Troubleshooting Complaints Flashcards
What do real ear measurements allow us to see?
The amount of audibility we provided
Its purpose is to provide us with a visual aid to guide our clinical expertise as we make changes for improved user satisfaction
Based on researched standard deviations, its expected about 1/3 of patients will prefer gain that is either higher or lower our +/- 5 dB guideline
What do you need to consider before starting to finetune a program?
Is this a problem that can be fixed through follow-up programming, or is it a counseling issue?
Communication strategy training? (go closer to the person speaking when they are in the other room)
Speech or visual perception training?
Will fixing one problem create a new problem?
Will the problem solve itself over time through acclimatization?
Does the patient know what is best for them? (yes, it’s not just matching the target; we are the experts so we should be responsible with making these decisions)
What are pitfalls of environmental classifications?
Advanced DSP features are intended to adapt the corresponding signal processing to a scene class to improve listener experiences
There are potentially hundreds of acoustic parameters that could positively or negatively influence the quality of each of the classification schemes they design
Is patient empowerment needed?
Yes
The process of helping clients discover personal strengths and capacities to take control of their lives (empowerment)
How can we empower our patients?
Explaining all aspect of audiologic rehabilitation (including non-HA solutions)
Conveying sufficient information in an easy-to-understand manner
Involving the client in decision-making and supporting the client’s choices
Does audiologic rehabilitation involve more than amplification?
Yes
Group aural rehab, communication strategies perceptual training
Will adaptation happen without the patient wearing the device?
No
Explain the importance of adaptation but then modify prescription to for improved tolerance
Lower volume or increase compression and gradually change these settings over time
Should we give the patient control of the device?
Yes
Enable VC or “pseudo” VC by adding a manual program that reduces output
Is it important to fully understand the complaint (no communication mismatch)?
Yes
Clarify your interpretation of the patient’s descriptors (Low? High? Everything?)
Sometimes descriptors aren’t words
I hear tst-tst-tst when people speak
Once you figure out its meaning teach patient an alternative descriptor, so you understand each other
“I think that “tst-tst-tst” sound means consonant sounds are annoying to you. Let’s call that tinny”
Or begin using “their” descriptor during fine-tuning: “Okay so if I make this adjustment does that “tst-tst-tst” improve?”
How should you conduct systematic fine-tuning?
Establish a baseline setting for comparison (this will be the original program that they weren’t satisfied with)
Change the program and check in with your patient. Keep their response simple:
“Does this sound better- worse- the same?”
Return to the baseline after every change for comparison
Should the changes to the fine-tuning be significant at first?
Yes
Make significant intensity changes initially- 4-6 dB
Initially select broad frequency ranges: i.e., all frequencies above/below 1.5k Hz
Final adjustments should be minimal when compared to the baseline (about 2-3 dB)
If initial programming was verified be cautious of changes > 12 dB SPL (based on research suggesting that programs close to target have an overall high satisfaction rate)
Does systematic change require careful tracking of adjustments so you can return to baseline?
Yes
Carefully count the number of ‘clicks’ you made
Use the back arrows to return to the baseline settings
What should you do if you get lost in the land of adjustments?
Exit programming module without “saving” to instrument or Noah data base
The device will revert to originally programmed settings
How is an occlusion effect diagnosed?
Prevalent when low frequency thresholds are < 40 dB HL
The complaint persists when the device is turned off
How you manage the occlusion effect?
Open vent, increase canal length
If a non-occluding dome doesn’t allow enough high frequency gain due to feedback, a custom hollow-shell earmold with a 2mmor larger vent effectively allows low frequency energy to escape from the ear canal and offers significant reduction of occlusion-related complaints
What is the low frequency amplification origin of own voice complaints (not OE)?
Complaint is due to low frequency amplification
It can combine with the occlusion effect to exacerbate the complaint
Sound of their voice amplified through the hearing aid (voice is much louder bc it is closer to the mic)
How is low frequency amplification complaints diagnosed?
The complaint stops with the hearing aid turned off
A gain-related complaint will not be present when the hearing aid is turned off
How do you manage LF amp complaints of own voice?
Too much - or surprisingly - too little gain in the low frequency region can lead wearers to complain that their own voice sounds too loud
Try lowering LF band 4-6 dB for improvement
If complaint persists, try increasing LF band 4-6 dB to overcome a combination of mild occlusion and under amplification
Try the manufacturer’s fitting assistant
Is the occlusion effect test different from the REOR?
Yes
What does the occlusion effect test tell you?
“PROBE MICROPHONE” scale shows the SPL reaching probe microphone tip
“REFERENCE MICROPHONE” scale shows the SPL of speech signal reaching the reference mic
“OCCLUSION” scale shows the degree of occlusion in dB SPL
How do you conduct the occlusion effect test?
Insert probe tube in canal
Place device in ear- muted or off
Patient vocalizes “eee” at moderate vocal effort
Press “stop test” to capture OE
For every 1 mm increase in vent diameter, how much will the occlusion effect be reduced?
4 dB
What is an alternative assessment to determine origin of complaint (without the occlusion effect test)?
Step 1: place the device in the ear but turned off
Step 2: ask patient to say, “Baby Jeanie is teeny tiny”
Step 3: turn on device & repeat steps 1 & 2
Step 4: ask if there is a difference in the quality of their voice when the device is turned on
If it sounds better with the device on or no difference - it is probably a shell origin
If it sounds better with the device off - amplifier origin (modify device output/gain)
How do you check the physical fit of the device?
Push on the hearing aids so it is tighter/deeper and pull them out slightly?
If sound improves when device pushed in? Recase to increase canal length of device or improve aperture seal
If sound improves when device is pull out of ear slightly? Increase size of vent or shorten canal length
If there’s no difference - It may be amplifier origin (try modifications to gain/output)
