Let’s loop America!

Hearing loops broadcast sound from a sound source wirelessly to hearing aids. All users need to do is switch their hearing aid to the telecoil or Mic + telecoil mode.  Hearing loops provide phenomenal hearing in situations where poor acoustics, reduced word discrimination and auditory processing problems would have made understanding nearly impossible. For a sound demo in and out of a hearing loop – Listen here

If you would like to learn more about bringing hearing loops to your community feel free to post questions or remarks.  The goal of this blog is to inform and bring those interested together to help loop one community at a time.

Juliette Sterkens, AuD – Audiologist 
HLAA National Hearing Loop Advocate

 

People who have had normal hearing but acquired hearing loss later in life have the advantage of remembering speech the way it used to sound and access to a large vocabulary to piece together what they hear with an imperfect auditory system.  Children with hearing loss don’t have that advantage. Their speech and language is still developing. A hearing loop can give them an advantage by providing access to clear sound input that hearing aids and/or cochlear implants alone simply are unable to provide unless their ears were mere inches away from the speakers on the TV.  A loop in effect brings the speaker of the TV directly and wirelessly into their ears. Voila – clear sound that may allow them to hear TV better than their parents!

In a recent article in the AG Bell Volta Voices Magazine (http://www.loopwisconsin.com/PDFFiles/VoltaVoicesSterkens.pdf)  I explain why some children need more than their hearing devices, be they hearing aids or cochlear implants, to develop speech and language. While hearing devices help to make sound louder, the instruments may not provide enough clarity and understanding to let children carve meaning out of what was heard.  Distance, background noise and reverberation all affect the speech clarity negatively and for this reason audiologists recommend the use of a personal FM system in the class room and there is plenty of research to back this up.

While children are busy developing speech and language they need access to best speech clarity there is to be had. Imagine learning to speak French while in a busy café near the Champs-Élysées in Paris or while watching a fast speaking Spanish speaker on TV.  This would be difficult even for a normal hearing adult – let alone for children whose vocabulary is limited and whose auditory systems do not permit clear and concise speech understanding no matter what type of hearing instrument or cochlear implant they wear.  This is where a hearing loops can be of great benefit in the home.

While most parents do not want their children to be hanging in front of the TV for long hours, that children will watch TV any chance they get is a given. (Mine did and, despite my worries, turned out just fine!) So why not ensure that what children with hearing loss hear is of the best clarity there is to get in a TV hearing loop?   Several parents and children have commented on what a loop in their TV room did for them. They say it better than I ever could. (I am sharing this information with their permission.)


What children say about hearing loops:

“Ever since our T.V. has been connected to the loop, I have loved it! It makes my listening so much easier because I can now fully understand conversations on the shows and hear sounds that I would not be able to hear without the loop.” said Anna Blair, a 14 year old and bilateral CI user. Her brother Adam, age 8 who also uses cochlear implants agrees with her. He says he likes listening in the loop because it “puts the sounds right inside my head, and it’s easier to hear”, and (with a huge smile) explained that his favorite shows to watch on TV with the loop are “action shows” because “when all the sounds are ‘in my head,’ it makes me feel like I’m in the middle of it all.”

Their mother Laura Garmon Sarsfield, a member of the Georgia Commission on Hearing Impaired and Deaf Persons https://dhs.georgia.gov/gchidp-members ,  reports that her children both very much love the idea of the loop being able to bypass all the background noise and deliver the TV audio directly to their cochlear implants.  “As a family we can listen to the TV without having to increase the volume and have confidence that they aren’t missing a thing because they are hearing everything completely and easily through the loop.  It has definitely been a game-changer for them, even though they are both very successful CI users who are both “A students” in their mainstream classroom settings in the largest public school system in Georgia.  I just can’t say enough about how much the loop has helped them.  It has just eased their listening so they are able to relax and enjoy it, and not have to work so hard just to hear and follow it”.

