To Hear or Not to Hear
is that a Question?
Joseph A. Vespe, MS, MBA
DISCLOSURE STATEMENT
JOSEPH VESPE, MS, MBA
Financial Disclosures: Nothing to disclose
Non‐Financial Disclosures: Nothing to disclose
WHAT IS SOUND?
• Sound waves are caused by the vibration of objects and radiate outward from their source in all directions.
• A vibrating object compresses the surrounding air molecules (squeezing them closer together) and then rarefies them (pulling them farther apart).
• Although the fluctuations in air pressure travel outward from the object, the air molecules themselves stay in the same average position.
• As sound travels, it reflects off objects in its path, creating further disturbances in the surrounding air.
• The changes in air pressure vibrate the tympanic membrane which create; nerve signals which hare sent to the brain and interpreted as sound.
Sound*……sound!
•Sound must be clear.
•Sound must be intelligible.
•Sound must be loud enough to hear.
•Soundness of Sound must be Sound! * Of substantial or enduring character.
SOUND BASICS
• Gain
• Too much is not good
• Noise
• Definitely too much is no good
• Amplification
• Too much can be no good
Gain
• Gain controls what comes "into” an amplifier circuit.
• First stop after the microphone.
• Quality of Amplified Sound is critical
• Components dictate the clarity of the sound.
• Too much gain before amplification causes distortion.
• Distorted Sound is useless and unintelligible.
Noise
•Noise is unwanted sound from many sources
• Off key singing, Peking Opera
• Running engine, loud AC blowers
• Vibrating loudspeaker diaphragm
• Machines operating
• Busy restaurant
• Cats in an alley
Amplification
• Quality vs. Quantity
• Quality of the Amplified signal is critical.
• Simply making it loud doesn’t cut it.
• Must be able to discriminate sound from noise.
• Volume and Frequency is also critical.
• Components & design dictate the quality.
• Massage the sound and filter out unwanted.
• Boost or diminish unwanted, also Highs and Lows.
I Can’t Hear You!
• Noise and distance makes listening hard for everyone.
• Our environment is contaminated with all sorts of noise.
• Greater the background noise, the harder it is to hear.
• Sound discrimination especially spoken is very difficult
• Farther away the source, the harder it is to hear.
• Except at concerts – the boon to hearing aids!
• Auditory issues ‐ noise & distance compound issues.
• Need specific tuning based upon hearing loss.
Assistive Listening Devices or ALD’s
• Devices other than hearing aids that provide an “assist” to hearing and help improve patients quality of life.
• Used to amplify and sometimes condition sounds.
• Provides a general solution to sound amplification.
• Used by the hard of hearing or those with “normal” hearing who may need a little extra.
• A Band‐Aid not a solution to hearing loss.
ALD Systems
• Manual, Non‐Electronic
• Electronic
• Personal Sound Amplifiers
• Amplified Telephones
• TV Listening Devices
• Large area amplification systems
Manual Analog Devices
• Ear Trumpets, etc… Cupped ears.
Electronic Devices
•Amplification
• Amplified Telephones
• Personal Sound Amplifiers
• TV Listening Devices
• Coupling Devices
• Large area Amplification
•Alerting Systems
Amplified Telephones
• Strengthen incoming sound up to 50 dB’s
• Adjustable Frequency ranges and boost to high end for clarity
• Hearing Aid compatibility via “T”‐ coils
• Incorporates visual and audio signals can be wired or wireless
• Many incorporate answering machines with sound boost.
• Improves communication with the outside world.
Amplified Telephones
• Many from which to choose in many $ ranges
Full Featured Wired
Wireless with Remotes
Full Featured Wireless with Answering & alerting system
Personal Sound Amplifiers
•Direct
• Pocketalker, Duett, Maxi, others…
• PSAP’s
•Wireless
• Infrared
• Bluetooth
• FM
• Induction Loop
DIRECT
• Direct connection, includes PSAP’s
PSAP’s FDA – October 2009
• Classified as an ALD
• “Starter” Hearing aid?
• Many Available, most are inferior!
Wireless
Wireless
Infrared or IR
• Original wireless transmission method found in theaters.
• IR light waves carry sound from transmitter to receiver.
• LED provide a focused beam of invisible, pulsating IR light.
PROS:
• High‐end IR systems produce sound matching wired quality.
• No static or radio interference.
CONS:
• Needs clear line of sight from the transmitter to receiver.
• Audio can not be transmitted through walls.
• Limited to approximately 10 meter range.
