Top 10 ideer til en god høreapparat tilpasning. Astrid Haastrup, Audiologist GN ReSound

Transcription

1 HVEM er HVEM Top 10 ideer til en god høreapparat tilpasning Astrid Haastrup, Audiologist GN ReSound

2 HVEM er HVEM

3 WRITE DOWN YOUR TOP THREE

4 NUMBER 1 Performing appropriate hearing assessment

5 Thorough audiological evaluation Children OAE ABR ASSR BOA VRA Bone conduction Otoscopic inspection Emissions Reflexes Adults Otoscopic inspection Air conduction Bone conduction Emissions Reflexes 5

6 NUMBER 2 Fitting a hearing aid without buy-in from the patient

7 Parent and Patient motivation Parents who do not think that their child needs hearing aids. Carry out behavioral test Adults who do not think that they have a any problems hearing Adults who do not think that they have a any problems hearing. Use live speech mapping in counseling

8 IDA - institute Communication Ring GPS Motivation Tools 8

9 NUMBER 3 Taking manual dexterity into account when selecting the hearing aids or Style issue What should be considered to a child?

10 Factors affecting management of hearing aids Low tactile sensitivity Reduced flexibility of joints Impaired vision Illness, reduced cognitive function or other issues More difficult to learn new HA-related tasks with increased age

11 Selecting the hearing aid - Adults Increased difficulty in managing HA with age Considerations for ease of management: Style Battery size Controls Automatic functions Acoustic indicators Maintenance Motivation Support from family/others

12 Selecting the hearing aid - Children A child s hearing aid should have: Output adjustment capabilities, FM and telecoil option, direct input capabilities, directional design. A BTE is the suggested style for infant-adolescent children. A child s pinna and concha can continue to grow until age 9, which results in recasting every 3-5 months.

13 NUMBER 4 Appropriateness of Higher-Tech Hearing Aids

14 Beltone Lifestyle Chart

15 What else to consider Options must be assessed relative to the needs and abilities of the child and the adult, which h include: Use of remote control Multiple vs. single memory Multiple vs. single channel Compression parameters Attack and release times slow for children and older

16 NUMBER 5 Automatic Steering programs

17 Environments

18 Automatic switching directionality Switches between an omnidirectional setting and a directional setting. An automatic switching directional program can be good for small children as the parents can not keep track of what kind of environment the child is in. Adults who do not know when to change or if their dexterity is so that it is very difficult for them to use the controls on the device.

19 NUMBER 6 Assistive listening devices 19

20 Assistive Listening Devices Examples of Assistive Listening Devices: Telecoil FM system Direct Audio Input (DAI) Bluetooth 2.4GHz wireless technology Considerations for ALDs for older children: Degree of hearing loss Needed gain for language learning Listening from greater distance Considerations for ALDs for older adults: Degree of hearing loss Needed gain Ability to handle device/equipment 20

21 NUMBER 7 Gain/Frequency Response Considerations Using first time, new user, or inexperienced user gain settings for all patients

22 Rationale for acclimatization levels The first fits of some manufacturers provide too much amplification, though some provide too little. Neither scenario is appropriate for a patient attempting to learn speech and language or For acceptance of the amplification

23 Experience level mild-to-severe sloping hearing loss

24 Experience level flat severe hearing loss

25 Prescribed first time user gain mild-to-severe sloping hearing loss

26 Prescribed first time user gain flat severe hearing loss

27 DSL What is it? and What does it do? The DSL Method makes use of HL audiometric data and converts it to SPL at the eardrum (using the Real-Ear-To-Coupler-Difference (RECD) measurement) Like other prescriptive measures, the goal is to select hearing aid frequency and gain characteristics that place as much as possible of the long-term speech spectrum (LTASS) into the amplified range New version prescribes a higher level of gain and output in the pediatric/congenital prescription than in the adult/acquired prescription (about 7 db for flat 50 db HL audiogram) Adult prescription has less gain and slightly lower compression ratio 27

28 NAL-NL2 Takes into consideration: Dead regions of the cochlea Age Gender Cognitive ability Frequency selectivity Experience with amplification Higher overall gain for children than adults Increase the CR for adults and children with mild and moderate hearing loss, while restricting the CR for those with severe/profound hearing loss 28

29 NUMBER 8 Assuming the manufacturer defaults are right for every patient

30 Defaults include Prescription Acoustic properties Age, experience level Programs Directionality Noise reduction Feedback cancellation

31 Example Default settings for 3 similar directional BTE s HA1 HA2 HA3 Experience Level 2 of 4 3 of 3 2 of 4 No. of programs Directionality Asymmetric Automatic Automatic Noise Reduction Environmental On Lowest level Vent None Prescription Manufacture Manufacture Manufacture 31

32 Summary Defaults are meant as a starting point Defaults may affect gain, programs or special processing Listen to the patient and set-up hearing aids accordingly

33 NUMBER 9 Do appropriate counseling to Parents and Hearing aid user

34 Counseling Specific to the Childs Parents The parent need to get all information regarding: Device handling Programs Hearing aid status Listening situations Speech development

35 Counseling Specific to the Geriatric Population Should include family in the hearing aid fitting process The impact of the family/significant other is great Wax in the receiver is a common repair in this population because they can t see it is there. Adult children/friends/spouses should be taught to change wax guards Too many programs limit programs to one or two Consider repeating counseling session at 2 week follow up Give written materials other than the user manual to help with explanations on hearing aid features, programs, volume controls, push buttons 35

36 NUMBER 10 Verify the fitting with probe tube measurements

37 Verification Audiologist often use probe microphone measurements, functional gain measurements, speech recognition measures, and/or questionnaires to see the benefits from amplification. There are two commonly used methods of estimating the sensation level of amplified speech: 1) sound field aided audiogram approach and 2) probe microphone system approach.

38 Real-ear-to-coupler difference Difference in decibel, as a function of frequency, between the SPL at a specified measurement point in the ear canal and the SPL in 2CC coupler for specified input signal. If you know the acoustic difference between a 2 cc coupler and a child s occluded ear canal then you can add this difference to the HA coupler response to predict what is happening in the child s real ear. Degree of cooperation and amount of time required from the patient in the fitting process is greatly reduced. 38

39 END Note The direction of the Hearing Aid Development? Spatial hearing E2E - more than program and volume change 2.4 GHz is the Future Direct connection to compatible electronics without a device at all Direction connection to Internet Download new signal processing Connect to sound systems in theatres

40 Conclusions Did I cover your top three? What did I miss? Questions?

41 THANK YOU