Fine-tuning tips & tricks for SUPER


Fine-tuning tips & tricks for SUPER

 
By Geoffrey Cooling

Introduction

This bulletin is concerned with the handling of specific issues that may occur during the fitting and fine-tuning of WIDEX SUPER hearing aids. The first section deals with minimising feedback. The following sections deal with adjusting the volume individually in the left and right ear, choosing between different speech and noise modes, and choosing between different AO C settings.

Minimising feedback

The feedback cancelling system in Widex hearing aids is extremely efficient at controlling dynamic feedback problems. Even so, people with severe to profound hearing loss may occasionally experience feedback due to the large amounts of amplification provided by their hearing aids. To minimise feedback, it is recommended to go through one or more of the following steps:

1. Tightly fitted earmould

in the ear canal Feedback can be minimised in high-power fittings with an earmould providing a tight fit in the ear canal. If the earmould is not tightly fitted into the ear canal, the large amounts of amplification needed to ensure audibility of, not just soft sounds, but also normal and loud sounds, can cause feedback. The feedback cancelling system constantly works to obtain the largest possible amount of amplification. However, when the acoustic path changes, for instance when chewing, the feedback canceller has to adapt to the new condition. While this adaptation is taking place, feedback can occur.

2. Sensogram measurements and feedback test

It is recommended to perform Sensogram measurements to ensure that the effect of the earmould, the size of the individual ear canal and the hearing loss are taken into account when the correct gain is calculated. Furthermore, it is recommended to always perform a feedback test when fitting clients with severe to profound hearing loss. During the fitting session it is important that the earmould is inserted in the same way that the user normally inserts it. This will ensure that the result of the feedback test is reliable in relation to daily use.

3. Deep ear canal impressions beyond the second bend

Earmoulds for super-power users must fit deeper into the ear canal than earmoulds used for other groups of hearing aid users. When the earmould impression is taken, make sure that it reaches all the way to the second bend in the ear canal.

4. Adjusting gain in Compass

Because of the magnitude of the clients’ hearing losses, a very large amount of amplification is applied for soft sound levels. As a result, even with a tightly fitted earmould, feedback can occasionally occur in quiet surroundings and environments with soft sound levels. This problem can be solved by identifying the specific frequency region in which the feedback occurs and reducing gain in that region. The region can be identified by means of a feedback test in Compass.

In the example below, there is limited available gain in the frequency region around 4 kHz on the left ear. This indicates that the risk of feedback is greatest in this specific region.

imageFig. 1. The feedback test shows limited available gain around 4 kHz. This is an indication that feedback is most likely to occur in that particular region.

The SoundTracker also provides information about which frequencies should be given less gain to avoid feedback. By watching the SoundTracker while simultaneously provoking feedback, it is possible to identify the specific frequency region. In figure 2, feedback occurs in the frequency region around 4 kHz, which is indicated by the peak of the specific channel.

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Fig. 2. The SoundTracker indicates occurrence of feedback around 4 kHz.

When the specific frequency region has been identified, the gain for soft sounds should be reduced by a minimum of 3 dB in the relevant region. If further adjustment is needed, it is recommended to do it in steps of 1 dB at the time. If adjusting the gain for soft sounds is not permitted, adjusting the gain for normal sounds may be relevant. It should be pointed out that gain reductions will inevitably reduce the audibility achieved by the hearing aid user, so these should always be kept to a minimum.

It is not recommended to choose ‘Limited audibility for soft sounds’ in the Gain settings window in Compass. This setting reduces gain for all frequencies, not just within the specific frequency region where feedback occurs. This setting will therefore cause a general reduction in audibility across the entire frequency range.

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Fig. 3. It is not recommended to change the mode for soft sounds. Instead, adjustment of gain for soft sounds should be restricted to the specific frequency region where feedback occurs.

