fitting the lyric trial · · 2017-04-17hydrocephalus shunt deep brain ... ear examination and...

Fitting the Lyric TrialPart 1

Candidacy Assessment

Evaluating and Preparing the

Ear Canal

Sizing the Ear for Lyric

Preparing the Lyric Devices for Placement

Lyric Device Placement

Validating Placement for Feedback and

Comfort

Validating Lyric Sound

Quality

Post-Fitting Counseling

3



Ear Canal





Comfort


Quality


4

Lyric Candidacy—Primary Criteria

Medical History,

Noteworthy Consideration

& Lifestyle

Ear Geometry / Anatomical Features

Fitting Range

5

Lyric Candidacy Assessment

• Use the Lyric Candidacy Form to help make an informed recommendation

6

Lyric Candidacy

7

Lyric Candidacy

Electromagnetic Interference

Pediatric UserCoagulation

Immune System

8

Immune System

Compromised System• Lupus• Autoimmune• HIV/AIDS

Diabetes

Chemotherapy

Medical Clearance Suggested

• How is your general health?

• Do you have recurrent infections?

• How well do you heal?

• Are you on antibiotics often?

• Is your condition closely monitored by your physician?

• Have you had chemotherapy within the last 6 months?

ASK

Lyric should be contraindicated if an underlying condition is significantly impacting a patient’s immune system and/or presents with recurrent infections

9

Coagulation

Prescription anticoagulation• Coumadin/Warfarin• Plavix


• Do you bleed or bruise easily? • If you do bleed do you struggle to stop the bleeding?” • Do you get your blood tested monthly (INR/Clot factor)?• Are your levels stable? • If you take aspirin, what is the dosage and how often?

ASK

Lyric should be contraindicated if the patient has a history of spontaneous bleeding and/or very easy bruising.

10

Electromagnetic Interference

Pacemaker

Hydrocephalus shunt

Deep brain stimulation


• Is the implantable medical device responsive to magnets?

ASK

Lyric is programmed and adjusted via a magnet. Patients need to keep the SoundLync more than 1cm from the implantable device or its control port.

Lyric should be contraindicated if

11

Pediatric User

As defined in your province


• What is the patient’s age?• Is there sufficient knowledge and understanding of the Lyric

device and process?

ASK

It is important to proceed with medical clearance for pediatric amplification as per usual practice and according to your provincial guidelines.

12

Lyric Candidacy

13


• Medical Clearance Form

– Description of Lyric device and use

– Reason for request

– Complete and send to physician

14

Lyric Candidacy—Ear Geometry / Anatomical Features

• Noting challenging canal shapes or anatomical features is vital for ensuring a comfortable fit

• Noteworthy canal shapes:

– Hourglass shape

– Anterior or Anterior/Posterior bulge

– V-shaped canal at any location

– Substantial step up or shelf in canal

15

Lyric Candidacy—Ear Examination

• Note characteristics of ear canal skin type

– Cerumen

– Dry skin

– Moist

– Oily

– Hairy

16

Lyric Candidacy—Fitting Range

• Evaluate the hearing status

• Tympanometry

Pre- and Post-fitting Measures:

• Hearing questionnaire (e.g. COSI, APHAB)

• Speech in Noise testing

Be cautious of steeply sloping losses

17

Is the Patient a Lyric Candidate?

• Make strong recommendation for Lyric based on information from these sources:

– Medical history

– Noteworthy considerations and lifestyle

– Ear canal examination

– Fitting Range

• Obtain medical clearance if necessary

• If Lyric is appropriate, move on to preparing the ear canal

• If Lyric is not appropriate, demo with Phonak daily wear

18



Ear Canal





Comfort


Quality


19

Ear Examination and Preparation

• Visualize the complete ear canal to develop flight path for sizer and device insertion

• Ensure clean and healthy skin throughout the whole canal

• Detect any abnormalities in the ear canal regarding skin condition, canal shape and the tympanic membrane (TM) to rule out related contraindications

