Single-sided deafness (SSD) is a condition in which a person has lost hearing in one ear, but can still hear with the other ear. It’s also known as unilateral hearing loss, which is prevalent in 40% of the population with hearing impairment.
We are designed to have two ears for a reason—the brain uses both ears to pinpoint the location of a sound and to improve hearing quality and range. This is known as binaural hearing.
Unable to judge the loudness of a sound
Confusions in pinpointing the location of a sounds
Poor understanding of speech/ muffled speech due to the head-shadow effect
Difficulty to filter the noise to understand speech in noisy listening environments
There tends to add up stress, anxiety, and frustration as well
Single-sided deafness can be experienced because of various factors such as-
A patient of age 37yrs suffered from unilateral hearing loss after a head trauma due to an accident. He was a university professor and had an active lifestyle. He used to attend and give seminars, conduct classes, and attend meetings on daily basis.
The hearing loss started causing hindrance in his career as he found it extremely difficult to locate and understand when his students and coworkers communicated with him.
After diagnosis and analyzing all his needs, he was recommended usage of Contralateral routing of sound system (CROS), this system is uniquely made for people with single-sided deafness in one ear and normal hearing in the other.
When you wear a device on either side of the ear, the signal from the non-functional ear is routed wirelessly to the well-functioning ear. The nonfunctioning ear has a transmitter, which only transmits the signals received from the particular side to the receiver that is placed on the functional ear.
With the help of this system, my client did not miss out on any discussions and was completely satisfied with the results. For people who have mild to moderate loss on the functional ear, there is an option called Bi-cros, which works in a similar way, only by providing the necessary amplification through the receiver in the functional ear.
Benefits of using CROS and BiCROS hearing aids device-
Clearer and easier conversations with precise speech audibility and accurate speech detection in difficult listening situations
A better understanding of speech in noise
Wind, noise, whistling, and feedback management for optimal speech accuracy
Simultaneous processing of multiple sounds for a comfortable listening experience that makes speech crisp and clear while keeping ambient noise natural
Improved phone conversations with ear-to-ear streaming.
Signia’s CROS and Bi-cros hearing aids provide fitting accessories called CROS Pure available in two different technologies, Primax (Px) and Nx respectively.
CROS/Bi-Cros Px works on primax technology, compatible hearing aids with this transmitter are
2. CROS/Bi-Cros pure 312 Nx works on Signis Nx technology, compatible hearing aids with this transmitter are
Pure 3Nx /5Nx/7Nx
3. Nx technology also provides CROS/Bi-Cros Silk Nx transmitters on Completely in the Canal (CIC) model. Compatible hearing aids with this transmitter are
4. CROS Pure Charge & Go Nx transmitter is specially made for rechargeable hearing aids. Compatible hearing aids with this transmitter are
Mr.Ajay D is a Chartered Accountant and also a Coffee Planter. He resides in a very remote location in the middle of his coffee estate at Coorg. Lately, he is facing problems in responding when people speak softly. He came to me for consultation as he is a huge music lover, basketball, tennis & hockey player. He is also into riffle shooting. Lately, he is not able to take part in any of these because of his hearing problem which is making him too uncomfortable.
After a detailed evaluation, I suggested him pure Nx. His main concern was he cannot travel all the way from Coorg to Bangalore. Every time he needs any sort of changes with the hearing aid.
I suggested to him the Telecare program which is helping him make necessary changes just by sitting in his estate. Let’s see how this Telecare program is helping Ajay.
What is Telecare?
It makes the patient closer to the Audiologist like ever before.
From the patient’s smartphone to the Audiologist’s smartphone.
It helps to monitor your progress during the trial.
Helps to stay in direct contact with the Audiologist.
Helps you to get remote fine-tuning.
What are the awesome benefits of Telecare?
Helps the Audiologist to get full transparency of the patient’s progress during the trial.
Let’s track the patient’s satisfaction.
Allows reacting more precisely for better trial outcomes.
It helps you to get the comfort of daily living with new hearing aids.
Reduces interruptions in follow up with the clinic.
Avoids extra visits.
Prevents simple issues from ruining the comfort.
Lowers the barrier to communication.
Lets the Audiologist to troubleshoot any problems in the most efficient way.
Saves time and cost of traveling.
What is Telecare 3.0 and its benefits?
It is nothing but the advanced version of Telecare 2.0
It provides remote hearing care at a new level with Bluetooth.
The Bluetooth connection to the phone enables the Audiologist to see hearing aid settings and environmental data in the Telecare portal.
Valuable predictors of success are plotted daily for monitoring while real-time data is displayed to assist remote tuning.
It helps to know the daily wearing time, program use, daily user satisfaction.
Helps Audiologist to assist you with program, volume, battery status, environmental classification, environmental noise level.
It helps the patient feel happy with new hearing aids quickly from the comfort of their daily lives.
What is the difference between Telecare 2.0 and Telecare 3.0?
Telecare 2.0 is only for primax hearing aids, whereas Telecare 3.0 is for Nx hearing aids
In Telecare 3.0 we can give different programs, which is not available in Telecare 2.0
How does Telecare help the Audiologist to provide best service?
Helps in real-time tracking
Helps in tracking daily satisfaction
Enables to react more precisely
Helps to provide the best support
Reduces interruptions ensuring better comfort
Avoids extra visits
Doesn’t let simple issues ruin the comfortability
Closer to patients
Lowers the barrier to communicate
Lets to troubleshoot any problems in the most efficient ways
How does Telecare help the patient to receive best service?
Instant advice and troubleshooting
Fewer follow up visits
Increased satisfaction with hearing aids
Helps to handle new hearing aids
Many issues can be addressed without delay
You are more likely to become engaged with the new hearing aids
Shorter adjustment time
Fast and clear hearing success
Wearers learn at their preferred pace
Feedback options for a higher individualization
Fewer dropouts from wearing a hearing aid
Mr.Ajay was facing problems during the most challenging period of adjusting to new hearing aids that is typically the first few weeks. In order to manage critical moments effectively and to increase his comfort with hearing aids, he used Telecare. He says “It is a perfect hearing tool for smoother, faster and more successful use of hearing aids”
Do you want to experience the sound of joy just by sitting at your home too?
