I am an advocate of not messing with MPO.
I have also been taught on this forum most self fit aids are under fit. Comfortable is not always the best for speech understanding. Give the brain a chance to acclimate.
I like what you have done except the MPO changes. Are you at 100% experience? Or even 110%.
What does Target recommend for venting?
Are your audiograms from Audiogram Direct consistent?
Try a little stronger occlusion settings, see what that does. It will probably drop lower frequency gains a little.
Are you running feedback tests?
Maybe one of the pros will chime in. They helped me a bunch in the past.
Target says use .6-.8mm vent, the smallest vent i can find at all the earmold labs around here is a “pressure vent” which is 1mm, no one makes a smaller vent that i have found locally.
If i give the brain a chance to acclimate, my head feels like its going to explode, and its painful, very painful, believe me, i have tried. Everyone once in awhile when the pain subsides, I’ll turn the MPO to target prescription, or turn off occlusion effect, and the pain slowly accumulates again. And its additive pain, each day it grows and grows til it comes to a head, and usually takes like 5 days to go away.
I have it at 100%, the audiogram directs are pretty consistent with each mold i use. The only issue with venting, or occlusion effect, is they both substantially and directly affect the low gains i need. Its a trade off, if i use them, the gains i need in the lows disappear and i’m struggling. Also, in the 40 years i’ve worn aides i’ve never had a vent. Entirely new to me. But i tried 3 sizes and recalculated accordingly in target.
All the pros are pretty aware of the situation on this forum, going back to probably over a year + ago now. No one really has any input on occlusion effect. Like i said, most audi’s dont even know thats an option on target. I have gotten a lot of good feedback on here from the pros tho, they pretty much got me to where i am now, better than any audi i have seen locally.
Everyone looks at me like I’m crazy, all the audi’s, even ENT’s. So here’s my theory. I have enlarged vestibular aqueducts. Visibly on my CT scans and MRI’s the stapes is pushed open all the time as a result of the enlarged vestibulars aqueducts, or cochlea’s for simplicity sake. The cochlea’s are preventing the stapes from closing. So maybe, just maybe the pain is coming from the cochlea’s being fully, 100% exposed to 100% volume 100% of the time… only thing i can come up with.
Another thing i notice is its most painful in silence, i can hear the mechanics of hearing aids screaming in silence much like tinnitus except when i turn them off, its not present anymore, unlike tinnitus which remains. They scream when i have the prescribed settings before i make adjustments. That is when in silence, when theres noise going on they sound great.
Thanks for all the information.
You might try the tinnitus settings to cover up the quiet screaming you mentioned. It might keep the brain busy when in quiet.
Try setting the aids up as Target presriscribes with tinnitus on. Lower the experience level to 75%. This will keep all of gains as prescribed, just lower. Then when you can, bump the entire prescription up when you can.
Just thinking out loud.
Yeah i’ll try that out.
I did try the tinnitus masking and that was more distracting than dealing with noise with it off. I tried all 3 options. But also, this message would pop up and said limit hearing aid usage to 16 hours a day, assuming from all the added noise.
But i will try the 75% and work way up. I beliebe i did try maybe a 90% once and it just wasnt loud enough so i went to 100%
I think it’s strange that in 40 years of using HAs in occlusive fittings without issue and now having issues with the “occlusion effect” because the molds are now vented, why would you vent at such profound loss in those lower frequencies? Target may well suggest .6 and .8 for the left side,which on paper should help with occlusion, but everyone is different, now it seems obvious that it’s not helping, the lower frequencys you do need, but not booming like it is, @Raudrive is correct and you shouldn’t be using the MPO like this, you need to use the G’s like G50,G65,G80 leave the MPO as it is, if your not getting “clipping” then it’s set by target at a level that is comfortable.
As you know your issues are coming from the lower frequencys, so maybe click on 6 handles and make some adjustments there using the G’s, just lower 1 step at a time, as you’re already taking about the possibility of a medical procedure that could be at play, it’s worth looking into more, I was thinking “recruitment” reading through the thread, those lower frequencies are just pawns in this game, you can afford to lose some, you got better mids which is where the clarity is for speech, so concentrate on this speech aspect of your fitting.
I did a dummy fit with your loss and I noticed target recommended occluded for right side as well, one thing I may of missed, have you got SoundRecover on or off, if on which one, 1 or 2, you can calculate each side independently as well, makes quite a difference I noticed.
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Did you account for bone conduction?
I do use sound recover, each side independently.
Also, i am using occluded molds, i habe better results with occluded than with vented. When i went vented, i lose valuable gains
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No I didn’t use BC, and yes absolutely your gonna lose those lower frequencies with venting, this is a feedback thing not just the occlusion effect.
I was thinking, did you do some of the adjustments with occlusive molds, as in no vent but made changes within target with venting, you probably know that isn’t going to work (just asking)
I just tried putting the MPO at the target, and reduced the gain. I’m back to the aides screaming and nout enough gain. The gain’s are good at target, i would like them increased but thats not acheivable. The reduction in MPO really helps with the screaming/mechanical sound issue. More so than tinnitus tool. The tinnitus tool just adds more noise.
You think the mechanical noise I’m hearing is feedback??? In addition to my occlusion issue?
Well something else is at play, obviously I don’t know what it is, but you shouldn’t have this combination of things going on all at once, I mean it’s understandable that you and the audiologist’s are having a hard time getting things set up like this, a real struggle, reach out to @Neville and @Um_bongo for some advice, they may of come up against something similar.
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Ok, thank you!!! 
I’ll talk to them
I think a lot of my issue is getting a good bone conduction test too. On all my audiograms the air conduction is pretty consistent +5/-5db. But the bone conduction tests are all over the place… all the audi’s say its difficult to get a good test since bone conduction travels to both sides, obviously thats wjy they mask the opposite side, but even so, i’ve been told thats not a 100% good measurement…
Turn Sound Recover off. It’s definitely not needed with your hearing loss.
I am starting to think on the initial set up something is not right. Something fundamental. If you missed SR it can be anything.
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This sounds odd to me. This is where the pros can help for sure.
His problem at quiet times would tell you to lower the gain in G50 lower frequencies.
IMO
Yeah he needs to at least make some changes in lower frequencies, soft is a start (G50) I didn’t mean to across the board, just pointing out the it’s not the MPO to change.
That’s the thing I wanted to know if he had this on or off, target recommends it to be on, so it’s taking say 8Hz to 6Hz, not like when we use it, remember it’s a reverse slope for him.
Sound Recover is frequency lowering technology. His reverse slope hearing loss definitely does not need frequency lowering or am I missing something?
I’m away, but it would be useful to see some bone lines and also useful to get a different description of this “screaming”. Plus, I don’t think the thing described as an occlusion problem is really an occlusion problem, so venting concerns are a red herring.
That loss at low frequencies is pretty severe. Upwards spread of masking is going to be an issue for clarity, but so is gain tolerance. At a certain point things can just be too loud, can start to influence the vestibular system.
Bone conduction testing is way more variable than air.
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