How to Hear Better in the Car


Hearing in the car is a challenging listening environment for people with hearing loss. The signal to noise ratios are less than optimal for maximum speech understanding. Moreover, conventional directional microphones are typically oriented for face to face communication which is not ideal when communicative partners are seated side by side or behind. Binaural directional microphones which can add an additional 3-4 dB of SNR improvement definitely require a face to face orientation in order to work properly. Finally, one cannot take advantage of lip-reading cues, especially if one is the driver. At night, the lack of adequate lighting negates the use of lip-reading cues for the passenger as well.

The noise levels generated inside an automobile can vary greatly by type of vehicle and the speed the vehicle is traveling. There are several websites available that list the interior noise levels of various automobiles. The data in the chart below, taken from http://www.auto-decibel-db.com/, is a sampling of several vehicles operating at various speeds.Noise Levels in Car

As you can see the noise levels can vary as much as 12 dB. Typically high end gas powered luxury sedans tend to have the lowest interior noise levels, while entry level automobiles and diesel cars tend to have higher noise levels. If we assume that speech is typically 65 dB in intensity, what then are the signal to noise ratios? In the table below, I have simply subtracted the measured noise levels from the 65 dB speech levels to obtain the SNR.

Noise levels in car 2 SNR

The next thing we need to consider is what SNR’s do people with various degrees of hearing loss need in order to communicate effectively. Below is the classic Killion data showing SNR’s as a function of hearing loss. Note that this is data for a typical adult. Children need higher SNR’s as do many geriatric clients. It is therefore ideal to actually assess a client’s speech in noise capabilities through a test such as the Listening in Spatial Noise Test – Sentences with the Prescribed Gain Amplifier, otherwise known as the LiSN-S PGA.

Noise levels in car 3 SNR Needed

Let’s look at a couple of examples of how to apply this information. The first example is a 40 year adult with a moderate sensorineural hearing loss. This gentleman owns a Honda Civic and frequently drives on highway of speeds 100-120 KM/hr. He is usually is driver rather than passenger Our chart indicates that the SNR at 100 km/h would be -1 dB and the SNR at 120 km/h would be -3 dB. The Killion data suggests that he will requires a SNR of at least 6 dB in order to understand speech. Which technology will work for him?

First there are conventional directional microphones that can only pick up speech from in front of the listener. This will of course not work in a car since a driver must face the road whilst driving and not the talker beside. Some hearing aids have the capacity to shift the directionality of the microphones to the side and in some cases stream the signal to the other side of the head that does not have an optimal microphone placement. The signal to noise ratio improvement that can be obtained from this arrangement is still the same as conventional directional microphone and is about 4-5 dB. This will be satisfactory for speeds up to 80 km/h, but not higher speeds.

What about a binaural directional microphone? Hearing aids with these features combine all of the microphones on each hearing aid to achieve an SNR of 8-9 dB. While this certainly fits the SNR criteria numerically, it will not work in this case as he is frequently the driver and must keep his head facing the road. Binaural directional microphones work in front only.

The final options are remote microphone technologies such as Bluetooth or FM (non-adaptive) or adaptive digital remote microphone such as the Roger microphones from Phonak. Since Bluetooth remote mics provide about a 10 dB improvement this will certainly meet the criteria.

But what happens if one needs a higher SNR or there is a need to hear multiple talkers? This is certainly the case with the next example. This is a 38 year old mother with two children. She frequently needs to drive her 2 children or her elderly parents to various appointments in her Ford Focus. She presents with a moderate-severe sensorineural hearing loss and the LiSN-S PGA results were in the red zone indicating that she needs SNR boosts of at least 15 dB. In this client’s case she could use a non-adaptive remote Bluetooth remote microphone for local 50 km/h city roads as this will improve the SNR from about 7 to 17 dB.   However, she will still experience difficulties hearing multiple talkers and at highway driving speeds. The only technology that can cover all of her driving listening needs would be an adaptive digital remote microphone.

Below is a picture of a set-up that I have commonly used for these situations. In it you see both communication partners using adaptive digital remote microphones that switch automatically between the talkers.  In this picture, we are using two Phonak Roger Pen transmitters.  These transmit both the talkers voices to receivers connected to hearing aids or cochlear implants.

Noise levels in car 4 Two Mics Pic

In summary, I would recommend that you and your hearing care professional look at the following critical pieces of information:

  1. What car do you drive ?
  2. Are you typically the driver or the passenger?
  3. Do you do a lot of highway driving?
  4. Do you need to hear multiple talkers?
  5. How do you perform on a Speech in Noise test.

Only when you have all the relevant information can you determine the best solution for listening in a car.

 

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I Didn’t Think That Had Anything To Do With Hearing…


images

The other day I was talking to a friend who heard another person claim that I was a snob.  Conversation went something like this:

“Hey Pete, how’s it going”

Good, thanks, and you?

“Fine.  Hey, I bumped into someone the other day that knows you.  Funny thing she said that you were stuck up.”

Really, me? Stuck up??  A snob??  Why did she say that?

“Well, you walked by her the other day.  She said “Hi!”, but you just kept on walking on by.  Didn’t say a word to her.  She was really insulted”

Ahhh.  Could it be I just didn’t hear her?

