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Opinions on BTEs with optimal speech performance

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An elderly relative of mine is about to switch from her current hearing aids with encapsulated UP receivers fitted in fully occluding custom earmolds (cShell) to devices. With the current hearing aids, she no longer hears adequately, despite having them set to maximum gain for the past few months.
The current RICs are rechargeable Unitron Moxi Blu. The full spec sheet is available here1 and below I am only reporting the fitting range of the UP receivers currently in use (40–105 ).

unitron moxi blu up receiver fitting range

The most recent pure-tone was performed one year ago by an otorhinolaryngologist, however I don’t have a speech audiometry report.

otorino 3.2.25 esame audiometrico tonale_2

When I showed this audiogram to her audiologist, he stated that it didn’t accurately reflect my relative’s actual hearing loss, which he consider to be significantly worse. Please also take into account a further deterioration over the past year.

Within the Unitron family, I could consider the 3 BTE models (“Stride”), in order of increasing power: PR, SP, UP. Based on the fitting ranges, I believe that the most powerful version (UP) might justify the transition from RIC to BTE.

unitron bte stride b-up fitting range

I say “justify” because afaik in BTE the receiver is not positioned in the ear canal as in RIC systems, therefore there may be a significant reduction in perceived “audio definition” (forgive the non-technical term!) compared to RIC HAs. In addition, afaik the most powerful BTEs are not rechargeable, unlike her current RICs, which introduces the issue of battery replacement. My relative lives in a rest house and the staff are often reluctant to replace HAs batteries nad, when they do, they sometimes damage the battery compartment due to incorrect polarity insertion!

Given all of the above, I’d appreciate recommendations regarding which BTEs my relative should trial, both in terms of output power and manufacturer. The primary objective is that she be able to distinguish people’s voices as effectively as possible, despite the reduced acoustic definition typically associated with BTE devices compared to RICs; at her age and in her living environment, nothing else is truly necessary.
I’d also appreciate clarification on one technical point. Since new custom earmolds will need to be fabricated for the BTEs trial, can the same earmolds be used if different tubing options are tested? And if BTEs from different manufacturers are trialed, can they be fitted using the same newly fabricated earmolds?

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Edited

Hi,

Honestly, this is a difficult question to answer. From the , it does look like the kind of loss a UP receiver on a can service. However, if you say the audiogram is actually now worse than this, then we would be looking at SP or UP Superpower aids. Out of these, the following would be strong candidates:

  • Phonak Lumity SP or UP/Unitron Stride V-SP/UP Blu UP *these are grouped as they both come from the same parent hearing company, Sonovo and have shared technology.
  • Resound Enzo IA (Rechargeable)
  • Signia Motion Charge & Go SP IX (Rechargeable)

The Resound Enzo IA is the very latest out of these and has a claimed 50 hours of charge. They are also claiming that speech in noise is good.

Now, what I would say is that, within this category of hearing loss - severe to profound , it’s important to use assistive devices/microphones etc for this kind of loss, as in my experience (having a similar loss), that if the speaker is more than 5 feet away, and also in noise conditions, it becomes very difficult to understand speech. There is no magic hearing aid, whatever brand, that will deliver easy to understand speech or the television at distance without the use of assistive devices.

With respect to the moulds, I believe you should be able to use the same one in each trial. However, I am unsure about whether the venting would be the same across all aids. An audiologist will have to answer this one.

Good luck.

Edited

Battery changing could really be an issue. With Phonak Naida SPs using “13” batteries, the little retaining bit on the battery housing is weak. I buy may aids used, and that bit has often been snapped off. When you open the drawer, the battery stays in! Phonak Naida UP use the much bigger, and less fiddly “675” battery. The battery drawer looks less flimsy too. Also, the 675 will last about twice as long.

I also understand that the actual speaker in Naida SP & UP hearing aids is bigger than speakers, so you should get a richer sound.

Peter

Edited

What I don’t understand about currently is why there is a lag in implementation of what appears in the segment. I say lag, in the case of Phonak, the Sphere chip with noise reduction is not present in the Lumity and nobody knows if it will appear in the next version. The Oticon Xceed is technology dating from 2019. The Resound Enzo IA may be up to date. Anyone know? But yeah, I’m guessing it’s a question of power, but I think something like the Sphere processing is badly needed in this segment, as it’s this cohort that has the most difficulty in noise. Please please please manufacturers, step up your game in this area.

