TALive! Keeping Your H.A.T. On Hearing Assistive Technology
My. Name is Cheri Conrad and I'm with our MTC, DHH I'm gonna be monitoring, the room for our presenters, today welcome. To this one-hour. Webinar, titled. Keeping, your hat on hearing, assistive, technology, I'm. Joined, by Lyn mystical, Asha, certified. In Florida licensed, speech-language. Pathologist. An audiologist. As well as listening. And spoken, language certified. Specialist. And dr. Chrissy. Sanchez, an assistant, professor and clinical, audiologist. At the University, of Miami Institute. Excuse. Me University of Miami ear Institute, both, presenters, currently, practice, at the University of Miami Debbie school in their auditory, oral program after, this presentation is complete, we're going to take some questions you. Should know a bit about the zoom environment, before we begin, today's. Webinar is being closed captioned, to, see the closed captions, click, the captions, button in the zoom menu and captions. Will appear along the bottom of your screen thank. You so much to an Armstrong, with alternative, communication services. For providing the captions for us today. We. Want to make sure everyone, can contribute, to the conversation, even though your mic is muted we, want to hear your questions comments. And your thoughts and for you to have the capability to interact, with others in this room if, you don't see the chat panel click. The chat panel in the zoom menu and you can select specific attendees. To chat with during this webinar above. The field where you enter text you'll see a blue drop down menu you should be able to select everyone, if you want to communicate with everyone. We. Will be monitoring the chat during the presentation, we. Mention it in our email notifications. But this webinar is being recorded and, it will be archived, on the our MTC. Thht, a live web page as. A reminder, we do request you take a post survey, for ta light at the end of this session we, thank you in advance to, contributing, to our continued, self-assessment. Of our work with. All that business done I want to welcome Lynn. Misko and Chrissy Sanchez thank. You ladies for being here today the, floor is yours, hey. We're excited we feel like we're cutting edge on how like everybody's, gonna be learning pretty soon, again. I'm Lou missional I direct auditory, oral education program. At the University of Miami Debbie school and, we're really fortunate to get to work with dr. Sanchez she, assists, us and our, auditory, access going, for all of our students, we, know what a challenge that is every, day a student comes in with different technology. How, to sync it all together and make it work so we're really fortunate to get to share her resources, and her knowledge and now, you all have, that advantage too, so really, my name on the presentation. Is really tech support, so I'll turn it over to dr. Sanchez and, she, will answer so many of the questions we know you had, Thank. You Lynn and thank you everybody for having. Me I'm really excited to host this month he, live tech Nam a presentation. On sharing, assistive, technology. For sure. This is a rather, equivocal. Topic. And could. Probably be spoken about for several. Hours, but. I only have one of them so, I will make sure that I keep it timely now. I do want, to disclose. Look. I have a clicker that just works a little fast. My. Only disclosure, is that I'm a research. Investigator. For a Modell's study I also. Want, to disclose at this point that I am probably. By trade. And by. Profession, a clinical, audiologist. And just. Recently starting, to collaborate, with the Debu school in, an educational. Audiology. Role and that. Not, only has been a very unique, opportunity for, me but it's really opened my eyes on. The. Reality, of the. Utilization of, hearing assistive, technology, and the, challenges really that it poses, especially. In an auditory, oral program, where, the, majority of the children in these classroom, settings are hearing impaired and use, a multitude, of different devices that we, have to find kind of the common, denominator, to help them hear ideally. So. With. That being said a. Lot, of this is not as intuitive, to me as it may come off on, this presentation, and. Really. The technology is just drastically. Changing, so quickly that. What may be presented, today may change in a month from now but. I do hope, that you all can use this presentation as a resource. Because. I think it is at least helpful from a general perspective to, just kind of take. A deep breath and not feel so intimidated when dealing with hearing assistive, technology. So. The aims of our presentation. I want to really review the fundamentals and, characteristics. Of noise and I wanted you to say that need a less scientific, fashion, and more of a practical fashion.
To. Really understand, I'm, sorry, dr.. Sanchez um. I think we, are having some technical difficulties, we, are still looking at your title slide and, the. Slide. So. We're looking at it almost in edit mode. I. Was. Waiting to make sure that she wasn't just going to present from there which is fine. From this computer it still shows. Yeah. I think you just need to go into present, mode which. Would be. No. It's. Changing, but. Okay. So, now it's like is, this better on your screen so. Yes, it's bigger but if you go up to the tab where it says slideshow. Which. We have done is it's actually showing on our it was showing on our monitor, in normal, in the way. So. Like on our big string here it's in presented. On the. Small screen it is not can. We. Share. Yeah. Maybe I'll stop my share scream a new, share oh you, want to know what, I'm. Pretty, sure when we've been selected, to share he just selected a page hold on I want, to share my screen yes. There we go okay. Excellent. Is, that better that is but now move back into the video space Oh as. You, see Christie's, troubleshooter. It's like I see I am. Well. Thanks, for letting me know like actually, looking to left and realize my screen wasn't moving either but yeah but - I know I was waiting one more sliders, like wait this is origin all right let's see now that I probably need to use this. Guy progress. Or. Now. The copy then I go stand up there and move, the. File take the keyboard that's the only way to oh, my. Got it. Alright, and it's changing, you can see the disclosure slides, now. Can, you hear us yes. We can sorry my. Math. You don't hear me typing but, yes we can see. Alright, so here. We're here's where we aren't perfect so the, aims of today's presentation. I wanted to review the fundamentals and, characteristics. Of noise again. Not from a scientifical, background but merely from how it's relevant, to, why were you been utilizing this kind of technology and, then, a brief, history of hearing assistive technology, where, we started and where we are now the. Benefits, the caveats what, currently, exists and then what, else is out there. So. We're. Gonna start with how noisy. The world is the. Impacts of noise exposure are, obviously, well established, osha, has regulated, those standards, for quite some time now and they. Regulate, these noise standards because they can be detrimental to, someone's, hearing and actually, the impact of noise has, far.
