GOING BEYOND THE NORM: Sherlock’s Rule of Thumb in
Resolving Fitting Complaints
Note: The following is a summarized guide for
professional dispensers to follow in converting hearing
aid patient complaints into verifiable solutions. It is
based on workshop materials provided during Chartrand’s
Nuts & Bolts Problem Fitting Cases Workshop. The reader
will notice that many such complaints could have been
anticipated early on, during otoscopy,
impression-taking, or complaints of prior amplification
experience. The solutions offered align with Chartrand’s
neuroreflex model of the external ear.
“SOUNDS ARE MUFFLED”
Tell- tale Indications: very active otoscopy “red
reflex”
Probable Cause: Trigeminal reflex due to missing keratin
Possible Solution: 1) Very light pressure when making
impression, 2) Modify impression before sending to the
lab, by removing TMJ artifacts and by tapering the
canal.
“I FEEL PLUGGED UP WHEN I WEAR THESE THINGS” (EVEN AFTER
APPROPRIATE VENTING)
Tell- tale Indications: Cough, eyes water when you place
otoblock in ear.
Probable Cause: Vagus reflex
Possible Solution: 1) Mid-open mouth/chewing motion
during impression taking, 2) Taper canal up to the
aperture area.
“IF I WEAR THESE AIDS MORE THAN AN HOUR, THEY FEEL SO
TIGHT THAT I CAN BARELY GET THEM OUT OF MY EARS!”
Tell- tale Indication: Pain when otoblock approaches
bony isthmus area, evidence of: fungus, yeast,
pseudomonas, dermatitis.
Probable Cause: Lymphatic reflex (swelling)
Possible Solution: 1) Mid-open mouth impression, 2)
Avoid deep insertion, use extended receiver tube
instead, 3) Taper at bony isthmus, 4) Ensure that mold
material is non-allergenic (clear, without tint
coloring).
“THE LOUDER I TURN THESE HEARING AIDS UP THE LESS I SEEM
TO HEAR!”
Tell- tale Indication: SSPL90 PTA at or above
110HL/130SL
Probable Cause: Tensor Tympani Reflex (taut eardrum upon
sound pressure levels >87.5dBSPL)
Possible Solution: 1) Reduce SSPL90 PTA 2) Use AGC-O/I
with appropriate TK setting.
“IN THE MORNING THESE HEARING AIDS SOUND PRETTY GOOD,
BUT AS THE DAY GOES ON I START FEELING PLUGGED UP, AND
SOUNDS BECOME MUFFLED!”
Tell- tale Indication: Severe recruitment (MCL-to-UCL
<25dB), precipitous loss, OR works in noise, AND aids
were ordered without user VC
Probable Cause: Auditory Fatigue (loss of sensitivity
during the day)
Possible Solution: 1) Reorder with user VC, 2) Counsel
re: auditory fatigue, abnormal loudness growth, 3) Teach
about “function control” re Hybrid Digital, DSP, AGC-I,
etc.
“I’VE HAD THESE HEARING AIDS FOR 30 DAYS NOW, AND STILL
CAN’T UNDERSTAND ANY BETTER THAN WHEN I GOT THEM!”
Tell- tale Indication: Patient was not given appropriate
rehab format/counseling, progress was not
reported/measured/charted.
Probable Cause: Phonemic Regression
Possible Solution: 1) Counsel re: auditory deprivation
and neurophysiology, 2) Use wearing/rehab schedule re:
“circle of hearing”, etc. for 90-120 day period 3)
Enlist 3rd party’s assistance. (Note: Thirty-day trials
are the enemy of auditory rehabilitation).
“I STILL CAN’T HEAR IN NOISE OR IN A CROWD OF PEOPLE!”
Tell- tale Indication: Longstanding loss, possible CAPD
overlay, poor listening habits, poor mental attitude,
SHI
Probable Cause: Attentional/Squelch Deficit (CAPD)
Possible Solution: 1) Teach how to use technology
options, 2) Teach attending/squelching, 3) Assign
practical exercises, 4) Integrate re wearing/rehab
schedule, 5) counsel re poor residual thresholds,
introduce ALD’s, CS’s.
“I STILL CAN’T HEAR (TV)(SERMON)(TEACHER) WITH MY
HEARING AIDS!”
Tell- tale Indications: SHI, precipitous loss, history
of Meniere’s, Diplacusis, etc.
Probable Cause: High Frequency residual thresholds
>80dB, impossible to make audible without inciting
diplacusis or discomfort.
Possible Solution: 1) Introduce, counsel re ALD’s, CS’s,
(CC, FM, IR, Loop, speech reading, etc.) 2) Refer for
aural rehabilitation.
*NOTE: This above assumes the ear impression and earmold
meet customary standards of fit, the venting is correct
for the degree of loss in the lows, and that adequate
gain is appropriately provided at each possible
frequency. |
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