Download - Professionals

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.
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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).
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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
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effect reduction strategies, laser shell manufacturing
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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
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Phone +41 31 998 15 15
Fax +41 31 998 15 90
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Phone +61 7 3250 0300
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Albany, Auckland 0632
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New
PhoneZealand
+64 9 415 7917
Bernafon
Zealand Ltd.
Fax +64 9New
415 7916
Level 1, Building F
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Albany, Auckland 0632
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Phone +64 9 415 7917
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Cadzow Industrial Estate
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ML3 7QE Scotland
Phone +44 1698 285 968
Fax +44 1698 421 456
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