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The digital sunrise

by In Wales Fri Aug 31st, 2007 at 06:21:38 AM EST

Back in April I put a diary together called The dawn of a new digital aid which took a quick trot through a lifetime of audiology clinics, technology developments and my new digital hearing aid.

I promised to update on my progress and have utterly neglected to do so. So while my risotto cooks, I'll give you a belated update, although I fear I may have left it a bit too long since I can barely remember what my analogue was like...

From the diaries ~ whataboutbob


This is what all the fuss is about:


One of the latest and the most powerful digital hearing aid you can get. I got used to it extremely quickly, unlike the one I trialled a few years ago.  

This one has three programmes, 1,2 and 3.

Programme 1 is just a regular, unfiltered everything setting.  It 'hears' whatever sound there is and feeds it into the lughole.  I say unfiltered but you can argue this isn't entirely true.  Being digital, it can be programmed by computer to match my frequency profile.  So it tries to fill in the gaps a little more for the frequencies that my hearing is poorest for.  

This was noticeable in the older one I trialled, since the bass sounds overpowered everything else and shook my ear to pieces, and the higher frequencies drowned out anything in between, leaving me with a situation where rustling crisp packets or footsteps in the distance were far louder than the person next to me that I was attempting to converse with.
Not Very Helpful.

So I was sceptical about this new piece of technogadetry and reluctant to let go of the analogue I was so familiar with.
Married To The Sea
marriedtothesea.com

It turns out that the frequency compensation on this aid is very good. I don't feel dissociated, and I've got used to how it sounds very quickly.  It was a little different, but not enough to still notice it after a few days.  It ought to be louder but feedback is still an issue since we decided to try a new material for the hearing aid mold, that holds the aid in my ear. It doesn't suit. The fit isn't tight enough and with an aid as powerful as this the feedback can be horrific. At inconvenient moments it squeaks like all of Mouse Hell Karaoke Night breaking loose.  

With a mold that fits well I should be able to up the volume a bit.  The only problem with things being any louder than they are is that it starts to hurt.  I feel my ear vibrating with every sound, my head is dealing with 110 plus decibels bellowing at my inattentive cochlea, just for a few neurons to fire lazily at the PC in my skull.  I may or may not be able to decipher all that noise, but my headaches do all tend to be on the left hand side, feeling like some sharp clawed monster has embedded its grip in the side of my head and face.  

The volume button is my biggest bugbear.  Rather than an easy to use 'wheel' to turn up and down, from zero sound to loudest, you have to push the switch up and down 4 levels, from 'loud' to 'loud with lots of feedback'.  Only switching the aid off, can remove all sound.  Which is darned inconvenient when I need to switch on, change programmes or when a sudden loud noise takes off around me.

The default volume appears to be 'loud with lots of feedback', so when I switch it on, sleepily, first thing in the morning, barely awake... I'm greeted by "EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE".  I've actually stopped putting my hearing aid in first thing, especially when I'm alone in the flat.  I've even reached the stage where I don't notice for a few hours that I still haven't got around to putting it in.  This signals a remarkable change in my attitude and ability to cope with hearing nothing at all. It's extremely significant but perhaps I'll discuss elsewhere. Ask me in a comment if you like.

Well, programme 2.  This is the real magic of this newfangled piece of technogadetry.  It cuts out background noise.  I'm unable to filter and prioritise sounds and background noise, the result being that everything is as loud as everything else and I can't tell what is important and what is just noise.  Programme 2 does this for me.

The first time I tried it, walking down the busiest road through the city centre, talking to my friend, I switch on programme 2 and the traffic noise faded to almost nothing within a couple of seconds.  It then picked out my friends' voice from all the babble and background around us. Astonishing. I stood there like a fool with my mouth wide open just saying "wow, I can hear you".  He walked in a circle around me, talking, and I could still hear him without any traffic noise intruding. As though we'd stepped into a quiet room. It has to be one of the most amazing things I can think of. Duly impressed.

It's not as helpful in a room full of people talking since it is designed to cut out the frequencies that traffic and machinery usually fall into.  So a room full of people talking are broadly at the frequency programme 2 is designed to highlight, but still it emphasises the voices closest to me which is better than anything the analogue could do.  

