Tinnitus is a concern for many people, and affects approximately 15 percent of the population. As hearing loss is increasingly identified and diagnosed, this trend is most likely to continue and grow. Many clinicians feel overwhelmed and uncertain about tinnitus and what can be done. During the 2013 AudiologyNOW! conference in Anaheim, California, ReSound’s Michael Piskosz, M.S., presented unique tinnitus case studies. Let’s take a look at one of his examples today.
First, there are two distinct tinnitus “camps” that patients can fall into:
- I have tinnitus. These patients want to be more informed about what tinnitus is and is not. They usually do not have any negative associations/reactions to tinnitus. Basic counseling with good information regarding their individual concerns should be addressed so the patient can feel comfortable and confident and can make smart, informed decisions in daily life.
- Tinnitus has ME! These patients are often misinformed of what tinnitus is and is not. They tend to have strong negative reactions and become extremely vigilant which can cause emotional, mental, motivational and behavioral distress. Regular directive counseling coupled with sound therapy is warranted. These patients are looking to regain their quality of life.
Case Study: Female, 73 years old in good health
- Described as constant loud ringing; left ear worse than right; worse in quiet.
- TJMD but was not really told for certain by physician
- No reported history of noise exposure.
- White noise helps; possibly decrease in salt and caffeine also.
- Medications: Tekturna (high blood pressure), Singular, Nexium/Ativan PRN
Patient’s grades of severity:
- Tinnitus 9/10
- Hearing loss 6/10
- Hyperacusis 4/10
- Most troublesome tinnitus 9/10
- Influence on life (tinnitus) 9/10
- Influence on life (hyperacusis) 4/10
- Tinnitus Awareness/Annoyance 80% / 90%
- THQ = 50
3-month Follow-up Appointment: Patient is doing well with devices and hearing, especially at work. The patient wears the devices most of the day and uses a sound machine at night. She is sleeping approximately 6hrs/night and feels well-rested. At this appointment the neurological model was reviewed and THQ reduced to 43.
6- and 9-month Follow-up Appointments: Patient continues to do well. She notices a stark difference when devices are not in place. With devices out the tinnitus awareness is 50% and tinnitus annoyance is at 90%. THQ has been reduced to 20.
12-month Follow-up Appointment: At this appointment the patient also went through an annual audio evaluation. She continues to wear her devices most of the day, every day, and sleeps 6 hrs/night, feeling well-rested upon waking. Her audiogram was consistent from last year and the devices are in good working order. Her THQ is now 21 (20, 43 and initially 50). Follow up appointments going forward are necessary for maintenance of devices.
Posted in Tinnitus
Open fit hearing instruments can be fit with a multitude of solutions for coupling to the ear canal. Manufacturers have different strategies for accounting for these solutions, and it may be unclear to clinicians what the result of choosing different parameters in fitting software is. ReSound’s Jennifer Groth, M.A., & Erica Koehler, Au. D., provided tips for open and occluding fittings at the 2013 AudiologyNOW! conference.
In 2003 the open fit option revolutionized how we fit hearing aids today for one of the most common hearing losses. Dome options include:
- Open domes: least occluding and ideal for normal hearing below 1kHz.
- Power/double domes: occlusive. Ideal for those that have hearing greater than 40dB in the low frequencies and need 10dB or more of low frequency gain.
- Hollow molds: more occlusive than an open dome but less occlusive than a double dome or solid mold.
- Solid molds: provides the most low frequency gain, 3-11dB at 250-1kHz.
Acoustic mass determine occlusion:
Coupling choices also impact canal resonance:
How fitting ranges are calculated:
- Electroacoustic specs in coupler
- Real-ear-to-coupler difference +MLE (CORFIG)
- Fitting prescription
- Add CORFIG to coupler FOG to get max insertion gain.
- Plug audios into prescription.
- Build in safety margin based on MSG to allow VC use and fine-tuning.
Remember, fitting ranges are not standardized! The first fit matters more than the fitting range.
In conclusion, make sure that the physical configuration of what you are fitting matches the software configuration and if in doubt, and even if not, measure.
Hearing aid manufacturers are increasingly offering technology that claims to improve sound quality, hearing in noise, spatial awareness and automatic changes for directional microphone modes. While the benefits may be gleaned through subjective evaluation, objective verification of these features requires new protocols for real-ear and test box measures.
