1. Hearing Aids, Hearing Assistance Technologies & Implants
Chapter 3
Hearing Aids,
Hearing Assistance Technologies
& Implants

2. Latest Technology
Phonak Roger Pen
GN ReSound LiNX
MED-EL Rondo

3. Question Which of the following is NOT true?
A cochlear implant primarily amplifies sound
A hearing primarily amplifies sound
Hearing aids can be worn by infants from birth
Less than 25% of Americans who could benefit from a hearing aid, wear a hearing aid
Children function better with 2 cochlear implants

4. Purpose of Hearing Devices
Make speech audible
Make non-speech audible
Restore range of loudness
Alerting
Keep in touch with environment

5. Hearing Challenges Hearing soft speech Hearing speech clearly
Hearing speech in noisy environment
Hearing speech in reverberant environment

6. Question
The Augustana Chapel provides a conducive listening environment for persons with a hearing loss? Yes No

7. Definition of Hearing Aid
Hearing Aids (noun, plural) 1 (archaic): electronic devices usually worn by a person for amplifying sound before it reaches the auditory receptor organs. 2 (modern): electronic devices worn by a person for processing sound to provide audibility and improve the signal-to-noise ratio before it reaches the auditory receptor organs.
A New Definition for Modern Hearing Aids, Victor Bray, Ph.D. & Michael Nilsson, Ph.D., Auditory Research Department, Sonic Innovations, Inc.

8. Types of Listening Devices
Hearing Aids
ALDs/HAT
Alerting Devices
Brainstem Implants
Middle Ear Implant Devices (BAHA & Envoy)
Cochlear Implants (CI)
Smartphone

9. Hearing Aid Styles Air conduction Bone Conduction
Body Aid
Glasses
BTE
RITE
RITA
ITE
ITC
CIC
Bone Conduction
Middle Ear Implant Devices (BAHA)
              

10. Open Canal
Receiver in the Ear
RITE
Receiver in the Aid
RITA

11. Question A RITA hearing aid has the speaker component in the?
Ear canal
Hearing aid
Middle ear
Both ear canal and hearing aid

12. Bone Conduction HA
When a conventional hearing aid cannot be worn due to microtia, atresia, obstruction in EAM, bone conduction hearing aids may be beneficial

13. BAHA (unisensory conductive loss)
Bone Anchored Hearing Aid:
Surgically embedded titanium "post" into skull with a small abutment
A sound processor sits on abutment
The implant vibrates the skull and stimulates the cochlea via bone conduction bypassing outer & middle ear
Treatment for:
Conductive loss
Mixed hearing losses
Unilateral sensorineural hearing loss,
Chronic ear infections
Congenital external auditory canal atresia

14. Alpha 2 (M) Bone Conduction Hearing System
Sophono Inc.
Differding Family Story and Sophono

15. MED-EL BoneBridge
BoneBridge

16. SoundBite Hearing System
Single sided deafness or conductive hearing loss
No surgery required
Removable and totally non-invasive
No dental work or alterations to teeth
BTE (behind-the-ear) microphone unit, housing receiver, wireless transmitter, and attached microphone
Removable ITM (in-the-mouth) hearing device

17. Question The BAHA is? Air conduction hearing aid
Bone conduction hearing aid
Cochlear implant
Brainstem implant

18. Envoy Implant
Middle Ear Implant
Envoy Medical

19. ESTEEM Implant Criteria
at least 18 years of age
stable, moderate-to-severe, bilateral sensorineural hearing loss (Range = 40 dB to 70 dB, defined as the average of pure tone thresholds at .5, 1, 2 KHz)
speech recognition test score (WRS) greater than, or equal to, 40% in the worst hearing ear
normal tympanic membrane & middle ear anatomy
normally functioning Eustachian tubes
worn properly fit hearing aids for at least one month
no history of immune compromise or chronic staphylococcal skin infections
room in their mastoid cavity to accept the ESTEEM components
able to undergo a 3-4 hours general anesthetic

20. VIBRANT SOUNDBRIDGE Middle Ear Implant System (Medel)
Placement Options: Ossicular RoundWindow

21. Hearing Aids Analog (conventional) Programmable (analog or digital)

22. Type of Hearing Aids
Analog
hearing aids pick up the sound and convert it into electronic signals. These hearing aids have trimmers that are manually adjusted by a hearing healthcare professional using a tiny screwdriver. Analog hearing aids are the least flexible, but also the least expensive, level of hearing aid technology.
Programmable
Programmable hearing aids must be connected to a computer in order for your hearing healthcare professional to make adjustments. These hearing aids offer more flexibility and can provide more features.
Digital
Digital hearing aids contain computer chips that convert the electronic signal into digital signals. The digital hearing aid can perform complex processing of the sound, such as reducing the intensity of loud background noise. Typically programmed via a computer, offers the greatest flexibility in its ability to match the hearing aid response to the hearing loss.

