A Hearing Loss & Late Deafened Blog

Deaf Audiologist

In Deafness, Hearing aids, Hearing Loss on August 1, 2009 at 8:29 pm

I sometimes wonder how audiologists can sell hearing aids they have never tried.  I realize not every audiologist can be hard of hearing or deaf, but because most aren’t, I wonder how it’s possible for them to know what we hear when we put on hearing aids or to understand our feelings about feedback and sharp sound.   I wonder if they realize what an important step self-disclosure is in navigating the minefield of accommodations.  I wonder if they realize how proud we feel once we’ve finally embraced our deaf selves?

Lately, I’ve been weighing the pros and cons of the Oticon Epoq RITE (receiver in the ear) against the Phonak Naida.  I already read all the materials I could find on both aids before making the appointment with my audiologist.  The Epoq has a blue tooth streamer and some extra equipment for watching TV, but nothing for conversing with people at parties or the office.  It offers open fit, even for profoundly deaf– but with mixed results I‘ve heard.  Epoq also coordinates sound between instruments in each ear wirelessly, so that they automatically detect direction of sound.  Naida, on the other hand can come with the super-duper Phonak FM  — which is admittedly pricey but everyone I know who owns one of these babies loves it.  Naida has the frequency transposition.  People with profound ski slope hearing loss and dead zones like mine have been raving about Naida because they’re able to hear sounds they haven’t heard in years– like the s sound.  Never before has so much technology been packed into a high end aid.  Never before have I even considered shelling out the kind of money I will be in the next few weeks.

Open fit sure seems like a dream come true.  I hate that plugged up feeling of having a huge ear mold in my ear, especially during the hot summer.  They’re sweaty and oh so itchy.  Supposedly this aid is made for people with up to a 110 db hearing loss.

Even so, I’m having a hard time believing I can get a good fit.  I’m concerned about feedback.  I have one touchy ear canal that always feeds back no matter what.  I already know someone with a similar audiogram to mine who had to trade her open fit Epoq in for a regular ear mold on that side because it didn’t work well for her.   She claims she’s happy with the sound quality now though.  She can hear voices.   But her hearing loss isn‘t progressive like mine.  Looking at the ‘best fit audiogram, I’m right on the lower edge of not benefiting from this aid– the lower edge being 110 dbs.  If I lose more hearing (which I will), the Epoq will not provide enough power.  At $6000.00, that’s a pretty big gamble.

“Why should I get these?” I ask my audiologist.  “How does the sound quality compare to the Naida?”

“Oh– these are GREAT!”  he assures me.  “Everyone loves them.  You’ll hear better and they look great too, because of the open fit!  They‘re practically invisible!”

For the third time, I remind him that I’m less concerned about looks than how well I can hear.   If I can’t hear well with them, it won’t ‘look’ that great no matter how ‘invisible’ the aids are.  I must defend my audiologist here though.  I realize I am probably one of the rare patients who has been wearing hearing aids since I was young.  MOST of his patients probably DO want their hearing aids to be as invisible as possible.   In the past week, two people (over fifty) have confided to me that they know they need hearing aids, but just cant’ get past the old age stigma.  Excuse me?  Try wearing them at 20!

But back to my audi– “We’ve got an intern working with us this summer.” he says.  “He’s from Gallaudet.  You know Gallaudet?”

I nod.

“I’ll bring him in. You can ask what he thinks.  He wears Phonaks.”

I notice the handsome young man wearing big metalic, awesome looking aids with obvious thick plastic tubing.    His aids are obvious, sleek, and evidently very effective because he seems to have no trouble understanding me.  After introductions are made, he looks over my audiogram, then asks,  “Is your hearing loss progressive?”

I nod.

“You might want the Phonaks, then.  They have more power.”

“What’s the biggest drawback to these Epoqs?” I ask.

“Feedback,” he says.

Just as I thought.

