fitting modifying

8/13/2019 Fitting Modifying

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Fitting and Modifying

Hearing Instruments


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Contents The Ear The Impression

The Audiogram

Hearing threshold diagnosis Classifications of Hearing Loss

Important Terms

Trimmers

Hearing Instrument Fitting

The ITE Program


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THE IMPRESSIONIDENTIFICATION

HELIX

TRAGUS

ANTI-TRAGUS

BOWL

SECOND BENDIN CANAL

FIRST BENDIN CANAL

CRUX

OTO-BLOCK

BASE

THE EAR

HELIX

ANTI-HELIX

APERTURE

ANTI-TRAGUS

LOBULE

CRUX

CONCHA

TRAGUS

INTERTRAGULARNOTCH


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The Audiogram

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Loss

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CLASSIFICATIONS OFHEARING LOSS

0-20 dB

21-40 dB

41-60 dB

61-80 dB

81-110 dB

NORMAL RANGE

MILD LOSS

MODERATE LOSS

SEVERE LOSS

PROFOUND LOSS

AIR BONE

L R L R

UNMASKED

MASKED

NO RESPONSE

NO RESPONSE

AUDIOMETRIC SYMBOLS


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The Pure Tone Audiogram

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Loss

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Air Conduction Test

Masking

This test is performed with headphones.The sound is transmitted via the outerand middle ear and through the fluidcontained inside of the cochlea.

Bone conduction testThe sound is transmitted by bone con-

duction (vibration) directly to the cochlea(inner ear).Important: Not via the outer and middleear.

In this test, the patient's good or better ear is blocked with noise, while the ear with the highest degree of hearingloss is measured. Reason: This prevents the test signal being heard by the better ear.

Uncomfortable loudness level

This is the upper limit of the auditorysensation area.Important: The "U" level is the point wherethe threshold of pain begins.


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in dB

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0110Frequency (Hz)

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Loss

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0110Frequency (Hz)

Loss

Middle ear hearingimpairment

Inner ear hearingimpairment

Combined midle ear-inner ear hearing impairment

in dB in dB

Hearing threshold diagnosis

- Normal bone conduction- Air conduction impairedcompared with normal

- Air and bone conduction impairedcompared with normal.(Both equally strongly)

Important:A hearing loss without boneconduction - air conduction difference rulesout middle ear hearing impairment

- Air and bone conduction impairedcompared with normal.

- Air conduction however morestrongly than bone conduction


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in dB

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Loss

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Loss

MEDIOCOCHLEARinner ear hearing impairment

Ankylosis of themiddle ear

Combined middle ear-inner ear hearing impairment

in dB

Hearing threshold diagnosis

Bone conduction = air conductionMedium tone hearing impairmentThis hearing impairment is typicalfor hereditary genesis

However, the most frequent form of innerear hearing impairment is high-tone loss

Ankylosis of the conductive system:Bone conduction still approx. 0 dBAir conduction hearing loss in the low-tone and medium-tone rangeDiagnosis: Commencing otosclerotic orscarred fixation of the stapes or - lesspronounced - negative pressure inthe middle ear

Cause:- Influenza- Chronic otitis (mucous membrane,suppuration, bone suppuration)

- Otosclerosis (advanced)

in dB

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0110Frequency (Hz)

Loss

KL = LL


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Hearing Instrument Fitting1. Behind-the-ear (BTE) Hearing Instruments

A number of different rules (e.g. NAL, POGO, Berger) exist for fitting hearing instruments, allof which yield similar results. The simplicity the half-gain rule is applied for basic fitting.

A reserve gain of 5 - 10 dB should be added to avoid continuous operation of the hearinginstrument with maximum volume control.

2. In-the-ear (ITE) Hearing InstrumentsThe "1/3 gain rule" is normally applied when tuning these instruments. Since they are fittedcloser to the wearer's ear drum, ITE instruments require a lower gain. Still, a reserve gain of 5 -10 dB should be added anyway.

Note: Reserve gain must not be added when fitting (BTE and ITE) instruments withautomatic gain control. If any additional gain is required, the instrument mustbe reprogrammed.


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Audiogram No. 1

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SENSORINEURAL hearing loss:Sloping hearing lossIn this case, the threshold curve is identical

for aerial and bone conduction.

DIAGNOSIS:Either the inner ear or the auditorynerve is damaged.

HEARING INSTRUMENT FITTING:For this degree of snesorineural hearing loss,a gain of: >/= 50 dB for BTE instruments

>/= 45 dB for concha instruments>/= 40 dB for canal instruments>/= 35 dB for CIC instruments

is required.Instruments with compression circuits (dynam-ic compression) are recommended.

