Expectations of Power Hearing aids for severe to profound loss.

Discussion in 'Hearing Aids & Cochlear Implants' started by set2, Jan 7, 2007.

  1. set2

    set2 New Member

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    I will be starting a trial with Power Hearing aids and have some questions.

    I have a severe to profound loss, should I expect good speech understanding for TV, Radio and movie theaters, with the power hearing aids or did good speech understanding get left at mild to moderate?

    I have not worn power hearing aids before, any advice on adjusting to them other than Aspirin?

    I have been wearing hearing aids for 6 years and have only used the skeleton style of earmolds. The earmolds for the new hearing aids will be the full shell style. Are full shell earmolds worse as far as trapping moisture or about the same? How are they comfort wise?

    What should I expect the audiologist to do in order to verify the hearing aids are working for me?
     
  2. deafskeptic

    deafskeptic Active Member Premium Member

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    Your ablitly to understand speech will depend a great deal on the nature of your hearing loss and not just the degree of your loss.

    My deafness is classifed as "severe to profound" hearing loss according to my audiogram that I took at UNC at Chapel Hill. My loss was recorded as low as 85 db to 115 dbs accross all frequencies.

    If your new HA doesn't help you understand speech, you may want to consider a CI.

    I've never used a Skeleton type of earmold - just the standard reciever type of molds used with body types of HAs and Shell type for my BTE HA.

    Judging from the looks of those skeleton types, I think Shell types would seal out water better. I've found that keeping water out of the HA is easier to do if you let your ears dry out before sticking the HA in it.
     
  3. highlands

    highlands Active Member Premium Member

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    I have severe/profound loss in both ears. My loss lies between 70 to 100 db. My digital aids (Bernafon win112 btes) help me much with environmental sounds but I have to lip read in order to understand speech to some extend and I cannot understand the tv set,radio and so on.. speech sucks for me :( and I'm considering getting an implant in a few years or so since hearing aids do not offer me enough speech perception.. I am waiting for more advanced implants who could offer me more than speech perception including music etc..
     
  4. Hear Again

    Hear Again New Member

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    I've had severe-profound hearing loss for the past 11 years and was able to understand speech with a Comtek FM system for 2 out of those 11 years. My hearing loss was 90 dB at 250 Hz, 95 dB at 500 Hz, 110 dB at 750 Hz and no measurable hearing (aided or unaided) at 1000 Hz and above.

    As has already been mentioned, your ability to understand speech will depend on your specific loss. I know one person with severe-profound hearing loss who can understand 85% of speech with his hearing aids. I, on the other hand, was no longer able to understand speech with HAs and an FM system after I lost what speech discrimination I had in my right ear (my left ear has had no discrimination for the past 11 years).

    Speech discrimination will also depend on the type of hearing aid used. For example, I could never benefit from digital HAs. For whatever reason, they didn't provide enough amplification and made speech sound muddy and distorted. I had much better success with analogs.

    I've worn skeleton earmolds for as long as I've worn HAs. One thing I like about skeleton earmolds is the fact that they allow more air to get inside your ear canal thus reducing the potential for ear infections to develop.

    Having said that, one advantage of full shell earmolds is that they allow for more amplification. I know one HA user with severe-profound loss who used skeleton earmolds and had alot of difficulty understanding speech. When he started using full shell earmolds, his speech discrimination improved noticeably and he was able to get more power/amplification from his HAs than he could when using skeleton earmolds. For example, where he previously had his HAs set at a volume of 4, he was able to turn them down to 2 or 3 without compromising his hearing.

    You might want to look into the possibility of getting an FM system to help you understand the TV, radio, etc. When I was diagnosed with severe-profound hearing loss, using an FM system with my HAs (through direct audio input) was the only way I could understand speech.

    Good luck! Let us know how your new HAs work out! :)
     
  5. set2

    set2 New Member

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    I have been trying new hearing aids for the past few days and it has been kind of mixed.