Later. Consequences. So they're they're usually not immediate in that if you, go to a concert or you're. Routinely, around loud construction noise, without hearing, protection the. The, symptoms, or the consequences, of that may not actually be received, for another 10 to 15 years and this. Has been well established in, the literature and. There's. A lot of noise that we live around that it's just unavoidable the. Challenges, exist for a normal hearing listener so we're not talking about hearing-impaired. Students. At this time but you know talking in a restaurant with the plates clinking, and the dishes and the, noise and the ambiance, and the music, going to parties events gatherings. This. Is a problem, right we know that the world is a noisy place for people who have normal hearing and so we are now entering. This noisy, place for those who have hearing loss that we we're dealt with a little, bit double, double, our challenges, so. We. Characterize, noise rather uniquely, from an audiology, side to help us evaluate the, benefit, of technology. In general not, just here in assistive technology, and probably. The biggest quantifier, of how we utilize noise, and how we can quantify that is using an SNR, which is a signal. To noise ratio. And quite, simply this, is just the level of the signal that we want to listen to you so in the classroom, would be the teacher and we're. Comparing that to the level of the environmental. Noise so whether that's the students. Someone. Asking questions someone knocking on the door and we. Compare that in your ratio. Where. If there's, a positive number, so say, a positive, 35 SNR, it means that the speech source is 35. Decibels louder, than, the background noise this is a great environment you. Can hear this audibly. However. A negative, SNR, which is something like negative, 15, means, that the signal is softer. Than the noise and the noise is that, much louder and this is a Jencks environment, right. And so this is probably one of our bigger quantifiers. Of how we classify, noise, and this. Is just a drawing. That I did I do love to dry feel like I'm going to be whiny like a children's. Illustrator in, the future but those are my previous. Calling. But. I very. Much visually, and so I wanted. To illustrate how, SNR affects this, lovely couple enjoying, their dinner in this vacant. Restaurant, but the reality is is that a restaurant look like this we have you, know our waiters and then we have family, members who enter, and those, plates are clack clanking, and the waiters are still taking their orders and then there's there's the, bruise over here that are enjoying their beers and.
All. These people come in. To. An environment where, it becomes, much noisier, than what, this couple is speaking at an average of a 65, decibels so, to speak and I. Wanted. To quantify these colors, is just the amount of background noise and if, we're now in an environment where it's 95. Decibels compared. To that 65. DB of what, we're trying to listen to we're, at a negative, 30 SNR, and that is a very challenging listening. Environment, and can, sometimes be emulated, in a classroom setting so not just a restaurant condition, but classrooms. Can sometimes, get to these these, levels and that's really hard to listen for as a normal hearing, listener. And you can only imagine the challenging, that challenges. That these hearing-impaired, kids have as well. So. On top of single, signal, noise ratio we also can quantify noise, by reverberation. Which is really just the time we, it's a time source, and really. Just the time it takes from sound. To get from one area to another so you. Know we don't want echoes essentially, so if you're shutting off the mountain it's going to take maybe a few seconds for you to continuously, hear your voice and that's, really challenging for hearing technology. To to quantify, we. Also characterize. It by distance, so it is, been said in the literature that we lose, about 6 decibels, with, every doubling, of distance, and if. We, think about distance, in a classroom if the teacher is one foot away from you going, from one foot to two feet may not be, as big of a deal but, we're losing about 60, B was just that small, change of distance from the teachers sound, source and. Then. We have more, subjective factors. Such as the talker dependent, factors how, much effort is the teacher putting into their voice the. Spectrum, of their speech, the rate at which they're talking, are, they fast talkers, like myself that is, mine. My Hispanic, roots um, how. Do they articulate, didn't have an accent and their, orientation, so are they facing the. Students, are they facing the whiteboard we. Also have language dependent factors such as what vocabulary, level, grammar the idea and the context, and. Then. Of course our listener dependent, factors such as what. Is the chronological, versus, developmental. Age of the, listener and so. That's going to really kind, of tie, into their cognition, what's, their hearing status and, their. Attention status, and how, they're processing, and their fluency, of just understanding so there's just a lot of things we have to consider when. We talk about just, simply noise. So. If we take our what, we know about noise and we put it into a classrooms fear, there. Was a study conducted in 2005. That just, measured the, the. Noise levels in classrooms, and the frig classroom measured to be about a 68, DB a, squad. You Toria was about 79, DBA and a. School cafeteria was, about 82, DBA or, I continued. DBA. Is, just simply I don't, want to be such a technical term to classify. Decibel. And it's really just a weighted, average so. It's a filter that, they put when they're measuring, noise to. Endless, to de-emphasize, the low frequency, sound so when, we talk about noise, in, general or if you look at literature that talks about noise, standards, they. Usually use, a DBA, that's all that means doesn't, otherwise mean anything else. But. If we talk about SNR, s right so we know that these average classrooms, have these noise levels, this is just there's there's. Standing, noise there's stagnant, noise. What, about the signal-to-noise ratio, so let's put a teacher in this condition, and let's. Look at these average. Ratios. For about 47, classrooms, and in, 17, kindergarten, classrooms, the average signal-to-noise ratio, was negative, 1 DB where the noise was 1. DB louder than than the teacher. And that's, pretty even that's really that's an actually very challenging listening, environment where the noise and the teacher are up the same volume. Whereas. 12 elementary, school classrooms had about a plus 5 and 12 high school classrooms, also had a plus 5 and these. Levels are recorded, in traditional, classroom settings and this data was also collected in 1965. And, I, don't know who, can here attest to what a classroom was like in 1965. But, it doesn't look like that anymore and, I, wasn't. Alive in 1965. I know it but what I actually almost guarantee, that a classroom did not look like how they do in 2020. And so. When we think about 2020. Classroom, spaces we're talking about different, floor plans and.
