When Hearing Aids Alone Aren’t Enough: Remote Microphones and TV Listening Devices

Dave Kemp 0:10
All right, everybody. And welcome back to another episode of This Week in Hearing. I’m very excited to be joined today by Dr. Mike Valente. This is the fourth time he’s been on the show. So he’s definitely up there on the Mount Rushmore of This Week in Hearing guests. So he approached me wanting to come on, he had another presentation, it looks like this one’s all around remote microphones and TV listening devices. So with that, I’ll turn it over to you, Mike, unless you take it away.

Michael Valente 0:37
Dave, thank you so much for the invitation. On this presentation, what I really want to get across is the is the belief that if you want to truly restore a person’s hearing, so that they can hear well, in noise, we’ve come to learn through research and experience that well fit hearing aids in and of themselves are not sufficient, and the hearing aids need help. And the help is in the form of remote microphones. And I’ll be sharing some of the latest technology, and some of the research that shows how well these devices improve the signal to noise ratio. And then the other one is TV look at devices and some of the technology that’s available with that. And then towards the end of the presentation, I’m going to talk about two inexpensive ways that users with hearing aids can create, in essence, their own remote microphone, and also their own TV listening device. And we’ll go through that. The way I wanted to start it off with is oftentimes our hearing impaired patients kind of think that hearing aids are kind of like eyeglasses, that as well as I do with eyeglasses, I should do equally as well with my hearing aids. Well, we know that hearing aid eyeglasses can automatically transition to sunglasses, while maintaining visual acuity and therefore negating the need to purchase some devices. Unfortunately, hearing aids cannot automatically transition between listening and quiet and listening and noise. And at the same time maintain consistent auditory acuity without assistance. That is hearing aids don’t perform in noise as well as they do in quiet. And there’s really no way to transition between one and the other. And that assistance is in the form of a remote microphone. So me personally, I’ve been an audiologist for 45 years. And I’ve done 1000s If not in the 1000s of hearing aid fittings. And in my 45 years, I often felt restricted when I was counseling my patients on the benefits of hearing aids, because I had to include somewhere in my counseling, a reminder of what hearing aids cannot do. Instead of just fully focusing on what hearing aids can do, I had to remind patients, hearing aids unfortunately will not restore your hearing to normal. Hearing aids are not like eyeglasses, you will not do as well in noise as you do in quiet. And you’re still going to experience problems in some listening situations. But I would always say at the end of this little spiel to my patients, we do have the tools that will allow you to overcome these difficult listening situations. And it’s called a remote microphone. So think about when that patient first comes into your clinic. One of the first things in the adult population, again, I was an adult audiologist and did not see children. Consistently their primary complaint is I do not do well in noise, especially with women and children if they aren’t close, and if they’re not looking at me. Then you’ve gone through and you’ve done everything that you possibly can they return after you’ve been fit after they’ve been fit. And then they say the same thing. I still don’t understand what people are saying, especially women and children in noise. If they aren’t close and they’re not looking at me and they give you this report not again, not all patients but a significant number. In spite of you providing them with a bilateral pair of hearing aids that you selected based upon their responses to an appropr- an appropriate questionnaire. We use the APHAB and the COSI and the COSI. You counsel them on realistic expectations of what hearing aids can do in quiet and noise. And I’ll share that with you in a few moments you completed 2cc analysis When the hearing aids arrived, to be sure that they performed to manufacture specifications, you program the hearing aids to a valid prescriptive target for 50, 65 and 80. Utilizing either NAL or DSL IO, utilizing Real Ear measures that you corrected for binaural summation, power summation, venting and so on. You counsel them on the use in the care of the aids and accompany app- app on their phone. You assist there unaided and aided performance in noise, we utilize a QuickSIN, and I’ll share that with you later on. And you’ve completed unaided and aided outcome measures. And again, we utilize the COSI. Again, all of this is best practice, you’ve done all of this, so you know that it’s an appropriate fit. But yet when they come back at the hearing aid assessment, four weeks after the fit, and you ask them, How are you doing? It was not uncommon for a patient to say I do okay in quiet but in noise, it’s not what I was hoping. So, in these cases, where the aided performance is very similar to their unaided performance, and why they came into your clinic, have we done? What have we done to improve the performance in the one listening situation that brought these patients to your clinic in the first place? it would appear very little. Also, what has this patient experience done to increase