MedRx is an advocate of Live Speech Mapping (LSM). LSM utilizes actual live speech (clinician’s and family members or significant others) as the input signal for measuring the Aided Response (AR) in Real Ear Measurements. Real speech is an interesting and familiar stimulus for the patient and family and, at the same time, this is the type of signal the hearing instrument is required to process.
Live Speech Mapping provides a unique opportunity for the patient to experience and understand the benefits of quality hearing instruments. “Seeing” the benefits of high end hearing instruments is important in the auditory rehabilitation process for the patient. LSM also allows the professional to demonstrate live, with the chosen hearing aid, in the patients ear, that they have achieved the
Live Speech Mapping provides a dynamic presentation of how much “speech” is reaching the patient’s eardrum. When measured in the unaided ear canal, LSM is used to counsel the patient and third party on the effect of the hearing loss on understanding speech (shows how much speech is not audible.) A better understanding of the hearing loss usually makes it easier for the patient and third party to accept and commit to rehabilitative help. Live Speech Mapping is also a fast and accurate approach to successfully program hearing instruments for fitting and troubleshooting.
How it works in AVANT Instrumentation
Speech input, measured by the probe microphone is analyzed by the system and displayed in “real time” as a continuously updating peak curve from 125Hz to 8kHz. The measurement can be directly compared to the patient’s Audiogram values (in dB HL or dB SPL display), the modified aided speech spectrum and UCL values on the display. The live speech input level is monitored in real time with a reference level meter on the display. Louder or softer input
levels are obtained either by varying distance between the speaker and the reference microphone or by adjusting the percentage output level of the external speaker accordingly.
During testing, a peak curve representing the maximum dBSPL reached at each discrete frequency over the duration of the live speech input appears on the screen. In addition, the actual dB level at each octave band is displayed as a bar at each octave and a text box displays the peak decibel level numerically at each octave or half octave frequency. This detailed information is useful in programming the gain and compression of the hearing instruments for soft, moderate and loud input levels.
The Live Speech fitting can be done either with the Speech Spectrum or with Prescription Rules.
What is the Modified Speech Spectrum?
The long term speech spectrum for normal voice in quiet, modified to represent the most comfortable listening level for normal speech levels in quiet for the patient’s reduced dynamic range of hearing.
Live Speech Mapping can be used either with the modified speech spectrum or with target curves. If a target rule is used, the speech spectrum is not shown on the screen as the fitting is performed by target curves. Target rules can be enabled or disabled in the LSM Options.
How to use LSM for Aided testing with Speech Spectrum
When the hearing instrument is set to a comfortable volume, demonstrate it’s performance for normal, soft and loud speech. If you have programmed the instrument correctly, the Live Speech Map will remain within the boundaries of the patient’s dynamic range of hearing for soft, comfort and loud input levels. This demonstrates the advanced technology in the hearing instrument as it is self adjusting to provide the correct amount of amplification for the listening environment, without the need for the patient to continually adjust a volume control.
Live Speech Mapping is the most useful demonstration of how much “normal” or “soft” speech is inaudible to the unaided ear. When a hearing instrument is fitted, Live Speech Mapping clearly shows how soft, moderate and loud input speech input levels fit in the patient’s dynamic range of hearing.
Aim to have the peaks of the measurement for “normal“, comfortable speech to fall between the lower third and half of the dynamic range. Aim to have as much of the soft speech audible for as many frequencies as possible. You may need to adjust the kneepoint(s) to allow sufficient gain for soft inputs. Make sure the UCL tolerance limits are never exceeded for a loud input. Make adjustments to the compression ratios or limiting to ensure the UCL’s are never exceeded for loud inputs. The patient is subsequently “witness” to the fact that the hearing instrument circuit is “ACTing” properly
(making sound Audible, Comfortable and Tolerable)
Using Prescription Rules with LSM
To start using prescription rules with LSM, choose a rule from the list in the LSM Options (Menu: LSM Options > Show Targets).