How The teachers and the, students, are oriented. And we have enclosed. Classrooms, which may take up to about 25, students, compared. To semi-open. Classrooms, which are about 40, plus students, and then, our open classrooms, which we can more quantify us maybe a college auditorium which, is about 91, to 200. And these. Just really these, are more, susceptible to more intrusive, noise, levels, and, subjective. Data and normal, hearing listeners, confirmed, that obviously both the student and the teacher are, reporting. In two minutes in these settings, obviously. So. So. We know that these classrooms are noisy and we. Know that children have, to do a lot of listening in these noisy classrooms, so, children. Spend about nearly. 60%, of their classroom, time engaged, in listening although maybe that's probably intent right 60, percent of a classroom time want, these children to be actively, listening so. You can imagine the negative effects of noise has, on these children who spend 50% of their effort just, focusing, on hearing from the purposes, of learning right. And we. Throw a noise in the situation, and now, we have to really quantify the impact that this has on children who are hearing-impaired. Background. Noise in general has demonstrated to, be detrimental in. Reading. Scores for elementary, school-age children who are normal hearing so the higher the background, noise the poorer the reading scores and so. What is our reality children. Are requiring much, more complete and efficient auditory information and. Better, listening environments, that adults do in order to learn and develop speech and language and that's, really just the kind of the bread and butter or the, meat and potatoes I, suppose whatever you prefer it to your, meal of. The. Crux of it right we they need a clean, space, they need a clean drawing, board they. We can't throw them into an environment that has already been tampered, with and and is very noisy they need a clean slate just to really optimize them. So how is it regulated, fortunately. We have an see you. Call this an T to the rescue sort. Of and. I only say sort of because the American, National, Standards Institute, they, do provide guidelines, and recommendations for. Classroom acoustics, and they're, very good guidelines, they say that an unoccupied, classroom. Was not exceed 35, DB that's very soft that's. Great and that. The SNR in an ideal classroom should be plus 15 at ear level so, the teacher should always be at least 15, decibels louder than any noise source at the, level of listening. Listening. Level an unoccupied. Classroom. Reverberation, must not surpass point six two point seven seconds the. Caveat, which is why we say sort of is that this is only a mere recommendation. And not, necessary, is necessarily. A standard, that needs to be abided, by, some. Newer schools may have to adapt to these standards in order to be up to their building code so a lot of times some buildings want to want, to say they'll Eames and half the ANSI standards, but, again it's just a recommendation. And. So. If we think about hearing loss and noise and now we're really getting into the depth, of it if we remember SNR, generally. Speaking individuals. With hearing loss required at, least a plus 5/12 plus 18, SNR, in order, to obtain speech. Recognition score similar to their normal hearing peers so, on average here. These children with hearing loss are needing about 5 to 20, DB louder in, order to score, the same as their normal hearing peers but definitely not on an even playing field at this point, and. Our objective, donítö suggests the same that children listening in a classroom so if we imagine a very noisy classroom, with typical background noise our. Normal hearing children are only getting about 70%. Of that understanding where, a child with hearing loss is going to get 50%. And. Now we've created a room with a high reverberation. And a significant, listening, a noise. Condition, our, no.1, hearing kids are only getting 30% while. The hearing loss children, are getting 11%. Word understanding, that's huge and, it's, not okay not. Okay for the normal hearing parents let alone those children with hearing loss these are really, tough listening, environments. And we, don't quantify, a listening, it's just oh just. As the objective, this is an SNR and they're going to struggle, what, about listening effort because, that's really, been want to find a lot in the data as well and the literature shows that listening effort, the, children with hearing loss show significantly.
More Listening effort than their normal hearing peers, there. Was a study that compared children's ages 5 to 11 with, either mild and moderate hearing loss or, a high-frequency hearing loss and. They. Chose these two hearing loss cohorts, because these. Are usually the the. Hearing. Losses that are probably least aided, Armada, moderate kids well, as, an audiologist we're, recommending amplification. The. I, suppose. The. Parents. The, buy into these types of hearing loss is a little bit more challenging, because, parents. Don't notice these. Hearing impairments, as much especially, with high frequency, hearing losses but. They, chose these cohorts, of hearing, loss groups because they, wanted to prove a point that even in these hearing, loss not our severe to profound kids, another moderately severe e kids were obviously, saying that they need hearing technology, these, are the kids that we're recommending and the family was like well think about it the. Effort was significantly, higher in both easy and difficult listening, conditions, so these kids are reporting, that they're struggling. And additional, effort is required to listen noise that may compromise the students ability to perform simultaneous, tasks. And I, think this really comes into play when the child. Transitions. From learning how to listen to listening. In order to learn, and. That's really when they have to listen to then start taking notes and listening to then, perform, a multi-step, tasks and, that. Really becomes challenging when, we're having noise I'm a very shaded really challenging. Noise, conditions to. These these complaints. So. What do we do about it we know that amplification helps, right it really does, it. Helps children hear everything and you mean everything right, and what I need - is that. The. Amplification is amplifying everything, right so it's also amplifying, both the noise and the teachers voice and, while, technology, has significantly. Advanced, in that, that we have directional, microphones, and, moist processing, strategies for, these technologies, they. Are man-made devices and they do amplify. Noise. And I would actually probably argue. As a, pediatric audiologist, who I kind, of remove all of the personalization. 'el settings or, maybe an adult we have different. Programs for a noise environment. And so, to speak these kids are being set to just go. We don't want them fiddling with their technology we don't want, them altering their volume, levels so, these kids are truly, kind of getting full, amplification. And probably an omni, setting. Where the. Microphones. Are picking up what's around them because that's important, right for, instant - learning we do want the kids to hear what's going on behind them as well as what's going on in front of them but, in a noisy, environment you, can see this is a challenge, because now we're also amplifying, the noise that. We so desperately want, them to avoid and. If. The signal is really too difficult hearing. Aids bone, anchored devices, and cochlear, implants have trouble filtering what's important, versus what isn't important, I mean, we, are approaching AI technology, but thus far there. Is not a smart little human in there like well, that's the teacher and that's, Little Jimmy and we don't want to listen to Jimmy today we want to listen to the teacher and it's. Really just hard for these devices to pick up and reduce. Certain. Noise areas, unless there's a manual program, to do that or unless they're set to do that and I would like I stated before would. Probably venture on the side that as a pediatric, audiologist. We usually. Set them to want, to hear everything. Versus. Having the hearing aid choose. But. The good news is, that personal, hack systems, we use with, conjunction, with amplification are widely recognized, as the most effective method, to improve, these.