23. Question A receiver is another name for: Microphone Speaker Battery
Amplifier

24. HA Components
Microphone The microphone picks up sounds from the air and convert them into electrical signals. Amplifier The amplifier increases the intensity of the signals from the microphone. Filters modify the sounds so that only sounds which are relevant for the person are amplified. 'Loudspeaker' (Receiver) The third basic component is the 'loudspeaker' (receiver). It converts electrical signals into acoustic signals, which the person then hears. Small computer (Digital) (How it works) These three components exist in all hearing aids. Furthermore, in digital hearing aids a small computer can be programmed to manipulate the signals to fit the hearing loss of the individual hearing-impaired person.
              

25. Batteries
Various Sizes
Chemical

26. Question Most hearing aid batteries are? Mercury Zinc-air Hallogen
Sulfer-free

27. Earmolds Earmolds direct sound into the ear canal
Variety of styles, colors, and other characteristics

28. Ear Impressions

29. Thin Tube (Open Canal)

30. HA Verification Real Ear (probe microphone)
Speech tests (HINT, QuickSIN, BKB-SIN, SPIN)
Subjective ratings of intelligibility and quality
Loudness verification
Questionnaires
Functional gain
ABR—for infants & young children

31. Probe Microphone
Real Ear measures of sound pressure in the ear canal

32. Speech Tests
HINT
QuickSIN
BKB-SIN
SPIN

33. QuickSIN/BKB-SIN
1.   SNR loss of 0-2 dB: Normal to near-normal.  These patients will probably do well in noise with any hearing aids that provide undistorted output.  With directional microphones, they may hear better than their normal-hearing peers in noisy situations.
2.  SNR loss of 2-7 dB: Mild SNR loss.  Today’s directional microphones provide SNR improvements of 2 to 5 dB; with directional microphones, these patients should be able to hear almost as well as their normal-hearing counterparts in noisy situations.
3.  SNR loss of 7-15 dB: Moderate SNR loss.  While directional microphones will provide benefit for these patients, they cannot provide enough SNR improvement to allow the person to hear as well as their normal-hearing counterparts in noisy situations. Microphone arrays, such as the LinkiT, provide a 7 to 13 dB improvement in SNR.
4.  SNR loss greater than 15 dB: Severe SNR loss.  These patients need the maximum amount of SNR improvement, and FM systems are the technology of choice for these patients. Today’s ear-level FM systems are cosmetically appealing and are available in a wide range of hearing aids. Contact hearing aid manufacturers for more information.

34. Subjective Ratings Magnitude Production Category Scaling
Pt is given a number and instructed to adjust a given parameter such as intensity, SNR, until that number is reached
Category Scaling
Pt is given a bounded scale such as 1 to 10 and asked to make a judgment of a speech passage based on intelligibility, quality, etc.
Paired Comparisons
Pt compares 2 different settings or hearing aids
Clarity
Pt asked to judge if sound is clear, distinct, pure…the opposite is diffuse

36. Loudness Restoration
PAL
Soft, comfortable, loud

37. Questionnaires
APHAB
SADL
IOI
SSQ
GHABP
PAL

38. Classroom Function Hearing Evaluation Using Clickers

39. Functional Gain Compare Aided vs. Unaided results
In the example, the aided (green) thresholds are compared to the unaided thresholds for the right (red) and left (blue) thresholds

40. Ling 6 (HL) CD from Phonak

41. Ling 6 Sound Check
Evaluate student at variety of distances to determine maximum distance Ling sounds heard
Ling 6 Sound Check Chart
Ling 6 Behavioral Daily Checklist
Ling 6 Recording Chart

42. Ling 6 (HL) (free CD from Phonak)

43. UWO Plurals Test (free CD from Phonak)

44. UWO Plurals Test (free CD from Phonak)

45. Phonak Logatom Test Adaptive, computer controlled test
Developed by Phonak
Female speaker: “My name is…”
Software track level in dB SPL that corresponds to 50% correct performance

