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AMP II > Practical > Flashcards

Practical Flashcards

1
Q

what happens if you increase soft gain

A

increases CR

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2
Q

increasing SG & CR

A

makes soft sounds audible

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3
Q

what happens when you decrease soft gain

A

decreases CR

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4
Q

what does decreasing SG & CR do

A

makes soft sounds audible

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5
Q

what happens if you increase loud gain

A

CR decreases

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6
Q

increasing LG & decrease CR

A

makes signal more crisper and clearer

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7
Q

decreasing LG

A

increases CR

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8
Q

decreasing LG & increasing CR

A

improves the comfort of loud sounds

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9
Q

noiseblock

A

DNR in phonak

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10
Q

machine noise

A

DNR in starkey

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11
Q

normal hearing

A

0-20

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12
Q

mild hearing

A

20-40

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13
Q

moderate hearing

A

40-55

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14
Q

moderately severe

A

55-70

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15
Q

severe

A

70-90

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16
Q

profound

A

90+

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17
Q

what vent for 50-60 loss

A

.5 to none

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18
Q

vent size for 40-49 loss

A

1-2mm

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19
Q

vent size for 30-39

A

2-3mm or power

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20
Q

20-29 loss vent size

A

3-3.5 or closed dome

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21
Q

</ 20dB up to 1.5

A

open dome

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22
Q

what is the occlusion effect

A

Increased perception of ones own voice when there is something blocking the ear canal

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23
Q

what hearing loss does BTE fit

A

all

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24
Q

what hearing loss does slim tube fit

A

mild to mod HL
-10 in lows up to 55

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25
Q

RIC fitting

A

min to severe
-10 to 90

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26
Q

ITE fitting

A

normal LF to mod severe
-10 to 70

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27
Q

ITC fitting

A

slight LF to mod severe
20-70

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28
Q

cic

A

mild to mod severe
25 to 70

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29
Q

IIC

A

mild to mod severe
25 to 70

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30
Q

what HA’s can be used for a patient with mild to moderate hL

A

BTE
Slim
RIC
ITE
ITC
CIC
IIC

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31
Q

What HA’s can be used for normal LF to moderately severe

A

BTE
RIC
ITE
ITC (needs 20 LF)

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32
Q

what HA’s can be used for near normal LF to moderately severe

A

BTE
RIC
ITC
CIC

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33
Q

what ha’s can be used for mild to moderately severe HL

A

BTE
RIC
CIC
IIC

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34
Q

what HA’s can be used for severe HL

A

BTE
RIC

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35
Q

what HA’s can be used for profound HL

A

BTE

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36
Q

what is a cros

A

Contralateral routing of sound
Single sided deafness - one ear is normal and poorer ear is unaidable
One good ear and one bad

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37
Q

full shell fitting

A

higher output for sev to profound

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38
Q

what is a bicros

A

Bilateral contralateral routing of sound
Bilateral asymmetric HL - one ear has threshold loss & poorer ear is unaidable
Both ears are bad, asymmetry HL

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39
Q

skeleton moldfitting

A

mild to severe (25-90)

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40
Q

canal mold fitting

A

mild to severe (25-90)

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41
Q

canal lock fitting

A

mild to severe (25-90)

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42
Q

half shell fitting

A

mild to severe (25-90)

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43
Q

open dome

A

</= 20 in LF and HF loss

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44
Q

closed dome or tulip

A

20-29

can be accompanied with custom with vent 3-3.5

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45
Q

power dome

A

30-39

can be accompanied with custom with vent size 2-3

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46
Q

when should you use vinyl

A

infants, firm ear texture, high gain, older adults w/ dexterity issues, facial flex concerns