Speech, Recognition and noisy environments, so there's a solution and that's why we're here today. So. To, mimic how hat would work in a situation, like this here's the other little drawing we have our, teacher here and, we have our child is here with her bilateral, and. She's. Followed her IEP she's, sitting right in the front she's getting strict access, to that teacher and, this. Classroom is very great she's the only one in it but the reality is is that maybe, it looks more like this and even this you feel like this is a great classroom I want to teach it there but. The true, reality, is that it probably looks more like this with, all these kids making all of this ruckus and then. We have the alarm that may go off or the door is knocking, or there's, cars outside honking, or, the air is rumbling and the, reality, is is we want to create a listing environment that's more like this we, want to remove all of those external factors and the, way we can do that is by, putting on our hat technology. High. On this teacher both. An actual hat and a hat and really. That's what the point, is so this cochlear implant is going to be receiving whatever the teacher is wearing she's, going to be wearing some form of Technology that's going to be streaming directly to, those a child's. Device. So. Why I want to quickly review the tree I've had and this really also kind of hones into the history of having I used to palm tree because we are in Miami, Florida an, ode, to Miami. We never palm, trees never get considered, in more, of a tree of life schematic. So I wanted, to do their part here, and so, if we have hearing assistive, technology, as the leaves of our palm tree then, this would be our base in that we have our standard FM our. Dynamic, FM are, adaptive. Digital, FM. System, then. We have probably, more historically, our induction loop system our infrared, system, and our, Bluetooth and remote microphone system, and what, I'm going to be covering today is, probably, everything, on the, left side. Induction. Loop more like looped environments. Probably, well if I if our classrooms could be looped that'd be great but I'm working, on a telecoil, system, and our infrared system is slightly outdated so. We won't be reviewing, those two as much but, we also will be reviewing our Bluetooth and remote microphone options. As well. For. Who so. Who this is help it. Helps everybody, children. With normal hearing can help forth assistive hearing. Assistive technology, for them with hearing loss and children, with auditory processing difficulties. Are usually, our our. Group of kids that we want to focus on and if we're incorporating, the normal drink and some we're including everybody, really. But. Hat. Has been proven to help with attention, behavior, fatigue academic. Performance, speech, and language outcomes, I mean, really it's, it's not there's. No real negative to it with the exception of cost and, the. Configuration of this ever adapting, technology in. That, you, have spent a lot of money purchasing, all of this technology and, in one year it is worthless, because. All these kids have now upgraded technology and, you have antiquated. Technology, that. Can be used for maybe one or two kids and figuring, out that combination is, truly, the. Solution. That I am not providing for you today. So. I hope nobody has that expectation. But I'm, here to talk about the real transparency. Behind it and this is probably why, it is, less use is because it's very confusing, but it is so, beneficial for these kids so I hope that there's more positive, take it away from this than, any negative.
So. Let's start about FM versus DN than these these kind, of terms are used interchangeably and. They're talking about more, traditional. FM which. Traditional. FM is really, actually not used in a today's technology, anymore this is more of on, a linear model what, what, the FM did was that, it always kept, the signal, or the speech source 10, DB, above, the noise no, matter what, it didn't adapt it, didn't, matter if the noise if the signal was 10 DB so someone with his brain and the. Trouble with that was that things like whispers, became. No longer whispers, they were much louder to, the child who had hearing devices than everybody else and that's, important, because when. We program, things like amplification. We do want to see that, children can separate, soft. Understanding. Versus their speech at loud understanding. And what, was happening with traditional event system is that it was keeping everything 10 DB louder whoever. Was wearing that microphone, was going to be 10 DB louder didn't, matter the background noise. And. So a lot of that technology then, shifted to more of an adaptive, FM system, where. The SNR would vary so that signal-to-noise ratio. Was varying depending on the ending voice this is probably a little more smarter, technology and, that the the, transmitter, was always, feeling. Out the environment and recording. A noise level and if the noise increased. To above 57. DB SPL then. The FM kicked in and the estimate was increased automatically, based on that noise level so, this is really great because it was adapting, to the child's environment and there's a little more consistent, so soft, sounds, remain soft those kids may not if it's a truly quiet environment, and the only person speaking is the teacher the, child with hearing devices may not need that assistance, but. Everything. That noise level starts increasing that's when the PAL things help and that's when the FM estudia. And. Then we talk about our DM. So. It's just really a different way that the signal is being transferred, and allowing for a wider bandwidth. Is intended to provide a greater SNR, at higher noise levels, so it's just far more advanced at the adaptive FM system and really. The foundation, of what we now know today as the Roger technology. Is used, is, using, digital modulation and, I. Would say that Phonak was the proprietary. Owner of the Roger system as probably. They're, probably the forefront, of just, hat in general and. They. Have kind of steered, there's a lot of there's, a lot of research, to show that. Even trogdor, technology. Is superior. To traditional, DM. Adaptive. Event and even traditional, FM and, this. Is a this was just a graph done by a. Study. Done in Texas, UT. Dallas and, they. Tested, children, is only, a 10. And a 10 is only 10 kids and they, tested been using a hearing in noise test, and what. They saw. Was. That if you, see the the polka dotted the fairly white bar is using a fixed traditional. FM our, hatched. Bar in the middle is using an adaptive, event and the, dark black, bar is using the adaptive, digital, FM and what, you can see it what I wanted highlight, here was that in noise, level is just quiet, up until probably. 60. To 65, they're, performing, fairly, the same and, you, can really see that that adaptive, and digital FM ins start to really start improving, performance. Because. They're regular, they're constantly, regulating, that noise environment, we're just. Making, the sound source 10 DB higher really, doesn't help in a very noisy environment, because. Now you imagine your listens you're having a child listen, to. A voice at 90 DB was still 80 DB, of noise it's not actually actively, reducing, anything it's just making everything else, louder and. What. We see here what this study concluded was that digital was by far superior than any fixed, or adaptive, FM system.
