9/26/2012. Counseling & Troubleshooting

Transcription

1 9/26/2012 Counseling & Troubleshooting

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3 Key clinical messages Patient selection and candidacy are vital to happy Lyric patients Follow candidacy guidelines Select motivated patients Adhere to the proven sizing system Use length sizer to determine depth Use device sizers to determine device size Work in a clean, healthy canal Ensure all cerumen and debris is removed from the EAC prior to insertion Pre-fitting counseling Set realistic expectations regarding feel Set realistic expectations regarding acoustic habituation Post-fitting counseling/follow-up care Have an out-bound call within 48 hours of initial fitting Key Clinical Messages Schedule patient within the first two weeks to verify fit and address any issues

4 Counseling Lyric offices are provided with Lyric kits for each patient initially fit with Lyric to take home. The Lyric Kit includes: SoundLync adjustment wand Patient instruction booklet 2 Removal trays Lyric ID card In addition, a counseling video is available on DVD

5 Counseling - Setting Patient Expectations Pre-Fitting Lyric is a unique product and therefore requires that patients understand Lyric s unique benefits Explain the differences between Extended Wear and Daily Wear device types Discuss the Lyric subscription plan & refit process Explain the initial sizing & fitting process This helps reduce anxiety & set expectations Be sure to set realistic expectations regarding hearing device benefits

6 Counseling - Setting Patient Expectations Post Fitting As with any hearing device, there is an adaptation period to become adjusted to device use 24/7, continuous hearing including sleeping with Lyric The feeling of having something deep in their ear canal Hearing new/forgotten sounds Reassuring patients that they may experience some initial comfort issues that often pass over time or through slight office adjustments is vital

7 Counseling - Setting Patient Expectations Post Fitting Be sure the patient has a clear understanding of: What to do if they experience discomfort How to use the SoundLync Adjustment Tool Activities they can/can t do with Lyric Explain expected Lyric visits going forward and schedule first follow-up first follow-up appointment to check on patient s initial experience Describe how patients should schedule refits Discuss the terms of the trial period

8 When to Remove Lyric Lyric should remain in the ear, however, there are times when the device should be removed When having an MRI If scuba diving or sky diving If the device stops working (remove within 24 hrs) It is best for a hearing professional to remove the device, however, if the device is not working and the patient cannot return to the office within 24 hours, he/she can remove the device at home A friend or family member can help remove the device if needed Should your patient encounter any problems, strongly encourage him/her to return to the office for device removal or contact your office the next business day following self-removal so that the health of the canal can be evaluated

9 Device Removal If patient or family member needs to remove the device: Unscrew cap from magnet to expose removal tool Place tool inside ear canal so it touches the Lyric Rotate tool until it snags the removal loops Gently remove Lyric by slowly rocking the device as it slides out of the ear

10 Counseling Checklist The following should be emphasized after the patient watches the counseling video Adapting to Continuous Hearing Adapting to the Feel Sleeping with Lyric Telephone Use Do s & Don ts Water Exposure Using SoundLync Adjustment Tool Device must be removed within 24 hrs from when it ceases to function

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12 Troubleshooting Lyric Complaints Initial Discomfort Pain Feedback Migration Sound Quality Dull Sharp Volume Soft Loud Patient changed settings New to Amplification Pumping Water protection

13 Troubleshooting: Initial Discomfort Query the patient as to degree of discomfort Awareness (acceptable and expected) Annoyance (acceptable and expected) Discomfort (acceptable and sometimes expected) Pain (unacceptable) Patient should not leave office in pain; may need to reinsert Recommend over-the-counter pain medication for discomfort during the first few days of wear (avoid naming specific brands) Coach patient to adjust sleeping position, initially at least Counsel patient that these sensations should diminish over time Remind patient that a self-removed device cannot be reinserted

14 Troubleshooting: Pain Recommendations surrounding patients presenting with pain: Immediately remove the device and inspect the ear canal If an office visit is not possible, advise patient to self-remove Evaluate canal health Check for redness (increased vascularizationis not always trauma), abrasion, hematoma If abrasion or hematoma is noted, allow days before inserting another device Once healthy, verify size and re-fit. If pain returns on the second fitting, contraindicate. Analysis has shown that multiple sizes & multiple insertion depths do not alleviate pain & ultimately result in trial cancellation

