Integrating best practice in hearing care

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1 Integrating best practice in hearing care Accurate fi t t i n g, easy verification

2 True DSL Targets for accurate target transparency SPLogram view for easy fit-to-target verification EasyRECD for adjusting to individual ear acoustics The perfect partners Sensei s flexibility meets Genie s paediatric expertise Sensei is the most advanced paediatric hearing instrument family Oticon has ever created, helping the paediatric audiologist to set a new standard in paediatric hearing care. With its powerful sound processor and unique tools for individual fitting, Sensei provides high-performance speech understanding, even in the most varied and demanding environments. With your clinical skills and the help of our advanced Genie fitting software, Sensei also offers impressive versatility through adapting to the specific and changing needs of every child. To help you get the best out of this unique hearing solution, the Paediatric Fitting Mode in Genie will automatically be activated when the software detects Sensei hearing instruments. Maximum flexibility for optimal results Accurate diagnosis needs to be followed by accurate fitting to help the child to develop to the greatest extent possible. A comprehensive fitting process, in keeping with published best practice guidelines, is the key to full development across a variety of domains such as speech, language, educational and social development. Genie has been developed with those goals in mind, offering a variety of tools to guide you through the fitting process. The Paediatric Fitting Mode enables you to maximise performance for children between 0-16 years of age, right from the first fitting. For example, you may be working with various formats of audiometric data, or have a particular preference for which automatic features should be used, based on the child s age. To give you maximum flexibility, you can easily change Genie s default recommendations using Genie Preferences. Smooth transition from diagnostics to hearing instrument fitting and verification Genie Paediatric Fitting Mode for an easy and reliable programming process 2 3

3 Optimising fitting accuracy and transparency Designed for paediatric audiologists The Paediatric Fitting Mode in Genie is designed to meet the needs of paediatric clinicians and help them follow best practice guidelines. Acknowledging the unique challenges of fitting children, Genie offers greater flexibility and the peace of mind that comes from knowing the instruments are set as intended. Our commitment to best practice To help you follow best practice guidelines, targets shown in Genie are clearly displayed and follow the original rationale prescription. For example, targets displayed in Genie follow the specifications as described by DSL, but will not take hearing instrument acoustics and hardware characteristics into account. There are times when the response provided to the child will not match the targets exactly, due to venting decisions or other electroacoustic characteristics of the device. However, the curve labeled simulated gain/output will show these effects. This new way of displaying both targets and the actual best estimate of the response of the device provides a more obvious comparison between targets and actual hearing instrument performance. This helps you to better visualise the influence of acoustics and hardware characteristics on the instruments frequency response. It also ensures that the targets displayed in Genie match the ones displayed in external REM equipment, such as the Interacoustics Affinity. More flexible fine-tuning The latest version of Genie now allows you to fine-tune the hearing instruments soft, loud and moderate inputs to achieve a precise fitting. In addition, it is possible to adjust the MPO when verifying the fitting, to ensure that loud sounds are comfortably below the predicted UCL thresholds. All very important when trying to provide optimal amplification! Did you know...? A recent major US survey involving 195 children with hearing loss showed that more than half of infant and young child fittings had an unsatisfac- tory match-to-target. In this multicentre study, hearing instrument fit- ting was evaluated for proximity of the hearing instrument to the in- tended DSL target. One key parameter was the verification method. The use of age-related average RECDs was signifi- cantly less effective than individual RECD measurement. (McCreery et al. 2013) 1. Genie Fitting screen showing the SPL0gram view and the fitting handles for fine tuning. Interacoustics Affinity REAR screen 1. McCreery, R.W., R.A. Bentler, and P.A. Roush, Characteristics of Hearing Aid Fittings in Infants and Young Children. Ear Hear,

4 From diagnostics to precise fitting Expressing thresholds accurately Choosing the appropriate measurement method is an important part of paediatric hearing aid fittings. Auditory Brainstem Response (ABR) thresholds using frequency-specific stimuli such as the tone burst can vary from the estimated behavioural thresholds by as much as 20 db in the low frequencies. 1 Genie automatically provides the appropriate correction values to convert normalised (nhl) thresholds into estimated (ehl) behavioural thresholds. To automatically apply the corrections, simply choose Tone Burst ABR as the measurement method in Genie s Audiogram screen. New REM AutoFit feature For users of the Affinity, it will now be possible to conduct automatic real-ear measurement adjustment through Genie, using the REM AutoFit tool. With this tool, the hearing instrument will be adjusted to target automatically, without the need for manual fine tuning. REM AutoFit would be appropriate for older children on whom real-ear measurements can be performed. For infants and young children, coupler-based verification with RECD (real-ear to-coupler difference) remains the preferred method for fitting and verification. Built-in fitting accuracy Thanks to the automatic correction of the tone burst ABR thresholds into estimated behavioural thresholds, you can be confident that the thresholds used to calculate hearing instrument gain will be accurate. Helping you make a smooth transition Once the audiogram has been corrected and saved in Noah, it can now be used in the Affinity suite to generate DSL targets. Real-ear-to-coupler difference (RECD) measurements which have been conducted with the Affinity can also easily saved to Noah, then imported to Genie using the Import from Noah button, and be used for the gain prescription. This convenient feature removes the need for re-entering data. 1. Ministry of Children and Youth Services Ontario Infant Hearing Program Audiologic Assessment Protocol and Support Documentation, Did you know...? If using the ASSR measurement method, no correction of the threshold is necessary. For the ASSR, the measurement equipment (such as the Interacoustics Eclipse system) provides a pre-corrected ASSR audiogram. This makes the audiogram transfer to Genie very easy when using the ASSR Noah Module. Setup for the ABR measurement on an infant. Genie showing the estimated HL audiogram corrected to the normalised HL audiogram. The corrected nhl audiogram is represented by the solid line on the audiogram. Screenshot of Genie showing imported RECD values. Data can be directly imported from Noah using the the Affinity Suite via Noah. 6 7

