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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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.

Working Out Deaf


I won the contest at work.  We had a bet who could lose the most percentage weight.  Yippee for me!  I lost 29 lbs in 9 weeks.  Just over 11% body weight reduction.  I still need to lose about 25 more to finally put an end to the “chubby deaf guy.”

Working out Deaf…do you wear your hearing instruments or not?  Yes, I have a water resistant hearing aid and cochlear implant.  But years of being taught  to fear moisture on my expensive hearing devices still is in me and I can’t seem to get over that.  Thus I always remove my CI and hearing aid when I work out.  This has pros and cons.

Pros:  I like being in my own little world sometimes.  I enjoy the peacefulness, and I seem to focus better on exercising.  I can work out as intensely as I wish with no concern about damaging my hearing instruments.  Lastly, at the gym, there can be some arrogant jocks spewing off stupidity.  My son tells me some of the conversations he has heard.  A real classic was some meathead dude looking forward to visiting LA because  “Almost all the women in LA have done porn.  Its true dude!”  These are the times I consider myself blessed to be deafened.

But there are some cons and some safety points to consider.

First, I think I need a t-shirt that says “I am not a douche-bag…I am deaf”.  Although I try really hard to not block anybody and be aware of my surroundings, sometimes people ask me questions like “are you done with that machine”.  I look like I am ignoring them, which gets erroneously interpreted as arrogance.  I mean, thats what guys do in the gym, right?  It is almost a dick slapping contest.  Well, no, not for me…I am not a jerk like some of the other guys in the gym, I am just deaf.

Then there are the safety issues.  I also run outside with no hearing aid or CI.  Let me officially state that I am not advocating this for anyone because you may not hear a car and get run over.  The safest thing would be to run on a treadmill if you insist on doing it “deaf”. Or use your hearing instruments whilst running outside.  Try protecting them with products like the Hearing Aid Sweat Band or Ear Gear.  I have not personally used these products, so don’t interpret this as an endorsement…but check it out.  Lastly, you when you are done with your exercising, put the hearing instruments in a Dr-Aid kit of some type.

There are now hearing aids that are water resistant.  Phonak has the new H2O line of hearing aids as does Siemens with the Aquaris product.  In addition, the Cochlear Nucleus N5 is water resistant, while the Advanced Bionics Neptune is actually waterproof.

But I have taken some steps to increase my safety, namely by enhancing my visibility.  First, I wear a reflective safety vest.  This makes me pretty much glow when headlights shine on me.

This vest makes me more visible.

But I didn’t stop there.  I also added some flashing lights to the vest.  I have a white at the front and a red one on my back.  If you can’t see me now, should you legally be driving?

These lights make me look flashier than Elton John.

The decision to exercising “deaf” is entirely personal.  I prefer it for myself, and I accept the related risks (not hearing traffic, and not hearing jocks).

What Does a Person with Hearing Loss Know About Hearing Loss?


Recently I was sent an email from an audiologist (really nice recent grad) asking how to help a patient with hearing loss hear better in the noisy workplace.

When the issue of using an FM system came up, apparently the person with hearing loss stated “No, that would not work in my situation because it is too noisy”.  So I was asked to come up with some other suggestions.

Ummm, ok,  I have a whole bunch of problems with this.

First, I think we need to clarify when we need to listen to our patients and follow the patients lead.  At other times we, as audiologists, SLP’s, hearing instrument practitioners or hearing resource teachers need to provide leadership and guidance to our clients with hearing loss. As an Audiologist with hearing loss, I have walked in both sets of shoes, so I would like to offer some suggestions.

First, here is a list of things where the person with hearing loss knows best:

  1. Ask and find our all the different situations in which the person with hearing loss is having difficulty.  List them all and seriously look at how we are going to help overcome those challenges.
  2. The patient knows and can tell you how it feels to be in a given situation.  Don’t be afraid to ask about this.  When a patient says ‘I could not hear at my daughter’s wedding” find out how they felt about that.  It is good to just let the patient explore their feelings and frustrations.
  3. Discuss past experiences both good and bad to see what you are up against.  For example, find out if the client ever tried an FM system or ever used directional microphones in the past.  Likely if something was a failure in the past, find out how much coaching the patient had in how to use the equipment.