I have not met very many deaf audiologists in my life, but this guy knows his stuff.  He has actually worn the aids he’s selling.  He understands feedback.  His own aids are clearly visible and he apparently doesn’t care.  HE GETS IT.  I like that very much.

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  1. This is something that actually sort of makes me want to be an audiologist. I feel that every audiologist should have to do the following for 2 weeks each:
    Wear different sound loss earplugs, from mild-severe.
    Wear hearing aids.
    Now i think the hearing loss replication would be a good learning experience, but the hearing aid wearing doesn’t seem to make sense to most. Most of the problems I have with my hearing aids are strange sounds/bad ear mold fit. These are things that even a hearing person wearing hearing aids would learn about from experience. It’s impossible to explain an odd noise you’re getitng from an aid, and unless they know what the noise is, they can’t diagnose what’s wrong with it. There’s also a misconception among audiologists and the hearing (non hearing equiptment-using world) that louder = clearer, which is completely not so. But some audiologists don’t quite understand that. It motivates me to become an advocate for hearing loss and explaining issues.

  2. Oh, and the phonaks are great, if you’re thinking of what i got. Sometime no matter what I do i can’t get feedback 😀 Insurance covered them for me. Basically when given my choices the audi was just like “These are the two I’d reccomend, these have the fm receiver built in, these it comes as a boot. Same price. Besides the fm thing, these you can do the two different colors.. OH– and if you get the Phonaks, ask about T3 and such. I didn’t and now feel like a moron since i can’t get them to work w. any of my phones. (And the FM is pretty great. It’s got a pretty long battery life, and can be hooked up to your mp3. It’s got a distance of about 100 feet or so, I think.)

  3. Awesome post. It should be required reading for audiology students.
    Terrific to hear about a deaf audiologist.
    Sarah

  4. You just found a hearing impaired dispensing engineer, getting back into the industry after a hiatus.

    I also have an unaidable hearing loss; and the only solution for me is a cochlear implant, which I’ll be getting one by Advanced Bionics this autumn.

    I’ve been getting reports of infant mortality failures on the Naida’s vs what I’ve seen with the Oticon Epoq’s. Also, the RIC (receiver-in-canal) design is less prone to feedback, since a custom earmold can be used in lieu of the umbrella and less gain is needed since the receiver nozzle is pointed directly at the eardrum.

    On the other hand, if your hearing loss is progressive, there are new fitting guidelines for cochlear implants; though many audiologists don’t refer out for CI evaluations, instead trying to sell a pair of high-profit hearing aids of limited benefit.

    I recommend you compare your audiogram in figure two of “Identifying Cochlear Implant Candidates in the Hearing Aid Dispensing Practice” in the May 2009 issue of Hearing Review at:
    http://www.hearingreview.com/issues/articles/2009-05_02.asp

    While you’re at it, look at Table 1, which is the referral % broken down by who dispenses hearing aids.

    At least once a week I run across someone who discovers they are a CI candidate after telling to look at Figure 2.

    What’s more, for ski-slope losses, MedEl has been fitting them with EAS (electrical-acoustic stimulation) (combo hearing aid-cochlear implant), where a short electrode reproduces the highs and a hearing aid (if needed) reproduces the lows. They are used extensively in Europe; and are in open FDA clinical trials here in the United States.

    Here is the page on the MedEl corporate site describing the DUET II:
    http://www.hearingreview.com/issues/articles/2009-05_02.asp

    And on this page,on the right, you’ll see the fitting range for it:
    http://www.medel.at/english/30_Products/EAS/01_EAS.php

    Hope this helps!
    Dan Schwartz
    Cherry Hill, NJ
    Host of The Telegraph Hearing Blog

  5. M– GO FOR IT! 🙂 I think there needs to be more hh/deaf audiologists in the field. I’m trying out both the Epoq and the Naida for now.

