Download 02 - Deaf and Hard of Hearing Technology

ASSISTIVE TECHNOLOGY FOR INDIVIDUALS
WHO ARE DEAF AND HARD OF HEARING
Objective:
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Discuss type of devices and reasonable accommodations.
Gain insight through hands-on experience.
Relate accommodation to employment outcomes.
Discuss unique funding issues and alternative resolutions.
Presenters: Christine Day
SPS Unit Supervisor
Woodrow Wilson Rehabilitation Center
Susan Hansborough
Senior Audiologist
Woodrow Wilson Rehabilitation Center
Mary Nunnally
Deaf and Hard or Hearing Services Program Coordinator
Department of Rehabilitative Services
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Deaf and Hard of Hearing Technology
INTRODUCTION
Technology continually changes -- Counselors cannot be the “technology
experts” for all disabilities. When working with individuals who are deaf or hard
of hearing, ask the following questions:
What are the communication barriers?
 Assess communication in general and on the job. Think in terms of
auditory cues in our environment.
o Telephone
o Alarm clock
o Door knock
o Fire/smoke
o Alarm
o Verbal communication
 Questionnaires for communication needs are an excellent assessment
tool. There are several types available. One is located at the end of
this section.
Which device is appropriate?
 Review the “general” definitions of each device
 Experiment -- obtain devices for consumer to utilize on “trial basis”
 Consumer preference -- visual, tactile, auditory
What resources are available?
 Program Coordinator, Deaf and Hard of Hearing Services
804-662-7614 (V/TTY) 800-552-5019 (V) 800-464-9950 (TTY)
 Audiologist at Woodrow Wilson Rehab Center
540-332-7086 (V) 800-345-9972 (V) 800-811-7893 (TTY)

Virginia Department for the Deaf and Hard of Hearing
804-662-9502 or 800-552-7917 (V/TTY)
 Deaf/Hard of Hearing Services Unit Supervisor (WWRC)
540-332-7236 (V/TTY) 800-345-9972 (V) 800-811-7893 (TTY)
 Regional Rehabilitation Counselors for the Deaf
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FUNDING SOURCES
 Department of Rehabilitative Services
 Technology Assistance Program (TAP): The Virginia Department for the
Deaf and Hard of Hearing (VDDHH) distributes telephone equipment to
individuals in the state who are deaf, hard of hearing, deafblind, hearing
impaired/visually impaired, or speech disabled. Eligibility is based on the
hearing or speech disability and financial need. VDDHH also manages
TAPLOAN, which provides individuals and organizations with the opportunity
to evaluate equipment available through TAP, prior to purchase, for up to 30
days. TAPLOAN also allows people who have purchased equipment through
TAP to borrow the same or similar equipment while their own equipment is
being repaired. TAPLOAN sites are located throughout the Commonwealth.
Most TAP equipment is on state contract, which offers a potential reduced
cost for any state agency. Check with VDDHH or DRS Deaf and Hard of
Hearing Services before purchasing any related telephone equipment.
 Central Virginia Lions Hearing Aid Bank: Reconditioned hearing aids are
provided for individuals with a hearing loss. Eligibility is based on financial
need to anyone in the state of Virginia. Program is a fund of last resort. For
detailed information, contact (800) 407-4327 or (804) 285-8245
http://www.lions24b.org/cvlhab.htm
 Consumer Service Fund: Assistive technology can be purchased through
this fund which is financial need based. Program accepts applications
quarterly. Program is a fund of last resort
 Civic Organizations: Many civic organizations have assisted in the purchase
of assistive technology for individuals with disabilities in financial need that do
not qualify for any other program
 Assistive Technology Loan Fund Authority (ATLF): The ATLFA makes
loans and loan guarantees to people with disabilities for equipment and
technology that increase independence, quality of life and employment
opportunities. Loans are made through this program in partnership with
SunTrust and feature easier loan approval criteria, flexible terms and
favorable interest rates. Loans not approved by SunTrust Bank may qualify
for an ATLFA guaranteed loan. Many families on fixed incomes, or who have
credit problems related to their disability, have qualified for loans through the
ATLFA.
 Care Connection for Children (CCC): Care Connection for Children is a
statewide network of centers of excellence for children with special health
care needs (CSHCN) that provide leadership in the enhancement of specialty
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medical services; care coordination; medical insurance benefits evaluation
and coordination; management of the CSHCN Pool of Funds; information and
referral to CSHCN resources; family-to-family support; and training and
consultation
with
community
providers
on
CSHCN
issues.
http://www.vahealth.org/specialchildren/cssprogram.htm
TYPES OF DEVICES
Assistive Listening:
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FM System
Infra-red System
Induction Loop
Personal Amplifier
Hearing Aid with FM
Sound-field FM
Hearing Aid Accessories
Amplification:
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Behind-The-Ear
In-The-Ear
Canal Aid
Completely-In-the-Canal (CIC)
CROS Aid
Bi-CROS Aid
Programmable Aid
Analog Aid (old technology rarely used)
Digital Aid (today’s standard)
“T-Switch”
Hearing Aid Accessories
Direct Audio Input
Bone Conduction Aid
BTE/FM Aid
Alerting Devices:
 Visual
 Tactual
 Auditory
Specialized Equipment
 Amplified Stethoscope
 Digital Blood Pressure Monitor
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 Emergency Systems
Telecommunications:
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Amplifiers
Binaural Headsets
Hearing Aids w/ Telephone switch and/or Bluetooth
Hearing Aid Accessories
TTY/TDD
Uniphone
(VCO) Voice Carryover Phone
Fax machine
Wireless Pagers / PDAs
Text messaging
CapTel
Video Telephone
Video Relay
Computers:
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Computer Assisted Note Taking
Computer Aided Real-time Translation
Communication Software/Networks
Video Telephone
Television:
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Telecaption Decoders
Decoder Chips
Assistive Listening Device
Hearing Aid Accessories
Captioned Videos/DVDs
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Clocks and Wake Up
Alarm Systems
Sonic Boom Alarm
Clock with bed shaker
AlertMaster 6000 Alert Wireless
Doorbell and Telephone
Signaler
Sonic Shake for
Travel
Telephone Products
VCO Phone
Crystal Tone
Amplified Phone
Dialogue CL-40
Amplified Phone
Easy Recall
Answering Machine
for Voice and TTY
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Wireless TTY’s
PocketComm
Pocket Speak &
Read VCO
Compact TTY/C
Pocket VCO & PocketComm
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Wireless Technology
ALD for Cell Phones
NEW! Artone
Bluetooth Neckloop
www.etoengineering.com
T-Coil Loopset for
Nokia Cell
phones
HATIS Freedom
Mach I
Hearing Aid Compatible
Cell Phones
•
•
•
Try before you buy. Not all labeled “HAC”
phones would work for you.
