Both you and Billgem are using the Tulip domes with very similar losses to me. My latest test shows slightly more loss now but still on the edge of severe. Billgem has a lot more low freq loss than I do while yours is pretty similar. Any occlusal effect with the tulips?
In the Compass GPS program the Tulip domes don’t quite match my loss but the sleeved vented does. I imagine the Tulips will probably work though and will ask on the 5th when I get my SmartRIc. My low freq hearing is better in the right ear but both would need lots of venting to avoid occlusal issues.
I’m very sensitive to occlusal issues and I’m wearing vented sleeves, with anything more open I’ve had feedbacking problems, but my left side is kinda bad.
Yes it’s that good hearing you have at 500 hz from what I’ve read. You and I are not candidates for molded inserts because the vent would have to be huge to avoid occlusion…maybe 4 mm or more. I’ll have this discussion with my audi when I get my SmartRic on the 5th. I would love open domes like the Philips. I only have feedback when I put a hand to cover my ear or something comes very close to my ear and it’s brief and really not as bad as feeling occluded. I would be willing to sacrifice some speech understanding to avoid occlusion. The open bass Oticon domes I have are better than the Widex open domes to avoid feedback but even the totally open Oticon older domes didn’t feedback any more. And the double bass, two small vents, did not make the feedback less. It’s a blessing to have good low freq hearing and a curse if you also have high freq hearing loss lol…mostly for the audi trying to fit you. The most, not all, of the fitters at Costco only go by what the program tells them to do and don’t have the knowledge to do much more.
The Dome I have is the second one you shown described as Instant sleeve vented. I don’t perceive any occlusion effect in my fitting. Like fbacher1 I do get feedback if I cover the ear with my hand.
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Yeah that sort of feedback, while not perfect, really is a minor issue for me. If I had it all the time during the day it would really bother me. It just says my dome is a compromise and not perfect. My dad’s very old hearing aids would feedback all the time and he constantly had to turn the volume down. He would have loved modern hearing aids a lot.
I will try the tulip and instant vented sleeve on the 5th but might ask for spares to fully evaluate them day to day. The REM will need to be redone for whichever dome I settle on but that’s a given I guess.
It can still be worth trying molds with as large a vent as possible. For some, that level of occlusion is a tolerable trade-off.
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Yes if the the domes don’t work that is an option.
No, not typically.
What was your previous experience with occlusion that you are so worried about it now? You’re certain it was occlusion and not ampclusion? The greater majority of users with loss like yours are fine in closed domes, but certainly there is a smaller subset that is sensitive to it and maybe that’s you. Just keep in mind that if a closed fit doesn’t bother you when the hearing aids are turned off, it’s not occlusion.
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The term “ampclusion” denotes the occlusion effect experienced during hearing aid use when the physical occlusion of the ear canal and the hearing aid amplifier gain are included in the wearers’ perception.
So I would say there’s the one extreme example of occlusion from something like Apple Airpod pro ear buds. Then there is this amp occlusion or unnatural voice perception, which I know I experience “from time to time”. I might be related to the volume of my speaking voice at times but I’ll have to do more research on this. I know the OVP with the Lexton BiCore did not help even a little bit. I get this with the Philips even with the open domes and it’s worse the more gain I employ so 80% is OK, 90% is almost tolerable and 100% is currently just too annoying. The sound I hear is almost microphonic in natural and very unnatural without generating any feedback. And it’s all generated by my own voice. I thought I had worked my way up to 100% over 1 1/2 years but then gradually was finding that 100% was just too disconcerting and unnatural for me and I’m back at 90%. Like I said, I’m not sure if the volume of my voice at times brings this on or maybe a mispositioning of the domes. The latter happened a lot with the double bass domes I was trying and even generated lots of hiss unless I re-inserted them. I’m going to be reading this today to learn more: Ampclusion Management 102: A Five-Step Protocol | The Hearing Review
One check I made as a result of reading this article is the insertion gains from 125 to 750 hz for my Philips 9030’s and that gain is set to zero for both sides.
I did a similar check of the Compass GPS software and my initial fitting with various domes or molds and all provide a bit of gain at these low frequencies with the left ear showing a lot more gain. And this is true even selecting a 1.5mm vent for the soft molds. I can see fitting me needs to be in the hands of skilled audi not a CostCo tech, lol. I just hope this audi is as good as his reviews indicate. I just have to be patient because it could take a while to get the best fit…and that’s without my guitar playing sounds taken into account, lol.
I have moulds and love them. And here’s something strange, but true: I have the right mould sealed–no vent–with no issues with occlusion. this helped to boost my overall sound perception, or anyway my bass perception, and give a richer, fuller sound to my classical guitar when I play. The left remains vented. Again, no occlusion issues, even at the start. But when I tried closing the left, no vent, I didn’t like it. As I recall, occlusion became an issue and I preferred the vent for sound when playing. My left ear has much better hearing than my right.
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This isn’t strange. After about 45db HL of loss we don’t really worry about occlusion, although there’s considerable individual variability. Users who need a truly open fit tend to be very normal at 1k and below. It sounds like fbacher is actually more sensitive to gain than occlusion.
Just turn the hearing aids off. If you are not bothered by the sound of your own voice when they are off, you are not experiencing occlusion. Sometimes with a closed fit your voice is understandably muted when the hearing aids are off, also not occlusion. Occlusion is boomy/crunchy own sounds.
