Troubleshooting Guide
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Content Troubleshooting Guide
1 Programming Assistance .............................................................................................. P.2
2 Troubleshooting Programming .................................................................................. P.3
3 Troubleshooting Feedback ........................................................................................... P.4
4 Troubleshooting Migration .......................................................................................... P.6
5 Troubleshooting Occlusion .......................................................................................... P.8
6 Troubleshooting Discomfort and Pain ........................................................................ P.11
7 Troubleshooting Dead Device ...................................................................................... P.14
8 Device Removal and Re-Insertion ............................................................................... P.15
1
1 Programming Assistance
Soft Level Gain (SLG) n SLG controls the compression knee point.
n Tip:
– An increase in SLG will lower the compression knee point and increase relative gain.
– A decrease in SLG will raise the compression knee point and decrease relative gain.
Low Frequency Cut (LFC) n LFC reduces gain 6dB/octave below the selected frequency.
n Tip:
– Patients typically prefer lower LFC settings; especially when the device is set at a lower volume.
Volume (Vol) n Volume should be based on the patient’s preferences and communicative needs.
Maximum Volume (MaxVol) n Set MaxVol +1 or +2 of your set Vol. n Tip:
– This is more important for patients with lower volume settings as you do not want them to have the ability to cycle through 6 settings. These adjustments do not affect the MPO.
High Frequency Boost (HFB) n HFB provides approximately 4-6 dB boost above 2000 Hz. n Tip:
– HFB “ON” may over amplify high frequencies resulting in feedback and cause Lyric to compress.
2
2 Troubleshooting Programming
Background n Apply the methods mentioned in the previous section “Programming Assistance”. n Once the device is programmed and in place, confirming Lyric’s sound quality can be as easy as asking 2 questions:
– Volume related issues
– Own voice related issues
Query the patient & troubleshoot n Volume related issues:
– Ask the patient “if you had a remote control, would you turn the volume up, down or leave it as it is?”
� Based on the patient response to this question you should set the volume to where the patient is comfortable and then set MaxVol to Vol +1 or +2.
� Changes to SLG should be saved for complaints of background noise, soft sounds or pumping. n Own voice related issues:
– Ask the patient “from where do you hear your own voice?”
� Options may be needed to help facilitate an answer, for example:
� On top of the head
� Back of the head
� From the mouth
� From far away n If the patient response is anything other than from the mouth, changing LFC is recommended. Lowering the LFC increases the frequency response bandwidth and increasing the LFC decreases low frequency gain.
– If the voice is coming from the back of the head or there is an echo: Raise LFC.
– If the voice is coming from the nose or is tinny: Lower LFC.
– If the voice is coming from the throat: Lower or raise LFC.
– If the voice sounds or feels like it is underwater: Lower LFC.
If questions about volume and own voice related issues were adressed, the overall sound quality the patient is experiencing should be positive.
3
3 Troubleshooting Feedback
Background n The most common cause for feedback is due to an incomplete seal. Always check the physical fit of the device if there is feedback and before re-programming.
n To troubleshoot feedback follow these steps:
– Query the patient
– Inspect the ear canal with the device in place and the pinna at rest
– Inspect the canal with the device removed (if necessary). See chapter 8 for more information.
Query the patient n Ask the patient “what he/she is experiencing?”
– Squealing
– Hissing
– Static/Distortion n Ask the patient “when is feedback occurring?”
– Always
– Intermittently
– Only when_________ n Ask the patient “what he/she thinks is the cause of the feedback?”
– Did the feedback start after showering or any other activity?
– Did the patient manipulate the device?
– Did the patient adjust the volume to a higher level? n Ask the patient “how much of a bother is the reported feedback?”
– Intolerable
– Annoying, but tolerable
– Tolerable, just concerned that it happens at all
4
3 Troubleshooting Feedback
Inspect the ear canal with the device in place and the pinna at rest n Check the placement of the device: Are there any gaps or folds?
– Gaps noted: Re-size current size and 1 size larger (if available). Pay close attention to how the insertion depth interacts with the sizer. You may have to use a larger size at a more shallow depth. Be aware that reducing the depth of the insertion may contribute to occlusion, reduction in volume and sound quality issues.
– Folds noted: Re-size current size and 1 size smaller (if available). n Check the angle of the device according to the orientation of the ear canal: Should the superior indicator be towards the 2 o’clock position? 10 o’clock? Noon? If necessary change the position of the device according to the orientation of the ear canal.
n The canal wall is touching or close to the microphone. If the inspection revealed no gaps or folds, a collapsing ear canal might be the cause:
– Consider placing the device slightly short of ideal depth of insertion to ‘prop’ the ear canal open.