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47
Q

adv/dis of vinyl

A

adv: easily modified, softens at body temperature, snug fit

dis: shrinks, discolors, hardens, has to replace very 6-12 mos

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48
Q

when to use silicone molds

A

peds
high gain
allergies
facial flexa

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49
Q

adv/dis of silicone

A

adv: doesn’t shrink, durable, hypoallergenic, snug fit

dis: can cause blisters, disocomfort, hard to modify, costs more

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50
Q

when to use lucite/acrylic molds

A

adults
mild to sev losses
soft floppy pinnas

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51
Q

adv/dis lucite/acrylic

A

adv: durable, doesn’t srhink, smooth for easy insertion

dis: incrased risk of feedback, injury if hit, doesn’t compress to move beyond narrow/tortuous areas

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52
Q

tubing for mild to moderate losses (30-50)

A

13 standard

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53
Q

tubing for moderate to severe (50-70)

A

13 heavy wall

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54
Q

tubing for severe to profound (70-100)

A

13 double wall

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55
Q

describe expansion

A

needed when someone complains about soft sounds they do not need to hear

really low CR (lower than linear), adds large amounts of gain to increase TK

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56
Q

describe WDRC

A

AGCI
input compression
needed to add more to soft sounds, less to moderate sounds and even less to intense sounds

restores loudness perception

CR is low - almost linear

TK is low

SLOW AT & RT

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57
Q

describe output limiting compression

A

protects the ear from loud sound
AGCo

high TK

high CR

fast AT
variable RT

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58
Q

what is SII

A

Calculates % of speech info that is audible and usable to the listener

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59
Q

what is an SII of 50%

A

SII of 50% of speech cues supporting intelligibility are audible in a quiet setting

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60
Q

Increase in # of dots

A

requency region with higher contribution to intelligibility (HF)

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61
Q

Decrease in # of dots

A

frequency region with reduced contribution to intelligibility (LF)

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62
Q

what is the purpose of LDL

A

needed to ensure amplified output doesn’t exceed the individual’s loudness tolerance

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63
Q

how to explain LDL results to a patient

A

This test determines how much loudness you will be able to tolerate out of a hearing aid or in everyday environments. The average is 100-105.

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64
Q

what is ANL

A

determines how much willingness a listener can listen to speech in presence of background noise

Predictive of hearing aid satisfaction with 85% accuracy
Identifies those who will have more difficulty adapting to amplification

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65
Q

what is a low ANL score

A

<7

Indicates the patient ACCEPTS a lot of noise background noise w/o issues
This patient is likely to wear hearing aids on a regular basis

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66
Q

what is a high ANL score

A

> 13

Indicates the patient LACKS TOLERANCE for background noise
This patient is less likely to wear hearing aids regularly

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67
Q

Indicates the patient LACKS TOLERANCE for background noise
This patient is less likely to wear hearing aids regularly

A

May require extra post-fitting counselling or adjustment period

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68
Q

how to explain anl to a patient

A

This test where I had you face the speaker and noise and a story was coming out at the same time allowed me to test your tolerance level of background noise. Do you find that you are bothered by this easily or it takes a lot before it does?
Yes bothered easy - this test and the results confirmed this and showed me that you do (high anl score)
No - this test and the results confirmed this and showed me that it takes a lot of background noise before it bothers you. (low anl score)

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69
Q

what is SNR

A

Speech intelligibility in noise remains the #1 improvement patients seek with hearing aids

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70
Q

SNR loss of 0-2

A

normal

might benefit with omni or directional mic

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71
Q

snr loss of 2-7

A

mild

recommend standard directional mic

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72
Q

snr loss of 7-15

A

moderate

requires beamforming mics in additon to directional mics

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73
Q

> 15 snr

A

severe

need remote mic in addition to the rest for the other losses

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74
Q

what is the point of rem external loudspeaker

A

generating variety of input signals

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75
Q

what is the ear level probe module

A

connects to the REM systema

has ref mic
retention cord
probe tube
probe mic

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76
Q

what is the ref mic on probe module

A

monitor and calibrate the soundfield speaker output, maintaining the desired signal intensity at the measurement point

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77
Q

what is the probe tube on teh probe module

A

measure the intensity of the signal arriving to the TM

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78
Q

what is the prob mic on the probe module

A

collects and measures sound from the probe tube attached to it
Stem

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79
Q

Aided output of 15dB in needed to achieve binaural benefit

A

true

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80
Q

describe type i test signal

A

Brief puretone signal swept over a variety of frequencies

dribes higher output than speech and accurately shows MPO

DFScan attenuate it & doesn’t show how compression or channel interaction affect output