Most cellular phone providers have some
phones and accessibility for hearing
disabilities
Per FCC, by February 18, 2008, fifty
percent of all digital wireless handsets
offered must meet the hearing aidcompatibility requirement
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Wireless Technology
Text Pagers & PDA’s
T-Mobile Sidekick 3
Blackberry 8700g
 E-mails
 TTY Messages
 Instant Messages
 Relay Service
 Internet Access
 Signal coverage continues to improve
 911 Not Ready yet
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Treo 700W
Smartphone
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Assistive Listening Devices
Basic FM System
Pocketalker
TV Listener
Amplified Stethoscope
ALD – New!
Portable Clipboard
www.puredirectsound.com
Portable InfoLoop
http://www.ovalwindowaudio.com/infoloop.htm
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Two Ways of Video Calls
Video Phone using TV
Web Cam using
Computer
How Video Relay Works
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Assistive Listening Devices (ALDs)
ALDs are electronic devices used along with or instead of hearing aids to
overcome problems of background noise and distance from the speaker:
 The microphone that picks up sound on hearing aids is on the aid itself. That
means it is at or near the wearer’s ear. When there is background noise
present in a listening situation, turning up the hearing aid volume means
increasing the level of the background noise as well as loudness of the
speaker’s voice. This often reduces the benefit of wearing the hearing aid.
 When speakers are at some distance, turning up the volume of a hearing aid
may not be sufficient to enable adequate reception of their voices. Use of
ALDs can often greatly reduce these problems because:
 The microphone that picks up the sound in an ALD system is at or near the
speaker’s mouth. Therefore, turning up the volume on one’s hearing aid (if
used with an ALD) or on the ALD receiver will increase the loudness of the
speaker’s voice more than the ambient background noise. The negative
effect of the background noise is greatly reduced.
 Because the microphone is at the speaker’s mouth, the effect of distance on
the understanding is greatly reduced when using an ALD system. The voice
of a speaker coming through an ALD system sounds as if the person were
standing at the shoulder of the listener, even when the speaker is at some
distance. Using ALDs properly in many situations will prevent or greatly
reduce communication problems.
Knowing the advantages and disadvantages of various ALD systems and
knowing how to use them properly enables the person with a hearing disability to
anticipate problems in various situations he or she may encounter and to plan
when and how to use them to minimize communication hassles.
There are many conditions at work where listening can be made easier through
the use of an ALD. Some common problems that arise due to a hearing disability
at work are the inability to fully participate at staff meetings or more informal
discussions, difficulty understanding during training sessions or lectures, and
problems using the telephone. The use of ALDs may be helpful in each of these
situations.
An Assistive Listening Device usually contains a microphone, transmitter,
receiver/amplifier and earpiece. ALDs are more effective than hearing aids in
noisy environments because the microphone that picks up sound on an ALD is
positioned close to a speaker’s mouth. This means that the effects of
background noise are greatly reduced compared to that experienced through
hearing aids. Also, the closeness of the microphone to the sound source
(speaker’s mouth) eliminates sound distortion and weakened signal which results
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from distance between the source and the receiver, adding clarity to the sound
(speech).
ALDs create a listening environment, which makes a speaker’s voice louder and
background noise quieter. There are a variety of ALDs for a variety of listening
situations. Below are several commonly used ALD systems:
 FM Systems: A FM system consists of a transmitter, microphone and one or
more receivers with earpieces. A FM system is “wireless”. Sound is sent
from a transmitter to receiver by radio waves. A FM system does not require
wiring between the sound source (microphone) and receiver. FM systems
can allow up to 500 feet between speaker and listener with no loss of integrity
in the transmission of the speaker’s voice. These units are portable and can
use rechargeable batteries. The FM signal will travel through walls which can
cause security concerns when discussing private information.
To use the FM system, the person who is hard of hearing gives the
transmitter and microphone to the “speaker”. The speaker holds the
microphone in front of his or her mouth or attaches it to clothing three to six
inches from their mouth. The FM user listens to the speaker through an
earpiece or “T- switch” and neckloop connected to the FM receiver.
 Infra-Red Systems (IR): Infra-red systems use light waves rather than radio
signals to transmit sound. Similar to a FM system, IR is also wireless
(meaning there are no wires between the transmitter and the receiver). The
speaker uses a microphone that is connected to a transmitter. The listener
has a receiver to pick up sound with an earpiece (some IR units combine the
receiver and earpiece into one unit).
