Having a hearing aid shouldn't keep you from enjoying the convenience of a cell phone. Although incompatibility of the two technologies is still an issue, cell phones and hearing aids are getting along better than ever. The following edited podcast, one in a series from the American Speech-Language-Hearing Association (ASHA), taps the expertise of Hearing Loss Association of America Executive Director Brenda Battat and U.S. Access Board Senior Accessibility Specialist Tim Creagan to discuss the compatibility of cell phones and hearing aids. This podcast was moderated by Joseph Cerquone, director of Public Relations for ASHA.
ASHA MODERATOR: Brenda, how many people currently wear hearing aids and are expected to need them in the future? And how big of a decision is it for someone to purchase and wear a hearing aid?
BRENDA BATTAT: Today there are about six-million-plus people who actually are using hearing aids, a very small number. It's estimated that about 80 percent of people who could actually benefit from them don't get them. And that's for a variety of reasons. First of all, we all know that there's still a level of embarrassment about wearing a hearing aid and about admitting that you have hearing loss. Another issue is sometimes people will take the step and then they find out it's quite expensive. It's an out-of-pocket expense for many people. So it's a big decision and it's impacted by several factors, but the end result is many more people could actually get help for their hearing loss than do.
ASHA: On the question of compatibility with things like cell phones, what do you hear from your constituents?
BB: It's actually quite positive; things are getting better. There was a survey done recently by Georgia Tech; they found that satisfaction level is increasing but still it's a little difficult for people to find [cell phones]. And I think that's an educational process they need to know what to look for and where to look.
ASHA: You say that matters have improved. What helped bring about a positive change?
BB: The hearing aid manufacturers really got quite aggressive and they worked on this problem and were able to increase the immunity significantly in hearing aids. So on that side there was action, and then on the phone industry side, as a result of FCC [Federal Communications Commission] regulations, phones are rated to know what kind of performance you can expect. And so with those two things going on, on the phone side and the hearing aid side, we've had great improvements.
ASHA: Tim, where there is a compatibility problem between a hearing aid and a cell phone, what could the problem be? And how does one go about finding phones that are compatible?
TIM CREAGAN: Typically the problem with hearing aids and cell phones [is] an issue of what's called interference, and it's an interaction between the hearing aid and the cell phone, which can produce an electronic buzz or a hum. The closest example I could provide, for someone who does not wear hearing aids, would be the sound that a fluorescent light makes when it's about to burn out. That's a very similar sound to what a hearing aid user experiences when using an unshielded phone and [it] is often worse when the hearing aid is being used on telecoil setting.
What happens is the faceplate of the phone and the antenna may generate interference with the hearing aid, and so you're experiencing the sound being drowned out by this noise. In August 2003 the Federal Communications Commission required that the telecommunications industry and its members work to reduce interference in cell phones, requiring them to produce at least two [models of] cell phones which had minimized interference.
When it comes to looking for a phone, what I'm looking for is a rating called M for microphone, or T for telecoil switch on the box, and the ratings are from one to five, with the higher numbers being better. Most phones are rated three or four.
ASHA: You mentioned a telecoil. How does one know whether a hearing aid has a telecoil to begin with?
TC: Typically it's something that would have been offered as an option at the time you were purchasing a hearing aid. And it's something that hopefully would be discussed with you, or if the audiologist doesn't bring it up, it's certainly something that you should bring up because it makes a big difference in your daily operations.
BB: I'd just like to say one thing and that is the FCC actually has a minimum rating requirement, which is three or four, so you are not going to see ratings below three. However, if you have a high immunity hearing aid, there's a chance that it actually might work fairly well with a phone that is not rated. It's really hard to predict, even with a rated phone, how it's going to perform. And certainly if somebody doesn't know exactly the immunity of their hearing aid, it could be hard to predict whether or not they'd be able to use an unrated phone. So we always say, Try before you buy. You can narrow down the search by first looking for a phone that's rated three or four, but if that's not working out, just try any phone that's out there and see how it goes.
ASHA: Try before you buy is easy to remember and very good advice. With respect to the M and T ratings, where would those ratings appear on the packaging? Where should one look?
