Hearing

Hearing

Key Takeaways

What is Hearing Assistive Technology (AT)?

  • Many devices have been designed and developed for people with hearing loss.
  • Such technology enhances sound or substitutes sound with visual or tactile signals.
  • Hearing AT can be helpful anywhere that effective communication is needed.
  • Hearing AT can assist with communication when face-to-face, on the telephone, and on other media platforms and includes alerting devices.

Common No-Tech and Low-Tech Hearing AT Solutions:

  • Consider the environment – where is the person sitting relative to the information that needs to be heard? Can the individual see to read your lips? Is the room well-lit? Is there a lot of background noise? Can any of these factors be controlled?
  • Can visual cues be provided? For instance, can captioning be provided if a video is being played? Can written materials of what is being said be provided? Additionally, consider dictating a lecture and provide it in writing.
  • Use good communication skills:
    • Face the person
    • Have a well-lit room
    • Avoid noisy background
    • Speak clearly
    • Get the person’s attention first
    • Ask what works best for that person
    • Give clues when transitioning topics
    • Rephrase rather than repeat
    • Don’t shout (it distorts the words)

When Do I Need to Use Hearing AT?

  • Listening needs vary with the situation and the individual’s level of hearing loss.
  • Challenging environments, such as restaurants, meetings, classes, houses of worship, social gatherings, public presentations, lectures, theaters, and home environments – TV, telephone, doorbell, smoke alarm, etc.

Who Needs Hearing AT?

Anyone who needs help with:

  • Face-to-face communication with others
  • Enjoyment of electronic media (radio, stereo, television, movies, etc.)
  • Telephone
  • Awareness of environmental sounds

Why are Hearing Aids / Cochlear Implants not Enough?

  • Situations may cause the need for additional AT, such as environmental factors including distance from the speaker, background noise, size and acoustics of the room.
  • Hearing aids or cochlear implants may prevent the use of earbuds or other sound source receivers.

Situations for Using Hearing AT:

School Environment

  • Lectures in the general classroom
  • Small group activities
  • Social classmate engagement
  • Listening to computer tasks, audiobooks, or an in-class movie

Socialization

  • Meeting with friends
  • Sports
  • Music, games, TV
  • Groups and club activities

Family / Home Environment

  • Conversations at home
  • Mealtime
  • At the park
  • In a car
  • Talking on the phone
  • Emergency/Safety alerts - smoke alarms, tornado siren, or other emergency alarm

Work Environment

  • In-person meetings
  • Talking on the phone
  • Remote meetings via computer
  • Training
  • Emergency / safety alerts
  • Daily tasks that require listening

Community

  • Church or Sunday School
  • Movie theater
  • Grocery store
  • Doctor's office
  • Plays or musicals
  • Dining out

Commonly Asked Questions about Hearing AT:

  • Q - If a student wears hearing aid(s) or cochlear implants, there may still be a need for additional hearing AT such as sound amplification for particular situations or settings. How does the sound amplification system work with hearing aids or cochlear implants?
    • A - Most audiologists will consider the age of the person when determining how the AT is paired with hearing aids or cochlear implants. Ear-level amplification, such as an FM System, is a great solution to assist in amplifying sound and may be necessary even if the person has hearing aids or cochlear implants. It would require transmitter(or microphone) that transmits the sound to the receiver. This can be via telecoil in the hearing aid or a special receiver that connects directly to the transmitter being used. Many receivers can connect universally to any hearing aid or cochlear implant. Eliminating the sound to noise ratio can be beneficial to anyone – whether living with a documented hearing loss or other barriers to receiving sounds such as auditory processing disorders or attention deficit disorders. Coupling hearing AT with hearing aids and choclear implants helps achieve this.
  • Q - Are there any laws to provide an accommodation or prevent discrimination in the workplace based on having a disability?
    • A - Yes. The Americans with Disabilities Act (ADA) and other federal laws have provisions covering the workplace. The ADA, Title 1, requires employers to make reasonable accommodations to the known disability of a qualified applicant or employee unless such an accommodation would impose an undue hardship on the employer. Reasonable accommodations include a wide variety of actions – making worksites accessible, modifying existing equipment, providing new devices, modifying work schedules, restructuring jobs, reassigning an employee to a vacant position, and providing readers or interpreters.
  • Q - What is a hearing loop?
    • A - A hearing loop is a wire that circles a room and is connected to a sound system. The loop transmits the sound electromagnetically. The electromagnetic signal is then picked up by the telecoil in the hearing aid or cochlear implant. To use a hearing loop, connect to the t-switch on the hearing aid or cochlear implant to activate the telecoil. Usually, no additional receiver or equipment is needed. Using a telecoil and hearing loop together is seamless, cost-effective, unobtrusive, and requires no additional equipment. Hearing loops are also called audio-induction loops, audio loops, or loops. If a hearing aid does not have a telecoil, a headset plugged into a loop receiver will be needed. Additional technology that has telecoil in it can alsoconnect to ones hearing aids to achieve the same effect.
  • Q – What concerns should someone with a hearing loss consider when looking for or maintaining employment?
    • A - Excerpt from the Hearing Loss Association of America (HLAA) Employment Toolkit: “Looking for a job, landing a job, and keeping a job can be difficult under the best of circumstances. Whether you are a graduating student seeking employment for the first time, looking to change jobs, returning to the workplace after an absence, or you are concerned about keeping a job, you might find employment issues more challenging if you have a hearing loss. There are ways to be successful in the workplace with a hearing loss. Landing a good job, fitting into the workplace, and successfully advocating for the kind of accommodations that will make you a productive and valued employee can all be accomplished. But you need the right tools, do your homework, find out what’s right for you and your employer, and find ways to successfully advocate for yourself.”