46. Functional Listening Evaluation
Determine how listening abilities are affected by noise, distance, and visual input in an individual’s natural listening environment
Designed to simulate listening ability in situations that represent actual listening conditions in student’s classroom– not sound booth
Administration of the evaluation, the student’s teachers, parents, and others gain understanding affects of adverse listening conditions encountered by the student.
The evaluation results are also useful in justifying accommodations, such as assistive listening devices, sign language or oral interpreters, notetakers, captioning, special seating, and room acoustic modifications.
Functional Listening Evaluation
(Ying , 1990), (Ross, Bracken & Maxon, 1992)

47. FLE (cont.)
Test administration takes approximately 30 minutes, including set up, with sentences and 20 minutes with words.
1. Auditory-Visual Close Quiet
2. Auditory Close Quiet
3. Auditory-Visual Close Noise
4. Auditory Close Noise
5. Auditory-Visual Distant Noise
6. Auditory Distant Noise
7. Auditory Distant Quiet
8. Auditory-Visual Distant Quiet

48. BKB SIN Test 10 sentences presented twice
Increasing noise with each sentence
SNR loss is the increased S/N ratio required by a listener to understand speech in noise
BKB-SIN Test scores are reported in SNR
Age normative data
Allows audiologist to recommend appropriate assistive technology (e.g., omni-directional microphones, directional microphones, array microphones, FM systems, etc.) for students with HL to function in noisy situations
Rich in semantic context, thus individuals with HL may be using top-down processing to improve their performance—does not tax bottom-up processing
(Niquette et al 2003)

49. AB IT-MAIS (free iPad app)

50. LENA Developmental Snapshots

51. Hart & Risely

52. Oticon Hearing Diary App (iOS)

53. Oticon
Functional Auditory Measures

54. Binaural vs. Monaural Advantage
head shadow
loudness summation
localizing
signal to noise ratio

55. Marvel Superhero HL
A 4-year-old boy in Salem, MA who decided he did not want to wear his blue hearing aid to school anymore received some new inspiration after Marvel Comics designed a superhero after him.

56. Hearing Assistive Technology (HAT)
Refers to devices and services that help deaf and hard of hearing people compensate for hearing loss
Four primary categories of HAT:
assistive listening devices
alerting devices
telecommunications devices
visual communication devices

57. ALDs/HAT Function Catch the desired sound as cleanly as possibly
(using well-selected microphones or a direct audio feed)
Carry the sound intact via a specific type of transmission to a receiver
(using infrared light waves, radio waves, induction, or wires)
Couple the receiver to the hearing device or ear with as little background noise, feedback or distortion as possible
(using neckloops, silhouettes, cords, headphones, or earbuds, depending on the user's equipment or lack thereof)

58. How ALDs/HAT Help Bypassing or minimizing background noise
Overcoming the weakening effect of sound traveling through air
Reducing the effect of poor room acoustics

59. HAT in Schools FM (radio frequency) preferred method
Loop Induction (best in churches, homes, public meeting places)
Infrared (not common in schools)(best in courtrooms)
Hardwire systems (rarely found)

60. ALDS/HAT Loop Induction (Loop)(Electromagnetic) Radio FrequencyAM
FM (most used system in educational settings)
FM plus Video
900 MHz (Starkey)
2.4 GHz (ReSound)
Bluetooth
Light (Infrared)
Hardwire

61. Loop Induction Systems
ALDs/HAT
Loop Induction Systems

62. Looping the World with Audiocoil
“The ordinary telecoil is perhaps the most common and most underestimated assistive listening device available for hearing impaired individuals today.”
Ross (2002).
“By changing the label to something more general—my suggestion is ‘audiocoil’—we do not restrict to a single function the way we think of the coil”.
Ross (2006). Telecoils are about more than telephones. The Hearing Journal, 59,

63. Loop Induction Components
Microphone
Loop amplifier
Loop wire
Telecoil

64. Loop Inducton
Large area
Home area (cushion loop pad)

65. Loop Options Silhouette: Neckloop: Portable Loop
Near telecoil and signal relatively low therefore less susceptible to) most EMI (ElectroMagnetic Interference).
Stay aligned relative to the hearing aid, they are less sensitive to head position.
Neckloop:
Drive both hearing aids (not with true stereo, but with a mono signal into both aids).
Does not require wires running up the neck to the hearing aid(s), and can be worn under a shirt or jacket.
Portable Loop
Portable and able to carry
Communicate one on one or in small groups, cars, etc.

