The Hearing Blog

April 3, 2013

One Brits’ Justification For Hearing Aid Self-Programming

Filed under: Auditory Perception Group,CAM2 prescriptive method,Hearing Aid Self-Programming,Professor Brian CJ Moore,The Listening Studio,Uncategorized,University of Cambridge — Dan Schwartz @ 10:57 am

 

Last year, the BBC reported that more and more hearing aid users are programming their own hearing aids. Today, British subject Robert Mandara lays out a compelling case for user programming in the first of his three-part series in The Limping Chicken; and although we disagree with him on several key points, in fact his overall premise is strong.

Hearing Aid Professionals on both sides of the pond should pay close heed, as unlike in Britain where 90% of the hearing aids are dispensed by their troubled National Health Service (with an average 18 week delay and long waits for followup), UK private (“High Street”) dispensers and US Hearing Aid Professionals can address some of the reasons cited by Mandera by simply providing speedy service and implementing the Telehealth paradigm we laid out six weeks ago.

Here is Mandara’s compelling case, with our Editor’s Notes interspersed:

Would you buy a television if the salesman insisted that only he could set the channel, volume, tone, brightness and contrast? Would you be happy to make 3-hour round trips back to the showroom with the TV for adjustments? No? Then why do we surrender control in this way for hearing aids?

We are surrounded by gadgets, iThis and iThat, which we can configure to our heart’s content, yet hearing aid users have almost no control over the most vital item of technology in our lives.

In this article, I set out the reasons why users should be able to program hearing aids themselves. In the next two articles, I will explain what you need and give some tips for how you can do it.

Editor’s Note: At this point we are not planning on publishing the second and third installments of this series. However, the interested reader can go to The Limping Chicken website if they are so interested.

I have programmed my hearing aids and wish that I had done it much sooner. Trust me, I’m a far happier, more social animal as a result.

Editor’s Note: Hearing aid professionals need to realize how important these devices are to our daily existence — Mandara’s statement “I’m a far happier, more social animal as a result” should be on a sticker on every audiometer, NOAHlink, and laptop in the office.

Hearing aid programming consists of two distinct branches:

1. Acoustic programming: Settings which affect the sound – such as gain and frequency response. You could, if you’re crazy enough, potentially damage your hearing by making the wrong settings.

2. Operational programming: Settings which do not affect the sound. Compare these to selecting a ringtone or desktop wallpaper. Why shouldn’t users be able to set these themselves?

Editor’s Note: Although we agree in principle with his two broad categories, we would argue that the second category be divided in half, with one part being the audiological features such as adjusting microphone beamforming, noise reduction processing, expansion, wind noise reduction & such; with the other part being the configuration of telephone connections, wireless accessories, and other assistive listening devices. On the latter subject, we salute GN ReSound and Beltone for their enabling pushbutton user pairing of their Unite wireless accessories to their Verso and Alera hearing aids (much as one would pair a Bluetooth headset to a mobile phone) without needing to return to the hearing aid professional. In addition, the combination of their Phone Clip Plus and their iPhone & Android Control App allows for the balance between ALD and environmental audio to be fine-tuned with the flick of the finger. The other manufacturers require the pairing and adjusting of their accessories to their hearing aids through their fitting software and hardware, which is both an inconvenience to the patient and a time-waster for the professional: In a perverse way, this “lock-in” to the audiologist’s office provides just one more justification for users to self-program.

In no particular order, here’s why you might want to program your own hearing aids:

Economics. By avoiding making multiple visits to your audiologist, you (and also the health service or audiologist) can save time, money and frustration. Besides, if you have bought or begged spare hearing aids in the past, now you’ll only need one, which can be programmed for the left or right side as you need it.

Immediacy. Why tolerate bad sound while you wait to see the audiologist, when you could make the required changes right now?

Editor’s Note: American hearing aid professionals, are you paying attention? Also, as we see later in the article, Mandara in fact has a profound hearing loss, and this population needs “hot spare” hearing aids: This is why US cochlear implant (CI) programs all dispense a backup CI processor for each ear.

Control. Answering the audiologist’s favourite question “How does that sound?” is like trying to paint the Mona Lisa with a broom. For a start, we simply don’t have the adequate vocabulary. You know what you’re hearing; the audiologist can only guess.

Curiosity. Wouldn’t it be easier to say how the sound could be adjusted if you knew the range of adjustments and settings that were possible? In fact you can explore the software without connecting it to your hearing aids. Users who have explored the software will be better able to explain their needs to the audiologist while using the right terminology. You might be amazed at how much information is stored in your hearing aids. Your name, sex, date of birth and audiogram are probably stored. If data logging is enabled, you (or your audiologist) can see how much time you spend using your heading aids and on which programs. Big brother is watching you. You may find features in the software that your audiologist is unaware of. I found sound clips, representing different situations (birds, parties, radio) which are useful for testing out changes. If the software has hearing test functionality, you can measure what you actually hear.

Master of one. Audiologists program many types of hearing aid, use many software applications, serve many patients and have limited time. I say that they’re jacks of all aids, masters of none. You, on the other hand, can focus on one hearing aid, one software application, one very special patient, and can invest as much time as you like. Be the master, not the slave.

Real world. Sounds in the audiologist’s room don’t represent the real world. Program for the real world where the dog’s barking, the kids are screaming and the kettle is boiling, not for the quietest little room you’ll ever encounter.

Editor’s Note: We wholeheartedly agree with Mandara on this point: Even with crude noise simulations in the sound booth, it is no substitution for in situ adjustments in the actual environments where the patient is having trouble. This is where The Hearing Blog’s Telehealth Initiative, Starkey’s “T2″ DTMF (Touch Tone) remote adjustment, and Apple’s “Made for iPhone Hearing Aid” (MFI) become valuable additions to the savvy Hearing Aid Professional’s arsenal.

As for Mandara’s contention about real world sounds not in the hearing aid professional’s room, we agree. Short of the professional coming to the actual location of the difficulty (workplace, classroom, etc…), about the only way we’ve seen to get even close is to go to the Listening Studio¹ at the Center for Hearing and Communications²  in Lower Manhattan:

Ellen Lafargue of the Center for Hearing and Communication and Edward Erenburg, who has hearing loss, at the Listening Studio

Ellen Lafargue of the Center for Hearing and Communication and Edward Erenburg, who has hearing loss, at the Listening Studio

 

Continuing with Mandara’s article…

Try features before you commit to them. Modern hearing aids can do amazing things! At the more exotic end of the scale, they can talk to each other, switch between programs automatically and even lower the high frequencies so that you can hear them. Features usually have drawbacks as well as benefits. Wouldn’t you be happier to test them if you knew that you could turn them off as soon as you knew that they weren’t for you? If you make the wrong choice in the fitting room, it can take weeks to have features deactivated.

To accessorize. I bought Phonak’s iCom and iPilot accessories for my hearing aids. Audiologists are supposed to pair accessories to your hearing aids but it’s very easy to do it yourself.

For the best sound. Audiologists are under pressure to program quickly and, if the patient seems sort-of happy, that’s usually good enough. To be fair, audiologists are doing an impossible job. In the old analogue days, they just twiddled a couple of screws. Now the adjustment possibilities are infinite. Probably every hearing aid on the planet (including mine) isn’t optimally programmed. Why wear a hearing aid on sub-optimal settings? If you can extract the very best sound, you’ll hear more and inevitably be happier. Pimp your soundscape and unleash the hidden potential of your hearing aids!

This is where, in our experience, self-programming blows up, especially the second way with musicians and engineers:

  • First and foremost, there is a tendency to adjust the frequency response and gain to where it sounds best, and .NOT. for where speech discrimination is optimized, especially in noise. More specifically, this manifests itself as too much low frequency gain being used, wrecking speech perception in noise. That being said, there is an important exception with the Music program, where we believe all patients should make these adjustments themselves after basic instruction, even if they are being fit by a Dispenser or Audiologist: Ask them to show you how to adjust the response for your music program, and then play your favorite music while tuning the settings to where it sounds best to you;
  • Second, there is the tendency to see the audiogram, and to want to mirror the thresholds with that much gain, i.e. if the threshold is 40dB HL, to select 40dB of gain — Which will blow out the user.³ Instead, various prescriptive formulas are used, such as DSL5-I/O, NAL-NL2, and our favorite, CAM2 (CAMEQ2-HF) from the Auditory Perception Group at the University of Cambridge.

Continuing on with the last of Mandara’s points…

Because you want to. If you have ever wished to seize the controls, are computer literate, experimental, patient and have some understanding of sound, self-programming is quite probably for you. If, like me, you were being advised to have a cochlear implant, you can prove to yourself whether hearing aids really have nothing more to offer you. In my case, I found that I hadn’t reached the end of the road at all.

This is where objective speech perception testing in both quiet and noise is really needed, as Mandara is profoundly deaf: Even with his self-programming, he may still get much more benefit from CI’s. For someone with up to a moderately severe hearing loss, however — And with the proper professional guidance in person or at least via Telehealth – hearing aid self-programming can be quite useful.

Bootnotes:

1) To learn more about CHC’s Listening Studio, see A Hearing Test Made for the Big City in The New York Times (5/17/09);

2) The century-old Center for Hearing and Communications in Lower Manhattan was originally the New York League for the Hard of Hearing 1911-2008;

3) The exception to this is with a purely conductive hearing loss, where the gain is in fact set to the air conduction thresholds. Depending on the fitting prescription used, the formula is about 50-60% of the sensorineural component + 100% of the conductive gap.

Comment problems:

It’s been brought to our attention from several of our readers that they were having their comments rejected by the Akismet plug-in for WordPress as spam. This is unacceptable to us; and we are soliciting suggestions for a replacement. Unfortunately, we have to use something to screen for spam, as we were receiving over 100 spam comments per day at its’ peak. In the interim, to save retyping, we recommend selecting & copying all of your text to the clipboard: If your comment is accidentally rejected, simply paste it into an e-mail message, put “Rejected Comment” in the subject line, and send it to us at Dan@Snip.Net and we’ll manually post it for you~



March 22, 2013

First Person Report: Widex M-Dex Hearing Aid Streamer Woes

Filed under: Clear,Dream,iOS 6.1.2,M-Dex,Super,Uncategorized,Verso — Dan Schwartz @ 12:47 pm

 

Atlanta software engineer and applied mathmatician Rippah Ultmuncher shows in his stinging blog entry that although he is having great success with his Widex Clear 440 hearing aids, the same cannot be said of his M-Dex combination remote control/Bluetooth streamer.

Here at The Hearing Blog, we like to publish First Person Reports from people describing how technology that supposedly looks good on paper isn’t all it’s cracked up to be, such as London flautist and blogress Deafinitely Girly who exposes a major flaw in non-linear frequency compression (NFC) in Hearing aid update: My flute and Paper Aeroplanes. This First Person Report is quite astute, and in fact raises additional points that even we had not discovered with our own M-Dex and Clear 440 Fusions with high power RITE’s.

From Clear C4FSBR – the good and the bad in Hearing Aid Hacks

M-DEX
After the glowing review of my hearing aids and my audiologist, it is unfortunate that I have to be so negative about the other component in question. The M-DEX is a piece of shit — I am a software engineer and architect, and I have never seen such poor interface quality or assumptions about the listener.

First, let’s start with the good things:

  • FreeFocus — being able to tell the hearing aids in what direction to focus on. This is very useful.
  • Bluetooth pairing with iPad — when I pair it with my iPad to watch a film, the quality is remarkable as I have noted earlier.
  • Direct audio input – if I run a cord from my device to the M-DEX, it works well.
  • Changing programs — this is moderately useful, though I am able to change it directly on my hearing aids.

However, these are the only positive things I can say about the M-DEX.

  • When a Bluetooth device drops a connection, such as my iPhone or iPad doing so when not actively playing sounds, it switches to the Master program, and loudly announces it. So the cycle happens like this: The program on the iPhone or iPad plays, the bluetooth connection is brought up, a beep emanates from my hearing aids. When it stops, it changes back to the Master program. Every time this happens, this announcement is made. Repeatedly.
  • Further compounding this issue is that the ‘room off’ which mutes my hearing aids microphones turns off, and unmutes every time the bluetooth connection drops. If I am listening to a movie, and I exit out of the film to check on something, I get the loud announcement, ‘Master program’, and a blast of environmental noise. I then have to re-mute.
  • Further compounding the unacceptable state of affairs, it does not work well as a headset or headphones. The Widex engineers obviously did no testing or quality assurance outside of mobile phones. It does not work at all with my Mac laptop or my Mac desktop — when I attempt to play sounds through it, the M-DEX believes it to be a phone call for the duration of the sound effect and then disconnect. This causes the computer to no longer play sound effects through the Bluetooth connection, as it is disconnected. Most of the time, it does not even work — the computer tells me that there was a Bluetooth error.
  • The M-DEX barely works with the iPad and iPhone outside the context of a phone call — as I have mentioned before, it works as a hands-free profile, and a headphone profile. But it does not work as a headset with a microphone. Skype on my iPad and iPhone is a no-go due to this — I briefly get a connection and then it drops.
  • The microphone quality on the M-DEX is poor — I would have imagined that Widex with its state of the art research into microphone and signal quality, would be able to put some of this technology into the M-DEX. This is a $350 device that is surpassed by a $10 piece of electronics.
  • Effectively, the only way I can do phone calls with the M-DEX is as a handsfree headset for phone calls. Which is unfortunate, as my mobile phone quality is far inferior to what I can get over VoIP which is important to me as a Deaf person. I need every bit of call quality I can get, and this device cripples me.
  • The user-interface is extremely poor. I am a software engineer, and I get a little confused as to how to get to certain functionality. How is a normal non-geek supposed to use this device?
  • Also rage-inducing is the fact that this device only pairs with one bluetooth device at a time. If I have it paired with my iPad and want to use it with my iPhone, I have to go through the whole pairing process. Logitech with its cheap headsets is able to support multiple bluetooth pairings!

It is obvious that the people who worked on the M-DEX have no understanding of people with hearing loss and their actual needs. This is perhaps due to being an entirely different product and project than the hearing aids themselves which are wonderful.

The following naive assumptions were made:

  • That other devices would maintain a Bluetooth connection throughout the life of the session. This is only true for mobile calls. In every other context, Bluetooth connections are dropped, to conserve battery.
  • That the user would want the program to actively change when the Bluetooth connection drops. Again, this is only true for mobile calls. If an user is using this device for other purposes, the user does not want to hear the loud announcement that the program has changed.
  • That the user would only want to use Bluetooth for phones. This shows a shocking lack of creativity, vision and initiative. Bluetooth is much more versatile than that, and they should have expected that an user would want to use this device with their computer or to watch films on a mobile device with.
  • That the user would not care about his own voice quality with the shoddy microphone — sometimes, those of us that have hearing loss need every bit of clarity that can be transmitted to the other party, due to accents or inflections. Did they actually test the microphone as a deaf person?
  • That they do not need to put thought or effort into the user interface of the device — the paths to some of the functionality are simplified to the point of being un-simple to use. Any good human interface person would have spotted these issues.

It is extremely unfortunate that with all the careful engineering and thought that Widex put into the hearing aid instruments, to see them fumble so severely with the M-DEX. The whole experience is basically like getting a flawless one-hundred yard pass for the touchdown, and then suddenly fumbling and going back thirty yards.

 The Hearing Blog Editor replies:
Our single biggest complaint with the M-Dex is in the 10.6 mHz antenna design for the link from the M-Dex to the hearing aids: It is extremely sensitive to angular position, i.e. twist it more than about 20 degrees, or turn your head to the side, and it drops out in one ear or the other, i.e. it is anything-but isotropic. As any antenna engineer, or even Ham radio hobbyist will tell you, this is one hell of a feat to pull off in the 28 meter band, but somehow the Widex engineers accomplished this dubious feat. What this means is that the wearer must slide the M-Dex 6-8 inches up the lanyard, and then button the bottom of the lanyard into the shirt… Or safety-pin it for a pullover shirt. This means that once it is buttoned or pinned into place for streaming, it has to be unpinned to lift it up to see the display and keys. Granted, some of this is due to the antenna design in the hearing aids themselves, as the instruments also communicate with each other; but nonetheless it is still a poor design… And one the TV-Dex does not suffer as badly from.

Another issue: We saw one report that the M-Dex can handle as many as 8 pairings; but this does not seem to the the case with iOS 6.1.2, as we have to re-pair it when we switch between our iPod Touch 4 and iPhone 5.

Also, even though the M-Dex presents as an A2DP headset to the sending device, in fact (and unlike the TV-DEX) it only transmits a channel mixed monaural signal to the hearing aids. Worse, the headphone audio input jack is monaural, only sending one of the two stereo channels to both hearing aids: This we can tell because there’s a particular Color Beautiful commercial that is (annoyingly) played every hour on a particular DFW broadcast station where the speech audio switches between channels: We only hear half of the words when our iPod is plugged in via stereo cable.

Even worse, when we went to the Widex Clear training session in August 2011 (and wearing a pair of Clear440 Fusion instruments with our M-Dex), we explicitly asked if there would be a firmware upgrade to enable stereo transmission and/or using the USB jack for digital audio input; and we were informed:

  • The M-Dex is not capable of firmware updates, which I found out a year later that it’s due to them using ASIC architecture instead of FPGA architecture (probably to save battery drain and also to deal with their proprietary digital signal transmission protocol);
  • The USB jack only has two pins connected for charging, and is not capable of accepting any digital data.

Another complaint we have is that the size of the M-Dex is huge, compared to the ReSound Phone Clip Plus:

ReSound Unite Mini Mic, Unite Phone Clip+, Widex M-Dex

Left to right: ReSound Unite Mini Mic, Unite Phone Clip+, and the much larger Widex M-Dex, compared to a standard business card for scale
Click to Enlarge

That being said, the Clear uses a 33k sample/second rate in the ADC connected to the mics with a 107 dB input dynamic range (IDR); and 22k sample/second rate for the digital audio signal path, both industry-bests. UPDATE: The new Dream has a maximum input before saturating of 113dB SPL (re 20µBar).

However, severely deaf and power junkie users will gag at the downright fuggly power Receiver-In-The-Ear (RITE) assemblies, which are built even if the patient has a large canal: Starkey can get their AP70 RIC into a canal mold with the same receiver. Although we can see the RITE earpiece being used for the Output Extender plumbing (which is negated anyway when the Sensogram is used… Duhhh), it being supplied for standard earpieces is dodgy at best. What’s more, we have repeatedly asked that a Libby Horn bore be made for extended high frequency response – Which is a trivial task in the CAMISHA process – with the wax filter being placed at the throat of the horn. At present, we have to take a Dremel grinder to make this vital acoustic modification; however when this is done, the wax filter is lost.

Here’s a picture of the downright fuggly Widex Power RITE:

band-aid_r-0815-small

Widex Power RITE for the Clear Fusion, Super and Dream hearing aids
Click to enlarge

Our Recommendation:

Although somewhat quirky, and with a lack of programming granularity with everything tied to the Master program, the Widex Clear, Super and Dream hearing aids offer good performance, especially with music. However, if you’ll be a heavy user of audio streaming, we recommend the ReSound Verso instead, as their Unite wireless accessories work much better, especially the Mini Mic and new Phone Clip Plus.

Comment problems:

It’s been brought to our attention from several of our readers that they were having their comments rejected by the Akismet plug-in for WordPress as spam. This is unacceptable to us; and we are soliciting suggestions for a replacement. Unfortunately, we have to use something to screen for spam, as we were receiving over 100 spam comments per day at its’ peak. In the interim, to save retyping, we recommend selecting & copying all of your text to the clipboard: If your comment is accidentally rejected, simply paste it into an e-mail message, put “Rejected Comment” in the subject line, and send it to us at Dan@Snip.Net and we’ll manually post it for you~

 

March 18, 2013

Hearing Aid Frequency Lowering: Not All Work Equally Well

Filed under: Adam Tierney PhD,Alyson Harmon,Auditory Therapy,AVR Sonovation,Casey Adkins,Dana Strait PhD,Erika Skoe PhD,Jane Hornickel PhD,Joshua M Alexander PhD,Music,Nina Kraus PhD,Northwestern University Auditory Neuroscience Laboratory,Purdue University,Siemens,Uncategorized — Dan Schwartz @ 9:12 pm

 

London’s Deafinitely Girly shows how the Phonak SoundRecover hearing aid frequency lowering scheme totally wrecks music… And when convolved with the groundbreaking research at Northwestern’s Auditory Neuroscience Laboratory that has connected the strengthening of the auditory cortex in musicians that leads to improved speech discrimination in noise, the results should give clinicians pause before enabling non-linear frequency compression on Phonak, Unitron, and now Siemens hearing aids.

Here at The Hearing Blog, we like to publish First Person Reports from people describing how technology that supposedly looks good on paper isn’t all it’s cracked up to be, such as the spacing on the electrodes in the Nucleus CI is too close, causing channel crossover. In Daniela’s case, it was her being a musician that exposed the known flaw in the implant design; and once again it’s London flautist and blogress Deafinitely Girly who exposes a major flaw in non-linear frequency compression (NFC) in Hearing aid update: My flute and Paper Aeroplanes

Yesterday was a music-filled day and I loved it.

You see, since coming home on Friday evening after work, broken from my week of partying, I wasn’t able to get the amazement that I’d been able to hear my neighbour’s daughter playing her flute in the downstairs flat.

I mean, if I could hear that flute, then surely I’d be able to hear my own.

So yesterday afternoon I decide to locate my flute and all my sheet music, both of which were buried right at the back of my spare room underneath the bed, where I hid them to try and dull the sadness I felt at not being able to play anymore when I moved in three years ago.

I loved my flute. As a violinist from the age of 6, I begged the rents to let me play the flute too, but my amazing flute teacher-to-be said I had to be 10 years old so that I was big enough to reach the keys without constricting my rib cage and breathing.

On my 10th birthday I had my first lesson. It was love at first hear and I flew up the grades.

When I lost more hearing in my teens, I just ploughed on through, playing my pieces an octave lower until I knew the tune then dealing with the silence the higher notes brought.

When I moved to London I sought out a teacher. He was amazing. He taught me sound visualisation so that I got the right diaphragm pressure to create the high notes I couldn’t hear.

But instead of being happy, I found myself being a ball of emotion in my fortnightly lessons. I cried frequently, sometimes out of sadness but mostly out of frustration that I was no longer getting the same enjoyment from my flute.

It affected everything and I could feel a growing resentment for my deafness � something I’d fought hard to overcome, so in the end I stopped my lessons and banished the flute to the depths of my underbed storage.

So you see, really, yesterday wasn’t really just about seeing whether the Sound Recover on my new Phonaks was going to help me get my flute back.

I started with some trepidation, warming up with a few Bach studies and Morceau de Concours by Claude Arrieu. The sound came. My lungs seemed horrified at the breathing I was asking them to do.

And the sound?

Well, I think I could hear the Sound Recover function’s adjustment of the higher notes but the problem was, these weren’t moved into a harmonious place, the notes were jarring with the pitch of the note I was actually playing.

It was so frustrating.

It would be like playing a piano piece with the left in the correct key and the right hand a semitone apart from what it should be. It was not pretty.

But it made me wonder – and if any knowledgeable hearing aid peeps could answer this I’d be eternally grateful – can the Sound Recover be moved so that the notes come out in harmony or even better an octave lower? Is there anything I can do to improve this? Or is it something that will improve over time?

What I can confirm is that yesterday I enjoyed playing more than I have done in a long time. My hearing aids definitely made the music better and because of this, I played better. I wasn’t nearly as rusty as I’d thought I’d be and practising the fast-moving high bits was easier and more rewarding because I wasn’t just hearing nothing. OK, it was a slightly out of key Sound-Recovered pitch, but beggars really can’t be choosers.

My reply:

Return the hearing aids and get Starkey or Widex hearing aids instead: Phonak’s Sound Recover uses non-linear frequency compression, which you exquisitely describe:

Well, I think I could hear the Sound Recover function’s adjustment of the higher notes but the problem was, these weren’t moved into a harmonious place, the notes were jarring with the pitch of the note I was actually playing.

It was so frustrating.

It would be like playing a piano piece with the left in the correct key and the right hand a semitone apart from what it should be. It was not pretty…

What I can confirm is that yesterday I enjoyed playing more than I have done in a long time. My hearing aids definitely made the music better and because of this, I played better. I wasn’t nearly as rusty as I’d thought I’d be and practising the fast-moving high bits was easier and more rewarding because I wasn’t just hearing nothing. OK, it was a slightly out of key Sound-Recovered pitch, but beggars really can’t be choosers.

As I tweeted to you and Amy, what you want are hearing aids from Starkey with SpectralIQ or Widex with their Audibility Extender [application manual]: Both frequency lowering technologies maintain the harmonic structure, which is necessary for music.

So Yes, you can be choosy and bring back the music!

You can read my entire reply here.

 Unfortunately, Deafinitely Girly received her hearing aids for free via Britain’s National Health Service, so she is stuck with them for the next 3-5 years, unless she goes private.

Just what is frequency lowering, why is it used, and how does the Phonak/Unitron/Siemens scheme differ from the Widex and dbx/Starkey schemes? And, just why did you say “dbx/Starkey,” anyway?

One of the underlying principles in audio engineering is that in stereo audio the information is the same in both channels below about 100 Hz; and this principle is used to derive the audio fed to subwoofers since the mid-1970′s, and later extended to 5.1 & 7.1 surround sound systems. In 1978, dbx extended this principle to disco sound systems, by first recognizing that low A on a bass guitar and the fundamental on a kick drum are both about 40 Hz; and then filtering the low frequency audio between 80 and 40 Hz, dividing the frequency in half (i.e. generating a new spectrum between 40 & 20 Hz), and adding it back in, to give the music an extra bass kick. They gave their system the descriptive name of the “dbx 120 Subharmonic  Synthesizer;” and to this day, 35 years later, it’s still available, with prices in the product family starting at under $200.

Fast forward to the April 1992 ASHA Convention in Atlanta, where a small Israeli company named AVR Sonovation introduced a radical new hearing aid concept called the TranSonic: Ithad a bodyworn processor the size of two decks of cards, with a wire running to a BTE earpiece with the mic & receiver. Instead of just amplifying the sounds, it actually took the input above about (IIRC) 2500 Hz or so and shifted it down: For the first time, people who had profound losses in the high frequencies – Extreme ski-slope with high frequency cochlear dead zones (≥≈90dB HL) had access to the high frequency unvoiced consonants such as /s/, /sh/, /p/, /t/, /Θ/, /k/ & /sh/, drastically improving their speech discrimination; and in fact this author fit five of these devices to grateful patients. [We aren't sure which exact frequency lowering scheme they used, as they simply said they "threw away" the excess cycles. If anyone knows, please write us.]

In 2008, Phonak released their SoundRecover frequency lowering algorithm, which first compresses the high frequency spectrum above a certain kneepoint, and then shifts this new spectrum into the lower frequencies. Joshua M Alexander PhD at the Purdue University EAR Lab has conducted research into this, and came up with a set of frequency kneepoint-compression ratio locked pairs which are the defaults; while in the advanced settings the pairings can be unlocked. Last year, their Sonova sister company Unitron released it; and in January 2013 Siemens released their Micon hearing aid line with this feature.

[For a very good description of the nuts and bolts behind this strategy, see Skepticism Lab: How Low Can You Go: A Tale of One Frequency Lowering Technique by Purdue audiology students Alyson Harmon & Casey Adkins. Their paper would be rated as excellent; but it gets docked for its not challenging the claim on page 3 that "apart from speech, SoundRecover also improves… listening pleasure, such as in the clarity of music." What we need to stress is that although non-linear frequency compression works well for speech, by it's very nature it destroys the harmonic structure of music, as the harmonic frequencies are shifted to frequencies not harmonically related to the fundamental note: This is exactly what Deafinitely Girly reported.]

Shortly after SoundRecover came out, Widex answered back  However, in 2006, Widex struck first with their awkwardly named Audibility Extender (an annoying eight syllables when the voice prompt announces it during program shifts) in their Inteo instrument line [For this correction, see comment #1 from Anders Jessen]; but in fact it basically divides the signal in half or into one-thirds, maintaining the harmonic structure, and hence enjoyment of music. Then, in fall 2011 Starkey released their SpectralIQ, which is an exact high frequency version of the dbx subharmonic synthesizer… All that is old, is new again!

Differences between the Widex and Starkey frequency lowering methods:

Although similar, SpectralIQ differs from the Widex scheme in that the original higher frequencies are left in place, although the gain in the higher channels can be reduced if excitation of cochlear dead zones is not desired (and there is controversy in extending the response into these zones). In addition, SpectralIQ processing only divides the fundamental in half, while Widex can also divide it into thirds. However, the Widex system is not without flaws: Unlike Starkey, which provides the industry’s best per-program granularity providing flexibility to the clinician and patient, Widex ties the Audibility Extender (and also Zen, Phone+, and streaming audio) gain, noise reduction, microphone steering, and feature selections to the settings in the Master program, which must be set first. What’s more (and unlike SpectralIQ), Audibility Extender cannot be engaged while receiving streaming audio from the Dex accessories, which is a Major Flaw: If it works so well, why would you want it locked out when using the phone?!

► Update (3/20/2013) According to this comment by Dan Tibbs AuD of Widex, apparently they got the message that if a patient needs Audibility Extender on the Master program, they need it across the board; and the new Dream has fixed this flaw. However, the Super, which has the same chipset as the Clear, apparently has not yet had this bugfix applied.

