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Audiologist concerns

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Hi,
I wanted to get some opinions. I have severe RSHL and was fitted with Phonak Audeo Sphere i90. I have a M receiver and rubber power domes. I found about Real Ear Measurement online, after I had already visited this audiologist once. So when I went to get the hearing aid, since she just gave it to me without any further tuning, I asked if they do .

After I asked about REM she told me that she has set my hearing aids to 80% of prescriptive target, would increase it 2 weeks later and said they do real ear measurement then.

I notice that the sound on these hearing aids is unclear, kind of distorted and jittery(music and hearing mode both). However if I press the dome tightly into my ear to make a better seal, or close my ear or tug on the wire with just right strength, it sounds clearer and much much better, but loses some loudness.

I’m wondering:

Is it normal to delay REM and start at 80% power?

Is the choice of receiver and dome correct?

Is my audiologist following reasonable steps, or should I be looking for someone else?

I don’t want to jump to conclusions, but I’m worried they’re being a bit generic with my fitting and not using best practices and that I might be getting the best results for me.

Thanks in advance!

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Yeah I wouldn’t worry about for now, let them do it in a few weeks time as you’ll be at 100% gain.

As for domes, you shouldn’t be using Power dome for the right side, open would work, that left reverse slope is ok , but a custom mold would be fine also, M (medium) receiver seems a bit low, a power for those lower end frequency wouldn’t hurt, discuss this with them when you go back in a couple of weeks.

Here’s the speech banana just for reference.

Screenshot_20251012_093821

Interesting ! Your right ear is like what I had as a child - darn near perfect! :slightly_smiling_face:

I can see where you’d need a powerful aid in the LEFT ear, and I thought custom mold was the “default” for Sphere? Perhaps others will chime in.

What you describe about the “jittery” sound quality could be a FIT problem. I also find if I push my soft, double power silcone domes into my ear canal, my hearing improves like 10-15%. That is why I’m now going to try out custom molds. But again, FIT, comfort and one’s own tolerance for materials used is the key. Keep us posted on your next visit’s outcome.

Edited

Do you have one hearing aid or pair of them?

If you have only one (left) ear to aided - M receiver is definitely too weak. Your loss on the left is even for UP receiver in cShell (kind of canal earmold) with very small vent, max 1mm or less.

You can test P receiver (not UP) with power domes with proper physical size (I have large), but if your thresholds are below 60 - it’s a very makeshift option, P is probably too weak.

Regarding right ear - @tenkan is right.

What’s your in quiet percentage in each ear separately and binaurally?

Only my left ear is aided. my says 44% on the left and 100% on the right. but idk how accurate that is since with this aid, if I seal it by pressing on my canal, I understand everything spoken while streaming albeit sometimes it feels quiet. If I don’t seal manually, it feels loud and distorted.

you think i should ask for p or up receiver with custom mold?

@Ramesh said:

if I seal it by pressing on my canal, I understand everything spoken while streaming albeit sometimes it feels quiet.

Maybe your power domes aren’t tight enough, allowing unprocessed sound to go directly to your eardrum. But that’s just a theory.

Sealing a canal helps much with low frequencies, because they don’t have possibility to leak out. It helps also with high frequencies when the gain needed is over feedback threshold.

Distortion may be probably because your active feedback reduction (WhistleBlock) is constantly activated making slight (10-20 Hz) shifting of the frequencies which give feedback.

How much hours your Sphere works on one charge if you don’t need to activate Spheric programme?

@Ramesh said:

you think i should ask for p or up receiver with custom mold?

Regarding your low frequency loss and the fact that sealing a canal helps you in hearing - definitely UP receiver with pressure vent (ideally 0.6mm, but not more than 1mm).

I see that your 8 kHz is a bit out of UP fitting range, but it shouldn’t be a problem and that UP will give you much needed gain for lower frequencies.

You should have a deep impression made for the earmold, at least 5mm past 2nd bend of ear canal.

Yesterday i had it on for maybe 10 hours it went down to 58%, mostly was on automatic, maybe 30 mins of sphere and around 3-4 hours of streaming. While on a full charge if i check the phonak app says > 16 hrs on auto and ~7 in sphere

Discharging is probably on the edge of considering it a bit exaggerated, but I don’t know that for sure.

