Lyric-The Extended-Wear Hearing Device

Tech Topic: Extended Wear Hearing Aids | March 2014 Hearing Review

By Mark J. Sanford, MS, Tamara Anderson, and Christine Sanford

The InSound Medical Lyric hearing device (now owned by Sonova and sold under the Phonak brand since January 2010) was developed over the past 12 years in Newark, Calif, and was offered commercially for the first time in January 2007.

Lyric is the first hearing device that can be worn continuously in the ear canal 24 hours a day for up to 4 months. This extended wear device was developed on several key concepts:

  • Sound quality improves with proximity to the tympanic membrane;
  • Some people with hearing impairment resist wearing hearing aids due to stigma associated with hearing loss; and
  • People want an invisible and hassle-free solution to their hearing loss.1
  • There are many benefits to having a device deep in the ear canal, including2,3:
  • An overall increase in gain and output, especially in the high frequencies;
  • Reduction in the occlusion effect;
  • Ability to use the telephone and other ear level listening devices (headphones, stethoscopes) without feedback;
  • Security of fit and retention;
  • Reduction of wind noise; and
  • Improved localization.

Sergei Kochkin has documented through his MarkeTrak studies that the market penetration of hearing aids is approximately 25%. Therefore, even with all the improvements in technology during the past decade—directional microphones, Bluetooth compatibility, multiple programs, etc—the percentage of hearing-impaired people using hearing aids has not changed or, more importantly, increased. The Lyric device has the benefit of being a device placed deeply in the ear canal and eliminates the stigma of wearing a hearing device due to its invisibility and convenience.

The Lyric device received approval by the FDA to be placed by an ear nose throat (ENT) physician in 2002. In May 2008, InSound Medical received approval by the FDA that audiologists and hearing aid dispensers also could size and place the Lyric device with proper training. It also received clearance from the FDA to be worn for up to 120 days continuously by a patient.

Integrating Lyric into a Practice

The Lyric device is very different compared to fitting a traditional hearing aid. The equipment, the evaluation of the ear canal, and skills of the clinician are critical to being successful with the Lyric. In addition, the medical issues that should be considered make the learning curve substantial.

Fitting the Lyric Device

Candidacy. There are three steps to evaluating a patient for the Lyric hearing device. First, the ear canal is evaluated otoscopically to determine if a patient’s ear is an appropriate candidate for the device. Second, an audiogram is performed to determine if the patient’s hearing loss is in the fitting range. Third, the ear canal is then sized by the Lyric fitting procedure, ideally under a high-magnification microscope, to determine if the patient’s ears can accommodate the Lyric device. There are some medical conditions that are contraindications for some patients: transplant recipients, uncontrolled diabetes, radiation to head and neck, and autoimmune compromised patients.

The otoscopic examination is the foundation for placement and successful fitting of Lyric. The bony portion of the ear canal is very sensitive, and visualizing where the medial seal should/will sit in this part of the ear canal is extremely important. Discomfort is the number-one reason patients do not keep the Lyric, and 95% of pain complaints come from this area when fitting Lyric. The discomfort or pain is almost always on the floor of the ear canal or on the lower sides of the canal wall. In some cases, the top of the ear canal by the tympanic membrane can be sore.

 

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The customary hearing aid evaluation for Lyric takes 45-60 minutes if you decide to test, size, fit, and counsel all at the same appointment. Approximately 5-20% of patients who are sized will need to return for fitting 5-10 days later due to sensitive skin that may appear slightly bruised during cerumen removal and/or during the sizing procedure. As a practitioner gains experience and knowledge, the number of patients who need to return for an initial fitting after bruising from initial sizing will decrease to less than 5%.

The Lyric device is sold on a subscription basis, so patients will want to be “re-fit” as soon as possible after the device ceases to function.. A re-fit generally takes only 5-10 minutes, depending on if it is a unilateral or bilateral change. When a pattern of device longevity develops for a patient, they may decide to come in at regular intervals before a device becomes weak and runs out of power.

