, he did the Audiodirect test in Target. He said my hearing was slightly better, but put that down to the RICs being closer to my eardrum. He did NOT do the feedback or the real ear test, as he said it would reduce the “headroom” he could work with. He spent a long time increasing MPO’s and the soft sounds, especially in the upper frequencies. I think he reduced some lower frequencies, but not sure. He then spent a long time on compression of the upper frequencies. This was beyond my knowledge (and still is), so I didn’t really know what, or why, he was doing it. He was frustrated with the Target software, as it constantly wouldn’t let him make certain adjustments, but he got round it somehow. About 2 hours spent. He was using the Phonak fitting formula.

The results are astounding. My speech recognition is much much better. I have not meddled with his work in the P90s since, and won’t.

I’ve since self programmed the M70s, and they aren’t up to his standards, but they’re getting there. I’m trying to get away with vented domes on these. My process at the moment is to take them to the pub, and open the app, select music (my default), and make adjustments in the graphic, to improve speech recognition (there’s usually 3 or more conversations going on around me). I save the amended programme, come home, and try and replicate those changes in Target on the original program. This deletes the custom program. As of now, I think some of the mids are too high as there’s a certain “honk” to the overall sound. Work in progress, and certainly great as spares. Using the TV Connector, I forget which hearing aids I have in!

Hope this helps
Peter

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my experience also, basically been told I have severe loss and it is what it is

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Well it just isn’t. I was told: “You’ll need more powerful hearing aids to increase those frequencies”, when my loss was well within the parameters. She just didn’t know how to get round Phonak’s feedback management, and probably never will. One tried real ear, but it wouldn’t connect, so he just upped the overall volume 2 steps (6dB I think), which just created upwards masking, and no improvement in speech.

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@PeterH That’s uplifting actually. Sounds like your guy was the real deal. For me, the one and only change from first fit happened with the audiologist I’m seeing now. I thought I’d try flogging a dead horse and asked one of the bigger chains if they’d look after my OPN1s on a fee-for-service basis. The testing was comprehensive and they got me moulds (which should have happened five years ago). I made a comment as I was leaving at my last visit that I found the sybilants were overpowering everything else in the speech I was hearing. She made a quick change and the improvement was very real. I do wonder what might have been possible when I first got them.

Unfortunately they have me pegged as a future CI recipient and I think they’re marking time waiting for me to accept that. Also, old aids. Not worth spending too much time on. That’s not my current audiogram btw.

I’d really like to try self-programming. If nothing else you learn what’s possible. It would improve communication with the audi I imagine.

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@d_Wooluf
If you take that route, there is fantastic help here

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I haven’t had an audiologist to ask more than how do they sound, whole in the sound proof room. I learned early on to take the lead when it comes to my hearing and every other aspect of my health.
Doctors are programmed to be pill pushers not finding a cure. I have to say my present audiologist is one of us, he wears aids but I would never have known it if he hadn’t shown me the CIC aids he wears. We talked about his cookie bite hearing loss, which by the way is how my hearing loss started.
You have to be willing and able to take the lead, and in some cases the bull by the horns.

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I’ve leared to “own” my hearing loss, and it’s up to me to get the best out of the equipment I’ve got.

Peter

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You are asking the tuff question.

Hearing aids are like so many other things in life that it takes knowledge to ask the right questions.

Helping the fitter understand what is good and bad about your hearing can be very difficult for some.

Getting back to your question. I have been to 6 fitters/audiologist in my life. The Costco fitter was the best with hearing aids due to best practices and listening skills. With CI I have seen 2 audiologist and 1 has been superior to the other. This is from listening skills and flat out experience. He is also bilateral CI.

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I really believe it takes one of us, an audiologist with hearing loss, to know us. I have had two audiologists with hearing loss and both were the very best at helping me get my hearing aids adjusted the best possible. The first was a young lady just out of graduate school, she was the one that introduced me to Oticon hearing aids. The other is my present audiologist. He told me that once I got use to a certain sounding hearing aid it is not that easy to go to different hearing aid brands. I have to agree as I have tried other brands of aids. The closest one was Resound, but it even sounded harsh to me. To me Phonak was the worst, I didn’t like the sound blinder feeling I got. I love being able to hear all around me. Sure I still have a tough time with conversations if I am not facing the person but at least I know which direction the sound is coming from most of the time.

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So I am a surgeon with a background in neuroscience, my wife is an ENT, and I’ve worn HA for 25 years and worked with 7-8 audiologists in major metro areas, including those that worked for my wife. But, while I have a good background and a lot of experience, it is NOT ENOUGH to make intelligent decisions about my HA setting most of the time.

My current audiologist works in a school that is nationally known for its integrative program with CI users and children with severe hearing loss, and is fellowship trained in CI audiology. Her level of understanding far eclipses that of the audios I’ve worked with in the past (who have, to be fair, been uniformly excellent, smart and patient), and I feel like we can communicate on a fairly high level and work very collaboratively. She doesn’t have a lot of adult patients, so I’m also a bit of a guinea pig for her, I think, but she has been wonderfully responsive. Also, I see the EOB’s from my insurance and she has been utterly underpaid for the amount of time she has spent with me. With her CI experience, I think she understands how much tweaking and adjusting needs to happen to get it just right.