Adjusting volume individually in the left and right hearing aid

Unlike hearing aid users with less severe hearing loss, super-power users often need to be able to adjust the volume individually in the left and the right ear. The MDEX can be recommended for this purpose. With the M-DEX, the hearing aid user is able to make a large number of individual adjustments, including separate volume changes in the left and right ear. The other InterEar features are not affected by this option in the M-DEX.

image

Fig. 4. With the M-DEX it is possible to change volume separately in the left and right ear.

If an M-DEX is not an option, fitting two SUPER hearing aids as two monaural fittings is another option. The procedure for this involves detecting and fitting each hearing aid separately in Compass. Once a hearing aid has been detected, it is important to select the binaural fitting rationale in the Rationale conditions window, as Compass will automatically select the monaural fitting rationale if only one hearing aid has been detected.

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Fig. 5. The fitting rationale must be changed from Monaural to Binaural if a pair of SUPER hearing aids are fitted individually in Compass.

If the user is to have a remote control, it must be matched to both hearing aids. The user can adjust the volume individually in the left and right hearing aid by means of the volume control buttons on the aids, to achieve the required balance. The user can subsequently use the remote control to change the volume simultaneously in both aids while maintaining the balance that was achieved by individual adjustments of each aid. The user-defined balance will be reset when the user chooses another listening program.

Choosing between different noise reduction modes

Internal trials have shown that super-power users fitted with SUPER hearing aids prefer the Noise Reduction setting. In Compass, the default speech and noise mode is therefore Noise Reduction when SUPER is fitted with an SP-receiver. On the other hand, if SUPER is fitted with a P-receiver for a client with a less severe hearing loss, the Speech Enhancer is the default noise reduction, as with other Widex hearing aids. In our internal trials, severely-to-profoundly impaired participants fitted with the SP-receiver found the Noise Reduction setting more comfortable than the Speech Enhancer.

This is most likely a result of the users’ speech discrimination ability and degree of hearing loss. The Speech Enhancer is adjusted according to the degree of the hearing loss, and focuses on optimised speech intelligibility in every instance. If the hearing loss is in the profound category, the Speech Enhancer will therefore be less inclined to reduce gain, even in very noisy sound environments, because its primary aim is to preserve speech intelligibility.

In situations with high noise levels, profoundly impaired hearing aid users may therefore find that the Noise Reduction mode generates a more comfortable sound. If the user has some speech discrimination ability, it may be beneficial to change from the default Noise Reduction setting to Speech Enhancer. On the other hand, if the user has limited speech discrimination ability, retaining the default Noise Reduction mode may be a better choice.

image

Fig. 6. The default speech and noise mode is Noise Reduction, rather than Speech Enhancer, when users with severe-to-profound hearing loss are fitted with SUPER with an SP-receiver. 

Choosing between different AOC settings

SUPER hearing aids can be fitted with two receivers (SP and P). Super-power users have different needs with respect to output, compared to users with less severe hearing loss. A special AO C strategy is therefore introduced for super-power users in connection with SUPER. Thus, instead of having the usual two ’On’ and ’Off’ AO C settings, three settings are available when super-power users are fitted:

• Off

• AO C profound

• AO C normal

AO C normal is the well-known, existing setting where it is possible to adjust in 4 bands (it corresponds to ‘On’ with other hearing aids). Off is for people who need as much sound as possible – even if the signal is distorted. There is no 4-band adjustment option with this setting.

AO C profound is something in between. Because it offers fast regulation, it will enable a higher output level than AO C normal, but the sound quality will be better than with Off. There is no 4-band adjustment option with this setting.

image

Fig. 7. It is possible to choose between three different AO C settings when fitting SUPER.

The default Automatic Output Control feature is chosen automatically on the basis of the degree of the hearing loss, according to what is estimated to be optimal for the specific degree of hearing loss. If a hearing aid user is not satisfied with the perceived sound quality for loud sounds, choosing another setting could be beneficial.

The Full Audiological Bulletin can be downloaded here Fine tuning tips and tricks for Super

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How to fine tune with Widex Compass


By Geoffrey Cooling

Here is another one of those excellent video tutorials uploaded by the Widex Denmark team. The video outlines how to fine tune instruments using the new updated Compass.

