Reverse slope, cookie bite

What is a cookie bite?

Curious about what “pattern” my loss fits in (it’s not a slope, it has a big peak of “good” hearing at 4K which I’m told is one of the main reasons I’ve been able to function so far without HA (and have normal speech – exaggeration?)

Anyway, reading your post, wondering if a loss profile like mine poses particular challenges for programming a HA? (sorry if my technical language is clumsy, my audiology-related vocabulary is all in French ;-))

@HearingAidHelper said:

Reverse slopes are not hard to fit at all… so as long as the person doing it knows what to do.

Venting and gain are critical to understand to get it right. You may have vents too big for your loss. I am assuming these things as I cannot see what you have, but this is a fair guess as you say you can’t understand conversations.

My advice is to try blocking your vents (pack gently with cotton using a toothpick) and see what it sounds like. If I am right, you should hear better instantly. I am not sure if you will have enough programmed gain there, but it should be a noticable improvement.

Let me know how it goes.

Thank you HearingAidHelper;
The vent are really very small, and yes I think blocking it improves speech a little bit, but it causes occlusion. In the beginning I trialled a hearing aid without venting, the speech was clearer, but I couldn’t handle my own voice.

@HearingAidHelper said:

Which ear is causing the occlusion with your vents blocked? You may need to modify the gain and compression ratio for your vocal range. Occlusion for mens voices are roughly centred around 600Hz, womens voices are roughly around 800Hz.

There are also 2 types of occlusion to consider. Ampclusion versus physical occlusion. If your voice sounds occluded with your vent blocked when the hearing aid is in your ear and turned off, this is a physical occlusion… this needs modification of the hearing aid shell. If not, then you have ampclusion which can be modified using the programming.

If you can isolate which ear is the culprit as well as determine the nature of your occlusion, you will be better able to solve your own problem.

Yes occlusion is there even if the hearing aid is muted. If I pull/move the hearing aid a little bit outward the occlusion goes a way but so does the clarity of speech. So, I think it is physical occlusion because my ears are plugged and can’t breath. my check sounds like a drum if I hit it softly with the tip of my finger. Things like eating and walking causes humming. The shell fits my ears perfectly and very comfortable I wear the HI all day without any discomfort. Will modifying the shell change how they fit my ears or something else?

@Ringingears said:

Yes occlusion is there even if the hearing aid is muted. If I pull/move the hearing aid a little bit outward the occlusion goes a way but so does the clarity of speech. So, I think it is physical occlusion because my ears are plugged and can’t breath. my check sounds like a drum if I hit it softly with the tip of my finger. Things like eating and walking causes humming. The shell fits my ears perfectly and very comfortable I wear the HI all day without any discomfort. Will modifying the shell change how they fit my ears or something else?

Technically even though the fit is comfortable, the hearing aid shell is connecting your canal wall into a solid mass, which is compounding your occlusion. As you rightly discovered, when you pull the hearing aid out of your ear slightly, it reduces your physical occlusion. If the canal tip of your hearing aid was tapered more, you may not suffer with so much occlusion, and walking and chewing won’t cause so much irritation.

@HearingAidHelper said:

Technically even though the fit is comfortable, the hearing aid shell is connecting your canal wall into a solid mass, which is compounding your occlusion. As you rightly discovered, when you pull the hearing aid out of your ear slightly, it reduces your physical occlusion. If the canal tip of your hearing aid was tapered more, you may not suffer with so much occlusion, and walking and chewing won’t cause so much irritation.

Thanks HearingAidHelper,

I would love to try the canal tip tapering, but my HI are out of warranty for month now and didn’t extended it. I wish it was something easy to try. Do you have any ideas about tweaking the software to improve speech? I think I can live with the occlusion thing in return for improved speech recognition, it is not any worse than the tinnitus I am suffering.

@HearingAidHelper said:

There is always something that could be done, but the limiting factor is your ears. I didn’t see a posted speech perception ability on your audiogram data… If your ears are capable of 80% discrimination or better then you should be able to tweak some more clarity out of the hearing aids.

The issue is that you have a physical occlusion issue which is going to cause issues no matter what you do, and increasing gain levels is going to set off your occlusion.

