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.
A couple of years ago I attended the showing of a movie “the Hundred Foot Journey” in a small hearing looped community theater – (if you have not seen this movie, I can highly recommend it) with three friends and my husband. As an ESL – English as a Second Language person – I struggle understanding dialogue through the music, sound effects, and background noise. I have stopped attending movie theaters. I wait until I can order the DVD from Netflix. At home I turn on the captions and do not have to struggle and get to enjoy and understand movies with ease.
I had previously seen the “The 100 Foot Journey” and, as I often do with movies I enjoyed, I was looking forward to seeing it again. A hearing loop announcement was made by one friend whose foundation helped fund the loop, and we settled into our chairs with our popcorn.
As soon as the movie started, I realized the captions were not on. This upset me; I knew one of my friends has limited speech discrimination. I turned to my husband – who motioned a “don’t bother, honey.” I knew the movie involved actors with Indian and French accents, which would not only make hearing difficult (hearing loop or no hearing loop) for my friends who use hearing aids and/or implants, but it would also make it difficult for me to enjoy the movie.
So, I got up and pleaded with the pop-corn lady to turn the captions on– my request was dismissed with a terse “No. Our patrons do not like to see captions!” But when I insisted, explaining that several persons in the theater would not be able to enjoy the movie without them, she recommended I talk to the community theater director in his office. He didn’t think their equipment had that capability but suggested I talk to the volunteer in the theater control room. “Captions? I have never seen them in use here!” he protested when I asked about activating them. He pointed to the remote control for the DVD player on his desk. I spotted the “CC” button on the device right away – pushed it, and instantly the captions appeared on the white screen. Success! Upon returning to my seat, I got two thumbs up from each of my friends and once again settled in my chair, to enjoy the movie.
The best part? When we were leaving the movie theater, I overheard someone say that they really enjoyed the captions because people with accents are so difficult to hear! Ha! I felt vindicated.
Why aren’t more films screened with open captions? Shari Eberts recently wrote a blog about a group of advocates in New York City is trying to achieve just that. This group supports a city ordinance that would boost the required number of open captioned screenings at local cinemas. Their aim: more equal access at the movies for people with hearing loss. I singed it as I personally would much rather see block-buster movies in the theater with many others. Read Shari’s blog below and don’t forget to sign the captioning petition https://www.change.org/p/open-captions-subtitles-are-healthier-for-everyone
Hearing loss advocates in Seattle WA were able to pass a bill that requires televisions in all of the city’s public spaces to show closed captioning whenever those TVs are on. This includes bars, restaurants, fitness centers, and hospital waiting rooms. Albuquerque, NM recently passed similar legislation. Maybe, bills like this will get folks used to seeing open captions on TV. Perhaps getting to open captions acceptance is a journey. Plus, the Boomers are aging fast and with age comes a change in hearing. Perhaps that too will lead them to request open captions shows in movie theaters. I too would like that.
To say it in advance: The classic induction (hearing) loop is still the clear choice. And that will probably remain the case for the next 10-20 years.
In January 2020, after 7 years of planning and discussion at the instigation of EHIMA (European Hearing Instrument Manufacturers Association), an extension to the Bluetooth Low Energy standard was finally decided: Bluetooth Low Energy Audio (short: BLE Audio).
Previous versions were either not able to transmit audio at all, or if so, only with expensive hearing aids and usually only with proprietary technology from Apple compatible only with newer iPhones. So far, however, only a limited number of devices (max. 2 hearing aids in parallel) can be connected. As a public assistive listening system it is therefore not suitable. That has changed with the new BLE Audio standard, at least in theory. Only the future will show whether this can be achieved in practice. It depends on very different factors, such as the acceptance of the hard of hearing people, the usability and, last but not least, whether it can succeed in ensuring a stable transmission network.
One thing is certain, BLE Audio will appear in the first hearing aids in 1-2 years at the earliest. So far, it has not been installed in any hearing aid. It will also not be possible to issue a software upgrade for already existing hearing aids, as the physical hardware would not be compatible. Some hearing aid manufacturers now have to redesign, reprogram, produce and, above all, re-approve their hearing aid chips worldwide. That alone will consume time and money. Therefore, it is very likely that the most expensive hearing aids will be equipped first, then the medium-priced hearing aids, and only after a considerable delay will the basic devices also be equipped with BLE Audio functionality, as we have seen with other innovations in hearing aids.
