Category Archives: Tech Tips

The Holger’s Scale vs the IPS-Score

A Review of Percutaneous Implant Complication Scores for Audiologists

What is the Holger’s Scale?

The Holger’s Scale was created as a measure of the clinical status of soft tissue surrounding a titanium implant, such as the Ponto™ System. Its goal was to evaluate the frequency and magnitude of adverse reactions more effectively in this population in future research.1

How was it developed?

The foundation of the Holger’s Scale was a comprehensive study that examined 60 patients who received 67 abutments/implants. Patients were followed for periods ranging from three to 96 months. Over this period, only one implant was removed for reasons associated with skin complications.1

Why is this relevant for audiologists?

The Holger’s Scale is a simple tool that clinicians can use to record any adverse skin reactions ranging from swelling and redness to skin overgrowth and implant removal. Additionally, this measure is often utilized in research regarding percutaneous implants.1

Where do most patients lie on the Holger’s scale post-Ponto implantation?

Studies show that Ponto implant patients, when undergoing the MIPS or MONO procedures, typically have minimal skin-related complications as noted by a Holgers Score of ≤2.2,3 Remarkably, 97 percent of patients exhibit no or minor skin reactions post-operatively.

Are there any limitations to the Holger’s Scale?

Kruyt et al. (2017) suggest several limitations to the Holger’s Scale despite its simplicity and usability.4 These include:

  • The scale can be used to indicate treatment, but these decisions are not standardized.
  • The scale was designed to evaluate skin reactions three months post-operatively, and thus cannot evaluate complications in healing.
  • The scale does not evaluate any pain reported by the patient.
  • Skin height, in regards primarily to skin overgrowth, is not noted in the original Holger’s scale. Often, skin overgrowth can lead to abutment changes or revision surgery.

Additionally, it does not describe possible complications of transcutaneous implants. Due to these limitations, a new scale, the IPS-Scale, was developed to evaluate complications related to percutaneous and transcutaneous implants.4

In response to these limitations, the IPS-Scale was developed to provide a more comprehensive evaluation of complications related to both percutaneous and transcutaneous implants. The IPS-Scale differentiates between the two types of implants and assigns scores for specific categories, such as inflammation, pain, and skin height (for percutaneous implants) or skin numbness (for transcutaneous implants). These individual scores are then combined to generate the IPS-Score, offering a more nuanced guide for treatment selection.

The three scores are then combined to generate the IPS-Score, which then can be used to guide treatment selection.4

No matter which scale you utilize, Ponto implantation patients experience minimal complications post-operatively, and thus benefit from excellent skin outcomes, favorable aesthetic results, and fast recovery times with few complications.5,6

References

  1. Holgers KM, Tjellstrom A, Bjursten LM, Erlandsson BE. Soft tissue reactions around percutaneous implants: a clinical study on skin-penetrating titanium implants used for bone-anchored auricular prostheses. Int J Oral Maxillofac Implants. 1987 Winter;2(1):35-9. PMID: 3471713.
  2. Holmes, S., Hamiter, M., Berry, C., & Mankekar, G. (2021). Tissue preservation techniques for bone-anchored hearing aid surgery. Otology & Neurotology42(7), 1044-1050.
  3. Data on file at Oticon Medical, Clinical study BC108
  4. Kruyt, I.J., Nelissen, R.C., Johansson, M.L., Mylanus, E.A.M. and Hol, M.K.S. (2017), The IPS-scale: A new soft tissue assessment scale for percutaneous and transcutaneous implants for bone conduction devices. Clin Otolaryngol, 42: 1410-1413. https://doi.org/10.1111/coa.12922
  5. Oticon Medical Whitepaper – The MONO procedure
  6. Lagerkvist H, Carvalho K, Holmberg M, Petersson U, Cremers C, Hultcrantz M. Ten years of experience with the Ponto bone-anchored hearing system—A systematic literature review. Clin Otolaryngol. 2020; 45: 667–680. https://doi.org/10.1111/coa.13556

The Ponto 5 SuperPower

Technical Tips from Auditory Technical Services

We launched the much-anticipated Ponto™ 5 SuperPower in May. Clinicians and patients alike have been eager to experience the smallest, most powerful abutment-level bone anchored hearing device on the market. For this blog, we asked Auditory Technical Services to provide some tips for clinicians to consider when they are fitting this brand-new device.

