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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 5 • • • • 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 8 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 9 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 10 cShell with skeleton lock • Any configuration of lock is possible on a cshell 11 Slimtip & cShell with skeleton locks 12 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) 13 Canal locks & Custom products • Keep in mind: locks are digitally modeled; therefore, they are the same color as the shell (no exceptions) 14 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 17 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. 19 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” 22 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: • • • 35 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 36 36 Advantages of AOV Delivers the “right sized” individual Vent – and the smallest possible instrument size 37 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. 55 A few random pointers from your Audiology Team 56 Size Matters: Floating Antenna in Virto V products Floating antenna attachment points Wireless vs non-wireless instruments: Size differences 58 CROS II Coupling…. • Trick Question…sort of 59 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 60 Phonak CROS II Hook 61 Acoustic coupling videos in Target 62 Thank you for joining us today!