Final Exam, Case #4 Flashcards
Which hearing aid would you recommend?
Due to the audiological results, the patient’s lifestyle, and his cosmetic concerns, the Completely in the Canal (CIC) hearing aids were recommended. This style works well with a mild to moderate-severe hearing loss. The CIC hearing aids are the easiest to insert and remove in the ear, and they do not interfere with wearing eye glasses (Dillon, James, and Ginis, 1997). This style of hearing aid directly addresses the patient’s cosmetic concerns, because they are the most invisible style when situated in the ear. The CIC style also has a stable positioning in the ear, which is ideal for the patient’s active lifestyle (Tye-Murray, 2015). Due to its position in the ear, the CIC style is able to maximize the sound collecting and attenuating properties of the head and ear (Dillon, 2011).
Additionally, the Lyric hearing aids were suggested as an additional option if the patient does not want a traditional hearing aid. The Lyric system is an extended wear hearing aid that is seated deeply in the ear canal. Due to their positioning, the system takes advantage of the natural acoustics of the pinna and the ear canal. This also means that the system is unaffected by wind noise. It is an analog system, which has a natural sound quality. The patient was informed that there is an inadequate literature regarding Lyric hearing aids, making it difficult to make a recommendation. Overall, the CIC was highly recommended to the patient due to the current evidence, but the Lyric was mentioned as a viable option.
Explain the advantages of the hearing aid you are recommending over the patient’s current hearing aids, with respect to the limitations of his current hearing aids.
When compared with his current instruments, the CIC style or the Lyric would offer the patient many advantages regarding wind noise, device visibility, battery life, and acoustic feedback. First, the Lyric is the option that best addresses the patient’s concern regarding wind noise. The CIC style has minimum wind noise levels, while the Lyric would not pick up on any noise (Zakis, 2011). The CIC style can be programmed with a wind noise reduction program, which can help to minimize the noise reduction. Second, both the CIC and Lyric styles address the patient’s cosmetic concerns. The CIC style has one body and is positioned into the ear canal, making it less visible than the RIC style. The Lyric style is completely invisible, due to its deep positioning in the ear canal. Both of these options are more cosmetically appealing than the RIC style.
Third, only the Lyric would be able to address the patient’s concerns for a short battery life. The CIC style typically uses a size #10 battery, which has a shorter battery life than the RIC style (Taylor and Mueller, 2017). Unlike both traditional hearing aids, the Lyric has a battery that can last up to 120 days, or approximately four months. The FDA has approved the Lyric for 120 days of continuous use. This characteristic of the Lyric system would meet the patient’s concerns for longer battery life. Lastly, only the Lyric can address the patient’s concerns for acoustic feedback. The CIC style completely occludes the ear canal, which can lead to the patient experiencing some occlusion problems. Additionally, this style is prone to frequent feedback (Taylor, Mueller, 2017).
Describe how will you verify appropriate hearing aid output.
If the patient decides to pursue either the CIC or the Lyric style, the fitting would be verified with Real-Ear Measurements (REM). This verification strategy is key to ensuring that the devices are matching prescriptive targets while the patient is wearing them. These measurements are conducted with a probe microphone inserted into the patient’s ear canal and then the hearing instruments placed over the probe. Speech mapping will be conducted during REM. The speech map presents the hearing threshold, uncomfortable level (UCL), and amplified speech stimuli with recorded real speech. The goal of this measurement is to ensure that speech is audible and comfortable and that loud sounds are not uncomfortable. Verifying the Lyric style with REM requires a few modifications. The probe microphone needs to be inserted closer to the ear drum and past the end of the Lyric device (Pumford, 2014).
Describe how you will validate the hearing aid fitting.
Lastly, if the patient decides to pursue either the CIC or the Lyric style, the fitting will be validated through subjective outcome measures and speech in-noise testing. Subjective questionnaires, such as the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Client Oriented Scale of Improvement (COSI), can provide insight into the patient’s self-perceived disability. Both questionnaires can be administered before the fitting and then one month after the fitting. Additionally, speech-in-noise testing, with the Quick-SIN, can evaluate how the patient can understand speech in the presence of background noise (Taylor and Mueller, 2017). Results obtained in the aided condition can be compared with unaided results to objectively measure aided benefit.
