FAQs - Virto B Titanium
What’s the Titanium FitGuide (TFG)?
The TFG evaluates canal dynamics to get deeper fittings. It is a tool for you to use at your clients’ hearing aid evaluation, and indicates how deeply we can comfortably build a Virto B-Titanium hearing aid. It represents the minimum space requirements for moderate (M) or power (P).
What’s the benefit of the TFG?
More than 50% of people get a deeper fitting Virto B-Titanium by an average of 2.5 mm. In cases where the TFG will not result in a deeper fitting, the value will be discarded. For consistent results: perform 10-15 practice insertions, read the indicator from 0° azimuth (nose), and halt the insertion just beyond the first bend. Visit the evidence page for more information.
How do I collect the measurement?
Find the indicator sitting directly in the client’s intertragal notch when the TFG is comfortably placed in the client’s ear. Place your thumb nail at the intertragal notch and carefully remove the tool from the ear canal. Count from the thumb nail to the end of the scale in the direction of the module e.g. 10. The numerical value is entered on the order form for each ear.
How much pressure should I apply to the TFG?
Apply similar pressure to the TFG in the ear canal as you would when conducting other in-ear endeavors, like inserting a speculum into the canal during otoscopy, or using a pen light to place an otoblock. Do not apply force greater than twice the weight of the TFG. For collaborative insertions, the client should apply similar pressure as they would when ”writing with a pen.”
Is the TFG inserted collaboratively or by the hearing care professional alone?
When inserting the TFG, if you reach beyond the first bend (IIC depth) comfortably, there is no need for a collaborative insertion. In the event that the tool stops before the first bend, a collaborative insertion can be beneficial as the patient is able to constantly evaluate their comfort level. If possible, avoid collaborative insertions for first time users.
When do I stop TFG insertion?
IIC devices are defined by the placement of the faceplate "beyond the first bend“. Halt the medial advancement of the TFG when it reaches this depth. The further advancement of the tool comes at no additional size benefit, but exponentially increases risk. (Caution: consider individual anatomical variances carefully)
What steps can I take to ensure a comfortable outcome?
Halt the TFG just past the first bend. Allow the client to sit for a minute if needed to decide if the pressure is ok. Ensure any discomfort is not occlusion related. If comfort is questionable, move the tool laterally until a comfortable depth is found. Take your time and move slowly. Have the client imagine the ear canal pressure for a full day of wear.
How can I be sure my impression is deep enough?
Once the impression is removed, confirm adequate impression depth has been achieved. Hold the TFG indicator up to the medial end (otoblock) of the impression. If the module tip of the TFG exceeds the intertragal notch on the impression, the impression is not a sufficient length.
How do I know if the TFG will help?
The TFG value will only help make the Virto B-Titanium more discreet. If a client prefers the TFG at a shallower depth than the standard modeling indicated the TFG is not a good in-office indication of depth in these cases. The TFG value will only be implemented if it helps make the hearing aid more discreet.
How to clean the Titanium FitGuide?
The TFG is a multi-use tool so it is critical to prevent cross contamination. The TFG needs to be cleaned and disinfected. After use, clean the tool by putting the TFG in an ultrasonic bath for two minutes to remove large pieces of cerumen. To disinfect, wipe afterwards with a 70% alcohol wipe. After disinfection, store the TFG in a clean, dry place. For full instructions, see the TFG Leaflet.
What is Extra Retention?
Extra Retention is a new shell surface ordering option with slightly more grip. It is particularly effective for very straight canals and for clients with a history of migration challenges. The surface is slightly more matte than the default surface.
What is Biometric Calibration and does it benefit the Virto B-Titanium?
Biometric Calibration extracts more than 1,600 data points from the client’s impression. This data is then compared to an algorithm that considers how the individual’s ear has reflected sound before it arrives at the microphone. The audiological benefit is present with directional models and is not present for CIC and IIC form factors, due to already deep in the ear placement of the microphone.
How are remakes handled with Biometric Calibration for original and new Virto B-Titaniums?
