ACCEPTANCE MANAGER

Some clients are not initially satisfied when they are fit with new hearing instruments. For example, it is not unusual for newly fit individuals to describe the sound quality as “tinny” even though they find speech clarity improved. It can be necessary to compromise not only on the overall gain settings, but also on the desired frequency response and compression settings for the patient to be willing to wear the devices.

In the case of a new user, preferred gain is often much lower than the gain recommended to maximize speech intelligibility. Humes et al (2000) found that new hearing instrument wearers preferred to use their devices at a volume setting 6 to 9 dB below the prescribed settings. In contrast, individuals who have worn linear hearing aids for many years may prefer higher than recommended gain settings.

In either case, the hearing instrument wearer is likely to require time to adjust to the new settings. In fact, literature on acclimatization to amplification suggests that several months may be required for patients to be able to make optimum use of amplification (Gatehouse, 1993). To address this issue, the Acceptance Manager assists clients in adjusting to the optimum gain prescription over the first weeks and months of hearing instrument use. Acceptance Manager gradually and automatically effects changes in gain, compression and frequency response in the hearing instrument as it is worn. This feature allows the fitter freedom to precisely adjust both start and end points for the adaptation.

When it comes to prescribing gain for the hearing aid wearer, hearing care professionals take either a client-driven or audiologist-driven approach. The client-driven approach is one in which the client’s individual loudness growth data and subjective comments are incorporated to make adjustments to the response of the hearing instrument, while the audiologist-driven approach incorporates average loudness growth data into predetermined gain settings with no adjustments made based on client comments (Lindley et al, 2000; Lindley, 1999).

With the client-driven approach, the hearing care professional may send the client home with more comfortable settings, but they may not be optimum for speech intelligibility. The professional using the audiologistdriven approach may optimize amplification for speech understanding, with the risk that the wearer rejects the hearing instruments due to the sound quality issues such as loudness and sharpness of the sound.

Figure 12: Acceptance Manager provides the fitter with great flexibility in helping the wearer adjust to his hearing instruments. Acceptance Manager allows the hearing care professional to use Audiogram+ as an endpoint or to define a custom endpoint using 9 frequency gain handles at 2 input levels.

Acceptance Manager makes no assumptions about how the hearing care professional has fine-tuned the instruments. Instead, the finetuned settings are always the starting point for Acceptance Manager, and the end point can be either the Audiogram+ prescribed fitting, or a custom end point defined by the fitter. Figure 12 shows the Acceptance Manager screen, to which the fitter can easily navigate from the Aventa fitting screen.

The Acceptance Manager is an important supplement to the Environmental Optimizer for new users in particular, in that it enables changes in compression and frequency response. Once the desired frequency response characteristics are achieved, the Environmental Optimizer can ensure that environmentally dependent preferences in overall volume are met.