Lab / GTO Work Group: Johnny Hansen Charlotte T. Jespersen Jan-Peter Rekling Niels Stengaard Hansen

Content Audiological rationale Occlusion Venting Acoustic Mass Openness of vents Technical Lab aspects Custom Open Products The Conscious Choice Sample survey Stepvent advantages Step Venting New Techniques Vent Strips Flex Vent The ‘Triangle’ Lab KPIs Lab Training

Occlusion

Occlusion

Occlusion

Occlusion

Occlusion

Hearing loss & the occlusion effect The user typically complain that own voice sounds too loud and or like he/she is speaking in a barrel. The occlusion effect is commonly experienced by hearing aid users with low-frequency hearing thresholds less than about 40 dB HL (Dillon, 2001).

5 reasons for using vents To allow bone-conducted low frequencies to escape To allow amplified air-conducted low frequencies to escape To allow unamplified signals to pass unobstructed to the eardrum To allow pressure relief To allow aeration of the ear canal

How do Vents work ? Vents affect the low frequencies (Dillon, 2001)

Why do vents affect the low frequencies ? Eksperiment: pick up a cup or whatever you might have in front of you and move it slowly from side to side in front of you, then increase the rate with which you move the cup/other thing from side to side.

What determines the vent effectiveness Acoustic Mass determines the vent effect The lower the Acoustic Mass the higher the vent effect (occlusion relief) Formula Vent Length ------------------------ x Constant Vent diameter2

Acoustic mass illustration Experiment: Pick up the long straw and try to blow through it Then cut it so that the length is reduced to about 50%

Effects of Ventilation Low frequency sounds can enter and leave the ear canal through the vent. Transmission of low frequency sounds is easier the smaller the acoustic mass of the vent. The acoustic mass of the vent is calculated from the length & diameter of the vent. Increasing the diameter reduces the acoustic mass Decreasing the length reduces the acoustic mass

Openness of vents Non-occluding Non-occluding Open Closed Closed

How open are our instruments ReSoundAir rating 1 FlexV (L) rating 3 FlexV (M) rating 4 Tmold (2.4) rating 6 Tmold (1.6) rating 7 S.CIC (2.3) rating 5 T.CIC (2.3) rating 5 FV(M):4 FV(L):3 Air:1 IROS SCIC:5 Here you see the subjective occlusion rating (HI subjects) from the Giessen trial. Explain why the stepped vent doesn’t alleviate occlusion. Venten kortes af, men kun ud til et hulrum som ikke er åbent, idet resten af apparatet fylder en del af øregangen ud. Vent length in custom products: 19 x 2 (right and left) CIC devices vent length (stepped vent): average of 1,48 cm 19 x 2 (right and left) CIC devices vent lengh (traditionel vent): average of 1,99 cm. Vent length of tradional earmold vents: 6 Earmolds 2,4 mm:average of 1,9 cm (vent length) 6 Earmolds 1,6 mm: average of 1,8 cm (vent length). TCIC:5 Tmold:7 Tmold:6

Custom Products

Problems in the Lab Custom products with open fittings, especially CIC’s often cause trouble for the Lab. To get room for the vent canal you occasionally have to compromise. You can focus on either Cosmetics or Comfort. You can compromise on either vent diameter or instrument size.

Full cosmetic benefits Custom Open Products Vent diameter Small Large Full cosmetic benefits Small Select cases* * Cases of larger ear canals Instrument size Full comfort benefits No perceived benefits Large Ø 1.6 mm (~2.0 mm2) Ø 2.6 mm Ø 3.0 mm (~7.0 mm2) <-Closed Open ->

Vents on Custom Products Non-occluding Non-occluding Open Custom Closed Closed

The conscious choice Compromise on instrument size. Risk of Return due to protrusion Comfort Limited room for vent Cosmetics Compromise on vent diameter. Risk of Return due to occlusion. Keep in mind that 40% of users experience Occlusion as the primary problem

DF

Lab samples - survey 7 different labs. Netherlands – Spain – Italy Germany - UK – Japan - USA 2 impressions (J & K) K : average J : more challenge 4 instruments each K-impression: one 710-OC one 730-OC J-impression: one 710-OC

Full cosmetic bennefit Lab sample CIC B B C D F G Jennifer B B C D E F Kevin B J-sample K-sample Vent canal data: J-sample K-sample Diameter: ~2.2mm ~2.2 mm Length: 13 mm 17 mm Full cosmetic bennefit Full comfort bennefit No percived bennefits Select cases Instrument size Vent diameter CIC B : Germany Ø 1.5 mm Ø 2.6 mm Ø 3.0 mm