New Virto B-Titaniums have Biometric Calibration. The calibration is confirmed on the device anytime it leaves the repair facility. If you’re sending in an original Virto B-Titanium for remake or repair, the hearing aids will not have this feature as it is unique to the new hybrid. If an original hybrid needs replacing, the replacement will not include Biometric Calibration.
What are the new smaller vent options?
New 0.8mm vents are great for clients who want the most discreet hearing aid possible, those with feedback concerns, and with greater power needs. The 0.8mm vents can only be cleaned, and therefore functional, if they are a trench style. If a standard vent is preferred, the minimum diameter is 1.0mm. These can now be easily cleaned with our new narrow brush cleaning tool.
Why is the vent size selection important?
Vent selection is paramount for patient satisfaction/remake prevention. Tradeoffs have always existed between sound quality and occlusion. The consequences of open venting can include excessive feedback, gain reduction, larger devices, and poorer sound quality. Deeper fitting devices are more prone to feedback and require less gain, and therefore benefit from more closed fittings.
Is the Virto B-Titanium capable of streaming?
No. Titanium is a dense metal that has a shielding effect, and wireless transmissions are not possible. This includes incompatibility with wireless accessories used for streaming and Binaural VoiceStream Technology. User control options include either a push button, or a MiniControl.
Is a T-coil available?
Yes. If your clients need a T-coil, it is available upon request. It is important to keep in mind that the T-coil is a sizeable component and adding this feature could have size and esthetic consequences for your clients.
Is Virto B-Titanium modifiable?
The shell of the Virto B-Titanium is metal. Titanium is dense and cannot be ground down using standard in-house shell modification equipment like a Red Wing or Dremel. Also, due to post processing of the devices, UV material will not properly adhere to the shell. While 3D printing of titanium shells is more accurate than acrylic, it is beneficial to send in a high quality and deep earmold impression to ensure a secure fit and avoid remakes. If a remake is necessary, it will be sent to the manufacturer where a new shell will be generated. As the Virto B-Titanium is silver, canal locks will not be available either in acrylic or titanium; an acrylic lock will not adhere to the titanium canal and a lock made from titanium would defeat the purpose of the discreetness offered by an IIC device. The finish on the shell walls was specifically selected to not discolor over time and to aid retention and help prevent migration.
My Virto B-Titanium has a t-coil, is it compatible with the MyLink?
This will depend on the placement in the ear. If somebody wants to use a MyLink with a custom product we recommend they order a mini canal or larger device to ensure a consistent signal.
What form factors are available? Is it a CIC or an IIC?
The Virto B-Titanium will be made as small as possible given the anatomical parameters of the client’s ear canal and the components ordered. This will result in an IIC form factor in the majority of cases. However, if the patient has a narrower ear canal and requires a power or super power receiver, the outcome might look more like a CIC. If the smallest device possible is desired, follow the guidance of the “slim track” on the bottom left corner of the order form.
How large of a size can we build for titanium; will we recommend they change to a different device if we can’t build at least a CIC?
The Virto B-Titanium will only be an IIC or CIC. IT will be the smallest custom product that Phonak can build for the patient based on their ear and the features selected. It will never be larger than a CIC. We will only call on devices that need to be built larger than a CIC
What is AOV?
AOV, or Acoustically Optimized Vent, is Phonak’s long-standing proprietary venting algorithm that determines the largest vent possible based on the anatomy of the ear that will not compromise performance. The fundamental idea behind a vent is to allow the most direct sound possible. We have all had the experience of manually selecting the same 2.0 mm vent for three individuals with the same audiogram, and receiving dramatically different feedback from them regarding occlusion. Anatomical differences are what accounts for this discrepancy. A 2.0 mm manually selected vent in one ear could have a much smaller vent mass due to the size and configuration of the vent in the canal. AOV calculates vent mass according to the anatomy. What AOV does is take the impression into account, and makes calculations to ensure that if a 2.0mm vent is most audiologically appropriate and that the effective vent mass is also 2.0mm. The AOV algorithm considers four factors in addition to the impression to select the most appropriate vent mass: risk of occlusion, chance of feedback, direct sound compensation, and low frequency gain needs.
What is AOVo? Which client can it benefit?
