Throwing in the Towel

Happy to help. Regarding the counterintuitive stuff:

1. My first fit from an audi–and the phonak target software itself–focuses on open fitting for my type of loss. Oh great–any background sound with open fitting and I can’t understand the speaker I’m trying to decipher. So I use earmolds with vents to restrict interfering incoming sound. I switch between 3mm and 2mm vents in a couple molds, depending on how much hearing difficulty I expect (e.g., 3mm at home or with a friend, 2mm for business meetings, scientific conferences–still somewhat unsuccessfully–etc.)
2. i’ve tried an algo in the phonak target that is recommended specifically for people with severe loss (Phonak Adaptive Digital Contrast, probably developed for the severe, flat across the audiogram loss, not the ski loss). With it, trying to hear hurts my ears less due to fewer uncomfortable sounds AND I have better comprehension. You asked about which cues–if you look up what Phonak says about their algorithms, you will see that different speech cues are preserved by Phonak Adaptive Digital and Phonak Adaptive Digital Contrast. This allows people with different needs to receive the cues that bring them the most information.
3. I am still experimenting with sound recover. You have better high frequency hearing (I am deaf up there), so you may be able to use all the high frequency sounds that can be shifted down the spectrum. For me, it’s too much sound and it feels confusing and overwhelming. But then, I’ve been deaf at highs, from 6k up, since my teens. So I roll off the highest frequencies–I turn them down a lot, and then the frequency shifting favors the mid to lower end of the high range, not the highest highs. Phew, better! I find the largest comprehension effects come from tweaking sound recover, especially around where things cut off and how far down the spectrum I push things.

Hope this is helpful, your own ears will be the best judge. I have a mutation in a protein that functions in the network that converts motion of fluid to electrical impulses in the cochlea, so I really DON’T hear like Hearing people–or even HOH people. So take everything I’m saying as “maybe helpful, maybe not helpful” until you do the experiment. Good luck and stay in touch!

@Neville said:

Disagree. The vast majority of my adult patients are very happy with their settings based on REM-confirmed independent targets

I will deflect to you pro’s on that as you have the knowledge but will add that in my circle of friends and workmates with aids, after REM either most have been back for multiple adjustments or the aids sit unused. I admit I did assume that after multiple adjustments, gains are off target, which is my assumption without any real facts to back that up other than my own programming. Apologies for my error, and thanks for your input

Unused hearing aids are the worst.

Interesting observation though. I think controlled studies suggest that, on average, REM reduces follow-up and increases satisfaction, but that’s just on average. It also doesn’t proclude providers who use it but are BAD at it or patients whom it does not suit.

I also have a very strong optimization/rehabilitation bias and honestly, sometimes it probably causes me more headaches than if I didn’t worry about it so much.

@cohen said:

I don’t wear my HAs like I should

@paulpuente: I’m not posting this comment to dismiss Barb/Ms Cohen’s experience, nor am I directing it specifically at you. I’m just disinclined to recommend to anyone on the Forum with not much experience wearing hearing aids to put too much stock in the advice of someone who is not wearing their HAs regularly.

This is due to the fact that the brain needs to be given ample and consistent opportunities to exercise its amazing plasticity and adapt to the new soundscape with which it is being presented.

Sporadic hearing aid use denies the most powerful element in the auditory processing chain a chance to work. Therefore, any opinions proffered are based on experience that is not just Incomplete; it is also biased against the hearing aids’ potential to help the wearer to deal with their hearing loss because the devices never got a fair chance to team up with the brain and show what they could do.

