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Long time wearer hopes to keep ITE aids. Advice?

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I'm 65 and, after cholesteatoma surgery 32 years ago, have been wearing aids ever since. Rexton, Siemens, Starkey and for the past 8-10 years, Phonak. Nine sets over that time frame. It's time for new aids. My newest Phonaks, Virto Ms, are pushing six years. They work OK. They don't stream and use 312 batteries. Could be better with loud live music. Serve me well in conversations.

My loss is "moderate to severe mixed loss bilaterally," especially challenging at high frequencies. My right ear, in which I had ossicular reconstruction 12 years ago, is better than my natural left. I have negative middle ear pressure in my left year; a tube in my right. I wear reading glasses which go on and off multiple times daily.

I recently tried Phonak Infinio ITE aids but returned them due to feedback in the left in various settings and with loud music. My audiologist (I moved five years ago; she's not fitted me before) says the feedback is because the Infinios can't handle my needed gain; it's time to go big and behind-the-ear. She's pushing Phonak Audeo Spheres.

I'd strongly rather not go after 30+ years and doing decently with the current Virto Ms. I'm looking at Starkey Signature or Omega ITEs. I may also consider Phonak P 312s because they may be "close" to my current Virto Ms which, again, I am OK with. If I must go BTE, I'd rather not go with a big model.

Two questions: 1. Isn't this my choice? I've had a successful career and wonderful family life with ITE aids. Is it wrong to insist I find a decent ITE match -- even if it means finding a different audiologist? 2. Any advice on ITE aids or, if I truly must go BTE, any comments on Resound Vivia which I've read are smaller than Spheres?

Thank you.

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We can't provide you fair and adequate advices without your tonal (and speech audiogram if possible). You can enter it in your profile settings.

If you had feedback, perhaps you had too large vent? If you have reverse slope hearing loss you need that vent very small - 0.5-0.8 mm diameter or no vent at all.

In reply to @TheRealEman

@TheRealEman said:

moderate to severe mixed loss bilaterally

We need your with full masked bone conduction and more information on the type of procedure you had for cholesteatoma removal, how much bone was drilled out and whether your ear canal is much larger than average as a result in order to comment further.

If there are no devices on the market that meet the power requirements then the market has unfortunately made the decision for you. I had a similar situation with another client a few years ago and the most powerful option (and the only one that met their gain needs) also had a characteristic sound quality they didn't like that I couldn't improve upon because it was how the manufacturer processed sound. There wasn't another option powerful enough at their price point so they had to compromise somewhere: either style or sound quality. You may be in a similar situation.

Thanks. I posted my most recent , which showed a slight decrease in my left ear over 2024. Right ear stable. I had ossicular reconstruction on might right ear 12 years ago -- same one with the cholesteatoma 30+ years ago -- so there are no middle ear bones there. Yes, I believe that canal is larger now. Left is "natural" but due to other conditions, with negative pressure. I don't have bone conductivity data. Price point is not a factor for me. Just to reiterate: I do decently with Phonak Virto Ms , power up I'm sure. They are below par for loud, live music.

Edited

In reply to @TheRealEman

This is the fitting range for the Virto Infinio R UP. This is the most powerful Infinio Virto. As you can see, it barely fits your (left ear) and, because it is an , it is possible , with them amount of power needed, that you will get feedback.

The issue is that your left ear loss is borderline profound and, ITEs are not optimal for that level of hearing loss. The seal would have to be perfect and , any small movement can create a gap where sound can escape .

Feedback occurs when sound from the ear canal reach the mics. ITEs mics are next to the ear canal: so any small amount of sound leak will create feedback. This is not the case with that are further away from the ear canal .

https://www.phonak.com/en-us/hearing-devices/hearing-aids/virto-infinio/for-professionals3

Edited

In reply to @TheRealEman

Assuming that your bone conduction thresholds in your left ear are at least as good as the air conduction thresholds in your right ear, with an enlarged ear canal on that side you really need an ultrapower hearing aid to get a balanced sound if you're using an air conduction aid. You may find that a is now the only option for the left ear.

Another potential option is a bone conduction implant which uses bone conduction to send sound straight to the organ of hearing, bypassing the conductive portion of your loss. You might find that this gives you better, more consistent sound quality with less risk of feedback. The Cochlear Osia System is an implantable hearing solution. The new Cochlear Osia 3 may be an option for you (the Osia 2 isn't powerful enough) and has the lowest risk of feedback of any device you might use. The surgical procedure to install the implant is typically performed under general anaesthetic.

