L’USAGE DES ÉCOUTEURS INSÉRÉS (INSERTS) EN AUDIOMÉTRIE ... · l’usage des Écouteurs...

L’USAGEDESÉCOUTEURSINSÉRÉS(INSERTS)ENAUDIOMÉTRIE

PROTHÉTIQUE.IMPLICATIONSDELANORMEIEC61669:2015DANSLAMESUREDURECD.

Atelier1– CongrèsUNSAF2017XavierDELERCE

L’audiométrieauxinserts:pourquoi?

24 C A N A D I A N H E A R I N G R E P O R T | R E V U E C A N A D I E N N E D ’ A U D I T I O N

For the 7000, if an audiologist doesnot measure and then enter the indi-vidually measured REDD, the Fryesoftware applies the average HL toSPL transformations (last column inTable 1) based upon data from ANSIS3.6-1989 (Table G1). Using thesevalues, the average transformationsshown in the far last column wouldbe added to the entered audiometricthreshold (in dB HL) to predict thepatient’s threshold in dB SPL for anySOG or LSM measures to follow. Ascan be seen in Table 1, the valuesmeasured for this patient differ fromthe average transformations and somedegree of error would be presentbetween the predicted and “actual”threshold of this patient. For example,at 250 Hz, the actual threshold (in dBSPL) would be 4 dB higher (i.e., poor-er) than predicted. The importance ofmeasuring the individual REDD forgreater accuracy in creating the indi-vidual DR cannot be overemphasized.For example, Figure 3 reports theintersubject variability at 500, 1000,2000 and 4000 Hz of the measuredREDD in 435 ears from 306 subjectsbased on an unpublished Capstoneproject by Keller.3 In Figure 3, therange of the intersubject variability ofthe REDD was 27.6 to 37.4 dBdepending upon test frequency.Further, Figure 4 reports the meanREDD for the WUSM study3 com-pared to the mean REDD reported in

ANSI-1989. As can be seen, the meanREDD measured in the Keller study3

(WUSM) is very close to the meandata reported in ANSI-1989 as well asreported in NAL-NL1 by Byrne et al4

and Valente et al.5 For those interest-ed, the standard deviations associatedwith the WUSM data were 4.8, 4.6,4.9, and 6.1 dB at 500, 1000, 2000,and 4000 Hz, respectively.

Clinical Use of REDD-Converting Threshold (dBHL) into dB SPL for SOG orLSM Due to issues related to the noise floorof the test room and probe micro-phone, it would be impossible tomeasure the SPL in the ear canal atlow hearing levels. By measuring theREDD at 70–80 dB HL, the audiolo-

gist can eliminate this artifact.That is, the REDD is theREDD no matter the dB HLused to make the measureassuming the attenuator of theaudiometer is linear (if not,then the audiometer shouldnot be used in the first place!).Once the REDD is measuredat the high dB HL for thepatient, this value is added tothe HL to document thepatients threshold in dB SPLas measured near the eardrum.

For example, observe the data inTable 2. In this example, the patient’shearing thresholds ranged from 5 to80 dB and the REDD (from Table 1)ranged from 10–23 dB SPL. By addingthe REDD (dB SPL) to the threshold(dB HL) the audiologist would havethe patient’s threshold in dB SPL andnot a predicted threshold based uponaverage transformations. As men-tioned earlier, using SOG’s and LSM,the goal may be to verify that REARfor a soft input level (e.g., 50 dB SPL)exceeded these values to assure thatsoft speech is audible. In some REMsystems, the clinician is able to inputthe individually measured REDD (col-umn three in Table 2) and these val-ues are used to create the thresholdtarget instead of the default averagetransformations.

Table 2: Convert threshold indB HL to dB SPL

Right EarHz HL REDD SPL250 5 23 28500 10 10 20 1000 25 13.5 38.5 2000 45 15 60 3000 55 20 75 4000 65 11 766000 70 14 848000 80 12 92

| RESEARCH AND DEVELOPMENT FOCUS

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Figure 3. Intersubject variability of REDD (Keller, 2006).

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Figure 4. Mean REDD reported by WUSM, ANSI-1989, NAL-NL1 and Valente et al., 1997 from Keller (2006).