      * It is always important to consult with the audiologist or manufacturer for more specific details and special circumstances.

  AT Solutions at ABLE Tech:

Visit ABLE Tech’s Hearing Inventory

Visit ABLE Tech's Hearing AT/DME Reuse/Exchange Inventory

Helpful Links & PDF Resources:

Videos and Webinars:

  • Assistive Technology Solutions for Students who are Deaf or Hard of Hearing
    Oklahoma ABLE Tech discusses AT solutions for students who are deaf or hard of hearing.
  • AT Assessment Made Easy
    The content of this video comes from AT Consultant, Dr. Penny Reed. She presented at the 2014-2015 Oklahoma AT Team Regional Trainings hosted by Oklahoma ABLE Tech and the Oklahoma State Department of Education. Content covers three major laws that affect AT, service provision, considering AT for all students with disabilities, and the AT Assessment process: who should be involved, what procedures should be followed, and what resources can help!
  • Using the SETT Framework
    Oklahoma ABLE Tech explores Joy Zabala's SETT Framework: What it is and how to use it when helping students find AT solutions for the classroom.
  • Hearing Loss in the Classroom
    View a demonstration of how hearing AT assists students in the classroom when used appropriately.
  • Deaf and Hard of Hearing Students in the Classroom
    This is a short informational video about students who are deaf and hard of hearing. Learn about the challenges students who are deaf and hard of hearing face and some accommodations for teachers to help these students.
  • Hearing Loss Simulation
    Fred Flintstone and friends take a journey on simulating hearing loss.

Check out these videos highlighting hearing devices available to borrow from ABLE Tech.

EDUCATION

Case Studies of Individuals with Hearing Needs and Recommendations 

Case Study #1

A student in Pre-K, uses hearing aids, continues to have difficulties in the classroom setting, gymnasium, and art class

This student has recently been fitted with hearing aids but needs additional assistance in multiple environments including the classroom, gymnasium for physical education, and art class. The student is having a hard time staying focused in the general classroom and is not able to follow directions while in the gymnasium and art class where room acoustics are very noisy with excessive reverberation.

Possible Recommendations:

In this case study, the student is very young, and the audiologist is involved in the recommendations. The AT need is very specific because it needs to be able to go into multiple environments. The recommendation is an ear-level receiver, that could also be used at home. The school is considering adding a classroom amplification system to the general classroom. In this case, the SETT framework (see below) becomes even more valuable in comparing tools and features. The audiologist does not want to see the student using headphones with the hearing aids, as it blocks the microphone in the hearing aid. She also thinks the student would benefit from an ear-level receiver, such as a Roger X receiver with the Phonak Roger Pen.

Goals and Outcomes:

The student will show increased participation in all classroom settings, including the gymnasium, art class, music class, etc., by using the personal amplification system. Some suggested goals to track outcomes are to track the percentage of questions answered appropriately on topic; track the increase in social interaction with peers during group work with verbal exchange; track the student’s initiative to ask for the pass around mic or independently request that peers repeat statements.

See the attached SETT Framework for feature-matching solutions based on the Student, Environment, Task, and Tools.

Case Study Form - SETT Framework
Sample Solutions:

Case Study #2

A student in elementary school with moderate hearing loss and difficulty listening in class or group settings

This case study is based on a student who is in the classroom where learning occurs by listening to teacher lectures and participating in group work and group discussions. The student's participation is marginal, and the teacher would like to see the student benefit from more classroom participation. The student’s challenges are hearing the teacher over the other classroom noise and hearing the other students as group discussions take place. The student wears hearing aids but still needs assistance with decreasing noise to sound ratio and hearing discussions well and clearly.

