Martin, Robert L. PhD
Dr. Martin has been a dispensing audiologist in private practice in the San Diego area for more than 30 years. He has been writing Nuts & Bolts since 1989.
I have some exciting news: my new hearing aid test unit operates with a touchscreen. The difficultly of entering a mountain of audiometric data has disappeared. I love it! We learned to work with touchscreens using our cell phones and notepads, and I recently ordered a hamburger and fries using a touchscreen. The touch functions are similar; this data entry format is the wave of the future.
Touch and hold the screen to get the master screen. Having trouble seeing the screen? Tap the screen, and the image gets larger. Want to input audiometric thresholds? Tap a screen, and each tap equals a threshold. It is possible to enter two or three thresholds per second with practice. Want to generate predicted uncomfortable listening level (UCL) thresholds to study output? Tap the UCL column. I am not going to miss the knobs and buttons on my old hearing aid test system. I am especially not going to miss entering audiometric thresholds to perform hearing aid tests.
We work with many numbers — more than 100 on the hearing aid evaluation sheet. These include air conduction thresholds, bone conduction values, masked thresholds, masking levels, speech scores, aided threshold values, and unaided values. I dream about the day when I never have to write another number in a box or put an X or O on a chart.
Figure. Robert L. Ma...Image Tools
Touchscreen technology makes it unbelievably easy to work with audiometric data. It used to take me 15 to 20 minutes to create targets and perform hearing aid tests for both ears. It now takes just seconds to generate a test. I generated Figure A in 29 seconds: 11 seconds to input the thresholds, two seconds to select the next menu screen, four seconds to expand the screen, and 12 seconds to run the test. Life does not get much easier.
Figure. Hearing and ...Image Tools
THRESHOLDS ARE A BREEZE
I used to hate working with midfrequency thresholds because it increased the paperwork, but a touchscreen makes it easier to include them. Simply touch each active point as you glide your stylus across the screen. Entering midfrequencies makes it easier for the patient to see the audiogram; the threshold line is more solid.
I had to re-enter the threshold by typing or pushing buttons in the past if I made a mistake. Now, I hold a special stylus over the screen to touch a threshold point. My touch is instantly converted into an easy-to-read numeric value (e.g., 75 dB) and displayed on an extra-large monitor. I simply retouch the screen and instantly correct the value if I miss the exact point (e.g., 80 dB instead of 75). The old days of turning wheels and pushing buttons to select the frequency and intensity level are gone.
KEEP IT SIMPLE
Hearing aid test systems allow us to generate huge amounts of complex information. The American National Standards Institute's curves come to mind. Patients, however, are only interested in their own hearing, the amplification provided by their hearing aid, and how to make their hearing aid fit better. I loved, taught, and promoted real-ear targets, but I have stopped showing them to patients. Discussion about matching the target takes us away from the primary discussion on hearing aid use and how well the patient is hearing.
I am experimenting with ways to best use my new system. I have tried doing the hearing and amplification study shown in Figure A with all patients. They are impressed and want me to complete the evaluation on both ears. I perform an output study if a patient is annoyed by a loud voice: enter thresholds (about 10 seconds), tap the screen to generate predicted UCL values (less than a second), and measure the output using an input (80-dB composite noise) that replicates a loud voice. Total time is about 40 seconds. I use a 90-dB pure-tone sweep to study the output if the patient is irritated by a crying baby or dishes banging together. (Figure B.) The time for this test is about 45 seconds. You are going to love using a touchscreen.
POWERFUL PERSONALIZED PRESENTATION
The touchscreen on my new system is small, but it is attached to a huge monitor so the patient and the family see an extra-large display. I have found the best use is showing frustrated patients why they do not hear well. A teaching graphic is created by superimposing hearing and amplification. The solution is visualized by studying the curves on the screen.
Figure C shows a patient who could not understand her husband when he spoke to her. She had purchased a pair of open-fitted hearing aids at another office. I performed a hearing test and entered the data into my new unit. I placed her hearing aid on an open-ear simulator and ran the test. I was surprised when I saw the result. I could have studied the audiometric configuration, looked at the instrument style, and used my knowledge to tell the patient my thoughts. Years of experience, however, have taught me that patients need to see the test results presented in a graphic form. I ran the demonstration shown in Figure C. I told the patient that her hearing aids were not helping her and pointed to the screen in the lower frequencies.
I believed when I was younger that patients would listen to me because I was a college professor with three professional degrees. I now know better. Emotions dominate logic. If I have a nasty cough, and my doctor tells me not to worry, I have difficulty accepting that. But I can accept it if she shows me clear lungs on my x-ray and does not hear anything using a stethoscope. We have to build credibility into our presentations if we want patients to believe us. Document your opinion or risk being ignored and having your professional view discarded.
WHAT MAKES ME A DOCTOR?
Several times a day patients come to the office complaining about poor hearing. Sometimes the hearing aids are dead, weak, or need to be adjusted. When some market cheap hearing aids by advertising a low price, I separate myself from the little-to-no-service competitors by solving patients’ problems and showing them and their families my technological skills.
The Figures in this article can be used to show the patient how we can improve word understanding (e.g., provide functional bandwidth), study and eliminate feedback (e.g., reduce peaks), reduce background noise (e.g., use low-cut filters and directional microphones), keep amplification comfortable, and hold output below UCL points.
I demonstrate a major reduction of unwanted noise if background noise is the problem, or show the issue on a large easy-to-see monitor if the issue is a poor response curve. My interaction with patients has a new format. A hearing and amplification study helps us show competence. The patient and the family become involved and ask questions. One family member took a photograph of the data on the monitor to show her sister. Another patient wanted me to capture the data and email him the graphic. The possibilities are endless working with this system.
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© 2012 Lippincott Williams & Wilkins, Inc.