the chance of these patients, referring patients and family to you? And has this contributed to the low adoption rate for hearing aids? And then how many times has your response to this complaint been to re-counsel on the realistic benefits of hearing aids in noise, and you know, that likely this is not going to improve the patient’s satisfaction, and you do other things, you tweak the high frequency response, you do other things. But yet, the patient consistently reports, you know, I do well in quiet, but you put me in a noisy situation, I take these things out. And that’s what that’s that’s the scenario that I want to talk about today. So we can, and we must do better. The primary goal of what I want to talk about today is some of the ideas on what is available to help these hearing impaired patients perform better in conditions. Where we know optimal performance with hearing aids alone is simply not possible. Yes, directional microphones have improved. Noise reduction has improved comfort and noise. But the fact remains, even with all of these advances in technology, we still have a very large contingent of patients who consistently report I’m not performing in noise the way I thought I would. So achieving the goal of helping them to the best that you can, is going to help your patient and help yourself, it will make your interactions easier. It will increase your patients aided satisfaction, and they will refer more patients to you. Because you have resolved the one listening situation that brought you to the clinic in the first place. So I just wanted to share with you how I counseled my patients on the realistic benefits they can achieve in noise. And I did this at the hearing aid evaluation. And again, at the hearing aid fitting, this was on three separate pages and I went through separately with my patient. First thing I said aided performance in quiet will be better than your unaided performance. If I can achieve this, I can achieve anything, this is the easiest thing for me to achieve. This is the most important aided performance in noise is going to be better than without your hearing aids. But it’s not going to be good as your aided performance in quiet. And then I say to the patient, let’s repeat this together. Your aided performance in noise is going to be better than without your hearing aids. But it will not be as good as your aided performance in quiet. Then I followed up I do a little lying here. When I tell them I have normal hearing. I really don’t. But I’ll show you that later on. I tell them I have normal hearing and I don’t do as well in noise as I do in quiet. Therefore it would be unrealistic for you to expect your hearing aids to do this. And then I tell them soft sounds will sound soft. Average sounds will be comfortable and loud sounds will be loud, but they will not be uncomfortable. These are my deliverables. This is what I think I can tell you I can do. Now some patients don’t do well with verbiage. They do better with numbers. So I explained it this way

without your hearing aids in place in quiet, let’s just say your performance is 50%, you get half right, you get half wrong. Now we put noise in the background, you drop to 20%. If you’re if you’re lucky, it’s going to be poor than in quiet. Now I put my well fit hearing aids on you. And I’m going to pat myself on the back, I’ve done such a good job, your aided performance and quiet is going to go from 50% to 90%. Now notice that 90% is not 100%, because hearing aids will not be able to restore your hearing to normal. Now I put you in noise. And you’ll go up to 70%. Again, what I said before, your performance in noise is going to be better than unaided. 70 is better than 20. But it’s not going to be good as your aided performance and quiet 70 is not as good as 90. But with a remote microphone, you will be able to hear significantly better in noise than with your hearing aids and low. In fact, as I’ll share with you later on, there is some data to suggest that with remote microphone, a person with hearing aids can hear better in noise than a person with normal hearing. And I will share that with you later on. And then there’s the last way I explained it. I said to them on the left side is what percent of time are you going to have problems. Zero means you have no problems at all. 80% means 80% of the time, you have no idea what the what somebody said. On the bottom you have quiet listening and noise and listening and reverberation and the blue bars is unaided. And you can very easily see as you go from quiet to noise to reverberation, you have increasingly greater number of problems. Now I put your hearing aids on and you’ll notice the red bars are lower than the blue bars, you have less problems in quiet and noise and reverberation. But your aided performance ie the red bar in noise is not as good as your performance and quiet. And your score for reverberation is not as good as noise or quiet. That is we’ve made your performance better. But your best performance is going to be quiet, your poor performance is going to be reverberation, and under no aidid condition or any of those red bars anywhere near zero, you’re still going to have some difficulty, but less difficulty than what you had without your hearing aids. So using myself as an example, the lower right is my hearing loss that I took and I’ll share with you later on with an app. And I have a long standing mild to moderate bilateral symmetrical sensory neural hearing loss. I have because of the you know the