Rexton Bicores -> Oticon Intent 1

[Bubbly]

Happy Wednesday! I just got back from my audiologist’s office for my one week follow-up appointment, and feel somewhat bad for her, as I marched in with a typed, highly detailed set of instructions on changes that I wanted to make, and basically gave her no say-so in the matter Kidding aside, she was extremely gracious and agreed with every one of @Volusiano’s suggestions, even asking me at one point if I’d consulted with another audiologist

Although it’s far too soon to tell how effective the changes were, I’ll outline them as best I can, for anyone else who might encounter similar issues with a new pair of Oticon Intent hearing aids. I addressed the following questions with her, and will put the answers and any changes below each one:

1. What is the NNS (Neural Noise Suppression) set to? (max is 12)

   • The original software suggested settings had me at 4 (Easy) and 10 (Difficult) for NNS. I was surprised by this, as ithat is nearing max capacity, and I’d already had so many issues with background noise with those settings. She kept me at these settings, and then created another program (P2) for me to use in noisy settings with both NNS settings maxed out. She also set the microphones forward-facing.

2. Can we add a Speech-in-Noise program with max NNS?

   • As noted above, she created another program (P2) for me to use in noisy settings with both NNS settings maxed out. She did not use a pre-set “Speech-in-Noise” program, but just copied my P1 program and increased both NNS values to 6 (Easy) and 12 (Difficult) (they are 4 and 10 in P1). She also set the microphones forward-facing. I believe she also increased the Soft Sound Perception another notch for P2.

3. What fitting algorithm do I have?

   • I have VAC, which is the Oticon proprietary software. At my next appointment, she will add another program for the DSLv5 algorithm. She agreed that the DSLv5 can be better for speech. She was reluctant about adding the NAL-NL2 algorithm as another program, as she said that is the software she tends to use for new hearing aid users, and did not see much benefit for me.

4. What can be changed to enable me to hear soft women’s voices better?

   • She set the Soft Sound Perception to Detail. (Not sure if she did any fine tuning to increase dB beyond that)

5. Other changes: She also added the Speech Rescue frequency lowering feature, and increased the Sudden Sound Stabilizer to soften sudden loud noises.

Immediately after the appointment, I went to the grocery store, then to pick up medicine for my cat at the vet’s office. At the grocery store, I had a very soft-spoken cashier at the register, but still heard at least 80% of what she said, a marked improvement over last week! And I had no issues at the vet’s office. Although it’s too soon to tell how well these changes have helped, I’m hopeful! I’ll report back once I’ve been to a busy restaurant and tried to have a conversation with my fiancé’s mumbly teenaged sons

Oh! And she also increased some sort of Whisper setting, which should help me to hear whispers/soft sounds better. Volusiano might know more details about this particular setting, it was totally new to me.

[Volusiano]

@Bubbly

2. Can we add a Speech-in-Noise program with max NNS?

   • As noted above, she created another program (P2) for me to use in noisy settings with both NNS settings maxed out. She did not use a pre-set “Speech-in-Noise” program, but just copied my P1 program and increased both NNS values to 6 (Easy) and 12 (Difficult) (they are 4 and 10 in P1). She also set the microphones forward-facing. I believe she also increased the Soft Sound Perception another notch for P2.

Oh! And she also increased some sort of Whisper setting, which should help me to hear whispers/soft sounds better. Volusiano might know more details about this particular setting, it was totally new to me.

Glad to hear that you’re getting better results in your second round of fitting now. I just have a couple of comments to address on a couple of things you said above;

It’s OK if your audi just made a copy of P1 into P2 then make changes in there for you to make it like the SIN program instead of choosing the built-in SIN program like many people do. I’m not sure what her reason for avoiding the built-in SIN program, but as long as she upped the NNS value to the highest max value available, then it’s really the main thing that counts. The built-in SIN program’s gain curves seem to be slightly increased a little bit in the mid frequency range (at least for my audiogram), I guess to help make the main part of speech a little louder. You can always up your volume a notch to get a similar experience, I guess, but that will increase the volume across the whole frequency range instead of just the mid frequency range only. I guess you can try it her way this time, and if you’re still not 100% happy with her P2 setup, you can ask to try out the built-in SIN program next instead of her P2.