ReSound’s Stephen Hallenbeck, Au.D., and Tammara Stender, Au.D. presented at the 2013 AudiologyNOW! conference concepts and tools to objectively verify binaural features in hearing aids.
Why do we verify:
- To align expectations.
- To provide mental construct from which clinicians can develop effective counseling messages.
- To ensure proper function.
It is important to understand which features to verify. Binaural processing is a “buzz word” and some features may be easily verified and other extremely difficult. The ReSound template includes:
- Binaural Directionality: presence of speech or noise on one side will alter which hearing aid is in directional. With one test box we can establish that changing the stimulus on one side changes the other side.
- Comfort Phone: use a magnet to trigger the Comfort Phone in the HI outside the test box. The HI inside the test box should reduce by 6 dB and when the magnet is removed the hearing aid should return to baseline.
- Environmental Optimizer II: with both hearing aids in the test box and speech in noise we expect the output of the measured HI to increase by approximately 6 dB. With one HI out of the test box, we expect the difference in environments to cause the increase to be slightly reduced.
- Synchronized Softswitching: this is an environmentally dependent automatic change between omnidirectional and directional settings. The Synchronization ensures that these changes happen in both simultaneously and is difficult to visualize within a test box.
For years, ReSound has had a business partnership with Bosma Enterprises, a non-profit NIB (National Institute for the Blind) agency that provides job training, rehabilitation, and employment services to people who are blind or visually impaired. Earlier this year, ReSound expanded this partnership by working with Bosma’s call center to enroll ReSound customers in a registry. The registry will help ReSound identify hearing healthcare providers across the country in response to requests from insurance companies.
On May 7th, Kim Herman, President of ReSound North America along with Paul Martin, Director of Strategic Accounts and Kevin Roseff, Strategic Accounts Sales Representative visited Bosma to meet the outbound call team tasked with enrolling hearing healthcare providers in the ReSound Registry.
“As an organization also working to help those with sensory impairments, we couldn’t have found a better partner,” says Herman. “The visit at Bosma was very inspiring. We appreciate the work they are doing for us and are pleased to be part of a program that provides meaningful work to the people involved.”
By combining special software with exemplary customer service skills, pride, and determination, the Bosma outbound call team has aided ReSound in exceeding their ReSound Registry enrollment goal of one thousand provider locations in their first month on the job. Through this partnership, ReSound is working to help further Bosma’s mission of reducing the 70% unemployment rate among those who are visually impaired or blind.
How do you make sure your hearing aid fittings result in positive outcomes where patients become successful users? How do you avoid the negative outcomes where the hearing aid is not worn or is returned?
As you know, the negative consequences of untreated hearing loss are irritability, fatigue, stress, withdrawal, depression, reduced job performance and lower earning power. When a person with hearing loss is fit with hearing aids and subsequently has a negative outcome, they are unable to experience the benefits of amplification and overcome these negative consequences.
At the 2013 AudiologyNOW! conference, Laurel Christensen, Ph.D., outlined why some fittings have negative outcomes and suggested ways to increase the likelihood of positive outcomes.
As an audiologist you know that hearing aid users enjoy not only a better quality of life than non-users but also better overall health. Hearing aid users are less introverted and more likely to engage in social activities than those who don’t wear hearing aids. They also communicate better with people around them and have better personal relationships. So why do almost 20% of hearing aids get returned for credit? The graph below breaks down some of the more common return reasons:
What do patients expect from their hearing aids? Patients want to “put on” their “invisible” hearing aids and forget the hearing aids are even there. Patients also expect to hear no matter what listening environment is presented. Luckily today the hearing aid user is successful in more listening environments than ever before as well as they have more choice in types and styles, but audiologists must gain an understanding of the communication needs of the patient, extent of the program (audiological evaluation) and the patients motivation/self-perception of the problem to truly drive a positive outcome.
Here are some common fitting tools & tips to help gain more positive outcomes:
- Characterstics of Amplification Tool (COAT), 9-question intake form.
- Red Flag Matrix as Counseling Tool
- Self-Perception on Hearing Ability – ask the patient to rank their overall ability to hear.
- Patient involvement – it should be a shared decision making process with the patient involved as much as possible and with the audiologist quantifying whatever and whenever he or she can.
- Fitting Verification – optimize for speech intelligibility and sound quality and maximize audibility and “first-fit” acceptance.
- Fitting Validation – how does the patient feel, how much benefit, how much satisfaction are they gaining?