The IR system produces a very clear signal. Because it is a light ray,
however, this signal is susceptible to interference from either natural or
incandescent light. Therefore infra-red is often only used in theaters or rooms
that are heavily draped or without windows. IR signals do not travel through
walls and require a direct “line of sight”; therefore they offer security within the
room. Unlike the FM system, the infra-red transmitter does not operate on
batteries. Transmitters or “emitters” are usually attached to walls; however,
smaller, moveable units are available for home use and sit atop the television
or stereo. For a large area, the transmitter can be plugged into the public
address (PA) board, when an existing PA system is already in use. The infrared receiver is powered by battery, and the user should not be more than 30
to 50 feet from the transmitter.
 Induction Loop Systems: An Induction Loop system consists of a coil of
wire surrounding a listening area. This wire is connected to an amplifier that
controls the volume of the sound transmitted through the loop (wire). One or
more microphones, plugged into the amplifier are positioned within the room
to be used by persons in any part of the room wishing to speak. Speech
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signals are amplified and circulated through the loop. The resulting electromagnetic energy radiating from the loop wire is picked up and amplified in the
telecoil or “T-switch” in listeners’ hearing aids or by an induction receiver.
Loop systems can be permanently installed in a room or remain portable.
The closer to the loop the listener is seated, the better the signal. Low power
equipment such as computer terminals or florescent lighting can cause
interference with a loop system. Neckloops are used as individual connectors
to FM, Infra-red or personal “hard wire” systems. The neckloop allows the
person using hearing aids with a good built-in telecoil to benefit from
“customized” amplification of their own hearing aids.
 Personal Amplifiers: Personal amplifiers are “hard wired” systems, and
consist of a receiver/amplifier connected to a microphone by wire. The
speaker holds or wears the microphone. The listener keeps the receiver, and
controls the level of sound by adjusting the volume dial on it. They are
available in monaural or stereo and some have individual volume/tone
controls for each ear.
Personal amplifiers are ideal for one-on-one
conversations when the speaker and listener can be located near one
another, as in a counselor/consumer interview. Extension cords are available
in lengths of up to twenty feet or more, but may introduce a safety or nuisance
factor. The microphone of a personal amplifier can also be placed near the
speaker of a TV or radio to afford easier listening.
 Earpiece Options: The earpiece can be any one of a variety of devices. For
example, a neckloop for users with a hearing aid with a telecoil (T) switch, a
silhouette (plastic strip worn between the mastoid bone and a behind-the-ear
aid with a “T-switch”), and earmold with snap receiver (used with no hearing
aid), a walkman type headset (used with no hearing aid, and in-the-ear or
canal hearing aid), or an “earbud” (a small speaker covered by spongy
material) placed just at the opening of the ear canal.
 Sound-field FM System: Small, wireless, high-fidelity public address
systems that are self-contained in a classroom or other type rooms. The
room is amplified through the use of one to five walls or ceiling mounted
loudspeakers. The teacher or speaker wears a wireless FM microphone
transmitter that sends speech via a radio signal to an amplifier that is
connected to the loudspeakers. This enables the speaker’s voice to be heard
over the ambient background noise. It has proven to be very beneficial to
individuals with hearing loss (even minimal hearing loss), central auditory
processing deficits, and ADD/ADHD. This technology is also available in a
personal system that has a small speaker that is placed near the individual
and can be carried from room to room.
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ALERTING DEVICES (SYSTEMS)
Alerting devices can be essential at work to inform the client when a significant
event is occurring in the environment. An alerting device can produce a visual
(flashing light), tactual (vibration) and/or auditory (very loud) signal that is
activated by a loud sound or manipulation of equipment. Any employee expects
the safety and security of knowing when the fire or smoke alarm is sounding, that
the phone is ringing or that someone needs their attention. The employee with a
hearing disability is no exception.
 Visual Cueing: For blinking lights, both transmitters and receivers are
plugged into 110-volt electrical outlets or wired directly into the building’s
wiring. Receivers containing the lights are situated wherever the consumer
may need to go at any time during the workday within the building.
 Vibro-Tactile Cueing: If the consumer needs to move substantially within the
workplace or even outside, portable systems are available. Using a vibrotactile device, transmission is via FM waves. Transmitters are battery
powered and placed as near the sound source as possible. The consumer
carries receivers. Often a receiver is worn on the wrist or is attached to
clothing. When the transmitter is stimulated (by the smoke alarm or ringing
phone, etc.), the receiver begins to vibrate. A coded light will indicate which
sound source has triggered the vibration.
 Auditory Cueing: By changing the frequency and/or volume of: telephone
ringers, doorbells, alarm clocks, as accommodating to an individual’s need.
Auditory cueing can be used alone or in combination with visual or tactile
cueing.
 Specialized Equipment: There are a number of commercially available
emergency systems that present both visual and audible signals for
fire/smoke alarms. Some can be connected easily while others require
electricians for proper installation. Prices vary considerable form $100 to
$400 per unit.
TELECOMMUNICATION DEVICES
For the person with normal hearing, being able to use the telephone at work is
seldom an issue. However, for the person unable to hear clearly or to hear at all,
take accurate information, or place an emergency call, telephone
accommodation is a primary consideration.
 Telephone Amplifiers: To improve hearing on the telephone, many types of
phone amplifiers are available. Some are more helpful than others are and
some are much more expensive than others are. Because one type of
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amplifier is more expensive than another, it will not necessarily be the most
helpful.
 Different Varieties of Phone Amplifiers: Small, inexpensive ($10 to $40)
“in-line” amplifiers give minimal amplification, but are often adequate for the
user with a mild to moderate hearing disability. This type of amplifier is
connected between the body of the standard telephone and the receiver.
Depending on the make of amplifier, this system may or may not
accommodate multi-line phones. To use this system, dialing may not be done
from the handset. The “in-line” amplifier can be battery operated or powered
by the telephone.
