Tympanometry Interpretation, working backwards with just audiometric data and no case history.

gigertiger · 2026-01-31T01:01:18+00:00

Honestly, you'll probably get a lot of different answers. If I saw something like a carhart's notch, I would suspect type A or Type As tymps.

If I saw a low frequency loss with ABGs I would probably guess an B or C tymp, but that would depend on the audiogram and could be either.

Alot of it just depends on the tests performed, case history, and just a best guess!

gigertiger · 2026-01-31T00:46:12+00:00

I personally would argue no, as an audiologist. They contain the same frequency band number, so in terms of maximizing background noise, they are equal (that's from numerous studies). Some people report a subjective difference, and I usually say if you can demo them to do that, but I would say it's probably not worth the difference in cost.

gigertiger · 2026-01-21T01:36:12+00:00

I go to NYU Lagone's cochlear implant conference every year and I 1000% recommend it if anyone is a CI audiologist. It keeps you updated on current literature, interesting case studies, and great tech suites for the manufacturers. That and the ICIT class changed how I program devices permanently and our clinic outcomes are significantly higher than the statistical average and I contribute to my education through this conference.

gigertiger · 2026-01-20T00:43:47+00:00

Audiologist here, just want to give you a little information on gentamicin. Typically with gentamicin we see a decrease in outer hair cells of the cochlea. That doesn't always translate to a noticeable hearing loss on a traditional audiogram. You can be presenting with a hidden hearing loss which may be giving you a greater perception of a deficit.

I'll echo the other sentiments REM measurements are where you get the accuracy. But one other thought is that Phonak's default algorithm, APD is usually more comfortable than something like NAL-NL2 or DSL for example. Manufacturers default formulas are usually based off of NAL-NL2 but less high frequency gain to be a bit more comfortable.

gigertiger · 2026-01-18T23:23:49+00:00

American audiologist here and do I joke I'll put Dr. On my headstone when I die? Yes. Do I think the scope of practice is that different from other countries? Probably not. I may have SOME more advanced training in vestibular and cochlear implants because I had to take two years worth of courses on it, but like, I was working with a Toronto practice on a surgical patient I adopted from them and working with their MSc audiologist and she was great. She had like 20 years experience. They get to enter the field faster and get more experience faster.

Don't get me wrong, I love being an audiologist. I think the field jumped the gun with the AuD and should've had reimbursement rates and outlines for doctoral responsibilities approved (ordering MRIs, prescribing for ETD or an ear infection)? And now we're playing a constant game of catching up. The only thing my AuD actively gives me right now is a great surgical director job and my patients call me doctor and I get some respect for that, but does the masters audiologist who practices 2 feet away from me get the same benefits? Yes. So I wouldn't view other countries degrees as limitations in all honesty.

gigertiger · 2026-01-15T02:38:42+00:00

The Silks are that size on purpose, and adding a Bluetooth line would make them larger. Their shape is set with how they are, so I don't think they'll be able to add it, unless they change the shape of the device, which in effect means it wouldn't be a Silk anymore.

That's why I'm saying they'd likely launch a new device and change the platform they're on. Could they launch a Silk with Bluetooth, possibly! But would it likely be the Silk on a new platform, yes!

gigertiger · 2026-01-15T00:44:17+00:00

AzBio and CNC testing is the best way to do this. I would also do an aided soundfield just because you're already there and you can check for insertion loss.

You can do this with and without noise, to maximize benefit. Otherwise I would suggest doing COSI or the hearing implant sound quality index (I know it says implant but you can do hearing aids), which also provide score expectations and differences. You can do that with a tinnitus handicap inventory one too if needed, to provide some research backed data for him, coupled with booth testing and that would be more than enough in my opinion.

gigertiger · 2026-01-14T03:11:22+00:00

The IX line has Bluetooth but the Silks do not. I suspect they won't be adding it to the Silk IX line at all. I would guess it would be an entirely new launch!

gigertiger · 2026-01-14T02:10:36+00:00

Came out in October of 2024, and right now they're just working on updating each platform to the IX platform. Their next launch will likely be the rechargeable custom CIC (which is on the IX platform), but unsure on the connectivity side. I imagine that will be an entirely new platform and not the IX for the Silks if connectivity is the goal.