By reducing overall background noise, I can pitch my own voice much better and be more aware of my own volume, something I couldn't do with the analogue in a noisy environment. It often led to me shouting myself hoarse whilst people around politely failed to tell me that I was bellowing 3 times louder than they needed me to.  The opposite tends to happen now. "You're speaking very quietly." ... "Oh. I'm on programme 2."


Programme 3 is for induction loops, such as with cinemas, theatres, conference and meeting audio systems for hearing aids.  Microphones pick up the sound, the signal is converted and transmitted as a radio wave and the hearing aid picks up that particular frequency - giving better quality and clarity of sound (you only here what goes through the microphones, meaning to chat to someone next to you, you need to flip programmes which is fiddly).  Hundreds of different loop systems exist. Some are brilliant and some are worse than useless.  Ask in a comment if you want a separate diary on this, there's more than enough to say on these.  The induction setting exists on analogues too but I can make it louder on the digital aid. Every bit helps.

I've tried playing with different settings in different environments.  At the gym, I can pick programmes depending on whether I want to hear the music or the instructors voice more; in the office pick to choose whether I want to be aware of and involved with the background chat or to cancel it out as much as possible.  My MP3 Player seems to deliver better clarity of sound, and music is a big thing for me. The longer I can hang onto that, the better.  Getting access to decent MP3 players, the right type of induction loop and friends with good taste in music has enhanced my life drastically.  It's these seemingly small things that change my world.

So, this new aid is great. Great in that it is better that anything I have had before, it gives me new forms of access to the world around me. The technology has got better and my hearing has got worse. I'm better off now than I would have been with the technology available 25 years ago. It's no cure, it is not perfect, I'm not a 'hearing' person with it (as if I'd want to be!) but I can see myself running with it for a few more years, many years I hope, disasters aside.  I'm glad I gave it a go.

Display:
As for my risotto, it was cooked and eaten hours ago and I had a massive bowl of Swedish Glace non dairy ice cream too.  How do diaries manage to take up a whole evening without even trying?!
by In Wales (inwales aaat eurotrib.com) on Thu Aug 30th, 2007 at 04:13:48 PM EST
110 plus decibels bellowing at my inattentive cochlea

Yow. No wonder that hurts.

Well, programme 2.  This is the real magic of this newfangled piece of technogadetry.  It cuts out background noise.

Reading this, I'm disappointed it has taken this long. Audio isn't rocket science and there are all kinds of clever things, from adaptive filtering and equalisation to echo cancellation to feedback elimination that should be standard issue on any audio processor.

The feedback is inexcusable. It's fantastically simple to design an audio processor that recognises and eliminates feedback. I have no idea why it's not included as a standard feature.

But this is interesting for other reasons. One of the problems with any kind of location recording is that what ends up on the tape and/or hard disk isn't what you hear when you're there. Normally the brain is good at prioritising certain sounds. So - e.g. - if you're listening to a busker, you won't hear people's footsteps, passing traffic, or other ambient noise.

It's always interested me that this changes if you use a microphone and a pair of headphones. For some reason this turns off the brain's filtering abilities and suddenly all of those ambient sounds become just as important as the 'target' sound.

The effect works whether you listen to a recording later, or through headphones on the spot. It would be interesting to know what's happening there. If you could somehow get the built-in filtering to work again, it might do something useful for hearing aid design.

by ThatBritGuy (thatbritguy (at) googlemail.com) on Thu Aug 30th, 2007 at 05:50:36 PM EST
There is a feedback elimination process when they tune the hearing aid using the computer. It tries to work out what feedback is escaping, to cancel it.  But wearing it, sitting still in the audiology room is different to real life when there is more movement creating further feedback. Hence feedback still being an issue.  I'm guessing the processor in the hearing aid itself doesn't monitor for feedback, there's only so much you can fit into a hearing aid before it gets too big.

Perhaps headphones take away the filtering abilities because you lose the ability to judge direction and distance?

by In Wales (inwales aaat eurotrib.com) on Fri Aug 31st, 2007 at 02:33:47 AM EST
[ Parent ]
If there's a one-off feedback elimination pass the digital signal processor in the aid probably has what it takes to do adaptive feedback elimination.

I'm curious about what algorithms are being used. There's a lot of hands-on experience in music and audio engineering of eliminating noise and increasing perceived volume. I have a depressing feeling that audiology is off in a separate world, and the two disciplines aren't talking to each other as much as maybe they could be.