work that I’ve done over the years, four pairs of premium RIC hearing aids with custom earmolds programmed to NAL2 and we move microphones and streamers. I’m a very, very fortunate person, I’ve got the best of the best, and I can try them all out. Without these hearing aids. I had tremendous difficulty understanding my wife and my grandchildren and quiet and especially in noise and distance as well as listening to the TV. Aided performance in noise was significantly better than unaided but not as good as I wanted it to be under all conditions, but especially in noise with my remote mic, I hear as well, if not better than when I had normal hearing. in noisy situations. The signal to noise ratio is incredible. And you as clinicians have heard continual problems with aids in noise for many of your patients, and what can you do about it, you can help them as I help myself with remote microphone and use this technology to bring more patients into your clinic. We need to learn how to use all the tools in the toolbox and not just hearing aids. Because for many patients in many listening environments, hearing aids simply aren’t enough to resolve the number one reason they came to your office in the first place. And that is I want to hear better in noise. So since 2004, and I’ll show you where that came from. I have been a strong proponent of remote microphones. When I did hearing aid evaluations. I always paired a remote microphone to the demo hearing aids. During the hearing aid evaluation. I counseled the patient on what this box was that I had in my hand and I told them I was going to close the door. Walk 50 feet away. They can’t see me, they have no idea what the topic is. And I’m going to talk about something. And then I’m going to come back and I’m going to ask questions about what I just said. And because I’m single minded on Cardinal baseball, I would always talk about the Cardinals. In every in every case, without hesitation, the patients would respect risk expressed a wow effect when I got back inside the door. And I knew they clearly understood what this technology could provide. I didn’t have to sell it. I mean, it, it spoke for itself. When I directed the program, that’s almost three years ago. Part of our policy is we provided a free remote mic or TV Streamer at no charge to patients, we dispense bilateral level one, level two, which is our premium level hearing aids. And my feeling was number one, we’re going to resolve their problem. And number two, they’re gonna be so happy that they’re going to refer patients. And they did. And so it was, for lack of a better word. It was it served as a marketing tool, as well as a technology to help these patients. So everybody wins. It’s a win win situation. So, so you don’t think I live in an alternate universe. I know that many patients use remote mic, because they did not use remote microphone, because it was something else to carry around, but couldn’t recall how to use it. But I also knew that a significantly larger number of patients did use the remote microphone. And those patients raved about its effectiveness and utility. Some of them used it as a TV streaming, which you can do with several of these devices, as well as stream audio devices, their computer as an example. To them. It was a game changer. And they were grateful. They also tended to refer patients so their friends could experience what they were experienced, because they have already heard the horror stories from other people how poorly hearing aids performed. So how would you know clinically, that a patient could benefit from a mic a remote microphone, you need to know how well did they perform it noise? There are many many ways in which to do it, we utilized the QuickSIN. So we use the quick send routinely in the clinic and as part of our protocol to assess unaided and aided performance in noise to help determine if a remote microphone might be helpful. That is hearing aids alone, we knew simply will not bring your patient where he wants to be communicating in noise. Consider this. How many times have you thought your patient thinks they are doing well? But you know, they can do better? Well, when you have somebody who hasn’t heard, and you put hearing aids on, they’re gonna hear better. But the question is, could they do better than better? That’s the question. So this is similar to an under achieve performance, using hearing aids program to a manufacturer fit, instead of program to a valid prescriptive target, I can’t begin to tell you how many patients we saw in the clinic. When you ask them, How are you doing? Okay. And then we would do really measures and we saw that their aided responses were well below target, we would reprogram the hearing aid to target and was like, wow, what have I been missing all of this time. And then as the other one is, how many patients have been fit more normally, but they should have been fit binaurally. And they would have been done by just simply putting on that second hearing aid. If you don’t believe me, take a set of earphones while you’re watching TV set it to one ear through one ear, and then put the other earphones on. If you’re not hearing so much better with that second earphone something is not right in Missouri. It’s inevitable, as think about all the patients walking around with underfit, monaural hearing aids, and how well they could be doing just by simply reprogramming the hearing aid and putting a second hearing aid on and then add to that a remote microphone or a TV listener.