This got me thinking about some of the funny or unusual things people with hearing loss sometimes do.  Most people would not connect that these behaviors are in fact related to our hearing loss.  Below is a list of some of the weird things people with hearing loss do, why we do it, and how we can make it better.

  1. Ignore People.  This is the example above.  Likely what happened to me is that the environment was noisy and I didn’t hear my name in all the racket.  Alternatively, the person could have been on my left side, which is my non-implanted ear.  I don’t hear much on that side even in quiet.  Or my batteries might have been dead.  Or maybe I just wanted to enjoy some peace and quiet and turned everything off.
    1. What to do about it:  First off, anyone that knows me, knows I am a very social person who never snub anyone.  Don’t take offense.  Try to get my attention visually or by tapping me on the shoulder.
  2. Close Proximity:  I do not do this too often, but I have seen others with hearing loss do this.  Since we can’t hear well, especially in background noise, we sometimes invade one’s social space try to get closer to the sound source, in this case the talker.
    1. What to do about it.  First off, this behavior is most likely exhibited by people who do not get amplification to assist with the hearing loss.  Get proper hearing aids and assistive listening technology for noise and you won’t have to do this anymore.
  3. Forgetting Names.  Actually, I am not sure I am forgetting people’s names, but rather I never heard it correctly in the first place.  The reason we have such a hard time with names is that there is no linguistic context to assist us.  For example, if some said “Please pass the salt and _______”, we know that the most likely final word is pepper.  But if someone says, “Hello my name is ______”, it could be anything.  Other times, I may have misheard the name and called someone the wrong name.  Eg, Norma instead of Nadia.  Hearing, learning, and remembering names is brutal for people with hearing loss.  
    1. What to do about it.  Well use a wireless system that gets rid of noise.  So in a noisy social situation, you have a better chance of hearing the name correctly.  I also use a buddy system with my wife who has normal hearing.  She fills me in with the names after the introductions.  I also have a cue for my wife when introducing her to someone whose name I ought to know.  For example, if I do not now the name of a person I really ought to know, I turn to my wife and say “Have you two met yet”.  She then promptly extends her hand and says “Hello my name is Kim”.  Other person reciprocates.  Problem solved.
  4. Knock Over Drinks at Dinner Table.  How on earth could this be related to hearing loss you ask?  Simple. I am busy listening to someone across the table.  It is a noisy restaurant.  So now I have to rely more on lipreading cues for communication.  I am staring at the person’s lips, reach for my beverage without properly looking, and then knock it over.
    1. What to do about it.  Don’t reach for the beverage while trying to listen.  Use a wireless system to get rid of noise.
  5. Bump Into Things/Scratch Up My Watch.  This is very similar to the above scenario.  If I am walking down the street with someone I am looking at their face face to lipread.  Since I am not paying attention to what’s in front of me, I bash my watch into walls and posts.  Sometimes I crash into people.
    1. What to do about it.  Buy cheap watches.  Apologize profusely to people I bump into.  And again, use a wireless system to get rid of the noise.
  6. Speaking Too Loud.  This one is more obvious.  Folks with hearing loss routinely have trouble monitoring their vocal intensity.  And it gets worse when in noisier environments where it is harder to hear oneself or others.
    1. What to do about it.  This behavior is also more typical in people who do not have personal hearing aids yet.  Get some!
  7. Speaking Too Soft.  This is more common for me.  I do this for a number of reasons.  First, I am scared that I am speaking too loud and so I overcompensate.  Secondly, I do have a tendency to overestimate the hearing capabilities of normal hearing people.  I think you can hear a whisper from across a room.
    1. What to do about it.  I carefully watch the faces of people I am speaking with.  If it looks like they are straining to hear me, I speak up.  If their eyes widen and they push back from the table, I am likely speaking too loud.  Lastly, I inform close friends and family to let me know if I am too loud or too soft.
  8. Inconsistent Hearing Behaviors.  Sometimes I hear you, sometimes I don’t. What’s up with that?  Guy must be faking it.  Actually, no.  The inconsistencies are likely due to varying noise levels.  Sure in a face to face situation in a quiet room I hear pretty well. BUT THE WORLD IS  REALLY NOISY PLACE.  I would say that I find myself in a ideal listening environment at best about 10% of the time.  The other 90% of the time, the noise levels severely impact my ability to communicate.
    1. What to do about it: This is why I have been using my wireless FM system so diligently.  I cannot imagine how I could function without this technology.

So there you have it.  Some weird behaviors that are in fact related to hearing.  I am sure there are other examples.  So please share your stories, I would love to hear about them.

Resolution Acheived.


This will be a quick blog post.  I have been in contact with the management at Spring Rolls and they have done the following.

  1. The have apologized for what transpired.
  2. They have agreed to add the appropriate signs stated that Service Dogs are welcome.
  3. They have agreed to provide sensitivity and awareness training for their staff.

Note that this is not just about complying with the Ontario Human Rights Code but also the Accessibility for Ontarians with Disabilities Act.  Specifically, as of January 2012, all providers of goods and services must comply with the Customer Service Standards.  I urge you to click this link for more details. 

I am pleased that Spring Rolls plans to take the necessary steps to ensure this experience does not happen to others with disabilities.  Thank you.