List of hearing aids compatible with the Telecare 2.0 are as follows,
Below hearings, aids compatible with Telecare 3.0 are as follows,
Mrs. Minaxi Lahoria is my 48yrs old patient who has a tinnitus problem, she is unable to sleep or concentrate on anything because of this problem. She is feeling it very uncomfortable to carry out her everyday routine. She has already taken a lot of medicines for this problem and nothing seems to work. She consulted me in despair seeking a solution.
After a detailed evaluation and explanation about tinnitus, she was recommended pure 2px hearing aids to solve her concerns.
What is tinnitus?
Our world is alive with sound. Laughter, unforgettable melodies, waves breaking on the shore, all these sounds enrich our lives and are literally music to our ears, lifting our mood, what happens when one sound suddenly takes control?
Tinnitus is the noise that originates from within the ear rather than from the outside environment. This may affect one or both ears. Unfortunately patient often learns from their doctors that their complaint is incurable. This kind of information makes patients feel isolated convinced that no one can understand what they are going through. Because tinnitus has many causes, so far we have no specific medication or patent cure for all types of tinnitus.
How a person does feel with tinnitus?
The noise differs from one person to the next in nature, pitch, and volume. Many describe the noise as a whistling, hissing, roaring, or ringing in the ear.
What are the types of tinnitus?
Acute Tinnitus – If the noise occurs only temporarily and soon disappears again for instance after a loud concert, it is called acute tinnitus.
Chronic Tinnitus – For millions of people, though the noises are permanent (more than six months), thus developing chronic tinnitus.
What are the possible causes of tinnitus?
One of the most common causes of tinnitus is hearing loss. This may be due to blast injury or exposure to exceptionally loud music.
Frequently occurs alongside sudden hearing loss.
Stress is the most commonly quoted cause of tinnitus.
What are the other problems which you can face due to tinnitus?
How can tinnitus be diagnosed?
Doctors may conduct ENT, dental, orthodontic, and orthopedic examinations.
A hearing test can reveal whether the hearing impairment is also involved.
How can you cope with tinnitus? What are the treatment options available?
Even if there is no specific cause is determined, tinnitus can be treated. There are many possibilities to help patients find ways to cope with their condition. This means changing habits and attitudes so that tinnitus no longer controls your everyday life.
How can you manage tinnitus?
Learning relaxation methods
Practicing imaginary journeys to elicit positive emotions
Transforming negative thoughts and attitudes into a helpful mindset
Weaning off habits that encourage tinnitus
Training for use of hearing instruments, noisers, combined devices, or other audio sources to deflect attention away from tinnitus.
Tinnitus noiser is one of the popular and most effective ways of tinnitus management.
Modern technology can help subdue tinnitus. The main principle is allowing your brain to hear and therefore focus on external sound rather than tinnitus.
What are noisers?
Noisers are for people without hearing loss.
They look like hearing instruments but do not amplify the sounds in the environment.
They generate a soft murmur that is mixed in with the tinnitus to distract the patient from the tinnitus.
Noisers generally offer considerable relief from tinnitus.
What are hearing instruments?
Sometimes wearing hearing instruments both improves hearing and alleviates tinnitus.
The reason being that if you can hear better, you can also ignore tinnitus better.
Hearing instruments pick up ambient sound over a microphone and amplify it before passing it onto the ear.
This enables wearers to better focus on the noises, sounds, and tones around them.
The rustle of leaves in the forest, friendly conversation, or beautiful music restore the emphasis on pleasant hearing impressions and narrow the scope of tinnitus.
In many cases, users scarcely or don’t hear the tinnitus at all as soon as the hearing instrument is switched on.
What are tinnitus combined devices?
Some hearing instruments also feature a noiser function.
As hearing instruments can only amplify noises actually present around us, they are of little use as tinnitus therapy tools in very quiet hearing environments.
This is when the noiser function can be helpful.
In these situations, the noiser can generate a soft noise to distract the patient from tinnitus.
In modern hearing instruments, like those from Signia Seimens, various hearing programs can be selected at the touch of a button: pure hearing instrument function, purely noiser function, or the combination of two.
What are the tips for living with tinnitus?
Relearning how to hear
Have a good night sleep
Get active, stay on the move
Promote physical fitness
Learn to relax effectively
Mrs. Minaxi Lahoria is very happy and contented after resolving all her problems, she has been using hearing aids for the past 6 months and has found a considerable amount of relief from tinnitus. She is comfortable in carrying on with the daily routine and she feels that the tinnitus is subsided.
List of hearing instruments which has a tinnitus option in it are as follows,
Mr. Mahesh, a 38yrs old is man is a busy person and works in the clothing industry for 8yrs. He likes his profession and heads his department. His job requires him to conduct group discussions often.
For 5-6 months, he felt that he had trouble understanding during the discussions and this led to miscommunication. This ended up in lesser performance later and started to affect his productivity at work.
When he discussed this with his cousin, she suggested him to see an audiologist as soon as possible to know if there can be any hearing-related problems. He then had his consultation with the Audiologist and was diagnosed to have moderate Sensorineural hearing loss in both ears. He panicked with this mere diagnosis and after the counseling with the audiologist, he felt better than he could actually start understanding speech well with the usage of hearing aids and was positive to have a trial with hearing aids for both ears.
After a brief discussion about the different models, styles, and features of hearing aid, he was recommended to have a trial with RIC Pure 312 3NX devices for both ears considering his listening needs. He addressed his fears and also enquired about how he would feel when he was exposed to loud or impulse sounds. He was briefed about the features in these devices and a feature which helps in these situations especially called ‘Sound Smoothening’. After about 3 days of trial with them, he revisited the audiologist and shared that he was feeling very satisfied and comfortable in all situations and that he wanted to start using them immediately.
Let us have a look at what this feature ‘Sound smoothening’ is all about.
Basically, if you’re in the kitchen and someone drops a plate on the floor you are less likely to jump out of your skin as the hearing aid reacts immediately to loud and unexpected sounds and softens them. Background noise has long been a major issue for hearing instrument wearers. Not only does this noise often reduce speech understanding, but in many cases, it creates annoyance making hearing instrument use an overall unpleasant experience.
Research has shown that new wearers of hearing instruments report background noise to become significantly more annoying after being fit with hearing instruments.
