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Amplification > Midterm > Flashcards

Midterm Flashcards

1
Q

What is part of hearing aid evaluation?

A

Audiogram
HA selection and fit
Follow up to verify HA working correctly

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2
Q

Maximum Output

A

The maximum amount of output the hearing aid can produce, suited towards the patient’s UCL — HA will cap off at a certain point, typically 110dB

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3
Q

Gain

A

What is being added to the input signal—60dB is a lot

Make sure to look at graph output levels and see if it is gain or output on the y-axis

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4
Q

BTE Style

A

a. easier to use controls
b. more power
c. not as cosmetically appealing
d. great sound quality but worse for “wind noise” because mic is not protected as easily
e. good for phone use–inside HA there is usually a telecoil (electromagnetic pickup and can be picked up by HA)–room for more programs
f. Better for occlusion, more natural sounding (but depends on earmold—could have open dome, closed dome, custom mold with vent or custom mold

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5
Q

CIC Style

A

a. smallest HA
b. less powerful
c. harder to use
d. less wind noise –better because microphone is more in the canal
e. good for phone use
f. Occlusion effect–voice does not sound as natural
g. more susceptible to cerumen and moisture

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6
Q

RITE

A

Receiver in the ear–

pros because less feedback (mic and receiver are farther away from each other), smaller HA

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7
Q

RITA

A

Receiver in the Aid
-Lower possibility of damage to technology–receiver is not exposed to cerumen, more possibility of feedback

More reliable, resistant to cerumen and moisture

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8
Q

Open Dome

A

More natural LF, less occlusion, greater comfort

However, less power–for greater HL may need this power–could leak out of the opening

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9
Q

Phone Use & HA Style

A

Anything between CIC and BTE is not good for phone use because either too small for a telecoil/bluetooth and would result in more feedback

Putting phone against mic, trapping sound and sending it back through the HA

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10
Q

Lyric extended wear CIC

A

deeply inserted into bony portion of canal (~4mm from TM) deep mic insertion allows use of pinna and concha cues (resonance and localization). smaller residual volume requires less gain –> designed around average male ear canal –> only good for so many individuals, cannot have too small of an ear canal
–subscription: 2 lyrics over 5 years will cost you about ~$30,000 whereas typical 2 HA costs $5,000

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11
Q

Medical Referral Criteria

A

deformity of outer ear, significant cerumen accumulation, history of drainage within 90 days, history of sudden loss within 90days, acute or chronic dizziness, unilateral loss of sudden/rapid onset within 90 days, ear pain or discomfort, conductive component/air-bone gaps

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12
Q

BTE

A

open fit, no gain up to ~2000Hz, can accommodate tcoil, directional mics

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13
Q

mini-BTE

A

preferred for cosmetics, but it may not have tcoil/ALD (assisted listening device) capability, not always a tcoil

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14
Q

ITE Full Shell

A

good for up to moderate HL, maybe moderately-severe (except for the smallest one), can have directional mic, sometimes can fit tcoil depending on ear size

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15
Q

ITE-Half Shell

A

Can have directional mic, may allow for a tcoil depending on ear size

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16
Q

ITC

A

can have a directional mic but will most likely be less effective

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17
Q

CIC

A

no directional mic, recessed into ear canal (mic is deep in concha can take advantage of high frequency boost from concha resonance, space where sound comes out of CIC, that space between HA and TM is smaller so that increases the level), increased gain from small ECV at top of HA

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18
Q

Open Fit & Feedback Risks

A

possibility of feedback, more you try to turn up high frequency gain, riskier it is to get the feedback–not really suitable for severe high frequency hearing loss but are good for natural low and mid frequency listening – Risk of Feedback!!!

