Download In-depth product training

October AudioLounge
1. Who are we?
2. Acoustic Coupling Options
3. Retention options
4. Feedback & Acoustic Coupling
5. Moisture & Coupling
Other upcoming sessions
3
Sound Delivery System (SDS) options
• Instant fit:
–
Smokey Domes
• Custom EarPieces:
–
SlimTip (hard/soft)
–
cShell (hard/soft)
–
Earmolds (hard/soft)
SlimTip
cShell
Earmolds
Compatibility
•
•
SlimTubes
xS, xP receivers
•
xS, xP, xSP receivers
•
•
•
#13 tubing
Slim Tube
Power slimtube
Advantages
•
•
•
Retention
Comfort
Performance
•
•
•
•
•
Retention
Comfort
Performance
Moisture control
Possibly better for more
length
•
•
•
Moisture control
Retention
Performance
Limitations
•
•
Fitting range
Impression required
•
•
•
Receiver replacements at
Phonak
Perceived as ‘bulkier’
than slimtip
xSP for cShell hard only
Perceived as
bulkier
Impression
required
N/A for RICs
•
•
•
Canal/helix locks
Soft coats
Hard vs soft
•
•
Options
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•
•
•
•
Canal/helix locks
Soft coats
Hard vs soft
Hollow vs solid
•
•
•
Acrylic, silicone
soft 40 or 70
Many styles to
choose from
Coupling Options – Important Points to consider
• Retention
• Feedback
• Hearing performance
• Venting via plumbing
• Anatomical challenges
• Outer/middle ear disorders
• Moisture
• Comfort
• …just to name a few…..
NEW! Digitally modeled locks
• Same color as the shell (ie. Blue shell = blue canal lock)
• Helix locks & canal locks can all be done digitally
• Retro-fittable
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CIC with canal lock
• Most common solution for retention
• Canal locks always the same color as
shell. No exceptions.
• Canal lock on this CIC is also pink
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Slimtip with skeleton lock
• Color of shell and lock are the same
• Compatible with either the slimtip
hollow or solid
Not available:
• Any type of flexcanal
• Slimtip/cShell soft are not compatible
with any locks
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cShell with skeleton lock
• Any configuration of lock is possible on a cshell
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Slimtip & cShell with skeleton locks
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Earmold with helix lock and canal lock
• Extra retention
• Great for those with shallow concha
bowls
• Available on slimtips hard, cshell hard
• Also available on custom hearing aids;
however, it will cause the instrument to
protrude more (not as discreet)
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Canal locks & Custom products
• Keep in mind: locks are digitally modeled; therefore, they are the same color as the
shell (no exceptions)
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Earmold styles
Earmold materials
Select the desired earmold material.
• Acrylic Hard – very durable, for those with mild/mod to severe HL
• Silicone Soft 70 – tight fit, for those with severe-profound HL
• Silicone Soft 40 – minimal leakage, for those with profound HL
Unique Scenario
Bolero V + Slim tube + skeleton mold
How to order?
• Option 1: Use the custom eartip order form and just put in special instructions that
you want it to be a skeleton mold
• Option 2 : Use the earmold order form and ask for slimtube compatibility
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Recommendations for Better Retention
For slimtip/cShells where there are retention issues and the patient also has a
shallow concha bowl, consider:
• Helix lock
• Extra length (?)
• Soft coat
Shallow
18
normal
Final Thoughts on Retention….
Slimtip/cShell (hard)
• Try adding a soft coat
• Consider a canal/helix/skeleton lock, depending on the concha bowl (ie. shallow
concha bowl would be best with a skeleton lock)
• Add extra length (may protrude more in some cases)
• Consider orientation of ear canals: For long and straight canals, consider a soft
material OR a canal lock on a hard material from the first fit
Note: SP receiver not available for cShell soft (hard only). And soft material tends to
be not as durable.
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Coupling Options – Important Points to consider
• Retention
• Feedback
• Hearing Performance
• Venting via plumbing
• Anatomical challenges
• Outer/middle ear disorders
• Moisture
• Comfort
• …just to name a few…..