Subscription model. Lyric is sold on a subscription model, meaning the cost the patient pays covers all services for a year. The subscription is usually for 1 year, and patients can buy extended years, especially if they have an insurance benefit that covers more than the cost of 1 year. There are a few patients whose devices last 120 days, but this cannot be determined in the beginning for a patient trying the Lyric. The patient’s ear adapts to Lyric over time and a fairly consistent interval of service life develops. Most patients will come in at regular time intervals to have their Lyric(s) changed for a new device(s).

There is an interesting irony with patients who wear the Lyric: they have an invisible device, but they tell everyone about it. They say to their friends to look in their ears that they have this great new device. The hearing aid industry has been trying to be cosmetically oriented for years to reduce the stigma of wearing an aid, and now there is a device that is basically so invisible that our patients want everyone to know they are wearing a device.

Additional benefits. The Lyric differentiates our clinic from local and even national competitors. In many ways, the Lyric sells itself and should be introduced to all patients, especially those who will not use a traditional device. The patients who do wear Lyric provide incredible word of mouth about the device, creating a higher referral rate for the practice.

Lyric changes the clinic’s perception of hearing as patients are extremely satisfied, happy, and want to wear a hearing device.  This is compared to many traditional device users who tend to have more negative feelings toward their devices.

We believe the relationship between the patient and practitioner also changes. The practitioner is much more involved with the patient when sizing and fitting the Lyric compared to a traditional device. This intimacy makes the patient more loyal and “tied” to the office than with a traditional hearing device that the patient can think they can get from any dispensing office.

The Lyric hearing device is a great option for hearing-impaired patients, and we believe that it is tapping into people with hearing loss who normally would not wear a traditional device. It has been fit on thousands of patients successfully who have the appropriate anatomy and hearing loss for the Lyric, and the latest version of the device has proven to fit a high percentage of ears.

 

Tricks to protect Musicians Hearing

Musicians Like to Turn the Volume Up and Most Don’t Really Care

Everyone would agree that rock and roll needs to be loud. When working with musicians or people who like to listen to rock and roll, this is a given, and telling them to turn down the volume will “fall on deaf ears.” Well, actually if you tell them to turn down the music, a certain finger (which will remain nameless) may go up in the air.

It may be true that rock needs to be loud, but it doesn’t have to be at a high sound level. Exploiting this difference between sound level and loudness can add significantly to the hearing care professional’s toolbox of hearing loss prevention strategies.

Unlike sound level, which can be measured with a sound level meter (or even a Smartphone app), there is no loudness meter. Loudness is a subjective attribute of sound that allows us to place it on a scale going from soft to loud without relation to any physical measure. As such, loudness can be affected by background noise, the nature of the noise or music spectrum, the degree of vibro-tactic response, and even your mood or whether you have a hangover.

Add this to the fact that 85 dBA (the sound level where noise or music will start to have a long-term effect if listened to long enough), is simply not loud. We hear 85 dBA sound levels everywhere. The dial tone on a telephone land line is 85 dBA; the tone during testing of admittance is in excess of 85 dBA; and the sound of the toilet flushing (with your head in the bowl) is about 85 dBA. Humans are wonderful at discerning differences in frequency (especially those with perfect pitch), but we are not great at discerning differences in sound level. And this makes sense: a change in sound level does not yield a linguistic change in meaning because it is not linguistically distinctive. Imagine a language that ascribes a different meaning to the vowel /a/ as in “father” if it was spoken at a louder level. That language just wouldn’t work. Shouted speech would have a different meaning than softly spoken speech.

Dial It Down  and Give Them More Bass and Vibration

More bass. One strategy that is frequently used when counseling musicians is to turn up the bass. This is something that many rock musicians do in any event and, besides, rock music sounds cooler that way. This increase in low frequency sound energy “deludes” the musician into thinking that the music is at a higher sound level than it really is—the musician feels that it is loud, but at a lower sound level. Since it is sound level that contributes to hearing loss and not loudness, I feel that I have done a good day’s work!