So this is how we did our unaided quicksin at the hearing aid evaluation. The patient sat in the center of a calibrated room calibrated to ANSI 2018 which had a mark on the wall on the floor, which was the reference point and that chair sat on top of that mark. It was calibrated to that point. We had a loudspeaker in front and a loudspeaker behind and we instructed the patient imagine you’re at a party. There’ll be a woman talking and several of the talkers gonna be talking in the background. The woman’s voice is easy to hear at first because of what says louder than the others, the background talkers will gradually become louder, making it difficult to understand the woman’s voice, Please guess and repeat as much of each sentence as possible. And we configure the audiometer. So the speech came from the front, and the noise four talker babble came from behind. And in our calibration, we set channel one, which was speech at 40 dB HL. And that created a signal from the front of 60 dB SPL, that was what we wanted for average conversation speech. And then channel two, we started off at 15 dB HL, which was 35, creating a positive 25 dB signal to noise ratio, presented the sentence, the next sentence, we increased it by 5dB, the next sentence, another five, the next one, another five, and the next one, another five. So by the time you got to the sixth sentence, it went from a positive 25 to a zero dB signal to noise ratio. And for each one of those senses, they had to repeat back the number of words. And we usually use three or four lists, and we use list 1268 10 or 11, based upon the research. And then we just simply scored the number of words correctly, and then subtracted that from 25.5. So here’s what the score should look like. So for this patient on the first sentence, they could all five words, right. By the time you got to the sixth sentence, which was a zero dB signal to noise ratio, they got to because it’s more difficult, you add all those up, it comes to 24 25.5 minus 25, is 1.5 1.5 would tell you, this person’s performance in noise is pretty darn good. They don’t need a remote microphone, because the signal to noise ratio is only 1.5 dB, the signal is only 1.5 dB above the noise noise ratio. So below, you’ll see that event score was between zero and three. They do well in noise, if they three to seven mild signal to noise ratio hearing loss, and they probably would do well with a remote microphone seven to 15, they have bigger problems in noise, definitely need a remote microphone, and greater than 15. They really have a problem in noise and can really consider a remote microphone. So this is the chart that Mead created when he created the quicksin. So along the bottom, you’ve got signal to noise ratio. And along the the other axis you have the hearing loss. So zero is normal hearing, 90 dB would be a profound hearing loss based upon a pure tone average. So what it is showing you is that if a person has a mild hearing loss, you need to increase the signal to noise ratio by four dB. In order for them to hear as well as a person with normal hearing. If they had a 40 dB hearing loss, you have to find the technology to increase the signal to noise ratio by five dB in order for them to hear like a person with normal hearing. And you work your way up. As the hearing loss is increasing. Your goal is to increase the signal to noise ratio, so they can perform as well as a person with normal hearing. So as a clinician, what are your strategies to reduce the noise and increase the signal to achieve the targets or the noise ratio? Well, to reduce the noise, we know what the best strategy is directional microphones, but directional microphones will decrease the noise, maximally, probably somewhere between three to five dB. With three to five dB, you’re not going to help too many people beyond 50 dB hearing loss with just a directional microphone. And I would argue that even with a person with a four dB signal to noise ratio could benefit from a remote microphone. So, we also then did the aided quicks in four weeks after we did the hearing aid, because we want to allow for climatization and repeated the same process. And what we wanted to find out if you can demonstrate that the ated performance is one and a half to two dB better than your previous that would be a considerable improvement in signal to noise ratio. But if the eight is signal to noise ratio was greater than seven dB, that is the absolute value not the revenue not not the relative then remote microphone is recommended. And I had plenty of patients who between three and seven dB I provided microphone, because they’ve reported difficulty and noise, distance and reverberation. So my basic philosophy was remote microphone unless proven otherwise. And that was the way I operated the way I ran the clinic, my my patients. So this is the research and I only selected three or four articles to make my point. You can do a Google Scholar search or you can go Medline and put in the word remote microphone, and you’ll find similar studies, I’m going to show you what I’m about to show you. So the evidence clearly shows that remote microphones can improve speech and noise, reverberation and distance and bring their performance to patients with normal hearing. It is the silver bullet. And it is the Holy Grail. I started my knowledge base with remote microphones, if you can believe it all the way back in 2004. Some of the listeners of this presentation maybe not even been born at that man, maybe it went I don’t know. But it’s it was quite a while back. So we did this study, Samantha Lewis Carl Crandall, myself and Jane and read a horn on perception in noise utilizing an FM system. The upper left is the average audiogram of the 23 subjects in Washington University. The lower right are the 23 subjects at the University of Florida. You’ll note that the hearing loss in the people in Florida is a little bit poor than the hearing loss in Missouri. We’re not gonna get the politics but there may be an answer for that. But we’re going to bypass that for now. Anyway, these are the results. So this is your unaided performance. Zero means zero dB signal to noise ratio. The higher the bar, the poorer the performance. So as an example, for Washington University, which is the black bar, on average, the unaided signal to noise ratio was a little under five dB. And for the University of Florida, six to seven dB, remember, they had a greater hearing loss, and they have four needed more signal to reach the same level of performance as us at the universe at Washington University. So now we put on hearing aids. The first one is omni directional. The second one is directional. And again, these will fit utilizing real ear measures. And you’ll notice that it improves the performance a little bit, maybe three four dB, for both groups, for both the Omni and a little bit better performance for the directional. So roughly, the directional performance was better than unaided by about five dB. And the omni directional by about three dB, give or take, then we fit them with the FM system. And look at that, it improved the supermarts ratio for a binaural FM system to negative 20 DB, negative 20 relative to the positive seven. That is a 27 dB improvement in signal to noise ratio. For binaural FM. If you took a monaural FM thing again, look at about 16 DB, again, you’re seven DB five dB, that’s greater than 20 dB improvement in signal to noise ratio. Remember back in the previous chart, for a person with found hearing loss you needed to improve by 18 DB. This exceeds that. So the FM improve the simple noise ratio by 20 to 30 DB relative to unaided, the right to the left. FM improves similar ratio by 15 to 20 DB relative to hearing aid with an omnidirectional 15 to 20 with an omni with the directional and by putting on a second FM receiver, you will improve the performance by additional two to three dB the binaural advantage.