Possible Recommendations:

An AT solution would be a sound amplification device that accommodates wide area listening. The transmitter and receiver are two separate units: 1) The speaker wears a microphone/transmitter which sends a signal through FM, digital, infrared, or induction loop to the receiver. 2) The listener wears a receiver that captures the signal through earbuds, headphones, or a neck loop that couples with the telecoil of the hearing aid/cochlear implant. Wide area listening systems reduce the impact of background noise, poor acoustics, and distance. Consider also the environment: noise, room acoustics, distance, visual access, and lighting, along with AT.

Goals and Outcomes:

The student will show increased participation in classroom discussions by using the personal amplification system. Some suggested goals to track outcomes are to track the percentage of questions answered appropriately / on topic; track the increase in social interaction with peers during group work with verbal exchange; track the student’s initiative to ask for the pass around mic or independently request that peers repeat statements.

See the attached SETT Framework for feature-matching solutions based on the Student, Environment, Task, and Tools.

Case Study Forms - SETT Framework
Sample Solutions:

Case Study #3

A student in high school with moderate to severe hearing loss who uses hearing aids

This high school student is transitioning to higher education and has moderate to severe hearing loss. He's having difficulties hearing in the classroom and also difficulties with supplemental videos and computer work that is required in the classroom. His hearing aids make it difficult for him to wear headphones for audio output on the computer, and the noise to sound ratio in the classroom makes it difficult for him to hear his peers in group discussion.

Possible Recommendations:

An AT solution would be a sound amplification device that augmentshis hearing aids to improve his hearing in group discussions as well as on the computer or video. Ideally, it would be a unit where the transmitter and receiver are two separate pieces: the speaker wears a microphone/transmitter and there are also additional microphones in the classroom for peers to use when speaking. The student wears the receiver that captures the sound coming from the microphones and creates better noise to sound ratio. The most effective receiver would be an ear-level receiver such as a boot receiver that attaches to the hearing aid. The receiver could also be used with a neck loop feeding directly into the hearing aid telecoil.

The transmitter can also be used to plug directly into the audio output to receive direct sound from the computer or other source of video replay via the worn boot or neck loop receiver.

Additionally, best practice is for students who wear hearing aids to consult an audiologist for recommendations.

As always, consider the environment: noise, room acoustics, distance, visual access, and lighting, along with AT.

Goals and Outcomes:

The student will show increased participation in the classroom with learning topics and peer participation. There should also be increased accuracy in computer use, as evidenced in computer assignments; increased initiative in independently asking for the device, using the device, and returning the device to the primary teacher for ongoing charging and maintenance.

See the attached SETT Framework for feature-matching solutions based on the Student, Environment, Task, and Tools.

Case Study Forms – SETT Framework
Sample Solutions:

Funding Sources for Individuals with Hearing Needs

Public Sources

Private Sources

EMPLOYMENT

Case Studies of Individuals with Hearing Needs and Recommendations

Case Study #1

An adult who is deaf entering employment with support from a Vocational Rehabilitation (VR)counselor at the Department of Rehabilitation Services (DRS)

She applies for a housekeeping position at a hotel. She uses American Sign Language (ASL) and can read/write English messages. She receives services through VR to gain new employment.

Possible Recommendations:

The job interview would require ASL or Communication Action Realtime Translation (CART) if interviewing in person; however, she could interview over the telephone using video relay services that she already has set up through VR. In regard to daily job performance, little AT will be needed. Since the employee can read/write text, the company will review policy on allowing personal cell phones on the job to text, email, or use other types of written communication to complete daily assigned tasks. The phone could also be equipped with video relay calls for communication on the job. If there is a policy against personal cell phones, consideration could be made to provide one while at work instead of using a radio or walkie-talkie.  Additional supports for new employee orientation or additional job training could include: captioning of any video training materials, CART, remote CART, or ASL services. Coordination and timely notification should be considered when offering these services.

Goals and Outcomes:

She will perform daily tasks and maintain gainful employment. She will perform job functions alongside her peers. She will erceive appropriate training side-by-side with her peers.

See the attached Human Activity Assistive Technology (HAAT) Model form to see how to match the employee to needed AT.

Case Study Form - HAAT model
Sample Solutions:

Case Study #2

Bank teller who is deaf, wears cochlear implants, and uses English, lip reading, speech to text, and ASL for communication

An employee working as a bank teller has to communicate with hearing customers, co-workers, and supervisors. She is capable of performing the basic job functions for banking transactions. She is deaf but has cochlear implants. She can communicate with spoken English, ASL, written text, lip-reading, and speech to text.