Discrimination Against Hearing Ear Dogs


Photo by Richard Lautens, Toronto Star.

Photo by Richard Lautens, Toronto Star.

On Thursday April 18th at around 12:30 p.m., I attempted to go for lunch with my two work colleagues at a restaurant called Spring Rolls.  When we arrived, the manager told us we could not bring my Hearing Ear Dog in.  We immediately informed him that this was not a pet but a Hearing Ear Dog and as such was legally entitled to come into the restaurant.  He still continued to refuse to seat us, telling us first that Health Code laws prohibit this.  We told him this was nonsense and in fact the law allows me to bring a Hearing Ear Dog into the restaurant.  He still refused, saying that we cannot have a dog near other customers.  Again, we pointed out this was nonsense as well and the law allows us to be served.  He then proceeded to suggest we sit on the patio or in an upper area of the restaurant that was closed, but he would reopen so we would not be seen near anyone else.  We rejected those two options.  First, it was not warm outside and did not want to sit on the patio.  Second, segregation is also a form of discrimination.  We don’t segregate on the basis of skin colour, gender, or anything else, so why should I be segregated because of reliance on a Hearing Ear Dog?

After about 5 minutes of arguing, and his continual refusal to serve us, we were forced to leave.  We then proceeded to be served without any problems whatsoever at Jack Astors.

Lets review what the Ontario Human Rights Code says.

Ontario’s Human Rights Code  is a provincial law that gives everybody equal rights and opportunities without discrimination in the social areas of:

  1. employment
  2. accommodation
  3. goods, services and facilities
  4. contracts
  5. membership in vocational associations and trade unions

The Code’s goal is to prevent discrimination and harassment because of many areas (race, gender, age sexual orientation etc.), including disability.  Section 10 (1) of the Code defines “disability” as follows:

“because of disability” means for the reason that the person has or has had, or is believed to have or have had,

  1. any degree of physical disability, infirmity, malformation or disfigurement that is caused by bodily injury, birth defect or illness and, without limiting the generality of the foregoing, includes diabetes mellitus, epilepsy, a brain injury, any degree of paralysis, amputation, lack of physical co-ordination, blindness or visual impediment, deafness or hearing impediment, muteness or speech impediment, or physical reliance on a guide dog or other animal or on a wheelchair or other remedial appliance or device,
  2. a condition of mental impairment or a developmental disability,
  3. a learning disability, or a dysfunction in one or more of the processes involved in understanding or using symbols or spoken language,
  4. a mental disorder, or
  5. an injury or disability for which benefits were claimed or received under the insurance plan established under theWorkplace Safety and Insurance Act, 1997

The two relevant themes are that I was discriminated in the social area of “goods and services” due to a “disability“.

Through various contacts, two media outlets were contacted and agreed to do a story on this issue.  The Toronto Star published an excellent article.  Here are the contents of the article.

Interesting how the manager has modified his story to the Toronto Star reporter.  The article states the following.

“At the Spring Rolls restaurant on Queen St. W., Rupinder Bahl told the Star the reason Stelmacovich and his friends were offered seats upstairs or outside was because the tables at the front were either occupied or reserved. Stelmacovich, however, says many of the tables up front were empty.

When the restaurateur was asked if he understood that under Ontario’s Human Rights Code Stelmacovich cannot be refused proper service, Bahl said the dog didn’t need to be inside because he had friends who could help. Asked if he refused proper service he said, “Of course not.””

Point of clarification.  The restaurant was almost three quarters empty.  He never mentioned the need for reservations, this is something he made up after our incident.  The only reason he offered the upstairs area was to segregate us.  This was a special area used for parties and events and was not open to the public.  There was absolutely no reason that we could not have been seated in the normal part of the restaurant.

In addition to this article, the CBC also sent a camera crew to interview us.  This segment appeared on CBC on Saturday April 20 on the local Toronto 6 p.m. news.  Here is a link to the story of the CBC website.

Again, he brings up the lie about reservations.  Here is the relevant quote:

“The manager of the Spring Rolls restaurant didn’t want to appear on camera — but over the phone he told CBC News it was never his intention to offend anyone. He said the empty tables were for other patrons with reservations and he offered to welcome Stelmacovich back with a free meal.”

I told both reporters from the CBC and the Toronto Star that I will not file a Human Rights Complaint under the following conditions:

  1. That he acknowledges that he made a serious mistake by discriminating against me.
  2. He apologizes for this error.
  3. That he guarantees that it will not happen again not only to myself, but to anyone who relies on a service dog.

He failed to do that.  As such, I will be forced to proceed with a formal Human Rights Complaint.

Some may wonder, why bother with the hassle? My experience recently in Ottawa is the reason.  Before, when I had Amie, my previous Hearing Ear Dog, I had some incidents with taxi cab drivers.  However, when I went again to Ottawa with Flora, all the taxi cab drivers were excellent.  I asked one driver what he knew about the rules on service dogs  and he replied “Yes, we have be clearly instructed we must take people with service dogs”.  Obviously someone took a stand, and by doing so, made my life easier.

Now it is time for me to return the favor.  So this is not about me, or Flora, and a free meal.  This is about all people who rely on service dogs and face this kind of discrimination every day.

Keep your free meal buddy.

How Do You Know You Need a Wireless Microphone?