Now, about that linkage between music and speech perception in noise:

 The importance of music appreciation has been preached to the hearing impaired by Dr Mark Ross for over a decade; but most of it was based on anecdotal evidence and early research. However, the Auditory Neuroscience Laboratory at Northwestern University, led by Nina Kraus PhD, has produced extensive peer-reviewed research proving the link between playing a musical instrument and speech discrimination in noise; which you can see on the labs’ Neural Encoding of Music and Speech in Noise pages. From the Music page, Dr Kraus writes,

Musical experience has a pervasive effect on the nervous system. Our recent articles show that lifelong musical experience enhances neural encoding of speech as well as music, and heightens audiovisual interaction. Our work suggests that musicians have a specialized neural system for processing sight and sound in the brainstem, the neural gateway to the brain. This evolutionarily ancient part of the brain was previously thought to be relatively unmalleable; however, our studies indicate that music, a high-order cognitive process, affects automatic processing that occurs early in the processing stream, and fundamentally shapes subcortical sensory circuitry.

 Just in the last three years, the lab has churned out the following outstanding R&D of which hearing care professionals of all stripes — But especially pediatric audiologists – should be well aware:

2012
Parbery-Clark, Anderson, Hittner, Kraus. Musical experience strengthens the neural representation of sounds important for communication in middle-aged adults. Frontiers
Strait, Parbery-Clark, Hittner, Kraus. Musical training during early childhood enhances the neural encoding of speech in noise. Brain & Language
Skoe & Kraus A little goes a long way: how the adult brain is shaped by musical training in childhood. J Neurosci
Parbery-Clark, Tierney, Strait, Kraus Musicians have fine-tuned neural distinction of speech syllables Neuroscience
Kraus Biological impact of music and software-based auditory training J of Comm Dis
Strait, Chan, Ashley, Kraus Specialization among the specialized: auditory brainstem function is tuned in to timbre Cortex
Parbery-Clark, Anderson, Hittner, Kraus Musical experience offsets age-related delays in neural timing Neurobiol Aging
Kraus, Strait, Parbery-Clark Cognitive factors shape brain networks for auditory skills: spotlight on auditory working memory. Annals of the NYAS
Anderson, Parbery-Clark, White-Schwoch, Kraus Auditory brainstem response to complex sounds predicts self-reported speech-in-noise performance JSLHR
Kraus, Anderson (2012) Hearing matters: Hearing with our brains. Hearing Journal
Anderson, Kraus cABR: A neural probe of speech-in-noise processing Proceedings of ISAAR 2011
Song, Skoe, Banai, Kraus Training to improve hearing speech in noise: Biological mechanisms Cereb Cortex

2011
Strait, Hornickel, Kraus Subcortical processing of speech regularities predicts reading and music aptitude in children Behav and Brain Func
Parbery-Clark, Strait, Kraus Context-dependent encoding in the auditory brainstem subserves enhanced speech-in-noise perception in musicians Neuropsychologia
Marmel, Parbery-Clark, Skoe, Nicol, Kraus Harmonic relationships influence auditory brainstem encoding of chords NeuroReport
Strait, Kraus Musical training shapes functional brain networks for selective auditory attention and hearing speech in noise Frontiers in Psych
Parbery-Clark, Strait, Anderson, Hittner, Kraus Musical Experience and the Aging Auditory System: Implications for Cognitive Abilities and Hearing Speech in Noise PLoS ONE
Strait, Kraus Playing Music for a Smarter Ear: Cognitive, Perceptual and Neurobiological Evidence Music Percept
Skoe, Kraus Human subcortical auditory function provides a new conceptual framework for considering modularity. In: Language and music as cognitive systems
Tierney, Parbery-Clark, Skoe, Kraus Frequency-dependent effects of background noise on subcortical response timing. Hear Res
Anderson, Kraus Neural encoding of speech and music: Implications for hearing speech in noise. Seminars in Hearing
Anderson, Parbery-Clark, Han-Gyol, Kraus A Neural Basis of Speech-in-Noise Perception in Older Adults Ear Hear
Hornickel, Chandrasekaran, Zecker, Kraus Auditory brainstem measures predict reading and speech-in-noise perception in school-aged children Behav Brain Res
Parbery-Clark, Marmel, Bair, Kraus What subcortical-cortical relationships tell us about processing speech in noise. Eur J Neurosci
Song, Skoe, Banai, Kraus Perception of speech in noise: Neural correlates J Cogn Neurosci

2010
Kraus Musical training gives edge in auditory processing Hear Journal
Strait, Kraus, Parbery-Clark, Ashley Musical experience shapes top-down auditory mechanisms: evidence from masking and auditory attention performance Hear Res
Kraus, Chandrasekaran Music training for the development of auditory skills Nat Rev Neurosci
Chandrasekaran, Kraus Music, Noise-Exclusion, and Learning Music Percept
Kraus, Nicol The musician’s auditory world Acoustics Today
 Anderson,Chandrasekaran, Yi H, Kraus Cortical-Evoked Potentials Reflect Speech-in-Noise Perception in Children. Eur J Neurosci
Anderson, Skoe, Chandrasekaran, Zecker, Kraus Brainstem Correlates of Speech-in-Noise Perception in Children. Hearing Research.
Anderson, Kraus Objective neural indices of speech-in-noise perception. Trends in Amplification
Anderson,Kraus Sensory-Cognitive Interaction in the Neural Encoding of Speech in Noise: A Review.JAAA
Anderson, Skoe, Chandrasekaran, Kraus Neural Timing is Linked to Speech Perception in Noise J Neurosci
Chandrasekaran, Kraus Music, Noise-Exclusion, and Learning Music Percept

 Connecting The Dots:

Musical training has become an important part of auditory therapy/rehabiitation; and it is extremely important that the hearing aids and/or CI’s fully support this vital activity, and don’t interfere. Although on the hearing aid side, non-linear frequency compression can contribute to high frequency audibility of unvoiced consonants to improve speech discrimination, as flautist Deafinitely Girly discovered it also destroys music, and we explained why. The same goes for spacing CI electrodes too close together, as Melbourne pianist Daniela Andrews discovered and we explained why.

These two deaf musicians have, with their First Person Reports, provided a window into how technologies that may look good on paper can have unintended, detrimental consequences.

You can e-mail “Deafinitely Girly” at deafinitelygirly@googlemail.com and follow her on Twitter at @deafgirly

Comment problems:

It’s been brought to our attention from several of our readers that they were having their comments rejected by the Akismet plug-in for WordPress as spam. This is unacceptable to us; and we are soliciting suggestions for a replacement. Unfortunately, we have to use something to screen for spam, as we were receiving over 100 spam comments per day at its’ peak. In the interim, to save retyping, we recommend selecting & copying all of your text to the clipboard: If your comment is accidentally rejected, simply paste it into an e-mail message, put “Rejected Comment” in the subject line, and send it to us at Dan@Snip.Net and we’ll manually post it for you~

February 18, 2013

Telehealth for Programming Hearing Aids and MAPping CI’s

Filed under: Alera series,Clear,Compass,Dream,GN ReSound,Hearing instrument fitting,Starkey,Super,Uncategorized,Verso,Widex — Dan Schwartz @ 7:56 pm

Telehealth is coming to the hearing care profession, and it will be everywhere from a pediatrician handing you the Georgia Tech Remotoscope attachment for your iPhone to monitor your child’s ear infection, to the Sydney Cochlear Implant Centre (SCIC) remotely MAPping CI’s across Australia and throughout the South Pacific, to speech-language pathologists providing “clinical face time” to clients in rural areas, to Bristol PA-based America Hears and Melbourne-based partner Blamey & Saunders (formerly Australia Hears) remotely programming hearing aids, to using online auditory rehabilitation programs such as Neurotone’s LACE with patient compliance monitoring integrated into Sycle.Net practice management software, to CI’s e-mailing implant and processor health & reliability data silently in the background… And so much more, still to be dreamed up.

 In this article:

• Benefits of Telehealth
• Telehealth in the Hearing Aid Professional setting
• Step-by-step instructions for enabling Telehealth for the ReSound Alera and Verso, and Widex Clear, Super and Dream hearing aids
• References
• Bootnotes

Benefits of Telehealth

There are numerous benefits to using Telehealth in hearing care:

  • In situ resolution of hearing aid & CI performance issues while the patient is in the actual work or school environment;
  • Access for both routine appointments and emergency problem resolution from early morning to late at night when a pool of clinicians is available across multiple time zones;
  • Top professionals in the field can see more patients for difficult-to-solve problems beyond the abilities of the local clinician;
  • Access to the physician or hearing care professionals when the office is closed, or when the clinician is traveling;
  • Patient convenience in not having to travel in city traffic or long distances;
  • Access to quality hearing care for shut-ins without expensive and time consuming ambulette transportation;
  • Resolving problems while the patient is traveling.

Of the various issues above, two are worth delving into, because they are not readily apparent:

1) In situ   resolution of hearing aid & CI performance issues while the patient is in the actual work or school environment: For example, let’s say a nurse is having trouble performing auscultation, a student needs her FM/mic balance adjusted, or a bartender is having trouble understanding the waitress. Under the current health care delivery paradigm, the nurse would have to take off from work and bring her gear with her for a simple adjustment, the student would wait a few days until the school district audiologist showed up… And the bartender would be pretty much SOL, having to return numerous times for trial-and-error problem resolution relying on his problem descriptions. For all three of these scenarios, Telehealth allows the hearing care professional to rapidly and effectively resolve problems when and where they are occurring;

2) Access for both routine appointments and emergency problem resolution from early morning to late at night when a pool of clinicians is available across multiple time zones. Let’s say you’re the Chief Audiologist for the Veterans Administration, supervising over 520 audiologists and hundreds more dispensers and technicians, who dispense 18% of all hearing aids in the United States across six time zones from Maine to Hawai’i, from Florida to Alaska: Telehealth will enable both flex-time and telecommuting for your professional Federal employees, while at the same time speeding access and reducing traveling and lost work time for our Heroes.

Although an unspoken taboo among hearing aid professionals, Telehealth enables one additional patient benefit: Self-programming by tech-savvy patients if they so choose, which we at The Hearing Blog endorse. It is worth reminding the skeptical reader that there are other things besides setting gain, which are suitable to user adjustments, such as noise reduction, anti-feedback, and expansion strength, directional microphone adaptivity, hearing aid mic ↔ DAI/FM mix ratio, and configuring the Music program for maximum enjoyment.

Our friend Elaine Saunders PhD of the aforementioned Blamey & Saunders has a brilliant analogy, comparing self-fit hearing aids to adjusting the temperature of your morning shower:

I can’t understand why hearing aids are usually just fitted to an audiogram. Hearing aids need to work well in everyday sound levels, but typically they are set up to predictions — And there seems to be a whole industry engaged in developing predictions [Editor's note: Dr Saunders is talking about statistically determined fitting prescription models falling into the universal category such as CAM2, DSL-5.0 and NAL-NL2, and those falling into proprietary category from each major hearing aid manufacturer based on their own clinical research and statistical analysis] – which don’t work very well, so that you have to have a highly qualified professional tweak it away from the prediction. It made me think of an analogy with my shower. My shower has a somewhat unintuitive mixer tap. The angle from the wall (tipping the handle towards me) determines the flow, and the rotation of the handle determines the temperature. However, the control for the flow works slightly differently for the hot and the cold. To deal with this in the morning I fiddle with the temperature till the water flow and the temperature are comfortable.

Taking the hearing aid analogy though, I would set up the “cold” to determine what the coldest water temperature that I could tolerate was. Then I would call in a tertiary qualified professional to load in a formula to set up the overall temperature to what it should be (based on overage preferences) then another tertiary qualified person would “tweak” the setting away from the prediction to what I am prepared to use. They might even do some thermometer checks to make sure that my temperature judgements were suitable. Hmmm…

As we somewhat alluded to in the opening paragraph, Telehealth is becoming quite popular in Australia, where except for four densely populated cities many of the remainder of the 22 million people on the continent live far away from their excellent facilities, often necessitating expensive air travel for routine appointments. Australia’s HEARing Cooperative Research Centre (“HEARing CRC”) is actively conducting R&D aimed at improving hearing health delivery to the Outback and nearby Pacific neighbors. From this October 25th 2012 article by HearingCRC:

HEARing CRC Chief Executive Officer, Associate Professor Robert Cowan, said several of the CRC’s research projects have used new technologies to deliver remote hearing healthcare that includes configuring cochlear implants to improve performance (known as MAPping) and undertaking paediatric hearing assessments. “A good example is our Management of Cochlear Implants Using Remote Technologies project which is developing procedures where audiologists can have remote consultations with their patients via the internet. By having such a setup, that includes video conferencing technologies, an individual who has received a cochlear implant can receive follow up device management and habilitation consultations without having to go into the clinic,” Professor Cowan explained.

“One of our Members involved in this project, the University of Queensland, has been effectively using a specialized Australian Telehealth support system called eHAB to work remotely with children between ages of 3 and 12 with cochlear implants. A similar project based at the Sydney Cochlear Implant Centre has had success with providing cochlear implant mapping support to patients located in the pacific nation of Samoa. Preliminary results from this work have shown that 83% out of the 70 clients who had remote consultations were pleased with the outcome.”

Telehealth in the Hearing Aid Professional setting

Before starting with Telehealth in your own hearing healthcare practice, keep in mind it is very important to carefully select your patients: Although today’s wireless programmers simplify the instrument connections, we do not recommend this for initial fitting of first-time hearing aid users, as these people need guidance on instrument insertion, changing the battery, and in-person counseling; along with hands-on resolution of physical fit issues. We also actively discourage Telehealth for initial fitting of pediatric patients, as this population needs real ear measurements using a probe microphone to compensate for variations in SPL due to widely varying ear canal volumes.

For adult patients, there are two elegant solutions to them not owning an expensive probe mic system: Some instruments from Starkey have a simple adapter that converts the instrument microphone into a probe mic for simple in situ measurements. Also, America Hears, Widex and Cochlear (for the BAHA) have the Sensogram, which is a special channel-based in situ audiometry function in their fitting software, modeled after CI MAPping software: Whereas ReSound Aventa and Starkey Inspire also have in situ audiometer functions, those are based on standard audiogram frequencies with real-ear coupler data (RECD) values “guesstimated” based on entered receiver and earmold venting values. On the other hand, just as T and C/M values are measured in “clinical units” or “charge units” (CU’s) by patient feedback with the MAP being built from these values, hearing aid threshold and UCL values in each channel are measured directly in millivolts delivered to the receiver terminals automatically compensating for any variations of in-situ acoustics; although to keep from freaking out the clinician the fitting software makes an attempt to display the approximate dB levels, even though they are irrelevant to the fitting software building the programs. Put another way, if you can grasp how to MAP a CI, then you should be able to grasp the Widex, America Hears, and Cochlear Sensogram concept. You can watch this video which explains the Sensogram:

One recommendation we can make is – If possible — the patient opens up a video communication channel on a separate device for face-to-face conversations, as opposed to running it on the PC performing the programming (we use an iPod Touch sitting on our laptop; the patient can use any mobile device, tablet, or another webcam-equipped PC): Although Skype will work if the patient is running it on their laptop, the image of you on their screen gets in the way; and also the video window motion bogs down the screen updates.

Another recommendation is that although Aventa will run on an XP PC with 512 mB of RAM, it will be slow: Invest $20 for a 1 or 2 gB DIMM from Egghead.com or Amazon.com:
→ Buy More Memory: It’s Cheaper than Therapy…

Step-by-step instructions for enabling Telehealth for the ReSound Alera and Verso, and Widex Clear, Super and Dream hearing aids

• For ReSound: First, use a fresh install of Aventa 3.4 and very importantly the 3.4.0.356→3.4.0.362 Patch N4 updater which installs a clean database when operated in standalone mode. [NOTE: If you run Aventa 3.4 in standalone mode, you'll want to temporarily rename the Resound folder to hide it from the Aventa installer since you don't want the patient to see your other patients' data: See two steps below]

• Next, based on extensive discussions with the patient, enter the patient data and the audiogram, click the Aventa button in the upper right corner, connect to the instruments, pre-load four programs into the hearing aids (usually Everyday, Restaurant, Outdoors, and Music), and configure the Unite accessories using Aventa 3.4 in Standalone mode. [Very Important: Do not use a copy linked to NOAH, as you'll need to export the database for the fitting.]

• Copy the Aventa 3.4 software installer,  the 3.4.0.356→3.4.0.362 Patch N4 updater, and .Net 3.5/SP1 standalone installer onto a USB memory stick or DVD to install it on the patient’s own PC. Also, since Aventa will be running in standalone mode on the remote PC, also copy the ReSound folder located in:
C:\ProgramData
as the database is located in:
C:\ProgramData\Resound\Aventa3
[NOTE: If you run Aventa 3.4 in standalone mode, you'll want to temporarily rename the Resound folder to hide it from the Aventa installer since don't want the patient to see your other patients' data.]

• Before installing Aventa on an NT5.5 (WinXP or Server 2003) PC, make sure SP3 is applied: You’ll receive a cryptic incompatible OS error message otherwise. Also, check to see if  Microsoft .NET Framework 3.5/SP1 and .Net 4.0 are installed: You’ll get a specific error message otherwise. The .NET Framework 3.5/SP1 standalone installer is included in the Aventa package or can be downloaded here; while the .NET Framework 4.0 standalone version is available here;

• Deliver the hearing aids to the patient, and configure their PC by installing Aventa 3.4, and very importantly the 3.4.0.356→3.4.0.362 Patch N4 updater; and also copying the
C:\ProgramData\Resound
folder with their database;

• For Widex, simply install Compass 5.6; and then separately install the USB driver in the Support.exe file;

• Again, we also recommend setting up a Skype account for them on their iPad or mobile (if possible); if not then on their PC using their webcam (Skype works so much better on a mobile or iPad/pod, or even a second PC, as this separate screen will not cause the main screen to bog down;

• Configure and test remote screen sharing:

• If you’re using Windows Remote Assistance, send a special one kilobyte invitation file, in either Windows XP or Windows 7. For Windows 7:

♣ Start → Help and Support 

♣ Click on More support options in the lower left corner

♣ Click on the Windows Remote Assistance link

♣ Click on Invite someone you trust

♣ Save the invitation file to a location you can find

♣ When prompted, copy the password to the clipboard

♣ Compose an e-mail to your account, paste the password into the message and attach the .msincident file. [Note: some POP3 malware/spam filters, including Barracuda, accidentally strip this type of file off the e-mail message. We use a Gmail account to receive and download the message.]

♦ The procedure for Windows XP and Windows Server 2003 is similar, though you need to manually create a password, and also set an invitation expiration time of 30 days;

• If you’re using something else besides MS Remote Assistance, punch a hole in their router firewall (and PC firewall software, if applicable): If you use MS Remote Desktop Protocol, then open up port 3389 to TCP & UDP traffic. More from Microsoft here;

• If for some really odd reason you can’t use port 3389, change it to another using RegEdit. To launch:
Start → Run → regedit.exe
then modify this key:
HKEY_LOCAL_MACHINESystemCurrentControlSetControlTerminalServerWinStationsRDP-TcpPortNumber
Here’s Microsoft Knowledge Base article 306759 with the full instructions;

• Alternately, load a copy of the RealVNC lite server, and configure it (usually) to work on TCP port 53, and also open up TCP & UDP port 53 in the router firewall;

• Another alternative is to use LogMeIn Free or Pro: You won’t need to punch a hole in the router to use this, as it tunnels on TCP port 443. [Sydney Cochlear Implant Centre uses LogMeIn software for their Remote MAPping Programme, for what it's worth; however ];

• Install Dynamic DNS and assign a host name: Dynamic DNS runs as a background service allowing me to “find” their PC by hostname, instead of having them manually query the router. You need this if you’re using VNC or Microsoft RDP directly; however it’s Handy for quickly troubleshooting connection & firewall issues for LogMeIn & MS Remote Assistance.  Alternately, if their router has Dynamic DNS (many do now), then you can give it a host name; however if you implement dynamic DNS this way, you can’t find their laptop if they take it out in the field for in situ instrument programming;

• Finally, test everything out, and then have the initial face-to-face fitting session; and instruct them on how to use the fitting software if they want the “keys to the car.” Generally, I caution them to leave the gain & compression settings alone (I change them in a remote session); however I instruct them on how to pair accessories, and also tweak the noise reduction, mic zooming settings, and mic on/off when the DAI, TV, Phone Clip and Mini Mic accessories are used: This way if they want to add accessories, they can configure it themselves;

• GN ReSound has several eCademy Aventa training videos the patient can view. [However -- And despite repeated pleas from hearing impaired professionals -- these videos, like most of GN ReSound's video content, are .NOT. captioned.] Also, ReSound has a series of free training webinars and text-based courses on their AudiologyOnline channel.

Now this is how you do Telehealth properly!

References

  1. iPhone Attachment Designed for At-Home Diagnoses of Ear Infections: Georgia Tech Newsroom http://www.gatech.edu/newsroom/release.html?nid=155181
  2. Remotoscope YouTube video: http://www.gatech.edu/newsroom/release.html?nid=155181
  3. Georgia Tech YouTube channel: http://www.youtube.com/user/GeorgiaTech
  4. Research shows new technology can deliver hearing health services from afar: HearingCRC news releas http://www.hearnet.org.au/research-shows-new-technology-can-deliver-hearing-health-services-from-afar/
  5. LogMeIn suite of remote assistance software http://www.LogMeIn.com
  6. Sydney Cochlear Implant Centre http://www.SCIC.org.au
  7. Why setting up hearing aids, is like adjusting your shower temperature, by Elaine Saunders PhD http://elainesaunders.com.au/why-setting-up-hearing-aids-is-like-adjusting-your-shower-temperature/
  8. CAM2 software for hearing aid fitting http://www.enterprise.cam.ac.uk/industry/licensing-opportunities/cam2-software-hearing-aid-fitting/
  9. Comparison of the CAM2 and NAL-NL2 Hearing Aid Fitting Methods http://www.ncbi.nlm.nih.gov/pubmed/22878351
  10. DSL (Desired Sensation Level) History http://www.dslio.com/page/en/dsl/history.html
  11. Widex M-Dex remote control/streamer: http://www.widex.com/en/products/dex/mdex/
  12. Microsoft .NET 3.5/SP1 standalone installer: http://www.microsoft.com/en-us/download/details.aspx?id=25150
  13. Microsoft .NET 4.0 standalone installer: http://www.microsoft.com/en-us/download/details.aspx?id=24872
  14. GN ReSound Aventa fitting software: http://www.resound.com/professionals/fitting
  15. GN ReSound eCademy uncaptioned training videos: http://www.gnresound.com/professionals/training-and-education/ecademy/aventa-training
  16. GN ReSound training webinars and text-based courses on AudiologyOnline.com: http://www.audiologyonline.com/expo/resound/

Bootnotes

  • Our friend who is a deaf audiologist in Toronto got implanted in Germany, and her CI centre gave her the programmer for them to perform remote MAPping.
  • Top CI audiologist Bill Shapiro at NYU Langone Medical Center in Manhattan also uses Telehealth in the operating room during CI surgery, performing implant boot-up and diagnostics from his office without having to scrub in.
  • There is also preliminary talk in the pediatric auditory brainstem implant (ABI) community that Dr Vittorio Colletti’s audiologist in Verona, Italy will be performing remote ABI MAPping, as most of his infants & toddlers are using Med-El ABI’s, which do (not yet) have FDA approval. Of course, any time an ABI is MAPped it must be closely supervised by a physician with resuscitative gear, in addition to having an audiologist with the patient.

Dan Schwartz,
Editor, The Hearing Blog
All incoming Facebook friend requests are welcome~ 

Comment problems:

It’s been brought to our attention from several of our readers that they were having their comments rejected by the Akismet plug-in for WordPress as spam. This is unacceptable to us; and we are soliciting suggestions for a replacement. Unfortunately, we have to use something to screen for spam, as we were receiving over 100 spam comments per day at its’ peak. In the interim, to save retyping, we recommend selecting & copying all of your text to the clipboard: If your comment is accidentally rejected, simply paste it into an e-mail message, put “Rejected Comment” in the subject line, and send it to us at Dan@Snip.Net and we’ll manually post it for you~

 

January 29, 2013

ReSound Alera & Verso Wireless Streamed Audio Bass Boost

Filed under: Alera series,Bluetooth,IEEE 802.15 Bluetooth,Made for iPhone hearing aids,Streamed Audio Bass Boost,Uncategorized,Verso — Dan Schwartz @ 2:37 pm

On occasion we get very interesting reader comments; and this one from ReSound fires the first shot in the “Made for iPhone” War, Part 1 left by Hank is good enough to merit a separate article:

I have the Verso 9 BTE and just got the Unite Phone Clip + last week. It works fine with my iphone 4, but I’m hoping maybe I can improve the awful tinny sound of streaming music by changing the eq settings on one of my H.A. preset programs. I don’t know if that would work, but I sent email to Resound asking them about it before I speak to my Aud. Didn’t want to sound stupid. :-)

Hank, first off no question is stupid; but you indeed have a Very Good Question. In fact, the Mini Mic and TV streamer have Streamer BassBoost for just this reason. Unfortunately, this feature is Not Available for the Phone Clip & Phone Clip+. Please see these two Aventa 3.4 fitting screens:

Aventa 3.4 programming screen showing where Streamer BassBoost is selected and displayedClick to enlarge in a new screen

Aventa 3.4 programming screen showing where Streamer BassBoost is selected and displayed
► Very Important: The default for Streamer BassBoost is Mild. Please see the text for the ramifications. ◄
Click to enlarge in a new screen

Aventa 3.4 programming screen showing where Streamer BassBoost is Not AvailableClick to enlarge in a new screen

Aventa 3.4 programming screen showing where Streamer BassBoost is Not Available
Click to enlarge in a new screen

Discussion & Recommendation:

The idea of a boost in bass while using a streamer is used to compensate for the loss of low frequency response from the commonly used receiver-in-canal (RIC) and thin tube “open fit” using a tulip dome eartip; and in fact it appears that Streamer BassBoost is switched on to Mild by default.

Increasing the low frequency response while listening to streamed is a double-edged sword, however: Although it will “sound good” while listening to the TV audio, in fact we’ve found it can be detrimental when using the Mini Mic, especially in noisy environments when it has the most benefit for improving the signal-to-noise ratio of the talker.  For this reason, it is the recommendation of The Hearing Blog to disable Streamer Bass Boost if the Mini Mic is part of the hearing aid system… And it is also the strong recommendation of The Hearing Blog to include the Mini Mic in every Verso and Alera fitting: It’s that important.

On The Other Hand, due to the general nature of the source of Bluetooth streamed audio, namely that it used for phone and music as opposed to picking up ambient audio, we hope they include Streamer BassBoost for Phone Clip & Phone Clip+ accessories.

Hank, you had a Very Good Question!

Comment problems:

It’s been brought to our attention from several of our readers that they were having their comments rejected by the Akismet plug-in for WordPress as spam. This is unacceptable to us; and we are soliciting suggestions for a replacement. Unfortunately, we have to use something to screen for spam, as we were receiving over 100 spam comments per day at its’ peak. In the interim, to save retyping, we recommend selecting & copying all of your text to the clipboard: If your comment is accidentally rejected, simply paste it into an e-mail message, put “Rejected Comment” in the subject line, and send it to us at Dan@Snip.Net and we’ll manually post it for you~

 

January 21, 2013

ReSound fires the first shot in the “Made for iPhone” War, Part 1 (update 2)

Filed under: Alera series,Apple,Beltone,Bluetooth,GN ReSound,IEEE 802.15 Bluetooth,iOS 6.0.1,iOS 6.0.2,M-Dex,Made for iPhone hearing aids,Uncategorized,Verso — Dan Schwartz @ 3:24 pm

GN ReSound introduces the Phone Clip+ Bluetooth streamer, the first “Made for iPhone” device on the market… And The Hearing Blog has the review, including the discovery of a bug in the companion v1.0.0 Control app (article updated 6:00pm CST 1/21/2013)

 The folks at GN ReSound build very good wireless capable hearing aids, with the older Alera able to receive audio and remote control command signals in the 2.4 gHz band; and the new Verso adding inter-ear communications, providing coordination of microphone directional beam steering for 360 degree coverage, binaural noise reduction coordination, and binaural compression coordination, which is used to maintain left and right balancing of gain and sound, to further preserve directional cues. In addition, the Verso introduces a Music Mode feedback suppression algorithm, which will also be discussed in an upcoming report.

Both the Alera and Verso use the 2.4 gHz Unite wireless accessories for programming, control and audio streaming, as do their parallel Beltone private label models. These accessories are:

• Unite Mini Mic, which is a very powerful “spouse mic” that is a direct digital replacement for FM assistive devices. We at The Hearing Blog especially like this accessory, and strongly recommend it for all Alera and Verso owners;
• Unite Remote, which is their bidirectional remote control;
• Unite TV, which is their low-latency direct-to-hearing aid transmitter;
• Unite AirLink USB programmer transceiver, which can be used instead of a HiPro or NOAHlink programmer;
• Unite Phone Clip, which is their original Bluetooth streamer;
• Unite Phone Clip+ Bluetooth streamer and remote control, which is the subject of this review.

