in-depth product training - phonakpro · pdf file• consider a canal/helix/skeleton lock,...

October AudioLounge

1. Who are we?

2. Acoustic Coupling Options

3. Retention options

4. Feedback & Acoustic Coupling

5. Moisture & Coupling

Other upcoming sessions

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• Instant fit:

– Smokey Domes

• Custom EarPieces:

– SlimTip (hard/soft)

– cShell (hard/soft)

– Earmolds (hard/soft)

Sound Delivery System (SDS) options

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SlimTip cShell Earmolds

Compatibility • SlimTubes

• xS, xP receivers

• xS, xP, xSP receivers • #13 tubing

• Slim Tube

• Power slimtube

Advantages • Retention

• Comfort

• Performance

• Retention

• Comfort

• Performance

• Moisture control

• Possibly better for more

length

• Moisture control

• Retention

• Performance

Limitations • Fitting range

• Impression required

• Receiver replacements at

Phonak

• Perceived as ‘bulkier’

than slimtip

• xSP for cShell hard only

• Perceived as

bulkier

• Impression

required

• N/A for RICs

Options • Canal/helix locks

• Soft coats

• Hard vs soft

• Hollow vs solid

• Canal/helix locks

• Soft coats

• Hard vs soft

• Acrylic, silicone

soft 40 or 70

• Many styles to

choose from

Coupling Options – Important Points to consider

• Retention

• Feedback

• Hearing performance

• Venting via plumbing

• Anatomical challenges

• Outer/middle ear disorders

• Moisture

• Comfort

• …just to name a few…..

NEW! Digitally modeled locks

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• Same color as the shell (ie. Blue shell = blue canal lock)

• Helix locks & canal locks can all be done digitally

• Retro-fittable

CIC with canal lock

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• Most common solution for retention

• Canal locks always the same color as

shell. No exceptions.

• Canal lock on this CIC is also pink

Slimtip with skeleton lock

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• Color of shell and lock are the same

• Compatible with either the slimtip

hollow or solid

Not available:

• Any type of flexcanal

• Slimtip/cShell soft are not compatible

with any locks

cShell with skeleton lock

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• Any configuration of lock is possible on a cshell

Slimtip & cShell with skeleton locks

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Earmold with helix lock and canal lock

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• Extra retention

• Great for those with shallow concha

bowls

• Available on slimtips hard, cshell hard

• Also available on custom hearing aids;

however, it will cause the instrument to

protrude more (not as discreet)

Canal locks & Custom products

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• Keep in mind: locks are digitally modeled; therefore, they are the same color as the

shell (no exceptions)

Earmold styles

Earmold materials

Select the desired earmold material.

• Acrylic Hard – very durable, for those with mild/mod to severe HL

• Silicone Soft 70 – tight fit, for those with severe-profound HL

• Silicone Soft 40 – minimal leakage, for those with profound HL

Unique Scenario

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Bolero V + Slim tube + skeleton mold

How to order?

• Option 1: Use the custom eartip order form and just put in special instructions that

you want it to be a skeleton mold

• Option 2 : Use the earmold order form and ask for slimtube compatibility

Recommendations for Better Retention

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For slimtip/cShells where there are retention issues and the patient also has a

shallow concha bowl, consider:

• Helix lock

• Extra length (?)

• Soft coat

Shallow normal

Final Thoughts on Retention….

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Slimtip/cShell (hard)

• Try adding a soft coat

• Consider a canal/helix/skeleton lock, depending on the concha bowl (ie. shallow

concha bowl would be best with a skeleton lock)

• Add extra length (may protrude more in some cases)

• Consider orientation of ear canals: For long and straight canals, consider a soft

material OR a canal lock on a hard material from the first fit

Note: SP receiver not available for cShell soft (hard only). And soft material tends to

be not as durable.

Coupling Options – Important Points to consider

• Retention

• Feedback

• Hearing Performance

• Venting via plumbing

• Anatomical challenges

• Outer/middle ear disorders

• Moisture

• Comfort

• …just to name a few…..