Kelleren2006:435oreilles(adultes)• Onenvoieaucasque70dBHL• UnesondedeMIVmesureleniveauatteint

endBSPL• àSPL– HL=REDD

Historique

• Crééen1984parEtymoticResearch :modèleER-1pourlarecherchedansunpremiertemps

Historique

• En1985:modèleER-3Apourlesaudiologistes/audioprothésistes• Courbederéponseplate(peudepondérationsdecalibrationparrapportaucasque)• Simuleleseuilnormald’auditionautympan=MAP=situationdechamplibre

Evolutions

1985–ER3A

2005–ER5A

2015–ER3C

Conseil:préférerlesinsertsàtubeslongsER3A(toujoursenvente)ouER3C(plusrécents)

Aspectspratiques

1. Deuxlongstubesreliésauxécouteurs2. Unraccordplastiquefixéautube3. Lamousseetsontubenoirdanslequels’insèreleraccord4. Unsystèmed’attacheparclipouscratch(pluspratique)

Rappelsd’audiologieprothétiqueMAP,calibrationetRETSPL

Calibrationsurcoupleur2ccetRETSPL

Audiometer Calibration made portableAudiometer Calibration SystemsThe G.R.A.S. Audiometer Calibration Systems are all configured to meet the requirements of modern audio-meter calibration. They are easy and fast to setup and control, and can be upgraded as your calibration needs changes. Two standard packages are available and se-veral options can be added depending on the type and features of the audiometer and respective ear-phones connected.

Artificial EarsThe calibration systems are based on G.R.A.S.’ modular artificial ears and enables standardized calibration of supra- and circum-aural earphones, ear-inserts and tym-phanometers and free-field speakers. This means that

only one base is needed and that only the couplers are exchanged. All the ear simulators are combined with IEC 60941 standardized Type 1 measurement microphones and are covered by G.R.A.S.’ 5 year warranty program against defective materials and workmanship*.

Audiometer Calibration AnalyzerThe lightweight, handheld analyzer simultaneously shows the values for Leq, exact frequency and distortion - all in the same display. It includes a 1/3 octave frequency ana-lyzer for checking the ambient noise of the audiometric test room and free-field calibration. The free-field calibra-tion option includes a free-field microphone, extension cord and tripod in order to move the equipment out of the sound field.

Sound CalibratorIn order to verify the calibration system – artificial ears and analyzer – a reference sound source is efficient. The sound calibrator generates a sound pressure level of 114 dB at 1 kHz and is delivered with the needed adap-ters for all G.R.A.S.’ artificial ear systems. Depending on your quality control system requirements and daily use, G.R.A.S. recommends a traceable or accredited calibra-tion every 12 months for this unit.

* G.R.A.S. microphones can also be repaired should you by mistake damage the diaphragm.

HDA-200 Circum-aural earphones mounted on the IEC 60318-2 Ear Simulator (high-frequency coupler). This setup is based on a 1/2” measurement micro-phone.

EAR 3A Ear-insert mounted on the IEC 60318-5 2cc Coupler. This setup is based on a 1” measurement microphone.

TDH-39 Supra-aural earphones mounted on the NBS 9-A / IEC 60318-3 6cc Coupler. This setup is based on a 1” measurement microphone.

Calibration:1. Vousdélivrezunecertainetension

l ’écouteur2. Lorsquelapressionsonoredansle2cc

atteintuncertainniveau(=leRETSPL)…3. …leniveauaffichéparl’audiomètredevra

êtrede0dBHL

Calibrationsurcoupleur2ccetRETSPL

Audiométrie•EndBHL

Calculautomatique•dBHL+RETSPL2cc=SPLcoupleur

•dBHL+RETSPL0,4cc=SPLcoupleur

Commentpasserduniveau

(connu)danslecoupleurau

niveau(inconnu)autympan?

?

Avantagesdesinserts

Ilsnedécoiffentpas…

Plusfacilepourlesenfants

Avantagesdesinserts

• Facilitédeport• Emissionà+/- 5mmdutympan=moinsdefluctuationsinter-individuelles qu’aveclecasque

Emettrelesondansleconduitauditif(inserts)donnet-ilun« meilleurseuil »qu’aucasque?

Insertearphones :applicationtoavoid collapseoftheexternal auditory canal– Rev.Soc.Bras.Fonoaudiol.2012.Marangoni &Al.

Emettrelesondansleconduitauditif(inserts)donnet-ilun« meilleurseuil »qu’aucasque?

