These advocates know why: Ask Ann Thomas, Cheri Perazzoli, Ginevra Ralph and Sue Pritchard.
Hearing loops in venues and telecoils in hearing aids: Today, this combination is still the gold standard for hearing accessibility the world over. In fact, hearing loops are so beloved that they inspired local and even national movements like HLAA’s Get in the Hearing Loop and even Loop Washington, which was founded by our HLAA-WA President Cheri Perazzoli.
You’ll hear a lot about new Bluetooth technologies like Auracast, and while these technologies are promising, they’re not yet ready for prime time. Auracast will co-exist with hearing loops and telecoils for years. That means we need audiologists to help us use all the technologies available to us — including telecoils — for the foreseeable future.
Audiologists juggle a lot of priorities during a patient’s visit, and it can be easy to forget to talk to patients about telecoils in their hearing aids. Armed with the knowledge of telecoils and the know-how to use them in public spaces, however, patients can truly make the most of their hearing devices. Which means they can live, work, play, and travel more safely and confidently.
We often say, “People with hearing loss want to hear wherever they go.” Ann Thomas from HLAA-Diablo Valley adds, “People with hearing loss live uncertain lives.” Hearing loops, telecoils, and Bluetooth reduce that uncertainty and empower people with hearing loss to communicate in more places.
That was our message as we connected with audiologists at the American Academy of Audiology conference (HearTECH Expo) April 19-22, 2023, at the Convention Center in Seattle.
A huge THANK YOU to the American Academy of Audiology and the terrific audiologists who welcomed us to their conference and provided a complimentary booth for us in the accessibility pavilion.
Ann Thomas talks with Henry Wong at the American Academy of Audiology conference in April 2023 in Seattle, Washington.
As we all know, hearing loops are old technology. So is the wheel. For years, we’ve been told that personal jet-packs and flying cars are just around the corner. And for about the same amount of time, we’ve been told that reliable Bluetooth broadcasting is just around the corner to create a new standard for assistive listening. Have you seen either? I’m still waiting… Are we halting the manufacturing of wheels today because 5 or 10 years into the future, magnetic levitation might challenge the status quo? Then why are we skeptical about integrating the only globally universal open standard for hearing access that coincidentally offers the highest level of convenience for the user, virtually non-existent latency, and extremely low power consumption? Hearing loops are needed and viable more than ever before.
“Hearing loop technology isn’t perfect,” you might say. Well, are hearing aids? How else can you achieve an increased signal-to-noise ratio of sometimes more than 20 dB? Not with noise reduction algorithms. Not with directional microphones. As Marshall Chasin wrote a few years ago, “Killion had it all figured out in 1988.” (https://bit.ly/2r7mPpm) And he’s absolutely right. A lot of us have been frustrated with the lack of recent innovation in the hearing aid industry. While the ultimate goal should be to improve an individual’s hearing ability, particularly to hear clearly in noise, we now see smart home connectivity, usage tracking and behavioural analysis, smartphone apps, remote care, and rechargeable batteries touted as revolutionary features. When you study Mead Killion’s K-AMP paper from 1993 (https://bit.ly/2ShY4CE) – and if you’ve never looked at it before, I strongly encourage you to read the whole thing – it becomes rather obvious why the industry seems to have hit a ceiling. We have physics working against us.
Nobody’s Perfect. But We Can Get Pretty Close…
There are exactly two routes to a dramatically increased signal-to-noise ratio when trying to separate the voice of one talker (signal) from the voices of multiple other talkers (noise that looks like signal). The first route is to leverage artificial intelligence and identify each individual talker to then separate their voices in real-time. In essence, this is what IBM Watson launched for their speech-to-text platform less than two years ago (https://ibm.co/2TPzOt9) and of course, it doesn’t work for people speaking simultaneously (yet). The second route is to improve microphone placement. Most of us are familiar with ReSound’s Microphone-in-Helix. Fewer of us are familiar with ExSilent’s “MaRiC” approach (https://bit.ly/2Shqehc), where both the microphone and the receiver are placed inside the ear canal. But you’re thinking inside the “hearing aid box” again… If you explained to any live sound engineer what the hearing aid industry has been trying to accomplish, they’d just be shaking their heads. They will all tell you that the microphone belongs close to the sound source, not on top of an ear 30 foot or more away from what you’re trying to hear. Remote microphones are a step in the right direction, but how about we all share the much better microphones that the presenters or musicians on stage are already using?