You are unfortunately stuck between a rock and a hard place.

Did you really mean that?

Changing gain at 250–500 Hz can work either way, both in terms of clarity and occlusion.

@Um_bongo said:

Did you really mean that?

Changing gain at 250–500 Hz can work either way, both in terms of clarity and occlusion.

Yea, I read a research/article yesterday, it says just putting the audiogram and following the software recommendation doesn’t work for reverse slope hearing loss. It says boosting the lows overpowers the highs and decreases speech intelligibility. It also, says “The better NAL fitting philosophy is to equalize, rather than normalize loudness relationships across speech frequencies. If all the speech frequencies are amplified so that they are heard equally loud, speech intelligibility is maximized”
It doesn’t allow me to paste the link, but you can copy past the quote to Google to get the whole article.

@Ringingears said:

Yea, I read a research/article yesterday, it says just putting the audiogram and following the software recommendation doesn’t work for reverse slope hearing loss. It says boosting the lows overpowers the highs and decreases speech intelligibility. It also, says “The better NAL fitting philosophy is to equalize, rather than normalize loudness relationships across speech frequencies. If all the speech frequencies are amplified so that they are heard equally loud, speech intelligibility is maximized”
It doesn’t allow me to paste the link, but you can copy past the quote to Google to get the whole article.

My observation was related to HearingAidHelper’s assertion that the electronics were playing a part in the level of occlusion. Occlusion is purely a physical effect though you can add or remove from the low frequency resonances in that area with the electronics.

The effect of the ‘upward spread of masking’ is well established, but what was being described above was physical occlusion: this isn’t the same thing.

I’m familiar with Dillon’s work in respect of NAL, though it’s not universally agreed upon as some natural loudness growth appears to suit most people to detect the nuances of speech. Making it all equal loudness may maximise speech, but you can bet people will suffer from aural fatigue from the bombardment.

Reverse slope losses are unusual, especially as they might be evidence of low frequency dead regions that don’t reveal themselves on the audiogram.

Hey,
Have you ever seen a hearing loss like mine? I’ve got a “V” in the right ear. I was diagnosed with Auditory Neuropathy Spectrum Disorder in the beginning of the 2000, but only recently got hearing aids.

Would you have any advice for me? Doctors here ruled out Cochlear Impants for my specific case.

I think I have a bit of physical occlusion too. Have just noticed that, when I speak, the sound reverberates into my left ear. I don’t feel anything on the right ear in the same circumstances.

HearingAidDoctor said that, for such physical occlusion, changing the shell is recommended. But what does “shell” exactly mean? Changing the length of the tubes? Changing the kind of domes? Changing the entire housing (and consequently having to buy a new HA)? Could you clarify me, please?

I’m actually fitted with a pair of closed domes with standard vents. Have also a pair of power domes and open domes as well. I think it’s a good idea to make a custom slimtip (earmold for slimtubes), but I’m not exactly sure if it’s worthy the price. In the case I opt out for a slimtip, what should the vent size be? 1.2 mm?

Cheers!

@factus said:

I think I have a bit of physical occlusion too. Have just noticed that, when I speak, the sound reverberates into my left ear. I don’t feel anything on the right ear in the same circumstances.

HearingAidDoctor said that, for such physical occlusion, changing the shell is recommended. But what does “shell” exactly mean? Changing the length of the tubes? Changing the kind of domes? Changing the entire housing (and consequently having to buy a new HA)? Could you clarify me, please?

I’m actually fitted with a pair of closed domes with standard vents. Have also a pair of power domes and open domes as well. I think it’s a good idea to make a custom slimtip (earmold for slimtubes), but I’m not exactly sure if it’s worthy the price. In the case I opt out for a slimtip, what should the vent size be? 1.2 mm?

Cheers!

Shell means the hard plastic that is custom formed to your ears.

As for your particular fit, while it is unlikely you have actual physical occlusion with domes, it isn’t impossible. The best way to know for sure which type of occlusion you have it to put the hearing aid into your ear with no battery installed. If you continue to get a reverberation, you likely have physical occlusion. If you do not, you likely have ampclusion which is caused by amplification. Once you know which you have, you can then start working on solving the problem.

Good luck,