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WORKSHEET 9

By Vivian Bennett,2014-01-20 05:06
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WORKSHEET 9

    MEASURING IN-SITU REAL EAR AIDED RESPONSE

    (AURICAL)

WARNING: When using the probe microphone equipment be VERY careful

    with the microphones as they are easily damaged. Also please do not change

    headsets between the different systems as each system has been calibrated

    for the particular headset.

AIM: Familiarisation with real ear probe tube microphone

    measurements

OBJECTIVES: Competency in measuring:

    ? REAR (REUR, REOR & REIR)

    1. Click on NOAH, when it asks for a password select OK.

2. Click on FILE, select NEW CLIENT, enter any Last Name, First Name &

    DoB (if typing in manually our computers use American format)

    3. Click on OK, then Select ALL CLIENTS and double click on your entered

    client.

4. Click on AUDIOMETRY MODULE

5. Enter the following hearing loss:

     500 Hz 1000 Hz 2000 Hz 4000 Hz

    Right Ear 35 35 40 40

    Left Ear 35 35 40 40

    (You can copy one ear’s threshold onto the other ear by clicking on EDIT,

    then select COPY TO OTHER EAR.)

6. Click on AUDIOGRAM, select SAVE (or click on disk icon) and then

    click on lower small ‘X’ to close the window.

    Save disk icon

    Click on lower ‘x’ to close window

7. Attach Starkey Strata 312 hearing aid to the programming leads and

    plug into the hi-pro box.

8. Click on OPEN MODULE SELECTION icon.

    9. Click on your STARKEY ICON, then HEARING AID FITTING to launch

    the hearing aid software.

10. The software may appear behind your ‘Legacy Host’ screen, if it does

    minimise the legacy host screen so you can see the Starkey software

    (see diagram over page)

    Starkey softwareStarkey software

    Legacy Host Screen Legacy Host Screen

    (minimise & it will drop to the(minimise & it will drop to the bottom of your screen & the Starkeybottom of your screen & the Starkeysoftware will become accessible) software will become accessible)

    11. Click on the appropriate ear (Right or Left) then click on READ.

12. If the hearing aid has been programmed before it will ask you if you want

    to use the audiogram from the hearing aid or the current session. Which

    one do you think you should use? ______________________________

13. Click on CURRENT SESSION. If the ‘Reading Device’ screen doesn’t

    disappear close the message box (click on it’s X).

14. Change the prescriptive procedure to DSLi/o and mute the hearing aid.

15. Find the NOAH platform again. It may be minimised to the bottom of

    your screen, if so click on it.

    16. You want to have access to the OPEN MODULE SELECTION icon

    again (click on it).

17. Click on MEASUREMENT’ so that you have access to all the

    measurement modules. Double click on AURICAL REAL EAR M to

    launch the REM module.

(See additional Aurical notes to learn how to customise shortcut keys back in your own

    clinics).

    18. The ‘DSL set-up targets’ screen defaults on our computers (click on

    target if it doesn’t, then OK). This is an extremely important screen as

    DSL uses the information you input to calculate frequency gain targets.

    Click on the same selections as below (selections in YOUR clinic will

    vary depending on your set up etc):

    Check DoBInsert earphone with Check DoBInsert earphone withfoam tip was used tofoam tip was used toObtain the audiogram.. A non-linear A non-linear Obtain the audiogramhearing aid is hearing aid is being fitted. being fitted. Take care when Take care when BTE hearingBTE hearingusing Phonakusing Phonakaid is being aid is being aids as they may aids as they may fitted.fitted.default to dSCor default to dSCor dPCwhich are dPCwhich are linear strategies.linear strategies.

    Select predicted Select predicted compression compression For worksheet select For worksheet select threshold. If threshold. If predicted predicted (indicates targets(indicates targetsWDRC hearing aid WDRC hearing aid are generated using a are generated using a 40-45 dB OK. If 40-45 dB OK. If predicted RECD). In clinic predicted RECD). In clinic you know exact you know exact better to try and measure so better to try and measure so CT then click on CT then click on use RECD if available.use RECD if available.appropriate value.appropriate value.

Click when all options have been selected.

    19. Ensure you are in INSITU SPL mode. If you are NOT click on MODE and

    make sure ‘Coupler Test’ is NOT selected.

20. You are now going to calibrate the probe tube (must be done every time

    you change the probe tube). Use a new black tip probe tube, attach it to

    the probe mic attachment then position the end of the probe tube so that it

    is aligned with the reference microphone (see manual for picture). Hold

    the probe tube and reference microphone facing the loudspeaker at the

    same distance you will be placing the individual (90cm as recommended

    by the manufacturer).

