It is theorized that both factors, the hollow voice sensation and the unfamiliar sound of amplification (or overamplification), may manifest at the same time. However, one can determine if the patient is reacting to the occlusion effect rather than ampclusion. With the aid in place, turn it off and ask the patient to speak or phonate the vowel(ee) or read a passage. (In bilateral fittings, remove the contralateral aid.) If the annoying sensation is still present, gently break the seal of the aid, or pull it slightly out of the ear. If the sensation disappears or lessens as the aid is loosened, the culprit is the occlusion effect.