Audiological Management

Question 1

What is a CROS hearing aid?

Answer 1

Contralateral routing of signals.
Used with those with unilateral hearing losses where any sound coming from the dead ear will be sent over to the hearing ear

Question 2

When would we resort to a BAHA?

Answer 2

When traditional hearing aids are not possible (ex. Middle ear pathologies that are permanent or external ear pathologies)

Question 3

What are the four types of custom hearing aids?

Answer 3

ITE (in the ear)
ITC (in the canal)
CIC (completely in canal)
IIC (invisible in the ear)

Question 4

When selecting a hearing aid, what are things we need to consider?

Answer 4

1. Type of hearing loss
2. Degree of hearing loss
3. Personal limitations: ex. Dexterity, vision impairment, etc.
4. Comfort/personal preference
5. Type of dome or mold

Question 5

What is the difference between CROS and BICROS?

Answer 5

CROS = one ear is normal hearing and the other has non functional hearing
BICROS = the better ear has some hearing loss and the other has non functional hearing

Question 6

Explain binaural vs monaural

Answer 6

Monaural is hearing with one ear, binaural is hearing with two ears.
Binaural is always better because :
- Improves localization
- Binaural summation
- Better SNR

Question 7

What is the importance of real ear measurements?

Answer 7

To evaluate how the hearing aid is working in regards to the patients hearing loss

Question 8

What is REUR/REUG?

Answer 8

REUR = real ear unaided response
REUG = real ear unaided gain

• It is how much the ear can amplify without the hearing aid.

Question 9

What is REAR?

Answer 9

Real ear aided response.
- This is the response when the hearing aid is turned on and amplified in the clients ear.

Question 10

What is RECD?

Answer 10

Real ear to coupler difference
- It is used to see the difference between a real ear and a 2cc coupler

Question 11

What is OSPL90, or MPO?

Answer 11

It is the maximum level the hearing aid can reach in terms of volume

Question 12

What is the formula for insertion gain?

Answer 12

REAR - REUR
It is the difference between how much volume the hearing aid is providing with how much volume the ear is without the hearing aid.

Question 13

What is attack time for hearing aids?

Answer 13

It is a response to a sudden change in volume levels.
Attack time reduces gain in response to a sudden increase (ex. Door slamming)

Question 14

What is a release time for hearing aids?

Answer 14

It is a response to a sudden change in volume levels.
Release times is when there is a delay before gain returns to the original. (Ex. Door slams, attack time kicks in, goes back to normal = release time)

Question 15

What is full on gain?

Answer 15

The amount of gain provided by the HA when the volume is at the highest level

Question 16

What is the frequency response curve for HAs?

Answer 16

The frequency response at 55, 65, and 75 dB SPL across speech frequencies of the HA

Question 17

What is the difference between compression and expansion?

Answer 17

1. Compression = type of automatic gain control where there is a smaller increase in output
2. Expansion = type of automatic gain control that reduces amplification for very soft sounds such as ventilators for example.

Question 18

What is peak-clipping?

Answer 18

When the hearing aid reaches a certain level where the hearing aid cannot produce a louder signal, it results in peak clipping, which can make sounds distorted

Question 19

What are three benefits of compression in hearing aids?

Answer 19

1. Soft sounds are audible
2. Moderate sounds are comfortable
3. Intense sounds are loud but not uncomfortable

Question 20

What is the ideal compression ratio and why?

Answer 20

Anything under a 3.0, because it improves audibility of softer sounds and speech

Question 21

When would we use NAL-NL2 VS NAL-NL1?

Answer 21

NAL-NL2 is the standard to make speech intelligible and overall loudness comfortable but NAL-NL1 is a louder more powerful prescription that is good for those who want to hear better and louder in general

Question 22

What is the one main issue with WDRC? What is one solution?

Answer 22

It amplifies soft sounds such as the fridge, floors, etc.
- It allows soft sounds to be heard in an audible range and can be overwhelming to the auditory system.
One solution is expansion which helps silent the hearing aid for those sounds like a noise reduction.

Question 23

What are the three types of domes and who are they used for?

Answer 23

1. Open domes = used for good low-frequency hearing to allow for natural hearing and more ventilation.
2. Vented/closed domes = used for more significant losses, allows for more gain
3. power domes = used for the most significant losses, helps to eliminate feedback,

Question 24

Name the four components of a hearing aid

Answer 24

1. Microphone
2. Amplifier
3. Receiver
4. Battery

Question 25

What are the main differences between ITE/ITC and CIC/IIC?

Answer 25

1. Directional microphones (ITE/ITC) 2. Bluetooth connectivity (ITE/ITC) 3. Longer battery life (ITE/ITC) 4. Almost invisible (CIC/IIC)

Question 26

What is the most popular type of hearing aid and why?

Answer 26

RIC/RITE (receiver in the canal or receiver in the ear). COMFORT! These are the most comfortable hearing aids compared to customs. They have a longer lifespan and better reliability (Bluetooth)

Question 27

The patient says; there is an echo in my voice, my voice is too loud. What is the problem? What are the solutions?

Answer 27

Occlusion. Switch to a more ventilated ear piece or increase size of vent on the mold

Question 28

The patient says that they hear whistling coming from the hearing aid, what is the problem? What is the solution?

Answer 28

Feedback. 1. Check for wax 2. Make sure hearing aid is fitting properly 3. Make sure gain is not exceeding MPO 4. Reduce venting if possible 5. Re-run feedback test 6. Decrease HF gain >3kHz

Question 29

Patient reports that peoples voices sound robotic or artificial? What do you do?

Answer 29

Decrease HF gain >3kHz by 2 steps and decrease CR (increase MPO)

Question 30

Patient reports that all sounds are too loud, what do you do?

Answer 30

Lower all gain by 2 steps

Question 31

Patient reports they aren’t able to hear soft sounds well, or people are mumbling. What do you do?

Answer 31

Increase g50 by 2 steps

Question 32

Patient says they hear too much ambient noise, like fridge running, ACs, etc. What do you do?

Answer 32

Lower g50 <1kHz by 2 steps

Question 33

Patient reports they feel like speech is unclear, what do you do?

Answer 33

ALWAYS check what the WRS was and make link between the results. Increase HF gain >3kHz by 2 steps

Question 34

Patient reports the sh and s sounds are too harsh and tinny, what do you do?

Answer 34

Enable frequency lowering and decrease HF gain by 2 steps

Question 35

Patient reports they cannot hear well in noisy environments, what do you do?

Answer 35

Compare QSIN and WRS results first !!! Add noise program or speech in noise program

Question 36

Patient reports they cannot hear well in noisy environments, what do you do?

Answer 36

Compare QSIN and WRS results first !!! Add noise program or speech in noise program