• Allows you to check the integrity of the acoustic coupling

• Option to delete the results and start again

• A poor result here can have disastrous effects for your client

Acoustic Coupling & The Feedback Manager

“Conscious Coupling”

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Case 1: Poor Feedback Test Result

• Gain Limit

• Feedback threshold

• Target gain

• Actual gain

Case 1: Results of a poor Feedback Test = Limited high frequency

gain

Case 2: Borderline Acceptable

• Gain Limit

• Feedback threshold

• Target gain

• Actual gain

Case 2: Better (?) Test Result, Borderline Acceptable product

selection

Case 3: Good FB Test & Good Product Selection

Comparing Feedback Test Results

• Poor FB Test Result =

Limited high frequency gain

• Better FB test result, but

pushing limits of hearing

instrument

• Best FB Test result

Coupling Options – Important Points to consider

• Retention

• Feedback

• Hearing performance

• Venting via plumbing

• Anatomical challenges

• Outer/middle ear disorders

• Moisture

• Comfort

• …just to name a few…..

Which way to vent?

• Venting via ‘plumbing’

• Venting via electronic low cuts while programming

Remember: no hearing instrument electronics can compete with the low distortion

and the very flat frequency response that a vent can provide!

Custom Earpiece Order Form Vent Options

Custom Hearing Instrument Vent Options

AOV: Optimal individualized Vent size

Based on:

• Client audiogram • Shell size • Acoustic coupling

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Design the largest vent that will

provide gain appropriate for that

audiogram

Complex Vents – Advantages of Digital Manufacturing

page

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• The vent size is calculated as an acoustic mass

• This mass incorporates the cross-section and the length of the

venting throughout the shell

• Only by applying all these measures can such complex vents be

built in a digitally controlled environment

4,0 mm

2,7 mm

Vent area

A = 13 mm2

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Advantages of AOV

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Delivers the

“right sized”

individual

Vent – and

the smallest

possible

instrument

size

Spontaneous

acceptance is

equal to the

correct

manually

selected vent

Takes the

guess work

out for difficult

shaped ear

canals

Easy to order,

simply select

AOV

Automatic

read out into

Phonak Target

Hearing Performance: Tubing thickness

• Internal diameter affects the passage of sound along a tube

• Outer diameter (thickness) affects the amount of leakage, important to consider for

high gain instruments

– Example: #13 thick wall tubing provides 2 dB more attenuation than

standard #13

Tubing Comparison

In Summary…..

Tubing

Diameter

Change

<750 750-1500 1500-3000 >3000

Wider Minimal Moves peak to

higher Hz

Moves peak to

higher Hz

Minimal

Narrower May

Decrease

Moves peak to

lower Hz

Reduces height of

peak and moves to

lower Hz

Decrease

Source: Valente, M., Hosford-Dunn, H., Roeser, R. (2008). Audiology Treatment. Thieme Medical Publishers: New York.

Hearing Performance: Receiver Size

40/122 (2cc) 50/122 (2cc) 60/122 (2cc) 70/133 (2cc)

Coupling Options – Important Points to consider

• Retention

• Feedback

• Hearing performance

• Venting via plumbing

• Anatomical challenges

• Outer/middle ear disorders

• Moisture

• Comfort

• …just to name a few…..

MOISTURE

Coupling Options and Moisture

Best Case Scenario:

Options for RICs:

• Custom cShells with SmartGuard

• Slimtips

• Domes

One possible explanation: Moisture

• But you say…

“This person has dry ear canals! The hearing aid is remarkably clean! My client

takes good care of their hearing aids! This person is not a ‘sweater’! This person

does not have an active lifestyle! These hearing aids are WaterResistant!”

+ =

Ear Canal Forecast

Ear Canal

Temperature 37°C

Humidity 40 – 70%

Winds 0 km/hr

P.O.P. unknown…

Conditions Cerumen advisory

So what is the weather like in your ear canal?

• Average body temp = 37 °C (98.6 °F)

– The temperature in the ear canal increases the closer you get to the

TM

– The capillaries of the TM reflect the arterial temperature inside the

body

Pompei, M. and Pompei F. Physicians reference handbook on temperature. Exergen Corporation, Watertown, 1996.