The original Phone Clip was, quite frankly a dog with cryptic flashing lights and button pushes. It had a poor quality 802.15.4 Bluetooth implementation, which caused all sorts of loss of pairing problems; and this was confirmed in our conversations with several GN ReSound insiders both in Minneapolis and Chicago. On the other end, when it came to the Phone Clip ↔ hearing aid connection, it also had a very poor antenna and weak transmitter, so that it had to be carefully oriented & within about 18” of the hearing aids for it to even work. These hardware problems have been fully addressed to our satisfaction in the Phone Clip+

The Phone Clip+ also took a page from the Widex M-Dex streamer/remote and incorporated much new functionality into this matchbox-sized device (continued past the jump):

ReSound Unite Mini Mic, Unite Phone Clip+, Widex M-Dex

Left to right: ReSound Unite Mini Mic, Unite Phone Clip+, and the much larger Widex M-Dex, compared to a standard business card for scale
Click to Enlarge

• Program shift: You can switch among the four programs in the Alera and Verso;
• “Room Off” microphone muting;
• Initiating and terminating a call; and if the phone has voice dialing, not even needing to take it out of your pocket or purse;
• Control of the actual hearing aid volume at any time;
• When used with the Control app, independent control of streamed (Bluetooth, Mini Mic or TV) audio and environmental (hearing aid mic) audio;
• Ability to remain paired to more than one Bluetooth source, which we have verified.

ReSound Control app screen shot composite 1

Left to right, top to bottom: GN ReSound Control app v1.0.0 screen shots operating in P2 with no streaming; with Bluetooth audio streaming; and Mini Mic audio streaming
Click to enlarge

To learn more, we recommend downloading the ReSound Unite Phone Clip+ Setup and Use Guide and FAQ, and the ReSound Control app FAQ.

Now, about that bug we uncovered…

There are two parts to ReSound hearing system ↔ iDevice connectivity:

• Basic Bluetooth 2.1 A2DP and headset connectivity;
• Status and programming communication from the Alera and Verso hearing aids to the Phone Clip+ which is then relayed on to the Control v.1.0.0 and Beltone SmartRemote v1.0.0 iDevice apps; and soon Android OS apps.

As it turns out, the coders and project managers didn’t quite do enough regression testing when they built the apps; and we spent an hour Sunday with Apple “Genius” Cathy Kennerck at their Naperville IL store chasing it down. Basically, the app works properly on iOS 6.0.1 running on the iPhone 4, iPhone 4S, and iPod Touch 5; and also runs properly on iOS 6.0.2 on the iPhone 5.

However, the Control app does not work properly on the iPod Touch 4/iOS 6.0.1, as the status and programming communications from the Phone Clip+ to the iPod Touch 4 is .NOT. properly detected and interpreted. When we discovered this flaw on Friday, we originally (and erroneously) attributed it to an iOS 6.0.1 bug that was fixed in the 6.0.2 release. However, Ms Kennerck did some checking, and the 6.0.1 → 6.0.2 update was only for the iPhone 5 to fix an AT&T connection issue. She also helped me eliminate whether my own iPod Touch 4 bought in August was the culprit, as she brought out a new iPod Touch 4 from stock, where we duplicated the problem. Thank you Cathy!

UPDATE 2

The situation with the iPod Touch 4 is getting “curiouser & curiouser:” Although we duplicated the problem on a virgin iPod Touch 4 at the Apple store, the people at GN ReSound couldn’t. When I suggested that it may have been a case of supposedly “identical” machines actually having extra libraries, parts of programs, and even kernel patches not uninstalled when doing testing (I’ve seen this happen before), they conducted additional tests on two virgin systems, and could not duplicate what we found.

Now, it gets even funkier: We conducted more tests on Wednesday, uninstalling and reinstalling the Control app… And suddenly it started working properly.

► Keep in mind that even with the Control app not working, the iPod Touch 4 always was able to properly use the Bluetooth headset profile for phone calls (on Skype) and A2DP stereo streaming for music; and that the program shift, muting and call initiate/terminate functions all worked properly ◄

On Friday (25 January) we conducted more testing: It was back to the Apple store for a complete wipe of our iPod Touch 4, and the Control app worked just fine. Then, we received two more Phone Clip+ units, so it was back again to the store with the two new devices, for two more system wipes. Each time, the Control app worked flawlessly with the two new devices, so we’re as puzzled as they are as to the gremlins we experienced. We are sending the original Phone Clip+ that experienced these gremlins to their lab for evaluation; but it appears that the issues we experienced were a one-off. We are now confident enough to start sending them to Alera and Verso users; but at least in the beginning we’ll be testing each one to assure they work properly before delivery.

This article will be continued in Part 2, which is in progress, where we will have a more thorough review of the Phone Clip+ and Verso system.

Comment problems:

It’s been brought to our attention from several of our readers that they were having their comments rejected by the Akismet plug-in for WordPress as spam. This is unacceptable to us; and we are soliciting suggestions for a replacement. Unfortunately, we have to use something to screen for spam, as we were receiving over 100 spam comments per day at its’ peak. In the interim, to save retyping, we recommend selecting & copying all of your text to the clipboard: If your comment is accidentally rejected, simply paste it into an e-mail message, put “Rejected Comment” in the subject line, and send it to us at Dan@Snip.Net and we’ll manually post it for you~

December 7, 2012

HTC Rolls Out Windows Update For Hearing Aids App

Filed under: Mobile Phones,Uncategorized,Windows,Windows Mobile Phones — Tags: — Dan Schwartz @ 4:42 pm

Windows Phone Hearing Aid App Screen ShotHTC has rolled out an update to version 2.4.0 of its Hearing Aids app for the Windows Phone mobile platform. The app is a system tool for those of us who require higher in-call volume levels: Should you happen to find it hard to hear sound from the Windows Phone when in a call with a contact, simply enable the Hearing Aids app to improve call quality.

At this point there is  no changelog presently available, so we can only assume minor fixes and improvements have been made. Be sure to be on the look out for more system app updates released by other Windows Phone manufacturers.

Hat tip: Windows Phone Central

Comment problems:

It’s been brought to our attention from several of our readers that they were having their comments rejected by the Akismet plug-in for WordPress as spam. This is unacceptable to us; and we are soliciting suggestions for a replacement. Unfortunately, we have to use something to screen for spam, as we were receiving over 100 spam comments per day at its’ peak. In the interim, to save retyping, we recommend selecting & copying all of your text to the clipboard: If your comment is accidentally rejected, simply paste it into an e-mail message, put “Rejected Comment” in the subject line, and send it to us at Dan@Snip.Net and we’ll manually post it for you~

November 28, 2012

Superimposing deafness on top of watching a 3D movie

Filed under: Assistive devices,Sony Access Glasses,Uncategorized — Tags: , — Dan Schwartz @ 11:54 am

 Or, “when you’re up to your ass in alligators, it’s hard to remember you’re draining the swamp”

Life of Pi has opened to deservedly huge crowds due to rave reviews; but what is the experience if you are hearing impaired and watch the 3D version? Author Shanna Groves describes her experience watching this movie with the new Sony Access Glasses system, which provide both captioning on a private heads-up display and direct amplified audio to headphones or the wearer’s hearing aids. We at The Hearing Blog recognize the technical difficulties of providing on-screen open captions for 3D films, and we applaud Sony for developing the Access Glasses for us in the hearing impaired community. We also thank Regal Entertainment Group who operate Regal and UA cinemas across America for spending $2000 for each of the Sony devices to accommodate our needs.

Here is Mrs Groves describing her “interesting” experience with her friend watching Life of Pi in 3D in her Lipreading Mom blog:

Are Captioning Glasses Really the Wave of the Future?

What’s black, worn over the eyes, and communicates in fluorescent green text?

Why, captioning glasses, of course.

My latest adventure at the cinemaplex featured the latest captioning equipment on the market: Sony Entertainment Access Glasses. Yesterday my friend, Terri, and I ventured to a Regal movie theater to wear one of only 10 sets of these $2,000 glasses in the Kansas City area. Was it worth the drive? I’ll get back to that in a minute. But first, check out these super-duper glasses in their 3-D splendor…

Here is what Sony says about the shades, verbatim: “When wearing this stylish and lightweight see-through eyewear, users can see closed caption text seemingly superimposed onto the movie picture that they’re watching on screen — It’s a natural subtitle movie experience.”

But that’s not all.

“In addition,” Sony declares, “as the captioning glasses’ receiver box is equipped with an audio assist function, this solution is useful not only for people with hearing difficulties but also for people with visual impairments—both can enjoy movies far more than ever before.”

Too good to be true? Too confusing?

Check out this visual demonstration, complements of Sony (photo below).

Yesterday’s movie choice was the 3-D saga “Life of Pi,” directed by Ang Lee. It involves an adolescent Indian boy, a Bengal tiger, a small boat, and lots of peril. How would I ever understand a heavy-on-the-accents movie or talking animals without captions?

The glasses rested on the bridge of my nose for the opening credits. The lenses were outfitted with a special 3-D film so that I could watch Mr. Tiger in the opening montage leap off the screen fangs first. Then the actors began talking, and I searched everywhere for my captions. After sliding the glasses up and down my nose, I finally located the words at the bottom of my spectacles. They were minty green and only visible at the blackened bottom of the screen.

No problem, right? I’d just sit with my neck craned to an awkward angle in order to read the words dancing above my nose.

Then, ferocious Mr. Tiger jumped out of the shadows again and nearly scared the glasses right off my face. That’s when the words disappeared yet again. POOF! I slid the glasses up and down my nose until I caught up with those pesky green letters.

I spent the next two hours alternating between sheer wonder at my high-tech 3-D captioning glasses…and the seated position at which to best read those captions.

All in all, my movie experience was state-of-the-art, Oscar-caliber exciting. Until my nose flinched and I momentarily lost sight of the captions.

Would I use Sony Entertainment Access Glasses again? If the movie was something as visually and intellectually stimulating as “Life of Pi”—yes. Any subpar captioned flick would have been too much for my eyes, nose, and neck to endure. The movie has to be Oscar-worthy in order for me to use these glasses again.

I want to publicly thank Sony and Regal theaters for making my movie experience so memorable and for trying to accomodate my captioning needs. Imperfect technology aside, I appreciate the ability to see and understand a first-run movie.

In the future, I think producing films with open captions (captioning printed directly on the movie film) is the way to go. But that’s for another blog post.

To find movie showings that have Sony Access Glasses availability, simply go to Captionfish and select SONY® Access Glasses from the Filter popup menu. We also suggest changing if needed your location in the upper right corner of the Captionfish page, as often the guess by IP address on where you are can be quite far off~

November 26, 2012

Guest article by “Deafinitely Girly:” My life enhancing hearing aids

Filed under: Hearing Aid Benefit,Uncategorized — Dan Schwartz @ 11:57 am

From time to time we find interesting articles by other bloggers we syndicate. This one is by “Deafinitely Girly,” who is an anonymous severely Deaf blogger in London who just got her first pair of hearing aids. We are republishing this with her permission, to stress the point to our readers that Yes, hearing aids work, and work well. Quoting from the article:

When my audiologist said my hearing aids would get better over time, I didn’t really believe him. I kinda thought it was a ploy on his part to get me to keep them in and give them a chance. But I’m quite excited that in December I can go back for my appointment and tell him that they do work, even though he probably knew that already.

And now, her article in full:

My life enhancing hearing aids

This morning I put my hearing aids in earlier than normal after waking up at 5.30am and not being able to get back to sleep.

I lay there listening to the sounds of a Monday morning and marvelling at just how loud everything sounds in my flat.

What I could mainly hear however, was the pub around the corner and up the road from me getting a keg delivery. It was making a racket. I’d never heard that in my flat before.

It’s been like that a lot recently – hearing things I’ve never heard before. Yesterday while visiting NikNak and chatting to her in her living room I was aware of some noise filtering through. ‘What is that?’ I asked her, baffled. ‘Church bells!’ she replied. I was amazed and I think she was a bit, too. I mean, I can only hear church bells normally if I’m right by the church in question.

It’s been a bit of a shock. After all, you know how much I liked my pre-hearing aid world. I think, because I can lipread so well and London is quite a noisy place, I never really thought about what I wasn’t hearing. And it’s not like I could have told you what I wasn’t hearing because I didn’t know those sounds existed.

The only thing that really really reminded me that I couldn’t hear was the fact that I was completely reliant on subtitles to follow anything on the TV.

But get this…

Again, while at NikNak’s house yesterday, there was a Peppa Pig DVD playing on a loop as Mini K was poorly and being a massive Peppa fan, this was taking her mind off things.

At one point the entire family were out of the room doing things except for me and Mini K and so we sat in companionable silence watching precocious Peppa flounce around the screen. And do you know what? I could pick up words. I heard actually words from the TV without any subtitles to give me a clue. I could make out enough to work out what was going on in the world of Peppa Pig. OK, so this is a cartoon with kid’s language but it’s a cartoon, and you can’t lipread cartoons!!

How utterly brilliant is that?!

When my audiologist said my hearing aids would get better over time, I didn’t really believe him. I kinda thought it was a ploy on his part to get me to keep them in and give them a chance. But I’m quite excited that in December I can go back for my appointment and tell him that they do work, even though he probably knew that already.

They are not miracles and I am not hearing. I am Deafinitely Girly and always will be. But they are life enhancers. And right now, I’m more than happy to have a little bit of that in my world.

Happy Monday peeps!

DG

 You can e-mail ”Deafinitely Girly” at deafinitelygirly@googlemail.com and follow her on Twitter at @deafgirly

Comment problems:

It’s been brought to our attention from several of our readers that they were having their comments rejected by the Akismet plug-in for WordPress as spam. This is unacceptable to us; and we are soliciting suggestions for a replacement. Unfortunately, we have to use something to screen for spam, as we were receiving over 100 spam comments per day at its’ peak. In the interim, to save retyping, we recommend selecting & copying all of your text to the clipboard: If your comment is accidentally rejected, simply paste it into an e-mail message, put “Rejected Comment” in the subject line, and send it to us at Dan@Snip.Net and we’ll manually post it for you~

November 24, 2012

The Remotoscope: The iPhone-based otoscope from Georgia Tech

Filed under: Apple,Biomedical Engineering,Brian Parise,Optics,Professor Wilber Lam,Uncategorized — Dan Schwartz @ 6:09 pm
The Remotoscope: The iPhone-based video otoscope from Georgia Tech that enables Telehealth for parents, school nurses, in-home caregivers, and hearing care professionals

It warms our heart here when we come across a nice development out of the labs of our alma mater: This one came out of the 1000+ student Wallace H. Coulter Department of Biomedical Engineering, the centerpiece of their 800,000 ft² Biotechnology Complex

The Wallace H Coulter School of Biomedical Engineering at Georgia Tech

The Wallace H Coulter School of Biomedical Engineering at Georgia Tech, part of the 800,000 ft² Biotechnology Complex
Click to enlarge

Dr. Wilbur Lam, assistant professor in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University, and Emory medical student Kathryn Rappaport review images of the ear taken with Remotoscope, a clip-on attachment and software app that turns an iPhone into an otoscope.

Dr. Wilbur Lam, assistant professor in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University, and Emory medical student Kathryn Rappaport review images of the ear taken with Remotoscope, a clip-on attachment and software app that turns an iPhone into an otoscope.
Click to Enlarge

Assistant Professor Wilbur Lam and his team came up with a clever hardware & software package to leverage the capabilities of the iPhone platform to turn it into an inexpensive-yet-high quality video otoscope: Remotoscope’s clip-on attachment uses the iPhone’s camera and flash as the light source. It also relies on a custom software app, enhanced by Brian Parise, a research scientist with Georgia Tech Research Institute’s Landmarc Research Center, which provides automatic zoom and crop, image preview, and auto calibration. The iPhone’s data transmission capabilities seamlessly send images and video to the patient’s electronic medical record, or to the physician’s inbox. This device is rather handy for parents of children who have recurrent ear infections; and also for parents of children who have hearing aids; but it can, of course, be used for any age.

Other uses would be having the physician remotely check for bulging or retracted eardrums before flying if a patient has a cold. Other professionals who would benefit from the Remotoscope are in-home caregivers and school nurses to provide remote imaging to the physician.

Finally, hearing aid professionals would have two uses for the Remotoscope as well: First, in the office and on house calls as they use a video otoscope now, i.e. for their own records and ENT referrals; and also for their patients, who would transmit images to their ENT, and also for inspecting things like hearing aid receiver & microphone openings, battery contacts, and other small things on the instruments themselves.

Watch this short video to see the Remototscope in operation:

If this embedded video does not display properly, click here to open in a new page

An FDA clinical trial for the Remotoscope is currently under way at Children’s Healthcare of Atlanta to see if the device can obtain images of the same diagnostic quality as what a physician sees with a traditional otoscope.

Click here for the press release for the Remotoscope
Click here for the Georgia Tech YouTube Channel

November 10, 2012

Surge Impedance: Why you see the spark when you unplug your iron

Filed under: Audio Engineering,Professor John Dorsey,Surge Impedance,Uncategorized — Dan Schwartz @ 1:36 pm

One morning last month started off over coffee with a Sherlock Ohms article in Design News Magazine titled Noise Messed With the Automation System …Hmmm, this looked interesting, so lets see what the problem was [annotated with my comments in blue]:

I manage the new product verification team for a small manufacturer of industrial automation equipment. We sell most of our products through partners who sell them as their own products. About six month ago, we had one of our partners come to us with an intermittent customer issue. The customer had one of our analog output (4-20mA) modules installed next to a relay module (made by our partner).

The analog module controlled the speed of a conveyor through an oven, and the relay module switched a contactor that controlled the heaters in the oven. The customer had installed a number of these systems at various locations with both AC and DC power to the heaters. [Hmmm, I'll bet this involves arcing when the load is switched off…]

After installation, the systems worked very well, but after about a month, only on the AC-powered systems, one channel of the analog output would go to 0 mA, stopping the conveyor and burning a lot of product. After a power cycle, the system would work again, but with a decreasing failure interval. Our module had been redesigned recently and the older version was not showing the problem at all. [Nothing here: Move along…]

Our partner asked us to try to duplicate the problem with our own equipment. They had managed to duplicate it on one system, but could not on another. One of my test engineers worked with the design engineer for two months trying various loads and accelerated switching rates [But what were the test conditions?! ], but he could not recreate the failure. It appeared that either our module was not the source of the problem, or no one understood the conditions of the failure very well. [As you'll see in my comment on the article, duplicated below, this was the problem.]

Our partner came back to us with more information on the system. They told us that they were able to demonstrate the failure regularly on two systems: one with a large contactor as a load, and another with a resistive load. [Gee, I'll bet this is switching transients from an inductive load, despite the "resistive load" he called it…] They also had a third system with a resistive load that would not show the failure. While reading the new data, I noticed that the test system they had managed to duplicate it on had a step down transformer between the relay and the resistive load (local power was 220V and the load was designed for 110V). [Like I said, inductive load!] All of the systems that showed the failure were switching a large inductive load with the relay, while those that worked properly were switching a resistive load directly… [Balance in two page article]

Ding Ding Ding!

It’s called surge impedance Zo, which is defined as √(L/C), where L is the inductance in Henrys, and C is the capacitance, which for a coil of wire in a transformer or motor is the interwinding stray capacitance (very small value). The back EMF v= Zo(∂i/∂t), and it will have an oscillation frequency 1/(2π√LC) and is typically in the tens to hundreds of kilohertz. When you open up the contacts supplying an inductive load ∂i/∂t → ∞ hence  v= Zo * ∞ i.e. ∞ volts: You see this as the arc when you unplug an iron; and also when relay & motor starter contacts are switching off an inductive load.

This is also why contactors & motor starters have serious current deratings when switching off DC: Once the arc is established and current starts flowing through the ionized channel, there is no zero crossing to extinguish the arc, as occurs with AC.

When dealing with AC, you design using the peak (not RMS) value of the load current when calculating, because you don’t know where in the AC cycle the contacts will open.

Note: Those of you who are RF jocks will quickly recognize  Zo = √(L/C) as the equation for the characteristic impedance of a transmission line (like 75Ω RG11 coax): Yes, it’s the same thing. [Oh, and by the way, it applies not only to RF transmission lines, but also those big power transmission lines you see criss-crossing the country: They have a surge impedance too, and on this switchgear engineers keep close tabs.]

Zo(∂i/∂t) arcs aren’t necessarily confined to switches: This photo of a train shows the carbon pickup shoe arcing as it is bouncing over an expansion joint in the 600 volt third rail:

Arcing train pickup shoe

Arcing train pickup shoe: Click to enlarge

 

Now, you’re probably scratching your head wondering “what the hell does this have to do with my hearing aids (or CI’s)?!” The answer is not very much, except for two areas:

  • If you try to use a T-coil on a train or subway, you’ll get a large BANG! every time there’s an arc – Electrical noise is the fatal flaw of baseband induction “hearing loop” systems and the telecoils that enable them;
  • Direct Audio Input (DAI) is still used on CI’s and a few hearing aids: Unplugging the cables will cause switching transients; and depending on how robust the surge suppression is designed, it can cause the whole hearing aid or processor to fail.

Aren’t the fundamentals of Electrical Engineering fun?!

Comment problems:

It’s been brought to our attention from several of our readers that they were having their comments rejected by the Akismet plug-in for WordPress as spam. This is unacceptable to us; and we are soliciting suggestions for a replacement. Unfortunately, we have to use something to screen for spam, as we were receiving over 100 spam comments per day at its’ peak. In the interim, to save retyping, we recommend selecting & copying all of your text to the clipboard: If your comment is accidentally rejected, simply paste it into an e-mail message, put “Rejected Comment” in the subject line, and send it to us at Dan@Snip.Net and we’ll manually post it for you~

November 9, 2012

Made for iPhone Hearing Aids Are Coming – URGENT UPDATE

Filed under: Apple,IEEE 802.15 Bluetooth,Made for iPhone CI's,Made for iPhone hearing aids,Starkey,Uncategorized — Dan Schwartz @ 8:29 pm

URGENT UPDATE: We just received a polite-but-panicked “OOPS!” phone call from a Starkey vice president…

Turns out, this special Starkey PowerPoint presentation to the audiology students at the Academy of Doctors of Audiology annual convention wasn’t really for publication yet; and needless to say, it ruffled a few feathers in Eden Prairie and Scottsdale, with my VP friend requesting that we remove this article, as some of the information is not correct, and other is just preliminary. However, it is the policy of The Hearing Blog to present to our readers unbiased, accurate inside information from the hearing care industry, so we politely refused (just ask Advanced Bionics about the veracity of our “Failing Ugly” articles on their November 2010 HiRes 90k recall here, here and here, us breaking the news of their resultant January 2011 big layoffs here; and ask Cochlear about us calling out a design flaw in their CI’s here).

That being said, Starkey will now issue to us a statement detailing what is preliminary with their “Made for iPhone Hearing Aid” program, and also what is incorrect; which upon receipt we will both update this article and publish it in full in a separate article, with our response.

Dan Schwartz, Editor

Guest article on the Starkey roadmap, with comments by Dan Schwartz

It’s been a whirlwind day and a half so far at the ADA Conference. The Biltmore resort area is beautiful, and the weather has been very balmy. Definitely a big improvement over Memphis this time of year.

Yesterday was our special student workshop. There were some great sessions and information shared. One that I just could not wait to write about was the last few minutes of the Starkey presentation on technology and how today’s patients are all “connected.”

If you remember back in June, when Apple announced the iPhone 5, there was a great deal of interest in the audiology and hearing impaired community over one little phrase in the press release, “made for iPhone hearing aids.” Everyone was curious as to which manufacturers would be involved, how closely would they integrate with the iPhone, what would make them better than “non i-phone” compatible hearing aids.

Over the past couple months, there have been bits and pieces of information added to the puzzle. We have learned that Starkey, GN Resound, and Oticon all appear to be working with Apple to launch these products. We now know that Apple will itself not be producing hearing aids but that all 3 manufacturers will have some type of product that enables them to label their products:

…which according to the Apple website, signifies that “electronic accessory has been designed to connect specifically to iPhone and has been certified by the developer to meet Apple performance standards.”

We did not get much more information yesterday, but it was a big step forward.

  •  The Starkey “made for iPhone” hearing aids will only be compatible with iOS6 on the iPhone5  due to the fact that specific antennas had to be installed on the phones for the wireless protocol;
  • The Starkey iPhone hearing aids will operate on 2.4 Ghz protocol variant (Similar to the wireless protocols used by GN Resound, this also explains how Resound, Oticon, and Starkey will all be functioning off the same antenna);
  • This represents a change from Starkey who typically uses a 900 Hz wireless protocol;
  • This means the Surflink Mobile will NOT be compatible with the “made for iPhone” hearing aids (Granted the iPhone should replace all these features);
  • Per the Starkey trainer, there will be TWO lines of hearing aids, one operating on the 2.4Ghz protocol (“made for iPhone”) and one operating on the 900 Mhz protocol (current standard)’
  • Control of the hearing aids will be app based;
  • The first release will be a RIC style

App features will include:

  • Audio streaming
  • Remote mic
  • Bluetooth
  • Record, save, and email audio
  • A limited version of Starkey’s soundpoint software

Soundpoint is a user tuning software that Starkey has for client’s to use in the office with the hearing healtchcare provider.. The trainer reported that 90% of users end up with 2 dB of the initially prescribed settings. The version on the iPhone will be limited in that users can only make gain and compression changes and are restricted to an 8 dB window. The app allows the saving of multiple user created profiles or “programs” which are stored on the iPhone, not on the hearing aid. This will enable combining location services on the iPhone so that particular programs can be geotagged. Walk in to Starbucks and your phone will ask if you’d like to change programs.

One initial flaw I see are that with the features that can be adjusted there will not be as much benefit for adverse acoustic environments. Changes to DNR and directionality would bring about more benefit for those situations in my opinion. While Apple has the largest market penetration of any single Smartphone manufacturer, Android OS market share is growing greatly. Obviously the sheer variety of manufacturers creating Android phones would require a much greater amount coordination among manufacturers for getting appropriate antennae installed in devices

What are your thoughts?

Editor Dan Schwartz replies…

This is just one product roadmap for one of the “Big Six” hearing aid manufacturers; and it is troubling that Starkey will have two different lines of wireless accessories — 900 mHz & 2.4 gHz, meaning that hearing aid professionals will need to stock more inventory. What’s more, unlike the open Bluetooth 4.0 standard that will allow universal wide area direct-to-hearing aid broadcasting for large venues to replace the troublesome baseband induction “hearing loops,” owners of these 900 mHz instruments will be left in the cold. (For this, think of a universal 2.4 gHz version of the excellent Starkey SurfLink Media that will reach all hearing aid users).

We are also troubled that the Starkey instruments will only work with the iPhone 5 due to the special antennas: This was originally supposed to be supported on the iPhone 4S, as that too has Bluetooth 4.0 capability. Although Maxwell’s Equations tend to be inviolable, it will be interesting to see if GN Resound, Oticon, and Cochlear run into the same problems.

Whether Phonak/Unitron and Widex abandon their 10.6 mHz RF platform remains to be seen, as they also use it for inter-ear communications, including zoom mic steering & compression coordination; however the lure of reduced power consumption using the emerging Digital Moore’s Law Radio architecture may pry their engineers loose. That being said, Widex is unique among the hearing aid manufacturers: They use an Application Specific IC (ASIC) DSP architecture, which costs tens of millions of dollars to develop & regression test before committing to silicon. The other manufacturers, however, all use Field Programmable Gate Array (FPGA) DSP’s (mostly from ON Semiconductor with feature libraries from Two-pi), so they will get to the market in about six months… But with the penalty of twice the battery drain than Widex, and frequent firmware flash upgrades, like your WiFi router at home.

As for the “social media” functions of program shift for different acoustic environments, those choices Starkey made are fluid, and will probably change rapidly after focus group and widespread beta testing. One thing we would like to see is an acoustic version of Google Maps, where certain venues have snapshots of their acoustical parameters such as reverberation time measured, and then transmitted using geolocation technology: For example, let’s say the Cheesecake Factory around the corner has a T(60) of 1.4 seconds: When you walk into the restaurant, the iPhone will use that data downloaded from the ‘net (or pull from the cache) and construct a program, and send it up to the hearing aids.¹

Finally, we really like the concept of using the iPhone as an assistive device, either handheld “pocket talker” style with a zoom mike (like the Blue Mikey, which our friend, composer Richard Einhorn, likes to do now), or as a replacement for an FM assistive listening system or ReSound Mini Mic(“spouse mic”). That being said, there is an issue of accumulated latency between the DSP’s in the hearing aids themselves, the Bluetooth 4.0 digital transmission, and iPhone’s own audio processing, which will vary according to the CPU load and thread scheduling priority. Latency is important because once it exceeds 10 mSec, the “comb filter” effect comes into play when the hearing aid mic is mixing in ambient sound, i.e. a delayed version of the sound is being added to itself, distorting the frequency response. Also, when the latency reaches 40 mSec, synchronization to speechreading cues becomes a problem. We can see these already in the various iPhone “hearing aid” apps, such as SoundAMP; along with a second problem: The built-in microphone itself: It’s basically acoustically optimized for near-field use for “talking on the phone” and not for pointing at someone across the room, or even sitting on a conference table.²

 

Bootnotes:

Widex Quattro Model Q-9 Behind-the-Ear (BTE) Hearing Aid System With Remote Control

Widex Quattro Model Q-9 Behind-the-Ear (BTE) Hearing Aid System With Remote Control:
Click to enlarge

1) All that is old, is new again: Some of you may remember the Widex Quatro, released in 1988, had an architecture where you programmed the gain & filter settings in the remote control; and every time you changed the volume or shifted the program, the parameters were transmitted to the hearing aids for instant changes. Yours truly wore a pair of Quatro Q9 hearing aids from 1992-2001, until the ferrite antenna in the remote control broke. You can see more photos of this wonderful hearing aid system in the Hearing Aid Museum at this link.

