Is the Phonak Virto Infinio R ITC hearing aid suitable for severe to profound hearing loss?
- Koorosh Nejad
- 3 days ago
- 7 min read
Updated: 8 hours ago
I have a few patients with severe to profound hearing loss who are young and wish to replace their power BTE hearing aids with in-the-ear ITE models. Rechargeable ITE hearing aids look much nicer than power BTE hearing aids. They fit and look better. They support an active lifestyle, such as when you do mountain biking, Skiing, etc, by retaining better and feeling better when one has to use a helmet. So they certainly have a special place for young and active patients.
Since the Phonak Virto Infinio rechargeable ITC/ITE has been released, patients have more options to choose from. In this article, I will briefly examine the suitability of the rechargeable Phonak Virto Infinio ITC/ITE for patients with severe to profound hearing loss. For further consultation, please book a free hearing care telecare here.
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A brief on severe to profound hearing loss
If your hearing loss is in the range of 70 to 90 dB, it is classified as Severe hearing loss. If any frequency points of your audiogram are recorded at or higher than 90 dB, it is classified as Profound hearing loss. People with severe to profound hearing loss easily miss the doorbell. They have the TV volume set very high, and without their hearing aids, they struggle communicating with others.
Most, if not all, the patients with severe to profound hearing loss are fitted with behind-the-ear (BTE) battery-powered hearing aids. In the UK market, the popular power BTE hearing aids for severe to profound hearing loss are Phonak Naida L90-UP and Oticon Xceed 1. These BTE hearing aids are the most powerful ones in the market and can provide the highest power needed by this group of patients. Almost all power BTE hearing aids are fitted with silicone earmould, which provides a better seal in the ear canal. This is the best option to minimise the chance of feedback.
What are the challenges of fitting hearing aids for patients with severe to profound hearing loss?
I found a few specific challenges to a successful fitting of a pair of power hearing aids for patients with severe to profound hearing loss, including:
Dynamic range - Most people without hearing loss have a dynamic range of hearing at around 100 to 120 dB. This is the range of the quietest to the loudest sound they can hear (comfortably, on the louder side). This dynamic range starts narrowing down as the patient ages and starts having hearing loss. Unfortunately, both the floor and the ceiling of the dynamic range start squeezing the range. That means the patient is not able to hear the quiet sounds, but also s/he cannot tolerate loud sounds either. These boundaries limit the hands of the audiologist (and the hearing aid) in providing adequate amplification range. The result is that the discrimination of the sound and speech clarity is compromised, regardless of the model of hearing aids or how powerful they are.
Power hungry - Most patients with severe to profound hearing loss are long-term users of hearing aids, and for that reason, they often have got into the habit of manually increasing the volume of the hearing aids in the hope of hearing and understanding speech better. The result is that their brain has got used to louder sounds, louder than what their audiogram suggests.
Wind noise - Due to the very high gain setting on power BTEs, the users of the behind-the-ear power hearing aids are more likely to notice the annoying wind noise compared to other hearing aid users with moderate or moderately-severe hearing loss. In that sense,
Whistling and feedback - Due to the high gains set on power BTEs and the need for more power, patients with severe to profound hearing loss are more at risk of experiencing whistling and feedback problems. Hearing aids are becoming more and more intelligent in controlling the feedback noise, which is promising.
Frequency lowering and speech clarity - Often, the hearing loss in the high frequencies is more profound than the mid and low frequencies. For that reason, your audiologist may decide to use frequency lowering, which simply means that the hearing aid lowers the range of higher frequency sound and superimposes it with a range at mid range where your hearing loss is less. This technique may provide you with better speech intelligibility. Here is the area where I spend some time to fine and tune a set of power hearing aids for my patients. The success rate of frequency lowering in improving speech understanding and discrimination depends on a lot of factors, including your hearing loss profile.
I have severe to profound hearing loss. Should I choose Phonak Naida L-UP or Phonak Virto Infinio R ITC?