More vibration. Another way to “delude” a musician is to provide vibro-tactile feedback in addition to listening to the music. There are some devices on the marketplace with various trade names such as Bass Shakers™ or Tactile Sound Transduces™ (www.sensaphonics.com). These can be bolted to the vertical bar on the seat of a drummer or bolted onto a 1-square-foot piece of 3/4” plywood and placed in the playing area of the drummer or bass player. When a bass note is played or a bass drum is hit, this ultra-low frequency sub-woofer loudspeaker vibrates and this causes the musicians in the area to feel that the music is sufficiently loud…but at a lower sound level.

Both cases—turning up the bass and using additional vibro-tactile loudspeakers/vibrators—can be very helpful, and both are predicated on the fact that sound levels can be reduced while still maintaining adequate loudness. Rock and roll just needs to be loud but not intense (… I mean, “but not at a high sound level”).

 

Benefits of iphone FaceTime for hearing aid users

Everyone has experienced how difficult it can be to carry out a phone conversation in a noisy situation. For hearing instrument wearers, using the phone can be very challenging even in quiet situations and impossible in the presence of any background noise. While the ability to use the phone may seem of secondary importance, phone use is an important communication medium to which everyone should have access. In fact, phone use has been linked to self-reported quality of life.

Numerous factors contribute to hearing instrument wearers’ experienced difficulties communicating on the phone. These include presence of background noise, inappropriate or inadequate coupling to the phone, handset positioning difficulties or constraints, and absence of visual cues.

Many hearing instruments have the option to operate in one of three modes for phone conversations: Acoustic phone, inductive coupling (telecoil), and digital wireless coupling.

Acoustic mode. Hearing instruments operating in acoustic mode (holding the phone receiver to the hearing instrument microphone) receive and amplify all sounds surrounding the hearing instrument wearer. Sounds amplified in this mode include the phone’s audio signal—typically conversational speech—as well as ambient sounds.

Telecoil. Hearing instruments operating via inductive coupling (telecoil) receive signals from magnetic fields generated by telecoil-compatible phones. Inductive coupling can be inductive coupling only, in which amplification of ambient sounds is avoided by turning off the hearing instrument microphones in the inductive coupling program (telecoil program). Inductive coupling can also be a combined inductive coupling and hearing instrument microphone mode (microphone-and-telecoil program) allowing the phone signal to be delivered through the inductive coupling while ambient sounds are being amplified through the hearing instrument microphones.

Wireless streaming. The third option for phone use is streaming either via a hearing aid accessory or directly from an iPhone. When streaming through a hearing instrument accessory, the accessory is paired to a Bluetooth compatible phone. When using the phone, the sound streams from the phone to the accessory, via Bluetooth, to the hearing instruments via another digital wireless technology.

As with inductive coupling, streaming from the phone can be done with and without the hearing instrument microphones activated, and thereby allow either amplification of or removal of ambient sounds. Inductive coupling and streaming improves the signal-to-noise ratio (SNR) by streaming the phone signal (typically speech). The degree of SNR improvement depends on the technology used and whether the hearing instrument microphones are activated or not. Deactivation of the hearing instrument microphones may be needed for some in order to be able to carry out a phone conversation, whereas activation of the hearing instrument microphones might be preferred by others to allow awareness of the environmental sounds around them.

Streaming, whether via an accessory, removes the reliance on correct placement of the phone handset. Streaming also allows the listener access to the phone conversation in both ears, which has been shown to provide significant benefit even in the presence of several different noise configurations. This benefit has been attributed to binaural summation (or binaural redundancy), and binaural squelch.

