IHS - International Hearing Society Hearing Instrument Fitting Questions and Answers — Questions and Answers
Question 1: A client with a severe-to-profound, steeply-sloping sensorineural hearing loss requires a new BTE hearing aid. To prevent acoustic feedback and provide adequate low-frequency gain, which of the following earmold characteristics is most appropriate?
- A soft silicone material with a small parallel vent
- An open-fit dome with a large vent
- A hard acrylic material with a large vent
- A soft silicone material with no vent and a long canal (Correct answer)
Correct answer: A soft silicone material with no vent and a long canal
For a severe-to-profound hearing loss, a tight acoustic seal is critical to deliver high levels of amplification without causing feedback and to properly amplify low-frequency sounds. A soft silicone material provides a better seal than hard acrylic. A non-vented (occluding) earmold with a long canal maximizes the seal, prevents feedback, and ensures low-frequency energy is delivered effectively to the eardrum. Large vents or open domes are inappropriate as they would allow sound to leak out, causing significant feedback and reducing low-frequency amplification.
Question 2: A new hearing aid user complains that their own voice sounds loud and hollow, as if they are 'talking in a barrel.' This client has good low-frequency hearing. Which of the following is the MOST common and effective modification to alleviate this complaint?
- Increasing the overall gain of the hearing aid.
- Increasing the size of the vent or adding a vent. (Correct answer)
- Switching from a soft dome to a hard acrylic shell.
- Reducing high-frequency amplification.
Correct answer: Increasing the size of the vent or adding a vent.
The client is describing the occlusion effect, which is common in new users with good low-frequency hearing when their ear canal is blocked. The most effective way to reduce the occlusion effect is to increase venting. A larger vent allows the low-frequency, bone-conducted sounds of the user's own voice to escape the ear canal instead of being trapped and over-amplified.
Question 3: What is the primary purpose of measuring the Real Ear to Coupler Difference (RECD) during a hearing instrument fitting, especially for pediatric patients?
- To measure the maximum output of the hearing aid before it is placed on the ear.
- To verify the function of the directional microphones in a quiet environment.
- To account for the individual's ear canal acoustics, allowing for precise verification without requiring the patient to be present for the entire measurement. (Correct answer)
- To subjectively assess the client's perceived sound quality and comfort.
Correct answer: To account for the individual's ear canal acoustics, allowing for precise verification without requiring the patient to be present for the entire measurement.
The RECD measures the difference between the sound pressure level in a standardized 2cc coupler and the individual's actual ear canal. This measurement is crucial because it captures the unique acoustical properties of the patient's ear. It is especially valuable in pediatrics because children have smaller ear canals which can significantly alter the sound pressure level. By applying the RECD, the fitter can accurately verify the hearing aid's output in a test box, simulating the real-ear response without needing the child to remain still for extended probe microphone measures.
Question 4: During a follow-up appointment, a client reports that while the hearing aids are helpful in quiet settings, they still struggle significantly to understand conversations in a noisy restaurant. Which verification measurement would be most effective to objectively demonstrate the benefit of the hearing aid's noise reduction technology?
- Aided soundfield thresholds (functional gain).
- Real-ear measurement with a speech-in-noise signal, comparing directional microphone and noise reduction feature activation. (Correct answer)
- Real-Ear to Coupler Difference (RECD).
- Maximum Power Output (MPO) measured in a 2cc coupler.
Correct answer: Real-ear measurement with a speech-in-noise signal, comparing directional microphone and noise reduction feature activation.
Real-ear measurement using a speech-in-noise signal is the most effective way to objectively verify the performance of features like directional microphones and digital noise reduction. By presenting speech from the front and noise from other directions, the fitter can measure the improvement in the signal-to-noise ratio when these features are activated, providing objective proof of their function and benefit in challenging listening environments. Functional gain measures improvement in quiet thresholds, not performance in noise.
Question 5: Which of the following best describes the difference between hearing aid verification and validation?
- Verification is measuring functional gain in the soundfield, while validation is measuring insertion gain with a probe microphone.
- Verification uses manufacturer software to program the aid, while validation uses a standardized questionnaire.
- Verification is the objective measurement of the hearing aid's acoustic output in the ear, while validation is the subjective assessment of the client's perceived benefit. (Correct answer)
- Verification is the process of taking an ear impression, while validation is confirming the physical fit of the earmold.
Correct answer: Verification is the objective measurement of the hearing aid's acoustic output in the ear, while validation is the subjective assessment of the client's perceived benefit.
Verification involves objective, electroacoustic measurements to ensure the hearing aid is meeting a specific prescriptive target. The most common method is real-ear measurement (probe microphone measurement). Validation, on the other hand, is subjective and measures how well the hearing aid is meeting the client's real-world needs and expectations. This is typically assessed using self-report questionnaires (like the COSI or APHAB) or aided speech-in-noise testing.
Question 6: A practitioner is performing functional gain testing to assess the benefit of a new hearing aid fitting. The results show the aided thresholds are 15-20 dB better than the unaided thresholds across most frequencies. This measurement provides information about the:
- hearing aid's performance in noisy environments.
- maximum output level of the hearing instrument.
- improvement in the audibility of soft sounds. (Correct answer)
- frequency response as measured at the tympanic membrane.
Correct answer: improvement in the audibility of soft sounds.
Functional gain is a verification method that measures the difference between a client's unaided and aided thresholds in a soundfield. It directly demonstrates how much the hearing aid improves the client's ability to detect soft sounds (i.e., their hearing thresholds). While useful, it is considered less precise than real-ear measurements for fine-tuning and does not directly measure performance in noise or the true response at the eardrum.
IHS - International Hearing Society Hearing Instrument Fitting Questions and Answers
A client with a severe-to-profound, steeply-sloping sensorineural hearing loss requires a new BTE hearing aid.
To prevent acoustic feedback and provide adequate low-frequency gain, which of the following earmold characteristics is most appropriate?