Sound smoothening is a very interesting feature in hearing aids and is a component in the speech and noise management system. It is an algorithm that reduces the annoyance of transient noises. It changes the way people feel when they use them in extremely noisy situations.
People with normal hearing also find it annoying most of the time when impulse sounds are heard but Signia hearing aids technology makes the user feel drastically less irritated in such situations.
How this feature helps to solve the Annoyance problem:
It is important to consider the range of noises which the hearing instrument wearers experience in their everyday life to reduce the annoyance from noise. A potential solution to the noise annoyance problem is the implementation of digital noise reduction (DNR). Research has shown that when implemented, DNR does produce a more pleasant listening experience. When listening to speech in background noise, the majority of the listeners will prefer DNR ‘ON’. Hence listeners find fewer levels of annoyance.
DNR algorithms have been modulation based. This helps effectively in differentiating speech from broadband stationary noise and when noise is detected as a primary signal, the channel-specific gain reduction occurs.
This method is very successful in reducing the annoyance of any type of continuous noise. A second DNR algorithm is based on the Wiener Filter – sometimes also referred to as “Spectral Subtraction”. This fast-acting noise reduction filter complements the modulation-based algorithm and provides further reduction of stationary broad-band noise. As it is fast-acting, it is effective in reducing unwanted noise during gaps in speech.
First, the spectral and temporal properties of the input signal are determined by a spectro-temporal analysis. The spectral information allows SoundSmoothing to attenuate transient high-frequency or low-frequency sounds without affecting frequency areas not containing transient sounds.
The temporal properties are calculated with a very high resolution and an exceptionally low processing delay(< 1ms) in order to shorten SoundSmoothing’s reaction time on transient sounds to a minimum.
In the next stage, envelope features are extracted. These then are used to decide whether speech or non-speech sounds are present.
For this purpose, the envelope features are analyzed using a speech model. Only for non-speech sounds, an attenuation factor is calculated. The amount of transient gain modification is determined by the ratio of peak level to long-term overall RMS level (i.e. the more transient, the more gain reduction). The maximum amount of gain reduction for transients is adjustable as well as the detection threshold. Transient sounds with levels below the detection threshold are not attenuated by SoundSmoothing.
How these parameters can be set via the fitting software is explained in the section “Software Fitting Options.” Finally, the output signal is reconstructed in the “Re-synthesis” stage.
What happens when we apply a combination of different noise reduction techniques?
Continuous sounds also can be annoying or may cause increased listening effort when simultaneously present with speech.
An ideal noise management system will combine various DNR algorithms: modulation based noise reduction, Wiener filter, and Sound Smoothing. Whereas modulation based DNR (“Noise reduction”) is very efficient when only stationary noise is present, the Wiener Filter (“Speech enhancement”) takes over as soon as speech and noise are simultaneously present. Finally, SoundSmoothing reduces non-stationary, transient noises, whether or not speech is present.
All these noise reduction techniques efficiently reduce the amount of noise, but do not degrade the sound quality of speech. This is the result when we combine different noise reduction techniques.
A research project in NAL, Australia for SoundSmoothing for Different Environmental sounds found that a strong preference was chosen for SoundSmoothing for transient signals. For all noises with a relatively short duration, SoundSmoothing “On” was preferred by the majority of listeners, in most cases by a very large margin.
Are there any adverse effects of Sound smoothening?
As mentioned earlier, SoundSmoothing is very positive. Whenever new signal processing is introduced, however, it is critical to question, if there are any possible negative effects for the wearer when the processing is implemented.
With the Sound Smoothing algorithm, it is necessary to confirm laboratory data with regards to two important listening conditions: SoundSmoothing does not affect speech understanding and auditory localization.
To examine the effects of SoundSmoothing on speech understanding, research at the National Acoustic Laboratories conducted aided speech intelligibility testing using the BKB sentences in background noise (paper rustling and cutlery).
Testing was conducted for SoundSmoothing “On” versus SoundSmoothing “Off.” The results showed no significant effect of SoundSmoothing (p = 0.85). That is, as expected, there was no negative effect on speech understanding when the SoundSmoothing algorithm was used.
Auditory localization testing also was conducted at the National Acoustic Laboratories. Since SoundSmoothing reduces the slope of the acoustic envelope (to effectively reduce the annoyance of transient noise) this research was conducted to investigate whether this signal alteration distorted the spatial location of the signal for the hearing instrument wearer.
Localization performance was assessed with SoundSmoothing “On” versus SoundSmoothing “Off” using hammering as a stimulus. The localization RMS errors revealed that as a group, there was no significant difference in localization ability as a function of the algorithm turned “On” or “Off” (p > 0.33).
In addition to the laboratory findings at NAL, subjects from another study conducted at Giessen (see next section) rated localization of signals in everyday life the same for SoundSmoothing “On” versus “Off,” indicating that SoundSmoothing has no adverse effect on localization.
SOME FITTING GUIDELINES:
As discussed, SoundSmoothing is an efficient new DNR algorithm that addresses an important concern of the hearing instrument wearer. Some general guidelines regarding the fitting of this algorithm, and patient counseling related to its processing are as follows:
1. SoundSmoothing can be used in conjunction with other DNR processing, or it can be used independently. It is an enhancement, not a replacement for the more traditional DNR techniques that also have proven patient beneficial.
2. There is no specific audiometric profile for the SoundSmoothing algorithm. If transient environmental noise is audible, as it is for nearly all hearing instrument wearers, then it would be expected that SoundSmoothing would reduce the annoyance of these signals.
3. Research has shown that in general both new hearing instrument wearers and experienced wearers will obtain listening benefit from the SoundSmoothing processing. More specifically, results from clinical studies suggest that first-time wearers may benefit even more than experienced wearers.
4. There is no negative impact of the SoundSmoothing algorithm, hence, it should be considered routinely for all hearing instrument wearers.
5. Because SoundSmoothing is designed to be sensitive to abrupt signals, the hearing instrument wearer will only notice the benefit of SoundSmoothing when such signals are present. To demonstrate the advantages of SoundSmoothing, therefore, it is recommended that the dispenser presents annoying abrupt sound samples (e.g. hand clapping) to the prospective hearing instrument wearer. Paired comparisons using SoundSmoothing “On” versus SoundSmoothing “Off” in two programs as were used in the research findings previously described may be one such technique for demonstration.
