Lecture 10 Flashcards
1
Q
Regardless of the technology level or hearing aid features selected, our goals in hearing aid features should align with the following:
A
- Speech spectrum should be amplified to an audible and comfortable listening level
- Maximum output of the hearing aid should not exceed the patient’s loudness discomfort levels
2
Q
During counselling and setting patient expectations, we need to look at performance in what 3 areas?
A
- Performance in quiet
- Performance in noise
- Performance at a distance
3
Q
How should soft, average, and loud sounds be perceived?
A
- Soft sounds (-50 dB) should be perceived as soft
- Average level sounds (-60-65 dB) should be perceived as comfortable
- Loud sounds (80 dB) should be perceived as loud, but OK
4
Q
How should earmolds and domes feel?
A
Earmolds/shells, and domes should be physically comfortable, and should not create feedback- ideal for a full day of wear
5
Q
Patient’s voice should be ____ to them
A
Comfortable
6
Q
Microphones work up to about ____ feet
A
10
7
Q
What 3 questions should we ask when selecting basic electroacoustic characteristics?
A
- How much gain will be provided at each frequency?
- Will the amount of gain vary dependant of the input (i.e. WDRC or Linear processing)?
- What will the Maximum Power Output of the hearing aid be (comfort and safety)?
8
Q
What is dynamic range?
A
Area in dB HL between detection and level of discomfort in normal hearing sensitivity listeners can be upwards of 100 dB
9
Q
With sensorineural hearing losses, the dynamic range is ____. What setting is used?
A
Reduced. Compression setting is used.
10
Q
With conductive hearing losses, the dynamic range is ____
A
Generally unchanged
11
Q
With mixed losses, the dynamic range can be ____
A
Variable
12
Q
How is a compression strategy chosen?
A
It is important to import all audiometric information into Noah and subsequently the manufacturer’s software to determine what compression strategy will be best for a given hearing loss
13
Q
What 8 questions should we ask when selecting features and models?
A
- What style will be fitted? Will an impression be required? What earpiece will we select (venting)?
- Will we select entry, mid-level, or advanced technology? These are the software chips in the HA (may see limitations of features in entry-level HAs)
- Will the hearing instrument have volume control?
- Will the hearing aid have a telecoil?
- Will the hearing aid have directional microphones?
- Will the hearing aids have multiple program memories?
- Should we consider Bluetooth capabilities?
- Should we consider accessories?
14
Q
Why does WDRC reduce the need for volume control?
A
Compression should manage peaks that are uncomfortable for high level sounds
15
Q
Who will likely prefer VC?
A
- Experienced users who have used VC in the past
- Patients who want VC in their hearing aids where WDRC does not provided preferred gain settings
16
Q
How is VC achieved in today’s technology?
A
- Toggle wheels, switch (red, right, raising the volume)
- Can activate or deactivate
- Handhold remote control (good for dexterity issues)
17
Q
How does VC work in a HA?
A
Volume control can raise the volume in both HAs (but can also adjust each HA individually if different HLs in both ears)
18
Q
What 4 patients may not want VC?
A
- Patients with dexterity issues may not be able to manipulate a VC button on the devices themselves or accidentally adjust
- Patients who prefer to have a “fully automatic” listening experience
- Patients with cognitive issues (can deactivate VC)
- Pediatric patients (don’t want volume readjusted, since prescription is so important)
19
Q
Should I select a HA with VC?
A
- Sometimes it can be difficult to determine if a patient will be successful with VC (ask if they want VC)
- If selecting a model with VC, you can deactivate VC in software
20
Q
What do telecoils do?
A
Telecoils, commonly referred to as “t-coils” are used as an alternative way to introduce a sound signal to a hearing aid wirelessly (not through the HA microphone, but through the t-coil in the HA)
21
Q
How do telecoils pick up sound?
A
- The t-coil picks up sound through an electromagnetic induction signal to provide a wireless signal direct to the hearing aid
- Generally, for wireless hearing in a public venue or with connection to landline phones (phones will have a “T-rating”)
22
Q
How do telecoils work in public venues?
A
- “Loop systems”- enormous benefits when competing with background noise, or distance
- Loops can be in a room, area of the room, a chair, or a neck loop
- Various configurations to the hearing aid microphones selected in the program settings
- You need to be within the loop
23
Q
How do telecoils work with phones?
A
- Landline telephones can be used in conjunction with telecoil
- Magnet in the receiver communicates with the telecoil (may be manual or automatic)
- May deliver sound monaurally or binaurally
- May have microphones active, attenuated, or off
- Enhanced SNR
24
Q
What is acoustic phone signal?
A
- Telecoils use the microphone of the HA to let sound from the phone in
- With telecoil, there is no possibility of feedback because the mic system is turned off
25
What is important to do when using a telecoil with a phone?
Phone needs to be held up to HA to get a good signal
26
What 3 patients will benefit from a telecoil?
1. The greater the loss, the more patients can potentially benefit from t-coil in listening situation (mild losses may not require t-coil)
2. Patients who score poorly on SIN testing
3. Patients who self-report difficulties in different listening areas. Can you reach out to those venues to inquire about loop systems?