If you are just sensitive to gain, then the trick is to figure out which gain specifically. What speech sounds bother you? Commonly people are bothered by 3/4khz (s-sounds) or by 750/1 (“ahhhh”). Open fits, depending on ear canal resonance and done shape, can sometimes make things worse by making the sound peaky. But yeah, a good clinician should be able to figure it out. Real-ear helps. A patient who can talk very specifically about what they are experiencing helps.
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I thought that many audi’s look at your loss at 500 hz to attempt pre-sizing venting to avoid the occlusal effect? In my case that leads to a very large vent since my 500 hz loss is very low and even better in my latest testing. But at any rate I don’t believe it’s anyone else’s voice other than my own voice. And not a specific word…all of them, lol. While amplified I don’t find other voices to be too loud or hollow (in a tunnel loud) to me, only mine. And since I have hyperacusis maybe it is mostly the gain that is bugging me.
I’m willing to try any dome or mold my audi recommends on the 5th so I’ll just keep an open mind, express my concerns and let the audi try to help me get along with my hearing aids better. I don’t talk on the phone thru them and seldom stream music but when I do I use a 10 band equalizer that improves streamed music (but nowhere near as good as a air pod pro).
My audi initially fitted me with open domes [it’s barely a dome, it’s this flower thingy that just holds receiver in the ear], I’m assuming due to <500Hz being almost unaffected, but that was a mistake, due to my highs needing serious amplification and I had various issues. Not as much due to feedbacking, more related to everything being overly compressed. Also, gains were nowhere close to my prescription.
Maybe your audiogram in your avatar doesn’t match your updated audiogram? 20 dB is slight/borderline loss, it’s not super normal. So yes, audiologists use low frequency loss to assess venting requirements, but yours don’t necessarily call for an open dome.
I’ll be interested to see where you end up. 
Ok I just updated my entire audiogram. Oh I did have my low freq/ears checked by an ENT when I saw the left ear and her results for 250 hz were -30 db and no issues found when she did a diagnostic tympanometry. Yes it will be interesting and if molded inserts are called for then I give them a try for sure. Paying more attention to my own voice complaints, I think it’s when I’m talking the loudest. And the Philips has lot more gain at 80 dB than the Widex which is 0-1 dB insertion gain. I’m not sure if this is part of the “Widex sound” or not. I’m going to print out my Philips gains for my audi so that he might get some idea of where I’m at now. HearUSA only seems to sell Widex, Rexton and Signa. Makes sense since they are owned by WD. I’ve tried the Rexton BiCores for two months initially and found them to be very tinny sounding and I think I’m lucky in that HearUSA carry Widex, this audi has such a good rep. and they are one of two places that take my $3k insurance. My Philips 9030 have mostly been pretty good but lots of artifact hair sounds/movement and terrible in wind (mtn biking, etc.) It will be interesting with the SmartRic forward facing mics if the wind noise is still a lot better as claimed.
Got my new SmartRIC today and a bit disappointed. Too loud, wind noise is really worse, guitar about the same with the music program, had to turn volume down 3 steps and lots of feedback. The audi used the vented sleeve dome and occlusion is not noticeable but if these were my first HA I would be very discouraged. No Noise program like the Philips so I can escape kitchen noises easily and the HA don’t react and automatically correct kitchen sharp noises. I wanted audio to set to level 3 instead of level 4 the final level and full settings but he said he "doesn’t mess with acclimation settings. Music is just the std music program and that has feedback too and is too loud. I tried puresound and that has feedback when talking. Audi didn’t want to install the wire hook that helps hold this in saying these domes won’t slide out but I found they do a bit. Lots of hair and artifact noise, about the same as the 9030 Philips. So more and louder feedback than the Philips when I put my hand to my ear…new audiogram does result in higher gains and the Widex is at 100% while the Philips is set to 90% for more comfort. I’ll give them a week since I go back again but I think I’ll be waiting for the 9050 at Costco.
This means that you have incorrect size [or not inserted far enough], Sgnia uses the same domes [same parent company] and they never slide out for me [even when I’m very sweaty], no matter what I do.
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@fbacher1 very interesting and is to show how individual HA fitting is. I have zero feedback unless I put my hands close to my hear(s) reflecting the HA sound output back in. Wind noises I have no experience with other HA to compare, but 20-30mph I hear it amplified until the wind reduction kicks in (RIC 440, this feature is not available on other lower levels), not all gone, depends on angle speed etc but not too annoying. Working up the adaptation levels, but pretty much maxed out now. What do you refer as feedback? Feedback is a whistling noise caused by the HA generated sound reflecting in the mics, not amplification, so perhaps your tips are too open or too small causing too much sound to escape perhaps?
Yes I do know what feedback is. My Philips will have a quiet chirp if my head gets too close to something or if I put my hand close to my ear. These have a very loud feedback when I do the same. In puresound mode they feedback even while I talk. These dome are a good match for my loss. Think of the open dome not having any feedback margin, then the tulip domes almost work and then the vented sleeve domes fully cover my range of loss. As far as wind noise they were good for about 10 mph but then got pretty loud and I was also picking up things like a loud click of my shifter, the chain…things I never hear with the Philips in the normal mode and really pretty quiet when I select the noise mode, which has all the noise controls available max’d out.
Amplification or gain is just pretty overwhelming for me with how they are set. Much louder than my 90% Philips settings. And of course higher gain makes feedback worse since it pushes the gain curve right into the feedback zone. The domes appear to be the right size and maybe I didn’t have one of them inserted all the way. I don’t mind the hooks and I just didn’t want to risk loosing one on a ride over bumps or rocks. This is the 440 by way so all the bells and whistles, no pun intended. I finally had to take them out to get some peace and put the Philips in for now and will try them again tomorrow.