Insertearphones :applicationtoavoid collapseoftheexternal auditory canal– Rev.Soc.Bras.Fonoaudiol.2012.Marangoni &Al.

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250 500 1000 2000 3000 6000

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1- Pourquoicesdifférencesdanslesaigus?

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250 500 1000 2000 3000 6000

InsertsCasque TDHInsertsCasque TDHInsertsCasque TDH

Uncoupleurd’étalonnagespécifique

6ccpourlescasques

Audiometer Calibration made portableAudiometer Calibration SystemsThe G.R.A.S. Audiometer Calibration Systems are all configured to meet the requirements of modern audio-meter calibration. They are easy and fast to setup and control, and can be upgraded as your calibration needs changes. Two standard packages are available and se-veral options can be added depending on the type and features of the audiometer and respective ear-phones connected.

Artificial EarsThe calibration systems are based on G.R.A.S.’ modular artificial ears and enables standardized calibration of supra- and circum-aural earphones, ear-inserts and tym-phanometers and free-field speakers. This means that

only one base is needed and that only the couplers are exchanged. All the ear simulators are combined with IEC 60941 standardized Type 1 measurement microphones and are covered by G.R.A.S.’ 5 year warranty program against defective materials and workmanship*.

Audiometer Calibration AnalyzerThe lightweight, handheld analyzer simultaneously shows the values for Leq, exact frequency and distortion - all in the same display. It includes a 1/3 octave frequency ana-lyzer for checking the ambient noise of the audiometric test room and free-field calibration. The free-field calibra-tion option includes a free-field microphone, extension cord and tripod in order to move the equipment out of the sound field.

Sound CalibratorIn order to verify the calibration system – artificial ears and analyzer – a reference sound source is efficient. The sound calibrator generates a sound pressure level of 114 dB at 1 kHz and is delivered with the needed adap-ters for all G.R.A.S.’ artificial ear systems. Depending on your quality control system requirements and daily use, G.R.A.S. recommends a traceable or accredited calibra-tion every 12 months for this unit.

* G.R.A.S. microphones can also be repaired should you by mistake damage the diaphragm.

HDA-200 Circum-aural earphones mounted on the IEC 60318-2 Ear Simulator (high-frequency coupler). This setup is based on a 1/2” measurement micro-phone.

EAR 3A Ear-insert mounted on the IEC 60318-5 2cc Coupler. This setup is based on a 1” measurement microphone.

TDH-39 Supra-aural earphones mounted on the NBS 9-A / IEC 60318-3 6cc Coupler. This setup is based on a 1” measurement microphone.

2ccou0,4ccpourlesinserts

Audiometer Calibration made portableAudiometer Calibration SystemsThe G.R.A.S. Audiometer Calibration Systems are all configured to meet the requirements of modern audio-meter calibration. They are easy and fast to setup and control, and can be upgraded as your calibration needs changes. Two standard packages are available and se-veral options can be added depending on the type and features of the audiometer and respective ear-phones connected.

Artificial EarsThe calibration systems are based on G.R.A.S.’ modular artificial ears and enables standardized calibration of supra- and circum-aural earphones, ear-inserts and tym-phanometers and free-field speakers. This means that

only one base is needed and that only the couplers are exchanged. All the ear simulators are combined with IEC 60941 standardized Type 1 measurement microphones and are covered by G.R.A.S.’ 5 year warranty program against defective materials and workmanship*.

Audiometer Calibration AnalyzerThe lightweight, handheld analyzer simultaneously shows the values for Leq, exact frequency and distortion - all in the same display. It includes a 1/3 octave frequency ana-lyzer for checking the ambient noise of the audiometric test room and free-field calibration. The free-field calibra-tion option includes a free-field microphone, extension cord and tripod in order to move the equipment out of the sound field.

Sound CalibratorIn order to verify the calibration system – artificial ears and analyzer – a reference sound source is efficient. The sound calibrator generates a sound pressure level of 114 dB at 1 kHz and is delivered with the needed adap-ters for all G.R.A.S.’ artificial ear systems. Depending on your quality control system requirements and daily use, G.R.A.S. recommends a traceable or accredited calibra-tion every 12 months for this unit.

* G.R.A.S. microphones can also be repaired should you by mistake damage the diaphragm.