I’ve had my Phonak Naida M70s BTE HAsfor two months now. I am 68 years old and these are my first HA. Because they cost me nothing on the NHS, I had no choice of models, no trial period and no follow-up. I went for my appointment, was given the HAs and was sent away with some batteries, cleaning wires, an info leaflet and instructions to wear them every day and report back if I had any problems. The audi did tell me I’d probably need custom moulds, but as it turned out I’m now fine with the vented domes after initial problems with discomfort. For me there was no acclimatising period soundwise at all. None whatsoever. Not even for one second! It was instantly life-changing and like stepping back ten years in time. I wonder if this is because I was a practising musician all my life and that part of my brain was already highly trained to pick out, analyse and process important sounds and discard non-relevant sounds. The initial discomfort, pain and soreness of the vented domes has now worn off and most of the time I’m not aware of their presence. I do mostly keep the sound level two notches down from prescribed, especially when I’m on my own. I have totally got used to the sound of hair rubbing against the mic and my brain just ignores it. I don’t experience any of the crackles, wheezes, pops, static and artefacts that other people report, but I do have to clean out the slim tubes very frequently. As far as sound quality goes, the very high frequencies are amazingly good. Birds in particular sound exactly as I remember them, and the tiny, very high sounds of small baby birds are excellent. Songbirds like blackbirds, robins and thrushes sound truly wonderful. I cried with joy at hearing them against after years of not hearing them and assuming there weren’t any. Going lower down the frequency spectrum, things are not so wonderful. Speech sounds tinny but I can live with that. My cat’s miaowing sounds slightly artificial. What I am very disappointed in is the sound of music, which sounds distorted. I was a classical singer, and I can’t listen to music through these. Human singers sound appalling. The Music program on the Phonak app doesn’t make it any better. The audi was aware that I was a musician and programmed the default settings accordingly. For serious music listening, I find it best to remove the HA and use my natural hearing with a pair of really good quality headphones. Bottom line: for HAs that cost me nothing, these were not only life-changing for me but essential!

@corinne.orde said:

no follow-up

With the NHS, you quite often have to ask for a follow up.

@paulpuente said:

I believe we both understand how the brain functions with regard to hearing but are trying to find solutions to the problems that are preventing us from wearing them all day, every day. I think we will get there but perhaps with a somewhat unorthodox approach.

@paulpuente: Your point is well taken, however, as I said in my post, I feel that newcomers need to be made aware that there are more orthodox approaches than yours that ought to be exhausted before “improvisations on a theme” are resorted to. In reading and rereading your posts, I agree with other Members who have suggested that your audiologist is probably missing something with respect to the way your devices are fitted. Millions of people wear hearing aids, all day, every day. Of course, there are always exceptions to the rule, but I’m still not convinced by your rationales.

My purpose in posting was simply to apply a caveat to your discussion to remind newbies that wearing your hearing aids as much as possible has been the key to success for most satisfied hearing aid users, and not your approach.

These members have paid good money to an audiologist, in most cases … they need to keep pestering the audiologist to persist with adjusting these highly-sophisticated devices until they are wearable and fit for use.

I think another issue or two, at least for me, might be that #1 I am retired and don’t interact with people every day like I did when I worked and #2 with Covid, at age 73, I do not chose to sit in a noisy restaurant and always get food to go or eat outside. So even though I have diligently worn my new BiCore HA for 12-14 hrs every day for a month now, my brain is not hearing sounds enough to make use of that time (guessing here). I still doubt that the very tinny, distorted sounds I hear when the volume it up high enough to benefit me is ever going to sound smooth, rich and understandable. And while I’m extremely disappointed so far I have not completely given up. I have found another person at another CostCo that is convinced she can help me get thru this transition and saw some issues with my HA. My current fitter doesn’t seem to know what to do except wait 6 months. Maybe she is right and I will adapt.

Even with my losses I scored a 90% and 86% on speech at 65 dB and I think it’s the quiet sounds or in a crowd where I really suffer and of course my wife is very quiet, lol. And TV is OK with my wireless headset without the HA. I do know that unless I grow the hair back on the sides of my head I can’t mtn bike with my HA. Wind noise is just overpowering even with the maximum wind noise reduction the tech turned on. It just can’t handle anything above 10 mph or so and for some reason the left HA is far worse.

@fbacher1 said:

And while I’m extremely disappointed so far I have not completely given up. I have found another person at another CostCo that is convinced she can help me get thru this transition and saw some issues with my HA. My current fitter doesn’t seem to know what to do

@fbacher1: Well, I’m glad you haven’t given up, because all the issues you’re describing seem to me to be fitting/adjustment issues. My added bold italics of your words pretty much sums it up!

