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June 2013 TOPICS IN AMPLIFICATION Acriva – Truly Invisible-In-the-Canal (IIC) The outstanding feature of the Acriva IIC is its small size, as shown in Fig. 1. Importance of Cosmetics Do you remember a client ever asking for a hearing instrument to be bulky? If so, it must have been a rare exception. The opposite is usually true: almost all clients prefer a small, discreet style. This was a trend in the past, it is the same today, and it will continue to be a trend in the future. In fact, already more than a decade ago, a study by Kochkin (2000) showed that the smallest style of hearing instrument received the highest percentage of satisfaction. The comparison is shown in Fig. 2. Hearing Instrument Style Style matters. Style preferences play a key role regarding hair, fashion and many other domains, including hearing instruments. Style is a determining factor in hearing instrument selection with many favoring a small and discreet design. In this situation, you – as a hearing care professional – need a complete arsenal of hearing instrument options. This enables you to attract a wide range of clients, including young and first-time users who are often hoping for an invisible solution. Their wishes are now easier to fulfill, thanks to the Acriva IIC. The Acriva IIC allows you to provide the invisible style to all those who satisfy the physical and audiometric requirements of a deep-fitting instrument. 50 ITE – Full ITE – Partial ITC – Visible ITC – Invisible 55 60 65 70 Satisfaction [%] Figure 2: Satisfaction scores with ITE and ITC hearing instruments Figure 1: The small size of the Acriva IIC The small size allows for a deep placement in the ear canal, which entails a number of advantages: invisibility when worn, a natural sound of the wearer’s own voice, and beneficial side-effects due to the fact that the microphone is placed deeply in the ear canal. As a result, the IIC style not only satisfies cosmetic needs but also provides tangible benefits. www.bernafon.com According to Fig. 2, the point is invisibility. The invisible ITC received a satisfaction score of 66%, whereas all the visible styles received lower scores between 56% and 58%. The difference between a slightly visible instrument and an invisible instrument is indeed distinct as far as cosmetics are concerned. A comparison is shown in Fig. 3. voice sounds to them. It may sound unnatural or hollow. This problem occurs because of the occlusion effect. The occlusion effect is the result of sound vibrations that propagate through the skull and the cartilaginous portion of the ear canal. The energy from these vibrations becomes trapped in the ear canal when it is occluded with a hearing aid. a b Figure 3: Patient wearing different hearing instruments – a) a visible CIC; b) a new invisible IIC. Fig. 3 shows what a difference the invisible vs. the visible style makes. When you look at these pictures through the eyes of your clients, you will understand their preference for the invisible device. Within the last 10 to 15 years, the composition of hearing instrument users has changed. Many people are staying in the work force longer, pensioners lead a more active lifestyle, and more people under 65 years of age suffer from hearing loss (Morla, 2011). Because of these changes, the preference for small devices has even grown stronger. The typical image of a hearing instrument user has changed and now reflects a younger, active user. Today’s hearing instrument users need devices that match their lifestyles as well as their hearing needs. Summarizing the situation, Morla (2011) noted that the respondents to her survey conveyed a “strong preference for hearing instruments that are small, discreet, almost invisible” (p. 38). This finding dates back two years, but a brand new style preference study just confirmed, “Most clinicians have considerable experience with patients who express a strong desire for the smallest and most cosmetically appealing hearing aid available” (Smith et al, 2013, p. 91). So if there is one thing to take away from these reports, it is this: the demand for an invisible instrument is invariable. Compared to an open ear, an occluded ear canal potentially increases the sound levels in the frequency region from 125 Hz to 750 Hz by 10 dB to 30 dB (Mueller, 1994; Smith et al., 2013). Due to this boost of low-frequency