In short the patient knows, better than you the clinician, the situations they are having the most difficulty in, and what it feels like to have a hearing loss.  But here is what the patient does not necessarily know and where the expertise of the professional is required.

List of Things a Patient with Hearing Loss Does NOT Know;

  1. Whether or not a hearing aid is even needed.
  2. What electroacoustic characteristics are needed in the hearing instrument
  3. What style of hearing instrument is most appropriate.  A patient can wish all they want for a tiny hearing aid, but if the loss is too severe, it can’t be done.  Period.  Yes, many patients have lots of choices of the form factor, but some do not.  We need to lead here, not follow.
  4. What technology for managing noise is needed?  For example, if a client has a moderate severe loss and a speech in noise test such as the LiSN-S PGA indicates that an FM system is needed, the hearing health professional NEEDS to communicate this to the client.  The client does not know what technology is required.  They just know the situations they find challenging.
  5. How to effectively use the equipment.  You cannot simply toss the equipment at the client and hope they figure out how to use it in the difficult listening situations that were identified.  Patients need our counseling and coaching here.

Now back to the patient who can’t hear at work.  The specific situations at work need to be fully explored.  Ideally, you can do this formally with the COSI.  Again, the patient understands this so much better and he needs to tell us as much as he can about his challenges if we are going to have any chance of finding solutions.  Next we need to explore why he feels that an FM system would not work.  He likely does not know how the technology works or how to use it effectively.  There are excellent FM counseling tools available for this purpose.

But we have to stop letting patients dictate the wrong things.  I have seen in my 20+ years of professional experience numerous patients who are wearing “dirty little secret” tiny aids and are not getting the correct amplification.  We need to provide leadership here and work the client towards more appropriate amplification.

Similarly, we must always consider not just the amplification needs but also the hearing in noise needs as they relate to the client’s own personal situation.  Will the client need directional microphone technology?  Should it be fixed or adaptive directional microphones? Will directional microphone technology be enough or will FM technology be needed?  Most patients with moderate severe loss and greater will likely find themselves in situations in which a hearing aid or cochlear implant is not enough.

I agree that we cannot force anyone to take our professional advice.  But patients do have a right to make an informed decision.  In my opinion, we are obligated as Hearing Health Care Professionals to give the patient all the facts.  Too often, when I give talks about directional microphones, FM systems, and other assistive devices,  a patient will ask me “How come this is the first time I am hearing about this stuff?”

More Gig Pics…


Performing live music in a band is like a dream come true for me.  I still can’t believe that I am able to do this with my hearing loss.  On one hand, I am a bit pissed that I have a hearing loss at all, but the fact of the matter is that shit happens to all of us in one form or another. Hearing loss is the hand that has been dealt to me, but I am going to play this hand the best I can.  If it was not for cochlear implants, hearing aids and FM systems, I would have been really screwed.  But I am not.  This pictures are proof of that to me.  I am one lucky dude.

Again, I must thank my friend and professional photographer Arsenio Santos for taking photos of the event.  There were so many good ones to choose, but here are some of my personal favorites.

Thanks also to me awesome bandmates Deb, Luigi and Warren.  I love you guys!  Thanks also to my buddy Dave for doing the acoustic set.  And one more shout out to one of my best friends in the world, Ryan Switzer from Massive Tank Studios, not just for doing the sound, but for helping me become a musician.

Deb is such a passionate singer.

Looking cool in a B&W photo

Warren is a fantastic drummer.

Luigi singing and playing guitar. You are awesome Luigi!

I am having a good time, can you tell?

But I do need a haircut.

Behind The Scenes with a Deafened Rock Star.


Ok, this title is wishful thinking.  Deafened, yes, but rock star, perhaps not.  We did a gig to raise money for a friend and colleague Warren Estabrooks whose organization is called “We Listen International”.  Warren and his team provide professional education, training and consultative services for professionals who work with children, teens and adults with hearing loss.

We started out the evening with some acoustic covers of some songs.  I played my acoustic bass whilst my buddy Dave played his 12 string and sang.  Later, my friend Maxine Armstrong, also an audiologist, did a beautiful rendition of Tom Petty’s Free Fallin.

