Welcome to Lyric Training!

Introducing Lyric Hearing First and Only 100% Invisible, Extended Wear Hearing Device • Placed by an appropriately trained hearing healthcare professional −

No surgery or anesthesia required − Same day fitting • Replaced as needed −

Can be worn for up to 120 days or until battery expires − Approximately 4-6 replacement visits per year • Patients purchase Lyric on a subscription basis

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A Completely New Approach to Hearing

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Lyric Development Developed by ENT physicians, engineers and audiologists, Lyric was built around several key concepts: • Consumers desire an invisible, hassle free solution with “natural” sound • Sound quality improves with proximity to the tympanic membrane • Many people resist wearing hearing aids because of the stigma associated with hearing loss

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Advantages of Deep Canal Fittings • • • • • • •

An overall increase in gain and output, especially in the high frequencies Greater headroom resulting in less distortion Reduction of the occlusion effect Security of fit/retention Improved localization Reduced wind noise Ability to use the telephone and other ear level listening devices (headphones) without feedback

CIC Handbook, Marshall Chasin, 1997

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Three Primary Patient Benefits 100% Invisible • Ear canal placement makes it totally invisible

Effortless Hearing, 24/7 • No batteries to change, no maintenance • No daily insertion or removal • Can be worn while showering, exercising, sleeping

Natural Sound Quality • Placement allows natural pinna/concha effects to remain intact • Exceptional sound quality in noisy and quiet environments • Placement minimizes occlusion and feedback

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Key Lyric Features

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Evolution of Lyric

Lyric3 Lyric2 Lyric1

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Device Characteristics Analog, single channel device • Purest form of the signal • Chosen to meet the requirements for an extended wear hearing

aid

Deep placement • Microphone 4 mm or more inside the ear canal • Receiver 4 mm from the TM estimated 0.3 cc residual volume

Device Life • Lyric may remain in the ear canal for up to four months or until

the battery is depleted • Currently, the average life of the device is 2-3 months

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Key Technology Features • Biocompatible soft foam seals engineered to contour to the ear

canal; safe to wear 24/7, months at a time • Proprietary coating & mechanical technology designed to protect device from moisture and cerumen • Proprietary battery shape and functionality designed to reside in ear canal up to 120 days • Removal loops provided for ease of device removal

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Device Components 3

2

4

5 6

1

1. 2. 3. 4. 5. 6. 7.

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7 9

8

8. 9. 10.

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Insertion handle “This side up” indication Microphone protection Microphone and signal processor Receiver Medial cerumen shield Battery Medial seal Lateral seal Removal loop

Moisture & cerumen protection new medial port protection Big Bang ! May 2011

Module encapsulation 12

nano-coating

Venting

Trench vents through core of the device • Design allows venting between the device core and seals to ensure pressure equalization

and wearing comfort

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SoundLync

Used for: • Patient removal • Patient Adjustments: − On − Sleep − Off

Keychain Housing

Magnet

Removal Tool

− Volume

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Cap

Lyric Patient Journey

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Candidacy Assessment

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Evaluating and Preparing the Ear Canal

Sizing the Ear for Lyric

Preparing the Lyric Devices for Placement

Lyric Device Placement

Validating Placement for Feedback and Comfort

Validating Lyric Sound Quality

Post-Fitting Counseling

Lyric Candidacy, Sizing & Fitting

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Keys to Success • Appropriate patient selection • Follow candidacy guidelines • Avoid traumatizing ear canal • If there is canal trauma, wait 10-14 days to fit/refit

Setting realistic expectations & counseling is very important!

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Lyric Candidacy—Primary Criteria Medical History, Noteworthy Consideration & Lifestyle

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Ear Geometry / Anatomical Features

Fitting Range

Lyric Candidacy Assessment • Use the Lyric Candidacy Form to help make an informed

recommendation

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Lyric Candidacy

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Lyric Candidacy

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Immune System

Electromagnetic Interference

Coagulation

Pediatric User

Lyric Candidacy

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Medical Clearance Suggested • Medical Clearance Form

Description of Lyric device and use – Reason for request – Complete and send to physician –

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Ear Geometry / Anatomical Features • Noting challenging canal shapes or anatomical features is vital for ensuring a comfortable fit • Noteworthy canal shapes:

Hourglass shape – Anterior or Anterior/Posterior bulge – V-shaped canal at any location – Substantial step up or shelf in canal –

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Lyric Candidacy—Ear Examination • Note characteristics of ear canal skin type

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–

Cerumen

–

Dry skin

–

Moist

–

Oily

–

Hairy

Ear Examination Examples • Focus on the bony portion as it is important for fitting success • Examples of what you may come across:

Cerumen that needs to be removed

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Bulge at front, round shape at the back + cerumen +small exostoses

Bulge on both sides leading to strong v-shape

Exostoses

Lyric Candidacy—Fitting Range • Evaluate the hearing status • Tympanometry • Pre- and Post-fitting Measures:

