Phonak Lyric User manual

Troubleshooting Guide

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This Troubleshooting manual and all materials contained herein have been prepared for the
sole purpose of providing instruction, review, and reference material to Lyric providers.
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Please read and maintain the important safety information when working with Lyric as
outlined in the Lyric user guide.
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transmitted in any form or by any means without the express prior written consent of
Phonak.

1
1 Programming Assistance.............................................................................................. P.2
2 Troubleshooting Programming .................................................................................. P.3
3 Troubleshooting Feedback........................................................................................... P.4
4 Troubleshooting Migration.......................................................................................... P.6
5 Troubleshooting Occlusion .......................................................................................... P.8
6 Troubleshooting Discomfort and Pain........................................................................ P.11
7 Troubleshooting Dead Device...................................................................................... P.14
8 Device Removal and Re-Insertion ............................................................................... P.15
Content Troubleshooting Guide

2
1 Programming Assistance
Soft Level Gain (SLG)
nSLG controls the compression knee point.
nTip:
–An increase in SLG will lower the compression knee point and increase relative gain.
–A decrease in SLG will raise the compression knee point and decrease relative gain.
Low Frequency Cut (LFC)
nLFC reduces gain 6dB/octave below the selected frequency.
nTip:
–Patients typically prefer lower LFC settings; especially when the device is set at a lower volume.
Volume (Vol)
nVolume should be based on the patient’s preferences and communicative needs.
Maximum Volume (MaxVol)
nSet MaxVol +1 or +2 of your set Vol.
nTip:
–This is more important for patients with lower volume settings as you do not want them to have the
ability to cycle through 6 settings. These adjustments do not aect the MPO.
High Frequency Boost (HFB)
nHFB provides approximately 4-6 dB boost above 2000 Hz.
nTip:
–HFB “ON” may over amplify high frequencies resulting in feedback and cause Lyric to compress.

3
2 Troubleshooting Programming
Background
nApply the methods mentioned in the previous section “Programming Assistance”.
nOnce the device is programmed and in place, confirming Lyric’s sound quality can be as easy as asking 2
questions:
– Volume related issues
– Own voice related issues
Query the patient & troubleshoot
nVolume related issues:
– Ask the patient “if you had a remote control, would you turn the volume up, down or leave it as
it is?”
�Based on the patient response to this question you should set the volume to where the patient is
comfortable and then set MaxVol to Vol +1 or +2.
�Changes to SLG should be saved for complaints of background noise, soft sounds or pumping.
nOwn voice related issues:
– Ask the patient “from where do you hear your own voice?”
�Options may be needed to help facilitate an answer, for example:
�On top of the head
�Back of the head
�From the mouth
�From far away
nIf the patient response is anything other than from the mouth, changing LFC is recommended. Lowering
the LFC increases the frequency response bandwidth and increasing the LFC decreases low frequency gain.
– If the voice is coming from the back of the head or there is an echo: Raise LFC.
– If the voice is coming from the nose or is tinny: Lower LFC.
– If the voice is coming from the throat: Lower or raise LFC.
– If the voice sounds or feels like it is underwater: Lower LFC.
If questions about volume and own voice related issues were adressed, the overall
sound quality the patient is experiencing should be positive.

4
3 Troubleshooting Feedback
Background
nThe most common cause for feedback is due to an incomplete seal. Always check the physical fit of the
device if there is feedback and before re-programming.
nTo troubleshoot feedback follow these steps:
– Query the patient
– Inspect the ear canal with the device in place and the pinna at rest
– Inspect the canal with the device removed (if necessary). See chapter 8 for more information.
Query the patient
nAsk the patient “what he/she is experiencing?”
– Squealing
– Hissing
– Static/Distortion
nAsk the patient “when is feedback occurring?”
– Always
– Intermittently
– Only when_________
nAsk the patient “what he/she thinks is the cause of the feedback?”
– Did the feedback start after showering or any other activity?
– Did the patient manipulate the device?
– Did the patient adjust the volume to a higher level?
nAsk the patient “how much of a bother is the reported feedback?”
– Intolerable
– Annoying, but tolerable
– Tolerable, just concerned that it happens at all

