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RIC -> BTE switch and bluetooth phone listening

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An old relative of mine is about to move from with max-power receiver embedded in custom earmolds to max-power HAs, again with custom earmolds. She currently makes & takes phone calls by streaming via bluetooth directly to her RICs, and this will remain the same with the BTEs. At the moment, phone listening via bluetooth is not optimal, while face to face listening is very poor; that’s the reason for switching to max-power BTEs, which should improve her face to face speech intelligibility.
She’s going to evaluate BTE models from the same brand and very likely on the same electronic platform, so the /chip should be identical. I therefore assume that management (codec, bandwidth, gain mapping, streaming processing) in the new BTEs will be the same as in the current RICs.
The current RIC custom earmolds have a specific feature: the right one is larger, fills the entire concha, and has a vent, while the left one is much smaller and without vent. I assume this is because the right ear has a more severe , however the audiologist told me that the earmold SW determines shell size and venting after all “data” are entered and there’s no way to explicitly request and obtain no vent in the earmold manufacturing SW. Is that true? My concern is that a vent in the new BTEs earmolds may introduce a slight loss of effective acoustic output, since part of the amplified sound can escape through the vent instead of reaching the eardrum, especially in power fittings.

The only thing I know for sure is that moving from RIC to BTE will increase available acoustic power but will worsen perceived audio quality. Face to face listening will therefore certainly be “different” and hopefully better but what I’m wondering is whether, all else being equal, I mean same electronic platform HAs, same phone, same type of custom earmolds, it’s more predictable what will change in bluetooth phone listening. I’m especially interested in feedback from those who have personally gone through a RIC → BTE power switch.
I’m asking in order to understand whether the investment in new BTE HAs is justified also in terms of improved phone call performance, or whether little or nothing will change in this specific aspect.

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Depending on what hearing loss she has, a Aid could be better.

Reason is only go to 105dB.

BTE Ultra Power goes to 120dB.

Mean more gain.

The point of my question is if such an improvement from → will necessarily also be reflected in phone listening via Bluetooth, I mean in a scenario where the signal remains fully digital up to the amplification stage.

Hard to say as we don’t know the hearing loss.

If she’s pushing the limit of the Aid then she might see an improvement but apart from that we can’t say!

As I mentioned at the beginning, we’re considering switching from with max-power receivers to ultra-power because she can no longer hear adequately face to face with the RICs, even though they’re set at maximum volume.
We don’t have recent tests, but I’m sharing this pure-tone performed exactly one year ago, when the current RICs were already fitted with max-power receivers. However, her hearing has worsened significantly since then.

otorino 3.2.25 esame audiometrico tonale_2

In reply to @tenkan

Let’s not forget that the UP receivers in use cover losses up to 105 and her hearing has worsened over the past year.
I remember that last year the doctor who performed the pure-tone audiometry refused to carry out speech audiometry, arguing that it wouldn’t be possible to determine whether the patient failed to understand words due to insufficient audibility or because of some degree of senile dementia. I can share those other tests ( and speech), but they’re quite old (2023)

otorino audiogramma tonale vocale

What remains a fact is that, at present, she hears better on the phone via streaming than face to face.
In your opinion, before considering a → switch, is it necessary to repeat pure-tone audiometry now? And if the doctor refuses again to perform speech audiometry, how should I proceed?

In reply to @audio_hunter

@audio_hunter said:

In your opinion, before considering a RIC → BTE switch, is it necessary to repeat pure-tone audiometry now? And if the doctor refuses again to perform speech audiometry, how should I proceed?

Well yes you need to determine exactly what is going on, could be both and really I’m not sure why the Audiologist wouldn’t try to find out themselves, so if their refusal is getting in the way of finding a solution for this problem nothing wrong with getting a second opinion, no point in buying/fitting other if the problem persists, just “pumping” more gain doesn’t always work for speech comprehension.

In reply to @audio_hunter

@audio_hunter said:

she hears better on the phone via BT streaming than face to face.

This is because using the phone via is going straight into her hearing aids where’s face to face the sound is going over the air first before getting to her hearing aids which means whiles it’s in the air, the sound is degrading.

I find exactly the same as I’m profoundly deaf.

I find using a Microphone attached to the person helps regarding to hear them.

In reply to @tenkan

I understand. I’ll try to go back to the specialist who carried out the tests in 2023, I mean the one who also performed speech audiometry, and see whether she agrees with the assessment of the other specialist from 2025, who instead refused to administer the test.
I’d like to ask a question regarding the 2023 speech audiometry. The report states that “speech discrimination is 70% in the right ear at 100 .” How should this finding be interpreted? Does it mean that, at that time, it was plausible that the patient might have achieved better word recognition in the right ear if max-power capable of delivering levels above 100 dB had been used?

@audio_hunter said:

My concern is that a vent in the new BTEs earmolds may introduce a slight loss of effective acoustic output, since part of the amplified sound can escape through the vent instead of reaching the eardrum, especially in power fittings.

This is not an issue. Hearing aids are sized and selected based on the hearing loss/. The receiver like the sound tube are both placed near the ear drum.

As mentioned the BTE aids have more capacity for gain than the RIC aids.

If the triangles are the right ear sound audiogram that attachment has me curios too. Most RIC aids will fit that loss easily. Is there an issue with auditory nerve or cognition issue.

For those curious about the symbols used (triangles, circles, etc.), I’m posting this explanatory table from the 2025 pure-tone test, however I believe the symbols are the same as those used in the 2023 test

otorino 3.2.25 esame audiometrico tonale simboli

I’ll try to translate it, hoping not to make (too many!) mistakes:

Destra: rosso → Right: red
Sinistra: bleu → Left: blue
Orecchio D S → Ear R L
Via aerea in cuffia → Air conduction (headphones)
Via aerea in cuffia con mascher. controlaterale → Air conduction with contralateral masking (headphones)
Via ossea → Bone conduction
Via ossea con esclus. orecchio controlat. (metodo…) → Bone conduction with contralateral ear exclusion (method…) or Bone conduction with contralateral masking (method)
Via aerea in campo libero con mascher. controlaterale → Free-field air conduction with contralateral masking
Via aerea in campo libero → Free-field air conduction
Logotomi → Logatomes or Nonsense Syllables
Fonemi → Phonemes

In any case, the more I reflect on these results, the more I realize that the transition from to , despite the increase in acoustic output, will probably not lead to better speech understanding, even when limited to phone calls with the phone connected to the via Bluetooth.

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