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Literature Review 7.2 Audio coupling mode “… audio signal-to-interference ratio of 20 dB provides a signal quality that is acceptable for normal operation …” [B41] (= M3) “At a signal-to interference ratio of 30 dB, 90% of hearing aid users find the WD highly usable” (= M4) “… reduction of the signal-to-interference ratio to 10 dB degrades the performance to that which would generally be judged to be useable but not acceptable for regular use” (= M2) [B41] Levitt, H., Kozma-Spytek, L., and Harkins, J., “In-the-ear measurements of interference in hearing aids from digital wireless telephones,” Seminars in Hearing, 26(2), pp. 87–98, 2005.

Levitt et al 2005 Exposure: mobile phone in test transmit mode Subjects: Volunteers (n = 42) HLAA (SHHH) members (by mail) ITE and BTE hearing aids Mild to severe hearing loss Test: subjective Inter-individual variability >25 dB GSM 50% “highly usable” = 18.2 dB S/N

Hansen Poulsen (1996) Scand Audiol 25: Exposure: Simulated GSM noise over speech Not correlated with E-field, just SPL Subjects: volunteers (n = 17) Subjective Testing GSM noise superimposed on speech background Inter-individual variability >30 dB GSM 50% “not annoying” = 17 dB S/N Objective Testing Word score reached max at 10dB S/N and did not improve with increased margin

Nabelek et al ( ) Exposure: Speech babble background noise – not GSM Subjects: volunteers (n = 191) Clinic Subjective Testing (MCL – BNL recruited from U Tennessee Audiology = ANL) MCL = most comfortable speech level (quiet background) BNL = background noise level (max tolerated) Inter-individual subjective variability >40 dB “acceptable” ANL (full- vs part-time HA) = 7.5 vs ~14 dB Smaller ANL predicted HA success (85% of the time)

EHIMA GSM Project ( ) Telecon Denmark Exposure: GSM Mobile phones placed to users ear Subjects: volunteers (n = 5) Hearing aids (n = 5) (i.e., ~ 25 samples) Subjective Testing Normal hearing individuals GSM 50% “slightly annoying” = 15 dB S/N in normal environment

Julstrom et al / T-coil

U Oklahoma ( ) Exposure: Mobile phones in test mode placed to users ear Subjects: volunteers (n = 78) Testing Objective (word recognition) Subjective (annoyance) Interference reported primarily as distance for interference to occur Perception of interference increased with increasing severity of hearing loss

National Acoustics Lab (1995) Exposure: mobile phone placed to users ear hooked to network no make / model / antenna type phone oriented and positioned to maximize coupling Subjects: volunteers both hearing impaired and normal hearing 5 groups of 4-8 volunteers 2 x ITE and 3 x BTE models Test: interference detection data presented in terms of field strength, distance, and HA immunity for “noticeable interference” Acceptable performance requires HA immunity ~ 28 dB

Summary Average S/N for acceptable performance from recent GSM “usability” testing = dB Variability in subjective response (25-40 dB) Current 20 dB S/N in ANSI C63.19 incorporates >3 dB for testing error Refinements in testing and predictive modeling may support a relaxation in M / T limits ~ 3 dB corresponds to testing margin, not limits per se significant improvement in HA immunity refinements in testing and predictive modeling increasing inter-lab consistency in testing

Usability Definitions (M/T1) Highly Usable—I would use this phone for almost any call. (M/T2) Minor Limitations on Use—I would use this phone for most calls, but it is not ideal. (M/T3) Major Limitations on Use—I would use this phone for a few calls, ‘‘in a pinch.’’ (M/T4) Not Usable—I would not use this phone for any calls.

Usability Definitions Are the questions consistent across user groups nature of conversation ? duration ? demographics (age, occupation, regional location) do we need to define a more specific use case ? Is this the most appropriate approach ? A) does WD + HA combination allow user to hear well ? B) does WD degrade baseline HA performance ?

HLAA Meeting – Reno Nevada “Mobile Phones, Hearing Aids, and the ANSI C63.19 Standard to Make Them Work Together” Friday June 13, 2:15-3:15pm Confirmed: Harry Levitt, Joe Morrissey, Dave Preves Tentative: Dave Case