So remote microphone improve the signal ratio by 15 to 30 dB. Recall the previous slide said for a 90 DB hearing loss you need 18 DB, and many connect many of these devices connect to virtually any audio device and stream to the hearing aids. Here’s some additional research. This was done by Rotamark and Glauster back in 215 2015. So 16 adults, three hearing aids Phonak resound and Starkey for remote microphone systems Phonak, Starkey, resound and Phonak again, the microphone was at the remote microphone was six inches from the front microphone a loudspeaker. They put people the the participants six feet and 12 we the double the distance to see if distance had any effect upon performance and on the hearing aid. they activated the onboard microphone or they deactivated the onboard microphone. And they did hit sentences at zero and noise at 45 135 225 and 315. So for those your research is out there, that’s 48 test conditions. All right, so this takes a little bit of explanation already. On the left, you have the upper one is the participant was at six feet, the hearing aid microphone was off. But the RM was on the remote microphone below. The participant again was at six feet, the remote microphone was on and the hearing aid microphone was on. On the right hand side, we just simply doubled the distance, the participant was 12 feet away. Again, hearing aid microphone off hearing a microphone on look at these results. The red is the unaided performance, and it’s roughly at around three dB. For the four graphs. The next are the hearing aid only conditions, it improves the signal to noise ratio by one to three dB. And then with the remote microphones, it improve the signal to noise ratio anywhere between six to 17 DB, going from the upper left to the lower right, just by adding a remote microphone to the condition. So ad performance in noise was not significantly better than unaided utilizing an omnidirectional microphone. The remote microphone improved performance by 16 to 17 DB relative to unaided or aided on directional for all four microphone remote microphone conditions, the performance really weren’t impacted yay or nay, whether or not the onboard microphone was on or off. And it really didn’t affect performance if the listener was six feet away from the loudspeaker or 12 feet away from the loudspeaker. Think about that. A six to seventeen dB improvement and signal to noise ratio by having this little box that the patient has access to. Here’s the second one by Wolf et al they came out in 2015, 17 patients. They utilize the Phonak Bolero and the Resound Versa, and two remote microphone conditions in a classroom, again with a loudspeaker at zero utilizing Az bio sentences in quiet and at noise at 85 DB. These patients as you can see have quite a significant hearing loss all the way down to 90 dB at four, six and 8000 hertz looked at this performance in quiet with the hearing aids the performance was a little better than 80% for either one of the two hearing aids. And the performance for the two remote microphones improved slightly, but not a lot. But again, it’s a quiet listening situation. Now you increased 55 db of noise in the background. The performance with the hearing aids went down from 80% to 60%. The performance of the microphone stayed the same. So there’s about a 2025 difference in word recognition by only a 55 DB background noise, the noise was increased by another 10 DB. performance with the hearing aids went from 60% to 10%. But the performance with the Remo microphones stayed at 70 to 85% 86% 75 0% for the noise for the hearing aids at 80 DB 0% for the noise. But even in the 75 dB. The resound Mini Mic maintained about a 46% improvement in noise. Again, a dramatic improvement in noise for remote microphone relative to a hearing aid to hearing aid fitting. This is 2017 and now we’re looking at a cochlear implant with a hearing aid as well as a remote microphone. And here are the results. With the hearing with a cochlear implant alone. The average signal to noise ratio was about 5.5 DB. With the well fit hearing aids and improved performance bar went down by about two dB. So this is a cochlear implant and the hearing aid with the cochlear implant and On the remote microphone, it improved by another five by five and a half dB. And with the cochlear implant, the hearing aid and the remote microphone, about seven and a half dB. So even in the case of severe hearing loss to the cochlear implant, the cochlear implant, plus the hearing aid plus your remote microphone, improved performance by seven and a half dB. So if you if you assume a 10% improvement, for every 1 dB, you improve the signal to noise ratio, that comes to about a 75% improvement in noise in that latter lower right box than the left cochlear implant box. That is a significant improvement in noise. So let me just share with you some examples of microphones that are currently out there. Okay, I’m just going to show you pictures, if you will. And so you’ll note it. Now, before I get to that, again, I need to emphasize, we were such an advocate of remote microphones. Our policy was, we provided the patient, the remote microphone, or a TV listener at no charge. I mean, we literally didn’t charge anything, we didn’t boost up the you know, the dispensing fee to compensate for it. We everything was exactly the same. We simply gave them the remote microphone did note charge, or TV listener? We were not charged for these devices, and we did not charge the patient.