Sounds below the detection threshold are not affected by SoundSmoothing. This is employed to ensure that very soft transient signals – which typically are not very annoying and often carry important information – are audible (e.g. the ticking of the clock will not activate SoundSmoothing).
For patients who desire less reduction/more audibility of very soft transient sounds (i.e. clock ticking), reduce the setting. For patients who are highly bothered by transient sounds (e.g. door slamming, cutlery) increase the setting (e.g. max).
Sound Smoothening is compactible with the following hearing aids:
Silk 2PX Click
BTE Motion P/SP 2PX
RIC Pure 2PX
Insio 3PX (1 adjustment step)
BTE Motion SP 3PX (1 adjustment step)
RIC Pure 3PX (1 adjustment step)
Insio 5PX (3 adjustment steps)
BTE Motion SP 5PX (3 adjustment steps)
Insio 7PX (3 adjustment steps)
BTE Motion SP 7PX (3 adjustment steps)
Insio 3NX (1 adjustment step)
BTE Motion 13P 3NX (1 adjustment step)
BTE Motion 13 3NX (1 adjustment step)
RIC Pure 312 3NX (1 adjustment step)
RIC Pure 13 3NX (1 adjustment step)
Insio 5NX (3 adjustment steps)
BTE Motion 13P 5NX (3 adjustment steps)
BTE Motion 13 5NX (3 adjustment steps)
RIC Pure 312 5NX (3 adjustment steps)
RIC Pure 13 5NX (3 adjustment steps)
Insio 7NX (3 adjustment steps)
BTE Motion 13P 7NX (3 adjustment steps)
BTE Motion 13 7NX (3 adjustment steps)
RIC Pure 312 7NX (3 adjustment steps)
RIC Pure 13 7NX (3 adjustment steps)
RIC Pure Charge and GO 3NX (1 adjustment step)
RIC Pure Charge and GO 5/7NX(3 adjustment steps)
BTE Motion Charge and GO 3NX (1 adjustment step)
BTE Motion Charge and GO 5/7NX (3 adjustment steps)
Mr. Nitish of age 42yrs visited our clinic a week back with a complaint of reduced understanding of speech for a year. When we were reviewing the history, it was found that he was identified as having Mild to moderate sensorineural hearing loss in both ears in 2017.
When enquired, he said that he had not had a trial with hearing aids before and currently he felt that this was gradually worsening. He also mentioned that he was feeling anxious at work because it was a noisy environment and that he had stopped watching TV as he no more understood the dialogues.
Another audiometry was done and he was diagnosed as having moderate sloping sensorineural hearing loss in both ears. Test findings were shared with him and he was counseled regarding how important usage of hearing aids is for him.
Trial with Pure Charge and GO 5NX was done for both his ears and he seemed to be most comfortable and delighted. He took them for a 3 day home trial and then purchased them the same week. His major concern was that he was working in a place where there were many people and he was unable to focus and understand conversations in group meetings or conversations at home over the dining table.
Let’s see how noise plays a role in speech understanding
It’s a noisy world, and the noise continues to be a major issue for hearing aid users. Let us take a look at Noise management strategies, general guidelines for assessing patients hearing abilities in noise, the intended applications for the various noise reduction strategies, as well as when and how to implement them.
Let’s face it, our environment is noisy.
Noise is the 1st main complaint of all participating consumers when eating at restaurants. Individuals cannot even escape from the noise in their own homes, as noise is the number-one neighborhood complaint. Since normal-hearing people are subjected to considerable amounts of noise on a daily basis, it is not surprising that the number-one complaint of all hearing aid users is difficulty hearing in noise; almost half (49%) of those who return their hearing aids reportedly do so because of problems with background noise.
Normal-hearing people also encounter difficulty hearing in noise but are better able to recognize or discriminate speech than those with hearing impairment. However, as the background noise or when the distance is increased or when unfamiliar topics are introduced, the natural discrimination of speech decreases.
The discrimination capacity in speech is often lost when someone has hearing loss and parts of phonemes might not be audible. Auditory coding (frequency resolution) also might not be as precise, which can result in the stimulation of additional frequency areas within the cochlea, making it more difficult to differentiate among the sounds being heard.
A second problem for those with hearing impairment is the ability to detect changes in the duration of sounds (temporal gap discrimination).
Older adults with hearing impairment often face other difficulties in addition to the above-mentioned problems. Given the same hearing loss configuration, studies have shown that older adults perform worse on speech recognition measures in quiet than younger adults. In addition, older adults might experience more difficulty processing language in the presence of competing speech due to cognitive involvement.
With all of these factors that can contribute to hearing in noise problems, what approach are most clinicians taking, and is there more that could be done?
Most clinicians are using audiograms and speech discrimination measures in quiet on a routine basis as assessment tools for their hearing aid clients.
Results indicate that less than half of the hearing instrument specialists were routinely performing some type of speech in noise test, although hearing in noise has consistently been the number-one complaint from hearing aid users for years.
Addressing Noise Issue(s)
It is important to Identify the Source of the Hearing in Noise Problem
Although audibility can easily be predicted from an audiogram, speech recognition ability in quiet is a poor predictor of speech recognition ability in noise. Furthermore, significant differences have been reported in the ability to understand speech in noise among hearing-impaired listeners with similar audiograms.
In order to address the hearing in noise complaints, it is important to measure hearing in the various auditory domains that can contribute to hearing in noise difficulties. In general, there are three domains for assessing these difficulties:
Basic auditory function or the audiogram
Speech discrimination ability in quiet
Speech discrimination ability in noise
Addressing the Noise issues
Audibility. Current American Academy of Audiology (AAA) guidelines recommend performing real-ear measurements (REM) as a tool for verifying hearing aid gain in adult patients. REM can be used to provide objective information regarding whether an incorrect gain is a contributing factor in a reported hearing in noise problems.
The gain values that the manufacturer recommends for a given hearing aid user in the fitting software assume the patient has an average-size ear canal.
Therefore, if a given patient has a larger-than-average ear canal, they may not receive enough gain and could complain that speech is not loud enough or that noise is too loud due to a primary audibility issue. Likewise, if the patient has a smaller-than-average ear, the hearing aids may provide too much gain, resulting in everything being too loud, including noise.
