{"id":2277,"date":"2013-06-03T12:30:19","date_gmt":"2013-06-03T09:30:19","guid":{"rendered":"https:\/\/earbook.online\/pora\/?p=2277"},"modified":"2014-08-01T16:11:19","modified_gmt":"2014-08-01T13:11:19","slug":"doris-vercelli-answers-remote-fitting-and-rehabilitation-26-05-2013","status":"publish","type":"post","link":"https:\/\/earbook.online\/pora\/blog\/2013\/06\/doris-vercelli-answers-remote-fitting-and-rehabilitation-26-05-2013\/","title":{"rendered":"Doris Vercelli answers the questions of experts and parents in the seminar on Remote Fitting and Rehabilitation 26.05.2013"},"content":{"rendered":"

\u00abRemote fitting is a technology which forms
\na transition to home-made fitting,
\nand self-fitting by the patient\u00bb.
\nProf. A. Buechner (Director for Science,
\nGerman Hearing Center, Hannover,
\nENT Clinic of the Hannover College of Medicine)<\/em><\/p>\n

[Evgeniya Grigorieva-Astrakhan] Is remote fitting likely to be worth performing [to a higher degree] on adult patients with late onset of deafness? <\/strong><\/em>
\nDefinitely not; it is just as suitable for younger children with different indications. But this is circumstance-dependent; the expert doing the fitting remotely should have a good rapport with the family and the child.<\/p>\n

[Ulyana Kovna-Lviv] How old should a child be before it is possible to fit them remotely?<\/em><\/strong>
\nThis depends on how well the expert is acquainted with the situation and the needs as well as the hearing ability of the child.
\nA webcam does not enable the expert to see the child’s reaction in detail, yet this is the data on which the correct settings are partly based. This is why the Hannover experts have spoken against remote fitting for infants and early school age children.<\/p>\n

[Jana Frey_Berlin] So which age is appropriate for beginning the practice?<\/strong><\/em>
\nI think this may be considered once the child is one year old. The expert doing the fitting should also know the child very well.<\/p>\n

[<\/em><\/strong>Monika<\/em><\/strong> <\/em><\/strong>Lehnhardt<\/em><\/strong>–<\/em><\/strong>Auggen<\/em><\/strong>] I know that in Australia as well as in Poland remote fitting is done on very young children, due to the huge distances involved. <\/em><\/strong><\/em><\/strong>
\nWe might try this in the future; after all, we opened just in 2011. We are very open to new experiences in remote rehabilitation.<\/p>\n

[Nikiforov Konstantin] Do both children and adults receive remote fitting? Or is this just for the adults?<\/em><\/strong>
\nSo far we’ve gained experience just with older patients; our youngest is 10 years old. We are confident that fitting over distance is possible for younger children, too.[Oksana Gunko-Kherson] How often should a new device be provided? Our experts think it is once every 5 years. Is this obligatory if the device is working? <\/em><\/strong>
\nIt all depends on whether hearing aids are worn every day. If yes, then after 5 years of daily wear some elements are so depreciated that the HA should be replaced on purely physical grounds. But it’s a different story if the HA is worn only occasionally.
\nIn Germany medical insurarance covers not only replacement of a HA (once in 6 years), but also upgrade to the speech processor once every 5 years.<\/p>\n

[Liubov_Osnabr\u00fcck] Who makes certain that implanted children do get further fittings and upgrades, if necessary? Should the parents or caregivers be responsible, or is this monitored by the centers who conducted the post-operative fitting, and now send notifications to parents? <\/em><\/strong>
\nIt is a shared responsibility of the parents and the centers. The bulk of it falls to the parents, but often they don’t trust themselves to do it and ask the centers to send reminders.<\/p>\n

Question about a patient (example No. 1 in the slides)
\n<\/em>[<\/em><\/strong>Monika<\/em><\/strong> <\/em><\/strong>Lehnhardt<\/em><\/strong>–<\/em><\/strong>Auggen<\/em><\/strong>] Why was the patient refused in two other CI centers?<\/em><\/strong>
\nShe was refused a cochlear implant in two other centers because her speech intelligibility and hearing were considered too good. Speech discernment with HA was at around 50%.<\/em><\/strong><\/p>\n

[<\/em><\/strong>Jana<\/em><\/strong> <\/em><\/strong>Frey<\/em><\/strong>_<\/em><\/strong>Berlin<\/em><\/strong>] Does that mean that 50% is not enough for a phone conversation?<\/em><\/strong>
\n50% of speech intelligibility meant that the patient was able to hear with her HA what was said by someone sitting in front of her in relatively quiet surroundings. However, in case of phone conversations it was practically impossible to make out what was being said; in noise it was impossible altogether.
\n50% of speech intelligibility don’t always mean inability to talk over the phone,\u00a0 but this was the case for the patient we discuss.<\/p>\n

[Oksana Gunko-Kherson] Do you have cooperation with Ukrainian hearing centers? Do you know of their methods of post-CI rehabilitation? <\/em><\/strong>
\nNo; unfortunately, we don’t have such experience as of yet. We will be glad if that can change.<\/p>\n

