Fitting Guide SymFit 6.1 - Med-El
Contents
1. CEE ads iie hi a iin 15 m in Tem 1 C F b re al jun Li LI Fi om 4 AL Yonma mhuni F amga T a ee i oe mm w me wi u Lal l w xx i 5i figure 16 figure 17 Fitting formula and acclimatization level A modified version of the DSL I O NAL NL2 or NAL NL1 as the Fitting Formula in the Fitting Method window is recommended figure 17 All three fitting formulas are optimized to the output characteristics of the Vibrant Soundbridge system Setting the Acclima tization Level reflects the client s experience with am plification from conventional hearing systems Level 1 should be selected for inexperienced hearing aid users Level 1 has the lowest starting volume and cautious high frequency gain so sounds are not uncomfortably loud Level 2 is for beginners with some amplifica tion experience and level 3 for experienced hearing aid users Acclimatization level 4 can be used as the set ting for patients who are the most experienced with amplification Level 4 provides the highest volume for all settings Next the Number of Programs will be selected Up to 3 programs can be stored in the Amade One or more programs can be created during the first fitting Additional up to 3 total programs can be added at any time after the first fitting There are 3 default pro grams Universal Noisy Environment TV Music After selecting the number of programs click Apply First Fit This will compl2. Hardware MINIMUM SYSTEM REQUIREMENTS Processor CPU Pentium Ill 800 MHz Hard disk space 300 MB free storage RAM 256 MB Graphics Display 1024 x 768 resolution 64k colors Programming Interface HI PRO or NOAHlink Programming cable with CS44 interface CD ROM drive Windows XP USB interface 1 1 RECOMMENDED SYSTEM REQUIREMENTS e Processor CPU Pentium 4 2 GHz e Hard disk space 2 GB free storage e RAM 1 GB e Graphics Display 1280 x 1024 resolution 16 7m colors e Programming Interface HI PRO or NOAHIink e Programming cable with CS44 interface e DVD drive e Windows XP Pro Windows Vista Windows7 USB interface 2 0 Fitting software discussed in this guide e Siemens Connexx Software v6 4 3 6 4 5 e VIBRANT MED EL SYMFIT Hearing Instrument Data base Accessories e Audio Processor Adapter to check the function of the Amade e Audio Processor Fitting Kit Amad It contains all the necessary accessories for the Amade fitting and maintenance For the Vibrant Soundbridge SYMFIT 5 1 or SYMFIT 6 1 For the Bonebridge SYMFIT 6 1 III Amad Audio Processor Characteristics of the Amade audio processor The Amade audio processor figure 1 contains the digital signal processing for both the Vibrant Soundbridge and the Bonebridge implant system The state of the art signal processing provides these features e Digital signal processing in 16 frequency bands Frequency range 250
3. When the data for the new client is complete click the Save button The newly added client information should now be transferred and appear in the client list The client list To search for a client in the client list enter the first or last name into the corresponding field and click Search Now To display the complete list of clients click on Show all To load data for a specific client double click on the corresponding dataset Or click on the client dataset and click on Load Client V First Fitting for the Soundbridge Amade The Vibrogram The Vibrogram is a pure tone audiogram received by direct stimulation of the inner ear through the Vibrant Soundbridge It can be performed with all types of the VSB Amade audio processor Pure tones are presented through the Amade and are adjustable in frequency from 500Hz to 6000Hz and loudness between 15dB and 105dB Measuring the audiogram through the implant does not only provide information about the hearing loss of the patient in the Vibrogram Dut also about the frequency response of the Vibrant Soundbridge and the coupling of the FMT to the Inner ear THE VIBROGRAM THRESHOLDS ARE RECOMMENDED TO BE USED AS A STARTING POINT FOR THE FITTING OF THE VIBRANT SOUNDBRIDGE SYSTEM Detecting a connected Amade Audio Processor The first step is the detection of the hearing instrument via the detect connected instruments button in the toolbar figure 9 File
4. Binaural link For bilateral Amade users a setting for both audio processors can be changed simultaneously Click on the marked button figure 44 to apply a change in one Program to the respective program on the contralateral ear at the same time figure 44 Critical Gain Measurement If feedback occurs after activation the Feedback Cancellation system can be activated within the Speech Sound settings Furthermore programming adjustments can be made to eliminate the feedback A suggested adjustment strategy follows start by Increasing the knee point a few steps in compression band no 8 If the feedback level stays the same bring it back to the initial position and try the same strategy with the next compression band no 7 Continue until you have identified which band creates the feedback Seach programm for mean urermen ifur Pan eee pd l muniti u jin Tr ee A jiem Br a re ade figure 45 Note that this is the recommended manual procedure Additionally an automated Anti Feedback analyzer is available by selecting Critical Gain Measurement in the Fitting menu figure 45 When selecting Start Measurement the hearing implant generates an impulse sound across the whole frequency range for the programs that have been selected This impulse sound is ciphered and analyzed by the microphones Select Optimise to apply therecommended settings Import and export of client data With the help of this
5. Your NOAH user ID has to be entered IMPORTING CLIENT DATA Client data can be added to the database via the import function figure 47 by clicking on Import client data from file navigating to the file s location and selecting the appropriate file The Client database location displays the database to which the new data will be added If an NHA file is selected the whole list of clients which will be added by the import process is shown in the list field Click the Import button to start the import Process 36 Ai Doppi Ta Ciar impeet eset VULL Fer er aa Pies Capra Le ork tige tin ili fe at a basi pi araw Fik pork ape te l Dass cf beet re Paer 1 a ae ATP ak pnma EE Be xha Su Ar dpt ghene n anp arn r ch figure 47 REMARK Please be aware that importing client data is only possible with the identical version of the Import Export tool that you used for exporting the client data The client database is not backwards compatible to earlier versions of Connexx Fitting Assistant In addition to the information found in this Programming Guide the Fitting Assistant available in the SYMFIT software figure 48 provides fitting and troubleshooting suggestions Start the assistant by selecting Fitting Assistant from the Fitting menu Test settings Besides the Vibrogram settings two other test settings can be useful for the fitting session They can be selected via Fitting gt Test Settin
