Shared "Good Practice Procedures"

Pre-fitting
Shared views on optimal procedures
Counselling and preliminary audiological talk
Counselling/information about course of hearing aid provision. General information about assets and drawbacks of hearing aids, specific characteristics, possible applications. Open interview about problems and expectations
Medical history and otological examination
Structured interview about medical history and complaints (e.g. sudden deafness, otitis media, ear pain, ear surgery, tinnitus, congenital hearing loss, dizziness). Otoscopy, Tuning fork testing (optional), Tympanometry (optional)
Questionnaire
Collecting individual problems and aims
Standard audiometry in quiet (headphones)
Pure tone audiogram air and bone conduction with adequate masking
Speech audiometry in quiet
Test of patient's ability to recognise speech unaided in a quiet situation. Specific tests and parameters vary.
Speech audiometry in noise
Test of patient's ability to recognise speech unaided in a noisy situation. Specific tests and parameters vary.
Loudness scaling
Vary

 

Goals and options
Shared views on optimal procedures
Defining goals
Defining goals for rehabilitation based on anamnestic and otological data, the unaided measurements, and the questionnaire results. Counseling about realistic expectations
Technical options
Choice of ear(s) to be fitted. Choice of type of hearing aid(s). Specification of type of earmould

 

Hearing aid fitting
Shared views on optimal procedures
Earmould
Taking ear impression; creation of earmould or earshell. Final fitting of earmould
Fitting and fine tuning
Prescriptive fitting according manufacturer or current fitting rules. Verification of hearing aid fitting using Real Ear Measurements. First rating of speech intelligibility, sound quality.
Handover fitted aid
Explain handling and care of the hearing aid to the user. Arrange regular checkups. Present information about accessories to the user
Trial use period
Trial period in everyday listening situations and counselling during trial period. Fine tuning of at least one hearing aid (in several sessions). If necessary. Real Ear measurements if necessary, gradual build-up of amplification to adapt new users to hearing aid.

 

Evaluation measurements
Shared views on optimal procedures
Selection
Varies between countries
Speech audiometry in quiet
(sound field)
Single words measured for each individual aided ear (contra-lateral ear blocked) and for both ears bilaterally fitted
Speech audiometry in noise
(sound field)
Adaptive sentence testing to determine speech-to-noise ratio at intelligibility threshold
Loudness scaling
(sound field)
Adaptive loudness scaling (ACALOS) left/right.
Plug ear not in use in sound field measurements
Horizontal localization
(sound field)
See NL-AMC specification in country-specific views
Insertion gain measurements
The selected hearing aids are characterised with real ear measurements using broadband speech noise at 55, 65, and 80 dB SPL. The hearing aids are used in the preferred gain setting. The hearing aids are measured after deactivation of noise reduction circuitry in an omni-directional mode. The curves obtained are compared with generic prescription rules for non-linear hearing aids (usually NAL-NL1 or DSL i/o).
Documentation of settings
Print and save settings, if necessary coupler measurements. Hearing aid with trimpots: test box results
Questionnaire
The hearing aid benefit is rated by questionnaires.

 

Follow-up
Shared views on optimal procedures
Additional rehabilitation needs
Counselling about other training (speech-reading, hearing strategies and communication training). Strategies to encourage the client to wear the hearing aids. Determine need of other action (compare expectation with achieved aims), e.g. audiological therapy, psychosocial consulting.
Closing of provision
Remind clients about handling and care of the hearing aid and respond to problems raised. Arrange future care and support.
Present information about accessories to the user. Complete formal fitting documentation
Open access repair service
Users may come without an appointment if they are having any problems