In my last blog posting, I spoke about the technologies available to help you hear better in noise.  These included:

  1. Directional Microphones
  2. Fixed Gain Wireless Systems.
  3. Dynamic Wireless Systems. ZoomLink+ Transmitter

But how do you know what technology you need?  This is a very important question that needs to be answered right away before you decide what kind of hearing devices you wish to purchase.  Let’s say you need Dynamic Wireless system in addition to hearing aids.  If you have sufficient financial resources at your disposal, you may wish to purchase a premium hearing and a wireless system.  This is the best of all worlds.  But if you have limited resources, you may wish to spend less money on your hearing aids in order to have enough money left over for a wireless system.

It is also important to know this in order to have realistic expectations about your hearing instruments.  If your hearing loss requires that you use a wireless microphone system in order to hear in a noisy environment, you can do countless hours of hearing aid fine tuning with your Hearing Care Professional and you are still not going to hear better in noise.  Its simple physics: a Dynamic Wireless microphone placed in close proximity to a speaker’s mouth will always outperform a microphone at the ear level.

Ideally you will have answered this question early in your hearing device selection process.  Here’s how this question can be answered:

  1. Experience with Existing Hearing Devices.  If you already have hearing aids or a CI equipped with directional microphones and you are still struggling to hear better in a noisy environment, you will have answered your question about the need for a wireless system.
  2. Experience with a Bluetooth Wireless Microphone.  As I mentioned in my previous blog posting, a Bluetooth Wireless Microphone will provide better performance than a directional microphone on your hearing devices.  But if you are still struggling with the Bluetooth mic, there are still significant improvements that can be obtained with a Dynamic Wireless System.  The microphones cut noise better, and the dynamic nature of the system will reduce the amount of noise your hearing aid or CI microphones will pick up.
  3. Experience with a Fixed Gain Wireless System.  Similar to the above, if you already have tried a fixed gain system (Eg Phonak Campus, SmartLink SX, ZoomLink or EasyLink; Oticon Amigo, Comfort Audio Digisystem) and are still having trouble, then a Dynamic System will provide additional benefits particularly at noise levels at around 70 dB or greater.  This is about the level of a restaurant.
  4. Audiogram Approach.  Most people with moderate-severe hearing loss or greater will require more than a directional microphone on the hearing instruments.
  5. Direct Assessment of Hearing in Noise Abilities.  There are several tests that your Hearing Care Professional can perform to help determine right away what kind of technology you need.  The one I am most familiar with is the LiSN-S PGA test and as such I will highlight this test in the remainder of this blog posting.

LiSN-S PGA stands for Listening in Spatialized Noise.  Performed under headphones, a virtual 3D space is created with target sentences coming from the front and distracting sentences are coming from the left and the right.  The PGA stands Prescribed Gain Amplifier.  The stimuli are amplified according your hearing test results.  So it simulates the way you would hear in a noisy environment if you had hearing aids and an omni-directional microphone.

LISN-S PGA

LiSN-S PGA accurately measures your ability to understand speech in noise as if you were wearing hearing instruments (amplification), and by your performance on LiSN-S PGA with normative data stored in the software, LiSN-S PGA predicts accurately the your performance in noisy situations compared to normal hearing listeners of the same age, and if the predicted performance is not good, LiSN-S PGA gives you clear, individual, technology recommendations how to improve speech understanding in noise. So based on your responses to the sentences, you get an evidence based recommendation.

The test takes about 5 minutes to perform.  You will hear noise first coming into both ears.  It will seem like the noise is coming from the sides.  Then you will hear a sentence that sounds like it is coming from in front of you.  Your task is simply to repeat back the sentence.  Your Hearing Care Professional simply needs to click on how many words you repeated correctly.  The computer will then automatically make the next sentence softer or louder depending on how well you did.  The test stops when the software has sufficient results to make a recommendation for you.

Condition 1

Here is what the recommendations screen looks like:

recommendation

Personally I find it interesting that difficulty hearing in noise is one of the most common complaints that a person reports when getting a hearing test, yet most hearing care professionals never assess this.  Far too often we wait for a patient to fail with the hearing devices before we explore additional noise reduction technologies.  This is unacceptable.  Why frustrate people with hearing loss unnecessarily?

I know many Hearing Care Professionals are thinking, “Yes Peter, but many patients won’t use additional microphones, so I don’t bother introducing this technology”.  This thinking is also unacceptable.  You are making a pre-determination and denying people hearing loss technology that is critical to helping them function in our noisy world.   Our duty, as Hearing care Professionals is to help people with hearing loss make an informed decision.  Yes, some may reject such technologies initially, but it is still their right to be informed.

For more information about the LiSN-S PGA, click here.

For more information about the development of the LiSN-S PGA test click this link here.

Best Ways to Hear Better in Noise


Noisy-restaurants

Hearing loss results in two main problems; loss of audibility and loss of clarity in noise.

Loss of Audibility. This means that sounds are too soft to hear.  We have a couple of strategies to make sounds more audible.