Acoustic Coupling & The Feedback Manager
• Allows you to check the integrity of the acoustic coupling
• Option to delete the results and start again
• A poor result here can have disastrous effects for your client
“Conscious Coupling”
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Case 1: Poor Feedback Test Result
• Gain Limit
• Feedback threshold
• Target gain
• Actual gain
Case 1: Results of a poor Feedback Test = Limited high frequency
gain
Case 2: Borderline Acceptable
• Gain Limit
• Feedback threshold
• Target gain
• Actual gain
Case 2: Better (?) Test Result, Borderline Acceptable product
selection
Case 3: Good FB Test & Good Product Selection
Comparing Feedback Test Results
• Poor FB Test Result =
Limited high frequency gain
• Better FB test result, but
pushing limits of hearing
instrument
• Best FB Test result
Coupling Options – Important Points to consider
• Retention
• Feedback
• Hearing performance
• Venting via plumbing
• Anatomical challenges
• Outer/middle ear disorders
• Moisture
• Comfort
• …just to name a few…..
Which way to vent?
• Venting via ‘plumbing’
• Venting via electronic low cuts while programming
Remember: no hearing instrument electronics can compete with the low distortion
and the very flat frequency response that a vent can provide!
Custom Earpiece Order Form Vent Options
Custom Hearing Instrument Vent Options
AOV: Optimal individualized Vent size
Design the largest vent that will
provide gain appropriate for that
audiogram
Based on:
•
•
•
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Client audiogram
Shell size
Acoustic coupling
Complex Vents – Advantages of Digital Manufacturing
Vent area
A = 13 mm2
4,0 mm
2,7 mm
• The vent size is calculated as an acoustic mass
• This mass incorporates the cross-section and the length of the
venting throughout the shell
• Only by applying all these measures can such complex vents be
built in a digitally controlled environment
page
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Advantages of AOV
Delivers the
“right sized”
individual
Vent – and
the smallest
possible
instrument
size
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Spontaneous
acceptance is
equal to the
correct
manually
selected vent
Takes the
guess work
out for difficult
shaped ear
canals
Easy to order,
simply select
AOV
Automatic
read out into
Phonak Target
Hearing Performance: Tubing thickness
• Internal diameter affects the passage of sound along a tube
• Outer diameter (thickness) affects the amount of leakage, important to consider for
high gain instruments
–
Example: #13 thick wall tubing provides 2 dB more attenuation than
standard #13
Tubing Comparison
In Summary…..
Tubing
Diameter
Change
<750
750-1500
1500-3000
>3000
Wider
Minimal
Moves peak to
higher Hz
Moves peak to
higher Hz
Minimal
Narrower
May
Decrease
Moves peak to
lower Hz
Reduces height of
peak and moves to
lower Hz
Decrease
Source: Valente, M., Hosford-Dunn, H., Roeser, R. (2008). Audiology Treatment. Thieme Medical Publishers: New York.
Hearing Performance: Receiver Size
40/122 (2cc)
50/122 (2cc)
60/122 (2cc)
70/133 (2cc)
Coupling Options – Important Points to consider
• Retention
• Feedback
• Hearing performance
• Venting via plumbing
• Anatomical challenges
• Outer/middle ear disorders
• Moisture
• Comfort
• …just to name a few…..
MOISTURE
Coupling Options and Moisture
Best Case Scenario:
Options for RICs:
• Custom cShells with SmartGuard
• Slimtips
• Domes
One possible explanation: Moisture
• But you say…
“This person has dry ear canals! The hearing aid is remarkably clean! My client
takes good care of their hearing aids! This person is not a ‘sweater’! This person
does not have an active lifestyle! These hearing aids are WaterResistant!”
+
=
Ear Canal Forecast
Ear Canal
Temperature
Humidity
37°C
40 – 70%
Winds
0 km/hr
P.O.P.
unknown…
Conditions
Cerumen advisory
So what is the weather like in your ear canal?
• Average body temp = 37 °C (98.6 °F)
–
The temperature in the ear canal increases the closer you get to the
TM
– The capillaries of the TM reflect the arterial temperature inside the
body
Pompei, M. and Pompei F. Physicians reference handbook on temperature. Exergen Corporation, Watertown, 1996.
