My Enzo Resounds are at the end of their useful life and I am trialing both the Oticon Real 1 and Phonak Lumity L90.
I should mention at the outset I’ve very little high frequency useable hearing. As a result, my of many years and I have attempted to maximize useability of existing hearing (albeit within its narrow frequency range) as opposed to using super power . The results have been more than satisfactory from my perspective (I’ve held customer-facing technical positions, speak foreign languages, etc) so that’s why we’re looking at the L90 and Real 1, which both cover my useable hearing range.
I’ve been wearing the Real 1s for 4 days now and have the following problem. Certain sounds such as a faucet running water and a running microwave kick off a feedback-like “tinkling” in my ears. I also hear this tinkling when I’m driving and by tapping a fork against a porcelain mug. While I’m no frequency expert, based on the above, both mid and high frequency sounds seem capable of setting off the tinkling sound.
Turning down the aids helps get rid of the tinkling but at the expense of needed volume. This sound is NOT true feedback (escaping sound being re-captured by the microphone) as my wife tells me she hears no feedback (a sound she knows all too well) when I turn on the faucet or microwave and she listens very closely.
I am the first client my HCP has fit with Real 1s. I’m currently using the 85db which cover my loss on the , although I can certainly go up to the next level 105 RICs. I am seeing my HCP on Wednesday to adjust the HAs. Does anyone have any advice on adjustments that might make sense fo the Real 1s? I use custom-fit, full ear molds which haven’t had any issue with my Enzos or trial L90s. I completely trust my HCP but do like to factor in the formidable wisdom of this crowd
It should be noted, while I much prefer the way Oticon handles phone and streaming, I never had any extraneous tinkling type sound while trialing the Phonak L90s – either with the 85 or 105 RICs. The L90s seemed to be able to handle almost any sound reasonably well.
I am self programing my Phonak P90’s. I find the first fit provides 10 to 15 DB to much gain in the 3 to 8K range and that give me the tinkling sound that you are getting. For me it is all in the left ear.
After lowering the gain in that ear that sound is much better.
Looking at your show’s profound loss in the higher frequencies, obviously they to lower these a bit, a simple thing for your clinic to do, take you mug and fork with you, don’t leave until you get it to a acceptable level, also as @anon33641277 has mentioned you should give SoundRecover a try, as at your loss it could well be beneficial, one other thing your audiogram show’s only to 4Hz are the rest “dead regions”
It ‘is’ the handling of feedback peak causing the issue, now it might be that there’s the potential for a bit of distortion at very high output levels too. As has been said above the frequency shifting might also be contributing.
Try winding down the gain for higher input levels above 2KHz a shade and also the (more importantly) get the receiver to stop saturating. Doing it this way will allow the normal application of gain and a ‘soft ceiling’ when the output gets over driven.
Also I think you need 100+ receivers and good canal moulds too.
Is “SoundRecover” the same thing as "“MoreSound Booster” which shows up as an option I can turn on in my P1 General Program? Or is this something the turns on during programming?
I’ll definitely bring mug and fork along and get the high frequencies lowered.
Thanks very much. This all makes sense and is much appreciated.
One question – I’m using the 85db receivers while I have new molds made with a wide enough hole for the larger 105db receivers. So, this was a dry run while waiting on the molds – one of which had to be redone.
I did see that the fitting showed the 85db receivers were sufficient to cover my loss. Is your sense that regardless of the REM fitting, the 85db receivers are being overworked / saturated and the 105db receivers – along with reducing and higher frequency gain – has a chance of performing better?
Also, is SoundRecover the way Oticon handles frequency shifting and would I normally want that turned on or off – or should I try it in both modes? I’m guessing Sound Recover is turned on by the and different from the “MoreSound Booster” option I see in Program 1.
No SoundRecover is frequency shifting, a little different from the MoreSound Booster, it’s called Speech Rescue by Oticon and yes it’s set up by your audiologist so you should try it out, as usual our resident expert @Um_bongo has given “sound” advice on what you can also try.
Is “SoundRecover” the same thing as "“MoreSound Booster” which shows up as an option I can turn on in my P1 General Program? Or is this something the HCP turns on during programming?
SoundRecover 2 is the Phonak technology. They do this generally by compressing the higher frequency sounds (called the “source” range) into a lower frequency range where you have better audibility (called the destination range). I think SoundRecover 2’s destination range can go as low as around 700-800 Hz).
Speech Rescue (not MoreSound Booster which is something else entirely) is the Oticon frequency lowering technology. They don’t do frequency compression, but they do this by “transposition” and “composition”. Transposition is taking a chunk of the sounds in the high frequency (source) range and transpose those sounds into the lower frequency (destination) range. Composition is because they cut up the source range into 3 sections, then transpose them into the same destination range but they stack these 3 sections on top of each other (hence composition). Unlike the Phonak’s SoundRecover destination range which can go as low as 700-800 Hz, the lowest Oticon Speech Rescue destination range is between 1.4 to 2 KHz.