Selection of HEARING INSTRUMENTS:Non-programmable: Programmable:

Recommended: 1. BTE: PIANO 566H ViVA2 Pro, MUSIC2. Concha: PIT S1/S1+ 113/45/03, PITV2 118/45/03,

PITM118/45/033. Canal:CT K-AMP113/40/06, CTAGC-I/D113/40/12 PCT M 113/40/03, PCM 1001 110/40/124. CIC: PCIC M 110/40/00

It is less advisable to fit linear instruments in such cases

Hearinglossin dB


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Hearing

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in dB

Audiogram No. 2 CONDUCTIVE HEARING LOSS:The difference between air and bone con-duction is very large. The uncomfortable

loudness level lies above 110 dB

DIAGNOSIS:In this case, either the outer ear or the middleear is damaged.E.g., the ossicular chain is interrupted

HEARING INSTRUMENT FITTING:For conductive hearing loss, a gain isrequired for the difference be-

tween air and bone conduction.A gain of: >/= 50 dB for BTE instruments


is required.Linear hearing instruments are recommendedhere.


Recommended: 1. BTE: PIANO 566H, 568H ViVA2 Pro, MUSIC2. Concha: PIT S1/S1+ 113/45/03, PITV2 118/45/03, PITV2 123/50/03

PITM 118/45/033. Canal:CT/D113/40/03, CTAGC-I/D113/40/12 PCT M 113/40/03, PCM 1001 110/40/124. CIC: CIC/D 113/35/03 PCIC M 110/35/00

Less advisable are: K-AMP instruments


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Audiogram No. 3 Combined HEARING LOSS:The sound perception is impaired for bothair and bone conduction.

Bone conduction is OK up to 500Hz.

DIAGNOSIS:Combined conductive and sensorineuralhearing loss resulting from injuryto the outer, middle, inner ear and/orauditory nerve.

HEARING INSTRUMENT FITTING:

In this case:A gain of: >/= 40 dB for BTE instruments>/= 40 dB f. concha instruments>/= 35 dB f. canal instruments>/= 30 dB f. CIC instruments

is required.


Recommended: 1. BTE: PIANO 562A,566H,568H, ViVA2 Pro, MUSIC, SWING S1/S1+, 1001, 30042. Concha: IT 110/40/06, PIT S1/S1+ 113/45/03, PITV2 118/45/03, PITM 118/45/033. Canal: CT/D113/40/03, CTAGC-I/D113/40/12 PCT M 113/40/03, PCS M 115/40/03,

PCM 1001 110/40/06,VIVA Pro 110/40/03

4. CIC: CIC/D 113/35/03 PCIC M 110/35/00, VIVETTE Pro 105/35/06


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Hearing

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Audiogram No. 4 FLAT-CURVESENSORINEURAL HEARING LOSS:The hearing loss is roughly the same at all

frequencies.

DIAGNOSIS:Bone conduction = air conduction.Damage has occurred to the inner ear orauditory nerve.

HEARING INSTRUMENT FITTING:With this degree of sensorineural hearing loss,

a hearing instrument that also offerspower in the low frequency range is required.A gain of: >/= 50 dB for BTE instruments


is required.Often PP instruments are required.


Recommended: 1. BTE: PIANO 568H, 564P ViVA2 Pro, MUSIC, SWING S1/S1+, S2/S2+,

2. Concha: IT 110/40/06, PIT S1/S1+ 113/45/03, PITV2 118/45/03, PITM 118/45/033. Canal: CT/D113/40/03, CTAGC-I/D113/40/06 PCT M 113/40/03, PCS M 115/40/03, PCM 1001 110/40/06,4. CIC: PCIC M 115/40/00,

Not recommended: K-AMP instruments


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Audiogram No. 5

Ski slope hearing loss:Hearing loss begins at approx. 1000 Hz.

DIAGNOSIS:This hearing loss may be caused by noiseor due to age.

HEARING INSTRUMENT FITTING:An "open" fitting (BTE) should be sup-plied in such cases.A gain of: >/= 50 dB for BTE instruments

>/= 45 dB for concha instruments>/= 40 dB for canal instruments and>/= 40 dB for CIC instruments

is required.A hearing instrument with a large vent (IROS)is required here. The TILL function is also ad-vantageous.

Selection of HEARING INSTRUMENTS:Recom- Non-programmable: Programmable:mended: 1. BTE: PIANO, HI with open fitting ViVA2 Pro, MUSIC, SWING S1/S1+, S2/S2+,

566H, 568W2. Concha: IT 110/40/06, PIT S1/S1+ 113/45/03, PITV2 118/45/03, PITM 118/45/033. Canal: CT/D113/40/03, CTAGC-I/D113/40/12 PCT M 113/40/03, PCS M 115/40/03, PCM 1001 110/40/06,

4. CIC: PCIC M 115/40/00,

Not recommended: Custom CS and CIC instruments without enough space for a large VENT.