66. Loop Induction Oval Window
LI transmits via an electromagnetic field and require no receiver if the hearing aid wearer has a telecoil
Oval Window

67. Loop Induction: Telecoils
Inductive/audio loop systems transmit an electro- magnetic field
Receivers are not necessary for hearing aid wearers with a telecoil (the telecoil itself is the receiver)
Loop receivers can be provided for people who do not have telecoils.
Loops are often permanently installed
Silhouette inductor
Neckloop
Direct audio input

68. ClearSounds
Quattro 4.0

69. Radio Frequency Systems
ALDs/Hat
Radio Frequency Systems

70. DAILY EVENT ASSISTIVE DEVICES Wake-up
Alarm clock with vibrator and/or flashing light
Land lines: home and work
HAC phone, texting, built in amplification, ringer connected to visual or vibrator indicator, speech recognition
1:1 conversations
Personal communication device (FM or infrared)
Small group meetings
Portable FM or infrared device placed in the middle of the table, loop, real-time captioning, 1:1 personal communicator
Noisy restaurant
Personal device with directional mike
Large group meetings,
Large-area infrared, FM or loop system
Cell phone
HAC phone, vibrate option, texting, high volume output 
Vehicle
1:1 device with directional mike, emergency siren recognizer
Family dinner
Portable infrared or FM device in middle of table TV
Captioning, Infrared, FM or loop connected to TV
Door bell
Vibrator worn on body and flashing lights
Child care
Baby monitoring device with vibrating annunciator
Fire-alarm
Flashing lights and/or vibrating annunciator

71. Question Radio Frequency can include: AM FM Bluetooth All the above
A and B

72. Question Which is a digital signal for HAT technology? AM FM Bluetooth
All the above
A and B

73. Radio Frequency
FM (radio frequency) systems transmit radio waves to receivers
Used in classrooms and where mobility is required
Not affected by light, able to cover 100+ feet, and are portable
Systems can be set to different frequencies to allow several uses in same place
Miniaturized FM receivers using the mhz range are available as an attachment for some BTEs and CI processors
Some FM transmitters have built-in microphones that can switch from an omnidirectional, directional and/or super directional setting
Susceptible to some radio interference

74. Radio Frequency Systems
Phonak
Multi-frequency receivers (MLxS, ML8S and ML9S)
synchronized automatically using the WallPilot or directly with Campus S. The MLxS also has a standardized connector that makes it compatible with both Phonak hearing instruments and BTEs from other manufacturers
Single-frequency receivers (MLx, ML8, ML3-7)
single-frequency receiver which clips to BTE hearing aid
MicroLink CI S
miniaturized FM receiver for cochlear implant users that attaches directly to the bodyworn speech processor
WallPilot
hangs at the entrance to a room and performs an Automatic Frequency Synchronization (AFS) and ensures that the multi-frequency receivers of wearers entering the room are automatically set to the correct frequency

75. Phonak Dynamic FM Inspiro
Phonak Dynamic Inspiro
Studies show students with Dynamic FM on average improve 50% in loud noisy situations
Recommended for students wearing hearing aids or cochlear implants

76. Phonak Roger
Roger
Phonak Roger Pen
2.4 GHz

77. FM Radio Frequency Systems
Phonic Ear
Sprite BTE FM
used by people of all ages who have hearing abilities ranging from normal to profound loss used in the car, at restaurants and parties, watching TV, on tours, and talking with others across a distance.
students with ADD or CAPD benefit
Toteable

78. Oticon (FM)

79. AVR (FM)
AVR Sonovation was one of the first companies to develop FM receivers inside the BTE hearing aid.

80. Audiovisual FM AudiSee
Assistive device to facilitate speechreading and hearing, primarily in educational settings
Portable
Camera and microphone worn by speaker
less strain to speechread when teacher moves about the classroom or turns to write on the blackboard

81. Bluetooth 4.0 LE
Bluetooth is a short-range, wireless, digital communication standard.
Bluetooth devices send data and voice in a clean, clear, digital format
audio signal is not subject to the same sources of signal degradation that sometimes compromise the quality of analog (FM, AM or inductive) transmissions.
Radio frequency transmission in the 2.4-gigaHertz range

82. BlueTooth Advantages
Bluetooth signal is extracted from the noise; it alone is transmitted and amplified, while noise is rejected.
Minimizes battery consumption for portable devices
Also, it places an intentional limit on the range of transmission — the most common version has a range of 10 meters which helps to avoid interference among nearby devices
Walls and other obstacles have a negligible effect on Bluetooth transmission

