Module 11: Fine Tuning

Question 1

T/F: first time hearing aid users need to re-learn to ignore certain sounds in the environment (e.g., fan noise, footsteps)

Answer 1

True

Question 2

Questions to ask patient at the first follow-up post-fitting

Answer 2

-Improvement in hearing, example of situations that remain difficult, comments from significant others
-Clarity of sounds: own voice, voices of others, conversation
-Tolerance to loud sounds
-Hours of HA use, frequency of VC use, use of manual programs
-Hearing on phone
-Handling of hearing aids (insertion/removal, batteries)
-Physical comfort
-Anything else that you noted in your journal/progress notes at the time of fitting
-Questions related to situations specified on COSI

Question 3

What two things do we need to consider when a patient tells us their “voice doesn’t sound normal”?

Answer 3

Is it an occlusion problem or an issue with the acoustic/conductive balance?

Question 4

When people without hearing aids speak, they hear their own voice through ____ (acoustic/conductive) pathways

Answer 4

Acoustic & conductive

Question 5

When people with hearing aids speak, they hear their own voice more through the ____ (acoustic/conductive) pathway

Answer 5

Acoustic

Question 6

True Occlusion: when we put in a hearing aid, the vibrations from the ____ portion can no longer escape via the ear canal and this can raise the level reaching the TM (highly variable) & is typically low frequency in nature (500 Hz and below)

Answer 6

Cartilaginous

Question 7

What can result in a ‘head in a barrel’ quality of our voice?

Answer 7

Occlusion

Question 8

The occlusion effect can cause an increase of ____ dB in an occluded vs “open” canal

Answer 8

20-30

Question 9

Occlusion effect complaints

Answer 9

-Own voice sounds loud, hollow, and/or boomy
-Chewing becomes aggravating

Question 10

How can we determine if occlusion effect is causing the own voice complaints or if it’s something else?

Answer 10

-Ask if other people’s voices are “bad” too. If no, then suspect OE
-Turn HAs off and in place and ask if the complaint is still there. If yes, suspect OE
-Measure ear canal SPL to patient’s voice (“ee”). If SPL increases with HA in place and turned off, then it’s OE

Question 11

Possible solutions for occlusion effect

Answer 11

-Increase venting (so that sound pressure in canal can escape)
-Open-canal fitting (if audiometric configuration allows)
-Decrease LF gain (not additionally adding low frequency gain unnecessarily)
-Increase LF gain for high level sounds so that amplified speech exceeds (masks) the SPL caused by OE

Question 12

What could it mean when a patient tells us “my voice sounds distorted”?

Answer 12

-The input level could be saturating the hearing aid (in a saturation response, higher input does NOT translate to higher output)
-Patient could mean boomy, hollow, tinny etc. Is this the OE? Could changes be required in HA gain at specific frequencies?

Question 13

What could it mean when a patient tells us “my hearing aid sounds dull, muffled, unclear”?

Answer 13

-If this occurs in noisy environments only, we could reduce noise reduction
-If this occurs in all environments, we could increase HF gain for additional clarity

Question 14

What could it mean when a patient tells us “my hearing aid sounds tinny, sharp, hissy, metallic”?

Answer 14

-Want to know if this is most noticeable in noisy environments or all environments
-Possible solutions include decreasing HF gain, reducing speech enhancement, and increasing LF gain

Question 15

What could it mean when a patient tells us “I hear noise, static, etc in the HA”?

Answer 15

-If the person has good LF hearing, it could be internal noise (EIN)
-It could also be the fan in the clinic room or the hair against the mic
-Gain may need to be reduced for soft sounds
-Hearing aid could be malfunctioning

Question 16

What could it mean when a patient tells us “I can’t understand speech when there is noise around”?

Answer 16

-If there is a good fit to prescribed targets, we may need to counsel on realistic expectations of hearing aids (what were the WRS and Quick-SIN scores pre-fitting?)
-Are some HA features making speech understanding worse (e.g., noise reduction or frequency lowering)?
-Are DMs programmed appropriately? Is patient manually switching to noise program if applicable?
-Are accessories needed (e.g., remote mic or FM systems)?
-Counselling on environmental modification when possible

Question 17

What could it mean when a patient tells us “things are too loud”?

Answer 17

-“I can hear my footsteps”: reduce gain for soft sounds? Does the brain need to re-learn to ignore some sounds (adaptation)?
-“The hockey game I went to, the cheers from the crowd were too loud”: tolerance issue? reduce MPO? reduce gain for loud sounds? counselling instead (it should be loud)?
-“Everything is just a little too loud”: decrease overall gain? Adaptation?

Question 18

What could it mean when a patient tells us “it’s too loud when there’s noise around”?

Answer 18

-Tolerance problem? Reduce MPO
-Too loud but no discomfort? NR could be made more aggressive, gain for loud sounds decreased

Question 19

What could it mean when a patient tells us “things are too quiet when there’s noise around”?

Answer 19

-How aggressive is the NR system?
-Is average speech still audible with the NR activated?
·Using a noise input, obtain REAR with NR off and with NR on. Is REAR still audible when NR is on?
·With NR on, compare REAR with speech vs noise input

Question 20

What could it mean when a patient tells us “my noise program (or directional mic) doesn’t make any difference”?

Answer 20

-Does the patient understand the technology?
-Is the patient setting themselves up for success?
-How is the patient “testing” the noise program or directional mic?
-Is the directional mic working well?
-Measure front-to-back ratio in 2-cc coupler

Question 21

What could it mean when a patient tells us “my hearing aid cuts in and out”?

Answer 21

-Is the HA intermittent (needing repair or cleaning)?
-Is the HA “pumping” at high level inputs?
·Attack and release times?
·What is the CR?
-Is the noise reduction system too aggressive (too much change too rapidly)?

Question 22

What could it mean when a patient tells us “I can’t hear on the phone”?

Answer 22

-What phone system is being used?
-How is the phone being placed on the ear or near the hearing aid?
-How is the hearing aid coupled to the ear (open dome or closed dome or occluded earpiece)?
-What are the monaural WRS?
-Should the phone signal be coming to one or both ears?
-Placement, equipment, and signal choices**

Question 23

T/F: when making decisions regarding fine tuning of HAs, try changing one parameter at a time

Answer 23

True (remember that a change can potentially create a new problem)

Question 24

What should you adjust if patient complains that loud sounds are too loud (e.g., children screaming)?

Answer 24

Reduce high level input or increase CR

Question 25

What should you adjust if patient complains that soft speech is not loud enough?

Answer 25

Increase low-level input gain or lower TK

Question 26

What should you adjust if patient complains that speech is not clear?

Answer 26

Reduce CR

Question 27

What are software fitting assistants?

Answer 27

-Using drop-down menu, select the problem that matches the patient’s issue. The software will propose some HA modifications
-Need to decide if we agree on the proposed solution before applying**