– Be aware that reducing the depth of the insertion may contribute to occlusion, reduction in volume and sound quality issues.
n Did the device migrate? See chapter 4 for more information.
n Is there cerumen adjacent to the lateral end of the device? If yes, replace with the new device to the same depth of insertion. n Consider reprogramming Lyric:
– Turn HFB OFF if it is ON. If feedback stops, and there is not a decrease in patient benefit, complete.
– Reduce gain 1 step (Vol or SLG):
If feedback remains and the patient perceives it as intolerable, consider contraindication.
5
4 Troubleshooting Migration
Background n Migration is defined as movement of the Lyric device from the original insertion depth. Migration is completely normal and can occur immediately after the patient has been fit with the device or a sizer, or may take a few hours up to a couple of days after the patient has left the office.
n This movement can be classified as “insignificant” or “significant”:
– “Insignificant” migration is movement of 2mm or less and occurs while the device finds its “sweet spot”. Insignificant migration has no negative impact on sound quality or patient comfort and therefore does not require replacement. The patient may or may not desire a program change due to the new distance from the Tympanic Membrane.
– “Significant” migration is movement greater than 2mm and is considered “significant” if there are any reported sound quality, comfort or feedback issues. If you find this to be an issue in your practice, consider using the suggestions in this chapter.
Query the patient n Ask the patient “what he/she is experiencing?”
– Decrease in sound quality
– Comfort issues
– Feedback n Ask the patient “when is migration occurring?”
– After sleeping
– Patient manipulated the device
– During/following chewing
6
4 Troubleshooting Migration
Inspect the ear canal with the device in place and the pinna at rest:
– Gaps noted: Re-size current size and 1 size larger (if available). Pay close attention to how the insertion depth interacts with the sizer. You may have to use a larger size at a more shallow depth. Be aware that reducing the depth of the insertion may contribute to occlusion, reduction in volume and sound quality issues.
– Folds noted: Re-size current size and 1 size smaller (if available).
n Inspect the ear canal while the patient opens and closes jaw and determine if there is excessive jaw movement.
– Determine the current depth of the device using the Lyric1 forceps:
– To do so, gently grasp the handle of the device with the forceps and move the depth ring so that it lines up with the posterior meatus. Remove the forceps and make note of the measurement. n If migration is “significant”, follow these steps:
– Rule out patient manipulation of device. Remove the device and re-evaluate the device size with sizers.
You may have to upsize to prevent further migration.
– Determine if changing insertion depth will also allow a more secure fit.
– Evaluate TMJ movement with Lyric in the patients ear. When the patient opens and closes their jaw, does the device move? This may be a contraindication if migration continues to be an issue.
If significant migration continues to be an issue, consider contraindication.
7
5 Troubleshooting Occlusion
Background n There are two types of occlusion with hearing aids: “Physical occlusion” and “acoustic occlusion”. n As long as an acoustic seal in the bony portion of the ear canal is achieved, the patient should not experience “physical occlusion”. n “Acoustic occlusion” is caused by under-amplification of low-frequencies (insertion loss from device placement), or giving over-amplification of low-frequencies (sound quality and own voice has too much bass).
Query the patient n Ask the patient “what he/she is experiencing?”
– Feels plugged up
– Feels like he/she is talking in a barrel
– Voice sounds hollow
– Feels/sounds like he/she has a cold n Ask the patient “how much of a bother is the reported occlusion?”
– Intolerable
– Annoying but tolerable
– Tolerable, just concerned that it happens at all
Determine type of occlusion n Before troubleshooting determine if this is physical occlusion or acoustic occlusion:
– Does the patient feel occluded with the device turned off? Try turning the device to SLEEP mode or
OFF: troubleshoot acoustic occlusion).
8
5 Troubleshooting Occlusion
Physical Occlusion n Before changing programming parameters, please check the following:
– Is the device ON?
– Is the patient aware of the device(s) in the ear?
– Awareness is a normal feeling when adjusting to wearing Lyric 24/7. This perception should last between the first few days to a few weeks of wearing the device(s).
– Do not let the patient get confused between awareness and true occlusion. n Could the device be placed at the desired or maximum insertion depth?
– If not, was the patient comfortable with the placement? Re-insert the device to maximum insertion depth. It may be necessary to decrease the device size in order to achieve the desired or maximum insertion depth.
– If yes, was the patient comfortable with the placement? Try upsizing and use the next size. n Ask the patient “from where is your voice coming?” The correct answer is coming from the mouth. Based on patient response to this question you should increase/decrease LFC as needed:
– Coming from the back of the head/echo: Raise LFC – this is helping to accommodate occlusion.
– Coming from the noise/tinny: Lower LFC – this is increasing the bandwidth of the device and adding more low frequencies.
– Coming from the throat: Lower or raise LFC – the patient could be experiencing acoustic occlusion and by lowering the LFC you increase the bandwidth. However, too much low frequency gain will require raising LFC.