2) We use the more accurate feedforward comb filter effect to differentiate it from the less commonly encountered “feedback comb filter effect” – Here is a graph of the feedforward comb filter frequency response:

 

feedforward comb filter frequency response

Typical feedforward comb filter frequency response:
Click to enlarge

 

 

 

 

 

 

 

 

Also, here is a brief audio demonstration of the feedforward comb filtering effect:

References:

Smith, J.O. “Feedforward Comb Filters”, in Physical Audio Signal Processing, online book, accessed 7/18/2012~

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September 18, 2012

Made For Apple Cochlear Implants: The Dominos Are Falling…

Filed under: Apple,Bluetooth,Bluetooth,GN ReSound,IEEE 802.15 Bluetooth,Uncategorized,Verso — Tags: , , , , — Dan Schwartz @ 5:22 pm

The Bluetooth 4.0 dominos are falling: Following up on our Apple Hearing Aid? Not So Fast…  post on Friday 14 September, we have this post from the Official ReSound Blog: Cochlear Adopts GN ReSound’s 2.4 GHz Wireless Technology

Cochlear Pty… has entered into a Technology Development and License agreement with GN ReSound to leverage [their] 2.4 GHz wireless technology.

Cochlear offers implants and bone anchored hearing technologies for hearing impaired individuals who are unable to use ordinary hearing devices. The adoption of GN ReSound’s wireless technology by Cochlear reinforces the superiority of 2.4 GHz as a wireless platform.

One of the benefits of 2.4 GHz technology is that it enables the end-user to receive streamed sound directly without wearing an intermediary device around the neck. We know that eliminating body worn streamers and being as discreet as possible are priorities for hearing aid users. Currently, GN ReSound is the only hearing aid manufacturer to use 2.4 GHz wireless technology in our hearing aids.

This serves as a confirmation that the low latency wireless technology ReSound has implemented (via field programmable gate array (FPGA) architecture) in their excellent Alera and brand new Verso lines of hearing aids is, in fact very close to the final implementation of the “Made for Apple” hearing aids. However, neither the Alera nor Verso will be able to communicate directly with the iPhone 4s or 5 — That is the next model series.

Those of you with Advanced Bionics CI’s are also in line to get Bluetooth — In fact, you almost had it, as when the Harmony BTE speech processor came out in 2005, it already had the hardware hooks in the circuit, using the headpiece coil as an antenna. All it would have taken was adding the  Broadcom Bluetooth chip, and it would have been there seven years ago.

September 14, 2012

Apple Hearing Aid? Not So Fast…

Filed under: Alera series,Apple,Bluetooth,Body Area Networks 802.15.6,Electromagnetics,FM Assistive Devices,IEEE 802.15 Bluetooth,Induction Hearing Loops,Personal Area Networks 802.15.4,Sam Lybarger,Telephone Compatibility,Uncategorized,Wi series,Widex — Tags: , , , , — Dan Schwartz @ 6:01 pm

Speculation started several weeks ago at Apple’s WWDC that the new API’s in iOS 6 would create some kind of linkage between the iPhone and hearing aids. This speculation was ramped up by this July 19th AppleInsider article revealing two key patent applications from January 2011. This article will examine these patent applications individually; and later we’ll provide our own SWAG (Silly Wild-Assed Guess) to add fuel to the fire.

First, a bit of history…

Users of hearing aids received their first big break in 1947 when the late Sam Lybarger, the Father of the Modern Hearing Aid, accidentally developed the telephone coil:¹ For the first time, deaf and hard-of-hearing people could hold the phone receiver over their (hot!) vacuum tube-powered hearing aid, switch on the T-coil, and through inductive magnetic coupling the baseband audio was picked up, amplified, and then transmitted to the button earphones… And it worked. However, two things conspired to break telephone compatibility: First, in the early 1960′s as the market shifted away from body aids and into transistorized behind-the-ear (BTE) instruments, the Electrical Engineers at the European hearing aid manufacturers seemed to have forgotten Maxwell’s Equations, namely that that the induced EMF in the telecoil magnetic pickup coil is proportional to (œ) the scalar dot product of the flux line vectors, which are oriented on the axis of the two coils, i.e. the EMF v, the vectors A & B, the absolute value of the vector magnitudes |A| & |B|, and the angle θ between A & B:

v  œ A • B = |A| * |B| * cosine (θ)

As a brief reminder from high school trig, cos (0°) = 1 & cos (90°) = 0

Cosine function as it applies to the scalar dot product of the angle between the axes of a hearing aid telecoil and the voice coil of a telephone receiver or room induction "hearing" loop

Cosine function as it applies to the scalar dot product of the angle between the axes of a hearing aid telecoil and the voice coil of a telephone receiver or room induction “hearing” loop
Click to enlarge

[Note: The actual value of electromotive force v  is a pretty complex calculation using Maxwell's Equations; but the important thing to note is the constituent relationship between the induced telecoil audio signal and the axes of the coil orientations.]

Although like a squirrel stumbling upon a nut, this vertical alignment of the hearing aid telecoil in fact works with horizontal room induction “hearing” loops on the floor or in the ceiling, in fact it broke telephone compatibility — Nice going, guys.

The second factor that conspired against hearing aid telecoil efficacy was that back in the late 1970′s, the Bell System and their Western Electric telephone manufacturing subsidiary came out with a new, lower cost receiver that was more efficient — In fact, it was a bit too efficient, as it did a better job of confining the magnetic flux to the voice coil — magnet gap area… And hence weakening by over 10dB the induced voltage in the hearing aid telecoil, which was already weakened to almost zero by the vertical alignment by the European BTE manufacturers. In fact, some American ITE manufacturers — notably Starkey, Telex, and Argosy — had Engineers who understood Maxwell’s Equations, and used either pancake coils glued to the faceplate, or long thin telecoils on a ferrite core stuffed down into the canal portion of the shell.

From A Look at the Telecoil — Its Development and Potential, by David A. Preves, the longtime Chief Engineer at Starkey Labs,¹

After a huge outcry, a powerful consumer movement was started In Washington, D.C. by a lobbyist named David Saks and his organization — OUT  (Organization for Use of the Telephone) — to ensure that persons with hearing loss would be able to use their hearing aids with the telephone.

In 1982, the federal government passed the Telecommunications for the Disabled Act which required that telephones be labeled as to their hearing aid compatibility. The resulting legislation from the Federal Communications Commission (FCC) brought engineers from hearing aid companies and telephone companies together for the first time to work on the compatibility problem of telephones and hearing aids. The outcome of these meetings in the early 1980s was a new measurement standard for determining whether a particular telephone was compatible for coupling with hearing aids via induction pickup. A telephone that produced the proper amount of magnetic leakage In the proper direction, as specified in the standard, could be labelled and sold as “Hearing-Aid Compatible.” The law specified that coin-operated telephones in public places like airports were required to be hearing aid compatible. These hearing aid-compatible telephones were identified by a blue grommet at the junction of the cord and the telephone handset.

This consumer-driven movement on behalf of people with hearing loss went much further In 1989 when all telephones with cords sold in the United States were required to be hearing-aid-compatible, and in 1991, when all cordless telephones sold in the United States were required to be hearing aid compatible.

TIA-1083 Logo Fast forward to 2007, and the Telecommunications Industry Association had introduced the TIA-1083 logo program for mass-produced phones: Just go to your local WalMart or Target and look for a box with this logo:

 

 

Moving on to mobile phone connectivity…

Getting a mobile phone to work directly with hearing aids has been a recurring nightmare, and more so on the AT&T, T-Mobile (Deutche Telekom), and European 2G & 3G GSM networks, and somewhat less so on the North American Sprint and Verizon CDMA networks. As it turns out, although the mobile phones work in the UHF portion of the radio spectrum, they “burst” their data differently, with GSM bursting at several hundred packets per second — Right smack in the audio range. This causes two distinct problems: First, with older hearing aids, one would hear a terrible screeching sound whether the microphone or telephone pickup coil was used. This was caused by inadequate shielding, and more importantly a lack of RF bypass around the semiconductor junctions: What would happen is that this strong RF signal would be rectified by the p-n semiconductor junctions, with the burst envelopes in the audio range being demodulated just like an AM signal would be… And then amplified to full power and faithfully reproduced loudly screeched by the output amplifier stage straight into the user’s ears. For much more on this mechanism, please see Update 3 below.

About a decade ago, mobile phones started to incorporate IEEE 802.15.4 “Bluetooth” wireless Personal Area Network (PAN) connectivity both for synching to a user’s desktop PC, and for connecting to the ubiquitous headset (the ones that look like the wearer has a cockroach on their ear). You’ll notice that we spell out “IEEE 802.15.4″ instead of using the more generic “Bluetooth” for two distinct reasons:

• To emphasize that, in general, the IEEE 802.15 family is similar to TCP/IP in general, and moreso to IEEE 802.11 “WiFi” in that it is a two-way protocol, i.e. that the transmitting station sends a packet of data along with error correcting codes and a checksum, and then the receiving station decodes the packet, verifies and corrects what errors it can, and then transmit back an ACK(nowledgement) signal. If the sending station does not receive an ACK, then it will send the packet again. This presents issues with power consumption and up to 150 mSec latency, which will be discussed below;

• To separate out the commonly used 802.15.4 Personal Area Network (PAN) standard that we all know from the still-evolving 802.15.6 Body Area Network (BAN) standard that we believe Apple may be implementing in iOS 6.

Let’s look at how “Bluetooth” is currently implemented with hearing aids for connectivity, and the significant drawbacks.

First and foremost, we need to understand that any digital reception in a hearing aid is going to consume extra power — And lots of it, due to the decoding operation. Add to this the 802.15.4 overhead of transmitting ACK signalling, even occasionally in A2DP (Advanced Audio Distribution Protocol), and it makes for a real issue. Austin-based Audiotoniq has mostly sidestepped this with their hearing aids by using a Li-ION cell; but in fact their hearing aid wireless communications protocol is only really for phone use and not continuous streaming (though they have a clever workaround for it).

Most every other manufacturer uses a “Bluetooth streamer,” which acts as a “relay station” communicating via 802.15.4 to the phone or other Bluetooth -equipped device, and then using a second transmitter to broadcast a proprietary Hearing Instrument Body Area Network (HI-BAN) signal to the hearing aids. There are three basic ways this is accomplished, and it’s important to understand the distinction, as it is key in understanding what we speculate Apple will be doing:

• Widex and Phonak use a 28 meter (10.6 mHz) “near field” digital signal.² Phonak and Widex also use 10.6 mHz for ear-to-ear communication between the instruments for binaural coordination of directional microphone beam steering, compression to maintain binaural localization, and also program shift. Widex also uses it for binaural “Phone Plus” operation and Phonak for CROS and BiCROS communications; and both manufacturers also use it for wireless programming;

• Starkey uses a 33 cm (900 mHz) UHF digital signal for streaming and ear-to-ear communications; however they also have direct-to-instrument broadcasting through their SurfLink Media transmitter, i.e. unlike the Widex TV-Dex media transmitter, no additional relay is used. However, Starkey also just released their SurfLink Mobile device, which can be used as a Bluetooth relay, and also as a remote mic up to 20 feet away — But it’s on backorder until at least fall 2012 due to unanticipated demand;

• GN ReSound uses a variation of a 2.4 gHz 802.15.4 signal — An “unofficial” 802.15.6 HI-BAN — for direct, low (under 10 mSec) latency, direct-to-instrument broadcasting from various Unite accessories to their Alera series hearing aids, as well as for remote control and wireless programming (with inter-ear coordination available 4Q2012). It is this style of direct-to-hearing aid broadcasting that we believe Apple will be implementing in software in iOS 6, by essentially “hacking” the 802.15.4 Bluetooth stack and turning it into a de facto 802.15.6 HI-BAN stack for low latency broadcasting.³

 If this direct-to-instrument 802.15.6 2.4 gHz digital broadcasting standard is indeed brought out by Apple forcing the Big Six hearing aid manufacturers as well as chipmakers such as Intricon, ON Semi and others to agree on a single standard, we at The Hearing Blog cannot overstate the significance of this to those of us in the hearing impaired community, as well as to hearing care professionals and sound reinforcement engineers.

Here are just several reasons why this will vastly improve the life of us in the hearing impaired community — And not just those who use an iPhone with hearing aids:

• This will elegantly solve the issue of people needing to carry or even wear a Bluetooth streamer relay to use their mobile phones, wirelessly bringing the audio into both ears;

• This will allow for all hearing aid users to have a very effective and inexpensive alternative to FM assistive devices (ALD’s), as what ReSound is now doing with their very good Unite Mini Mic will be duplicated by other HA manufacturers. We cannot understate both the efficacy and cost aspects of this approach, especially with pediatric hearing aid (and eventually CI) users, as current 72 mHz, 168 mHz (H band) and 216 mHz (N band) analog narrowband FM (6F3 NBFM) systems are plagued with interference, as well as high current drain for headworn devices, messy and unreliable direct audio input (DAI) cables, and troublesome neckloops which are subject to head movement drop-outs and electromagnetic interference;

• This will open the door for hearing aid and sound reinforcement manufacturers to use inexpensive, off-the-shelf chips for direct-to-hearing aid room-sized broadcasting from entertainment devices such as TV’s, stereos, and game consoles;

• Most excitingly, at least for this writer, is this will enable inexpensive wide area direct-to-instrument broadcasting in large venues such as airports, lecture halls, theaters, arenas, and mass transit using an open source standard. What’s exciting about this is that there is already in place mass-produced high power data transmission chips that can easily be adapted via firmware to implement 802.15.6 broadcasting, and in fact there’s a good probability you’ve received this very page via IEEE 802.11 WiFi — That’s right: The technology to deliver the broadcast signal to a wide area is already being mass produced, and all it will take is a firmware update and an analog-to-digital converter (ADC) to turn a $39 WiFi-enabled Linksys router into a transmitter that covers up to several hundred yards.

• Once in place, gone will be the close call we are currently on the edge of experiencing with obsolete technology “lock-in” of baseband induction “hearing loops,” which are being forced upon those of us in the hearing impaired community by those with no technical background such HLAA’s  David Myers and Brenda Battat; and worse by Juliette Sterkens and Janice Schacter, who don’t even have to “eat their own dog food” because they don’t have hearing losses themselves. The problems with magnetic flux line alignment causing orientation problems with telephones (which is, umm, why it’s called a “telecoil”) has been documented above; while the very real problem of electromagnetic interference (EMI) that cannot be filtered out (because of the very nature of the baseband beast) is well documented, and is plainly evident to those who either are forced to use it or have an actual knowledge of electromagnetic and communication engineering.

We already know that Apple is in close consultation with the Big Six hearing aid manufacturers: Given their current state of haphazard connecting Apple (and hence other) mobile phones to their hearing aids, this is the most likely initial part of the roadmap ahead. This brings us to…

But just what about those two patents breathlessly cited in the AppleInsider article?

Glad you asked! Let’s look at them individually at first and then together, in the context of the S.W.A.G. we just laid out.
• Remotely updating a hearing aid profile, United States Patent Application 20120183165 (PDF here)
• Social network for sharing a hearing aid setting, United States Patent Application 20120183164 (PDF here)

Although at first blush these patents look sexy, let’s look at them individually:

Remotely updating a hearing aid program (or for that matter, cochlear implant MAP) is something that has already been done by America Hears (and their partner Australia Hears, now Blamey & Saunders) for over a decade, and what Audiotoniq is using through mobile handsets. In fact, there is a possibility that Apple’s patent application for this function is invalid, as it represents prior art and is henceforth not patentable.

Sharing hearing aid settings through GPS-based “Foursquare” social networking is indeed a possibility; however there are significant HIPAA (privacy) issues in play. However, this would still involve communications between the iPhone and hearing aids… Via 802.15.6, as described above.

UPDATE 1: Near-Field Communications will .NOT. be supported on the iPhone 5

We originally penned this article eight weeks ago; but held off because of the near-field communications (NFC) wild card Apple could have played. Unlike the software changes outlined above in iOS 6, NFC requires an additional hardware chip. What we didn’t know until the iPhone 5 release two days ago, the “Made for Apple” hearing aids will also work on the iPhone 4s — Which would have made it obvious that it did not involve the NFC protocol.

For more on what NFC is and why Apple did not include it, please see iPhone 5 NFC snub explained by Apple in c|net UK.

 UPDATE 2: The T-coil goes further back… all the way to 1936

After publishing this article, we received this rather interesting note from our good friend Dr Neil Bauman, who in addition to moderating the very good Hearing Loss Help website, is also curator of the Hearing Aid Museum — You may have seen his collection in the Expo Hall at the 2011 HLAA Convention in DC:

T-coils had been around and used in hearing aids for more than a decade by 1947. The first hearing aid with a t-coil was likely the Tel-Audio hearing aid of 1936. It was made by the National Electrical Research and Mfg. Co. of Washington, DC. Then in 1938 Multitone of England came out with their VPM model with a built-in t-coil–becoming probably the first wearable hearing aid in the world with a t-coil. (The Tel-Audio was a table top hearing aid and had an external t-coil). In 1940 Sowter reported on electromagnetic induction with hearing aids. So by the time Lybarger came along, this was not new technology at all. He certainly didn’t invent the t-coil. It is true, however, that RadioEar’s Phonemaster hearing aid was the first American-made wearable hearing aid with a t-coil.

UPDATE 3: Knowles Application Note AN-3 on cordless phone interference of hearing aids

The good people at Knowles published Application Note AN3, which is a comprehensive eight page guide on identifying and reducing interference from wireless phones using the time division multiplex access (TDMA) architecture, of which GSM is a particularly egregious offender.

 

References & Footnotes:

1) A Look at the Telecoil — Its Development and Potential by David A. Preves

2) This use of 10.6 mHz presents a problem for Phonak’s Advanced Bionics division’s CI’s, as their Clarion II and HiRes 90k implants also use a very weak 10.6 mHz signal for the reverse updates to monitor implant integrity and telemetry, the interference of it causing a loss-of-lock and instantaneous shutdown of the implant circuit. This means that “bimodal” (CI + HA) users cannot avail themselves of the iCom or other wireless 10.6mHz technology

3) There is also the possibility that Apple has plans for using the 802.15.6 standard for a more general body-area network for connecting other medical devices such as pulse monitors, blood glucose monitors, and other things; but the FDA Device Branch will have the final say~

 

Comment problems:

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July 8, 2012

Some upcoming posts in The Hearing Blog

Filed under: Alera series,Audio Engineering,Auditory Neuropathy Spectrum Disorder,FM Assistive Devices,Uncategorized,Widex — Dan Schwartz @ 6:24 pm

Here is a list of articles that are “in the typewriter” at various stages of completion, pending research, verification, vetting, and lab testing:

Book Reviews

Auditory Neuropathy Spectrum Disorder

  • The “Black Swan” of Deafness: Auditory Neuropathy/Dys-synchrony (now called “Auditory Neuropathy Spectrum Disorder”)

Hearing Aids

  • Widex Clear 440 & Clear Fusion 440 Hearing Aids: User + Engineering + Dispensing Review
  • Starkey Wi series i110 Hearing Aids: User + Engineering + Dispensing Review
  • GN ReSound Alera 977 Hearing Aids: User + Engineering + Dispensing Review

Note: These may be combined into a single “shootout” review

Assistive Devices

  • FM: The Unfair Classroom Advantage
  • FM for infants and children: Of IDEA, FAPE and the IEP
  • FM Shootout: Bellman Audio Domino vs Etymotic Companion Mic vs Comfort Digisystem vs ReSound Unite Mini Mic

Yes, we have all four of these systems in-house, along with a Widex Clear Fusion 440 hearing aid system w/M-Dex streamer, and also a Starkey Wi Series i110 system with SurfLink Media transmitter.

 

These two photos will be part of the Shootout article:

ReSound Sparx showing it drawing 1.0 mA quiecent current. Note the knob on top is set for 0-1 mA scale.

ReSound Sparx showing it drawing 1.0 mA quiecent current. Note the knob on top is set for the 0-1 mA scale.
Click photo to open in a new window.

ReSound Sparx with a Comfort Digisystem DT10 receiver plugged in, showing it now drawing over 6.0 mA total current. Note the knob on top is now set for the 0-10 mA scale.
Click photo to open in a new window.

 

May 20, 2012

Book Review: Programming Cochlear Implants, by Jace Wolfe PhD and Erin Schafer PhD

Filed under: Book Reviews,Charge distribution,Cochlear Implant,Erin C Schafer PhD,FM Assistive Devices,Jace Wolfe PhD,Uncategorized — Dan Schwartz @ 3:30 pm

Programming Cochlear Implants is a pretty darned good book for a college educated CI candidate,  CI “power user,” or even the parents of a “CI kiddie,” as it provides a nicely detailed view of CI’s, rather than what you can extract from the “FDA-sanitized” marketing hype from the CI manufacturers. This book has some very nice troubleshooting tips, especially for parents and school audiologists. Also, Chapter 7 on hearing assistance technology (HAT), which is mostly all on FM, is very good, as it lays out how configuring FM assistive devices with CI’s differs from hearing aids: In the opinion of The Hearing Blog, this chapter is worth the price of the book alone. One minor shortcoming, though, is that it does lack the channel interference table — The “recommended channels” — for Phonak MicroLink receivers operated on the 168mHz H-band  and 216mHz N-band when they are connected to the commonly used Cochlear Freedom processor, and almost certainly the Nucleus 5 processor.¹
Update: In a call to Professor Schafer, she agreed with this point; and the table will be included in the second edition, when published.

Where this book is quite helpful to the CI user community is pointing out where Best Practices can be (and often are) skimped  to speed things along in busy clinics; and when these shortcuts are taken, should serve as Warning Flags to the astute user or parent. A large part of these shortcuts are due to poor 3rd party reimbursement; but also it’s a bit troubling that the ramifications of the CI audiologist taking these shortcuts in terms of patient performance is not fully discussed in this book, i.e. it’s OK if the CI audiologist has an attitude of “it’s good enough for government work,” which, as an Engineer, this reviewer finds a bit lacking. Most notably, the common shortcut of assuming T levels of 10% of M levels on the AB and Med-El systems will result in an incorrect input dynamic range (IDR) being displayed: It will work, but in an unpredictable manner depending on the actual (measured) T levels the patient has. (Hat tip to Mike Marzalek of CItheory.com for teaching us this important point.)

However, there are two  interrelated shortfalls in this book we hope the authors will address in the second edition: The first is a total lack of useful signal (timing) charts in Chapter 2, instead relying on awkward verbal descriptions of the various stimulation algorithms, as a picture is worth a thousand words. The second shortfall is the almost complete glossing over of current steering and beam forming, which are the processes of simultaneous firing of adjacent electrodes to shift the charge cloud to stimulate intermediate nerve endings for more pitch percepts (Med-El i100 & AB HiRes90k implant circuits);  and firing of alternate polarity charges to adjacent electrodes to get  a tighter, more focused charge pattern, to yield a “cleaner” stim (HiRes 90k only).²

Greenwood tonotopic chart courtesy of Med-El

Greenwood tonotopic chart, courtesy of Med-El Click to enlarge 

One item notable by it’s absence is a Greenwood chart graphically explaining the cochlear tonotopic structure vs angular insertion depth of the electrode. Another item notable by its absence is any mention of Advanced Bionics’ ClearVoice noise reduction technology, which received the CE marque in January 2010 and was quickly rolled out across Canada & UK in February & March of that year. Granted, ClearVoice was just approved by the FDA in March 2012;³  but since this book is listed for sale in Britain on the Amazon.co.uk website, at least it was worthy of mention since it’s a released product; and was being beta tested at the AB factory as far back in September 2009.

There was also one minor author-date style annoyance while reading this book: The use of inline references for journal articles and books, as opposed to numbering and placing the footnotes at the bottom of each page. Yes, it’s permitted; and yes, it’s a bit more time consuming when typesetting to do this, but it’s a lot easier on the reader.

Overall, we give Programming Cochlear Implants a 4½ Star rating; and we highly recommend it to CI users, parents of CI kiddies, and to CI candidates.

Footnotes: 

1) Permitted FM Channels when using the Freedom Speech processor: From page 16 of Phonak’s FM Solutions for Cochlear Implants:

To avoid interference, the following channels are recommended to be used with the MicroLink Freedom
N Band: N09, N12, N13, N16, N17, N18, N52, N57, N61, N62, N64, N65, N68, N73, N76
H Band: H06, H07, H16, H17, H18, H19, H20, H47, H48, H57, H59, H77, H78, H79, H85, H86, H87, H88, H89, H90

2)  This is indicated by the number of virtual channels, about 90 for the i100 and 120 for the HR90k; and manifests itself as more, and more closely spaced, pitch percepts. This is made possible by separate current sources for each electrode contact: The HR90k can fire both positive AND negative pulses simultaneously, while the i100 can fire multiple simultaneous positive OR negative pulses for basic current steering. To this day, even the new Nucleus 5 only has a single current source for all 22 contacts, as AB and MedEl have their technologies tightly wrapped up in worldwide patents.

3) 5/31/2012 correction: ClearVoice was approved by FDA in March 2012, not March 2010 as originally stated. The text has been changed to reflect this correction.

Wolfe, Jace, and Schafer, Erin C. 2010.  Programming Cochlear Implants.  San Diego: Plural Publishing. ISBN 978-1-59756-372-7

Some of the search terms people have used to find The Hearing Blog

Filed under: AB 2010 Recall,AB Layoffs,Acoustical wave propagation,Acoustics,Auditory Neuropathy Spectrum Disorder,HLAA Convention,John Niparko,Kirsty Gardner-Berry,NBC Today,Profiles,Shelley Borgia AuD,Starkey AMP,Uncategorized — Tags: , , , , — Dan Schwartz @ 12:44 pm

One of the intriguing things about publishing The Hearing Blog is looking at the list of search engine terms people all over the world use to reach our humble publication. Sometimes, we like to copy & paste them into Google to see where we rank, and it heartens us when we are near or even at the very top of the list, as it shows us Google believes our content is relevant. So, with that in mind, here is a list of some of the more popular terms and how many hits they have, with a discussion on each (note that variations in spelling are combined for the hit count). When you click on the term, a new window will pop up in Google so you can see where it ranks.

 • “Advanced Bionics recall” (757 hits): This makes us both heartened as we delivered relevant content, but also saddened because these articles were on Advanced Bionics’ fifth implant recall in less than a decade. It’s sad because they have, by far, the best implant technology, superior to the Med-El i100 and light years ahead of Cochlear CI512; and many thousands of people in fact benefit from them. However, their poor implant reliability has been proven repeatedly, with their assurances of “we fixed it this time” being (deservedly) subject to ever-increasing scrutiny by the medical device branch of the FDA. We are saddened by this as every time there is an implant recall from any maufacturer, the anti-CI crowd seizes on it and tars with a broad brush CI’s in general.

• “John Niparko” (27 hits) and “Kirsty Gardner-Berry” (15 hits): We really like both of these outstanding people: Dr Gardner-Berry is an audiologist and researcher at Sydney Cochlear Implant Centre (SCIC) and National Acoustics Labs (the people who bring you the NAL hearing aid fitting prescriptive methods), and is one of the world’s leading authorities on ANSD. We had the pleasure of meeting her at the Auditory Neuropathy Spectrum Disorder Conference 2012, and came away very impressed with her knowledge of this very complex subject. Dr Niparko practices at Johns Hopkins Hospital in Baltimore where he runs their world-class CI program. According to our sources inside the CI manufacturers, he is one of the very top CI surgeons in the world, not only handling difficult cases other surgeons turn down, but also cleaning up the messes other surgeons make (including one that happened to a close friend). I know a number of people who were implanted by Dr Niparko, and all of them have outstanding outcomes. In addition, Dr Niparko is on the boards of The River School and the Hearing Loss Association of America, where he hosts very popular convention workshops on the latest advances in hearing and also fields any & all questions in his “Ask the Doctor” sessions.

• “Starkey AMP review” (57 hits): This came from Frustration with so-called “minimal” hearing loss, where we discuss various factors where the pure tone audiogram does not adequately convey the patient’s communications difficulty, either through peripheral or central auditory deficits, and how the Starkey AMP and the (now-discontinued) Songbird FlexFit are indeed helping people overcome their listening difficulties.

Shelley Borgia, AuD, of Park Avenue Acoustics in NYC

Audiologist Shelley Borgia, AuD, of Park Avenue Acoustics in NYC

• “Dr Shelley Borgia” (202 hits; when combined with “Matt Lauer hearing aids” & related, 279 hits):  This one has been at the top of the rankings since it appeared, as it related to what was otherwise a dynamite seven minute NBC Today segment on hearing loss, seen by many millions of people on August 10th, 2011. Unfortunately, the title of our article on this sums up our equal disappointment with audiologist Dr Shelley Borgia and subject Jim McDade: Less-than-honest NBC Today segment on hearing loss. We have invited Dr Borgia to respond either in a comment or in a standalone article, unedited; but so far, despite 481 people googling her name or her NBC Today appearance reading our article, we have received no response from her. Update (6/26/2012): In the last 3o days, the total number of searches with “Shelley Borgia”  has climbed to 266, including several that she has left Park Avenue Acoustics.