So. All of that is to say in like I mentioned before is that today's modern, gaze at FM systems are on using Xion sort of technologies, so you don't have to worry that you're compromising, anything today's technology and then, I wanted to briefly review the RM systems, so a lot, of these these, acronyms, are usually used interchangeably. Like. Oh if you have RM on your kids do you have a DMR in SM and they've more, commonly, all used to. Replace FM but, I really wanted to have this light up here to really showcase the differences, between those and it's really like we're not via I'm not the FM police use. Them as you will but. Just know that there are differences, to these actual terminologies. And our remote, microphone. Differs. From an FM system because. It's more, used, to. It's. More used to just overcome. Speech. In noisy situations over, distances. It's, really not designed to help in a classroom setting some. Remote systems, can connect to multiple devices, while. Some are note systems are just merely a one-to-one connection and. The. Way that they're transferring, signal, they're, not using a digital modulation, sometimes. They're just using bluetooth, technology to, function, and so, the way that they're transferring, that 2.6, gigahertz. Transfer. Of, sound. Kind. Of makes it classified, differently than, what an FM or a DM would, and. Remote. Microphone systems, though I'm not saying that they're negative in any and any in any means of Technology, I would say actually the opposite that the remote microphone systems, what they have an. Advantage, to, compared, to an FM is really cost the. Cost of our microphone, system is far less than our. Roger system if we're going to compare that to kind, of the mecca and. Remote. Microphone systems can also be used as our third party, but murdered to make certain. Technology, and them, RDM compatible, we'll talk about that in a moment but. What. I wanted to talk about remote microphone here as well is that the. Access to remote microphone may be a little bit easier as well given that at. Least now modern-day. Fittings, a lot of the companies of maybe pediatric, companies are, providing a, remote, microphone option, at no charge to. These families, so that they, and, if. We think about it something is truly probably, better than absolutely. Nothing. So. How does hat work. So. I love this little schematic and. I hope it's not confusing so, here we go we, need a transmitter, and we think of a transmitter, let's call it a microphone, for layman's terms and this is won by the speaker, so our teacher is wearing as a transmitter. Right, here we have our lovely if you recognize it the inspire oh it's great it, connects to many things this, is a phone a proprietary, thing again. The pictures that I'm using are just of. One company but there are many different types of transmitters, which we'll review again this is just for how, it works. Except. Tuned you need a hearing. Aid we will talk about going anchored and cochlear implants in a moment but for the hearing aid kids you need a hearing aid and this is worn by the student these two things alone will not communicate with one another. Because. Step. 3 you need a receiver okay now. In what. Is now called olden, day technology, because we have some cool stuff on the horizon this. Receiver will come in either one or two fashions, like, I just demonstrated here.
It. Would require like an additional battery, door where you would replace their battery door and now, that our battery doors make a little bit bigger because there's an FM receiver here, or. You. Could buy a kind. Of, all-in-one. Universal. Receiver, such, as this lovely Roger X which is really a golden. Little nugget if you have them they're great and you can probably understand, the value of them and you. Can make this Roger X compatible, with the hearing aid but. What I wanted to showcase here is that these two are both considered, receivers, and that's. How this microphone is communicating. With it so the microphone really, is not designed to communicate with the device itself it really needs that receiver to, facilitate. Communication and. If you're wondering how we can make this Roger X from that bottom compatible, that you're you know on the top we can do so I assist, some like, adding instead, of a receiver we would add an audio shoe so if we see that hearing aid just to the right it, looks, the same but that's just a simple audio shoe, which, that we would put a. Roger. Eggs to it. So. This, this. Would arguably be doing the same thing and they would be able to communicate with, this so. There are different combinations. Of how we think and FEM we're hearing assistive technology, work but, you can imagine that if you don't it. Takes a lot of study to figure out what's compatible, with what well. Let's see you have a boning for device award by the student, we, can do that in other, ways as well sometimes, and most voting core technology, requires. A third-party remote. Microphone so we'll get into this in a moment but what I wanted to showcase here is that this is also it can be coupled to a Roger X and now, this is an FM, compatible, device and. The. Same with a cochlear, implant most. Modern-day, cochlear, implants have a receiver, it. Would be this guy back here and that. Receiver, would then communicate, with the in spiral, and we would have FM. Connectivity, and if this, doesn't make you want to cry I don't know, what will because, this is the. Reason why this is so hard because. There's too many combinations, and, too, many receiver, numbers and you, don't know if you need around a 21 or an X or an audio shoot 18 I mean the, combination and Phonak, at least does. A really great job of providing guides, like, if you have a metal device this is what it need to make it Roger compatible. But, Roger really isn't the only thing that exists now so we really have to be flexible and, trying to get the resources, that we need for these children. So. I wanted to briefly talk about current compatible, devices and, I, want to I don't want to I was, thinking I was going back and forth with Flynn about doing, a show, how to, connected, and really the. Reality is if I can be quite, honest, I. Have. To read the manual every time I get a new device it's not intuitive it. Really isn't and it shouldn't be because there's so many varieties and so many options and really, so many combinations that, it, would be impossible for, it truly to be intuitive and I think I have a probably pretty good head on knowing, the, current technology. That exists but, to then know the current, poll, possibilities. And combinations and, assistive. Technology that is compatible oh. Yeah. Give me a raise for that align this really. Absolutely. So, if you really were if you had a child with a specific device and as, you wanted to connect it with a specific, device, all you need to do is go to any of these four pioneering companies and I'll list them below and you. Can go to Phonak Oasis, Phonak Roger died, or, Otakon, amigo died and all of those companies have a resource, guide and, it's. And if you want I can actually email it to you also if you want to email it to listserv. Or whatever the case may be that's something that I can easily do for you I haven't. Saved to my desktop because, anytime, wind calls let's say we have a banal, sonnet, or now. We have a middle Rajjo, how do we make that if I'm compatible I'm like I don't know but I can find out and so those, researches are really great thank you. So. Far our phone eye technology and, I like to start with Phonak because again they are the proprietary, old. Phone app in itself is not Phonak, is owned by Sonova, but. They have the proprietary roger, technology. And. These. Devices look so cool you may recognize some some, may be old so may be brand new but. Their current. Hearing aids I. Didn't. Want to die too much into this but I, will because. It's. Important. And really. Only gonna talk about the Maine Patrick. Lines. And, this because, there are far more hearing, aid companies than just three. But. I didn't want to talk about the primary, pediatric, lines because that's really what we're seeing a lot in the school system now. Phonak. Is. Already. Inherently going to be compatible with the Roger system but.