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81
Q

describe type II signals

A

complex “speech-like” signals
Broadband signal consisting of random frequencies occurring at different intensities

mimics speech
might not see all spectral issues or device’s true response to different spectral shapes

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82
Q

types of type II signals

A

Type II Signal Standardized Speech Signals (Calibrated)

Non-standardized signals

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83
Q

Standardized Speech Signals

A

Calibrated
repeatable, consistent signals to verify a device’s ability to meet prescriptive targets for output & frequency response

ex: Speechmap- speech signals filtered to provide the long-term average speech spectrum (LTASS)
ISTS- International Speech Test Signal: 6 female talkers reading the same passage in American English, Arabic, Chinese, French, German and Spanish
ICRA- International Collegium for Rehabilitative Audiology: distorted speech signal is a recording of an English-speaking talker that has been digitally modified to make the speech largely unintelligible

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84
Q

Non-standardized signals

A

not used for amplification programming

Measures output of different signals, good for counceling, intensities and frequencies are less repeatable

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85
Q

Visual representation of modulated speech sounds

A

LTASS “SPEECH ENVELOPE”

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86
Q

Measured by averaging a measured signal for 10 seconds

A

ltass

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87
Q

Speech envelope has a crest factor of ______ dB (louder speech signals) & valleys of _____ dB (soft speech signals)

A

+12
- 18

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88
Q

The difference between the valleys (softest signal) and peaks (loudest signal) of speech is ______dB SPL

A

~30

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89
Q

The Speech Intelligibility Index (SII) is maximized when the entire speech is above threshold.

A

yes

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90
Q

Difference bw threshold & LDL represents

A

dynamic range

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91
Q

Probe Mic calibration

A

Place tip of probe directly over reference mic
The modified pressure concurrent equalization calibration signal arrives simultaneously to the probe tip and reference mic during. Therefore, the “distance” b/w the reference mic and probe tube tip becomes acoustically invisible

Ref mic must face speakers during calibration
Hold probe module 6” to 36” away from the speaker
Keep your fingers and body out of the way!
Present calibration signal

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92
Q

test box calibration

A

Position reference test mic on reference point with reference test mic grid w/ in 1mm from reference mic
Close chamber
Press Tests, Test box measures, calibrate, start test

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93
Q

Measurement mic that is sealed into the coupler and collects output data from the HA

A

Coupler mic

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94
Q

Calibration Method Protocols

A

Substitution method of soundfield equalization

Modified pressure methods

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95
Q

Substitution method of soundfield equalization

A

Done before the PT arrives, placed at where subject’s head would be, stored as a reference point, used to calibrate the reference mic and probe
Impacts results if the subject changes location or moves

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96
Q

Modified pressure “concurrent equalization”

A

reference mic monitors test signal throughout test to equalize and adjust, calibration signal replays every 10 seconds (pink noise segment)

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97
Q

Modified pressure “stored equalization”

A

probe is calibrated one time on PT’s ear & stored for fitting process
Used to avoid ref mic contamination (stops it) - happens when amp output escapes ear canal through open dome

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98
Q

Probe tube Calibration & Acoustic Transparency

A

probe microphone module cannot be physically located in the ear canal; the probe tube serves as an extension to the probe microphone
Probe tube tip is placed directly over the reference microphone during calibration. This protocol accounts for the different intensities arriving to the probe microphone module’s reference mic and through the probe tube.
The unit mathematically adjusts the intensity differences removing the tube’s resonance effects.
This procedure makes the probe tube “acoustically invisible”

99
Q

HA1 coupler

A

simulates custom products

small

100
Q

ha2 coupler

A

bte
longer

101
Q

what is working distance

A

Distance allowed bw PT and speaker (18”-36”)
Reflective surfaces & tester: 2 x WD (about 34-36 in away)