The other thing different with the built-in SIN program is that it uses Neural Automatic (like P1 does) for the Directionality Setting instead of the Full Directional value like your audi has set it to. A lot of people who use the SIN program have their audi go in there and change it to Full Directional like your audi did anyway, in order to put the beamforming focus toward the front, so what your audi did there is consistent with what many other people change in their SIN program anyway. Don’t forget that there’s a MoreSound Booster feature in the phone app that should be very similar to the SIN program that you can use. The main difference is that it’s a one time enablement in the app that will automatically get disabled after you’re done with the app, and will need to be re-enabled each time on the app. But that’s not so different than you having to manually change to the SIN program or P2 program in your case when you need to anyway. But the advantage of the MoreSound Booster feature is that you don’t have to dedicate a whole program in one of your 4 available programs for a SIN setup, so that you can free it up for something else. So keep that in mind that it’s an option to get rid of the SIN program to free up a program space and use the MoreSound Booster instead. Of course the trade-off is that you need access to your phone app to activate the MoreSound Booster feature, while a change to a SIN program can just be a touch of a button on your aid with no phone app involved.

Finally, on that “whisper” setting, I’m actually kinda stumped because I’ve never heard of such an option on Oticon aids myself. If anybody knows what it’s about, I’d be interested to find out. The only thing I can think of is the Soft Sound Perception feature that’s only available on the VAC+ formula that we already discussed about. The only other thing I can think of is that your audi went into the Fine Tuning section and increased the Soft row of gain values one or 2 dB across the board to let you hear all softer sounds better. If you can now hear about 80% of what soft spoken people say with the Soft Sound Perception feature already maxed out to the most Detail value, but you wish you can get to 100% with that, then the next step to do would be to boost the Soft row of gain in the Fine Tuning section to another dB or two.

[Bubbly]

Now that I think back on it, I bet you’re absolutely right about the “whisper” setting. Maybe that is just what she personally called it, but she did mention increasing the gain values 1-2 dB, so I bet she was in the Soft Sound Perception feature. I’ll be sure to ask her next week!

So I’ve been playing around, turning up lots of background noise in my house, then switching back and forth between my P1 and P2 (P2 having more aggressive SIN settings) and honestly, cannot notice any difference between the two at all. There is no decrease in the background noise sounds, nor an increase in my speech comprehension. Especially strange since P2 has forward-facing microphones, so the background noise SHOULD fade as I turn away from it, but does not. With my Rextons, I could change the direction of microphones in my app, and it really helped and was a noticeable difference in background noise to put them forward-facing. I wonder if the lack of difference in my Oticon programs could be that they are too similar, as P2 is simply a copy with more aggressive settings. So, it would be worthwhile to try out the built-in SIN program next instead of her P2. Perhaps the built-in program has more features that she did not capture.

I’m also noticing that I seem to be missing more of the mid-frequency range now, because sounds seem less “full” if that makes sense, and I’m having to say “what?” to my fiancé more frequently. His voice seems to fall in the MF range, not too deep or soft. I did not have this problem with my Rexton hearing aids at all - it sounded as if he were talking directly into my ears with those, even from across the room! So I wonder if we got too aggressive with the soft sounds, but also need to turn up the MF.

To capture more MF, I’ve tried playing with the Sound Equalizer settings in the app, and it does help a bit. And oddly, I notice zero difference when I use the MoreSound Booster button. (I had a similar button in the Rexton app and DID notice a difference when I used it). Do you think it’s possible it has anything to do with the hard custom molds I’m using now, vs the closed domes I used with my Rextons? She did mention that we could switch out my mold for a closed dome on my better (left) ear, if I wanted to. I’m not sure what the benefits could be, I need to research this more.

As always, thanks so much for all your thoughtful and detailed replies - they are SO very helpful!