So what’s the weather like in your ear canal?
• Average humidity in a normal ear canal = 40-70% (even higher in pathological
canals)
R.F. Gray, A. Sharma, S.L. Vowler (2005). Relative humidity of the external auditory canal in normal and abnormal ears,
and its pathogenic effect. Clinical Otolaryngology, 30 (2), 105–111, April 2005
• Hall & Croutch (2010) measured ear canal humidity at a depth that reflected
receiver placement in a deep canal device
• People with ongoing cerumen, debris, or dead skin accumulation were excluded
from the study
• Participants with humidity values greater than 60% were most likely to have
receiver failures as a result of moisture, whereas participants with 40% or less
have dramatically fewer problems relative to receiver problems
• Large vents had no effect upon the humidity measures
Hall CM, Croutch C. A Field Study on the Effect of Relative Humidity on Hearing Aid Receivers. Hearing Review.
2010;17(1):32-35.
So what’s the weather like in your hearing aid?
• Bailey & Valente (1996) measured the temperature and humidity inside ITEs
and ITCs
–
77% of the temperature readings were between 80 and 99°F
– 63% of the humidity readings were between 30% and 49%
Bailey JW, Valente M. Measurements of relative humidity and temperature in hearing aids. Hear Jour.
1996;49(10):59-63. (as cited by Hall and Croutch, 2010)
It’s not one or the other… it’s both!
So, are you recommending ALL my clients use a
dri-aid kit?
• Even ear canals with lower humidity values were still measured around 40%
humidity
Definition of hypothermia: 35 °C (95.0 °F)
A few ways moisture can affect hearing aid components are:
•
Moisture on the microphones or receiver diaphragms will limit their
movement. Therefore, both the input (mics) and output (receiver)
could be diminished.
•
Moisture on the wires can affect conduction of electrical signals.
•
Moisture on the circuitry can cause a variety of sound quality and
performance issues depending on which area is affected.
•
Even if the hearing aid and the ear canal look clean and dry, it’s the
condensation and humidity inside the hearing aid you should be
concerned about
*Also… moisture combined with dust, wax, or skin debris can form a sticky paste
that wreaks havoc with hearing aids!
What can you and your client do to combat moisture?
D Dry Premium
• 3 functions in one device: electrical drying, hygienic cleaning with UV-C light and
safe keeping in sanitization chamber
• UV-C Light works for either 3 or 6 hours
• According to manufacturer, best to remove batteries prior to use
• Phonak Accessory deal
Coupling Options – Important Points to consider
• Retention
• Feedback
• Proper amplification/hearing performance
• Venting via plumbing
• Anatomical challenges
• Outer/middle ear disorders
• Moisture
• Comfort
• …just to name a few…..
Comfort
• Domes do not contain latex or rayon constituents
• Slimtubes are composed of a poly (ether-block-co-polyamide) polymer (trade name
Pebax)The domes are attached to tubing using no glue, it uses a threaded fitting.
• Slimtip materials are all hypoallergenic. For those still irritated, you can requested
that we rebuild without the final lacquer.
FYI: Hearing aid housings are made of Grilatrog in different colors which is
combination of Trogamid CX 9710 (Nylon) and Grilamid TR 90 LXS (Nylon). On the
housing we applied a hydrophobic (fluorinated) layer. The hearing aid label is made
of ABS. The housings have different colors -color pigments of Polyamide or colorlacquered Acryl/Polyurethane based resin.
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A few random pointers from your Audiology Team
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Size Matters: Floating Antenna in Virto V products
Floating antenna attachment
points
Wireless vs non-wireless instruments: Size differences
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CROS II Coupling….
• Trick Question…sort of
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Phonak CROS II acoustic coupling choices
CROS DemoHook
CROS SlimTip
NEW
For demonstration
For comfort
CROS SlimTube
CROS II Hook*
NEW
For instant fitting
For more retention
*only for CROS II-13
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Phonak CROS II Hook
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Acoustic coupling videos in Target
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Thank you for joining us today!