Full cosmetic bennefit Lab sample CIC C B C D F G Jennifer C B C D E F Kevin C J-sample K-sample Vent canal data: J-sample K-sample Diameter: 3.0mm 3.0 mm Length: 13.5 mm 17 mm Full cosmetic bennefit Full comfort bennefit No percived bennefits Select cases Instrument size Vent diameter CIC C : Netherlands J-sample: Good fit. Compromised a on instrument size to get room for a large vent. K-sample: Nice fit, protruding due to large vent. Ø 1.5 mm Ø 2.6 mm Ø 3.0 mm

Full cosmetic bennefit Lab sample CIC D B C D F G Jennifer D B C D E F Kevin D J-sample K-sample Vent canal data: J-sample K-sample Diameter: 2.0 mm 2.5 mm Length: 13.4 mm 15.8 mm Ø 1.5 mm Ø 2.6 mm Ø 3.0mm Full cosmetic bennefit Full comfort bennefit No percived bennefits Select cases Instrument size Vent diameter CIC D : Italy J-sample: Fit OK, compromise be-tween instrument size and vent size. K-sample: Fit nice, no profound protrusion. Could have used 3.0 vent and made instrument a bit larger.

Full cosmetic bennefit Lab sample CIC E B C D F G Jennifer B C D E F Kevin E J-sample K-sample Intentionally left blank Vent canal data: J-sample K-sample Diameter: 2.3 mm Length: 15.8 mm Full cosmetic bennefit Full comfort bennefit No percived bennefits Select cases Instrument size Vent diameter J-sample: No instrument produced due to misunderstaning of order. CIC E : Japan J-sample: No instrument produced due to misunderstanding of order. K-sample: Fit nice, no profound protrusion. Could have used 3.0 vent and made instrument a bit larger. Ø 1.5 mm Ø 2.6 mm Ø 3.0 mm

Full cosmetic bennefit Lab sample CIC F B C D F G Jennifer F B C D E F Kevin F J-sample K-sample Vent canal data: J-sample K-sample Diameter: 1.5mm N/A Length: 10 mm N/A Ø 1.5 mm Ø 2.6 mm Ø 3.0 mm Full cosmetic bennefit Full comfort bennefit No percived bennefits Select cases Instrument size Vent diameter CIC F: Spain J-sample: Nice fit , but very smalll vent. Can not be regarded as an Open Fitting. Furthermore the step vent is made so it will be occluded by the ear canal. K-sample: Fit OK. Vent looks like 2.0 mm, but narrows in in the middle and is almost closed. (Cannot be measured)

Full cosmetic bennefit Lab sample CIC G B C D F G Jennifer G B C D E F Kevin J-sample K-sample Vent canal data: J-sample K-sample Diameter: 1.5mm N/A Length: 18 mm N/A Intentionally left blank Full cosmetic bennefit Full comfort bennefit No percived bennefits Select cases Instrument size Vent diameter K-sample: No instrument produced due to misunderstaning of order. CIC G: USA J-sample: Not a good fit. Does not fit the ear canal well. Protruding and still a quite small vent. K-sample: No instrument produced due to misunderstaning of order. Ø 1.5 mm Ø 2.6 mm Ø 3.0 mm

Full cosmetic bennefit Lab sample ITC A A A A E B C D F Jennifer Kevin B C D F G A J-sample K-sample Vent canal data: J-sample K-sample Diameter: 2.5 mm 2.5 mm Length: 19 mm 21 mm Full cosmetic bennefit Full comfort bennefit No percived bennefits Select cases Instrument size Vent diameter ITC A: U.K. J-sample: Fit OK. Little too big considering the 2.5 mm vent. K-sample: Could have used a lager vent without increasing the instrument size and hereby get a more open fitting. Ø 1.5 mm Ø 2.6 mm Ø 3.0 mm

Full cosmetic bennefit Lab sample ITC B B B A E B C D F Jennifer Kevin B C D F G A J-sample K-sample Vent canal data: J-sample K-sample Diameter: 3.1 mm 3.1 mm Length: 16.5 mm 20 mm Full cosmetic bennefit Full comfort bennefit No percived bennefits Select cases Instrument size Vent diameter ITC B: Germany J-sample: No big difference between J and K sample. Good utilization of space for the Large D-vent. Alternative layout of faceplate with good access to push button. K-sample: Same as J-sample. Ø 1.5 mm Ø 2.6 mm Ø 3.0 mm

