If you have access to Oticon, then you could put an Xceed on the left and a RIC on the right and if the levels and generations matched they would be ear-to-ear compatible, which might be nice. I’d go with the miniRITE T on the right (with a custom tip) rather than just the miniRITE because then you’d get the volume toggle and with an asymmetrical loss it’s nice to be able to toggle the volume separately.
You are not a good candidate for a CIC. The Ria is quite a bit older than the Xceed.
I didn’t pay attention to an important point that I live in the south of Egypt. The summer is extremely hot so I think RIC might not be the best option.
What about BTE for the right ear as well? Oticon Siya, for example?
P.S. There are no accessories available and my phone is Android.
@Don - you mentioned asking for an aided word recognition test - is that something that most audiologists should be able to do? I have asked mine for exactly that, and she said it wasn’t possible. We’ve been trialing different aids, and it seems to me that that would be a useful differentiator.
Why not just an Xceed on both?
You need an audio booth with a soundfield. Not all clinics have this.
We have a soundfield but we don’t do aided speech testing unless there’s a special reason for it. We do real-ear verification, which is more precise. You need to ask yourself what the aided speech test is FOR.
But if someone asked me for it and offered to pay for my clinical time, I’d do it even if I didn’t think it was that clinically relevant.
Yes, its common. Every audiologist i have asked could do it.
Isnt the purpose of hearing aids to increase my word recognition? Dont ask me “how does that sound”. Show me how it improves my understanding.
If they’ve properly verified to presciptive targets, they know whether they’ve optimized your access to sound. What will doing an aided WRS, a dramatically variable test, tell them further that your day-to-day experience in the world won’t?
I told my audiologist i was hearing better with the domes than the new C-shell molds. She didnt believe me. The molds didnt fit well but even pushed in, i could tell a difference. I asked if she could do aided word recognition. So i proposed we do the test with the molds, then swap the receivers, tell target about the domes, and repeat the test. Both pair of receivers passed the REM test.
With the molds i was getting just over 50% (52-53). With the domes i was getting 67%. She had the molds remade.
I agree REM is a good tool to verify the receivers are working correctly, but i dont agree that REM gives you the best possible sound and understanding.
For example, i have dead regions. I might hit the button when i hear something on 4000 hz but i may not hear anything between 3100 and 3900hz. To have a shot at hearing as much as possible, i need heavy Sound Recover (frequency lowering). My audiologists are scared to death to make any adjustments, especially SR, or maybe they’ve been taught it doesn’t work.
With trial and error with Sound Recover we have it where im probably getting the best possible understanding now. Is there a way to get to this that is better than aided word recognition?
Sound recover should be verified.
If you found the domes uncomfortable then they should be remade, and if you feel like they are making you hear worse that should be identifiable–did they do a direct comparison with REM to see where the differences were?
But 50% to 67% is not actually a statistically significant difference on a WRS test, which is one of the reasons it’s a poor test. I trust that there was a real difference, but only because you say so and your reported experience is reliable.
Well, how does REM work with Sound Recover? Does it disable SR? The REM matches the target. If i have tones at 3000 and 4000 but 2 dead regions (DR) in between 3k and 4k, target still thinks i can hear there. Say my loss is 80 at 3000 and 90 at 4000. Would Target think my loss is 85 at 3500, where it may be 120? So target is 85, REM is 85, but im not hearing it.
That’s why i think aided word recognition is important. It could verify all is well, or it could show the person is not getting expected results.
You think that aided wrs would be more meaningful than your own self-report? Humans are phenomenal pattern detectors. If you say that you are hearing better one way, you are correct and the job of the audiologist is to trust you, and if they are curious to found out why. I’m saying that aided wrs doesn’t add anything further to your report, given it’s wide variability. You can detect smaller changes than it can detect. If a statistical non-difference in aided wrs helped your clinician believe you I suppose that’s good, but she should have believed you in the first place. That’s not to say there’s no place for aided wrs, but this isn’t a situation where it is clinically useful.
Verification of /s/ audibility confirms that sound recover is doing it’s job. Looking at your audiogram, the lowering would likely need to be below 2khz in the left and even stronger in the right to achieve /s/ audibility, so dead regions above that are neither here nor there.
Thanks for your insight, Neville! I’m currently at 1300 on Sound Recover for both ears and that seems to be a good spot. I still get very good results on one-to-one conversations in quiet environments so i think i will delay a CI for another year or so.
You think that weaker ear result is 100% proven given the asym?
I don’t know. I think there’s a know history of middle ear pathology that supports conductive, but are those unmasked bone scores fake? Who knows. 24% wrs actually seems high if it’s really sensorineural, but that wasn’t masked either. 
But the OP suggested CI might still be an option. I’d always at least try to aid an ear if there was some chance of CI, but whether that’s actually realistic I don’t know. Implantation has really ratcheted up where I am, and I’ve probably had a dozen patients implanted since the pandemic all with good outcomes, but other places in the world might be very different.
I’m still thinking it’s spurious: 24% is getting into good guesses plus a bit of transcranial effect.
I think it’s easy to forget the geometric/log progression of asymmetric sensitivity because the loss is plotted in a more linear fashion. The ears have approximately a 64,000 times difference in my book.
We already know that using REM targets, I get unacceptable distortion of vowel sounds. So we have to always be under REM targets, and my audi has given up on doing REM. But I’ve been trialing different hearing aids, and get the feeling that I’m having more difficulty distinguishing words with my most recent ones. I’d like to have an aided WR test to be able to compare results with one type of aid vs another, in alll cases after they have been tweaked to get the best result we think we can get.
Okay. Just remember that on a full 50-word NU6 recorded list, if your first score is 66% and your second score is 80%, that’s not actually a statistically significant difference due to test-retest variability within the WRS test, and I believe that’s under inserts–variability on the aided test would probably be higher, and variability with a 25-word list will also be higher.
You see what I’m saying? You are better at detecting small but meaningful differences than the test is. So if your word recognition with no hearing aids is 0% and with hearing aid brand A is 72% and with brand B is 84%, this is a clinically meaningless difference and may not reflect differences in your real-word performance with the devices. So what do you DO with that information?
Thanks @Neville. I do get what you’re saying, and I must say I’m shocked that the test-retest variability of the WRS test is so bad. I wonder why that is.
On a somewhat related note, how does the standard audiometry test (the one in the booth where you press a button on hearing tones) fare? I’ve always felt more unsure of my own responses in that one than I have felt on the WRS test.
Yes, WRS is a pretty gross test. It has some utility as a red flag for retrocochlear lesions that might initiate a referal. Max WRS can also give you a general sense of an individual’s speech clarity to help set reasonable hearing aid benefit expectations. I see it used for sales/marketting in various ways. But as a comparison test for an individual it’s very poor, and if done with live-voice totally useless.
Test-retest variability on audiometry is about 5 dB assuming good testing practices, but there are areas of easy error that can lead to higher variability depending on the tester.
I find the desire for precision within the fuzziness an interesting part of the practice, but it can also be pretty frustrating.