Dave Kemp 36:36
Can I just ask did you? Did you have to make a case for this with the manufacturer? Oh, yeah, absolutely manufacterers? And what was that like for anyone? Because I agree with you that this seems to really only strengthen the case for hearing aids and the satisfaction rate and the referral rate and all that. So I think there’s a lot of incentive by the hearing aid manufacturers to support practices in this kind of program. What were those conversations like?

Michael Valente 37:00
Yeah, I think the conversation began with one manufacturer. And that was the manufacturer that we did the most, we ordered the most hearing aids. Now again, I will at the time, we were doing research with all four manufacturers. And we had a reputation give good, bad or indifferent. And I told them that it was my feeling that we could help them and our patient at the same time, if we could give them remote microphones or a TV listening device at no charge. And we felt that that would just improve the performance so greatly for these patients, they would send more patients to us, and it would help the manufacturer. And then that was my that was my spiel so to speak. And in order to do that, I need to get these devices at no charge. And they did. So once I had that in place with one manufacturer. I use the same spiel with the second manufacturer. And I said, Well, this manufacturer is agreed to do it, will you agree to do it? And then I did the same thing with the third these to agree to do it. Will you agree to do it? And then I did it with a fourth and I said these three agree to do it. Will you do it? And that’s how I did it. I just simply needed to convince one manufacturer my thinking was the number one complaint is the hearing aids don’t do well in noise. We know we have the technology to address that. And I think we should give them these devices at no charge. But it was certainly helped my case better with the chairman of the department, if you gave me these no charge. And that’s that’s how we came about.

Dave Kemp 38:33
Awesome. Go ahead, continue on.

Michael Valente 38:35
Good question. So in my in my thinking it’s a win win situation. It’s great for the patient. And it’s great for your practice because these gratified patients are likely to have a positive experience and refer more patients to you than they might ordinarily do. Instead of saying no I just spent X 1000s of dollars and this is a garbage which is you know you’ve you’ve heard that more than once before. So these are the latest from Starkey. The upper one is the mini remote microphone. The lower one is the table microphone that utilizes eight surface microphones and they also have something called a remote microphone plus this is resound which is the manufacturer that I have the most experience with with remote microphones. The top one is the multi mic and that’s one of them we gave away at no charge that we got to no charge and then the micro mic which is not as flexible as the multi mic but certainly would serve the purpose quite well. This is new, this just came out this is the Resound sound assist. If you know resound prior to this being released I mean just recently only like recently, you had to have a secondary streamer to stream from their remote microphone to their stream to your ears. So it was you had to have a streamer and remote microphone to your hearing aids. This eliminates that. These, this device now goes directly to your hearing aid without the need for a streamer. And it has six functions built into one. It’s a partner mic. It’s a table mic. It’s a hands free phone call device. It’s a streaming device. It’s a remote control. And it’s a telecoil all built into one device. This is the Phonak Roger on. And this is the Phonak Roger table, Roger select, and the Roger Pen. Now, some of you listeners may not be familiar with this, but here’s a little tip for you to tell you a patient’s. Now remember, I have all four sets of hearing aids. And I’ve done this. So if you have a patient that has a bilateral set of hearing, or even a Monroe set of hearing aids, and it’s paired to your iPhone, all you have to do is take your on button, which is your you’re on my iPhone, it’s on the right hand side, you triple click it rapidly BUMP BUMP BUMP, and you’re gonna get this on the left hand side, this Accessibility Shortcut Menu will instantaneously appear, you tap on hearing devices. And the screen to the right will come on. And on the lower left is a live listen off, you tap on that the microphone on your remote microphone on your phone becomes a remote microphone. So you could take your remote microphone and put it next to any auditory source. And it will stream directly to your hearing aids. Because you have your phone, you don’t need a remote microphone yet, your phone becomes a remote microphone. So if I were there’s an example right now, if I had an audio coming on my my, my laptop, I would just put my phone next to my laptop and it was streamed to my hearing aids in my living room, I could put this next to the loudspeaker of my TV, and it would stream the TV to both of my hearing aids. So it’s a very economical, not quite as good as a remote microphone. But a very quick economical way to have your phone become a remote microphone by just simply clicking the on off button, if you will, on the right hand side three times rapidly, it will immediately put on what you see the screen to the left, you tap on the hearing device. And then you tap on live listen on, and your phone becomes a