Back to “hearing loop technology isn’t perfect.” The common criticisms and limitations of hearing loop technology are (1) cross-talk between systems in adjacent spaces, such as movie theatres, (2) electromagnetic interference (EMI) from electrical mains wiring, and (3) sensitivity to the direction of the pickup coil. The first issue can easily be solved by designing a low-spill array or by employing cancellation loops (https://bit.ly/2zss8o9). The EMI issue has been solved very elegantly by Steve Julstrom even in the analog domain (http://bit.ly/2Q3d4I0). And the third issue is easily overcome by utilizing a tri-axial telecoil pickup as proposed by Tim Riehle (http://bit.ly/2P3OX6r).
[[[Footnote: Of course, I am fully aware that it is essentially impossible to convince any hearing aid manufacturer to free up the required physical space and to dedicate 3 ADC channels to telecoils, but if you want to do all of us a huge favour, try to convince the manufacturers to at least implement a decent hum filter. It doesn’t require much processing capacity but makes a significant difference for the consumer.]]]
Now contrast that with the challenges of other technologies conceivable for assistive listening: Connectivity issues, audio latency and drop-outs, and most importantly, the lack of universal compatibility with hearing aids and cochlear implants across all manufacturers. We get to pick between a poor listening experience that’s easy for the venue to implement or an exceptional listening experience that requires a little bit of engineering skill. Which would you prefer?
Thinking Outside the Box
I’d like you to think completely outside of the “hearing aid box” for a minute. Think of a live concert. Think of the artists on stage. How do they hear their mix? In 1987, Stevie Wonder became the first musician to ever perform using wireless in-ear-monitors. It allowed him to move around the stage freely, adjust the volume to his liking without any impact of extraneous noises, and most importantly – and this is not a joke – his sound engineer could speak to him directly and make sure Stevie wouldn’t fall off the stage.
Let’s take a step back and think of your listening experience at the same show, say in an arena with 20,000 people in the audience, and contrast that with listening to a vinyl record with high-end headphones at home. You can’t even compare the two. So, why aren’t we bringing wireless in-ear-monitoring to the audience? Rather than being isolated with headphones in your home, we could make high-fidelity music listening a shared experience. With hearing loop technology and what we call “hearing aids” we can do exactly that. Whether it’s an open-fit RIC or a custom ITE, all that matters is that it has a telecoil. Add a smartphone app with user-customizable microphone/t-coil mix, volume control, equalization, and enough reserve gain to combat the 110 dB SPL from the loudspeakers (which hopefully we’ll be able to eliminate in the long run), and you have a winning combo.
Music to my Ears
Fast forward to 2018 and the world of Dolby Atmos (http://bit.ly/2PXP4pj). With this new object-based audio format, we can explode sound into the space around you. Each individual audio source has spatial coordinates attached to it and can be rendered out for your specific room and loudspeaker setup or headphones. Dolby Atmos for Music is now available in a select few night clubs and DJs produce music that is literally flying around the audience. Last year, the Beatles album “Sgt. Pepper’s Lonely Hearts Club Band” was released with a new Dolby Atmos mix and you can get a sense of what it’s like here (http://bit.ly/2rgDgQB). Listen to it with headphones and pay attention to every nuance you can hear in the 6-minute clip. Then think of this quote from one of our happy hearing loop users: “I literally couldn’t believe my ears. I heard David Crosby’s pick against the guitar strings, his swallowing before the next verse. The depth of the sound was truly overwhelming.”
What’s Next?