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SUPER440 – Widex for hearing healthcare professionals


SUPER440 – Widex for hearing healthcare professionals.

 
By Geoffrey Cooling

An in-depth look at the Super can be had at the above link. I will review the device and my experiences with it over the next few weeks.

There is also some great elearning modules at

http://widex.pro/en/widexlearn/learn/

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The New Widex Super


Super

The power to hear

Small, comfortable and versatile – WIDEX SUPER introduces RITE technology to the super power segment for the first time. The Super has both a programme button and volume control. It uses a size 675 battery and also has an on-board telecoil as well as our proprietary Widex Link technology. The Super can be fit with a Power receiver and a Super Power receiver.

 

SUPER:

  • has the power to provide loudness
  • has the gain for speech understanding 
  • has no feedback/doesn’t whistle
  • has a long battery life
  • is made for all day, everyday use
  • has a robust and stylish design
  • gives you the choice of two receivers, for either moderate to severe or profound to severe hearing loss, plus various ear-tips and ear moulds. This versatile model is packed with InterEar features for better localisation.

Read more about benefits for you
The SUPER family

SUPER440

The high-end SUPER440 hearing aid comes with a full range of advanced features that let you localise and focus on the dominant voice in a crowd. SUPER440 also comes with Zen, the revolutionary tone and relaxation program that plays random and harmonic tones in stereo to help you relax or manage tinnitus.

SUPER440 gives you the power to hear more, it provides you with better orientation of sound, it can be used all day in all kinds of weather and yet it is a very small and smart looking RITE solution.

SUPER440 is compatible with all DEX devices.

 
SUPER220

The SUPER220 hearing aid is a powerful wireless hearing aid at an affordable price. A small, weather-resistant and stylish hearing aid that provides the advantages of comfort and clarity while giving you the power to hear. Furthermore the clever design reduces wind noise by up to 18 dB.

SUPER220 features the Audibility Extender, which helps hearing aid users to better hear high frequency sounds such as birdsong and children’s voices.

SUPER220 is compatible with all DEX devices.

 

 

SUPER is perfect in many different listening situations

 

Super_listening

 

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Using The Gain Panel In Compass


 
By Geoffrey Cooling
This is one of the new set of Videos placed on Widex DK’s YouTube channel. It is a pretty good video tutorial on how to use the gain panel in Compass.

 

Posted in Dispenser Education, Widex Clear Platform, Widex Compass, Widex Hearing Instruments | Leave a comment

The Real Value Of Your Services


What is the value of your services? More importantly, who sets the value?

 
By Geoffrey Cooling

I really love LinkedIn, although just lately I have not been on the site or the forums much. I love it because the forums or groups that I have joined allow me to connect to people internationally with differing life experiences and views. People who see our profession through the prism of their life experiences and culture. This leads to really interesting conversations, it also allows you to see familiar issues from a differing point of view. This can only be good for your professional and indeed personal development.

It was during one of my many conversations on one of the groups recently that I realised something. Something base, a concept that I had nodding acquaintance with but had not really appreciated the profound impact of. I have said before that I believe your Patients in fact set the terms of your brand. It is what they feel about you and your Practice and more importantly what they say about you and your Practice that set the terms of your brand. I suddenly realised that they also set the value of your services.

Let me explain, the conversation was based around the separation of product and services as a commercial strategy. There was debate to and fro with some believing that the bundling of services with detailed cost breakdowns on invoices was the way forward. Whilst others leaned towards the separation of charges as an on-going commercial strategy. I put in my ten cents, as I am want to do, I pointed out that either way it was important for our profession to display our value. That in fact it was imperative for us to communicate our value in the process of hearing well as opposed to just hearing better.