Full cosmetic bennefit Lab sample ITC C C C A E B C D F Jennifer Kevin B C D F G A J-sample K-sample Vent canal data: J-sample K-sample Diameter: 3.0 mm 3.0 mm Length: 13 mm 15 mm Full cosmetic bennefit Full comfort bennefit No percived bennefits Select cases Instrument size Vent diameter ITC C: Netherlands. J-sample: Quite large instrument with some. Do not follow ear line which makes the instrument create unwanted shadows and angles in the ear. K-sample: Same as J-sample. Both instruments could have been made smaller by using a D-vent. Ø 1.5 mm Ø 2.6 mm Ø 3.0 mm

Full cosmetic bennefit Lab sample ITC D D D A E B C D F Jennifer Kevin B C D F G A J-sample K-sample Vent canal data: J-sample K-sample Diameter: 2.0 mm 2.5 mm Length: 10 mm 10.6 mm Full cosmetic bennefit Full comfort bennefit No percived bennefits Select cases Instrument size Vent diameter ITC D: Italy. J-sample:Small instrument with vent canal in the top. Even if the canal looks big at the ends it narrows down in the mittle decreasing the vent effect. Vent size has been compromised for instrument size. K-sample: Not a good fit. Presses against Tragus and have a bad fit in the bottom part. Ø 1.5 mm Ø 2.6 mm Ø 3.0 mm

Full cosmetic bennefit Lab sample ITC E A E B C D F Jennifer E Kevin B C D F G A J-sample K-sample Vent canal data: J-sample K-sample Diameter: 3.0 mm N/A Length: 13 mm N/A Intentionally left blank Full cosmetic bennefit Full comfort bennefit No percived bennefits Select cases Instrument size Vent diameter K-sample: No instrument produced due to misunderstaning of order. ITC E: Japan J-sample: Nice small instrument with a large 3.0 mm vent. Nice layout. K-sample: No instrument produced due to misunderstanding order. Ø 1.5 mm Ø 2.6 mm Ø 3.0 mm

Full cosmetic bennefit Lab sample ITC F F F A E B C D F Jennifer Kevin B C D F G A J-sample K-sample Vent canal data: J-sample K-sample Diameter: ~2.0 mm ~1.0 mm Length: 11 mm 12 mm Full cosmetic bennefit Full comfort bennefit No percived bennefits Select cases Instrument size Vent diameter ITC F: Spain. J-sample: Instrument fit nicely, but vent is small and not stepped back correct. The canal is narrowing down in the mittle. K-sample: Same as J. In the canal the vent is blocked by the ear canal. Ø 1.5 mm Ø 2.6 mm Ø 3.0 mm

Full cosmetic bennefit Lab sample ITC G G A E B C D F Jennifer Kevin B C D F G A J-sample K-sample Intentionally left blank Vent canal data: J-sample K-sample Diameter: N/A 2.0 mm Length: N/A 21.5 mm Full cosmetic bennefit Full comfort bennefit No percived bennefits Select cases Instrument size Vent diameter J-sample: No instrument produced due to misunderstaning of order. ITC G: USA J-sample: No instrument produced. K-sample: Large protruding instrument with a bad fit. Vent space is not opti-mized considering the size of the instrument. Ø 1.5 mm Ø 2.6 mm Ø 3.0 mm

StepVent

StepVent advantages Greatest potential risk of increasing the vent effect is increased likelihood of feedback - the feedback penalty Vent Diameter: A wider vent gives more vent effect Vent Length: A shorter vent gives more vent effect Shorter vents also tend to reduce likelihood of feedback because the feedback frequency resonance is shifted to a higher frequency range which helps to optimize the Stabilizer DFS. 10 2 3 4 -80 -70 -60 -50 -40 -30 -20 -10 Frequency, Hz Feedback path response, dB Stepped Not stepped

Step Venting Process StepVent reduces the canal length. but not enough to compensate for a small vent diameter.

Venting Process 1

Venting Process 2 Select the largest possible diameter vent wire for the Canta Open Canal instruments. Press it against the shell wall firmly from one end to the other.

Venting Process 3 Apply UV material in two thin lines on each side of the vent wire. Make sure that the material floats gently around the wire. Cure the material completely in the UV-machine.

Venting Process 4 Completely cover the remaining part of the vent wire with the UV venting material. Cure it in the UV-machine until completely hard.

Venting Process 5 Gently, pull out the vent wire. Inspect the vent for holes and thin areas.

Large vent issues Faceplate Module Battery Hybrid Receiver

Large vent issues Faceplate Module Battery Hybrid Receiver

Large vent issues Faceplate Module Battery Hybrid Receiver

New Techniques - Large vent procedure 1 Drill holes at the expected end position of the step vent.

Large vent procedure 2 Insert vent strip through the drilled holes

Large vent procedure 3 Fill up. Apply two times. Be sure to fill up solid at the tip at second apply.

Large vent procedure 4 Cure vent material and remove vent strip.

