Using the Fine tuning graphics and sound features to investigate the potential in mind440 signal processing

This bulletin describes the graphics and sound features in Compass V4.5. The descriptions focus on the graphic and sound options in the different windows in the Fine tuning section of Compass. Please refer to Compass in order to see the details of the screen. Remember that Compass offers several help functions to explain the different options in the program: Tooltips, Using this window panels and the help manual. The Fine tuning graphics and sound options allow the user and hearing care professional to explore the sound processing capability of mind440. These tools can be used for visual and auditory evaluation and demonstration of the individual fitting, as well as for adjustment of the sound processing schemes in the hearing aid.

Fine tuning tools
In the Fine tuning window you have access to three basic tools – performance graphics with SoundTracker or static curves, LifeSounds MicroPlayer and the Program starter, which - used in combination - can be a powerful instrument in the follow-up process. The three tools are useful when evaluating the user’s subjective perception of the initial hearing aid fitting, when demonstrating the effect of further adjustments and when explaining recommended situational usage to the hearing aid user.

Graphics panel
The Graphics panel displays dynamic and static views of the hearing aid’s performance for the individual fitting. The type of view can be selected form the Graphics drop-down list in the Toptool bar.

SoundTracker
By default, the SoundTracker is activated, showing the real-time hearing aid performance for the current sound environment. Four different SoundTracker views are available, each presenting the hearing aid’s performance from a different perspective. The aided view is active by default. SoundTracker offers three alternative views: the unaided view, which clearly shows the fast dynamics of most input signals, the gain view, where the slow acting compression of mind440 is very evident, and the accumulated view, where an accumulated output spectrum as well as band specific and overall RMS levels of the output of mind440 can be produced. All the different SoundTracker views are available both in dBHL and dBSPL.

SoundTracker shows the dynamic performance of the hearing aid
Static graphic options
If you prefer a static view, you can use the Graphics drop-down list in the Toptool bar to select one of the classic Widex performance graphs. Please be aware that all performance graphics are now available as either dB HL or dB SPL data. If no hearing aid is connected, the static graphics are available in simulated mode.
• Speech Spectra
• Insertion gain versus input
• Insertion gain versus frequency
• Input versus output
• Output versus frequency
In Compass V4.5 and above it is possible to view targets for the individual fitting in the Insertion gain versus frequency and Output versus frequency curves.

ISTS - International Speech Test Signal
The new graphic Insertion gain versus frequency uses an input signal called International Speech Test Signal (ISTS). ISTS is a new speech like test signal that reproduces the most important human speech characteristics relevant to the characterisation of hearing aids. This signal is intended to provide a satisfactory correlation between objective measurements and the real operation of hearing aids when processing speech in natural environments.

The new graphic Insertion gain versus frequency is estimated with input of the ISTS signal

Program starter
If you have defined more than one program in the hearing aids, you can use the Program starter panel in the upper part of the window to shift between the different programs and let the user evaluate them one by one. The listening program highlighted in the Program starter panel will be the one the user listens to, and all parameters and graphics in the window will relate to that program. The Program starter also indicates the interdependency between the different listening programs. By default all additional programs are linked to the Master program, meaning that all fine tuning carried out in the Master program will also affect the other programs. For more information about the link features see the bulletin “How to fine tune non-master programs in mind440 fittings”.

LifeSounds MicroPlayer
If you have the Widex LifeSounds™ module installed, you have access to your Sound Library in the Toptool bar. Use the MicroPlayer drop-down list to select sound situations, and use the play button to play the selected sound. You can choose sound examples that suit your client’s lifestyle, or sound examples that are specifically targeted to the different listening programs. In this way, you can demonstrate and evaluate the different programs in realistic situations.

Using the Program manager in mind440 fittings

This bulletin describes how to use the Program manager in mind440 fittings using Compass V4.5. The descriptions refer to the Program manager in the Fine tuning window. You access the Program manager from the Toptool bar. Please refer to Compass in order to see the details of the screen. Remember that Compass offers several help functions to explain the different options in the program: Tooltips, Solution guide, Using this window panels and the help manual.