BB: On the box, which is not very helpful because you all know when you buy the cell phone, the box is probably the last thing you see. And I'm talking now about company-owned stores, not big-box stores. The reason I'm referring to company-owned stores is that I would encourage people with hearing loss to try to purchase their phones from company-owned stores because they are required by the FCC to let you try them out before you take them home. Also, they train the salesperson to help you find something to go with your hearing aid. So on the box, in the call-out cards, and then also on the Web site. I strongly recommend people go to the Web and do a little research before they go shopping; it's going to make it easier to dialogue and communicate with a salesperson if you've already done your homework.
ASHA: If someone cannot find a phone that's going to work for them in terms of compatibility, what would be the first step for them?
BB: I'd be surprised if they can't find one, but it really depends on what we're talking about here. If it's that they can't find one because they keep getting interference, I would just keep trying and try a lot of different phones. There is a difference between the operating system GSM and CDMA. CDMA, because of the nature of the signal, tends to cause much less interference than GSM. So one thing I would do in that case is default to a CDMA operating system, although we do have situations now where some phones offer both systems. So that's getting a little more complicated than it used to be.
If it still is not working, then you could look for hands-free accessories that enable you to get the phone away from the hearing aid, so there's less interference. In this day and age, it wouldn't be interference that would stop somebody from being able to find a phone they can use. It might be that their discrimination is not good enough, that they can hear but they can't understand. That might be a situation where they want to think about moving to using a caption phone, where you have the benefit of some text to back up what you're hearing. The other thing to be aware of is that there are certain form factors in a phone that will make a difference. For instance, a fl ip phone gets the interference further away from the hearing aid versus the candy bar [style] people do better with a fl ip phone. The bigger the screen size, the more potential for interference, so with some phones, iPhones and phones with big screens, it may be a little more difficult to find a compatible one.
Also, now we're getting into an age of metallic is sexy. Metallic casings are a lot harder to make compatible than the plastic ones that we used to have. Avoiding casing materials that are metallic, looking for screen size that is not so big, and a fl ip versus a candy bar these all make things a little more likely to be compatible.
TC: I've certainly found it to be true that the fl ip phone, for instance, is more likely to be compatible with hearing aids, because once you open the phone, there's a greater distance between your microphone that you're speaking into and where the antenna on the phone is. The more miniaturized the phone is, the more difficult it is to find something that will work with your hearing aid. Not that it would be impossible but it would be more difficult.
ASHA: I think the question's been answered to some degree already, but have advances in hearing aid design obviated the need to be concerned about compatibility with cell phones?
TC: One of the things we do is work on design standards for electronic and information technology, which includes telecommunications products. Our guidelines would then be reviewed and adopted by the FCC as a basis of design standards for telecommunications products. One of the issues we look at is whether or not telecommunications equipment is compatible with hearing aids. And, as Brenda talked about, the GSM or the candy bar phones, which are very popular right now, are not accessible either in a visual or hearing aid setting. The manufacturers are working on that and they're making progress. But it's one of these situations where just because it's a new product, you shouldn't automatically assume that accessibility features have been integrated. I think Brenda can speak to this, but a few years ago, cordless phones, which had traditionally been analog, were required to be hearing aid-compatible. But then, when they switched from analog to digital service, some people were finding that cordless phones were not compatible; something had changed and the compatibility had been lost. That was an issue that had to be addressed through consumer input. And I believe
that was successfully addressed, isn't that right Brenda?
BB: Yes, that's absolutely right. Something else with the new technology in cell phones is that you've got companies coming along who have never made phones before. And there's a requirement in the FCC regulations which says if you don't have more than a certain number of products, then you're not held to the requirement of making the phone hearing aid-compatible. So if you have a computer company suddenly come out with a phone, all of a sudden they only have one product and they're actually, for the moment, not held to that regulation. And that is a real problem. The iPhone wasn't hearing aid-compatible and [Apple] can actually claim exemption because they only have one [cell phone] product. And that's an issue that we are quite concerned about.
ASHA: How is it being addressed?
BB: We filed a complaint with the FCC, we're working one-onone and talking to the company involved. We have asked the FCC for clarification on that and we did not get what we were hoping for. We didn't feel that the [exemption] was meant for a large company that has tremendous assets and just happened to come out with a new product. I think the company is trying hard to work on being compatible but it didn't come out that way in the beginning.
ASHA: Tim, along these lines, are more rulings or policy developments anticipated that could further foster compatibility?