None of the audios I’ve worked with have been shills for one implant company, though familiarity with the software and support certainly makes recommending one system easier.

I tried Phonaks with her (admittedly, I kinda boxed her into it - was annoyed with multiple receiver failures in my Signia Charge and Go AX’s, watched too much YouTube Audiology, and decided I wanted Phonaks) and we ran into the same issues as others noted with the Feedback management system limiting headroom. Her solution, which I vigorously resisted, was occlusive earmolds (I wanted venting). I could t do ActiveVent because my prescription needed more power than was compatible. We tweaked and tweaked - four visits over 6 weeks usually for over an hour each, with us leaving only to pick up our children. I got frustrated with the battery life, their playing poorly with my phone and CarPlay because they weren’t MFi, and, after two months, sent them back and tried Starkey. Again, tried multiple tweaks to my prescription, played with programming, fixed problems with embedded earmolds and, after 3-4 more visits and several emails, I finally am happy with where my HA are performing.

My biggest issue is always that I seem to lack the vocabulary to adequately describe what I like, what I don’t like and what I need to function better. Over 25 years, I’m not even sure that I’ve gotten much better at that…

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I don’t like this either. I’ve changed all my programs to 360⁰, so much better now. Speech in noise still works

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That’s interesting…I trialed two sets of HA’s, got custom molds shaped by the audi, went back for adjustments, including contacting the Signia audi on the phone to walk us through adjusting the music program, and later, having the right mold shaped in house for a perfect fit. All for no money. I used to to go in for cleanings roughly twice a month–no appt, just walked in, or rather called in advance–also free. I now have a HA vacuum and simply do the cleanings myself.
In short, when we talk about private audis, Costco, etc,…we may have had very different experiences. And then we extrapolate from our own experience and make judgements about ‘private audis’ and ‘Costco’ in general.

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Everybody has a different experience in this regard, it’s fantastic you’ve had such great service from your audiologist’s clinic, but this is the thing, those of us with 25 years (or more) experience with using HAs and clinics within the industry and those with just a few years and only one or two clinics could be biased on how they see this, it’s true I did find one many years ago who used HAs ( these ones have a very good understanding of our situation) unfortunately he passed away, but I learnt a lot of valuable information/lessons from within the “industry”
Jeff, one thing I have noticed is the overwhelming posts here on hearingtracker complaining about not being able to “relate” to their respective audiologist, or understand their own hearing loss, I believe this gives rise to a lot of the misunderstandings on this subject, but good or bad, it’s always good to hear from someones experience with their clinic/fitter.

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The advice I’ve heard at HLAA conferences and webinars is to keep a diary of what you hear/ environments where you hear well and don’t hear well. Also some advice I have recorded on how to describe what you are hearing to your audiologist.
Identify the sounds

Is it speech, noise, a specific sound or everything?
Is the sound soft, average or loud?
Is the sound low or high frequency?
Is the sound simply “too loud” or is it “uncomfortable” Right, left or both

If voices are distorted, how? Do they sound muffled? Loud or metallic? Tinny? Can you hear “s” or “t” sounds clearly or not at all?
.
Also, use “high” and “low” exclusively to describe pitch and “loud” and “soft” to describe volume. For example, a piccolo is always a high sound, but it can be soft. A bass voice sounds low and but can also be loud.
And it is important to also report the acoustic circumstances.

If you listen to a phone call, zoom call, podcast or audiobook, do you have the same problems understanding speech that you do in, say, your local park or around the dinner table? Any feedback of this sort should be helpful to an audiologist

It can be helpful to build or label different sounds that are good or bothersome to you – try to be as
descriptive as possible such as saying it sounds:
Robotic
Screech
Like I am in a box
Too much background noise
Muffled
Echo-y
Bubbly
An annoying sound in the background
“Too boomy,”
“Too much echo,”
“Too much bass,”
“Needs more treble.”

“Volume is fine, but needs more clarity,” “Too percussive”

And it is important to also report the acoustic circumstances:

Be as specific as you can - What is the room like where you experience problems? Keep a diary of circumstances where you have trouble hearing such as large family dinners, specific restaurants, locations, or, with specific people such as those who are soft spoken.

Music

If music “doesn’t sound right,” try to be a little more exact. Can you follow or recognize the tune? Does it sound harsh or “off-key”? Too loud? Muddy? Does this happen with recorded music or only when you’re singing or playing, say, piano or guitar?

Try to use easily understood similes/metaphors but don’t get too “literary.” For example, “Everyone sounds like they’re speaking in a tunnel” will be pretty clear to an audiologist but “the sound is too plummy” will likely be harder for them to understand.

Finally, try to avoid using technical terms unless you know exactly what they mean. For example, “I’m hearing a frequency shift of 25 dB at 10 Hz” sounds very impressive but is completely meaningless.

With thanks to Dr. Michelle Hu, Aud.D. and Richard Einhorn, former HLAA Board Member, for answers to this question.

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