Synchronized SATISFY: Easy Steps Towards Optimal Hearing Benefit.

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1 Synchronized SATISFY: Easy Steps Towards Optimal Hearing Benefit. 1

2 Abstract A common complaint of new users at the hearing aid fitting is that sounds are too loud. This problem, which stems from the abrupt change from unaided to aided loudness perception, is not insignificant. Depending on the motivation level and personality of the user, a negative first impression can be generated by this complaint, potentially leading to the dreaded hearing aid in the drawer or general non-adoption of the hearing aids. Synchronized SATISFY is a new feature in Beltone First TM hearing aids which incorporates ear-to-ear communication between ears to achieve optimal amplification without sacrificing user comfort at the fitting. Tammara Stender, Au.D. speech in noise perception as the prescribed gain settings. 4,7 Some researchers have noted that new users may prefer more gain four weeks post-fitting than at the initial fitting. 8 In contrast, other studies have noted no difference in initial gain preference for new users as compared to experienced users. 9 In fact, preference for prescribed gain levels over reduced levels has been For new users in particular who are uncomfortable with the prescribed gain settings, the hearing professional is faced with a dilemma. Reducing the gains to comfortable levels will not provide the adequate amplification to give the greatest hearing benefit. Yet if the client is very uncomfortable with the loudness, the risk is that they may reject wearing the hearing aids at all. When faced with this dilemma at the fitting, a compromise often must be A primary goal of the hearing professional is to pro- able with and achieves optimal benefit from the observed among some new users. 10 Further, some made for the individual s gain settings. vide the optimal gain levels to achieve adequate amplification provided by a new hearing aid. 1 The research indicates that no change in gain prefer- hearing for speech and sounds in the environment. process begins with the fitting visit. Acclimatization ences may occur among new users over the first One approach to this compromise is to initially pro- An important goal of the client is to hear a wide range to amplification regardless of whether the user is 12 months of use. 9 gram the user s gains at more comfortable settings. of sounds at comfortable levels. Yet what is pre- new to hearing aid technology or is a previous user In the case of a typical new user, gains would be scribed for optimal hearing ability may not be what of different technology is an individual, personal In the case of previous users of linear amplification, programmed lower than the recommended levels is most comfortable for every new user. Individuals process, which can range from a few weeks to sev- certain individuals being fitted with wide dynamic for optimal performance, based on the fitting ration- new to amplification, or those who have worn lin- eral months in duration. 2,3 Due to the differences range compression signal processing may report ale. This could be done manually or through the se- ear hearing aids previously, may require some time observed in groups of individuals, there is no strong sounds are too soft. In particular, louder aspects of lection of a new user setting in the fitting software. to acclimate to the way sounds are perceived with agreement in the literature regarding the preferred speech such as vowels will receive less amplification When the client returns for the follow-up visit in a compression-based amplification. Everyday sound gain settings among new users and users experi- with compression processing than with linear pro- few weeks, the gains could then be increased to the inputs such as conversational speech, the user s enced with linear amplification. cessing. For these users, initially preferred settings experienced non-linear user setting, which is the own voice, and environmental sounds such as wa- would provide more gain for loud sounds (or de- prescribed target level. ter running from a faucet will have a different loud- Individuals who have never worn hearing aids some- creased compression ratios) than the target settings. ness and quality to the newly fitted individual. times note that sounds are too loud, and indicate Another option is to initially set the gains at a level they would prefer a slightly lower level of gain. 4-6 This Resolving the dilemma of halfway between the client s preferred level and the The acclimatization process is defined as the pe- lower gain requirement of new users, on the order optimal settings versus prescribed target. 8 At the follow-up visit, the gain riod of time in which the user becomes comfort- of 2 to 3 db, has been noted to provide equivalent comfort would be increased to the target, or kept at the 2 3