Ellie, age 12 who uses one hearing aid for a mild hearing loss because she is deaf in the other ear explains that using the loop the sound is clear and that she can hear every single word while without the loop “I only hear the loudest sounds of the TV.” And the loop has one more benefit; she doesn’t have to listen to the annoying sounds of her brothers! Ellie’s first TV loop experience was posted on YouTube https://www.youtube.com/watch?v=J5OiqHyW7vw  as was Jill Villnow, Ellie’s mom emotional response to the benefits of loops for her daughter see  www.youtube.com/watch?v=4jL4x2kkAJ0

Josie, age 12, who has a bilateral moderate degree of hearing loss and uses bilateral hearing aids, says:  “I don’t have to have the sound turned up so loud or use captions. The clarity is so much better; you can actually understand and hear the voices.” Her sister Emily, who is 11 and also uses BTEs ads, “I like it better because the loop blocks out the background noise so I can hear the TV better.”

The parents of Josie and Emily, Jim and Vicki Denzin from Neenah WI add a warning for parents. One of the first evenings after they installed a TV loop, their girls kept laughing and giggling and would not settle down in their beds. It was then they found out the TV loop signal from the adult movie they were watching downstairs could still clearly be heard in the bedrooms upstairs as long as the telecoil in the hearing aids were on. They now make sure the TV loop amplifier is turned off when the girls go to bed!

 Where else can children benefit from hearing loops?

That is easy:  Anywhere a microphone is used and the ADA mandates that reasonable accommodations are made for

The children's Museum in Fort Collins has installed a  hearing loop in its Dome Theater.

The children’s Museum in Fort Collins has installed a hearing loop in its Dome Theater.

people with hearing loss such as high school or middle auditoriums, Houses of Worship, museums and movie theaters.  Who is going to install these hearing loops? Trained installers now found around the country. Many of whom can be found on www.hearingloop.org under vendors. Who is going to make sure that hearing loops are the “go to” hearing assist technology? That is where we need to get involved and work together as advocates for everyone who uses hearing devices:  Hearing care professionals, hearing aid and cochlear implant users, hearing loop installers and advocates, hearing aid and cochlear implant companies,  parents and family members of children with hearing loss and everyone who works in the ADA community https://adata.org/ and http://www.access-board.gov/the-board/laws/americans-with-disabilities-act-intro . Our mantra should be “No Decision About People with Hearing Loss – Without Them”.

Adults who have experienced the three different assistive listening technologies prefer will choose hearing loop technology over FM or Infra-Red systems nearly 9 to 1 see http://www.loopwisconsin.com/PDFFiles/LoopingStudy_Oct_HR2014.pdf.  It is easy to understand why: All a user needs to hear in a loop is a personal hearing aid or CI and the ability to activate the telecoil. While it is true many children may not have experienced a hearing loop based on the comments from pediatric loop users listed above, anecdotal evidence of adults consumers who have both used Bluetooth wireless and loops at home, the recently published study in the Hearing Reviewhttp://www.hearingreview.com/2word014/09/consumer-perceptions-impact-inductively-looped-venues-utility-hearing-devices/  and a small study in Denmark by Aida Poulsen Regal www.cfh.dk/Do_school_chn_with_hearing_loss_have_preferences_for_ FM_or_loops?.pdf  this choice is likely not any different for them.

The OtterBox  Digital Dome at the Fort Collins Museum of Discovery is now fully accessible for children (and adults!) with hearing loss.

The OtterBox Digital Dome at the Fort Collins Museum of Discovery is now fully accessible for children (and adults!) with hearing loss.

As the HLAA Hearing Loop Advocate, what I am doing in my home state of Wisconsin, in the country and beyond is not just promoting loops.  I am foremost raising awareness and improving the understanding of hearing loss.  By explaining what hearing loss is, how hearing aids help but have significant limitations especially for those with more severe loss, and in reverberant and noisy larger public places (and yes professionals need to hear this message too) and how hearing loops can provide seamless access much like wheelchair ramps do for people with mobility handicaps, I build the case for hearing loops.