Large vent procedure 5 Grind down from each end until the entrance of the vent canal is reached. Mount faceplate and components.

Vent strips Small: 1.0 mm (0.040) 9103-059 0.8 mm2 Name Diameter Part # Area Small: 1.0 mm (0.040) 9103-059 0.8 mm2 Medium: 1.5 mm (0.060) 9103-209 1.8 mm2 Large 1: 2.2 mm (0.085) 9106-079 3.8 mm2 Large 2: 2.3 mm (0.090) 9106-069 4.1 mm2 Iros: 3.0 mm (0.118) 9103-229 7.0 mm2 Small D-vent: 3.1 mm 9103-219 3.8 mm2 Large D-vent: 4.2 mm 9103-239 7.0 mm2

Full cosmetic benefits Survey Summary Small Large Vent diameter Vent diameter Small Large Spain Italy Japan UK USA Germany Netherlands Full cosmetic benefits Small Select cases Small Instrument size No percived benefits Full comfort benefits Large Large

FlexVentTM – a complete solution

FlexVent™ - a complete solution “ Canta7 Open BTE combined with FlexVent™ is our unique and preferred choice” – because it; - provides optimal comfort benefits to the end-user, and is a true USP (nobody else has FlexVentTM) to the dispenser FlexVent (rear) (front)

Benefits & key issues Canta7Open BTE combined with FlexVent™ addresses 58% of users (Dialogue study) FlexVent offers Minimal-Occluding Natural sound benefits to the hearing impaired - as well as great wearing comfort (cool, light and comfortable) – with no compromise on gain! FlexVentTM provides a 100% improved vent effect compared to traditional ear molds (Giessen study) The Canta7Open BTE offers competitive Minimal-occlusion benefits compared to IROS ear molds – and is fully compatible with IROS ear molds The Unique GN ReSound FlexVentTM concept must be offered by well trained selected external - alternatively by own labs

Lab - Key Performance Indicators

Making sure the “Triangle” works Most labs communicate with dispensers through internal sales Make the dispenser believe in Open, give him RFC awareness and give him dummies documenting possibilities/restraints Establish “rules of engagement” both between sales and lab and sales and dispenser Make sure that Sales and Lab people have common understanding of Open and agree on company policies (do joint training) Dispenser Sales external internal Lab

Lab KPIs KPIs will be become focus areas of Management tracking and Lab Continuous Improvement Training Dialogue on-going with Global Ops how to most rationally collect these data Final process to be defined

GTO / Lab Training: Cluster Work Shops

Lab Training America Asia Europe North Europe South 4 Lab training sessions to be co-ordinated with Product/Mkt/Sales training America (Bloomington) March 3rd US – CND Asia (DanaJapan) March 9th JPN – CHI – AUS - NZ Europe North (Taastrup) March 9th GER – HOL – FRA DEN - SWE – NOR - BRA Europe South (Madrid) March 12th SPA – ITA – U.K. BEL - SWI - A

GTO/Lab Training Outline Mindset building (shared knowledge base) Audiology Lab / GTO Demos Hands-On training Advanced StepVent – New shortening techniques D-vents New materials Face plate colors Full day program Target audience: lab/quality manager + super operator Mindset building – same contents as for Sales Team

Thank you. Questions ?

Full cosmetic benefits Lab/GTO: Key Takes Select cases* Full cosmetic benefits Full comfort benefits No percived benefits Maximize vent diameter – only way for full Comfort benefits Compromise instrument size. Comfort The conscious choice – Comfort or Cosmetics Limited room for vent Cosmetics Compromise on vent diameter. New Venting Techniques to support max vents

How open are our instruments ReSoundAir rating 1 FlexV (L) rating 3 FlexV (M) rating 4 Tmold (2.4) rating 6 Tmold (1.6) rating 7 S.CIC (2.3) rating 5 T.CIC (2.3) rating 5 FV(M):4 FV(L):3 Air:1 IROS SCIC:5 Here you see the subjective occlusion rating (HI subjects) from the Giessen trial. Explain why the stepped vent doesn’t alleviate occlusion. Venten kortes af, men kun ud til et hulrum som ikke er åbent, idet resten af apparatet fylder en del af øregangen ud. Vent length in custom products: 19 x 2 (right and left) CIC devices vent length (stepped vent): average of 1,48 cm 19 x 2 (right and left) CIC devices vent lengh (traditionel vent): average of 1,99 cm. Vent length of tradional earmold vents: 6 Earmolds 2,4 mm:average of 1,9 cm (vent length) 6 Earmolds 1,6 mm: average of 1,8 cm (vent length). TCIC:5 Tmold:7 Tmold:6