My son’s Band Sticks and Stones were up next.  They played all original material that they wrote themselves.  Their sound is sort of “Indy” with jazz-like instrumentals.  Absolutely fantastic stuff.  If these guys had a recording contract, I am sure they would be hugely successful.  Check out their You Tube stuff here.  Also, you can download their songs here.

Finally, my bandmates and I got up to do about 18 songs.  I am so proud to be playing with these guys, everyone put in such a fantastic effort.  None of us are professional musicians, but we did our best to sound like it!

Speaking of professionals, special thanks to my good friend Ryan and his assistant Laura from Massive Tank Studios for doing the sound for the evening.  I love you guys!

Interestingly, while it is fun and exhilarating to perform music and have folks cheer for you, it is also quite stressful.  Why?  Because nothing ever goes exactly as planned.  The key is to not freak out, persevere, problem solve and find creative solutions. Lets take a behind the scenes look at the day to show you what I mean.

1 p.m.:  Start loading up the PA system, speakers, stands, bass amp, bass guitars, mics, cables etc etc.

2 p.m.: Start unloading gear at Pub.  First surprise.  Only one outlet box for all the gear.  Go and find more power bars and hope we don’t blow any fuses.

4:30.  Go to Music Studio to rehearse Free Fallin with Maxine.  Plan is to have two guitarist and one bass.

5:00.  Maxine still stuck in traffic.

5:15.  Rehearse with Maxine.

5:30.  Rush home to change.

6:00.  Go to Pub to finish setting up gear.  Three cables are dead, need to find replacements.  Deb, our singer needs a music stand.  Call wife to get her to bring one.  Forgot MyLink Receivers.  Call wife again to get those.

6:30.  My son has not arrived yet to do his set up and sound check.  He’s still at the tattoo parlor getting two new tattoos.  Really buddy?  On the day of the gig?  Is that a good idea?

7:00.  Supposed to start, but still setting up.  Someone has unplugged my TX300V FM from the Aux Out 1 and used it for something else.  I don’t think so people.  Deaf guy gets first dibs on sound.  Plus its my mixing board, so I get to call the shots.  Slightly tense conversations ensue, solution found.

7:40.  We start to do the acoustic set that was supposed to start 40 mins earlier.  First three songs are fine as we over-rehearsed these.  Maxine comes up to do her song.  Ryan was supposed to join us by playing guitar, but we ran out of inputs on the PA for another guitar.  Bummer, because while I love my buddy Dave who is playing guitar, he is rhythmically impaired.  Maxine sings like an angel, but I lose my timing.  Sound man Ryan sees I am struggling and becomes my human metronome.  I read his lips as he is counting out the time.  While I am playing some other folks with Cochlear Implants are requesting the MyLink FM receivers I promised.  Shit, they are still in my car.  Cant’ get them now, I am playing (for Pete’s sake!)

8:00.  Son’s band sets up to play.  No sound check because my philosophical artsy son decided to get tattoos earlier.  Their performance was fantastic, but the pub owners are complaining it is too loud.  Trying to get drummer to play as lightly as possible so everything else can be turned down.  All drummers are now unhappy.  I think all drummers were all born as Bam-Bam Rubble.

8:10.  I am using my son’s band as an opportunity to check my sound through the FM.  I discover the compressor is set wrong. Knee point is too low, compression ratio is too high and release time is too slow.

8:25:  Adjust compressor.  Hope its ok.  Run to car and get MyLink+ receivers. and hand them out.

8:30.  Start to play first set with my band.  Sound still not right.  Mouth to Ryan the sound man to increase vocals to Aux Out 1.  Reach behind me and increase knee point on compressor a bit.  Raise output on FM but over did it.  Sounds distorted.  It is peaking in the red too much.  Next song plan to lower it.  Can’t hear Luigi, the guitarist now.  Thankfully I know some basic chords on guitar, so I watch his hands to see what he is playing.  Luigi sees this, and moves a bit so I can see him play better.  He understands what I need.  I love you man.

8:35.  Discover I am not feeling the kick drum through my platform very well.  Look at mic on kick and discover its too far away.  Lower gain on FM.  Better.

8:40.  Move mic on kick closer, still not right.  But now I remember why…Warren, our drummer, is trying to play quietly (Quiet drummer…is that oxymoronic?).