    After leaving the audis and going out in to the real world I fiound the hearing aids sound too staticky. I turned them down which helped the static It looks like I will only be able to turn the up about half way before the static is a problem. I have found this to be more of a problem in my worst ear which has 0 speech discrimination. I have also found that some sounds make the earmolds vibrate. I have also found that some sounds make the earmolds vibrate. I am going to see what adjustments can be made at my next visit.

    I was at a party and as far as hearing in noise It is just ok. I still had to really concentrate and be face to face with who I was talking to. I found myself tired and headachy after awhile.

    On the positive side, I have found I can hear music a bit better but vocals are still a problem. I also found the background noise (i.e. ventilation system)more tolerable. I can actually enjoy music on the car radio again. Talk radio is still no good.

    At this point it looks like the new HAs will work for my better ear but I am not sure about the other one. Fortunately, I have a trial period.
     
  6. Hear Again

    Hear Again New Member

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    set2,

    Yes, definitely take advantage of the 30 day trial period. If you are unhappy with your HAs for any reason, you can always return them for another pair.

    I'm glad your HAs are working well for music. :)

    As for the problems you are experiencing with some sounds causing your earmolds to vibrate, you might want to consider having vents added to your earmolds. Vents are small holes drilled into the earmold which equalize the air pressure in the ear. Some people have one vent in their HAs while others have two.

    I've always had two vents in my earmolds which helped give my voice a more natural sound quality instead of it sounding as if I were in a barrel (barrel effect).

    The static you are hearing in your worse ear may or may not be correctable. When I lost what speech discrimination I had in my left ear, I heard static as well and no HA (analog or digital) seemed to provide enough clarity to enable me to understand speech.
     
  7. hohDougRN

    hohDougRN New Member

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    skeleton molds great, stay in ear good too. I'm sorry to hear you aren't getting benefit from PBTE's. I use em too for profound loss and speech discrimination 60 in right 80 in left still. going to try DAI connection for Ipod to see what it does for music. Not all music is good hear with aids depend on type I guess.
     
  8. Hear Again

    Hear Again New Member

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    If you have a chance to try DAI with your iPod and HAs, let us know how that works out.

    Ever since I was diagnosed with severe-profound hearing loss, I've always used DAI when listening to music. If I tried listening to music with my HAs alone using the speakers of my computer or stereo, it always sounded distorted.

    Even now that I have CIs, I still prefer to listen to music using DAI because the sound is much clearer.
     
  9. SteveAUD

    SteveAUD Member

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    What's the manufacturer of the aids? Model?

    The hearing aids should not be blasting you, let alone giving you a headache. Just because they are power aids, doesn't mean all the power needs to go to you. Did your audiologist measure Most Comfortable Loudness (MCL) levels and Uncomfortable Loudness (UCL) levels? If the aids are too loud you need to go back and have him/her measure the above. The difference between the two is called the dynamic range, this is the area you want the hearing aids to be programmed at. If things are over-amplified then it does you no good. Louder isn't always better, at some point louder can become distorted.

    How well you understand speech with the hearing aids is predicated on the measured word recognition ability that was assessed during your last hearing eval. I see plenty of severe-to-profound hearing losses with good word recognition ability, so it's not only for those with mild-to-moderate losses.


    There is no difference between full shell and skeleton molds in term of hearing aid performance. It is strictly a cosmetic thing (taking out alot of the material in the concha, while retaining the form of a full shell mold).
     
  10. ismi

    ismi New Member

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    I thought fullshell molds made a difference in terms of attenuation? That for losses around 90 dB (maybe lower), without the attenuation of a fullshel, feedback would be an issue? Maybe I'm thinkng of vents.
     
  11. set2

    set2 New Member

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    Steve thanks for the advice. The hearing aids I am trying are Oticon SUMO DMs. I am keeping a "HA diary" and I will bring that with me when I see the audi later this week. I am going to request the testing you suggested because it has not been done.