6. tuning window to start a new first fit REMARK High frequency sounds are essential for speech understanding Considering this the user should get used to these kinds of sounds over time It Is suggested to slowly increase the high frequency sounds from fitting session to fitting session 23 VIII Fine Tuning The Fine Tuning settings allow frequency specific gain and compression as well as advanced speech in noise adjustments to be made Frequency Shaping Frequency Shaping Gas eh dE mi Eiti jet ili 1600Hz 38 s Hanm Ppa MAA LO Max dE Speech Sound Instrument settings Vibrogram figure 27 The first tab in Fine Tuning allows the gain for each of the 16 individual frequency bands to be adjusted Separately in incremental steps of 1 dB using a drag and drop method see figure 27 If the mouse is moved over one of the controls the central frequency of the frequency band appears as well 24 as the current gain applied By marking several frequency bands with the mouse the gain in user defined frequency areas can be changed easily and quickly REMARK The number between O and 60 is interpreted in the way that 60 is equivalent to the maximum amplification on the specific frequency band and every 1 dB lower means 1 dB below the maximum amplification The information value of this number is limited The exact values of the amplification applied depending on frequency and input level can be taken f
7. Edit Fitting View Settings i 9 GF u Help figure 9 It is not necessary to select the processor first the detection automatically recognizes which audio Processor Is connected NOTE TROUBLESHOOTING IF THE AMADE IS NOT RECOGNIZED CORRECTLY THE FOLLOWING MAY HAVE OCCURRED 1 The wrong SYMFIT version is installed To check which version of the VIBRANT MED EL SYMFIT database you have installed go to Help followed by Info about Database Here it can be confirmed that SYMFIT 6 1 is installed to program an Amade BB SYMFIT 5 1 or 6 1 is required to program the VSB Amades 2 The programming cable is not properly connected to the processor Please refer to chapter Ill on page 11 of this guide to learn how to connect the programming cable correctly 3 The hardware is not installed correctly Please refer to the user manual of the HI PRO box or NOAHlink for assistance Make sure that the HI PRO box is set up ona serial port COM1 to COM4 Detea heanng instruments Find Haamea Inka BRAT METIEL fines Bes Prison fli Lafi Hin hing imin Bi need Garnet korn ia eal pew bho ba de aa a assi lee DP a eee ting fg Petr ordner i Fois is tating foo to Pepa Terse Al ME a wv gt Placi Mi k Parcel figure 10 Figure 10 shows that Connexx has detected an Amade in this example Amade Hi on the side where the audio processor Is connected to the HI PRO box Now it can be differentiated
8. Hz 8000 Hz B compression channels e Directional microphone e Advanced speech in noise management 3 storable programs e Zinc Air 675 battery figure 1 battery life 5 7 days depending on amplification level How to wear the Amade The Amade audio processor should be worn by the patient as shown in figure 2 The battery compartment should be placed pointing downwards as it is the heaviest part of the processor In this position the two microphones form a horizontal line and the effect of the directional microphones if activated is optimized Be aware that there is a left and a right version of the Amade To achieve correct directionality the correct version of the Amade should be used for the corresponding ear figure 2 Front and back of the Amade audio processor FRONT Program Change Button Two Battery Door figure 3a On the front side of the Amade the user can choose between three programs by pressing the program change button The two microphones allowing for a directional microphone option can also be seen in figure 3a On the base of the processor figure 3b the serial number of the device is printed On the right hand side there is a mark for the Amade version Hi for a high power Amad for the Vibrant Soundbridge Lo for a low power Amade for the Vibrant Soundbridge e If there is no mark the device is a standard Amad for the Vibrant Soundbridge BB for an Amade for the B
9. If the setting is not to be stored press the Cancel button to return to the main Connexx window For evaluation purposes it may sometimes be useful to compare the currently used Amad settings with a previously made fitting To recall previously stored Amad settings select Recall Settings in the Edit menu or press the highlighted button in the toolbar figure 38 a e a er ta oau PGI figure 38 The following dialog box figure 39 appears i Tira emre BEME KEN Fua 262i htt Pie Fap Tuning OUEST Ot Et Pete Tunai a ji 2 figure 39 To select a hearing instrument setting from the menu click on the desired setting Click the Delete Dutton to delete the hearing instrument setting selected only programs with marked checkbox will be deleted in the dialog box The setting cannot 33 be recovered later With the Program selected settings button the hearing instrument settings only programs with marked checkbox are immediately programmed into the connected Amade Press the Ok button to update the selected Amade setting onto the screen Pressing the Cancel button closes the dialog box and the working area remains unchanged REMARK Please note that everything stored here is not stored in the user database It is only stored on your local Connexx installation and these settings cannot be exported Save a session To save a completed hearing instrument fitting
10. and all associated data select Save Session in the File menu or click the highlighted button in the toolbar figure 40 ue ma ww figure 40 PGI The dialog box for saving a session will appear figure 41 Session Comment Enter a comment for this fitting This comment will appear later in the session list Completion of this field is optional Measurements Fitting Select the data you wish to store for this fitting by checking Audiogram right hearing instrument and or left hearing instrument The input fields Manufacturer and Hearing Instrument are automatically filled in and cannot be changed Enter the serial numbers of the hearing instruments in the input field Serial number if desired By pressing Ok the selected fitting data are stored and are available for later use The Ok button cannot 34 rt Era Cie hua Jene al ea hm ee fini mu ern x Fal oes l u Chae hes il Bere ONAT HED G FANY rAr Behe aji imma E mri na mies i mi PR i i TAF figure 41 be pressed if no data have been selected By pressing Cancel The dialog box is closed and data are not saved Mute button Click on the loudspeaker symbol figure 42 in the lower toolbar to mute the Amade Press the button a second time to unmute the Amade gy Nr ER o PEE is CH B figure 42 Program link To applv a change in one program to all active programs click on the marked button figure 43 CECE D LL CE ECE figure 43