 

• “Adiabatic vs isothermal propagation” (24 hits) This came from Rarefaction and condensation… or should it be compression? …and it warms our hearts as we made the case that using the term “condensation” in acoustics is improper, as it implies a gas-liquid phase change; and instead “compression” should be used as the opposite to “rarefaction.”

• “Advanced Bionics layoffs” (173 hits):  This article was a world scoop when we broke the news on that Friday night, with some AB employees reading about it even before they received their pink slips when they reported to work the next Monday; and in fact our scoop it was quoted in The Wall Street Journal Sadly, Advanced Bionics’ reliability problems has hurt a lot of good people besides just their implant recipients: In fact, there were over a hundred people laid off around the world just in that Sonova division alone; and more saw the handwriting on the wall and headed to the exits even before the axe fell on their necks… And the remaining people saw their retirement accounts take a big hit, as Sonova stock lost one-third of it’s value.

• “Auditory Neuropathy Spectrum Disorder” (82 hits) These hits came from our entries on the Auditory Neuropathy Spectrum Disorder Conference 2012 in March. This reminds us we need to post the rest of the articles which have the papers. Also, as a “teaser” we have nearing completion an article on this titled The “Black Swan” of Deafness: Auditory Neuropathy/Dys-synchrony (now called “Auditory Neuropathy Spectrum Disorder”), which after completion will be sent out for vetting before publication~

April 25, 2012

FCC Updates Standards on Mobile Phones and Hearing Aid Compatibility

Filed under: Telephone Compatibility,Uncategorized — Tags: — Dan Schwartz @ 3:41 pm

There are many different wireless mobile phones available, and some of the wireless mobile phones work better with some hearing aids than others. The FCC has requirements for some, but not all, wireless phones to be hearing aid compatible.

On April 9, 2012, the FCC approved a new technical standard for testing phones for hearing aid compatibility (HAC). After this new standard is adopted and a 2-year transition period is completed, the Commission’s rules requiring phones to be hearing aid-compatible will apply to handset operations over additional air interfaces and frequency bands. Stated another way, the Commissions’ HAC rules will now apply to a range of new technologies and will allow for more accurate measurements of hearing aid interference, i.e, the new standard will improve the measurement criteria for determining if a mobile phone is hearing aid compatible or not.

You can download the MS Word .doc here, or you can download the Acrobat .pdf document here.

March 27, 2012

Setting Hearing Aid Maximum Power Output Using Stapedial (Acoustic) Reflex Thresholds

Filed under: Adjusting C/M levels,Adjusting SSPL-90/MPO,Auditory Neuropathy Spectrum Disorder,Central Auditory Processing Disorder (CAPD),Hearing instrument fitting,Madsen ZS76 Tympanometer,Stapedial (middle ear muscle) reflex,Tympanic membrane compliance,Tympanometry,Uncategorized — Tags: , , , , — Dan Schwartz @ 8:43 pm

Perhaps the handiest weapon in the Hearing Aid Professionals’ arsenal is the tympanometer, as if you draw a straight line between the audiologic information it can reveal and how that information will impact a hearing aid fitting, you’ll be rather surprised… And will have you running to your equipment dealer or eBay to buy one.

The tympanometer performs two separate functions, which each reveal significant data those of us “in the trenches” which we can use to nail down a good fit, by performing measurements in two disparate areas:

  • Tympanic membrane mobility via compliance measurement, which can yield all sorts of mechanical problems from the TM itself all the way through the Eustachian tube, & all stops in between;
  • Neural measurements, through stapedial reflex thresholds; also called “acoustic” or “middle ear muscle” reflexes.

The first item, relating to mechanical (conductive) problems, such as commonly found fluid in the middle ear cavity, is something that, when we detect a problem, we refer to a physician, as it is above our pay grade. Of course, busy doctors appreciate it when we give them good data in an easy-to-comprehend format, especially if there is a nice graph. For more on tympanometry, the reader is directed to this good article, which explains the various bugbears it uncovers.

However, the purpose of this article goes to the second function of the tympanometer, namely the detection and measurement of middle ear muscle reflexes to sound stimulus, as this can be highly revealing. In normal and some impaired ears, a reflex contraction of the middle-ear stapedius muscle will occur when sound is of sufficient energy, typically 90dB. The stapedius muscle is attached by a tendon from the rear wall of the middle ear to the head of the stapes; and when the stapedius contracts, the tendon produces tension on the stapes, causing the middle-ear ossicles to stiffen. This action reduces the transmission of sound energy through the middle ear, by acting as a dampener, to protect the delicate structures of the cochlea.

Stapedius and Tensor Tympani illustration

One way of visualizing the acoustic reflex function is to treat it as a negative feedback process with a unity gain amplifier, with the forward path signal (the so-called “afferent” signal) applied to a non-inverting Schmitt trigger and then fed back (the so-called “efferent” signal) into the negative input of the amplifier, acting as a control vector, hence reducing gain by 10dB. Note well that the stapedius muscles on both sides contract in response to sound delivered to either ear, as the signals are summed in the cochlear nuclei:

Acoustic (stapedial) reflex pathways using an equivalent negative feedback circuit model. Drawing ©Copyright Dan Schwart\z 2012

Acoustic (stapedial) reflex pathways using an equivalent negative feedback circuit model.

For more detailed drawings of the neural pathways, please see reference 3

First, acoustic reflex thresholds will give you an upper limit to the Maximum Power Output (MPO; previously SSPL-90) of the hearing aids, as the operating theory is that you do not want the instruments to constantly trigger the stapedial muscle reflex, as it is tiring to the patient.1 In fact, according to this paper by Ed Overstreet, this principal is extended to cochlear implants (CI’s) to determine M/C levels;2

Second, it can be used to screen for the dreaded Auditory Neuropathy Spectrum Disorder, which will tell you if a hearing aid will even work. This will be the subject for an upcoming article; but in the mean time, any stapedial reflex thresholds – Ipsilateral (“ipsi”) or contralateral (“contra”) greater than 90dB means ANSD can be in play, and must be followed up with more testing to confirm it or rule it out.

References:

  1. Using Acoustic Middle Ear Muscle Reflexes and Their Utility in Fitting Hearing Instruments by Jay B. McSpaden, PhD, BC-HIS, and Dana K. McSpaden, MSEd
  2. Relationship between Electrical Stapedial Reflex Thresholds and HiRes Program Settings: Potential Tool for Pediatric Cochlear-Implant Fitting by Ed Overstreet PhD, Lisa Buckler MA & Kristen Dawson MA
  3. Acoustic Reflex Threshold (ART) Patterns: An Interpretation Guide for Students and Supervisors Diana C Emanuel PhD

 

Comment problems:

It’s been brought to our attention from several of our readers that they were having their comments rejected by the Akismet plug-in for WordPress as spam. This is unacceptable to us; and we are soliciting suggestions for a replacement. Unfortunately, we have to use something to screen for spam, as we were receiving over 100 spam comments per day at its’ peak. In the interim, to save retyping, we recommend selecting & copying all of your text to the clipboard: If your comment is accidentally rejected, simply paste it into an e-mail message, put “Rejected Comment” in the subject line, and send it to us at Dan@Snip.Net and we’ll manually post it for you~
 

March 23, 2012

National Institute on Deafness and other Communications Disorders (NIDCD) 2012-2016 Strategic Plan

Filed under: 2012-2016 Roadmap,NIDCD,Uncategorized — Tags: — Dan Schwartz @ 9:18 pm

Established in 1988 by an Act signed into law by President Reagan, who himself was severely deaf, the National Institute on Deafness and other Communications Disorders (NIDCD) is one of the Institutes that comprise the National Institutes of Health (NIH). NIDCD is legislatively mandated to conduct and support biomedical and behavioral research and research training in the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language. The Institute also conducts and supports research and research training related to disease prevention and health promotion; addresses special biomedical and behavioral problems associated with people who have communication impairments or disorders; and supports efforts to create devices which substitute for lost and impaired sensory and communication function.

As part of their mission, the Institute periodically issues a roadmap, and we at The Hearing Blog are pleased to republish the Cochlear Implant and Hearing Aid Science Capsule excerpts from their 2012-2016 Strategic Plan,  along with an augmented Executive Summary.

Science Capsule: Cochlear Implants

The development of the multi-channel cochlear implant has made it possible to restore the perception of sound to people who are profoundly deaf or severely hard of hearing (HoH). In contrast to hearing aids, which amplify sound, cochlear implants directly stimulate the auditory nerve.

Over the past two decades, NIDCD-supported research led to major advances in multi-electrode signal processing, as well as in understanding the benefits of early implantation in children and the possible benefits of implantation in both ears. Because of this research, we now know that children with hearing loss who receive a cochlear implant within the first two years of life will typically experience a smaller gap in language skills and will be more likely to succeed in mainstream classrooms.

According to the U.S. Food and Drug Administration (FDA), in December 2010, approximately 219,000 people worldwide have received cochlear implants, including approximately 42,600 adults and 28,400 children in the United States. Roughly 40 percent of children who are born profoundly deaf now receive a cochlear implant, which is a 25 percent increase from five years ago. The rise in cochlear implant use among eligible people between 2000 and 2010 exceeded the target set in the U.S. Department of Health and Human Services’ (HHS) Healthy People 2010 (a set of science-based 10-year national health objectives), and a new target is being developed for Healthy People 2020.

NIDCD-supported scientists continue to improve cochlear implant technology through the development of noise-reduction signal processing and innovative electrode designs. For example, insertion of traditional cochlear implant electrodes can damage hair cells throughout the cochlea, so researchers are investigating methods to preserve residual hearing in eligible individuals by implanting a shorter electrode array. In addition, animal studies are underway to assess the risks and benefits of a new electrode design that is positioned inside the auditory nerve, with the hope this will provide an improved sense of hearing in crowds and other social situations in which more than one person is speaking. NIDCD researchers continue studies with children who received cochlear implants at a young age to determine what factors contribute to successful language learning and subsequent academic performance. Continued research to assess how current users benefit from a cochlear implant in one ear, along with a cochlear implant or a hearing aid in the other ear, will help inform the design of the next generation of implants.

Science Capsule: Hearing Aids and Hearing Health Care

NIH- and NIDCD-supported research has driven the development of hearing aids from the first electronic hearing devices invented in the 1950s to the sophisticated digital devices available today. Innovative collaborations between the NIH, the Department of Veterans Affairs (VA), and the National Aeronautics and Space Administration (NASA) have significantly improved hearing aid technology over the past 20 years. In addition to amplifying sound, today’s hearing aids are better designed to address the challenges of understanding speech, localizing sound, and hearing in noisy environments.

Despite these advances, NIDCD-supported scientists are continuing to seek ways to improve hearing aid technology, hearing aid fitting strategies, and auditory rehabilitation programs to enrich the communication experience and quality of life for millions of Americans who have hearing loss. NIDCD-supported scientists are developing more effective methods to reduce sound distortion, improve sound localization, and combine hearing aid and cochlear implant technologies. For example, NIDCD-supported research on the tiny fly named Ormia ochracea provided a model for the development of a miniature directional microphone for hearing aids to help users focus on a single speaker in a noisy room.

Improving hearing health is an ongoing priority for NIDCD. An estimated 17 percent of all American adults and nearly half of adults ages 75 years and older have some form of hearing loss, yet only about 20 percent of those who could benefit from hearing aids actually use them. For the past two decades, the NIH and the VA have cosponsored biannual national and international meetings to facilitate information sharing among hearing aid technology researchers. In 2009, NIDCD convened a workshop titled “Accessible and Affordable Hearing Health Care for Adults with Mild to Moderate Hearing Loss,” that resulted in research recommendations and a series of NIDCD research initiatives to explore new approaches, assessment methods, and small business technologies to improve access to hearing health care for underserved individuals. In addition, increasing the rate of hearing aid usage was a HHS Healthy People 2010 goal and continues as a Healthy People 2020 goal. NIDCD is committed to pursuing research to understand and improve hearing health for all Americans.

Executive Summary:

Approximately one in six Americans will experience a communication disorder in his or her lifetime. Communication disorders affect hearing, balance, taste, smell, voice, speech, and language. For hearing and balance: estimates indicate that 36 million American adults report some degree of hearing loss; two to three out of 1,000 babies born in the United States each year have a detectable hearing loss; and almost eight million adults report a chronic problem with balance. For taste and smell: more than 200,000 people visit a physician for taste and smell disorders annually, and many more of these disorders go unreported. For voice, speech, and language: approximately 7.5 million people in the United States have trouble using their voices; by the first grade, roughly five percent of children have noticeable speech disorders, the majority of which have no known cause; and between six and eight million people in the United States have some form of language impairment.

Modern society depends on our ability to communicate with one another. While science and technology have greatly improved this capacity, life can be profoundly difficult for those with communication disorders. Such disorders can affect the emotional, social, educational, and cognitive development of an individual, and the cost of these disorders in terms of human suffering, unfulfilled potential, quality of life, and economic factors is incalculable.

The National Deafness and Other Communication Disorders Act of 1988 became Public Law 100-553 on October 28, 1988, establishing the National Institute on Deafness and Other Communication Disorders (NIDCD) within the National Institutes of Health (NIH). The mission of the NIDCD is to conduct and support biomedical research, behavioral research, and research training in the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language. The Institute also conducts and supports research and research training related to disease prevention and health promotion; addresses special biomedical and behavioral problems associated with people who have communication impairments or disorders; supports research evaluating approaches to the identification and treatment of communication disorders and patient outcomes; and supports efforts to create devices that substitute for lost and impaired sensory and communication function. NIDCD’s focus within this broad mission is to bring national attention to the disorders and dysfunctions of human communication and to advance biomedical and behavioral research to improve the lives of the millions of people with a communication disorder.

To accomplish this mission, NIDCD manages a broad portfolio of both basic and clinical research. The portfolio is organized into three program areas: Hearing and Balance; Taste and Smell; and Voice, Speech, and Language. The three program areas seek to answer fundamental scientific questions about normal function and disorders and to identify patient-oriented scientific discoveries for preventing, screening, diagnosing, and treating disorders of human communication.

Public Law 100-553 also requires NIDCD to prepare a plan to initiate, expand, intensify, and coordinate Institute activities concerning the disorders of hearing, balance, taste, smell, voice, speech, and language. NIDCD met this requirement by convening a task force of scientific experts in 1989 to prepare the first strategic plan, which guided the Institute over its first few years. NIDCD has continued to update or rewrite its Plan on a regular basis.

The NIDCD Strategic Plan (Plan) serves four purposes:

    1. It helps the Institute to prioritize its research investment;
    2. It informs the nation’s scientists of emerging areas of opportunity for research and provides them with guidance as they formulate their own research plans;
    3. It informs persons with communication disorders and their support organizations of research accomplishments and potential future breakthroughs;
    4. Finally, the Plan shares research progress and areas of future research opportunity with the public.

The goals listed in the NIDCD Strategic Plan were selected by experts as research areas that present the greatest scientific opportunities and public health needs over the next five years. The Plan is not a comprehensive list of all research areas that NIDCD is currently supporting or plans to support in the future. Basic and clinical research being supported by NIDCD will continue to be given high priority. The NIDCD is committed to supporting new, innovative, hypothesis-driven, meritorious research, which can lead to improving the health of individuals with communication disorders.

To develop the 2012-2016 Plan, NIDCD convened a series of working groups and solicited input from scientific experts, the National Deafness and Other Communication Disorders Advisory Council, NIDCD staff, and the public. In consultation with communication research scientists and the public, NIDCD identified four Priority Areas that have the potential to increase our understanding of the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language and to further our knowledge in human communication sciences.

Within each Priority Area, the Plan lists emerging research opportunities identified as goals. A summary of the research goals for the Hearing & Balance portion of NIDCD’s three program areas is listed below [Editors' notes: Sections on Taste & Smell, and Voice, Speech & Language Research have been omitted; while each section of the Priority Areas has the full description from the Strategic Plan document added]:

Priority Area 1: Understanding Normal Function.  Deepen our understanding of the mechanisms underlying normal function of the systems of human communication. By defining what is normal in both animal models and humans, we can better understand mechanisms of disease.

  • Development of the Auditory and Vestibular System: Identify the molecules and genes involved in development of the peripheral and central auditory and vestibular pathways. Understand how auditory neurons recognize and establish tonotopic organization.
  • Homeostasis and Microenvironment: Increase understanding of homeostasis in the inner ear (e.g., ionic composition and maintenance, inflammatory response and toxin elimination, blood-labyrinth barrier, microcirculation, hormonal and other control systems) and in the middle ear (e.g., gas exchange, fluid regulation, innate immunity, and gene expression).
  • Mechanics: Expand knowledge of mechanics in the cochlea (e.g., interaction of hair cell membranes and sterocilia with supporting structures); in the middle ear (e.g., resolve important issues of middle ear mechanics, including tympanic membrane/ossicular coupling and the role of non-piston-like modes of stapes motion); and in the vestibular system (e.g., cupular and otolithic maintenance of posture and equilibrium).
  • Sensory Cell Transduction: Identify the molecular constituents of hair cell transduction: nanomechanical properties, molecular motors in hair cell membranes and stereocilia, ion channels and pumps; and their integration for hair cell tuning and maintenance.
  • Cochlear Amplification: Identify molecular determinants responsible for the biophysical traits that influence amplification, including the basis of its fast kinetics; delineate roles of stereociliar vs. somatic mechanisms in mammalian cochlear amplification; determine roles of amplification in low and high frequency regions of the cochlea; refine mathematical models of amplification and outer hair cell function.
  • Functional Connectivity: Clarify how afferent and efferent neural circuits process auditory and vestibular peripheral input. Understand how coding schemes influence plasticity and enable attention, cognition, and stress. Incorporate advanced techniques of functional and structural neural imaging and connectivity, ranging from molecular to systems scale.
  • Perception:
    • Auditory System: Determine how sound detection, discrimination, and recognition interact with learning, memory, and attention as well as with vision, tactile sensation, and balance to better understand auditory perception in real-world listening environments.
    • Vestibular System: Determine how vestibular, visual, and proprioceptive (the sensing of motion or position) systems interact to perceive space and motion and to maintain orientation.

Priority Area 2: Understanding Diseases and Disorders.  Increase our knowledge of the mechanisms of diseases, disorders, and dysfunctions that impair human communication and health. Understanding mechanisms that underlie diseases and disorders is an important step in developing better prevention and treatment strategies.

  • Epidemiology: Investigate natural history; genetic and environmental risk factors; racial, ethnic, and gender differences; and practical objective metrics for subpopulations to inform the development of evidence-based treatment strategies. Explore how complex comorbidities create differences in disease phenotypes and treatment outcomes.
  • Inherited Disorders: Identify gene mutations responsible for congenital and age-related deficits, understand structural consequences of such mutations, and develop high-throughput platforms for testing individuals. Understand how specific mutations relate to the severity and progression of disease. Investigate protein function to inform better prevention and treatment strategies.
  • Otitis Media: Improve understanding of susceptibility and pathogenesis related to genetics, prior upper respiratory infection, eustachian tube dysfunction and reflux, bacterial biofilms, polymicrobial infections, inflammatory dysregulation, and mucosal hyperplasia. Define immune pathways for effective middle ear protection by vaccines. Determine impact of vaccination on disease prevalence and infection by other microbes.
  • Inflammatory and Autoimmune Responses of the Inner Ear: Identify and characterize first responders to injury in the inner ear. Determine how molecules and cells cross the blood-labyrinth barriers to initiate immune response and autoimmune disease. Identify genetic and epigenetic risk factors. Investigate innate and cognate immunity in resolution of OM.
  • Tinnitus: Develop new animal models to understand the specific neural deficits responsible for tinnitus.
  • Other Acquired Disorders: Improve understanding of the pathogenesis of noise-induced, traumatic, idiopathic, ototoxic, neurotoxic, metabolic, and non-hereditary degenerative auditory and vestibular dysfunction. Improve delineation of the multiple processes resulting in presbycusis. Relate molecular, cellular, and structural (e.g., temporal bone research) otopathology to the clinical progress of disease.
  • Pathways and Damage: Determine how the peripheral and central auditory and vestibular pathways are reorganized following injury. Define the long-term changes resulting from early sensory loss. Identify molecular, genetic, and anatomical underpinnings of plasticity. Relate functional deficits to specific lesions in the pathways.
  • Changes in Perception with Disease:
    • Auditory System: Identify sources of variance contributing to large individual differences in response to similar intervention strategies among people with hearing loss. Improve understanding of the time course, sensitive periods, and complications of hearing loss
    • Vestibular System: Understand how disease affects perception of motion and spatial orientation, including connections with limbic and autonomic systems.

Priority Area 3: Improving Diagnosis, Treatment, and Prevention.  Develop, test, and improve diagnosis, treatment, and prevention of diseases, disorders, and dysfunctions of human communication and health. Diagnosis considers normal function and provides targets for prevention and treatment. Improvements in prevention and treatment lead to better outcomes with fewer side effects.

  • Regeneration: Develop in vitro systems to identify genes and factors that promote regeneration of specific cellular phenotypes (e.g., hair cells, supporting cells, spiral ganglion neurons, cells of the stria vascularis); understand factors that regulate hair cell regeneration; and determine which genes and extracellular factors control cell-specific differentiation.
  • Pharmacotherapeutics: Develop targeted delivery of viral vectors for gene therapy and site-specific, controlled, sustained molecular therapy for both developing and dysfunctional pathways. Develop therapies to improve neuronal stimulation, resist cell damage, and enhance cell repair.
  • Tinnitus: Apply advanced imaging techniques to provide measures of changed neural activity in people with tinnitus. Identify pharmacologic agents to prevent tinnitus resulting from traumatic, ototoxic, degenerative, and other acquired disorders. Identify behavioral, pharmacological, surgical, and device-based treatments for improving tinnitus.
  • Otitis Media: Develop polyvalent vaccines for polymicrobial middle ear infection. Develop new drug delivery systems to the middle ear to prevent development of, enhance innate immunity to, and speed recovery from inflammation. Develop therapies to prevent and treat biofilms.
  • Interventions for Hearing Loss:
    • Examine existing and develop better aural rehabilitation strategies. Investigate how aural rehabilitation strategies are affected by treating comorbid conditions that influence success, such as dementia, diabetes, osteogenesis imperfecta, and stress.
    • Traditional (external) Hearing Aids: Improve device performance in background noise and other real-world settings.
    • Cochlear Implants: Improve efficacy of bilateral implants, short electrode implants, and hybrid cochlear implant/hearing aids in the same or opposite ear in conjunction with auditory/aural rehabilitation, assistive electronic devices, sign language, in home and educational environments. Improve prediction of outcome and maintenance of outcome over time.
    • Other Implants: Improve efficacy of partially and fully implantable middle ear devices, round window transducers, bone-anchored devices, ABI, and other brain implants.
  • Interventions for Dizziness and Balance Disorders:
    • Develop safer, better tolerated, and more effective pharmacological treatments for vertigo.
    • Develop vestibular prosthetic devices and minimally invasive surgery for better control of imbalance and vertigo while preserving hearing and other functions.
    • Develop improved behavioral approaches for the rehabilitation of chronic vestibulopathies.
    • Develop improved methods of systematic diagnosis and delineation of subtypes of dizziness/vertigo in order to identify subpopulations that might respond best to targeted therapies.
    • Understand post cochlear implantation dizziness and the connection with vestibular migraines.
  • Metrics:
    • Hearing Disorders: Develop metrics that better define functional hearing and communication abilities under real-world listening conditions; differentiate clinical subtypes of hearing disorders; identify early pathology in its preclinical stage; provide better measures of performance, communication skills, and disease-specific quality of life instruments for cochlear implant users; and improve assessment of the perception of, and reaction to, tinnitus.
    • Balance Disorders: Develop metrics for the perception of equilibrium, dizziness, vertigo, and spatial disorientation with emphasis on relationships among disequilibrium, emotional disabilities, and cognitive disabilities.
    • Identify common data elements to improve communication among scientists and clinicians across different specialties.
  • Management of Older Adults: Improve hearing loss management, including screening, treatment, and rehabilitation. Define the underserved population of older adults for hearing health care. Determine if early access to hearing health care changes health outcomes later in life. Develop and evaluate the effectiveness of screening methods. Reduce risk of falls in older adults due to imbalance. Develop assistive balance aids and training programs to augment stability and posture in the elderly.
  • Clinical Trials and Other Clinical Research Studies: Develop and implement infrastructure to identify 1) investigators with expertise in epidemiology, clinical trials, data registry, and other clinical research and 2) academic- and community-based clinical practice settings with geographic, racial, and ethnic diversity in order to facilitate rigorous, cost-effective clinical research and maximize human subjects protections.
  • Emerging Technologies (including Bioengineering, Nanotechnology, and Neural Prostheses): Capitalize on emerging scientific advances and technologies from nanoscience, biomedical engineering, and other areas to improve treatments and develop novel devices that support impaired function.
  • Training: Promote the cross training of basic scientists, clinician scientists, and physician scientists to facilitate the development of interdisciplinary research teams and to stimulate translational research.

 

  • Priority Area 4: Improving Outcomes for Human Communication.  Accelerate the translation of research discoveries into practice; increase access to health care; and enhance the delivery, quality, and effectiveness of care to improve personal and public health. Scientifically validated prevention and treatment models will lead to better personal and public health only if they are translated effectively into routine practice.
    • Hearing Health Care: Identify factors that influence a person’s motivation and perceived need for hearing health care. Examine the impact of organization, financing, and management of health care services on the delivery, cost, access to, and outcomes of services. Develop innovative delivery systems, including telehealth and the Internet, to increase awareness, access, and affordability. Identify cost-effective approaches for diagnosis and treatment.
    • Comparative Effectiveness Research and Evidence-Based Medicine: Through clinical trials and epidemiological comparative effectiveness research, identify best treatments for a given medical condition for a defined set of individuals. Develop and use clinical registries, clinical data networks, and other forms of electronic health data to inform the conscientious, explicit, and judicious use of current best evidence in making decisions about hearing health care options.
    • Implementation and Dissemination Research: Investigate effective implementation of “best practices” among health care providers to translate advances into routine community practice. Increase the effective dissemination of health information to the public to promote healthy behaviors.
    • Community-Based Participation in Research: Promote community-based research to identify factors that influence outcomes for people with hearing and balance disorders in diverse real-world settings. Engage deaf and HoH individuals in community-based research to aid in developing behavioral interventions to improve their quality of life. Develop methods to address communication disorders in diverse populations, considering variations in care and practice settings.

We at The Hearing Blog are happy to mirror at these links the PDF files for both the Strategic Plan and the Executive Summary~

March 22, 2012

My new $25 Auditory Neuropathy/Dys-synchrony Sniffer (Madsen ZS76 Tympanometer)

Filed under: Audiologic Test Gear,Auditory Neuropathy Spectrum Disorder,Madsen ZS76 Tympanometer,Sam Lybarger,Stapedial (middle ear muscle) reflex,Tympanic membrane compliance,Tympanometry,Uncategorized — Tags: , , , , — Dan Schwartz @ 6:16 pm

This is a two-part story on me scoring a working clinical tympanometer for $25… And why it’s such a valuable tool for both detecting  Auditory Neuropathy Spectrum Disorder, and also for adjusting & troubleshooting hearing aids.¹

One of the big mistakes I made when I closed my hearing aid dispensing lab in 1995 was letting go of my Rexton I-28 tympanometer (impedance bridge), as it was providing valuable auditory neuropathy/dys-synchrony diagnostic information — But I didn’t recognize it at the time… Nor in fact, did almost anyone else in the hearing care profession.  More on this in an upcoming article on auditory neuropathy spectrum disorder.

So, recognizing the need to add a clinical tympanometer back into my arsenal against hearing loss, I had been combing the pages of eBay for another I-28, or maybe something a bit newer (and nicer), to find something that I could properly test stapedial reflex thresholds again. (These are also called middle ear muscle reflexes or acoustic reflexes.) Besides searching for tympanometer  I was also combing through impedance  looking for a mis-labeled bargain, when this gem popped up:

Madsen Impedance Audiometer ZS 76 1B

Madsen Impedance Audiometer ZS 76 1B (click to enlarge in a new window)

Headset from Madsen Impedance Audiometer ZS 76 1B

Headset from Madsen Impedance Audiometer ZS 76 1B (click to enlarge in a new window)

Up for your bid is a Madsen Impedance Audiometer ZS 76 1B. It is in overall good shape as shown in the pictures. There is some wear here and there as expected. The case has some writing on it and the top looks like something dribbled down it leaving a light stain. The unit and case will need a light cleaning by the new owner. When the unit is plugged in the light came on as shown. The knobs seemed to turn easily. The one red light to the left of the db meter did not come on but it might be because of the settings of the unit at the time. When I put the headphone on my ear I did hear some noise coming out of it but not alot. There again it may be the settings of the unit. Please note: I know nothing about these so you are buying it “as is”. This is why I listed it as for parts and repair. It may work fine but I don’t know. My loss is your gain. Please feel free to ask any questions you have before bidding and I will try to answer them. Thank you for looking and your bid.

Well, I’m an Electrical Engineer, and I figured that if the seller couldn’t figure out how to use it (there was no manual), there was a either a chance that it indeed worked, or that if it wasn’t working, at least I could use my voltmeter & ‘scope to take a shot at fixing it. Well, guess what folks? It works! So, all that is left to do is get a 1.0 cm³ calibrator cavity (or have my machine shop make one), get some eartips, and I’m off to the races. There is one modification I’ll most likely add: Although I don’t test infants, the 226 Hz probe tone has too long a wavelength to use for tiny ears, so I’ll splice in a 1000 Hz oscillator, to give me that capacity.

