How to Use miGuide www.siemens.com Philippe Lantin Abstract: miGuide is a part of the Connexx 7 fitting workflow that intuitively steers the hearing instruments to provide the preferred sound in all situations and to support acclimatization to amplification. This paper explains what miGuide is, what it does and how to manipulate it within Connexx 7. How to Use miGuide 1 I. miGuide: what it is miGuide forms part of the fitting workflow of Connexx 7. It allows micon hearing instrument (HI) users to tailor their own hearing preferences: “To hear what they want to hear, how they want to hear it.” To reach this goal, the Hearing Care Professional (HCP) can program all micon hearing instruments to offer the wearer new benefits via the four sophisticated algorithms within miGuide. • The Data Logging algorithm of miGuide records data that give relevant information on the acoustic environments encountered by the patient in his daily life, use of hearing instruments and hearing programs. This information gives the HCP useful clues for counseling and fine tuning the micon hearing instruments according to the patient preferences for these very environments. These data is saved in the chip memory and can be easily accessed in the Data Logging tab. • Generally, new users prefer wearing completely automatic hearing instruments that do not require manual program changes according to the environmental acoustic situation, even though environment specific frequency shaping may be beneficial for hearing comfort and speech intelligibility. micon can provide the benefits of different programs customized for specific listening situations. This can be programmed by the HCP under the "Sound Equalizer" algorithm of miGuide. • micon hearing instruments can learn the listening preferences of the user, for six different acoustic environments. During this learning process, micon will gradually change to provide the preferred loudness and tonality for each of these listening situations. This is the "Learning” algorithm of miGuide. Just like a hiker who would get the maximum benefit from his new boots if they are flexible enough to stretch to conform to his feet, the HI should adapt to the wearer’s listening preferences. • Knowing that these listening preferences might be more comfort oriented, micon will guide the patient to supplement the comfortable hearing by gradually leading him towards increasing speech intelligibility. This upwards progression in gain will also help him to get used to his new hearing instruments, and can be programmed through the "Acclimatization Manager" algorithm of miGuide. Going back to the hiking boots analogy, the wearer should get progressively used to walking in them before getting the maximum benefit from them, and be able to enjoy a day-long hike in the wilderness. Thanks to miGuide, the HCP can completely tailor the fitting of the micon hearing instruments to fulfill patients’ specific expectations in different acoustic environments, without the bother to change programs, thereby ensuring that the fitting will gradually match the wearer’s increasing needs of audibility during the acclimatization process. While the miGuide feature of Connexx 7 is helpful for all patients by reducing the number of follow-up visits, it is especially beneficial for patients who are unable to regularly visit the HCP for fine tuning sessions. For these “remote” patients, the HCP will no longer have to choose between an initial setting that will in time become too weak to ensure better speech intelligibility, Copyright © Siemens AG 2012. All rights reserved. How to Use miGuide 2 and a final setting that might be too uncomfortable at the beginning. Additionally, many patients have difficulties explaining precisely the variety of acoustic environments they are in, so the HCP cannot always make the most effective fine tuning adjustments accordingly. With miGuide, improved personal fine tuning can be achieved when the gain adjustments are done directly in the situation. II. miGuide: what it does miGuide features four different algorithms that work in synergy to customize the fitting for each and every patient. 1. Data Logging A B C Data Logging collects separate data from both right and left devices, and displays them individually in Connexx 7 to provide useful information to the HCP for further fine tuning the hearing instruments. This information helps to understand the comments of the HIs user and supports counseling. Note that Data Logging starts automatically after first fit. Clicking the corner of the page resets all the data already logged. bottomright right button on the bottom A On top of the page, the starting date of the logging, the read out date, the total wearing time and the average daily wearing time are displayed. The HCP is warned if the wearing time differs between left and right devices. There are two tabs on which you can click. B In the "All" tab, are displayed: • • The usage of each of the six programs (in percentage of time). The acoustic environments or situations in which the hearing instruments were (in percentage of time across all programs). The detected situations are Speech in Quiet, Speech in Noise, Noise, Music, Car and Quiet. Copyright © Siemens AG 2012. All rights reserved. How to Use miGuide • C 3 The average number of manual changes per day across all programs for volume control and SoundBalance, and the average number of program changes per day. The second tab "Programs", displays the acoustic environments logged during the time each of the selected programs has been used. This allows the HCP to verify if the patient has been using different programs appropriately. For example, in a dedicated music program, the percentage of time for music should be the highest. 