[Volusiano]

Oticon design their General P1 program to be a jack-of-all-trade program that should cover 80-90% of the listening environments by default. If you increased your P2 to 12 dB max NNS and your P1 is already at 10 dB, unless you’re in a real and very noisy environment like at a very crowded restaurant, you may not be able to tell much of a difference because a max of 10 dB in P1 is already pretty aggressive to begin with. So if P1 at 10 dB max NNS can handle it in a medium to high noise environment, switching over to P2 in the same place might not improve speech understanding any further.

Also, remember that it’s not about suppressing the noise level as much as it is about making speech more clear among the noise. After all, Oticon aids are prescribed to the open paradigm, so they do let the noise in, and only suppress the noise temporarily only when it detects speech. And remember that the noise might be droning on and on, but speech is usually just short bursts of talking. So if you’re looking for P2 to suppress the overall noise level for you, you’re looking for the wrong thing. You should be looking for P2 to help you further with speech understanding (and not noise suppression), and only if P1 is not helping you enough already with speech understanding. If you’re already doing well with P1 and are not struggling with speech understanding in P1, switching over the P2 or the MoreSound Booster is not going to make much of a difference for you.

And simulating a noisy environment at home is far from being in a real and authentic noisy environment. There’s simply not enough noisy things you can turn on and up around the house that can really match the cacophony that exists in a real noisy place like a fully crowded restaurant.

Also remember that the Full Directional value set in P2 is not necessarily the same as frontal beamforming on your Rexton. The traditional frontal beamforming is all about blocking sounds on the back and sides. But the Oticon Full Directional setting is more about letting the sounds in the front in more, not necessarily about blocking the sounds on the back and sides in the same aggressive manner as with a traditional beamforming approach. Don’t look to see how much Oticon aids suppress the noise by comparing it to other brands’ aids noise suppression. That’s the wrong approach. Look to see how Oticon aids help with making the speech more understandable amongst the noise.

Also, don’t judge things in a “simulated” noisy environment that you attempt to emulate at home. You can never come close to simulating it at home unless you have a sophisticated setup professionally designed for an authentic simulation. Go to a real/truly noisy place where you’re actually struggling with speech understanding and judge the speech understanding part of the Oticon aids there. That’s probably why neither the MoreSound Booster option nor the P2 SIN type setup you have seem any much different than P1. Also, if you’re in a real noisy place but you’re doing OK and not struggling to understand speech with P1, then switching P2 or the Booster is not going to seem any much different than P1 anyway.

As for you feeling to miss out on the mid frequency volume, using the equalizer can be a temporary thing to confirm that it helps, then on your next visit to your audi, just ask her to go to Fine Tuning to make it a more permanent adjustment for you. I presume that your audi has already done REM adjustments for you to make sure that your setup should meet the target gain curves already.

[Bubbly]

Okay, you make some fantastic points about Oticon prescribing to the open paradigm, and to strive for speech understanding more than overall noise suppression.

I do confess that I have leaped to conclusions about previous reviews/ads for the Intents to mean that background noise would somehow be subtracted, so that speech would be much louder. Having this faulty understanding has led to my expectation that the NNS setting on max level was going to somehow suppress ALL background noises in the same type of way that my Rexton “Noise/Party” app did. So you can imagine why I thought it wasn’t working when I could still hear background noise

I’ve clearly got some expectations to adjust! I think now I need to turn my focus to bettering my speech comprehension, rather than getting hung up on background noise. I definitely have some tweaking yet to do. I bought these in the hopes that they’d be an improvement over my Rextons, and as they are now, they are about the same for speech comprehension, possibly a bit worse (as I believe I’m missing some MF tones now).

I have a full trial month, so I’m committed to making these work!

Also, great point about not being able to simulate a noisy environment

[Volusiano]

@Bubbly

I do confess that I have leaped to conclusions about previous reviews/ads for the Intents to mean that background noise would somehow be subtracted, so that speech would be much louder. Having this faulty understanding has led to my expectation that the NNS setting on max level was going to somehow suppress ALL background noises in the same type of way that my Rexton “Noise/Party” app did. So you can imagine why I thought it wasn’t working when I could still hear background noise

I’ve clearly got some expectations to adjust! I think now I need to turn my focus to bettering my speech comprehension, rather than getting hung up on background noise.