Not too shabby for a total of $39.52, including shipping to my door.

Footnote:
1) Now, about my statement on  using a tympanometer for adjusting & troubleshooting hearing aids: As it turns out, one trick taught to me many years ago (I think it was by the late Sam Lybarger) is to measure the acoustic reflex thresholds, and use those figures to set the instruments’ SSPL-90 (now called MPO), on the theory that you don’t want to have the hearing aid output constantly triggering the stapedial reflex, as it is tiring to the patient. The fact that this is now being done to set C/M levels on CI’s for infants & others who can’t report back, as described here by my friend Ed Overstreet PhD, appears to validate this tried-and-true concept~

March 18, 2012

ANSD 2012 Conference: Variation in Detection and Discrimination Abilities in AN/AD: Implications for Management

Filed under: Auditory Neuropathy Spectrum Disorder,Uncategorized,Variation in Detection and Discrimination Abilities: Implications for Management — Tags: , — Dan Schwartz @ 2:47 pm
Linda Hood PhD (right)

Linda Hood PhD (right)

At the ANSD 2012 Conference in St Pete on Friday, March 16th, Professor Linda Hood PhD presented on the Variation in Detection and Discrimination Abilities in AN/AD, and the Implications for Management. You can download her presentation here.

ANSD 2012 Conference: Hyperbilirubinemia and Bilirubin Induced Neorological Disease (BIND)

Filed under: Auditory Neuropathy Spectrum Disorder,Hyperbilirubinemia and Bilirubin Induced Neurological Disease (BIND),Uncategorized — Tags: , , — Dan Schwartz @ 1:57 pm

Steven Shapiro MDAt the Auditory Neuropathy Conference 2012 in St Pete on Thursday morning, we had a very interesting presentation by Steven Shapiro, MD on Hyperbilirubinemia and Bilirubin Induced Neurological Disease (BIND). Dr Shapiro is with the Division of Neurology in the Department of Pediatrics, at Children’s [sic] Mercy Hospital, which is part of the University of Missouri-Kansas City. You can download the handout here (5MB PDF file)

March 13, 2012

Auditory Neuropathy Spectrum Disorder Conference 2012

Filed under: Auditory Neuropathy Spectrum Disorder,Auditory Therapy,Cochlear Implant,Education,FM Assistive Devices,Uncategorized — Tags: , , , , , — Dan Schwartz @ 11:56 am

Diagnosis and Management of Auditory Neuropathy Spectrum Disorders Conference, All Children's Hospital, St Pete, Florida

We’ll be live blogging from the upcoming Conference on the Diagnosis and Management of Auditory Neuropathy Spectrum Disorders (ANSD), hosted by USF Professor Charles Berlin and Vanderbilt Professor Linda Hood, this Thursday through Saturday March 15th through 17th at All Children’s [sic] Hospital in St Petersburg, Florida.

Topics covered include:
• Results and Outcomes from more than 500 ANSD Patients
• Hearing Aids vs. Cochlear Implants
• Cortical Evoked Potentials
• Newest Developments in Trans-Tympanic ECochG
• Speech Language Management

You can follow developments on Twitter by using the #ANSD hashtag & by following @ANSD2012

On the docket are the following sessions: Just click the links below for the separate blog entries, as they become available…
Thursday:
• The Pathophysiology and Clinical Presentation of Auditory Neuropathy/Dys-Synchrony, by Charles Berlin PhD
• Hyperbilirubinemia and Bilirubin Induced Neurological Disease (BIND), by Steven Shapiro MD
• Sample Case Presentations and Discussions, by Courtney Oliszewski AuD, Sybil Faylo AuD & Bridget Rickman AuD
• Differentiating ANSD from Central Auditory Processing Disorders and the Use of Cortical Evoked Potentials in ANSD, by Thierry Morlet PhD
    For more on cortical potentials as discussed, please see Cortical Reorganization and Cross-Modal Plasticity in Children with Cochlear Implants: Clinical Implications by Dr Anu Sharma
• Cochlear Implants in Infants & Children with ANSD, by Kirsty Gardner-Berry PhD
    [Kirsty is coming all the way from Sydney Cochlear Implant Center, and we are looking forward to hearing her views on the Nucleus vs HiRes 90k vs i100 implant circuits.]

Friday:
• Genetics of Hearing Loss in General and auditory neuropathy/auditory dyssynchrony (AN/AD) in Particular, by Melissa Crenshaw MD
• Hands-on Practice Session in Otoacoustic Emissions (OAE) and Auditory Brainstem Response (ABR) Testing, by Kathy Slifer AuD
    [We're looking forward to this one, and will have pictures.]
• Pediatric Grand Rounds: Hyperbilirubinemia, by Steven Shapiro MD
• Variation in Detection and Discrimination Abilities in AN/AD: Implications for Management; by Linda Hood PhD
• Managing Infants with ANSD During the First 12 Months of Life – Let’s Not Just “Wait & See,” by Kirsty Gardner-Berry PhD

Saturday:
• The All Children’s Hospital Cochlear Implantation Process, Selection and Management, by Peter Orobello MD, Kathleen Wasylik MD, Anne Oliver MA, & Shelly Ash MS
• Hearing Aids, vs. Monaural vs. Binaural Cochlear Implantation Results in Speech and Language Acquisition, by Susan Spirakis AuD
    [We're looking forward to this one too, and will have questions regarding differing findings from Mike Dorman & his bimodal studies.]
• Little Patient, Big Doctor: My Journey and Experiences with Big Doctors vs Children as Patients, by Haleh Rabizadeh-Resnick JD
    [Haleh was the subject of the controversial report   Don't let a doctor destroy your baby's hearing on CNN]

   

March 10, 2012

Dangerous new young adult trend on hearing loss vs technology

Filed under: Education,Teenage hearing loss,Uncategorized — Tags: — Dan Schwartz @ 9:39 am

 

Update: The New York Times weighs in with a front page story (more below)

We’ve known for decades that loud music causes permanent, irreversible sensorineural hearing loss, and since time immemorial teens have always had a sense of invincibility.

However, there’s a very important — And dangerous — new trend we’re seeing with today’s youth: Watch this video produced by high schoolers, paying close  attention to the boy at 0:58 & girl at 1:18. You’ll see that these two teens have the attitude that “technology will fix the problem” …And that they are somewhat correct.

 

When you look at what these kids see in their daily lives, with the sophisticated technology in their latest iPhones, software, cars, and medical devices such as Bluetooth-enabled hearing aids, their optimism of technology addressing noise-induced hearing loss is not irrational — And that perception is causing teen deafness at an alarming rate, with the latest studies showing an increase from 14.9% in 1994 to 19.5% — That’s one in five – by 2006, according to this robust study in JAMA.

Hat tip to Mimosa Acoustics for pointing out this surprisingly insightful video, originally published here.

July 28, 2012 UPDATE: The New York Times weighs in with Working or Playing Indoors, New Yorkers Face an Unabated Roar:

The New York Times published an excellent front page story on July 19th on the causes and effects of recreational noise in the Big Apple, such as in restaurants, gyms, clubs, and with iPods. This well-researched article follows up on the excellent February 2010 story in the Wall Street Journal titled Pass the salt… and a Megaphone, which detailed why restaurant designers and managers are using “New Design Styles, High Ceilings and Hardwood Floors [which] Are Making Restaurants Noisier;” with the NY Times story connecting the dots between these noisy new venues and noise-induced hearing loss.

On page two of the online NYT article, we find another example of this dangerous new trend that “technology will fix it” in this quote:

One waiter at Lavo, who, like several other workers, did not want his name published for fear of losing his job, said he knew his hearing could be in jeopardy. But, he reasoned, slight hearing loss was inevitable, since he had also played in a band. “When it happens, it happens,” he shrugged. “Hopefully by that time they’ll have better fixes for it.”

Just how bad is the recreational noise level at Lavo, at 39 East 58th in Midtown Manhattan? Check out these first three paragraphs of the NYT story:

The waitress’s lips were moving but nothing seemed to be coming out. Hundreds of voices swallowed her words as a D.J. pumped out a ticka ticka of dance beats. The happy hour-fueled din rose with it, amplified by tin ceilings and tiled walls.

“I’ve been getting migraines,” the waitress shouted on a recent Thursday night, leaning in to be heard. She said that she woke up with her ears buzzing, and that her doctor had recently prescribed seizure medicine: “It decreases the amount of headaches you get.”

The restaurant, Lavo in Midtown Manhattan, is not just loud but often dangerously so. On that night, the noise averaged 96 decibels over the course of an hour, as loud as a power mower, and a level to which, by government standards, workers should not be exposed for more than three and a half hours without protection for their hearing.

 

February 27, 2012

Is your infant, child or adolescent hearing impaired? Take the quiz!

Filed under: Pediatric hearing loss,Uncategorized — Tags: , , — Dan Schwartz @ 5:27 pm

For those of you who suspect a child from age 4 months to 12 years has a hearing or listening difficulty,  the free Early Listening Function (ELF;  4 months to 3 years), and the Childrens’ Home Inventory for Listening Difficulties (CHILD; 3-12 years) Discovery Tools  for parents and caregivers are short questionnaires to fill out that can provide answers, and guidance on how to ask for help.

You can download ELF (4-36 months) here, and download CHILD (3-12 years) here, both as PDF files.

• The CHILD questionnaire focuses on the parents’ role in the observation and monitoring of their childs’ listening behavior. The 15 items in this questionnaire represent typical family communication situations at different distances and in background noise. The CHILD tasks relate to dynamic communication situations and is appropriate for use with children aged from 3 – 12 years. The parent uses an eight-point scale to estimate the childs’ listening ability. Adults carrying out the tests check the childs’ response to both speech in different environments and to other important sounds such as an alarm clock. Apart from providing the hearing care professional with vital information regarding the effectiveness of hearing aids, the CHILD also represents a reality check regarding the communication challenges the child is facing in daily life. If a child is having difficulty communicating in background noise or when speech is at a distance at home, this could underscore the need for an FM assistive system included in the IEP or 504 to improve the “listening ease,” especially when the child enters school. The CHILD questionnaire can also be used to compare different hearing instruments and settings for effectiveness.

• The second questionnaire, the ELF, defines 12 contrived listening activities that parents and caregivers present in the home environment and then observe the responses of their children aged from 0 – 3 years. The object of these activities is to elicit child responses to quiet, typical and loud sounds in order to discover the individual child’s hearing range or “listening bubble:”

The 'Listening Bubble' as described in the Early Listening Function (ELF) test

An example of a quiet activity is rubbing together the palms of the hands or saying ‘sh, sh, sh’ out of the childs’ view, while noisy activities include knocking loudly on a door and speaking in a loud voice. The user-friendly questionnaire allows the parent or caregiver presenting the activities to monitor the child’s response at various distances from the sound’s source and to rate this on a simple, three-tier scale. As the adults observing the responses gain experience and confidence, they are able to better understand the effects of hearing loss on their child’s access to communication in the home. When the ELF results are shared with the audiologist the information will be invaluable to ongoing effective audiological management and validation of the hearing aid fitting

ELF was developed by Karen Anderson PhD and CHILD was developed by Anderson and Joseph Smaldino PhD stimulate the secret ingredient of successful pediatric intervention: Parental involvement

The questionnaires are also mirrored  on The Hearing Blog here for ELF and for CHILD.

We thank Oticon USA for sponsoring the publication of ELF and CHILD, and we thank AudiologyOnline.com news for some of the material used in this article~

February 17, 2012

Advanced Bionics website hacked for over 24 hours

Filed under: Advanced Bionics corporate security,Uncategorized — Tags: — Dan Schwartz @ 10:34 am

Go to the Advanced Bionics main website (http://www.AdvancedBionics.com) and then in the lower right corner, click on the Country selector, and choose Singapore. (or, click this link to go directly to the  http://www.AdvancedBionics.com.sg page). Pretty ugly, ehhh? What’s worse, this has been going on now for at least 24 hours.

The Hearing Blog takes this very seriously, as does the United States Food & Drug Administration (as well they should): This is a corporate website for an implanted medical device manufacturer; and if it has been breached, this is a Very Serious Matter, as once breached, what documents have been viewed, destroyed, or altered by malware planted inside the firewall rings of protection. We are calling on the FDA to order that a complete audit of the Advanced Bionics corporate IT system be conducted, as besides the defacement we do not know what other damage has been done.

We originally saw this yesterday morning, and got a chuckle out of it, as did others who saw my post on Facebook pointing it out… In fact, we wrote a friend joking that if we did this, it would be the booking photo of Sonova CEO Andy Rihs when he was arrested last year by Swiss authorities for insider trading. CI advocate Rachel Chaikoff said she sent a few e-mails to AB; and we figured that the Sonova  corporate IT security department would have jumped on this, and patched their server & firewall holes… especially since they are part of a $6 billion Swiss conglomerate; and this was on a weekday. However, “on further review” when we saw this security breach continuing for over 24 hours showing poor IT security, we here at The Hearing Blog are now calling on the FDA to take action, as among other things, HIPAA patient privacy laws may have been broken.

This is a screen capture of the Advanced Bionics Singapore home page, as of about 9:30am EST on Friday, February 17, 2012 (click to enlarge):

Screen capture of the Advanced Bionics website hack, 9:30am EST 2/17/2012

Screen capture of the Advanced Bionics website hack, 9:30am EST 2/17/2012

Short link for this post: http://TinyURL.com/AB-webhack

February 10, 2012

Rarefaction and condensation… or should it be compression?

Filed under: Acoustical wave propagation,Acoustics,Audio Engineering,Physics,Thermodynamics,Transmission Line Loudspeakers,Uncategorized — Tags: , , , , , , , — Dan Schwartz @ 1:44 pm

One annoyance I’ve had for over three decades is the use of the term “condensation” (the opposite of rarefaction) when describing acoustic wave propagation in gaseous fluids. Instead, I’ve always preferred the term “compression” instead of “condensation,” as it more accurately describes the thermal process taking place, whether the propagation is taking place in an isothermal (P*V)=constant or more commonly adiabatic (P*V)γ=constant thermodynamic process; where γ = 1.4 for an adiabatic process, and unity for an isothermal (such as an ideal gas law) process, with the exponential notation typically omitted.

My reason for this change is that the term “condensation” implies a phase change from gas to liquid, such as occurs  in a condenser in a refrigeration circuit or boiler steam circuit. Since (in most cases) we are dealing with adiabatic propagation, the temperature actually increases when gases are compressed, moving away from the phase change curve.

For the less common case of isothermal propagation, such as through fiberglass insulation, then condensation could (theoretically) occur; however, I would still prefer to call it “compression” as even at the linearity limit of an acoustic wave of 194 dB intensity (which is 14.7 psia or 1000 millibars), gas → liquid phase change will not occur… But it will be guaranteed to rupture your eardrums. [Hat tip to Wayne Staab PhD for pointing this out.]

Update: It turns out I’m not the only one using this terminology: While looking through the Audio Related Things page of the late Georgia Tech Electrical Engineering Professor W Marshall Leach, I ran across  An Electroacoustic Analysis Of Transmission Line Loudspeakers, the 2007 Georgia Tech PhD thesis by Robert Allen Robinson Jr of which Dr Leach was one of the advisors. Dr Robinson too uses the “rarefaction and compression” nomenclature throughout, including on page 100 (PDF page 117). Here’s an animation of the process:

compression-rarefaction animation

Compression -- Rarefaction Animation

 

Adiabatic and Isothermal descriptions

 

As a side note, loudspeaker engineers trained by Georgia Tech professors Eugene Patronis &/or W Marshall Leach (both Fellows of the Audio Engineering Society) will quickly recognize that the way to increase the box volume of a loudspeaker is to pack it with fiberglass for a volume increase of about 1.2x (using a  γ ≈ 1.2), as the acoustic waves will propagate in a manner in between adiabatic and isothermal… At the expense of lowering box Q, which is Not Good for the unassisted 4th order vented response. Of course, you can pack your cabinet with steel wool for a  γ approaching 1.4, but then it gets messy with the driver magnet. For a more thorough discussion on this, including frequency dependence and derivation, please see pages 100-101 (PDF pages 117-118) in  An Electroacoustic Analysis Of Transmission Line Loudspeakers, the 2007 Georgia Tech PhD thesis by Robert Allen Robinson Jr~

February 7, 2012

Frustration with so-called “minimal” hearing loss (updated)

Filed under: Central Auditory Processing Disorder (CAPD),HLAA Convention,Minimal hearing loss,Single-Sided Deafness,Songbird FlexFit,Starkey AMP,Tinnitus,Uncategorized — Tags: , , , , , , , — Dan Schwartz @ 3:47 pm

UPDATE: Please see the new item below about an audiologist for a hearing aid manufacturer in footnote 4

Better Hearing Institute  director Dr Sergei Kochkin had an interesting reply to Jason Galsters’ What motivates hearing aid use:

“So many of the people with hearing loss have mild hearing loss and are simply not candidates for amplification.“

We don’t buy that statement, for two reasons:

(1) When a person walks through the Hearing Aid Professionals’ doorway, this individual realizes they have an issue with understanding spoken communications. We give them a free, quick hearing threshold test & speech test in quiet, discover they have 10-15dB average thresholds, and then send them on their way with a pat on the head, telling them “too bad, your hearing loss isn’t bad enough to qualify for hearing aids” …And who can blame them, as there’s a fear of a reprimand from a licensing board for selling hearing aids when there’s no benefit? (But, more on this in a few moments).

But wait a minute! The person has a problem communicating, and the salient question should be, does the minimal peripheral screening test detect the cause of the difficulty? And the answer is a resounding NO: Do we screen for auditory neuropathy (ANSD) by running a stapedial reflex threshold (SRT) test, or at least a speech-in-noise (QuickSIN or HINT) test? Do we screen for auditory processing disorders (CAPD)?  Do we screen for outer hair cell integrity using otoacoustic emissions (OAE)?

Bueller? …Bueller? …Bueller?…

(2) Led by the surprisingly good Songbird FlexFit hearing instrument and followed up by the Beltone First Step  program  and Starkey with the AMP micro canal hearing aid (nice work, Jason!), these people are bypassing the barrier thrown up by the dispenser or audiologist and getting the help they need.

Sergei, here is my question for you, as the “Keeper of the MarkeTrak industry statistics:” Of the many thousands of Songbird instruments sold every month, I wonder what percentage of people are motivated to buy who have already had “free” screenings & have been told “Sorry, your hearing loss isn’t bad enough for hearing aids?” I have actually seen people with a PTA of almost 20dB with thresholds @3-4k of 30dB being told those dreaded words. [And parenthetically to our severely deaf readers, how many have you been told that you aren't "deaf enough" to qualify for cochlear implants, and left to struggle with the help you need but is just out of reach?]

Many years ago at the NJHAA convention  (during my first stint as a Hearing Care Professional 1985-95), Dr Bob Martin alerted me to these issues, and he raised the points above. In addition, he pointed out that some of the problem goes back to the the whole concept of “Audiometric Zero,” which is no more than a statistical average of what “normal” hearing is, based on the landmark work by Bell Labs of Fletcher & Munson at the 1939 Chicago World’s Fair. But, as any of us who has tested kids & teens knows, we often see -5 & -10dB thresholds, and as “Dr Bob” pointed out, if a person had a -10dB threshold at, say, 1kHz & it’s now +15dB, that’s a 25dB drop that the brain has to deal with.

BENEFIT:

Now, let’s circle back around to the issue of benefit I raised early on in section (1): What do we do with this population with a communication handicap more severe than the screening audiogram indicates, like with my colleague, speech pathologist Martha, who was having all sorts of problems in restaurants & meetings? (Some of you may have met Martha at the Hearing Loss Ass’n of America 2010 Convention in Milwaukee, as she was my co-presenter on (class)room acoustics). Her thresholds are in the 10-15dB range, not “deaf enough” for hearing aids. She knew, however, from her audiology training she has a problem, and that it needed addressing. Same for my friend Jenifer, whom I counseled to go to the nearest Miracle-Ear: The audiologist told her the same thing: “She doesn’t qualify.” But for both ladies, it left their communication problems unaddressed.

Noted longtime audiologist and textbook author  Wayne Staab PhD weighs in with this quote in Hearing aids: Who needs ‘em?  in Hearing Health Matters:

Dr. Staab, who’s been practicing audiology since the 1960s, points out that a person’s decision to get hearing aids is “never based on the degree of hearing loss, but only on the degree of ‘hurt. If the hurt is not great enough psychologically, emotionally, economically, or socially, there is no justification for hearing aid use.”

Elaborating, Wayne says that in the farming and ranching country where he comes from, older people often have treatable hearing losses as defined by their audiometric thresholds. However, they but don’t hurt enough to feel the need for hearing help. Why is that? It’s often a matter of lifestyle, he explains. For example, he says, “Many farmers live with their spouses, they speak with them from fairly close distances, and they use their television volume controls as their hearing aids.” In other words, they hear well enough for the way they live.

Sometimes, it works the other way, Wayne adds. He has fitted people with “normal” hearing thresholds because they weren�t satisfied with their unaided hearing. [Emphasis added: DLS]

What I counseled both ladies to do was order a Songbird (1 for Martha, 2 for Jen), as they have a 45 day free trial, take it out for a spin in meetings, restaurants and  the cafeterias, and see if it actually helps clear up their communications problems. [I believe this is ethical, because both ladies had been screened for diseases by the school district audiologist & Miracle-Ear audiologist, respectively. Also, I felt comfortable because I had no financial interest in the initial Songbird trials to determine if there's indeed benefit.]

What happened with these two ladies?

Martha, who had audiology schooling, was so pleased, she went to a local audiologist & bought an Oticon Vigo, complete with the Streamer, which you saw her strutting around the Milwaukee HLAA convention, purchased even before the battery on her disposable Songbird died;

Jen was having an issue with fitting¹ but she was so surprised at what she was missing, she returned them in the 45 day free trial period, instead purchasing a pair of Starkey AMP micro canal hearing instruments to try, programmed at gain family 2, -4db in lows & +6dB in highs� And she immediately liked it right at the default volume of 3, of 5 volume steps. What’s more, I love the ability to remotely tweak her programs over the phone, which is a Really Nice Feature.

THE SALIENT QUESTIONS:

A) How many more people like Martha & Jen are there out there, who have a communications handicap that is missed by what the hearing aid professional checks for in the screening audiogram & speech-in-quiet tests?

B) How many of these people have purchased Songbird hearing aids²  or personal sound amplifier products  (PSAPs) to address their handicap after “passing” the dealer screening?

C) How many of these people are, in fact, part of the statistic of 33 million Americans with hearing problems? This has Major Implications for Market Trak, as if these people are in the universe of 33 million, the HA dispensing profession may indeed be *reducing* the universe of (33-8.4 = 24.6 million) candidates;

D) On a related note, this affects children as well as adults, as how many schoolchildren fall into this crack, and would benefit from FM or low gain HA’s in school, even if the classroom meets ANSI/ASA S12.60-2009 acoustical standards for reverberation time & background noise? For more on this, please see my comment about the twin problems of tinnitus  & “I can’t hear what the teacher is saying” that the supposedly “normal” hearing six year old daughter of my author friend Shanna Bartlett Groves‘  faces every day in Test The Ears You Love  on her Lip Reading Mom  blog.

CONCLUSIONS:

Many Americans with auditory communication challenges are taking the steps necessary to overcome them, but are being met by hearing aid professionals who rely solely on the screening audiogram and basic speech audiometry, which do not fully address the challenges the patients face, especially with respect to listening ease, and are turned away as not being “deaf enough.” Some of these people are resorting to over-the-counter hearing aids and other PSAPs with mixed results, while a few hearing aid professionals will go ahead & fit hearing aids; but as we’ve documented above, even when the audiogram says the patient won’t benefit from amplification, the patient deigns to disagree.

UPDATE:

After this article was published, we had the following e-mail conversation with a support audiologist for a hearing aid manufacturer after she read this article. Here is the exchange:

Audiologist: On a side note, I read your blog and couldn’t agree with you more.  In fact, I am one of those people whose perceived handicap does not match my “normal” hearing thresholds.

DLS: Incidentally, since you are “one of those people whose perceived handicap does not match my ‘normal’ hearing thresholds,”  do you (proverbally) “eat your own dog food?” Hitch up your NOAHlink, slip on a pair of [redacted] instruments, and play around some on yourself, especially with your streamer!

Audiologist: I have had the same thought, but have never actually used hearing aids.  Text messaging and closed captioning are my friend.  Your suggestion is a good one.  I just might try it.

 DLS: Ummm, if you’re using text messaging, that’s one thing; but if you’re using closed captioning, that’s a whole new ballgame. I’ll bet if you used Bob Sweetows’ LACE you’ll find yourself already a good speechreader.
What are your ipsi & contra reflex thresholds? Your QuickSIN (or HINT) scores? Have you ever been evaluated for ANSD? For CAPD?!
Hmmm, this could get interesting, especially if you plug in hearing aids & things do NOT improve.

See, this can happen to even a hearing care professional…

FOOTNOTES:

(1) Jen also had a minor issue related to eartip size vs need for venting, and needing more gain, which caused feedback. If she were local, I would have made a custom earmold with proper venting and use it instead.

(2) If it seems like I’m a fan of the Songbird FlexFit  hearing aids built right here in New Jersey, you’re right: Unlike the other over-the-counter “listening devices” from China you see on eBay & at WalMart with poor high frequency response, the FlexFit is unique in that when you look at the specifications  it is a real digital hearing aid with an ANSI S3.22-2003 response to 8kHz and an AGCi kneepoint of 67dB (click to enlarge):

Songbird FlexFit acoustical performance, with annotated graphs

Songbird FlexFit hearing aid acoustical performance. Please note my annotations on the graphs

 

(3) Here’s why I’m a Big Fan of the Songbird family… And it’s due to their RCA Sarnoff Labs connection.  As many of you who know, I was a Georgia Tech co-op Electrical Engineer at RCA-Camden in 1979 & 80; and while I was in the IRR project I had the privilege of spending time at the RCA David Sarnoff Research Center in Princeton, opened in 1942. Some of you who are older may have learned acoustics from the Labs’ Harry Olson, whom along with Leo Beranek wrote the textbook you used. The first time I walked into the lobby, I saw in a glass case the 1955 Emmy® trophy awarded to the labs for Color TV — One of twelve Emmy® Awards the Lab have received for everything from stereo TV audio to H.264 Digital TV. [If you're a technology buff, watch this amazing December1953 YouTube clip].  So, the next time you see a Songbird commercial, know that you can draw a straight line between the technology in that hearing aid and the TV you’re watching it on.~

 

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It’s been brought to our attention from several of our readers that they were having their comments rejected by the Akismet plug-in for WordPress as spam. This is unacceptable to us; and we are soliciting suggestions for a replacement. Unfortunately, we have to use something to screen for spam, as we were receiving over 100 spam comments per day at its’ peak. In the interim, to save retyping, we recommend selecting & copying all of your text to the clipboard: If your comment is accidentally rejected, simply paste it into an e-mail message, put “Rejected Comment” in the subject line, and send it to us at Dan@Snip.Net and we’ll manually post it for you~

September 26, 2011

New Research Shows Listening And Hearing Is Different For Children With Cochlear Implants

Filed under: Cochlear Implant,Education,Impact on Education,Uncategorized — Tags: , , , , , , , , — Dan Schwartz @ 12:14 pm

Cochlear implants allow profoundly deaf infants to hear speech, which, with proper auditory therapy, allows them to learn spoken language. However, this new study from cognitive psychologist Derek M Houston, PhD, associate professor of otolaryngology at Indiana University School of Medicine shows that the children receiving the implants don’t automatically know how to listen when people speak to them.

Research presented at the recent Acoustical Society of America research meeting showed that deaf babies with cochlear implants spent the same amount of time “listening” as normal-hearing infants of the same age. However, these children with implants spent less time listening than younger normal-hearing infants who had the same amount of hearing experience. Dr Houston said,

When infants are born deaf, their development is shaped by a silent world.  They learn to tune into the sights, smells, and touches that are relevant to them in their environment – but not the sounds. When they receive a cochlear implant, their world changes and is filled with sounds.  But for these infants who have already begun to adapt to their silent environment, sounds may not – at least at first – be perceived as relevant to them.

It has been well-established that infants will look longer at a simple display – the checkerboard pattern – when hearing something they are interested in.   I measured their ‘looking time’ at the pattern when it was paired with a repeating speech sound, and compared that to the looking time at the same pattern with no sound.

Houstons’ research revealed children with cochlear implants spent less time looking at the checkerboard pattern than children who could hear from birth. In addition, two years after implantation, children who were less attentive to speech early-on performed more poorly on a word recognition task. In other words, these infants and toddlers may hear the sounds around them, but not have any motivation to focus on them, which slows their ability to learn speech… And this can be traced for years through word recognition testing.

Furthermore, this research goes towards explaining why prelingually deafened children and adults have not developed a sense of danger to environmental warning signals: For example, they may hear a car horn while crossing a street, but it does not register in their brain properly, i.e. it does not trigger the instinctive danger reflex.