energy, clients report an unnatural loudness of their own voice and of sounds when chewing. A conventional method to ease the problem is to increase the length of the hearing instrument into the bony part of the ear canal (Chung, 2004). This is exactly where an IIC should fit, given that the ear canal has the appropriate physical dimensions. A tight fit in the bony portion reduces the vibrations in the canal and therefore diminishes the occlusion effect, as shown in Fig. 4. Figure 4: Real-ear measure of occlusion: unoccluded (pink), ITC (green), and IIC (blue) Fig. 4 shows measures that were made with Verifit real-ear measurement (REM) equipment. The equipment recorded the sound pressure level (SPL) in the ear canal for three different conditions. In each condition a 30 dB speech signal was used via bone conductor placed on the mastoid bone of a test subject (Stender & Appleby, 2009). Natural Sound of Own Voice 1. No hearing instrument (pink curve); 2. An ITC instrument (green curve); 3. An Acriva IIC instrument (blue curve). When clients initially try hearing instruments, they often express problems with how their own Both the ITC and the IIC instruments operated without gain. BERNAFON TOPICS IN AMPLIFICATION Compared to the unoccluded ear (pink curve), the ITC (green curve) results in an excessive sound pressure level at 500 Hz. In contrast to the ITC, the placement of the deep-fitting Acriva IIC (blue curve) reduces this low-frequency energy and provides your clients with a more natural sound experience. To achieve the benefits of a deep fitting, it is important to produce high-quality ear impressions. · The canal length must extend past the 2nd bend. · There should be no indentions from hair or cerumen. · The length and width must be clearly defined. Beneficial Side-Effects of Deep Fit In addition to the reduced occlusion, the Acriva IIC offers further benefits. However, these benefits become apparent only when the hearing instrument fits properly in the ear canal. The correct position is shown in Fig. 5. Tympanic membrane 2nd bend Concha 1st bend Tragus Figure 5: Deep placement of an IIC instrument in the ear canal The deep placement produces these four additional benefits: 1. Preservation of the pinna effect; 2. Need for less gain; 3. Reduced risk of feedback; 4. Protection from weather conditions. Preservation of the pinna effect is important for localizing sounds. The pinna provides natural directionality by boosting sounds coming from the front and giving less amplification to sounds coming from behind. With the deep placement, the sound arrives at the IIC almost as it arrives at the ear canal of an unaided ear. The IIC therefore allows your clients to maintain their normal spatial awareness and know where sounds are coming from. This is crucial for speech understanding and safety in noisy situations (Musicant & Butler, 1984). BERNAFON Need for less gain occurs because the sound outlet of an IIC instrument is closer to the tympanic membrane than the outlet of other styles. This proximity means a reduced residual volume, which in turn increases the intensity of the sound at the eardrum (Palmer, 2005). This naturally occurring boost in sound pressure level (SPL) allows for achieving the required SPL with less gain in the hearing instrument. With less gain needed, the IIC becomes an option for a wider range of your clients. Reduced risk of feedback results from three factors. The first factor, just discussed, is the need for less gain. The other two factors solve problems of sound leaking back to the microphone of the hearing instrument (Branda, 2012). One of these factors is that the IIC style overcomes the occlusion effect through its deep placement in the ear canal – instead of through a vent. Removing the vent eliminates one escape route for sound. The other factor is the tight fit of an IIC in the bony part of the ear canal, which prevents sound from leaking around the instrument. TOPICS IN AMPLIFICATION 10_UK - 03.06.2013 Since 1946, we have been passionate about developing quality hearing systems that enable people with hearing difficulties to enjoy authentic listening experiences. With Swiss Engineering, precision technology, and our commitment to individual service, we strive to exceed our customers' expectations. Protection from weather to everyReferences Our aim is to provide extra conditions value to our relates partners