FM and Infrared assistive technology were and are a solution for hearing access but not a seamless solution. FM and IR devices are a hassle and rarely excite folks like loops do.  Hearing aid users have to go out of their way to use FM/IR, hearing aid users have to self-identify to find these devices only to find out they malfunction, and are like Richard Einhorn says – are just not a dignified solution… more an afterthought.  And many of us have found that the typical hearing aid user (the people who sit in the typical audiology and HA offices, the ones who are not likely to join HLAA even when given membership materials) will not bother using FM or IR devices.

Hearing loops, I have found, are very much used and appreciated by the typical non-HLAA member hearing aid users. Knowing about hearing loop technology also spurns action by normal hearing folks and thanks to them many loops are being installed in houses of worship, retirement centers and libraries. Once the loops are in the response from the users is often overwhelmingly positive, emotional and accompanied with lot of smiles. All this of course reinforces that the loop installation was the right thing to do.

Looped waiting room in audiology office

Looped waiting room in audiology office

But…in order to benefit, consumers need telecoils in their instruments.   It is unfortunate that hearing loop advocates like myself,  continue to run into far too many consumers around my state and the country who were never informed or never demonstrated how the telecoil can wirelessly link into the hearing loop.

How can we increase the number of hearing aids that are equipped with telecoils? It foremost means raising awareness of the benefit of telecoils. I have heard some anecdotal evidence that this positive word of mouth thanks to nearly 300 hearing loops in Wisconsin is increasing the number of consumers who know about t-coils.  I hear from hearing aid manufacturer’s reps that Wisconsin hearing aid providers now routinely inquire about telecoils in new products. And it is not just consumers who benefit. I recently received an email from a minister in Oshkosh thanking me for educating her on telecoils. The minister was confident when she counseled one of her parishioners on the kind of hearing aid features to consider. Her advice was confirmed with big smiles and thanks you’s when he used the loop for the first time after following her advice.  Awareness would also increase if audiologists and dispensers would loop their waiting rooms. In the Fox Valley many providers have taken this step – see here and here

That telecoils are an important feature in hearing aids was recently endorsed by the Office for the Deaf and Hard of Hearing in Wisconsin. The  Council for the Deaf and Hard of Hearing proclaimed that all consumers need to be told about telecoils before ordering hearing aids.  I would think it would better yet for consumers in Wisconsin if WSHA , the Wisconsin Speech, Language and Hearing Association for audiologists and speech, language pathologists, as well as WAHP, the Wisconsin Alliance of Hearing Professionals, would go on record recommending the same.  These professionals are licensed by the State of Wisconsin to provide hearing healthcare that is in the best interest of consumers.  Together we could strengthen consumer protection for consumers with hearing loss and support a similar law Arizona recently passed.

The Arizona law mandates telecoil counseling for potential hearing aid clients by audiologists and hearing instrument specialists. A similar law in Wisconsin would certainly make it less likely that I encounter hearing aid users who were never told about the telecoil benefits even though they followed the costly recommendations of the professional licensed by the state of Wisconsin. Without telecoils consumers are unable to benefit from hearing loops nor can they use  all kind of other assistive technology that requires a telecoil such as the new ClearSounds Quattro. Consumers deserve better than to be left out of the (hearing) loop.

Recently my church, St. Raphael Catholic Church in Oshkosh had a hearing loop installed. A hearing loop is an assistive listening system in the form of a  wire that is installed around the seated area of a facility, in this case a house of worship, connected to the PA system.  The loop creates a magnetic signal in the seated area that hearing aids or cochlear implants equipped with telecoils can pick up wirelessly broadcast to their own ears without any background noise. Users who don’t own hearing aids with telecoils or hearing aids can use small loop listening devices to pick up the signal.

This hearing loop is installed on a temporary basis because the  loop wire could not  be installed exactly where it should be, this would have involved cutting of old, glued down carpeting,  for an optimal signal. Once the church gets recarpeted the loop wire will be put where it needs to be and the magnetic loop signal will be optimized. Yet, even with the hearing loop slightly out of spec it is helping people hear.

