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BTE for speech discrimination in an old person. Realistic expectations

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An elderly relative of mine has been using for a long time Unitron Moxi Blu B9-R (equivalent to Phonak Audeo Lumity L90-R) with max-power receivers embedded in custom earmolds, covering up to 105 . Since last summer, despite her audiologist increasing the R receiver gain to the maximum, it’s now insufficient. On the L side the situation with these HAs is better, although she still misses some words.
A few days ago she underwent new , speech audiometry, and immittance testing, performed by an audiologist at a public hospital (not her usual one). I’m posting the graphs below.

audiologo test tonale 11.3.26

audiologo test vocale 11.3.26

Below is the English translation of what the audiologist wrote in the report:

Suffering from: Bilateral sensorineural hearing loss
After evaluation, the average Hearing Loss is determined:
in the Right Ear: 95
in the Left Ear: 73 dB
Notes: Profound sensorineural hearing loss in the Right Ear, severe in the Left Ear bilaterally with a dip on high frequencies.

Pure tone audiometry examination: Profound sensorineural hearing loss in the Right Ear, severe in the Left Ear bilaterally with a dip on high frequencies.
Speech audiometry examination in booth: Word recognition is very poor in the Right Ear, reduced in the Left Ear bilaterally starting from 90 dB.
Perception threshold: 90 dB in the Right Ear and 80 dB in the Left Ear.
Examination performed in a sound-treated booth

Tympanogram: Bilaterally of type “As” (A-shallow).
Acoustic reflexes: In the Right Ear, Ipsilateral (Same-ear) and Contralateral (Opposite-ear) are absent on all frequencies. In the Left Ear, Ipsilateral and Contralateral are present only at 0.5K (500 Hz).

Let me know if you also need the immittance data.
The hospital audiologist was rather discouraging: he said that even if my relative tried a max-power HAs (covering up to 120 dB), the expected improvement in speech discrim would only be about 10-15% vs the current RIC HAs!
Nevertheless, I’d still like to try maximum-power BTE HAs with custom earmolds. After that, I’d bring my relative back to this audiologist to perform two speech tests: one with the RIC HAs and the other with the BTE HAs under trial, in order to objectively determine the improvement.

I’d like to ask if my idea of performing two speech tests with the two different types of HAs is the best way to obtain an objective measurement of the difference in speech discrimination between the two solutions. More generally, I’d like to ask what you’d do in my situation to try to improve a scenario like this, eg. I’d like to know if anyone has ever tried wearing a RIC in one ear and a BTE in the other, with the goal of optimizing word understanding.
Finally, I’d like to ask if, in a case like this, it’s realistic to try anything else or if we simply have to accept the situation. It’s certainly unrealistic to consider cochlear implant surgery for someone over 90 years old :slight_smile:.

My take is that they should get an eval for cochlear implant. That’s the only thing that’s likely to provide significant help if they really want to hear.

Looking at the and results is a bit curious. Has she been properly aided the past 6 months or year? Her word understanding is bad and her audiogram is 50-75 db across all frequencies. I would think she could hear better than described. Just my opinion.

As mentioned a evaluation might shed some light on what’s going on with her hearing and if aids could help her.

@Raudrive said:

As mentioned a CI evaluation might shed some light on what’s going on with her hearing and if aids could help her.

Could you elaborate on that? What kind of findings could emerge from such an evaluation? Do you mean that it might provide a scientific explanation for why speech audiometry results in the right ear are significantly worse than what would be expected based on the pure-tone on that same side?

@audio_hunter said:

Do you mean that it might provide a scientific explanation for why speech audiometry results in the right ear are significantly worse than what would be expected based on the pure-tone audiogram on that same side?

Yes. A evaluation is testing from an and a CI audiologist. ’s or scans are also part of this evaluation. The tests are thorough to validate what is causing the hearing loss. It also proves if the candidate is wearing properly fit hearing aids.

Once the science and medical tests are done then it moves into the candidates mental state concerning CI, lifestyle is a big part as well. Doctors want to know if the candidate is going to put in the effort to have a successful implant. They also want to know if the candidate still hears well enough for aids rather than implants.

I have probably missed a few things but I hope you get the idea of what a CI evaluation consists of. Lots of helpful information comes out of this testing.

IMO your relatives loss is not going to benefit from hearing aids. Even with super power or UP aids in the right ear, you would need to weigh up the cost against benefit. ’s are expensive if the relative isn’t going to gain enough benefit from them.

I’m another that supports a evaluation. This is thorough testing with aids and without aids, words and sentences. Duration approx 2 hours in length. Some surgeons require a balance test as well as tests mentioned by @Raudrive. There’s a lot to consider before testing, family circumstances, age, health, health insurance, is the relative capable of doing rehab alone or will they need help. Today’s CI’s are all hooked up to a smart phone, is the relative able to use smart phone. Good luck.

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