9:10:  Finish first set, and take a small break.  Decide to play second set without my shoes on so I can feel the kick drum better.

9:25:  Start second set.  Sound is much better now.  I am feeling the kick drum on my platform through my shoeless feet  better now.  My timing improves.  Tweak the compressor a bit more.  Warren, the drummer, and I are communicating well via eye contact.  We are finishing our songs well.  If you pay attention to recorded songs, you will notice that they most pop songs don’t really end, but they are faded out by the recording engineer.  Live music requires a definite end, and getting everyone to finish a song at the same time is one of the challenges of playing live music.  We devoted an entire rehearsal to finishing songs!

9:50.  Sound is perfect now.  But that’s the last song.  Bummer.  We finally have everything perfect.

10:00:  Everyone is very kind with compliments.  Some of my brutally honest asshole “friends” also pay us compliments.  Hey, maybe we were good?  Actually, come to think of it, we were great.  Everyone loves our singer Deb, and they should.  She is a natural frontman (front-woman?) for a band.  I love you Deb!

10:15.  Tear down all equipment, load up cars, take equipment home.

11:30:  Go to Deb the singer’s house for drinks.

12:30 a.m.:  Son calls and says he needs to be picked up because his friends parents kicked everyone out of the house for being too rambunctious.  Hey, they are teenagers, what do you expect?

1:30 a.m.: Come home and unwind.

2:30 a.m.:  Go to bed.

Moral of the story.  Nothing ever goes as planned so don’t expect it.  Roll with it.

Stigma and Hearing Loss.


Over the past year, I have been growing my hair.  I have done this for a couple for reasons.  First, I am still in the midst of a mid-life crises, but in a good way.  I am celebrating the fact that I still have a full head of hair at 47, and I am showing if off it a silly display of vanity.  Second, it looks good when I am playing in my band (its great for head banging).  But thirdly, I must confess, is that it is helping to conceal my hearing devices.  The latter was not one of the initial motivating reasons to grow my mop, but I have noticed a change in the way people look at me now that the devices are less visible.

People tell me I look like Matthew McConaughey's chubby, but sexy, deaf brother.

So what is the issue here?  Obviously there is still a stigma associated with hearing loss.  Lets look at the definitions of this word “stigma”.  The Merriam Webster on-line dictionary defines stigma as “a mark of shame or discredit” and “an identifying mark or characteristic; specifically : a specific diagnostic sign of a disease”.

So do I see using a hearing aid, a cochlear implant or an FM system as a sign of shame or discredit?  Of course not.  In fact Canadians, Americans, Europeans, Australians, and others who live in the developed world should realize how fortunate we are to be living in a society in which our either our incomes or social programs can afford to provide us with devices that can help us hear again.  World wide, there are likely millions of individuals with hearing loss who cannot afford the luxury of better hearing.

Are using hearing devices a specific diagnostic sign of a disease?  Well, maybe.  It certainly does give away the fact that I do have a hearing loss.  But as I will point out later, there are other signs that indicate the presence of a hearing loss, namely, one’s communication abilities.

I think that for many years, hearing aid companies did not help to diminish the perceived  stigma associated with hearing devices.  They constantly tried to advertise “invisible” hearing aids.  One could even order hearing aids that were delivered to your home in a “plain brown envelop”.  What’s up with that?  Are we ordering porn here? These kinds of marketing practices only served to reinforce the notion that hearing loss is shameful.

Frankly, I think most of the notion of hearing aids being stigmatizing on an individual is bullshit.  The ultimate proof of that comes to me every year around Christmas time in which I go to lots of Holiday parties.  What I am about to describe to you has happened to me so many times, I wish had a nickel for every time it occurred.

The scene is set as follows.  I have my refreshing beverage in my right hand.  In my left hand is my Phonak SmartLink+ FM transmitter.  I am happily conversing away with lots of folks, and inevitably, someone will ask about it.  The conversation goes something like this:

Other Person: “Hey, what’s that thing you got there?”

Me: “Well, that’s my FM transmitter”

Other Person: “Oh yeah, so what does it do?

Me: “”It picks up your voice and helps block out the background noise.  so I can hear you a lot better in this noisy party”

Other Person: ‘Wow, cool.  so how do you hear with it?”