What software do I need to program the Ponto 5 SuperPower?

There is a new update with Genie Medical BAHS for the Ponto 5 Superpower. You will need Genie Medical 2022.1. This can be obtained by using the Genie Medical (GM) Updater in your hidden icon menu. You can right-click to start the download and installation.

If GM Updater does not work for you or you cannot find it, feel free to call Auditory Technical Services at 888.277.8014 and choose Option 4 when prompted. We can send the software to you via a share link after account verification.

What features in the Ponto 5 SuperPower will benefit my patients?

The Ponto 5 SuperPower has all the wonderful features of the Ponto 5 Mini, but with added MFO allowing a fit for hearing loss up to 65 dB HL BC. Ponto 5 SuperPower also offers OpenSound Navigator™ for 360o sound that provides proven better speech understanding in noise, OpenSound Optimizer™ for 5 dB more stable gain with less potential for feedback and is built on the Velox S™ platform. As a bonus, this most powerful sound processor also has low-energy Bluetooth® for direct connectivity to Apple® products and other connectivity.

What wireless accessories are compatible with the Ponto 5 SuperPower?

Our entire portfolio of wireless accessories that patients have come to rely on are compatible with the new Ponto 5 SuperPower, including the ConnectClip™, EduMic™, TV Adapter™ 3.0, and remote control. As with the Ponto 5 Mini, this new device is Made for iPhone® and has the ability to stream an audio signal directly to the iPhone. Our Oticon ON™ app is available for use for both iPhone and Android™ users.

Which app(s) can be used with the Ponto 5 SuperPower?

  • Oticon RemoteCare for remote programming sessions
  • ON can be used for controlling the Ponto 5 SuperPower using a compatible smartphone
  • Ponto Care™ app is great for support and guidance, but also to help patients develop good cleaning and maintenance habits with their softband, abutment or Ponto processor
  • Lastly, Oticon RemoteCare allows providers to perform adjustments to patient processor settings during telehealth visits

I have a patient who wants to upgrade from the Ponto 3 SuperPower. Where do I start?

That is a great question! It is actually a very simple process. There are two insurance forms that need to be completed and returned to the Insurance Services Department at Oticon Medical: a Patient Insurance Form and an ENT Insurance Form.

  1. The patient will complete and return the Patient Insurance Form to Oticon Medical Insurance Services Department along with a copy of their insurance card.
  2. The audiologist and ENT will complete the other form, the ENT Insurance Form and return it to Insurance Services along with these documents:
  • A signed prescription for the ordered upgrade (must be signed by a physician)
  • Medical notes (should be within the last year)
  • Latest copy of audiogram (should be within the last year)
  • Processor and Accessory Order Form

The items can be returned to our Insurance Services Department via email at insuranceservices@oticonmedical.com or faxed to 888-683-8736. If you have any specific questions, our Insurance Services Department is happy to assist you by email or phone at 855-400-9761. They are available Monday-Friday, 8am-8pm EST.

Lastly, if you are wondering if the patient is eligible for an upgrade based on the age of their current Ponto processor, please contact Customer Service M-F 8am-8pm ET at 888-277-8014 (choose Option 1) or email anytime to info@oticonmedicalusa.com and they can quickly provide you with that information.

Is the Ponto 5 SuperPower MRI-safe?

No, the Ponto 5 SuperPower processor is not MRI-safe and should be removed prior to getting an MRI scan. However, the implant and abutment are MR-Conditional and may be subjected to a MR scan as long as following conditions are met:

  • Static magnetic field of 1.5 and 3 Tesla only
  • Maximum spatial field gradient of 3,000 gauss/cm (30 T/m)
  • Maximum MR system reported, whole body average specific absorption rate (SAR) of 4 W/kg in the first level controlled mode.

