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NAL

NAL

Real-Ear Measures

Real-ear measures (REM) are recommended in hearing aid fitting. However, reports suggest that only approximately 30 percent of audiologists routinely perform REM. Rationale (or excuses) for not performing REM are numerous, but little peer-reviewed research has been conducted to support or refute the use of REM in regards to benefit in speech understanding and subjective quality of fitting.

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CROS and BiCROS Hearing Aids

Contralateral routing of signal (CROS) amplification systems are intended to be used when (essentially) one ear is normal or has a mild/moderate hearing loss (i.e., is generally a candidate for amplification) and the other ear is (more-or-less) not “aidable.” CROS hearing aids might be recommended for single-sided deafness (SSD) or for people with very poor unilateral word recognition scores.

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Major Issues in First Fittings

Mueller (2015) reports that if you have an approximate idea of how much gain a patient needs, and if we were to somehow fix sound to have only one constant input level, there exists more than 1400 gain curve options available in today’s highly sophisticated hearing aids. Mueller notes that the “heavy lifting” associated with choosing the correct curve may be accomplished by choosing DSLv5 or NAL-NL2, as long as one verifies and validates that what the professional selects is actually being delivered!

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Real-Ear Measures: Status Quo 2015

Sanders et al (2015) report that not only are real-ear measures (REMs) an important part of all hearing aid best practice guidelines, REMs are simply a necessary part of each fitting. They note, as a result of acquiring REMs, it is likely “considerable subsequent adjustments” would need to be made to bring the hearing aid fitting into compliance with the prescription selected, such as NAL-NL2 or DSL v5.0.

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NAL vs DSL in Children with Severe-to-Profound Hearing Loss

Ching et al (2015) report on prescribed and measured gain, as prescribed by NAL-NL1 and DSL v5, using the Phonak Naida V SP hearing aid. Sixteen children (aged 7 to 17 years) with severe-to-profound sensorineural hearing loss (SNHL) participated. The Speech Intelligibility Index (SII) and estimated loudness of the fittings were calculated with input loudness levels of 50 (low), 65 (medium), and 80 dB (high) SPL. Of note, NAL aims to maximize speech intelligibility, whereas DSL aims to normalize loudness.

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