That's a good point about headphones, because the folds around the ears physically steer sound and add directional information that won't be picked up with a point microphone or reproduced with a pair of point headphone speakers.

You can fake the effect using either a plastic head with fake ears (it looks odd, but it works surprisingly well) or mathematically using something called a Head Related Transfer Function. (Great name...)

I suppose potentially you could improve noise filtering by increasing the effect of the HRTF. You'd get more directional hearing - which wouldn't always be useful, but could be an improvement in some situations.

(Just speculating...)

by ThatBritGuy (thatbritguy (at) googlemail.com) on Fri Aug 31st, 2007 at 10:17:32 AM EST
[ Parent ]
An interesting point about potential overlap of audiology and music/audio engineering.  I've no idea at all how much information and experience is shared in developing digital aids.

I'm far more seeing the privatised aspect of the field of audiology creeping in, with adverts all over the waiting room, and all reading material aimed at buying aids and accessories.  I'd assume that technology development takes place within these companies in a fairly closed way.

I'd love to see one of those fake heads!

by In Wales (inwales aaat eurotrib.com) on Fri Aug 31st, 2007 at 10:34:21 AM EST
[ Parent ]
Here's a home made version.

And here's a commercial (if that's the word...) binaural mike system:

Dummy head recording gets rediscovered as a fun thing to do every ten years or so. Apparently Pearl Jam used one on a recent-ish album.

by ThatBritGuy (thatbritguy (at) googlemail.com) on Fri Aug 31st, 2007 at 10:58:35 AM EST
[ Parent ]
Smart! Thanks!!
Surely it would need some piercings to be cool enough for Pearl Jam?
by In Wales (inwales aaat eurotrib.com) on Fri Aug 31st, 2007 at 11:04:32 AM EST
[ Parent ]
Must...not...Photoshop...
by ThatBritGuy (thatbritguy (at) googlemail.com) on Fri Aug 31st, 2007 at 12:27:59 PM EST
[ Parent ]
my 91-year-old massage client has one of these, and when i lean over and give her a kiss, all hell breaks loose...sounds like a kitten yowling.

i don't understand why!

great diary, thanks in wales-

'The history of public debt is full of irony. It rarely follows our ideas of order and justice.' Thomas Piketty

by melo (melometa4(at)gmail.com) on Fri Aug 31st, 2007 at 05:16:52 PM EST
[ Parent ]
That's feedback!  It happens when anything gets too close to the microphone of the aid.  What are you doing with these clients of yours???
by In Wales (inwales aaat eurotrib.com) on Fri Aug 31st, 2007 at 05:37:10 PM EST
[ Parent ]
i know it's feedback, i just don't understand why me leaning over her and bringing our heads together makes it go off.

i'm just a person, not a mike or a speaker.

and no, i don't usually kiss my clients.

when i get to know someone really well, they become 'frients'

i can't help it with her tho', and at her age she doesn't have to worry about darker motives!

'The history of public debt is full of irony. It rarely follows our ideas of order and justice.' Thomas Piketty

by melo (melometa4(at)gmail.com) on Sat Sep 1st, 2007 at 01:42:33 AM EST
[ Parent ]
Reading this, I'm disappointed it has taken this long. Audio isn't rocket science and there are all kinds of clever things, from adaptive filtering and equalisation to echo cancellation to feedback elimination that should be standard issue on any audio processor.

I disagree, actually. Battery life must certainly be a huge issue in a hearing aid when running a DSP, even an audio DSP that doesn't have to run at relatively high clock speeds. DSPs in cell phones have been around for about 8 years, and back in 1999, cell phone batteries were probably 100x larger than the tiny batteries you can fit into a modern hearing aid. As a rough guess I think a DSP in a hearing aid would have been possible about three years ago, primarily because ultra low power DSP's are a specialty device (ie, very low volume (no pun intended)), meaning the market doesn't get the same attention as the consumer electronics market, and when it does, I'd also expect the development time to be longer. That's also about the time that bluetooth audio devices came out which are a roughly analogous product with maybe half the complexity.

you are the media you consume.

by MillMan (millguy at gmail) on Fri Aug 31st, 2007 at 06:37:12 PM EST
[ Parent ]
Also, I have no idea which companies are developing the DSPs / software for modern hearing aids. It wouldn't surprise me, though, if the audiology field really is a bit divorced from the people that make these products as you implied in another comment. Even though there are a lot of people in the world with hearing problems, the market is tiny when compared to the consumer electronics and durable goods (cars, etc) markets. The basic critique of capitalist priorities applies.