In non-clinical testing, the image artifact caused by the device extends approximately 10 mm from the Ponto Implant System when imaged with a gradient echo pulse sequence and a 3.0 Tesla MRI system.

What should I consider when fitting a pediatric patient with a Ponto 5 SuperPower?

You are off to a great start by considering fitting a pediatric patient with the Ponto 5 SuperPower. There are several benefits that you and your patient will appreciate, and we are excited to have an opportunity to touch base on a few of them:

  • High MFO, OpenSound Navigator & OpenSound Optimizer. The ideal choice to ensure audibility and output and headroom for the dynamic range of speech, sound processing technology that provides access to the full soundscape to support incidental learning, and advanced feedback management that prevents feedback without compromise, as it does not reduce gain.
  • Integrated battery door lock. There is no need to change out the battery door, because it has a locking mechanism right on the door that is intuitive to use and ensures the battery door is tamper-resistant to small fingers. Simply use the Multitool and turn the screw clockwise in the direction of the locked padlock icon to lock the battery drawer. To unlock the drawer, turn the screw counterclockwise in the direction of the unlocked padlock.
  • Excellent battery life with the 675 (CI) battery of approximately 54-120 hours.
  • Pediatric Preferences Settings. Directionality and noise reduction features based upon age of the child.
  • Age bracket notification. When a child comes back for follow-up, this makes it easy to identify if changes to the Pediatric Settings are due to be reviewed and adjusted.
  • Multiple pediatric Outcome Measures (ELF, CHILD, PEACH)
  • DSL-BC Pediatric Fitting Rationale. Found under Program Manager or set it as your fitting default under Preferences
  • LED Indicators for peace of mind (Start-up, Continuous, Program, and Volume Changes)
  • EduMic compatibility for school-friendly, easy-to-use FM connectivity or remote mic use
  • Parent-friendly Connectivity. Oticon ON App, direct-to-iPhone, Find My Processor, and  ConnectClip
  • Ponto 5 Softband. Coming soon! Anticipated for release in late summer 2022 (NOTE: implantation is contraindicated for patients up to 5 years of age)

Oticon Medical has a great resource for pediatrics. The Pediatric Fitting Guide is available on our website for download, or you can request hard copies for your clinic from your local Oticon Medical Clinical Specialist. ATS is available should you have any questions, or you would like fitting assistance.

I am fitting a Ponto 5 SuperPower for the first time, and I might need some assistance. Who can I call?

The Auditory Technical Support team is available and on standby to support you when you need it. You can reach us via email at audiologysupport@oticonmedical.com and by phone at 888-277-8014 (Option 4). Our hours are 8am-8pm EST.

About the authors

Gail Leininger, Au.D., CCC-A is an audiologist who has worked with implantable technologies for over twenty years. She is an Auditory Technical Specialist for Oticon Medical.

Nicole Maxam, Au.D. CCC-A is an Auditory Technical Specialist at Oticon Medical and joins the team with 17 years of experience as an audiologist.

Alicia Wooten, Au.D. CCC-A is a Senior Auditory Technical Specialist at Oticon Medical. She specializes in implantable hearing devices and has a strong passion for aural rehabilitation and its impact on patient outcomes.

EduMic – The Easy FM Connectivity Solution

We all know the importance of supporting children with hearing loss when distance, noise, and reverberation affect listening and learning in a typical classroom setting, but what do you do when the student wears a hearing device? What if they need to use an FM system in the classroom? Before your head starts to swim and eyes glaze over, I have great news for you—Oticon’s EduMic™ is a product you will fall in love with! Oticon Medical’s Ponto™ device[1] works together with the EduMic to maximize children’s speech understanding for language development, learning, and socializing opportunities.