Me: “Well, it transmits via FM radio waves to little receivers attached to my cochlear implant and my hearing aid”

Other Person: “Wow, thats so cool.  You know my Dad should get one of those.  His hearing is way worse that yours”

Me:  “Really?  Wow. His hearing is worse than mine?  Is he deaf?”

Other Person: “No, no , no.  He’s not deaf.  Probably just hearing loss due to age.  But he just completely falls apart in social gatherings.  He totally avoids them.  Constantly saying “what?” all the time.  Drives us all crazy, especially my Mom.  He won’t even go to things like this anymore.”

Me:  “Does he wear a hearing aid.”

Other Person:  “No, he doesn’t want anyone to know he has a hearing loss.”

So what do I conclude from this exchange?

  1. People judge the amount of “disability” you on the basis of your behavior and your ability to function, not just on the presence of hearing devices.
  2. Because I seem to function better in a noisy environment with my FM system, hearing aid, and cochlear implant, I am perceived as having LESS of a hearing loss than a silly old coot with presbycusis (hearing loss due to age) who won’t even wear a hearing aid.
  3. Often the biggest barrier to better communication is the person with hearing loss themselves.  They erroneously think others won’t notice their hearing loss if they do not wear a hearing aid or use an FM system.  The fact is that they are constantly having communication breakdowns and this is extremely obvious to everyone.

But this brings me back to the hair thing.  The cochlear implant is bigger than a hearing aid, so folks do stare a bit.  It can get annoying.  So, I grew my hair a bit and it covers it up more.  So shoot me for wanting to look a bit cooler.  But I can assure you, I would never trade my ability to function for the sake of cosmetics.  I know that I would be perceived far worse if I kept saying “what, huh, pardon me”.  The hearing devices and FM system help me function and decrease negative perceptions.

Hearing during the Holidays.


The Holiday Season is now upon us.  There are work Holiday parties, Christmas parties in the neighborhood, Christmas or Hanukkah family dinners, you name it.  And they all have a couple of things in common:

  • It is noisy
  • Alcohol is usually served
  • The main activity is talking and listening.

These functions are not easy for people with hearing loss.  We function best in quiet settings and smaller groups where there is no competing noise.  Moreover we need to concentrate harder to communicate, so remaining sober and unintoxicated is a must.

You don't want to be like this guy.

Given that you will be going to places in which there is a high noise level, you need equipment and strategies on how to communicate in this environment.

So here is the Stelma Survival Christmas Guide for People with Hearing Loss.

  1. If you have a mild loss of hearing, you must use a hearing aid with a good Directional Microphone.  As I discussed in a previous blog entry, these microphones will pick up the person talking in front of you and reduce the noise behind you.
  2. Due to the high noise level of these functions, people with moderate, moderate-severe, severe, or profound  losses of hearing will definitely require an FM system attached to the hearing device (hearing aid or cochlear implant).
  3. You need to set your FM system microphone to the SuperZoom position for maximum noise reduction.
  4. If it is a cocktail party type of event, you will be standing and talking.  So you will place the FM transmitter in your left hand and your refreshing beverage in your right hand.
  5. When conversing, you will point the transmitter at the person you wish to communicate with.  We call this the Reporter Style of using an FM system.  Also make sure you hold the transmitter correctly.  See this video clip for more details.
  6. Remember to use Specific Requests for Clarification if you misunderstand.  For example instead of “what?”, say “Can you repeat the last part you said?”.  See my earlier blog entry on “What’s Wrong with Saying What
  7. Try to position yourself in areas with lower noise.  So if the music is blasting in the living room, move to the kitchen or dining room where these is less noise.
  8. Try to position yourself in areas with better lighting.  Again, if the living room is dark, stay in the kitchen where there is better lighting.
  9. Keep your alcohol consumption to a minimum.  It takes a lot of concentration for us people with hearing loss to communicate and alcohol gets in the way.  Not to mention drinking and driving is illegal.  I typically drink Gin and Tonics, but I alternate with mineral water and lime.  That way nobody bugs me about not having a drink in my hand.

If anyone else has some strategies that they use for coping with Holiday Parties, I would love to hear from you.