102
Q

Ambient noise in the room must be 10dB lower than REM signal

A

true

103
Q

Horizontal plane: 0º azimuth: greatest reliability

A

true

104
Q

Vertical plane: speakr should be level to the PT’s ear in order to accurately measure HF output

A

true

105
Q

what is reur

A

natural response resulting from the pinna and ear canal that the PT walked in the door with
Changes due to: size, shape, abnormal anatomy, age, and ear to ear

106
Q

Otoscopy

A

Watch direction/angle of EAC
Helps w/ probe tube insertion
Check for cerumen/debris
Can interfere/plug tube and interfere with placement
Insert at an angle to avoid cerume or remove it before

107
Q

probe tube placement protocol

A

Place patient at appropriate distance/azimuth from loudspeaker (e.g., 0.5 m/0 degree).
The reference mic must face the room (away from the patient’s neck)
Use the blue cord to stabilize the probe module under the earlobe
Clip the probe module cable to the opposite side to stabilize the location of the reference mic
Slip the probe behind the blue cord so the black marker lays in the inter-tragal notch
On audioscan navigate to On-ear measurements, speechmap, Present 65 dB SPL pink noise signal and insert probe
Go until HF output confirms tip is w/in 5mm of ™
move black marker to intertragal notch

108
Q

how can you confirm tube is w/in 5mm of tm

A

Look at HF notches
It is w/in 5mm when notch no longer dragging gain curve down in HFs (not >5dB at 6kHz)
More than 5mm away results in acoustic nulls from standing waves

109
Q

what is REOR

A

measurement of insertion loss caused by placing an earmold/dome in the ear canal

110
Q

what is RECD

A

A sound generating transducer produces a signal in the ear canal and in a 2cc coupler to measure the resonance of each.
Difference bw SPL resonance of a 2cc coupler and that of the real ear

111
Q

what is the practical benefit to recd

A

personalizes conversion factors; adjusts for the absolute volume as well as impedance differences in the canal

112
Q

what are the 2 purposes to recd

A

correct & convert individuals HL audiometric thresholds to SPL values (allows for precise adjustments for differences in ear canal volume and impedance variations) & predicts the real–ear output when the HA measurements are made in the test box

113
Q

what are ansi standards of RECD

A

Can be made with a custom earmold or foam insert

requires use of HA1 Coupler

114
Q

Meets ansi standard, #1 standard for RECD

A

ha 1

115
Q

2 standard for ansi

A

ha2

116
Q

RECD protocol (with patient first)

A

Connect the coupler to the RECD transducer’s nozzle and place in the test box to calibrate

On audioscan, go to tests, on ear measurements, RECD
Prompt will be either foam tip or earmold

Calibrate

Go to tests, on ear, speechmap. Perform HAND WASHING & OTOSCOPY then REUR (see above protocol) to ensure probe is 5mm from ™
Insert foam tip into the ear making sure the probe tube doesn’t move & allowing it to fully expand

Go to tests, on ear, RECD, press (measure real ear)

Once it stabalizes click continue to save data. Print data

117
Q

negative RECD in the LF

A

check foam seal
increase the size or add lubricant

118
Q

RECD curve deviates more than 10dB from 4-6

A

check probe tube placement
may have blockage (foam tip or cerumen)

119
Q

RECD pink lin

A

real ear measurement
real ear resonance

120
Q

RECD green line

A

recd calibration
coupler resonance

121
Q

recd dots

A

avg HA1 RECD

122
Q

RECD blue line

A

HA-1 RECD (measured on PT)

actual RECD measured

123
Q

negative LF value suggests

A

slit leak
(blue line dips below in LFs)

When pink goes below green in LF = slit leak = acting like a vent effect = poor seal

124
Q

LF sound leaks out around it and causes negative RECD values below 1000 Hz

A

loose fitting mold or large vent

125
Q

Negative LF results are expected when

A

perf or pe tubes are present

Below 1.5 kHz RECD will be up by 8dB lower than the adult avg indicating ECV is larger than normal