3 same level if it is still too loud for the client. However, at the fitting, and incrementally increase the level to ing aid are naturally matched in their progression the disadvantage is that the gain may never approximate the prescribed levels if the client is still uncomfortable with increased gain at the follow-up visit. the prescribed, optimal target level by the date of the follow-up visit or another set end date. 1st Visit Final Setting toward the end target. However, if for some reason one hearing aid is not used, is lost, or is sent in for repair, or if the user forgets to open the battery Beltone SATISFY Initial Fit, New User Taget door for one hearing aid at night, the progression of For a previous user of linear hearing aids, the new When SATISFY is activated through the fitting soft- SATISFY will be unequal for each hearing aid in a compression hearing aids can be set to a more lin- ware, a fixed change in the gain (the delta, ) is Figure 2a: SATISFY delta + fine tuning at the fitting only binaural pair. For example, the right hearing aid may ear response (e.g., an experienced linear preset) added to the user s comfortable settings or user ex- have progressed 75% to the target levels while the at the fitting, and then altered to higher compres- perience preset. This delta is the difference in gain left hearing aid may only have progressed to 25% sion ratios at the follow-up visit. However, as with between the final or target settings and the initial of the target. This may lead to a noticeable dif the previously stated options for fitting new users, if the client fails to return for the second visit or re- settings (Figure 1). 1 st Visit 2 nd Visit Final Setting ference in sound quality or loudness between ears when both hearing aids are worn again as a pair. fuses a sudden increase in gain, the amplification would remain at suboptimal settings. Fine tuning can be done at the fitting and added to the SATISFY delta, and/or at the follow-up visit after Initial Fit, New User Taget Figure 3 shows the Synchronized SATISFY feature The ideal solution to this problem would be to SATISFY has completed the gain changes (Figures 2a-b). This allows for individual preferences to be Figure 2b: SATISFY delta + fine tuning at the fitting and follow-up visits in Solus Pro 1.6. Once activated, the duration and average estimated daily usage can be set. The gradually and inconspicuously increase or change incorporated while incremental gain changes still hearing care provider can choose from durations the gain settings over time, between the fitting and follow-up visits. This functionality was introduced occur over the acclimatization process. Synchronized SATISFY ranging between one week to six months, and average daily usages ranging from 2 hours to 16 in past Beltone products through the SATISFY fea- SATISFY clearly is a true solution to resolving new hours. Fine tuned gains can be preserved or not ture. SATISFY is an acronym that stands for Slow Adaptation To Ideal Settings For You. Through SATISFY, gradual changes in gain, compression and frequency response can be programmed to New user Connection Target Experienced- Full- User Settings Fixed user complaints about sounds being too loud at the first visit, while still achieving the desirable gains at the end of the time period. Commonly, binaural hearing aid users wear their devices equally and preserved from the initial programming, for either or both ears. It is also possible to employ SATISFY for only one hearing aid. Leaving the check box to synchronize the feature unchecked results in stand- occur over a set time frame. The goal of SATISFY is open the battery doors on the devices when the ard SATISFY functionality. At the follow-up visit, the to start the new user or experienced user of linear amplification with a more comfortable level of gain Figure 1: Fixed SATISFY delta hearing aids are not in use. The result of this common use case is that the gain adjustments per hear- progress of Synchronized or standard SATISFY can be observed through Data Logging. 4 5

4 References 1. Schum DJ, Weile JN, Behrens T. New insights into first-time users. Audiology Online. Feb 1, Gatehouse S. Components and determinants of hearing aid benefit. Ear Hear. 1994:15(1); Gatehouse S. The time course and magnitude of perceptual acclimatization to frequency responses: Evidence from monaural fitting of hearing aids. J Acoust Soc Am. 1992:92(3); Smeds K. Is normal or less than normal overall loudness preferred by first-time hearing aid users? Ear Hear. 2004:25(2); Marriage J, Moore B, Alcantara J. Comparison of three procedures for initial fitting of compression hearing aids. III. Figure 3. Syncrhonized SATISFY in Solus Pro The default setting for Synchronized SATISFY with Beltone First devices is off for both hearing aids, as the literature is not in strong agreement that an acclimatization period with respect to hearing aid gains is necessary for all new users However, Solus Pro provides great flexibility for hearing professionals to provide comfortable amplification to clients who require this acclimatization process to achieve optimal gains To account for situations such as these, Synchronized SATISFY was developed. Taking the general functionality afforded by SATISFY to the next level, Synchronized SATISFY incorporates ear-to-ear synchronization of the gain adjustments over the time period. If the use time for each hearing aid is different, this feature will match the SATISFY progress for each hearing aid, to be congruent when the hearing aids are worn together again. In the example provided in the preceding paragraph, both hearing aids would be set to 25% progression towards the end target. Conclusion Synchronized SATISFY may not be necessary for all new users. Yet the availability of such a feature may mean the difference between a successful fitting at the follow-up visit and non-adoption of hearing aids. Further, different individuals may require different amounts and time periods for the acclimatization process to occur. The flexibility offered through Solus Pro provides the hearing professional with the necessary tools to achieve an optimal and comfortable fit for the individual client, resulting in user acceptance and ultimate benefit with hearing aids. Inexperienced versus experienced users. Int J Audiol. 2004:43(4); Laugesen S, Vestergaard H, Nielsen C. Common Conceptions About First-time Versus Experienced Hearing Aid Users: Facts or Fiction? (2005). In A Rasmussen, T Poulsen, T Andersen, & CB Larsen (Eds.), Hearing Aid Fitting (p ). 21st Danavox Symposium. 7. Keidser G, O Brien A, Carter L, McLelland M, Yeend I. Variation in preferred gain with experience for hearing-aid users. Int J Audiol. 2008:47(10); Dillon H. Hearing Aids. New York, NY: Thieme, 2001: Convery E, Keidser G, Dillon H. A Review and Analysis. Does Amplification Experience Have an Effect on Preferred Over? Australian and New Zealand Journal of Audiology.2005: 27 (1); Arlinger S, Lyregaard PE, Billermark E, Öberg M. Fitting hearing aids to first-time users. Scand Audiol. 2000:29;

5 Worldwide Headquarters Beltone A/S Lautrupbjerg 7 DK-2750 Ballerup Denmark Tel.: Fax: M GB Rev.A 8

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