By Dennis Van Vliet, AuD
The Comprehensive Approach to Hearing Aid Trouble-shooting.
I have always tended to be the type of person who would much rather be doing something with my hands as opposed to sitting and relaxing. Give me a task like gardening, changing a light socket, a small plumbing project—or better yet the opportunity to make some sawdust—and I not only get a little creative rush planning out the job, but a nice sense of satisfaction when it’s done.
Recently, we spent a long weekend with friends in Santa Fe, NM. They had just purchased a home that is very nice, but old enough to need a few projects here and there. One puzzling quirk in the house was the fact that two of the recessed lamps would intermittently click off, and spontaneously come back on sometime later. There are several identical fixtures, but only two in different rooms were intermittent.
All of the light bulbs were the same type and wattage. We took a look at the fixtures to see if there was any obvious problem. The only thing I noted was a possible problem with the center contact in the socket that looked like it could pull away from the bulb with a temperature change. We set out to the home improvement store to pick up some tools and nonincandescent bulbs that operate at a cooler temperature, hoping my theory was right about the temperature.
Once inside the store, we were able to get a good look at the recessed fixtures like the ones in the house. With a clear view of the uninstalled fixture, a separate component was visible that was very likely a safety shut-off thermistor that cut the power when the socket was too hot.
That answered a few questions! The bulbs in use were the same, but tolerances were different enough to cause only two of the fixtures to periodically shut off. We went back to the house with lower wattage compact fluorescent bulbs, and the problem was solved. Then we could relax!
A Comprehensive Approach to Hearing Aid Trouble-shooting
Trouble-shooting hearing aid problems isn’t all that different from a problem like we experienced with the lamps. We understood the symptom; in this case, it was intermittent operation. The next step was to try to figure out why the intermittency was occurring.
A good visual inspection can often reveal problems. In the case of the intermittent lamps, I was only partially correct. I guessed that the problem was related to heat, but I had missed the critical element that a protective heat-sensitive switch was in the circuit to prevent damage or fire due to using bulbs with wattage that exceeded the rating for the fixture.
Once we fully understood how the lamp fixtures were designed, the intermittent behavior was easier to understand and remedy. I could have blundered into a reasonable solution based on my partially correct theory, but blunders aren’t good enough when we are serving patients needing help with their hearing.
Fully understanding a problem not only helps us get the solutions correct for the immediate problem, but also may prevent related problems in the future. For example, if feedback is a complaint, one might suspect a poor mold or shell seal, or a vent too large for the loss and required amplification. These are reasonable-enough suspicions, but what about internal feedback, cracked tubing, or a distorted and peaky response due to a failing component? Remaking an earmold or plugging the vent might help in the short term, but won’t address the underlying problem. It may result in less feedback, but leave the patient with poor sound quality or occlusion—and poorer overall performance. The only way to provide the care and service our patients need is to take the steps to fully understand why a problem is occurring, then take the steps to correct the root of the problem.
The Importance of Solid Starting Points
When a patient has a vague complaint about their performance with hearing aids, where do we start? Knowing what performance characteristics we should expect from the hearing aids is a good start. Is there a 2cc coupler or real-ear analysis of the hearing aid “as worn” in your patient record? Many of us have relied too much on subjective comments from the patients, or the software cartoon simulation of the response, and have nowhere to start when things go wrong. It is difficult to understand why there is a complaint when we have no reference to what was once good for the patient.
The Final Word? Trouble-shooting a problem with hearing aids can be a challenge, but is a critical skill for us if we are to serve our patients properly. Fully understanding the individual hearing aid system on the patient is a good first step. Asking the right questions, listening carefully to the complaints, and following up with a logical step-by-step process is a good way to finish up.
||Dennis Van Vliet, AuD, has been a prominent clinician, columnist, educator, and leader in the hearing healthcare field for nearly 40 years, and his professional experience includes working as an educational audiologist, a private-practice owner, and VP of audiology for a large dispensing network. He currently serves as the senior director of professional relations for Starkey Technologies, Eden Prairie, Minn. Correspondence can be addressed to HR or: [email protected]|