It was Fr. Doug LeCaptain who OK’d the installation when he realized it could be a year or two before a perfect loop could be installed and that this temporary loop would work quite well in most of the seated area.  Fr. Doug was also “nudged” at the insistence of several hard of hearing parishioners. These parishioners had experienced hearing loops in the many looped churches in and around Oshkosh (see a complete list here) and kept asking for the technology at St Raphael.

The hearing loop was announced in the bulletin and during a hearing loop dedication weekend this past August.  Vicki Denzin, a parishioner and mom of three girls, publicly thanked the congregation gathered.  Her emotion came through loud and clear when she spoke. Two of her daughters use hearing aids and the girls have extensive experience using a loop in their TV room. Vicki and her husband Jim had advocated for a loop at St Raph’s.

When people experience a hearing loop for the first time they are often overwhelmed.  I have learned there is a story behind each and every hearing loop testimonialTo capture how hearing aid users benefit from loops I am gathering hearing loop experiences with a simple survey.  To gather responses from the many local loop users I dropped some paper and pencil surveys off at twelve hearing aid offices in the Fox Valley. These survey responses are coming in. I hope to publish an article on these findings soon but in the meantime I would like to share one story.  A story that does not use many words… just the response of one hearing loop user at St. Raph’s.  (St Raphael Catholic Church). 

Hearing Loop Survey response

Prior to the hearing loop installation this user reports to hear a “2” on a scale of 1=”heard nothing” and a 10=”hear every word”. In the hearing loop this same user reports to hear a “9”. In the hearing loop the hearing aid user went from hearing nearly nothing to nearly hearing every word.  Wow! These results almost made me cry.  Who knew? Who knew but this person who sat in the pews trying to carve meaning out of the words of the service? I cannot imagine how this person felt after worshipping in a facility where hearing the homily was impossible? Why bother attending? I am sure that many others have stopped attending, because of this same problem.

With the hearing loop this hearing aid user is once again able to hear the messages that Fr. Doug so carefully prepares every Sunday, broadcast wirelessly from the loop to the telecoil in the hearing aids. Imagine hearing clear and crisp sound without any background noise straight from the sound board?  

It is possible to hear in reverberant houses of worship (and many other venues) with the use of hearing loops. This is news that deserves to be shared by clergy around the country and heard by millions of hearing aid users.  Everyone deserves to hear. 

StRaphaelloopphoto

This is a rerun of a letter to the editor of Hearing Journal – back in December 2010

As an audiologist for close to 27 years in a small private practice, I think I’ve stumbled on what will finally make many of my patients happy. I have been in houses of worship and other public places where, although I have normal hearing, it was difficult to hear. That made me think about my patients: If I could barely hear, how wouldthey fare? I know that few of them speak up, pick up an assistive device, or move closer. More often they will complain about their hearing aid (to me!) and just sit there or stop attending these events.

The seminars I’ve given at churches and senior centers did little to increase use of FM assistive devices, and advocating for neckloop purchases rarely turned them into believers in FM technology. I have tied myself in pretzels trying to get them to advocate for themselves. That is, until I heard Dr. Dave Myers speak at a meeting about his success in looping Western Michigan.

Hearing loops turn any telecoil-equipped hearing instrument into a speaker for the PA system. This simple, unsexy, low-tech t-coil turns your hearing aid into a personalized listening device that significantly and effortlessly improves the signal-to-noise ratio—that elusive goal we all are looking for when we fit directional-microphone instruments.

As audiologists, we also know that the small SNR improvements these D-microphones provide rarely satisfy the needs of the patient, who, besides having a hearing deficit, frequently has auditory processing challenges and therefore needs an SNR improvement not possible with an ear-level device, no matter what its level of technology. This is a physics problem, not a hearing aid problem.

Enter the hearing loop, also known as “Wi-Fi for hearing aids.” It circumvents the physics problem. It does for hearing aids what no other assistive device can: Make our patients hear better in situations where heretofore they could not. It is truly the missing link in our practice. Hearing loops use the t-coil, which is present in 60% of all hearing aids sold in the U.S. and in over 90% of high-power instruments. The t-coil is low cost, low in power consumption, and, best of all, easy to use.