126
Q

Negative RECD >10dB in the 4-6 kHz region

A

probe tube blockage
check probe tube placement or blockage and remeasure

127
Q

RECD Below the average line

A

larger than avg

128
Q

RECD Above the average line

A

smaller than average

129
Q

what does open mastoid cavity look like

A

decreases RECD in mid to highs

130
Q

what does MEE look like

A

increased REC in mid frequencies

131
Q

protocol to programming in the test box

A

enter into noa & audio

Connect HA to software
Connect HA to coupler

On audioscan, go to tests, test box, speechmap

Change instrument to BTE HA-2

Click Audiometry and change
Rx method (dsl, nal, etc.)
Set UCL to measured
Set RECD to measured
Enter audio, UCL & RECD data

On software:
Set planned acoustic parameters for the device
Set fitting algorithm (NAL, DSL, manufacturers)
Set experience level to 100% & create “first fit” for PT
Do not run DFS

On audioscan, run speechmap verification in test box at 65dB
Adjust bands as needed to meet targets
Run 50-55 dB
Adjust gain in compression shaping channels as needed
Run 70-75
Adjust gain in channels as needed
Run MPO at 90
Adjust MPO to maximize or reduce output of device

Verify audibility of HFs /s/ sound
Adjust FL to MOAF as needed

132
Q

Proprietary formula

A

developed by manufacturers
REM targets aren’t available

133
Q

NAL-NL2

A

Loudness equalization formula - balances perception of loudness over a range of frequencies (LFs have more energy than HF so this increases mid and high intensity until energy equals the lows)
Uses REIG targets
If PT is desiring increased intelligibility
Adults only

134
Q

If PT is desiring increased intelligibility

A

nal nl2f

135
Q

DSL 5.0

A

Loudness normalization formula - maximizes audibility to assist language development
Uses REAR output targets (soft, moderate and loud are increasted)
Provides targets for MPO
PT is desiring increased comfort or their REUR is not average
Adults and kids

136
Q

Milder thresholds

A

low TK (~30 dB SPL)

137
Q

Severe thresholds

A

higher TK (~60 dB SPL) - too much gain of soft results in loss of intelligibility here

138
Q

PT is desiring increased comfort or their REUR is not average

A

dsl 5.0

139
Q

decrease intensity of loud inputs does what to compression

A

increase

140
Q

Decrease intensity of loud input levels (increase CR) of what portion of LTASS

A

upper

141
Q

soft signals

A

Adjusting CR in order to optimize detection of soft input signals or reduce loud input signals for increased comfort

142
Q

Adjustments here adjusts the bottom portion of the speech envelope

A

soft signals

143
Q

Adjustments here adjusts the top portion of the speech envelope

A

loud signals

144
Q

what can raising MPO do

A

make it sound clearer, brighter & scrisper

145
Q

what can lowering mpo too low do

A

sound muffled, dull, distorted or squashed

146
Q

too high of an MPO pt complaints

A

PT experience is negative and they conclude HA’s are not useful

147
Q

too low of an mpo pt complaints

A

distorted speech due to peak clipping

148
Q

When you adjust a band, you adjust

A

entire speech envelope up and down

149
Q

When you adjust a channel, you either adjust

A

bottom or the top of the speech envelope

150
Q

move bands, raise soft sounds, then raise loud sounds - maintain balance bw

A

all the CR TKs

151
Q

SII for frequency bands

A

60-70%

152
Q

SII for compression shaping of soft input

A

35-40%

153
Q

clinical reasoning for LTASS levels falling within +/- 5dB

A

Begin by following +/- 5dB match target rule as a good general guideline
However, make further adjustments based on PT complaints
The line must match the shape (contour) of the targets that are present

154
Q

How do you adjust and verify HF /s/ sound

A

Use the /s/ stimulus on audioscan to assess HF audibility
Adjust frequency lowering in manufacturer software if needed
Too much audibility = poor sound quality
Goal is to add least amount of FL needed

155
Q

Lower limit of MOAF

A

frequency where LTASS becomes inaudible

156
Q

UPPER LIMIT OF MOAF

A

upper range frequency where speech envelope becomes inaudible

157
Q

what is MOAF

A

Max audible output frequency range)
Region where audibility ends?