Safe to use open fit up to 55-60 in the highs, once you get above those thresholds you may not be able to provide enough power
—With normal lows and severe highs would want to consider some venting to do the balancing act

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19
Q

APHAB

A

Abbreviated profile of hearing aid benefit

questionnaire for prefitting hearing aids — see how well they will likely benefit from hearing aids and what their expectations are

Evaluates: 
reverberation
ease of communication
background noise
averseness to sound
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20
Q

COSI

A

questionnaire allowing patient to identify areas of HA listening that need improvement

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21
Q

QuickSIN

A

Individuals with mild-moderate performance need HA that really will benefit them in background noise–directional mics,

Severe scores will benefit most from an assisted listening device in addition

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22
Q

To fit one ear or two?

A

Consider the loss –symmetrical or asymmetrical between ears?
Consider word discrimination score, localization abilities and needs of the patient—really need to counsel with the patient, give them options and explain the benefits associated

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23
Q

EAA

A

electroacoustic analysis: testing done to verify that HA is working as it should–put into the box & hook up to NOAH

24
Q

EAA testing

A
  1. known sound source–> Hearing Aid —> Measure output (in coupler)
  2. coupler=2cc= meant to mimic residual ear canal volume
  3. Known signal –> transmitted to HA–> goes through coupler –> transmitted to equipment
  4. Calibration: Substitution vs Pressure (feedback loop, can get accuracy that way)
  5. When measuring directional mic with BTE: by putting it in right location in test box
25
Q

Coupler sizes

A

a. if we test in a 2 cc coupler, they should get the same thing as manufacturer–most importantly=standardized way to test
b. CIC coupler=smaller because less space in the ear canal
c. HA1 2cc coupler: ITE/ITC and BTE with receiver–use putty
d. HA2 2 cc coupler: for BTE, take off ear mold and take earhook off BTE–tubing is acting acoustically like the tube that belongs to the earmold in a more standardized way —NOT OPEN FIT HA or RITE

26
Q

How to set the HA in the anechoic chamber testing box

A
  • Set to ANSI testing
  • Then set to patient’s audiogram

look at output of the HA

27
Q

Graphs on EAA

A
  1. Output Graph (in dB SPL): frequencies where patient has more HL requires more gain—should be a mirror image of audiogram
  2. Gain Graph (in dB): higher input levels are the low curves on graph because need less gain—softer sounds need more gain — amount of gain differs for different amounts of input levels
  3. Input/Output function: look for max output
28
Q

Real Ear Testing

A

place HA in patient’s ear with known sound source that is shaped to look like speech

  1. known sound source—> HA –> Measure output (in ear)
  2. unique to the patient’s ear–real ear to coupler difference–how different the individual ear is from the coupler, smaller ear canal, larger RECD than someone with a larger canal —bigger RECD in kid than adult
  3. Loudspeaker, probe mic
29
Q

RECD

A

real-ear-to-coupler difference

helps to show what the HA is doing in the individual’s ear, combined with test box measures can give a relatively accurate portrayal

30
Q

Distortion

A

How much energy is present at frequencies other than the test/input frequency—dashed line on Real ear

As more sound gets put into the HA, more distortion is present

less distortion in LF but more as get into the HF

31
Q

Verifit Testing

A

Test box –> AGC (compression)–> Start test (coupler and reference mic together to calibrate the test box microphone)->does all its measures
green arrow: tells us how much we need to lower the volume –> Print out ANSI specs and compare the results with these regulations

  1. Max Output: 2 things to look at it –> first is the peak SPL 90 and HFA (high frequency averages—1000, 16000, 2500Hz) OSL 90. Consider tolerances and is within specifications with the tolerance
2. Gain HA is producing: HFA FOG (full on gain): take into account tolerance
HFA RTG (reference test gain): take into account tolerance
  1. Distortion/Noise: EIN (equivalent input noise): should be less than 25 — want a very low number
    Total Harmonic Distortion (THD): percent values: normal for THD to be higher at 500 than other frequencies–typically in the single digits
32
Q

Quick Fit Screen

A

Coarse tuning adjustments: control for HF/LF gain & output, can make occlusion control only for low frequencies

experience level
gain
max output
black dashed line is max output of HA–can adjust for MCL or UCL

33
Q

Fine Tuning Screen

A

Can select just one frequency range and increase/decrease the gain–
have adjustment for loud/soft sounds, compression, volume control

