What is the best hearing aid for a reverse slope cookie bite loss?

Rivka Strom, AuD

Audiologist in Brooklyn

09 November 2017 - 2.15K Views

There is no product that we can say is "the best" as ultimately it is a personal decision. Some individuals prefer one manufacturer and other may prefer another manufacturer or another model. Still, I will say that many individuals that I know have a preference for oticon aids for RSHL but again, that does not mean it would be best for you. I would add that the most important factor should be choosing an audiologist who has a good understanding of reverse slope or cookie bite hearing loss (btw, revere slope and cookie bite are two different configurations of hearing loss...do you know which one you have?). It is important to not only understand the numbers on your audiogram but to ask your audiologist to perform other tests such as speech in noise testing or the TEN test to look for dead regions. In general when we program the hearing aids for reverse slope, it is important not to add too much gain in the low frequencies that could potentially mask important auditory information in the mid and high frequencies. You dont have to worry about the specifics in programming as long as your audiologist does;) 

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Parth P
Parth P 10 November 2017
biggest comment is speech intelligiblity in noise and from distance talk currently distance speech not understadable and speaker nois i.e phone tv(news) not understandable clearly as young 27 year unemployed hence i am ready to buy top notch. echo and transient is also big problem as i im frequently in situation of large surface area(hall) with noise(trafic). i mean active lifestye. i need bit more answer current research like enchant new signal processing to come up more frequencys wiring speech spectrum that rectified by them with new signal processing technology how much channel i need.yes i also asked other member that have similar loss told that opn has limited benefit not as we require in active lifestyle.
Rivka S
Rivka S 10 November 2017 Replied to Parth P
I think you have to try it out for yourself rather than relying on others experiences as each individual processes sound differently. There are many other great hearing aids that can also be an option for you but as I said, having the right audiologist that understands your loss and your needs is most important.
Parth P
Parth P 11 November 2017
i am reluctant to noise like road, fan, trafic, multiple speaker etc and impluse/transient noise aslo like door slam keyboard type etc. so first paramete is which aid can effectively handle this and can balance sound in both ear . since i have asymatrical loss within ear and in ear and it felt that loud noise in affected ear and tiny in one better ear if wear binaural HA fitting. iresponded to audi he said i should used to it no way to handle this is true? my audiogram frq .250 .500 1k 2k 3k 4k 8k L 65 65 55 20 50 65 40 R 60 50 30 20 30 20 35

Charles Darby PhD, MA, BC-HIS, BC-HIS

Hearing Healthcare Provider in Little Rock

10 November 2017 - 2.11K Views

Interesting question!  Reverse slope and cookie bite loss are typically looked at differently as they are not the same thing.  Perhaps you mean reverse slope in one ear and cookie bite in the other.  Nevertheless, opinions on the "best" hearing aid for either type of loss will vary greatly among health care providers.  Honestly, most manufacturers have products that will address either of these types of losses.  What is most important is that your provider can confidently address the needs, regardless of the loss, and will work closely with you to maintain the aids for your best audibility.  As a rule of thumb, difficult losses usually require more advanced features that allow more control and better adaptability.  Don't be shy in asking about the various options and be sure you understand the whys behind the recommendation.       

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Parth P
Parth P 10 November 2017
my audiogram frq .250 .500 1k 2k 3k 4k 8k L 65 65 55 20 50 65 40 R 60 50 30 20 30 20 35 my requirement is about channel requirement more channel good? currently 16 channel signia aid not much help in speech intelligibility and sligh audiblity due to asymetry . does increasing HTHL in audiogram necessary to achieve required audibility and if receiver not cover HTHL 20-33 db in 1.5k to 8k hz . my audi suggested that . but i suspect that it will increase my difficulty more as unnecessary gain give to some frequency more over if my loss not in area of fitting range it will be incomplete fitting so i am in thought that signia do not have receiver that can work for me correct if i am wrong. note i am on custom mould without venting as my audi stated i am not candidate for vent and confirmed by insitu that loss not changed even in insitu (varience is only 5db in .500hz and in high 5-10 )

Sheri Gostomelsky, AuD

Doctor of Audiology in Deerfield

09 November 2017 - 2.13K Views

It is my humble opinion that there really is no "best" hearing aid; however the best device is one which is properly programmed to fit your needs.   All of the major hearing aid manufacturers have  technology which can be adapted to fit most hearing profiles, including what you describe.  I strongly believe that the provider you choose is more important than the product.  The right provider will make sure that your needs are addressed.

