12
Lyric2 candidacy checklist
Right
Left
Soft Level Gain
Low Frequency Cut
Volume
Max. Volume
High Frequency Boost
m
Off
m
ON
m
Off
m
ON
5. Fitting: Target Settings
Lyric Candidacy & Fitting
Client Name: Date:
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
(green)
to the right.
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?
(Medical clearance recommended)
❑ ❑
Do you bruise easily and / or take a high dosage of anticoagulants (blood thinners)?
(Medical clearance recommended)
❑ ❑
Do you have any known allergies (e.g. nickel, chrome)?
(Medical clearance recommended)
❑ ❑
Do you have a compromised immune system?
(Medical clearance recommended)
❑ ❑
Have you had chemotherapy within the last 6 months?
(Medical clearance recommended)
❑ ❑
Do you have chronic ear pain or problems with the jaw joint (TMJ)?
(Not recommended for wearing Lyric)
❑ ❑
Do you have regular magnetic resonance imaging (MRI)?
(Not recommended for wearing Lyric)
❑ ❑
Have you ever had radiation therapy to the head or neck in the past?
(Not recommended for wearing Lyric)
❑ ❑
Medical consult necessary?
4. Sizing Protocol
Client is a Lyric candidate?
❑
Yes
❑
No, due to: __________________________________________________________
Fitter Signature: ________________________________________ Date: _________________
Client Signature: ________________________________________ Date: _________________
Lyric left device label
Lyric right device label
Right
Left
Insertion Depth
mm
mm
Device Size
Left Ear
Right Ear
