Lyric2 Candidacy Checklist - Phonak Lyric2 Instruction Booklet

12

Lyric2 candidacy checklist

Lyric Candidacy & Fitting
Client Name:
To size and fit Lyric, the ear canal and the tympanic membrane must be clean and healthy. For any medical conditions/therapies present (Yes) in
"Section 3. Medical History", please note recommended action indicated in
1. General contraindications
Yes No
❑ Hearing loss out of range?
❑
❑ Sloping hearing loss > 30dB per octave?
❑
❑ Client goes scuba diving regularly or skydives?
❑
❑ Client is not motivated or willing to try amplification?
❑
❑ Client is not willing to wear hearing aids continuously?
❑
❑ Lack of cognitive ability to understand device use?
❑
❑ Client or significant other is unable to self remove Lyric from own ear if necessary?
❑
2. Anatomical contraindications (otoscopy)
Yes No
❑ Unsuitable ear canal geometry e.g. bulges, v shape, step up, hourglass, etc.?
❑
❑ Skin conditions in the ear canal, e.g. eczema, chronic otitis externa, etc.?
❑
❑ Abnormalities in the bony part of the ear canal, e.g. osteoma, exostoses, etc.?
❑
❑ Abnormalities of the tympanic membrane, e.g. perforations, ventilation tubes, large atrophic scars, subtotal defect, etc.?
❑
3. Medical history (questions for client)
Yes No
❑ Do you suffer from diabetes?
❑
❑ Do you bruise easily and / or take a high dosage of anticoagulants (blood thinners)?
❑
❑ Do you have any known allergies (e.g. nickel, chrome)?
❑
❑ Do you have a compromised immune system?
❑
❑ Have you had chemotherapy within the last 6 months?
❑
❑ ❑ Do you have chronic ear pain or problems with the jaw joint (TMJ)?
❑ Do you have regular magnetic resonance imaging (MRI)?
❑
❑ Have you ever had radiation therapy to the head or neck in the past?
❑
❑ Medical consult necessary?
❑
4. Sizing Protocol
Insertion Depth
Device Size
5. Fitting: Target Settings
Soft Level Gain
Low Frequency Cut
Volume
Max. Volume
High Frequency Boost
(Medical clearance recommended)
(Medical clearance recommended)
(Medical clearance recommended)
(Medical clearance recommended)
Right Left Client is a Lyric candidate?
❑ Yes ❑ No, due to: __________________________________________________________
mm mm
Fitter Signature: ________________________________________ Date: _________________
Client Signature: ________________________________________ Date: _________________
Right Left
Left Ear
Right Ear
m Off m ON m Off m ON
Date:
(green) to the right.
(Medical clearance recommended)
(Not recommended for wearing Lyric)
(Not recommended for wearing Lyric)
(Not recommended for wearing Lyric)
Lyric left device label
Lyric right device label