The mind440 hearing aid is, by default, a one program hearing aid, with a Master program designed to provide the best possible overall performance in all environments with all adaptive features working together to optimise audibility, intelligibility and comfort. However, some hearing aid users encounter environments in which they may wish the hearing aid to operate with a different focus. For this purpose, mind440 features a range of additional listening programs that can be selected initially during the fitting procedure, or later on during follow-up.In the Fine tuning window, the Program Manager is accessible from the Toptool bar. The Program manager allows you to select, copy and delete listening programs, as well as to change the order of the programs. The Program manager offers a selection of different program templates that may serve as inspiration in the hearing aid fitting process.

  The Program manager allows you to select, add, copy, delete and change the order of the programs in the hearing aid

Using the Program manager
To add a program, select the desired program name in the program list and select the add arrow button or double click on the selected program. Whenever you point to or select a program, an illustration or a short explanation of it is displayed on the screen. Click the button in the lower right hand corner to shift between illustration and explanation. The Program manager allows you to select more than one program of the same type either by selecting two identical programs from the program list or by using the copy button in the program item you want to copy. Selecting identical programs from the program list gives you programs with default
settings, while a copy will include any fine tuning performed in the original program. You can change the program order by pressing the arrow buttons in the program item in the Program manager.

Press the delete (trash can) button for a program item you want to delete. Note that the original Master program can never be deleted. Before you delete a program, it can often be useful to save your fitting in the NOAH database using the save button in the Toolbar. This will allow you to re-establish the deleted program including any fine tuning you may have performed. In binaural fittings you will typically have identical programs in the two hearing aids. It is possible to have a different number and different types of programs in the two hearing aids. Press the appropriate binaural adjustment icon, which allows you to select programs individually for the two hearing aids. Be aware, though, that such a choice requires extra careful counselling of the user. We strongly recommend that the number of listening programs in binaural fittings is identical to avoid any confusion. You should also be aware that two hearing aids cannot be operated with the same remote control unless the number of programs in the hearing aids is identical.

Program types
The Program manager offers a selection of listening programs. A maximum of five programs can be selected in the basic Program manager. Additionally the SmartToggle feature can be added. Note that the number and type of listening programs should always be selected based on an analysis of your client’s auditory needs as well as his/her ability to understand and manipulate the program button or remote control.
Depending on the Direct Audio Input system you use, the M-DAI and DAI programs may be placed at program location 1 and 2. You must use the DAI Manager to set up the DAI system correctly for the equipment you use.

Please be aware that telecoil programs are not available for CIC hearing aids, m models and for ITE instruments without a telecoil.

Master
Provides the best possible overall performance in all environments. All adaptive features work together to optimise audibility, intelligibility and comfort. The default settings in this template are:

Gain/compression characteristic optimised for audibility, intelligibility and comfort
Microphone mode is set to Hd Locator with Speech Tracer (Hd Locator omni for CIC)
Speech and noise mode is set to Speech Enhancer
Feedback cancelling mode is set to SuperGain

Audibility Extender
Provides audibility for high-frequency sounds by means of frequency transposition. This is a program template for users with little or no hearing in the high frequencies. The default settings in this template are:

Linear transposition of high frequency sounds. The start band frequency is defined by the Sensogram configuration.
Microphone mode is set to Hd Locator with Speech Tracer (Hd Locator omni for CIC)
Speech and noise mode is set to Widex classic noise reduction
Feedback cancelling mode is set to Off

Zen
A program playing soothing and relaxing tones by means of fractal technology. The tones are randomly generated, meaning that the tone sequences are never repeated. The Zen style to be played in the Zen program can be selected amongst five different Zen styles. In the default setting the Zen tones are played linked to the Master program. Therefore the acoustic settings are the same in both the Zen and Master programs. The default settings in this template are:

Gain/compression characteristic optimised for audibility, intelligibility and comfort
Microphone mode is set to Hd Locator with Speech Tracer (Hd Locator omni for CIC)
Speech and noise mode is set to Speech Enhancer
Feedback cancelling mode is set to SuperGain

