Intro to Hearing Aids - FINAL EXAM

• vents: up to 1500 Hz (lows)

• dampers: 750-3000 or 4000 Hz (mids)

• acoustic horns: 1500 and above (highs)

• swept pure tones are sometimes perceived as feedback, thus, the gain gets reduced

• speech mapping (Carrot Story/Intl Speech Signal) has all the sounds of speech in it to ensure they can all be measured, adjusted, and affected with the HAs' Rx formulae

• speech is always, always, ALWAYS better because humans are not robots!

• intended for fitting linear HAs, as it provides the same gain for all inputs

• used to raise speech to MCLs (which is halfway between the HTLs and LDLs)

• really only ideal for flat (linear) losses

• real ear unaided gain

• measures the open, natural ear canal

• real ear aided gain

• measures HA in place and on

• real ear insertion gain

• the difference value between REAG - REUG

• use: verifies Rx targets

• real ear occluded gain

• measures HA in place and OFF

• real ear unaided response

• measures the open, natural ear canal

• real ear occluded response

• measures the HA in place and OFF

• real ear aided response

• measures output when aided

• use: verifies Rx targets

• measures REAR with an 85/90 dB SPL input

• use: determines real ear MPO for the HA, based on unaided LDL measures

• a difference measure between the input and what's happening in the real ear

• an absolute measure

• the output of the HA in the real ear

• 1/2 gain rule

• Rx of Gain and Output (POGO, POGO II)

• Nat'l Acoustics Lab (NAL, NAL-R, NAL-RP)

• Desired Sensation Level (DSL)

• Desired Sensation Level (DSLv4.0 and v5.0)

• Nat'l Acoustics Lab Non-Linear 1 and 2 (NAL-NL1, NAL-NL2)

• more emphasis on high fx

• fewer correction factors (tonality, gender, etc.)

• has more gain

• ALWAYS used for children

• has less gain than the DSLv5.0

• has many correction factors (tonality, gender, etc.)

• make soft sounds audible

• make average sounds comfortable

• make loud sounds tolerable

1. Dillon's rule

2. Venema's rule

3. Ricketts' rule

measurements should be within +/- 5 dB from the target in the 250-4000 Hz range, IF the formula has evidence to support it

measurements should be at or slightly above target in the 500-4000 Hz range

• for 250-2000 Hz, measurements should +/- 5 dB

• for 3000 and 4000 Hz, measurements should +/- 8 dB

• real ear to sound pressure level (the measurement of audiometer to coupler)

• converts HL LDLs to 2cc values (for earphones)

• real ear to coupler difference

• the 2cc coupler response (output) MINUS the real ear response of the same earphone

• use: helps determine max output in the ear canal

• real ear to dial difference

• a difference in dB between SPL of TM from the audiometer dial

• use: derive ear canal SPL display of audiometric and Rx output data for REAR verification

• Texas licensure REQUIRES it..."verify appropriate fit...may include real-ear measures, functional gain measures, etc."

• nationally, "best practice methods" are a must at all times!!

• tasks completed by an AuD to ensure a well-fitting HA

• real-ear measures

• are we building the system right?

• does the HA act in the way we'd expect?

• assessments made by patients using outcome measures to determine if HAs have made a difference in their lives

• are we building the RIGHT system?

• is this assisting the patient in the way we'd expect?

1. earmold/shell is excessively blocking the ear canal = increase area and/or decrease the vent length; electrically cancel the occlusion-generated sounds

2. HA distorts when the patient speaks = source-to-ear distance is too short; SPL level of own voice may be high; compare their voice to the AuD's loud voice to see if same issues occur; they may want less gain for their own voice

3. HA is excessively amplifying low fx sounds = patient may have forgotten what their own voice sounds like

1.HA makes a ringing noise when certain sounds occur (problem is feedback oscillation) = make sure REAG has no excessive peaks, decrease vent size, change from closed to open dome, decrease high fx again or the high fx compression ratio, or increase the high fx compression threshold in the relevant channel

• be aware that these 3 things may affect speech intelligibility or sound quality

2. other solutions = remake/recoat ear mold (takes extra time and expense); change to HA with a more effective feedback system

1. excessive high fx = sounds shrill, harsh, sharp, metallic, and tinny

2. excessive low fx = sounds muffled, unclear, dull

• change the balance of the high and low fx gain

• can involve 3 complications

1. excessive peaks in a response with balanced and high fx gain

2. complaints may only be for low level or high level inputs

3. pts may not be used to high or low sounds that they've missed for a long time

1. excessive amplification of noise

2. inadequate speech clarity

3. inappropriate loudness of wanted signals

know whether the pt is unhappy with the loudness of weak, medium, and loud sounds

1. HA is noisy in quiet places = internal noise may be amplified in quiet; external noise means patient may not realize that others can hear these sounds

2. soft speech in quiet places can't be heard = provide more gain to low level sounds

3. HA is sometimes too loud and needs to be shut off = decrease OSPL90 or improve input-output characteristics (compression ratios)

4. background noise makes difficult for understanding speech = check if noise reduction is working or suggest directional/remote mics

5. people in background are easier to understand than those close by (close speech may trigger higher compression) = adjust output, use compression limiting, have an excessively low or high compression ratio

Ok, so today is all about you! I am going to make sure your hearing aids are working correctly according to your hearing loss. I'll put them in this test box, and then make some adjustments on how they pick up sound. All these changes are based off your audiogram that I've put into the computer.