[<\/em><\/strong>Jana<\/em><\/strong> <\/em><\/strong>Frey<\/em><\/strong>_<\/em><\/strong>Berlin<\/em><\/strong>]<\/em><\/strong> Do you think the Hannover experts make time savings when doing the fittings remotely?<\/em><\/strong>
\nYes, the economy is significant. A physical meeting in Hannover takes up one hour; remote sessions last only 20 minutes, because greetings, technical checks, conclusion and questions from the patient are not included.<\/p>\n

[Nikiforov Konstantin] Which software is used for remote fittings? In Michelin in Belgium they recommended that we use TeamViewer.<\/em><\/strong>
\nThe manufacturer would be AURIC. However, the product is not TeamViewer but proprietary software. We think that the software should be custom-made.<\/p>\n

[Lilit Abrahamyan – Yerevan] Anush from Yerevan is asking who does the fitting, and what the costs are.<\/em><\/strong>
\nA subsequent fitting costs around 200 euros. The first fitting is more expensive, but the fact is, we don’t know just how much it is. It is included into the mutual balance or cooperation between clinics and the ‘Krankenkassen’.<\/p>\n

[Artur Salmiyarov-Surgut] Is a CI programmed by one person, and a HA by another? Or will it be the same expert?<\/em><\/strong>
\nYes, this is the same remotely operating expert. He also carries out speech tests, which is important for patients.<\/p>\n

[Artur Salmiyarov-Surgut] In Russia we’ve encountered the problem of many experts doing the fine-tuning on HAs, but not having any involvement with CIs, and vice versa. This leads to a poorer quality of bimodal fittings. What training do experts in fitting CIs and HAs receive?
\n<\/em><\/strong>Getting qualified as a HA acoustician in Germany takes 3 years; another year is devoted to writing a Master’s paper. Once you have that, you take a short theory and practice course to become a CI acoustician.<\/p>\n

[Nikiforov Konstantin]<\/em><\/strong> Hearly all experts skilled in programming a CI, can also fit a HA. When the child is not wearing a HA on the other side, we must ask ourselves whether a fitting might be to blame. The child gets lots of input from a CI and the HA is an impediment – at the start. This is an organizational issue, too, so the fitting of the HA is not always a significant influence.<\/p>\n

[Anastsia-BobruiskBelarus] I really need to know whether the number of electrodes has an influence on speech intelligibility. <\/em><\/strong>
\nI my experience, patients with different electrode counts can achieve an identical intelligibility level.<\/p>\n

[Nikiforov Konstantin] The number of electrodes does impact intelligibility. However, we must understand that the difference between 22 and 24 electrodes is fairly small. What matters is the number, the percentage, of the ones that become defunct.<\/p>\n

[Anastsia-BobruiskBelarus] My child, implanted with Combi 40, has only 9 out of 12 working electrodes, and the 9th is borderline. <\/em><\/strong>
\nWhat do you see about the performance of your son: does he really understand less? How has his progress been affected since the electrodes started failing?<\/p>\n

[Nikiforov Konstantin] Anastasia, it’s fine. 9 electrodes are quite enough. I don’t think reimplantation should be considered. Just keep a close eye on the situation. Fewer than 4 electrodes failing means no reimplantation.\u00a0 More than 4 means a new implant. These guidelines were issued by MedEL for CIS.
\nWhen electrodes fail in the device, regardless of manufacturer, we check to see whether this affects speech understanding and other hearing capacities of the child.<\/p>\n

[Anastsia-BobruiskBelarus] Our electrodes did not fail – they were not inserted into the cochleum properly. The processor failed several times. I have a fear of something happening to the implant. <\/em><\/strong>
\nThis is a surgical issue. We recommend that a competent person – from the side of the clinic or of the manufacturer – have a look at the child and assess the situation.<\/p>\n

[Nikiforov Konstantin] If I were you, I would not worry. Implant failure rate is extremely low. But you do have to keep monitoring this.<\/p>\n

[Anastsia-BobruiskBelarus] Should we not have a CI in the second ear?<\/em><\/strong>
\nThis is not so easy to answer. Why could all electrodes not be fitted into the first ear? The second ear should be thoroughly assessed; the physiological structure and residual hearing analyzed.<\/p>\n","protected":false},"excerpt":{"rendered":"

\u00abRemote fitting is a technology which forms a transition to home-made fitting, and self-fitting by the patient\u00bb. Prof. A. Buechner (Director for Science, German Hearing Center, Hannover, ENT Clinic of the Hannover College of Medicine) [Evgeniya Grigorieva-Astrakhan] Is remote fitting likely to be worth performing [to a higher degree] on adult patients with late onset … <\/p>\n

Read more<\/a><\/p>\n","protected":false},"author":506,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[33],"tags":[56,27,76],"class_list":["post-2277","post","type-post","status-publish","format-standard","hentry","category-questions-and-answers","tag-organization-of-rehabilitation","tag-rehabilitation-method","tag-telepractice"],"jetpack-related-posts":[{"id":6840,"url":"https:\/\/earbook.online\/pora\/blog\/2021\/01\/profile-andrew-kendrick-2\/","url_meta":{"origin":2277,"position":0},"title":"Profile: Andrew Kendrick","author":"eduard","date":"January 10, 2021","format":false,"excerpt":"Andrew Kendrick has worked extensively in the field of Auditory-Verbal Therapy over the past 35 years. 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