New Phonak Audeo P90s - trying to adjust

Hi @Sinead - best of luck on your journey, it’s not easy, but with patience, and careful observations on how your hearing is in various situations, you’ll hopefully be able to tweak the aids to your preference. Reading your post, I felt like I was reading about my own experience!

I’ve had my Phonak Lumity aids for 2 months now, having had Oticon ITC hearing aids for about 20 years. I initially tried medium vented closed domes which were very sore. After two weeks I moved to small vented closed domes which were much more comfortable. However, sound wise, with both the small and medium, I found myself working hard to hear people. People talking to me in a quiet open plan office, walking and talking on the stairs, walking outside with others, I just had to work really hard to hear them. I could sense the aids had potential, but they just weren’t loud enough for me. Turning them up did NOT have the desired effect. Very frustrating. I wanted to throw them back at the audi!

By chance, I had noticed some sounds were warbling, which were distracting from my hearing. When the audiologist investigated it, the solution was to move to power domes (to reduce the potential for feedback, as the aids were pre-emptively modifying sounds which it thought might cause feedback). I tried the medium power dome which completely blocked up the ears, but then immediately tried the small power dome… and it just felt and sounded right! I knew even before leaving the audiologist that this simple change of moving from closed dome to power dome was going to be a game changer for me!

I don’t know… but I believe the phonak software did suggest open domes. The audiologist put in closed domes because I was wearing ITC hearing aids. But the power dome was the only thing that actually gave me the required fullness / volume of sound. The difference in the quality of the sound is amazing. I wonder do Phonak / Audiologists suggest the more open fit, as it’s more “natural”, and therefore more likely to be accepted by the wearer, in particular people who are wearing aids for the first time. Are these people missing out on the true potential of their aids? Is it better to have people at least wear aids, than give up and not wear them at all? Probably another topic for another day.

Regarding differences in sound, yes, different aids will be different, but focus on speech recognition in different scenarios, and write down how you got on in that scenario. When you go back to the audiologist you can look back over the various scenarios and explain what worked and didn’t work.

I initially wasn’t impressed with Phonak Lumity, and thought my ancient aids were better. But I persevered because I could see that there was potential in them. I just had to get the right molds, re-run the feedback management, and only then did I notice a big difference.

This change away from open domes will help with streamed music. But there is also a feature on the Phonak App where you can reduce the surrounding sound by adjusting the “Ambient balance”. I usually move it just one or two notches to the right (towards audio sound) so I can still hear passing traffic etc. But even moving it just one notch to the right makes a big difference. The streamed music should not sound tinny.

BTW - if you have the power domes already to hand, then yes you can switch them yourself, but I still believe you’ll need the audiologist to re-run some checks to cater for the change in dome.

Best of luck.

Domes image for reference (but also do note that you can get ear molds too)

1. I’d try the closed domes. The advantage of closed domes is that they allow for more gain to be delivered to your ears without feedback being generated. The disadvantage is what’s called “occlusion.” Your voice sounds very loud and “boomy,” and chewing can be very loud. Many people adjust to it over time.
2. For the tinny music your provider needs to supply more gain to the lower frequencies for streaming music.

3)Regarding Speech Recognition. Did your provider do a Speech Recognition test with a recorded voice? If so, what are the scores? This is the best indication of how much hearing aids can help your speech recognition. So, if you have the potential for improved speech recognition, then you need to be sure you’re getting enough gain. Ideally your provider would do REM (Real Ear Measurement) but they may not have the equipment.
4) Yes, it sounds like you’d benefit from more gain. Hopefully this will be increased over time. It’s easy to get overwhelmed with too much gain so going slow is ok. You might want to ask about “Frequency Lowering” It’s called Sound Recover 2 on the Phonak P90s. I think it will be hard to give enough gain to the high frequencies for you. Frequency lowering lowers the higher frequencies to a lower frequency where it can be more easily heard. It’s not just an on or an off. If words sound very “lispy,” have him weaken the settings.
5)Ears get itchy. Doubt if it has anything to do with dome fit. Should improve with time. If it gets worse, have somebody take a look to make sure they aren’t getting inflamed. Some people are allergic. It shouldn’t hurt. Taking your hearing aids out for a break during the day is ok while you’re getting used to them.

Hi @MDB - thanks so much for replying and giving me some concrete requests for the audiologist. TBH, she’s been a bit laid back so far, so it’s good to have the guidance.

She didn’t offer a speech recognition score and originally programmed the HA based on my posted audiogram (from 2013!!!) and then did another test. I need to get those results, which are largely the same except for a slight loss at lower frequency. I’m not even sure whether the test using the HA is the same as a standard test?

I’ll ask about the speech recognition test and REM scores. It’s meant to be a state of the art clinic, but it’s not been my experience so far!

I’ll ask about frequency lowering and see what she says. I suspect you’re right and that I’ll build gain over time. The last 10 days has been a shock, but I can already see the difference. I just need to be patient. I want this to work!!

@Sinead said:

Providers here deal with just one brand at a time.

Here they deal with multiple brands but are usually most familiar with one. My audiologist prefers Phonak but offered a choice of 3 of the brands thus large University practice sells. She did mention we could have a consultation with someone more experienced with Oticon if needed.

@Sinead said:

She didn’t offer a speech recognition score

That is usually done while wearing headphones. In my last test I had static white noise in one ear while a recorded voice read some 2-syllable words. I repeated the word spoken and the audiologist tallies a percentage score from the results. This last test had much better results indicating that the volume level they select for the test greatly affects the results.

Is the REM equipment connected to the programming software for the aids?

I don’t know. I think they are separate, but there may be some where they are integrated. My understanding is that one uses the readout from REM to adjust the hearing aid software settings to obtain the prescribed gains.

Perhaps @Louie or @Um_bongo can clarify.

Thank you. I’ll ask for this. Weirdly, I don’t think I’ve EVER had this done.

Hi Nevile,

Thanks for the detailed response. I should clarify that my last sets of hearing aids were all prescribed in Ireland, not Qatar (I only moved here five years ago).

So - I was about 4/5 when I got my first hearing aid. It was a big bulky 1980s BTE with full earmold. I’m guessing I would have had this replaced a few times during childhood. Provision for new HAs stopped when you reached 16. My main memory of this involves constant whistling and feedback, although I obviously didn’t have the language to describe that at the time. I’d have had apts every year/two years for check ups but certainly no regular fittings or adjustments.

I got my Oticon ITE aids when I was 22 and about to go backpacking. Realised I needed it for understanding accents. (It was that audiologist who explained I had bilateral hearing loss, and who couldn’t understand how I got through college without HAs!) I wore it on and off for about a year, but it would keep breaking and because I was overseas, I’d no way of getting it fixed.

I’ll request a trial of different domes next week at my apt to see how it affects gains. I’ll also ask about REM.

Appreciate all the advice.

Can I ask what is probably a really dumb question, but how are the moulds created and what does it cost? Everything takes a long time here and is super expensive (my P90s cost approx $9k USD for instance)…

It’s not a dumb question. To make moulds the audiologist will fill your ear canal with a soft putty that will harden within a few minutes to create an impression of your ears. That impression will be sent to the manufacturer who will digitally scan it and 3D print custom moulds for you. In my clinic in Australia we charge $60 AUD per ear for standard slimtip moulds.