Yes. My understanding is that power have their own design problems related to 1) power usage and 2) avoiding internal feedback (feedback that occurs INSIDE the hearing aid because of the volume level of sound from the speakers passes through the components to the mics). I don’t know that the rechargeable battery is enough yet to provide a satisfactory battery life in this form factor and power the sphere chip, and then there are size issues managing all the other stuff and then fitting in the lithium ion battery. And finally, the segment of the population is small for R&D and getting smaller as outcomes get better and uptake expands. But maybe Oticon will get to it first by wrapping the chip around the battery and encapsulating the whole thing like the zeal (and charging a premium for it).

That said, Signia has an SP rechargeable BTE.

The design overcomes a high frequency roll-off down a BTE tube, but by the time patients are in power BTEs they often don’t have anything truly aidable in the highs anymore anyway so it stops mattering. Theoretically the RIC UP receiver can deliver a lot of power, but practically the limit is usually the custom earpiece rather than the receiver. If you have a giant ear canal you can access that gain, but for a lot of people the physical fit on the ear the the bottleneck and a traditional earmold can overcome that.

In reply to @glucas

@glucas said:

Now, what I would say is that, within this category of hearing loss - severe to profound , it’s important to use assistive devices/microphones etc for this kind of loss, as in my experience (having a similar loss), that if the speaker is more than 5 feet away, and also in noise conditions, it becomes very difficult to understand speech. There is no magic hearing aid, whatever brand, that will deliver easy to understand speech or the television at distance without the use of assistive devices.

Honestly, that statement really shocked me. Almost all of my relative’s day-to-day interactions take place at distances greater than 5 feet. I did not realize that it’s considered “normal” for costing several thousand euros to have this limitation. You truly opened my eyes.

With her current Unitron devices, I could consider the Unitron PartnerMic, a worn by the talker whose voice is streamed directly into the hearing aids, however… I believe I’ve achieved a similar outcome using a smartphone-based workaround. Specifically, I pair my relative’s phone directly to her HAs via their integrated “Bluetooth wireless” connectivity (meaning no intermediary streamer accessory required), I then call her from my own phone, so that my voice is transmitted from my phone directly to her HAs. In this configuration, she hears me significantly better and understands almost everything I say, even when we are standing face to face at a distance of about 3 feet :slightly_smiling_face: . There are 2 practical drawbacks: her phone must first be paired with the hearing aids; if several people wish to speak with her, the phone has to be physically passed around :slightly_smiling_face: .

Since you have experience using “assistive devices/microphones etc”, I ask you: what advantages do they offer compared to my “face-to-face phone call" via Bluetooth wireless method?

@glucas has said about severe to profound hearing loss mainly. This is often related to loss of much compared to milder losses or normal hearing.

Perhaps that is not the case in your situation. Attaching to the profile could help in saying what you should expect from hearing aids.

Edited

In reply to @audio_hunter

Well, I think the comparison to be made here is microphones v a bluetooth means of communication. I don’t think these should compared in terms of an apples to apples comparison, as we are looking at apples v oranges here.

A microphone is used in a situation where you are at a physical distance from a talker or group of talkers and what it is doing is improving the so that it brings the voice closer. I think the bluetooth wireless setup you are describing is doing something else entirely as it’s transmitting audio directly from another audio source like a PC or phone. Of course, this latter set up is optimal in terms of quality. The microphone will only be optimal or near optimal if it’s placed around the neck of the talker. In the case of multi-mic setups like the Roger Select or Roger In, it has the problem of a) distance between the talker(s) and the mic and b) filtering any noise.

Fortunately, this key aspect of direct audio streaming to the via phone has come up. My relative uses an older-generation feature phone with physical keypad and with Bluetooth 3.0 + EDR. Her current Unitron support HFP (Hands-Free Profile) (as stated in the manual) and the same applies to Unitron Stride . This is particularly important since I guess no many other manufacturers implement native Bluetooth HFP in their HAs; instead, hands-free call functionality is typically limited to /-based smartphone streaming and/or requires proprietary intermediary accessories.

If no one disagrees, I’d open a separate thread to ask users/audiologists whether there are HAs from manufacturers outside the Sonova group (Phonak/Unitron) that natively support Bluetooth HFP for direct call streaming, with no additional accessories required.

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