    1. Amplification. Today’s modern hearing aids selectively make softer sounds louder than louder sounds.
    2. Frequency Compression.  In some hearing aids such as the ones provided by my company, Phonak, the hearing aid can shift high pitched sounds down to lower pitches.  The logic is that you may have too much damage in the high pitches to amplify the sounds sufficiently, so we will shift these sounds to regions where you have better hearing.
    3. Cochlear Implants.  If high powered hearing aids equipped with frequency compression no longer helps you hear, we now turn to a Cochlear Implant to make sound audible.  See these links for more information of Cochlear Implants.  Also here.

Loss of Clarity in Noise.  I wish that hearing loss was merely a problem of loss of audibility.  It would be so much easier just to amplify the sounds and be done with it.  Just like wearing a pair of corrective lenses for vision, right?  Wrong.

After we do our best to make sound audible, we also have to do something about getting rid of the background noise.  As one’s hearing loss gets worse, not only do we need stronger and stronger hearing aids, but we also need to get rid of more and more noise.  For example, a person with normal hearing can handle a signal-to-noise (SNR) ratio of 0 and still understand most of what is being said.  An SNR of 0 means that the person talking to you is the same loudness as the person you don’t want to listen to.  This happens all the time.  Imagine a restaurant.  There are people all around you talking at the same loudness as your significant other across from you.  You normal hearing folks can handle this, people with hearing loss cannot.

Strategies to Hear Better in Noise.

  • Ear Level Directional Microphone Technology
  • Remote Bluetooth Microphones
  • Fixed Gain FM/Infra-Red/Digital Technology
  • Dynamic FM

These 4 strategies are not all the same.  They vary significantly in the amount of noise reduction provided.

Directional Microphones:

A directional microphone works by picking up the sound from one direction (typically the front) but not from anywhere else.  So now you won’t hear the annoying kid in the restaurant behind you as much.  Independent research has shown that a directional microphone on the hearing aid does help you hear better in noise compared to a regular omni directional microphone. The range of improvement found in these studies is anywhere from 3 to 8 dB.  So it gets rid of about 5 dB of noise.  This is not huge, but for people with milder losses of hearing, this may be all they need.  It certainly is convenient.  You don’t need to carry extra equipment.  In fact, in today’s modern hearing aids such as Phonak Bolero Q or Virto Q, these microphones get switched on automatically when it gets noisy.  Pretty awesome technology in there.

Remote Bluetooth Microphones.

Many companies, including the one I work for, now have affordable Bluetooth microphones that can be used with your hearing aids.  You clip this microphone onto the person you want to hear and it transmits wireless via Bluetooth radio waves to a device around your neck which in turn sends it to your hearing aids.  By moving a microphone from the ear level to a much closer proximity to the talker’s mouth, we can achieve much higher signal-to-noise ratios than a directional microphone located on your head.  Here is the example from Phonak which involves the use of the Remote Microphone in conjunction with either a ComPilot or an iCom.

Phonak Remote Mic

The advantage of Bluetooth microphones are that you get rid of more noise compared to ear level directional microphones.  They are convenient, and easy to use with simple and intuitive controls (just an on/off switch and volume).  Finally they have the advantage of low cost.  It is a very affordable solution, much less than FM.

Traditional and Fixed Gain Wireless Systems

To achieve an improvement in SNR up from a Bluetooth Microphone system would be to use a fixed gain wireless system. Examples of include:

  • Phonak’s 2nd Generation systems such as Campus, SmartLink SX, ZoomLink, EasyLink (silver casing)
  • Oticon Amigo
  • Comfort Audio Digisystem

These are all examples of fixed gain systems and achieve similar results.  The reason these perform a bit better than the Bluetooth microphones is that most incorporate directional microphones on the transmitters and therefore can get rid of more noise.  Additional benefits include greater operating ranges and longer battery life.  However, cost is significantly higher for what is really just a modest improvement over a lower cost Bluetooth microphone system.

Adaptive Wireless Systems

Some wireless systems are adaptive.  For example, the Dynamic FM technology that Phonak uses is different than fixed gain systems in that it adjusts the FM gain depending on the environmental noise level.  Therefore additional gain is added if the background noise level increases.  The technology works by measuring the ambient noise levels in the room during speech pauses.  If the ambient noise level rises to over 57 dB SPL, a command is sent from the transmitter to the Dynamic FM receivers to increase the FM gain.  When the FM gain increases, you get a higher signal to noise ratio.  It is still comfortable to listen to because today’s modern hearing aids all have compression which keeps this at a comfortable level.  Examples of Adaptive Wireless Systems include Phonak inspiro, SmartLink+, ZoomLink+, EasyLink+ and any 3rd generation Phonak receiver (eg MLxi, ML9i to ML16i)

ZoomLink+ with Dynamic FM

How Do These Technologies Compare?

1. Directional Microphones vs Fixed Gain FM.  This classic study by Valente et al in 2002 compares an omni mic to a directional mic on a hearing aid which in turn compares this to an FM system.  The data is backwards, so the lower the number, the better the result.  It is very powerful data showing how well an FM system can help over just an ear level directional microphone.

