Download - Oticon

Paediatric Fitting Guide

Introduction
The Paediatric Fitting Guide for Sumo DM is designed to provide you with
practical, step-by-step fitting advice following the Genie software fitting
flow.
Special consideration has been included to address the different needs
and approaches required when working with young children, compared to
older children who can actively participate in the fitting. Thus, some suggested
steps may not be appropriate for all ages of children. In addition,
you may have your own established fitting protocol that includes additional
steps not noted here.
An abbreviated single sheet “Quick Paediatric Fitting Guide for Sumo
DM” is also available.
When fitting adults with Sumo DM, please refer to the Adult Fitting
Guide. That document follows a similar style as this guide, however
it does not include the detail and focus on the software features specifically
designed for paediatric fittings.
3
Step 1: ..................... pg 4
Step 2: ..................... pg 10
Step 3: ..................... pg 19
Step 4: ..................... pg 25
Step 5: ..................... pg 26
Appendix 1: Paediatric Loudness Judgement Scale
Appendix 2: Childrens Outcome worksheet (Cow)

1. Selection
SELECT INSTRUMENT
COMPLETE PERSONAL PROFILE
CONFIGURE THE INSTRUMENT
4

1. Selection
1.1 Select instrument
Tips & Notes:
Sumo DM is fitted with Genie 6.0 or higher.
When Genie detects the instrument, the model and type
are indicated.
CLICK ’DETECT INSTRUMENTS’
Make sure the instrument is switched on and connect
Sumo DM to the Hi Pro or Noah Link via programming
cable #3 and the Sumo programming shoe. Click ‘Detect
instruments’.
OR,
SELECT SUMO
Choose Sumo from the hearing instrument families displayed
across the top of the screen. Click on Sumo, then
BTE, DM.
5

1. Selection
1.2 Complete Personal Profile (1/2)
CHECK AGE
Genie will import the childs age for the first fit of
Sumo DM directly from Noah. If the correct age is not
in Noah, then the default for the fitting will be 70-79
years. The child’s age is extremely important as it can
affect the predicted RECD and REUR data that the software will use to
prescribe gain and MPO.
6

1. Selection
1.2 Complete Personal Profile (2/2)
Tips & Notes:
For the small ears of infants and children, the acoustics
of standard measurement couplers are not representative.
Corrections are needed because hearing instrument and
audiometer calibrations are performed with adult sized
couplers.
Information entered in the Audiometry field has no impact
on fittings for children older than 7 years. In addition, predicted
RECD/REUR values for children over age 7 are the
same as those for adults.
When using measured RECD/REUR data, be sure to select
one of the three measurement methods; ITE adaptor/Foam
plug, BTE adaptor/Foam plug or BTE adaptor/Own mould.
Change the graph view from RECD to “Audiogram corrected”
to view corrections to audiometric data.
OPEN RECD/REUR DIALOGUE
Use the Audiometry field to specify the
transducer used for obtaining audiometry
measurements. Genie corrects the audiometric
data according to the transducer chosen.
Choosing “Other” (for example, if results
were estimated based on ABR results) will
not cause any correction to the audiometric data.
ENTER RECD VALUES BY ONE OF THE THREE
METHODS:
1. Use average RECD and REUR values based on the age
selected or
2. Enter actual measurements. You must fill in ALL of the
values and click ‘Use’ to apply the new data to the fitting.
3. Click ‘Import from NOAH’ to import values from REM
equipment.
Click ‘OK’ when finished.
7

1. Selection
1.3 the Children’s Outcome Worksheets (Cow)
Tips & Notes:
The COW can also be accessed at the End Session screen.
A copy of the COW can be found in the appendix of this
Fitting Guide. There are separate worksheets for the child,
parent and teacher.
ESTABLISH EXPECTATIONS AND GOALS FOR THE
CHILD
The COW, an outcome measure for children aged 4-12, is
available as a PDF file, accessed here on the Personal Profile
page of Genie.
Ask the child, family and teachers to identify specific
situations in which they would like the child to hear better.
These items can become goals to measure the child’s performance
and benefits after a period of use with Sumo DM.
8

1. Select
1.4 Configure Sumo DM
Tips & Notes:
Within the 3 Programs, different Identities or linear
ratio nales may also be chosen. Click on the "+" to
open the drop-down menu.
The Program Manager can also be accessed in the
Fitting screen.
The default hook is undamped.
SELECT PROGRAMS
The 3-position switch on Sumo DM offers a combination
of 3 programs. The default configuration is
M-MT-T. For very young children where access to a
Telecoil (and FM) function is not required, the switch
can be configured as M-M-M with the same or multiple
acoustic programs. In addition, one or more switch positions
can be set as a dedicated OFF function.
If the child requires separate T and FM or DAI programs,
this can be completed in the Telecoil program in the
Fitting screen. (see section 2.7)
CHECK ACOUSTICS
Ensure Genie has an accurate representation of the
child’s earmould acoustics: venting, tubing, and earhook/damping.
If you are using a paediatric earhook,
select one denoted with (C) for child.
9

2. Fitting
RUN FEEDBACK MANAGER
ENSURE OVERALL LOUDNESS
CHECK MPO
PROGRAM THE V OLUME CONTROL
REVIEW PROGRAM MANAGER
CONFIRM SETTINGS FOR
T PROGRAMS
10

2. Fitting
2.1 Run Feedback Manager (FBM) (1/2)
Tips & Notes:
The purpose of running the FBM is to maximize the
actual gain in each of the 8 channels. The actual feedback
margin can differ from the estimated margin due
to the child’s earmould fit and ear canal characteristics.
Once the new feedback margin is established it will be
applied to all potential Identities, rationales and programs.
Running the FBM ensures optimal operation of the
Dynamic Feedback Cancellation system, which manages
any potential feedback from dynamic acoustic changes
e.g., caused by a hug or chewing.
Establishing the feedback margin ensures full use of the
Volume Control without feedback.
ENTER THE FEEDBACK MANAGER (FBM)
Run the Feedback Manager whether feedback is present
or not, before making any adjustments.
RUN THE FBM - STEP 1
Automatic detection is used while the child remains inactive.
(It may help to distract the child).
RUN THE FBM - STEP 2
Ask the child to move her jaw and head while the automatic
detection is running to address dynamic conditions.
11

2. Fitting
2.1 Run Feedback Manager (2/2)
Tips & Notes:
When working in the Fitting screen, adjustments to any
of the trimmers will not exceed established feedback
limits.
Using the Feedback Manager graph:
The dashed line represents the prescribed gain for a
specific program. The shaded region above is where
feedback is anticipated. The white region in-between
represents the amount of additional gain that could
potentially be accessed when the volume is increased.
USING THE FEEDBACK T RIMMER
This optional trimmer can be used to provide a quick
overall reduction, applied equally across all channels in 2 dB
steps per click. The resulting change in the feedback margin
is seen on the graph.
Running the FBM routine is recommended rather than
using the Feedback Trimmer since the FBM provides changes
in the margin in each channel independently, rather than
the overall reduction applied by the Feedback Trimmer.
The Feedback Trimmer is excellent for babies or children
who can't sit still as you can make overall adjustments
quickly and easily.
12

2. Fitting
2.2 Ensure Overall Loudness
Tips & Notes:
Each adjustment of the trimmer typically results in 2 dB
incremental changes in MPO and gain. Headroom is maintained
across changes in MPO and gain.
Changes made to the Overall Loudness trimmer will be
applied automatically to other programs and Identities
(not between Identities and rationales). The gain at the prescribed
Volume Control settings will be reset according to
the Overall Loudness trimmer.
INCREASE OR DECREASE OVERALL LOUDNESS
The Overall Loudness trimmer offers easy
combined adjustments of MPO, gain and
compression to accommodate the child’s
perception of loudness.
13

2. Fitting
2.3 Check MPO
Tips & Notes:
Use sounds within Genie's “Sounds and Pictures”
dialogue to simulate the loud environments the child
encounters during the day.
A MPO set too high may cause discomfort, causing
some children to decrease the VC and therefore reduce
audibility of speech.
RESHAPE THE MPO ACCORDING TO THE CHILD’S NEEDS
(IF NECESSARY)
Compare and modify the MPO settings
according to the child’s aided real ear
measurements. MPO controls are displayed
in dB HL.
You can access the MPO control for each of the 8 channels if
desired, using the Standard fitting panel.
Ensure that the child does not experience unnecessary discomfort
during MPO testing. If the child is old enough, you can use the
paediatric Loudness Judgement Scale (in the appendix) to help
obtain an accurate response from the child.
14

2. Fitting
2.4 Verify the Fitting
Tips & Notes:
Sumo screen
kommer
Access the “Settings for REM” and “Tips for REM” by opening
the Tools menu and selecting “Real Ear Measurements”.
These dialogue boxes will indicate what issues you should
consider when running REM. The “Settings” options lets you
turn off those hearing aid features that might interfere with
certain input test signals; changes are applied to the instrument
during the testing and reset when you close the REM
Tool dialogue.
Genie provides trimmers across three input levels for fitting:
Soft (30 – 45 dB) input level; Speech (65 dB) input level; and
Loud (85 dB) input level. Select the level that best suits your
fine tuning needs to match the targets from the REM equipment.
COMPARE TARGET AND ACTUAL CURVES
If your REM equipment is compatible with NOAH, open the
REM dialogue from the NOAH toolbar.
Confirm targets with Real Ear Measurements (REM) for soft, speech, and
loud inputs.
Compare curves in the REM equipment with those in Genie. Look for
any large, systematic differences between the curves. Verify audibility of
soft, speech, and loud inputs.
Gain or response changes are easily achieved in the Quick Panel using
either the channel or input level trimmers. If changes are needed within
one of the 8 channels, adjust the response curves with the trimmers in
the Standard panel.
15

2. Fitting
2.5 Verify automatics
Tips & Notes:
You may want to consider the medium setting of TriState
noise reduction for a child that has never used noise reduction
before.
TriState noise management can be disabled.
REVIEW AUTOMATIC SETTINGS
To review settings for compression time and
TriState Noise Management (default setting is
“Full”), open the Expanded Panel.
16

2. Fitting
2.6 Program the Volume Control (VC)
Tips & Notes:
Disabling the VC also disables the OFF functionality in
VC.
The instrument's VC is disabled when connected
to Genie and the gain will default to the prescribed
vo lume setting regardless of where the user has manually
set the VC.
The prescribed VC setting (typically level 3) is indicated
by an audible beep and flash of the LED.
The actual prescribed setting is available in the End
Session screen together with adjustments to audible
and visual status indicators.
SET RESERVE GAIN
Check reserve gain, which is the amount of gain available
to the child above the preferred/prescribed VC
setting. The child or caregiver can identify the prescribed
VC settings through an audible beep and flashes of the LED.
CONSIDER MAKING THE VC WHEEL TAMPER RESISTANT.
To make the VC wheel tamper resistant, click “Disable” to disable the VC
wheel. This will also disable the OFF function in the VC.
17

2. Fitting
2.7 Review Program Manager
Tips & Notes:
Program changes for R and L are linked by default.
Within the Program Manager, the prescribed
Identity is noted with the bull’s-eye icon.
You can also use the Program Manager to create different
programs for different listening environments, or for
comparison of different Identities or rationales.
Change telecoil programs by choosing the appropriate
program P1/P2/P3 containing a telecoil function and by
adjusting the appropriate trimmers.
CLICK ON THE PROGRAM MANAGER TO ENTER THE
CONFIGURATION
The Program Manager offers full flexibility to pro gram
the 3-position switch with any desired combination of
M, MT and T as well as an optional OFF position.
For two different microphone programs using the same identity, click P2
then choose “copy P1” Remember to “unlink”. You can shape and modify
P2 after opening it from the toolbar.
18

2. Fitting
2.8 Confirm settings for T programs
Tips & Notes:
For MT and T programs linear processing is applied,
this can be seen in the trimmer values. For non-linear
adjustments, select unlock - giving acces to each individual
trimmer - and copy the values from the general
program.
When an FM/DAI shoe is connected to Sumo DM,
the T program becomes ‘FM only’ and the MT will
become ‘FM + M’, by default.
To allow the child’s use of the telecoil when an FM/DAI
shoe is connected, disable this automatic detection.
ACCESS THE T ELECOIL FUNCTION WITHIN A DESIG NATED
PROGRAM
To boost the T in an MT program, select input level trimmers and
increase gain. Then decrease the M relative to the increase of the T
trimmer. The telecoil has 6 dB more gain available than the M.
Change the MT or T response shaping by using the channel trimmers.
Ensure availability of T and MT programs (this is needed in order to
have FM and M+FM programs)
Click on “unlock” in order to get a non-linear response of telecoil.
19

3. Fine Tuning
Tips & Notes:
When fitting young children who cannot provide
reliable feedback, fine-tuning typically will be postponed
until a follow-up visit, with adjustments made
according to parental report or an assessment tool.
Please refer to Oticons new assesment tool overview
"Incorporating Functional Auditory Measures into
paediatric pratice".
REVIEW CHOSEN IDENTITY
USE THE FINE T UNING GUIDE IN GENIE
FINE TUNE WITH THE
TRIMMERS
20

3. Fine Tuning
3.1 Review chosen Identity (1/2)
Tips & Notes:
Older children with severe-to-profound hearing loss
have different listening experiences and auditory resolution
abilities. These differences may lead to different
processing requirements. The Identities provide an
easy and intuitive method to vary the degrees of gain,
compression and noise management to address these
differences.
If the child or family has a specific complaint, the Fine
Tuning guide will provide the best outcome.
MINIMIZE FINE T UNING
CONSIDER CHANGING IDENTITY
The Active Identity is the default for children under age
17 providing a moderate amount of compression.
Consider other Identities if the child is old enough to
provide feedback and you believe the child may perform
better.
If the child reports a general speech clarity problem or
an overall dissatisfaction, consider changing to an Identity
next to the one chosen.
21

3. Fine Tuning
3.1 Consider changing Identity (2/2)
Tips & Notes:
The Dynamic Identity provides the most complex signal,
while the classic Identity provides the simplest signal.
Dynamic Identity: Provides increased access to soft sounds
and the highest amount of compression with a maximum
responsiveness to environmental changes. Suitable for
children with a high auditory resolution.
Active Identity: Provides moderate compression and a
rapid response to environmental changes. Suitable for
children who can make use of soft sounds and an active
noise reduction.
Gradual Identity: Provides less access to soft sounds and
minimum compression with a slower response to environmental
changes. Suitable for children who benefit from
minimum amounts of compression and a gradually acting
noise reduction.
Classic Identity: Provides linear processing and a stable
response to environmental changes. Suitable for children
with left corner audiograms.
CLICK ON THE IDENTITY SELECTOR TO
CHANGE IDENTITY
Select a different Identity, and allow a few seconds for
the instrument to adjust to the new Identity.
If an Identity has been fine-tuned in the same session,
you can choose between the prescribed or fine-tuned
version.
If you have made comparisons of the Identities within
a session, remember that any fine-tuning will only be
retained for the saved identity.
Click on “i” to access the description of the different
identities.
22

3. Fine Tuning
3.2. Use the Fine Tuning Guide
Tips & Notes:
Play sounds to help the child and the family define the
problem. Genie contains sounds and pictures specifically
adapted for and appealing to young children. You can
access the “Sounds for Children” from the Sounds and
Pictures dialogue.
Link the programs to apply fine-tuning changes to all
programs.
IDENTIFY THE PROBLEM
Select one of the five buttons at the top of the screen
that matches the child’s or family’s specific complaint.
Press the words that further describe the
complaint.
Double click on the word at the end of the tree
structure.
Click “Apply” to implement the changes.
23

3. Fine Tuning
3.3 Use the Trimmers (1/2)
Tips & Notes:
The Quick panel provides three input levels of
trimmers, Soft, Speech and Loud.
Soft (50 dB) input level
Speech (65 db) input level
Loud (80 dB) input level
The eight channels are bundled into three channels,
LF, MF and HF.
Use of the Overall Loudness trimmer is highly recommended
to make adjustments to gain, MPO and compression
ratio.
FINE TUNE WITH THE QUICK PANEL
TRIMMERS
Consult the Fine Tuning Guide in Genie to get suggestions
for adjustments based on the child’s specific complaints.
Adjust trimmers by:
INDIVIDUAL BOXES
Click on the individual box. Then click on the up and
down trimmer buttons.
INPUT LEVEL
Click on the ‘Soft’, ‘Speech’, or ‘Loud’ boxes. Then click on
the up and down trimmer buttons.
FREQUENCY
Click on the ‘LF’, ‘MF’, or ‘HF’ boxes. Then click on the up
and down trimmer buttons.
24

3. Fine Tuning
3.3 Use the Trimmers (2/2)
Tips & Notes:
In the Standard and Expanded panels, the MPO and
input level trimmers are provided for all 8 channels.
The Compression Time can be defined separately for
each microphone program. Apart from the default setting,
slower and faster compression times are available.
The TriState Noise Management can be defined
separately for each microphone program, if desired.
The default setting is Full; Middle and Off are also
available.
FINE TUNE WITH THE EXPANDED PANEL
TRIMMERS
The Expanded Panel displays all 8 channels, and the three
input level trimmers for each, as well as MPO.
Use the TriState Noise Management trimmer to change
the setting to middle effect or to turn off.
Use the CR button to view compression ratio.
Use the Compression Time trimmer to select faster or
slower compression time.
25

4. End Session
Tips & Notes:
Sumo DM defaults to a beep level of 70 dB and beep
frequency of 500 Hz. The beep frequency and intensity
level can be changed to meet the audibility requirements
of the child.
In Sumo DM, audible beeps are provided for:
program/switch change (optional)
preferred VC level setting (optional)
low battery warning
Sumo DM also has a flashing light mode when the VC
is at the preferred level and for program/switch changes
(Simultaneously with the audible beep indicator).
REVIEW PROGRAMS AND STATUS INDICATORS AT THE
END SESSION PANEL
Review the programs and Identity that
will be saved into the instruments.
Click on the Status Indicator to view
and change the default levels of the
audible beeps.
Consider activating the visual status
indicator. This feature is default ON
below age 8. It indicates that the instrument
is ok and the battery is functio ning.
26

5. Counselling
INSTRUCT T HE CHILD, FAMILY
AND TEACHERS
USE THE COW
RUN SUMO DM LIVE
27

5. Counselling
5.1 Instruct the child, family, and teachers
Tips & Notes:
The handling and user instructions can be printed to
aid in counselling the child, family, and teacher. You
can also refer to the Sumo DM “Instructions for Use”
booklet. There is a generic use and care booklet, “Your
Hearing Aids” for counselling school-age children.
Oticon’s OtiKids program has created the Parents’ Guide
and Teacher’s Guide which explains hearing loss, communication
options, and ways to support the child.
The Family Notebook aids in collecting the observations
of the parents and caregivers to provide feedback
on how the child is doing with their hearing aids.
More information on support materials is available on
www.otikids.com
REVIEW SWITCHES AND PROGRAMS
Instruct the child and family on how to handle Sumo DM,
including the use and functions of the 3-position switch;
use of Telecoil; OFF functionality; FM/DAI usage; and the
status indicators.
Use the pictures in End Session to enhance this review.
Click on the ‘i’ button next to hearing instrument instructions.
28

5. Counselling
5.2 Use the COW
Tips & Notes:
When working with older children with previous
hearing aid experience, it might also be important
to consider differences and improvements compared
to their previous instruments.
DETERMINE NEEDS AND DISCUSS GOALS
Access and print out the COW (Children’s Outcome
Worksheets) from within the End Session screen. A copy
of the COW can be found in appendix 2 of this Fitting
Guide.
There are separate sheets for the parents’, child’s, and
teacher’s needs. These can be used to evaluate the benefits
of the new instruments.
29

5. Counselling
5.3 Run Sumo Live
Tips & Notes:
When using Sumo Live, instruments need to be connected
and ON to run the Live View.
Pause Live View to emphasize a point and counsel the
family.
Access Sumo Live in the Fitting screen to demonstrate the performance and benefits
of Sumo DM.
ENVIRONMENT IDENTIFICATION
Indicates intensity level of sound in each of Sumo DM’s channels and if feedback
is detected.
AMPLIFICATION STRATEGY
Demonstrates aided and unaided response of Sumo DM in relation to the child’s
hearing thresholds in each channel.
TRISTATE NOISE MANAGEMENT
Demonstrates the performance of TriState Noise Management, based on the input
type. Choose appropriate sound environments from the Sound Player. The amount
of reduction in each channel is also demonstrated.
SOUND STUDIO
Open the Sound and Picture Dialogue. Select
the 'Sound Studio' tab. Select the situations the child
encounters in daily life. Demonstrate how the child can
expect to hear in these situations.
30

Appendix 1
Loudness Judgement Scale
Too Loud Loud but comfortable Comfortable Soft but comfortable Too Soft
31

Appendix 2
The COW
32

www.oticon.com
We believe that it takes more than
technology and audiology to create
the best hearing instruments. That’s
why we put the individual needs
and wishes of people with a hearing
loss first in our development of
new hearing care solutions.
904 55 810 00/01.05 Printed in Denmark