It is estimated that visual information makes up approximately two-thirds of all communication.3 Most of us are probably unaware of our usage of visual cues in many situations, but become aware of them when in challenging communication situations like in background noise. The absence of visual cues might be the reason why people with normal hearing periodically experience difficulties hearing on the phone when in background noise. The addition of visual cues is also helpful for people with hearing impairment. In fact, those with very severe losses rely as much or more on visual information as on auditory information.

One of the advances that have come with smartphones and tablets is the possibility to carry out video calls. This means that the camera on the smart device can be used to pick up and transmit an animated image of the face of the caller at the same time he or she is talking. In this way, the call recipient can both see and hear the caller.

Many different apps exist that can be downloaded to smart devices for video calling. They require that both the caller and call recipient are using the same app. Assuming that the same benefit of visual cues is available on a video call, this technology could provide an important benefit for hearing instrument users. In particular, for those with severe-to-profound hearing losses, this technology could make the difference between successful phone use and no phone conversation at all.

11 Hearing Aid Myths You Shouldn’t Believe

Dispel these outdated beliefs before you decide whether to get hearing aids.

Technology is changing at a very fast pace, and it’s hard to keep up—with computers, with cell phones, and with hearing aids. If you’ve had experience with hearing aids in the past, or even if you’ve just heard about previous generations of hearing technology, it’s very likely that you have some misconceptions.

Let’s say you want to buy a phone, but your concept of a telephone includes a rotary dial: you’d be operating under some outdated ideas, wouldn’t you? The same holds true with hearing aids. Technology has changed a lot—even in just the last five years. If you are considering hearing aids, the best thing you can do is to dismiss any pre-existing ideas you have about hearing technology and then do your research with a clean slate. Here’s a bit of myth-busting to get you started.

1. MYTH: Hearing aids are only for old people-or they’ll make me feel old.

“People think having hearing aids means that you’re old,” says Prabhu Ponnusamy, an audiologist and owner of Abel Hearing Clinic based in Launceston, Tasmania. “That’s just not the case anymore,” he says. In fact, about two-thirds of those with hearing loss are younger than age 64. Hearing loss has many causes and affects people of all ages.

Wearable assistive technology is becoming more and more prevalent across age groups, as well. From wrist-bands that track your movement to in-ear Bluetooth devices to Google Glass, people are wearing technology for all kinds of reasons, making hearing aids a bit more status quo.

2. MYTH: Hearing aids are big, bulky, and unsightly.

Today’s hearing aids are considerably smaller and more discreet than ever before, and they come in a wide range of colors, just like watches, purses, and cell phones. There are even hearing aids that can be placed completely within the ear canal so as to be totally invisible.

Prabhu Ponnusamy, who recently started his own practice after 15 years’ experience at a clinic, agrees that the big, bulky hearing aid is a thing of the past. “Definitely people have this misconception: they think of that brown banana, the huge BTE [behind-the-ear] hearing aid,” he says. “Things have changed so much: hearing aids are stylish; they’re discreet; they’re easy to use.”

3. MYTH: Hearing aids are only for people with severe hearing loss.

Anyone who’s seen fuzzy newsprint spring into focus when they don a pair of reading glasses can tell you that vision correction isn’t just for people with severe myopia. In the same way, hearing aids can greatly assist people with mild to moderate hearing loss, and many models are intended for just that. Even with mild hearing loss, you may be missing out on conversations with grandchildren, the sounds of birds singing, elements of your favorite music, and more.

“We hear with our brains, we don’t really hear with our ears.”

It’s also important to correct hearing loss when it first begins, for a variety of reasons. “There’s a link between hearing loss and loss of cognition,” says Prabhu, pointing out that treating hearing loss isn’t just cosmetic. “We hear with our brains, we don’t really hear with our ears. The ears just turn the sound into a signal that the brain can interpret. Controlling our hearing pathways also seems to help with memory, helps people connect socially, and all of those factors contribute to aging in a more graceful way. It lets you live your life on your own terms, rather than kind of shrinking away gradually into the night.” Prabhu also points out that the longer a person has gone with hearing loss, the more rehabilitation and “re-forging of neural pathways” they need in order to accurately translate sound into meaning again.