The prescription rules (such as DSL m[i/o]) are available as Peaks of Speech or a Long Term Average Speech Spectrum (LTASS) targets. Normally the chosen rule provides targets for soft, conversational, and loud speech. This offers a valuable tool for fitting WDRC hearing aids. Use live voice or recorded speech stimulus when working with the Peaks of Speech Targets. Aim to reach target levels for the three input levels you selected in the Rule Setup screen. Remember to adjust the stimulus levels (using the attenuator on the control panel) to match the input levels you selected in the rule Setup screen.
The prescription rule parameters are individual for every client and hearing aid. Please verify that the rule parameters on the Rule Setup screen match the client and the hearing aid. Some of the parameters that can be modified are: client age, hearing aid circuit type and crossover frequencies, program type, etc. The displayed parameters depend on the chosen fitting rule.
Other uses for LSM
When you are performing Live Speech Mapping, you can monitor the curve on the screen for the presence of feedback. It is possible to “see” feedback before it is audible to you.
Use LSM to demonstrate directional microphone effects, compression features, volume control adjustments, earmold modifications and multiple memories.
If RECD measurement was done and RECD curve is present, LSM can be performed in the coupler instead of the client’s ear. The option to choose from Ear or Coupler measurement is accessible from the control panel. If Coupler is chosen, the measured data is automatically corrected for RECD.
Utilizing these tools and having a defined selling protocol will undoubtedly lead to more high-end sales and higher patient satisfaction levels. Returns will decrease, and overall fitting and adjustment periods will be reduced. Now, go out there and sell with confidence!!
Terry Ross is Vice President of MedRx, Inc., a leading global manufacturer of PC-based diagnostic and testing instrumentation. He has over 35 years of executive management experience in the hearing care industry. He is responsible for directing the global sales and distribution activities for MedRx, and is responsible for sales and distribution of the full line of MedRx brand audiometric instrumentation.
Mr. Ross has spent the last thirty-five years in a variety of executive positions in sales, training and marketing of hearing care related products and services. He has authored a number of published articles for the hearing industry. He received his B.S. degree from Minnesota State University, and is a certified sales trainer from Wilson Learning Center, an international professional sales training organization.
Other Articles by Terry Ross:
by Terry Ross
Vice President, MedRx, Inc.
Fitting hearing instruments accounts for the vast majority of the total revenue stream in the hearing care industry. More than $3.00 of every $4.00 is due to hearing aid sales revenue. It is the sales of these devices that allow audiologists and hearing care professionals to enhance the lives of our hearing impaired population. Ironically, many students who graduate from most of the country’s Au.D. programs, often arrive bright-eyed and ready to serve their patients, yet also arrive unprepared to enter and successfully navigate the retail selling process. Business classes are typically not part of the Audiology curriculum.
Today, the options for consumers to purchase hearing aids are changing, growing and expanding. The market is fluid and will continue to shift due to technological advancements, new healthcare services options and locations, and the reach of the Internet, plus the Direct-to-Consumer hearing aids exist and will continue to challenge more traditional patient care access. To compete today, there needs to be more focus on the selling process to attract and retain customers. The great news is that today, there are also powerful tools and a process that can assist professionals in addressing the two main reasons consumers don’t buy hearing aids:
1. Perceived value does not align with the retail selling price in the mind of the consumer
2. Consumer expectations typically exceed performance limitations of amplification.
As a past sales trainer some 30 years ago (Wilson Learning), I am a strong advocate of “consultative selling”. This protocol engages the salesperson, the customer, and in the case of the hearing care market often the 3rd party (family or friends). Before even talking about hearing aids, this consultative process must be initiated to identify the critical patient needs, lifestyle, expectations, and concerns. The industry has many templates to
collect this information, but now that you have it, how do you utilize it to guide the patient to a logical and committed conclusion?
An effective and meaningful consultation includes the following elements:
• Explain the “levels” of technology as they relate to personal needs and lifestyle
• Effectively demonstrate the depth of the hearing loss to the 3rd party
• Limit the hearing aid “choices” based on the
patient profile you have collected
• Gain a true “commitment” to move forward once the technology level has been agreed upon.