In addition, audibility—especially in noise—can generally be improved by fitting hearing-impaired patients with two hearing aids instead of only one, when possible. Such benefits include better hearing in quiet and noise, better sound quality, better localization of sounds, and higher listening comfort in various situations.
Although some studies have shown an improvement in the ability to understand speech in noise when fit binaurally, there may not be an improvement in the actual acceptance of noise. Studies also have shown there is a small segment of the elderly population who may actually perform better on speech recognition in noise tests when fitting monaurally due to possible binaural interference.
Overall background noise. If your patient is complaining about the overall level of background noise, the problem could be due to noise that is mixed in with the signal of interest or noise that is being amplified in other areas along with the signal of interest.
The noise that is embedded in the signal of interest. It is extremely difficult to develop a hearing aid algorithm that removes all of the noise embedded in speech without eliminating or distorting a portion of the desired speech signal.
Most hearing aids on the market today have a noise reduction algorithm that uses modulation rate/depth or spectral subtraction to eliminate unwanted noise from the signal. Enabling noise reduction or increasing the noise reduction gain for the environment(s) in which the patient is experiencing difficulty hearing in noise can be especially helpful in improving listening comfort.
A noise that is separated from the signal of interest. Directional processing can be helpful when a patient complains that he/she is having difficulty hearing in noise, and the speaker or signal of interest is separated from the unwanted noise. Directional microphones are the most effective noise reduction strategy in hearing aids and are reported to provide a 3 to 4 dB SNR improvement in real-world environments with low reverberation.
There are several basic directional technology schemes that can be selected for a given hearing aid user. Fixed directionality is best at canceling noise located behind the hearing aid user when the speaker or signal of interest is located in front of the user.
Adaptive directional processing can be helpful when a hearing aid user is confronted with multiple noise sources. With adaptive directionality, multiple noise sources in different locations can be canceled out at the same time. There are several different ways in which hearing aid users can access the directional programs within their hearing aids. Users can change the programs manually by using a button located on the hearing aids or by using a remote control device.
Wind noise. Wind noise generated by random turbulent flow across the hearing aid microphone(s) can be a mere annoyance or a debilitating interference for hearing aid users. Research has shown that wind noise interference can vary based on the style of hearing aid, the processing is used, and the direction of the wind flow.
As a general rule, the best way to reduce the annoyance of wind noise is to prevent it from entering the hearing instrument in the first place. Some custom device styles, such as CICs that fit deeper into the ear or remote microphone instruments in which the placement of the microphone lies within the contours of the ear, offer natural wind noise protection. Other hearing aid styles, such as BTEs, are more susceptible to wind noise.
The microphone mode is also important. With a directional microphone, the interfering wind noise that is generated very close to the microphone is sensed with high sensitivity while the desired sound from the far-field is sensed with low sensitivity.
Whenever there is a choice, the directional microphone on a hearing aid should not be used when wind noise is present. Thus, fitting a patient with a single microphone hearing instrument or utilizing a program with omnidirectional processing can reduce wind noise complaints.
In addition to the above options, many manufacturers offer software-based wind noise programs that are designed to reduce gain in the frequencies in which wind noise is detected. Possible issues with such wind noise reduction features are that they may detect wind noise when it is not actually present, or they may fail to detect wind noise when it is. The result can be annoying gain reductions at unwanted times or lack of comfort in windy conditions.
Ambient noise. Although wide-dynamic range compression (WDRC) and/or directionality can be quite beneficial, they also can create a problem: ambient noise.
WDRC is used to restore audibility for weak sounds and simultaneously restore some of the normal loudness perceptions that are lost with recruitment. To accomplish this, more gain is applied to low-level input sounds than high-level input sounds, with input signal levels below the threshold of compression typically receiving linear amplification.
Loud sounds. If loud noises are intolerable, but all other sounds are okay, likely, the patient’s UCLs for at least some of the frequencies have been exceeded. Real-ear and coupler verifications of loud sounds are excellent ways to verify that loud sounds are tolerable to the patient. Measured results can be compared to the patient’s actual or predicted UCLs to adjust hearing aid gain and output.
Counseling and Setting Realistic Expectations
The main goals when fitting amplification are
to improve audibility and to increase the signal-to-noise ratio resulting in an overall improvement in speech understanding.
Even with amplification, some patients will still encounter significant hearing problems due to a damaged auditory system, reduced cognitive ability, and/or difficult auditory environment.
Therefore, it is important to use the subjective and objective test results to counsel the patient about realistic expectations. If the patient demonstrates a significant SNR loss, he/she might benefit from assistive listening devices (ALDs), aural rehabilitation/counseling, or computer-based auditory training programs in addition to amplification.
With all of the wireless hearing aids in the market today, many new ALDs have been introduced that can improve the SNR by offering direct connectivity to TVs, phones, iPods, or remote microphones.
In addition, studies have shown that when hearing aid users attend group support programs on average they have fewer return visits and report their hearing aids to be beneficial in more listening environments than those who do not attend a group. Computer-based auditory programs also can be helpful in improving speech understanding ability in noise.
While technology and training can help improve the SNR for hearing-impaired people, the noise will always be an issue that even normal-hearing people have to contend with daily. The best option continues to be starting with a good SNR by being selective about the environment when possible and manipulating the environment when necessary.
Clinicians can be most beneficial to their hearing-impaired patients by providing them with hearing tools—not just hearing aids—and these tools should include ALDs, counseling, and listening strategies.
Speech and Noise management is compactible with the following hearing aids:
Intuis 3 products
RIC/BTE/Custom 1PX ,2PX ,3PX,5PX and 7PX products
RIC/BTE/Custom NX Products
Pure Charge and GO NX/Motion Charge and GO NX Products
Mr. Sen is a retired Bank officer who has been facing difficulties in hearing for the last 4-5 years. He has used hearing aids in the past however he finds it difficult to follow telephone conversations and has clarity problems while watching TV.
He also likes to hear debates, listen to old Hindi songs and speeches on his phone, and often miss words due to reduced clarity. He is an iPhone user.
Mr sen approached Aanvii Hearing Solutions to get a solution for his problems. We proceeded with his testing. After assessing his listening needs and problems, he was recommended Pure Charge & Go 5Nx hearing aids in both ears which are Made for iPhone hearing aids.
