My son has a significant hearing loss on the right ear (see attached to my profile) and is trying out a Sky L70 PR (selected by the audiologist), but after looking at the specs, it looks that it isn’t the appropriate one for his loss (as it is only recommended for mild to moderately severe hearing loss and he has a severe hearing loss.
After discussing this with the audiologist, she said that SP and UP models are made for profound hearing losses and that we would lose the convenience of rechargeable hearing aids, the hearing aid would be much bigger and heavier and the sound would also be not as clean due the extra power of the most powerful models.
However, all of those things are the opposite of what I’ve read and don’t make a lot of sense to me. She also said that usually we don’t try to recover the hearing 100% and we just try to recover 50%, which is even more non-sense to me.
Can someone with more experience give me some advice on this?
Note: I think that the left ear would also benefit from an hearing aid, but we are just starting with one for now.
I’m far from being knowledgeable in this topic (kids ) but based on the specs, you are correct. Plus, it doesn’t make sense to prescribe something so power-borderline without the possibility of increasing the gain in the future. But again, with kids, I don’t know
I’ll say one thing: If you see a clinician and have doubts, get a second clinical opinion. @Neville@Um_bongo : thoughts?
How old is your son? Do you know the etiology of the hearing loss; is it likely to be progressive? Is the loss sensorineural or conductive? Are you working with a pediatric audiologist?
You can fit an SP on the right ear and an M or a P on the left ear, although it’s a bit awkward to have one battery version and one rechargeable version–but sometimes that’s just what you need. Better to be a bit awkward than have a device that really doesn’t help him. BUT, has your son been evaluated for a right cochlear implant? There’s not a lot of hearing in that right ear, particularly if the loss is sensorineural. I wouldn’t recommend staying with just one hearing aid, but if you are only going to aid one he’ll get better benefit in the left–that ear has more function and will do pretty well once sound is returned. Restoring the hearing in the right ear with a hearing aid has more limitations.
I wonder if you might benefit from a second opinion. But if he’s young, it’s important to move pretty quickly.
How old is your son? Do you know the etiology of the hearing loss; is it likely to be progressive?
He is now 5 years old. He has a complicated clinical history that could have caused the hearing loss. If it will be something progressive or not, we don’t know. However, it has been very fluctuating over the last year and a half, without no real explanation after scan, , and a lot of .
Better to be a bit awkward than have a device that really doesn’t help him.
I guess that you’re referring to the PR model for the right ear, right? Is there any logic on that comment from the audiologist when she says that usually we just try to gain half of the loss?!
BUT, has your son been evaluated for a right cochlear implant? There’s not a lot of hearing in that right ear, particularly if the loss is sensorineural.
The option was on the table, but as the hearing loss isn’t a “common” one and it looks lore conductive than sensorineural, we wanted to give it a try with a hearing aid first (and he noticed a lot of difference immediately after fitting the hearing aid - and I believe that it isn’t properly configured for his loss)
I wouldn’t recommend staying with just one hearing aid, but if you are only going to aid one he’ll get better benefit in the left–that ear has more function and will do pretty well once sound is returned. Restoring the hearing in the right ear with a hearing aid has more limitations.
You don’t recommend staying with just one hearing aid in general or is that based on his audiogram where it is visible that he has a mild loss on the left one as well?
I wonder if you might benefit from a second opinion. But if he’s young, it’s important to move pretty quickly.
Unfortunately we’ve being dealing with this hearing loss for more than a year now, so we really feel the need to decide for the best quickly as you suggested. But I think that there is no other way than trying to find a second opinion.
Just out of curiosity, are you an audiologist @Neville?
Based on the hearing loss in the left ear, yes, he needs a hearing aid on that side. He has around 60% speech audibility in the left ear right now and needs 80% (0% audibility in the right), and a hearing aid could likely give him nearly 100%. However, if this has been fluctuating in and out of normal and you don’t know if it’s permanent yet then it’s a harder call.