Valente et al 2002

2. Fixed Gain vs Adaptive Gain Wireless Systems.

The most extensive study comparing fixed gain vs adaptive gain wireless systems was conducted by  Dr. Linda Thibodeau, PhD, University of Texas at Dallas, USA, and the Callier Centre for Communication Disorders, Dallas.  AFMA refers to the Adaptive Gain FM while Fixed of course refers to fixed gain wireless less.  Remember that fixed gain wireless systems include Bluetooth microphones, Phonak’s second generation FM (Campus), Oticon Amigo, and Comfort Audio DigiSystem to name a few.  As you can see, when the room noise gets louder, the word recognition score for the adaptive gain wireless system is much higher.  In this example, the transmitter used was the Phonak inspiro with Dynamic FM.

Results of Dynamic FM over traditional

3. Adaptive FM vs Digital Wireless.

This study, conducted at the University of Orebro in Sweden, compared a digital wireless system with fixed gain (Comfort Audio Digisystem) to a adaptive gain FM system (Phonak Dynamic FM).  The question is what leads to better performance in noise.  The result s clearly showed that the adaptive gain system (Phonak Dynamic FM) leads to better performance.

Dynamic vs Digital

So which do you need?

I will make my next blog post on how to select the correct technology for your needs.  But here are the summary points.

  1. You need technology that helps you not only hear soft sounds, but also helps get rid of background noise.
  2. Directional microphones on the hearing aid itself can get rid of about 5 dB of noise.
  3. Bluetooth microphones provide additional improvement in noise.
  4. Fixed gain wireless systems such Phonak’s second generation FM, Oticon Amigo and Comfort Audio Digisystem provide additional improvements over a Bluetooth microphone, but these may be modest improvements.
  5. Adaptive gain wireless systems such as Phonak Dynamic FM still provides the largest amount of noise reduction.

Meet Flora my new Hearing Ear Dog


Flora 1

Well folks, we have a new working family member.  Meet “Flora” my Hearing Ear Dog!

Flora is a Flat Coat Retriever.  I never heard of this breed before meeting Flora (but then again, I never hear a lot of things…).    This is a fairly old breed.  Dating back to the early 1800’s, this breed was the most popular birding dog, before Labradors and Golden Retrievers were developed.

Flora with her cool camo vest to keep burrs off her beautiful coat.

Flora with her cool camo vest to keep burrs off her beautiful coat.

In appearance, the Flat-Coated Retriever resembles a black or brown Golden Retriever. Flat-Coats are often called the “Peter Pan” of retrievers. They generally mature more slowly than other dogs and maintain their puppy-like exuberance for years. In my experience, the best Hearing Ear Dogs combine intelligence, playfulness, and an eagerness to please.  So far Flora seems to be all those things.  I do notice that she while she is a responsive and sensitive dog, harsh corrections will cause her to shut down until I make amends.  She tried to eat some nachos off the coffee table, and I scolded her for that.  She marched into the corner to pout for 20 minutes until I encouraged her to come back into the room.

This is her usual happy-go-lucky face!

This is her usual happy-go-lucky face!

Flora is a tolerant and friendly dog.  She adores everyone, perhaps a bit too much.  Thank goodness for the “Halti” head collar.  These things are a godsend for anyone trying to control a large or busy dog. Flora is definitely both of those things. The Halti works off the theory that a dog does not like to walk with its head turned left or right. If Flora pulls the leash, or forges off in a different direction, the energy is gently transferred into turning Flora’s head, thus stopping the behavior.

Halti

Note that even though Flora may appear to be a bit of a spaz in public, this same energy and playfulness are what will make her a fantastic hearing ear dog.  Plus, she is only 14 months old; she is still a bit of a puppy.  For the record, for those of you who knew Amie my previous hearing ear dog, she also required the use of a Halti for the first 3 years I had her until she settled down.  Radar, my first hearing ear dog, was a breeze to handle in public, but he never had the passion for hearing ear dog work as Amie did.  So my point is that smart and playful dogs are the best Hearing Ear Dogs.

One thing I am working on with Flora is to curb her desire to jump up on everyone and kiss their faces (she is long enough to do that with most average sized people).  First, the Halti collar will get rid of most of this behavior.  Second, the rule for everyone is as follows.  If you want to pet Flora, she must be sitting first.  Training a correct behavior that is incompatible with the undesired behavior is better that a harsh correction.  So in this case, we will make her sit first, give her a treat for a reward (I will have them, not you) and then we pet her and say hello.  If she tries to jump up, I will restrain her with the Halti, and you must not pet her.

Flora, like all Flat-Coat Retrievers require a fait bit of exercise. Flora needs a give 45-minute walk, run, or other activity daily to satisfy her exercise needs. The nice thing though is that once she has her exercise, she enjoys relaxing with us at home.  So she does have the capacity to settle down.  As I like to run, this makes her a perfect match for me.  We have gone on 2 runs so far and it has been great!  I now have a buddy to run with.

I am also amazed at how loyal Flora is and how well we have already bonded after only a few days.  She follows me everywhere, even to the bathroom, which is not a wise thing to do especially after I have consumed some Chicken Tikka Masala with extra Pataks Hot Curry Paste.  I left her with the family yesterday while I went to the gym…apparently she just stared at the door for almost an hour waiting for me.  Here’s the picture my wife took…

Flora is waiting for me to come home...

