Real-ear Measurements with the A-35

1. Real-ear Measurements with the A-35 Presented by: Kristina Frye Frye Electronics, Inc

2. Topics • Interface from the A-35 • Entering an Audiogram and Creating a Target • Performing Insertion Gain Measurements • Measurements in SPL: Comparing HTLs and UCLs • Testing with Visible Speech • Testing Open Fit Hearing Aids • Doing all this from the FONIX NOAH Module

3. FP35 Real-ear Screens • Audiogram Entry • Real-ear SPL • Unaided & Aided • Insertion Gain Move between these four screens by using NEXT and BACK

4. Audiogram Entry Screen Amplitude Frequency F2 — Select HTL/UCL/Bone F3 — Generate Target

5. NAL-NL1 Target Settings Press MENU and BACK to change target settings • Compression • Channels (1-18) • Aid Limiting (Type of output limiting) • Fit Type (Unilateral or Bilateral) • Reference (Almost always Head Surface) The Compression and Channels settings have the most impact on the target!

6. Insertion Gain Testing Press NEXT until you enter the Real-ear Insertion Gain screen

7. Traditional Real-ear Protocol Measuring the Insertion Gain Response

8. Let’s get sidetracked for a few minutes… PROS and CONS of Measuring the Unaided Response

9. Save Time! To save testing time, you can probably skip the unaided response measurement! • Thresholds are measured with an occluded response • Targets are generated from those thresholds • Many hearing aids alter the ear canal resonance when inserted, so the unaided response is extraneous data

10. Exceptions When is the unaided response useful? • Fitting a mild/moderate loss: Make sure that the hearing aid is proving a benefit to the patient • Checking the position of the probe microphone

11. Back to the Protocol…

12. Proper Placement of Microphones Ref Mic Above the Pinna Marked 30 mm from the tip for Adults and 25 mm for children Inter-Tragal Notch Probe Mic

13. Level the Sound Field Speaker • Internal sound chamber converts to sound field speaker; should be ear height • 12 inches from the speaker at 45° angle • Stand away from the patient/loudspeaker during measurements • The hearing aid (if silent) and/or probe tube can be inserted during leveling Press F5 and START in the Real-ear Measurement screen to level the sound field speaker

14. Choose the Curve with F2 Four Curves Available • Unaided • Ins. Gain #1: 50 dB • Ins. Gain #2: 70 dB • Ins. Gain #3: 90 dB Selected curve shown above F2

15. Testing Protocol • For Quick Testing, measure only Ins. Gain #2. This measures at average speech level (70 dB SPL) • For Complete Testing, measure Ins. Gain #1, #2, and #3 (50, 70, and 90 dB SPL) • If no unaided response is measured, the average is automatically substituted

16. Example of Insertion Gain Meas Prescription: This patient could use more amplification between 2000-6000 Hz!

17. Overview for Quick Insertion Gain Testing • Enter Audiogram Entry screen Press F2 from Opening Screen. Use NEXT and BACK if necessary • Input audiogram and generate target Use arrow keys to enter audiogram. Press F3 to generate target. • Enter Insertion Gain screen Use NEXT until screen appears • Level the sound field speaker Press F5 and START • Measure Ins. Gain #2 and fit to target Use F2 to select curve. Press START/STOP to start and stop test • If desired, also measure Unaided response and Aided Curve #1 and #3

18. The Real-ear SPL Protocol Compare the Real-ear Response to HTLs and UCLs on one graph

19. Real-ear SPL Screen UCLs Target HTLs

20. Real-ear SPL Measurements Goal: Aided 3 below UCLs Aided 2 meet target Aided 1 above HTLs

21. Overview of the SPL Protocol • Enter Audiogram Entry screen Press F2 from Opening Screen. Use NEXT and BACK if necessary • Input audiogram and generate target Use arrow keys to enter audiogram. Press F3 to generate target. • Enter Real-ear SPL screen Use NEXT until screen appears • Level the sound field speaker Press F5 and START • Measure Aided #1 to compare to HTLs Use F2 to select curve. Press START/STOP to start and stop test • Measure Aided #2 to compare to the target • Measure Aided #3 to compare to UCLs

22. Visible Speech • Use External Signals such as Live Voice in the real-ear measurements • Perform this measurement in the Real-ear SPL screen • NEW! Both the real-time response and the average response are displayed

23. Example of Visible Speech Average Response Real-time Response

24. Visible Speech Protocol • Enter Audiogram Entry screen Press F2 from Opening Screen. Use NEXT and BACK if necessary • Input audiogram and generate target Use arrow keys to enter audiogram. Press F3 to generate target. • Enter Real-ear SPL screen Use NEXT until screen appears • Put analyzer in Spectrum Analysis mode Use F4 to select the source type. Use DOWN arrow to turn source OFF. • Perform Visible Speech measurement Press START/STOP to start measurement. Begin speech signal.

25. Open Fit Hearing Aids • Coupler measurements: Use our new Open Fit Coupler! • Real-ear measurements: Same protocol but disable the reference microphone

26. Open Fit Coupler • Insert the hearing aid into the coupler as you would into the ear • No sealing is necessary • Produces a frequency response more like a real-ear response • For ANSI measurements to specifications, use HA-1 coupler

27. Real-ear Measurements • Some Open Fit hearing aids interfere with the reference microphone measurement outside the ear (feedback management and/or amplified signal escaping from ear) • Disable the REF MIC setting in the real-ear measurement screen local menu • Test as usual • Expect very little amplification below 1000 Hz. Fit to target only in mid-to-high frequencies

28. Example of Open Fit Real-ear

29. Using the FONIX NOAH Module • Friendly Windows-based interface • Automatically use NOAH audiogram • Can send NOAH audiogram to analyzer • Perform real-ear and coupler measurements from computer • Save all results into NOAH database • On Top window: Perform real-ear while adjusting the hearing aid!

30. Interface

31. Now for a FONIX NOAH Module Demonstration!