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Hearing

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Audiogram No. 6

Reverse slope hearing loss:The hearing loss is less pronounced at

higher frequencies (5-10 dB per octave).

DIAGNOSIS:e.g. M?i?e's disease (accompanied bydizziness)

HEARING INSTRUMENT FITTING:

For this hearing impairment, a PP (BTE orITE) instrument should be recommended..A gain of: >/= 45 dB for BTE instruments


is required.Reason: Power required in low-freq. range.


Recomm.: 1. BTE: PIANO 566H, 562A, VIVA 703 ViVA2 Pro, MUSIC, SWING S1/S1+,584P, 584 P-2

2. Concha: IT KAMP113/40/06 PIT S1/S1+ 113/45/03, PITV2 118/45/03, PITM 118/45/033. Canal: CTAGC-I108/35/06 PCT M 113/40/03, PCS M 110/35/00, VIVA Pro CT 105/35/03

PCS V 105/35/034. CIC: CIC/D 113/35/03 PCIC M 110/35/00, VIVETTE Pro 100/30/03 and 105/35/03

Not recommended: Linear ITEs


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Audiogram No. 7"COOKIE BITE" MID-FREQ. HOLLOW:Little loss at high and low frequencies.125 250 500 1000 2000 4000

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Frequency (Hz) 500 1000 2000 4000

DIAGNOSIS:Probably due to an hereditary hearingimpairment

HEARING INSTRUMENT FITTING:Persons exhibiting this hearing impairmentshould be supplied with multi-channel hearinginstruments.Reason: Different ampification for differentfrequency areas.A gain of: >/= 45 dB for BTE instruments


is required.


Recomm.: 1. BTE: PIANO 568W, MUSIC, Triton, S1/ S1+, S2/S2+2. Concha: IT KAMP113/40/06 PITM 118/45/03, PIT 3004, S2/S2+ 118/50/03,3. Canal: CTAGC-I/D113/40/06 PCT M 113/40/03, PCS M 115/40/00,

PCM2131 107/40/124. CIC: CIC/D 113/35/03 PCIC M 115/40/00, VIVETTE Pro 110/40/03

Hearing

loss

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Hearin l

oss

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Audiogram No. 8PROFOUND HEARING LOSS:Only minimal residual hearing abilitycan be found between 500 Hz and4000 Hz. (almost total deafness)

HEARING INSTRUMENTFITTING:Only the most powerful PP instrumentscan be used for such hearingimpairments.Pocket-size or maximum-power BTEinstruments should be recommendedhere.


Recommended: 1. BTE: 684 P-AO2. Concha: IT PP 125/60/03 PIT -S3/S3+ 125/60/03

Also recommended: High-power BTE or pocket hearing instruments

Note recommended: Cosmea-Top, Cosmea-small, and CIC ITE instruments

DIAGNOSIS:e.g. caused by interruption of theblood supply to the inner ear.


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LINEAR CIRCUIT TEST DATA

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RESP dBSPLSSPL90 dBSPL

.25 .5 1 2 4KHz

60 dB IN FULL ON GAIN SSPL90 CURVE

MAX SSPL90: 107.3 dB

AT 1700Hz

HF AVG SSPL90: 106.5

HF AVG FULL ON GAIN

37.6 dB AT 60 dB IN

HFAVG RESP CURVE GAIN

29.8 dB

REF TEST GAIN=29.6 dB

RESP LIMIT: 72.0 dB

F1=272 Hz

F2=6500 Hz

% TOT HARM DIST AT dB

4.6 AT 500Hz 70

AT 800Hz 70

2.8 AT 1600Hz 65

EQ IN NOISE: 26.5 dB

BATT. MA.: 1.0

AT 1.30 VOLTS (ZINC AIR)

PEAK GAIN HARMONICDISTORTION

BATTERYCURRENT DRAIN EQUIVALENTINPUT NOISE

PEAK SSPL90 HFA SSPL90HFA GAIN


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AGC CIRCUIT TEST DATA

70

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RESP dBSPL SSPL90 dBSPL

.25 .5 1 2 4KHz

50 dB IN FULL ON GAIN SSPL90 CURVE

MAX SSPL90: 106.0 dB

AT 1700Hz

HF AVG SSPL90: 100.9

HF AVG FULL ON GAIN

33.9 dB AT 50 dB IN

REF TEST GAIN=33.9 dB

ATTACK 2MS

RELEASE 45MS

MEASURED AT 2 KHZ

RESP LIMIT: 64.0 dB

F1=294 Hz

F2=6700 Hz

% TOT HARM DIST AT dB

2.6 AT 500Hz 70

3.1 AT 800Hz 70

1.0 AT 1600Hz 65

EQ IN NOISE: 22.3 dB

BATT. MA.: 0.6

AT 1.30 VOLTS (ZINC AIR)