An abstract of Dr Houstons’ research is available at http://asa.aip.org/web2/asa/abstracts/search.may11/asa220.html

Short Link to this story: http://wp.me/p1mNFo-7c

Original source: Listening and Hearing, Not the Same for Children with Cochlear Implants







August 14, 2011

Dying to Hear Again… And She (Almost) Did [Reposted from The Telegraph (UK) Hearing Blog]

Filed under: Cochlear Implant,Kristin Fleig,Profiles,Re-posts from The Telegraph (UK) Hearing Blog,Uncategorized — Tags: , , — Dan Schwartz @ 6:54 am

Originally posted in The Telegraph (London) Hearing Blog on October 15th, 2009 17:14 BST

Dying to Hear Again… And She (Almost) Did

Kristin Fleig is one gutsy Kentucky girl. She gambled her life to break her curse of deafness once and for all, almost dying from other causes in the process.

The girl from Bardstown lost her hearing to meningitis as a baby in her left ear, while her right ear deafness is due to MYH9 Chromosome Mutation. This mutation affects the hearing, vision, and kidneys of the person who suffers from it. Kristin, unluckily, has problems with all three. Six years ago at age 13, she had a lifesaving kidney transplant; but by late last year [2008] it too had failed; and was then placed on the transplant list while undergoing dialysis three times per week.

Also, Kristin lost her hearing completely last year; and most cruelly, it happened the week of Christmas. Having worn a hearing aid in her right ear, she stopped, because she had no benefit from it; and then passed the tests to qualify for a cochlear implant on March 19th [2009], starting the ball rolling for her to hear again, including financing by Medicaid of Kentucky.

All was going reasonably well when I first met her in April of this year. In May, when an infection from dental work temporarily took her off the transplant list, Kristin made a gutsy call: She was going to stay off the transplant list until she could get her cochlear implant. That’s right: She chose continued dialysis, with all of the risks and many hours per week in a chair at a clinic. She essentially was betting her own life, to hear again. She did this because, of specific immune conditions, once she had the transplant, it would be at least three years before she could have the implant surgery, leaving her in total silence.

In early July, she was finally approved for the surgery; and was waiting for Dr. Gorden McMurry at Jewish Hospital in Louisville to schedule her for time in the surgical suite.

Disaster struck on the afternoon of Friday, July 16th,  when, during her dialysis, she threw a massive blood clot in her brain the size of the palm of a hand. Her condition was so tenuous, she had to be taken by medevac helicopter to the head trauma ICU in Louisville, where she stayed in hospital for 11 days in great pain, receiving well wishes from all across America, and from friends and strangers from as far away as Australia and the United Kingdom.

But, on August 18th, her dream finally came true: She got her shiny new Advanced Bionics CI surgically implanted into her skull & electrode array threaded into her cochlea; and was now on the path to hearing. As soon as she healed, she also put herself back on the transplant lists, and is waiting for that phone call telling her she has two hours to get to the transplant hospital for her new kidney.

Today on October 15th at 8:00AM EDT (1:00PM in London), Kristin goes to her CI audiologist Barbara Eisenmenger AuD to have the implant activated, during the “first stimulation” process. Finally, after months of silence, gambling (and almost losing) her life, she finally will taste success.

We at The Telegraph Hearing Blog have been watching this dramatic story unfold since April when we first met her; and in just an hour those first sounds will begin magically appearing in her head. We would like to welcome her back to the hearing world. It was one gutsy call by the kid from Kentucky, betting her life she can hear again. So, the next time you believe hearing isn’t that important, remember Kristin’s life-or-death gamble.~

Short URL to this entry: http://tinyurl.com/CI4Kris

UPDATE: Kristen posted this note on her Facebook page

I was activated today. I am “hot” as my friend calls it. It was a wonderful day despite the cold air and rain. I could hear some today, but it is mostly a “whistling” sound. I have heard some interesting things in the short time I have been turned on. First, I will tell you about the process then I will tell you what I have heard.

I arrived at the audiologist office this morning. I was taken back right away to the room. She put my CI on and did all her “fancy schmancy” work as I call it. BTW, she calls it the most boring of all the mappings. She fiddled around to set it up. She kept asking me to tell her where her voice was on the chart. The chart was numbered 1-10. Depending on the setting and her voice, that is what number it was. She said I was so low on the chart starting out, that it would be the reason for some of my “whistling”. She then turned it up and it was a little clearer. I could actually make out some words when she talked. It was interesting. After we practiced a little, she made me some programs. I have three programs that I am to work with for the next 10 days. I am to change programs when the one I am set on is not working (i.e. no sound or not hearing clearly). When I go back on the 26 she will see where I am at. After she made me some programs, she ask me to repeat 3 words. I did have some trouble repeating the words, but got 2 out of the 3. After that, she told me about my “box of goodies”. May I add that box has a lot of stuff and more for me to find room for. LOL! My Dri-Aid case is included. She told me to use it every other day or as needed. I will start using it tomorrow. Last step of the day was the sound booth. I got my first hearing test with my CI. The lowest I heard was 30 DB. She said it would get lower as we moved on. Over all it was a good day.

Now as to what I was hearing so far today. I have heard some interesting noises, condsidering that everything is constantly noisy for me at the moment. I have heard the dogs running, dogs scratching carpet, microwave beeping, mom’s voice, sister trying to get my attention, clicking of keys on keyboard, paper rustling, turning signal in car, car beeping when doors open, and my favorite thing of all water running. The audiologist office has a fountain outside, I heard it. I was so amazed. This is just the beginning soon it will get better.

That was my day today. I will be sharing more as I move on in my journey.

Kris

Kristin Fleig at 1st stim

Kristin Fleig

August 10, 2011

Less-than-honest NBC Today segment on hearing loss

Filed under: Education,NBC Today,Shelley Borgia AuD,Uncategorized — Dan Schwartz @ 2:00 pm

As an RCA Engineering alumnus, I’ve always had a soft spot for their NBC Division; and this sentimentality still exists to this day, even though Comcast now is the owner. Imagine my delight when my friend & crack Audiologist Dr A U Bankaitis posted this clip of a seven-plus minute segment on this mornings’ NBC Today show featuring an interview by Matt Lauer of hearing loss sufferer Jim McDade & his Audiologist Dr Shelley Borgia (e-mail) of Park Avenue Acoustics; and also of Lauer getting his hearing tested by her; and finally a “dog and pony” show of the various hearing instruments on the market:

 

…And much to NBC’s credit, the video is fully captioned: Thank you.

But, as I listened to it, something struck me a bit odd: Listen carefully to McDade speak in this clip:

 

 

Does something sound a little out-of-whack to you, too? Here is what was said:

Matt Lauer: 39-year-old Jim McDade is a true child of the 80′s growing up with headphones.

Jim McDade: I would wake up in the morning and my ears would be throbbing.

but compare it to his speech formation. Something smells a bit ripe to you too now, doesn’t it?

Perhaps the answer is in this next clip, starting at 6:20. Turn on the captions so you can follow the exact dialog:

From the transcript:

Matt Lauer: These are a little larger over here?

Shelley Borgia: These are the older traditional hearing devices.

ML: That made him cringe.

SB: Yes.

ML: Those are the ones that worried you?

Jim McDade: I had to grow up in grade school with something like that [Emphasis added].

Whoa! Looks like we caught Jim McDade and Dr Shelley Borgia being a bit less-than-truthful about the cause of his (McDades’) deafness: Although the “Advocacy Journalism” message of the NBC Today segment is that loud headphone usage can lead to hearing loss — And it certainly can; and may in fact have exacerbated his deafness – there is more to the story, with his childhood hearing loss significant enough to both require his need for hearing aids .AND. affect his speech production.

What makes this segment less-than honest is that, except for the slight speech impediment and McDades’ offhand admission of wearing hearing aids in grade school, we would have never known the cause of his problems is not as advertised. I’ll give Matt Lauer a pass on this, as he is neither an expert; and also maybe his “crap detector” had been been turned down a bit because he’s dealing with the identification of his own mild hearing loss.

On the other hand, I fault both Borgia and McDade for their less-than fully truthful, agenda-driven statements, as when pertinent facts to a story are withheld, the issue of iPod-induced hearing damage loses credibility; and for this they should both be reprimanded.

Shelley Borgia, AuD, of Park Avenue Acoustics in NYC
Audiologist Shelley Borgia, AuD, of Park Avenue Acoustics in NYC, who was less-than 100% truthful in her appearance on NBC Today

 

 

As a side note, there may indeed be a real issue of McDade not wanting to show he wears hearing aids: Perhaps he was teased & bullied when he wore them in grade school, as kids can be merciless, especially on the playground. Fortunately, in the last several years, I’ve been receiving anecdotal reports that this has subsided; and in fact we are seeing more and more kids strutting their ear hardware, as you can see from this photo gallery I’ve assembled.

 

July 5, 2011

Please Don’t Use Sarcasm With My Students: Guest article by (e

Filed under: Education,Relationships,Uncategorized — Dan Schwartz @ 2:26 pm

July 5th Update: Footnote added on the interrelated subjects of bluffing, “tuning out” and late afternoon exhaustion.

We at The Hearing Blog do not pretend to have a corner on the market when it comes to Hearing & Deafness issues; so when a particularly good article comes along, we request of the author permission to reprint it in its’ entirety, as we did with Lost in Music Trivia.

Today, it is our pleasure to present Please Don’t Use Sarcasm With My Students, written by my friend (e

Please Don’t Use Sarcasm With My Students

I wish some teachers and school staff members would stop using negative sarcasm with some of my deaf and hard of hearing students. Sarcasm can sometimes be confusing. Some of my students are not sure how to respond because they may not know if the person is being serious or not. It can be hard for deaf and hard of hearing people to hear the slight difference between a sarcastic tone and a serious one. Many rely on facial expression and if the person says something harsh but is smiling, we may assume that he or she is being sarcastic. But, not everyone express sarcasm or seriousness in the same ways. It can be hard to tell if the person is being sarcastic especially if you are unable to hear the tone of their voice.

I think that when sarcasm is being used with some students, it would be helpful for the person to explain to the students that they are being sarcastic. People should be careful with how they use sarcasm with students. Lighthearted sarcasm is fine, if used in moderation, but negative sarcasm or sarcasm used to put down the student is not all right, in my opinion.

Negative sarcasm can be hurtful and embarrassing. For example, if I were to state the obvious, I think it would be rude if someone I work with were to sarcastically tell me, “Really, Einstein?”

I remember as a child I thought one of my teachers was being sarcastic and I laughed thinking she was only joking. She got angry and acted as if I insulted her, because it turned out she was not being sarcastic. That was a very uncomfortable situation.

e)

Footnote: While we’re on the subject of trying to help our normally-hearing friends understand what it’s like to be hearing impaired, our friend e) has written another superb article titled Eh? What? Huh? What’s That? Come Again? Wait–What? that also merits reading, along with this authors’ comment and e)s’ reply.

June 25, 2011

Smashing Success: HLAA Convention 2011

Filed under: Education,HLAA Convention,Katie-louise Bailey,Telephone Compatibility,Tinnitus,Uncategorized — Tags: , , , , , , , , — Dan Schwartz @ 11:51 pm

This past Thursday afternoon to Sunday morning the annual Hearing Loss Association of America Convention was at the Hyatt Regency in the Crystal City section of Arlington, just outside of DC… And it was a smashing success, with over 1200 people preregistered, and hundreds more walk-up for free Expo Hall passes and on-site registration, making it the largest HLAA Convention in history.

All of the HLAA workshop classes provide ASHA & AAA CEU’s; and the two I attended on Saturday were chock full of information needed by hearing healthcare providers of all stripes:

Hearing Aid Compatibility in the 21st Century was led by Senior Group Manager for Accessibility Tony Jasionowski of Panasonic and Senior Engineer Al Baum from Uniden. Al, who is active both in IEEE¹ and TIA², spared no engineering detail explaining TIA-1083 — Telephone Terminal Equipment Handset Magnetic Measurement Procedures and Performance Requirements. Yes, it’s a mouthful; but for us Engineers (and for hearing aid dispensers & audiologists) it’s a G-dsend, as it lays out on which two orthogonal axes as well as the magnetic field strength scalar quantities new phones must supply to hearing aid telecoils.

What makes TIA-1083 so nice is that it addressed the problem we Hearing Aid dispensers & users had with 1A2 POTS compatibility with  the vertical T-coils found in BTE instruments, as well as the vertical T-coils glued to the faceplate of ITE’s by some manufacturers. As someone who has worked in the trenches as a retail hearing aid dispenser, nothing was more frustrating than taking the calls from irate patients (legitimately) complaining that they couldn’t hear on the phone, especially with BTE’s. HLAA’s Lise Hamlin & others cooperated with TIA to make this specification work… And it’s a signature achievement for all parties involved.

 

Tinnitus: Current Neuroscience Research and Theories was conducted by Amber Leaver PhD, who is a post-doctoral research fellow at Georgetown; and she taught us a lot, treating us as she would a class of grad students, and not dumbing it down. The only downside is that neither of the two recent treatments — Neuromonics or Widex Zen.

Our friend Bonnie O’Leary at Northern Virginia Resource Center (NVRC) took copious notes and emailed her Seminar report to Members; however, since the link has not yet been posted to their HLAA Convention Reports page, I am pasting Mrs O’Learys’ report below:

NVRC News – June 22, 2011

Tinnitus:  Current Neuroscience Research and Theories

By: Bonnie O’Leary, 6/22/11

If you struggle with tinnitus, you are not alone.  There are over 46 million people in this country who have some form of this often debilitating condition.  This tinnitus workshop was presented by Amber M. Leaver, PhD, who got involved with tinnitus research at Georgetown University’s [sic] Medical Center two years ago.  I thank her for providing notes from her power point to assist us in our report.

Dr. Leaver began the workshop with some background on tinnitus.  It is a common hearing disorder in which a person hears a “phantom sensation” of sounds in the ear – buzzing or ringing are the most common – even though no external sound is present.  Tinnitus can come and go, it can bother us
for long periods of time, or it can be present constantly.  Groups at high risk for developing tinnitus include those who are exposed to loud noise: construction workers, musicians, and military personnel.  More military veterans receive  compensation for tinnitus and hearing loss than for any other medical issue.

Tinnitus can be associated with difficulty sleeping and fatigue, stress, anxiety, depression, and other factors.

Causes of tinnitus

The exact cause of tinnitus is unknown, but there are triggers to watch out for.  The  most common is exposure to loud noise and resulting hearing loss.  Head or neck injury, temporomandibular joint/jaw dysfunction (TMJ), and certain drugs are other triggers.  However, not everyone with hearing loss or head injury develops chronic tinnitus, and this is a phenomenon that neuroscience research is attempting to understand.  To understand tinnitus, we need to understand how the brains of people with tinnitus are different from those without tinnitus.

Neuroscience research

How does tinnitus affect the brain?  Currently, research identifies changes in two parts of tinnitus patients’ brains: the auditory system and the limbic system.

The auditory system begins in the ear, where sound is converted to neural impulses which travel to the auditory sensory processing center, or the auditory cortex.  People with tinnitus have hyper-responsiveness to sound in their auditory cortex, especially sounds like their tinnitus sensation.  In all people, the auditory cortex contains tissue that’s organized by what pitch it responds to best, like a keyboard on the brain. This is called tonotopy.

When we lose our hearing, these “brain keyboards” are missing “keys” corresponding to the hearing loss, and they also have extra “keys” corresponding to pitches close to their hearing loss.  In tinnitus sufferers, these extra keys often match the tinnitus sensation, and it is thought that the imbalances in hyperactivity and tonotopy produce the tinnitus sensation.  What is unclear is whether these changes are due to hearing damage or to tinnitus itself, making it hard to prove that changes to the auditory system alone cause tinnitus.

The limbic system is considered the emotional part of the brain, but it has also shown to be involved in deciding the value of our thoughts and behaviors.  The limbic system seems to be different in people with tinnitus due to a section of the brain being structured differently than in people without tinnitus.

Similar differences in this part of the brain are found in people with depression and chronic pain.  Dr. Leaver and her colleagues propose that this part of the limbic system works like a noise-cancellation system. When this system doesn’t work well, people are not able to suppress unimportant thoughts and perceptions – including phantom perceptions like tinnitus.

The impact of research on the development of treatments for tinnitus

As many of us know, there is currently no cure for tinnitus, and there is no treatment that works for everyone.  It will be crucial to identify the brain basis of tinnitus to develop effective treatments.  If the brain basis is mostly auditory, then treatments should target the auditory system.  If, on the other hand, the brain basis is limbic, then treatments will have to target the limbic system.

To learn more, Dr. Leaver directed us to the website for the American Tinnitus Association.

However, the highlight for me was meeting Miss Katie-louise Bailey, who came all the way from Derby, England for an action-packed week here in America with her friend Anna Herriman. For those who don’t (yet) know her, Katie-louise is a star soccer player who played for the England Deaf Ladies football team in international tournaments as well as University of Derby; and she is also one of UK’s top 250cc motocross racers, riding  for the Kawasaki factory team. Besides being a well-known athlete who just happens to be hearing impaired, she is also quite a role model for deaf & HOH young adults in the Derby & Nottingham region, across England, and around the globe, with her leading by example… And I’m proud to call her my friend.

Given the size of the crowd, all went surprisingly well, with the only real glitch Sunday at the Awards Breakfast when the adjacent session of the (Wired To Fail) Loop Conference bled into the banquet room, raining on Joe Gordons’ parade as he received a Lifetime Advocacy Achievement Award for his captioning advocacy. Other than that hiccup (which was Ampetronics’ fault), Convention Director Nancy Macklin indeed did a very good job with the largest HLAA convention in history.

Footnotes:

1: IEEE = Institute of Electrical & Electronics Engineers, of which yours truly is also a Member.

2: TIA = Telecommunications Industry Association

June 19, 2011

Wired to Fail: The Second International Loop Conference

Filed under: HLAA Convention,Induction Hearing Loops,Uncategorized — Tags: , , , , , — Dan Schwartz @ 12:58 pm

The Second International Hearing Loop Conference started out as a troubled convention as far back as last June, culminating when the HLAA convention planning staff the conference site booking by not anticipating demand (after HLAA vigorously marketed the conference for six months), with many people being turned away; and many more not even coming, because it was “sold out” two weeks beforehand — This is the first time in history a convention has actually sold out! I spoke to AAA President Pat Kricos — Whom I actually felt sorry for — on Saturday about the sellout, as, having entrusted the booking to HLAA, AAA Members who depend on these classes for CEU’s were also left out in the cold.

 

Then, having strongly cautioned HLAAs’ senior staff last year in Milwaukee to perform a site survey for electromagnetic interference (EMI, noise) at the venue, and to make sure every room that had loops was working properly, we walk into the HLAA Awards breakfast, switch on our T-coil receivers… Only to clearly hear the of the loop conference next door. As it turns out, loop equipment vendor Ampetronic installed the loops but didn’t bother to check it for spillover into the main ballroom (and vice versa). Worse, this rained on the Hall of Fame Award being given to my friend Joseph Gordon, for his many decades of his effective advocacy.

 

Now, as an Electrical Engineer and long time hearing aid dispensing engineer, I have written extensively about my opposition to baseband induction “hearing” loop use on purely technical grounds, as it is a very troublesome “hack” that should have never been, especially for large rooms: And what happened this morning only proves the point: Even loop provider Ampetronic botched the job. Worse however, someone in authority ordered that the wonderful infra-red system donated by Williams Sound be shut down, because this “is now a Loop Conference” — Nice going.

 

Next, the workshop on “Understanding and Addressing Causes of Environmental Interference with Telecoils” was misleading at best, because presenter Richard McKinley of Contacta — who himself is (fortunately) not hearing impaired — played down, and even skipped over the very real causes of EMI in the United States; and why there is less EMI in the UK & Europe than in the US. Please see section 2 of Poynting the Wrong Way: Why “hearing loops” are almost useless for the reasons why, including that electric utilities run their  distribution transformers at 110% of Φ(sat), which causes harmonics to be generated from  the 60 Hz sinusoid being convolved with the B-H hysterisis curve (transfer function).,

 

However, McKinley made a significant error on his analysis of high voltage (115kV & up) power distribution & transmission line interference, when he stated that it is only a problem within 3-5 times the phase conductor spacing: This is demonstrably false, both from my own experiences, and also that he failed to take into account that in fact when there is negative sequence current from a phase current unbalance on a wye power system, zero sequence currents will flow through the ground conduction path. For the tower system used for 115kV & up, the ground wires you see above the phase conductors are much thinner than the phase conductor bundles themselves, as they are there only for voltage balance and shielding against lightning: 90% of the zero sequence current is actually carried through the earth, through a buried conductor, and through the shielding of the buried relay wiring.
More later…

 

Comment problems:

It’s been brought to our attention from several of our readers that they were having their comments rejected by the Akismet plug-in for WordPress as spam. This is unacceptable to us; and we are soliciting suggestions for a replacement. Unfortunately, we have to use something to screen for spam, as we were receiving over 100 spam comments per day at its’ peak. In the interim, to save retyping, we recommend selecting & copying all of your text to the clipboard: If your comment is accidentally rejected, simply paste it into an e-mail message, put “Rejected Comment” in the subject line, and send it to us at Dan@Snip.Net and we’ll manually post it for you~

June 1, 2011

Cochlear Implant Channel Crossover: First Person Report

Filed under: Charge distribution,Cochlear Implant,Music,Uncategorized — Dan Schwartz @ 10:23 pm

Melbourne piano teacher Daniela Andrews (Blog | Facebook)  accidentally leveled a Very Damning Indictment of her simultaneously implanted Nucleus 5 CI’s, where she points out a major flaw in Cochlears’ design, with its’ 24 electrodes spaced too close together for its’ 22 hardware channels: This causes Channel Crossover, which Daniela unintentionally — Yet so eloquently — described. If you remember back in February, there was the special Interior Design Concert by the Bionic Ear Institute for people with CI’s. Daniela, as a music professional, was one person involved with it; so you know she has the “street creds.”

At some point after she was implanted, she wrote the following that was picked up in the Australia Hears blog under Listening to music with a hearing loss. I copied & pasted it below; with my notes [blue, in brackets]:

3. Playing music

There is not a large amount of research investigating whether playing music can help with re-training the brain after a hearing loss. However there are some personal stories we can share. Daniela Andrews lost her hearing around 4 years ago, and for the last 10 months [implanted April 2010] has bilateral cochlear implants:

“At first, the piano sounded terrible. Like somebody had broken into it while I was in surgery and mixed up all the notes for fun. Playing scales barely resembled an up and down pattern at all. [This is channel crossover, caused by the electrodes being spaced too close together, stimulating the wrong nerve endings in the spiral ganglion] There were random low tones in between higher ones, and vice versa. Being simultaneously implanted brought another challenge – each processor rendered two different tones for the same note. [This is diplacusis -- the same tone sounding different in each ear -- which is exacerbated by the randomness caused by the channel crossover.] Familiar songs sounded alien-like with all these extra wrong notes thrown in. How was my brain ever going to make sense of that mess?”

Technically, each channel could have been remapped to produce a chromatic scale; but that would be painstaking and time consuming… And according to feedback from several CI manufacturer insiders, is above the skill level of many CI audies.

There are two parts to the solution for better music enjoyment:

  • Wider electrode spacing, to stop the crossover;
  • Current steering (think of a spotlight, instead of a floodlight), to shape the charge distribution, which will fill in the gaps between the electrodes.

    • Of the four CI manufacturers, Advanced Bionics uses 16 electrode contacts spaced out over 21mm; Neurelec (not available in the USA) uses 12 electrodes spaced out over 23mm; while MedEl uses 12 electrodes spaced over 31.6mm. In addition, both AB (Fidelity 120) and MedEl (FineHearing) have current steering, for much better music performance (though AB has severe implant reliability problems, with five recalls in the last decade).

    There are many factors that go into choosing a CI, as indeed there are differences in performance, as well as ergonomics and reliability. We recommend treating the issue of channel crossover as one data point in your decision matrix.

    April 21, 2011

    Advanced Bionics: Fingers tapping…

    Filed under: AB 2010 Recall,Cochlear Implant,Uncategorized — Dan Schwartz @ 3:13 pm


    As many  readers are aware, last week Advanced Bionics has received TÜV approval to ship newly modified HiRes 90K implants with the CE marque, with submission to the US FDA pending. Over the last four days, we have repeatedly reached out to AB media relations, corporate, and other individuals with requests for more information contained in their TÜV and FDA applications, specifically as to the steps they have taken in Engineering, QA/QC, and Reliability, to assure audiologists, surgeons, and most importantly patients that the failures that occurred leading up to the November 23rd “voluntary” recall will not happen in the future.

    We are interested in presenting facts surrounding the steps Advanced Bionics has taken to improve the reliability of the HiRes 90K; and we await their reply.  If AB so chooses,  a reply may be posted in the comment section of this article; and we will publish it unaltered.

    If anyone from Advanced Bionics wishes to contact us, we can be reached anytime at 609-417-1348 or at Dan@Snip.Net ~

    3 June 2011 Administrative Update: When I removed the Disqus comment plug-in, the comment nesting was lost, so all comments are now listed flat

    12 April 2012 Update: Removed the recall ticker~ 

    February 19, 2011

    TIA Urges FCC to Retain Existing Hearing Aid Compatibility Requirements

    Filed under: FM Assistive Devices,Telephone Compatibility,Uncategorized — Tags: , , , — Dan Schwartz @ 11:38 am

    Washington, D.C.  The Telecommunications Industry Association (TIA)  filed comments with the FCC on Monday, 14 February in response to its request for comments on existing Hearing Aid Compatibility (HAC) requirements. TIA urged the Commission to retain existing HAC regulations, which have been enormously successfully in promoting innovation and accessibility in the wireless market place.

    HAC regulations require mobile service providers and device manufacturers to offer a certain amount of hearing aid compatible devices to ensure accessibility by consumers with hearing aids. Per the Better Hearing Institutes‘ MarkeTrak VII industry survey there are approximately 8.4 million people wearing hearing aids, of which a subset of 5.1 million people have T-coils of unknown orientation (polarization). The percentage benchmarks are a result of a consensus plan developed by consumers, industry, and standards organizations in 2008, with an agreement to review in 2010. TIA comments are part of this review.

    TIA, which represents companies that manufacture and supply the products and services used in global communications across all technology platforms, urged the FCC to delay revising HAC percentages or revising technical requirements tied to the standard by stating in its filing that: “Issues concerning the ANSI C63.19-2007 standard should be revised after the 2010 standard is adopted and manufacturers have had the opportunity to test and obtain HAC certification.”

    On behalf of its members TIA submitted the following comments regarding the Wireless Telecommunications Bureau’s Public Notice:

  • TIA should retain the existing benchmarks adopted in 2008 and provide time for manufacturers and service providers to test and deploy new models and services under the current standard.
  • Consistent with Section 710 of the Communications Act, FCC concerns related to HAC requirements would be more effectively addressed through the standards development process. TIA recommended that all relevant industry stakeholders should be presented with the opportunity to engage the HAC industry in that process.
  • The FCC should continue to ensure that information collected under the Accessibility Act not impose an undue burden on manufacturers and service providers. The current reporting requirements, which TIA argued could be streamlined, have proven effective in responding to consumer input.
  • The FCC should not dictate technical standards for handset manufacturers. To do so would jeopardize industry innovation in improving such features as volume control, display screens and backlights.
  • TIA urged the FCC to facilitate collaboration among all stakeholders including the Food and Drug Administration (FDA), in order to facilitate a dialogue among hearing aid manufacturers and hearing aid users.

    • “TIA members have been integral to the successful implementation of the Commission’s hearing aid compatibility policies,” TIA stated in its filing. “Consistent with its recently-announced Innovation Package of policy recommendations, TIA submits that by encouraging collaboration among stakeholders and the utilization of voluntary consensus-based standards, the Commission can continue to improve accessibility and encourage innovation, thereby meeting its statutory obligations under Section 710 of the Communications Act and maintaining the enormous success of the Commission’s HAC regime.”

    In its filing, TIA also pointed out FCC Chairman Julius Genachowski’s “decision to follow the recent Presidential memorandum to Federal agencies targeting burdensome regulations.”

    “TIA’s members – companies in the information and communications technology industry – are among the most innovative in the world,” said Vice President for Government Affairs Danielle Coffey. “President Obama recognizes that, while sometimes regulation is necessary, it is imperative that we carefully consider the impact regulations will have on bringing new and improved products and services to the marketplace.”

    TIA’s full comments on Hearing Aid Compatibility (PDF opens in a new window) are available on its FCC filings page at tiaonline.org.

    February 1, 2011

    Guest column: Lost in Music Trivia

    Filed under: Relationships,Restaurants & bars,Uncategorized — Tags: , , , — Dan Schwartz @ 9:28 pm

    By guest author Sarah Mosher of the Kansas City chapter of the Hearing Loss Ass’n of America

    Foreword: From time to time The Hearing Blog will publish articles by guest authors who have a unique perspective. This article struck the editor, because it shows what can go wrong when a normal hearing person dates a hearing impaired person without knowing all of the ramifications. Here is the story of Sarah Mosher at a noisy bar on Sunday night…

    Have you ever played music trivia games? You know, where you go to some bar that’s hosting a music trivia night, and they have a really loud announcer there barking out orders, and people sit around and listen to the song that’s being played and try to guess who sings it? Yeah,  me neither…

    Well,  last night, a friend of ours wanted to go play music trivia with his girlfriend. So my boyfriend and I decided to go with him. We figured we’d eat dinner with them and chat for a bit and then leave when they started to get into the game. I knew this, and I thought I was mentally prepared for the evening. I was thinking, “Loud, noisy bar. Check. Lots of screaming people. Check. Music in the background I may or may not be able to hear over all the other ruckus. Check.” I was ready for it.