Another inexpensive ($10 to $30), but often completely adequate phone
amplifier is the portable amplifier that attaches to the receiver of the standard
telephone. The portable phone amplifier can be easily carried in a pocket or
purse and is powered by an AA battery or 675 hearing aid battery. This type
of phone amplifier is also useful for the person with a mild to moderate
hearing disability. It can be used on single or multi-line telephones.
Telephone receiver handsets with built-in amplifiers are commonly selected
by individuals needing phone amplification. They can provide a 10 to 18 dB
gain (usually sufficient for a moderate to severe hearing loss) and attach by
replacing the existing handset on the standard telephone. Should the user
have a hearing aid with a telephone (or “T”) switch, the “T” switch can
enhance the effect of this type of amplification, by increasing the gain as well
as eliminating background noise. This type of telephone amplifier cannot be
used when dialing is done from the handset. Some amplified handsets will
accommodate multi-channel phone lines, others will not.
 Amplified Telephones: Amplified telephones with frequency response
selections can help the person with moderate to severe hearing disability.
These systems are more costly (usually several hundred dollars) and may not
work with multi-line phone systems.
Phones may also be amplified when optional equipment is available with
some personal amplifiers and receivers from infrared and FM systems.
Amplification of this type can help people with moderate to severe hearing
disability. The use of these systems, hearing aids and neckloops allow the
user to use both ears for hearing when wearing two hearing aids with “Tswitches”. Walkman type headsets or earbuds can also give binaural hearing
when aids are not used. Often people who have been unable to hear on the
phone in the past, by listening with both ears and phone amplification, are
able to use the phone adequately. It may take some practice to build phone
skills and a sense of confidence about using equipment they have been
unable to use.
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 Text Telephones (TTY) also known as Telecommunication Devices for
Deaf (TDD): For the late deafened individual, unable to hear on the
telephone, Text Telephones (TTY) are available. A TTY is a modem that
looks much like a small typewriter and is used with or instead of a telephone.
A visual display of the conversation is produced rather than voice or auditory
signals, by tones emitted through phone wires. The “sender” types the
message. The message is displayed on a light emitting diode (LED) screen
at the receiving end and may also be printed on paper if the TTY has a printer
option. A TTY (or compatible telecommunication equipment such as a
computer with a modem) is required at both ends of the telephone
conversation. Some models of the TTY have a paper printer, automatic
answering machine, direct dialing from the key board of the TTY with a directconnect feature which allows the user to by-pass using a standard telephone
in unison with the TTY. Less expensive TTY models simply display the
message on a small LED screen, as the message moves from right to left
across a 20 character display panel.
 Telecommunications Relay Service (TRS): When a TTY call is placed and
no TTY is at the destination of the phone call, a TRS is necessary, and
available through all states as mandated by the Americans with Disabilities
Act. A relay service allows a person with a TTY to place a phone call to a
person who does not have a TTY, and vice versa. When a phone call is
placed through a relay service by someone using a TTY, an intervening
operator is contacted and given the name and telephone number of the
person to be called. The operator reads this information on a TTY screen.
The operator then calls the person for whom the call is intended. The
operator speaks or “voices” the TTY message to the receiver. The operator
to the person originating the phone call then types this person’s verbal
response on the TTY.
 CapTel: CapTel (Caption Telephone) is a voice carry-over telephone and
relay service used by individuals who are deaf or hard of hearing. A CapTel
phone is programmed to interface immediately with a contracted relay
service. When a call is placed using a CapTel phone, the number dialed is
routed through the contracted relay service. A relay operator types the
conversation to the CapTel user which is viewed on the small digital screen
located on the CapTel. The caller is then able to use their own voice when
responding in the conversation.
 Voice Carryover: For TTY users who choose to speak their message rather
than type it out on the TTY with the relay operator speaking for them, there is
the Voice Carry Over option within the TRS. This speeds up the conversation
considerable and adds a more personal flavor to the message. It also
encourages use of a TTY by persons who would not use one previously since
VCO eliminates the need for typing skills.
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 Uniphone: Combination telephone and TTY with voice carryover (VCO)
capabilities. Other features may include visual flasher, amplified handset.
 Video Telephone: Using a commercially available web-camera and high
speed internet connection, telephone calls are made person-to –person.
Individuals are able to see and hear each other, allowing for total
communication styles (auditory, signing, speechreading).
 Video Relay: VRS makes it possible for sign language users to converse in
their native language with the person they are calling. With this feature, users
can express real emotions and feelings (similar to a person-to-person
conversation) and benefit from increased communication speed.
To make a VRS call, individuals use a computer or a television and a video
device to connect to the VRS provider of their choice. Once a connection is
made, a professionally trained video relay interpreter begins translating the
user’s sign language into spoken language or text for the other (hearing)
party. When the other person responds, the operator translates his or her
words back into sign language for the VRS user.
COMPUTERS AND TELEVISION
 Computer Assisted Notetaking (CAN): Computer Assisted Notetaking
(CAN) is a relatively new option for communication access for individuals with
profound hearing disability who receive limited benefit from hearing aids and
ALDs. This visual alternative to receptive speech communication requires a
transcriber able to “type” quickly on a computer keyboard, summaries of what
is being verbalized in any given situation, usually meetings, lectures or
classroom presentations. What is transcribed can be viewed on computer
monitor or projected onto a larger screen/wall, depending on how many
individuals need to use this service in a specific setting. An additional benefit
is the potential for creating a hard copy of what has been transcribed for
review.
 Computer Aided Real-time Translation (CART): Computer-Aided Real-time
Translation (CART) got its start in the captioning of live television programs -mostly national news and sports events. More and more of these programs,
including local news, are being captioned at the present time. This
technology, through the operation of skilled stenocaptioners, allows the
viewer with a hearing disability to read almost all words in a given situation, a
few seconds after they are spoken. The ability to provide this important
service has developed through the willingness on the part of trained court
reporters to expand their skills to include stenocaptioning, not only for TV
captioning, but also for use in situations where CAN had been used before.