I felt into the EXACT same trap you did when I bought my Oticon OPNs to replace the Rextons I bought at Costco. I thought that the OPNs weren’t working right… Why was I still hearing all the background noise that I didn’t hear with my Rexton. I changed to Full Directional like you did and the noise still didn’t subside. I experimented with swiveling my chair around in front of my desk where a noise source was a fan. I could tell that as I spun around so that the fan was behind me, it was less pronounced than when it was in front of me, so the directionality setting works, but for sure not as aggressively as the Rextons I had.

On top of that, my HCP didn’t understand the implications of this new open paradigm shift that Oticon has undertaken, so she couldn’t explain to me why the OPNs didn’t meet my expectation on the noise handling aspect. She got an Oticon sales rep to sit in the second fitting with us to make sure that she didn’t mess anything up, and the Oticon rep blessed her adjustments, but it still didn’t help with my (incorrect) expectation about the noise handling. Unfortunately that was the first generation of aid Oticon released with the open paradigm, so even the Oticon rep was also clueless about how the OPN is supposed to really work as well.

So I took to start the DIY route, and as part of that process, read about this new technology and the open paradigm and the concept of brain hearing that Oticon started introducing to people in order to help support their open paradigm. To be clear, Oticon didn’t invent brain hearing, that’s just something that everybody has inherently in their brain, to help them sort out sounds so that they know how to focus on what they want to hear and ignore what they don’t want to hear. Of course, for the hearing challenged folks, their brain hearing acuity is affected by their hearing loss. But Oticon put in lots of technologies to help those people still be able to understand speech better despite all the sounds still presented to them as part of the open paradigm. But it requires an acceptance level from the users to embrace the open paradigm and not reject “having to hear” all the extra sounds that Oticon now let them hear that were blocked before.

So it takes a different understanding and expectation from the users when they switch from a more traditional hearing aid that uses the traditional beam forming noise blocking technology to the Oticon aids prescribed to the open paradigm. If you truly don’t like to hear anything except speech in a noisy place, don’t buy Oticon aids. The other aids will suit you better. But if you don’t mind (or even prefer to) hearing other sounds in a noisy place as long as the speech is cleaned up well enough for you to understand, then with that appropriate attitude and expectation, you will find the Oticon aids to work out for you better in the long run. It does take some adaptation time to accept the fact that you’re going to be hearing a lot more sounds in noisy places, though. But your performance yard stick now should be whether you can still understand speeches better or not, despite all the other sounds you’re still hearing. Your performance yardstick shouldn’t be how quiet the noisy place should become so that you can “hear” speech better.

[Willheim]

I have been having a similar issue. There is an algorithm - call it and expander, compressor, limiter, whatever you want - that keeps frequencies under a certain decibel very low. The intent is to reduce background noise, but along with that suppressed noise, dialogue can be lost.

I have a Med-El CI Rondo implant in one ear and I have a Widex evoke and an Oticon More in the other.

I just got the implant. So I watch a lot of tv, etc.

In the series I watch I sometimes use the closed captioning, sometimes not. The closed captioning will often say “Soft piano music plays” and I hear absolutely nothing.

Similarly, I get the cvolume adjusted just right to enjoy the show and when the main title comes in - it is just blasting away so loud that I have to turn it down. Certain effects will play the same way.

When I meet with my audiologist for an adjustment next week I will explain this.

I was a film and TV composer for thirty years. I know a little about this.

It seems to me the over all range of my set up is too broad - the limiter (for the loud stuf) has to be set so the explaosions and music do not exceed the db level of the vocal and general mix of the show. The expander, for the quiet sections, need to be set so as to not reduce the noise so much.

We all have problems in noisy restaurants, hearing issues or not. I remember, before hearing impairment, in my thirties wondering why everyone had to shout at each other. Why where all the parallel surfaces hard glass or materials that exacerbated the acoustics.

Last year I was at my bank and the acoustics were terrible. Everyone complained. Not just hearing impaired.

I said - look it is easy - see all the parallel hard surfaces? Put some rugs on the floor. Make some framed quasi art pieces stuffed with R30 wall insulations in different shapes and break up the reflections. Cost is peasly.