Flora is waiting for me to come home…

Just as a final reminder why I have decided to get another Hearing Ear Dog, please click here to read my previous post on this topic.   If you are too lazy to do that, then I will sum it up again.  Without my CI, I hear nothing whatsoever.  Therefore for at least 10 hours out of 24, I won’t hear any sounds such as fire alarms, door knocks, alarm clocks or phone calls.  Secondly, the microphones of hearing aids or CI’s really work best in a 2-3 meter (6-9 foot) range.  So if I am on another floor of the house for example, my ability to hear sounds is very inconsistent.  Finally, there is the issue of signal to noise ratio.  Even if something is close by I can’t hear it if there are other competing sounds such as the television.

Some Rules for Everyone.

  1. Don’t feed Flora.  Anything.  Ever.  Don’t even ask me.  No exceptions.
  2. Don’t pet her unless you ask me.
  3. If I do allow you to pet her, she will need to sit first, and then you can pet her.  If she tries to jump up and kiss you, turn away.  This behavior should go away in time.

That’s really it for rules for you.

I want to thank Tracy Church and the Hearing Ear Dog Team at Lions Foundation of Canada for training such a wonderful animal for me.  If any of you are feeling the urge to donate money to a worthy cause, I cannot think of a better one.

On Being Normal…


As a person with hearing loss, I often ponder the question of what it means to be normal.  Does my cochlear implant give me normal hearing again?  Am I a normal person?  If not, am I less of a person because not everything about me is normal?

For any hearing aid or cochlear implant user, I think no one will ever have normal hearing again.   There is some form of damage in the auditory system that cannot be corrected.  For example, in cases of sensorineural hearing loss, the hair cells remain damaged even after we add the hearing devices.  Until hair cell regeneration therapies become clinically available, the ear is still not normal.

Some people have compared using hearing aids to using eyeglasses to restore vision.  While it is tempting to draw such an analogy, I do not think this comparison works.  For most people with glasses, there is nothing damaged or unhealthy about the eyes.  Typically, the lenses of the eye are simply not the correct shape but the eye is still healthy.  Moreover, eyeglasses do not convert the light energy from one form, digitize it, manipulate it and then attempt to reconvert it back into light energy again.  What hearing aids do is far more complex than eyeglasses.

What we can do when it comes to hearing loss is try to restore normal function. By this I mean we can use equipment and communication strategies to allow us to function better in the various communication situations we face.

In cases of milder hearing loss, we try to restore the normal function of the outer hair cells via sophisticated hearing aids that amplify softer sounds more than louder. We try to restore normal ability to hear in noise via directional microphone technology or additional wireless microphones. We try to restore normal audibility of high frequency speech sounds via techniques such as non-linear frequency compression.  When hearing aids no longer help, we try to restore normal audibility via a cochlear implant.

But at no point are we ever making hearing normal.  The ear is still not the same as someone with a fully intact auditory system.  The extent to which we can normalize function is contingent upon many factors such as the degree of hearing loss, the technology employed, the behaviors we use and sadly financial resources.

Clearly, the more severe a hearing loss is, the more challenging it will be to communicate even with the best equipment currently available.  Also, if one has a more severe loss and chooses not to utilize the proper type of amplification for the hearing loss including wireless microphones, then such a person will also not function as well in all situations.  This also relates to behaviors.  Learn to how to use the equipment in various situations.  Learn how to communicate effectively.  Teach others how to best communicate with you.

Ok, so my hearing is not normal.  Does that make me an abnormal person?  Maybe, but frankly who on this planet is completely normal.  If you are not the ideal weight, not the ideal height, take medications for some medical condition, you too would not be perfectly normal either.  But so what?

I do not worry or care about being perceived as normal because frankly very few people on this planet are normal.  But just because I am not “normal”, this does not make me less of a human being.  I still want all the things anyone else wants in life.  I do not want to be discriminated against nor denied things simply because of my hearing loss.

So lets not even worry or talk about being normal…it is an impossible quest.  Lets learn to embrace  and accept all of the things that make us different and make us who we are.

Elephant Shoes or I Love You…The Good and Bad of Lipreading.


Lipreading, or speechreading is the process in which we try to understand speech by observing the movements of the face, lips, and tongue of a talker.   Note that I say we “try” to understand speech.  It is not possible to fully understand speech from visual cues alone.  Here’s why:

All speech sounds can by classified by three parameters (see chart below):  Place, manner, and voicing.  Place of articulation refers to where the sound is made.  For example, the sounds /p/, /b/, and /m/ are all referred to as bilabials since they are produced using both lips.  The sounds /f/ and /v/ are referred to as labiodentals since the lower lip is placed between the teeth.  There are a whole bunch of sounds that are produced at the alveolar ridge, which is the little shelf jest behind your two front teeth.  With these sounds, the tongue is placed on this ridge.   The remaining sounds are produced further back in the mouth and are pretty much invisible to the eye.  These include sounds such as /sh/, /ch/, /g/,  /k/, and /h/.

Bilabial Labiodental Interdental Alveolar Palatal Velar Glottal
Stops Voiced /b/ bet /d/ dent /g/ goat
Voicedless /p/ pet /t/ tent /k/ coat
Fricatives Voiced /v/ vet /th/ these /z/ zed /zh/ garage
Voicedless /f/ fed /th/ think /s/ sent /sh/ sheep /h/ hot
Affricates Voiced /j/ jeep
Voicedless /ch/ cheap
Nasals Voiced /m/ met /n/ net /ng/ bang
Liquids Voiced /l/ let /r/ reap
Glides Voiced /w/ wet /y/ yell

The other two parameters are manner and voicing.  Manner refers to the type of sound produced.  For example, fricatives sound like air rushing or hissing.  Stops or plosives sound like a burst of sound.  It is very hard to see the manner of a consonant.