The advantage of CART over CAN is that CART produces a verbatim
transcription of everything said in a meeting, in the classroom, etc., while also
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providing a printed hard copy. Persons with severe to profound hearing
disabilities generally prefer the CART to the CAN and other communication
options for a variety of reasons. Like CAN, one or many consumers can use
the CART system at once. The major drawback to both of these systems is
the lack of trained, qualified persons to provide these services to meet the
level of demand. The costs for CART services can be prohibitive but are
moving downward with the increase in the market. Rehabilitation personnel
can take the cue from this concept by transcribing commonly asked questions
onto computer software to be used when communicating with people who
have hearing impairments in the office setting. This not only saves time for all
involved; it can decrease frustration and demonstrates sensitivity to the needs
of these individuals.
 Captioned Videos & DVDs: When information or training is done via video
tapes or DVDs for employees, it is important to remember those tapes/DVDs
need to be captioned to allow the employee who is unable to hear and
understand what is said to “read” what is said.
 TV Listening Devices: These can be coupled to the television and hard of
hearing individual using wireless FM or IR technology. The transmitter is
plugged into the TV, video or DVD player, or cable box and the transmitter is
worn as a head set by the listener. The listener can adjust the volume control
on the receiver to a comfortable level, allowing the sound to be heard clearly.
Most have a volume and tone control that can be adjusted by the user. It
does not affect the volume setting of the TV for normal hearing listeners.
BEST PRACTICES IN CHOOSING AMPLIFICATION
Have a complete audiological evaluation:
 By a licensed Audiologist
 Conducted in a sound booth
 Should include: case history; otoscopic examination; testing with tones
and words; counseling about degree, type, and communication difficulties
resulting from the hearing loss; realistic expectations of amplification; an
understanding by the audiologist of your listening environments and
specific hearing problems.
Obtain medical clearance from your medical physician, those under 18 must be
seen by an otolaryngologist (ENT).
 To rule-out a serious health condition that needs medical or surgical
treatment
 Can not sign a medical waiver if certain conditions exist
Thoroughly discuss the pros and cons of each style of hearing aid:
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Deaf and Hard of Hearing Technology




What are you capable of manually handling?
What are you capable of maintaining?
What will provide the best hearing results?
What are you the most comfortable wearing?
 A word of caution about CICs (completely-in-the-canal): they have fewer
advanced features than larger styles, are the most expensive, have the
poorest maintenance record, and have been shown to provide the lowest
customer satisfaction ratings.
Discuss levels of technology in amplification that are currently available:
 Don’t expect to understand it all, but do your best. Your dispensing
audiologist should gladly provide this information so that you understand
what you’re getting in this expensive purchase.
 Low Technology: Analog (rarely dispensed); Entry level digital with basic
features (The Chevy)
 Mid Technology: Mid level digital with some sophisticated features (The
Honda)
 High Technology: Digital with all advanced features (The Lexus)
Discuss cost of amplification and what is included:
 Follow-up visits, warranty period, loss and damage, cost of extended
warranty, cost of minor repairs
 Consider the need to purchase hearing aid insurance
 Find out the cost of the 30-day trial period
 It is your privilege to compare costs with other dispensers. The price tag
can vary tremendously. Just make sure you’re comparing apples with
apples!
Following the fitting, urge your clients to contact the dispenser with any problems
that they may be experiencing!
 The initial settings may need to be tweaked for a better fitting
 A period of “learning to use the hearing aid” is necessary for all new users,
and may take as much as 6 months
 Initially, use the aid in easy listening environments then move to more
demanding listening situations
 Consistent use of amplification is a requisite for successful adjustment.
Wear it daily!
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TYPES OF AMPLIFICATION
 Behind-the-ear (BTE): This type of hearing aid is worn behind the ear and
tends to be more powerful than hearing aids worn within the ear. However, a
BTE can also be fitted for a mild hearing loss. These aids require separate,
attachable ear molds. This type of aid is often best for greater losses, as they
can provide greater power and more circuit features. The BTE also has
larger switches for easier control. A behind-the-ear hearing aid can also be
used with a direct audio input whereby sound is transmitted from a
microphone along a wire that connects to the hearing aid. This is useful not
only to better hear a speaker’s voice, but also to assist in modulating the
wearer’s own voice.
 In-the-ear (ITE): Usually this type of hearing aid fits entirely within the bowl
portion of the ear canal opening and wearers often feel it is less visible than
the BTE aid. Power is more limited compared to the BTE style and is usually
not appropriate for severe or profound hearing loss.
 Canal Aid: This aid is smaller than the ITE in that it fits only in the opening of
the ear canal but it is completely visible. It appeals to some individuals
because it is less bulky and is slightly less conspicuous than the ITE. The
batteries required for this aid are very small and some individuals may have
difficulty handling them. Because of their size, the batteries do not last as
long as the ITE and BTE. Most hearing losses, except for severe to profound,
can be fitted with this style aid.
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 Completely-in-the-Canal (CIC): This is the smallest, most cosmetically
appealing hearing aid. It is also the most expensive, most difficult to fit
properly, has the highest repair record, and the least amount of circuit
features. Some individuals are not able to successfully use this style of
amplification due to unusual ear canal shape/size, excessive
temporomandibular joint movement, discomfort, severity of the loss,
excessive feedback, or difficulty manipulating the small size. CICs have
become popular because they are worn deep in the ear canal and are the
least visible. They are too small to allow for a telecoil. Because of the
difficulty in fitting this aid properly and the extra effort required in maintaining
it, recommendations for such fittings should be made cautiously.