11. between a first fit session and a follow up fitting 13 Follow Up fitting go to Fine Tuning should be chosen for the Vibrogram measurement Press OK to confirm the selection Starting the Vibrogram measurement The necessary calibration settings are stored in the processor via selecting Fitting followed by Test Settings The following window figure 11 will Teel soit TG ka ER f rm PR eR TER b la Pui cn gan amang a be m ee tea ise Te figure 11 appear Click on Vibrogram Settings The Amade is programmed and the Vibrogram table figure 12 is activated CAUTION Do NOT close the Test settings window Select the Vibrogram tab from the 6 tabs in Fine Tuning The Vibrogram table will appear figure 12 The Vibrogram process Is similar to an audiogram In order to prevent external sounds from being picked up by the microphones mute the Amade Refer to figure 42 on page 34 on how to mute the Amade THE PRE PROGRAMMED AMADE IS NOW GIVEN TO THE PATIENT AND PLACED OVER THE IMPLANT 14 Begin taking measurements at 1kHz 30dB above the bone conduction threshold Click on the corresponding symbol to activate the tone and start the measurement The tone will remain active until either another test tone is activated or the measurement Is complete The active tone will be displayed on the top and bottom of the Vibrogram screen figure 12 Vibrogram Acie OOOH Bh OF O71 12 J 4 g et be BeBe EB i MBB Ee e
12. input sounds in up to 8 channels With the help of the eyeglass control these 8 channels can be combined into 1 2 or 4 groups and then be adjusted accordingly This is very useful as it allows the clinician to directly respond to comments of the user concerning specific listening situations As already mentioned in the section Basic Tuning changes in the input related amplification are equivalent to changes in the compression settings compression kneepoint and ratio in the specific frequency band which should therefore be observed figure 28 Setting the Compression Kneepoint and Ratio Of course Connexx also allows to manually set Compression Kneepoints and Compression Ratios The frequency range can be also split here with the eyeglass control By double clicking on the respective field a dropdown menu opens which allows to set the compression kneepoint between 35 dB and 75 dB the compression ratio between 1 00 no compression and a maximum of 4 00 Dual and Syllabic compression DUAL double temporal component compression Dual compression operates with both a fast and a slow level meter The fast level meter provides an immediate reduction in gain for higher level impact sounds The Frequency Shaping Compression Gan for soft rounds LI 4040 si sm dB Bd BiB 248 IE lidE 12dE 308 ate ite cite miu gt TA 5 4 EHE Gain fot loud sounds LI 30dM kai itie de Mi Od Od ce le ce ie Teilen F
13. syllabic compression are fixed Speech Sound With the tools in this tab the Speech and Noise Management Sound Smoothing Wind Noise reduction and Feedback Cancellation can be set These settings can support the user s hearing experience in different environmental situations figure 29 Speech and Noise Management This feature is an adaptive algorithm following the currently detected noise that maximizes both the hearing comfort and the speech intelligibility for each acoustical situation This means that speech signals are emphasized while interfering noises such as traffic noise or air conditioning are suppressed If the checkbox is enabled you can select between med noise attenuation of 8 15 dB and max noise attenuation of 12 24 dB noise attenuation Sound Smoothing This feature guarantees high listening comfort The algorithm detects loud sounds with a sudden onset like clattering dishes rustling paper or slamming doors which are annoying for hearing impaired people Sound Smoothing eliminates only these sounds 26 Frequency Shaping Compression Speech Sound v Speech and Morne Managemen med w Mir Ji Sound Smoothing i med v mii W Wind Noise reduction Chill m gt max Feedback Candelabcn Instrument settings Vibrogram figure 29 without affecting speech or soft impulsive sounds and therefore maintains the naturalness of sound A choice can be made between med
14. the Amade The microphone system is set to omnidirectional Speech and Noise Management as well as Sound Smoothing are set to medium and the Wind Noise Reduction is set to maximum Please find more information about these features on pages 26 and 27 of this guide In slot 1 the program Universal Is always active Nevertheless you can change any setting within the program Noisy Environment The program Noisy Environment is predefined in slot 2 and designed for noisy situations such as traffic conversation in a large group restaurants or similar noisy situations To provide speech intelligibility and comfort within these situations the Amade parameters are modified as follows the microphone system Is set to directional Additionally Speech and Noise Management Is set to maximum attenuation Sound Smoothing is set to medium and the Wind Noise Reduction is set to maximum Furthermore the channel gains are reduced in the lower frequency range as well as the gain for loud sounds for the whole frequency range TV Music The TV Music program which is the predefined program for slot 3 is primarily intended for listening to music but also for TV applications It aims to provide a natural wide band sound for the Amade user To achieve this goal Wind Noise reduction is turned off and for this particular acoustical environment the Sound Smoothing feature is also turned off The overall gain is also increased especially in the lo
15. the patient UCL are defined by the Vibrogram It is therefore suggested to use the Vibrogram as a basis for the fitting as it includes the hearing thresholds of the ii p F HE ators Er ee all Vale ey evar ra ee Teeter fe pores nr bi a mhi nrs ir fee eae ang Er ae ee pe od ee ee 4 Br feb sre Pe Ce ep ed p MAn a ie D meee ces fe pe i aflm u Ei figure 13 Amad For the first fitting the thresholds of the patient have to be entered at least on the side which is to be fitted figure 14 Bak lii patient as well as the efficiency of energy transfer from the FMT to the Inner ear Air Conduction svmbols are used to enter the Vibrogram thresholds if UCL values have been measured UCL svmbols are used to enter them here 15 The First Fit Configurator After entering the Vibrogram as a basis for the first fit the first fit configurator can be started This is done via selecting Fitting and then First Fit from the menu or using the highlighted icon in figure 15 File Edit Fitting View Settings CEEE s a Help figure 15 First fit approach First select whether the first fit should be done for the left the right or for both connected hearing instruments in the case of a bilateral fitting In the following example figure 16 an Amade is connected on the right side Therefore the other two options cannot be selected here Click on Next to continue 4 ii Ful F 3 jie na e en ii de