Constantly activated feedback reduction like WhistleBlock could lead to a bit more energy usage.

Check your hourly discharging after being in quiet environment with no spheric and no streaming.

If there was no talking, that would be normal. It would be higher if there was talking in a quiet environment because the gain, which is the parameter on which feedback depends, would be engaged, aside from dome/earmould leaks.

Also something very interesting, if I bring my hearing aids close to the bad ear but not insert the tip, I hear so so so much cleaner and better than when I have them inserted when streaming. I put AirPods and xm5 on noise cancelling on the other ear, and checked that it definitely isn’t the good ear picking up the sound.

Edited
@Ramesh said:

Is it normal to delay REM and start at 80% power?

As you may already have inferred from Tenkan’s answer, the answer to this question is: yes.

The reason is that many folks who haven’t had hearing aids at close to full strength before find full strength in the settings to be harsh, jarring, too much. "The kitchen water faucet sounds like a high-pitched roaring waterfall!” Some get home and a few hours later want to yank the aids off and return them, or throw them in a drawer, never to emerge again! Long-term results are better for most newbies when they start off at a lower setting and give the brain 2-4 weeks to adjust to processing all the new sound it hasn’t heard recently. Unlike plug ‘n’ play new eyeglasses for most people, hearing aids need time to allow cognitive adjustment. And at 80%, isn’t meaningful. Your audi is doing you a favor, and it’s often done that way with new patients.

I think that delaying for the pure reason that the hearing aids are set to 80% is a generally a mistake. I’ve done countless REMs and there can be significant differences up to 10-15dB away from the predicted amplification in either direction. So though they are set to 80% in the software, they could be massively over amplified still. Or set to 100% they might still be under amplified and not helpful. It’s not known until the sound pressure is measured inside their ear.

And for a different perspective, I frequently fit people to their full prescriptive targets and I would say that complaints of the loudness at the initial 2 week follow up are infrequent. I would even say that having to make adjustments away from REM targets at the follow up are occasional. I don’t have a real number to give, but I would estimate … 75% - 85% of the time no changes are needed. Some counseling on what to expect at the beginning is also important. And I think there’s something to be said for avoiding “over counseling” someone also. Give them an opportunity to form some of their own opinions about the sound quality.

REM is a tool and as any tool, it is not the only tool available. But it is incredibly effective, and if providers were using it (and using it correctly!), I think the number of posts on this forum of people struggling to hear would go way down.

My two cents. I’m always open to other opinions, also. I just want to share with people because I’m a huge believer in what REM can do, or rather what can be done with REM.

I have to agree with @mindsil I believe it is wrong to wait to do . Best fit is for amateurs, which is where your at. I believe and do it at the initial fit then turn it down to 80% to begin. This way you get the correct fitting from the beginning. Also, with your reverse loss every one is different with how much power but to get the power in the low frequencies you need a stronger receiver so agree with at least a P if not UP with Cshell. which one would depend on your discomfort level as to which I would choose. Just one more humble opinion with 38 yrs experience and more low frequencies fits than many as runs in family as well

I tried the Phonak i90 Spheres for 2 months with multiple adjustments. They were always muddy, distorted, sounded like reverb was added to everything. I finally returned them (I was in the trial period) and got Widex Allure’s instead. Immediately clearer. I also switched and went to the head audiologist at our biggest hospital and she did on the first visit. Hearing aids sounded crisp and clear immediately. Music was not distorted. She said that Phonak takes the high frequencies and shifts them down to lower frequencies. This doesn’t bother most people, but really bothers musicians like myself. I had at least 6 or 7 visits at the Phonak dealer trying to get those i90 Spheres to sound right….never did. First visit with the Widex and REM test…. just about perfect on the first visit.

@Alaria said:

She said that Phonak takes the high frequencies and shifts them down to lower frequencies.

Probably your previous Audi didn’t know how to turn off the SoundRecover 2, which is high frequency compression? Strange, it’s very easy to do.

I play the guitar with my I Sphere 90 and music is okay and I say that as former Widex user.

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