So what’s the weather like in your ear canal?

• Average humidity in a normal ear canal = 40-70% (even higher in pathological

canals)

R.F. Gray, A. Sharma, S.L. Vowler (2005). Relative humidity of the external auditory canal in normal and abnormal ears,

and its pathogenic effect. Clinical Otolaryngology, 30 (2), 105–111, April 2005

• Hall & Croutch (2010) measured ear canal humidity at a depth that reflected

receiver placement in a deep canal device

• People with ongoing cerumen, debris, or dead skin accumulation were excluded

from the study

• Participants with humidity values greater than 60% were most likely to have

receiver failures as a result of moisture, whereas participants with 40% or less

have dramatically fewer problems relative to receiver problems

• Large vents had no effect upon the humidity measures

Hall CM, Croutch C. A Field Study on the Effect of Relative Humidity on Hearing Aid Receivers. Hearing Review.

2010;17(1):32-35.

So what’s the weather like in your hearing aid?

• Bailey & Valente (1996) measured the temperature and humidity inside ITEs

and ITCs

– 77% of the temperature readings were between 80 and 99°F

– 63% of the humidity readings were between 30% and 49%

Bailey JW, Valente M. Measurements of relative humidity and temperature in hearing aids. Hear Jour.

1996;49(10):59-63. (as cited by Hall and Croutch, 2010)

It’s not one or the other… it’s both!

So, are you recommending ALL my clients use a

dri-aid kit?

• Even ear canals with lower humidity values were still measured around 40%

humidity

Definition of hypothermia: 35 °C (95.0 °F)

A few ways moisture can affect hearing aid components are:

• Moisture on the microphones or receiver diaphragms will limit their

movement. Therefore, both the input (mics) and output (receiver)

could be diminished.

• Moisture on the wires can affect conduction of electrical signals.

• Moisture on the circuitry can cause a variety of sound quality and

performance issues depending on which area is affected.

• Even if the hearing aid and the ear canal look clean and dry, it’s the

condensation and humidity inside the hearing aid you should be

concerned about

*Also… moisture combined with dust, wax, or skin debris can form a sticky paste

that wreaks havoc with hearing aids!

What can you and your client do to combat moisture?

D Dry Premium

• 3 functions in one device: electrical drying, hygienic cleaning with UV-C light and

safe keeping in sanitization chamber

• UV-C Light works for either 3 or 6 hours

• According to manufacturer, best to remove batteries prior to use

• Phonak Accessory deal

Coupling Options – Important Points to consider

• Retention

• Feedback

• Proper amplification/hearing performance

• Venting via plumbing

• Anatomical challenges

• Outer/middle ear disorders

• Moisture

• Comfort

• …just to name a few…..

Comfort

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• Domes do not contain latex or rayon constituents

• Slimtubes are composed of a poly (ether-block-co-polyamide) polymer (trade name

Pebax)The domes are attached to tubing using no glue, it uses a threaded fitting.

• Slimtip materials are all hypoallergenic. For those still irritated, you can requested

that we rebuild without the final lacquer.

FYI: Hearing aid housings are made of Grilatrog in different colors which is

combination of Trogamid CX 9710 (Nylon) and Grilamid TR 90 LXS (Nylon). On the

housing we applied a hydrophobic (fluorinated) layer. The hearing aid label is made

of ABS. The housings have different colors -color pigments of Polyamide or color-

lacquered Acryl/Polyurethane based resin.

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A few random pointers from your Audiology Team

Size Matters: Floating Antenna in Virto V products

Floating antenna attachment

points

Wireless vs non-wireless instruments: Size differences

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CROS II Coupling….

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• Trick Question…sort of

Phonak CROS II acoustic coupling choices

For more retention

For demonstration

CROS II Hook*

CROS DemoHook

CROS SlimTube

CROS SlimTip

NEW

NEW

For comfort

For instant fitting

*only for CROS II-13

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Phonak CROS II Hook

Acoustic coupling videos in Target

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Thank you for joining us today!