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Introduction to Amplification and Aural Rehabilitation > Fine tuning and troubleshooting hearing aids > Flashcards

Fine tuning and troubleshooting hearing aids Flashcards

1
Q

What are the 5 most common problems that hearing aid wearers report?

A
  1. Aid is too loud
  2. Aid is too quiet
  3. Problems with quality of own voice
  4. Problems with the tone of the aid (too tinny/ too boomy)
  5. Speech is not clear in background noise
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2
Q

What is a possible cause of “all sounds sounding uncomfortably loud”

A

The overall gain of the aid may be too high

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3
Q

How might you solve all sounds being uncomfortably loud?

A

Reduce overall gain a couple of dB at a time until a comfortable level is achieved

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4
Q

What is a possible cause of all sounds sounding louder than expected?

A

Acclimatisation issue

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5
Q

How might you solve all sounds being louder than expected?

A

-Need to “re-educate” the patient about the fact that hearing aids amplify all sounds and that it is normal to find sounds a little loud to start with
-Advise that this should settle over time
-May need to reduce overall gain of the hearing aid or use “acclimatisation levels” as a temporary measure and gradually increase gain

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6
Q

What is a possible cause of loud sounds being uncomfortable?

A

Maximum output of the hearing aid might be too high (being amplified beyond the ULLs)

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7
Q

How might you solve loud sounds being uncomfortable?

A

Reduce the maximum output level of the hearing aid

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8
Q

What is a possible cause of high frequency sounds being too loud (e.g. “ss” consonant)

A

High frequency gain is too high

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9
Q

How would you solve high frequency sounds being too loud?

A

Reduce high frequency gain

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10
Q

What is a possible cause of low frequency sounds being too loud (e.g. traffic noise)?

A

Low frequency gain is too high

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11
Q

How would you solve low frequency sounds being too loud?

A

Reduce the low frequency gain

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12
Q

What is a possible cause of all sounds being too quiet?

A

Overall gain of the aid may be too low

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13
Q

How would you solve all sounds being too quiet?

A

Increase overall gain a couple of dB at a time until a comfortable level is achieved

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14
Q

What is a possible cause of all sounds being quieter than expected?

A

Issue with expectations- especially when reported by an experienced hearing aid user, especially those moving from linear to non-linear amplification

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15
Q

How would you resolve all sounds being quieter than expected?

A

-Need to “re-educate” the patient about the fact that modern hearing aids work on the basis of speech clarity rather than loudness
-May need to increase the overall gain of the hearing aid “fitting to patient expectations”

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16
Q

What is a possible cause of quiet sounds being too quiet?

A

Gain for quiet sounds may be too low

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17
Q

How would you resolve quiet sounds being too quiet?

A

Increase the gain for quiet sounds

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18
Q

What is a possible cause of high frequency sounds (e.g. “ff” consonant) being too quiet or problems distinguishing speech?

A

High frequency gain is too low

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19
Q

How would you resolve high frequency sounds being too quiet?

A

Increase the high frequency gain

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20
Q

What is a possible cause of low frequency sounds being too quiet (e.g. traffic noise”)?

A

Low frequency gain is too low

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21
Q

How would you resolve low frequency sounds being too quiet?

A

Increase the low frequency gain

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22
Q

What are the two possible causes of a patient complaining of poor quality of own voice?

A
  1. Patient may have forgotten what their own voice sounds like
  2. The patient may be suffering from the occlusion effect (voice becomes hollow-like, echoey and boomy)
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23
Q

What are the solutions to patient complaints of poor quality of own voice?

A

-Re-educate the patient about the effect of long term hearing loss and that their voice will sound different with the hearing aid in
-Can reduce the low frequency gain of the aid (however causes loss of amplification)
-Can use an earmould with a long meatal tip
-Can vent the mould
-Can use open earmould (only suitable for mild to moderate losses)

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24
Q

What are possible causes of the tone of the hearing aid being “tinny”, “sharp”, “hissy”, “shrill”, “harsh”, “metallic”?

A

-May be caused by a peaky response in the high frequencies
-High frequency gain may be too high

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25
Q

How would you resolve the tone of the hearing aid being “tinny”, “sharp”, “hissy”, “shrill”, “harsh”, “metallic”?