You think hearing loops are dead? I think they’re just reaching puberty. The installation base is growing rapidly where users are advocating for the technology and we’re seeing more and more “non-traditional” applications that aren’t just limited to speech. What are the problems we have yet to solve? First, the lack of stereo capability, which isn’t all that difficult to do. It just hasn’t been a priority for anyone. Second, we need to get people to understand that hearing loops aren’t just for those with hearing disabilities. They are for everyone. We have a much greater need to change perceptions and attitudes than to change technology. We already have the right tools. We just need to use them properly.
We have an opportunity to bring a dramatically improved signal-to-noise ratio to any attendee of a theatre play, worship, a lecture, a professional conference, or a rock concert in a much healthier and fully customizable way. We can go beyond stereo sound and create fully immersive listening experiences. We can let people hear sound the way it was meant to be heard, sound that is true to our ears. But we are dramatically underutilizing the technology we have available today; a technology that has the potential to completely transform the way all of us experience sound in our daily lives.
You may say I’m a dreamer, but I’m not the only one…
With heartfelt thanks to Thomas Kaufmann for allowing me to reprint this article on my LoopWisconsin blog.
Thomas Kaufmann is a disability advocate, entrepreneur, meditator, lateral thinker, inventor, foodie, traveler and founder of OTOjOY.
In my previous blog I made a case for the need for hearing loop technology in public places. For hearing loops to benefit consumers – the hearing loops have to be installed to meet the IEC 60118-4 standard, clear hearing loop signage has to be provided and the consumer needs to know how to link into the hearing loop signal.
The good news is that more and more hearing aids, even small mini-devices, now come equipped with telecoils. And, thanks to the advocacy of the Hearing Loss Association of America (HLAA), active HLAA members and ardent hearing loop advocates around the country, more and more places are installing hearing loops.
But…a common complaint among loop advocates is that still way too many hearing aid using consumers are tragically unaware their hearing devices include this telecoil. What can we do to correct this? That is where audiologists could play an important, even a pivotal, role. By including and activating telecoils in the hearing aids they fit, taking 5 minutes to demonstrating their benefit, and handing out information on the Americans with Disabilities Act would go a long way.
Here is what I believe hearing aid consumers should expect from hearing aid providers:
The provider orders hearing aids that have built-in, vertically oriented telecoils. These telecoils, when turned on, need to offer the same gain and frequency response setting to a 60 dB sound input as compared to a 31.6 mA/m magnetic sound input. In audiology parlance this means the instrument has to have a matching ANSI SPLIV test The good news is that most European hearing aid makes meet this so called Nordic Telecoil standard.
The audiologist activates the telecoil and offers the consumer clear instructions on how to use it (preferably in writing). The gold standard is that the telecoil setting is verified in a test box or in a waiting room with a TV connected to a hearing loop. If your provider doesn’t offer a hearing loop in their waiting or treatment room– share this article by Drs. Caccavo and Lopez . In it they explain why every provider needs a loop in the office.
The hearing care provider explains the capabilities as well as the limitations of hearing aids, and how to overcome these limitations. Consumers need to be told that thanks to the Americans with Disability Act hearing well (in places where PA systems are used) is their civil right. That consumers should expect reasonable accommodations for people with hearing loss, just like people in wheel-chairs expect ramps and elevators. Every consumer needs to be given information how assistive technology works with a telecoil. Brochure examples can be found on the Hearing Loss Association of America and the American Academy of Audiology websites.
The audiologist is a vocal advocate for hearing access rights in the community. Where providers take on this role or where providers work hand in hand with their clients, hearing loops appear. Some providers even hand out hearing loop advocacy cards their clients can take around in the community. Many a loop has been fostered when this conversation about hearing access was started. And when places are unwilling to offer access mandated by the ADA? Providers could offer the link to file complaints with the Department of Justice:ada.gov/filing_complaints on their practice websites.
Should you be told, when you ask about telecoils, that 1) you don’t need one, 2) that they are old technology or 3) that there aren’t enough loops around to make it worthwhile for you to get one – question his or her authority. Telecoils and hearing loops have greatly improved in the last decade and progress is being made daily in the Looping of America. To find hearing loops near you visit www.aldlocator.com , www.LoopFinder.com or download the Loop My Phone app on iTunes.
