Unusual hearing loss pattern?


I’ve been reading this forum for a while and find the advice really useful, but have only just registered. I’ve been wearing hearing aids for about 20 years and am currently trialling Phonak Audeo S 9 RITE with power domes. I’ve also recently tried Oticon Agil Pros and Starkey S7 ITE.

The audiologist has made a lot of adjustments but I seem to have the same problem with all the aids in that I’m still having problems making out some speech even in quiet - I can hear the sound as loud enough but can’t make out the speech. Also sounds are very processed / metallic / artificial especially in noisy situations. They are still better than previous aids I’ve had, especially in terms of noise reduction and speech in noise, and I would really like to keep them if we can sort out the problems.

We are still working on adjustments, and I’m due to meet with the Phonak rep this week to see if they can suggest anything else.

I am aware that I have a fairly rare pattern of hearing loss, and every audiologist I have worked with has advised me that this pattern is particularly hard to fit.

I was wondering if anyone on here has a similar pattern, and if so would be willing to share any experience on what aids / adjustments have worked best? I’ve glanced at audiograms when I’ve read posts but haven’t seen any that are similar so far.




On some of the better Starkey aids, and I dare say other brands too, there is sometimes the feature to do a hearing test using the aids themselves to generate the sound.

The prescription for your loss is then based on the actual acoustic response of your actual aids, based on threshold and ULL. Thus ensuring the fitting is nicely within your dynamic range.

Then as far as voices go, that’s going to have to do with compression ratios and kneepoint settings.

Your loss, at least on paper, is not that unusual, and should not be that hard to fit. If you try a bunch of different brands and none of them sound good, eventually you are going to have to ask the question whether it is the aids, or the hearing professional doing the programming.

When a hearing professional starts talking about bringing a rep in to adjust the aids, that tells me he or she is not an expert at what they are doing. Reps are usually well trained, but a hearing professional should see to it that they are more expert than the reps on programming the aids.

You have what’s dubbed a cookie-bite loss. I don’t know that it’s that difficult to fit, but it’s less common than your typical high-frequency sloping loss. Also, realize that this means that your audiogram dips the furthest in the frequencies that are most critical to understanding speech, which may limit your hearing potential (even with hearing aids). How were your speech discrimination scores (the test where they have you try to repeat words at an amplified volume)? They can offer insight into how much better hearing aids can help you hear (high = good, low = not so good).

As far as sound quality: I’d be concerned if part of the fitting process didn’t include adjusting the aids to make the sound more natural, or perhaps they sounded good in the office. Generally “metallic” means too much high frequency gain and is an easy fix.

I have the same type of loss. I don’t have my curve in front of me, but my highest loss is around 55 decibels, and it slopes up in both directions similar to yours, ending around 30 decibels. Anyway, I bought the Oticon Agil Pro’s, and I love them. They’re my first HA, but I think they’re amazing. My audiologist fitted me with custom earmolds that fit into my ear canal only. They’re made from silicon so that they have more grip; otherwise, if I had gone with the acrylic, I would have needed a lock thingy that went into my outer ear. Just because I was new to the whole thing, I tried the regular domes and power domes as well. I lasted about 5 seconds. Not only were the domes significantly less comfortable than my custom molds, the domes were not nearly as powerful. I understand this is is because replicating the low frequencies is difficult without a tight seal. The domes don’t create a good enough seal, whereas the custom molds do. Domes are preferable, though, because they prevent occlusion. But I’m not occluded, either, because I have a fairly large vent, which the silicon earmold construction allows. You should try a custom mold- you need the seal to get the low frequencies, which provide loudness.
Hope this helps.

I’m interested in seeing your speech discrimination scores also. And like others mentioned, albeit cookie bite losses aren’t what I would call common, they can be fit successfully if given a professional with experience fitting them. It’s all in the programming!

Good luck!

dr. amy

Thanks everyone who has replied, and apologies for not coming back earlier. I found all the comments and suggestions really helpful.

I’m still waiting on an appt with the Phonak rep.

Re domes / custom mould - I think this may solve some of the problems and I’m going to try the moulds, thanks for the comments kevmh. I did have CIC aids before for 5 years and they had large vents so I didn’t have problems with occlusion (they just weren’t powerful enough). I find the domes really irritating - they won’t stay in one place and keep slipping out or if I push them in far enough so that they stay put I get an echoey, underwater sound quality. Every time I move my head the domes shift and the sound quality changes noticeably. I’ve tried all the sizes.

I did try the Agil Pros, and thought the sound quality was more pleasant than the Phonaks but the speech in noise wasn’t as good?

Re: high frequency adjustment - the audiologist has made quite a lot of adjustments with this but nothing seems to improve it.

Re: speech discrimination scores - I don’t remember ever having this test? I definitely didn’t have it in the most recent test. Is this a standard test in the UK as well as the US? I need to check this.

I don’t know whether it is just programming or if there is something beyond what’s “on paper” from the tests that is preventing me discriminating speech effectively, even beyond the difficulties posed by the “cookie bite” pattern.

I’m curious about the Widex Passion - seems to get good reviews in terms of sound quality, also the Wii? I don’t know whether to keep trying different aids, or to focus on working on the programming with the audiologist / rep.