The EduMic is a remote microphone system (RMS) featuring 2.4 GHz wireless technology. Built on the Velox STM platform, the EduMic features advanced signal processing, including OpenSound NavigatorTM technology. When noise, distance, and reverberation become challenging in the classroom, EduMic is a vital partner to the Ponto processor. EduMic uses the same innovative open sound technology found in other Oticon Medical[1] products to analyze, balance, and remove noise. It delivers stable and clear access to the teacher’s voice by continuously monitoring the environment and removing unwanted noise—even between words.

Designed for dynamic learning environments and built to last

Beside its ability to be used as a remote microphone, the EduMic provides easy access to an FM system in use at school without the teacher needing to wear two microphones. EduMic also enables access to a variety of audio sources to ensure that students stay connected and engaged during class. Teachers can plug the EduMic into a computer, smartboard, or tablet using the 3.5 audio microphone jack connection. The audio jack also allows easy integration with existing sound field systems, accessing multiple audio sources and microphones simultaneously. Smaller and lighter than many remote microphones at just 32 grams,  EduMic features a sleek, modern design and 10-hour battery life.

Built to last, EduMic is robust and designed to handle the demands of everyday life and withstand accidental dropping. EduMic uses a single rechargeable Li-ion battery that can be left charging overnight without fear of overcharging. Signal strength is also thoroughly tested in a typical classroom environment to ensure a high-quality connection. The 2.4 GHz signal is strong and stable even in a typical WiFi-heavy environment when the teacher is speaking through EduMic.

EduMic teacher and student benefits

Best of all, teachers love EduMic! A usability study conducted by Oticon Inc. examined teacher’s perspectives on ease of use, discreetness, attractiveness in relation to design, and also wearing comfort.[2] The study showed teachers have a strong preference towards EduMic’s design and comfort compared to a competitor’s remote microphone solution. Teachers rated EduMic as easier to use compared to a leading device on the market, very user-friendly to pair and mute, and very comfortable to wear.

According to a study at Boys Town National Research Hospital, researchers found a significant improvement in speech understanding in a noisy and reverberant environment for students fitted with hearing aids wearing the EduMic.[3] Speech understanding improved as 6 dB more noise could be tolerated in the noisy environment test condition when EduMic was used with hearing aids compared to using hearing aids alone. In the noise + reverberation condition, 5 dB more noise could be tolerated when EduMic was used together with hearing aids over hearing aids alone. The results support the positive impact of using EduMic compared to hearing aids alone in both noisy and noisy + reverberant acoustic environments. EduMic allows children with hearing aids to handle poor signal-to- noise ratios in the classroom.

EduMic is available as a Ponto accessory choice

EduMic and our Oticon Medical bone anchored hearing devices are based on our BrainHearing™ technology, which is designed to deliver what the brain needs to make sense of sound. We are excited to announce that this extraordinary remote microphone system  is now available as a free accessory choice with Oticon Medical Ponto orders! Do you have pediatric bone conduction patients to whom you would like to offer EduMic as an accessory option? To learn more about the many exciting features in our Ponto processors and their clinical benefits, including integration with the EduMic accessory, please contact your regional Clinical Specialist.

About the Author

Gail Leininger, Au.D., CCC-A is an audiologist who has worked with implantable technologies for over twenty years. She is an Auditory Technical Specialist for Oticon Medical.

For more information on EduMic, please visit:

[1] Ponto 4 and Ponto 5 Mini
[2] Gordey & Rumley 2019 Enhanced Learning with EduMic Oticon White Paper
[3] Data on file

Evaluating Benefit and Monitoring Progress in Young Children with a Bone Conduction Hearing Device

Providing early access to sound is critical for children with prelingual hearing loss to develop speech and language skills on par with their typical hearing peers (Sininger, Grimes, and Christensen 2010; Bagatto et al. 2011, 2016; Tomblin et al. 2015). Evidence-based prescriptive formulae, such as DSL v 5.0 and NAL-NL2, are available in hearing aid fitting software and real-ear verification measures when fitting air conduction hearing aids to infants and children who have hearing loss (Scollie et al. 2005; Keidser et al. 2012).

