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Amplification II > 1 - Review & Fit > Flashcards

1 - Review & Fit Flashcards

1
Q

What is the patient-centered care model?

A

Care that isn’t just about us dictating a solution. We need to ask the patient what they want and what is important to them.

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2
Q

What are we looking at with patient-centered care?

A

1) is the patient a candidate for amplification?
- audiological profile
- communication needs
- motivation
2) what hearing aid parameters and technology level should be fitted?
3) what are the patient’s post-fitting rehabilitation needs (beyond HA fitting)?

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3
Q

What are the 14 steps in the process of a HA fitting?

A

1) candidacy, needs, and expectations
2) hearing aid selection
3) ear impression (sometimes)
4) order devices through manufacturer
5) pre-programming of hearing devices prior to fitting on patient
6) physical fit of hearing aids on patients
7) verification of performance (REM)
8) complete the fitting in the fitting software
9) hearing aid orientation - counselling
10) trial of devices in patient’s own environment(s)
11) follow-up phone call/contact patient 24-48 hours post fitting (or sooner if having difficulty)
12) follow-up appointment ~2 weeks post fitting
13) validation
14) post fitting rehabilitation

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4
Q

What 4 things are we looking at with candidacy, needs, and expectations?

A

1) audiological assessment
2) communication needs assessment (lifestyle, listening needs)
3) COSI
4) speech tests (WRS, SRT, QuickSIN)

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5
Q

What 5 things are we looking at with HA selection?

A

1) consider audiogram and listening/lifestyle needs
2) hearing aid style
3) receiver size/power
4) technology level
5) need for other devices and accessories

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6
Q

What are 3 reasons why you need to take an ear impression?

A

1) a standard BTE with earmold
2) a custom ear tip for RIC or RITA
3) any custom HA (ITE, ITC, CIC, etc)

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7
Q

What 3 things do we do to pre-program a hearing device prior to fitting on a patient?

A

1) enter parameters (receiver size, venting, accessories) in manufacturer’s software
2) pre-select programs & features as needed
3) first fit the devices (also ensures that the aid and fitting interface, Noahlink Wireless, is working prior to the patients arrival)

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8
Q

What 5 things do we need to check with the physical fit of HAs on a patient?

A

1) does HA shell, earmold, or eartip fit well?
2) is the earmold tubing cut to appropriate length?
3) RITA & RIC: pick size of dome and slim tube wire length
4) perform feedback test as needed
5) how do the HAs sound?

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9
Q

Explain the 4 steps of verification of performance (REMs)

A

1) enter hearing thresholds in HA analyzer (software converts to dB SPL at TM)
2) select/confirm a prescriptive fitting formula
3) obtain REAR with 55, 65, and 75 db SPL input and REAR with 85-90 dB SPL input
4) fine tuning based on REM and on patient feedback

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10
Q

What are the 3 steps in completing the fitting in the fitting software?

A

1) fine tune programs/features as needed
2) program access of push buttons/rockers
3) demonstrate alerting beeps

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11
Q

What 3 things do we do at the follow-up appointment 2 weeks post fitting?

A

1) inquire about HA benefits and satisfaction
2) check datalogging of HA
3) re-program as needed based on patient feedback and HA use

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12
Q

What is done during validation?

A

Interview or self-assessment questionnaire on HA benefit and satisfaction

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13
Q

What 4 things happen during post-fitting rehabilitation?

A

1) communication strategies training
2) auditory training
3) assistive listening devices
4) counselling with family members/communication partners

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14
Q

What are 6 questions to ask at post fitting/follow up appointments)

A

These are 6 questions to ask beyond the COSI
1) improvement in hearing, situations that remain difficult?
2) tolerance to loud sounds?
3) frequency of HA use?
4) handling HA (insertion/removal, on/off, batteries, push buttons, etc)?
5) physical comfort of shell/device?
6) anything else that you noted in your Noah notes or in the file at the time of fitting?