5 EasyRECD Accurate in-situ measurement EasyRECD for adjusting to individual ear acoustics Fitting hearing instruments to babies and small children can be very challenging. In this critical period of language acquisition, the need for accurate amplification becomes crucial. The importance of real-ear-to-coupler difference (RECD) measurements The more you know about the child s individual ear canal acoustics and predicted real-ear performance, the better the fitting you can provide. RECD measurements are used both to correct the audiogram and to predict the amplified sound pressure level in the real-ear. RECDs form a central part of the DSL Fitting Protocol 1 as well as the paediatric amplification clinical practice guidelines issued by the American Academy of Audiology (2013) 2. EasyRECD helps you to follow best practice The EasyRECD option developed for Sensei allows you to easily account for individual ear acoustics when fitting to infants and children, without the need to use free-standing realear equipment. The hearing instrument and EasyRECD boot adaptor act as a probe tube system. This is especially important as children s ear canals grow quickly and require regular replacement of earmoulds. The speed and accuracy of EasyRECD means that you can test as often as you ought to, rather than only as often as you can. The RECD tab in Genie guides you through a three-step protocol with illustrations and explanatory texts. Although Oticon acknowledges using external equipment as best practice, EasyRECD is a viable alternative, especially when measurement equipment is not available or if you are under time pressure. EasyRECD was developed and clinically tested in collaboration with leading research audiologists, renowned for their expertise in paediatric audiology. Eight school-aged children participated in the pilot study. Their EasyRECD values were obtained and used to program Sensei hearing instruments. Subsequent test box values showed that the EasyRECD measurement procedure provided an accurate prediction of real-ear hearing instrument performance (Moodie et al. 2013) 3. In addition, usability testing was carried out with both novice and experienced clinicians on the EasyRECD tools, as well as the software user interface. Eight out of nine audiologists found that the length of time it took to complete the EasyRECD procedure was appropriate for incorporation into routine clinical practice. Did you know...? 29% of audiologists never or seldom perform RECD measurements during verification. The main reasons given for this were lack of confidence (29%), lack of time (24%) and lack of REM equipment (13%). 4 EasyRECD removes these barriers. 1. Bagatto M, Moodie S, Scollie S, Seewald R, Moodie S, Pumford J, Liu KPR (2005) Clinical Protocols for Hearing Instrument Fitting in the Desired Sensation Level Method. Trends in Amplification 9(4): RECD (db) EasyRECD measurement flow 2. American Academy of Audiology: Clinical Practice Guidelines, Pediatric Amplifi cation (2013). cationguidelines.pdf EasyRECD REM equipment Calibrate 8 Probe tube placement Measure Finish The EasyRECD screen in Genie will easily guide you through the process step-by-step. 3. K. S. Moodie, S. T.F. Moodie & V. Easwar. Oticon s EasyRECD measurement procedure: Pilot validity study. Podium Presentation at the Canadian Academy of Audiology (CAA) Oct Moodie S, Rall E, Lindley G, Eiten L, L. D, Littman T, Gordey D (2011) Survey of Best Practices: Pediatric Hearing Aid Fitting.Learning module presentation at The American Academy of Audiology: Audiology- NOW! Conference, Chicago, IL. The EasyRECD screen in Genie, showing the flow and step-by-step process. Frequency (Hz) Acoustic precision of the EasyRECD equipment. RECD data was obtained using a custom-made artificial child ear canal with a 0.34 cm 3 volume. The RECD measurements were made using the EasyRECD equipment and the REM equipment procedure, respectively. The mean difference between methods was 0.5 ± 0.3 db across frequencies, ranging from -0.5 to 1.2 db. The tools were re-assembled and re-calibrated for every trial and the test-retest repeatability was db and db (S.D. error bars on curves, n = 10) for the EasyRECD system and the REM equipment respectively. 8 9

6 A better future for every child with hearing loss Empower children at every stage of childhood Every child deserves the best future possible and children with hearing loss are no exception. That is why we defined an Audiological Mission that has guided the development of Oticon Sensei: A better future for every child with hearing loss. Our Mission s three defining dimensions Individualisation To empower you to adapt solutions to meet each developmental stage of every child, according to their individual physiological, educational and lifestyle needs. Performance To deliver technology that will optimise auditory and cognitive habilitation, giving children the best possible speech understanding in every situation while minimising their cognitive load. Living To acknowledge the very real and challenging every day complexities of growing up with hearing loss and accordingly develop support to assist children, parents and audiologists. Performance A better future for every child with hearing loss Individualisation Living 10 11

7 People First is our promise to empower people to communicate freely, interact naturally and participate actively Our paediatric audiological mission is to ensure a better future for every child with hearing loss. We will deliver solutions, tools and techniques that optimise auditory and cognitive habilitation, embrace the complexities of growing up with hearing loss and empower you to adapt solutions to each child s developmental stage on their journey towards adulthood UK/12.13 Printed on 100% recycled paper

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