HDA-200 Circum-aural earphones mounted on the IEC 60318-2 Ear Simulator (high-frequency coupler). This setup is based on a 1/2” measurement micro-phone.

EAR 3A Ear-insert mounted on the IEC 60318-5 2cc Coupler. This setup is based on a 1” measurement microphone.

TDH-39 Supra-aural earphones mounted on the NBS 9-A / IEC 60318-3 6cc Coupler. This setup is based on a 1” measurement microphone.

Coupleursetréalités

Casque:théorique=6cm3 Insert:théorique=2cm3

Réalité:de7à1cm3 ?????? Réalité:de0,5à0,25cm3 enfonctiondel’âge

Chezlesenfants:encoreplusdedisparités

sound field, TDH, and insert earphoneconditions were derived from data collectedwith normal adult subjects. Thus, theassumption of equivalence across signaltransducer type should hold reasonablywell when testing the hearing of adults.

To illustrate, the monaural air-conduc-tion thresholds, in dB HL, for a hypo-thetical adult with sensorineural hearingloss are shown in Figure 1. In theory, thisindividual’s thresholds could be measuredin the sound field, or by using either aTDH series or insert earphones, and theresult in dB HL should be the same. This,of course, assumes that each of these alter-native audiometric signal transducers hasbeen properly calibrated and that the phys-ical/acoustic properties of the individual’sexternal ear approximate that of an aver-age adult.

Casual observation tells us that the exter-nal ears of infants differ in certain respectsfrom those of the average adult. The pur-pose of the following simulation is to con-sider how the physical characteristics of theexternal ears of infants might influence thevalidity of audiometric test results whenconventional procedures are used.

AN ILLUSTRATIVE EXAMPLETo illustrate the predicted effects of exter-nal ear acoustics on audiometric measures,we employ the following experiment. Wemeasure the hearing thresholds of a pre-

cocious 9-month-old under the same con-ditions that we used in testing the adult.For this simulation, we will assume thatthe 9-month-old has exactly the samedegree of sensorineural hearing loss as theadult at each frequency.

Three different monaural audiogramsare plotted in Figure 2 for this infant. Oneaudiogram was obtained in the sound field,one using a TDH-series earphone, and oneusing an insert earphone. It can be seenthat for the 9-month-old, the predictedthreshold values, measured in dB HL, nowvary as a function of the signal transducerused in the testing. The predicted differ-ences among the three audiograms can beexplained by what we know about thetransfer of sound from audiometric signaltransducer to the eardrum in infants andtoddlers9,14-16 relative to the correspond-ing acoustic transforms for the average adultear.17-19

Further, on the basis of availabledata,9,14,16 it can be predicted that the mag-nitude of these “signal transducer effects”increases inversely with age. (For example,greater differences for the three transduc-ers would be seen for a 3-month-old thanfor a 9-month-old.) Thus, when hearingsensitivity is measured in dB HL, theassumption of equivalence across audio-metric signal transducers is simply not valid.

Now let us assume that amplificationcharacteristics will be selected for this infant

on the basis of the audiometric data shownin Figure 2. The problem we confront isthat, depending on which of the alterna-tive signal transducers is used in the test-ing, the fitting algorithm used will select adifferent set of amplification characteris-tics for the same infant. Clearly all threeprescriptions cannot be equally appropri-ate for the same infant.

This is a problem to which there is asolution. To circumvent this problem, how-ever, one must be willing to consider analternative to conventional audiometricprocedures, one that is not based entirelyon adult norms.

SOME SOLUTIONSOver the years, many have asked whyaudiometric variables are defined in dBSPL (ear canal level) in the Desired Sensa-tion Level (DSL) method20 rather than inthe more conventional dB HL. One rea-son is contained in the preceding discus-sion. The key point is that the SPL at theeardrum required to hear a given test signalwill be the same regardless of the transducerused to deliver the signal. Consequently, theproblems associated with dB HL measuresdescribed above can be eliminated by mov-ing to a different point of reference in defin-ing threshold (i.e., dB SPL in the ear canal).

We are aware of two approaches thatcan be used to measure/define audiomet-ric measures in dB SPL in the ear canal.

66 The Hearing Journal Audiometric testing of infants October 1999 • Vol. 52 • No. 10

Frequency (Hz)250 500 1000 2000 4000-10

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Figure 1. Monaural air conduction thresholds, in dB HL, for an adultwith a sensorineural hearing loss.