So, it will take at least several years, until (perhaps) most new hearing aids will have BLE audio. However, not all people will have hearing aids with this technology by then. Hearing aids in Germany usually have to be worn for 6 years. Most people who have to make a co-payment however, wear their devices significantly longer. This means that we can expect comprehensive coverage with BLE Audio at the earliest 10 years after the sale of the last hearing aids without BLE Audio. These periods are mostly underestimated, as not all people are supplied with high-end devices or have the money for new ones. Especially people aged 80 and over often no longer buy new hearing aids “because it doesn’t pay off for me”.
Induction loops will not “die” that quickly. They are still the most reliable, cost-effective and low-maintenance hearing system available to us. They are also the only public assistive listening technology that are barrier-free and will remain so, at least for the next 2-3 generations of hearing impaired people! This is why the International Hearing Access Committee (IHAC) assumes a time window of at least 10-15 years or even more. (https://www.ampetronic.com/2019/08/hearing-loops-and-telecoils-could-they-be-replaced-soon/)
After that, induction loops and BLE audio (or other successor standards) could coexist, and maybe it will stay that way for a very, very long time. It is not yet clear whether this will not even become the norm. We recently spoke to the Technical development manager of a hearing aid company. He strongly believes that for hearing aids which only have BLE audio (instead of telecoil), there will be additional external devices for inductive reception.
Perhaps inductive hearing aids will eventually be replaced by this or another technology, but one thing is certain, BLE Audio will not be an option for the next generation of hearing-impaired people. Most of them will not be able to use it and will therefore be dependent on a different solution. Also, as a rule, the inductive hearing system (installed above ground) continues to be the basic technology for primary care. The telecoil will not disappear, despite gloomy predictions, because it will remain necessary for those countries, where a comprehensive supply of the latest smartphones is not economically viable.
But what use does the new Bluetooth 5.2 (BLE Audio) from January 6, 2020 have?
What could the previous Bluetooth versions in hearing aids achieve?
Bluetooth Classic (BTC) is only available in very few hearing aids because actually it does not make sense. Although it can transmit audio, it consumes a lot of energy, battery-wise, and has a high latency (time between the spoken and heard word) and is therefore not able to lip-sync.
Bluetooth Low Energy (BLE), also called BT Smart, has no audio transmission, so it is only used in Hearing aids for remote control.
Bluetooth Low Energy (BLE) with Apple extension (“made for iPhone”) can transmit audio, but only with newer Apple devices, all other smartphones, notebooks and tablets need an additional device, subject to additional charge. There may also be problems with the latency here.
Pairing:
In all three versions, the hearing aid must be registered on the transmitter (the smartphone) i.e. the hearing aid must be individually paired with the transmitter. Before BT 5.0 only one audio pairing per transmitter was available. From BT 5.0 on a maximum of two audio receivers could be paired at the same time (e.g. a Bluetooth speaker and a hearing aid), not more.
These are the main reasons why Bluetooth up to version 5.1 is not suitable for a public hearing system
no audio or only with a special additional device
high latency
pairing
only two participants maximum
What’s new with BLE audio?
Bluetooth-Low-Energy 5.2 is now able to transmit audio, like previously the Bluetooth Classic. BLE 5.2 got a brand new CODEC (“LC3”) that shrinks the audio data, as with MP3, so that parts of the language are not transmitted. This reduces the latency to around 5ms. It will only be clear towards the end of 2020 how exactly this will work.
Bluetooth Low Energy 5.2 now offers a “streaming” solution. In addition, each audio data packet comes with a period of validity. If it cannot be sent during this period (e.g. due to overloading of the Bluetooth chip or network, or not processed by the hearing aid) it will just be left out. This results in dropouts, crackles and wrong sound in the hearing aid speakers.
Bluetooth-Low-Energy 5.2 now also has multi-streaming. One transmitter can have multiple audio streams sent simultaneously i.e. in a conference hall or cinema for translations e.g. German and English. The hearing aid can also subscribe to multiple streams e.g. a soccer game broadcast in a pub and the announcements of the host or an alarm system.
In addition to the normal pairing between the Bluetooth transmitter and the hearing aid, there is now also the so-called Broadcasting, i.e. a kind of radio. The hearing aid no longer has to be registered or paired with the transmitter but just ‘listens’. There are different types:
completely free listening
listening with approval (= passcode). Since Bluetooth radio goes through walls, too, this prevents someone from listening in on a park bench outside the venue.
With Bluetooth Low Energy 5.2, the hearing aid can automatically connect to a nearby hearing station (e.g. an exhibit in a museum). Additional aids or devices are not required. Although, the hearing aid must be switched to the correct mode beforehand.