Half gain is sort of a rough estimate, but yes that right ear has a lot of loss to get good audibility–although a conductive hearing loss will have a better outcome. But. . . if it’s mostly conductive has anyone talked to you about a bone conduction hearing aid? The benefit there is that it would give a stable signal regardless of fluctuation, assuming the fluctuation is in the conductive overlay and not the sensorineural component. It would also stimulate both ears. It would be useful to see some real . Maybe there are also some medical complexities that make a bone conduction device difficult.
What’s the reason for just one? Is it a financial concern, or is it that the hearing loss really isn’t quite stable/understood at this point?
However, if this has been fluctuating in and out of normal and you don’t know if it’s permanent yet then it’s a harder call.
Yes, the fluctuation is what makes it more difficult. Also, we aren’t sure if he is really at 30db level, as he started doing when he was 4 and even now (with 5) a 10db more or less is possible, I guess.
Half gain is sort of a rough estimate, but yes that right ear has a lot of loss to get good audibility–although a conductive hearing loss will have a better outcome.
So, not even with the right model in terms of power, wouldn’t it be possible to make him listening soft sounds, that’s it? (assuming that the speech discrimination is possible on that ear)
But. . . if it’s mostly conductive has anyone talked to you about a bone conduction hearing aid? The benefit there is that it would give a stable signal regardless of fluctuation, assuming the fluctuation is in the conductive overlay and not the sensorineural component.
Yes, he tried a Oticon Ponto while ago, but he said that didn’t notice difference and was struggling with the feedback caused by any touch on the receiver. But, the fluctuation isn’t just conductive, as we also have audiograms with bone conduction being affected and then recovered.
What’s the reason for just one? Is it a financial concern, or is it that the hearing loss really isn’t quite stable/understood at this point?
No, it isn’t a financial reason. It is more that his hearing loss isn’t stable and understood and there is no consensus on what to do, as he seems to be developing well in terms of speech, etc.. but I think that he isn’t listening 100%. Another complication is that he is still with a grommet on the left ear and as it is the good one, we don’t want to risk to cause infections, because when he was with an infection on that ear, it was really hard for him to listen anything (before having the trial on the right one).
Ah, k. So going with the right for now is reasonable and then track the left closely and be ready to aid that ear too. in the classroom if he’s in school. I’d go with the SP. It’s not that big–I have lots of younger kids in it. For boys the blue and the red are probably the most popular, let him choose.
But also, sounds like he already has a lot of language. That’s good.
Yes, he has a lot of language. I think that at the moment he just struggles with classroom conversations in a big round, noisy environments, etc. In 1:1 conversations he is able to listen pretty much everything.
Thanks a lot for all your comments and hints. Really appreciated!
If you’re concerned about the size of the SP/UP devices from Phonak and Oticon and they’re not fitting well behind the ear you could look at the Resound Enzo IA2 rechargeable which may be becoming available in your local market soon. It isn’t specifically a paediatric device but doesn’t need tamperproofing and is probably compatible with a Roger/ system via a europlug on Resound’ Multimic. With those hearing levels you may find that he doesn’t get a lot of benefit beyond improved sound awareness/localisation. As it’s a progressive/fluctuating loss it is probably worth aiding. If it were congenital we probably wouldn’t in my country but would focus on the better hearing ear.
I’ve seen quite a few mixed fluctuating losses caused by cochlear structural malformations that worsen with bumps to the head. Have the MR or scans shown anything abnormal?
I would definitely be aiding the left ear where the is at present. Inconsistent hearing levels cause considerable interfere with language learning as the brain doesn’t have the consistency it needs to form stable neural representations of words.
With fluctuating hearing losses if the pattern of loss remains the same it can be accommodated for using a volume control.
If the pattern of loss varies a lot and you live a long distance from the clinic a solution that is compatible with in-situ audiometry via teleaudiology may be worth considering. That way you can monitor the hearing more frequently to ensure that you aren’t over or underamplifying. I think Widex devices may offer this functionality. They are also really good at preserving natural sound perception for mild to moderate losses.
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