you are the media you consume.

by MillMan (millguy at gmail) on Fri Aug 31st, 2007 at 06:44:18 PM EST
[ Parent ]
It does reminds me of my grandfather who has gotten a bit hard of hearing in the past two decades - not much surprising as he's over 92 now. Lately it seemed he was not talking much in conversations, seemingly becoming borderline senile. (ah, the false ideas about old age)

About one year ago he got new implants, I suppose digital... And he sounds rejuvenated , talking much more. Obviously table conversations aren't painful to him any more.

Digital does seem to be doing wonders.

Un roi sans divertissement est un homme plein de misères

by linca (antonin POINT lucas AROBASE gmail.com) on Thu Aug 30th, 2007 at 07:17:15 PM EST
He's had a cochlear implant?  Really glad it's working well for him.  I think the technology in the aid is similar but the sound is transmitted by electrode directly to the cochlear.
by In Wales (inwales aaat eurotrib.com) on Fri Aug 31st, 2007 at 02:35:26 AM EST
[ Parent ]
(Dumb me) No, he just had a hearing aid. I still want the BabelFish kind of hearing aid to avoid stupid mistakes...

Un roi sans divertissement est un homme plein de misères
by linca (antonin POINT lucas AROBASE gmail.com) on Fri Aug 31st, 2007 at 03:06:16 AM EST
[ Parent ]
lol! I was thinking that he must be an extremely robust 91 year old to have gone ahead with an implant and anaesthetic!
by In Wales (inwales aaat eurotrib.com) on Fri Aug 31st, 2007 at 04:47:10 AM EST
[ Parent ]
My girlfriends father is just about to make the switch from analog to Nationa health digital. So this has come at just the right time.

Any idiot can face a crisis - it's day to day living that wears you out.
by ceebs (ceebs (at) eurotrib (dot) com) on Fri Aug 31st, 2007 at 07:48:52 AM EST
I hope it is as useful for him as it has been for me.  Once you find ways of getting around the slightly annoying things, the benefits are great.
by In Wales (inwales aaat eurotrib.com) on Fri Aug 31st, 2007 at 08:10:34 AM EST
[ Parent ]
When you say annoying, do you mean truly annoying? or just not how I was quite used to doing it before?

Any idiot can face a crisis - it's day to day living that wears you out.
by ceebs (ceebs (at) eurotrib (dot) com) on Fri Aug 31st, 2007 at 08:18:57 AM EST
[ Parent ]
Some aspects are annoying until you get used to it. But the volume thing, not being able to turn the volume right down, annoys me every day.  

The delay in switching programmes irritates me too ie if you are on programme 2 and realise programme 1 would be better, you have to switch to 3 to 1 and miss the first half of a sentence etc and have people look at you in a weird way while you faff about with the controls. It's less convenient than the set up on the analogue (which was effectively programme 1 and programme 3 with a direct switch between the two) but not enough to make me change back to the old aid.

by In Wales (inwales aaat eurotrib.com) on Fri Aug 31st, 2007 at 08:33:07 AM EST
[ Parent ]
It's sad that a great technological advance is marred by design issues. Get Apple to design them or something !

Un roi sans divertissement est un homme plein de misères
by linca (antonin POINT lucas AROBASE gmail.com) on Fri Aug 31st, 2007 at 09:40:46 AM EST
[ Parent ]
I know, it's silly.  Alas, I don't have access to the designers!  I wonder if there are feedback mechanisms (no pun intended).
by In Wales (inwales aaat eurotrib.com) on Fri Aug 31st, 2007 at 09:43:00 AM EST
[ Parent ]
Also, in this era of bluetooth this and wifi that, there is no reason not to have additional controls away from the hearing aid (as, in your pocket). And with the advent of bluetooth handsfree cell phones, the components are probably getting cheaper.

The 3000 $ markup probably comes from the health industry standard markup rather than any true building cost...

Un roi sans divertissement est un homme plein de misères

by linca (antonin POINT lucas AROBASE gmail.com) on Fri Aug 31st, 2007 at 09:48:32 AM EST
[ Parent ]
Here health insurance won't cover hearing aids (not even Medicare). It seems they think it belongs to the category of "lifestyle" choices.