16. tool client data can be imported and exported Start the tool by selecting Client DB Import Export from the File menu EXPORTING CLIENT DATA The saved client data can be exported by choosing between one several or all entries figure 46 With the Show all button you can display the whole list of clients saved on the current workstation Entries can be selected from this list Taice Gain Merna anaal E Minn bh ee eres Ha pa im ta lh Se eed Oe a a HE ma po mid ee ET Ped oe AT f L rya Te r banm ray h SSS e E ee ere B ua ta Soe eee r o ee ee M MIEN L ee et Me ee ees eed BL L ei oe H oe oe H hee oe ir et oh L he er J minie eel ri eed Bi rule et ko jiem ma j rael m arap f am ii 1 ee Q Termar re 35 To define the location to save the exported data insert the corresponding file path and file name in the field Export client data to file Pee mer re ar Frei os al Po mie Eats ol Earth L Lae Lik ae F gale al cherie Cort itia a Tan S en Be ere teed b Cy Demers Dach erTi lees pert ert dete bi J a mn figure 46 After you have selected at least one entry the export Process can be started by pressing the Export button In a subsequent step the type of export has to be defined Export data for standalone use SHS compatible data will be exported NOAH import is not possible with this format Export data for use in NOAH NOAH compatible data will be exported
17. B Be tul eee eb eE mM bn bkek eee ae BRB ee Bb amp Of bmn ef amp kull XII XII A kuN e G a a a An Lk ka ie a as A A Ae ee i A a 6 iG ht A A a A eb bib h oe ee a Mn a a KK FE ee bbb oe ee MEE EE Lf amp HOB d d d EE be See ee ee ee arr ee 6 iB iB mab i a a eb ID ee eh hb ib amp B amp B amp 05 Oo75 1 18 52 1 il fi lity Fiat figure 12 NOTE Test tones can be adjusted from 500Hz to 6000HZ in frequency and from 15dB to 105dB in volume REMARK If the patient is having difficulty finding satisfying fitting levels consider collecting the uncomfortable loudness levels UCL during the Vibrogram process so there is a full range of responses Vibrogram Measurement completion When the measurement Is finished click on Vibrogram Settings and Close the Test Settings window The following window will appear figure 13 select Yes It is not intended to leave the test settings in the Amade As the Vibrogram thresholds have been received as a basis for the first fitting it can now be continued with entering the thresholds and UCL values in the Audiogram tab The Audiogram Tab Select the Audiogram this is the first tab in the Connexx software and it will appear after creating a new client The data entered in this screen will be used by the Connexx software to calculate the target gains for the figure 14 When fitting the Amade audio processor of the Vibrant Soundbridge the thresholds and the dynamic range of
18. Business Unit Vibrant Fitting Guide SYMFIT 6 1 Table of contents I Introduction ll Setting up hardware and software HARDWARE FITTING SOFTWARE DISCUSSED IN THIS GUIDE ACCESSORIES III Amad audio processor IV Fitting Session V First Fitting for the Soundbridge Amade VIBROGRAM AUDIOGRAM VI First Fitting for the Amade BB AUDIOGRAM FIRST FIT CONFIGURATOR VII The Basic Tuning THE CURVE DISPLAY SETTINGS IN THE BASIC TUNING VIII Fine Tuning FREQUENCY SHAPING COMPRESSION SPEECH SOUND MICROPHONE DIRECTIONAL AND OMNIDIRECTIONAL INSTRUMENT SETTINGS IX Programs in the Amade PRESETS AVAILABLE IN THE AMADE SELECTING AND CHANGING A PROGRAM CHANGING PRESETS ACTIVATING OR DEACTIVATING A PROGRAM COPYING AND SWITCHING PROGRAMS BETWEEN SLOTS X Documentation XI Useful Connexx tools XII Further information oO oOo Or 12 13 13 15 17 17 19 21 21 22 24 24 25 26 27 27 29 29 30 30 31 32 33 38 Introduction The VIBRANT SOUNDBRIDGE and BONEBRIDGE Systems Vibrant Soundbridge INTRODUCING e The Vibrogram Direct Drive threshold measurement e DSL NAL NLI NAL NL2 available for the Vibrant Soundbridge fitting Bonebridge INTRODUCING e Fitting of the bone conduction implant system ll Setting up Hardware and Software The following components are necessary for fitting the Amade audio processors of the Vibrant Soundbridge and the Bonebridge systems
19. ai pe in Ba dei a 8 ed ep Ce Mee iing jja ta PriF Beet dine tp mmg bo iri Fre arg wer z w x Epi nira l L figure 21 For bilateral first fittings there is the option to use the same fitting strategy for both audio processors or a different fitting strategy for each audio processor Usually the same strategy for both audio processors is used as seen in figure 22 Each audio processor should be programmed one at a time on the patient s head After both processors are programmed place them on the patient and turn them on Adjust the volume with the gain setting until both sides have an equal level of sound Finally make sure sounds are not too loud for the patient If they are too loud turn the volume to an acceptable level for the patient This fitting guide will now continue with a case of unilateral fitting For a unilateral fitting the following example figure 23 is for an Amade BB connected on the right side After selecting the correct side click Next to continue For the the Amade BB It is strongly recommended to use 19 the modified formula DSL I O please refer to the next section Use the tickboxes as seen in figure 24 Fitting formula and Acclimatization level Use the DSL I O as Fitting formula in the Fitting method window figure 24 it has been optimized to the output characteristics for Bonebridge NAL NL1 should NOT be used for fitting the Bonebridge system Setting the Acclimatization Level ref
20. de connect the programming cable Make sure the Amade battery is sufficiently charged Open the battery door to access the programming socket figure 7 To connect the audio processor align the marks on the programming cable and socket and connect then figure 7 Next the battery door must be placed to the Programming position This position can be found while the cable is plugged into the programming socket and the battery door is closed enough so the AP Adapter shows the processor is turned ON After completing the steps above the Connexx software can be started LI IV Fitting Session Start fitting session enter client data After starting the Connexx software the Client List and Data screen will appear figure 8 For new clients complete the fields on the screen For existing clients existing data can De loaded Chet ated oe O ve Lee ilani Bidu Er nimi Fen pa E ala um Lit rili ee banie urn um rn i nite EF rar Dew mi ink ob vet tis i uE E I En PP Ca Cae E m Foren aun Pa EEE Loam mrt W Z ME ee PAR figure 8 12 Create a new client required and optional data To create a new client record click on the New button located in the bottom left corner of the Client List and Data screen On the right side you will see the fields to enter the client data First Name Last Name and Date of Birth are required to create a new client record All other fields are optional