158
Q

keys to adding manual programs

A

make sure programs are linked to the primary one so that changes are applied to all

159
Q

DSP features

A

directional mic
DNR
music settings
phone seetings
at/rt
tk levels
etc.

160
Q

Closer the lines are the higher the compression ratio is

A

true

161
Q

Further lines go apart - more linear

A

true

162
Q

If we shift tk up and down it impacts signal at kneepoint and the rest of the signal

A

no it doesnt effect the rest of the signal

163
Q

ILD

A

HF above 3 kHz

164
Q

ITD

A

LF below 850 Hz

165
Q

Strategies for binaural advantage

A

Fit better ear first
Relies on this for communication
Fit poorer ear second after good ear is optimized

166
Q

cros verification

A

PT sits with better ear toward speaker at 45 deg angle
present with no aids

turn same deg to poor ear
present with no aids

add aids
PT sits with poor ear & cros device at 45 deg to the speaker

the aided ltass equals unaided becuase CROSS elimaes head shadow

167
Q

type I NIHL fitting

A

represents the configuration after a few years of exposure
Normal or near normal to 2k Hz then crops to a moderate notch at 4 kHz back up to a mild HL in the HFs
Special fitting strategies aren’t necessary

168
Q

Type II NIHL fitting

A

represents many years of excessive exposure to noise
Threshold loss extends into the lower frequencies (i.e., below 2000 Hz).
Use of typical fitting strategies may help if output supplies HF audibility

169
Q

type III NIHL

A

represents the extreme case in which hearing is near normal for the low frequencies only
Threshold loss shows a precipitous slope into the high frequencies.
Special fitting strategies are needed to support success

170
Q

Full high frequency audibility is not a reasonable goal due to comfort and sound quality problems.

A

true

171
Q

Protocol for NIHL (i and ii)

A

add 5-8 before the drop
region of residual add audibility

disable FL
add audibility in residual frequency ranges (avoid adding to those close to LDL)
add 5-8dB to normal range before precipitous drop
enable expansion to reduce mic noise when hearing is near normal below 2
verify audibility of s
adjust and add FL 4-6wks after first fit

172
Q

protocol for type iii nihl

A

Add gain to thresholds below 85 dB HL

Strive to achieve a balance audibility from 500 Hz up to 3k Hz,for thresholds below 85 dB HL
Add 5-8 dB of gain to normal thresholds just before the precipitous drop
This bump of audibilityfor normal thresholds benefits sound quality and intelligibility
Enable expansion to reduce mic noise when hearing is near normal below 2k Hz
Internal noise will cause patients to lower overall volume
If a threshold is near LDL, apply no gain or 1/5 the threshold (2% of threshold vs.46%)

173
Q

Full high frequency audibility is not a reasonable goal due to comfort and sound quality problems.
Focus on supplying gain to heathier areas of the cochlea in the low and mid-frequencies
There’s no need to select a receiver offering wider frequency responses with extended high frequencies

A

nihl type III

174
Q

do you need special fitting strategies for 1-2 cochlear dead regioins?

A

no might need for more

175
Q

how to adjust for more than 2 dead regions

A

add HF gain only if 1-2 dead regions are bw 1-4kHz

2/3 of those with more than 3 dead regions preferred HF audibility

176
Q

reverse slope fitting

A

focus on residual hearing regions audibility

leads to unsuccessful fitting: adding too much LF gain (upward masking)

add 15-20 to LF & mids
add 10-15 to increase audibility at 2kHz & above if WNL
allow PT to habituate before increasing
add MF gain in 5 dB steps after habituation
once LF & MF are adjusted comfortably modify HF based on their perceptions and adding 5-10

177
Q

Additional gain is needed to overcome the attenuation caused by the mechanical loss