Frequency (Hz)250 500 1000 2000 4000

-10

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Figure 2. Predicted monaural air conduction thresholds, in dB HL,for a 9-month-old infant with a sensorineural hearing loss. Thresh-olds are plotted as a function of the three different signal transducersused in the testing.

Seewald,B.R.C.,&Scollie,S.D.(1999).Infantsarenotaverage adults :Implicationsforaudiometric testing.Thehearing journal,52(10),64–72.

InsertsChamplibre

Casque

Avantagesdesinserts

• Facilitédeport• Emissionà+/- 5mmdutympan=moinsdefluctuationsinter-individuelles qu’aveclecasque• Isolationdubruitextérieur

2- Pourquoicesdifférencesdanslesgraves?

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61 Martin Lane • Elk Grove Village, IL 60007 847-228-0006 www.etymotic.comER003441-B ©2015

Figure 10

ER-3C INSERT EARPHONES for Audiometry

EXTERNAL NOISE EXCLUSION ER-3 Series insert earphones provide greater than 30-dB exclusion of background noise. As insertion depth increases, the amount of attenuation increases. Deeply-inserted ER3 foam eartips can provide noise exclusion equivalent to a single-wall booth. Testing to audiometric zero can be done reliably whenever the SPL of the background noise is less than 45 dBA. Figure 8 shows the attenuation of two audiometric earphones. ER-3 Series insert earphones have significantly greater attenuation than traditional supra-aural earphones and circumaural earphones.

INTERAURAL ATTENUATION AND MASKING

A comparison of the interaural attenuation of a TDH-39 and ER-3 Series insert earphone is shown in Figure 9. High interaural attenuation values reduce the need for masking air conduction thresholds when using insert earphones. In cases of severe bilateral conductive hearing loss, a masking dilemma (overmasking) occurs when a high level of masking in the non-test ear reaches the opposite (test ear) cochlea via bone conduction and elevates threshold in the test ear. Interaural attenuation is significantly higher with insert earphones, making it possible to use lower masking levels in the non-test ear.

Interaural attenuation of ER-3 Series earphones increases with insertion depth. Figure 10 illustrates the importance of deep eartip insertion when maximum interaural attenuation is desired.

WARNINGS

• Do not use insert earphones when medically contraindicated, e.g., draining ear, infection, ear canal laceration or other otologic condition where use of insert earphones could potentially exacerbate a medical condition.

• ER-3 Series earphones can produce high sound pressure levels. Use caution when selecting presentation level and duration.

• Reliable test results can be obtained with ER-3C earphones only when the audiometric equipment they are used with is calibrated before initial use and at subsequent intervals as specified by the audiometric equipment manufacturer, in compliance with national and international standards and regulations.

• ER-3C earphones are available in 10-Ohm and 50-Ohm impedance. It is essential that the correct impedance be used in accordance with the specifications of the audiometric equipment. Labels on the earphones identify the earphone impedance.

• Use of accessories or replacement parts other than those supplied by Etymotic Research or its authorized distributors may result in inaccurate results.

• Modification or alteration of any parts may invalidate test results. Example: The sound delivery tube should not be cut. A change of 10 mm in the length of the sound delivery tube will change the frequency response by 0.5 dB at some frequencies.

• Do not use in or near strong magnetic fields (e.g., MRI).• Do not reuse eartips. All eartips, regardless of material or construction are for single-person use

only. Replace eartips for each test session.

Figure 8

EXTERNAL NOISE EXCLUSION OF 2 EARPHONES

Real

-ear

Atte

nuat

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in d

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TDH50

ER-3 Series

Figure 9

INTERAURAL ATTENUATION OF TDH AND ER-3 SERIES EARPHONES

LeK-Wayencabine…

Avantagesdesinserts

• Facilitédeport• Emissionà+/- 5mmdutympan=moinsdefluctuationsinter-individuelles qu’aveclecasque• Isolationdubruitextérieur• Absorptiondesvibrationsparlamousse=diminutiondutransferttrans-crânien=masquagerare

DenouvellesrèglesdemasquagepourlaCA

Denouvellesrèglesdemasquage:débutdelarépercussionenCA

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Audiométrievocale:courbesderéférencedifférentesselonletransducteur

ANSIS3.6IEC60645-2ISO389-212,5dBSPL

19,5dBSPL

Calibrationdesinserts– Unefuturenormedecalibration

Calibreretmesurerdans0,4cc?