What are ‘Made for iPhone’ hearing aids??
These are hearing aids with Bluetooth compatibility for iPhone. There is a special Bluetooth low energy protocol that is used which reduces the battery drainage of both devices without compromising the quality of streaming.
What is the use of this feature? How does it help to hear better?
This feature can be used for direct streaming of phone calls, music, or videos through iPhone, iPad, or iPod touch devices. It works on Bluetooth technology using which your hearing aids would work like wireless stereo earphones. The clarity of phone calls or music or anything you stream is crystal clear when streamed through Bluetooth.
Can these Hearing aids be used if I do not have an iPhone?
Yes. For using the streaming feature, you would need to use a streaming accessory called ‘Streamline Mic’ which will pair your android phone to your Made for iPhone(MFI) hearing aids.
How to pair these hearing aids to your iPhone?
Step 1: Switch on the Bluetooth by going to General setting on your iPhone
Step 2: Go to iPhone SETTINGS>>GENERAL>>ACCESSIBILITY>>MFI Hearing devices
Step 3: Ensure that hearing aids are completely charged and switch ON the hearing aids near your iPhone
Step 4: When you press on MFI hearing aids, the iPhone would begin scanning for hearing aids and display it on the screen once detected.
Step 5: Press on the hearing aids displayed. The pairing option will pop-up for both the hearing aids. Press on ‘Pair’ for both the hearing aids and YOU ARE DONE!
Can I control the hearing aids’ volume or settings through my iPhone?
Yes, You could increase or decrease the volume or change programs by going to Settings on iPhone. Settings>> General>> Accessibility>>MFI devices
An easier option would be using an App to control your hearing aids. The name of the app is the MyControl App. You could download the app from the App Store and the app provides easy access to the settings of your hearing aids.
Which iOS devices are compatible with Made for iPhone hearing aids?
iPhone 5 or later
iPad Pro (all models)
iPad Air (all models)
iPad(4th generation ) or later
iPad Mini (all models)
iPod touch(5th generation) or later
What happens if I receive calls once the hearing aids are paired to my iPhone? What do I need to do if someone else wants to talk from my phone?
Once the hearing aids are paired to the iPhone, the default mode would be through the hearing aids’ Bluetooth. In that case, you would hear in both ears and don’t even need to hold the phone on-ear you. You could talk hands-free.
If someone else wants to talk from your phone, press on the ‘AUDIO’ option on your screen after connecting the call. Then select ‘iPhone’ to enable iPhone’s speaker. One can then hold the iPhone on-ear and talk like we normally do. You also have the ‘SPEAKER’ option, which can be used to put the iPhone on speaker mode, which will be a hands-free option.
Can I pair hearing aids to two iOS devices at the same time?
No, if the hearing aids are paired to one of your iOS devices, they need to be disconnected before pairing it to other iOS devices. You cannot stream through two iOS devices at the same time.
Can MFI hearing aids stream audio through TV?
Yes. You would have to use an accessory for TV streaming called ‘Streamline TV’ using which you can stream TV audio directly into your MFI hearing aids.
If I watch something on my iPhone, will it be heard only by me or by others as well?
When you stream audio to Made for iPhone hearing aids, it will be heard only by you. When iPhone’s Bluetooth is switched off, it would not be streamed to your hearing aids anymore. So everyone around would be able to hear what you play.
How are MFI hearing aids different than other Bluetooth headphones/earphones?
When streaming through Bluetooth headphones/earphones, the ambient noise is suppressed and you can hear the audio that is streamed. Attending to other environmental sounds can be difficult. However, when streaming from MFI hearing aids, you can also hear other sounds in your environment enabling you to be more alert of other sounds in the environment. Headphones are external accessories that are often bulky and heavy on the ears, while made for iPhone hearing aids act as Bluetooth stereo headphones without any extra weight on your ears. Also wearing over-the-ear Bluetooth headphones /earphones can get uncomfortable if used for longer periods of time. Hence it is more convenient to use MFI hearing aids than headphones/ earphones as the audio is not only streamed but also enhanced based on your hearing loss.
If I want to use streaming feature, it is preferable to used rechargeable hearing aids or battery operated hearing aids?
It is preferable to use rechargeable (Charge & Go) hearing aids than battery-operated (Battery 13 and 312) hearing aids as when the streaming feature is active, the zinc-air batteries tend to drain out very soon and would need replacement often. Instead, if you use rechargeable hearing aids, Lithium-ion batteries are more durable. Hence it is advisable to go for Charge & Go hearing aids if you intend to use the streaming feature for a considerable time in a day.
Mr. Sen can hear phone conversations seamlessly now. He can also enjoy listening to debates on his phone & enjoys listening to old Hindi songs through his Made for iPhone hearing aids.
Following is the list of Made for iPhone hearing aids:
Mrs. Kavitha had consulted an audiologist 2 yrs back as she was suffering from hearing loss. This had created hassles in her daily communication and she wanted to hear well. She was recommended to use hearing aids and she purchased them too.
Later she had mentioned that she used it for a month and then stopped the usage as she was not happy hearing her own voice which seemed so unnatural. She met me recently and told me that she got demotivated and decided that she will never be able to comfortably use hearing aids. After a detailed evaluation and understanding of her needs and concerns, I told her that I recommend her to use Signia NX hearing aids which have OVP technology.
Let’s have a look at how your own voice perception using hearing aids actually help patients use their hearing aids comfortably with a lot of satisfaction.
Humans hear their own first cry and only then realize gradually their auditory senses and how it helps them hear and perceive speech. It is their own voice they hear right from the moment they are born. Hence own voice is sensitive to any minor changes and this will have humans feel different.
As hearing care professionals, we focus on providing hearing aid users the sound quality that replicates the most natural sound.
Most hearing aid users don’t like to hear their own voice and this negative perception heavily affects the acceptance and often leads to the rejection of the hearing aids.
Overall audibility and a natural sounding own voice are essential for the first fit acceptance. During the first fit, acceptance is highly important for them to start positively using hearing aids.
Resolving the own voice issue has been challenging for hearing care professionals. It has always been a compromise between overall audibility and sound quality.