5
3 Troubleshooting Feedback
Inspect the ear canal with the device in place and the pinna at rest
nCheck the placement of the device: Are there any gaps or folds?
–Gaps noted: Re-size current size and 1 size larger (if available). Pay close attention to how the insertion
depth interacts with the sizer. You may have to use a larger size at a more shallow depth. Be aware that
reducing the depth of the insertion may contribute to occlusion, reduction in volume and sound quality
issues.
–Folds noted: Re-size current size and 1 size smaller (if available).
nCheck the angle of the device according to the orientation of the ear canal: Should the superior indicator
be towards the 2 o’clock position? 10 o’clock? Noon? If necessary change the position of the device
according to the orientation of the ear canal.
nThe canal wall is touching or close to the microphone. If the inspection revealed no gaps or folds, a
collapsing ear canal might be the cause:
–Consider placing the device slightly short of ideal depth of insertion to ‘prop’ the ear canal open.
–Be aware that reducing the depth of the insertion may contribute to occlusion, reduction in volume and
sound quality issues.
nDid the device migrate? See chapter 4 for more information.
nIs there cerumen adjacent to the lateral end of the device? If yes, replace with the new device to the
same depth of insertion.
nConsider reprogramming Lyric:
– Turn HFB OFF if it is ON. If feedback stops, and there is not a decrease in patient benefit, complete.
– Reduce gain 1 step (Vol or SLG):
�If feedback stops, and there is not a decrease in patient benefit, complete.
�If feedback stops but compromises patient benefit, use recommendations above.
�If feedback continues, use recommendations above.
If feedback remains and the patient perceives it as intolerable, consider
contraindication.

6
4 Troubleshooting Migration
Background
nMigration is defined as movement of the Lyric device from the original insertion depth. Migration is
completely normal and can occur immediately after the patient has been fit with the device or a sizer, or
may take a few hours up to a couple of days after the patient has left the oce.
nThis movement can be classified as “insignificant” or “significant”:
–“Insignificant” migration is movement of 2mm or less and occurs while the device finds its “sweet
spot”. Insignificant migration has no negative impact on sound quality or patient comfort and therefore
does not require replacement. The patient may or may not desire a program change due to the new
distance from the Tympanic Membrane.
–“Significant” migration is movement greater than 2mm and is considered “significant” if there are
any reported sound quality, comfort or feedback issues. If you find this to be an issue in your practice,
consider using the suggestions in this chapter.
Query the patient
nAsk the patient “what he/she is experiencing?”
–Decrease in sound quality
–Comfort issues
–Feedback
nAsk the patient “when is migration occurring?”
–After sleeping
–Patient manipulated the device
–During/following chewing

7
4 Troubleshooting Migration
Inspect the ear canal with the device in place and the pinna at rest:
nDo you notice any gaps or folds?
–Gaps noted: Re-size current size and 1 size larger (if available). Pay close attention to how the insertion
depth interacts with the sizer. You may have to use a larger size at a more shallow depth. Be aware that
reducing the depth of the insertion may contribute to occlusion, reduction in volume and sound quality
issues.
–Folds noted: Re-size current size and 1 size smaller (if available).
nInspect the ear canal while the patient opens and closes jaw and determine if there is excessive jaw
movement.
–Determine the current depth of the device using the Lyric1 forceps:
–To do so, gently grasp the handle of the device with the forceps and move the depth ring so that it
lines up with the posterior meatus. Remove the forceps and make note of the measurement.
nIf migration is “significant”, follow these steps:
–Rule out patient manipulation of device. Remove the device and re-evaluate the device size with sizers.
You may have to upsize to prevent further migration.
–Determine if changing insertion depth will also allow a more secure fit.
–Evaluate TMJ movement with Lyric in the patients ear. When the patient opens and closes their jaw,
does the device move? This may be a contraindication if migration continues to be an issue.
If significant migration continues to be an issue, consider contraindication.

