Dumb CI Fitting Mistake In Chicago

Ugh. Just Ugh.

Ugh. Just Ugh

We at The Hearing Blog see some pretty dumb things in our travels, but this one out of Chicago where the pediatric audiologist uses an airtight-sealed earmold on a brand new Med-El Sonnet CI speech processor takes the cake… And No, this is not an EAS hybrid. With a CI, the ear canal should never be occluded, as changes in the middle ear cavity pressure — whether from otitis media or even air pressure — will dynamically change the stim levels needed.

 

 

#15 Free Field Non-Occluding Earmold. Applications: (Free field) For high-frequency losses, Tinnitus Masker, open-fit hearing instruments, CROS and BiCROS fittings, open fittings, and cochlear implants

Standard #15 Non-Occluding earmold for CI retention
Click to go to catalog page

Somebody needs to take this audiologist by the hand, and show her any old earmold catalog page such as this one from Westone where the standard NAEL #15 non-occluding mold is fit for CI and CROS transmitter retention.

 

 

She didn’t even need to shoot an ear impression: Hal-Hen has been selling the #2437 stock contoured CROS molds for at least 30 years that we know of, and they haven’t changed one iota.

 

 

Hal-Hen #2437 stock CROS earmolds -- Click to go to catalog page

Hal-Hen #2437 stock CROS earmolds
Click to go to catalog page

 

 

Our advice:

Hal-Hen #1016 Adco Hand Core Drill Set Call the patient back in and punch a vent hole through the earmold with your core drill.

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About the author

Dan Schwartz

Electrical Engineer, via Georgia Tech

10 Comments

  1. Rick
    April 13, 2015 at 11:48 am

    Very sad. I’ve seen BAHA’s on people when bone testing shows that Cochlear is dead and a BiCros would have helped the client at a fraction of the cost non invasively.
    As a hearing aid specialist that makes me lose respect for Audiologists and ENT’s.


    • Dan Schwartz
      April 14, 2015 at 4:26 pm

      Rick, in fact both the Oticon Ponto and Cochlear BAHA work quite well as a transcranial CROS aid for single-sided deafness, and in fact is fully FDA and TÜV approved for this use; provided the bone conduction thresholds on the good ear are no more than about 20 dB average. The issue of skin infections from the transcutaneous punch have been pretty much addressed by Daniel Coelho MD at MCV in Richmond by using a dermatologist’s biopsy punch instead of cutting back a skin flap.


      • Rick
        April 14, 2015 at 5:40 pm

        BAHA
        It’s good to hear that the punch has eliminated infections. Because I have had such good results with the new wireless bi-crosses I wouldn’t feel right recommending a BAHA without trying the bi-cross first.

        It may all be approved by the FDA but I worry the $ for the half hour surgery – that costs what? $20 to $30K and the BAHA that costs an additional … 5K to the patient, are often not the most prudent choice.


        • Dan Schwartz
          April 14, 2015 at 5:49 pm

          Rick, I don’t know where you’re getting your info on pricing; but if you’re in the Elite buying group you can see the cost of the BAHA device itself. In addition, the surgery is a 10 minute in-office procedure and only runs at most about $2k — In fact, the CI surgery procedure is only $8800 at Surgery Center of Oklahoma.


          • Rick
            April 14, 2015 at 6:08 pm

            Well, obviously I had old information. That price and the new procedure sound very encouraging. I have talked to people though that paid 5K for their BAHA unit, and that isn’t too far off the markup I often see, even with Elite prices.

            So – I’m enlightened and appreciate your blog.

            I’ve fit Phonak bi-crosses and with great results for less than 3K to my clients. True, maybe I undercharged, but often work with people on limited incomes.
            I believe Unitron is coming out with a bi-cross this year too(?), and have heard good things about another… I believe Widex.

            So, I still favor a non-invasive, economical approach in most situations. (But who knows, if I got 2K for a 10 minute procedure I might favor it instead:).)

            Rick


            • Dan Schwartz
              April 14, 2015 at 6:52 pm

              Yes, both Unitron and Widex as well as Phonak have CROS transmitters to match their aids.

              Try a transcranial CROS next time — They work very well.


  2. Rob
    April 14, 2015 at 3:09 pm

    I find the non-tactful way you posted this on social media and ridiculed the practice for making a “dumb mistake” offensive. Instead of taking the opportunity to positively showcase your knowledge and helpfulness as a tool to the practitioner, you start with an insult. Perhaps you think your article will be ignored without the inflammatory headline. I contend if the subject matter so bland that you have to resort to an attack and write with a “smarter than you” tone, your article isn’t worth the read.

    Having been in the industry 18 years, I have learned there are no absolutes. What if this were a surgical ear that cannot be exposed to the air for extended periods of time?


    • Dan Schwartz
      April 14, 2015 at 3:53 pm

      [Edited 5/1/2015]Rob, there is much more to this story, as this photo first appeared in the Med-El user group on Facebook, and in fact the offending audiologist at [redacted] outed herself, straining her shoulder patting herself on the back in the comments under the picture, a day or so before I saw the image and spotted the stuff-up.

      What’s more, I manage the 900+ Member Auditory Neuropathy Spectrum Disorder group on Facebook, and this facility has been notorious among group Members for fair-to-poor quality audiology services both for adults as well as peds; and in fact there are two other Chicago-area facilities that have much better pediatric audiology services.


  3. Bob
    April 29, 2015 at 8:52 am

    Hi Dan
    I was interested to read your comments. I just wondered if you could point me in the direction of your evidence base – specifically, that changes in middle ear pressure alter CI stimulation levels.
    Many thanks
    Bob


    • Dan Schwartz
      April 29, 2015 at 10:17 am

      [Edited to add FB URL] Bob, that’s a valid question, and the “back story” on this article will explain it all. Basically, the article started out in draft form as no more than a humorous “look at this mistake” piece for not using a comfortable skeleton earmold. While it was still percolating, I was having a chat with a CI audiologist who has about two decades experience, and I sent her the photo; and she came back and told me about the changes in middle ear pressure causing fluctuations in stim levels. Given the typically very tight 10 dBv range between T & M/C levels, small conductivity fluctuations can indeed cause changes in perception — And this is something verified to me by a senior engineer at a CI manufacturer.

      At that point, this article went from humorous to serious, and that is also when the working title changed from Less-Than-Comfortable CI Fitting to what it is now. For more, go to this link on my Facebook wall for the discussion.

      By the way, I saw your Facebook page with the cool X-ray!


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