And you’d be surprised just how many sounds that aren’t speech that your brain is registering.

Hi SpudGunner,
No offense taken here, either. What you state is well accepted in the field.
Furthermore, having no normal hair cells in my ears adds to the difficulty of extrapolating anything I report about my experiences. I am glad paulpuente clearly understood I was responding to his specific questions, not giving advice–as I am completely unqualified. I think the breadth of perspectives / personal experience is the most useful thing this forum has going for it. I’ve learned a lot.
Dr. Barb Cohen

We are on the same page, including the mutual respect and appreciation of each others’ posts. Plus the “try the orthodox approach first.” Very wise advice.

I think the only thing you may have missed was a reply I made a long time ago on a different thread, but I don’t think it changes much. It was in response to an exhortation to wear my HAs more so I would get used to them and hear better.

I had replied “Yes, I did that experiment too,wearing hearing aids for long times in noise. While getting my biotech startup running, I worked nights and weekends in a busy grocery store. It was loud–music, the box bailer machine, cold box fans, customers, etc. And whenever I go to my day job at clinics or scientific conferences I wear them. It was just something to gut out to get the job done. But after 7 years of trying and failing, I’m no longer optimistic about “wearing more consistently” equating to less painful recruitment.”

I think my ears are odd with recruitment because I never get a change to get used to it. I’m continually losing hearing. My brain is continuing to turn up the volume on successively lower frequencies, as the frequencies I can hear vanish from high to low. I used to flinch in the audi’s testing chamber at 6k and 8k, last time it was 3k that was shockingly painful. That may explain why, for me, “getting used to it” is something of a fool’s errand and a moving target.

Feel free to ask me to tip my hand if you are curious about my cards. I can tell you if I prefer to keep something close to the chest. Otherwise, it’s fodder for discussion and further relationship building. I’ve learned a lot from you and enjoyed your posts, I’m glad we are having this exchange.

@cohen said:

I’ve learned a lot from you and enjoyed your posts, I’m glad we are having this exchange.

@cohen: Same here, Barb.

As a matter of fact, I did read that post about your biotech startup days. I admit that I didn’t fully understand why the experience couldn’t be addressed by different HA settings.

Recrutement is something with which I have no direct experience … perhaps why my understanding is to tenuous.

Have a great day! I have to run now.

Hm, TOO much snap! crackle! and POP! outside of a breakfast cereal is not a good sign for any HA, I’m thinking? I get a fair amount of hair rustle as the wire or mic rubs in the hair behind my ear, and any crackle is occasional and usually inside the ear (maybe an ear hair?). I’d probably have someone look at those aids just to make sure the mechanical parts of it are all in working order.

I did ask if they were tested to see if they meet Rextons published spec but the lack of an answer tells me probably not. I’m going in today for another check up (on month now) but honestly I don’t have any idea what to tell the person at CostCo except I still can’t hear my wife’s quiet voice well, sharp sounds can be painful if I’m trying to increase the volume when watching TV and as I increase the sound the voices can drive up into a zone of distortion to my ears that is not easier to understand. At times I do think they help with sounds that are not in this zone but overall I’m constantly going up and down with the volume during the day. Since I’m not going inside noisy restaurants can’t test how they do there. I wear them all the time and shopping is OK I think. The BiCore and Rexton/Signia AX7 philosophy is not to apply traditional noise reduction but to keep it at a lower level than speech and I don’t think that is working well for me.

I know everyone says this will take 1-6 months for my brain to adjust but I thought I would perceive something by now. I did get some ear gear covers for the wind noise issue and no doubt they might help with the ear noise too. But I would have to remove the dome everytime I wanted to use them and charge the HA. I might look into the next size up from mini. But then they also could be bulky in back/top of the my ear. Too bad the HA can’t recognize it’s own hair to mic noise as noise because it does have a very unique sound unlike any speech, lol.