Like I said before you may need to have a receiver or something to attach to you so. When I say here venture, and beyond platforms. All that means is like if you ever saw it the sky rings. A bell, sky, simply, just means Pediatrics. For Phonak so I call phone I can say hey I have a sky, nice they're, gonna know immediately, that, you have a pediatric device, that's all that means okay, it does not mean that you have a, Rick. Device, or a BT it just seems that you have a pediatric model, then. If you go to the next letter which is V so, I said I have asked IV they're gonna know that I have a sky, that's on the venture platform, which is an older, level. Of technology, and then, fifty. To ninety eight I'm is, just it's really just the trim if, you think I'm like leasing a car do, you want like the basic level or do you want the you. Know the sport fancy, level and really. That just kind of has more bells and whistles and a lot of times when, we talk about this kind of trim that's the price point for, the hearing aid and when we think about Pediatrics, most, pediatric. Institutions, I can only speak for myself. We don't really try to sell devices, to these families so a lot, of these kids are in 50 level technology, simply. Because that's it's, good enough right they make it good enough and it's. Most cost-efficient, for the families and, so. Next to this we have a sky bee I don't know why they did that V and B just because people very confused. And. So, if you have any on the V and B which, maybe. Remember. Memorable, here those, receivers, attached like battery or it's like I had mentioned in that previous slide but. Brand. New is the Phonak sky. M which. Is our marble, platform, and what's. Really, kind of great. And novel. And TBD. Because it's just being released actively, as we talk is that, the the, FM, is fully integrated, into the device which is fantastic. They. Don't need to buy an extra part hold, on they don't need to. Physically. Have an, extra part now. The crux of having, all the, meat and potatoes in, this device so this is a sky marble BTE here. They're. Really the challenges, of having the, FM, inside of here right is that how, do we get access to it that's, a good question, and a lot of people I would imagine that a lot of schools are gonna start asking this question more and more as more, children are, wearing, technology, and it was just released in I, would, say I started for these marbles probably in I don't, remember early December, so, very. You know we're talking to fresh off the market in fact their. Entire line it's not even available yet, so any. Child who needs a device that's compatible with the more significant, hearing loss so their superpower, hearing, aid is not, even on the market yet in the Marvel platform so really if you have any children who are wearing Marvel technology, they likely have a. Hearing. Loss that's from. Maybe more of the mild some moderately, severe max but our our, Marlee severe to severe kids. Are. Not eligible for this technology just yet it's supposed to be released at the end of this month so we're really talking about really novel technology, and, the. Way to connect FM, to this you. Really the. Trick here is that you have to activate, it so, while it comes inside, of it you still, have to pay for it to get activated. And. That was really a disappointment I, think when they when they finally told everybody about this thing we finally clean, out the device that's integrated. With that then but. The trick, is you still have to pay us to activate, it and I, thought well that's that's, not nice.
I, Have, to compact the power to activate it but if I don't get money I can't do that that's, not true because that would truly draw an ethical line in my body but, the, reality, is is that you, need to have a compatible, transmitter. That gives, you like a cone to, activate, these, SM systems, now, if, you really are challenged, with this Marvel platform, you, and, if there's any maybe teach the Deaf here educational. Audiologist. The. Your, phone a CREP who, is your phone a cool rep should. Be providing, solutions. For the. Technology that you currently have and how to make that Marvel, compatible, so it is, possible. But I think current. Day it is, very. Confusing, and, it's, drawing a lot of questions, but. It's exciting, that it exists okay, so. That's how that's, how if that works in in the. Phone act now. They. Have the Roger system in their portfolio, is pretty pretty pretty, advanced, from the roger perspective. But. What's really coming in what's. More common. Not. In a school system from a personal perspective is, probably our Roger pen in our Roger select and. What. I talked about the integrated, is that you can buy a standard. Roger pen or a Roger pen i-n, which would be the integrated, compatible, with the integrated, project so I purchased a Roger, pen high-end that, would come with a little tool to then allow me to activate the FM in this guide so that's kind of what I'm saying you still have to purchase it to activate it but it's ready to go once, you purchase, it of course and, then. Another way to make it compatible is to use a third party like a compilot, and add a roger X to the bottom of a compilot to make this compatible, and then. They also have remote microphone options, but you can either user this, compilot with an older microphone, or, brand. New partner, microphone, which is actually, at least in our clinic being. Distributed. At, no charge to. These, families, who are getting the new Marvel technologies, so you, may see more of these guys in your classroom. You may see combination. Of these things but. Yeah Phonak. It's confusing but I hope this is at least a resource for people moving. On we. Have our Otakon devices. Now. Otacon. Has. Their own FM, line, so their own version, of Roger, just. A throw. Wrench in the system here they made the Amigo system, and. The. Amigo system has not, quite been updated, in quite some time, however. Just. Recently, Otacon came out with their brand new pediatric, device. Which is their open play and, historically. A lot of kids who are using coding on devices words and say or safari devices, and. Now. They're opening play is. Still. Compatible with their, their. Version, of FM which. Is the Amigo system, and you. Can see that this is a photo con play device with, receiver. Attached to it this is the Budokan, receiver, but. There is a way to make this so safe you only to Otakon kids in your class and then the rest of your kids are writing Phonak devices, or you, as a teacher have it in Spyro which is a Phonak device and you need to get this compatible. Do. Not fret there is a way to make Otakon system, is compatible with your Phonak transmitter, and that's. Listed here so you can attach a universal. And boot to a roger X. So. What, that really means is that the, patient. Would have an FM shoe. Similar, to a shoe and then, you would add a Roger X here so it really makes it almost the size of a cochlear implant I'm not gonna lie but it's possible, or you, could have a streamer, which, is actually only available, in older technology.
