Oticon Fitting Guide Comprehensive

Before fitting

During the fitting session

1. Through Noah, open Oticon Genie 2. Click on CONNECT in either the WELCOME or SELECTION screen. If using Genie 2 stand-alone, go to PATIENT and open Audiogram to enter the patient's audiogram and connect the hearing aids.
2. Select Personalization in either the WELCOME or SELECTION screen. Under PATIENT DATA, fill out basic information about your patient such as experience level and native language. Next, under PERSONALIZATION METHOD, select either the Audible Contrast Threshold (ACT) or the Personalization questionnaire.
   1. By selecting Audible Contrast Threshold (ACT), the obtained ACT value will either be automatically imported from Noah, or you may have to manually enter it in the designated box. Once entered click SAVE.
   2. If ACT is not available, the Personalization questionnaire can be filled out.

Description of Figure 1: The screen displays the Oticon logo and navigation tabs including WELCOME, SELECTION, FITTING, and END FITTING. Under CLIENT DATA, fields for Experience (right/left ear), Client language (English), and Gender are shown. The PERSONALIZATION METHOD section offers two options: "Audible Contrast Threshold (ACT)" with a description of its function in speech-in-noise ability and a note about mild speech-in-noise problems, and "Personalization questionnaire" with a description of its function based on subjective preferences. An input field for the ACT value is present, along with a slider ranging from 'Normal' to 'Severe' for hearing loss levels, indicating a recent change on 12/13/2023.

In FITTING, complete the following steps

1. Select Acoustics: First, ensure that the acoustics placed in the patient's ears match the selected acoustics in Genie 2. It is recommended to use the default acoustic option for best performance.
2. Select Program Manager: The recommended fitting rationale for Oticon hearing aids is VAC+. However, a generic fitting rationale can be selected when choosing programs for your patient.
3. Select Feedback Analyzer: Ensure the patient is wearing their hearing aids before clicking START. Remember to warn the patient that the sound produced during the measurement may be loud but will only last a few seconds. Running a feedback analysis better ensures preservation of gain all day when there is dynamic movement around the head or neck.
4. Select REM AutoFit: Perform a target match to the chosen fitting rationale using Real Ear Measurement. REM AutoFit or Manual REM can be performed. These measurements will ensure the hearing aid gain and output meet prescribed targets. The fitting rationale chosen in REM AutoFit must match the fitting rationale selected in step 2 above.
5. Select Fine-tuning:
   1. Optional: Adjust the Adaptation Manager (1, 2, or 3). Keep in mind that a new user may benefit from starting at a lower gain level (1 or 2) and gradually adapting to the prescribed gain (3) over time. Automatic adjustment over time is available under MORE TOOLS and then Automatic Adaptation Manager. For new users, the adjustment period may take up to 4 months.
   2. Optional: Adjust SUDDEN SOUND STABILIZER. This feature seamlessly monitors the sound environment and instantly adapts amplification to keep both soft and loud sudden sounds available, balanced, and comfortable, without compromising access to speech. By default, Sudden Sound Stabilizer is set to Medium. The feature is customizable and can easily be adjusted to address varying levels of patient sound sensitivity based on clinical judgment and UCL values.
6. If ACT is not measured: Select MoreSound Intelligence™ to adjust the advanced signal processing and provide the appropriate amount of help for your patient in complex listening environments.
   1. Turn your screen towards the patient and ask a simple question: "Which situations are Easy or Difficult for you?"
   2. Use the ENVIRONMENT CLASSIFIER with the patient to choose which situations are difficult or easy. Then, move the boxes at the top to the appropriate side.
   3. When finished categorizing the environments, move on to personalizing Neural Noise Suppression. This feature adjusts the strength of the support provided by the Deep Neural Network 2.0, for both easy and difficult situations.

Description of Figure 2: The screen shows the Oticon logo and navigation tabs. It features sections for CLIENT DATA, PERSONALIZATION, ACOUSTICS, and AUDIOMETRIC DATA. A key element is the ENVIRONMENT CLASSIFIER, which includes two columns: "I find these situations Easy" and "I find these situations Difficult." Within these columns, users can select various listening environments. Below this, the Neural Noise Suppression slider is displayed, with options for adjustment.

7. In Oticon Genie 2, it is possible to use data logging for counseling, employing the hearing aid user's voice activity in different listening environments. To obtain conversation activity data, it is crucial to receive consent in advance. Follow the steps to turn on conversation activity:
   1. Under MORE TOOLS, click on Data Logging.
   2. The patient must be informed that data logging tracks the progress of their hearing aid use, including use time, conversation activity, and time spent in different environments, and that conversations are not recorded as part of data logging. The obtained data can be used in a follow-up visit to discuss the patient's ability to converse and engage in different listening environments.
   3. If the patient consents, click on Patient agrees under Conversation activity.

In END FITTING, complete these steps

1. Go to Controls, then BUTTONS AND TAPS, and into CALL CONTROLS to adjust the settings for hands-free call control. This functionality makes it possible to answer and end calls by tapping the hearing aid. [note]
2. Go to AUDIBLE INDICATORS to demonstrate the available sound indicators for e.g., Program change (in STANDARD) or Answer call (in CALL CONTROLS). Additionally, the Battery low indicator is available as a spoken indicator in select languages.
   1. If the patient prefers no audible indicators, consider going to VISUAL INDICATORS to make modifications.
3. To end the fitting session, click SAVE AND EXIT.

After Fitting

1. Help your patient connect their hearing aids to any external devices.
2. If your patient uses a smartphone or tablet, recommend that they download the Oticon Companion app. With the app your patient can easily and discreetly control their hearing aids and access Oticon RemoteCare.

At a follow-up visit, either in-person or remotely

1. If the patient has initially given consent, click on Data Logging under MORE TOOLS.
   1. It is recommended to use the data shown in ENVIRONMENTS as an overview of time spent in different environments, while CONVERSATION ACTIVITY shows the average time the user has actively been speaking over a given time period.
2. Based on the patient's experiences after the last visit, further adjustments can be made to their help-in-noise settings:

   Go to MoreSound Intelligence

   Select Sound Configuration (See Figure 2)

   Adjustments for easy situations

   Consider adjusting Virtual Outer Ear, which helps spatial sensation in easy situations.

   Adjustments for difficult situations

   Consider adjusting Sound Enhancer. This feature works dynamically, i.e., it activates in noisy situations to preserve and enhance speech detail when noise suppression is actively working.

   Patient questions for easy situations

   Ask your patient these simple questions:

   • "Do you want to focus a bit more on someone in front of you, in quieter situations?" – if yes, choose Focused.
   • "Do you want to be very aware of all sounds around you in quieter situations?" – if yes, choose Aware.

   Patient questions for difficult situations

   Ask your patient these simple questions:

   • "In difficult listening situations, are you sometimes overwhelmed?" – if yes, choose Comfort.
   • "When listening to speech in difficult situations, do you prefer more speech details?" – if yes, choose Detail.
3. Complete an assessment questionnaire with your patient to validate their hearing aid fitting. If a questionnaire was administered prior to fitting the hearing aid, compare the patient's answers to determine the benefit from amplification and rehabilitation.

References

1. Cassarly, C., Matthews, L J., Simpson, A. N., & Dubno, J. R. (2020). The Revised Hearing Handicap Inventory and Screening Tool Based on Psychometric Reevaluation of the Hearing Handicap Inventories for the Elderly and Adults. Ear and hearing, 41(1), 95-105. doi.org/10.1097/AUD.0000000000000746
2. Laboratory, N. A. (2023). A clinical tool with a focus on patient's individual needs widely adopted when designing rehabilitation program in appointments. Retrieved from NAL: www.nal.gov.au/nal_products/cosi
3. Dillon, H., James, A., & Ginis, J. (1997). Client Oriented Scale of Improvement (COSI) and its relationship to several other measures of benefit and satisfaction provided by hearing aids. Journal of the American Academy of Audiology, 8(1), 27-43.
4. Noble, W., Jensen, N. S., Naylor, G., Bhullar, N., & Akeroyd, M. A. (2013). A short form of the Speech, Spatial and Qualities of Hearing scale suitable for clinical use: the SSQ12. International journal of audiology, 52(6), 409-412. doi.org/10.3109/14992027.2013.781278