However, strategies for fitting a bone conduction hearing device (BCHD) to a young child is lacking.  Additionally, the use of a consistent protocol within pediatric clinics for children with a BCHD has not been well defined.  In fact, a survey completed by Gordy and Bagatto (2020) found that audiologists are seeking guidance on how to provide optimal amplification to children who use BCHDs, and the aided audiogram is the only consistent measure used to verify BCHD fittings.

Given the limited availability of clinical tools, such as a skull simulator and prescriptive targets, audiologists need to consider other subjective test measures to use when fitting young children that are readily available in most pediatric audiology clinics.  These include, but are not limited to, parent report measures (e.g., The Auditory Skills Checklist, LittleEARs,) the Ling Six Sound Test, closed-set and open-set speech perception test measures, as well as standardized speech and language assessment measures.

As a leading manufacturer of bone anchored hearing solutions, we felt compelled to develop a suggested assessment protocol for monitoring the auditory skills of children ages three-to-five years fit with the Ponto bone anchored hearing system. This blog provides an overview of a straightforward assessment process that clinicians can incorporate into their fitting and management of young children with a BCHD.

Leveraging the Pediatric Minimum Speech Test Battery (PMSTB) developed by Kristin Uhler and colleagues in 2017, we created a streamlined assessment protocol for audiologists to consider when fitting young children with a BCHD.  This protocol is purely based on subjective assessment measures and a way for clinics to establish consistency among audiologists.  Beginning by verifying that a young child can detect the Ling Six Sounds, an audiologist would move to a closed-set speech perception test measure designed to evaluate a child’s pattern perception abilities and word identification skills.  Assuming the child demonstrated consistent word identification we suggest evaluating how the child responds to recorded open-set word and sentence recognition test measures. Finally, we recommend using a parent report measure to end the evaluation.

The protocol consists of a laminated card outlining the straightforward steps to evaluating benefit using a combination of speech perception measures, a parent report measure, and aided soundfield testing. The protocol provides guidance on the test administration, including suggested test level in dBA and calibration of the audiometric equipment.  A suggested test measures flow chart is provided along with a record sheet to document the child’s results. The protocol is recommended for all BCHD indications for a child ages three-to-five years.

Until a standardized objective verification protocol using a skull simulator with prescriptive targets is developed for young children, we would encourage clinicians to consider using this protocol or something similar to monitor a young child’s auditory development with a BCHD.

To learn more about this protocol, we encourage you to reach out to your regional clinical specialist 

About the Author

Carissa Moeggenberg is an audiologist who has worked in the hearing healthcare field for 29 years. She is presently the Training Manager for Oticon Medical.

References

1. Bagatto, M. P., S. T. Moodie, R. C. Seewald, D. J. Bartlett, and S. D. Scollie. 2011. “A Critical Review of Audiological Outcome Measures for Infants and Children.” Trends in Amplification 15 (1): 23–33. doi:10.1177/1084713811412056.
2. Bagatto, M., S. Moodie, A. Malandrino, C. Brown, F. Richert, D. Clench, and S. Scollie. 2016. “Prescribing and Verifying Hearing Aids Applying the American Academy of Audiology Pediatric Amplification Guideline: Protocols and Outcomes from the Ontario Infant Hearing Program.” Journal of the American Academy of Audiology 27 (3): 188–203. doi:10.3766/jaaa.15051.
3. Dave Gordey & Marlene Bagatto (2020): Fitting bone conduction hearing devices to children: audiological practices and challenges, International Journal of Audiology, DOI: 10.1080/14992027.2020.1814970
4. Keidser, G., H. Dillon, L. Carter, and A. O’Brien. 2012. “NAL-NL2 Empirical Adjustments.” Trends in Amplification 16 (4): 211–223. doi:10.1177/1084713812468511.
5. Scollie, S., Seewald, R., Cornelisse, L., Moodie, S., Bagatto, M., Laurnagaray, D., … & Pumford, J. 2005. The desired sensation level multistage input/output algorithm. Trends in Amplification, 9 (4): 159–197.
6. Sininger, Y. S., A. Grimes, and E. Christensen. 2010. “Auditory Development in Early Amplified Children: Factors Influencing Auditory-Based Communication Outcomes in Children with Hearing Loss.” Ear and Hearing 31 (2): 166–185. doi:10.1097/AUD.0b013e3181c8e7b6.
7. Tomblin, J. B., E. A. Walker, R. W. McCreery, R. M. Arenas, M. Harrison, and M. P. Moeller. 2015. “Outcomes of Children with Hearing Loss: Data Collection and Methods.” Ear and Hearing 36 (01): 14S–23S. doi:10.1097/AUD.0000000000000212.
8. Uhler, K., Warner-Czyz, A., Gifford, R. and PMSTB Working Groups. 2017. “Pediatric Minimum Speech Test Battery” J Am Acad Audiol 28:232–247. DOI: 10.3766/jaaa.15123