34
Q

Compression

A

HA does different things to different levels–lines get closer together, are they treating them similarly

look for this to see if linear or compression HA

35
Q

Band vs Channel

A

Band: all sounds–gain turning up adn down all at once, can select just one frequency range

channel: more detailed processing: amplitude compression, digital noise reduction, any kind of signal processing that is happening is happening to channel—can selectively adjust sound gain (frequency & level selection)

36
Q

Full on Gain

A

All gain is cranked up as high as HA can go

37
Q

Reference test gain

A

represents a lower volume setting because that is how the patient will use it–don’t want to do a ton of testing at a less than full on gain test level

volume is turned down so none of sound peaks are clipping with 60dB input

38
Q

Earmold

A

Shell
Skeleton
Canal

39
Q

Shell Earmold

A

earmold is all filled in, shell can get tubing to connet to earhook behind HA or can have a receiver for a body aid

40
Q

Skeleton Earmold

A

Earmold is cut away in some fashion, more cosmetically appealing instead of seeing a solid peice, will only see a little rim back around concha

41
Q

Canal Ear mold

A

Just fills up canal so nothing comes into bowl of concha, canal lock is protrustion that holds earmold into place a little better—wouldn’t order a canal with someone with straight ear canal—bigger possibility for it to follow out

42
Q

Hierarchy of Tubing (LESS power to MORE)

A

Slim tube + open dome/slim tube + custom open dome
Slim tube + custom mold
Conventional earhook with earmold with 13mm tubing
Larger BTE + earmold

43
Q

Earmold Materials

A

Hard acrylic

Soft PVC/silicone

44
Q

Acrylic Material

A

hard, best for most adults, durable easy to modify—canal is too long and you can make it shorter–can polish, grind, shorten it

45
Q

Silicone or PVC material

A

best for kids–they’re more active, don’t want hard immovable object in their ear when they are doing sports

soft has more give to it, safety less feedback as kid grows–soft mold expands just a little bit, protection that as they grow it gets looser

good for severe-profound hearing loss, want to get a lot of power out of HA will most likely have some leakage little bit of expansion so mold fits a ltitle bit more tightly when its in

hard to modify

46
Q

Style

A

Acoustic effect: No

Important: yes

47
Q

Material

A

Acoustic effect: No, doesn’t enhance HF or Lf, minimal feedback control
Worry about it: yes

48
Q

Venting

A

Acoustic effect: yes
should I worry: yes–less if get SAV
Available in ITE/ITC: yes, either choose vent size or get SAV if possible

49
Q

Tubing length

A

Acoustic effect: subtle
Don’t worry about it

legnth can only really affect it by earmold—enhance higher frequencies with short tube, reduce HF with long tube–shorter tube will be looser in ear and are more likely to have feedback

50
Q

Tubing diameter

A

Subtle acoustic effect

larger diamater #15, enhances HF
smaller diameter enhances LF

51
Q

Damping

A

Acoustic effect: Reduce peaks

HA company takes care of it in desgin of HA

52
Q

Vents

A

Effects frequencies up to 1000Hz, allowing low frequency sounds to pass out, not short waves

1mm vent: does nothing acoustically–better than totally occluded allows some ventilation, no acoustic addition

2mm: has effect up to 500Hz
3. 5mm: has effect up to 1000Hz

let more and more low frequency amplification escape as vent becomes larger—pressure vent just relieves pressure

53
Q

Sound Bore

A

Tweaks higher frequencies above 2000Hz

Can create a horn within the tubing–if tubing is made bigger, will increase HF if tubing is smaller towards medial tip of earmold will suppress HF and enhance LF

54
Q

Dampers

A

Tweaks mid frequencies 750-4000Hz

mostly don’t need to damp, add resistance to the system–just to reduce resonance in the signal–reduces peaks–don’t want a ton, effects midfrequencies

55
Q

Occlusion Effect

A

get a good 15dB boost to their voice, same with 1mm

as open up vent, occlusion decreases and by 3.5mm there is no more occlusion

Amplification (1 decks)

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