Voicing refers to the use of our vocal folds when we make a sound.  Try this little experiment.  Place your hand on your throat and make the /f/ sound and then the /v/ sound.  Don’t say these letters, make the sound.  You will feel your vocal folds vibrating for the /v/ sound, but not the /f/ sound.  This is of course invisible to the eye; we cannot see vocal folds vibrating.

Now lets look again at the sounds /p/, /b/, and /m/.  All three of these sounds will look pretty much the same via lipreading.  However they certainly sound different and more importantly, they change the meaning of the word.  If I say “pat”, “bat”, and “mat”, one cannot see the difference between these words.

So the reason that communicating exclusively via lipreading is difficult is due to two main reasons.  First, many sounds are produced at the back of the mouth and are completely invisible.  Examples include /h/, /g/, /k/, /ng/.  Second, many sounds look exactly the same because they are produced at the same place in the mouth.  The  consonants /p/, /b/, /m/ are a good example of that.

But lipreading can still be useful as a supplement to hearing.  Numerous research studies over the years have confirmed this.  Most studies show that while the scores of most people on lipreading tasks is typically quite low, it makes a great supplement to the auditory channel such that auditory-visual speech perception (lipreading + hearing) is much greater that auditory only.  In fact, I recall reading a study examining auditory only, visual only, and auditory visual speech perception in older adults.  Even though these adults scored 0% on visual only speech perception, their auditory-visual speech perception score was still greater than auditory only.

While I consider myself a pretty good lipreader, I have made some amusing errors over the years.  Here are some examples of embarrassing mistakes I have made. First sentence is what was actually said, and the second is what I thought was said.  It may also reveal the workings of my twisted mind.

What Was Actually Said:  My teacher is so cool, she plays the guitar.

What I Thought:  My teacher is so cool, she pees in a jar.

 

What Was Actually Said:  I am going to design you a tattoo.

What I Thought:  I am dying to touch you.

 

What Was Actually Said:  There is some nice grass over there for your dog.

What I Thought:  There is some nice ass over there…

So here is my advice when it comes to lipreading:

  1. Use it as a supplement to your hearing.
  2. Hearing is still the most important sense we have for communication via speech.
  3. If your are finding that you need to lipread a lot in quiet, you should consider getting assessed for a cochlear implant.  Lipreading all day long is highly inaccurate and very tiring.
  4. If you find yourself lipreading a lot when in noise, consider getting a wireless microphone system such as an FM system to help improve the signal to noise ratio.  Or get out of the noise.
  5. Training to improve lipreading skills is debatable.  Instead, focus on creating favorable conditions for llipreading.  Tune in next time to a discussion on how to enhance the conditions for successful lipreading.

Things to be Thankful for…


In Canada, this is our Thanksgiving Weekend.  While the originally designed to give thanks for the harvest, we generally use this holiday to share a meal with friends and family and reflect on all things for which we are grateful.  For me, the following represents things for which I am most thankful. There is no particular rank order here…

 

  1. Cochlear Implant Technology.  This technology has dramatically changed my life in enormous ways.  Simply put, without it I could not function.  Communication would be almost impossible.  I probably would have embraced sign language to a greater degree, but I would be limited to communicating to a much smaller and limited set of people.  I would have completely lost my ability to enjoy music.  Do I wish for improvements from this technology?  Sure.  Music perception and hearing in noise and are still challenges, but I have developed some additional compensatory techniques.  Still, a day does not pass in which I remind myself how my different my life would be without the CI.
  2. Wireless Microphone Technology.  While the the cochlear implant implant is amazing, it is the synergy of the FM system in conjunction with the CI that provides me even greater capabilities.  Adding FM technology allows me to use my mobile phone via Bluetooth, hear in noisy cars, restaurants, and bars, enjoy social events more fully, and enhances my ability to hear and perform music.  I wish more CI users would realize how much more they could get out of life if only they added FM or other wireless microphones.
  3. Music.  Music brings light to my soul.  It always has the ability to brighten my darkest days.  I am so grateful that I can still not only enjoy listening to music, but to perform it as well.  It has not been easy to keep music a part of my life.  I needed to experiment with vibrating platforms, compressors, equalizers, FM systems, and soundboards to make it happen.  Lots of money and time has been spent on this.  But it can be done.
  4. Family.  I have a wonderful, intelligent and beautiful wife that puts up with my shenanigans.  And I have a handsome, brilliant, and kind hearted son who is so full of passion.  I love you both.
  5. Health.  A weird thing happened the other day.  My son’s friend was looking at some pictures of both my son and I from his early childhood.  The friend remarked that I look younger today the I did 10 years ago.  That was such a compliment!  Losing 40 pounds of excess weight and getting into better shape has had the effect of turning back the sands of time.  Next week I will be completing a half marathon, something I never dreamed I would be capable of doing.  I am so grateful that I am finally on the road to better life.  It feels great.

 

Happy Thanksgiving!