Hearing questionnaire (e.g. COSI, APHAB) – Speech in Noise testing –

Be cautious of steeply sloping losses

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Equipment Before sizing or fitting Lyric, it is important to obtain and become comfortable using the appropriate equipment and tools: • Magnification and illumination: microscope or head loupe • Ergonomics: patient chair, provider stool • Tools: Lyric fitting kit

Lyric recommended equipment is also very useful for cerumen management

Magnification and canal illumination are paramount to Lyric success! 29

Lyric Fitting Fit

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Ear Examination and Preparation • Visualize the complete ear canal to develop flight path for sizer and device insertion • Ensure clean and healthy skin throughout the whole canal • Detect any abnormalities in the ear canal regarding skin condition, canal shape and the tympanic

membrane (TM) to rule out related contraindications • Detect any abnormalities before fitting of Lyric • If any abnormalities are detected, refer to an ENT for clarification

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Ergonomics and Head Position • Sit facing your patient so that you do not

have to bend or hunch over to work in the ear

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• Move the head of the patient to aid with

otoscopy • Tilt head to compensate for a rising ear canal

Ear Examination Techniques Hold speculum in your non-dominant hand With your dominant hand, gently retract the pinna to open and straighten the ear canal Introduce the speculum into the opening of the ear canal Methodically visualize the entire ear canal

1. 2. 3. 4. •

Tympanic membrane - Healthy and intact

•

Medial portion of ear canal - Examine the entire circumference of the ear canal

•

5.

Lateral portion of the ear canal - Examine the entire circumference of the ear canal Make note of the “flight path”

Always brace with the hand holding the speculum. 33

Sizing Objectives Determine if the ear canal is the appropriate length and diameter to accommodate Lyric • Measure the maximum depth of insertion (mm) • Determine correct device size (XXS, XS, S, M, L, XL, XXL)

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Canal and Device Dimensions Device is placed 4mm in front of the TM and at least 4mm from the entrance of the ear canal (Posterior Meatus)

Posterior Meatus

Lyric2 TM

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Sizing & Placement Reference Point Use the posterior meatus as a reference for sizing and placing Lyric

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Length Sizer Shaft

Flexible tip

Color-band markings

Handle

Touch TM and align color band marking with posterior meatus to read:

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Device Sizers • Replicas of the actual device

Have the same look and feel of actual devices – Represent device “drivability” • Not ear specific • Vented through the core • Seal sizes vary from XXS-XXL – The core is the same size throughout – Sizers are color-coded –

Superior indicator Venting Insertion handle Removal loops 38

Lyric3 now comes in two new sizes!

XXS

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XS

S

M

L

XL

XXL

Sizing and Placement—Lyric Tools Insertion Tool

Use for: • Sizer and device insertions

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Lyric Slider Forceps

Use for: • Sizer and device removal • Placement modifications • Measuring current insertion depth

Lubrication • Glycerin • Distilled water • Otoease

• Options will not leave a lasting residue and will be absorbed into the skin –

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Apply with a cotton swab to the device or canal wall •

Apply gently

•

Do not over apply

•

Avoid plugging the microphone or receiver

Re-apply as necessary

Lyric Sizing

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Sizing & Placement Instructional Movie

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Sizing Example: Poor fit

Extra large gap between seal and canal wall Minimal or no seal compression

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Sizing Example: Poor fit

Maximum seal compression between seal and core of sizer

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Seal compression causing folds in seal between seal and canal wall

Sizing Example: Poor fit

Large gap between seal and canal wall

Minimal or no seal compression

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Sizing Example: Proper fit Average seal compression between seal and canal wall Good contact between canal wall and seal

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Lyric Device Placement • Use a microscope or head loupe for placement • Place programmed device on insertion tool and apply lubrication with cotton swab • Carefully insert device in ear canal to insertion depth noted during sizing procedure

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Checking Device Placement • Following device placement, examine the ear

canal –

Look for gaps and folds •

If present, adjust for different angle and/or insertion depth

• Adjust device if needed with Lyric Slider

Forceps –

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Set the slider at the “do not exceed” Measured Insertion Depth and monitor when manipulating the device

Lyric Acoustics & Programming

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Deep Receiver Placement Gain measured in a coupler as a function of frequency • 0.3 cc approximates the residual ear canal volume with Lyric placement • Deep receiver placement increases gain by 5 to 20 dB 2cc Coupler vs. 0.3cc Ear Simulator

2cc Coupler 0.3cc Ear Simulation

40 30

dB

20 10 0 -10 100

1000 Frequency (Hz)

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10000

Lyric3 Specifications

0.4cc

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2cc

Max Output

Peak Full-on Gain

Max Output

Peak Full-on Gain

110

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95

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Acoustics & Programming • Single channel, analog sound processing • AGCo • Digital/wireless programming through Phonak •