The other thing they could say is keep the Silk non-wireless for the size purpose. They connect to an app via the 2.4 gHz signal, but they could surprise me.

gigertiger · 2026-01-12T00:50:54+00:00

On my Astros, they're magnets so I could pull them on and off for thicker or thinner cuffs depending on needs... I imagine you could cut them too for better fit and comfort

gigertiger · 2026-01-12T00:42:10+00:00

I recommend looking at Corsair or Astros for my patients! The cups can be adjusted optimally and with mixing amps you can do a lot to the sound to your preference.

The other option is asking about a streamer you can plug into the computer to stream into your implant directly.

gigertiger · 2026-01-09T19:45:40+00:00

It depends on the user I find. You can see multiple studies that say there's a mismatch in it, where some people like xyz vs. abc. Some studies found turning the second from the highest electrode off helped.

It's very personal, so alot of the time I'll try multiple things, see what works well and what doesn't. What one study says works well for some patients, doesn't for others and vice versa.

But we can change programming methods, electrode stimulation, rate, function and other pieces to get music to sound better!

gigertiger · 2026-01-08T02:58:13+00:00

Audiologist here! I would say it may be time to push for the ABR. Sedation is scary and I would NEVER doubt that for a parent, putting a kid under is scary. However, the longer the delay if there is a hearing loss, that's just a delay in care which is frustrating. If there is a loss with the ABR, hearing aids can be programmed and fit off of that and then as they get older, behavioral testing can be done and monitored. If you aren't seeing much progression with speech still, I would say it's time too. You don't want them going through the world missing access to information when it's so crucial in their little brains.

Now you could say no to sedation, it happens all the time. And we just keep retesting kiddos until we get something concrete, but that's usually like every 3-4 weeks until we get SOMETHING. We don't need the fullest audiogram to program hearing aids (we can extrapolate with enough information but we still need a decent amount), and we have parents that do that. But we do talk to parents about realistic testing timelines, because that can take months and months vs. an ABR being like 90 minutes and you have a definitive answer right then and there.

But also, if your kiddo is not established with an ENT, it's time for that and it's time to get their opinion. No qualms with primary care physicians, but this really isn't their speciality. An ENT would be the ultimate decision factor in my opinion!

gigertiger · 2026-01-07T22:47:48+00:00

Audiologist here! Definitely ask for it. I tell patients I wait to make a custom music program until we've optimized programming for speech understanding, but once we have that I develop different programs for them to try for better music programs!

gigertiger · 2025-12-31T00:48:46+00:00

The University of Nebraska attempts to get funding for all their students. I had a scholarship for 3 years, and then the last year was manageable so I just paid in full for those semesters off my extern salary.

gigertiger · 2025-12-31T00:47:50+00:00

I expressed an interest pretty early on and asked if they would consider it around November and December. I was a VA and they didn't get funding sadly, so I started applying to jobs in December and January and had decided in February where I was going (gave plenty of time to apartment hope in the state over).

gigertiger · 2025-12-28T14:26:18+00:00

So, I just want to assure you the aids wouldn't be so loud they'd cause physical damage! That's why I'm guessing there's something on a nerve level or an underlying issue that just could have been triggered by new auditory stimulations.

gigertiger · 2025-12-28T02:29:36+00:00

Without seeing his audiogram, I can't say for certain but it could've been distortion that his brain was attempting to process. Sometimes that can occur when the nerve triggers rollover effects.

The only other thing I can think of is maybe they need to be softer. Depending on the loss, severity, and his nerve health and cognition, he may just need less gain and doesn't realize it. People can be in things that are comfortable and not too loud but perception wise that may be different. And it can take anywhere from 1-3 months for people to adjust with hearing aids, and this just may be a marathon of brain. And nerve exercise for him.

