troubleshooting fittings with ipfg case studies using ipfg to troubleshooting fittings –what to...

Troubleshooting Fittings with iPFG

• Case Studies• Using iPFG to troubleshooting fittings

– What to ask?– What to look for in the fitting?– Counseling vs. Adjustments

• One very important thing to remember in this class-There are NO WRONG ANSWERS

• Laura Griffith, Au.D., Customer Trainer (CO, UT, NM, AZ, WY)• Andrea Gerlach, Au.D., Customer Trainer (TX, LA, OK)

Premium Advanced Basic

CORE Exélia Art Versáta Certéna

Style Audéo YES IX Audéo YES V Audéo YES III

Power Naída IX Naída V Naída III

Pediatric Exélia ArtNaída IX

Nios micro V Nios micro III

Phonak Portfolio

SoundFlow Standard

digital AudioZoom

WhistleBlock Technology

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QuickSync

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VoiceZoom (12 channels)



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WindBlock Management

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QuickSync


Real Ear Sound

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SoundRelax

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EchoBlock System

Exélia Art CerténaVersáta

CORE Portfolio

SoundRecover

SoundFlow Standard

digital AudioZoom



SoundRecover

SoundFlow Advanced





Real Ear Sound

SoundRecover

SoundFlow Premium





Real Ear Sound

SoundRelax

ZoomControl

EchoBlock System

Style Portfolio

Audéo YES IX Audéo YES IIIAudéo YES V

SoundRecover

SoundFlow Standard

digital AudioZoom



WaterResistant

SoundRecover

SoundFlow Advanced

digital AudioZoom



WaterResistant

QuickSync


Real Ear Sound

SoundRecover

SoundFlow Premium




WaterResistant

QuickSync


Real Ear Sound

SoundRelax

ZoomControl

EchoBlock System

Power Portfolio

Naída IX Naída IIINaída V

Pediatric PortfolioNew Nios micro

SoundRecover

SoundFlow Standard

digital AudioZoom



Integrated/Universal FM

SoundRecover

SoundFlow Advanced




Integrated/Universal FM

QuickSync


Real Ear Sound

Nios micro IIINios micro V

Troubleshooting fittings

• Challenges involved in troubleshooting fittings:– Identifying the issue (hearing aid related vs. patient

related)

Hearing aid related issues:

*Occlusion (physical vs. acoustical)

*Properly fit device

*Gain

*Sound quality

*Accessories (FM, bluetooth, etc)

Patient related issues:

*Realistic expectations

*Un-identified needs

*Previous User needs

*New User needs

Case #1

• 78 year old man, retired, fit 2 weeks prior with Certena full-shell ITE.

• Previous ITE user for over 10 years. Last set of hearing aids were Beltone ½ shell aids with VC only.

• Patient lives in nursing home and mostly watches television. Starting to have issues with dementia and dexterity.

Case #1

Case #1

• 2 week follow-up appointment patient comes and is accompanied by his daughter.– Patient reports he does not feel hearing aids are loud

enough.– He has been wearing the aids all the time but feels he

heard ok initially with new aids but now feels his olds hearing aids work better.

– Daughter reported she called right after he came home from the appointment and he could not hear her over the telephone.

Case #1

• Which issue noted would you address first? Why?– He has been wearing the aids all the time but feels he

heard ok initially with new aids but now feels his olds hearing aids work better.

– First thing you would want to check?• Are hearing aids working when patient walked in your door?• Datalogging?

Case #1

*Anything immediately stand out to you?

Case #1

• Experience/Loudness?– Level 2 equates to 80% to target– Experience level not filled out at initial fit screen so

defaults to level 2. Patient is a long-time user and is likely needing aids to be set to target gain.

Case #1

*Phone issues????

Case #1

• Why is patient having trouble on telephone?– What phone program did patient use with previous

hearing aid?– Does patient understand how to use manual program?– Would patient benefit from easyphone option?– What other phone options are available?

Case #1

• At appointment we figure out several issues:– Patient confused old hearing aid batteries with new

hearing aid batteries. Datalogging showed although time between appointments was 2 weeks, use time was approximately 1 week. When patient walked in he was wearing 312 batteries in aids vs. 13 batteries needed.

– To address volume issue we adjusted aids to adaptation level 4 since patient is long-term hearing aid user.

– Patient previously had automatic telecoil setting in old hearing aids. He did not realize for phone use he needed to switch the aids to another program. Set easyphone setting to telecoil and practiced use in office.

Case #1

• Patient returns after intial follow-up appointment approximately 4 weeks from initial fit date.– Patient reports volume sounds great.– Family reports he is doing fine over the phone now.– Only problem is that patient feels he is not

understanding speech as well as he would like.