As audiologists, we need to advocate for our patients. Our advocacy will help them hear so much better. I will even go as far as to say that, under some circumstances, persons using the loop will hear betterthan the persons sitting beside them.

Advocating for hearing loop technology is easy. You start with your own waiting room: Install a small loop driver and start demonstrating it. Contact a reputable professional audio company and explain that you would like to work with them in bringing this technology to area churches. Donate a hearing loop driver/amplifier to your own church, community theater, or seniors meeting room to get it going. And start giving speeches to service clubs or retirement centers. Trust me, hearing is believing!

Collectively supporting “hearing loop initiatives” in our local communities will result, sooner rather than later, in a “Looped America,” as Dr. Dave Myers has written in the Sept./Oct. 2008Hearing Loss Magazine.

No technology now or in the near future can do what induction hearing loop technology can do today! Our advocacy will let America know we truly “Care for America’s Hearing” and we will benefit with increased acceptance and use of hearing aids.

Juliette Sterkens, AuD

Oshkosh, WI

 (The original letter can be found here: http://journals.lww.com/thehearingjournal/Fulltext/2010/12000/Hearing_Loops_Make_Consumers_Flip_Where_Hearing.9.aspx)

On July 17th the ANSI A117.1 Committee convened in Washington DC voted to revise the current 2009 International Building Code to include a statement that when a hearing loop is installed it shall meet the IEC 60118-4 induction hearing loop standard.  This paper explains why this is important.

There are so many different groups involved each with their own acronyms… it is enough to drive someone like me, an advocate focused on helping people with hearing loss hear better in public places, to exasperation.  ADA, ANSI, ICC and IBC, Chapter 11 and Section 706 did not mean much to me up until a few weeks ago but the light is beginning to dawn.

The Americans with Disabilities Act, commonly referred to as the ADA, is a law that among other things, ensures access to the built environment for people with disabilities.  The ADA standard establishes design requirements for the construction and alteration of facilities subject to the law.  These enforceable standards apply to places of public accommodation, commercial facilities, and state and local government facilities.

It is the US Access Board that is responsible for developing and updating design guidelines known as the ADA Accessibility Guidelines (ADAAG).  These guidelines are used by the Department of Justice (DOJ) and the Department of Transportation (DOT) in setting enforceable standards that the public must follow.

In the ADA Standards, Chapter 2 on scoping, section 219, the reasons for accessible design are explained see http://www.ada.gov/regs2010/2010ADAStandards/2010ADAstandards.htm#pgfId-1010597

  • The term scoping refers to what facilities need to be accessible. In regards to hearing accessibility the scoping requirements dictate that in assembly areas where audible communication is integral to the use of the space, an assistive listening system shall be provided.  Section 219 lists one exception: Other than in courtrooms, assistive listening systems shall not be required where audio amplification is not provided.

It is in ADA Standards Chapter 7, section 706 that the technical requirements for accessible design are explained see http://www.ada.gov/regs2010/2010ADAStandards/2010ADAstandards.htm#pgfId-1006522

  • The technical requirements refer to the design and construction specifications and are found in section 706. In the case of hearing accessibility Section 706 dictates that 25% of the required assistive listening receivers shall be hearing aid compatible via the use of a neckloop, that a 1/8” standard mono jack shall be provided and that the individual receivers shall meet certain standards in regards to SPL, Peak-Clipping and  SNR levels.

It is the International Code Council (ICC), a member-focused association, dedicated to developing model codes and standards used in the design, build and compliance process to construct safe, sustainable, affordable and resilient structures that develops the International Building Code or IBC aka the “I-Code”.

Most U.S. communities and many global markets choose to reference the IBC. This code book, which is the most widely adopted building code in the United States, comprises of 35 chapters and a series of Appendices A thru M. When referenced in local, state or federal legislation, the IBC becomes the minimum requirement for construction.

Chapter 11 of the International Building Code addresses accessible design and construction of facilities for physically disabled persons. Chapter 11 is developed by the ANSI A117.1 committee. This A117.1 standard is a recognized accessibility standard that provides the technical criteria which must be met in order to accomplish the required level of accessibility. When sites, facilities, buildings and elements are built to the specifications in the A117.1 they become usable by people with disabilities.