Their, Streamer pro had a euro pen you, can connect your Roger x2 as shown here however, the streamer pro is not compatible with their gameplay technology. In fact, today they, come out with their remote microphone which is their connect clip so every, child getting an open play device now gets a reconnect, with the. Caveat to connect clip is that it does not have a girl pen so you cannot make the connection FM. Compatible. And. They just released fresh, off the market I have actually not fit any of these the edge' mic which, the difference between you had you mine kind the connect clip is that, the, edge of mine can connect to an infinite. Number of Otakon devices. Still. Using, the same platform that the connect clip uses so. It is unclear, on the Odum Khan website is this if this is truly a FM. DM or a remote, microphone. The. Other difference is that this does have a 3.5, millimeter jack so, like an auxiliary jack that you can connect it to a computer. Whereas. The, connected design so. Some. Benefits. Some caveats and. Then. I briefly wanted to talk about resound there's not many children in rahzel, say. There's a whole bunch of children or turns out whether. They should or should not be is not something we're talking about today but, resound, the only reason why I have magic is for mostly are by no little kids. Resound, has, partnered, with cochlear, America, in making. Their remote, microphone, systems, compatible. With both cochlear. America's, Baha. Five and, their. Cochlear, America's nucleus. Products, or their cochlear implants, compatible. With. Contralateral. Resound, hearing needs so they can share the same accessory, which is exciting and was. A really novel thing, when it came out in a few years ago. Resound, however. Doesn't. Have an own standalone, integrated, FM system so they don't have a Roger or an amigo, there. Is a way to make them compatible, and, that is through this remote mic and I, must say that the ups part is their traditional pediatric. Line but they have since, stopped. Producing it so there you. May have some kids in it but they, are no longer. Supporting. A pediatric, line which. Was sad it is for us but. To make it compatible you're gonna use the multi mic which you, may call it a multi might you may call it a mini mic cochlear. Causes them but you might result in a multi make it's actually the same exact device, and. You can double that with the Roger X and that will stream to both the hearing aid and to the cochlear plant or the Baha depending on what is, on the other Peter. Speaking. Of our donated, devices. Where. Would you briefly, talk about cochlear. Americas so the Baha 4 which. Is obsolete, and you're probably like why are you talking about obviously it's not the technology I'm, only mentioning it is because it truly had the only way of getting a true integrated FM, the. Ball form came with aced your, open, connection. To it where you could put the roger hex right into the Baja and they can put it on their head and they, would be at them compatible, by.
Making, The Baha I of significantly. Smaller they, compromise, that connection and then. Said well you can still have that connection through the remote mic so you can, only make our current. Baha 5 line compatible. With FM using. The mini mic which is the multi mic. And. You. Can also just remove that Roger X and it can just be your remote mic so it could be conserve is just a regular microphone or use, FM, technology using. This. Your ex Oh. Decon. Medical also has a bone anchored device it's called the Ponto. Pancho. Three was their old line they just recently came out with their palm took four and unfortunately. The Ponte 4 is not compatible in any way right now with an FN per diem system, that's. Unfortunate because a lot of kids are getting fit with the punter for because it is actually the smallest bone anchor device on the market so it's actually ten percent smaller than the Baja five and if, any would have seen a baja five in person it's pretty small so, the poncho Fork is very, small and it actually also has a light which is really advantageous for our pediatric population. It. Does come with the remote mic the connect clip but like I said before this connect clip is not compatible with like a euro pen now I'm um I'm only assuming that. The edge you might will be made compatible, with this poncho device, I'm, gonna con medical obviously shares Otacon as their main company, but they always lag, behind. In technology so. Otakon, hearing, aids just came out with this edgy bike and I am only assuming that the poncho for will, fall. The. Poncho three is their older technologies, if you have any kids and not the, way that FM would work would, be through their streamer which, was the. Accessory. That would come free with that poncho three. The. New I'm here know if anyone has a net here patients I have I'm AB, student I have several patients in the end here and the, reality is is like yes, you can make it we, can make it work, manal is a cochlear implant company, who is also, a boning your company, I must say they, in. Europe. At least have a lot of they, have the vibrant soundbridge which is my PA prepare they. Also have the bone which is just recently FDA approved the United States so they they are an established bone implant, company. However. They. I've. Just recently come out with the adhere and then here is an adhesive bone new device which really is, really great for a niche of people who, don't, want to have a surgical device and don't, want to wear a headband, the. Caveat, is is that it really is limited, with its technology and, it's, it's, very much designed, to be click. It and stick. That's, really how they actually promote, their technology, just like you, click it on and you just stick it on and you move on it's supposed to be very simple, it is not really designed it wasn't designed with you tend to be very, compatible with all the cool stuff technology. Because that's. Kind of the caveat of having a sticker, device now. There. Is a way you could make it FM compatible, this. Is not a gyro pin connector although it looks like one it is, a just a three-pronged, dài cable, that. Then you, could attach to an external, battery pack that then, you, could put a Roger X on but.