Case #1

• Counseling vs. Adjustment– Look at patients word recognition ability– Take into consideration patients old hearing aid.– Issue likely needs to be dealt with both through

counseling and adjustments.

Case #1

Case #1

• Note compression ratios of hearing aid.• For Phonak aid you can reduce global

compression parameter from 100% to lower setting to reduce compression ratios.

Case #1

Case #1

• 3rd Follow-up appointment• Patient and daughter report he is doing overall

well with new hearing aids. • What follow-up plan would you make from here?

Case #2

• 58 year old business man• Fit 2 weeks prior with Audeo Yes IX hearing aids

Case #2

Case #2

• History:– Otosclerosis left ear. Patient had surgery approximately

8 years ago but was unsuccessful and does not wish to pursue surgical options again.

– Reports difficulties in challenging listening environments like restaurants and problems with the telephone. No reported difficulties at home.

– No previous amplification history.– Pursuing amplification at this time due to insistence from

wife and boss.

Case #2

• Needs identified prior to fitting:– Size and visibility of aid is important.– Involved in multiple listening environments throughout

the day.– Conducts business over cell phone as well as work

telephone.

– Do you think aid fit is appropriate?

Case #2

• 2 week follow-up appointment– Patient reports right aid seems louder than left aid.– Overall satisfied with sound quality of aids– Overall seems to be hearing too much sound in all

environments.– Still struggling to hear on the cell phone.– Not sure they seem to be helping him much.

Case #2

• Where would you start?– Tackle each issue separately– Ask more questions– Identify problems that require adjustments vs. problems

that require counseling

Case #2

• Let’s take a look at the fitting-remember the hearing loss

Case #2

• Issue 1-Right aid seems louder than left• Why might that be?

– Did you take into consideration ABG due to conductive loss in left ear?

– Remember: iPFG will calculate additional gain required for conductive hearing loss if bone thresholds are entered into audio.

Case #2

• Issue 2-Overall seems to be hearing too much sound in all environments– Counseling vs. Adjustment-Which would you do?– Let’s do both. Remember to ask more questions.

• Has this improved at all since the first few days you wore the hearing aids?

• Are there certain sounds in particular that seem to be too much?• How bothersome is this issue for you?

Case #2

• Let’s try to adjust for that– After your questions you identify that he is bothered by

soft sounds such as fans, ticking clocks, etc. Reports those sounds seem to be louder than expected.

– What would you adjust?– Noise reduction vs. kneepoint vs. gain for soft sounds

Case #2

Case #2

• Issue 3-Still struggling on cell phone.• What would you do?

– Remember to always ask more questions about an issue a patient is having.

• Is it only the cell phone? How do you do on your work phone?• Which ear do you hold the phone to? How do you hold the phone?• Would you be willing to change the hearing aid settings if it would

help on the phone? • Would you be willing to use an additional device to help you hear

better on the cell phone?

Case #2

• Let’s try to adjust for that– From your questions you find out he is not willing to use

a remote or change the hearing aids. He does fine on the work phone but he uses that phone in the speakerphone setting. He would be willing to use an additional device if it made the cell phone easier.

– Let’s look at accessory options

Case #2

Case #2

• Issue 4-Does not seem to think that the hearing aids are helping.– What do you think?– Adjustment vs. Counseling– Again ask more questions.

• Why do you feel they aren’t helping you?• Is this in all situations or only certain environments?• How do you feel your family members and co-workers feel you are

doing with your new hearing aids?

Case #2

• For issue 4-focus on counseling. Use the tools you have to show benefit to patient.– Real ear measurements– Outcome measures– Family and co-workers perceived benefit

Troubleshooting fittings with iPFG

• So the previous cases are for patients you fit and followed up with for adjustments.

• What about the patients who saw a co-worker in the office or moved from out of town and they come to you for help.

• What to check-what to do.

Case #3

• 77 year old retired female. • Purchased aids 1 year ago in Florida but has been

moved since that time.• She was fit with micro Exelia BTE’s with slim

tubes and open domes.• She brought in previous audiogram from when

she purchased the hearing aids.

Case #3

Case #3

• Patient reports that she has loved her hearing aids but recently doesn’t feel she is hearing as well.

• She previously did fine on the telephone but now with her new phone she can’t hear at all.

• Hearing re-test at appointment shows no significant change in thresholds or word recognition ability.

Case #3

• Where would you start?– Start with the Basics

• Tubing-bent, open, etc.• Dome-wax, etc.• Hearing aid function-microphone covers, battery, etc.