Music
Focuses on optimum reproduction of music, whether it is performed live or played from stereo or surround systems. The program emphasises low frequencies. The default settings in this template are:

Gain/compression characteristic optimised for music (low frequency emphasis)
Microphone mode is set to Hd Locator omni
Speech and noise mode is set to Off
Feedback cancelling mode is set to SuperGain music

TV
Focuses on optimum reproduction of sound from television sets. TV and radio signals are very different from normal acoustic signals produced in the environment, as they have already been processed (compressed). The TV program takes this into account in its compression characteristic. The program attenuates low frequencies and emphasises high frequencies. The default settings in this template are:

Gain/compression characteristic optimised for TV sound
Microphone mode is set to Hd Locator with Speech Tracer (Hd Locator omni for CIC)
Speech and noise mode is set to Speech Enhancer
Feedback cancelling mode is set to SuperGain music

Comfort
Focuses on optimum comfort in noisy environments as well as in quiet environments. The default settings in this template are:

Gain/compression characteristic optimised for comfort (higher knee-point for soft input levels)
Microphone mode is set to Hd Locator with Speech Tracer (Hd Locator omni for CIC)
Speech and noise mode is set to Widex classic noise reduction comfort
Feedback cancelling mode is set to SuperGain

Acclimatisation
This template is designed for the first-time user who needs an alternative setting during the acclimatisation period. It is sometimes an advantage to reduce gain a little, so that the new sound picture does  not cause any discomfort. The gain can then be gradually increased over four acclimatisation stages. The default settings in this template are:

Gain/compression characteristic optimised for first-time users (reduced gain for all input levels (especially in the high frequencies) compared to the Master program)
Microphone mode is set to Hd Locator with Speech Tracer (Hd Locator omni for CIC)
Speech and noise mode is set to Speech Enhancer
Feedback cancelling mode is set to SuperGain

MT
An acoustic program combined with the input from the telecoil. Not available for the m model, CIC and ITE without telecoil. The default settings in this template are:

Gain/compression characteristic set as the Master program
Microphone mode is set to Hd Locator omni
Speech and noise mode is set to Speech Enhancer
Feedback cancelling mode is set to SuperGain

T
Focuses on the input from the telecoil. Not available for the m model, CIC aids and ITE aids without telecoil.

The default settings in this template are:
Gain/compression characteristic set as in the Master program
Speech and noise mode is set to Speech Enhancer

SmartToggle
This feature gives you access to the Zen+ program and is activated by means of a long press on the program up button on the remote control or on the hearing aid program button. A new long key press brings you back to the Master program

The Zen+ program.

The Zen+ program accessed via the SmartToggle feature can contain three different Zen styles. The Zen tones are by default played with the microphone active and linked to the Master program. In Settings, the microphone can be deactivated for each of the Zen styles individually to listen to Zen tones only. Once the SmartToggle feature has been activated, you can use short key presses to toggle between the three different Zen styles.
The Program manager with the SmartToggle feature (Zen+) activated

View program access
The view program access function allows you to view the number of programs available in the Program manager for the following conditions: Without remote control (RC), with RC4-1 and with RC4-2.

The View program access function lets you know the number of programs available in the Program manager

How to demonstrate the different listening programs
Note that the purpose of the Program manager is to select a program combination - not to demonstrate the programs. When the Program manager is open, the Master program will be active in the hearing aid. Once you have closed the Program manager, you can shift between the selected programs using the Program starter, which allows the user to listen to the differences in sound processing.

Changing the feature settings in mind440 fittings using Compass V4.5 and above

This bulletin describes the features you can change and how to do it using Compass V4.5 and above. The descriptions refer to the feature setting options in the Fine Tuning section. The feature setting may be changed for the microphone mode, the speech and noise mode and the feedback cancelling mode. Please refer to Compass in order to see the details of the screen. Remember that Compass offers several help functions to explain the different options in the program: Tooltips, Solution guide, Using this window panels and the help manual.