AOV-O is a new venting strategy introduced on the Virto B-Titanium platform. Currently, it is not offered on any other Phonak product lines. The new option AOV-O, or Acoustically Optimized Vent- Open, is for clients who want to take advantage of the discreetness of titanium, but are at risk of occlusion, like those with normal low frequency hearing who have comfort as their first priority, and size and performance is secondary. The AOV vent for the aforementioned audiogram would be rather large. AOV-O should be selected when you anticipant comfort needs beyond what AOV will calculate. The thinner shell of the Virto B-Titanium will automatically leverage the 0.2mm wall thickness improvement into the calculation of AOV if necessary and beneficial; AOV-O is available for more severe occlusion concerns. The AOV-O vent mass algorithm considers the same four factors in addition to the impression as AOV: risk of occlusion, chance of feedback, direct sound compensation, and low frequency gain needs. The only difference is that it uses modified criteria. For more guidance, see the AOV vs AOV-O flow chart).
How is new AutoSense OS treated in the Virto B-90 Titanium?
The Virto B-90 Titanium has 6 environments included in AutoSense OS: Calm situations, Speech in noise, Speech in the car, Comfort in noise, Comfort in echo, and Music. The titanium shields wireless signals so programs with Binaural VoiceStream Technology (Speech in loud noise) are not available, similarly to IICs on previous platforms. On the Virto B-70 Titanium, AutoSense OS includes Calm situations, Speech in noise, Comfort in noise, and Music.
What are the care and maintenance requirements of the Virto B-Titanium?
The Virto B-Titanium no longer uses MicGuards. The port to the integrated microphone is beneath the batter door, allowing for more insulation and in turn providing protection from sweat and debris. To clean the port, open the battery door and invert the device so that the mic port is facing the floor, then use the brush from the hearing aid case to gently go back and forth across the port to allow any debris to fall out of the opening. If the patient has moisture issues and utilizes a drying device, use of this device can continue with their Virto B-Titanium. The UV light or desiccant beads will not impact the bonding agent between the module and the shell UV light. The wax system options have not changed, so counsel on cleaning the receiver in accordance with the receiver protection system selected. To clean the vent, use the small brush from the Phonak hearing aid case. If the brush will not fit through the vent, remove the vent filament from the other end (magnet end) of the brush and use that to clean the vent.
Does is come in other colors?
The Virto B-Titanium is only available in silver and the battery module with integrated microphone is only available in black. The interior of the battery door and module will be color coded to indicate if the device is for the left or right ear.
Why did you pick Titanium over other material options?
Titanium custom shells have been used in the past as a material option in cases of severe allergic skin reactions to acrylic. Those shells were special ordered and were generated at 0.7mm thickness. In other words, not optimized for size, but for the health benefits. Titanium is naturally hypoallergenic and has been used in the medical industry for implants for years. The custom shells that we 3D print are classified as “medical grade titanium”. Secondly, titanium is 15 times stronger than acrylic, so it can be printed at half the thickness and still retain its strength. The thin walls of titanium shell garneted 30% more interior room which can be leveraged to make the IIC smaller than ever, or to accommodate other features like a bigger vent or receiver.
What type of in-office repairs can be done on the Virto B-Titanium?
While it is not possible to replace the modules in-house, battery door replacements are still possible. Full replacement of a retention wire is not possible due to the strength of the titanium shell and the inability to modify. Even in cases where the wire detaches cleanly from the shell, the adhesive used to secure the wire will not hold. With this in mind, the retention wires will come at the maximum appropriate length. This is done because if you find the wire is too short, you cannot add length, as that requires a complete wire replacement. If you find that the wire is too long, shortening the retention wire is an easy in house modification.
What is MLE?
“MLE” stands for Microphone Location Effect. This calculation is embedded into our RSM modeling software. When the modeling expert is determining the placement of the microphones on a custom hearing aid, they use this algorithm to determine the microphones’ placement in the lateral field.
What are the benefits and limitations of the microphone integrated battery module?