Siemens hearing aids till a few years back had only signal (speech) enhancement and noise-reducing technologies. Since very recently they have come with the latest technology known as the own voice processing in exclusively Siemens NX products (OVP). Signia NX, the world’s most advanced hearing aid platform provides the first genuine solution to this own voice issue.
It delivers excellent first fit acceptance by combining uncompromised audibility with a natural-sounding own voice. OVP improves spontaneous acceptance of own voice by 75% of dissatisfied hearing aid users. OVP technology works with bilateral hearing aids usage only.
FIRST EVER OWN VOICE DETECTION
The highly precise microphone network identifies the user’s own voice reliably due to its unique spatial sound path. The continuous binaural ensures dynamic detection in all situations.
The natural-sounding own voice provided by Signia NX is based on the ULTRA HD e2e Binaural link.
CONTINUOUS BINAURAL LINK
For the most natural experience, Ultra HD e2e always on-ear to ear (e2e) link now also uses binaural beamforming technology to scan precisely for the user’s own voice. This allows hearing care professionals to reprogram the hearing aids for optimal audibility of the entire acoustic environment without having to compromise the audibility to improve the sound quality of the user’s own voice.
In this way, Signia NX OVP benefits all hearing aid users as it replicates the natural hearing and understanding experience to deliver the highest sound quality and delivers the hearing aid’s full potential for best hearing performance in any situation, even in very noisy environments. This precision is only possible with the new fully integrated silicon microphone network.
Kavitha had a trial with RIC PURE 312 3NX for both ears and she was elated to feel her voice as most natural as ever. She has been using the same for 4 months now and has been pleased with this up-gradation in technologies.
OVP is compatible with the following hearing aids:
Headphones and earphones have become an integral part of our day-to-day lives without knowing the impact of it on our Hearing. One has to wonder, do headphones cause hearing loss, or is that a scare tactic to make teens take out their earphones?
However, many studies suggest that earphones cause hearing loss. This isn’t caused by using them, necessarily. Like most things, headphones can be used incorrectly and cause damage to our health. By using them too often and too loudly, we can irreparably damage our ability to hear. This is a primary concern for young people who listen to music too loudly and too frequently.
16% of the Population Worldwide suffers from Noise-Induced Hearing Loss (NIHL). The Portable Cassette Players was launched in the 1980s. Since then, there has been continuous discussion on the impact that headphones and their volume levels can have on an individual’s hearing. From the 1980s to 2020, there has been tremendous growth in technology.
The primary concern with the headphones is the volume exposure that they give the ears. Earphones are capable of producing very loud levels of sound very close to the ear and hence are very dangerous. However, it must be noted that it is not always about the volume of the headphones but also the long duration for which the earphones are used. Earphones are exposed to germs also as they are exposed to too many places where they are kept. Sharing the earphones paves way for the transfer of these germs which further induces harmful effects on ears.
Today, people have completely got dependent on their mobile phones and MP3 players. Not only for their music needs but all types of listening. Thus, making earphones and headphones a basic necessity these days. People find it hard to live without it. But, listening to loud music through earphones and headphones is one of the biggest dangers to your hearing.
This article lays down the theory if headphones and earphones can cause noise-induced hearing loss. But if you suspect you have hearing loss, we have something for you, that too completely free.
Free Hearing Assessment
So what exactly the problem is?
There are several situations where people have started using a pair of tiny speakers inside or over their ears such as:
When you’re traveling, you feel incomplete without listening to music or watching a video.
While exercising, morning walks, jogging, cycling, hard workouts in the gym do not start without putting the music ON.
Students find it hard to concentrate without listening to rock music while studying in the college or at home.
Bikers, while commuting, want to cut out themselves from all the honking and traffic noise so put loud music or podcast ON.
While clubbing, when loudspeaker got complaints about creating noise pollution, “Silent Disco” was introduced and now has become a new trend where people want to dance to their own choice of music.
All of the above and similar situations where people intentionally or unintentionally have got so used to earphones and headphones. In fact that they have put their hearing power in grave danger. They have started experiencing hearing loss at a very early age.
These devices as long as they are played at low volumes and shorter spans do not impact much. But the usage of earphones and headphones right from the time we wake up in the morning and till the time we go to bed, and for some even after they go to sleep, at a very loud volume is putting hearing ability at high risk.
How does noise-induced hearing loss occur in the above-mentioned situations?
The human ear contains three parts – namely inner ear, middle part, outer ear. The inner ear contains tiny hair cells that send signals to our brain through vibrations. When sound is too loud and for a long duration, these hair cells lose their sensitivity to vibration. Hair cells bend or fold over when exposed to loud noises.
Headphones and earphones are placed much closed to the outer ear and can produce very loud levels of sound very close to the ear. Long exposure to loud sounds through these devices can damage these hair cells resulting in a hearing loss known as Noise-Induced Hearing Loss, or NIHL.
Unlike an injury to other body parts, hair cell damage never recovers. This type of hearing loss occurs gradually, cumulative, and without obvious warning signs. Thus in the majority of people, it goes unnoticed until it’s too late. It’s not just restricted to elderly people; instead, it is becoming more of an issue for children and teenagers.
How to prevent noise-induced hearing loss?
Don’t panic; you don’t need to snip all your headphones cords to prevent hearing loss. Making sure to keep a reasonable volume can protect your ears from hearing loss; limiting your use of these devices helps as well. It’s a smart move to wear headphones with either good passive or active noise cancellation. By reducing the external noise, you can play music at a safe level and still hear it relatively loud and clear. Besides, take time during the day to enjoy silence or quiet noise, and never fall asleep with music playing through your headphones.
NIHL is irreversible but is preventable too just by making the following changes in headphone usage pattern.
Reduce the volume and listening time. Follow “60-60 rule” – Listen at 60% of the total volume and not more than 60 minutes at a time. Take a break and give 5-10 minutes rest to ears.
Choose headphones wisely. Select noise-cancelling headphones that can cut the outside noise. This enables you to listen to sound from your phone or MP3 player at a much lower volume. Also, always go for over-the-ear headphones instead of a tiny pair of in-ear earbuds. This would increase the distance between the ear and the speaker is little more thus reduces the chance of hearing loss.
Check with the people around you. If someone, sitting next to you or standing at an arms distance from you. If you can listen to sound coming out of your headphones. Or if you have to raise your voice while talking to them; then you immediately need to lower the volume.