15 Troubleshooting: Pain Pain is often alleviated with reinsertion at a slightly more shallow depth This can be seen in as little as 1mm Remember DOI is a not to exceed value If you are working in a drier ear canal, lubrication can ease insertion Developing the insertion flight plan and proper ergonomics are paramount to comfortable fittings Most canals are S shaped and have a gentle rise Angle of insertion will be affected by your seated position, head position of the patient, & your wrist plane while working Footprints left in the canal should help you guide subsequent insertions

16 Troubleshooting: Patient Adjusted Settings Changed to the wrong mode when applying the SoundLync adjustment tool: Re-instruct on settings, walk through adjustments Does not hear the beep : Be sure patient removed magnet from housing and the magnet is close to Lyric Volume setting: Lyric remembers the last volume setting like a TV or car radio

17 Troubleshooting: Feedback Determine whether the feedback is major or minor Major = audible feedback from a distance and is typically fit related Minor = forced feedback or subtle feedback reported by the patient

18 Major Feedback Troubleshooting: Feedback Reposition: Alter the angle of the device by rotating superior dot Check depth of insertion Resize: Check for gaps or folds Determine larger or smaller lateral seal size Upsize medial seal

19 Minor Feedback: If HFB is ON turn it OFF Decrease SLG by one step Troubleshooting: Feedback This will decrease relative gain rather than overall Decrease Volume by one step If the volume level is sufficient to meet patient needs Note: If these programming changes compromise the patient s communication needs or sound quality, treat as major feedback and reevaluate fit

20 Troubleshooting: Migration Significant migration = migrationthat negatively impacts sound quality, comfort, or aesthetics (visibility) Significant migration is most likely the result of one of the following: Under-sizing the ear canal Excessive jaw movement Patient manipulation Oil based lubricants during placement If you see device migration you should: Rule out manipulation, over lubrication, and jaw movement Re-evaluate the lateral seal size Determine if a larger lateral seal will allow the device to fit more securely at the predetermined depth of insertion

21 Troubleshooting: Sound Quality Too Dull Patient complains that the sound quality is dull: Increase Soft Level Gain Move SLG up 1 to 2 steps Reduce the Low Frequency Gain Increase LFC one to two steps Increase High Frequency Gain Turn on High Frequency Boost

22 Troubleshooting: Sound Quality Too Sharp Patient complains that the sound quality is too sharp: Decrease High Frequency Gain Turn off HFB Decrease Soft Level Gain Lower SLG by one step Increase Low Frequency Gain Decrease LFC by 1 to 2 steps Decrease overall volume

23 Troubleshooting: Volume Too Low If the patient requests more volume: Increase Volume Increase Soft Level Gain by one or two settings Decrease LFC by one to two steps Turn on High Frequency Boost

24 Troubleshooting: Weak Output Patient says the aid is softer than when initially inserted: Did the patient adjust the volume too low? Is the device in SLEEP mode? If the output is still weak, see patient a Lyric removal may be indicated Migration Wax in the microphone Fluid in the receiver Technical malfunction

25 Troubleshooting: Turns On and Off In Noise Patient complaining of pumping: Patient may perceive output limiting (second TK is fixed at 85 db) Reduce SLG by one to two steps (this increases the first TK) Counsel patient to use SLEEP mode in noise

26 Troubleshooting: Moisture Protection Complete submersion of the head is not recommended, however in the event of moisture exposure: Underwater exposure Custom ear plugs; ear plugs; neoprene ear bands; any combination of above Showering Banded ear plugs; ear caps Following exposure Use of standard hair dryer on a cool setting directed at Lyric avoid direct contact

27 Key clinical messages Patient selection and candidacy are vital to happy Lyric patients Follow candidacy guidelines Select motivated patients Adhere to the proven sizing system Use length sizer to determine depth Use device sizers to determine device size Work in a clean, healthy canal Ensure all cerumen and debris is removed from the EAC prior to insertion Pre-fitting counseling Set realistic expectations regarding feel Set realistic expectations regarding acoustic habituation Post-fitting counseling/follow-up care Have an out-bound call within 48 hours of initial fitting Key Clinical Messages Schedule patient within the first two weeks to verify fit and address any issues

28 9/26/2012 Counseling & Troubleshooting