Pros: Firstly, the module allows for the Virto B-Titanium to be made smaller. This design allows for quick replacement during factory repairs due to its modularity, it is colored to easily indicate right and left, the microphone is more protected and is more durable, and MicGuards are no longer a part of the maintenance of the microphone. While MicGuards effectively protect the microphones, this new module with integrated microphone is placed so deeply in the ear that there will be less wind noise and the microphone is better insulated. Now, since the battery compartment is insulated, it is much less likely that a patient will accidently push the battery into the other hearing aid components while attempting to insert the device.
Cons: There are a few draw backs to the new modular design: they are not replaceable in house and if one part breaks (besides battery door) the whole module needs replacement at the manufacturer. Also, for your existing Phonak IIC users, the maintenance is different and this will require some explanation and adjustment (see care and maintenance of Virto B-Titanium).
What do I do if the battery door on my Virto B-Titanium does not close?
The battery door for the Virto B-Titanium will only close if a battery is intact. The door will not close if there is not a battery present. If the battery door on your Virto B-Titanium has a battery intact but the door will still not close, remove the battery, take the battery door off the hinge pin, reattached the door, insert the battery, and try to close the door again. If this is still not successful, replace the battery door entirely.
How do I use this new order form?
Step 1: The top portion of the order form is similar to our order forms in the past: patient and office information.
Step 2: Select the performance level. The Virto B-Titanium comes in a B90 or B70.
Step 3: Product options. This selection is divided into two columns. On the left, is the “smallest possible” route. If your patient’s number one priority is to have the most discreet possible device for their ear, this column provides the smallest hearing aid options that will generate the smallest Virto B-Titanium. In the column on the right side are additional ordering options that could impact the size of the device. In this column you will see additional options for the power level, wax system, vent type, cosmetics, input options, etc. For instance, ordering a larger, more powerful receiver (up to SP), ordering a bigger vent (See AOV vs AOVo flow chart), telecoil, etc. These are useful options, but keep in mind that an SP receiver device will be larger than an M receiver device, because the internal components are larger, the entire device has to be larger to accommodate them. In the “cosmetics” row appears options for “asymmetric build” or “symmetric build.” In binaural fittings, there are always anatomical differences in ear canal size, length, and shape. In cases of larger anatomical discrepancies, sometimes one device can be built to be more discreet than the other. With this option you can elect if you want an “asymmetric build” which means the device will be built as small as each individual ear will allow. The other option is a “symmetric build” which means the device will be modeled as small as possible for the more anatomically limiting ear. Then the device for the more accommodating ear will be modeled to have the faceplate sit at the same depth.
Do I need to change my impression technique?
No we just ask for a full impression that is past the second bend.
Is it required to use EasyView Otoblock?
No, EasyView Otoblock is an option for hearing care providers who are looking to strengthen their impression taking skills or for new clinicians who are new to taking impressions.
How do you program the Virto B Titanium?
The Virto B-Titanium is programmed using the same cables as for Virto V-nano, which utilizes the white size 10 cables.
Will the serial numbers be printed in red and blue?
No the serial numbers will be printed in black on the side of the shell. For patients needing help identifying the left or right device they can see this by opening the battery door.
What about the IP68? How was that tested and why was it not communicated with more emphasis?
The Virto B-Titanium was tested using the same IP protocol as all hearing instruments and all electronics. There is an official certification available on the Claim’s Database. The reason this was not communicated with more emphasis is that deep fitting IIC devices are just as vulnerable to cerumen as before and out cerumen management options have not changed. As far as we can tell, an IP rating on a custom device has never been communicated by any other hearing aid manufacturer, however it does not necessarily mean that a custom device has never earned the rating or been evaluated.
How did you calculate the claims: 26% smaller than Virto V-nano and a 64% increased IIC fitrate?
There is always variability in custom products because they are made for an individual’s ear. We wanted to determine how much smaller of a device is possible with the new Virto B-Titanium when we leverage the thinner shell, the smaller electronics, and the microphone integrated module. We modeled the smallest possible Virto V-nano, meaning anatomy aside, how much internal space is required to fit all of the mandatory nano components? Then we did the same procedure for the Virto B-Titanium, meaning what are the minimum shell requirements to fit all of those mandatory components. Both Virto V-nano and Virto B-Titanium were M receiver devices. The results were a 26% decrease in volume. The second claim of 64% improvement in IIC fit rate was derived from an internal study that looked at 22 ear impressions and found that 11 out of 22 were not candidates for an IIC Virto V nano. Of those ears, 18 out of 22 could be fit with Virto B-Titanium IIC, therefore a 64% improvement.
