Severe/Profound Loss At a Loss

@Zebras
I guess those checkboxes are only there to confirm the Additional programmes, are there, and linked??
Peter

@PeterH

Exactly that.

@PeterH said:

I guess the frequencies above 1.6 KHz are shifted somehow, but where to?

Just lower. Phonak users compression rather than transposition etc. so maybe think of taking all the frequencies above a certain point and squishing then together. It depends on the settings. You can adjust the degree of frequency lowering, but also the static (lowered at all times) and adaptive (lowered ms by ms depending on frequency content) compression and that also effects the degree of lowering. And them there are also some limits built in to try to keep it from being outrageously distorted.

Ideally the method of setting frequency lowering is to verify with real ear that you have selected the least aggressive settings possibly that also maintain /s/ audibility.

I was reading through a paper the other day on how long it took over pediatric/adolescent patients to adapt to frequency lowering. I can’t remember the exact average time, maybe about 8-12 weeks, but what I find interesting is that while some reported adjusting gradually, others reported a sudden change from it sounding strange to sounding natural. This is a bit of a tangent I suppose, but the brain is neat.

@PeterH said:

Yes, by selecting the checkboxes

We should differentiate the difference between turning automatic subprograms into manual programs and removing automatic subprograms from the automatic program while still having it adjust. You can only do the latter with the speech in loud noise auto subprogram that’s at the 90 level–phonak added that option because some patients were finding it to aggressive and noticeable in a way that bothered them.

If you want to “remove” some of that automatic subprograms but maintain SOME automatic switching, you can also in a lot of cases just match the gain and feature settings of the program you don’t like to the program you do. I’m always a bit baffled by people saying that they hate the auto program and can’t handle it–for people who are sensitive to the switching there are a lot of different ways to make it more gentle. I’d think it might be better to pursue that prior to just abandoning the automatic functions altogether.

@Neville said:

I’m always a bit baffled by people saying that they hate the auto program and can’t handle it–for people who are sensitive to the switching there are a lot of different ways to make it more gentle

I’ve been experimenting with Speech in noise, to try and stop some of the noise reduction, as it actually reduces the clarity of the person in front of me.

@Neville said:

If you want to “remove” some of that automatic subprograms but maintain SOME automatic switching, you can also in a lot of cases just match the gain and feature settings of the program you don’t like to the program you do. I’m always a bit baffled by people saying that they hate the auto program and can’t handle it–for people who are sensitive to the switching there are a lot of different ways to make it more gentle. I’d think it might be better to pursue that prior to just abandoning the automatic functions altogether.

My guess would be that it is switching in situations the user didn’t intend for it to, even if it switches properly in other situations and the sub-program parameters such as gain, etc, are to the user’s liking for intended situations.

@godavid_d said:

. My hearing requirements are not very high. The ha have bt and I connect them to my pixel 7 android and my pc. Eighty percent of the time I understand what is being said with my phone and pc. I don’t stream to my tv. I watch movies and I understand the dialogue with out subtitles which is a miracle for me with my hearing loss. I too am a candidate for cochlear implant but refused because the percentage of hearing improvement for my age was not acceptable.

@godavid_d said:

Right : 40% at 95 db HL
Left : 28% at 95 db HL
Binaural Word recognition 48% at 95db

Yes, as @Raudrive mentioned, you likely qualify for CI on both ears. However, if you don’t have high expectations and you can manage with hearing in quieter environments, there’s no obligation to do anything. Many CI recipients simply wish they’d got it earlier.

@godavid_d said:

And yes there is lots of cases where the patients hearing is improved. The big drawback for me is that the surgery is irreversible and a ten percent hearing improvement was not acceptable.

I don’t trust such statistics, they can be misleading to someone who doesn’t fully understand how they work. If CI were ineffective in older people, no health system would recommend it to them.

I have no success with CI for several years, because of relying on better HA ear. Thanks to @Raudrive advices I train my CI ear e.g. by streaming only to it, bypassing the HA ear. It simply have worked.

However, sentences such as ‘ten percent hearing improvement’ are a little dangerous for people who need CI and may be discouraged from having a positively life-changing surgical procedure.

So, I agree - there is no guarantee, but we must be careful in making such explicit (and not necessarily true) formulations.

CC: @anon99509572

@anon99509572 said:

My guess would be that it is switching in situations the user didn’t intend for it to, even if it switches properly in other situations and the sub-program parameters such as gain, etc, are to the user’s liking for intended situations.

This is exactly the issue, it can’t get it right a lot of the time, remember it’s a “dumb” HA it can’t think for itself no matter how hard they try to tell you otherwise, one day in the not to distant future it’ll work as intended…

Yes Neville you may have seen speech clarity go from O% to 80% but that does mean anything to me. I stated in an earlier post with the OP that I saw it in the CI literature from an audiologist. You did not say if the patient was over 70. And as I have stated earlier I’m not going to have irreversible surgery with no guarantee. Some people don’t seem to understand what irreversible surgery means. It means loss of any hearing in the ear without an aid. You have to have an appliance on the side of your scalp along with an ha. Now if you can give me a name of a CI surgeon who will guarantee me and increase of 80% increase in my word clarity I will give it some thought.

