Imagine this happier future for the nearly 30-million Americans with hearing loss: Hearing aids have doubled in usefulness. They still serve as sophisticated amplification. But they also serve as customized loudspeakers.

In churches, auditoriums, theaters, and home TV rooms, clear sound—personalized to one’s own needs—is broadcast by tiny loudspeakers right inside one’s ears. Phone conversations are now less of a struggle, thanks to the conversation being broadcasted to both ears.

As word-of-mouth and the media inform people of the doubled functionality of hearing aids, people call hearing care professionals. Hearing aids, formerly worn by less than 1 in 4 people with hearing loss, now are welcome by most. After experiencing effortless assistive listening, patients seldom return their new hearing aids. In the public eye, the stigma of hearing loss and hearing aids is diminishing; hearing aids have become accepted as “glasses for the ears.” Likewise, demands for insurance and Medicare/Medicaid reimbursement for this doubly functional hearing technology is increasing. The net result: improved quality of life for people with hearing loss, and thriving, rewarding careers for those who serve them.

An impossible utopia? Actually, this imagined world is on its way to becoming reality due to promising new developments.

Hearing Aid Compatible Phones are Here and More are Coming
Thanks to the Hearing Aid Compatibility Act of 1988, most landline phones now broadcast not only sound, but also an electromagnetic signal that can be received by telecoil equipped hearing aids. Having been fitted by my audiologist with such aids, all I need do is tap my hearing aid while answering the phone and enjoy an incremental boost in the caller’s voice strength and clarity.

More good news comes from the FCC’s recent modification of its exemption for wireless phones (see August 2003 HR, p 12). Thanks to lobbying efforts by consumer organizations like the Self-Help for Hard of Hearing People (SHHH), the National Association of the Deaf (NAD), and Telecommunications for the Deaf, as well as trade organizations like the Hearing Industries Association (HIA), the FCC will in the future require “wireless manufacturers and service providers to make digital wireless phones accessible to the more than 6 million individuals with hearing disabilities that use hearing aids.” Although not all cell phones will be covered, manufacturers must make telecoil-compatible phones available to consumers by 2006.

Hearing Aid Compatible Assistive Listening is Spreading
Around the world and across the US, induction loop systems are enabling wireless communication to hearing aids. Here are some examples:

Great Britain. Recently, I sat with several hundred others in London’s Gatwick Airport departure lounge, straining to hear announcements about my delayed flight home. Alas, the speakers were too distant and the sound therefore too foggy.

But hold it! This was the United Kingdom, where induction loop systems now broadcast sound to telecoil-equipped hearing aids in most churches, cathedrals, and auditoriums, as well as at more and more train station ticket windows, tourist information counters, bank teller stations, and post office windows. On the chance that this vast lounge also was looped, I activated my telecoils. Voila! Suddenly the announcements were broadcasting inside my ears, and I could hear the announcements as well or better than other travelers. Just as my laptop was receiving information wirelessly, so too were my hearing aids!

With loop systems now mandated for all London Underground ticket centers and all future London taxis—and with Britain’s National Health Service (NHS) now routinely including telecoils in hearing aids—hearing aid compatible assistive listening is en route to becoming omnipresent in the United Kingdom. “The whole of the church is served by a hearing loop,” began Westminster Abbey’s program for the 50th anniversary celebration of the Queen’s coronation. “Users should turn their hearing aid to the setting marked T.”

As an occasional UK resident, I have found this invisible, hassle-free assistive listening much more user-friendly than the hearing aid incompatible infrared and FM systems that prevail here in the United States. (If you were hard of hearing, which would you prefer? To locate, check out, wear, and return conspicuous receiver and headset units, or to have the sound broadcast by your hearing aids?)

Australia and Denmark. In other countries, such as Australia and Denmark, hearing loops are also becoming commonplace. Corresponding from one of the world’s hearing technology centers, Denmark, the Rev. Jan Granborg Eriksen, president of Churchear, observed that “Here we can just install a good loop system in a theater or a church building or any meeting room (and we do—our churches are almost 100% covered now), and ask hard-of-hearing attendants to switch to T-position.”

West Michigan. So why not here in America, as well, and not just in a few scattered places?

For starters, I looped my home TV room. It took only minutes to link the TV’s “audio out” plug to a small loop amplifier. I then dropped the loop wire to my basement and stapled it to the ceiling studs underneath my seating area. I couldn’t be happier with the results. No longer do I need my former hearing aid incompatible TV listening system. Moreover, with one hearing aid set to the mic + telecoil (M+T) position, I’m also able to hear room conversation or the doorbell.

Thanks to a self-installed office loop, I also enjoy binaural phone conversation. This is strikingly better than one-eared phone conversation—even with my amplified phone. It’s a wonder so few people benefit from this binaural system, and it may not be too long until many people want to utilize binaural telephone listening via headsets or loop systems.