– Sound/feels underwater: Lower LFC – this is increasing the bandwidth of the device which makes the sound feel more transparent. Alter LFC until the patient hears his/her own voice coming from the mouth.
9
5 Troubleshooting Occlusion
Acoustic occlusion n Try the following programming adjustments:
– Set LFC (Low Frequency Cut) to 200 Hz. Remember that when you have lower volume settings with
Lyric2, patients prefer lower LFC settings.
– Change LFC based on the patient’s feedback of his/her own voice (see page 9 on how to troubleshoot physical occlusion).
Patient is still reporting occlusion n If you have tried the above recommendations and the patient still reports occlusion:
– Counsel on awareness (see chapter 6 for more information).
– Counsel on acclimatization period (see chapter 6 for more information).
If the patient continues to report intolerable occlusion after 30 days of continuous wear, consider contraindication.
10
6 Troubleshooting Discomfort and Pain
Background n Determine the level of discomfort/pain from the patient. Use the pain scale (Note: these are typical findings; individual patient responses may vary):
PAIN
DISCOMFORT
ANNOYANCE
AWARENESS
FITTING 14 DAYS OF WEAR
– Awareness – will typically recover within 14 days.
– Annoyance – will typically recover within 14 days.
– Discomfort – will typically recover within 14 days.
– Pain – is not expected to recover and the device should be removed.
11
6 Troubleshooting Discomfort and Pain
Query the patient n Ask the patient “what he/she is experiencing?”
– Sharp, shooting, stabbing
– Dull aching
– Awareness n Ask the patient “when is this occurring?”
– Always
– Intermittently
– Only when_________ n Ask the patient “how much of a bother is the reported discomfort or pain?”
– Intolerable
– Annoying, but tolerable
– Tolerable, just concerned that it happens at all n Query patient on when the discomfort or pain started:
– “Did you feel pressure in your ears like you needed to pop them?” you may see moisture accumulation in the ear canal.
– “Did you feel the device moving in your ear canal?”
– “Did you touch, move or manipulate the device?”
– “Do you chew gum regularly?” period.
12
6 Troubleshooting Discomfort and Pain
Reported awareness, annoyance and discomfort n Counsel patient on adaptation period and continue Lyric use. n If discomfort continues beyond 14 days or pain occurs, remove the device and see section below.
Reported pain n The device should be removed immediately, preferably by the clinician:
– If the device is removed by the patient, try to have them come into the office as soon as possible to perform otoscopy and the steps below.
– Clinical removal: Prior to removal, determine the insertion depth of the device to determine if the device has migrated. If migration occurred, , also see chapter 4 and use tips prior to re-insertion. n Otoscopy and ear canal examination:
– Make note of any “footprints” (that is abrasions, redness, irritation) to help determine the cause of the pain.
– If the “footprint” is deep into the ear canal (towards the medial end of the device) verify the canal length. In some cases you may need to place the device 1mm more shallow.
– If the “footprint” is located on the posterior/anterior/inferior/superior portion of the ear canal, check the angle of insertion.
– Medical referral if necessary and report in Target software.
– Do not immediately re-insert the device.
– Wait at least 10-14 days to re-insert or until ear is healed.
– It is very important that there is no cerumen, scab, or debris in the ear canal prior to device reinsertion.
If pain occurs again, remove the device and the patient should be contraindicated for
Lyric use.
13
7 Troubleshooting Dead Device
If the device is still in the ear n Use SoundLync to change device settings. Does the patient hear the beep?
– If yes, how many beeps?
– If no, please try the following:
Once the device is removed n Use the following tips to help investigate the cause of the device failure.
– Visually inspect the device:
– Has the yellow color of the device faded? This would indicate repeated water exposure.
– Check that water is not trapped in the protection tube. following a water event.
14
8 Device Removal and Re-Insertion
Inspection following a warranted device removal n Check if cerumen is still in the lateral ear canal
– If no, replace with the new device to the same depth of insertion.
– If yes, perform or refer out for cerumen management. n Check if the ear canal is healthy
– If yes, replace with the new device to the same depth of insertion.
– If no, rest for 10-14 days or until healthy and replace with a new device of the same size in the ear.
– Report device removal in Target/ALPS and indicate if the ear requires rest or if a medical referral was necessary.
Before re-inserting any device n Check if cerumen is present in the ear canal.
– Perform or refer out for cerumen management. n Check if the ear canal is healthy.
– If yes, replace with the new device to the same depth of insertion unless the device is not acceptable for re-insertion.
– If no, rest for 10-14 days until healthy and replace with a new device of the same size in the ear. n Take time to visualize the entire ear canal to determine the “flight path” for device placement. n When re-inserting the device lubricate the opening of the canal.
15
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