Let's compare a severe to a profound audiogram fitted with Phonak Virto Infinio R ITC versus when it is fitted with Phonak Naida Lumity L90-UP (pictures 1 and 2). As you can see in picture 1, the Phonak Virto Infinio ITC is equipped with UltraPower (UP), the most powerful speaker units. In this configuration, the Phonak Virto Infinio ITC is able to provide a maximum power of 90 dB at low to mid frequencies and 110 dB at mid to high frequencies. So, if your hearing loss is higher than these levels, then you'd better consider Phonak Naida UP instead (see picture 2).
Picture 1 - A severe to profound hearing loss fitted with Phonak Virto Infinio R ITC
Picture 2 - A severe to profound hearing loss fitted with Phonak Naida L90 UP
If your hearing loss is mostly in the profound range and, in particular, the low frequencies of your audiogram are deeper than 90 dB, you'd need a good seal in your ear canal to avoid feedback. Such a seal can best be provided by silicon earmoulds. Although there are techniques to acoustically reduce the chance of feedback in the case of ITC, including deep canal and coating but it highly depends on the shape of your ear canals as to how effective these techniques could work out. Please note that in the case of ITC and ITE, the microphones of the hearing aids are in your concha, which are much closer to the ear canal compared to the power BTE, which has the microphones behind your ears, hence a higher chance of feedback.
I have to remind you that if your hearing loss is severe to profound, then you need Ultra-power speaker units to be installed in the Phonak Virto Infinio. A prerequisite for this is that your ear canals are large enough to allow placement of the Ultra-Power receivers in the custom-made Phonak Virto Infinio. This may be a show-stopper if your ear canals are small or small to medium size.
What are the other considerations of picking the right hearing aids for severe to profound hearing loss?
My recommendation to patients with severe to profound hearing loss is to consider hearing aids, which are battery-powered. The reason is that, up until recently, the rechargeable hearing aids could only offer 20 hours or so for power users. If you want to consider rechargeable ITE hearing aids for your severe to profound hearing loss, you need to be aware that extensive streaming and hands-free calls will reduce the run time of the aids. You may be in a situation where you need to recharge your rechargeable ITE hearing aids at some point in the evening.
What can be done to ensure a custom-made Phonak Virto ITC works with severe to profound hearing loss?
When you are in our clinic, I'll discuss the following techniques to ensure that a pair of Phonak Virto Infino rechargeable ITC works for your severe to profound hearing loss.
Soft coating - We will make sure to ask Phonak to make a soft coating on the hearing aid for better retention and a better seal that would help eliminate the chance of feedback.
Deep canal impressions - My best advice for a patient with severe to profound hearing loss is to make a deep canal impression for a pair of custom-made ITC/ITE hearing aids. I'll also likely make an open-jaw impression of your ear canals for a better seal.
Half-shell - It is very likely that Phonak Lab would make a half-shell custom-made ITE for you instead of the ITC. The half-shell is a tad bigger than the ITC, and this is the compromise you have to make to reduce the chance ot feedback.
What other options do I have to improve the speech clarity with a severe to profound hearing loss?
Regardless of what model of hearing aids you use to manage your severe to profound hearing loss, I highly recommend that you consider:
Have a fresh hearing test and reprogramming once a year to ensure that your hearing aids are tuned up.
Ask your audiologist to do a real ear measurement (REM) to make sure that the settings of the hearing aids are optimised for the acoustics of your ear canal.
Use Phonak Roger assistive listening devices that could substantially improve your speech understanding in noisy spaces.
Conclusion
If you have a severe to profound hearing loss, there is a good chance that you can use in-the-ear rechargeable ITE hearing aids. My best advice is to consult with a local audiologist to have a look at the options you may have. After all, everyone's hearing loss and lifestyle is unique.
Have a question, need consultation?
Please book a free telecare consultation if you are interested in learning more about Phonak Virto Infinio R ITC, or to place an order for Phonak Virto Infinio ITC rechargeable with us.
Disclaimer: This article is not sponsored by Phonak.
References
1 Latzel, M, Heeren, J and Lesimple, C. (2024) "Speech Enhancer reduces listening effort and fatigue." Phonak Field Study News retrieved from www.phonak.com/evidence
Appleton, J. (2020). AutoSense OS 4.0- significantly less listening effort and preferred for speech intelligibility. Phonak Field Study News retrieved from www.phonak.com/evidence, accessed February 2022.
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