2. Sound Equalizer Sound Equalizer, the second algorithm in miGuide, automatically adapts the frequency shaping of the Universal program (program 1) to account for the changing acoustic situations in daily life. By doing so, the audibility or sound comfort might be enhanced in certain acoustic situations without the need to assign a dedicated program for it. As soon as the surrounding acoustic situation of the patient changes, the micon situation detection classifies the new situation, then triggers the Sound Equalizer algorithm of miGuide. Up to six different acoustic situations are recognized by the situations detection: Speech in Quiet, Speech in Noise, Noise, Music, Car and Quiet. The frequency shaping of the Universal program is adjusted automatically by applying gain offsets in up to 8 frequency channels to change the frequency shape accordingly. The applied gain offsets by Sound Equalizer have a fading time of average 16-20 seconds between situations to effect a smooth transition and avoid unnecessary gain adjustments for temporary sound changes in the environment. The default gain offsets of Sound Equalizer are also less than the gain differences of the relevant dedicated programs in order to have smooth transitions from the Speech in Quiet response curve. Note: All compression settings will remain unchanged, since only frequency shape is adjusted by the Sound Equalizer algorithm. E C B F A D In the Universal program, depending on the environmental noise, the signal processing algorithms (e.g. noise reduction) will apply frequency specific gain reduction settings from the Speech in Quiet response curve as programmed by the HCP. With Sound Equalizer activated, these schemes remain, but will be applied on modified response curves depending on the acoustic environment. The frequency scaling of the 8 channels is displayed under the gain offsets. A It is possible to select the desired number of handles/displayed channels. B The Sound Equalizer is activated by default after First Fit, and may be deactivated with the check box. C To display the gain settings of an acoustic situation, click on the button of the corresponding situation. D The gain (or output) curves displayed on top of the page will be updated when clicking on the situation buttons to give the HCP a direct visual indication of the changes he performs. E Copyright © Siemens AG 2012. All rights reserved. How to Use miGuide 4 To personalize the fitting according to the patient’s needs or preferences, the HCP may want to modify the gain presets of one or more situations, as he would do for the dedicated programs. The Sound Equalizer allows the HCP to change each frequency gain offset by steps of 1dB with the up / down arrows. 3. Learning Thanks to the Learning algorithm of miGuide, the hearing instruments can automatically adjust the gain settings to match the wearer’s individual loudness preferences, and situation specific preferences regarding optimal amplification. The hearing instrument learns these preferences from the volume and SoundBalance changes made by the wearer, but the learning parameters can be configured by the HCP. When the HCP has enabled Learning in the Universal program, the learning process is event-based: meaning when the wearer adjusts the volume or the SoundBalance in a certain acoustic situation and input level, the HI stores this information. The next time the wearer encounters the same situation at the same level, the HI will automatically adjust itself a bit towards the previously stored settings. After a few exposures and changes to the same environment and level, the patient will have his preferred settings without the need of any manual adjustment. This gradually leads to dedicated frequency response and compression for each of the six classified situations. The learning range, i.e. the maximum allowed deviation from the initial gain, remains the same for all classified situations. In the dedicated programs (programs other than Universal Program P1), the learning is time based, which means that the HIs will learn more and faster if the acoustical situation in which the volume change was made lasts longer. The learning time span is shorter for the telephone program than the others to compensate for the comparatively short amount of time wearers spend on the phone. Note: The HCP can individually set specific upwards and downwards learning ranges, for each program. The up/down ranges are usually set on the HCP preferences, but they also depend on the hearing loss: The HCP may decrease or increase them according to the residual dynamic range. Note that no matter how broad the VC range is, the HCP can decide to set a small learning range. See the example below of +4/-3 dB learning range for the universal program, and +5/-5 dB for the music program. One concern the HCP may have about the learning algorithm is for those patients that are not used to amplification yet. They might train the HIs to provide too little high frequency gain and too much compression for speech, both known to be detrimental for speech intelligibility especially in challenging listening environments. The risk of speech being too compressed is overcome when the devices are fitted with the micon fit rationale which employes adaptive time constants. The micon compression make use of long time to linearly process the fast fluctuating speech signals, no matter what the compression ratio may be. This ensures better speech intelligibility especially in noisy environments and very natural speech signals. If another rationale has been used to first fit the devices with a fast acting compression (i.e. syllabic compression), the risk of speech becoming too compressed can be overcome by choosing a narrow downwards learning