83. BlueTooth Interference Advantage

84. ALDs/HAT
Infrared Systems

85. Infrared
Infrared systems transmit sound via infrared light waves to receivers worn by users
IR commonly used in courtrooms, movies, and live performance theaters, conventions and with TVs (signal contained in room)
Infrared systems may be susceptible to interference from bright sunlight or fluorescent lights
Requires line-of-sight between the IR transmitter and the receiver, IR waves can effectively reflect off some surfaces, depending upon the power of the transmitter
                      

86. Sound Field Systems
Portable or permanently installed speakers placed close to listeners at a distance from the speaker
They are most often used in classrooms and are helpful for people with mild to moderate loss
They offer a secondary benefit to those who are not HOH
Wireless speakers perform the same function.
Audio Enhancement Video 1
LightSpeed

87. Phonak Dynamic Soundfield
Phonak Dynamic Soundfield with Inspiro

88. Vibrotactile Devices
Tactaid - small, battery-powered instruments that can help a deaf person understand sounds by allowing the user to feel the unique pattern of vibrations present in every sound

89. ALDs (HAT)
Assistive listening devices and systems (including couplers and accessories for hearing aids and cochlear implants)
Alerting devices and systems (weather, doorbell, phone, fire/smoke alerting devices)
Amplified telephones (some of which have tone controls and/or audio output jacks) and telephone accessories
TTYs (teletypewriters), VCO (Voice Carry Over) phones, CapTel, and telecommunications-related software and services
Speech-to-text services and technology, such as CART (Computer Assisted Realtime Transcription), C-Print and CAN; closed caption decoders
Videophones and other visual technology to facilitate speechreading and/or the use of sign language or cued speech

90. Question POTS Perry on teaching science Plain old telephone system
Peaches on tea and sun
Popular only TV shows
None of the above

91. TELECOMMUNICATIONS Television Telephones
POTS (plain old telephone system)
Cell Phones

92. TELECOMMUNICATIONS: TV
Television
There are two ways to understand communication on TV: hear it or read it:
closed captions, a menu option ability built into most TVs (TVs over 13 inches in diameter sold after 1993).
HAT
Increase volume on a personal receiver, not TV sound across the room
Most are cordless and utilize different types of technologies
Some devices marketed specifically for TV use
Hearing aid users and non hearing aid users can use technologies

93. TELECOMMUNICATIONS: PHONES
Two needs with phones:
understanding conversation on the phone
knowing phone is ringing
There are two ways to understand the conversation on the phone: hear it or read it. There are four basic types of telephone amplifiers: portable, handset, inline and phone set.

94. TELECOMMUNICATIONS: PHONES
Types of telephone amplifiers:
Portable
Handset
Inline
phone set

95. TELECOMMUNICATIONS: PHONES
Portable amplifiers
Not recommended for regular use
Inconvenient--strapped onto a phone handset and need to be turned off after use or the battery runs dead
Occasionally helpful with wireless phones that do not have amplification
May make a phone hearing aid compatible
Peace of mind for use while traveling

96. TELECOMMUNICATIONS: PHONES
In-line amplifiers
devices that connect to the jack in the phone where the curly handset cord plugs in
may be a good value, as some go as high as 40 dB
Compatible with most phones, home and business.

97. TELECOMMUNICATIONS: PHONES
Amplification handsets
Replace original phone receiver
Less popular
Adjustment controls in the handle
In some cases, not electrically compatible
universal amplifier (battery or A/C powered) used for compatibility

98. TELECOMMUNICATIONS: PHONES
Amplified phones
Many features
Some provide 50 dB gain.
Louder not always helpful for clarity
Some provide tone control
Additional features (optional)
variable ringer sounds
built-in ringer light flash
big buttons for dialing
audio jack HAT
may require electrical outlet connection
cordless amplified phones

99. TELECOMMUNICATIONS: PHONES
Other telecommunications devices
pagers
cell phones
fax
texting
Phone company custom calling helpful features
caller ID (for calling back the person through relay
distinctive ringing (for differentiating voice and TTY calls)
voice mail (to listen to voice messages with amplified phones or via the relay service)

100. Internet Email Social networks (FaceBook, Twitter, etc.)
FaceTime, Google Hangouts and
IP Relay
IP VRS
CapTel
Web CapTel/mobile CapTel

103. Hearing Aids and You!