A month or so later I came into the branch and to my amazement they gad done everything I suggested. Acoustics were much better.

The problem is just not for us hard of hearing people.

But as another reply to you missive stated, your ears have to train themselves again. I get that. I do not know how the AI whatever it is works. I do know that, well, say the total bandwidth range of your set up is, well, let’s say a foot. Maybe it should be more 8 inches.

Keep the db’s limited to a more narrow range. Bring up the low db stuff so you can hear it. Limit the high volume stuff to not exceed a level that blows your head off.

Aint no one gonna fix the noisy glass boxes.

The lack of acoustic consideration in public places is astounding.

I wanted to tell Chase “Hey, I can do this to all your branches. Just fly me around the country and I will identify the bad spots and fix them using local contractors and materials for an insignificant price, while enhancing the aesthetics of the branches at the same time.” You pay all my expenses and a million a year.

For what it is worth…I agonize over the same issues for over 12 or 13 years now.

[Bubbly]

I’m so glad I’m not alone in falling into this trap! And I didn’t realize you previously had the Rextons as well! Were they the Bicores?

Admittedly, I like having more control over the settings, so I really enjoy the directionality feature of the Rextons and the programs that all sound very different. I could flip back and forth between them to compare which ones I heard speech better with. Gotta admit, the “Noise/Party” worked pretty darned well ONLY if I was talking to one person sitting across from me in a noisy environment. Adding in another few people, and I was lost again

You are so right that so many hearing aid providers don’t understand the true differences between the technologies, and most of them don’t even wear aids, so it would be difficult to truly know! Maybe a bit like describing how to ride a horse when you’ve never done so yourself! I do believe the onus is on the consumer to do our own research, as it is with most things. I definitely failed myself here, because I went into this believing that increased speech comprehension meant “background noise subtraction”

However, that does NOT mean that these aren’t still the perfect aids for me! So far, I love the sound, but still need more tweaks. My audi already increased the soft tones and added frequency lowering, and now I’d like to try increasing the mid-tones. And another bothersome thing is the staticky/hissing “S” and “Sh” sounds that nearly overpower me when I’m trying to listen to speech. My brain spends so much time trying to filter out those staticky/hissing noises, that I’ve lost track of the conversation from the first sentence or two!

[Bubbly]

You are so right that noisy restaurants are a problem for most people, regardless of hearing impairment! I too, wonder why on earth the need for seemingly every restaurant to have the overly tall ceilings and hard surfaces that create echos. That is amazing your bank took your suggestions! And if Chase takes you up on that offer, let me know if you need an assistant!

I rely on CC and I’ve also experienced the “soft piano music plays” and… nothing. On the subject of training our brains, I wonder if my reliance on CC has negatively impacted my understanding of speech in some way

[e1405]

@Bubbly

And another bothersome thing is the staticky/hissing “S” and “Sh” sounds that nearly overpower me when I’m trying to listen to speech.

This is likely due to the “frequency lowering” feature that was set on. @Volusiano mentioned that this hissing sound usually goes away once your brain gets used to listening to it. I confess I tried frequency lowering a couple of times and was not able to cope with this (perceived) unnatural sound.

[Volusiano]

@e1405 nailed it on the head that the hissy “s” and “sh” sounds (some call it “lispy” sounds) is most likely from the frequency lowering. The key to getting acclimated to it more easily to start out with is maybe to begin with the least strength value on the lowered sounds, so that you can barely notice it but it doesn’t bother you. Then as you get more used to it and start depending on it to help you understand speech better, and you wish that you can hear it louder, then you can increase its strength value up another notch, until you’re happy with its presence to help you out but for it to not be intrusive to your taste. But if you’re perfectly happy with its initial lower volume level and it already gives you a good balance, then of course there’s no need to increase its strength value any more than where it is.

But many people didn’t know better and started out at the default volume or higher strength value, and find it too intrusive to be able to adapt to it quickly, so they just dismiss it outright and disable frequency lowering right off the bat after a day or two of trying. Of course some people can never get used to it, even at the lowest strength value, so eventually they turn it off altogether; which is OK too, at least they know that they gave it an earnest try.