Absolutely, that’s a fair decision, and no surgeon can guarantee outcomes.

But yes, patients over 70. I’ve probably had about 8 adult patients get implanted in the past 4 years (pediatrics are their own category) a couple of whom were over 70 (4 off the top of my head, but I’d have to double check), all with good outcomes. Even the worst case had more than a 10% hearing improvement, and that patient had been unaided in the implanted ear for 14 years. But I’ve certainly also had a lot of patients who just weren’t interested in pursuing it, and that’s fine too. I will also say that while I have seen some amazing outcomes with hearing preservation from colleagues down in the States, up where I am I have not seen any success with hearing preservation.

@anon99509572 said:

If you cannot remove the other sub-programs, I’m then puzzled as to why some of the other sub-programs appear unchecked in the screenshots.

@Neville said:

Yeah, I can see how that could be sort of a confusing way of them representing what is happening. But when you check one of those boxes the software creates a linked manual program for that particular subprogram, it doesn’t actually remove any of the subprograms from the auto program.

@anon99509572 said:

My guess would be that it is switching in situations the user didn’t intend for it to, even if it switches properly in other situations and the sub-program parameters such as gain, etc, are to the user’s liking for intended situations.

Yeah, fair, I see what you are saying. My normal instinct would be to put the settings they like into an unlinked manual program and then adjust the automatic program to stop it from doing whatever they find objectional. Certainly you cannot stop it from picking whatever it picks, but you can reduce directionality, reduce noise reduction, or reduce gain changes, which are typically the things folks are sensitive to.

There’s always a trade-off between noise reduction and speech reduction and increased distortion, so the degree of noise reduction that an individual with severe/profound loss can tolerate can be pretty individual.

@godavid_d said:

a ten percent hearing improvement was not acceptable.

I missed where this number came from. I see patients go from 0% speech clarity to 80% speech clarity with a CI. That seems like higher than a 10% improvement.

Okay, thank you for clearing that up about the sub-programs.

And while I’ve never been a fan of noise cancelling/speech enhancing sensing in general, I will do my best to give AutoSense a try. I may do the L30s just to keep things simple and more palatable at first. Like you imply, plenty of help from the right audiologist and attention to detail will also be important in getting it to sound and perform right, if possible. At the very least, I do like how one can switch it for a manual program with the default if it just can’t be done for my taste and needs.

I wear a hearing aid only in my left ear, where I’m legally deaf. My right ear has normal or near-normal hearing, so I don’t wear anything on that side. With the aid in my left ear, I can hear, but I’m running into serious issues with today’s digital hearing aids—especially those that use AI and environmental auto-adjustments.

The problem is how they react to sudden sounds. Things like a text message alert, keyboard typing, doorbell chimes, or cars driving by with windows down cause the volume to drop abruptly, then return to normal. This quick on/off effect creates a disorienting “stereo-to-mono” sensation. Since my right ear hears normally and my left depends on the aid, these fluctuations confuse my brain and become exhausting very quickly.

My old analog ReSound hearing aid never did this—it provided consistent, stable sound. Unfortunately, I’ve been told analog aids are no longer an option. From my research, it seems compression is to blame, where the aid reduces gain too aggressively in response to loud or sharp noises.

What I need is a hearing aid that stays on—no AI, no auto-volume adjustments, just consistent amplification. If anyone knows of a model or brand that offers manual-only settings or can disable all dynamic processing, I’d be grateful for the recommendation.

Currently, I’m using the Starkey AI 2400. I’ve also tried a current ReSound model, a Phonak, and several other Starkey models—they all exhibit the same issue described above.

If you really want an analog aid, try Lyod’s.

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Talk to your audiologist.
I believe the feature you do not like is adjustable.

In Phonak HAs, you can turn off features like SoundRelax (which is used for sudden impulse noise reduction if turned on). I am not sure about Resound HAs.

Another option is to choose semi- or linear fitting in fitting software. However, you should make sure the MPO limit is safe to protect your hearing from excessive amplification, which could occur in analogs if they have not output limiting.

@Bimodal_user said:

linear fitting

I’ve been going back and forth with the audiologist since August 2024 in an effort to resolve this issue. The hearing aid is currently set to a linear configuration, which has resulted in slight improvement, but the core problem still persists.

I believe the main issue lies in the Starkey hearing aids’ compression system. Their settings range from 1 to 3—1 being the lowest level of compression—but there is no way to fully disable it. If the hearing aid could simply maintain a consistent output without any fluctuation in sound—essentially just stay on all the time without adapting or adjusting—it would be ideal for my needs.

It’s frustrating that none of the major manufacturers seem to recognize this ongoing issue for patients with profound hearing loss. It’s hard to believe that no one has developed a piece of software that completely removes all forms of compression or automatic sound adjustment. That’s all many of us really need—just a steady, unfiltered signal.