Since a good quality hearing aid costs $3000+ this leaves many people without. There is a big market in semi-useless devices that sell for $200-300.

These differences don't get talked about when comparing plans from different countries. Our plans are so irrational people don't even have a baseline on which to make sane evaluations.

Policies not Politics
---- Daily Landscape

by rdf (robert.feinman@gmail.com) on Fri Aug 31st, 2007 at 09:11:12 AM EST
I find that so shocking. What about children?  I've always been really good with looking after my hearing aids so they haven't needed replacing often.  One pair got flushed down the loo when I was 3, but otherwise just wear and tear or updates for newer models, so in 28 years maybe 5 sets of hearing aids.  I could never have taken part in school or anything without that.

Add that to visits to audiology, new molds, new batteries, operations, all on the NHS. Despite delays, I really can't complain.

Even now as an adult, it's no lifestyle choice if I want to be employed and do my job well, and participate in society.

If I went for a $300 in the ear aid, it would be useless for me.  I'd find it hard to afford $3000, but it would be worth the cost.

The knock on effect of deaf people without access to appropriate hearing aids, in a society that is largely inaccessible to deaf people, is far more costly than giving them hearing aids in the first place.

by In Wales (inwales aaat eurotrib.com) on Fri Aug 31st, 2007 at 09:33:54 AM EST
[ Parent ]
It's so interesting that you posted this now.  My mother just yesterday picked up her new digital hearing aids; she's starting a two-month trial, but is already so impressed that I can't imagine she'll give them back.

She's got Oticon Epoq devices, with the Bluetooth-enabled streaming gizmo that allows her to route cellphone calls (and an MP3 player, if she had one) directly through her hearing aids.  I've watched her take several phone calls, and the difference is amazing.  No more shouting or feedback or asking for endless repetitions.  (One thing she used to do a lot was put calls on speakerphone so that her partner or I could tell her what the person on the other end of the line was saying.)

The two devices communicate with each other, so it allows her to locate sounds a lot better than she could with her 10-year-old analog hearing aids.

She's also doing exactly what you describe -- speaking in a much quieter voice than normal, which has (interestingly) revealed that my stepfather's hearing is not quite as good as he thought.  (I knew that already.)

I really can't quite believe the difference.  I was testing her in the car yesterday; she can hear me speak in practically a whisper, even over the sound of the engine, when before I'd have had to shout myself hoarse to have a conversation with her in the car.  She didn't do so well with the radio on (i.e. conversation-range background noise), but still, it's huge.  Huge.

We'd been pestering her for a while to get new hearing aids.  The old ones didn't really help much and had several layers of frustration attached; she even used to complain sometimes that she couldn't hear us "because my hearing aids are clogging up my ears."  She's been talking with the audiologist about the new digital devices for a while now, but she didn't have much hope that it would really help, since her history with hearing aids has been rather poor.  But wow!  These things are amazing.

The price tag is still shocking:  over $5000.  I had no idea until yesterday that neither insurance nor Medicaid will pay for them, as mentioned above.  (Good old USA healthcare system.... grrrr.)  She does get to write them off on her taxes as an "un-reimbursed medical expense," but still, it's a huge chunk of change, and she's on a fixed income.  And a tax writeoff wouldn't help a truly poor person pay for hearing aids like that....

by the stormy present (stormypresent aaaaaaat gmail etc) on Fri Aug 31st, 2007 at 10:46:57 AM EST
Ah wow, a real benefit for your Mother there. (I don't have a snazzy bluetooth feature - * jealous *) The difference is incredible.

So too is the price tag, I see. That is shocking. The right aid can change a person's life and to not have access to it because of cost is appalling.

by In Wales (inwales aaat eurotrib.com) on Fri Aug 31st, 2007 at 11:02:57 AM EST
[ Parent ]
What a brilliant diary and discussion, allowing me to enter a world i'd never known (despite a Gaulladet Home being a few hundred meters up the street from my childhood.)  I'm sure i will be more attentive and sensitive in the future.

Thanks, In Wales.

"Life shrinks or expands in proportion to one's courage." - Anaïs Nin

by Crazy Horse on Fri Aug 31st, 2007 at 01:50:55 PM EST
Thanks, I'm glad there was something to learn.
by In Wales (inwales aaat eurotrib.com) on Fri Aug 31st, 2007 at 01:54:59 PM EST
[ Parent ]


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