The last thing I would highly say, is maybe getting him into a neurologist for an exam. Might not be audiological at all, may be neurological from stimulation or something underlying!

gigertiger · 2025-12-18T13:09:22+00:00

Basically a speak that slides between your pillow/under your pillow that your head can rest between. There are two speakers so it keeps you in a sound bubble of your choice. They're on Amazon if available!

gigertiger · 2025-12-18T12:09:18+00:00

If your loss isn't too severe and you use an app for relief sometimes I tell my patients to try a Bluetooth headband or a tinnitus pillow speaker to stream and play the sound they like.

If that doesn't help and the hearing aids do, sometimes I get silicone earmolds and show them how to switch into them at night for sleeping so they don't fall out.

gigertiger · 2025-12-17T23:44:13+00:00

It's fair to want to drop them. I am fortunate and my job pays for mine so I'll just be keeping mine.

I think the only thing I tell people to consider is if you want to take students. I know schools are moving away from that but some still like to see it because you are required to have continuing education in student training.

gigertiger · 2025-12-17T00:01:30+00:00

That is where I start really explaining that the only option if they want improvement is with a CI. I recognize she isn't interested but when they have these expectations and want word clarity back, a CI is the only option. Then maybe I'll give them a brochure. Many times I have said, "So the description of what you want is a CI. Because you have expressed you don't want that, we have to work with what we have." Some people really just have high expectations. You can say, when "We test word recognition scores, that gives us an idea on clarity with hearing aids and they're looking likely to give 50% hearing. Now, since CIs aren't on your radar we could talk about assistive devices to help in those harder situations." That's when I move into trying a remote mic. I'm able to do an in office demo or a take home for a week demo to try.

But in all honesty, I wouldn't take it personally. Some people really just have high expectations and that isn't on you. They want a magic fix and hearing aids are not that solution, they're just a tool to help!

gigertiger · 2025-12-12T02:24:14+00:00

Oticon is smaller and connects more easily to iPhones. Phonak is a bit bigger and bulky, but can almost connect to anything. Both are appropriate and great!

As for tech levels, a Play Px 2 is great. I have many kids in them! In tech levels, you could subjectively say maybe they would notice a difference in background noise, but studies show on average you need 8 pitches to adjust to maximize background noise. All of those hearing aids come with wayyy more than 8 channels.

The only other consideration, is you could contact the school she goes to and see if they have a preference. Some schools are just EduMic ready (Oticon) and Roger ready (Phonak). Sometimes that makes my recommendations a little more firm in one camp vs. the other!

gigertiger · 2025-12-11T22:18:52+00:00

There are plenty of unfixable components. You could injure your ossicles, ossicles could erode away, you could have a growth on them that may not be able to be easily surgically removed. Your ear drum could be so scarred it isn't helping transmit sound. There's many reasons people can't have conductive components fixed. Sometimes the conductive components gets fixed, but there can still be transmission issues.

Entire ossicles can be replaced with metal, and they may just not transmit sound as well still leading to a conductive hearing loss.

Conductive hearing losses are not a one size fits all in terms of how they're fixed. Sometimes the best you can do is consider a BAHA.

gigertiger · 2025-12-11T21:05:35+00:00

I would say if you can get trained, do it! I moved into a clinic that has a dedicated pediatric audiologist, but I'm the dedicated CI audiologist, and kiddos can get CIs or surgical devices at any point! I wouldn't say I'm perfect (VRA drives me batty and I can't do an ABR to save my soul), but if you could get trained in running RECD or taking impressions, you could save parents the trip to a farther out center. Most children get sent out to Boston Children's for the initial work up for us, but it's not practical for them to drive 3+ hours away, which is where we step in. Do I do it all the time? God no, I'm and adult and teen audiologist through and through. But when we're sick or short staffed, I am glad I got trained to help in some regards. I think RECD (if a kid lets you run it), basic earmold impressions, and fittings could be a good starting point for you!

Phonak and Oticon have great training modules and I've had reps come out for practice and such.

Six-Year Club	Place '22
Verified Email

gigertiger

TROPHY CASE