– Read-out program in hearing aids to check settings• After connecting hearing aids to iPFG read from the instrument not

iPFG to see how patient’s hearing aids are set.• Check basics in programming-correct acoustic coupling, feedback

test, phone setting, etc.

Case #3

Case #3

• Acoustic coupling for programming has her fit with standard tubing and earmold but she walked in with microtubing and dome-be sure to change and re-calculate.

Case #3

• Phone issue??? Ask more questions. Did she change phones, how did she use it before?

Case #3

• Phone issue– She lives in a assisted living facility now and uses the

phone provided in her room. – When you ask her to show you how she uses the phone

she properly holds phone to behind her ear and explains she has not been hearing the beeps like she used to.

– What could be happening?

– New phone is likely not triggering easyphone program. Provide her with magnets to place on receiver of new phone. Practice with phone in office to make sure it’s still working.

Case #3

• GREAT JOB!!!– You figured out that aids needed to be cleaned and

tubing changed.– Adjusted aids for correct acoustic coupling.– Figured out phone had changed and gave her magnets

to use on the phone to help trigger easyphone setting.

– OUTCOME: Happy patient who just found a great new provider in her new hometown.

Case #4

• 85-year old male patient who has been long-term patient of office and typically sees your co-worker who just recently left the office.

• Patient has been wearing power BTE aids for approximately 20 years. Last set of hearing aids was analog 675 trimpot BTE aids.

• Fit with Naida IX UP hearing aids on 6/28/09. According to chart he has been in the office 8 times for adjustments since initial fit.

Case #4

Case #4

• Looking at chart notes from other audiologist below are list of complaints he has come in with over 8 appointments.

*Aids not loud enough*Feels plugged*Aids tinny*Can’t understand*Aids too loud*Fans are annoying*Aids shut off*Can hear everything*His voice sounds different*Can’t hear on home phone

Patient Complaints Audiologists adjustments

*Increased overall gain*Decreased occlusion manager*Adjusted soundrecover stronger*Decreased overall gain*Turned down soft sounds*Turned up speech sounds*Turned on echoblock*Adjusted low frequency gain*Adjusted high frequency gain*Uses Icom on cell phone and does well

Case #4

• Where do you start???• Let’s take a look at the fitting and check

everything out.

Case #4

Case #4

• Few things stand out– Why is patient set at experience level 2 (80% to target)?– Why is patient having occlusion issues?– Did we order a few earmold?

Case #4

Why was feedback test not run?

Case #4

Patient has several programs. What are they used for? Does patient use the programs set?

Case #4

Gain in low frequencies is below target gain?

Case #4

Compression ratios extremely high.

Case #4

• Looking at all that where would you want to start?• Let’s start over because we have done a lot of

adjustments.

Case #4

Case #4

Let’s re-calculate the fitting and start by entering patients hearing aid experience. Remember he has worn aids for many years and was in analog aids previously.

Case #4

• Let’s start again by doing the basics– Experience level 4-if patient doesn’t feel aids it loud

enough still-try by setting bass boost. Long-term users many times like additional low frequency gain.

– Run feedback system– Programs? Discuss how patient used the phone with his

previous aids. He may prefer a telecoil over acoustic phone setting and may prefer manual program over easyphone if he had a tcoil switch on old aids.

Case #4

Case #4

• Very important with this patient to counsel, counsel, counsel.

• Explain how hearing aid differs from previous aid.• Show patient Real-ear measurements to let him see how aid

is meeting gain requirements. Consider performing other speech understanding tests.

• If no outcome measure performed be sure to do one with (COSI is in software)

• Be sure to emphasize to patient the need to wear aid continuously in order to adapt to new hearing aid sound.

• Set specific follow-up appointments.

Conclusion

• Important things to remember when troubleshooting any fitting– Ask lots of questions. There are many things you can adjust in

hearing aid software. You need to fully understand the issue.– Don’t always jump into adjusting the hearing aid. Many issues

may be best dealt with using effective counseling.– Be sure you are comfortable with manufacturer’s software and

what adjustments you have within software. If you aren’t sure-ask. Tech support, sales reprensentatives, and trainers are all there to help you best understand products and software.

– Don’t forget to always remember the basics. Check earmold, fit, and function of aid.

– Use the tools you are learning in school. Real ear measurements and outcome measures can help troubleshoot fittings.

troubleshooting fittings with ipfg case studies using ipfg to troubleshooting fittings –what to...

Documents

ok slide

phonak portfolio slide

nada v slide

new user needs slide

sound quality

patient related issues

nios micro vnios micro

previous user needs