8
5 Troubleshooting Occlusion
Background
nThere are two types of occlusion with hearing aids: “Physical occlusion” and “acoustic occlusion”.
nAs long as an acoustic seal in the bony portion of the ear canal is achieved, the patient should not
experience “physical occlusion”.
n“Acoustic occlusion” is caused by under-amplification of low-frequencies (insertion loss from device
placement), or giving over-amplification of low-frequencies (sound quality and own voice has too much
bass).
Query the patient
nAsk the patient “what he/she is experiencing?”
– Feels plugged up
– Feels like he/she is talking in a barrel
– Voice sounds hollow
– Feels/sounds like he/she has a cold
nAsk the patient “how much of a bother is the reported occlusion?”
– Intolerable
– Annoying but tolerable
– Tolerable, just concerned that it happens at all
Determine type of occlusion
nBefore troubleshooting determine if this is physical occlusion or acoustic occlusion:
– Does the patient feel occluded with the device turned o? Try turning the device to SLEEP mode or
OFF:
�If yes, this is truly a physical occlusion.
�If no, this could be a result of the electronic gain/amplification (see page 10 on how to
troubleshoot acoustic occlusion).

9
5 Troubleshooting Occlusion
Physical Occlusion
nBefore changing programming parameters, please check the following:
– Is the device ON?
– Is the patient aware of the device(s) in the ear?
– Awareness is a normal feeling when adjusting to wearing Lyric 24/7. This perception should last
between the first few days to a few weeks of wearing the device(s).
– Do not let the patient get confused between awareness and true occlusion.
nCould the device be placed at the desired or maximum insertion depth?
– If not, was the patient comfortable with the placement? Re-insert the device to maximum insertion
depth. It may be necessary to decrease the device size in order to achieve the desired or maximum
insertion depth.
– If yes, was the patient comfortable with the placement? Try upsizing and use the next size.
nAsk the patient “from where is your voice coming?” The correct answer is coming from the mouth. Based
on patient response to this question you should increase/decrease LFC as needed:
– Coming from the back of the head/echo: Raise LFC – this is helping to accommodate occlusion.
– Coming from the noise/tinny: Lower LFC – this is increasing the bandwidth of the device and
adding more low frequencies.
– Coming from the throat: Lower or raise LFC – the patient could be experiencing acoustic occlusion
and by lowering the LFC you increase the bandwidth. However, too much low frequency gain will
require raising LFC.
– Sound/feels underwater: Lower LFC – this is increasing the bandwidth of the device which makes
the sound feel more transparent. Alter LFC until the patient hears his/her own voice coming from the
mouth.

10
5 Troubleshooting Occlusion
Acoustic occlusion
nTry the following programming adjustments:
– Set LFC (Low Frequency Cut) to 200 Hz. Remember that when you have lower volume settings with
Lyric2, patients prefer lower LFC settings.
– Change LFC based on the patient’s feedback of his/her own voice (see page 9 on how to
troubleshoot physical occlusion).
Patient is still reporting occlusion
nIf you have tried the above recommendations and the patient still reports occlusion:
– Counsel on awareness (see chapter 6 for more information).
– Counsel on acclimatization period (see chapter 6 for more information).
If the patient continues to report intolerable occlusion after 30 days of continuous
wear, consider contraindication.

11
6 Troubleshooting Discomfort and Pain
Background
nDetermine the level of discomfort/pain from the patient. Use the pain scale (Note: these are typical
findings; individual patient responses may vary):
– Awareness – will typically recover within 14 days.
– Annoyance – will typically recover within 14 days.
– Discomfort – will typically recover within 14 days.
– Pain – is not expected to recover and the device should be removed.
FITTING 14 DAYS OF WEAR
ANNOYANCE
DISCOMFORT
PAIN
AWARENESS