27
What are 2 disadvantages to telecoils?
1. Model potentially larger
2. Can patients learn when and how to use t-coil effectively?
28
Should I select a hearing aid with directional microphones?
Yes! Unless the instrument of choice does not have DM capability (very small HAs; CIC, IIC, lyrics)
29
DM use with manufacturer software is often ____
Automatic
30
Generally there are more DM configurations with ____ level devices
Advanced
31
There may be listening situations where a patient either wants to override or “lock” a DM into a particular configuration. What situations might these be?
Wheelchair user, driving, talking to one person
32
What are multiple memories in a HA?
- Hearing aids with more advanced technology aim to analyze the acoustic scene in greater detail, and adapt the features accordingly
- Entry technology may be limited to how they adapt to environments
33
What 3 questions should we ask ourselves when determining if we should select a hearing aid with manual program capability?
1. How to determine if multiple memories are appropriate?
2. What type of listening environments are the patients in?
3. Will having a manual program be positive in giving patient control?
34
What is the most important thing when considering manual program capabilities
Patients must be able to understand when and how to change programs
35
Explain how music mode in a HA works
- Typically only available in high-end premium devices
- Compression off, directionality will change, and gain will change
- Often times you can manually program this in a lower level technology and it gives the same effect
36
What can tell HA users which program they are in?
Number of beeps
37
In bilateral fittings, wireless hearing aids communicate with one another- for many reasons including:
- Bilateral signal processing
- Directional microphones
- Volume change
- Program change
- Streaming phone calls
38
What types of accessories and devices can wireless HAs be paired with?
- Tablets, Computers, Smartphones, remote controls, partner microphones, TV connectors
- Some will need a secondary streaming device (i.e. neck worn streamers) to link the hearing aid with the Bluetooth device
39
What 3 questions should we ask ourselves when determining if we should select a HA with wireless capability?
1. What are the patient’s listening needs?
2. Do they have Bluetooth devices?
3. Do they need accessories?
40
What are 6 factors to consider when selecting a specific brand or model?
1. Audiogram, Speech in Noise testing
2. Lifestyle
3. Product’s electroacoustic parameters (i.e. is there sufficient gain, what controls are needed, what accessories are required, what coupling will be needed?)
4. Manufacturer stipulations for repair, loss/damage
5. Budget
6. Shared decision making
41
What are the guidelines when using the manufacturer's software?
1. Create a patient profile in Noah- enter the audiometric data
2. Open the manufacturer’s software
3. Select a potential hearing aid and view:
- Fitting Range
- Coupling options
- Compatible accessories
- Feature/Program options
42
What else should we ask ourselves?
- First time hearing aid user; 65 years old, recent retiree. Quite tech-savvy (noted she just upgraded her iPhone. Based on COSI findings, our patient wants to:
- Hear better on the phone when speaking to her grandchildren. Likes to FaceTime.
- Reduce the volume of the TV (so that it does not bother her husband)
- Hear with greater ease when she goes out for luncheon with friends group weekly. Restaurant is noted to be busy/loud
- Hear her husband when he speaks to her from another room
- Also to note: she wants discreet devices and nothing that she has to adjust by touching her ear.
- Ask which HA style she prefers
- Want to know about dexterity
- Does she go to different restaurants every week
- Just a cell phone or does she use a landline as well
- Might be tough to be able to hear her husband from another room (may not be a realistic expectation) – counselling point
- We want directional microphones
- We possibly want telecoil (talk to patient)
- Cell phone-based control to manage programs
43
What else should we ask ourselves?
- Experienced user of amplification, 45 years old, working as an office manager at a downtown law firm. Aids are currently 6 years old, and have been draining batteries quickly (frequent changing is annoying). Looking to upgrade devices for potentially better communication. According to COSI, patient is looking for the following:
- Hear better on the landline phone at work
- Function better in office staff meetings (20 people generally in attendance)
- Reduce the need to turn down or turn off her devices when she cycles (wind noise is bothersome)
- Have an easier time in conversation with her family at the dining room table
- Have better sound quality when listening to live music (frequents theatre and live music venues)
- Also to note: no trouble adjusting volume or program change function via button on old set
- Wind noise may be a bit unrealistic (an ITE model would be good, but most custom HAs aren’t rechargeable)
- We want directional microphones
- Possibly want a telecoil
- Ask what kind of live music
- Bluetooth connectivity would probably be helpful
44
What else should we ask ourselves?
- Current hearing aid user with entry-level devices, 42 year old male patient. Our patient works a bank and has recently received a promotion where he will be expected to chair meetings, have client dinners out at various restaurants, and manage staff. Current CICs have a program button with two programmed memories (automatic, and a program for acoustic phone listening). No directional microphone technology used previously.
- Other notes: tech-savvy, no dexterity issues, and is willing to try different hearing aid styles if the technology is “better”.
- We want directional microphones
- Does he use a landline phone?
- What other things in his life (church, hobbies)