 CROS (contralateral routing of the signal) Aid: For unilateral losses. This
is a two piece hearing aid, with a transmitter worn on the poorer ear, which
sends signals to a receiver positioned on the normal ear. The wearer has a
better audibility of sound on both right and left sides with the use of this type
of aid.
 Bi-CROS Aid: For use with an asymmetrical hearing loss where one ear is
non-functional or cannot be fitted with amplification. This aid is much like the
CROS aid; however, the receiver is also an amplifier. The transmitter worn
on the poorer ear sends signals to the receiver worn on the better ear, which
hears from the opposite ear and through amplification within its own aid. This
allows the wearer to hear sound originating from either side of the head.
 Programmable Aid: This has become the standard. It is necessary for the
dispenser to have sophisticated computer hardware and software, and
training in working with these instruments. Programmable aids come in BTE,
ITE, Canal, and CIC styles. The superiority of these instruments lies in their
flexibility to acoustically shape the output to match the hearing loss.
Programmable aids can have either analog circuits or digital signal
processing.
 Analog Aid: This is older, less sophisticated hearing aid technology that
amplifies and shapes the frequency response through filters and other
electronic components. With this technology, all sounds are amplified and
advanced signal processing to improve speech understanding in background
noise, is not possible. These aids have limited circuit adjustments, making
them less flexible. Non-programmable, analog hearing aids have become
obsolete in recent years.
 Digital
Aid: These are the most technologically advanced hearing
instruments on the market and first appeared in 1995. They continue to
evolve to higher quality and fourth generation digitals are now in the
marketplace. They have become the standard and >85% of all aids
dispensed are digital. Digitals are similar to programmable aids in their
computer requirements for fitting. These aids are more flexible than the
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programmable aids because the acoustic signal is transformed to digital
coding and then manipulated to fit the hearing loss. The sound is of superior
fidelity with very low circuit noise. Several advanced signal processing
features are only available in digital instruments. Some examples include;
feedback suppression, noise reduction, speech enhancement, adaptive
directional microphones. The cost of this technology is very expensive.
Some digitals have fewer features and will cost less. That’s why it is
important to know the specific characteristics of the hearing aid when you are
comparing prices. All digitals are not equal!
 The “T-Switch: “T-switches”, or more accurately, telecoils, on hearing aids
have been available, but under utilized for years. The “T-switch” improves
telephone communication and allows the user to be connected to numerous
ALDs, which include large area audio loop systems, neckloops, or some
hearing aid accessories. The electro-magnetic field created by the “T-switch”
helps to hear the desired speaker and greatly reduces background noise.
“T-switches” are available on BTE, ITE and usually canal style hearing aids.
 Hearing Aid Accessories: Devices to be used with a hearing aid that
enhance hearing ability in specific situations. These devices cannot be used
independently. Some examples of hearing aid accessories include; remote
control, direct audio input boot, auxiliary microphone, induction silhouette,
neck loop, Bluetooth receiver, Smart Link with FM transmitter and receiver.
 Direct Audio Input (DAI): A special circuit available in many hearing aids
that allows direct connection to certain assistive listening devices as well as
stereos, television, and radio. The hearing aid is coupled to the other device
by a “boot” that slips on the end of the aid. A frequently used accessory that
is used with DAI is an auxiliary microphone that can be held by the
communication partner of the hearing impaired individual. This allows their
voice to be heard much more easily particularly in the presence of
background noise.
 Hearing Aid with FM: A receiver is located within the casing of BTE hearing
aids. A distant speaker can use a transmitter. This hearing aid makes using
a FM system much easier than carrying a separate receiver for the user.
Because the FM signal is received directly through an individual hearing aid, it
will be adjusted to the hearing loss more precisely than using a separate FM
system.
 Bone Conduction Hearing Aid: A hearing aid in which the amplified signal
directly stimulates the inner ear via a bone vibrator placed on the mastoid
process. The bone vibrator can be coupled to a body aid via a cord or a BTE
hearing aid attached to the headband. These aids are rarely used because of
poor sound quality and reserved for individuals with chronic draining ears or
those without an ear canal or pinna (outer portion of the ear that’s visible). A
surgical procedure has been developed in recent years that allows for the use
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of a bone anchored hearing aid (BAHA) for individuals who cannot use typical
aids. The BAHA offers superior sound quality to the traditional bone
conduction aid.
 Cochlear Implant: This is a surgically implanted multi-channel electrode
housed within the cochlea. A microphone to pick up sound is located in a
BTE hearing aid. An individual receiving a cochlear implant must be carefully
screened. There are specific criteria including severe to profound bilateral
hearing loss with poor speech understanding. The price for this procedure
varies from about $40,000 and up. Extensive aural rehabilitation may be
needed after surgery.
DESCRIPTIONS OF HEARING AID FEATURES
Programmable: The hearing aid is connected to a computer and the internal
hearing aid chip is adjusted appropriately for a specific hearing loss.
Programmable instruments are significantly more flexible and precise in their
adjustments. Nearly all hearing aids dispensed today are programmable.
Multi-channel: Think of channels as equalizers on a stereo system. They are
bands of frequencies that can be adjusted independently. In hearing aids, they
may number from two to twenty. The more channels, the more precisely the aid
can be programmed for each specific hearing loss.
Multi-memory: Think of a memory as an environment (ex. Noisy, quiet,
restaurant, party, music, etc.). The aid is programmed to process sound
differently in each environment for improved speech understanding or comfort.
Some aids have up to four memories. Access to the different Memories can be
either manual (you push a button on the aid) or automatic. Entry level aids may
only have two memories while more sophisticated aids may have four or five.
Adaptive Memories: The hearing aid will automatically shift between memories
depending upon how the environment changes. This feature is particularly useful
for clients who have limited manual dexterity or cognitive functioning; don’t have
their hands free to manually change the memories; or work in demanding
environments (background noise, reverberant rooms, changing work conditions,
etc.). Newer hearing aid models may have a combination of an adaptive setting
and fixed settings.