I'm Going to be honest that defeats the purpose of wearing me out here to begin with because. Like I'm telling you these kids are writing the adherence because they don't want anything to, be noticed let alone a cable, hanging from their device so I would, be very intrigued. To see a child wearing it here with. This dai setup but it is possible so that's the exciting part and then. Our cochlear implant companies we obviously have cochlear America's. Cochlear. America's does have integrated Roger receivers, that nucleus five and six have the Roger 14, which. Is this guy the. Nucleus seven hinges the Roger 20, which is that guy up there and then, the cancer which is the off air processor, can only be made FM compatible, using the mini mic and the Roger X configuration. You. Can also make the the. Nucleus, products, if. I'm. Compatible through the mini mic but they do have their integrated receiver which is ideal all, the literature has suggested that integrated, receiver is better than using a third-party communication. But there's. Options, with. The cochlear devices, and that's, again there are many make with the Roger X I. Met. Al like. We discussed with their I hear they, have cochlear, implants they have this on it they. Actually have the sonic wanted the sonic tune right now. The. Sonnet although the aesthetics, of the devices have not changed at all so the parts of the external parts and pieces are the same in that they come with the sonic. Comes with the battery sleeve that, has the euro pendant you can put a Phonak Roger, accent, to make the, sonic compatible, with FM and then. The Rondo is one and to need, an extra, battery packs this is what I hear. They need this extra battery, pack which then connects to this little Roger X and that's, how you take this off your processor, has I'm compatible but again I would. Argue that children, who are wearing to cancel, the. Rondo to my systems I kept a mess up here to you but I bet Rondo. The. Rondo devices are probably, wearing them because they don't tolerate much, else on their, body so. This. Seems a little cumbersome. The. Sonic 2 actually also has the audio link, and. Which, is a microphone, so, this is a microphone, it, also is the new tooth connector, it. Also is a remote control so to see three in one device it's brand new so, you mayn't, have Merion, see it I don't I think I only have maybe one child and a sauna - that's just got it just activated, like two weeks ago so they, are actively, pushing. These out on the market right now. And. Lastly. Advanced. Bionics, tiny. Of course but, still. Relevant a lot, of kids are wearing Advanced Bionics devices, they, share the same proprietary. Company as Phonak in that they are both owned by Sonova. So. Making a fan compatibility. With, AV. Devices is not as challenging in that the. 92 q 70, and 90 processors, come on this little receiver, which. Is the roger 17, and that alone can connect to any on, roger device. You. Can also have a Roger X combo, through there compilot, one so, so this was an accessory option, for some, some. Kids and they can put a Roger hex on the bottom of this I will, say that this is considered, obsolete so this is not even an option anymore, in today's you know 80 products but if you have a child and you Sena B's they may still have a compilot one and, interestingly. If, you, call Phonak to serve as your compilot, one they will tell you that they don't do that anymore you. Have to get an exclusively, from Advanced Bionics even though they have the same fathering. Company and, then, the Neptune which is a fully waterproof device, it. Is rather old but still being fit to this day has not been upgraded. Because, it is tried and true full, waterproof. By. Using the the net to connect you can put up Roger, Exodus. This. Is an off-year processor, so again I don't know how many people are making this compatible, with met them but it exists and in, the last thing I wanted to mention with our AV devices is that the. Compilot is obsolete but.
The Night of connect has just recently been released and, this, is made for streaming so if a child wanted, a stream Johnny Bluetooth, device they, could do so with this however. The. Caveat is is you're compromising, your roger receiver for. Your connect so. You. Kind of have to choose one at that point. What. Else so, in, the sake of time this is probably wrapping, up, we. Do have off, your options for hearing assistive technology, and this is really for children. Who have, normal, hearing and this is just maybe classroom, option so there's soundfield system setting, exist there's, a pastor on Mike the multimedia. Hub which would allow, Roger system to connect to a smart board as well so the child can hear what's, coming from the smart board as well, as a teacher at the same time and. Solutions. For normal hearing there's some, ear level processors. Such, as the roger focus, for the amigo star which. Are just been affirmed a you children you have attention deficits, auditory processing deficits that don't have hearing loss so, they don't need amplification. They just need the FM signal. And who, will this help like we said before children, with a PD learning, disabilities, unilateral. Hearing loss autism. Spectrum disorder, children. Who are diesel on top of those who already have hearing loss. Where's. The future taking us well. We. Need some legislation to start supporting FM, systems, at least the funding for them, the. Reality, is at least in Florida we're, still trying to get funding for hearing aids so this. Is probably a little bit in the future but I don't I don't doubt that we're gonna get there it's just we're. Slow on the bandwagon, we. Also want to use, maybe, more in the use of wireless or microphones, in the interim, seeing. Is if FM is a costly option, that is prohibiting, school systems for being implementing, them then, maybe having the counter remote microphone as an option would be great and really. Clinics, all, right need to start preparing more clinical testing to see how it's really applicable, in a rural setting versus. Testing just for the purpose of research all research is important, we have a lot of data suggesting, things work but we have to make them palpable in the real world. So. What's better some. Research has been compelling evidence to suggest that the remote microphone is actually yielding. Better how comes an effect but I don't. Want to reveal any spoilers that's, just some competitive, research here, and, but. What do we know for sure using. One FM with bilateral hearing loss is better than no FM at all however. One. FM on to each ear is ideal okay. The. Evidence suggests of both hearing aid users and cochlear implant recipients, to, ears are always going to be better than one. Any. Questions. It's gonna check, hey. Man. That was awesome oh, thank, you. Here. If you guys have any questions feel free to email me and I can also email those guys to, Lin. To. Share with you all as well, and. We, have actually created a hearing assistive technology, life binder so. So. We can add anything that you said we can add so that. Everyone can have access to it. Friends. We do want to thank you thank you so much dr. Sanchez and thank you so much Linda.
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