TC: The Access Board works on standards and guidelines to promote accessible electronic and information technology. We're currently involved in a renewal of the design standards and guidelines under both Section 508 of the Rehabilitation Act and Section 255 of the Telecommunications Act. We're looking at the current design standards for telecommunications products to revise them. In April 2008 our advisory committee submitted a report to us, which can be found on the Access Board Web site at www.accessboard.gov, in which the committee made recommendations to the agency suggesting that we amend our current standards and guidelines to address some of the telecommunications design issues currently out there. Among the recommendations they made were that we look to standards for voice over Internet protocol [VoIP] phones, that we continue to insist on hearing aid-compatibility and that we do further work in that area.
The Access Board is currently working on the revision of the standards and we anticipate that we may be able to issue an advance notice in which we will have draft text for review on our Web site at some period during this fall.
ASHA: We've been talking about consumers and vendors and manufacturers with respect to this issue of compatibility with technology. I'm wondering what role audiologists can play to help educate consumers about the compatibility question.
TC: I'm a long-time user of hearing aids and I have to tell you that, up until four years ago, I was actively discouraged by my audiologist from getting a telecoil in my hearing aid, and the reason I was given was because they don't work very well and it's not worth the hassle. Now since I've gotten one, I've found that to be absolutely not true. I've found that the T switch in the hearing aids is certainly a valuable asset and it measurably improved my quantity and quality of use of the phone. So I think
that hearing aid dealers and audiologists should be aware of the issue, and that they should, when they're meeting with their patients, make an effort to find out what their telephone usage is like and tell them about this information.
BB: That's right and I would like add one thing. I've had a hearing loss now for many years and I've been tested and evaluated in four different countries by audiologists and never once have I been asked the question how am I going to hear on the phone. And I'm not just talking about cell phones; I'm talking about land-line phones long before cell phones ever came to be popular. I think there's too much emphasis on being able to hear face-to-face in a soundproof booth or a quiet office. Once we leave that office, we go out into a busy, bustling world and we have to function, and one of the ways is on the phone. There needs to be enough time given to making sure that whatever hearing aid is prescribed is going to be able to be used on the phone by that individual. And I think [audiologists] need to know the immunity of the hearing aids that they are selling to people so that they can give them some idea of what to expect when it comes to interference potential with using other electronic devices. There's a video available on www.accesswireless.org [with] all of the information that we've been talking about today. It's good both for them and for their patients. Cell phone usage and land phone usage is a big part of our lives and if it's not taken into consideration when fitting the hearing aid, then we leave only half-prepared to deal with the world.
ASHA: Tim, hasn't your agency produced materials for hearing health professionals?
TC: We've produced information on our standards and guidelines on www.access-board.gov. On our first page, on the left-hand side of the page, there's a heading called Communications and underneath that are two provisions, one is Section 508 and one is Telecommunications. If you click on the link for Telecommunications it will take you to both the standards, as well as some links for additional information and guidance.
ASHA: Well, we've been talking about hearing aid and cell phone compatibility, but as we know, the popularity of audio technology continues to increase, I wonder where that leaves people with hearing loss. Are there other issues besides cell phone accessibility?
BB: Absolutely, and the big one is the proliferation of video everywhere video on your cell phone, video on the Internet. Right now you have FCC regulations governing video and TV. There are no regulations that cover video anywhere else. So right now there's a coalition of hundreds of organizations working to pass the 21st Century Video Accessibility Law, making sure that video over the Internet would be captioned. The other big issues are things like Skype with captioning. Any audio signal now that's relayed on the computer or cell phone needs to be accompanied with captioning.
TC: One of the concerns that we have had, which has been actually addressed in recent months, is the ability of media that's posted, for example, on YouTube, to be captioned. Government agencies, under section 508, are required to post multimedia which contains synchronized captioning and also synchronized audio description. YouTube has recently added a feature so that it's possible for people posting on YouTube to post synchronized captioning with the material. This is something that we're going to be paying very close attention to so that when we release the new design requirements we make sure to address the issues of embedded captioning in visual and auditory media.
Visit http://podcast.asha.org to see the full list of ASHA podcasts. Other items of interest include Infants and Hearing Aids, The Value of Early Intervention for Late-Talking Children, and Protecting the Hearing of the Young, with the Director of the National Institute on Deafness and Other Communication Disorders, James Battey, Jr., M.D., Ph.D. A new podcast is added monthly. Listen to individual episodes, download transcripts or subscribe to the feed and receive new fi les automatically through an aggregator program like iTunes.
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