remote microphone. Every hearing aid manufacturer will hate me for telling you this, but this is available for your iPhone. I’m not an Android or a Google phone person. I’m sure it’s available on those hearing on most phones. But this certainly works very, very well on an iPhone. So did you know I didn’t know? Did you know that the average person who was 65 and above, I’m in that category, watches TV on an average seven hours and 15 minutes each day. That’s a lot of that’s a lot of TV. And you know that there are a lot of people with hearing aids who will tell you you know, I do better you know with my hearing aids but it’s just I you know, you take you take like the crown and some of these English speaking actresses. I can’t hear a word they say, well, when I’m watching the news, and as a female anchor, I can’t hear a word they say or you’re watching a movie, I can’t hear a word there’s and you know, you go on you buy sound bars and all these other things. A TV listener, believe in I have four of them a TV listener. It’s like wow. And so that’s something to think about. This is the Resound unite. Excellent. This is the Starkey TV Streamer. This is the widex TV play streamer. And this is the phonak TV connector. All of these very easily attach to the back of your TV on your optical output, your pair your hearing aids and you get it in stereo and the sound quality is absolutely impeccable. Now, here’s something that you This is something that I just learned about literally this past summer. And I thought I would share it with you. So here is an economical option that you could do by configuring an air pod pro as hearing aids. And then Pair that with a Bluetooth adapter Bluetooth adapter to your TV for TV listening. And if I were in practice today, this wasn’t available when I was practicing. And I left two and a half years ago. But if I were in practice today, and I was with a patient, and I was telling the patient of all this great technology, and I was just getting this feeling that this patient was reluctant, because they simply couldn’t afford it. I will go ahead and tell them what I’m about to tell you. You could go to a store an Apple store online, buy a bilateral pair of Air pod Pro 2 configure them as hearing aids, and then pair it with a Bluetooth adapter that will cost you $78. And this is what this is all about. So again, using myself as an example, I have a mild to moderate bilateral hearing loss. Again, I have four pairs of devices and I have four listening devices. Without my hearing aid, I had still considerable difficulty hearing the TV aided performance with my hearing aids was significantly better than an unaided with my TV, but not as good as I desired. With a TV Streamer. Those four that I showed you a few moments ago. It was I didn’t strain at all at all. And and the TV was so long for my wife and my grandkids and it was just me and listening to the through the TV. So out of curiosity, I wanted to know if I could achieve equal a better TV listening with less expensive technology. As I was investing OTC for another presentation, I’ve done there’s my fourth one. So long story short, I purchased a pair of Air pod Pro 2 for $180. I completed the free Mimi test app, which I’ll share with you in a few moments you downloaded on your phone, and you take the hearing test through your air pod Pro. And then you take that result and you download it to your phone. And then it then utilizes that data to configure the air pod Pro 2 I that was free. And then I downloaded those results to my iPhone and I’ll share that within a few moments. And then I configure the airpods Pro as hearing aids. I purchased an aluratech BT5 Bluetooth adapter I did some research on this. It cost me $78 at a place called micro Center, you can do it online which I’ll share with you in a few moments. And I connected it to the optical output of my Sony big screen TV. And then I paired my air pod Pro and buy Bose headset to the aluratech BT5

and the listening through both of those transducers is impeccable. So let me kind of go through that with you. So I configured the air pod Pro to his hearing aids after I took the Mimi hearing test through the airpods pro. And it’s very very simple to do and it takes about 10-15 minutes and my results with that were virtually identical to the results I got with my hearing test in the sound booth. Except my hearing levels at 250 and 500 were elevated slightly they were they were poorer than what they were in the sound booth. I purchased a bilateral set of air pod Pro 2 for $180 and then I purchased the aluratech BT5 for $78 It’s now 49.74 on Amazon at the time I didn’t know about that. So if you put it all together it cost me $258 For the airpods Pro and for the adapter and then here I just got this two days ago. This is now the same thing is $49.74 I paid 78 What kind of an idiot am I I could have done this much cheaper. So if you want to know anything about the YouTube is like everything. I mean, I had my my son in law’s car and I wanted to change the oil. I was underneath the car for like an hour and I could not find the air filter. I went to YouTube to change your oil on his car, it showed me a video where it was I went under the car. There it was. I mean, you can put anything into YouTube. And it’s there. So I just Googled Mimi hearing test, and this came up. And I downloaded the Mimi test to my iPhone, I took the test. And interestingly enough, a recent article from Johns Hopkins showed that the results with the mini test on the app