Where is the Virto B-Titanium actually manufactured?
The equipment used for 3D-printing titanium requires a large scale facility and economies of scale therefore, we decided to centralize Virto B-Titanium production in our Vietnam facility.
You say Virto B-Titanium is the smallest device every produced. Does this mean it is smaller than the Lyric?
The Virto B-Titanium is the “smallest custom hearing aid from Phonak ever”. It is up to 26% smaller than its predecessor, the Virto V-nano. The Lyric device is not a custom or daily wear hearing instrument, and sits 4mm from the tympanic membrane. While the Virto B-Titanium may be smaller than a Lyric in your hand in some cases, a custom hearing aid is not designed to sit as deeply as a Lyric which is placed in the bony portion of the ear canal.
Will the Virto B-Titanium replace the Nano?
Virto B-Titanium will be launched as an addition to the portfolio. There will still be an acrylic IIC available in our custom product portfolio for individuals who prefer an acrylic device. For those individuals, the Virto V-nano is still available.
Can the Virto B-Titanium be considered an invisible-in-the-canal (IIC) instrument?
The Virto B-Titanium will be made as small as possible given the anatomical parameters of the client’s ear canal and the components ordered. This will result in an IIC form factor in the majority of cases. However, if the patient has a narrower canal and requires a power or super power receiver, the outcome might look more like a CIC. If the smallest device possible is desired, follow the guidance of the “slim track” on the bottom left side of the order form. We will however not deliver any product that is bigger than a CIC due to cosmetics.
Should patients be concerned about a skin reaction to titanium?
Titanium custom shells have been used in the past by many manufacturers as a material option in cases of severe allergic skin reactions to acrylic. Titanium is naturally hypoallergenic and has been used in the medical industry for implants for years. The custom shells we 3D print are classified as “medical grade titanium”.
What country is the titanium sourced from?
We get our titanium from TLS Technik in Germany.
Can we expect all hearing aids to be made from titanium in the future?
While the benefits of a titanium IIC device are undeniable, acrylic devices have different technology that is beneficial for some end users. Some users require wireless streaming capability which is not possible with Virto B-Titanium due to size and natural shielding effect. There are other users who need larger devices to have dual microphones or easier insertion. These users are not able to capitalize on the benefits of titanium, so acrylic form factors will remain available. Phonak prides themselves on having the broadest portfolio so there is a product to meet every individual’s needs.
How long did it take to develop?
The Virto B-Titanium has been in development over the last four to five years.
Is titanium cold?
No, in fact the Virto B-Titanium has a more balanced temperature transfer than acrylic. Acrylic can sometimes feel a bit sweaty after it has been in contact with the warmth of the skin. In contrast, titanium remains at a comfortable temperature throughout the day.
Any new updates to AutoSense OS since the last launch?
The new AutoSense OS contains new features including new approach to asymmetric hearing loss and expansion, and Sound Recover 2. These improvements are now available with any Belong hearing device.
What exactly does “medical grade” titanium mean?
Titanium has many different levels, according to its purity, properties, benefits, and industry applications. The titanium in the Virto B-Titanium is grade 23, which is known to be widely used in various biomedical applications. This grade is also surgically implantable.
Is Phonak the only brand that carries titanium hearing aids?
Titanium custom shells have been used in the past by many manufacturers as a material option in cases of severe allergic skin reactions to acrylic. Those shells were special ordered and had generated much larger wall thicknesses. In other words, not optimized for size, but for the health benefits. Phonak is first to have a titanium product for the mass market, leveraging all the benefits of titanium.
Where is modeling done?
This depends on the site ordering the Virto B-Titanium. The modeling for Europe will be made in POCV (Phonak Operation Center Vietnam). Due to the time difference USA (AODC) will model their own Virto B-Titanium shells.