Possible Recommendations:

Looking at her communication needs, there are several solutions to consider. Valid solutions include: personal sound amplification systems, portable or permanent looping systems, or devices that provide text-to-text communication from customers and peers to the individual and vice versa. The employer would want to consider providing CART or an ASL interpreter for staff meetings, or mandatory in-services.

Goals and Outcomes:

The employee will perform job functions and maintain customer satisfaction. She will perform work tasks at the same rate as her peers, and will receive training in a clear way to ensure compentent work performance. She will have improved job performance, job satisfaction, and will be able to communicate effectively with customers.

Case Study Form - HAAT Model
Sample Solutions:

Case Study #3

Service provider trainer in higher education with moderate hearing loss

This person is hard of hearing; works in a higher education setting. She has moderate hearing loss and wears hearing aids. She performs most job functions independently but finds challenges in certain circumstances such as working in a cubicle office setting or where there is excessive noise while on telephone calls. Phone calls, staff meetings, online training, and in-person group trainings all present challenges with her hearing loss.

Possible Recommendations:

A simple low tech/no tech solution to be considered when lots of time is spent talking on the phone includes relocating the employee to an office. This will provide a quieter space as it decreases the sound to noise ratio. A phone amplifier can be used as well as a desktop captioning service that transcribes telephone calls received at her desk. Requesting written materials or agendas will help in staff meetings as well as follow-up written documentation summarizing the results of the meeting. For staff meetings and large group trainings, using the Roger Pen and MyLink will help with sound amplification. She can also request that all training videos be captioned or written transcripts of videos be provided.

Goals and Outcomes:

The employee will interact on the phone and in person (in one-on-one and group settings)along with peers and have successful job performance.

See the attached HAAT Model form to see how to match the employee to needed AT.

Case Study Form - HAAT Model
Sample Solutions:

COMMUNITY LIVING

Case Studies of Individuals with Hearing Needs and Recommendations

Case Study #1

A child whose hearing loss is identified before the age of 3, candidate for hearing aids and is receiving speech therapy services

After seeing an audiologist and awaiting hearing aids, she needs amplification for speech therapy sessions so she can interact and receive aural stimulation from the therapist.

Possible Recommendations:

A small handheld amplification system would work well in therapy sessions. Options include a pocket talker, comfort duett, or a two-piece uni, such as the Phonak pen and ear-level receiver.

Goals and Outcomes:

She will hear sounds and speech around her and develop language skills. She will participate in music therapy, or other therapy, to increase her language skills.

Case Study Form - HAAT Model
Sample Solutions:

Case Study #2

52-year-old, has progressive loss of hearing, family complains of her challenges during daily activities

The TV is too loud; she can’t hear on the telephone, and she can’t hear the oven timer when cooking dinner. The family is afraid she may catch the house on fire.

Possible Recommendations:

Several pieces of hearing AT could be recommended . Consider visiting an audiologist to decide the best path or recommendation for hearing aids. Once that is determined, the individual can still benefit from additional hearing AT in her everyday setting. Something like ClearSounds Quattro 4.0 can assist her in amplification for conversations, TV, and landline phones.

She could also consider comparable hearing AT, such as a cell phone amplifier and an amplification system that connects only with the TV. In regards to cooking, she could utilize a visual or tactile alarm, such as a Time Timer, or cell phone alarm clock with vibration. In the case of a fire, she could benefit from a specialized alert device, such as a Lifetone that listens for the smoke alarm and has visual and tactile alarming of the smoke alarm, or a smoke alarm that provides strobe light notification in addition to sound alert.

Goals and Outcomes:

She will have much-improved relationships with those around her when she can hear them clearer. She will be able to resume her life activities safely and enjoyably!

Case Study Form - HAAT Model
Sample Solutions:

Case Study #3

72-year-old with severe hearing loss, wears hearing aids

His hearing aids need to go in for repair, and he will have difficulty communicating during this time. He needs a solution to help him hear when he does not have access to his hearing aids.

Possible Recommendations:

A personal sound amplification system would be beneficial for communication between him and his wife. A two-piece unit should be considered, so he can hear sounds around him but also be able to amplify his wife when she is speaking directly into the transmitting microphone. He has a smartphone, so a captioning app, such as Ava, or a nonverbal app, such as Flip Writer, would be helpful so he can see written text to support sound output.

Goals and Outcomes:

He will be able to have conversations with his wife and fully participate in his daily routines with those around him while his hearing aids are being repaired.

Case Study Form - HAAT Model
Sample Solutions: