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Clinic Hearing Aid Comparisons: CROS Technology

Clinic Hearing Aid Comparisons: CROS Technology. Scot Frink, AuD Salem Audiology Clinic California Academy of Audiology September, 2018. Disclaimer. Independent practitioner; do not work for or have any vested interest in any hearing aid manufacturer. Overview.

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Clinic Hearing Aid Comparisons: CROS Technology

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  1. Clinic Hearing Aid Comparisons: CROS Technology Scot Frink, AuD Salem Audiology Clinic California Academy of Audiology September, 2018

  2. Disclaimer • Independent practitioner; do not work for or have any vested interest in any hearing aid manufacturer.

  3. Overview • Brief review of available CROS / BiCROS Solutions for Single-Sided Deafness • Review of the 2016 – 17 clinical study by Salem Audiology Clinic

  4. Menti Question 1A!

  5. Additional Disclaimer • A weakness of product comparisons is technological turnover. • Since this study was completed, all four manufacturers involved—Signia, Starkey, Phonak, and Widex have all released new product platforms, all CROS compatible, some with significant changes. • Despite this, the information is still relevant.

  6. Salem Audiology Clinical Comparison Studies • 2000: Phonak (Adult utilization of FM technology) • 2005: Phonak, Unitron, Interton (CROS) • 2007: Phonak, Starkey (Feedback control) • 2010: Phonak, Unitron (CROS) • 2014: Phonak, Widex (CROS) • 2015: Superpower BTE vs. RIC • 2016-17: Phonak, Widex, Starkey, Signia (CROS) • 2017-18: AmpCROS Case studies • 2017 (in progress): Unitron, Widex, Signia (Tinnitus) • 2018 (in development): OTC vs. Prescribed comparison

  7. Salem Audiology Clinical Comparison Studies • 2000: Phonak (Adult utilization of FM technology) • 2005: Phonak, Unitron, Interton (CROS) • 2007: Phonak, Starkey (Feedback control) • 2010: Phonak, Unitron (CROS) • 2014: Phonak, Widex (CROS) • 2015: Superpower BTE vs. RIC • 2016-17: Phonak, Widex, Starkey, Signia (CROS) • 2017-18: AmpCROS Case studies • 2017 (in progress): Unitron, Widex, Signia (Tinnitus) • 2018 (in development): OTC vs. Prescribed comparison

  8. Salem Audiology Clinical Comparison Studies • 2000: Phonak (Adult utilization of FM technology) • 2005: Phonak, Unitron, Interton (CROS) • 2007: Phonak, Starkey (Feedback control) • 2010: Phonak, Unitron (CROS) • 2014: Phonak, Widex (CROS) • 2015: Superpower BTE vs. RIC • 2016-17: Phonak, Widex, Starkey, Signia (CROS) • 2017-18: AmpCROS Case studies • 2017 (in progress): Unitron, Widex, Signia (Tinnitus) • 2018 (in development): OTC vs. Prescribed comparison

  9. Salem Audiology Clinical Comparison Studies • 2000: Phonak (Adult utilization of FM technology) • 2005: Phonak, Unitron, Interton (CROS) • 2007: Phonak, Starkey (Feedback control) • 2010: Phonak, Unitron (CROS) • 2014: Phonak, Widex (CROS) • 2015: Superpower BTE vs. RIC • 2016-17: Phonak, Widex, Starkey, Signia (CROS) • 2017-18: AmpCROS Case studies • 2017 (in progress): Unitron, Widex, Signia (Tinnitus) • 2018 (in development): OTC vs. Prescribed comparison

  10. Menti Question 1B!

  11. Candidacy • Very poor or no residual hearing is the worse ear. • Aidable or normal hearing in the better ear • CROS: No amplification to the better ear • BiCROS: At least some amplification to the better ear • I have personally found that most patients prefer BiCRO even if they are truly a CROS candidate

  12. Candidacy • Word Recognition tests • If there is no residual hearing (confirmed) in the worse ear, test only the better ear. • If there is any residual hearing in the worse ear, you must test binaural to avoid causing auditory deprivation and to truly rule the patient a CROS candidate.

  13. Candidacy • Word Recognition tests • Good ear 80%, bad ear 20%, binaural 96% • FIT BINAURAL! • Good ear 80%, bad ear 20%, binaural 64% • FIT CROS! • Good ear 80%, bad ear 20%, binaural 80% • ??? -- Toss up! • Do a trial binaural first to determine perceived benefit • Do a trial BiCROS second if no perceived benefit with binaural • AmpCROS?

  14. Study Results • In 2016, both Starkey and Siemens introduced new CROS technology on their Muse and Primax platforms (respectively). • In addition, both Phonak and Widex have launched newer platforms (Venture and Unique). • How to do this study (four players!)

  15. Methodology • Study participants… • 18 previous users, 10 new users • Ages ranged from 26 to 86. • Hearing loss in the better ear ranged from normal (CROS) to severe (60 sloping to 90).

  16. Methodology • Each patient utilized each CROS system for 2-3 weeks, returning weekly for adjustments and counseling. • Upon completion of each trial, patients fill out subjective surveys on each product, evaluation perception of many areas…

  17. Methodology • Subjective survey analyzed… • Sound Quality for Speech • Sound Quality for Music • Perception of Localization Improvement • Performance in Background Noise • Battery Life • Cosmetics • Ease of use • Feedback

  18. Methodology • Objective testing was also completed, evaluating WRS in quiet when presented 90° azimuth to the poorer side • Both sides off • Better ear on (i.e. Aid only) • Both sides on (i.e. CROS transmission utilized). • Presentation at 65dBSPL, 25 words per run.

  19. Study Results: Objective Measures

  20. Study Results: Objective Measures

  21. Study Results: Objective Measures

  22. Study Results: Objective Measures

  23. Study Results: Objective Measures

  24. Study Results: Objective Measures

  25. Study Results: Subjective Survey • Sound Quality for Speech • 18 preferred Widex • 7 preferred Phonak • 2 preferred Signia • 1 preferred Starkey

  26. Study Results: Subjective Survey • Sound Quality for Music • 15 preferred Widex (broader dynamic range) • 10 preferred Starkey (2nd chip?) • 4 preferred Phonak • None preferred Signia

  27. Study Results: Subjective Survey • Perception of Localization Improvement • 14 preferred Phonak • 11 preferred Widex • 3 preferred Signia • 1 preferred Starkey

  28. Study Results: Subjective Survey • Performance in Background Noise • 17 preferred Phonak (Speech in Loud Noise Algorithm) • Available at the v70 and v90 levels, not at v50 or v30 • 9 preferred Widex • 2 preferred Signia • None preferred Starkey

  29. Study Results: Subjective Survey • Battery Life • 10 preferred Widex • 8 preferred Signia • 5 preferred Phonak • 5 preferred Starkey

  30. Study Results: Subjective Survey • Cosmetics • 14 preferred Phonak • 8 preferred Starkey • 3 preferred Widex • 3 preferred Signia

  31. Study Results: Subjective Survey • Ease of use (controls) • 9 preferred Signia • 8 preferred Starkey • 8 preferred Phonak • 3 preferred Widex

  32. Study Results: Subjective Survey • Feedback • 12 preferred Phonak • 6 preferred Starkey • 6 preferred Widex • 4 preferred Signia

  33. Study Results: Subjective Survey • Overall Results • 19 preferred Widex • 6 preferred Phonak • 2 preferred Signia • 1 preferred Starkey • However…

  34. Study Results: Subjective Survey • Purchasing Patterns… • 10 purchased Widex • 10 purchased Phonak • 4 purchased Starkey • 4 preferred Signia • Pricing was equal to eliminate that effect

  35. Study Results • Reasons for specific purchases • Cosmetics • Control manipulation • Specific sound qualities (music) • Specific features (Zen Sounds) • Reserve gain (Phonak Naida)

  36. Study Results • Summary of findings • Widex performed exceptionally, but wasn’t always the best choice • What to do when—specific choices based on options available.

  37. Study Results • Widex strengths • Best performance for WRS (46% improvement) • Good performance for music • Best battery life and tinnitus options • Widex weaknesses • Limited form factors (312 BTE, 312 RIC, 13 BTE) • Difficult manual controls / Ease of use

  38. Study Results • Phonak strengths • Good performance for WRS • Best perception of performance in BGN. • The most form factors offered (675 BTE, 13 BTE & RIC, 312 BTE & RIC, FS ITE, ITC) • Best perception of cosmetics • Phonak weaknesses • Battery life (but improved) • Limited tinnitus options

  39. Study Results • Starkey strengths • Better performance for music • Good for each of use / manual controls • Starkey weaknesses • Lowest improvement in WRS • Lowest perception of performance in BGN • Limited form factors (RIC and BTE) • Limited tinnitus options

  40. Study Results • Signia strengths • Best ease of use • Good for tinnitus options • Signia weaknesses • Poorer cosmetics • Limited form factors (312 RIC—at that time)

  41. Study Summary • Each manufacturer have their strengths and weaknesses. • Widex: Speech clarity, music, tinnitus • Phonak: Background noise, cosmetics, form factors. • New product introductions may change this • Rechargeable options (Starkey, Phonak) • Own speech quality (Signia)

  42. Menti Question 1C!

  43. Verification: CROS transmission Procedure: Real Ear or VSM • Place patient at 90 degrees azimuth, with the “dead” ear facing the presentation speaker(s). • Place the probe mic in the better ear, on the far side from the presentations speaker(s). • Measure as follows: • Unaided (both sides off) • Aided (better ear on only) • Aided with CROS • Repeat with face-to-face, 0 degrees azimuth

  44. Verification: CROS transmission Procedure: Sound Field • Place patient at 90 degrees azimuth, with the “dead” ear facing the presentation speaker(s). • Measure puretones and speech as follows: • Unaided (both sides off) • Aided (better ear on only) • Aided with CROS • Repeat with face-to-face, 0 degrees azimuth

  45. Verification: Sample #1

  46. Verification: Sample #1 Speech Discrimination Unaided: 88%

  47. Verification: Sample #1 Speech Discrimination Unaided: 88% Aid Only: 92%

  48. Verification: Sample #1 Speech Discrimination Unaided: 88% Aid Only: 92% Aid w/CROS: 100%

  49. Verification: Sample #1 Speech Discrimination Unaided: 88% Aid Only: 92% Aid w/CROS: 100%

  50. Verification: Sample #2

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