21. e un Ami ee ju di Os E 15 MH Compression Keepin and Hatin Is OGG Esdan Enamel Model Msani Alde ANAE 114 118 FTI 17 ET am 137 O RD 1 23 Ji ED EJ E Dual Qual Dual Dusi Sa SA Sl 130 OP S G6 ga C gs Oe 2 29 2 00 1 8 1 50 1 45 Speech Sound Microphone fi instrument settings Vibrogram figure 28 fast attack time is 5 ms The second level meter with 900 ms attack and 1400 ms release time provides gain adjustments based upon the average level of the incoming signal In this way the Amade operates with a quasi automatic gain control while at the same time preserving speech dynamics essential to understanding without allowing uncomfortably loud peak levels Dual compression follows the overall speech level and limits distortion For users who suffer from mild recruitment mild to moderate hearing loss dual compression protects the temporal contrast of their own voice 25 SYLLABIC or fast compression Syllabic compression adjusts the gain for instantaneous fluctuations that occur within speech It operates with a fast level meter using an attack time of 10 ms anda release time of 100 ms It should be used in frequency bands where a user has a strongly reduced dynamic range moderate to severe hearing loss which is more common in the high frequencies In this case it is preferable to select syllabic compression for the compression areas five to eight The attack and release time of
22. e the audio processor Is connected to the HI PRO Dox Now it can be differentiated between a first fit session and a follow up fitting New Fitting go to First Fit Configurator should be chosen in this context The software will start to calculate target gains according to the audiogram that has been entered Follow up fitting go to Fine Tuning for follow up fitting sessions It will read out the connected Amade and it can be proceeded based on these settings Press OK to confirm the selection Bilateral Fitting The software also allows simultaneous fitting for bilateral Bonebridge users When two Amade are connected detect connected instruments shows the window in figure 21 Select New fitting go to First Fit Configurator in case of a first fit based on the entered audiograms Select Follow up fitting go to Fine Tuning in case of a fitting based on the values stored in the connected Processors The First Fit Configurator First Fit Approach Select the side left right or both for bilateral fitting figure 22 Part Fa Aledo Fiii Fi Approach Filiraj Weihe Praeina Fast F fini E both brama ram fe he re Hing Beige hir er mki heard neue il A heer rn hieray fli ba ad Kall ALT Pd LL A ur Ful wi x Ba HTE ipe Ppp F D Lath figure 22 Arad H emmay Geol imil Hee rier WEINI ul AAT mi OL Aaa Foie anam Hi Aa MI Aba Moralia mal Ihnen zen hamia gi Wha m
23. elected 1 Gain G or Output O This defines whether the gain or the output of the system is displayed Both settings are equivalent via the calculation Output Level Input Level Gain The output level for the Vibrant Soundbridge is given in dB SPL sound pressure level The output level for the Bonebridge is given in dB FL force level 2 Coupler Type Ear Simulator 3 Stimulus Pure Tone Note These changes only have to be done once The changes will be saved and become default settings for future sessions 21 m Fa a z l a i i gt B mm g g A H I i p Ja a LI IC 74 TAIFA C c DADI UI an Il N i eel ee H ma l wa lli LM C gt _ DJ C A D K A WY amp fu Basic adaption of the programming is done in the Basic Tuning window figure 26 Simple questions about hearing impression with the Amade can be directly responded to in this window Master gain FM HdE Loudness ilu loud sounds au speech ilu soft sounds E au own voice Sound qualitp too sharp too muffled First Fit figure 26 REMARK Every setting in the software that is adjusted will be per default immediately sent to the processor and will therefore be perceived by the user 22 Master Gain If the user experiences the overall volume of the system as too loud or too soft it can be set with the Master gain in the Basic Tuning and also in the Fine Tuning window W
24. ement and Wind Noise Reduction are deactivated The Sound Smoothing algorithm is set to its maximum impact in this program Selecting and changing a program In figure 32 the first program is magnified meaning that the Amade is currently in this program The user is hearing with program 1 at this time and all the setting 30 changes will be done in program 1 To switch to program number 2 or 3 a simple click on the respective preview window is sufficient Changing presets activating or deactivating a program Universal Noisy Environment Tf husic Telephone acous Outdoor sports Privacy w TY r Music modifi 125 figure 33 If three programs have been selected for the first fitting by default the Noisy Environment program is stored in slot number 2 and the TV Music program in slot number 3 In the dropdown menu displayed in figure 33 one of the other presets can be chosen for the corresponding program slot In the same way programs can also be switched off if they are not needed by selecting Off in the dropdown menu REMARK Please note that you cannot switch off program number 2 as long as program number 3 is active A modified program will appear with the extension modified in the dropdown menu Predefined programs are not changed Copying and switching pro grams between slots PAT TI D IL T 44 Fagri Paghi g Echange we figure 34 By clicking on the activated preview wi