Schedule a Hearing Test. If you have buzzing, roaring, or ringing in your ears, or natural sounds around you are muffled or distorted after you take out your headphones, you should immediately book an appointment with a hearing expert known as an Audiologist.
To learn more about NIHL and safe hearing methods or to have your hearing examined at Aanvii Hearing, schedule a consultation with one of our audiologists.
Free Hearing Assessment
The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.
Historical information, in addition to the latest research, presents there are various advantages to getting your hearing tested early if hearing loss is suspected. Early detection with Hearing Test can imply the difference between a smooth transition into better hearing or going through the struggles of relearning how you can hear.
Nowadays most of us lead fairly busy lives. Which means some issues get pushed to the back of the line. However, when it comes to your health, it’s never a good idea to place issues at the back-burner. That’s especially true in terms of getting our hearing checked. Now you might be thinking that this is one examination you’ll be able to delay for some time, especially in case you haven’t observed any signs. However, there are some excellent reasons to get a check-up. Listed here are seven benefits of the hearing tests.
This article lays down the theory about the benefits of a hearing test. But if you are searching for practical results, we have something for you, that too completely free.
Free Hearing Assessment
1 – Better Family Relationships
When individuals lose hearing they have a tendency to start withdrawing from conversations and relationships with others. They could really feel like a hindrance, at all times asking people to repeat themselves or, they might be embarrassed they’ll observe conversations so that they avoid them. Even at work!
It’s usually a slow process and will be tough for those around you to identify. They might mistake it for a bad temper, attitude, or depression. You don’t have to sit down again and settle for the hearing loss. It is advisable to do something about it. The sooner you detect your hearing loss the better it’s to get help and enjoy your relationships as you did before.
Usually, members of the family might discover a hearing loss earlier than the individual with the difficulty. This could result in arguments over the volume of TV and films or who said what about something. Generally, individuals can misinterpret your actions if it appears you’re ignoring them (rather than just not hearing them). After you have the results of your hearing test, you may take action to fix any problems, including family fights.
2 – Hearing The Little Things You Miss
A hearing test offers a roadmap of types to allow the audiologist to find out where any hearing loss has occurred and the way best to program a hearing instrument so it will let you hear sounds in that range again. This means you’ll hear sounds you’ve been missing like a ticking clock, rustling leaves, chirping birds, or children’s laughter. It’s certainly one solution to brighten up any day!
No scientific study needs to be cited here. One recent hearing aid recipient told us the method of relearning how to hear was a struggle. When he began hearing sounds he forgot were necessary to him, he was quite grateful for his results.
3 – Removing The Uncertainty
In the event you’re considering getting a hearing test, you most likely suspect that you’ve got some hearing loss. Dwelling with uncertainty is irritating. Hearing tests are painless and take only about an hour of your time. Once you have the results, you’ll be able to decide the best to move forward. For many individuals, there’s relief in realizing that hearing aids will improve their quality of life.
If you happen to get tested and the results come back normal, you’ll be able to move forward with the confidence of knowing you have good hearing health. Should you get tested and hearing loss is found, you’ll be able to help yourself avoid all the potential health and personal issues mentioned previously. Identifying hearing loss and early treatment can change your life for the better on so many levels.
4 – Better Social Relationships
Socializing is awkward if you’re not hearing portions of conversation due to background noise or if individuals believe you’re aloof. There can also be that little concern about not hearing all the details of what the boss says at a meeting. Aren’t you tired of saying, “What?” or asking individuals to repeat themselves? Research indicates that better hearing results in better health as well.
5 – Catching Other Health Issues
Generally, hearing loss is a symptom. It might be caused by an infection or an earwax impaction or potentially serious health issues such as diabetes, cardiovascular disease, or kidney disease.
Hearing loss has been linked with cognitive decline, brain tissue loss, depression, dementia, and an elevated risk of falling. The older you’re, the tougher it is to get better from the effects of hearing loss.
Another major reason for this is as the ear is not exposed to the particular frequency of sounds the brain is adapted to its silence. Hence this could lead to additional difficulties to get appropriate benefits from the hearing devices.
Look out for treatment before permanent damage is done to the structures of your brain. Low-frequency hearing loss may be an indicator of underlying cardiovascular problems.
Any treatment, early or late into the process is better than none. Researchers found the brains of younger patients have the ability to strengthen different senses to compensate and adapt to a few senses what they might be missing. The latest research suggests the sooner we apply a hearing aid solution, the more efficiently our brain will use the solution.
6 – Better Overall Quality of Life for All
All the benefits of getting tested and treating hearing loss head-on are clear. There is uncertainty felt for those who are losing their hearing and a hearing aid can actually elevate your quality of life. With better hearing, it’s natural that you simply are going to have better relationships than you when you can’t understand speech. Research has proven it also results in better health. You can’t help but get a lift from hearing extra of these joyful sounds that you simply have been missing as well. Proudly owning your hearing health and doing something about it would also raise your confidence level to take on the adventures that life brings to you every single day. In different phrases, taking management of your hearing health leads to a greater overall quality of life for you and those who you care about and love.
7 – Better Office Performance
As hearing is not one thing we are able to “see”, it may be tough to determine whether or not a colleague’s hearing is impaired. This could make it tough for managers to know who to help, and when.
In meetings, presentations, networking occasions, or interviews, a hearing impairment might have an effect on an employee’s potential to do their job, if they aren’t properly supported or if the working surroundings shouldn’t be inclusive of their needs.
There may usually be an emotional response to hearing loss, which impacts the social and wellbeing of the employee. If you are unable to hear what colleagues are saying clearly, you would possibly miss out on important information needed by your role, or you would possibly miss the most recent bit of office banter, which makes you’re feeling isolated and excluded, having an unfavorable impact on morale.
A Hearing Test could help you to overcome these difficulties in your office and achieve great results.
When you consider these seven benefits of a hearing test, doesn’t it seem important enough to move it to the head of your to-do checklist? Audiologists have the education and training to determine the reason for any hearing loss and offer treatment options. They’re also there to give advice and discuss any concerns you might have about your hearing loss and its effect on your everyday routine. If it’s been years since your last hearing test, it’s in all probability time to see an audiologist.