Subject: Re: Dispensing digital aids to 60dB+ loss existing aid users? From: "Richard H." <auditory(at)AUGMENTICS.COM> Date: Wed, 20 Oct 2004 21:24:42 +0100This is a multi-part message in MIME format. ------=_NextPart_000_0041_01C4B6EB.3686F300 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Thanks Barbara, I'll check the fitting data when I'm back in the office. The aids I = dispensed have fully auto everything which certainly seemed to get in = the way. Turning OFF adaptive beam steering and turning DOWN Dynamic Noise = Reduction seemed to make speech clearer for the user. I'll try out your tips if the px wants to continue the trial. [He has = old but apparently very effective digital aids already] regards, Richard ----- Original Message -----=20 From: Barbara Reynolds=20 To: auditory(at)AUGMENTICS.COM=20 Sent: Wednesday, October 20, 2004 9:04 PM Subject: RE: Dispensing digital aids to 60dB+ loss existing aid users? Sometimes patients may not like the new aids because they often have = too much compression. In severe hearing losses, patients still like a = more linear hearing at with compression ratios of no more than 2.0. I = usually raise the kneepoint high (65dB) and keep somewhere between 1.5 = to 1.7 compression. They can also tend to be power junkies wanting more = low frequency tones than newcomers. A lot of the "first fit" programs, = underamplify low frequencies in the belief it will cut down background = noise, which in theory is true, but you lose more of the melodius tones = and fundamental frequencies that those with severe hearing losses need. = Try not to overamplify the high frequencies. Fit to their psychological = comfort, have them adjust for 1 to 2 months and see them back again for = any acoustic modifications. By 1 to 2 months, their auditory system at = the brain level with have adapted to the new sound and may require a = boost or a fine tuning to try to maximize their hearing processing. = Remember, there is a brain attached to the ears and patients experiences = differ including history, medications, personality, etc. which can = impact their experience with the aids. Do not marry yourself to fitting = by prescription formula - they are only an initial guideline, which may = not match the individual's comfort or performance. Barb Reynolds, M.S. Clinical Audiologist and Dispenser for 16 years. >From: "Richard H." <auditory(at)AUGMENTICS.COM>=20 >Reply-To: "Richard H." <auditory(at)AUGMENTICS.COM>=20 >To: AUDITORY(at)LISTS.MCGILL.CA=20 >Subject: Dispensing digital aids to 60dB+ loss existing aid users?=20 >Date: Wed, 20 Oct 2004 19:14:20 +0100=20 >=20 >Hi,=20 >=20 >I have just opened a dispensing practice in the UK, having passed my = dispensing exams.=20 >=20 >All is going well ... except that I am failing to "convert" existing = aid users with a fairly heavy loss.=20 >=20 >They expect a major increase in speech discrimination from the latest = top-end digital aids .... but 2 patients in the last week have=20 >stuck to their old aids [one analogue, 1 digital] after a trial of a = new aid. Any additional benefit has been so mild that they have=20 >decided to save their money.=20 >=20 >Is this a standard result? Should I assume that modern technology = runs out of steam in such cases?=20 >=20 >Or am I not being exact enough with the fittings? [All my other = fittings for lesser losses have gone very well]=20 >=20 >regards,=20 >=20 >Richard=20 >=20 >=20 >---=20 >Outgoing mail is certified Virus Free.=20 >Checked by AVG anti-virus system (http://www.grisoft.com).=20 >Version: 6.0.772 / Virus Database: 519 - Release Date: 10/01/2004=20 -------------------------------------------------------------------------= ----- Find the music you love on MSN Music. Start downloading now!=20 --- Outgoing mail is certified Virus Free. Checked by AVG anti-virus system (http://www.grisoft.com). Version: 6.0.772 / Virus Database: 519 - Release Date: 10/01/2004 ------=_NextPart_000_0041_01C4B6EB.3686F300 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"> <HTML><HEAD> <META http-equiv=3DContent-Type content=3D"text/html; = charset=3Diso-8859-1"> <META content=3D"MSHTML 6.00.2800.1458" name=3DGENERATOR> <STYLE></STYLE> </HEAD> <BODY bgColor=3D#ffffff> <DIV><FONT face=3DArial size=3D2>Thanks Barbara,</FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2>I'll check the fitting data when I'm = back in the=20 office. The aids I dispensed have fully auto everything which certainly = seemed=20 to get in the way.</FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2>Turning OFF adaptive beam steering and = turning DOWN=20 Dynamic Noise Reduction seemed to make speech clearer for the = user.</FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2>I'll try out your tips if the px wants = to continue=20 the trial. [He has old but apparently very effective digital aids=20 already]</FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2>regards,</FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2>Richard</FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <BLOCKQUOTE=20 style=3D"PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; = BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px"> <DIV style=3D"FONT: 10pt arial">----- Original Message ----- </DIV> <DIV=20 style=3D"BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: = black"><B>From:</B>=20 <A title=3Dbr_auditory(at)hotmail.com = href=3D"mailto:br_auditory(at)hotmail.com">Barbara=20 Reynolds</A> </DIV> <DIV style=3D"FONT: 10pt arial"><B>To:</B> <A = title=3Dauditory(at)AUGMENTICS.COM=20 href=3D"mailto:auditory(at)AUGMENTICS.COM">auditory(at)AUGMENTICS.COM</A> = </DIV> <DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Wednesday, October 20, = 2004 9:04=20 PM</DIV> <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> RE: Dispensing digital = aids to=20 60dB+ loss existing aid users?</DIV> <DIV><FONT face=3DArial size=3D2></FONT><FONT face=3DArial = size=3D2></FONT><FONT=20 face=3DArial size=3D2></FONT><FONT face=3DArial size=3D2></FONT><FONT = face=3DArial=20 size=3D2></FONT><FONT face=3DArial size=3D2></FONT><BR></DIV> <DIV> <DIV class=3DRTE> <P>Sometimes patients may not like the new aids because they often = have too=20 much compression. In severe hearing losses, patients still like = a more=20 linear hearing at with compression ratios of no more than 2.0. I = usually=20 raise the kneepoint high (65dB) and keep somewhere between 1.5 to 1.7=20 compression. They can also tend to be power junkies wanting more = low=20 frequency tones than newcomers. A lot of the "first fit" = programs,=20 underamplify low frequencies in the belief it will cut down background = noise,=20 which in theory is true, but you lose more of the melodius tones and=20 fundamental frequencies that those with severe hearing losses = need. Try=20 not to overamplify the high frequencies. Fit to their = psychological=20 comfort, have them adjust for 1 to 2 months and see them back again = for any=20 acoustic modifications. By 1 to 2 months, their auditory system = at the=20 brain level with have adapted to the new sound and may require a boost = or a=20 fine tuning to try to maximize their hearing processing. = Remember, there=20 is a brain attached to the ears and patients experiences differ = including=20 history, medications, personality, etc. which can impact their = experience with=20 the aids. Do not marry yourself to fitting by prescription = formula -=20 they are only an initial guideline, which may not match the = individual's=20 comfort or performance.</P> <P>Barb Reynolds, M.S.</P> <P>Clinical Audiologist and Dispenser for 16 years.<BR><BR></P></DIV> <DIV></DIV>>From: "Richard H." <auditory(at)AUGMENTICS.COM>=20 <DIV></DIV>>Reply-To: "Richard H." <auditory(at)AUGMENTICS.COM>=20 <DIV></DIV>>To: AUDITORY(at)LISTS.MCGILL.CA=20 <DIV></DIV>>Subject: Dispensing digital aids to 60dB+ loss existing = aid=20 users?=20 <DIV></DIV>>Date: Wed, 20 Oct 2004 19:14:20 +0100=20 <DIV></DIV>>=20 <DIV></DIV>>Hi,=20 <DIV></DIV>>=20 <DIV></DIV>>I have just opened a dispensing practice in the UK, = having=20 passed my dispensing exams.=20 <DIV></DIV>>=20 <DIV></DIV>>All is going well ... except that I am failing to = "convert"=20 existing aid users with a fairly heavy loss.=20 <DIV></DIV>>=20 <DIV></DIV>>They expect a major increase in speech discrimination = from the=20 latest top-end digital aids .... but 2 patients in the last week have=20 <DIV></DIV>>stuck to their old aids [one analogue, 1 digital] after = a trial=20 of a new aid. Any additional benefit has been so mild that they have=20 <DIV></DIV>>decided to save their money.=20 <DIV></DIV>>=20 <DIV></DIV>>Is this a standard result? Should I assume that modern=20 technology runs out of steam in such cases?=20 <DIV></DIV>>=20 <DIV></DIV>>Or am I not being exact enough with the=20 fittings? [All my other fittings for lesser losses have = gone very=20 well]=20 <DIV></DIV>>=20 <DIV></DIV>>regards,=20 <DIV></DIV>>=20 <DIV></DIV>>Richard=20 <DIV></DIV>>=20 <DIV></DIV>>=20 <DIV></DIV>>---=20 <DIV></DIV>>Outgoing mail is certified Virus Free.=20 <DIV></DIV>>Checked by AVG anti-virus system = (http://www.grisoft.com).=20 <DIV></DIV>>Version: 6.0.772 / Virus Database: 519 - Release Date:=20 10/01/2004=20 <DIV></DIV></DIV> <DIV><BR clear=3Dall></DIV> <DIV> <HR> </DIV> <DIV><A href=3D"http://g.msn.com/8HMAENUS/2731??PS=3D47575" = target=3D_top>Find the=20 music you love on MSN Music. Start downloading now!</A> <FONT = face=3DArial=20 size=3D2></FONT></DIV> <DIV> </DIV> <DIV><FONT face=3DArial size=3D2><BR>---<BR>Outgoing mail is certified = Virus=20 Free.<BR>Checked by AVG anti-virus system (<A=20 = href=3D"http://www.grisoft.com">http://www.grisoft.com</A>).<BR>Version: = 6.0.772=20 / Virus Database: 519 - Release Date:=20 10/01/2004</FONT></DIV></BLOCKQUOTE></BODY></HTML> ------=_NextPart_000_0041_01C4B6EB.3686F300--