1. Assistive Listening Devices: Why, When, and Which One? AHEAD Conference/ pepnet 2 Training Institute June 2016

2. Your Presenter Becky Morris, Hearing Loss Assistive Technology Consultant Independence, Kentucky

3. Hearing Loss in the United States Third most common physical condition after arthritis and heart disease. One in eight people in the United States (13 percent, or 30 million) aged 12 years or older has hearing loss in both ears. Apprx. 15 percent of Americans (26 million people) between the ages of 20 and 69 have high frequency hearing loss due to noise exposure at work or during leisure activities. (NIDCD estimate) Sudden, noise-induced hearing loss from gunfire and explosions is the number one disability caused by combat in current wars. In the United States, roughly 58,000 cochlear implant devices have been implanted in adults and 38,000 in children (as of Dec.2012).

4. Why Hearing Aids and Cochlear Implants May Not Be Enough

5. Hearing Aids and Cochlear Implants Hearing aid and cochlear implant (CI) technology processes sound from a microphone at ear level and delivers sound into the ear at prescribed amplification levels. Even with all the recent technological advances, these devices don’t perform well in all situations. Environmental factors challenge how well the hearing aid/CI perform.

6. Reverberation caused by reflective walls presents an acoustic challenge. Sound is distorted. Factors Affecting Speech Recognition

7. ( Adapted from Olsen, 1988) – Courtesy Sam Atcherson, Ph.D. No Reverberation

8. (Adapted from Olsen, 1988) – Courtesy of Sam Atcherson, Ph.D. Reverberation

9. Effect of Reverberation on Speech: A Visual Example No Reverberation Low Reverberation Moderate Reverberation Too Much Reverberation Courtesy: Sam Atcherson, Ph.D.

10. Factors Affecting Speech Recognition

12. More Factors Affecting Speech Recognition Student Fatigue. Interactive class discussions (multiple speakers). Is the sound level loud enough? Is the sound level louder than competing background noise? Is the sound level consistent throughout the room?

13. 125 125 250500 50 0 110 100 10 20 40 30 60 70 80 90 1000200040008000 Normal threshold Whispering Speech Food blender Busy street Power tools zv j mdb n ng e i u ia or p hg ch sh k f th s Audiogram and Everyday Sounds Breathing

14. Photo credit - PA Hands and Voices Visual Example of How Speech Sounds are Heard by Person with Hearing Loss

15. Hearing Assistive Technology and ALDs

16. ALD Benefits ALDs use a remote microphone to pick up the desired sound source and deliver it to the hearing aid/CI via some type of connection. Offers consistent sound signal regardless of distance. Overcomes challenges of reverberation and background noise. Some describe ALDs as “binoculars for the ears”.

17. How ALDs Work SPEECH Microphone Transmitter Receiver SPEECH Courtesy Sam Atcherson, Ph.D.

18. Permanent Portable Personal/Miniature 3 Types of ALDs

19. Permanent (Large Area) system installed with PA system – FM – Infrared – Room Loop Portable FM system Personal systems dependent on specific hearing aid manufacturer

20. Permanent ALD Systems Large Area systems use a transmitter connected to an existing PA system. Infrared and FM systems use a receiver listening option for connection to the hearing aid/CI. Room Loops Use TELECOIL in hearing aid/cochlear implant.

21. Large Area FM Systems LT-L02 Basic FM Listening System from Listen Technologies. 1500 ft. range Personal PA 377 FM Listening System from Williams Sound. 1000 ft. range Manufacturers: Williams Sound and Listen Technologies

22. Large Area Infrared Systems LS-90 ListenIR iDSP Level I System. Up to 50 seat range. WIR TX75 PRO System Two Manufacturers: Williams Sound and Listen Technologies

23. Room Loops

24. Portable FM Systems For Mild – Moderate Loss Williams Sound PFM Pro (Motiva, Hearing Helper)

25. Portable FM Systems For Mild – Moderate Loss Listen Technologies Systems

26. Portable FM/Digital System For Mild – Moderate Loss Williams Sound Digiwave 300

27. Portable FM/Digital System Directional Omni For Mild – Moderate Loss Comfort Audio Contego

28. Portable FM System For Severe to Profound Loss Comtek AT216

29. Portable Receiver Listening Options For People without Hearing Aids Headphones Earphone Dual Earbud Earbud

30. Behind-the-Ear Aid w/telecoil Ear Level Speech Processor w/telecoil Photos courtesy of Beltone, Cochlear Corp, Listen, Neckloop Portable Receiver Listening Options Hearing Aids/CI Speech Processors w/telecoils

31. Telecoils An option built-into a majority of hearing aids. Uses induction to pick up a sound signal. Is a recognized universal method to receive sound. Neckloops and Room Loops create the signal for the telecoil to pick up.

32. Personal FM Systems Systems include a body worn transmitter and miniature receiver. Works only with BTE hearing aids or CI. Good for group listening because hearing aid microphone can remain ON. Can plug into some streamer devices. Best option for many people with severe-to- profound hearing loss.

33. Personal FM System From Phonak MyLink Neckloop Receiver Roger Pen, Roger EasyPen, RogerMic Roger MLXi Receiver

34. Assistive Listening Systems with Multiple Microphone Options Phonak – up to 10 Roger Pens/Clip-on Mics Williams Sound DigiWave System

35. Assistive Listening Systems for Severe-to-Profound Hearing Loss Phonak Comtek

36. Which One Do I Choose? User Considerations User’s previous experience with ALDs. Level of hearing loss. Hearing aid or cochlear implant model. Telecoil programmed? Classroom Considerations Size of lecture hall/classroom. Is PA system set up in class. Single speaker vs. multiple speakers. Lecture vs. class interactions.

37. The Student Who Wants to Use Bluetooth Only 2 hearing aid models have Bluetooth Built-into the aid. (Linx2 and Halo) These 2 models pick-up the Bluetooth signal from cell phones that they have been paired with. They do not function as a traditional style ALD (or FM system).

38. Streamers Device that uses Bluetooth to connect to cell phones or other Bluetooth enabled devices. Must be worn around the neck like a neckloop or in a shirt pocket. (close proximity to ha/ci). Delivers sound to a receiver built-into the hearing aid/cochlear implant. Accessories include small remote mics and TV connectors. (works similar to a neckloop)

39. Streamers Are Not Universal They are manufacturer specific. (Oticon hearing aids cannot use a Phonak streamer.) An audiologist must program the streamer to the hearing aids. Streamer accessories like remote microphones are also manufacturer specific. Accessories use proprietary programming. (They are not universal.)

40. Streamers Are Personal Devices While the streamers are generally considered personal devices, many of them can, in fact, connect to personal FM systems like the Phonak Roger receiver.

41. Phonak Roger FM and Compilot Streamer

42. Only 2 Streamers Can Connect

43. 4 Streamers Cannot Connect

44. Cardionics Viscope Amplified Stethoscopes Cardionics Escopes Thinklabs ONE

45. Resources ADA info, accessibility issues, amplified stethoscopes, and more found in the resource section of: http://www.pepnet.org Association of Medical Professionals with Hearing Loss http://www.amphl.org Hearing Loss Association of America http://www.hlaa.org Finding Venues with Loop Systems http://www.loopfinder.com Information regarding hearing loops http://www.hearingloops.com

46. Resources Hearing Loss Statistics https://www.nidcd.nih.gov/health/statistics/quick-statistics- hearing ALD Manufacturers www.comfortaudio.com www.comtek.com www.listentech.com www.phonak.com www.williamssound.com

47. Other Questions?

48. Contact Information Becky.Morris@pepnet.org 859-992-3794 (email preferred)