Happy Holidays everyone!

Strategies for Communicating in Restaurants


Dining plays in an important role in many cultures.  I think we can all agree that we do not eat simply to nourish our bodies.  It is the human connection that seems to be the most important part of dining.  We propose marriage, celebrate birthdays and anniversaries, close business deals, and simply connect with friends and family while dining.

Unfortunately, many people with hearing loss cannot enjoy the social benefits of dining due to their reduced ability to communicate in this noisy environment.  Indeed, many simply accept that they will only be there to consume the food and not much else.  Others simply choose to eliminate this social activity from their lives altogether.  This is very sad.

There are solutions, however.  These will depend partly on your degree of hearing loss, and partly on how noisy the restaurant is.  In the chart below I list the possible solutions for the various environments for different hearing loss levels.  Note that I am assuming that you have a hearing aid.  The last line is suggestions for CI users.

Degree of Hearing Loss Cafe(SNR @ 5 – 0) Restaurant (SNR @ 0 to -5) Bar (SNR @-10) 
Mild Hearing Aid with Directional Microphones Hearing Aid with Directional Microphones FM system in Zoom
Moderate Hearing Aid with Directional Microphones Either FM system in Zoom or hearing aid directional mic FM system in Zoom.
Moderate-Severe Either FM system in Zoom or hearing aid directional mic FM System in Zoom FM system in SuperZoom
Severe FM system in Zoom FM system in Zoom or SuperZoom FM system in SuperZoom
Profound FM system in Zoom FM System in SuperZoom FM system in SuperZoom
Cochlear Implant Directional mic on CI or FM system in Zoom Directional mic on CI or FM system in Zoom FM system in SuperZoom

So what are these microphone positions I am referring to?  Well, on the SmartLink and ZoomLink there are three different microphones.  The Omni mic is at the bottom and it picks up sound in all directions.  I never use this position in a noisy restaurant.  The middle microphone is called the Zoom position.  This picks up sound from the front, but not from behind.  The top microphone is referred to as the SuperZoom position.  This is a beam forming microphone that only picks up sound directly in front, but not from the sides or behind.

The SuperZoom and the Zoom microphones are the most effective in noisy environments like a restaurant

The trick to getting the most out of your directional microphone or FM system is getting the correct seat. You want to have the noise that you don’t want to hear BEHIND you.  A lot of people make the mistake of getting a table in the corner and having the person with hearing loss sit in the corner facing the entire restaurant.  This is the WRONG seat.  You want the background noise in your back.  This way your directional microphones, either on the hearing aid or the FM system, cancel out this noise and only pick up the person in front.

So here are the steps I take when going our for dinner.

  1. Try to find restaurants that are already quieter.  Choose restaurants that don’t blast music during dinner.
  2. Ask for a table in a quiet section of the restaurant if possible.
  3. Seat yourself with your back towards the background noise.  The waiter will try to seat you in the corner with your back to the wall.  He means well, but ignore him and seat yourself correctly.
  4. If you are a small group, seat the other people in front of you.  Ideally you should see the people you wish to hear in front of you and that’s it.  This way your microphones are only picking up those you wish to hear.  I then place my FM system on the table about half a meter away from the people I want to hear.
  5. If you are a larger dinner party, this presents a challenge.  You will still seat yourself as I described.  But your microphones will not always be pointing at the person who is talking.  You need to move your microphone towards the person you wish to converse with.

A couple more points to consider.

  1. If I am having dinner with just one other person, I may get his person to wear the transmitter.  But I do so after the waiter finishes blabbing about all the specials and takes my order.  (Some of these waiters seem to love the sound of their own voice because they talk way too much.  Hint to waiters: Less talk and better service = bigger tip from me).
  2. The FM microphones work best when they are as close to the talker as possible.  So place the transmitter on the table no more than half a meter away.
  3. When the waiter brings the food, grab your microphone off the table, then reposition it.
  4. When having Sushi, keep the microphone away from your Soya Sauce.  I have killed a few transmitters from spills.
  5. In large dinner parties, you will still miss out on some conversation because the microphone is only pointing at one or two people at a time.  Yes, this is still a limitation.  But you can either sit at home and sulk, or you can still be partially engaged.