The Benefits of OpenSound Navigator in Children with Hearing Loss

Fitting children with advanced sound processing algorithms in their hearing devices is not always straightforward. Does the clinical evidence support it? Will it provide more access to all sounds, promote incidental learning, and improve speech understanding in challenging environments? These questions are frequently considered, and a conservative approach is often taken. Whereas, when fitting adults, there is typically clinical evidence to support advanced sound processing and they are better at reporting sound quality issues, so audiologists are more likely to take a less conservative fitting approach. However, if we take too much of a conventional approach with children, are we missing an opportunity to provide improvements in sound quality, hearing in noise, and reduced listening effort?

In 2019, OpenSound NavigatorTM was incorporated into the Ponto 4 sound processor. The success of this sound processing strategy had been seen in Oticon hearing aids with many research studies documenting the benefits provided to patients. So, what is unique about OpenSound Navigator that might provide optimal benefit for children with hearing loss?

OpenSound Navigator is a groundbreaking speech enhancement algorithm that preserves speech and reduces noise in complex sound environments. OpenSound Navigator operates as a holistic system that handles all sound environments from the quietest to the noisiest, by selectively reducing the dominant noise sources while preserving speech in all directions. OpenSound Navigator adapts seamlessly without modes or mode switches. Utilizing an omnidirectional beam that captures a 360° sound panorama of the environment along with a back-facing cardioid that estimates noise from the sides and back provides users with a natural sound experience.

Research has been conducted in children using OpenSound Navigator. Browning et al, 2019 demonstrated OpenSound Navigator improves speech recognition in noise for children. In fact, with speech to the front and noise from behind, OpenSound Navigator provided an average 5 dB SNR improvement as compared to an omnidirectional microphone. Elaine Ng, 2017 further demonstrated that OpenSound Navigator reduces perceived listening effort during a speech recognition task. This benefit is particularly important because hearing loss imposes increased fatigue and effort as experienced by children. Oticon Medical’s BrainHearing™ technology is designed to support the unique day-to-day challenges and developmental needs of children. Together with hearing technology prescribed according to best practice, OpenSound Navigator delivers an optimized speech signal and hence provides these children with the optimal conditions to listen and learn.

Based on the supporting research, we recommend the fitting of OpenSound Navigator in a child’s Ponto™ 4 sound processor starting at one year of age. From ages one to four years, we suggest OpenSound Navigator is active with the transition set to low, and then as the child ages to four years and older, the transition can be adjusted to medium or high similar to adult recommendations. These are the default pediatric settings incorporated into Genie Medical (2019) fitting software. To summarize, unlike conventional directionality and noise reduction technology, OpenSound Navigator does not require children to look directly at the talker the whole time to enjoy better speech understanding in noise. Young listeners may move around freely and can still experience the benefits of OpenSound Navigator.

Another important feature of OpenSound Navigator is that it preserves interfering speech coming from different directions. This new technology allows access to other talkers in the environment, which is fundamental to incidental learning for school-age children.

