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Troubleshooting Fittings with iPFG

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

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Troubleshooting Fittings with iPFG

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  1. 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)

  2. Phonak Portfolio

  3. CORE Portfolio Exélia Art Versáta Certéna SoundFlow Standard digital AudioZoom WhistleBlock Technology NoiseBlock (6 channels) QuickSync SoundFlow Premium VoiceZoom (33 channels) WhistleBlock Technology NoiseBlock (20 channels) QuickSync WindBlock Management Real Ear Sound SoundRecover SoundRelax DuoPhone ZoomControl (DirectTouch) EchoBlock System SoundFlow Advanced VoiceZoom (12 channels) WhistleBlock Technology NoiseBlock (16 channels) QuickSync WindBlock Management Real Ear Sound

  4. Style Portfolio Audéo YES IX Audéo YES V Audéo YES III SoundRecover SoundFlow Standard digital AudioZoom WhistleBlock Technology NoiseBlock (6 channels) SoundRecover SoundFlow Premium VoiceZoom (33 channels) WhistleBlock Technology NoiseBlock (20 channels) WindBlock Management Real Ear Sound SoundRelax ZoomControl EchoBlock System SoundRecover SoundFlow Advanced VoiceZoom (12 channels) WhistleBlock Technology NoiseBlock (16 channels) WindBlock Management Real Ear Sound

  5. Power Portfolio Naída IX NaídaV NaídaIII SoundRecover SoundFlow Standard digital AudioZoom WhistleBlock Technology NoiseBlock (6 channels) WaterResistant SoundRecover SoundFlow Premium VoiceZoom (33 channels) WhistleBlock Technology NoiseBlock (20 channels) WaterResistant QuickSync WindBlock Management Real Ear Sound SoundRelax ZoomControl EchoBlock System SoundRecover SoundFlow Advanced digital AudioZoom WhistleBlock Technology NoiseBlock (16 channels) WaterResistant QuickSync WindBlock Management Real Ear Sound

  6. Pediatric PortfolioNew Nios micro Nios micro V Nios micro III SoundRecover SoundFlow Standard digital AudioZoom WhistleBlock Technology NoiseBlock (6 channels) Integrated/Universal FM SoundRecover SoundFlow Advanced VoiceZoom (12 channels) WhistleBlock Technology NoiseBlock (16 channels) Integrated/Universal FM QuickSync WindBlock Management Real Ear Sound

  7. 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

  8. 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.

  9. Case #1

  10. Case #1

  11. 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.

  12. 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?

  13. Case #1 *Anything immediately stand out to you?

  14. 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.

  15. Case #1 *Phone issues????

  16. 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?

  17. 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.

  18. 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.

  19. 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.

  20. Case #1

  21. 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.

  22. Case #1

  23. 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?

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

  25. Case #2

  26. 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.

  27. 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?

  28. 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.

  29. Case #2 • Where would you start? • Tackle each issue separately • Ask more questions • Identify problems that require adjustments vs. problems that require counseling

  30. Case #2 • Let’s take a look at the fitting-remember the hearing loss

  31. 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.

  32. 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?

  33. 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

  34. Case #2

  35. 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?

  36. 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

  37. Case #2

  38. 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?

  39. 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

  40. 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.

  41. 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.

  42. Case #3

  43. Case #3

  44. 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.

  45. 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.

  46. Case #3

  47. 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.

  48. Case #3 • Phone issue??? Ask more questions. Did she change phones, how did she use it before?

  49. 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.

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