Not necessarily? I’m just saying that there are limitations and trade-offs with hearing aids. You mentioned some speech sound confusion. I cannot know for sure without seeing your specific fitting, but there’s a good chance that your current set up cannot give you the gain you need to resolve the particular speech sound confusion that you mentioned.
The frequencies you need to resolve the particular confusion you mentioned are around 3-4000 Hz, which I circled on the graph in the right ear above. Red line is your hearing loss, shaded pink zone is the expected fitting range with your set-up. You can see that your hearing loss comes out of this shaded range around where I have circled. Given the relative chance of feedback with a closed dome in that area, it is unlikely (but not impossible) that your clinician can provide you with any more gain in that area and reasonably likely that your gain is insufficient there. The left ear is just way out of the fitting range.
Now the right ear is fully in the fitting range, although there’s not much headroom at the target area. But your chances are higher that you might get sufficient gain in that area to resolve the speech confusion you mentioned, if the earmold is a good enough fit to manage feedback in that ear. The left ear is still not really powerful enough, but it’s better than it was.
Moving to a BTE with widex on the left ear doesn’t really support it either:
BUT, if you cannot tolerate an earmold then none of this matters. You have to have hearing aids that are comfortable enough for you to wear, and sometimes you have to make sacrifices to what is maybe “optimal” in order to support individual needs. But in that case, there are no software adjustments or hearing aid manufacturer changes that will make a difference–any brand of RIC with just domes is not going to support your hearing loss better. In this case, it’s the power level of the hearing aid and the acoustic coupling to the ear that is limiting things.
Thank you so much for the detailed reply! I appreciate it!
One more question, please! What is fitting? Is it different from the domes that I attached their photos previously?
P.S. I checked with two companies in Egypt about Phonak and Oticon and they didn’t have them!
Signia might also have a power BTE that would fit.
By “seeing your fitting” I just mean everything specific to you. Seeing your physical ear canal, seeing the feedback measure in the software, seeing the REM ideally (I think not available in Egypt, sadly). I can give average information, but people are individual and it’s possible that the actual fit could be better than expected. For example, if someone has a much smaller than average ear canal then the hearing aid will be louder in the ear and the fitting power range will be more forgiving, and if the dome fits just right then maybe the feedback management is really good and the hearing aid is actually providing reasonable gain at 3/4000 Hz afterall. I cannot know for sure, I can just make an educated guess.
The thing that is wild to me about places that don’t use real-ear measures (REM) is that those clinicians are probably totally unaware of just how underfit hearing aids frequently are, and at what frequencies they tend to be underfit. I often read people’s experience here and think that I could have an interesting job picking up a cheap REM machine and then just travelling all over the word providing services in places where they are not standard.
BUT, if I had to try to maximize hearing aid function within the limits of not having REM, I would aim for deep, snug (but comfortable) custom tips and do my best to optimize the feedback measure with physical adjustments (fit on the ear) and then I would run the in situ sensogram test inside of the widex software. I’d certainly put a custom HP receiver on the left ear if I could.
In Egypt, everything is almost done differently and not as professional as it’s supposed to be, unfortunately.
Hmm, I think I will check trying these custom moulds. Hopefully, I will be able to do so before the two week trial is over!
What do you think of keeping Moment 330 in the right ear with a custom mould while looking for a power BTE for the left? Or the idea of having two different brands and models isn’t recommendable in general?
You may not be able to get custom molds until you purchase, which may be why the provider chose to put you in domes at all. It’s usually a bit of a wait to get custom molds. If you had trouble with your left earmold walking out of your ear previously, try chewing a bit while getting the impression taken, or at least relaxing your jaw. I don’t know if they’d use bite blocks where you are or not.
Tough call on the left ear without knowing what’s available in egypt. If you quite like the moment 330, you might be okay just keeping the 110 RIC on the left with an HP mold if doing otherwise is a huge hassle. You have a complicated hearing loss generally, with such an asymmetry. You might want to investigate the Widex Sound Assist.
I have just checked with the company about accessories. They don’t provide TV streamers. Com-Dex and Sound Assist devices are not available in Egypt as well!
When I’m outdoors, I struggle with understanding people.
I have the aids with batteries. This is a handy option for me.
Overall, I’m not satisfied because my main goal of getting new aids was to understand people better and reduce mishearing which is not achieved so far.
Zeeza, ask your fitters to MAKE THIS WORK FOR YOU. If you’re no better off understanding people in situations, then you need something more. Tell them to find a total solution with aids AND remote mics for streaming.
There must be people in Egypt who have total hearing solutions with accessories that help them comprehend speech. How to find them and get some advice is the key.
Maybe you could post a NEW topic here: “Live in Egypt, need total hearing solution with accessories for speech”. Perhaps one of the audiologists here can steer you in the right direction?
Don’t give up! My in-laws lived in India and it was VERY challenging for them to find hearing solutions clear up to 2014 when one died, the other moved to the USA. Hearing clinics were located in odd places with dark stairways to negotiate. There simply weren’t the trained audis there either. I hope Egypt has something you can use, or if you have the means, travel to the closest country that CAN fit you with a total solution. If you could stay for a couple weeks and get this done, it could be a life changer.
I talked to the company about it. They told me “my brain” needs a few months until it gets used to the new hearing aids! The trial is only two weeks. What if I wait for a couple of months and no improvement is noticed/ heard? I paid a big amount of money and I can’t afford to pay for another pair of aids later.
Other people told me, this is “my problem” because I’m expecting too much from the hearing aids which are limited by my hearing impairment.
There is inflation in Egypt and many devices, not only the accessories of hearing aids, are not available in the market.
Finances would be the main problem to seek a solution in another country.
This probably wouldn’t make things better and it might make things worse.
Difficult decision whether to switch or not, and two weeks is certainly short. If you don’t feel like you have gotten any benefit an your old hearing aids are still functioning well, then I’d lean towards returning them and trying something else, but it’s going to depend on whether you even have other options. Also might depend on whether you pay a penalty for returning.
I don’t know that I’ve seen any providers on here from Egypt, but it sounds like a very different context from what I am used to.
I will see whether it’s possible to change the earmolds to the ones you mentioned earlier. If I still don’t feel\ hear any difference, I will take them back.
They will send the aids for check-ups before they accept to return my money. And yes, there is a penalty I have to pay.
What do you think of Oticon Xceed and Oticon Ria Cic? Could they be good alternatives?
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.
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.
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?