50 60 70

2 kHz I/O CURVE

80 dBIN

RESPONSE PEAK HARMONICDISTORTION

PEAK SSPL90 HFA SSPL90HFA GAIN

BATTERYCURRENT DRAIN

EQUIVALENTINPUT NOISE

AGC KNEEPOINT ATTACK &RELEASE TIME

HFAVG RESP CURVE GAIN33.9 dB


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GAIN

40 dBOUT

10 dBIN

FREQUENCY

PEAK = 45dB

PEAK GAIN vs. AVERAGE GAIN

20

30

40

10.25 .5 1 2 4KHz

50

GAIN

AVG = 35 + 42 + 38 / 3 = 38.3dB


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MAXIMUM OUTPUT (MPO)

FREQUENCY

PEAK = 109dB

PEAK SSPL90 vs. AVG SSPL90

.25 .5 1 2 4KHz

SSPL

90

AVG = 106 + 108 + 101 / 3 = 105dB

PHYSICALLIMIT

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FREQUENCY

TIME 1 SECOND

1 CYCLE 1 CYCLE

TIME 1 SECOND

2 CYCLES 2 CYCLES

= 2 Hz

= 4 Hz

1 V

1 V


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Peak to Peak

1 SEC 1 SEC

2 CYCLES

0.5VPP(Peak to Peak)

=

0.5 V 1 V

2 CYCLES

1.0VPP (Peak to Peak)

=

Amplitude


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HARMONIC DISTORTION

FUNDAMENTAL FREQUENCY = 100Hz

SECOND HARMONIC = 200 Hz


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EQUIVALENT INPUT NOISE

SIGNAL INTO AMP

SIGNAL OUTOF AMP

CIRCUITNOISE

CIRCUITNOISE


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TRIMMER OPTIONS

G

A

I

N

FREQUENCY

TONE / NH

HIGH CUT / NL

FREQUENCY

FREQUENCY

RPC

S

S

P

L

9

0

FREQUENCY

OUTPUT /PC

BLUE ARROW

YELLOW ARROW

GREEN ARROW

GRAY ARROW

G

A

I

N

G

A

I

N


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INPUT

INPUT

O

U

T

AGC

G

A

I

N

FREQUENCY

FREQUENCY

ASP

GAIN

SSVC

RED ARROW

WHITE ARROW

WHITE ARROW

ORANGE ARROW

TRIMMER OPTIONS

O

U

T

G

A

I

N


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TRIMMER OPTIONS for K-AMP Instruments

O

U

T

TK = G40

RED ARROW

G

A

I

N

GC = G65

G

A

I

N

LFC

FREQUENCY

G

A

I

N

FREQUENCY

LB = G90

G90 amplifies loud, high-frequency sounds up to 12dBNote: This is available only as a programmable function.

LFC= Gain-dependent low-frequency control

WHITE ARROW

ORANGE ARROW


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PATIENT

WHY PROGRAMMABLE HEARING AIDS?

NOWAY!

HEARINGAID

DISPENSERFACTORY

PATIENT

HEARINGAID

DISPENSERFACTORY

vs.


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Hearing Instrument FittingDiagram of a pure tone audiogram and the required target gain of the

hearing instrument


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Fitting Hearing InstrumentsDisplay: Basic setting and target gain of hearing instrument

Basic settingof hearing instrument

Target gain ofhearing instrument

It is the hearing instrumentdispenser's job is to bringthehearing instrument (blackcurve) as closely into line

aspossible with the redtarget gain.


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Hearing Instrument FittingDisplay: Fitted hearing instrument


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Custom instruments are available in four size classes,and modular instruments come in two classes.

Among custom instruments, a distinction is made between:

Concha instruments Battery type 13(INSITA TOP)

Canal instruments Battery type 312(COSMEA TOP)

Canal instruments Battery type A 10/230small

(COSMEA SMALL)

CIC instruments Battery type A 10/230(completely in the canal)

Modular instruments come in the following structural shapes:

Canal instruments Battery type 312

Canal instruments Battery type A 10/230small

Comparison of size classes bytheir fitting position in the ear

1 Concha instruments

2 Canal instruments

3 Canal instruments, small

4 CIC instruments

Size Classes

fitting modifying

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