A

chl

178
Q

A/B gaps with normal B/C thresholds: is compression needed

A

not needed because the dynamic range is normal.
very low cr or linear is good

179
Q

A/B gaps with abnormal B/C thresholds (mixed loss): is compression needed

A

Compression is needed in addition extra gain due to the reduced dynamic range

180
Q

which Rx method adjusts for ab gaps

A

na nls

181
Q

CHL formula

A

add 25% of AB gap to AC threshold
calculate gain rec for ac threshold
add 25% of ab gap
increase MPO by same % used for ab gap calcuatio allowing extra gain headroom

*Subtract AC threshold from BC threshold
Take this value and multiply by .25
This is the 25% conductive component

182
Q

small perf

A

1-2mm
minimal hl

183
Q

large perf

A

25-35 chl

184
Q

total perf

A

around 40 CHL

185
Q

Posterior-superior w/ ossicular erosion

A

may result in a loss as great as 60 dB

186
Q

options for perfs

A

BC/Bone ancored devices
Some dislike surgical recommendation or are not candidates
Ear level device (HA’s, etc.)
Will the pathology allow for an ear level device?
What pathophysiologic concerns must be considered?
Style considerations?
Prescriptive considerations?
Verification considerations?

187
Q

severe to profound fitting

A

use nal-rp
establish their LDLs
reset their MPO to LDL in fitting software to max headroom
evaluate audibility of 65dB signal (its ok if signal below LTASS audibility is not possible)

use nal-rp, low CRs, & slow acting compressions

188
Q

Raising or lowering TK modifies output for

A

soft input signals

189
Q

Increasing or decreasing low frequency bands changes perception of

A

volume and sound quality

190
Q

Increasing or decreasing high frequency bands improves

A

clarity or comfort

191
Q

Increasing or decreasing intensity of soft input signals improves

A

clarity

192
Q

Increasing or decreasing intensity of loud input signals improves

A

clarity or increase comfort

193
Q

Increasing or decreasing MPO manages

A

very loud signals (90+)

194
Q

“My voice is hollow I sound like I’m talking in a barrel; it’s annoying when I chew crunchy foods”

A

shell origin (OE)
or amp origin

195
Q

describe shell origin

A

Prevalent when LF thresholds are <40 dB HL
Complaint continues when device is off

196
Q

how to manage shell origina

A

Open the vent or increase the earmold canal length
If open dome doens’t allow enough HF gain due to feedback a custom hollow-shell earmold with a 2mm or larger vent can allow this LF energy to escape the ear canal

197
Q

does their voice sound better with the device on

A

shell origin - modify the shell

198
Q

if there is no change in their voice with it on or off

A

probably shell origin
modify shell

199
Q

if there voice sounds better with the device off

A

amp origin.- modify HA gain/output

200
Q

describe amp origin

A

can combine with OE to exacerbate the complaint
Complaint stops when HA is off because gain related issue isn’t present if it is off

201
Q

how to manage amp origin

A

Lower LF band 4-6dB to improve
If this doesn’t help increase LF band 4-6 to overcome combo of mild OE & under amplification
Try manufacturer’s fitting assistant
Change the loud LF channel first

202
Q

if you push the HA in to make it tighter or deeper and this improves voice complaint

A

increase canal length of device or improve aperture seal

203
Q

if you pull the HA out and this improves voice complaint

A

increase vent size or shorten canal length

204
Q

no difference when you push it in or out

A

probably amp origin and gain output needs changed

205
Q

voice gets worse when they are loud

A

Indicates saturation or excessive gain
Adjust mpo or loud input

206
Q

voice gets worse when they are softer

A

Insufficient gain
Increase LF band or soft inputs

207
Q

no difference with speaking at differing intensities

A

OE

208
Q

HF amp origin

A

Describes own voice as sounding like an echo, lispy, raspy or muffled
Report an unnatural perception of their voice coming from somewhere else

Increase gain in mids
Try manufacturers fitting assistant

209
Q

processing delay origiin

A

PT complains voice echoes or their head is in a barrel

PT hears delayed signal resulting from DSP

Reduce vent size if you can - test by putting finger over vent while they talk
Change brand for faster processing