Wireless
Radio Frequency or RF Systems
• Stereo frequency modulation (FM)
• Invisible radio waves
• High quality sound
PROS:
• Does not require line‐of site
• Approximate 100 meter range
• Unlimited number of receivers
CONS:
• Possible interference and static
Wireless
Bluetooth
• Open wireless technology typically used with cell phones.
• Bluetooth uses a spread spectrum, frequency‐hopping signal.
• Provides great sound quality.
PROS:
• Can connect to any other Bluetooth‐enabled device.
• Limited interference with low power consumption.
• Very secure frequency.
CONS:
• Short range of approximately 10 meters.
• Can only be connected to one device at a time.
Wireless
Large Area Amplification
• For groups, houses of worship, movie theaters
• IR (Inside)
• RF (Outside)
• Induction Loop (Inside)
• “T” coil Receivers
Coupling Devices
Coupling devices take signals from a receiver directly to the ear.
• No Hearing Aid
• Earbud or Headset.
• Hearing Aid with T‐Coil
• Neckloop or Silhouettes by Magnetic Induction.
• Hearing Aid without T‐Coil
• Headset however it is prone to feedback.
• Behind the Ear Hearing Aid (BTE)
• Direct audio Input cord or T‐Coil.
• Cochlear Implants
• Direct Audio Input cord connects to speech processor.
Coupling Devices
No Hearing Aid
• Earbud or Headset depending on comfort level.
Coupling Devices
Hearing Aid with T‐Coil
• Neckloop or Silhouettes behind the ear.
• Uses Magnetic Induction to communicate.
Coupling Devices
Hearing Aid without T‐Coil
• Headset – very prone to feedback.
Coupling Devices
Behind the Ear Hearing Aid (BTE)
• Direct audio Input cord or T‐Coil.
• FM receiver boot.
Coupling Devices
Cochlear Implants
• Direct Audio Input cord connects to speech processor.
ALERTING SYSTEMS
Alerting devices convert sounds
• Auditory ‐ Amplifies to make louder.
• Visually – Flashing lights or lamp controls.
• Tactile– Vibrating bed device or fob.
Alerting Systems
Alarm clocks
• Alerting alarm clocks are common assistive listening devices. • Specially‐designed with loud ringers, built‐in strobe lights, bed‐
shakers and or a lamp outlet.
Alerting Systems
Doorbell, Knock and Sound Signalers
• Work with or without existing doorbell.
• Alert door or window opening.
• Flashing strobe, Loud Ring, Vibration
• Central location or remotely.
Alerting Systems
Smoke, fire and carbon monoxide detectors
• Sold separately as a stand alone.
• Combination fire and carbon monoxide. • Extra loud alarms
• flashing strobe, wrist bands, shaker or fobs.
• Detects the pitch of existing smoke detector.
Alerting Systems
Phone signalers
• Plug directly into the phone.
• Detect ringing sound.
• Discreet, alert people to cell phone is ringing.
• Alerts phone calls, text message or appointments.
Alerting Systems
Baby cry signalers
• Regular monitors do not generate enough sound.
• Transmitters and receivers detect a baby's crying.
• Transmit it to a central alert system.
Alerting Systems
Weather alerts
• Dangerous storms
• Cannot hear the rumble of thunder or wind. • Don't watch TV or listen to the radio.
• Standalone or with other alerting devices.
• Shakers, lamp blinkers, etc…
Alerting Systems
Other devices
• Alerts from any noise or movement.
• Centrally located, or remote receiver.
• Phone ringing, doorbell sounding, baby's cry
• Transmitters located wherever needed.
PSA’s vs. Hearing Aids
For those not quite ready for hearing aids.
• Can help improve the quality of life.
• Can gain patient confidence.
• Will return when a hearing aid is needed.
• Price point much lower.
• Beware of junky imitations that patients may try.
$ 27.43
$ 27.43
Social Ramifications
Hearing loss is debilitating
• Isolation, withdrawal from social situations.
• Frustration with limited communication.
• Irritability, negativism and anger.
• Fatigue, tension, stress and depression.
• Social rejection and loneliness.
• Reduced alertness, increased risk to personal safety.
• Impaired memory and ability to learn new tasks.
• Reduced job performance and earning power.
• Diminished psychological and overall health.
Early Intervention
Recognition and treatment of hearing loss
• Earlier treated the better.
• Patients often in denial.
• ALD’s can assist and get patients adjusted.
• Price barrier is lower with ALD’s.
• Makes for a happier family.
• No more blasting TV!
In Conclusion
• There are many solutions and new ones being developed all the time
Rube Goldberg
Wakeup Machine
THANK YOU