The Cochlear Baha system is an older solution that is percutaneous, meaning it goes across the skin. It requires a procedure that can be performed under local anaesthetic to install. The Baha 6 Max would be the only sound processor appropriate for your loss.

Thanks, both of you. What I'm hearing is at this point, left ear especially, is basically required. If things get "worse," I may have to do more. I understand. Next question: Is the Phonak Audeo Sphere, which I understand is a large BTE by comparison, my only/best option? I think I've read the Resound Vivia is smaller. I'd at least prefer not to jump from to a large BTE, you know? I also wonder why I do fine, seemingly, with Phonak Virto Ms. I'm wearing them right now.

Do you have (Word Recognition Score) in quiet measured? For each ear separately and binaurally?

If your WRS is more suitable for , with your loss there is something you have to compromise and realise technology limitation.

You can try form factor, but only for ear where ossicles still exist and only with UP receiver which requires making earmold from deep placed impression, at least 5 mm past 2nd bend of ear canal.

If hearing in noise is a priority, there is Phonak Audéo Infinio Sphere 90 or you can wait for newest Phonak E-Sphere. If you will be use HA only in one ear, I think Resound Vivia isn't a good option, because benefits from it are mainly for fitting. Better would be Resound Enzo IA, but it lacks such advanced processing in noisy conditions like in Phonak Audéo Infinio Sphere 90.

Phonak Spheric Speech in Noise program works good even when used unilaterally.

Phonak Audéo Infinio Sphere is RIC form factor, not BTE.

I do appreciate the feedback and thank everyone. I'm going for a second with a second audiologist next week and if it's the same -- very well may be -- my next step may be clear. I do hear fine with the Phonak Virto Ms. I guess I may be missing high frequencies but with my history, and a cleft palate at birth, I'm used to missing things I guess. Doesn't mean I can't change though.

Apparently I'm "uploading too quickly" and need to wait another 64750 seconds, so I cannot post the single graph that I put together for you right now @AbramBaileyAuD :person_shrugging:

I looked at the specification sheets. The numbers look the same, but the curves are subtly different, with less mid and low-frequency output for the Virto I R and better high-frequency output. I'd say it has a more balanced profile, but unfortunately you need a lot more gain in the low frequencies so this isn't in your best interest. Feedback problems are a lot to do with the fit of a device and the Virto R has a new faceplate design may alter the fit for you substantially given your surgically altered ears, increasing the risk of feedback. You might consider another manufacturer who offers 312 such as Signia if their power output is strong enough to overcome your conductive component.

Keep Costco in mind. You likely need to call them to verify which models and form factors they offer. Most of the common knowledge here is about . As you may try an entirely new to you form factor the 180 day return period could be helpful even though you're an experienced aid user.

In reply to @Hearing_Potential

I should note why the virto R might be less suitable for you than previous Phonak . With the rechargeable redesign they've also done their best to slim the profile of the devices down which means the microphones may be significantly closer to the sound outlet than your previous devices, which of course increases the risk of feedback whistling occuring. You could also see if your audiologist could ask the shell lab to remake your Phonak hearing aids using more of the parameters of your previous devices to see whether this resolves the problems. It may be tricky though with the very different battery and faceplate configuration.

In reply to @Hearing_Potential

Also bone conduction isn't incorporated into non- device (e.g. . Ponto, Osia) fitting ranges which makes them less useful for someone with a mixed loss and a large conductive component that requires significantly more gain than would be the case for a pure sensorineural loss.

In reply to @TheRealEman

If the Virto Ms were not feeding back but the Virto Is were, then I would suspect one of three things (or all three):

  1. The ear impressions needs to be redone because the Virto Is were not sealing well enough.
  2. The ear impressions are fine, but the hearing aids were just made too small or big (or are vented too much).
  3. The Virto Ms are programmed quieter so they don't feed back as much (if at all). Having real ear (or test box) measurements done you could compare the actual output between the two devices.

Two other possibilities, which I would less expect, would be just plain internal feedback that can be repaired, or for whatever reason the feedback manager on the Marvel platform is working differently/better than that on the Infinio platform.

If you've been successful with devices, particularly for so long, then I would say stick with ITE devices. As a clinician I can inform and advise, but it is clearly your choice. After that we work together to maximize your benefit.

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