12
6 Troubleshooting Discomfort and Pain
Query the patient
nAsk the patient “what he/she is experiencing?”
– Sharp, shooting, stabbing
– Dull aching
– Awareness
nAsk the patient “when is this occurring?”
– Always
– Intermittently
– Only when_________
nAsk the patient “how much of a bother is the reported discomfort or pain?”
– Intolerable
– Annoying, but tolerable
– Tolerable, just concerned that it happens at all
nQuery patient on when the discomfort or pain started:
– “Did you feel pressure in your ears like you needed to pop them?”
�If yes, it is possible that negative pressure was trapped behind the device upon insertion and
you may see moisture accumulation in the ear canal.
�Make sure you insert in a smooth, slow pace (no pumping).
– “Did you feel the device moving in your ear canal?”
�If yes, re-size.
– “Did you touch, move or manipulate the device?”
�Counsel to not move/rock the device in the ear.
�If itchy, counsel to gently rub the outside of the ear.
�If the device moved, re-size (also see chapter Troubleshooting Migration).
– “Do you chew gum regularly?”
�Counsel not to chew gum or have excessive jaw movements especially within the adaptation
period.

13
6 Troubleshooting Discomfort and Pain
Reported awareness, annoyance and discomfort
nCounsel patient on adaptation period and continue Lyric use.
nIf discomfort continues beyond 14 days or pain occurs, remove the device and see section below.
Reported pain
nThe device should be removed immediately, preferably by the clinician:
– If the device is removed by the patient, try to have them come into the oce as soon as possible to
perform otoscopy and the steps below.
– Clinical removal: Prior to removal, determine the insertion depth of the device to determine if the
device has migrated. If migration occurred, , also see chapter 4 and use tips prior to re-insertion.
nOtoscopy and ear canal examination:
– Make note of any “footprints” (that is abrasions, redness, irritation) to help determine the cause of
the pain.
– If the “footprint” is deep into the ear canal (towards the medial end of the device) verify the canal
length. In some cases you may need to place the device 1mm more shallow.
– If the “footprint” is located on the posterior/anterior/inferior/superior portion of the ear canal, check
the angle of insertion.
– Medical referral if necessary and report in Target software.
– Do not immediately re-insert the device.
– Wait at least 10-14 days to re-insert or until ear is healed.
– It is very important that there is no cerumen, scab, or debris in the ear canal prior to device re-
insertion.
If pain occurs again, remove the device and the patient should be contraindicated for
Lyric use.

14
7 Troubleshooting Dead Device
If the device is still in the ear
nUse SoundLync to change device settings. Does the patient hear the beep?
– If yes, how many beeps?
�1 beep: Device was in SLEEP mode / OFF.
�2 beeps: Device is now in SLEEP mode. Turn it back ON (1 beep).
�Is there adequate gain?
– If no, please try the following:
�Attempt to reprogram the device while in the ear.
�If not successful, remove the device and replace with a new device (also see chapter 8).
Once the device is removed
nUse the following tips to help investigate the cause of the device failure.
– Visually inspect the device:
�Is debris blocking the microphone/receiver?
�Is the device wet?
– Has the yellow color of the device faded? This would indicate repeated water exposure.
– Check that water is not trapped in the protection tube.
�If there is water, counsel patients to roll-up a soft tissue and dab the canal opening and device
following a water event.

15
8 Device Removal and Re-Insertion
Inspection following a warranted device removal
nCheck if cerumen is still in the lateral ear canal
–If no, replace with the new device to the same depth of insertion.
–If yes, perform or refer out for cerumen management.
nCheck if the ear canal is healthy
–If yes, replace with the new device to the same depth of insertion.
–If no, rest for 10-14 days or until healthy and replace with a new device of the same size in the ear.
–Report device removal in Target/ALPS and indicate if the ear requires rest or if a medical referral was
necessary.
Before re-inserting any device
nCheck if cerumen is present in the ear canal.
–Perform or refer out for cerumen management.
nCheck if the ear canal is healthy.
–If yes, replace with the new device to the same depth of insertion unless the device is not acceptable for
re-insertion.
–If no, rest for 10-14 days until healthy and replace with a new device of the same size in the ear.
nTake time to visualize the entire ear canal to determine the “flight path” for device placement.
nWhen re-inserting the device lubricate the opening of the canal.

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