Audiology Manager at Phonak HQ
Jacqueline is a Doctor of Audiology and is currently the Audiology Manager for Phonak Target fitting software. She is passionate about ensuring best practices, especially in the delivery of eAudiology services. Jacqueline brings a unique perspective to product development with both her audiological background and experience living with hearing loss.
As a result of COVID-19, Phonak has accelerated new eSolutions to deliver quality hearing care during the stay-at-home orders and social distancing. The global restrictions on movement call for an alternative service delivery model so clients can still obtain the hearing care they need versus no hearing care at all. AudiogramDirect is one such tool now available with Phonak Remote Support. Jacqueline Drexler, AuD, is a Product Audiologist for Phonak Target fitting software at Phonak HQ in Switzerland. In this interview, I will ask her about best practices to consider when conducting AudiogramDirect with a Remote Support fitting. Happy reading!
Jackie, thank you very much for talking to us about AudiogramDirect today. Can you please start off by giving us a bit of background?
AudiogramDirect has been around for about a decade. It is an in-situ hearing test within Phonak Target fitting software. Hearing care professionals (HCPs) can test clients’ hearing directly through their hearing aids, considering the properties of the individual ear, the acoustic coupling, and the chosen hearing aids. It is now available with Remote Support, offering the world’s first in-situ audiometry, directly via Phonak Marvel hearing aids with any iOS or Android smartphone.
That is great to hear that nearly every client with a smartphone or tablet can have access, regardless of their device. Can you provide more details about when HCPs would use AudiogramDirect?
For existing clients requiring ongoing care, AudiogramDirect can be used to check a client’s hearing during a follow-up session. For potential new clients seeking immediate treatment for their hearing loss with or without previous audiometric data, AudiogramDirect can provide a starting point for a new remote fitting.
This would certainly help a lot of clients with hearing loss. What testing can be completed using AudiogramDirect?
Air conduction (AC) thresholds can be measured at all audiometric frequencies between 250 Hz and 6000 Hz. Bone conduction (BC) thresholds and speech testing cannot be completed. Thus, AudiogramDirect is not designed to replace a clinical audiological test. It is important that clients visit their HCP for an in-clinic appointment at the earliest possible time for continued audiological care.
…the world’s first in-situ audiometry, directly via Phonak Marvel hearing aids with any iOS or Android smartphone.”
Thanks for clarifying that. It is important for HCPs to know that this is not designed to replace the in-clinic audiological test and that it’s an alternative service delivery model to offer while clients are staying at home. What properties of the individual ear and hearing aids do AudiogramDirect account for?
AudiogramDirect takes into account the hearing aid insertion depth, the acoustic coupling seal in the ear canal, the effects of venting, the receiver power of the hearing aids, the length of the SlimTube (when applicable), and the chosen hearing aids. AudiogramDirect considers correction factors depending on the earpiece and vent are entered into Phonak Target and worn by the client.
So, how are the tones produced and calibrated?
The tones generated by each frequency are produced within the hearing aid, the same way a low battery warning beep or program change beep is generated. The tones are measured in dB SPL and then converted to be shown in dB HL in Phonak Target. The hearing aid is calibrated before it leaves the production facility.
Which type of environment should the client be in when AudiogramDirect is performed?
When AudiogramDirect is being performed, the client should be situated in a quiet environment. To overcome potential steady state environmental noise, measure thresholds using pulsed tones.
AudiogramDirect is not designed to replace a clinical audiological test. It is important that clients visit their HCP for an in-clinic appointment at the earliest possible time for continued audiological care”
What about a latency effect or a delay in tone presentation when performing AudiogramDirect during a Phonak Remote Support session?
A latency effect in signal transmission could potentially occur as this is dependent on the stability and strength of the internet connection from both the HCP and the client. Consider pausing a few seconds longer between tone presentations to account for this.
How does AudiogramDirect compare in measuring a threshold to a clinical audiological test?
AudiogramDirect and a clinical audiological test are highly related, but not identical as they serve different purposes. AudiogramDirect is performed using the client’s hearing aids, in order to optimize a hearing aid fitting. Thus, variations are expected when comparing thresholds between AudiogramDirect and a clinical audiological test.
Studies have shown that both behavioral and/or physiological changes can lead to a test-retest variability of audiometric test results of up to 10-15 dB.1 AudiogramDirect results have been shown to fall within the range of +/- 15 dB among pure-tone averages when compared to recent standard audiograms.2 The variation in thresholds could be due to several factors, including the acoustic coupling, placement of the hearing aid within the client’s ear, the client’s behavior, and human error.
What happens if the client’s hearing thresholds obtained through AudiogramDirect are significantly different from the client’s clinical audiological test?
If hearing thresholds are significantly different for a particular client when compared to the client’s most recent clinical audiological test, it is recommended the client moves to a quieter space for a retest and checks the earpiece or receiver for wax or debris. When possible, it is recommended that the client return to the clinic for a full hearing evaluation.
Until the client is able to return to the clinic for a full hearing evaluation, the thresholds obtained can be saved, but it is recommended to take into consideration the client’s reports on sound quality to make further fine tuning adjustments as needed.
Hopefully, it won’t be long before clients are able to return to hearing clinics for full hearing evaluations. But, until then, it’s reassuring to know that HCPs can still offer quality hearing care to their clients. Thank you very much Jackie for taking the time to answer these questions.
What are 3 takeaways for using AudiogramDirect with Remote Support?
- The digital pathway is not intended to serve as a diagnostic hearing assessment, but can serve as a powerful tool to support your clients’ hearing needs during this time of stay at home orders and physical distancing.
- For the most accurate measurements, the correct acoustic parameters used to measure with AudiogramDirect must be selected.
- Ensure your clients are empowered and set up for a successful and enjoyable experience when providing Phonak Remote Support.
1Landry J. & Green W. (1999). Pure-tone audiometry threshold test-retest variability in young and elderly adults. Journal of Speech-Language Pathology and Audiology, 23:2.
2Vercammen, C. (2020) Audiogram and AudiogramDirect: comparison of in-clinic assessments. Phonak Field Study News. Retrieved from www.phonakpro.com/evidence.
For more information about comparing Audiogram and AudiogramDirect, the above referenced Phonak Field Study News article is available here.
Theory to Practice is a series of interviews with experts in the field of audiology and beyond. Interviewees share their knowledge and insights on relevant topics. The special focus of each interview is to translate theory into key take-aways which can be implemented into daily practice.