  6. Dan
    Thanks so much! Actually I’ve been tested for the CI three times. This last time I was disqualified by the HNT test. See my personal blog at http://www.faceme.wordpress.com

    They have been testing Cochlear’s Nucleus hybrid in the Seattle area and I qualified for that back in Nov. 2007, but didn’t go for it because I’ve got a progressive hearing loss. I agree that it seems the perfect solution for people like me with steep ski-slope hearing loss. I’m getting a second opinion on that in a couple weeks. Still unsure whether to go with the hybrid, though I understand it’s really close to FDA approval now. I still plan to get the hearing aids.

    As to the Epoq– yeah they took an impression of my ear for that mushroom thingie. I’m still skeptical, but will try it. At this point I’ll try anything if it means I might hear better. 🙂

  7. Kim,

    Even though your audie has taken ear impressions & will be fitting the Epoqs, be sure you have a full 30 days to bail out. Else, if you finally “pass” (cough, cough) the qualifications for a CI, you’ll be stuck with a $7,500 white elephant.

    Anothr alternative is to hop on a plane to Sydney and pay US$24,950 for Cochlear Corp hardware, surgery & 1st stim at Sydney Cochlear Implant Center (SCIC).

    See Kate Locke’s excellent blog at:
    http://katelocke.wordpress.com

  8. I could be wrong about this, but I think the thirty day trial period on hearing aids is federal law. He knows I’m planning to try both the Epoqs and the Nadias. I will buy at least ONE aid. There is a restocking fee if you don’t buy an aid from him after that and I’ll just have to bite the bullet and pay if it comes down to that. OTOH– this second opinion will be interesting because I will be wearing the Epoqs by then. If the Epoqs help me, I really should not qualify for the implant, so I should know very quickly how well new hearing aids will work– and that’s exactly why I wanted the second opinion. I was so close to qualifying before. Will I hear better with new aids? I don’t know. . . But it seems reasonable to try out a better pair of hearing aids before opting for an implant, since my current aids are old. 🙂

  9. hey there mate. Just doing a twitter search for hearing aids. I bought the Phonak last year, and it’s pretty exceptional. For the first time I can actually go to pubs and hear what people are saying. I’m also a musician/soundguy/producer etc and they’re the best i’ve heard for that (i’d still rather not need them , but you know…).

    When I first went in to get fitted.. The audiologist I had basically couldn’t tell me features and benefits, aside from bluetooth. She literally said to me “well all the audiologists have their favourites… and the epoqs are mine..”. I even asked her directly WHY are they better.. And she couldn’t tell me. It’s so frustrating. I sit there going “man.. i wish I could just fit myself..”. So as a result I’m applying for Masters in Audiology at Melbourne Uni next year.. Fingers crossed!!

    Also.. You can get the thing called an icom for the Phonak that does bluetooth.

    -kris

  10. Kris,
    thanks for commenting. I have to admit I have been disappointed with my audiologist. I’ve been going to him for half my life, but the past few years, as I learned more, it became clear he was not as well-informed as he should be.

    For example, when I try the Epoqs, I want to try the streamer at the same time. In fact I told my audi that I wanted to try an FM system for work. He doesn’t handle any of the assistive listening devices. He asked his medical assistant to handle that, but she doesn’t even know as much as me. Rather than going to the usual places to find this stuff, she called Oticon and Phonak directly. Oticons streamer for the Epoq is not an FM system. They offer an FM adapter for the television. I told her three times I don’t care about TV. I rarely watch TV. But I am REAL concerned about my job which entails a great deal of interacting with the public. She kept going on about how I could use the TV adapter as an “FM system” I asked, “is it wireless?” Because you know I’m walking around talking to people. I need something that’s wireless. She says no.

    I already know the Epoq will not work for me for that very reason. Then getting back to where to find the FM system and all that I wanted to try. I know Epoq will work with another FM system. Well the medical assistant said she didn’t know about the Comtek which I suggested. She didn’t know where to find one. I suggested she try Harris catalog or our Hearing, Speech and Deafness Center. SHEESH! These people are working with hh/deaf people and they don’t know half what they did to know to help us. It’s mind-boggling!