Hearing advocates around the country are fighting for your right to hear. Join the fight – ask me how. Email me at jsterkens@hearingloss.org
Recently I received a letter (in Danish mind you) from an experienced cochlear implant user who describes her personal experience with Cochlear’s new Loop Booster accessory. Thanks to Google Translate and Janni, the writer of the letter, I was able to translate it so that English speaking CI users can read about her Loop Booster experience.
Full disclosure: Janni Glæsner is the past president of the Danish Adult Cochlear Implant Association CIF http://cochlearimplant.dk/ and is currently is employed by Danaflex, the Danish distributor of Cochlear Products.
The Johannes Church in Greve, DK offers a hearing loop for hearing device users. Like nearly all churches in Scandinavia
And the Noise Disappeared…
I don’t have to use a hearing loop often with my cochlear implant processors, but recently I was a confirmation at the Johannes Church in Greve Denmark and needed to turn on my telecoil to follow the sermon. I heard what I nearly always hear when I turn the telecoils my Cochlear CP810 processor on: a hum and crackling and my head orientation affects the loop signal strength. Now, this noise doesn’t really bother me as it will not drown out the speech I want to hear. The crackle is just there, like the humming of a heating system or a fan. So if I think the sound is a bit too far away and requires me to pay very close attention to hear, such as at a lecture, I use the telecoil, where possible.
A few weeks ago I learned of a new product from Cochlear called a Loop Booster. The Loop Booster is externally mounted on my Cochlear Implant device replacing the internal telecoil in the processor. The Loop Booster is larger and is said to improve the reception of sound through an induction loop system. Well, this aroused my curiosity! Could a Loop Booster, I wondered, dampen – or perhaps even eliminate the hum and crackling I hear when using a loop system? It was time for another visit to Johannes Church. So last Sunday I made the trek back to church to attend the All Saints Service.
I found a place discreetly on one of the back rows and settled in with a hymnal, my implant’s remote control and two Loop Boosters. Let the experiment begin!
Loop Booster Attachment
My first thought turned to the loop system itself. Would it be turned on for the service? It sure was. But, as soon as I turned my processors’ telecoils on, the familiar hum and crackling appeared and when I moved my head the voice of the minister faded and the hum became even worse. It was time to attach the Loop Boosters on both processors. What happened next was amazing: The humming and crackling noise disappeared … and the sound was louder and clearer. It was as if an audio cable was connected from the microphone in the church to my processors. And when I moved my head, the signal did not disappear like it did when I used the built in telecoils. I also did not need to fine-tune using my remote control like I had to in the past. The sound was clear and bright, just like I like! Wow!
Cochlear CP810 Processor with the Loop Booster attached
Janni Glæsner
Because I have heard that other CI users have problems with noise when they use the processor’s telecoils I am sharing this experience with you, and am curious as to whether the Loop Booster works for others. Signed: Janni Glæsner
PS: Readers of this blog may want to know that Janni lives in Denmark where, fortunately for all telecoil equipped hearing aids and all cochlear implants users, hearing loops are common place. She uses Cochlear Model 5 CP810’s in both ears, but told me that the Loop Booster can also be used for the Nucleus Model 6 CP 910 processors. Janni and I would love to hear from other users of the Loop Booster. Janni can be reached via her Facebook page www.facebook.com/janni.glaesner?fref=ts and I can be reached at jsterkens@new.rr.com
Kudos to Cochlear for listening to its customers.
A few years back, many cochlear implant users complained that the older Freedom processors with their vertically positioned telecoils had better hearing loop reception than the newer Nucleus devices whose telecoils were mounted horizontally. It is nice to know the company took these complaints seriously and developed this new telecoil attachment. Telecoils can dramatically enhance the cochlear implant user’s hearing experience in public venues that offer hearing loops as shown in a recently published study in the October 2014 Hearing Review
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
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.
Let's Loop Wisconsin 