Client hearing instrument fitting is done to help the functionality of the ear. This assists in the amplification of acoustic signs to the extent that it enables a person with hearing difficulties to make use of the left capabilities effectively. “The instrument is fitted to the patient’s ear and the acoustic performance is then evaluated” (Harvey, 2001).
This paper is therefore going to focus on Mrs. W, who has hearing problems. The paper will conclude by giving an insight into these rehabilitative strategies.
In the first mention, speech scores are not expected, the audiogram shows that both ears are the same and speech scores should be about the same. This client may not benefit fully from this aid in both ears due to poor discrimination scores. The left ear is slightly disadvantaged and needs an ENT for determination on aid and amplification fitting.
In the second mention, the hearing aid-fitting can be paused once the ENT provides medical clearance. If the problem persists though, hearing aids should be fitted. The patient should be subjected to speech rudimentary, binaurally as well as monaurally. If binaural results are good, then binaural fitting will be recommended if not, right ear amplification will be recommended. This is because binaural inhibition effects can be realized, “which are responsible for shaping frequency selectivity of single neurons in the inferior calculus” (Gooler, 2000).
The recommended hearing aid is the Phonak Certena. This aid has a fitting range for Mrs. W. The product’s frequency compression is recommended as; HF sounds can be audible to her without the aid being at uncomfortable levels. Frequency compression is highly advisable because, “in this aid, high frequencies (above 1600Hz) are amplified in addition to a lowered frequency without shifts” (Simpson, 2005). Phonak-Certena-BTEs are the most economical aids that have this. BTEs suit high-frequency hearing loss because “it is designed to amplify and modulate sound for the wearer and can connect to assistive listening devices (Simpson, 2005). The patient needs BTEs and Hard Acrylic Skeleton molds since soft molds deteriorate and needs replacement frequently. Once more, “acoustic feedbacks with short models are likely to be problematic. Skeleton molds are more comfortable, reduced, easy to insert and are made with extended helix for better retention” (Hayes, 2004)
As shown by Simpson (2005), 1.5 mm vents are reliable for the first time because of low-frequencies, prevention of occlusions, and hearing of own voice, hence the small vent. Alternatively, if still intolerable, audiologists can increase vent size in the client’s ear-mold. Considering the gain needed at 4000-Hz, “the Libby horn which leaves the amplifier available for future gain-increase is recommended should the patient’s hearing decrease” (Valante, 2007).
In the third mention, the patient is highly motivated to use a hearing aid. If she cannot take this up because of poor management, assistive listening devices would come in handy. The ALDs would be helpful with the TV, phone, and doorbell. These devices are fitted with flashlights and are priced at 130$ (Rudisill, 2009).
The patient has an OHS voucher meaning, she is eligible for subsidized hearing aids that can even have Tele-coil programs for phones. With dexterity issues, she might again have difficulties in using these gadgets. Top-up aids might also fit her as she only meets partial costs. This will happen in the fourth mention.
In the fifth mention, the patient will be fitted with aid that has frequency compression, most probably the economical Phonak Certena-BTEs. Speech testing will be done after which subsidized options would be put into consideration according to client preference and speech scores.
If the above remedies are ineffective and the patient still wants something else, then Hybrid Cochlear Implant would be advisable. The advantages of this option are that she will benefit from government funding, they do well with speech and she can easily hear the TV, phone, and doorbell. These Implants might be costly but due to government intervention, they are relatively cheap. They are recommended where other aids have failed as they “replace natural hearing by digitizing electrical-impulses sent to the brain, the brain then interprets the sound” (Briggs, 2008). This is also suitable for Mrs. W as she has a problem with TV, phone and doorbell.
References
Briggs, H. (2008). Comparing advantages of hearing aid. Journal on cochlear implantation 8 (4), 82-97.
Gooler, M. (2000). Binaural Inhibition. Journal of binaural inhibition effects 24 (2), 62-69.
Harvey, D. (2001). Hearing Aids. Sydney: boomerang Press.
Hayes, D. (2004). Audiology: Occlusion Effect. Audiology Journal 11 (14), 152-198
Rudisill, H. (2009). Assistive listening devices. New York, NY: Oxford University Press.
Simpson, J. (2005). Frequency-compression outcomes. International Journal of Audiology 15 (4), 142-167.
Valante, M. (2007). Hearing Disorders. New York, NY: Thieme Medical Publishers.