4. MYTH: I can’t afford hearing aids.

If you are concerned about the costs of hearing aids, you’re not alone.  Talk with your audiologist about your concerns; he or she may know of additional, local resources.

The Australian Government Hearing Services Program provides eligible people with access to a range of free and subsidised hearing services, including:

  • a comprehensive hearing assessment performed by a hearing services provider;
  • help with your hearing loss and communication needs, including support and rehabilitation services;
  • access to a wide range of high quality hearing devices, if required, made by leading manufacturers; and
  • optional maintenance support.  You can receive repairs and batteries to support your hearing device for a small fee.

Eligibility

 You are eligible for the program if you are an Australian citizen or permanent resident 21 years or older and you are:

  • a Pensioner Concession Card Holder;
  • receiving Sickness Allowance from Centrelink;
  • the holder of a Gold Repatriation Health Card issued for all conditions;
  • the holder of a White Repatriation Health Card issued for conditions that include hearing loss;
  • a dependent of a person in one of the above categories;
  • a member of the Australian Defence Force; or
  • part of the Australian Government funded  Disability Employment Services (DES) – Disability Management Service and you are referred by your Disability Employment Services case manager.
  • younger than 26 years;
  • an Aboriginal and Torres Strait Islander who is over 50 years;
  • an Indigenous participant in the Remote Jobs and Community Program; or
  • a former Indigenous participant in a Community Development Employment Projects Program, who received hearing services before 30 June 2013.

In addition, National Disability Insurance Scheme participants may access hearing services through the program if referred for services by their National Disability Insurance Agency Planner.

Not everyone is eligible for the Australian Government Hearing Services Program (the program). If you are not eligible for the program, you may be able to have a hearing aid fitted at a reduced cost through a hearing aid bank.  Information is available on the read more link below.

This information is general advice only.  For further information or to apply for the program please visit the Office of Hearing Services website or contact the Office of Hearing Services:

Website www.hearingservices.gov.au

Email hearing@health.gov.au

Client Services and General Enquiries please call  1800 500 726

If you use a telephone typewriter (TTY) telephone   1800 500 496

For the purpose of eligibility to the program, a member of the Australian Defence Force is considered to be:

  • a current member of the Permanent Navy, the Regular Army or the Permanent Air Force; or
  • a current member of the Reserves who is rendering continuous full-time service.

5. MYTH: Hearing aids make everything sound too loud.

“This is another thing that has changed,” says Prabhu. “Thirty years ago, people were always messing with their hearing aids, turning them up, turning them down. A lot of times it was an all-or-nothing thing.” But nowadays, hearing aids can be adjusted in extremely minute increments. Many have a variety of programs you can use for various situations: some will adjust automatically, and some have remote controls for discrete adjustment. It’s important to continue working with your audiologist until you’ve got the right fit.

6. MYTH: Hearing aids can’t help with my tinnitus.

Nowadays, some hearing aids come with a special tinnitus program that provides background noise or other features to help minimize the effects of tinnitus. By reducing the effect of the tinnitus while simultaneously increasing hearing, especially through digital streaming to both ears, this technology can make an enormous difference.

7. MYTH: I only need one hearing aid.

Research shows that speech is much easier to understand when hearing aids are worn in both ears. That goes for listening in normal environments as well as in noisy situations. Simply put, while one hearing aid hones in on speech, the other diminishes distracting background noise. The combination makes it a breeze to hear clear conversation.

By wearing hearing aids in both ears, sound is able to reach and stimulate each ear’s auditory nerve, keeping the nerve actively engaged. Studies have shown that if auditory nerves aren’t stimulated by sound, they can slow down and make hearing loss worse. This condition is called Auditory Deprivation. Hearing aids keep our auditory nerves functioning, which lowers the risk of Auditory Deprivation.