A117.1 is comprised of 11 chapters and it is chapter 7, section 706 that specifically deals with Assistive listening systems. Section A117.1 is a scoping free document. In other words, it has no triggers telling the user when to apply the specific criteria, that is what the ADA standard does.

For the readers of this document it is important to know that section 706 of the ANSI A117.1 Standard is not Section 706 of the 2010 ADA Standards.  At this time, it is only ANSI A117.1, section 706 that has been changed.  Section 706 of the ADA standards has not been changed.  Once states adopt the new A117.1 building code, the IBC code will be more stringent than the ADA standards.

What exactly was accomplished at the ANSI A117.1 meeting?

Until A117.1 is officially adopted, slated for December 2014, hearing loop installers and advocates will be able to state to architects, designers, construction companies and building inspectors  that the proposal to modify the 2009 IBC was passed and will be changed to reference the IEC 60118-4 hearing loop standard.

It is important to keep in mind that once A117.1 is officially adopted it will not indicate that hearing loops are the assistive listening system of choice for hearing aid users nor does it recommend using hearing loops as the default assistive listening system.

Currently the ADA Standards lists FM and IR technology as an equivalent assistive listening option for people with hearing loss. The ADA guidelines fail to take the users’ preferences into account, one study show experienced hearing aid users preferring hearing loops over FM/IR technology nearly 9 to 1, nor does it mention the numerous advantages of hearing loops listed here: http://www.hearingloop.org/fq_preferred.htm).

That hearing loops should be considered the assistive listening system of choice, because they are fully hearing aid compatible and therefore do not require the use of an auxiliary receiver, needs to be addressed by the Hearing Loss Association of America (HLAA) and other consumer organization such as ALDA, NAD, TDI and AMPHL, when the ADA Accessibility Guidelines are up for review.

Juliette Sterkens, AuD
HLAA Hearing Loop Advocate

On July 17th the ICC/ANSI A117.1 Consensus Committee on Accessible and Useable Buildings and Facilities passed a motion, nearly unanimously, to modify the building codes for accessible standards under the ADA guidelines section 706: Assistive Listening Systems. The modification will now specify that “Where hearing loops are installed they shall comply with IEC 60118-4 (2006)”

The IEC 60118-4(2006) induction loop standard specifies the allowable magnetic background noise, the maximum field strength of the signals, and the frequency response of the magnetic field in an induction hearing loop.  The levels it sets for hearing loop performance are tied to the requirements for telecoil performance in hearing aids which will appear shortly in a new edition of the hearing aid standard IEC 60118-0. For more specific information regarding the loop standard see here and here.

The justification to the committee was pretty straightforward. The hearing loop is the only system that is directly compatible with hearing aids by use of the telecoil. The hearing aid in a loop in effect becomes an integrated part of the sound system whereby the sound system’s microphones become the microphone of the hearing aid. However, the hearing aid user, whether fit in the UK, Australia or the US, can only benefit if the magnetic signal is calibrated to the IEC standard. While some users have a volume control to adjust for a low loop signal level, none have the capability to compensate for a poor quality, noisy or uneven signal response.  It is the IEC standard that specifies these qualities and without it there can be no guarantee.

The use of hearing loops is different than that of the typical FM or IR systems that require the user to pick up a generic intermediary device which needs a volume control to accommodate the hearing loss of whomever picks one up; in a loop the hearing aid itself is the receiver and the user benefits from the individualized settings of his or her hearing aid. This means that hearing loop users depends on proper installation of a hearing loop.

Ask any hearing loop user (see testimonials here) and they will wholeheartedly agree: Hearing loops that meet the IEC standard transmit clear, strong, and noise-free audio to their hearing aids. Those loops allows users to sit anywhere in the seated area and hear the same level of quality and sound broadcast directly to the telecoils in their instruments. Poorly installed loops add frustration and doubt: the user doesn’t know where to sit to get a loud enough signal, may experience dead spots, may have to hold his head sideways to hear a signal at all, the signal may be of muffled and of poor quality and the signal may be masked by (magnetic) background noise. These problems are of no concern in loops that meet the IEC standard. The clarity and understanding is excellent in those loops.