1. insertion/removal

2. HA features

3. battery specs

4. warranty info

5. care and maintenance

1. reduce background noise

2. speak at normal/slower pace

3. speak in short, clear sentences

4. talk face-to-face

5. ensure good lighting (avoid shadows)

• most patient specific/focuses on pt needs

• helps guide treatment

• quick

• provides specifics on what has worked, and what hasn't D

• norms not available

• too much variability

• short

• has norms

• unique for expectationsE

• complicated to score

• short

• has norms

• unique for satisfactionS

• hard to score

• easy to administer and interpret

• takes 10 minutes to do

• can function as a basis for counseling during HA selectionC

• no norms

• has reversed items for validity of responses

• measures pre and post-intervention

• available in 15+ languages

• hard to score

• steps not equidistant

• may be difficult for elderly to give exact answers

• confusion between answering for both unaided and aided conditions at the same time

• quick administration

• easy to score

• quick check on key areas post-HA fitting

• post-HA fitting measure only

• may lack specificity in determining HA outcomes

• takes 10 minutes to administer and score

• results used to ID HA tasks the pt needs further instruction/counseling

• only measures practical skills

• doesn't take patient's feelings into account

• used inside and outside

• has mobility

• broadcast possible to an unlimited amount of FM receivers

• access is easy through built-in receivers in HAs (can also be accomplished through DAI)

• expensive $$$

• requires frequent maintenance

• doesn't ensure privacy

• transmits high quality signal to listeners

• doesn't limit seating (provided there is a direct line of sight)

• privacy is assured (infrared can't pass through walls)

• expensive (each listener needs a receiver)

• affected by sunlight which degrades the signal

• has possibility of light reflecting off of the room's surfaces

• requires more light emitting diodes (sensors) in larger roomsI

• provide accessibility to listeners with telecoil-equipped HAs/CIs

• allows for freedom of movement within the loop

• available for relatively low expense

• requires telecoil in receiver

• subject to interference from a variety of sources (60-cycle hum, fluorescent lights)

• subject to spill-over from adjacent rooms

a. auditory closure and filling in blanks b. importance of audibility for inaudible sounds c. listening demands d. role of the patient's family/caregiver

• children are learning language

• they can't fill in blanks for inaudible sounds like adults can

• children spend more time listening to other children and women (higher fx than male speech)

• thus, it's important to make high fx cues audible

• children have to be able to use info acquired with amplified hearing and processed sound (ALL speech cues must be made audible!!)E

• children have MANY MORE listening demands than adults (especially in difficult listening situations)

• Rx targets may specify greater output in quiet situations

• remember the 2nd grade landmark = goes from learning to read, to reading to learn

• children's HA use is often heavily mediated by their caregiver

• thus, parents/caregivers have to know the ins and outs of HA maintenance and use

• Children are CONSTANTLY growing, thus, there's no point in custom devices because they'd have to be remade

• adolescent children could probably use a RIC/RITE

• BTEs are extremely durable for everything a child does (running, jumping, etc.)

• BTEs can be used with a variety of HAT systems for educational and social settings

• BTEs are also big enough to have indicator lights, tamper-proof doors, etc.

• hearing assistive technology

• NOT a medical deviceWh

1. live, face-to-face communication

2. broadcasting and other electronic media

3. telephone conversation

4. sensitivity to alerting signals and environmental stimuli (e.g. doorbells, smoke alarms, timers, crying kid, etc.)

1. at home

2. in the community

3. school

• personal FM (common for school)

• hardwired systems

• telephone amplifier

• telecoil

• telecommunication devices for the deaf (TDD)

• television

• alerting devices

• infrared system

• induction loopW

• Whistle-stop (goes over phone receiver)

• inline amplifier (amplifies sound signals by plugging into phone)

• amplified telephone (captioned and/or amplified)

• portable amplifier

• replacement handset

• TDDWh

• Ring Max (helps with auditory alerts)

• Shake Awake

• visual and auditory smoke detectors

• Lifetone HL (bedside fire alarm and clock)

• phone flasher

• wireless flasherW

• pocket talker