Now you can perform in-situ audiometry in a Remote Fitting session
The ability to remotely fine-tune your clients’ hearing aids with the Bernafon EasyControl Connect app has created flexibility and opportunity for both you and your clients. I’ve already touted the features and benefits of Remote Fitting in a previous blog. But I’d like to highlight the new helpful feature that is available through Remote Fitting. You can now perform in-situ audiometry in Oasisnxt 21.2 during a Remote Fitting session. You may not have incorporated in-situ audiometry into your daily routine, but let’s review some ways that it would be particularly useful in a remote situation.
I’m sure that you’re aware that a common complaint by clients is that they’re not hearing as well as they did before. Quite often a quick change of the wax filters and ensuring that the domes aren’t clogged with wax will solve this problem. In a remote appointment, you can confirm with the clients whether they’ve already changed the filters or even have them put the speaker up to the camera so that you can inspect it.
If the wax filters and the domes are indeed clean, we move to the next troubleshooting step. Remote Fitting allows you to turn up the gain in the hearing aids, but what if the client expresses the feeling that their level of hearing has changed? Before, this would have always required an office visit, but remote in-situ audiometry lets you check their hearing without coming into the office. Based on the results, you can confidently confirm that the client’s hearing has decreased or ensure that the hearing thresholds are the same. They might simply have become accustomed to the hearing aids and need a boost.
Performing in-situ audiometry will not only address the client’s concerns about potential further hearing loss, but it will also allow you to adjust their amplification more accurately.
Using the client’s hearing aids as the transducers will provide an additional level of fine-tuning to the fitting as the acoustics of the hearing aids will be reflected in the audiometric results. If there are changes to their hearing, use the new in-situ audiometry results to set the hearing aids to target, otherwise use the gain handles in the amplification screen if they just need some adjustment.
In-situ audiometry should only be performed remotely for clients that already have an established audiogram in their software profile. In-situ audiometry, whether conducted in the office or remotely, is never intended to replace a diagnostic audiogram performed with insert or supra-aural earphones.
However, it’s a convenient tool for follow-up checks of hearing thresholds and for personalized fine-tuning. When compared with conventional audiometry, differences between measurements with insert earphones and the acoustics of the hearing aids have shown differences between 10 – 30 dB HL. This varies by frequency and the type of acoustics used for the hearing aids (i.e., open domes versus ear molds) (O’Brien et. al., 2010; Kiessling et. al., 2015). Greater discrepancies between in-situ and conventional audiometry are typically seen in the lower frequencies and with more open acoustics. The primary cause is the coupling of the hearing aid with an open dome which results in a less occluded fitting. This allows for the transmission of ambient noise into the ear canal which can mask low level tones, and it allows low-frequency energy to leak out of the ear canal, resulting in the possible softer perception of tones meaning that the thresholds could be higher.
O’Brien et. al. (2010) examined the test-retest reliability of in-situ audiometry and found no significant differences between test results across frequencies and appointment dates. Therefore, in-situ audiometry is considered to be a viable option as the results are reliable. An important consideration is to control ambient noise as much as possible to avoid the possibility of generating higher thresholds due to the noise level (O’Brien et. al., 2010). Bernafon offers a tool specifically for this purpose. The new ambient noise level meter for Remote Fitting works in the same manner as the noise level meter in the Feedback Manager screen of Oasisnxt. The difference is that it works remotely to measure the noise level of the client’s environment. If the levels are too high you can recommend that the client find a quieter spot for the in-situ testing.
In-situ audiometry in Remote Fitting allows further possibilities when conducting remote appointments with your clients. While some clients will always prefer to come to the office for their appointments, by offering Remote Fitting with in-situ audiometry you have more options to maximize your schedule and meet more of your clients’ needs.
Learn more about Remote Fitting
References
Kiessling, J., Leifholz, M., Unkel, S., Pons-Kühnemann, J., Jespersen, C.T., and Pedersen, J.N. (2015). A comparison of conventional and in-situ audiometry on participants with varying levels of sensorineural hearing loss. Journal of the American Academy of Audiology, 26(1), 68–69.
https://doi.org/10.3766/jaaa.26.1.8
O’Brien, A. Keidser, G., Yeend, I., Harley, L., and Dillon, H. (2010). Validity and reliability of in-situ air conduction thresholds measured through hearing aids coupled to closed and open instant-fit tips. International Journal of Audiology, 49(12), 868–876. https://doi.org/10.3109/14992027.2010.503664