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15
Q

What are the 2 current researched, valid, and verified fitting methods?

A

1) NAL-NL2
2) DSL v5

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16
Q

Explain the NAL-NL2

A
  • national acoustic lab
  • the generally preferred method for adult patients
  • loudness equalization strategy
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17
Q

Explain the DSL v5

A
  • desired sensation levels
  • the generally preferred methods for pediatric patients
  • loudness normalization strategy
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18
Q

What are prescriptive methods the starting point for?

A

determining gain and frequency response

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19
Q

NAL-NL2 vs DSL v5 - experience level

A

NAL-NL2: more initial gain for experienced users, less initial gain for new users
DSL v5: no correction for gain based on experience level

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20
Q

NAL-NL2 vs DSL v5 - gender

A

NAL-NL2: reduces gain on average for females than males (2dB)
DSL v5: no adjustments in gain based on gender

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21
Q

NAL-NL2 vs DSL v5 - bilateral vs unilateral fittings

A

NAL-NL2: gain correction changes for bilateral fittings based on input (-2dB for low input, -6dB for high input)
DSL v5: -3dB decrease across input levels for bilateral fittings vs unilateral fittings

22
Q

NAL-NL2 vs DSL v5 - listening in noise

A

NAL-NL2: no correction factors for listening in noise
DSL v5: -3 to -5dB reduction for low importance frequencies (REM must allow this)

23
Q

NAL-NL2 vs DSL v5 - loudness discomfort levels

A

NAL-NL2: patient specific levels not taken into consideration
DSL v5: alters gain if patient-specific are specified

24
Q

Why does NAL-NL2 take into account an increased number of channels?

A

To mitigate the channel summation effect

25
Q

What is the conversion for HA fittings from audiometric data to sound delivery in the canal?

A

Audiometric data from dB HL to dB SPL

26
Q

What 5 targets and 2cc values do we need to take into consideration?

A

1) ear canal resonance
2) RECD
3) microphone location effects
4) earmold of BTE (tubing and venting effects)
5) shell modifications on custom HAs (fit and venting effects)

27
Q

What is REUG/REUR?

A
  • real ear unaided gain / real ear unaided response
  • what is the ear bringing tot he table without amplifcation?
28
Q

What is REAG/REAR?

A
  • real ear aided gain / real ear aided response
  • what is the response when we have amplification in the canal?
29
Q

What is REIG?

A
  • real ear insertion gain
  • how much gain are we actually providing
  • not often used
30
Q

What is REOR?

A
  • real ear occluded response
  • dbSPL in the ear canal when we have a HA in the canal but turned off (to see if a HA is open fit or not; is an open dome really an open dome), how much of a block the earmold is creating
31
Q

What is RECD?

A
  • real ear to coupler difference
  • difference between coupler and ear canal SPL
  • most important for pediatrics (kids ears grow quickly and RECD values will change)
32
Q

Explain the REAR

A
  • what is the response delivered to the ear canal with a HA turned on?
  • a REAR looks at the total response of the HA delivered in the ear canal, taking into account the gain provided by the HA and the patient’s ear canal when a signal is delivered
  • measured in dB SPL
  • what is the ear and HA bringing to the table together?
33
Q

What is functional gain?

A
  • an aided audiogram
  • before REM was a clinical tool, HAs were verified with functional gain
  • would put a patient in the sound booth with their HA on to see how they were hearing (doing another audiogram with HAs on)
34
Q

What are the 6 limitations of aided soundfield testing?

A

1) time consuming
2) can be difficult to obtain ear-specific information (masking may be require in the non-test ear)
3) no information on maximum output (MPO)
4) will not pick up narrow dips or peaks in the response of the aid
5) can be difficult to specifically provide information of how much gain is provided for average, soft, and loud speech
6) poorer test-retest reliability compared to REM

35
Q

Better test-retest reliability for ____ compared to ____

A

REMs, functional gain measures (when possible, REMs are best)

36
Q

4 circumstances when functional gain measurements are appropriate are…

A

1) fitting of BAHD and CI
2) REMS may be questionable due to ear canal or middle ear condition
3) when specifically requested by a third party
4) sometimes good to do both REM and aided threshold in pediatric fittings as a counselling tool/demo HA performance to family

37
Q

What is a first fit?

