'Identity' Options in Oticon Syncro

Question

Answer

Probably the most vexing question accompanying the concept of Identities is "When should a change take place?" Based on our experience from the field, we have made the following observations about changes to identities:

• A change is called for if the patient has a negative overall perception of what the device is doing. When we say "overall perception" we mean that the concerns expressed by the patient seem to arch over a variety of functions in the device. If the complaint can be isolated to a specific function (hearing too many soft sounds, brief loud sounds are too loud, etc.), then perhaps changes in a specific system in the device (most often the compression settings) is warranted. If, however, the concern seems to be more general or even vague, an Identity change may be called for. All changes need to be verified over a week or two of field use. Positive and negative aspects of a particular Identity setting may not be apparent unless the device is used in realistic sound environments.
   
• Sometimes patients report hearing the device react to the environment. In that case, the first question to ask is whether the patient considers that a positive or a negative! Some patients will be re-assured when they hear the device react, as they'll presume it is doing what is was designed to do. Others may not like hearing the changes. Some may notice the changes if prompted, but may not have a strong opinion (positive or negative). Obviously, patients who are bothered by hearing the changes may need a less aggressive setting. Likewise, those who want more immediate verification that the device is doing something, may need a more aggressive setting. Importantly, the desire for a change may be temporary and the professional should be cautious about making a change, just to make a change. The patient who wants to make sure that he is "getting his money's worth" from the device may actually not like hearing the activeness of the device after a few days. And as stated above, all changes need to be verified over a week or two. An alternative strategy is to show the effects of the device via Syncro Live, rather than making changes in the programming. Those who want less apparent effects may be accustomed to a more stable, traditional non-adaptive hearing aid. These issues again point up the importance of not making Identity changes too quickly. A few weeks use with the prescribed Identity may be required for the patient to have a really good feel for what the device does and can do!
   
• The patient requests better speech understanding in noise. The two most important factors that drive speech understanding in background noise are audibility and Signal-to-Noise ratio. Changes in the Identities do not fundamentally affect these two factors, since the directional system will attempt to maximize the S/N in any Identity, and even in the Calm and Gradual Identity, soft speech sounds still receive significant amplification. However, changing to a different identity may affect the listener's perception. There are three typical scenarios to consider....
   
  1. One available change in Identities is the speed of compression. Although most changes in Identities are driven by the patient's subjective preference based on sound quality and reactiveness. Data from Gatehouse and Lunner suggested that patients with better cognitive skills performed better with faster acting solutions, and those with poorer skills needed a slower acting approach. These data are relevant as we have based the prescribed Identity in a large part on patient age. Since age and the other Personal Profile information are not perfect predictors, changing Identity (and thus changing compression release time) may have a direct influence on speech understanding performance.
      
  2. It's possible that patients with excellent cognitive and suprathreshold processing skills, will benefit from extra audibility for soft speech cues (due to treble boost and lower kneepoints) through aggressive Identities. Recent performance data from Copenhagen suggests some patients who have the Dynamic setting are more satisfied when re-programmed to the Energetic setting. This observation was made by several experienced Syncro dispensers, while working with younger, more active and more demanding clients. The Energetic setting works well for those patients.
      
  3. Third, because the kneepoints between the directional modes are slightly lower in the more aggressive Identities, it is possible that the advantages of directionality are experienced more often.

Donald J. Schum, Ph.D./CCC-A
Vice President,
Audiology & Professional Relations
Oticon, New Jersey