• Detect any abnormalities before fitting of Lyric

• If any abnormalities are detected, refer to an ENT for clarification

20

Ergonomics and Head Position

• Sit facing your patient so that you do not have to bend or hunch over to work in the ear

• Move the head of the patient to aid with otoscopy

• Tilt head to compensate for a rising ear canal

21

Ear Examination – Microscope or Head Loupe with Speculum

1. Hold speculum in your non-dominant hand

2. With your dominant hand, gently retract the pinna to open and straighten the ear canal

3. Introduce the speculum into the opening of the ear canal

4. Methodically visualize the entire ear canal

• Tympanic membrane - Healthy and intact

• Medial portion of ear canal - Examine the entire circumference of the ear canal

• Lateral portion of the ear canal - Examine the entire circumference of the ear canal

5. Make note of the “flight path”

Always brace with the hand holding the speculum.

22

What to Look For

• A clean, healthy and straight canal without significant changes in shape and diameter

• However, for most ears the reality looks different …

23

Ear Canal Shape

Most canals are rising and / or…

… have an S-shape

TM

Source: Jean Courtois: Cerumen und Fremdkörper im Gehörgang

No

seN

eck

24

Ear Examination Examples

Focus on the bony portion as it is important for fitting success

– Examples of what you may come across:

Cerumen that needs to be removed

Bulge at front, round shape at the back + cerumen +small exostoses

Bulge on both sides leading to strong v-shape

Exostoses

25

Cerumen Management Tools

• Recommended equipment and tools

– Stainless specula

– Stainless curettes

– Stainless forceps

– Vacuum for suction

– Long wood-handledcotton swabs

26



Ear Canal





Comfort


Quality


27

Sizing and Placement—Sizing Objectives

• Determine if the ear canal is the appropriate length and diameter to accommodate Lyric

– Measure the maximum depth of insertion (mm)

– Determine correct device size (XXS, S, M, L, XL, XXL)

28

Sizing and Placement—Canal and Device Dimensions

• Device is placed 4 mm in front of the TM and at least 4 mm from the entrance of the ear canal (Posterior Meatus)

Posterior Meatus

Lyric

TM

29

Sizing and Placement—Reference Point

• Use the posterior meatus as a reference for sizing and placing Lyric

30

Sizing and Placement—Length Sizer

• Touch the TM gently with the tip of the length sizer

• Match up the color band marking with the posterior meatus

• Determine the “Do not exceed” insertion depth measurement

31

Sizing and Placement—Device Sizers

• Sizers are replicas of the actual device

– Same look and feel of actual devices

– Represent device “drivability”

• Not ear specific

• Vented through the core

• Seal sizes vary from XXS-XXL

– The core is the same size throughout

– Sizers are color-coded

Removal loops

Insertion handle

Superior indicator

32

Sizing and Placement—Lyric Tools

Insertion Tool

Use for:

• Sizer and device insertions

Lyric Slider Forceps

Use for:

• Sizer and device removal

• Placement modifications

• Measuring current insertion depth

33

Lubrication

• Glycerin

• Distilled water

• Otoease

• Options will not leave a lasting residue and will be absorbed into the skin

– Apply with a cotton swab to the device or canal wall

• Apply gently

• Do not over apply

• Avoid plugging the microphone or receiver

– Re-apply as necessary

34

Sizing and Placement—Instruction Movie

35

Sizing and Placement

• Many canals have a flat and angled front in the bony portion OR the complete canal is oval and angled

• What does this mean for Lyric?

The angle of the device should be adjusted according to the canal angle

The angle of the device should be adjusted according to the canal angle

36

Sizing Example: Poor fit

Minimal or no seal compression

Extra large gap between seal and canal wall

37


Maximum seal compression between seal and core of sizer

Seal compression causing folds in seal between seal and canal wall

38


Large gap between seal and canal wall

Minimal or no seal compression

39

Sizing Example: Proper fit

Good contact between canal wall and seal

Average seal compression between seal and canal wall

40

Lyric Sizing

41

Next module: Fitting the Lyric Trial, Part 2

fitting the lyric trial · · 2017-04-17hydrocephalus shunt deep brain ... ear examination and...

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