For two days I attended the ANSI A117.1 Committee meeting in Washington DC to be given a chance to address the committee in favor of the adoption of the IEC standard.  I came armed with nearly 30 letters of support written by consumers like Ed Ogiba and Ellen Semel, by audiologists such as Dr. Linda Remensnyder and Dr. Karen MacLennan, by numerous hearing loop installers who realize that the burgeoning loop industry will not survive unless a high standard of quality is adopted, by consumer advocates such as David Myers and Sergei Kochkin and technical experts in the industry such as Richard McKinley from Holland MI, John Woodgate and Julian Pieters from the UK, Stephen Julstrom from Chicago and Russell Gentner from from Utah.  The proposal was submitted by Sharon Toji who represents the Hearing Loss Association and is a voting delegate at these committee meetings.  We were so well prepared that they almost didn’t give me an opportunity to speak – “Imagine my horror!” ;o)

Many thanks go to Sharon Toji who took the initiative to make this change and Marsha Mazz and David Baquis from the US Access Board.

For the ADA guidelines on the current standards on Assistive Listening Systems see  2010 ADA Standards
For scoping requirements regarding assistive listening systems see Section 219.

What every hearing aid user should be told by their audiologist or hearing aid provider

There is some confusion among hearing professionals regarding Blue Tooth and Hearing Induction Loops.  The misunderstanding that is that Bluetooth and hearing loop technology are mutually exclusive when in fact they complement each other and have tremendous capability to improve quality of life for the user.

Hearing aid users can take advantage of both: many of my clients benefit from Bluetooth wireless technology watching TV at home, while using their cellphone or on Sunday morning when they happily switch to their telecoil in church.  Hearing aid users cannot benefit from telecoils if they are not educated about them and so equipped. One unhappy – because her audiologist failed to mention telecoils even once in 30+ hearing aid adjustment appointments – hearing aid user from Minnesota wrote me:  “One has to have one to take advantage of the loop. I would have chosen a different instrument”.

Bluetooth does a great job linking two devices together.  Some examples where Bluetooth is used to link are: a mouse to a lap top, a hearing aid to a TV device, a cell phone to a head set, a cell or home phone to a hearing aid.  Bluetooth’s effective range is limited to 30 feet and requires linking aka pairing the devices in order to communicate together.

When Bluetooth is used in hearing aids the hearing aid manufacturer’s employ proprietary versions of Bluetooth which are not compatible with other hearing aids or earlier version of Bluetooth devices.  This means that each user would need their own, individual Bluetooth transmitter to hear in a large venue, and would need to sit within 30 feet of the transmitter to receive the signal.

In a house of worship all the Bluetooth users would need to have their own Bluetooth microphones attached to the presenter and would need to sit less than 30 feet away in order to receive the signal in their hearing aids.  The sound quality of Bluetooth is limited and people who have listened to TV using Bluetooth and then through a Hearing Loop report that the sound quality of the Hearing loop is clear and instantaneous while the Bluetooth sounds can sound  more fuzzy, and users with normal hearing in the low frequencies have discerned delays in the audio.

Finally Bluetooth draws considerable battery power with some hearing aids consuming batteries 10 times faster when in the 2.4 GHz mode. For this reason many manufacturers use an intermediary device which utilizes NFMI (near field magnetic induction) which looks like a small iPod or remote control. This intermediary device receives the signal from the Bluetooth transmitter and sends it via a near field magnetic induction to the hearing aid.

While Hearing Loops can be used one-on-one such as:  a neck loop attached to a Walkman or telephone, or a home loop attached to a TV,  they are the technology of choice when many people need to listen in a large venue with a sound system such as a house of worship, conference room, or auditorium.  The loop signal is universally compatible (around the world) with all T-Coil equipped hearing aids.  A Hearing Loop installed to the IEC standard will have excellent frequency response from 100 to 5 kHz, often beyond what most hearing aids are capable of amplifying.   T-coils get their power from the loop signal and draw no, or nearly negligible power from the battery.

