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Real ear verification and Phonak Virto B-Titanium occlusion

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Edited

Currently trying a pair of Virto B Titaium (Phonak).
What exactly should I expect during real ear verification?

With the aids in place and small tubes (ear mics?) in the canals my audi spoke some words (she spoke not I) and adjusted the graphs a bit. Does this sound like real ear verification? I would think I should be speaking not her?

Also of concern she did not repeat the word recognition or tone portion of the exam with aids in place. I would think a second would have been done to see degree of improvement. Is this standard or is she missing something? As I am still trying maybe this is done right before I write the check for the aids?

My other big issue which i mentioned in a prior thread is I have occlusion effect. Present with aids in place and batteries out so it is occlusion. I’m sure some of the sensation is due to amplification and chewing is intolerable due to noise. Maybe more (larger vent) is needed. Supposedly with IIC in bony part of canal minimal f any occlusion effect.
It is an option on the order form: directly off Phonakpro.com5 order form

“AOV = Acoustically Optimized Venting — Phonak will set the correct
vent diameter and style in relation to Audiogram/shell geometry/
feedback canceller and required low frequency gain — this is the
recommended vent type.
AOV-O = Acoustically Optimized Venting — Open. This specific venting
is more open and recommended for first time users and clients who are
sensitive to occlusion.”

Did she check AOV or AOV-O box? Is it reasonable that I question this? Maybe have new pair made with AOV-O checked if not done first time. Not sure if Phonak will remake. If thy want my business I suppose they will.

Also an issue is that when she was trying to program the aids for either volume or program via the suppliedmagnetic remote device. she had some problems and this will be addressed at next visit.

With these aids you can change either via remote magnet or a push button on faceplate She stated that settings in only one ear need be changed by me via remote and other ear will automatically change as well. According to Cliff Olsen Aud. this is not the case.Each aid must be changed individually. He recommends program to alter volume as the auto sense feature on the Virtos do good job of changing environmental settings. Makes sense to me.

Now what if I did not pick up on this and she programmed remote on one side only. Do you see my concerns? Issue is I like her bedside manner but question her ability. She seems to have a real passion for her profession but…

I suppose in a sense I m second guessing her expertise. She is a relatively new graduate and told me this s the first set of Virto B she has worked with. Nice woman, acts professionally but I have my concerns. I do NOT want to be confrontational so how to best address my concerns. I don’t want it to appear as if the patient is telling the doctor what to do however I do want these aids fit and programmed properly.

Any thoughts on how to address my concerns? FIW: I got a ton of info off the Phonak pro website and after reading my concerns arose.

Apologies for the long post. I’m just trying to get this right.
Any thoughts are appreciated.

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The Costco I went to for their house brand aids did what is called for real ear measurement. The same thing…little tubes in “front” of the aids. The difference was that the tested sound was a foreign to me language and possibly even different languages. Not the fitters voice.
In your case with your fitter, maybe you can both progress on this journey. You’re finding pieces of information. Maybe she can use her expertise to incorporate what you find or explain it as maybe irrelevant to your needs. Maybe she would appreciate that you’re doing your homework.
Only you are able to feel and hear what you’re experiencing. Only you can relay that to the fitter.

Real Ear verification can come in a couple of forms: 1. Real Ear Measurement and 2. Live Speech Mapping. Based on your description, your provider was likely performing Live Speech Mapping which is an acceptable form of verification.

What verification does is makes sure your hearing with the hearing aid on and in your ear is meeting a target area of what you “should” be hearing (based on an algorithm). She was likely making adjustments on your hearing aid (“the graphs” as you described it) to make sure the frequency responses are within the target and not above or below.

The occlusion effect can be seen graphically when doing verification but it MUST to be mentioned to your provider. Tell your provider that chewing is intolerable. This is a Fit issue and you are correct to believe the venting may be the culprit. Your provider may need to make a new impression of your ear and send off the hearing aid to be remade.

The larger Virto models do adjust binaurally like that, but not the . She’s mistaken, but it’s an easy mistake if you haven’t worked with the IICs before. You can try for more venting in the right, but depending on the size of your ear canal it may not be possible to get rid of the occlusion with an IIC, which I imagine you were told when you selected an IIC rather than a . Moving to the button rather than that magnetic wand can help to reduce the size of the components and therefore open up a bit of space for more venting.

If real ear verification is done, testing in the booth isn’t really necessary to ensure the hearing aids are doing what they should. So no, it’s not standard anymore. Speech-mapping with standardized, recorded speech is the gold standard, but using her voice should maybe be better than nothing depending on how she’s doing it. Did she sit a metre away from you and talk about carrots for a while with a very even voice?

Do you feel like you are hearing better?

Edited

Appreciate the info, Neville. I am absolutely hearing better. I hear my dogs toenails on the floor as he walks., birds, clock. Shocked at what I have been missing !!! I feel like the 6 million dollar man.

During the real ear verification she did sit about 1 meter away and uttered the following " baseball, popcorn, alright, O.K" Phrase was preceeded by her uttering a shussing sound.

This was done several times as she made adjustments.

Although I place great importance on being discreet I would gladly go for a device if that would eliminate the occlusion effect.

Couple of questions for you:

  1. Do you recommend I choose the volume control option or the program control option? Cliff Olsen Aud. recommends volume as the auto sense chooses the program automatically?

  2. How do I know if the auto sense is effective? In other words; should I hear a difference when going from a noisy environment to a quiet one? How do i know what to ask her to adjust?

  3. Lastly: in my original post I cut and pasted a portion of the Virto order form and am given 2 options as far as vent. I believe my audi choose the first option however the second is recommended for first time users like myself. Any opinions? I realize the second may result in a less discreet fit but I’ll take that if it reduces or eliminates occlusion effect. Currently the aids are somewhat visible and are more of a CIC.

I assume Phonak would be willing to rebuild my devices to address my issues as opposed to tweaking the current ones. As you say the button may reduce size over magnetic remote so this means a new build. is this an unreasonable request to Phonak?
Maybe repeat the mold process as well as I believe we could have gone a bit deeper. I don’t think my audi would refuse this request

Thanks again

In reply to @drjay44

@drjay44 said:

I would gladly go for a CIC device if that would eliminate the occlusion effect.

I said though, which is the behind the ear guy with the wire and dome. may not make much difference.

It is reasonable to request a new build. Not uncommon for it to not be perfect on the first go. Better to go with a new build right away if occlusion is a big issue for you, rather than trying to adjust things. If they cannot resolve the occlusion to your satisfaction you’ll know pretty quickly, and if that’s going to be a deal-breaker for you better to know during the trial period so that you can return the device move to a different option. Titanium builds are slow anyway because they have to ship out of Vietnam or something.

It probably doesn’t matter which of the venting options she chose. The size of the device is likely the limiting factor for how big the venting is. AOV on those 20 thresholds in the right ear would be pretty close to open if the space were available.

Volume control or program control is up to you. Button only gives you volume up OR down, but you can hack a range of volumes with the program control if necessary. I’d suggest you try to just leave it where it is set.

The automatic switching is meant to be fairly transparent. Some people are sensitive to it, but it shouldn’t be a dramatic change. No directional mics on or CICs, so mostly what you might notice is the removal of steady-state noises and a bit of gain change in loud places. You don’t NEED to ask her to adjust anything. If you are hearing well, great. If you wish things were different, tell her.

Neville
I know you were talking about .
What I was saying was that a larger vent may result in a larger device which would be closer to
If this larger vent reduced or eliminated occlusion I’d gladly accept the trade off.
I am absolutely sold on hearing aids.
Now I just need to find right device/fit

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