I think how Phonak does frequency lowering via compression versus how Oticon does frequency lowering via transposition and composition is not as important as how low they can go on the destination range. Obviously Phonak has a leg up there because its destination range can go much lower than Oticon’s destination range. Specifically for your situation, your loss at 1 KHz is around 80 , but your loss between 1.4 to 2 KHz is between 90-95 dB, meaning that you can hear better at 1 Khz than at 2 KHz, so Phonak can lower the high frequency sounds to a more audible hearing region for you than Oticon can.
For your hearing loss, like you said, your wants to maximize the usability of your existing hearing range, which is rather narrow, so I’m assuming that for sure he (or she?) will want to apply frequency lowering for you. I think your hearing loss can benefit tremendously with frequency lowering, it’s almost a must.
While you’re trialing the Oticon Real, make sure that Speech Rescue is enabled for you, and that the destination range is set to the lowest possible (the leftmost configuration 2.4). Turn the Strength value to max, and turn OFF the High Frequency bands because your loss is so profound in those bands that there’s no need to try to amplify sounds in the high bands anymore anyway. This should help with potential feedback whistling that you may not know about. Of course when you start to trial the Phonak Lumity, also make sure that SoundRecover is enabled for you, also preferably at the lowest possible destination region.
Although you may think the 85 dB receivers can handle your loss in the usable hearing region you have left, the 105 dB receivers would be better for you in many respects, and in either cases, with custom molds for sure. First off, the 105 dB receivers won’t be driven as hard as the 85 dB receivers would for your level of loss → maybe longer life, perhaps less saturation/max out/clipping which you may hear as the tinkling or buzzing that you describe. But your HCP should also ease up on the gain above 2 KHz like @Um_bongo suggested. One simple way to do it on the Oticon Real is just to turn OFF the High Frequency Bands amplification in the Speech Rescue menu, and the gain curve will be re-prescribed accordingly. But your HCP can also manually dial it down in the Fine Tuning section for you as well if that’s how they want to do it.
That leads to my next suggestion, have 2 program where Speech Rescue is ON for one and OFF for the other so you can do A/B program toggle comparison on the fly. That’s the best way to know how much Speech Rescue can be helpful for you, or not. And if this is the case, then your HCP would want to manually dial down the high frequency amplification in the Fine Tuning section to remove the “tinkling” which we’re guessing is due to the saturation of the 85 dB receivers.
One last thing to mention is that if the above suggestions doesn’t remove the “tinkling”, it’s possible that what you’re hearing is not tinkling, but “fluttering”. Oticon has a new feedback prevention technology called the Optimizer that inserts “breaks” (technically called Spectro Temporal Modulation) to stave off and disrupt the energy potential that can cause feedback. But the side effect of these breaks is that they may be audibly noticed by some people (depending on their hearings). So if the tinkling doesn’t go away, it may actually be the fluttering from the Optimizer. If that’s the case, then usually turning down the Feedback Management setting in the Automatics page in Genie 2 from Normal to Low would alleviate the fluttering.
I personally think that this tinkling is the saturation due to overdriving the receivers in the high frequency region, but since you said “feedback-like tinkling”, the feedback part that you happened to mention causes me to think that it may also be fluttering. When there’s energy buildup that has a potential for feedback, the Optimizer inserts the “flutter” (STM breaks) to break up this feedback potential. So at least now you have plan A (dial down the high frequency gain and use Speech Rescue) and plan B (dial down Feedback Management) to try to fix your tinkling issue.
You ‘could’ fill the back if the hole with Blu-tack temporarily as the leakage around the receiver is likely causing some/all of the issue. When I deal with these receiver/mould issues I tend to push the receiver as far forward as practicable to allow the wax trap changes and seal the back of the receiver mould hole with UV set transparent acrylic gel solution. There’s hearing industry specific ones like Sonopal, but Acrylic Nail Gel works equally well in a pinch.
Yes the 85dB is powerful, but it leaves limited headroom for changes or when you need them turning up. The loss of nuance/clarity of the sound higher pitches isn’t likely to be a problem given your dead spots. Get the bigger receiver, let it do its job without saturation and it should work well after some fettling with the settings.
There are versions that can sit against your skin and you have to be a little careful that the material is fully set. Even then some people can be allergic to it.
So perhaps try a dab somewhere against your skin (back of a watch?) before applying it to your mould.
Thanks for this additional detail. I’ve put in an order for some Blu-tack to see if filling in the hole in back helps with the tinkling sound.
As far as your best practice of sealing the hole in back of the mold, does this mean that wax traps are then replaced from the ear canal portion of the mold while the back hole remains permanently sealed? Can the sealed area ever be cleaned out or is that area sealed for good?
but will make sure to test the HAs both without and without Speech Rescue.
Try to remember it may take a little time to adjust to . It can be strange until you get acclimated. Once acclimated typically the speech understanding will improve not to mention hearing birds and other higher frequency things.
Frequency lowering was a huge thing for me. It vastly improved my hearing.
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