25. ete the first fit configuration target gains will be calculated and stored in the Amade audio processor The programming is now complete place the audio processor on the implant site VI First Fitting for the Amade BB Audiogram Select the Audiogram this is the first tab in the Connexx software and will appear after creating a new client The data entered in this screen will be used by the Connexx software to calculate the target gains for the Amade BB For the first fitting the hearing thresholds of the user need to be entered Depending on the type of hearing loss the bone conduction BC threshold of either the implanted side or the contralateral side for single sided deafness should be entered as described below Values are entered by double clicking on the corres ponding level frequency point in the audiogram field Considerations for the Audiogram 1 Conductive and Mixed Hearing Loss When fitting the Amade audio processor for the Bonebridge consider that the inner ear is stimulated by bone conduction directly Meaning the hearing loss that needs to be compensated is defined by the inner ear component of the hearing loss measure and enter Ari figure 18 the bone conduction BC thresholds of the implanted side The Connexx software mainly uses air conduction thresholds for the target gain calculation however when fitting the Amade BB with conductive or mixed hearing loss the respective BC thresholds shou
26. g from the front of the Amade user are amplified over sounds coming from behind REMARK In the directional mode sounds being picked up by the rear microphone are amplified less than the sounds being picked up by the front microphone Therefore the overall volume is slightly lower in the directional mode than in the omnidirectional mode This can be compensated by increasing the master gain Instrument settings Two alert tone types can be enabled figure 31 to inform the user of the audio processor about an adjustment that needs to be made The alert tones can be activated to indicate the following situations Frequency Shaping Compression speech Sound Microphone Micpophasen 5 peebem Direcional gt E Orinideechonal Instrument settings Vibrogram figure 30 Information about program change The number of beeps depends on the selected program e g one Deep indicates program 1 The frequency of the alert tones can be adjusted for optimal audibility and set to 250 500 750 1000 1500 2000 3000 4000 or 6000 Hz figure 31 27 Low battery beep Indicates that the battery has to be replaced The low battery beeps are longer than the program change beeps and their frequency Is 250 Hz below the program change beeps The beep occurs 20 seconds after the battery supply voltage falls below a defined threshold subsequently every five minutes The loudness of both alert tones can be set in 5 dB ste
27. gs in the menu E Byer i Ta pace ge bpa ys wi rag E Fed ee wee ig Seley rg rg ee ee Pee ee 8 Se pepe wurd am ere ey ee peel Camera brach en irn pee Soe Be Be rem Beier Leis Fg a wei E Piia Fe gonad isi gise oman ha i peed gar ek figure 48 LOUDNESS SCALING available for the Soundbridge Amade This test setting can be used in order to assess if the fitting is appropriate in a way that e g 65 dB input sounds have equal loudness over the whole frequency range Activating the test setting Loudness Scaling figure 49 activates the table in the Vibrogram tab however the fitting in the Amade remains unchanged Tones can now be presented to the user to do a loudness scaling figure 49 FULL ON GAIN SETTING This test setting sets the gain in the Amade to the maximum value 37 XII Further Information If you need assistance regarding the Connexx Software please refer to the Connexx Help via Help gt Connexx Help or simply by pressing Fl on your keyboard If you need any further information regarding the fitting of the Amade please refer to the Instructions for Use IFU For further information on our products please visit the MED EL website www medel com or contact us via email vibrant medel com 38 VIBRANT MED EL Hearing Technology GmbH Furstenweg 77 6020 Innsbruck Austria Tel 43 512 28 88 89 vibrant medel com medel com pro f Y You
28. is not necessary to select the processor first detection will automatically recognize the connected audio processor File Edit Fitting View kl U f 2 settings Help figure 19 REMARK TROUBLESHOOTING IF THE AMAD BB IS NOT RECOGNIZED CORRECTLY THE FOLLOWING MAY HAVE OCCURRED 1 The wrong SYMFIT version is installed To check which version of the VIBRANT MED EL SYMFIT database you have installed go to Help followed by Info about Database Here it can be confirmed that SYMFIT 6 1 is installed to program an Amade BB 18 Please refer to section Il on page 6 to check which version of the SYMFIT database is required for the Amade to be programmed correctly 2 The programming cable is not properly connected to the processor Please refer to chapter Ill on page 11 of this guide to learn how to connect the programming cable correctly 3 The hardware is not connected correctly Please refer to the user manual of the HI PRO box or NOAHLink for assistance Make sure that the HI PRO box is set up on a serial port COM1 to COM4 Deen ee u a i l ree ju feo eel Maid Ele mary fa ee le i Bla ey Lee KIDFAT MECHEL Bi weet doc Darai ora aad we pou Mie ii dr qa a eed chee Pew rn foo bo Fe i ogor al Feier Beth ge ta Fanaa Titan Oo Kadi ra wf x Bazi Mid he La figure 20 Unilateral fitting Figure 20 shows that Connexx has detected an Amade BB on the side wher
29. ith this control the volume of the system can be increased or decreased by incremental steps of 3 dB REMARK The number displayed at the Master gain field represents the maximum amplification of the 65 dB input curve in the curve display for the respective view mode For detailed information about the amplification pattern of the system please refer to the curve display Volume of specific sounds To further improve the basic fitting it is also possible to respond to more specific questions in this tab For example the volume of the user s own voice convenience of loud sounds e g clapping hands or soft sounds REMARK Be aware that changing the settings in the Basic Tuning window influences the amplification and compression profile of the system It is therefore recommended to refer also to the Fine Tuning tab Changing the sound quality The Vibrant Soundbridge and Bonebridge systems provide excellent high frequency amplification that may or may not be used by the user For users who have not heard high pitch sounds for a long period of time these may sound metallic or sharp Because of this users may not be comfortable with these sounds The sound quality in the Basic Tuning window can be adjusted by clicking on too sharp This reduces the gain in the high frequencies and increases the gain in the low frequencies making the sound more muffled New First Fit Begin by pressing the button on the bottom of the basic