    If I were a first time hearing aid wearer I am quite sure they wouldn’t even mention the FM system.

    So– I am glad to hear you want to become an audiologist because there’s definitely a need for deaf/hh people in this field.

    Also thanks for letting me know about how well you hear music. That has been one thing I’ve been wondering about with the frequency transposition and all. I played the piano for many, many years, but quit a decade ago because of sound distortions with my aids.

  11. I’m an audiologist but I have normal hearing. Can I just say that just because I don’t have a hearing loss doesn’t mean that I have no idea what someone with hearing loss hears. I see patients 8 hours a day, 5 days a week. I have worn hearing aids myself for days to see what it sounds like, even though it’s not the same when you hear through them with normal ears. I’m not saying that this replicates hearing loss as I can only imagine the frustration you all go through but I can’t go out there and give myself a hearing loss and I still feel I do a darn good job as an audiologist.

    I do feel your frustrations though as it sounds like your experiences are with clinicians that don’t seem to have any listening skills! I do have to agree that some audiologists don’t keep up with the latest technology and a lot of them have no idea how to fit hearing aids. It concerns me what I’m reading because I understand feedback even though I don’t wear aids; and it concerns me that an EPOQ RITE is being recommended to someone at the same time as a Phonak Naida even if the Epoq being recommended is a power model. They are for completely different degree of hearing losses. I certainly do not speak to my patients in the manner described! I absolutely love the Epoq hearing aid as I think it has the most advanced hearing technology available but I say this only for people with the appropriate degree of hearing loss for the models available. A hearing aid is only as good as the person fitting it though!! If you are being recommended a RITE, your hearing is too good for a cochlear implant. It is your audiologist’s job to advice on all this and quite frankly I’m very disappointed.

    Kris, good luck with your application! I went to Melb uni myself. I can tell you why I love the epoq’s – they are my favourites! They have a feature called sychrony detection which looks for the fundamental frequency of “human” speech, when it detects it, it’s entire focus is on getting the speech to the listener. Oticon aids are the only aids that do this. The other aids tries to simulate the same effect but it’s not the same thing. This means when you are somewhere noisy like a pub, other aids go into a lovely comfort level but if someone starts speaking to you in all that noise, you won’t hear them. The epoqs, on the other hand, will recognise the dominant voice and ease up on the noise reduction so that you are aware of the noise, turn around and face the person, etc.

    The other reason the epoqs are great is that it’s the only aid with true binaural processing – ie. the two hearing aids do cross check with each other to give you as complete a sound picture as possible. In my “normal hearing ” opinion, epoqs are the closest thing I’ve seen to normal hearing sound quality so far (still a long way though!)
    If you become an aud, make sure you don’t treat your patients as dummies – I always, say it’s their ears so make sure they know what’s going on!! It sounds like the auds don’t even know themselves though.. sigh…

    In terms of the FM, the streamer is definitely not an FM!! Kim, you should check out the Bellman Audio max personal amplifier – much cheaper than an FM but works very similarly through the telecoil in the hearing aid.

    Maybe I do agree with you all, afterall… you all seem to know a lot more than your audiologists… great research skills! I guess you have to when it’s your hearing loss and you have to put up with it every day. I’m sorry to hear of your troubles though and a bit annoyed at my peers really.

    Good luck!

  12. Hello H,
    Thanks so much for reading and responding. I didn’t mean to sound like I was generalizing about all audiologists. You certainly sound very dedicated to your field and I bet you are a GREAT audie! If you work in the Seattle area I might even consider switching over to you after all these years of going to the same guy.