Acoustic Feedback Suppression: A hearing aid has the potential of "whistling"
when a high level of amplification is needed. The aid produces a loud tonal signal
similar to what you have heard in public address systems when the microphone
gets too close to the loudspeakers. This phenomenon is call acoustic feedback.
Some hearing aids have circuits that suppress acoustic feedback. A notched
filter is the most basic method of suppressing feedback but the drawback is a
reduction in gain which can reduce audibility of the high frequencies that are
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Deaf and Hard of Hearing Technology
needed for speech clarity. A model with many channels (15-20) will only reduce
the gain in the offending channel causing the feedback, while a model that only
has a few channels (2-8) will reduce gain in frequencies that may not be causing
the feedback resulting in reduced clarity of speech. The most sophisticated
method of feedback reduction is with a “phase inverter”. The aid detects
feedback then produces the same sound 180 degrees out-of-phase. The two
sounds cancel each other out and eliminate the feedback.
Noise Suppression: Many hearing impaired individuals have difficulty listening
in noisy situations. Certain types of electronic circuits in hearing aids are used to
amplify the signal of interest while suppressing the surrounding noise. The
processing chip in the digital hearing aid can identify steady state background
noise and reduce the gain in the specific frequency channels where the noise
while maintaining gain in the important speech frequencies. Best results occur in
digital hearing aids with the most channels and those with adjustable
suppression amounts (off, light, moderate, strong).
Directional Microphone (multiple microphones omni and directional): Some
hearing aids have more than one microphone, which can filter out some of the
background noise -- allowing you to actually hear speech better in noisy
situations. These are referred to as “directional mics.” It’s one of the most
effective and important features on hearing aids. If hearing in noise is a problem,
this feature is a “must”. Some directional mics require the user to turn it on by
touching a button on the hearing aid. Other models will turn on automatically
when noise is present. Some have a fixed null position (area of reduced
amplification) such as behind the user. More sophisticated models have an
adaptive microphone null position that changes from the side of the user to
behind the user depending on the location of the loudest noise. The most
sophisticated is an automatic, adaptive mic that is independent in all channels.
Each channel can have its own null position allowing for noise reduction from
many sources.
Telephone Coil: A telecoil (T-coil) is nearly standard in most BTEs and is an
option on some in-the-ear custom made hearing aids. T-coils “hear” magnetic
signals, such as the signal transmitted by most phones, representing an audio
signal. The T-coil is an important way to “couple” your hearing aids directly with
audio sources such as the TV, telephones, and assistive listening devices.
However, the smaller the aid is, the less likely it is to have a telecoil. When you
couple your hearing aid directly to an input signal, you automatically eliminate
background noise, you maximize the signal, and you get the best sound signal
possible directly to your hearing aid. Some hearing aids have automatic T-coils
that “turn-on” by themselves when a telephone is placed up to the ear. However,
sometimes the T-coil is not strong enough and a tiny magnet must be placed on
the telephone receiver to successfully engage it.
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Deaf and Hard of Hearing Technology
FM/Smart Link Compatible: Hearing instruments that can be used with the
Smart Link FM system. Not all manufacturers and not all models are compatible.
If it is compatible then it can be added later and it is not necessary to purchase it
with the hearing aids.
DataLogging : A valuable client counseling and follow-up tool. DataLogging
provides access to your client’s real life use of amplification (number of hours
worn per day, percentage of time used in each memory, volume control setting)
and proposes optimal corrections.
Echoblock: Removes reverberant components of the signal that may occur in
auditoriums, churches, large stores, houses with tall ceilings, big windows, and
hardwood floors.
Sound Localizer: Circuitry available in some advanced models that imitates the
curves and contours of the pinna in order to enhance localization. This helps in
detecting the location of a sound source as well as listening in noise.
Wind Noise Management: Reduces the microphone turbulences caused at the
inlet. Noise suppressor identifies the characteristics of the remaining noise and
suppresses it.
Low Battery Warning: The hearing instrument signals the wearer that the
battery is low by producing an audible (only to the wearer) beep.
Warranty Period: Period of time the manufacturer will repair a malfunctioning
hearing instrument from normal wear and tear at no charge to the consumer. It is
usually 1-2 years. Extended warranty coverage can be purchased.
Loss/Damage Deductible: Most manufacturers will give one or two-year
loss/damage coverage. Damage is something that is not caused by normal wear
and tear, in other words, abuse. Examples include, a dog chewing up the
hearing aid, putting the aid through the washing machine, driving over the aid
with a car.
Most high performance instruments have a deductible for
replacements of about $150.00 per instrument and manufacturers will only make
one replacement per instrument.
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CHECKLIST OF HEARING AID FEATURES
Manufacturer, Model, Style: _____________________________________
Price Quote: _________________________________________________
Dispensing Facility: ____________________________________________
FEATURES
# of Channels:
# of Fixed Memories:
BASIC
1
(Circle feature levels)
INTERMEDIATE
ADVANCED
2-8
9-14
MOST ADVANCED
15-20
1
2
3
4
# of Adaptive Memories:
None
2
3
4
Microphones:
Omni
only
Fixed
Directional
Adaptive
Directional
Adaptive
Directional &
independent in all
Channels
Noise Reduction:
None
Off / On
Off/light/moderate
Off/light/mod/strong
Feedback Suppression:
None
Notched Filter
Notched Filter
Phase Inverter
Telephone Program:
None
Acoustic
Program
Telecoil/T-coil &
Mic
Automatic T-coil
EchoBlock:
None
Yes
Wind Noise Reduction:
None
Yes
Sound Localizer:
None
Yes
Wireless FM Compatible:
No
Yes
Warranty/Loss&Damage:
1 Year
2 Years
3 Years
4 Years
Notes:
1. Acoustic Telephone Program does not block out noise in the environment,
cannot be used with assistive listening devices and is susceptible to feedback.