The groundbreaking technology of OpenSound Navigator marks a breakthrough in the development of speech enhancement systems. It is not only designed to improve acoustics at the child’s ears, but also to facilitate the brain’s own processing. It does not isolate the front talker but preserves access to all talkers. Its accurate and fast spatially informed noise estimator allows the Balance module to selectively attenuate noise sources at given locations. The Noise Removal module removes the remaining noise even between words. OpenSound Navigator opens many possibilities for new pediatric users.

To learn more about the clinical evidence supporting OpenSound Navigator in children we encourage you to register for our upcoming training on April 21, 2021 or reach out to your regional clinical specialist.

About the Author

Carissa Moeggenberg is an audiologist who has worked in the hearing healthcare field for the past 28 years. She is presently the Training Manager for Oticon Medical.

 

References:

Jenna M. Browning, Emily Buss, Mary Flaherty, Tim Vallier, and Lori J. Leibolda American Journal of Audiology Vol. 28, 101–113, March 2019
Elaine Ng, E. 2017. Benefits of OpenSound Navigator in children. Oticon Whitepaper.
Genie Medical (2019) Fitting Software

 

Clinical Test Protocol for Evaluating Bone Anchored Hearing Benefit During Patient Trial Process

Bone anchored hearing implants are beneficial hearing solutions designed to improve patients’ hearing through direct bone conduction. They are indicated for use in patients who have conductive or mixed hearing loss or in patients with single-sided deafness (SSD).

Adult candidates considering a bone anchored solution have the opportunity to experience sound through an acute simulation during a routine evaluation appointment.  It is during that appointment that the audiologist typically will counsel on device, discuss the benefits and outcomes, and provide the opportunity for the patient to hear sound through a clinic demo device, such as a Ponto 3 SuperPower or a Ponto 4 sound processor. This simulation provides significant value to the patient considering non-surgical versus surgical treatment options.

As clinicians, we are taught the importance of verifying device benefit for patients with hearing loss when considering their hearing device options, and then again as they are being fit with their device. In fact there are well-established protocols and tools in place for hearing aid verifications and cochlear implant assessments. However, there are few recognized protocols in place for validating benefit in a patient using a bone anchored device. It is for this reason that Oticon Medical has developed a bone anchored hearing system test protocol to assess benefit and compare performance with various hearing technologies.

At Oticon Medical, we understand the demands placed on our clinics each day and also know the importance of providing best audiological practice to patients considering a bone anchored solution.  Therefore, we took on the goal developing a simple test protocol for audiologists using the resources already available in their clinic.

The protocol consists of a laminated card outlining four straightforward steps to verify benefit with a bone anchored system or compare performance between different solutions and a test record sheet for documenting the patient’s results. Using published research from Snapp, et al (2010) we modified their suggested protocol to create our version that reinforces the use of a test band for simulations, sound field speech in noise testing using the QuickSin, and the administration of a self-assessment questionnaire. Finally, the protocol outlines additional verification measures that can be completed as well as highlighting the proper reimbursement codes that may be used for this appointment. The protocol is recommended for all bone anchored hearing loss indications.

To learn more about this protocol, we encourage you to register for our upcoming training on February 24, 2021 or reach out to your regional clinical specialist.

About the Author:

Carissa Moeggenberg is an audiologist who has worked in the hearing healthcare field for the past 28 years. She is presently the Training Manager for Oticon Medical.

References:
QuickSin Speech-in-Noise Test. User Manual. Etymotic Research Inc. Version 1.3
Current Procedural Terminology (CPT) Codes. Audiology. American Medical Association 2019
Snapp, H.A. et al (2010) A Clinical Protocol for Predicting Outcomes with an Implantable Prosthetic Device (BAHA) in Patients with Single-Sided Deafness. J Am Acad Audiol, 21: 654-662.