• +/- levolumerésiduelréeldel’oreille

• Possibilitédemesurerau-delàde8kHz

Calibrationdesinserts– Unefuturenormedecalibration

Calibreretmesurerdans0,4cc?

• +/- levolumerésiduelréeldel’oreille

• Possibilitédetestsetmesuresau-delàde8kHz…

Inconvénientsdesinserts

• Petitediminutiondel’intensitémaximalepossible

Unniveaumaximumentonaledifférent

Casque Inserts

Inconvénientsdesinserts

• Petitediminutiondel’intensitémaximalepossible• Uneaudiométriequiauncoût

Prix(parsachetde50)

• Newson =27€HT• Starkey =24€HT• Interacoustics =38€HT(les100)• GNOtometrics =50€95HT

2

Prixdesinserts

• Environ700€HT…• …plusunecalibration(env.500€)

Inconvénientsdesinserts

• Petitediminutiondel’intensitémaximalepossible• Uneaudiométriequiauncoût• UneinsertionproblématiquelorsdelaprésencedecérumendansleCAE

Auquotidien– Aspectspratiques

Travaillerauxinsertsauquotidien:branchements

GNOtometrics

6.3 Views of MADSEN Astera²

6.3.1 MADSEN Astera²

Front view - with cable cover Front view - without cable cover

A. On/Off indicatorB. On/Off switch

A. On/Off indicatorB. On/Off switch

Rear view -Connection panel

6.3.2 ACPFront viewMADSEN Astera² is operated from either the software or the ACP front panel.

The ACP front panel controls are described in detail in ACP front panel controls ► 106.

132 Otometrics - MADSEN Astera²

6 Unpacking and installing

Interacoustics

Affinity 2.0 Instruction for Use - English Date: 2008-10-03 Page 8/15

Operation Instruction Visible Speech VSP440 Module (optional software for REM440 module) 1. Enter the REM440 module as explained above in the paragraphs 1 - 5. If you have installed the optional Visible Speech VSP440 licence it is possible to press on the Visible Speech tag in left area where the test buttons are situated.

2. Push Start.

Various tools: Normal hearing view. This will show the unaided ear in a combined view with the amplified (aided) ear. Peak hold. Holds peak values allowing for visualization of the maximum exceeded values of the input signal. Show examples. Applies illustrations for demonstrating various everyday sounds. Both ears. Allows for a combined view of both left ear and right ear at the same time. Must be chosen before testing.

Affinity 2.0 - Connection Panel Dictionary

Visible Speech

Laconnexiondesinsertssefaitenparallèleàcelleducasque:l’usagedesdeuxtransducteursestpossible

Tailles

Modèle14C

18mm

Modèle14A

14mm

Modèle14B

10mm

Modèle14E4mm

Modèle14D

3,5mm

99%...

Miseenplacedesinserts

1– Préparation:écraserenroulant 2– Insertiondansleconduit

Contrairementaucasque:impactdel’occlusion

Insertioncorrecte Insertionpartielle Mauvaisdiamètre=effetd’évent

EffetsdupositionnementdansleCAE

Insertioncorrecte

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TravaillerauxinsertsReconfigurationdeslogicielsderéglagesetdeNoah

Travaillerauxinsertsauquotidien:leslogicielsfabricants(PHONAK)

Travaillerauxinsertsauquotidien:leslogicielsfabricants(WIDEX)

Travaillerauxinsertsauquotidien:leslogicielsfabricants(STARKEY)

Travaillerauxinsertsauquotidien:leslogicielsfabricants(OTICON)

Travaillerauxinsertsauquotidien:leslogicielsfabricants(RESOUND)

Travaillerauxinsertsauquotidien:leslogicielsfabricants(SIEMENS)

Travaillerauxinsertsauquotidien:Noah4

DanslemoduleAudiogram ModuledeNoah4

UsagedesinsertsenaudioprothèseEtaprès?