A

The software will provide predictions of what the patient needs (gain, coupling, venting, etc), but this isn’t patient specific, we need to do REMs

38
Q

What are proprietary formulas?

A
  • manufacturer specific fomulas
  • many manufacturers have their own prescritive formulas that are often based on DSL v5 or NAL-NL2, but with brand specific variations to suit the specific products that they offer
  • these formulas are a starting point, but not the best options for our patients
39
Q

How do proprietary formulas get their data?

A

Data is often based on information compiled by the manufacturer regarding:
1) preferred sound quality
2) initial acceptance data

40
Q

What are some examples of proprietary fomulas?

A

eSTAT, WFA (starkey), phoak adaptive digital, WFR (widex fitting rationale), VAC (oticon voiced aligned compression), audiogram+ (resound)

41
Q

How does verification with proprietary formulas work?

A
  • verification of proprietary formulas can be challenging
  • verification systems do not include manufacturer specific algorithms as a formula as a point of comparison
  • are we then, as clinicians, relying on manufacturer guided data, with manufacturer specific features to determine adequate audibility for our patients?
42
Q

Measured vs software 2cc values

A
  • software 2cc gain values tend to overestimate the actual 2cc gain provided by the HA
  • manufacturers tend to predict more insertion gain
  • not all manufactureers use the same correction values
43
Q

What does research on proprietary formulas indicate?

A

Studies show that proprietary formulas can fall short on providing adequate audibility for patients

44
Q

Explain the Leavitt and Flexer study

A
  • examined how default or first fit settings effect performance in background noise
  • examined 6 premium HAs and 1 analogue HA
  • found that manufacturer fits aren’t doing that good of a job
45
Q

How many people prefer REMs vs first fit? What 2 things do REMs allow for?

A
  • 79% of the study participants preferred programmed fittings using REMs vs first fit
  • the programmed fit, using REMs had 15% better word recognition and 4.2% improvement in background noise
    • significantly better perception of phonemes and words for the programmed fit
    • improved audibility and performance when REMs set appropriately
46
Q

What are the limitations of the first fit without verification?

A
  • multiple research studies have found that first fit under amplifies high frequencies and can negatively affect speech recognition ability
  • first fit programming alone leads to lower patient satisfaction with hearing aids
47
Q

Automatic REMs

A
  • automatic fine tuning integration with verification system
  • many manufacturers have an automatic REM protocol that is used in conjunction with verification equipment (can be done in test box or in an on-ear measurement)
  • gain for various inputs are automatically adjusted to match the targets in real time
  • research is being done on the accuracy of this, there are camps of research to suggest this is a valid measure
48
Q

What is the speech intelligibility index?

A
  • the SII measures the amount of a given speech signal that is audible to the listener
  • ideal to use as a counselling tool, integrated into verification software, and helps to understand how much speech is available with and without the hearing aids
  • in combination with our matching to target, the SII can be used to understand if the hearing aids are providing appropriate amount of audibility
  • the calculation of the aided SII is done by evaluating the recorded aided response curve and the points where the aided response curve is higher (above) the hearing threshold of the patient
  • different frequencies are given a different weight (frequencies that are more important for speech intelligibility have a greater impact on the SII)
    • 1500-3000 Hz
49
Q

Perform ____ to verify if hearing devices are meeting targets

A

verification measures

50
Q

Remember that the first fit option in the software is an ____

A

estimate

51
Q

Don’t rely on ____ as your final settings

A

manufacturer’s first fits

Amplification II (13 decks)

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