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Parth P
Parth P 10 November 2017
i need more clarity regarding using more channel HA does it degrade speech spectrum in my indiviual case?
Sheri G
Sheri G 11 November 2017 Replied to Parth P
I believe that the chances of your success are greater with each passing year due to the advancements in technology. We all have different needs and goals which can only be addressed by a thorough case history, a comprehensive evaluation of hearing and measuring the acoustics of the ear canal, including measurements of the device's performance ( real ear measurements). Today's technology can address your concerns with clarity due to the number of channels or bands. Amplification through hearing aids is never like the ears we were born and blessed with. It is important that the provider sets up realistic expectations to insure your success.
Parth P
Parth P 11 November 2017
ans to second post i am impaired from very teen age so i do not have idea about what normal hearing is. i am not sure till how much distance ican hear with aid clearly? i.e 7-10 feet currently i have to call people near due to low affected upto 65 db in 500 and 55 in 1k hz(1k in left only) notch in 4k 65 and 3k 30 in other ear as well. so mind is confusing if asymetrical amplification comming in brain. like one ear is not receiving amplification. if i remove 1 aid having more deafness i can hear other ear but if binurial it felt i am hearing in more affected ear louder. my is set by audiologist 10 times with no success. he performed only pTA and tympano but no real ear i have close mould. cc and ear simulator in built property in signia software he used no REM module used like aurical/audioscan. does increasing HTL in fitting safe? cause further deafness he suggested to cover fitting range this idea. any clue?
Sheri G
Sheri G 12 November 2017 Replied to Parth P
You need to find a provider who will perform real ear measurements. This will assure that you are fit properly and not overamplified. Look at the ADA (Academy of Doctors of Audiology), AAA (American Academy of Audiology, or Audigy websites to locate a provider to help you. Make sure that the practice has equipment to perform real ear measurements and/or speech mapping. Best of luck. Let me know how it goes!

Mark Butler, AAS

Hearing Healthcare Provider in Sparks

09 November 2017 - 2.15K Views

Most all of the major brands will adequately handle this type of hearing loss.  A higher technology level aid will do a better job of more precisely matching the loss itself but the bigger issue is finding a provider who is very good at fitting a reverse slope.  it is very easy to over amplify lower frequencies which mask the higher frequencies needed for clarity.  In that case you would experience good volume but a lack of understanding.  80% of the value of your fitting will come from who is programming it.  Only 20% of the value comes from the hearing aid itself.  

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Kim E Fishman, MA

Hearing Healthcare Provider in Minneapolis

09 November 2017 - 2.17K Views

Widex Fusion Products, Dream or Unique!  

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Parth P
Parth P 10 November 2017
does it will give feedback issue i have notch loss at 4k 65db in left and asymetry is in the ear and within ear thats why telling

Eloise Wall

Professional Member

11 November 2017 - 2.1K Views

I would look at ChannelFree technology from Bernafon, which seems to suit a cookie bite, especially with the new Zerena's. 

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Matt Watson, HIS

Hearing Instrument Specialist in Kitchener

10 November 2017 - 2.11K Views

I agree with the majority of what has been said, definitely find a provider with lots of varied experience who you trust.  Make sure you understand this is a process, often times people with complicated hearing losses or who are new to hearing aids will think the hearing aids are wrong for them because they are not an instant success.  Any hearing aid fitting should involve adjustments and reprogramming a few times to get it right, we are all individuals and no two people have their hearing aids set the same.  In terms of hearing aid recommendation, any manufacturer would be an option, but I would suggest a hearing aid with a custom ear piece (in the ear or behind the ear with custom mold) rather than a RIE/RIC style.  In my experience it is difficult to get that much low Hz amplification from an RIE/RIC.

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Parth P
Parth P 10 November 2017
nop 27 having loss from 14 . first ITE then RIC with Custom mould with zero vent since loss is 65 db in low. as per my audi no venting is possible

Clifford Olson, AuD

Audiologist in Phoenix

09 November 2017 - 2.13K Views

From more of the technical side, treating this hearing loss with any manufacturers hearing aid is complicated.  Depending on the severity, in order to get amplification in the low frequencies, you would have to occlude your ear.  You would then have to process sound for the mid-ranges that you may have normal hearing in. Then amplify the high frequencies as well.  Of course, you always have the option of not amplifying the low frequencies, leaving an open vent for the mids, and still amplifying the highs.  Essentially, answering this question well really depends on your hearing loss, and your perception of the way things sound when you are fit.  As long as the fitting concepts are well thought out, you have a shot at receiving benefit from most hearing aid brands and styles.

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Parth P
Parth P 10 November 2017
once again yes mid is normal thats causing problem in fitting my audiogram frq .250 .500 1k 2k 3k 4k 8k L 65 65 55 20 50 65 40 R 60 50 30 20 30 20 35 does increasing HTHL help? or this option not viable? requirement noisy /reverbant/transient management as young 27

Abbey Sanabia

Hearing Healthcare Provider in Orlando

09 November 2017 - 2.17K Views

Almost all hearing aids now are programmable so your hearing test is actually downloaded to the hearing aid and therefore adjusted accordingly. You don’t need to go to the top of the line but don’t go to the bottom either. When you have an out of the ordinary hearing loss, it is easier and more satisfactory to have more channels in order to really pinpoint your loss.

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Parth P
Parth P 10 November 2017
i need more bit tecnical answer regarding compression + signal processing schem level i.e with more channel vs enchant hybrid signal processing scheme. like signia emphasis frequency above 1.5k to understand speech and other frequency just need to be dempned or real compression ration altered manually by audi compared with fixed knee point and gain level of mid voice i.e 65. and more over widex has different classification based on noise level like soft sounds below 62 db checked for component of soft speech etc.

Discussion

Parth P
Parth P 11 November 2017
again i already have 16 channel and 8 band its not enough problem to maintain 2.5-8k curve.its not perfect and seems curve correct only in 20 band. i have no idea requirement of channel. seen 12 handel/band not accurate unnecesorily amplify 3k by 10 db. output so distortion of speech is evident.
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