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Reverse slope tips

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Edited

Hoping to keep a running list of tips that have worked for low frequency hearing loss/RSHL. Some of what’s worked for me is what I learned from 12.Podcast eleven: Fitting Low Frequency Hearing Loss71

I’ve been self programming for the past 4-5 years, here’s what’s worked for me.

-for streaming phone calls: adjust phone call to maximum volume and external mic to lowest setting.
-low frequencies to 10-18 max for soft sounds
-above 2000 hz, at least 10-15 dB gain
-for mask program, add 8-10 dB above 2k for soft sounds and 4-5 for mid sounds. No adjustment for loud.
-for tv, I use a Roku streaming stick for all my televisions. I then connect my iPhone to the Roku remote app and can stream whatever I watch to my aids.
-for work, I do a lot of Skype/teams calls and web conferences. Using a streamer to connect my aids to my work computer has been invaluable. I work with folks all over the country and some I’ve never met in person. People don’t even know I’m hoh unless they’ve met me or I’ve disclosed my loss.
-for social gatherings in noisy places (pre/post Covid), a partner mic is a must.
- - double vented

Edited

Useful links:
-(Essentially the RSHL must-read) The Bizarre World of Extreme Reverse-Slope Hearing Loss (or Low Frequency) Hearing Loss103

-(Oticon video for programming RSHL) 12.Podcast eleven: Fitting Low Frequency Hearing Loss69

-(RSHL Facebook group) Redirecting...23

-(Oticon article on programming for masks,not specific to RSHL but has worked for me) https://wdh02.azureedge.net/-/media/oticon-us/main/practice-support/15500-6051--covid-19-mask-programming-adjustment-guide.pdf?la=en&rev=5D56&hash=403FD00815A525D2428BC065740AEB61&fbclid=IwAR0yk_xLI8geaW5Sn7_M3sHJJUaF6n8GiHAwRu7Ypo1MnZocjxnhW4fJL1s30

-(RSHL article cited in many other articles) Managing Low-Frequency Hearing Loss | The Hearing Review38

Standard Versus Special Fitting Approaches23

Audiology, like other clinical sciences, strives to treat patients using consistent, evidence-based approaches. It is expected that caregiving professions ensure that all patients are managed using verified and generally accepted clinical procedures

I think you are providing people with reverse slope loss a great service by providing a “one stop shopping” information gathering experience. Every time I read how rare reverse slope loss is I’m shocked as being on the forum gives me a skewed impression. Although ski slope and reverse slope losses are diametric opposites, their programming needs do share some things in common: 1) Don’t try to “fix” the loss. Try to provide some amplification the user can take advantage of. 2) Don’t overpower the user’s good hearing.

Edited

Fitting Formulas -1st fits when plugging in my RSHL

I have Oticon Genie2, Philips HearingSuite and Phonak Target 7.1 all downloaded on my computer. I plugged my audiogram into each and used the proprietary manufacturer fitting rationales as well as the standard fitting rationales out there to see what the first fit offering is. If you look at my audiogram, you can see my right ear is a pretty typical RSHL while my left is a bit more jagged. These observations below are only using the first fit plugged in for my right ear.

-Oticon (VAC+): offers in my opinion a suitable starting point for RSHL programming. They don’t prescribe too much gain in the lows and they tend to give something in the highs. My experience has been having to boost the highs a bit with Oticon, but overall the first fit wasn’t bad.
-Philips (Fit4Speech): Seems very comparable to Oticon which would make sense considering they are both under the Demant umbrella. They use less compression in the highs which IMO is favorable for sound quality.
-Phonak (Adaptive Phonak Digital 2.0): Offers a heavy dose of low frequency amplification and none in the highs. This would need immediate correcting IMO.
: Similar to Phonak proprietary software.
NAL-NL1: Less amplification in the lows, but still a heavy dose. A decent boost in the mids and not much in the highs.
v5a Adult: Decent boost in the lows and mids and a decrease in the highs. I have trialed this before with a prior audi for a few weeks and I absolutely hated this fitting. I had a hard time understanding anyone and it was so bassy/boomy, that I couldn’t wait to rip the aids out.

I hope this information can help someone have a more educated discussion with their fitter since we reverse slopers tend to struggle with getting an acceptable fitting at times.

EDIT:
I figured it’s worth mentioning that on the RSHL Facebook group, there has been numerous posts about plugging in a flat loss across the board as the audio gram and having that programmed into the aids using NAL-NL2 and using that a starting point for RSHL.

My experiences with Reverse Slope Hearing Loss (RSHL)

I also have a RSHL, I’ve been self-programming for about 10 years, I was guided to the video by Don Schum (linked above) by the good folks of the facebook group about 3 years ago, the video helped me understand how to find best strategy to program for my loss, without that knowledge I was pretty much going round in circles trying to program my aids correctly.

The study that Don mentions he was part of in the video can be found here RSHL study32. The study supports his argument about how the fitting strategy used in the hearing aid industry is often of little help to people with RSHL, and that audiologists will usually need to focus on the residual hearing and avoid masking the sounds that people with RSHL need to hear. Once I adopted that strategy of preserving the high frequencies which I could hear, I tuned the other frequencies that could be made audible without masking my good hearing, I ended up with a good basic fitting where sounds are balanced and not masking the speech information I need.

Further to getting a good basic fitting I think you can then consider how the sound characteristics of devices can impact on improving outcomes even further, for example some devices might be brighter, tinnier, clearer and some might be boomier or bassy, you can use a mixture of programming strategy and the audio characteristics of devices to find solutions that work best in the real world background noise.

Here’s a 2016 Audiology Online course/presentation about RSHL fitting tips. Summarizes increasing high frequency gain, decreasing lows and increasing vent sizes. Talks about tricking the to show more of a flat or even high frequency loss.

Tricks for the Top Ten Challenging Fittings

Course: #27824

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