range. Copyright © Siemens AG 2012. All rights reserved. F How to Use miGuide 5 The risk of getting too little HF gain is overcome by combining the learning range limitation with the Acclimatization Manager in miGuide. The HCP sets the Learning Range to ensure that the wearer cannot decrease the gain too much, which may degrade speech understanding. Additionally, Learning works together with the Acclimatization Manager where the HCP can define the increase of gain over time (period & target). Via Learning, the wearer can fine-tune the gain within the limits of the learning range around this path of acclimatized gain (see dotted line in the figure). Back to the hiking boots analogy, the dispenser determines the road to go, while the wearer selects the preferred side of the road. Depending on his/her preferences, the wearer can either walk on the sunny or shady side of the road, but the road ensures that the wearer always gets to the proper destination. Since the learning function is intended for the wearer to further fine tune the hearing instrument settings after the HCP has already done most of the fine tuning, it should be only activated at this point. E C Learning range VC range A D B F The HCP selects in which programs to activate the Learning by clicking the start learning buttons. A Learning can be enabled or disabled for all programs at once, or separately for different programs. When a program has the learning functionality activated, 2 small green cogwheels/gears are displayed, B and a green check mark is visible on the left second level navigation panel. C Each program may have its own learning range, with a maximum up/down range of +/- 16 dB. D The purple shaded area reflects the learning range around the 65dB input curve (in gain or output view), while the light grey shaded area reflects the Volume Control range, for each program. E The initial as well as the learned settings are displayed for each program. To reset all learned data of all programs to the initial setting before Learning occurred, press the Reset F button. Copyright © Siemens AG 2012. All rights reserved. How to Use miGuide 6 The learning in the Universal program is situation dependant, and the HCP can visualize the learning for each situation. The learning range in the Universal program P1 is the same for all situations. In the Situations tab A , clicking on a situation button B will display the response curve C of the Universal program for the relevant situation, whether this situation has a personalized gain offset or the default gain offset. The initial as well as the learned settings are displayed for each situation. C A B 4. Acclimatization Manager The Acclimatization Manager enables the micon hearing instruments to progressively increase the gain over a pre-defined period of time to reach a pre-defined gain target. This enables the patient to gradually become used to the amplification: starting with a soft and comfortable gain setting and achieve optimum audibility and speech intelligibility at the end of the acclimatization road. This smooth and imperceptible increase of gain occur simultaneously in all hearing programs. See next an example of the advantages of this automatic acclimatization for the HCP who spends less time fine tuning fittings, and for the patient whose acclimatization to optimal amplification does not occur in a step-like progression. In a binaural fitting, the acclimatization is coupled, the gain increase is the same for both HIs. Note: The three level dependant gains are acclimatized together, all AGC-I settings will always remain untouched. The AGC-o will limit the output if needed. In the Acclimatization Manager page below, the HCP selects the gain target after acclimatization, A and the acclimatization level as a percentage of the final target. B The HCP can allow the patient to listen to the final setting by clicking the Prelisten button. C The curves and the progress bar then display the final status. It is also possible to acclimatize to a different fitting rule compared to what was applied by First Fit. In case a different compression schemes are used, the original fist fit compression (e.g. micon compression) will remain. If the HCP has a special concept or philosophy for the final fitting, he can choose the individual target where he will select the appropriate gain offset for each of the 8 frequency channels. D Copyright © Siemens AG 2012. All rights reserved. How to Use miGuide 7 Note: The gain offsets from the last preselected experienced fitting formula will be shown in the Individual Target as a starting point for the HCP to further fine tune the target of this fitting formula. The maximum deviation of gain values for the Individual Target is +15 dB and -16 dB. G A H B E F D I C The HCP selects the duration of the Acclimatization Period E . Note: 1 day count equals 10 hours of wearing time. In case the patient wears his hearing instruments more than 10 hours a day, a target that has been set with a Acclimatization Period of 4 weeks, for instance, will actually be reached in less than 4 weeks. When reading out the HIs, the Start Date will be displayed and the progression bar will indicate the advancement of acclimatization. F The curve view displays the acclimatization span (in yellow), and the current position of the 65 dB input gain curve according to the acclimatization progress. G To start the acclimatization, click the Start button H . To end the acclimatization and restore the original settings before Acclimatization was started, click the Reset button. I Copyright © Siemens AG 2012. All rights reserved. How to Use miGuide 8 The choice of the acclimatization duration is generally made depending on the patient’s age and experience with