It struck me as I wrote it that whilst we feel we have real value to bring to the process and that that skill is worth a certain monetary reward. Have we ever considered what the perceptions of our Patients are?  Because it is their perception of our services that sets our value, that is a sobering thought. Lets say that again,

OUR PATIENT’S PERCEPTION SETS THE REAL VALUE OF OUR SERVICES

It is kind of humbling really and I don’t know why I did not really see it before. The concept is just an extension of my other closely held beliefs about our Patients and the commercial strategy that we need to consider. It is something that we need to consider every day, we may set the price, but our Patients set the real value.

Posted in Business development strategy, Business Strategies, Commercial strategies, Dispenser Education, Patient Retention Strategy, Sales & Customer Care Strategies | Leave a comment

Managing Your Patients, Commercial Management tools For The Modern Health Practice


Its All About The Data

By Geoffrey Cooling

I have said it before and I will say it again, it is all about the information. Your business can thrive from its existing Patient base. But in order for this to happen you need the information, the skinny, the Intel. Not only do you need it, more importantly it has to be easy to use and deploy across your organization. So what is the answer? A CRM or Customer Relationship Manager software programme.

The release of Noah 4 has gone a long way towards handling the clinical needs of a Hearing Health Practice. It truly is a fantastic piece of kit for clear and easy use and the deployment of all the needed clinical data and notes to manage a Patient on an ongoing basis. However as a commercial management system it is I am afraid pants. For sound commercial management of your Patient database you need to look elsewhere. Preferably you would like to get a programme that is indeed designed with our Profession in mind. There are many out there at present, the beauty of those is that the connect in one way or other to Noah. This means better reporting facilities including test results and very little if any double entry.

Why do you need this facility, simply because it will give you power, power to run your practice in the most efficient way. Power to deploy commercial strategies with the minimum of fuss. Power to run your Patient journey programme in an automated way. Your existing Patients are your best form of marketing, I think that this is a universally accepted truism. You can not effectively leverage them without a CRM, you can not effectively run mail merge campaigns without a CRM. You can not with ease effectively run your Practice without a CRM.

The benefits of running a fully functional CRM include

  • Targeted Mail Merge Campaigns
  • Automated mailings
  • Integrated reminder
  • Automated Patient Journey
  • The easy and visible storage of all the data needed to effectively engage your Patients
  • Easy reporting
  • Easier financial transparency

These are just some of the valuable benefits that are provided by a fully functional CRM. The joy of running a database search for Patients not seen in the last six months. Getting a list and being able to instantly mail merge with a pre typed template call back letter can not be over stated. I would like to see you try that with an excel sheet. Another great use is for Test No Sales, they did not buy from you for some reason. But that does not mean they were not interested. So call them back for a yearly check up again with a simple search and mail merge. Maybe they will bite this time.

A CRM will also allow you to easier figure out the KPIs you set for yourself, the records just need to be queried in the right manner to spit out the data. With most CRMs you will just need to set up the search terms once, save them and they will be there to run in the background day after day. So first week of the new month, you get a list for six monthly call backs. Your receptionist undertakes the mail merge and over that week your diary is booked. Second week of the month, Test No Sales 12 months list and so on.

Reporting to a GP in Ireland and the UK and an MD in the USA is made easier. Organize a really good template report and run a mail merge at the end of every day on the Patients that were tested that day. Attach the audiogram printout and voila. Instant report to be sent to the Doctor. I truly believe that this in particular is imperative. I call it marketing by osmosis, it is non threatening soft marketing, the Doctor gets to see your reports semi regularly. The quality of the report is excellent and it is obvious that you are indeed a fellow Medical Professional.

You can go the other route and send him a Practice pack, but I guarantee you are wasting your time and killing trees for nothing. It will promptly end up in the bin. Its simple, a CRM gives you instant access to the information, information is power, the power to organize and run your clinical and commercial strategies in an easy and efficient way. It just does not get any better!

Regards

Geoff

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Posted in Business development strategy, Business Strategies, Commercial strategies, Dispenser Education, Patient Retention Strategy, Sales & Customer Care Strategies | 1 Comment