All technology connecting hearing instruments to sound sources or other people has one major functional goal–to improve the signal to noise ratio making speech easier to discriminate especially in the presence of background noise. Contemporary hearing instruments offer such connectivity through wireless streaming and wireless accessories.
ReSound’s Charlotte Jespersen, M.A., and Brent Kirkwood, Ph.D., presented information about available wireless options at the 2013 AudiologyNOW! conference.
First, the term “wireless” covers a multitude of technologies for transmitting information for many different purposes without the use of wires. Early wireless solutions included telecoils, infrared systems and frequency modulation (FM) systems. Today’s digital wireless solutions are:
- Near Field Magnetic Induction (NFMI + Bluetooth RF) – contain transmission energy within the localized magnetic field. Current hearing aids incorporate Bluetooth through an adaptor or gateway device. Advantages include ease of implementation due to existing RF chips, longer battery life when using wireless function, easy transmission through the head and stable performance for near-field part transmission. Drawbacks include short transmission distance, need of gateway device which can introduce delay and possibility to encounter interference with magnetic sources.
- Proprietary radio frequency (RF)+ 2.4 GHz Wireless Technology – use a radio to generate an electrical wave and an antenna to send the information, “far-field”. Advantages include no gateway device, long distance signal transmission, low latency, robust, reliable and frequency-band approved worldwide. Drawbacks include requirement of a specially designed antenna, streaming device for Bluetooth connectivity and higher current drain when using wireless functions.
Who can benefit from wireless accessories? In the case of a TV Streamer, any patient who struggles to understand what is being said without closed captioning activated on their TV set as well as any patient who enjoys listening to music and lacks fidelity with the hearing instruments alone. TV Streamers are not as useful for mild hearing losses. The external microphone can benefit patients who attend talks, seminars or church services where the speaker is at a distance. Patients who need sound enrichment to combat tinnitus can also benefit from an external microphone. The phone streamer can benefit any patient with a Bluetooth enabled phone who experiences difficult understanding speech on the phone when using other methods.
Remember when hearing aids had four components: microphone, amplifier, receiver and battery? Explaining hearing aids was much simpler. Today’s hearing instruments come with many more options and technology. Where does one begin the explanation? ReSound’s Jennifer Groth, M.A., and John Nelson, Ph.D., breakdown signal processing into four “chapters”: Model, Clean, Balance, and Stabilize at the 2013 AudiologyNow! conference. This provides audiologists with a structure to discuss amplification and technology with the end user.
- WARP Processing: Models the signal to replicate the way the natural ear breaks down sound into distinct pitches. It also forms the core for other sound treatment and is the foundation for clear and distinct sound. The benefit derived is near-zero distortion and remarkable purity.
- Environmental Classifier: Analyzes the sound environment then models the signal to replicate that environment in digital format as well as identifies how loud or soft sounds are whether they are speech or other and where they originate. The benefit derived is a foundation that allows us to balance the signal into fine nuances.
- Noise Tracker II: Eliminates just enough background noise for comfortable listening with reduced effort and allows speech signal to remain intact and natural sound quality is maintained. Benefit: increases end user comfort in noisy listening situations without compromising speech understanding.
- Expansion: Lowers the noise floor of the hearing instrument, ensuring best sound quality in quiet situations.
- Windguard: uses a new sound processing technique which utilizes inputs from both microphones together to recognize and reduce annoying wind noise.
- WDRC: Makes soft sounds audible and loud sounds comfortable for a perfect balance between audibility and comfort. It also personalizes for the individual’s hearing profile.
- Directional Mix Processing: Separates and balances low/high pitches enabling differential treatment of speech and background noise and improves speech understanding in noise in all directional modes.
- Environmental Optimizer (Binaural Fusion): Balances the volume level of the sound environment relative to the individual’s needs.
- DFS Ultra: Stabilizes the signal by suppressing feedback through phase cancellations and built in WhistleControl and provides sufficient gain without introducing artifacts or compromising sound quality. The benefit derived is that the patient can gain confidence using the telephone, embracing, wearing hats and so on.
In addition, today, we also need to consider connectivity. Connectivity allows for interaction between hearing instruments and allows receiving of audio signals from remote transmitters to increase signal-to-noise ratio for the listener. Examples include the ReSound Unite Mini Microphone which allows direct audio streaming up to 7 meters in range of the hearing aids with a fixed clip or lanyard.