[Volusiano]

@Bubbly

You are so right that noisy restaurants are a problem for most people, regardless of hearing impairment! I too, wonder why on earth the need for seemingly every restaurant to have the overly tall ceilings and hard surfaces that create echos.

Even the traditional front beamforming has its limitation. For it to work effectively, there are a few conditions that must be met:

1. The speaker in front is not too far away. Maybe within 6 feet in front of you and not further away.
2. The location cannot be full of reverberation like the tall ceilings and hard surfaces that you described.
3. The noise must be on the sides and behind you. Otherwise the noise coming in from the front, whether it’s the diffused noise from all around or the actual noise sources in the front, is still not blocked or filtered out and it still can muddy up the front speech anyway.

That’s why originally with the Oticon OPN, Oticon makes a noise model of the sounds on the sides and back and subtract this noise model from the speech coming from the front to clean up the “diffused” noise from the speech. That’s their trick on how to help make the speech more understandable despite letting the surrounding sounds. But after the OPN, they use the DNN to do the speech cleanup instead, which is a more clever way to do it.

[Bubbly]

I agree with every point, the conditions have to be near-perfect for beamforming to work well. And when it does, it’s so wonderful that I long to have it 24/7

Thankfully, I’m not in noisy environments very often. But I just traveled a few weeks ago (with my Rextons), and it was a nightmare despite my various programs and beamforming. The airport was so horrible, I couldn’t understand a single thing clearly over the cacophony. Couldn’t understand the cashier at a coffee stand, couldn’t make out the announcements for boarding, couldn’t hear/understand the flight attendant inside the plane when she asked “cookie or crackers?” It was SO stressful that I wanted to cry several times and my anxiety was level 10. But as soon as we arrived at our destination and back in a quiet room, I had zero issues and could hear everything clearly again like a button was switched ON in my head.

So this is my big hope for the Intents, that I’ll be able to hear in my usual lifestyle of quiet rooms AND be at least somewhat functional at the airport (should I ever be prompted to fly again after that disaster ).

[Bubbly]

Hi all! Just wanted to update everyone after wearing my Oticon Intents for a few months now, in many different environments! Here are some sidenotes, continued struggles and wonderful things about them:

1. The battery life is awesome, even streaming all day, I’ve never come close to running out of battery.

2. I can hear birds, trees creaking in the wind, cicadas - all noises i haven’t ever heard in such detail!

3. I currently have custom molds in both ears, and they create moisture build up and make my ears terribly itchy. Tomorrow, I’m going to have my audi switch my left mold (better ear) to a dome, to see if that helps. I’m also very curious how it will change the sound profile for me.

4. I need the frequency lowering decreased again, as the constant “sssss” hissing sounds interfere with my speech understanding. My audi has already decreased it once, but i need her to decrease it again. I’m afraid I might lose the benefit of it though.

5. Speech in noise. While these Oticons are an improvement over my Rexton bicores, I’m still struggling quite a lot in noisy environments – even after multiple audi adjustments and using both P1 and P2 programs with NNS turned up to 10 and 12. Just today, I could barely hear the receptionist at my dentist’s office over the TV in the waiting room behind me. I had to ask her to repeat herself many times. Same with cashiers in grocery stores.

I’ve also been to a themepark nearby many times this summer, and when we pop in to buy drinks/food, I struggle massively to hear any cashier. I see their lips moving, but can’t hear any sound Granted, most of the employees are soft-spoken teenagers, but I don’t think i should be having THIS much trouble.

I think the primary problem for me, is that these Oticons turn up ALL noise, so then it’s a struggle to understand speech over the din. And sometimes all the noise is overwhelming, so I turn them down, but then I have even more trouble understanding speech. Oh, the struggle!

6. I’m also still having issues understanding my finance when he’s not looking at me. And he’s not a mumbler, he’s got a pretty clear, loudish, mid-range male voice. Audi has increased soft and mid tones quite a bit, so not sure what is left to help me

7. And I’m only understanding about 50% of any speech happening in the backseat of the car, usually my fiancé’s 2 teenagers as they tell about their day. I wonder if the hearing aids are just not focusing on their voices because they are sitting behind me🤔

8. And I’m only understanding about 60-70% when I’m driving and have a passenger who is talking (right ear is my worst). This is an area where my Rextons were better because i could switch the directional microphones to my right!