210
Q

ex of low f soft signals

A

computer hum
purring kitten
vowels

211
Q

ex of high f soft signals

A

leaves rustling
clock tick
consonants

212
Q

ex of high f loud input signals

A

running water
paper crinling
dishes

213
Q

ex of low f loud input signals

A

slamming doors
traffic
own voice

214
Q

complaint: ha echoes

A

increase vent size
decrease LF gain bands

215
Q

complaint: barrel sounding

A

incrase vent size
decrease LF gain bands

216
Q

complaint: plugged feeling

A

incrase vent sie
decrease lf band gain
remake w/ longer canal

217
Q

own voice echoes

A

increase vent size
cecrease lf gain bands
remake w/ longer canal

218
Q

LF gain complaints

A

echoing, hollow sounding, barrel sounding

219
Q

too much gain and output complaints

A

background is too loud
voices are too loud
HA booms
HA is too loud

220
Q

complaint: loud background noise

A

decrease bands of LF gain
decrease loud LF gain to increase LF CR
decrease overall gain

221
Q

common adjustments for lf gain complaints (sounding hollow, in a barrel, feeling plugged)

A

increase vent size, decrease bands of LF gain

222
Q

common adjustments for too much gain and output complaints (background noise, voices are loud, ha boom, ha loud)

A

decrease overall gain
decrease bands of LF gain

223
Q

too little gain and output complaints

A

not loud enough
too soft
cannot hear with it on
ha is weak

224
Q

complaint: ha not loud enough

A

increase overall gain
increase mpo
increase lf gain bands

225
Q

too little gain and output complaints (not loud enough, cannot hear, weak)

A

increase overall gain
increase mpo
increase lf gain bands

226
Q

complaint: ha is too sfot

A

incrase overall gain
increase bands of LF gain
increase MPO

227
Q

cannot hear with ha

A

increase overall gain
increase lf gain bands
incrase mPO

228
Q

hearing aid is weak

A

increase overall gain
increase MPO
increase lf gain bands

229
Q

too much HF gain complaint

A

ha whistles
sounds tinny
sounds shapr
sounds harsh

230
Q

solution for ha whistles
sounds tinny
sounds shapr
sounds harsh

A

decrease HF gain bands

decrease loud hf gain to increase hf cr

231
Q

ha whistles

A

decrease bands of hf gain
decrease vent
remake
cerumen blockage?

232
Q

tinny ha

A

decrease bands of hf gain
increase bands of lf gain

233
Q

sharp ha

A

decrease bands of hf gain
decrease loud hf gain to increase hf cr

234
Q

harsh ha

A

decrease bands of HF gain
derease loud hf gain to increase hf cr

235
Q

my voice sounds echo, hollow, plugged, barrerl

A

increase vent or extend canal
decrease LF band
decrease overall gain

236
Q

my voice sounds muffled

A

increase loud HF and HF gain to reduce CR
increase overall MPO
increse HF band and decrease LF band

237
Q

my voice sounds distorted or unnatural

A

decrease loud HF and LF gain to increase CR

238
Q

voices are too loud
all sounds are too loud
voices are harsh

A

reduce overall gain
increase CR by reducing HF loud gain

239
Q

cannot understand SIN

A

increase HF band
increase soft HF gain to increase CR

240
Q

voices at a distance soun better than close

A

increase HF band
decrease soft HF gain to decrease CR then try soft LF gain

241
Q

thresholds at 250 are 30, 45 at 500 and 50 at 1000. slopes from a mild to severe hearing loss what vent and hearing aid style?

A

custom mold with a 1-2mm vent (not power due to 500 being below 45)

RIC, BTE

242
Q

thresholds at 250 are 55, 45 at 500 and 50 at 1000. slopes from a moderate to severe hearing loss what vent and hearing aid style?

A

no vent or .5 vent

RIC, BTE

243
Q

voices are too soft
all sounds too soft
ha too soft

A

increase overall gain
increase mpo
increase soft gain overall to increase CR

AMP II (7 decks)

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