The feature settings may be changed individually for each of the listening programs in mind440. Such changes are easily made in the Feature settings panel in the Fine tuning section in Compass. In this panel you can change the mode in which the microphone works, the mode in which speech and noise is handled in the hearing aid and the mode in which acoustic feedback is handled in the hearing aid.
The feature settings panel in the Fine tuning window of Compass

Microphone mode
The Microphone mode can be set to one of three settings: The default setting in the Master program is Hd Locator with Speech Tracer. The High definition Locator is a 15-channel fully adaptive directional microphone system that exploits frequency-specific information about the listening environment to improve the signal-to-noise ratio. The Speech Tracer ensures full audibility of single speakers in relatively quiet rooms, regardless of the intensity level and the azimuth of the speaker. The other two options are Hd Locator dir (fixed directional characteristic) and Hd Locator omni (fixed omnidirectional characteristic). We recommend that these two modes are primarily used for demonstration purposes.
The microphone mode options

Speech and noise mode
The Speech and noise mode can be set to one of six settings. The default setting in the Master program is Speech Enhancer. This is a signal processing scheme that utilises information about the individual hearing loss along with current information on the spectrum of the speaker and the noise source to optimise intelligibility according to the Speech Intelligibility Index (SII). You can also select
a classic Widex noise reduction scheme, Noise reduction, in the drop-down list. This would be an option for clients who have previous successful experience with Widex hearing aids and our classic approach to noise reduction. These two settings are supplemented by a less and a more active version, Noise reduction minimal and Noise reduction enhanced, and a version with special focus on listening
comfort in all types and degrees of background noise, Noise reduction comfort. Finally you can choose to deactivate the Speech and noise mode altogether using the setting Off.
The speech and noise mode options

Feedback cancelling modes
The feedback cancelling mode options

The mind440 Multidirectional active feedback cancelling feature integrates knowledge of the acoustic properties of the hearing aid in the ear with directional sensitivity for each of the 15 frequency channels in mind440. Its mode of operation can be set to one of four settings. The default setting of the Feedback cancelling mode in the Master program is SuperGain, meaning that the hearing aid gives as much gain as possible without the risk of whistling. You can use the drop-down list to change the setting to SuperGain music, especially designed for listening to music, or to SuperGain max, designed to give as much gain as possible, even if you risk that the hearing aid occasionally whistles. You also have the option to turn the feedback cancelling system off altogether, in which case an extra adjustment parameter will appear. This parameter allows you to adjust the static max gain limit across frequencies in case of whistling. Deactivating the Multi-directional feedback cancelling feature is only recommended in fittings with considerable headroom in the maximum available gain without feedback. Otherwise recurring acoustic feedback may be a considerable problem for your client.

PDF Copy of the bulletin for download Changing feature settings

How to measure the In-situ RECD with mind440 (m4-9) and Compass V4.5 and above

This bulletin describes how to measure the Widex in-situ RECD for mind440 using Compass V4.5. The description refers to the Acoustic conditions panel in the Preconditions window, the RECD calibration window and the RECD measurement windows in Compass. Please refer to Compass in order to see details of the screen. Remember that Compass offers several help functions to explain the different options in the program: Tooltips, Solution guide, Using the window panels and the help manual.

mind440 m4-9 includes the possibility of measuring the RECD with the hearing aid itself. The procedure is called Widex in-situ RECD and is part of the m4-9 fitting procedure. The measurement is made using a special RECD probe that is mounted on the hearing aid. While the mind fitting procedure takes into account all the acoustic aspects of the hearing aid and its coupling to the ear, the precision of the fitting may be further improved by performing an individual RECD measurement on the client. This ensures that the hearing aid delivers the exact amount of sound pressure at the eardrum prescribed for the given hearing loss – taking into account the shape of the individual client’s ear canal.
To perform the RECD measurement, select Widex in-situ RECD in the RECD drop-down menu in the Acoustic conditions panel found in the Preconditions window.
 Selecting Widex in-situ RECD in the Preconditions window

After having selected the desired settings in the Preconditions window, press Next. Compass now starts the Fitting wizard, with the in-situ RECD measurement as the first step. The measurement is divided into two parts: (1) RECD calibration and (2) RECD measurement.
RECD calibration
1. The first step is to calibrate the hearing aid; First, place the RECD probe over the rear microphone of the hearing aid. Secondly, insert the probe tube 5 mm into the hook of the hearing aid. Please observe that the hearing aid should never be placed on the ear of the client while the calibration is performed.