    Thanks for letting me know about the Bellman Audio max. I do have a pocket talker but I really want something that’s wireless. I’m going to check out this Bellman thing to see if it can help me. In the mean time, because of what you said here, I have decided to try out the Naida first. That’s the one I really wanted to try to begin with with. My audie said he has never even fitted one. I know it can be tricky to work around the dead zones, so it bothers me a bit that the intern will be programming them for me, but the audie said that this intern knows Phonak inside and out, since he’s from Gallaudet. I guess lots of students wear Phonak there. I asked him why he has never programmed a Naida before. He just shrugged and said he preferred Oticon.

    I realize I’ve out grown this office, and probably won’t be back. But it’s too late now.

  13. Nice article, I am a hard of hearing student going into Gallaudet in the fall to become and AuD. One of my main goals for going into this field was to be able to help young people like myself. Awesome!

  14. Best of luck Katy! 🙂

  15. Kim, I tried the Phonak Nadias from Jan. thru March of this year and didn’t see any benefit. However, at 50, I have never worn, nor had success with hearing aids. Part of the problem is hyperacusis–I have a hard time tolerating the volume I need.

    The other problem I have had is that often the audiologist conducting hearing aid trials–this was the case in January–seems to know less than I do about the features, etc. I lost all confidence after my audi insisted that the hearing aids were not synchronized. I had to look through the owner’s manual to show her that the ha’s come from the manufacturer preset and that she had the capability to disable that setting. She still argued with me and then stumbled onto the setting and then made light of it. I lost any confidence I had in getting a good trial at that moment.

    I know not all audiologists are the same, but I have had many over the years, from my 20’s to now, and I’ve never been completely happy with anyone.

    Good post!!
    Michele

    • Michele,

      There are special audiologic and hearing aid dispensing techniques to deal with impaired hearing when the ear(s) have hyperacusis and/or recruitment .

      The first order of business is to separate out each of these two discrete but similar phenomenon.

      There is one lady I know who has success treating hyperacusis: Dr. Marsha Johnson of the a href=”http://www.tinnitus-audiology.com”>Oregon Tinnitus & Hyperacusis Treatment Clinic in Portland.

      I have a distant relative going to her for treatment after another audiologist named Rikki Green, AuD fit a pair of hearing aids on her severely hyperacusic ears… Without setting the SSPL-90 (MPO) because she did not measure UCL’s!

      Michele, I would call or email Dr. Johnson for advice: If anyone can get you straightened out, it would be her.~

  16. Hi Michele,
    The Naidas are supposed to be the most powerful aids on the market for people with a steep skislope loss. I’ve only worn them for one day, so time will tell if they help me at work. I’ll be able to put them to the test this weekend. So far, I’m impressed. It was either between this or getting a hybrid. But I wanted to hold off on implants as long as possible. My main concern is being able to hear at work. If I didn’t work, I’d be perfectly happy just being deaf. I know that sounds weird, or maybe you understand? What I’m noticing with these is the sound isn’t painful like it was with my old aids. Consequently I don’t mind wearing them. Strange.

  17. […] I got there this morning, he had the EPOQS waiting on the counter instead.  Abe, the deaf audiolgy intern, listens better than anyone else in the office. He switched the Epoqs out for the Naidas, then […]

  18. Great post. I think hard of hearing audiologists definitely have the advantage.

    It’s the simple questions that you need answering: Which aid is best for me? How does this one sound? And so on. How can you answer those if you’ve never had first hand experience?

    I wrote about this myself a while back: http://www.deafness-and-hearingaids.net/2008/09/07/do-hard-of-hearing-audiologists-have-an-advantage-over-those-with-normal-hearing/

    I’ve been thinking about looking into training to become and audiologist myself for exactly this reason.

    • What school are you looking at to become an audiologist? If you are HOH or deaf, I would make sure that the school is deaf or HOH friendly because you will need a better accommodations (note taking services, extra time tests, assisted listening device & etc). I am looking in several schools in the east coast area. Mary Anne

  19. Just found this website – love it.

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