A

-Check REMs for peaks in the frequency response and remove by reducing the gain in the appropriate frequency band, or use filters
-Decrease high frequency gain

26
Q

What are the possible causes of the tone of the hearing aid being “dull”, “unclear” or “muffled”?

A

High frequency gain may be too low

27
Q

How would you resolve the tone of the hearing aid being “dull”, “unclear” or “muffled”?

A

Increase the high frequency gain

28
Q

What is the possible cause of the tone of the hearing aid being “bassy” or “boomy”?

A

Low frequency gain may be too high

29
Q

How would you resolve the tone of the hearing aid being “bassy” or “boomy”?

A

Decrease low frequency gain

30
Q

What are the possible causes of the background noise being too loud?

A
  1. Acclimatisation problems
  2. Low frequency gain may be too high
31
Q

How would you resolve the background noise being too loud?

A

-“Re-educate” patient about the fact that background noise can be quiet loud and even normally hearing people will struggle to hear in this type of situation
-May need to reduce the gain in the low frequencies
-Could consider applying noise reduction function if available

32
Q

What are the possible causes of the patient being able to hear internal noise from their hearing aid?

A

Aid may not be working properly

33
Q

How would you resolve the patient being able to hear internal noise from the hearing aid?

A

-Check the internal noise measurement in the test box
-Could use expansion is available
-May need to fit an alternative aid type

34
Q

What are the possible causes of the hearing aid distorting sound?

A

-Aid may not be working properly
-Gain may be too high

35
Q

How would you resolve the hearing aid distorting sound?

A

-Check the aid is working correctly (including harmonic distortion)
-May need to reduce gain
-May need to fit an alternative aid

36
Q

What is the possible cause of the patient being unable to understand speech in background noise?

A

Gain may be too high at low frequencies

37
Q

What are the solutions to inability to understand speech in background noise?

A

-Apply directional microphones
-Could try reducing the gain at low frequencies

38
Q

What are the possible causes of the hearing aid whistling/ feedback?

A

-Putting hand up/ wearing hat etc
-Wax
-Incorrectly inserted aid/ earpiece
-Wrong type of earpiece
-Vent in earpiece
-Faulty aid
-Incorrect aid settings

39
Q

What are the possible solutions for hearing aid whistling/ feedback?

A

-Check for wax in the ear canal: remove/ refer for removal
-Check patient can insert aid/ earpiece correctly: reinstruct if necessary
-Check the aid is working correctly: replace and reprogramme
-Check the type of earpiece being used: replace with less open earpiece or a tighter fitting mould or remove vent
-Check aid settings: use REMs is possible. Apply feedback manager if this is appropriate

40
Q

What are the possible causes of lack of sound when the aid is on?

A

-Faulty battery
-Earmould tubing/ wax filter is blocked
-Condensation in the hearing aid hook and filters
-Faulty hearing aid
-Wax
-Deterioration in hearing

41
Q

What are the solutions for lack of sound when the aid is on?

A

-Check ear for abnormalities e.g. wax
-Check the battery is working and replace if necessary
-Check the earmould tubing/ wax filter isn’t blocked
-Check for condensation in the hearing aid hook and filters
-Check on/off switch is working and repair/ replace aid if necessary
-If everything is working as it should be arrange another hearing assessment

42
Q

What are the possible causes of the aid being too quiet?

A

-Wax
-Deterioration of hearing
-Gain too low

43
Q

What are the possible causes of the aid being too loud?

A

-Maximum output is too high
-Gain too high
-Client is developing recruitment
-Client has hyperacusis
-Hearing has improved

44
Q

What are the possible causes of the patient being unable to get their hearing aid in?

A

-Patient can have manipulation problems
-May be unable to reach ear
-May be unable to use hands/ fingers well
-Patient may have poor insertion technique/ is inserting aid incorrectly
-Mould/aid is poor fit

45
Q

How can you solve the patient being unable to get their aid in?

A

-Ask client to insert aid and check for problems with manipulation of their aid and poor technique: re-instruct if necessary
-Modify earmould or type of aid if necessary

46
Q

What are the possible causes of the patient being unable to put the battery in?

A

-They may have forgotten where the battery compartment is
-Patient might be putting the battery in incorrectly
-Battery compartment could be faulty

47
Q

How would you solve inability to put the battery in?