 Placement of the RECD probe                            Insertion depth of the probe tube for calibration
  tube for calibration
2. Mount the orange seal sliding on the probe tube on the earhook to provide a tight seal between the hook and the tube.
3. Make sure that the noise level is low enough (in the green area), before you start the calibration.
4. Start the calibration by clicking the button Start calibration. When the measurement is done, the
calibration result is displayed as either OK or “---“ .

 RECD calibration in Compass showing that the calibration is OK

If the calibration failed (---), a dialog box is shown asking you to check the set-up once more and repeat the measurement. If the calibration is OK, select Next to move on to the RECD measurement window.

RECD measurement
1. In the RECD measurement window, select whether you are measuring the RECD with an open or closed vent in the “Mould used for RECD measurement” drop-down menu. If there is a vent in the earmould, we recommend to leave it open during the measurement.
2. Secondly, we recommend that you check your client’s ear canal status with an otoscope to make sure that conditions are normal and that the canal is not blocked by earwax.
3. Place the hearing aid on the ear, and place the probe tube and the earmould in the ear of the client.
Depending on the client, the probe should be placed at a recommended insertion depth from the intratragal notch:
31 mm for an adult male
28 mm for an adult female
15-25 mm for infants and children
Use the orange seal as a marker to mark the distance from the tip of the tube. You may also check the position of the probe tube at the eardrum with the otoscope after having inserted it into the ear canal.

                                           Placement of the hearing aid on the ear with the probe tube
and earmould in place

4. Make sure that the noise level is low enough (in the green area) before you start the measurement.
Then start the RECD measurement; the progress bar indicates how far the measurement has proceeded.
If the measurement failed, a dialog box is shown asking you to check the set-up once more and repeat the measurement.
5. The result of the in-situ RECD measurement is shown both as a graph and as values on the screen. The graph shows the in-situ RECD (in dB) as a function of frequency. The red (right ear) or blue (left ear) area indicates the range within which the measured in situ RECD is expected to fall according to the age of your client and the vent size in the earmould.

The graphics indicate the range within which the in-situ RECD measurement is expected to fall. The tables show the binaurally measured values in dB at the main audiometric frequencies.

6. When doing a binaural fitting, perform the measurement on the opposite ear. Alternatively you may choose to copy the RECD measured on one ear to the opposite ear. The best result will be obtained by performing the measurement on both ears, but in cases where this is not possible, the other approach may be used.
The measurement of the in-situ RECD is now finished and the in-situ RECD will be included in the fitting. Remove the RECD probe and select Next to continue to the Sensogram measurement.

Using the Zen program in Compass

This bulletin describes how to apply and fine tune the Zen program for mind440 using Compass V4.5. The descriptions refer to the Program selection panel in the Program manager and the Program starter panel in the Fine tuning window in Compass. Please refer to Compass in order to see details of the screen. Remember that Compass offers several help functions to explain the different options in the program: Tooltips, Solution guide, Using the window panels and the help manual.

Applying the Zen program in mind440

The Zen program is a new program in mind440 playing fractal tones. In Compass V4.5 and above the Zen program can be added using the Program manager or the SmartToggle function and subsequently fine tuned. If you are using a Zen program, please note that the Fine tuning window will look different than the Fine tuning window for other listening programs. Furthermore the content of the Fine tuning windows for the Zen programs differ slightly, depending on whether you have selected the Zen program as one of the basic programs in the Program manager or if you have selected it as a Smart-Toggle feature (Zen+ program).