• • •

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Target™ Fitting Software Pre-calculation based on NAL-NL2 – Industry-standard, evidence-based – Modified for deep canal acoustics, microphone location effect and residual volume 5 programmable parameters One-way transmission of settings to device Direct connection to ALPS (portal) during fitting to manage subscription records and ensure automatic inventory replenishment

Lyric Fitting Parameters Screen • First fit settings based on patient:

Audiogram – Age – Gender –

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Programming Parameters

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Device Activation Prior to Insertion • Remove the device from its packaging • Position the programming wand against the protection tube at the lateral end of the device • Press the programming button for the ear you want to fit (L or R) and listen for the two-tone ON

beep which confirms the device was programmed successfully • Perform listening check with stethoclip to verify function of device – Speak into the microphone – Use SoundLync to verify functionality

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Available Tools Supporting Target/ALPS • ALPS Fitting Guide • Lyric Fitting Guide • Target/ALPS instructional movie

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Validation of Fit & Post Fitting Counseling

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First Fit Checklist • On reverse of candidacy checklist

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Validate Comfort • Ask your patient to pay attention to how the devices

feel in the ears • Go over the different degrees of feeling: – Awareness, annoyance, discomfort, pain – Discomfort and pain are not OK • Ask the patient to respond in the different situations:

Neutral position – Moving jaw side to side and like they are chewing – Hand over ear –

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Discomfort Noted? • Did you have significant resistance upon insertion? • Check the angle of the device according to the orientation of the ear canal • Remove the device, inspect the ear canal and look for any “footprints” or abrasions

Initial Discomfort • Inspect the ear canal with the device in place and the pinna at rest

Did you have significant resistance upon insertion? – Check the angle of the device according to the orientation of the ear canal – Remove the device, inspect the ear canal and look for any “footprints” or abrasions –

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Discomfort Handling • Discuss scale:

Awareness – Annoyance – Discomfort – Pain –

• Discomfort and Pain are not OK

The patient should not leave the office with either – If pain/discomfort occurs after they leave, they should return as it needs to be addressed –

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Did you know that adjusting the physical fit of a Lyric device can solve

54%

of all feedback issues?

S.Banerjee ; Lyric3: Combating Feedback, Tips for successfully remediating, and even preventing, feedback Phonak Insight January 2016

If Feedback is Present in Neutral Position • Inspect the ear canal with the device in place and the pinna at rest

Check the angle of the device according to the orientation of the ear canal – Check if microphone is facing the canal wall – Check for gaps or folds – Use Lyric slider forceps to manipulate placement of device –

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Validate Feedback – If no initial feedback • Check for the presence of feedback for normal daily activities –

Ask your patient to do the following to check for feedback: • Open and close mouth like biting into a hamburger • Move jaw side to side • Cup hand over ear to simulate lying on a pillow • Hold cell phone or clinic phone to ear Manipulate device placement with Lyric slider forceps if troublesome feedback with above maneuvers

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Check Angle Reposition Check Depth

Feedback?

Reinsert

Follow “flight path”

Relubricate

Glycerin or Otoferm

Resize

Gaps or folds?

Decrease Volume Reprogram

& / or

Move Slope Control Off

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May be able to decrease more volume & / or

May need to increase OCC

Goals of Sound Quality Validation • Initial satisfaction with:

Volume • Talk to the patient at a normal conversational level • Adjust volume as needed – Clarity of speech in quiet and with ambient noise in room –

Refer to Lyric3.1 Programming Features as a guide for fine tuning 67

Lyric3.1 Fitting Workflow • Refer to Lyric3.1 Programming Features • Utilize Lyric fitting workflow techniques

Remember: Your patient may be new to amplification. Consider counseling accordingly and allow them time to adjust prior to making significant changes. Refer to module: Converting Trials to Subscription for more in-depth Sound Quality Management tips

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Care and Use of Lyric • Play Lyric Counseling Video • Provide Lyric Patient Kit

SoundLync – Instruction Booklet – Lyric ID Card – Plastic clamshell containers –

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Patient Counseling Movie

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Some final considerations…

Real Ear Measurements

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Care and use of Lyric devices • Store devices away from electromagnetic interference (e.g. microwave, x-ray machine, • • • •

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autoclave) Do not use if foil package seal has been compromised Do not use if temperature indicator has changed color Do not alter the device Handle devices hygienically

Infection Control Cleaning of insertion tool and specula: • Autoclave –

Note that the plastic components of the tool may discolor but functionality will remain intact

• Cold sterilization

Complete submersion in cold sterilant in designated tray overnight – Rinse and pat or air dry –

For further information about infection control: http://www.sac-oac.ca/sites/default/files/resources/Infection_prevention_control_Guidelines_Audiology.pdf 74

Next Steps Clinical Support

Marketing Support

www.lyricresourcecentre.com

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Thank You!