• Clearly discuss pricing, warranties, follow-up plans, and goals over the ensuing weeks.
• Fit and verify the fitting with the patient and the 3rd party.
Before ever indicating any prices, it is important to pair the appropriate technology with the patient’s lifestyle needs and preferences. By discussing different hearing aid performance characteristics, the professional can effectively guide the patient through the maze of different brands, styles, acoustic performance capabilities, and costs. Matching specific patient needs to levels of hearing aid performance is critical in the selling process. It builds trust. This process also involves the patient and 3rd party in understanding the patient’s expectations and needs as it relates to the “level” of technology required. You need to determine what is most important and non-negotiable, like to achieve, and least important to the patient in terms of performance attributes of the technology.
Hearing Loss Simulation – 3rd Party ONLY!
Many of today’s computer-based testing systems, including all of MedRx’s AVANT™ audiometers and REAL EAR Measurement systems, allow the professional to clearly demonstrate the patient’s hearing loss based on the measured audiogram thresholds. Not only is the breadth of the hearing loss usually quite compelling when compared to normal hearing to the third party, but the professional can also simulate how, by bringing back the frequencies that are deficient, the hearing capability can be enhanced through appropriate amplification. This simple tool is an effective “closer” for the 3rd party.
The Hearing Loss Simulator (HLS) demonstrates the effect of the client’s hearing loss for the spouse or family member. The program attenuates an input signal to simulate the audiogram. The spouse or family member listens to the free field speakers. The third party member can hear how their own voice is distorted by the hearing loss when the Record input option is used.
The Hearing Loss Simulator requires the client’s Audiogram data. This data can be manually entered in the Audio screen of this or any other task.
How to perform the Hearing Loss Simulator task with AVANT:
• Select the Hearing Loss Simulator tab on the toolbar.
• Enter the Audiogram values manually if the data is not automatically imported to this screen.
• Select the input signal type: File, CD or Record.
• Select the track and the Play button on the control panel.
• The HLS output is directed to the free field loudspeakers.
• Select Normal to play the input signal without modification.
• Select Simulated to turn on the simulation of the client’s hearing loss.
• Toggle between these selections as necessary.
• A volume control adjustment bar allows for manual adjustment of the output level to suit the listener, room size, etc.
• To stop the playback, select the Stop button on the player.
It is recommended you use a variety of tracks to effectively demonstrate the hearing loss. It is a compelling presentation.
AVANT audiometers and REAL EAR Systems also
allow the ability to record and play back voice of the spouse or a family member as a familiar stimulus.
In AVANT instrumentation the Reset option restores the audiogram to the original state. Use this option if you have modified the audiogram but want to undo the changes. The changes to the Audiogram that are made on the HLS screen are temporary and will not affect the original client’s audiometry record.
Showing myriads of hearing aid style, brand and performance choices is confusing and frustrating for your patients. Through a logical discussion of needs and desires, arriving at an appropriate choice can be greatly simplified.Based on the stated needs of the patient, the logical choice will become apparent to all parties. “Based on your stated needs and your lifestyle, clearly the technology that is best suited to meet your expectations is….”
Once the solution has been selected, it is a good idea to get a firm commitment to move forward from the patient. Some professionals get a signed document that if they can demonstrate and verify the effectiveness of the proposed device as it relates to the patient’s hearing loss, the patient agrees to move forward with the fitting and rehabilitation needed to address their loss. The professionals often also sign the document – there is something very persuasive about this physical act of commitment. It also sets the stage for verification – an absolute standard-of-care for achieving the professional’s fitting goals from the onset of the fitting.
The final discussion has now been logically set up to discuss the financing and payment options for the patient’s hearing device(s). Reiterating the agreements of needs, desires, and lifestyle, the price can be justified. Don’t be shy! Exhibiting doubt, fear or embarrassment about the price undermines all of the hard work you did to justify this purchase. Be confident and proud that you can offer this technology and solve their hearing challenges. Confidence is contagious and can make this process easier and effective.