1. Real-ear Measurements with the A-35
Presented by: Kristina Frye
Frye Electronics, Inc

2. Topics Interface from the A-35
Entering an Audiogram and Creating a Target
Performing Insertion Gain Measurements
Measurements in SPL: Comparing HTLs and UCLs
Testing with Visible Speech
Testing Open Fit Hearing Aids
Doing all this from the FONIX NOAH Module

3. FP35 Real-ear Screens Audiogram Entry Real-ear SPL Unaided & Aided
Insertion Gain
Move between these four screens by using NEXT and BACK

4. Audiogram Entry Screen
Amplitude
The Audiogram Entry screen is used to enter the patient's audiogram and generate an appropriate target.
Frequency
F2 — Select HTL/UCL/Bone
F3 — Generate Target

5. NAL-NL1 Target Settings
Press MENU and BACK to change target settings
Compression
Channels (1-18)
Aid Limiting (Type of output limiting)
Fit Type (Unilateral or Bilateral)
Reference (Almost always Head Surface)
The Compression and Channels settings have the most impact on the target!

6. Insertion Gain Testing
Press NEXT until you enter the Real-ear Insertion Gain screen

7. Traditional Real-ear Protocol Measuring the Insertion Gain Response

8. PROS and CONS of Measuring the Unaided Response
Let’s get sidetracked for a few minutes…
PROS and CONS of Measuring the Unaided Response

9. Save Time!
To save testing time, you can probably skip the unaided response measurement!
Thresholds are measured with an occluded response
Targets are generated from those thresholds
Many hearing aids alter the ear canal resonance when inserted, so the unaided response is extraneous data

10. Exceptions When is the unaided response useful?
Fitting a mild/moderate loss: Make sure that the hearing aid is proving a benefit to the patient
Checking the position of the probe microphone

11. Back to the Protocol…

12. Proper Placement of Microphones
Ref
Mic
Above the Pinna
Marked 30 mm
from the tip for Adults
and 25 mm for children
This illustrates proper placement of the microphones on the ear.
The reference mic is placed on the earhook above the pinna so that the microphone screen is approximately parallel to the pinna opening. The probe tube can be marked at 30 mm from the tip for adults, and about 25 mm for children depending on their size, so that insertion depth is adequate without causing pain by bumping the eardrum. Marking the tube with a red pen also serves as a means to make sure insertion of the hearing aid doesn't push the tube in farther. The probe tube should exit at the inter-tragal notch.
Inter-Tragal
Notch
Probe Mic

13. Level the Sound Field Speaker
Internal sound chamber converts to sound field speaker; should be ear height
12 inches from the speaker at 45° angle
Stand away from the patient/loudspeaker during measurements
The hearing aid (if silent) and/or probe tube can be inserted during leveling
Press F5 and START in the Real-ear Measurement screen to level the sound field speaker

14. Choose the Curve with F2 Four Curves Available Unaided
Ins. Gain #1: 50 dB
Ins. Gain #2: 70 dB
Ins. Gain #3: 90 dB
Selected curve shown above F2

15. Testing Protocol
For Quick Testing, measure only Ins. Gain #2. This measures at average speech level (70 dB SPL)
For Complete Testing, measure Ins. Gain #1, #2, and #3 (50, 70, and 90 dB SPL)
If no unaided response is measured, the average is automatically substituted

16. Example of Insertion Gain Meas
Prescription: This patient could use more amplification between Hz!

17. Overview for Quick Insertion Gain Testing
Enter Audiogram Entry screen
Press F2 from Opening Screen. Use NEXT and BACK if necessary
Input audiogram and generate target
Use arrow keys to enter audiogram. Press F3 to generate target.
Enter Insertion Gain screen
Use NEXT until screen appears
Level the sound field speaker
Press F5 and START
Measure Ins. Gain #2 and fit to target
Use F2 to select curve. Press START/STOP to start and stop test
If desired, also measure Unaided response and Aided Curve #1 and #3

18. The Real-ear SPL Protocol
Compare the Real-ear Response to HTLs and UCLs on one graph

19. Real-ear SPL Screen UCLs Target HTLs
The Real-Ear SPL screen displays the patient's threshold values, real-ear target, and uncomfortable levels all in one screen in dB SPL.
HTLs

20. Real-ear SPL Measurements
Goal:
Aided 3 below UCLs
Aided 2 meet target
Aided 1 above HTLs
In a typical hearing aid fitting, AIDED 1 is used at to make sure that soft sounds meet the patient's threshold values. AIDED 2 is used to make sure medium speech meets the target. AIDED 3 is used to make sure that loud sounds are below the patient's uncomfortable levels.

21. Overview of the SPL Protocol
Enter Audiogram Entry screen
Press F2 from Opening Screen. Use NEXT and BACK if necessary
Input audiogram and generate target
Use arrow keys to enter audiogram. Press F3 to generate target.
Enter Real-ear SPL screen
Use NEXT until screen appears
Level the sound field speaker
Press F5 and START
Measure Aided #1 to compare to HTLs
Use F2 to select curve. Press START/STOP to start and stop test
Measure Aided #2 to compare to the target
Measure Aided #3 to compare to UCLs

22. Visible Speech
Use External Signals such as Live Voice in the real-ear measurements
Perform this measurement in the Real-ear SPL screen
NEW! Both the real-time response and the average response are displayed

23. Example of Visible Speech
Average Response
Real-time Response

24. Visible Speech Protocol
Enter Audiogram Entry screen
Press F2 from Opening Screen. Use NEXT and BACK if necessary
Input audiogram and generate target
Use arrow keys to enter audiogram. Press F3 to generate target.
Enter Real-ear SPL screen
Use NEXT until screen appears
Put analyzer in Spectrum Analysis mode
Use F4 to select the source type. Use DOWN arrow to turn source OFF.
Perform Visible Speech measurement
Press START/STOP to start measurement. Begin speech signal.

25. Open Fit Hearing Aids
Coupler measurements: Use our new Open Fit Coupler!
Real-ear measurements: Same protocol but disable the reference microphone

26. Open Fit Coupler
Insert the hearing aid into the coupler as you would into the ear
No sealing is necessary
Produces a frequency response more like a real-ear response
For ANSI measurements to specifications, use HA-1 coupler

27. Real-ear Measurements
Some Open Fit hearing aids interfere with the reference microphone measurement outside the ear (feedback management and/or amplified signal escaping from ear)
Disable the REF MIC setting in the real-ear measurement screen local menu
Test as usual
Expect very little amplification below 1000 Hz. Fit to target only in mid-to-high frequencies

28. Example of Open Fit Real-ear

29. Using the FONIX NOAH Module
Friendly Windows-based interface
Automatically use NOAH audiogram
Can send NOAH audiogram to analyzer
Perform real-ear and coupler measurements from computer
Save all results into NOAH database
On Top window: Perform real-ear while adjusting the hearing aid!

30. Interface

31. Now for a FONIX NOAH Module Demonstration!