Studied by 35 people
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
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
Dillon's rule
Venema's rule
Ricketts' rule
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?
earmold/shell is excessively blocking the ear canal = increase area and/or decrease the vent length; electrically cancel the occlusion-generated sounds
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
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
other solutions = remake/recoat ear mold (takes extra time and expense); change to HA with a more effective feedback system
excessive high fx = sounds shrill, harsh, sharp, metallic, and tinny
excessive low fx = sounds muffled, unclear, dull
change the balance of the high and low fx gain
can involve 3 complications
excessive peaks in a response with balanced and high fx gain
complaints may only be for low level or high level inputs
pts may not be used to high or low sounds that they've missed for a long time
excessive amplification of noise
inadequate speech clarity
inappropriate loudness of wanted signals
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
soft speech in quiet places can't be heard = provide more gain to low level sounds
HA is sometimes too loud and needs to be shut off = decrease OSPL90 or improve input-output characteristics (compression ratios)
background noise makes difficult for understanding speech = check if noise reduction is working or suggest directional/remote mics
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
insertion/removal
HA features
battery specs
warranty info
care and maintenance
reduce background noise
speak at normal/slower pace
speak in short, clear sentences
talk face-to-face
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
short
has norms
unique for satisfactionS
easy to administer and interpret
takes 10 minutes to do
can function as a basis for counseling during HA selectionC
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
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
live, face-to-face communication
broadcasting and other electronic media
telephone conversation
sensitivity to alerting signals and environmental stimuli (e.g. doorbells, smoke alarms, timers, crying kid, etc.)
at home
in the community
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