2. Most manufacturers’ warranty/loss&damage coverage is 1 or 2 years but longer
policies can be purchased.
3. Hearing aid developments are continually occurring, therefore, this information is
time sensitive. (10/06)
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WOODROW WILSON REHABILITATION CENTER
ALD NEEDS QUESTIONAIRE
NAME:____________________ WWRC# ____________ DATE ____________
Has difficulty hearing:
________
________
________
________
________
________
________
________
________
________
________
________
________
________
________
________
________
________
________
________
(WITH or WITHOUT hearing aids [circle one])
A smoke alarm
An alarm clock
The telephone ring
Knocks at the door
A stove or microwave timer
In a quiet room with only one person talking
In a small group of people
On the telephone at home
On the telephone at work or other people’s homes
The television
The radio or stereo
While riding or driving in a car
At work with my boss or co-workers
In a classroom
At church
At the movies
In a restaurant or cafeteria
In a large auditorium
A baby crying from another room
Other situations______________________________________
Devices that are already owned include:
________
________
________
________
________
________
________
________
________
________
________
________
One or two (circle one) hearing aids Style:____________
Age of aid(s):_________ (average lifespan is 5-6 years)
With telephone switch (T-coil)
Uses hearing aid regularly
Does not use hearing aid because____________________
Does not have hearing aids but would like to try them
Telephone amplifier
Type:________________________
TV listening device
Type:________________________
Alerting lights
_____For the telephone
_____For a door
_____For an alarm clock
Vibrating alarm clock
TDD
Closed caption decoder
Other______________________________________________
Primary mode of communication:
ASL
English
Speech
Hearing
poor
____
____
____
____
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fair
____
____
____
____
good
____
____
____
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Deaf and Hard of Hearing Technology
WEB RESOURCES
Audiology:
www.asha.org – The American Speech & Hearing Association is a national
professional association for speech-language pathologists (SLPs) and
audiologists (As). Provides information for professionals and consumers on
topics of current interest and the Certificate of Clinical Competence (CCC) for
SLPs and As.
www.audiology.org – The website of the American Academy of Audiology which
is a national professional association for audiologists dedicated to providing
quality hearing care to the public. Offers professional development, education,
research and increases public awareness of hearing disorders and audiologic
services.
www.audiologyawareness.com – Audiology Awareness Campaign information
site. AAC was organized by five professional audiology organizations with one
main goal in mind: helping people with hearing loss.
www.audiologyinfo.com – Audiology information network of resources.
www.healthyhearing.com – a world leader in hearing information.
www.nidcd.nih.gov/ – Request a free copy of Information Resources for Human
Communication Disorders Directory published by the National Institutes of
Health. It is a well-organized, useful guide of national organizations that focus on
health issues related to hearing, balance, smell, taste, voice, speech and
language.
Organizations:
www.agbell.org – an international, non-profit, membership organization that
promotes better public understanding of hearing loss in children and adults. First
year of membership is free to parents who have children with hearing loss.
Provides newsletters, journals and information relating to oral education.
www.alda.org - Website for Assoc. of Late Deafened Adults, a self-help group
that provides information to those that have lost their hearing post-lingual.
www.cochlearamericas.com - Official website for the Cochlear Corporation, the
largest and one of three manufacturers of cochlear implants.
www.nad.org/ - National Association of the Deaf provides services and support
for deaf individuals and their families. Includes local chapter links and articles.
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www.hearingloss.org – Website for the Hearing Loss Association of America,
formerly Self Help for Hard of Hearing People.
http://tap.gallaudet.edu/ - contains information on Gallaudet’s Technology Access
Program.
Worksite Accommodation:
www.jan.wvu.edu/soar/hear.html - SOAR (Searchable Online Accommodation
Resource) website to provide information about compliance with ADA in the
workplace for individuals with hearing loss as well as many other types of
disabilities.
www.jan.wvu.edu/media/deaf.html - Work-site
individuals who are deaf or hard of hearing.
accommodation
ideas
for
www.eeoc.gov/facts/deafness.html - Questions and answers about deafness and
hearing impairments in the workplace and the Americans with Disabilities Act
provided by the Equal Employment Opportunity Commission.
Vendors:
www.ameriphone.com – listing of products available from Ameriphone (TTY’s,
VCO’s, etc.)
www.audioenhancement.com – On-line catalog of assistive listening devices
geared towards classrooms.
www.cardionics.com - Manufacturer of the E-Scope amplified stethoscope with
models that can be used with hearing aids. Also, it has the capability to provide
visual representation of respiration and heart sounds on a PDA.
www.harc.com - On-line catalog of products for the deaf and hard of hearing.
www.harriscomm.com – On-line catalog of products for deaf and hard of hearing:
equipment, novelties, books, videos, pagers.
www.hatis.com/ - HATIS connects hearing aids with cellular phones, telephones
and other listening devices to allow people with hearing loss to use any
telephone anywhere.
www.hitec.com/ - assistive communication products for deaf, hard of hearing,
speech impaired, mobility impaired and vision impaired individuals.
www.phonak.com - A renown hearing aid manufacturer that offers various forms
of FM and Bluetooth technology to be used with hearing aids.
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Deaf and Hard of Hearing Technology
www.potomactech.com/ - find sweatshirts, t-shirts, TTY’s and other accessories
for individuals who are deaf or hard of hearing.
www.soundbytes.com – hearing enhancement products for deaf and hard of
hearing individuals.
www.weitbrechtcom.com – on-line catalog of products for deaf, hard of hearing
and speech impaired individuals.
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