With support from local media, from our community foundation, from local audiologists, and from a skilled audio engineering firm, my hometown of Holland and adjacent Zeeland, Michigan, set out to become America’s model looped community. At the risk of understatement, the results have been gratifying. Most of our major churches, most of our high school and college auditoriums, and many other public and business facilities—over 80 venues in all—have installed hearing loops that broadcast sound to people’s in-the-ear loudspeakers. And I long ago lost count of all the delighted people who have written, called, or spoken to me after beginning to use this assistive listening. (The loop systems also come with receivers and headsets for those not yet equipped with telecoils, but like the IR and FM headsets, they mostly sit unused in closets.)

By equipping their clients with telecoils, our local hearing care professionals have been a key part of our community initiative. “Never in my audiology career has something so simple helped so many people at so little cost,” reports Jerry Owens, the owner of Lakeshore Hearing Centers. The Holland-Zeeland initiative has had “a profound influence on the people I see,” says James Walsh of the Holland Hearing Center. “Nearly everyone I’ve seen who uses the loop system has had favorable results.” Telecoils and loop systems “transform hearing aids into personal communication systems,” adds audiologist Karen Van Doorne of K.A. Van Doorne & Associates.

Installations are spreading to other West Michigan communities, including Michigan’s second largest city, Grand Rapids, where loop systems are now installed or in the works for the city’s massive new convention center, its symphony hall, its city commission chambers, more than a dozen churches, and assorted other college and public venues. With leadership from the president of the new Grand Rapids SHHH chapter, a retired state legislator, plans are in the works for looping the State of Michigan’s House and Senate chambers.

The United States and Canada. If hearing aid compatible assistive listening (which, for now, means loop systems) works in all sort of venues in the UK and in west Michigan, then why not loop America? The good news is that seems more and more like a realistic vision. Consider:

• The ball is rolling. The move to hearing aid compatible cellular phones and telephones drives the motivation for inclusion of telecoils in hearing aids which, in turn, increases the number of people who can immediately benefit from hearing loops.

• If you build it, they will come. With loop systems now abundant, our community’s hearing care professionals are equipping their new patients with telecoils, and congregations with new loop systems have found that usage grows with time as members visit their hearing care professionals.

• More incentives. The US Access Board will henceforth be mandating that 25% of assistive listening devices in new facilities be hearing aid compatible neck loops. Marsha Mazz, technical assistance coordinator for the Board, says that facilities with loop systems (which make neck loops superfluous) can therefore enjoy a 25% reduction in the required purchase and maintenance of ALDs (personal correspondence, December 7, 2004). This 25% reduction would become effective when the US Access Board guidelines are officially adopted by the Department of Justice.

• Public information. To provide information to interested consumers, including links to equipment vendors, I created the Web site www.hearingloop.org. Local media and word-of-mouth publicity, along with more than 25,000 Web site visits during 2004, have triggered many requests for more information concerning loop system cost, functionality, and installation.

• Congress sets example. Thanks largely to the efforts of informed hard-of-hearing people, loop installations are now happening in places large and small, including in late 2004 a signature installation: the main chamber of the US House of Representatives. When President Bush delivered his 2005 State of the Union address, our hard-of-hearing congressional representatives and guests could hear his voice broadcasting from speakers inside their own ears.

• Loop sales increasing rapidly. Oval Window Audio, whose American-made loop amplifiers were used in the US House installation, and Assistive Audio, the American distributor of British-made Ampetronic systems used extensively in west Michigan, both report sales surging more than 60% during the last 2 years.

Listening to the Hard-of-Hearing Community
As “the nation’s voice for people with hearing loss,” SHHH has vigorously supported the FCC mandates for hearing aid compatible phones and the inclusion of telecoils. It is the position of SHHH that telecoils be given the prominence they deserve as a valuable hearing aid feature that will allow the expanded use of assistive listening devices.1

Now, as a logical extension of its push for telecoil-compatible technology, many SHHH members and some of its state organizations and local chapters are also urging hearing aid compatible assistive listening:

• On behalf of Michigan’s hard-of-hearing persons, Michigan SHHH recommends that the state’s churches, auditoriums, theaters, courts, airports, and other venues where sound is broadcast install assistive listening systems that broadcast sound directly through hearing aids.2

• “In all new and extensively remodeled buildings, wherever there is a public address system, a loop should be permanently installed,” notes the California SHHH organization.3 “…When there is a loop, all a hard-of hearing person has to do to be able to hear is click on the T-switches on their hearing aids.”

• “Loop systems are preferred for houses of worship because personal receivers and especially headphones are often a problem,” observes the SHHH chapter in Rochester, New York (another city with many loop systems).4 “There is good evidence that many people do not extend themselves to identify their need, collect personal receivers ahead of time, and wear rather noticeable headsets. Such receivers are always required for FM and infrared systems.”