Fine tuning a basic Zen program

Fine tuning of a basic Zen program

If you select the Zen program as a basic program that is set directly in the Program manager, the program
can play one Zen style, that is one style of fractal tone composition. There are five different Zen styles available. The Zen styles selection panel in the Fine tuning window allows you to select a Zen style for the Zen program. You can listen to the five different Zen styles using the Zen styles library in the Zen styles selection panel. The Zen styles are: Zen aqua, Zen coral, Zen lavender, Zen green, Zen sand. The default setting is Zen aqua. When you use the Zen styles library, the selected style can be played through the loudspeakers connected to the computer. In this way you can listen to different styles even if you do not have the hearing aids online. Be aware that listening to the Zen styles through the computer loudspeaker
cannot be perceptually compared to listening to them through binaurally fitted hearing aids. In the upper panel, Zen visualisation, you can see the visualisation representing the selected Zen style by colour and music. You can also change between the visualisation of the left and the right hearing aid in the Zen visualisation panel.

Once you have selected the preferred Zen style for the Zen program, you can press the Settings button
for the Zen style. The Zen style setting panel opens and allows you to change specific elements of the
chosen Zen style. Adjustments are, by default, made binaurally, but can also be made for the left and right hearing aid individually by clicking the binaural icon button.
The elements that can be changed are:
• Tone volume Use the slider to increase or decrease the volume of the Zen tones
• Tempo Use the slider to increase or decrease the speed of the Zen tones, so that the tones are
presented faster or more slowly
• Pitch Use the slider to increase or decrease the pitch of the Zen tones

The Zen styles settings panel allows you to adjust tone volume, tempo and pitch of the selected Zen style

You can listen to the changed settings through the hearing aids by using the play/stop button. Use this feature to ensure that the setting is optimal before you close the window. In the default setting, the Zen program is played together with the Master program with the microphone on. You can, however, choose to present tones only, when you select the Zen program. This is done by deactivating the microphone in the check box in the Zen style settings panel. If you select Zen tones only, you must be aware that the hearing aid user may have difficulties hearing surrounding sound when he activates the Zen program as the microphone is deactivated, meaning that there is no amplification of sound. Select OK to close the Zen style settings panel when you have finished changing the settings.

Fine tuning the Zen+ program

Fine tuning of the Zen+ program set as a SmartToggle feature

If you have selected the SmartToggle feature, the Zen+ program can be accessed. The Zen+ program can contain three different Zen styles. The way to select and change settings for the different Zen styles in the Zen+ program is the same as described above for the basic Zen program. Additionally for the Zen+ program, you can choose how the volume control should function in the Volume control settings panel. The default setting is that the volume control regulates the tone level only. Changing the setting enables the user to regulate microphone level and tone level simultaneously. This function is also available in the User controls panel in the HA configuration window under Finalise.

The Volume control settings panel in Zen+ allows you to choose how the volume control should be regulated

In the default setting, the Zen+ program contains three Zen styles: Zen aqua, Zen coral and Zen lavender. You can delete one or two of these by selecting None from the Zen styles drop down list. You can also change the settings for the styles individually. Select the settings button for the style you want to adjust.
SmartToggle is accessed from any basic program in the hearing aid by means of a long key press on the hearing aid program button or the program-up button on the RC4-2. Once the SmartToggle feature has been activated and the Zen styles have been selected, you can use short key presses to toggle between the three different Zen styles. Another long key press will bring you back to program 1 of the basic hearing aid programs.

The Audibility Extender and how to individualise it

This bulletin describes the Audibility Extender program, the default settings in Compass, how to fine tune the Audibility Extender program as well as how to individualise it. The descriptions in this bulletin refer to the Graphics panel and the Audibility Extender settings panel in the Fine tuning window of the program in  Compass. Please refer to Compass in order to see the details of the screen. References will be found in the final section.

Audibility Extender default setting in Compass 

The Audibility Extender program uses linear frequency transposition and is developed for clients with little or no hearing in the high frequency area. Compass uses Sensogram data to set the start frequency of the transposed signals where normal aided speech cannot be made audible by normal amplification. The frequency range of the transposed signals is, by default, set to three frequency bands.



In the Fine tuning window in Compass you can see how the start frequency is automatically set, based on the Sensogram.