amplification. See the chart below with recommended durations for acclimatization. Patient Older Younger New to Hearing Instruments 2 months 4 weeks Experienced with Hearing Instruments 2 weeks 1 week However, besides these recommendations, the HCP should also take into consideration the motivation and desire of the wearer to get used to his/her hearing aids. For example, for a relatively unmotivated older patient with no experience, the appropriate duration might be up to 6 months. It would be also very useful to provide him/her with the Learning functionality. III. miGuide: how to use it in a few clicks 1. The first fit visit: programming the HIs After first fit, the HCP should complete all the fine tuning for program 1, the Universal program. When more than one program is required, the other programs should be defined in the Program Handling tab, before opening the miGuide pages. The Data Logging page of the miGuide section is purely informational for follow up visits. There is nothing adjustable here. The Sound Equalizer enables up to six programmable sub-programs in the Universal program. It is a powerful tool to offer the end user the maximum benefit from his/her HIs, with a hassle-free handling. - Click on the Sound Equalizer check box 1 and leave the default settings for all environments. 1 The Learning function is an intelligent algorithm that ensures the wearer’s hearing comfort by taking into account his/her listening preferences. It can be used in combination with the Automatic Acclimatization which makes sure the wearer receives the right amount of gain to fulfill his/her hearing needs. Satisfying both the listening needs and preferences, these two algorithms working in synergy to achieve the wearer’s full satisfaction. For most wearers with average hearing losses, the default learning range setting of +/- 6 dB is well balanced for enough learning efficiency without changing too much of the initial settings made by the HCP. - For hearing losses with a narrow residual dynamic range, the HCP can set a smaller learning range, +/- 4 dB for example. - Click on the Start All button 2 to start the learning in all programs, or select the desired programs. 2 Copyright © Siemens AG 2012. All rights reserved. How to Use miGuide 9 The Acclimatization Manager is a useful algorithm which provides an automatic and progressive increase in gain over time, to ensure optimal speech intelligibility in additional to a comfortable hearing experience. - Click on the Acclimatization Period 3 to set the duration from 1 week up to 6 months. - Click on the Acclimatization Target and set the Acclimatization Level 4 to select the final response curve after acclimatization. Most of the time, the best choice is the experienced level of the same target chosen for first fit. 3 5 4 - If a gain increase is required in the low frequencies, the HCP should consider reducing the vent size. - Click on the Start button to begin the acclimatization. 5 2. Follow-up visits The Data Logging page provides the HCP with useful information on the HIs’ usage versus the acoustic environment of the patient. In the example below, there is a mismatch between the music program usage vs. the music listening time, and the noisy environment program vs. the noisy time of the environment. The quiet + speech in quiet time match the program 1 usage. This is a hint that the program 2 may have a too narrow bandwidth since the patient preferred the large bandwidth of the music program also in noisy situations. This will help the HCP to ask the relevant questions in order to find the appropriate changes to make in the different programs. The long wearing time per day indicates that the patient is comfortable with his/her new HIs. In the upcoming follow-up visits, the number of manual changes per day (VC and program) should decrease thanks to the Learning and Automatic Acclimatization algorithms. It would be a clear indication of a greater ease of use for the patient. The Programs tab will indicate the distribution of logged acoustic environments for each program. This distribution will help the HCP to verify the correct usage of program for a specific environment by the patient in his/her daily life. In the Sound Equalizer page, the HCP can adjust the gain offsets for the different acoustic situations to improve the versatility of Program 1, making it even more universal. After fine tuning the environment specific programs, the HCP could program the Sound Equalizer gain offsets to match the frequency response of each relevant environment program. Copyright © Siemens AG 2012. All rights reserved. How to Use miGuide 10 In the same previous example, the HCP can modify the gain settings for Noisy environments to increase the bandwidth (see the screenshot below). As such, the HCP can expect the patient not to use the noisy environment program anymore. The patient’s ease of use of the devices would be improved if the need of manual changes of programs can be reduced. The Learning page indicates the patient’s preferences for each program and can be viewed in gain or output mode. Click on the situations tab to display the preferred settings for each environment. In the Acclimatization Manager page, the HCP can see the progression of the acclimatization from the status bar. Here, 50% has been achieved: . The HCP can also read the current state of the gain or output curves. In the example below, halfway through the acclimatization progress, the 65 dB input gain curve is in the middle of the yellow area. The HCP may continue the acclimatization process or end it with the button. In the latter case, the settings will be restored to the settings before the acclimatization started. Copyright © Siemens AG 2012. All rights reserved.
© Copyright 2020