So far only the basic plan (core specification) has been adopted, more than 20 necessary detailed features are expected to come later in the year. The first chipsets are expected to be available in a year.[1]
However, all of these new functions are not mandatory for a Bluetooth chip to be recognised as version 5.2, manufacturers are also allowed to install only parts of the standard. That means, even if a new notebook has a Bluetooth 5.2 chip installed, it is far from being said that this PC is suitable for use as a public hearing system. What functions in real hardware, in firmware (programs on the chip), what is in the driver, in the operating system or buried in the application software is not clearly recognizable. BLE audio will also not be available on Android below version 10, so an upgrade to a new device is mandatory for those with older models.
We could not find any information on Apple, although Windows 10 will receive an update at some point. Probably the new chips will be at first installed in the expensive smartphones / tablets / PCs and only afterwards with several years delay on the affordable mid-range devices.
Compatibility with previous devices:
All expensive hearing aids “made for iPhone” will not work with BLE Audio, unless a hearing aid manufacturer would develop a BLE Audio accessory “made-for-iPhone” and a corresponding app that controls the device. Bluetooth Classic devices could not pair either. It cannot be assumed that hearing aid manufacturers will develop new software for previous Bluetooth hearing aids, create a new driver and replace hardware parts. For each “made for iPhone” hearing aid there already exists an adaptor for Bluetooth classic. Now theoretically it could be possible, that a third-party manufacturer develops an additional adaptor translating BLE audio to Bluetooth classic. And these two devices have to be coupled. However, if that should be the case there would be a long latency period between the sound being generated and it being heard, e.g. in a thriller film a victim would fall over before the gun shot would be heard.
But what options will be available hearing aid users that currently use a telecoil ? Currently devices are available for a few Euros which receive Bluetooth Version 4.2 and output on a headphone jack to allow all wired headphones to receive Bluetooth audio. A hearing aid user can use the same device to drive a neck loop. Given that such a device will be required for the much larger headphone market, it is likely that a “Bluetooth 5.2 receiver” will be readily available.
Handling:
With a BLE audio hearing system, the hearing aid must be paired to the desired audio stream to receive it. The one to four buttons currently used on hearing systems almost certainly won’t be adequate, especially with content requiring approval; the passcode can hardly be entered on the hearing aid manually. Therefore, it is very likely that a smartphone will always be necessary to control hearing aid technology using this standard. Difficulties arise ensuring all those people who experience hearing loss have a current smartphone. That again takes time, for example even Bluetooth 5.0, launched in December 2016, is not even present in all current early 2020 smartphones.
“Coupling” to public hearing systems
Anyone who has ever tried to pair their Bluetooth speaker with their smartphone knows that this is not always easy. A hearing aid with Bluetooth 5.2 standard has to connect with a Bluetooth hearing system transmitter in a church, the parish hall or in public spaces. That this connection will most likely not be done on the hearing aid itself makes things more problematic and complicated, not easier. Presumably these hearing aids will come with an app. Even ignoring the considerable data protection problems for the moment, the app would communicate with the existing hearing system transmitter and you have to make a choice as to which of the available streams you want to hear. Nobody wants to watch Casablanca, just to hear Star Wars audio from the next room because of a wrong connection or the Spanish language channel instead of the native one. We are interested to see how this will be resolved. So far nothing has been decided yet!
“Coupling” to the induction loop, on the other hand, means that I only place my hearing aid on the telecoil program via a switch. This is one of the 3-6 typical functions of the hearing aid. Mostly it is a button on the hearing aid that is pressed to move from one program to another. Some, more expensive, hearing aids also have an app to enable the mode to be changed via a smartphone.
Every now and then during our consultations we are asked, whether elderly people, in particular, are able to cope with changing their hearing aids to the telecoil program. As a rule they are able, but if they are not, they will definitely not be able to use Bluetooth!
Our conclusion:
We all hope that one day there will be better and cheaper public hearing system technology that can replace induction. If this should be BLE audio, it will still take many years to get there and it will be much, much longer before induction can be replaced completely with a clear conscience. Whether BLE is the future will depend on its suitability. 2.4GHz technology is already considered overloaded today. Without change, this problem will only increase further in the future, leading to gaps in the transmission by BLE Audio, in transmission aborts or becomes incomprehensible. This would make BLE audio certainly not an appropriate alternative for induction loops.
Addendum:
In the meantime Bluetooth LE-ASHA is available for Android 10. It works similar to BLE Apple, but is not compatible with it, neither it is with the other versions. BLE ASHA is not intended for public hearing systems. Nevertheless, this makes a total of five (!) different, incompatible Bluetooth Systems for hearing aids to choose from. We will see which system(s) will prevail. Until then Induction loops are the only universally compatible systems.
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.
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.
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.
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.
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.
Let's Loop Wisconsin 