Can existing scans be used?
If the current scan is from a new impression (max. 3 months) it could be used. The recommendation is to take a new impression to have the most up-to-date and accurate ear status for the new Virto B Titanium and is should be done with the EasyView Otoblock if possible.
Which wax systems are compatible with the new Virto B-Titanium?
Please refer to Generic Fitter Order Form
Can the new faceplate (smaller components/module) be used with an acrylic shell?
No, it is not compatible with acrylic shells.
Can a Virto V-nano be re-cased in titianium?
No it cannot. If they are still within their trial period they can return the Virto V and order the Virto B-Titanium.
Can I go through airport security with this device?
Yes. Titanium is non-ferrous and should not set off metal detectors. However it is always advisable to follow TSA instructions.
Can I rush my Virto B-Titanium?
No, the Virto B-Titanium is a premium product that involves advanced 3D printing technology, and new processes that cause an increased turnaround time
How is the plastic part glued in the titanium shell, special superglue?
The module is clicked in and sealed with special silicone.
Is the serial number engraved in the shell?
Yes, there is a new engraving process for the titanium shells which is only done in POCV.
Are the RF on Virto B-titanium to be tested with the tensile tester?
Yes they are.
FAQs - Virto B
What is Biometric Calibration?
Biometric Calibration starts by extracting over 1600 individual data points from the client’s ear impression. This data is then compared to an ear model algorithm that knows how differences in pinna anatomy can affect the sound before it arrives at the microphone. The client’s anatomy is compared to the model and the difference between the two is calculated. The resulting beamformer knows how the individual’s ear has reflected the sound before it arrives at the microphone.
Will AOV-O be available for Virto B?
No, AOV-O is for Virto B-Titanium only. As titanium is a robust material, the shells can be printed at 0.2 mm. This allows us to leverage the additional space inside the shell to create a bigger vent for cases that would benefit from a more open fitting. As this additional space is not available with acrylic shells, AOV-O cannot be accommodated in Virto B acrylic models.
How is Biometric Calibration impacted by remakes and modifications?
With a remake order, the impression is scanned in and Biometric Calibration starts from scratch. The remade device will have a new Biometric Calibration. If you send a remake, but without a new impression, the remade device will have the original Biometric Calibration. Small modifications made in house will not impact Biometric Calibration.
What happens if an impression is poor quality?
With Biometric Calibration, all that is requested from the HCP is a full shell impression (regardless of the desired form factor). In the event that an impression is not ideal, e.g. parts of the helix are missing, Biometric Calibration will calibrate to the best of its abilities and used predicted data for the parts of the ear that are missing. In the event that the impression is poor, e.g. you want a Virto B10 but do not include any of the concha; the microphone calculation will default back to the previous consideration, MLE only.
What is the PU microphone?
The PU microphone is new to Phonak. Previously our custom products featured a PP microphone. “PP” stands for “pressure, pressure” referring to the anatomy of the microphone itself, two separate pressure microphones on one device. “PU” stands for “pressure gradient”; the two microphones are linked together, instead of independent. This makes the microphones durable and stable over time and no phase or mismatch between the microphones can exist. All directional wireless Virto B hearing aids are equipped with this new microphone. For more information, please see the Field Study News on Biometric Calibration.
What is the value of marking the horizontal plane?
While this topic does not directly impact Biometric Calibration, previous microphone topics have been brought up again in order to maximize custom product performance. According to T. Ricketts (2000) there is an impact on directionality when the horizontal microphone plane is +/- 10° from 0°. In cases where you anticipate this will be a concern for your client, continue to mark the horizontal plane as you would have before.
How far are the microphones apart?
All of our directional models have a microphone distance of 7.2 mm, regardless of directional form factor or microphone calibration style, i.e. this is true for Virto V and Virto B
Which products benefit from Biometric Calibration?
The lead claim regarding 2dB better directionality with Biometric Calibration pertains specifically to the Virto B directional models. UltraZoom is present in B30-B90 technology levels; therefore we expect 2dB improvement for all directional Virto B hearing aids, regardless of technology level. There are negligible benefits of Biometric Calibration in the omni directional models.