    21. Click on TUBE CAL. It should look similar to the screen below. If

    calibration is acceptable click OK, if not re-calibrate.

22. As an extra cross check, keep holding the probe tube in the same position

    as before, click on PURE TONE SWEEP then click on REOR. Check to

    see you have a flat line.

23. Click on MODE and check that FFT has been selected.

    24. Click on VIEW then ENABLE ON TOP MODE. This re-sizes your screen

    so that you can see both the hearing aid manufacturer and REM screen at

    the same time. Note when you do this, the GREEN TICK to the top right

    of the screen shades out. You will have to de-select ENABLE ON TOP

    mode to get the GREEN TICK back if you want to save your data.

    GREEN TICK indicates SAVE & EXIT.

    (There is a fault in the software because if you go FILE you will see that Save & Exit is

    ticked and you presume your data would automatically be saved…… it WON’T BE

    UNLESS YOU CLICK ON THE GREEN TICK.)

    25. You want to be able to see both the REM module and Starkey hearing

    aid software at the same time. See below.

26. Position subject in the appropriate position (90 cm) in front of the

    loudspeaker. Examine ear using otoscope and check for discharge or

    excessive wax.

27. Carefully position the probe tube (approx 27mm past tragal notch & at

    least 5 mm past the earmould). Check the positioning with the otoscope.

28. Carefully insert the earmould with hearing aid attached and switched on

    (make sure you un-mute the aid in the software). Take care to not move

    the probe tube.

29. In the Aurical REM module, check that the input level is set to 65 dB then

    select REIR 1 (stands for Real Ear In-situ Response not to be confused

    with Real Ear Insertion Response). Check to see if the hearing aid

    matches targets, if it does not, adjust the electroacoustic parameters of the

    hearing aid appropriately. Don’t forget if you are exceeding targets in one

    frequency region you can use the FILTER DESIGN to attenuate specific

    frequencies.

    30. Once targets at 65 dB are met, change the input to 80 dB (only do this if it

    is OK with your subject as it maybe loud) and click on REIR 2. Adjust the

    ‘output parameters’ to change the response at 80 dB. In clinic you would

    also check 50 dB input but the training room will be too noisy to check this.

    In clinic you would also run a 90 dB pure tone sweep to check the

    maximum output of the hearing aid. You may choose to do this ‘in-situ’ or

    you may check this in the coupler (Change mode to Coupler Set-up).

    Once you are happy with the response of the hearing aid ensure you

    PROGRAM the changes into the hearing aid. In clinic you should aim to

    get responses similar to those on the next page.

    31. To SAVE the REM response curves click on VIEW and de-select ‘Enable

    on top mode’. Once you do this the screen will re-store to it’s normal size

    and the GREEN TICK on the top right of the page will re-appear. Click on

    this and you will save and exit the measurement module.

    32. Return to the Starkey software and click on NOAH drop down menu and

     click on SAVE and EXIT.

    MEASURING REUR, REOR & REIR

    In your own time you might like to practice measuring more traditional real ear

    measurements such as the real ear unaided response (REUR), real ear

    occluded response (REOR) & real ear insertion response (REIR). These

    measurements are only appropriate for children whose ear canals are the

    same size as adults (have the same resonant peak).

1. To measure Real Ear Insertion Response (Gain) click on TARGET

    again and select NAL-NL1, click on OK and the setup menu will

    appear. If this is the first time you have used NAL-NL1 you may need

    to enter a password b0505.

    2. You should be relatively familiar with the different fields as they are

    similar to DSL set up. Try and decide for yourself what would be

    appropriate to click on or change. See the back page for the answers

    assuming you were fitting the same type of hearing aid as before

    (Starkey).

    3. Assuming you have already calibrated the probe tube, insert the probe

    tube to the appropriate length. Check that the input level is set to 65

    dB, that you are on GAIN/SPL mode in VIEW, then click on REUR.

    This is your unaided response (insitu gain of the open ear)

QUESTION:

    At what frequencies are there peaks in the REUR?

    ______________________________________________________________

    ______________________________________________________________

Do these peaks correspond with an average adult REUR?

    ______________________________________________________________

4. If the REUR does deviate from average, re-insert the probe tube

    checking it has not been blocked with wax or positioned against the ear

    canal wall. Also check for middle ear anomalies.

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