Common model procedures for the Netherlands
The procedures listed here represent the typical procedures used in an advanced Audiology centre in the Netherlands. Some less advanced centres may not make use of all of these procedures.
1. First assessment
At least 1 hour: ENT physician / Audiologist / Hearing aid professional
- Structured interview about medical history and complaints (e.g. sudden deafness, otitis media, ear pain, ear surgery, tinnitus, congenital hearing loss, dizziness).
- Otoscopy (optional)
- Tuning fork testing (optional)
- Tympanometry (optional)
Standard audiometry in quiet (headphones)
- Pure tone audiogram air and bone conduction with adequate masking.
- Uncomfortable loudness level (optional)
- Speech audiogram with monosyllabic words (complete performance intensity functions from threshold to uncomfortable loudness level)
- Comparison pure tone audiogram and speech audiogram.
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.
- Free interview about problems and expectations.
- Defining goals for rehabilitation based on anamnestic data and the unaided measurements.
- Counselling about realistic expectations.
- Choice of ear(s) to be fitted.
- Choice of type of hearing aid(s).
- Specification of type of earmould.
2 Hearing aid fitting
60 – 120 minutes in different sessions: usually by Hearing Aid professional
First fitting can take place at the audiological centre (on the subject’s previous earmould or on a temporary earmould) during the first visit, or at the hearing aid professional (usual procedure).
Preparation of the trial period (Hearing aid professional)
- Taking ear impression(s) by hearing acoustician.
- rdering of appropriate hearing aid(s) and programming according to the desired settings.
First fit and fine tuning (Audiologist/Hearing aid professional)
- Prescriptive fitting of one or two hearing aids according to manufacturer or generic fitting rules (usually one basic aid with full reimbursement of the costs and one more complex hearing aid with an own financial contribution).
- First rating of speech intelligibility and sound quality.
- Fine tuning of at least one hearing aid (in several sessions).
- Insertion-gain measurements (optional, only at a few places).
- Transfer of preferred hearing aid(s) and settings to hearing aid acoustician (if fitting is conducted by audiologist).
- Explanation of handling and care, service, and usage.
- Start of trial period in every day listening situations and counselling during the trial period.
- Based on the subject’s feedback during the trial period the hearing aid settings can be fine-tuned.
- During the trial period different steps of the adaptation manager can be followed.
- The subjectively favoured hearing aid is measured as result of fitting. If several hearing aids are rated subjectively the same, a sentence test in noise or a loudness scaling can be comparatively performed (optional).
3 Evaluation measurements
At least 15 minutes: Audiologist / Hearing aid professional)
Speech audiometry in quiet (sound field)
- Intelligibility scores for CVC-words measured for each individual aided ear (contra-lateral ear blocked) and for both ears bilaterally fitted with hearing aids, if applicable. The speech is presented at 65 dB SPL, and the hearing aids are used in the preferred gain setting.
Insertion-gain measurements (only in a few centres)
- The selected hearing aids are characterised with real-ear measurements using a broadband speech noise one or two levels: 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 of DSL i/o).
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 actions (compare expectation with achieved aims), e.g. audiological therapy, psychosocial consulting.
4 Follow up
Duration is difficult to estimate for the 5 –7 years of the lifetime of the hearing aids (Hearing aid professional)
Closing of provision
- Explain handling and care of the hearing aid to the user
- Arrange regular checkups
- Hearing pass as documentation for the user
- Present information about accessories to the user
- Complete formal fitting documentation
Follow-up appointments along 5 years
- 2 check-up dates (hearing device) per year
- 2 check-up dates (handling) per year
- 2 check-up dates (outer ear with and without hearing device with regards to dents and skin irritation)
Read on: Further details of the Dutch pathway or rehabilitation pathway in the United Kingdom or Germany.