    LIke ISMI I understood that full shell molds were better as far as feedback. So far I have found this to be true.
     
  12. SteveAUD

    SteveAUD Member

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    Honestly, attenuation is no different between the two given the same venting and tubing diameter. The main difference is the amount of material sitting in the concha. To stop feedback, you need to make sure the earmold is sealing off the ear canal, which in this case would/should be the same between the two styles.

    Skeleton:
    [​IMG]

    Full Shell:
    [​IMG]
     
  13. SteveAUD

    SteveAUD Member

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    Very good hearing aids! I've had great success with them. Lemme ask you this, how do they sound? If you can describe how your hearing then I can tell you what likely needs to be adjusted. Does it happen all the time, in noise, in quiet, anything strange happen when a pure tone hits the hearing aid (like a microwave beep).

    Likewise, if your audiologist entered you in as a long time analog user, the Oticon software may have went overkill (it tends to do that). I have the option to tell the software whether the person wearing the aids is a new user, short-term, or long term user. I also can tell it what type of hearing aid you've worn in the past (analog vs. digital). Based upon what catagory I put a patient in, the software adjusts the initial gain (power) based upon your past experience. In the case of Oticon, it tends to go overboard just a bit when I enter someone as a long term user (and sometimes short term as well).
     
  14. Hear Again

    Hear Again New Member

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    This was my understanding as well. However, during the years I've had severe-profound hearing loss, I've always worn skeleton earmolds (which contained 2 vents) with "super power" BTEs and never had problems with feedback.
     
  15. highlands

    highlands Active Member Premium Member

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    I wear Bernafon Win112 Btes .. and I have feedback problems ! and I couldn't get proper earmolds since I had started to use them.. My earmolds are either small and so cause feedback or too big and causes big pains and hurt or bruise.. I don't understand it !!!! My right earmold is a bit small and causes feedback when I smile or laugh and I cannot properly use headphones when listening to music. How can I get a proper earmold ? Sometimes, feedback problems drives me :pissed:

    BTW, I want to ask STEVEAUD somethings..

    I wanted the audi to set soft sound gain higher and high sound gain lower and he did .. I wanted this in order to understand speech better because standard gain level of the aid for soft sounds(low speech) isn't enough for me. but with this settings, sometimes I get too louder sounds.. What else should I do to understand low or quiet speech better ? Is there a better way ! How can the audiologist measure my MCL and UCL levels ? I don't have these measures on my audiogramme data ! Do they have effect of the performance of my hearing aids ?

    How can I calculate the peak gain level of my hearing aid for my own loss ? My aid has a peak gain of 76 dbl and is this enough for my loss at 92 dbl and 88 db ?
     
  16. Hear Again

    Hear Again New Member

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    Highlands,

    What kind of earmolds do you have? Are they soft or made of Lucite (acrylic)? My skeleton earmolds have always been made of Lucite and I've never had problems with feedback. When my audi made impressions of my ears, she asked me to smile so we could avoid the possibility of feedback when I smiled or laughed.

    I wonder if some HAs control feedback better than others? The aids I wore were Oticon 380P (analogs) and Oticon DigiFocus II super power (digitals) which I've been told have very good feedback control.

    When you listen to music with headphones, do you activate the T-coil? If not, that's something you might want to try. :)
     
    Last edited: Jan 16, 2007
  17. deafdyke

    deafdyke Well-Known Member

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    Narrow ear canals might be a culprit for feedback maybe in some people. Even if they aren't offically dx as having narrow canals, it could be the culprit....I have VERY narrow ear canals and my right ear is always feedbacking. I dunno.......just a hypothesis.
     
  18. Hear Again

    Hear Again New Member

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    I have very small ear canals yet feedback was never a problem for me. I wonder if this might be due to the fact that I used skeleton earmolds? When I tried using soft (Patriot) earmolds, I couldn't get them to stay in my ears. They also caused pain as well as a great deal of feedback.
     