A

-Check the patient knows where the battery compartment
-Ask the patient to insert a fresh battery and check for problems and reinstruct if necessary
-Check that the battery compartment is not faulty

48
Q

How would you solve the patient forgetting how to use the controls?

A

-Reinstruct as necessary
-Give written information leaflet
-Consider reducing the need for user-selected controls and remove if necessary

49
Q

What are the possible causes of the tubing coming out of the mould?

A

-The tubing could have deteriorated and broken
-The aperture for the tubing could be too wide
-The earmould could be broken

50
Q

How would you solve the tubing coming out of the mould?

A

-Retube mould- use tubing cement if necessary
-Check mould isn’t broken: take a new impression if necessary
-Check audiogram: consider an open fitting if appropriate

51
Q

What are the possible causes of the mould/ aid casing being broken?

A

The aid could have been dropped, chewed by a pet, put through the washing machine etc

52
Q

How would you solve a broken mould/ aid casing?

A

-Identify problem with mould/ casing- can it be temporarily repaired?
-Take new impression

53
Q

What are the possible causes of the aid/ mould hurting when inserted into the ear?

A

-Incorrect tubing length
-Poor impression
-Meatal tip too long
-Poor finish on mould or hearing aid casing
-Incorrect size dome

54
Q

What are the possible solutions for the aid/ mould hurting when inserted?

A

-Check length of tubing: too long/ short?
-Retube if necessary
-Look for pressure points on concha/ EAC: adjust mould/ casing if necessary
-Check for rough edges on the mould/ casing surface: file down if necessary
-Take new impression if necessary
-Replace dome

55
Q

What are the possible causes of the aid/ earmould constantly falling out?

A

-Tubing may be too short
-Patient is not inserting mould/ aid correctly
-Mould or aid is a poor fit
-Patient’s ear is very small and the aid hook is the wrong size

56
Q

What are the solutions for the hearing aid/ earmould falling out?

A

-Check patient’s ability to insert correctly and reinstruct if necessary
-Check the tubing length: adjust or retube if necessary
-Check hook fits: consider alternative type if necessary
-Take impression for new mould/ air
-Try alternative hearing aid with better retention (e.g. ITE)

57
Q

What are the possible causes of the patient changing their hearing aid batteries too frequently?

A

-Hearing aid is faulty and draining too much power
-The hearing aid is very high powered
-The hearing aid using lots of power-hungry features such as active feedback management, noise reduction, directional microphone
-Batteries are faulty

58
Q

What are the solutions for the patient changing batteries too often?

A

-Check power usage of the aid and replace if necessary
-Replace the batteries
-Check settings of aid and deactivate unnecessary features
-Replace aid
-Counsel wearer re power usage of aid

59
Q

What are the solutions for the patient not remembering which aid is for which ear?

A

-Reinstruct client about aid insertion and how to tell aids apart
-Assign red (right) and blue (left) markers to hearing aids

60
Q

Mrs B (89) has moderate bilateral sensorineural hearing loss typical of presbycusis. You are fitting binaural hearing aids for the first time. You switch the hearing aids on and start talking to her: she immediately winces and complains they are far too loud

What could cause this problem? How would you address this problem?

A

Possible causes: Gain could be too high, acclimatisation issue, output from hearing aid may be going above her ULLs
Actions: Turn the hearing aid down, re-educate the patient on their hearing loss and how it might have affected their perception of sound, reduce gain temporarily or use acclimatisation levels, do REMs to see if the loud sounds are being overamplified

61
Q

Mr. P (45) attends a review appointment. He has moderate to severe loss and is an experienced hearing aid user of bilateral hearing aids. Sound level is comfortable, and notices he’s hearing quiet sounds better than before. Difficulty hearing speech clearly, particularly in background noise.

What could cause this problem? How would you address this problem?

A

Possible causes: gain may be too high at low frequencies, hearing may have deteriorated, central processing problem, hearing aid might be faulty and distorting sound
Actions: do REMs to see if the gain is too high, apply directional microphones or noise reduction programs, test box measurements to look for harmonic distortion or equivalent input noise abnormalities, do speech testing

Introduction to Amplification and Aural Rehabilitation (9 decks)

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