Fine-Tuning Guide

Procedure

Otoscopic examination
Hearing aids checking
Hearing test: (a) Old results more than 1 year = perform AC; (b) Significant hearing drop = perform BC and Tympanometry
Ask for the purpose of visit

Parameters

G20 = Very soft background noise (e.g. air circulation)
G35 = Very soft background noise (e.g. air circulation)
G50 = Soft speech
G65 = Normal conversation level
G80 = Loud speech
MPO = Maximum power output

Identify issue

Hearing aids related issues

Occlusion (Physical vs Acoustical)
Properly fit device
Gain
Sound quality
Accessories (Bluetooth)

Client related issues

Realistic expectations
Un-identified needs
Previous user needs
New user needs

Troubleshooting

Question the client until you understand the problem well enough to make a statement (May present sounds in the clinic to gather further information: low/medium/high intensity or background noise)
Identify the parameter and the direction of change needed (Need to understand how each parameter like compression ratio, gains, MPO and features affect the gains)
Change 1 parameter and feature at 1 time

Key skills in fine tuning

Effective Communication: Ask questions to identify the issue as precisely as possible (Which situations, any description? How often does it happen? What did you do to resolve it?)
Knowing the parameters to adjust to achieve the desired outcome
Data-logging to see how often and when the hearing aids are used

Like in a barrel, tunnel, or well (Too much bass / too heavy)

Decrease low frequency gain (- under 1kHz)
Increase high frequency gain (+ over 2.8kHz)
Increase venting

Unclear

Decrease low frequency gain (- under 1kHz)
Increase high frequency gain (+ over 2.8kHz)
Decrease compression ratio
Increase MPO (+ MPO)
Increase overall gain (+ O.G.)

Too muffled "cotton in the ears"

Increase overall gain (+ O.G.)
Increase MPO (+ MPO)
Increase high frequency gain (+ over 2.8kHz)
Decrease compression ratio
Check for cerumen

Tinny / Sharp / Shrill

Increase low frequency gain (+ under 1kHz)
Decrease high frequency gain for normal / loud inputs (- over 2.8kHz, G50/G65/G80)
Increase high frequency compression ratio
Counsel to adapt

Too metallic "metal hitting / cover nose speech"

Decrease high frequency gain for loud inputs (- over 2.8kHz, G80)
Increase low frequency gain (+ under 1kHz)

Speech from microphone

+ mid frequency

Hearing aids make no differences

Ask for clarification
Increase high frequency gain (+ over 2.8kHz)
Increase overall gain (+ O.G.)

Cannot hear with hearing aids

Ask for clarification
Increase overall gain (+ O.G.)
Decrease compression ratio

Too soft / not loud enough

Increase overall gain (+ O.G.)
Increase MPO (+ MPO)
Increase low frequency gain (+ under 1kHz)

Hearing is too loud

Decrease overall gain (- O.G.)
Decrease low frequency gain (- under 1kHz)
Decrease MPO (- MPO)
Decrease gain for normal / loud inputs (- G65 / G80)

Voices are too loud

Decrease overall gain (- O.G.)
Decrease low frequency gain (- under 1kHz)

Hearing aids too noisy

Decrease high frequency gain (- over 2.8kHz)
Increase high frequency compression threshold

Sounds are painful "dishes clattering / water running"

Decrease MPO (- MPO)
Decrease gain for loud inputs (- G80)
Increase high frequency compression ratio

Loud sounds are too loud

Ask for clarification
Decrease MPO (- MPO)
Decrease overall gain (- O.G.)
Decrease gain for loud inputs (- G80)

Startle reaction

Decrease MPO (- MPO)
Decrease gain for loud inputs (- G80)
Increase compression ratio

Poor speech recognition at distance / soft speech

Increase gain for soft / normal inputs (+ G50 / G65)
Increase high frequency gain for soft / normal inputs (+ over 2.8kHz, G50 / G65)

Unclear speech in quiet

Increase high frequency gain for soft / normal inputs (+ over 2.8kHz, G65)
Increase mid frequency gain for soft / normal inputs (+ over 1-2.7kHz, G65)
Decrease compression ratio

Moderate speech in quiet

Gain: G65, G50 | Frequency: All

Distant speech

Gain: (- G65 G50 | Frequency: All

TV and radio

Gain: G65, G50 | Frequency: All

Speech in part noise

Gain: G80, G65 | Frequency: All (e.g. in restaurant

Speech in traffic noise

Gain: G80 | Frequency: All
Gain: G65 | Frequency: (Low, Mid), High (e.g. on street)

Too loud / too much / bothering

Ask for clarification
Decrease very soft gain (- G20 / G35)
Decrease low frequency gain (- under 1kHz)
Increase NoiseBlock (+ NoiseBlock)
Counsel to adapt

Own voice strange / not natural

Ask for clarification
Speak when the hearing aids are on / off
Other voice vs own voice

Occlusion Effect

Increase venting
Open-fitting
Remake (+ deep insertion
Occlusion management

Non-occlusion effect

Decrease low frequency gain for loud inputs (- under 1kHz, G80)
Decrease low frequency gain (- under 1kHz)
Decrease loud inputs (- G80)
Increase MPO (+ MPO)
Counsel to adapt

Distant sounds better than close sounds

Increase MPO
Decrease overall gain
Decrease compression ratio

Rear sounds not clear

Decrease Directional Mic
Communication strategies
Counselling

Hearing aids are whistling

Feedback test
Check for cerumen
Decrease high frequency gain (- over 2.8kHz)
Decrease soft / very soft gain (- G50 / G35)
Decrease venting
Mold thickening / remake
Increase WhistleBlock

/ sh /

Gain: G65 | Frequency: Mid
Gain: G50 | Frequency: High

Male / s /

Gain: G65 (- G50 | Frequency: High

Female / s /

Gain: (G65 G50 | Frequency: High

/ f /

Gain: (G65) | Frequency: (Mid, High)
Gain: G50 | Frequency: Mid, (High)