  19. deafskeptic

    deafskeptic Active Member Premium Member

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    I have fairly wide canals and I've always had feedback with my HA. This is because I tend to crank the sound all the way up. If I turn it down sound is too soft and I can't hear much. If I crank the sound all the way up, I risk recruitment. Can't win. :P
     
  20. SteveAUD

    SteveAUD Member

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    There are a couple of ways to stop feedback in your case:

    1. No vent (the aids are too powerful for a vent)
    2. Your hearing aids have feedback cancellation. Your audiologist can hook you up to the computer and run the feedback loop to detect feedback. This can be done while you smile or chew if that's when it occurs the most.
    3. Take an open mouth earmold impression. Using a bite block, your mouth is wide open while the impression material hardens. Because your ear canal changes shape when you move your jaw, this commonly nudges the canal portion or the mold out and breaks the seal of the earmold and your canal.
    4. Consider a earmold with an acrylic body and a soft flex canal. The softer canal material often reacts to heat and softens a bit, creating a better seal.
    5. Take a deeper impression, which lets them make the ear canal portion of the mold longer for deeper insertion. Caution, sometimes people experience pain from a deep seated earmold. That's because the bony portion of your ear canal is very sensitive. Most don't have problems, but I believe the patient/person should know what to expect in everything I do-What problems I foresee them having, and what I expect to be no problem. :D

    In terms of hearing speech better, part of that can be the hearing aid, part of that can be you. I understand what you did and it makes sense to most, however, I would have warned about a couple things before doing that. If you increase gain for soft sounds and decrease gain for loud sounds, you increase the compression ratio. The compression ratio is the ratio in which the hearing aid compresses sound when it gets above a certain dB level. I never want to see compression ratio's above 3.0 (1:1 being no compression-linear). If speech is compressed too much you can actually smear it and make it worse. Often if you increase gain for soft, you have to increase gain for loud a touch as well. The phenomenon that occurs when you don't is....."I can hear the person sitting 15ft away from me better than I can hear the person 3ft away". Why? Because the person's voice 15ft away from you is recognized by the hearing aid as a soft sound (as you increase distance from the source the intensity decreases), hence the hearing aid amplifies it more. Inversely, the person's voice 3ft away from you is hitting the hearing aid at a much greater intensity, the hearing aid is realizing the intensity and not amplifying it as much because the gain for loud sounds in decreased.


    The things I would try with you is to increase the gain for loud (not drastically), but enough to bring the compression ratio down. Increase the gain for the mid-frequencies (alot of consonants are mid pitch). If the hearing aids are too loud, I would turn down the the MPO (maximum power output). MPO is simply the ceiling, how high the hearing aids could go given an input. UCL's and MCL's are measured either using tones or speech. For UCL's I ask you to tell me when a tone becomes uncomfortably loud (I increase the intensity until you tell me). Once those are established, those set the point were I don't want the hearing aid to go above, they can be input into the computer. MCL's are the same, only I ask you at what point is the tone or my voice most comfortable for you. The difference between the MCL and UCL is called the dynamic range. This is the sweet spot of your hearing. Some have a very small dynamic range (some as small as 10dB :eek:), making the person a little more difficult to fit. Some measure UCL and MCL's, some don't. It really gives the audiologist a guide as to where they want to go and where they don't want to go.


    Peak gain is simply the maximum gain available given an input. I know it looks weird given your hearing loss (92 and 88dBHL). Your hearing aids have a peak gain of 76dB, however they have a maximum power output of 136dB. So your hearing aids can amplify sound and make it a maximum of 136dB to your ear (something you will never want). Gain is different, say I have a 45dB sound that's frequency is 1000Hz, your hearing threshold is 90dB at 1000Hz. So the hearing aid needs needs to take that 45dB sound and bump it up another 65dB, making it 110dB once it hits your ear. That's gain, how much the hearing aid can amplify a given input so that you can hear it.


    I hope this helps, if I missed anything let me know. :D
     

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