Strengthening Connections in Challenging Environments with the EduMic

Whether a child’s learning environment is in the classroom or virtually from their home, the ability to control the acoustics is difficult and underscores the need to optimize the overall speech signal.  Providing clear access to speech is critical for them to learn. Research has shown that children need quieter conditions and better signal-to-noise ratios than adults to have good speech understanding (Bradley & Sato, 2008). This is because children with developing language and auditory systems have a smaller vocabulary and are unable to rely on the redundancy of language to fill in missing words (Neuman, Wroblewski, Hajicek, & Rubenstein, 2010). Other studies have shown that an inability to understand the teacher due to poor listening conditions directly impacts the learning of new concepts (Yang & Bradley, 2009; Leibold, Hillock-Dunn, Duncan, Roush, & Bess, 2013). The exertion of mental energy and listening effort are also much higher when poor acoustic conditions exist (Bess, Gustafson, & Hornsby, 2014; McGarrigle, Gustafsson, Hornsby, & Bess, 2019).

The EduMic classroom solution

With the release of the EduMic™, Oticon Medical offers a unique solution for children to optimize listening effort in challenging environments. The EduMic – a remote microphone system (RMS) –features 2.4 GHz wireless technology and integrates with the Ponto 4 sound processor.  Built on the Velox STM platform, the EduMic features advanced signal processing, including Open Sound NavigatorTM technology. The EduMic preserves speech, operating within a wide bandwidth of 150 Hz to 10000 Hz while analyzing, balancing and applying noise removal to the streamed signal.  To improve the signal in outdoor environments, the EduMic also features Wind Noise Management, which employs an added level of “cleaning” to the signal.

While the primary function of the EduMic is in the microphone and transmitter mode, it has additional modes that are useful in and outside the classroom. The EduMic can stream stereo audio from various sources by connecting via a 3 mm jack cable, connecting to Frequency Modulation (FM) and Digital Modulation (DM) devices via a universal receiver, or it can function in telecoil mode. Additional features to help with the management of the device include LED indicators, a retention clip and protective skins.  The EduMic is robust and durable, provides stable transmission of the speech signal and provides the user with approximately 10 hours of use on a single battery charge based on internal device testing (EduMic Technical Data Sheet).   Figure 1 highlights the EduMic design and functionality.

Clinical evidence concerning EduMic supports both device usability and the improvement of speech understanding in complex listening environments. In fact, when the EduMic was subjectively evaluated by a group of educators, 80 percent reported a preference towards the EduMic over a competitive remote microphone system (RMS) and described it as “easy to use and comfortable to wear” (Gordey & Rumley, 2019).  When assessing the effectiveness in a noisy environment using a simulated classroom study design, the EduMic demonstrated improved speech understanding in children with hearing loss in both noise and noise plus reverberation environments when compared to using their hearing aids alone (Gordey & Rumley, 2019).

We encourage the use of the EduMic in all environments, including a child’s home where incidental learning occurs. This powerful solution provides children with an effortless transition into any environment because of its ease of use.  Finally, this product is a great balance of design and usability combined with advanced hearing technology to optimize the learning experiences of children with hearing loss.

To learn more about the EduMic and how it might benefit your patients contact your clinical specialist.

References:

Bess, F. H., Gustafson, S. J., & Hornsby, B. W. (2014). How Hard Can It Be to Listen? Fatigue in School-Age Children with Hearing Loss. Journal of Educational Audiology, 20, 1-14.
Bradley, J. S., & Sato, H. (2008). The intelligibility of speech in elementary school classrooms. The Journal of the Acoustical Society of America, 123(4), 2078-2086.
Gordey, D. and Rumley, J. (2019). Enhanced Learning with the EduMic. White Paper. Oticon, Inc.
Leibold, L. J., Hillock-Dunn, A., Duncan, N., Roush, P. A., and Buss, E. (2013). Influence of hearing loss on children’s identification of spondee words in a speech-shaped noise or a two-talker masker. Ear Hear. 34, 575–584.
McGarrigle, R., Gustafson, S. J., Hornsby, B. W., and Bess, F. H. (2019). Behavioral measures of listening effort in school-age children: examining the effects of signal-to-noise ratio, hearing loss, and amplification. Ear Hear. 40, 381–392.
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About the Author:

Carissa Moeggenberg is an audiologist who has worked in the hearing healthcare field for the past 28 years. She is presently the training manager for Oticon Medical.