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Amplification 2 > Verification Protocol > Flashcards

Verification Protocol Flashcards

1
Q

What should you do when you first see the patient?

A

Insert device and assess physical fit
Ensure ease of insertion
Confirm subjective comfort (static and dynamic movement)
Confirm directional mic orientation

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2
Q

Review speechmap setup

A
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3
Q

Will the system assume that the loss is SNHL unless you put bone conduction values in?

A

Yes
Enter BC only for ABG of 15 dB or greater

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4
Q

Should you say “no” to binaural when fitting NAL-NL2?

A

Yes
Even when you are fitting 2 hearing aids
NAL-NL2 doesn’t account for binaural summation, manually adjust the fitting down to account for it

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5
Q

Should you say “no” to binaural when fitting DSL?

A

No
You should say yes
DSL automatically adjusts for binaural summation when fitting is binaurally

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6
Q

What is REUR?

A

Real ear unaided response

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7
Q

Why is REUR done?

A

To confirm probe tube placement (turn on pink noise signal to guide)
To confirm cerumen hasn’t blocked the tip of the probe (clean probe tube if the cerumen hasn’t gone in the tube)

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8
Q

What is REOR?

A

Real ear occluded response

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9
Q

What does the REOR tell you?

A

The impact that the fitting tip, earmold or custom hearing aid has on the sound reaching the ear
Verifies vent effect or slit leak frequencies, transparency of open dome fit, and if the coupler will meet the patients needs

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10
Q

What are the steps for measuring REOR?

A

Insert hearing instrument without moving marker
Device is turned off
With the hearing aid and probe tube in canal present a 65 dB PINK NOISE signal on test #2
Select CONTINUE (or record) when the response stabilizes to measure REOR

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11
Q

What is the area of vent effect for the REOR?

A

Low frequency energy is released
The REOR is no different than open canal fitting

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12
Q

What is the usefulness of REOR?

A

Tells you if the vent effect or slit leaks limit the ability to add gain to those frequencies (low)

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13
Q

What is the REOR dip?

A

An unexplained dip in verified audibility
If the dip aligns with the transition point, it’s likely you’re seeing a transition b/w vented and retained gain
It might just be one of those things that you leave alone; even though the curve doesn’t look as pretty as you would like. The patient is not hearing a dip

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14
Q

Does the vent effect directly correlate with SNR advantage provided by directional mics?

A

Yes
Increased venting allows more audibility of direct signal which reduces SNR advantage

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15
Q

What is the REAR?

A

Real ear aided response
The absolute aided output and frequency response when a hearing aid is turned on

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15
Q

Why do we test REAR?

A

To view device’s absolute aided output in a unique ear canal
DSL prescriptive targets specifies REAR (OUTPUT) targets for signals arriving to the TM
In this way, the targeted output remains the same despite changes in anatomy
Average adult (peak resonance ~2-4k Hz)
Mastoidectomy (peak resonance ~ 1- 2k Hz)
Pediatrics (peak resonance ~ 6k Hz)
Perforation (peak resonance change based on change to volume)

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16
Q

Does the depth of receiver placement change the REAR?

A

Yes

17
Q

What is REIG?

A

Ear ear insertion gain
Measures the amount of GAIN needed to overcome the insertion loss (REOR) and restore audibility of the signal
The difference between the AIDED response and the UNAIDED response of the ear canal
REAR- REUR = REIG

17
Q

Why do we test REIG?

A

We adjust GAIN for soft, moderate and loud input signals within the programming software to achieve the desired real ear insertion gain (REIG)
NAL prescriptive targets specifies REIG (GAIN) targets to ensure loudness equalization is maintained

18
Q

What is the gray box?

A

Shows the speech envelope and LTASS for average conversational speech (65 dB SPL)

19
Q

What is the LTASS speech envelope?

A

Visual representation of modulated speech sounds
Speech envelope has a crest factor of +12 dB & valleys of - 18 dB
These two lines define the representative dynamic range of normal conversational speech over time (a 10 sec. measurement)

20
Q

What do prescriptive targets specify?

A

The REIG (gain) or REAR (output) needed at each audiometric frequency

21
Q

What do prescriptive targets need?

A

Verification and validation

22
Q

What is verification?

A

The process that let’s us see if our prescriptive formula provides sufficient output

23
Q

What is validation?

A

The process that let’s us see if the patient thinks our choices were beneficial

24
Q

What are contemporary REAR prescriptive target options?

A

Proprietary formula developed by manufacturers (REM targets aren’t available, but NAL-NL2 can be used)
NAL-NL2 (loudness equalization formula)
DSL 5.0 (loudness normalization formula)
Speech intelligibility index audibility targets (maximized audibility formula)

25
Q

What are the three characteristics that need to be verified and adjusted?

A

Gain/output (loud, moderate, and soft)
Compression
MPO

26
Q

What is the first thing to do when fitting?

A

First fit

27
Q

What is first fit?

A

Each brand’s software automatically programs gain, output, compression, and signal processing settings when you begin a fitting
The fitting software displays a graphic simulation of settings suggesting “first fit” settings provide sufficient gain and output
“Real ear” verification tells a different story

28
Q

Does REM identify a mismatch to targets?

A

Yes

29
Q

How do you get closer to targets?

A

Adjust frequency shaping bands to maximize audibility
Verify audibility of a speech signal by maximizing the Speech Intelligibility Index (SII) (present a 65 dB SPL standardized speech signal)

30
Q

What is the goal when matching targets?

A

To be within 5 dB +/- of the target cross

31
Q

Do you need to adjust the compression shaping channels when fitting?

A

Yes
You need to adjust compression ratio to optimize detection of soft input signals or reduce loud input signals for increased comfort

32
Q

How do you adjust the compression shaping channels?

A

Select a range of frequencies for only one input level (soft gain or loud gain) in a row to compression shape a channel
Avoid adjustments to gain for moderate input levels

33
Q

How do you check detection of soft input signals?

A

Present 55 dB SPL Speechmap input signal on a loop
You may begin making adjustment, BUT don’t record the LTASS until the 2nd concurrent calibration sweep
To adjust compression shaping channels, only highlight gain values for soft input signals. Increase or decrease gain until the LTASS falls w/i 5 dB of verification targets
Hit CONTINUE for the 10-second LTASS measurement

34
Q

If we adjusted gain for a 55 dB input signal what portion of the speech envelope was adjusted?

A

The bottom of the speech envelope

35
Q

How do you check detection of loud input signals?

A

Present 75 dB SPL Speechmap signal on loop
You may begin making adjustment, BUT don’t record the LTASS until the 2nd concurrent calibration sweep
To adjust compression shaping channels, only highlight gain values for loud input signals. Increase or decrease gain until the LTASS falls w/i 5 dB of verification targets
Hit CONTINUE for the 10-second LTASS measurement

36
Q

If we adjust gain for a 75 dB input signal what portion of the speech
envelope was adjusted?

A

The top of the speech envelope

37
Q

What is the purpose of verifying MPO?

A

To ensure tolerance of loud input signals

38
Q

What is the objective of verifying the MPO?

A

Set MPO to an intensity that’s close but about 5 dB under the patient’s LDL (DSL 5.0 supplies targets, NAL does not)

39
Q

How do you verify MPO?

A

Perform MPO assessment using a Type 1 puretone swept signal
Presentation level
‘On-ear’ - 85 dB SPL
‘Test box’ - 90 dB SPL
Check in with patient to confirm signal is either “loud and uncomfortable”, or “loud but okay”
Adjust MPO settings as needed

Amplification 2 (13 decks)

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