Because hearing loops get their signal directly from the source (the speaker’s microphone or other audio output) there is no need to process the sound so there is no need for the loop to use digital processing, and take advantage of any digital processing that is being done by the hearing aid itself.  And last but not least, in a looped venue the person with hearing difficulties need not self-identify as having difficulty understanding the spoken word, nor wear listening devices with unsightly and unhygienic headphones – all they need to do is discretely push the button on the hearing devices they are wearing to activate the telecoils. Testimonials of such experiences are abound on the internet on sites such as www.hearingloop.org and testimonials )

Hearing aid engineers advise that while a universally compatible Bluetooth-like device which would have similar one-to-many, wide area capability is technically feasible the hurdles of frequency spectrum allocation (not all countries have the same frequency authorizations), arriving at a mutually agreeable technology among the manufactures, and the need for people with hearing aids to buy new compatible hearing aids in order to listen.  If such a technology will ever exist it will not be in the foreseeable future and some experts in the field such as Dr. Jason Galster from the American Starkey Hearing Aid company see here  and Dr. Laurel Christensen from GN ReSound (who addressed this at the recent Minnesota Academy of Audiology annual meeting  2/23/2012) spoke publicly that a universal wireless standard may be 5 or 10+ years out.

It is my understanding that none of the big 6 hearing aid manufacturers and cochlear implant companies are seriously developing, or considering developing such a universal technology. The hearing aid companies continue to sell three different wireless technologies to the hard of hearing public (900MHz, 2.4GHz, and NFMI). Considering that the devices sold today as “state-of-the-art” will continue to be used between 5-7 years by the average hearing instrument user, and that Oticon recently introduced in 2nd generation NFMI computer chip platform (named the Alta see www.oticon.com/products ) and added a telecoil to the new Streamer Pro (Oticon only introduces platform changes every 3-4 years, and the first iPhone compatible hearing aids by GN ReSound are being introduced see hearingmojo , and no MFR has agreed to one type of technology as of yet, the estimate that a digital worldwide universal assistance listening system will be offered in 10 years is most probably conservative and it will likely be 15+ years – if ever.

Is it possible that hearing aid providers, who have failed to inform their clients of the benefits of telecoils, may be reluctant to admit their oversight?  I had similar feelings when I first started working with hearing loops in my community yet quickly realized that it was not right to put my embarrassment ahead of my patients’ well-being.   The overwhelming positive responses led me to work harder to find solutions for clients who did not have telecoils but could really benefit from them. It took some doing but I was able to either add telecoils or change many of clients’ instruments (some at my expense and some gratis thanks to my suppliers) to models that were T-coil equipped.

Audiologists and hearing aid dispensers who are recommending Bluetooth wireless or FM technology for their hearing aid and CI clients (because the BT wireless technology is beneficial for hearing on a cell phone, for TV or microphone clip in a restaurant) and counsel their clients on the use of telecoils in large venues equipped with hearing loops (now found all over the country in houses of worship, meeting rooms, as well as in transient situations such as check-out counters, theaters and airport gates see locations here or here) are meeting standard of care guidelines as specified by the American Academy of Audiology guidelines and endorsed by the American Speech Language and Hearing Association, see here. They may also be aware of the Hearing Loss Association of America (HLAA) and American Academy of Audiology Hearing Loop Task force recommendations regarding telecoils and hearing loops here)

Notable audiologists such as Mary Caccavo, PhD  (past president of the Academy of Doctors of Audiology and owner of a successful audiology practice in Lafayette, IN) and many others around the country are finding that by fostering loop installations in their communities they greatly their clients’ quality of life.

Advocates are not for hearing loops per se, they are for a technology that is relatively low cost, worldwide universal, non-proprietary, directly compatible with the majority of hearing aids useful in a variety of large area listening. BT wireless technology – though useful in many one-on-one situations is not setup for large area listening systems and won’t be for years to come. My husband is still waiting for his jetpack.

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