Long story short… Despite 6 audi appointments and tweaks, none of these issues have gotten much better for me. A little better, not significantly. I’m starting to think that this is close to as good as it gets, and perhaps I need to temper my expectations a bit. I feel envious of the posters who have noticed an immediate, life-changing difference with them!!

I am going to invest in the DIY software and try some tinkering myself, as all these audi visits can take a lot of time. Any advice appreciated!

[Volusiano]

Thanks for sharing your experience with the Intent 1. I think your contemplation to try DIY is a good step forward, especially now that you think your HCP has done as much as possible for you already. The immediate knowledge on whether a tweak works for you or not will help get you to an optimum point much faster than countless time consuming HCP visits.

Now I’ll comment on a few things just from my own observation, in case you might find any of it helpful.

1. You have a very weird hearing loss with that peak at 2 KHz, let alone the asymmetrical loss in the lows between your left and right ears. At least your high frequency loss is more symmetrical. I think the frequency lowering (Speech Rescue) is helpful with your kind of high frequency hearing loss, especially because your hearing in the 2 KHz region is not bad at all to serve as your destination region for your lowered sounds. But that’s also why the “s” and “sh” are too overwhelming for you. Just dial the Strength down to a lower (or lowest) value so that they don’t sound too pronounced.

2. I think switching your left mold to a dome with is OK, as that is your better ear in the low frequencies. The only thing is that it might be weird at first to have different fittings in each ear, but maybe you’ll get used to it. I wouldn’t change out the mold on the right ear for a dome, though, because your low frequency loss in that ear is pretty bad and you need the custom mold to contain the low frequency sounds from leaking out.

3. As for the Speech in Noise not doing enough for you despite having the NNS as high as 10 or 12 db max for you already, I presume that you have its Directionality Settings at Neural Automatic. I would keep it like that, but if you find yourself struggling in certain situation, try go to the phone app and enable MoreSound Booster. This is basically the same as Speech in Noise with max NNS, except that the Directionality Settings is set at Fully Directional to beam form the focus more to the front. If you find that it works better for you and you keep reaching out to your phone to enable it more often than not, then you can change your Speech in Noise Directionality Setting to Fully Directional instead of Neural Automatic. This Booster feature might help you out more in very noisy places like at the theme parks with cashiers and such.

4. As for being able to hear your fiance’s kids better in the car when they sit in the back talking, if you have a music program, maybe try it out in that situation because its Directionality Setting is usually set to Fixed Omni, meaning that it’ll try to pick up sounds all around and will not discriminate sounds in the back to favor sounds in the front.

5. As for your fiance, seeing that your right hearing in the low frequencies is pretty bad, if your HCP has already tried soft sound and mid sound gain increase, how about also try low frequency gain increase? That’s because your mid frequency hearing loss is not too shabby, so I’m just guessing that you’re missing out more on your fiance’s lower frequency tones and his mid tones.

6. It’s too bad that your worse right ear is in the direction where the passenger sits where you drive. I can only think of creating a custom program where you give a preferential over gain to your right hearing aid so that you can pick up sounds on the right ear better. It’d be an unnatural imbalance of volume for sure, but if you only limit it for while driving with a passenger on your right and having a conversation with them, then that might be a trade-off you can live with just for that ride.

All in all, I think if you’ve already felt like you’ve done enough audi office visits for fine tuning and are not sure what more they can do for you, taking up DIY at this point to further experiment and fine tuning until you’re happy with it would be a great approach. There are so many little things you can try and experiment if you have the luxury of being able to do it yourself with instant feedback of whether it works for you or not, instead of waiting for an office appointment, have some changes made, then go home only to find out they don’t help much, then having to wait for another week or two for a next appointment to give your feedback to the HCP again → it’s such a slow and painful process, especially after you’ve been through this half a dozen times already.