Wearing two hearing aids can increase your safety and awareness. The ability to know where sound is coming from depends on hearing with both ears. Everyday examples might be turning in the correct direction when you hear your name called, or knowing where an ambulance or fire truck is when you hear a siren in traffic.

Two hearing aids more accurately represent the way things are meant to sound. For instance, when music, television, movies, and peoples’ voices are heard with two ears, we enjoy a sound quality that’s rich, balanced and full. Hearing with one ear can make things sound “tinny” and unnatural.

A single hearing aid may require you to crank up the volume to hear. But, two hearing aids let you listen at normal volumes, which minimizes sound distortion and auditory fatigue.

Patient satisfaction is much higher for people benefitting from binaural hearing aids, versus a single hearing instrument. Double your listening pleasure with two hearing aids instead of one.

8. MYTH: Hearing aid salespeople are charlatans.

As with any professional you choose, from attorney to dentist, you should always make sure you feel completely comfortable with your hearing care professional. Some things to ask about include:

  • Level of education. The requirements range greatly, from a high school diploma to eight years of pre-and post-graduate study. (Philosophy and approach to treating hearing loss)
  • Professional experience
  • Commitment to your community
  • Particular experience with the kind of hearing loss you have
  • References

9. MYTH: Follow ups aren’t necessary; they’re just a way for audiologists to charge me more money.

On the contrary, follow-up visits are the only way to make sure your hearing aids are adjusted properly and working optimally. Prabhu uses real ear measurement tools to provide what he calls a “third-party verification” of how well hearing aids are working. With a tiny microphone placed inside the ear canal, he can see on how the hearing aid is performing. “You actually measure what’s coming out of the hearing aid,” instead of just guessing about how well the hearing aid is working, and make adjustments as necessary.

This technology is especially important with young children or people with severe hearing loss, who may not know or be able to describe how the hearing aid is performing.

10. MYTH: Hearing aids will work perfectly right away, like putting on a pair of glasses.

Treating loss of hearing is quite a bit different than treating loss of vision, and it almost always takes a couple of sessions to get things just right. This is partly a matter of making sure the hearing aids are adjusted correctly, but also of re-training the brain to interpret and prioritize sounds.The biggest surprise for new hearing aid users is how noisy the world is. “It can be a little overwhelming.”

Treating loss of hearing is quite a bit different than treating loss of vision, and it almost always takes a couple of sessions to get things just right.

Audiologists use specific techniques to help minimize the surprise of hearing again. Usually, with a first fitting, the audiologist doesn’t set the hearing aids to the full prescription, instead allowing patients to adjust incrementally. “It takes about three visits to get the hearing aids completely dialed in. People have to retrain their brains to filter out some of those loud sounds,” and also re-learn what sounds require their attention. The ticking of the clock and the hum of the refrigerator are sounds they may not have heard for a while, and it takes time to train the brain to ignore them again.

After a while, though, the important sounds stand out. “They can hear their grandkids, not just pretend that they did,”. “They can hear the fwap when they hit their golf ball. But it all takes time to adjust to.”

The audiologist also gives patients exercises to help them adjust, such as reading aloud to themselves for 10 minutes a day. “It’s not enough to just put hearing aids on someone and send them out the door,” he says.

11. MYTH: If I don’t like my hearing aids, I’m stuck with them. It’s a big decision and I won’t know if I’m making the right one until it’s too late.

Would you buy a car without taking it for a test drive? Prabhu lets his patients take a pair of hearing aids home for a few days or even a few weeks, and he says some other practitioners do the same.  Since he knows that his office isn’t the most realistic sound environment, he invites people to take them home. “I think they have to try them in the real world,” he says.

In addition, “Almost every clinic should have a return policy, too. At the Abel Hearing Clinic, you have a 30-day right of return.”