30. ld be entered with air conduction AC symbols and will be used as a basis for the first fit Bilateral conductive and Mixed Hearing Loss For bilateral fittings follow the steps listed above Enter the bone conduction values of the left and right ear in the respective audiogram field with AC symbols figure 18 Single sided sensorineural deafness SSD Bonebridge can be used for patients with profound unilateral sensorineural deafness or single sided deafness SSD In this case the Bonebridge is implanted on the deaf side Sounds are picked up by the audio processor on the deaf side and the Ari lli 17 vibrations travel across the skull via bone conduction stimulating the normal hearing inner ear on the contralateral side To include the attenuation of bone conduction from the deaf side to the normal hearing side measure the unmasked bone conduction measured on the implanted deaf side Use these values as a basis for the first fit enter in the audiogram tab on the implanted side with AC symbols REMARK Typically bone conduction thresholds are only measured from 500 Hz to 4 kHz Values at 250 Hz 6 kHz and 8 kHz should be entered by extrapolating from the given bone conduction thresholds Where no values are entered no gain will be calculated Detection of the Amade and First Fit Next to detect the Amade BB audio processor click the detect connected instruments button on the toolbar figure 19 It
31. lects the client s experience with amplification from conventional hearing systems Level 1 should be selected for inexperienced hearing aid users Level 1 has the lowest Starting volume and cautious high frequency gain so sounds are not uncomfortably loud Level 2 is for beginners with some amplification experience and level 3 for experienced hearing aid users Acclimatization level 4 can be used as the setting for patients who are the most experienced with amplification Level 4 provides the highest volume for all settings Next the Number of Programs will be selected Up to 3 programs can be stored in the Amade BB One or more programs can be created during the first fitting Additional up to 3 total programs can be added at f A 1 ed es oe i Pig bieg an Tig urn ii ic Po if wa i Fi l i Sd SR E Sums Pee F E 2 m 28 m mi x at u x mm fu i figure 23 figure 24 any time after the first fitting There are 3 default programs Universal Noisy Environment TV Music After selecting the number of programs click Apply First Fit This will complete the first fit configuration target gains will be calculated and stored in the Amade BB audio processor The programming is now complete place the audio processor on the implant site NOTE The remaining chapters in this guide are applicable to both Soundbridge Amade and Amade BB audio processors All settings can be used for both audio process
32. medium Sound Smoothing and max maximum Sound Smoothing The two settings differ with respect to the amount of attenuation of loud impulsive sounds Wind Noise reduction This feature is useful in special listening situations where wind generates unwanted noises in the Amad The reason for this fact is that the openings for the microphone ports can generate interference The Wind Noise Reduction algorithm evaluates the amount of wind noise at the housing openings of the microphones In case of strong and therefore annoying wind noise the gain in the low frequencies is reduced proportionally to the wind speed and the microphone system Is switched to omnidirectional You can select between med medium Wind Noise reduction and max maximum Wind Noise reduction Feedback Cancellation This feature enables a feedback reduction system This system continuously analyzes the feedback path of the Amade and subtracts the unwanted feedback if necessary If Feedback Cancellation is enabled the selection can be made between slow and fast base setting Slow base setting is optimized for maximum sound quality fast base setting is optimized for maximum effective gain Microphone Directional and Omnidirectional Option The Amade audio processor has a dual microphone system which can be set to Omnidirectional or Directional figure 30 In omnidirectional mode sounds from all directions are processed equally In directional mode sounds comin
33. ndow and drag and drop it over another one the window in figure 34 opens There are 2 options to choose between e Copy the activated program into another slot This can be useful to create another program with only slight changes e g increased decreased volume Exchange the activated with the targeted program Confirm the selection by pressing on OK 31 X Documentation figure 35 In the last tab a report about the fitting session can All parameters like the date and the name of the be created figure 35 clinician audiogram of the user hearing system Darameters and target gain can be stored or printed 32 XI Useful Connexx Tools Store and recall hearing instrument settings To store Amade settings for quick access for later use press the highlighted button in the toolbar figure 36 The following dialog box appears zz oa PSI figure 36 The following dialog box figure 37 appears jii FE qall A na figure 37 The hearing instrument type and date time are automatically entered and cannot be altered Activate the checkboxes for the program settings to be stored for the displayed Amad A Comment relating to this setting in the text field can also be added at the top of the menu of Amad settings Press the Store button to acknowledge storage of the hearing instrument setting The hearing instrument setting shown on the screen is stored permanently in the client s data form
34. onebridge BACK Serial Number Version Amade SN fifififiilit Side figure 3b Underneath all these markings there is an indicator showing on which side of the head the Amade should be worn L for the left side R for the right side The holding magnet is located in the center of the Amade It can be recognized with one to five dots The number of dots represents the strength of the magnet Amade audio processors are automatically shipped with a number 3 magnet Numbers 1 and 2 are weaker magnets Numbers 4 and 5 are stronger magnets and used in cases when the skin flap between the implant and the Amade is thicker than usual Battery door positions The position of the battery door defines the status of the Amade audio processor 4a 4b 4c figure 4 When the battery door is closed completely with a working battery inside as seen in figure 4a the Amade is ON To turn OFF the Amade open the battery door slightly 5mm anticlockwise figure Ab To program the Amade with the programming cable open the battery door to see the programming socket figure 4c Placing Removing the battery figure 5 The Amade audio processor uses a single Zinc Air 675 battery Figure 5 a c shows how to exchange the battery When the battery door is open the battery can be inserted or removed figure 5a Use a Zinc Air 675 battery inserted with the plus pole on top figure 5b c Remove the tab sticke