Fine tuning the Audibility Extender program

In the Fine tuning window, you can fine tune the Audibility Extender program. The elements that can be changed are:
The start frequency o • f the transposed signal
• The loudness of the transposed signal
• The frequency range of the transposed signal (Basic or Expanded)

Individualising the Audibility Extender program

Proper fine tuning ensures that the client is able to detect and discriminate relevant sounds. If a client
fitted with the Audibility Extender in the default setting has not benefitted from the program after a period of acclimatisation, it is recommendable to fine tune the start frequency and the Audibility Extender gain. One way to find the optimal setting is to make sure that the hearing aid user can hear the/s/ sound at normal speech level (approx. 30 dB HL). The energy of the /s/ sound lies in the range between 4 KHz and 6 KHz and is of great importance in speech understanding in many languages. It should therefore be in the transposed signal and be audible with the appropriate settings.

A simple method, based on this, is described below:

1. 
   
   Increase The start frequency three steps


2. 
   
   Check the audibility of the /s/. If audible end, if not audible proceed


3. 
   
   Adjust AE gain in steps


4. 
   
   Check the audibility of the /s/ after each step. If audible end, if not audible proceed


5. 
   
   Lower start frequency one step (reset AE gain to 0


6. 
   
   Repeat from step 2       

For clients who cannot hear the /s/ sound even at lowest start frequency, use the /sh/ sound (the energy
of this sound lies in the range from 2 KHz to 4 KHz). Be aware that it will normally take some time for the client to get used to the new sound. Several clinical trials have shown that benefit of the Audibility Extender improves over time (Kuk et al. 2008)

Frequently asked questions:

Who are candidates for the Audibility Extender?
Candidates for the Audibility Extender are both children and adults with an unaidable high frequency hearing loss. Clients who have hearing loss that is greater than 70 dB at and above the start frequency can often benefit from the Audibility Extender.

Verified fitting range for the Audibility Extender. From Kuk et al 2008

Is fine tuning always necessary?
If the client is satisfied with the Audibility Extender in the default setting, fine tuning is not necessary. If the client cannot get used to the sound in the Audibility Extender program after an acclimatisation period, fine tuning is necessary.

How long is the acclimatisation period in general?
Studies indicate that clients still improve in a speech discrimination test 6 weeks after being fitted with the Audibility Extender (Auriemmo et al 2008, Kuk et al 2007).

Can I make an objective evaluation of the settings of the Audibility Extender?
It is possible to make an objective evaluation of the settings in the Audibility Extender program by using SoundTracker: Say the /s/ sound and look at the bars of the transposed signals in SoundTracker. If the bars of the transposed signals exceed the thresholds, the sound should be audible. This is also a method that can be used if the client cannot provide a verbal response.

References and other relevant literature

Auriemmo, J., Kuk, K., & Stenger, P. (2008). Criteria for evaluating the performance of linear frequency
transposition in children. Hearing Journal, 61(4), 50, 51-54
Auriemmo, J., Thiele, N., Marshall, S., Quick, D., Pikora, M., & Strenger, P. (2008). Effect of linear
frequency transposition in school-aged children. AAA. American Academy of Audiology 2008, 1
Kuk, F, Keenan, D., Peeters, H., Korhonen, P., & Auriemmo, J. (2008). 12 Lessons learned about linear
frequency transposition. Hearing Review, 15(12), 32, 34, 36-38, 40-41
Kuk, F. (2007). Critical factors in ensuring efficacy of frequency transposition. Part 1: Individualizing
the start frequency. Hearing Review, 14(3), 60, 62-64, 66
Kuk, F., Keenan, D., Peeters, H., Lau, C., & Crose, B. (2007). Critical factors in ensuring efficacy of
frequency transposition part 2: Facilitating initial adjustment. Hearing Review, 14(4), 90, 92, 95-96.
Kuk, F., Korhonen, P., Peeters, H., Keenan, D., Jessen, A., & Andersen, H. (2006). Linear frequency
transposition: Extending the audibility of high-frequency information. Hearing Review, 13(11), 42,
44-46, 48.