day. Bernafon representatives and employees two issues: wind noise and moisture from wet in over1946, 70 countries ll our vision to about help people with impaired hearing communicate againpeople without Since we havefulfi been passionate developing quality hearing systems enable Branda, E. (2012). Deep canal fithat ttings: Advantages, weather. Wind noise bothers wearers of IICs less experiences. With Swiss Engineering, precision limitations. with hearing diffi culties to enjoy authentic listening challenges, and a new approach. The Hearing because of the deep service, in Review, 24-27. our customers' expectations. technology, andIIC’s our microphone commitmentlocation to individual we strive19to(4),exceed the ear canal – instead of at its entrance or on top Our aim is to provide extra value to our partners everyChung, day. Bernafon representatives and employees K. (2004). Challenges and recent developments of the outer ear. And fi nally, the ear canal offers hearing aids: Partcommunicate II. Feedback and occlusion in over 70 countries fulfill our vision to help people with in impaired hearing again without the instrument the best shelter against rain. effect reduction strategies, laser shell manufacturing limitations. processes, and other signal processing technologies. Trends in Amplification, 8, 125-164. An Appealing Solution without Compromise on Acoustic Performance Kochkin, S. (2000). MarkeTrak V: Consumer satisfaction revisited. The Hearing Journal, 53(1), 38,40,42,4546,50,52,55. Given that a client meets the physical and audiometric conditions, the Acriva IIC is an ideal instrument. Its cosmetic appeal is what attracts first-time users and young clients in the first place. There is no doubt, however, that they will eventually appreciate its additional benefits as well. The Acriva IIC is the appealing solution that is uncompromising on its acoustic performance. So, keep your eyes open for suitable clients. Morla, A. (2011). Four transformative patient demands: Convenience, size, simplicity, and flexibility. The Hearing Review, 18(4), 36-42. Mueller, H. G. (1994). CIC hearing aids: What is their impact on the occlusion effect? The Hearing Journal, 47(11), 29-36. Musicant, A. D., & Butler, R. A. (1984). The influence of pinnae-based spectral cues on sound localization. J Acoust Soc Am, 75(4), 1195-1200. Palmer, C. (2005). In fitting kids with hearing aids, ensuring safety and audibility is a good way to start. The Hearing Journal, 58(2), 10-16. Smith, S. L., Ricketts, T., McArdle R. A., Chisolm, T. H., Alexander, G., & Bratt, G. (2013). Style Preference Survey: A Report on the Psychometric Properties and a Cross-Validation Experiment, J Am Acad Audiol 24:89-104. Stender, T., & Appleby, R. (2009). Occlusion effect measures: Are they all created equal? The Hearing Journal 62(7), 21-24, 26, 28. Switzerland Bernafon AG Morgenstrasse 131 3018 Bern Phone +41 31 998 15 15 World Headquarters Fax +41 31 998 15 90 Switzerland Bernafon AG Morgenstrasse 131 3018 Bern Phone +41 31 998 15 15 Fax +41 31 998 15 90 Australia Bernafon Australia Pty Ltd. 629 Nudgee Road Nundah QLD 4012 Freecall 1800 809 111 Phone +61 7 3250 0300 Australia Fax +61 7 3250 0372 Bernafon Australia Pty Ltd. 629 Nudgee Road Nundah QLD 4012 Freecall 1800 809 111 Phone +61 7 3250 0300 Fax +61 7 3250 0372 New Zealand Bernafon New Zealand Ltd. Level 1, Building F 27-29 William Pickering Drive Albany, Auckland 0632 Toll Free 0800 44 22 57 New PhoneZealand +64 9 415 7917 Bernafon Zealand Ltd. Fax +64 9New 415 7916 Level 1, Building F 27-29 William Pickering Drive Albany, Auckland 0632 Toll Free 0800 44 22 57 Phone +64 9 415 7917 Fax +64 9 415 7916 United Kingdom Bernafon UK Cadzow Industrial Estate Off Low Waters Road Hamilton ML3 7QE Scotland United Kingdom Phone +44 1698 285 968 Bernafon UK 421 456 Fax +44 1698 Cadzow Industrial Estate Off Low Waters Road Hamilton ML3 7QE Scotland Phone +44 1698 285 968 Fax +44 1698 421 456 Bernafon Companies Australia ∙ Canada ∙ China ∙ Denmark ∙ Finland ∙ France ∙ Germany ∙ Italy ∙ Japan ∙ Korea ∙ Netherlands ∙ New Zealand ∙ Poland ∙ Spain ∙ Sweden ∙ Switzerland ∙ Turkey ∙ UK ∙ USA Bernafon Companies Australia ∙ Canada ∙ China ∙ Denmark ∙ Finland ∙ France ∙ Germany ∙ Italy ∙ Japan ∙ Korea ∙ Netherlands ∙ New Zealand ∙ Poland ∙ Spain ∙ Sweden ∙ Switzerland ∙ Turkey ∙ UK ∙ USA www.bernafon.com 06.13/BAG/UK/subject to change World Headquarters