35. or families unless stated otherwise 20 VII Basic Tuning Next in the third tab you will see the Basic Tuning tab Curve Display In figure 25 a VSB b BB the input output gain Curve Display of the Connexx software can be seen 25a 125 250 500 1k 2k 4k 8kHz 25b 125 250 500 tk 2k dk 8k He figure 25 In the Curve Display the relation between the following axes can be seen X axis Frequencies from 125 Hz to 8000 Hz y axis Gain Output depending on what was set on the Curve Display settings Three black lines and three cherry red teal lines depending on which side is to be fitted teal for the left side cherry red for the right side can be seen in the curve display The cherry red teal lines represent the target gain output that Connexx calculated in the first fit according to the audiogram for inputs of 40 dB soft sounds 65 dB conversational level and 90 dB loud input sounds The black lines represent the current settings that are stored in the Amade and therefore the actual gain output of the system for the same input levels REMARK ADJUSTING THE CURVE DISPLAY TO DISPLAY THE CORRECT VALUES FOR THE VIBRANT SOUNDBRIDGE AND BONEBRIDGE SYSTEMS THE DEFAULT SETTINGS FROM THE CONNEXX SOFTWARE HAVE TO BE CHANGED FOR THE CURVE DISPLAY This can be done by selecting Settings gt Preferences in the menu There the first tab is the Curve Display tab where the following settings have to be s
36. ps from 15 dB to 105 dB To demonstrate the program change beeps press the Play alert tone button Frequency Shaping Speech Sound Instrument settings Alert tenes fall pregrama Program change s L w Bamary Loudness 1 ate Frequency SQUH nt Piery aliniona ls Vibrogram figure 31 28 REMARK If the alert tone is enabled in one program all activated listening programs are affected The beep frequency and loudness of the alert tones can be changed independently for each program REMARK In case that the battery supply voltage falls below a defined threshold the Amade switches into a power management state with a reduced output of 18 dB The Amade can still be detected via HIPRO in this case but Connexx will ask the user to replace the battery before the fitting is continued IX Programs in the Amade For different listening situations up to three programs can be activated All Amade parameters can be modified and individually adjusted in every listening program The programs can be seen sorted 1 to 3 from top to bottom either on the right or the left margin of the Connexx programming screen figure 32 Universal figure 32 Presets available in the Amade The following presets are available Universal Noisy Environment TV Music Telephone acoustically Outdoor Sports and Privacy Universal The Universal program which is stored under slot 1 is automatically active after switching on
37. r from the battery To achieve optimized battery performance it is recommended to wait one minute after removing the tab before closing the battery door Changing the magnet figure 6 The adequate strength of the magnet should be checked during every fitting session If the magnet Is too weak the audio processor may not stay on the user s head and if the magnet Is too strong reddening of the skin or pain can occur If the magnet appears to be too weak or too strong please change accordingly 10 To change the magnet figure 6 a c turn the battery door 180 anticlockwise from the closed position Once opened 180 the battery door can be lifted off and the magnet can be replaced Place the metallic part of the magnet facing down towards the bottom of the Amade battery compartment the plastic foam should be facing towards the top Replace the battery door by moving it to the same position as it was when it was lifted off Then turn the battery door clockwise 180 to the desired position Connecting the HI PRO box and program ming cable To program the Amade the HI PRO box GN Otometrics and a programming cable CS44 interface are required NOAHlink can be used as an alternative Connect the HI PRO box to the computer where Connexx and SYMFIT are installed plug the programming cable into the connector of the corresponding side of the HI PRO box Connecting the Programming Cable to the Amade To program the Ama
38. rom the curve display REMARK Figure 27 shows that an increase of the overall gain with the handle is not possible as the control is shown as non active This is interpreted in a way that channels 11 13 are already set at maximum amplification To increase that overall volume of the system the gain in the channels 11 13 has to be reduced first then the Master gain can be increased again Of course this changes the frequency shaping slightly The Maximum Power Output MPO By setting this control the maximum output of the system can be limited The MPO is a very fast compression of signals represented in the last 2 dB of output of the Amade This can be useful if the user complains that very loud sounds are uncomfortable The MPO can be set in increments of 3 dB from O dB no reduced output limit to 21 dB output limit reduced by 21 dB Setting the MPO represents a reduction of the dynamic range of the system and it is therefore suggested to do this with caution Setting the MPO control to the utmost right position sets the system into the Peak Clipping PC mode the MPO is deactivated This means that the system uses 2 dB more of output however this causes strong distortions if sounds reach the output limit of the system It is not recommended to use this setting Compression Frequency dependent amplification for loud and soft input sounds It is possible to separately adjust the gain for loud 90 dB and soft 40 dB
39. w and high frequency ranges to provide more bandwidth and sound quality The time constants of the compression are set to high values dual and the microphone system is set to omnidirectional mode Speech and Noise Management is set to medium attenuation 29 Telephone Acoustically The program Telephone acoustically is intended for telephone applications It is aimed to provide speech intelligibility for the narrow band telephone signal Hence the amplification in the middle frequency range is increased and decreased in the very low and very high frequencies The Microphone System is set to omni directional Wind Noise Reduction is turned off and medium is set for Speech and Noise Management as well as for Sound Smoothing Outdoor Sports The program Outdoor Sports is predominately intended for outdoor activities such as cycling and eliminates disturbing wind noise To achieve this goal a maximum Wind Noise Reduction is used and the microphone system is set to omnidirectional characteristics Additionally the amplification in the lower frequency range Is reduced with the Speech and Noise Management and Sound Smoothing being deactivated Privacy The program Privacy is intended for all applications where the Amade user does not wish to be disturbed by environmental sounds Hence the amplification is decreased by 9 dB for the whole frequency range The microphone system is set to omnidirectional and the Speech and Noise Manag
Download Pdf Manuals
Related Search