Baseinserts:desdBHLauxdBSPLautympan

• X.DELERCE,N.DURAND– 2010–50sujets• Onenvoie50dBHLauxinserts• MesuresimultanéeendBSPLautympan• 95%dessujetssontdansuneincertitudede7à11dBautympan=4à6dBautourdelamoyenneattendueendBSPL

Etaprès?L’audiométrieauxinserts:ported’entréeidéaleverslaMIVSupprimerlapetiteincertitudeentrelesdBémis(HL)etatteints(SPL):leRECD

LeRECDLechaînonmanquantentrel’audiométrie(auxinserts)etlaMIV

Rappel:dBémis(HL)etdBatteints(SPL)dansleconduitNousconnaissonsleniveaud’émissionendBHL…

…maisnousnepouvonspasconnaîtreleniveauautympansanslemesurer

TransformerlesniveauxHLenSPLautympanaprèsuneaudiométrieauxinserts

Audiométrie•EndBHL

Calculautomatique•dBHL+RETSPL2cc=SPLcoupleur

•dBHL+RETSPL0,4cc=SPLcoupleur

DifférencedBSPLoreille– dBSPLcoupleur•RECDmesuré•RECDstatistique/âge

dBHL + RETSPL + RECD = SPLautympan

InsertsetRECD:deuxétapessimples!

1- Emissiondansuncoupleur2ccou0,4cc 2- Emissiondansl’oreille

2cc

0,4cc

DifférenceSPLoreille– SPLcoupleur=RECD

Emissiondansl’oreille

Différence=RECD

Emissiondanslecoupleur

-15

-10

-5

0

5

10

15

20

Comparaison des RECD mousse aux coupleurs 0,4cc et 2cc chez l'adulte

Fréquence (Hz)

Am

plitu

de (d

B)

250 500 750 1000 1500 2000 3000 4000 6000 8000 12500

HA1 mousse coupleur de 0,4ccHA1 mousse, coupleur de 2ccDifférence 2cc - 0,4cc

RECDbase2cc

RECDbase0,4cc

Audiométrieauxinserts:établissementfiabled’unSPLoGramme

LeRECDsouffred’uneimagepeuclaire…

1. RECDHA1« mousse »2. RECDHA1« embout »3. RECDHA2« mousse »4. RECDHA2« embout »5. RECDparl’appareil…

Etpourtantc’estunemesuretrèssimple!!!?

𝐸𝐶𝐿𝐷 = 𝐿𝑝𝑒 − 𝐿𝑝𝑐 = 20𝑙𝑜𝑔𝑃𝑠𝑒𝑃𝑠𝑐 + 20𝑙𝑜𝑔

𝑍𝑒𝑍𝑐 + 20𝑙𝑜𝑔

𝑍𝑠𝑐 + 𝑍𝑐𝑍𝑠𝑒 + 𝑍𝑒

MaisqueveutdirelanormeIEC61669:2015aveccetteformule?

𝐸𝐶𝐿𝐷 = 𝐿𝑝𝑒 − 𝐿𝑝𝑐 = 20𝑙𝑜𝑔𝑃𝑠𝑒𝑃𝑠𝑐 + 20𝑙𝑜𝑔

𝑍𝑒𝑍𝑐 + 20𝑙𝑜𝑔

𝑍𝑠𝑐 + 𝑍𝑐𝑍𝑠𝑒 + 𝑍𝑒

1- Sileniveaudel’étapel’oreilleestlemêmequeceluidel’étapecoupleur,

alorscetermes’annule

2- Silecouplageétapeoreille/étapecoupleurestidentiqueetquel’impédancedel’écouteurest

supérieureàcelledel’oreille,alorscetermes’annuleégalement

Ilrestedonc:

𝐸𝐶𝐿𝐷 = 𝑅𝐸𝐶𝐷 = 𝐿𝑝𝑒 − 𝐿𝑝𝑐 = 20𝑙𝑜𝑔𝑍𝑒𝑍𝑐

C’estàdire:1. Vousréalisezvotreaudiométrieavecinserts+mousse=vousutiliserezun

RECDHA1« mousse »=étapecoupleurHA1(intra)/étapeoreille« mousse »2. Vousréalisezvotreaudiométrieavecinserts+embout=vousutiliserezun

RECDHA1« embout »=étapecoupleurHA1(intra)/étapeoreille« embout »3. TouslesRECDaucoupleur« HA2 »(contour)sontvivementdéconseillés

RECDetMIV15minutesdemesure…2RDVderéglagesenmoins(Kochkin– MarkeTrakVIII–2011)

Lesinserts:petitchangement,grandseffets!

Merci!Desquestions?