    Apparently I wasn’t ready enough. We had a horrible waitress and by the time we got to order drinks we were already irritated with her. I asked if they could make a mojito, to which she replied, “Sure! But not frozen. On the rocks ok? With salt?” Out of the corner of my eye I saw the other people at the table react to her statement. So I repeated what I said: “mojito” not “margarita.” She goes “OHHH… Got it.” When we ordered food, I ordered a cheeseburger, with cheddar cheese, and fries. She responds, “you want fries AND cottage cheese??” Everyone else at the table said they understood me perfectly, so they didn’t know what her problem was. [Editor's note: Even a mild hearing loss can cause speech to be misunderstood -- This waitress needs a hearing test, and probably hearing aids.] But I felt…  a whole mixture of emotions, I guess. Thoughts like this were running through my mind: What was wrong with me? Was I not speaking clearly enough? Can people not understand me like I thought they could? It was not a good start to the evening.

    So, the bar becomes increasingly louder as we eat. I’m attempting to lipread around mouths full of food, glassware, and napkins. I catch less than one percent of what people say. I start watching the televisions. They’re showing the Pro Bowl game and the Winter X Games. None of the televisions have captioning on them. My boyfriend is nicely trying to draw me into the conversation and keep me in the loop. I appreciate his efforts, but last night it just wasn’t enough. It wasn’t him, by any means, but I just wanted, for once, to just understand.

    Finally, the music trivia game starts. ALL the televisions are still going, ALL the conversation is still going, AND the guy gets on a microphone and starts yelling through it. It was the most ridiculous thing ever and my hearing aid absolutely rejected it all. It was one loud mass of noise. Pure static. No comprehension anywhere. The guy on the mic stops speaking and every single head at my table cocks an ear upwards and gets that faraway look on their faces as they listen to the song being played. I cannot hear the song over everything else that is going on. So we sit there, locked in place as the seconds drag by until one of them bugs their eyes out and shouts “{unintelligible name of band}!”

    Oh. I hadn’t thought of that part… they are all shouting out the name of the band they think is playing the song. Yeah, that’s real easy. Lipread the crazy made-up name of some band you’ve never heard of. I can do that in my sleep. (Yes, that whole line is dripping with sarcasm there…)

    At that point, I just had it. I couldn’t take it anymore. I looked at my boyfriend and basically demanded we leave. It wasn’t a very nice exit, but I had to get out of there. I was just drowning in static and lost in noise. My brain was being suffused with noncomprehension. I had to leave.

    Walking out of that bar into the cold silence of the winter night was the highlight of my entire weekend. I could breathe again. I could hear the wind whipping around my head. I wasn’t lost. I knew exactly what was going on around me. I could feel the ground under my feet again. I knew who I was.

    *whew*

    Despite preparing myself mentally for that night of music trivia, it’s really hard to prepare yourself for the unexpected things that can break you down. It’s hard to know what to do in a situation like that. It’s not like people could interpret music. And if they don’t know what the song is, because that’s the point of the game, how are they going to inform you of it? I thought about it afterward, as my boyfriend asked what he could have done to make it better for me, and I really had no answer to give him. I couldn’t think of anything that would have improved the situation. Sure, there could have been captioning on the televisions. We could have had a nicer waitress. But when it comes to playing music trivia, there really isn’t anything that could be done.

    Have you ever been in a situation like that, where you just couldn’t handle the “being hard of hearing” aspect of yourself? Where the situation was harder than anything you’ve been in before and you just didn’t know what to do? Please share!

    January 27, 2011

    Auditory Therapy: The Missing Ingredient

    Filed under: Auditory Therapy,Cochlear Implant,Uncategorized — Dan Schwartz @ 6:44 pm


    By Dan Schwartz and Anne S, with an extensive comment by Jane R Madell, PhD

    February 24, 2012 Update: Added free pediatric resources from John Tracy Clinic, with corrected links~

    Often, the missing ingredient for many hearing impaired people is auditory therapy, or (re)habilitation (AR), especially for those who are sold hearing aids for mild to moderately severe hearing loss. AR is typically given along with speech therapy for hearing impaired children, and is especially important in the first three years as the regions of the brain that process auditory and visual information overlap: With a hearing impaired child, the natural tendency is for them to use the “easier” means of visual and manual communication — sign language — which will “crowd out” auditory development.

    For teens & adults, AR is also sometimes included at some of the 250 CI centers in the US (you pay your dues and you take your chances); and at all 21 CI centres in the UK.

    • The John Tracy Clinic, one of the finest pediatric audiology centers in the world, now has three free Distance Learning for Parents Courses, which can be taken  mail or now turbocharged by the Internet, online anywhere in the world.

    • Mini Course: Designed for use by families in the first few years after identification of their child’s hearing loss, this course summarizes initial information, provides considerations for decision making and gives suggestions on support. It has separate sections about hearing loss, communication and parent roles. Extended learning ideas help parents recognize what they know, consider how they feel and identify steps they wish to take.
    • Baby Course: Geared toward infants and toddlers (i.e., birth to two), this course discusses early hearing loss, infant-toddler development, parent-child communication and learning through play. Suggestions are given for emphasizing communication through natural routines. Parents can choose specific ideas to encourage beginning language and auditory learning.
    • Preschool Course: Developed with preschoolers in mind (i.e., ages two to five), this course provides parents with tools to foster language growth and facilitate family interactions. Modules discuss communication, thinking and social development. Suggestions are given for activities to encourage language, listening and speech. Parents choose ideas that fit their child’s developmental level and their family’s current concerns.

    These self-paced lessons are available at no cost to parents; and are available online or through the mail. Parents receive family friendly information with fun activities; and then submit report forms with their comments. Also, individualized encouragement and personalized correspondence from experienced parent educators is sent by the Clinic via web or mail. We at The Hearing Blog  recommend these courses for grandparents & caregivers; and strongly recommend them for both parents of hearing impaired infants and children: Click this link right now to register. Now, not tomorrow or later today: It’s that important.

    •  Well-respected University of California-San Francisco (UCSF) audiology professor Robert Sweetow has the very good Neurotone LACE Listening Program AR (auditory therapy) DVD and Web based program with many dozens of exercises. I have received good reports on LACE from audiologists, including one who dispenses hearing aids and includes it in her package. There are samples of each of the exercises you can download on the Neurotone website;

    •  There are additional resources from the cochlear implant (CI) community available for auditory therapy available for free from Advanced Bionics and for a fee from Cochlear:

    • Advanced Bionics has The Listening Room as part of their “Hearing Journey” website, with a number of environmental sound, speech, and music exercises. Although they may seem simple for people with mild to moderately severe hearing loss, they still nonetheless can be quite helpful as a “reality check;”
    • MedEl has a number of AR packages available for both purchase, and also complimentary web-based and downloadable SoundScape exercises. Download the Bridge PDF catalog for an entire listing of their AR pacages & materials for all ages;
    • Cochlear Americas has their extensive HOPE program which consists of their Sound and WAY Beyond and HOPE Notes software. To see how HOPE Notes was created by Providence RI musician Richard Reed, click here to read an interview of him by AudiologyOnline Editor Carolyn Smaka. If you are .NOT. in the Americas, i.e. in the EuroZone, Australia, or elsewhere, please click here and select your region and country from the map. Also, your CI centre may supply you the Sound and WAY Beyond &∓/or HOPE Notes software to supplement your auditory (re)habilitation program, as this will vary by country — Some — Like UK — provide much better post-implant rehab services than we receive here in America.

    If you don’t believe me that it can really suck here in the US, see the next item…

    •  Underscoring the importance of what happens when AR is not done, one need only watch the superb and touching HBO documentary Hear and Now, as filmmaker Irene Taylor Brodsky accidentally documents what happened when her parents did .NOT. get the AR they needed. From my detailed Movie Review on the Amazon.com Hear and Now page:

    I strongly recommend this movie for anyone who already has a cochlear implants, prospective CI candidates or parents of kids with CI’s; and also all Audiologists, whether practicing or are studying to become one, as filmmaker Irene Taylor Brodsky accidentally documented two avoidable CI failures, with Sally’s worse than Paul’s.

    Watch the movie twice: The first time, just sit back and enjoy the story with your entire family, as any member of the viewing public would do so, as that alone rates a good Four Stars. But then, watch the second half again, from the implant surgery forward through 1st stim and subsequent MAP’s to the end.

    Notice something missing?! HINT: Sally Taylor has personally told me this is the most common question asked at film screenings.

    —> WHERE IS THE FOLLOWUP AUDITORY THERAPY? <—

    That’s right, Paul and (especially) Sally were victimized by their CI center, with poor quality 1st stim, followup MAPs, and the total *lack* of auditory (re)habilitation. This is a superb documentary of an absolute, miserable #FAIL by the Audiology profession, *especially* in Rochester, NY, which has 90,000 deaf residents — The highest concentration in the world. In fact, both Sally and Paul are retirees from NTID (National Technical Institute for the Deaf; one of eight Colleges at RIT), so it’s not like deafness is an unknown quantity among the healthcare profession in the area.

    If you already watched the edited version on HBO, buy the DVD anyway as it has an additional 20 minutes that didn’t make the cut, mostly of booth testing… But it’s worth it to those to both groups — Hearing healthcare professionals and hearing impaired patients & their families.

    I very strongly recommend this film for any and all in the hearing healthcare industry, as it clearly demonstrates how auditory rehab is critical to patient success; and what happens when professionals #FAIL to provide adequate followup care.

    I also strongly recommend this film to any and all members of the hearing impaired (hard-of-hearing, deaf and Deaf) community, as well as to their families.

    Please see my detailed review on the Amazon.com Hear and Now page for a more extensive discussion of the importance of Auditory Therapy

    •  The John Tracy Clinic also offers intensive three-week On Site Family Summer Sessions for children with hearing loss 2 through 5 years old and their families worldwide are offered at the John Tracy Clinic (JTC) campus in Los Angeles. Children attend a spoken language preschool designed to identify their strengths and needs. Parents participate in an education program to learn about hearing loss, auditory-verbal techniques, emotional support for families and educational services for their children.Specialists provide audiology, counseling and consultation services to children and families. Summer sessions include a(n):

    • Auditory-oral preschool program
    • Comprehensive audiological services
    • Daily intensive parent education classes
    • In-depth speech-language assessments
    • Parent support groups led by trained counselors
    • Recreation programs for brothers and sisters, grades 1st through 6th

    Summer services are offered free of charge as are all other family services at John Tracy Clinic. To learn more, read the Overview page, read a first-hand account written by a parent, or download a one-page informational PDF. Enrollment applications and answers to general inquiries can be obtained by calling 1-800-522-4582 or emailing pals@jtc.org. ~Dan Schwartz, Editor

    Some of the listening practice stuff that I do… I have worked 1-on-1 with the CI program audiologist for an hour every week for most of the past 3 years; but many of what I’ve done are exercises you can do on websites like some of the ones that I have listed below, and some things with a friend or family member… And you don’t need a special sound-proof booth to do these. People often ask how I have improved so much with my level of comprehension of speech with my ABI, and I usually say that I’ve practiced a lot; but people say, “what do you mean by that?” How do you practice listening?” With the ABI [Ed.: Auditory Brainstem Implant], it’s kind of like you have to learn how to hear again, because as a baby you learned how to hear naturally, but now I needed to learn those sounds are not the same as they were before, and fit things together like its a big puzzle. I don’t understand everything with the ABI, but I do understand a lot. [The other day, I talked to my mom on my cell phone for 15 minutes and understood mostly everything she said!]

    Here are some of the things I use for listening practice, for my fellow ABI user friends…. (I tried to only tag people who’ve gotten ABI or CI in the past few years, or might be getting one soon… And people who just think that robot ears are awesome!)

    SUGGESTION: Keep a record of scores on the online listening quizzes and games, then do the same one in a few months or next week and see if you can improve your scores;

    LISTENING STORY/CONVERSATION ACTIVITY: Get a family or friend to try to talk with you while holding a piece of paper (or thin fabric, which works better) in front of their face. It can be challenging but when I started doing that, it was just sounds really. I’ve progressed to being able to have pretty clear conversation, or repeat back person reading a story — Read a sentence, pause, listener repeats… etc.)

    PHONE ACTIVITY WITH SOMEONE: Practice talking on the phone by calling a friend or family member (whom you know the voice of well) while they are in another room of the same house/apt/building. Try planning the call by making a list of what you will talk about. Example: You ask them a question about what they did this weekend, and they answer, then you confirm if that was what they said. Strategies include: Ask for spelling of words that you get stuck on (and I found it helpful to sometimes try using the military code alphabet letter list which you can switch some around on or make your own but you need 2 copies of same thing. A = Alpha, B = Bravo, C = Charlie… so if the word you didn’t understand was, for example dog, they can say “D – Delta, O- oscar, G-golf”), ask for something that is unclear to be rephrased, or repeated (but if 3 repeats don’t work, try spelling or rephrasing).

    PHONE ACTIVITY ALONE: And try listening to the words and stories on here: 1-800-458-4999 – Cochlear Practice telephone recordings, which can be viewed here. There are new recordings every day. If you get bored of the fairy-tales, there is some pretty interesting different ones, usually on the weekends, like such as the time line of Abe Lincoln, Dr Martin Luther King Jr’s “I have a dream” speech, Robert Frost poems, Cochlear Implantee success stories, and more.)

    OTHER ACTIVITIES: Lots of great stuff from the home page of the ManyThings.org links here and here. Play around and find what you like. The “minimal pairs” sound comparisons are great; or go to the home page of this site and try the “easy activities/games for beginners.”

    • www.elllo.org has a lot of listening activities at various levels here, here, here, and here. Most of them are geared at foreign students learning English, but its a great site.
    • There are also a large number of listening practice selections available through the TalkEnglish.com website
    • Free music online at www.GrooveShark.com , LOL. [Editor's note: This website uses the very latest browser plug-ins, which can at times cause computer lockups and crashes.]
    • The Grammar Girl: Listen, and you can read it too, but this one is really boring, I thought. My audiologist said she thinks this changes each week, but this particular link is new to me, so I’m not sure yet.

    ~Anne S., Auditory Brainstem Implant user

     

    Comment problems:

    It’s been brought to our attention from several of our readers that they were having their comments rejected by the Akismet plug-in for WordPress as spam. This is unacceptable to us; and we are soliciting suggestions for a replacement. Unfortunately, we have to use something to screen for spam, as we were receiving over 100 spam comments per day at its’ peak. In the interim, to save retyping, we recommend selecting & copying all of your text to the clipboard: If your comment is accidentally rejected, simply paste it into an e-mail message, put “Rejected Comment” in the subject line, and send it to us at Dan@Snip.Net and we’ll manually post it for you~

    January 14, 2011

    BREAKING: Advanced Bionics Layoffs

    Filed under: AB 2010 Recall,AB Layoffs,Cochlear Implant,Uncategorized — Tags: , , , , , — Dan Schwartz @ 11:22 pm


    BREAKING NEWS: Advanced Bionics lays off 150 100+ employees in the wake of the FDA-ordered Recall Production Halt, including longtime field support staff.  Details to be posted as they become available.

    Posted 11:15 PM January 14, 2011

    UPDATE 1A: We have received additional reports after the first one received Friday 11:00PM  that the number of layoffs is “slightly over 100.” We can confirm that there was one unnamed layoff at Rixheim; Linda Luallen being laid off from Valencia; Phil Ives, Ph.D being laid off in Denver; and we are still awaiting reports from Hannover and AB-UK

    CLARIFICATION: We received an email from a very upset friend, Terri Ives, Ph.D, about us naming her husband Phil as one of the 100+ that was laid off in Update 1 published on Monday; with the implication that he was the source of the leak on Friday night when we broke the story to the world — He was .NOT. our source. Instead, we happened to see a post on his wife’s Facebook page on Sunday that Phil was laid off. Phil and Terri are both honorable and trustworthy professionals; and anyone implying anything to the contrary will be met with the Full Force of this publication~

    Update 1A posted 3:00 AM January 19, 2011

    Clarification posted 8:00 PM January 20, 2011

    UPDATE 2: We are in receipt of an unusual email from Jennifer Raulie, an Audiologist at Advanced Bionics whom we know, sent Monday afternoon to a reader of this publication. Here is an excerpt:

    My name is Jennifer and I am one of the audiologists on staff at Advanced Bionics. I was reviewing the Hearing Journey [URL added: Ed.] today and came across several of your posts. Welcome to the online community! It is nice you see you there! I just wanted to reach out to you to let you know that the information in the links to The Hearing Blog you posted is absolutely false and not based on any factual information. The person that runs this blog has no connection to Advanced Bionics or Sonova and in fact is not even a CI recipient of any brand. It was clear to me, from reading your posts you figured this out on your own, but I just wanted to reassure you that what you read was in fact garbage.

    We would like to remind Ms Raulie that Sonova Holding AG (SOON.VX) is listed on the Zurich Exchange; and her denial — “what you read was in fact garbage” — of their  Advanced Bionics subsidiary’s  layoffs could be construed by Swiss and EU regulators as making  materially false statements about the financial condition of a publicly traded corporation.

    As we have previously stated, we are in no way affiliated with any corporation or other entity; and we accept no advertising; and for that, we thank Ms Raulie for emphasizing that point.  However, the Editor, Dan Schwartz, must take exception to a cheap shot by Ms Raulie when she wrote “in fact is not even a CI recipient of any brand.” That is indeed true, as although Mr Schwartz is a candidate for cochlear implants, he is not a user yet due to insurance issues. Why Ms Raulie chose to raise this extraneous issue cuts to the very core of her letter: Instead of explicitly addressing the issues she, as a spokeswoman for her employers, factually disputes, all she can do is resort to name-calling.

    Our answer to Ms Raulie, Sonova, and Advanced Bionics is this: Tell us explicitly where we are wrong, supply us with documentation so we can verify your claim; and we will promptly correct the record. Please address your correspondence to Dan@Snip.Net: We are awaiting your reply.

    Update posted 3:00 AM January 19, 2011

    December 10, 2010

    Failing Ugly II: More on the Advanced Bionics Recall

    Filed under: Cochlear Implant,Uncategorized — Tags: , , , — Dan Schwartz @ 12:10 am


    UPDATE #3 (1 August 2011): Vindicated! Our friend Tina in London has just published Why 2 Advanced Bionics HiRes 90K cochlear implants failed, including the source document (PDF) sent to the Malaysian Ministry of Health, Medical Device Control Division, confirming the failure resulted in a dangerous DC bias condition. The fact that Advanced Bionics significantly misrepresented to the Malaysian Health Ministry the damage occurring from the electroplating effect caused by DC bias conditions — Which involves the “ripping off of the metallic crystals from the electrode contacts, destroying it (them) over time… And leading to consequent damage in the tight spaces of the cochlea, as such electro-chemical reactions can produce bio-toxic byproducts, as well as introducing potentially damaging changes in the local pH,” and which is independent of any painful overstimulation and can occur silently — is in and by itself a matter for further investigation by the FDA and other regulatory authorities for the misleading statement to the Malaysian government.

    Original document: Advanced Bionics report to the Malaysian Ministry of Health, Medical Device Control Division (click to open PDF in a new window).

     

    UPDATE #2 (19  Feb. 2011): Please see the comment by “Mary” about the working conditions at AB.

    UPDATE #1 (7 Jan. 2011): Please see the update on the lack of implant burn-in in the first article in this series Failing Ugly: Advanced Bionics cochlear implant circuit goes haywire

    We at The Hearing Blog have received more information on the so-called “voluntary” recall of the Advanced Bionics HiRes 90k cochlear implant, making us stand up and take notice. If you haven’t read the first article in this series, please click on Failing Ugly: Advanced Bionics cochlear implant circuit goes haywire.

    The first item is pretty mundane, and confirms what we published previously: A scan of the patient recall letter, signed by Gerhard Roehrlein, PhD, CTO & Interim CTO (click to enlarge):

    Advanced Bionics US Recall Letter sent 11-29-2010

    Advanced Bionics US Recall Letter sent 11-29-2010

    The second item gives us pause: The five page PDF (click here for entire PDF file) sent to European and UK CI centres from their Rixheim office, signed by Michael E. Sundler, Senior Vice President. Several things in this communications jumped out at us. First was this paragraph at the bottom of the first page, which shows this recall was anything but “voluntary:”

    If our records showed that you have any unregistered implants in your possession, a list of serial numbers was provided for devices that must [emphasis added] be returned to Advanced Bionics.

    Second, the troubleshooting advice is unsettling, for reasons to be discussed:

    1. Identified recipient is reporting/showing signs of extreme pain with their typical program:

    a. Exchange all external equipment.

    b. Create a program with all M’s set to 0.

    c. Try the ‘zero’ M program.

    d. If the recipient hears nothing/does not demonstrate an adverse reaction, they do not have the issue. Discontinue use of the ‘zero’ M program.

    e. If they experience extreme pain or demonstrate an extreme adverse reaction with this program, discontinue use of the sound processor. It is likely that they have an implant with this issue.

    f. Contact your AB Clinical Specialist or Technical Service Europe.

    The rest of the letter just outlines scenarios where the user currently didn’t have symptoms, and also if implanted within the last two years; and then an acknowledgement letter to be signed & returned.

    What jumped off the page at us was that, in combination with the posting below for the young child, the M levels (upper levels of stimulation) can be set all the way to zero and the problem(s) still manifests itself.

    Put another way, if the M levels were set to an arbitrary level far below the T levels (threshold limits), i.e. the upper limit M levels were set to 5% of the threshold and overstimulation occured, that would point the finger at a failed voltage regulator module (VRM) on the implant circuit, as this would imply AC signals crossing the output capacitors. However, with no input (as stated with the M levels set to zero) we still have an overstimulation condition, this would imply a failed short output capacitor, leading to the electroplating effect: This involves the ripping off of the metallic crystals from the electrode contacts, destroying it (them) over time… And leading to consequent damage in the tight spaces of the cochlea, as such electro-chemical reactions can produce bio-toxic byproducts, as well as introducing potentially damaging changes in the local pH.

    The the third and most distressing is this post on Tina Lannin’s influential CI Blog about the recall:

    Firstly i have never posted on this site before and have only just found it after trying to find more information on recent events.

    I do know however some of the information on one of the confirmed cases relating to the recent recall and although i do not know or understand any of the technical details i do know of some of the time frame leading up to this.

    Bilateral implant surgery on the case that i know of was in April 09. Problems occured shortly after activation on one side. Company and audiologists tried various ways to fix problem but recipient was unable to wear device for integrity testing. Eventually integrity test was carried out under general anaesthetic in Nov 09 and device was explanted in Jan10. So AB have had faulty device since then to investigate. Confirmation of device fault came 2 weeks before AB made their recall press release.

    Like i said this is only one of the confirmed cases. The company where not very forthcoming in admiting this case was related to press release but after reading the description of problems recipient experienced and the timing of device fault notification they eventually confirmed this.

    Original implant that was not removed and showed no fault is working well as is the second implant recieved in Jan 10 but not at the same level.

    This is troubling on several levels:

    • First off, although very few adults get simultaneous implants, it is common among infants and young children;
    • Second, it shows how yong children cannot report back if they have a problem;
    • Third, something is pretty far amiss with the CI audiologist when s/he has to perform a sedated integrity check under general anesthetic. We can accept that if this was the only CI; but obviously the child is successfully using the other implant… In other words, the implant so badly Failed Ugly, the child could not even stand to have it turned on;;
    • Fourth, the bad implant was built prior to April 2009, which sets in motion a whole new set of questions consisting of what did they (Advanced Bionics & Sonova) know, and when did they know it?

    The first three questions not only go back to the competency of the AB technician, but also to the CI audiologist at that particular center; and also to the surgeon, who is “captain of his ship.”

    The fourth question goes back to how much Advanced Bionics disclosed to Sonova’s auditors when they were at their HQ in the second week of June 2009 when they were performing their Due Diligence. Given that Sonova Holding (SOON.VX) is a publicly traded company, and given how their shares have tumbled since the recall was announced two weeks ago, one has to be suspicious.

    Along these same lines, how much did the Advanced Bionics division of Sonova Holdings AG disclose to FDA regulators? To the UK and EU regulators (for their CE marque)? To the Zurich stock exchange to meet their disclosure rules?

    We here at The Hearing Blog have not received any return contact from Advanced Bionics. There are many thousands of people out there that have AB HiRes 90k implants in their head, in their young children’s head, have surgery dates, or are in a holding pattern, waiting for answers~

    Short URL for this article: http://tinyurl.com/FailUgly2

    Comment problems:

    It’s been brought to our attention from several of our readers that they were having their comments rejected by the Akismet plug-in for WordPress as spam. This is unacceptable to us; and we are soliciting suggestions for a replacement. Unfortunately, we have to use something to screen for spam, as we were receiving over 100 spam comments per day at its’ peak. In the interim, to save retyping, we recommend selecting & copying all of your text to the clipboard: If your comment is accidentally rejected, simply paste it into an e-mail message, put “Rejected Comment” in the subject line, and send it to us at Dan@Snip.Net and we’ll manually post it for you~

    July 13, 2010

    Series on FM: Soliciting User Experiences&c.

    Filed under: FM Assistive Devices,Uncategorized — Tags: , , , , , , , , — Dan Schwartz @ 4:58 pm

    Update #1 January 27, 2011: Please scroll halfway down to red portion of the text

    The project of rating two new digital FM systems, the Bellman & Symfon Audio Domino (PDF w/specs) ($495 street)  and the Etymotic Research Companion (specs;  how it works) system ($699 street w/three transmitters and ER-6i isolator earphones) is turning out to be a three-part series of articles, taking much more time than I expected… And I am soliciting comments on any FM system about your user, parent, teacher or hearing healthcare professional experiences — Good .AND. Bad. Please post your experiences in either the Comment section below, or email them to me at Dan@Snip.Net

    The first of the three will be how and why FM — When it’s done properly — is a tremendous help to the hearing impaired and others, from infants & toddlers receiving auditory therapy, to children (including those with cognitive impairments), to high school & college students in large classrooms & lectures, to adults on the job, and in noisy social situations, to the elderly watching TV.

    Most of the first article in this series will center upon the discussion on these 4 pages in Jamie Berke’s About.Com Deafness Forum.  [And Yes, the story about the beer is true!]

    The second article in the series will deal with the situation when FM is .NOT. done properly, and interference or other issues result. Phonak’s FM system appears to be a serial offender, but there are other culprits. This article will go into the techno-details on things like multipath distortion vs dropouts, transmitter power, and other things a computer geek or Ham Radio operator would understand… So the challenge is to make it readable for the average parent.

    The third article in the series will be test results from these three systems:

    § The Bellman & Symfon Audio Domino (PDF w/specs) ($495 as tested with earphones) is a flexible single transmitter system, with excellent audio quality, decent range, and highly directional microphones on both the transmitter & receiver;

    § The Etymotic Research Companion (specs;  how it works) system ($699 as tested with three transmitters and ER-6i isolator earphones) ships with either one or three transmitters, and is the only system (besides the Phonak DynaMic extension to the troublesome Inspiro) that provides many-to-one capability;

    § The Comfort Audio Contego ($795 as tested w/neckloop) is a single encrypted transmitter system; and was screened by the author at the HLAA Convention in Milwaukee.

    Update #1: Due to time constraints I have not been able to fully update this blog entry; however I posted this reply on Dr. A.U. Bankaitis’ blog:

    Although they have differences, the Bellman Audio Domino Classic costs $200 less, and performs as well as the Comfort Contego. While the Contego has a zoom mic, the Audio Domino Classic has a tone control on the receiver, and also when stereo is input into the transmitter jack, the system switches to digital stereo (more on this in a moment).

    Previously, A.U. raised a point about the 40ms latency of the Audio Domino vs 10ms delay in the Contego (vs. no latency with analog!) and how it can interfere with lipreading cues. [Note:In googling Comfort Contego specifications there is no mention of latency.] From personal experience, I haven’t noticed any latency issues; but more importantly, if either system is used with a TV, it is important to note that with the shift from NTSC to HDTV the lead/lag for the separate AC3 and MPEG audio streams can be up to 150mSec (and in practice is often much higher), so the (supposed) 30ms delta between the two doesn’t seem to be a factor.

    Now, let’s say your patient wants a zoom mic on the transmitter & receiver: With the Contego, the user has to walk over and manually switch the transmitter. But, remember when I said above that the Bellman Audio Domino Classic transmits in digital stereo? Well, so does the Audio Domino Pro… But also, the Pro version does something Really Clever: The audio from the omni mic rides on the left channel simultaneously with the audio from the zoom mic! This way, the user need only push the button on the receiver to “zoom” the transmitter, saving endless user fiddling.

    My friend Sarah, who blogs on her Speak Up Librarian website received upon my recommendation the Audio Domino Pro from her employer to use at work. She wrote two extensive first-person reviews here and here that are worth reading.

    Finally, I welcome everyone’s own observations of FM ALD’s, whether good or bad; clinician or user, on The Hearing Blog’s article covering all things FM.

    Update #1: January 27, 2011 @3:45PM EST

    June 13, 2010

    Welcome to The Hearing Blog!

    Filed under: Uncategorized — Dan Schwartz @ 2:02 pm

    Welcome to The Hearing Blog! I’m Dan Schwartz, your host; and we will be discussing issues related to Hearing and Deafness, with the occasional detour into related topics such as acoustics, noise control, and high fidelity audio. In short, if it deals with sound, then it’s fair game!

    While you’re at it, take a look at the various links to the right, as there is some very interesting content from other people around the world worth mentioning. While you’re at it, click the button below to follow this blog:

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