• Terry Portis, SHHH’s national executive director, believes that “Our country will never be accessible for people who are hard of hearing unless we make hearing aid compatible assistive listening a reality” (personal correspondence, November 12, 2003, quoted with permission). He anticipates SHHH developing and distributing a new brochure that explains telecoils and their usefulness with hearing aid compatible phones and ALDs.

Telecoils are Included with More and More Hearing Aids
One of the impediments to the spread of hearing aid compatible phones and assistive listening has been the claim that, here in the USA, only 30% of hearing aid wearers are equipped with telecoils. (For assistive listening, that is, of course, not a real problem, because anyone can be served with a loop receiver/headset.) Only “30% of modern hearing aids in the United States include a telecoil” and, with “the trend towards smaller and smaller hearing aids, it seems unlikely that this 30% figure will increase in the future,” declared a 1999 ADA Advisory Committee.5 The HR 2003 Dispenser survey, which tallies the responses of (primarily) private practice dispensing professionals, indicated that 37% of hearing aids dispensed contained telecoils.6

A survey of the 6 leading hearing aid manufacturers (producing 90% of new aids) was presented at the 2004 ASHA Convention in Philadelphia. The investigators, Rebecca Blaha and her Ohio State University audiology mentor, Stephanie Davidson, presented their findings on “Hearing Aid Telecoils: Current Numbers in the US Market.” Their main finding: 48% of the hearing aids sold in the United States contain telecoils.

One other striking finding in the study was the variation among the 6 major hearing aid companies (GN Resound, Oticon, Phonak, Siemens, Starkey Laboratories, and Widex). Three (unidentified) companies deserve congratulations for putting telecoils in most of their aids; the other three did so for less than 40% of their aids. However, 5 of the 6 companies included telecoils with virtually 100% of behind-the-ear (BTE) aids, with the sixth using telecoils in 80% of BTE aids. Thus, an increasing number (about half) of today’s new hearing aids are coming with telecoils, and that number approaches 100% among the BTE wearers whose need for assistive technologies generally is greatest.

Finally, a new generation cochlear implants—including Cochlear America’s Nucleus and Advanced Bionic’s Auria—are now coming with telecoils. This extends the utility of hearing aid compatible technologies to those most in need of assistance.

Hearing Professionals Can Accelerate the Momentum
In several ways, dispensing professionals can support the gathering momentum toward the increased functionality and use of hearing aids:

• Recommend telecoils for all new hearing aids, activate them, and explain their usefulness.

• Request and expect all the major hearing aid manufacturers to include telecoils as standard equipment in all ITE and BTE hearing aids.7 Audiologist Mark Ross also notes that telecoils should have a sufficiently vertical orientation to provide effect reception from induction loops.

• Offer simple home loop systems for sale. For example, Echo MegaLoop and Univox offer an extremely simple loop installation: a wired pad that slips under the cushion of one’s favorite chair or couch. One Grand Rapids audiologist recently has advertised a free home loop system with the purchase of hearing aids.

With support from both hearing care professionals and hard-of-hearing consumers, the mutually reinforcing momentum toward more telecoils and more hearing aid compatible phones and assistive listening will accelerate further. The tipping point is near. And when we cross it, the best news—of a real world in which hearing aids are rightly seen and celebrated as having double their present functionality—will not be far away.

f02a.jpg (8655 bytes)David G. Myers, PhD, is a social psychologist at Hope College, Holland, Mich. He is the author of the book, A Quiet World: Living with Hearing Loss, published by Yale University Press (2000), New Haven, Conn.

References
1. Self Help for Hard of Hearing People. SHHH Position on Telecoils. Available at: hearingloss.org/html/tcoil752a.html. Accessed: December 27, 2004.
2. Michigan SHHH Chapter. Available at hearingloop.org/shhh_resolution.htm;   Accessed: December 27, 2004.
3. California SHHH. SHHH Californian. 2002; winter. Available at: shhhca.org/html/newsletter/winter2002.htm. December 27, 2004.
4. Rochester SHHH Chapter. Hearing Accessibility Handbook: A Guide for Congregations. Available at: shhh-rochester-ny.org/onevoice.htm. December 27, 2004.
5. Bakke MH, Levitt H, Ross M, Erickson F. Large area assistive listening systems (ALS): Review and recommendations. Available at: access-board.gov/research&training/ALS/alsreport&figs.pdf. Columbia, SC: ADA. December 27, 2004.
6. Strom KE. The HR 2003 dispenser survey. Hearing Review. 2003;10(6):22-38.
7. Ross M. Telecoils: The powerful assistive listening device. Hearing Review. 2002;9(9):22-26,57.
Correspondence can be addressed to HR or David G. Myers, Hope College, Holland, MI 49422-9000; email: [email protected]; Web site: www.hearingloop.org.