is equivalent to the same test done inside of a sound booth and an n of one me, that was exactly what happened to me, with the with the exception of about a 10 DB elevation of thresholds at 250 and 500Hz. And that’s what my, that’s what my test came out with, with the, with the mini air pod with the mini test. And that’s what it looks like on my iPhone, I just simply switched the results over from that app to my my phone. And that now is in my hearing part of my my health app on my phone. And that’s what was used to configure the airport Pro. Now, if you don’t want to do the miniapp, I put this year for you. Because you can take a picture of your paper audiogram and then send it to your phone as a file. And this particular website will show you step by step by step, how to take your hearing results and download it to your iPhone, just like the miniapp only now you’re doing it in more steps with a with a series of steps. And so that’s what that is. This is just simply to share with you how you could take your results you got in a hearing clinic and download that to your iPhone to use to configure the airport Pro. Now, I did not know how to do this. So what did I do? I went to YouTube, and I put into the search box, configure air pod Pro to was hearing aids. And a slew of videos came up. And I just simply watched the videos for a half hour and had my phone had the air pod probe. And I figured how do I take my air pod pros and configures a hearing aid as opposed to a listening device to listening to music or whatever it might be. And then I didn’t know how to configure the transmitter. And so I went to YouTube, and I put in the name of the transmitter. And these two guys came up. And I gotta tell you, the guy on top is a little dull, I mean, it, he gets the job done. But he’s not as entertaining as the guy at the bottom. So if you’re gay, and then there are other ones as well, the point I’m making is you can watch either one of these two videos, and very quickly figure out how to pair your transmitter to your TV, and then Pair your hearing aids to the to the transmitter. And it took me maybe an hour because I had to go through and do all the steps. So if I had a patient, and I told them, This is an option for you. And the person said to me, you know, this sounds great, but I’m really not good with iPhones and not good with TVs, whatever it might be. I tell you what, I know how to do it, we can set up a zoom, and I will walk you through it and do it for you. And I’m not going to do it for free. I’m going to charge you whatever time it takes me to do it, but I can walk you through it and do it for you. And that’s an option for consideration. Now, for Dave, because I know him, I would do it for free. But for a patient, I have to charge the patient. So these are my final thoughts. A typical report report of many adult patients is I don’t hear well in noise. When listening and noise reverberation or distance aided will be better than ated. But for many, many patients ad performance in noise will not match expectations. Read counseling might help but often doesn’t resolve the dissatisfaction. You become frustrated, the patient is frustrated because the goal has not been achieved. And they have spent a certain amount of money for that care. I believe for all patients audiologists should counsel introduce remote microphones. To resolve this problem. We have the tools also fatigued a listing a the performance is better than an aided but for many patients including my Myself, performance will not match expectations again, counsel and introduce TV listening devices to resolve that problem. Perhaps the day will come when hearing aids will automatically maintain the equivalent auditory acuity and quieter noise to negate the need to purchase a remote microphone or an assist device. But that day is not yet here. In the interim. Remote microphones and TV listening devices provide very significant benefit to help hearing aids perform under conditions where they simply can’t adequately perform alone. These patients are grateful, and they tend to revert to refer other patients. Sometimes you just need a little help to get the job done. I’ll go goal should always be to try to match or exceed patient expectations. In many cases, we must do better than simply fit only hearing aids. Thank you for your interest. You can reach me at [email protected]. And I’d be happy to address any question or concern you might have

Dave Kemp 56:21
regarding remote microphones. Based on your experience, what kind of form factor have you found to be the most the one that people are I guess, like most tolerable love? Is it the neck loop is it having something they carry around in their pocket,

Michael Valente 56:36
the handheld one that they can that they can place on a table or hold next will give to the person next to them. They also tend to be the less expensive table mics are very, very, you know, the table microphone is very, very effective. But they’re very expensive, very expensive. Whereas the handheld remote microphone does quite well for most patients.

Dave Kemp 56:59
Lovely. Well, Mike, thank you so much. This has been great, as always, really appreciate you coming on here and sharing so much of this. I really think this is top of mind and in the kind of stuff that is relevant to the to the professional today. So

Michael Valente 57:17
I would also make one more last comment here so that she had to close the loop. I would have to be sure the person is in the state of Missouri, for me to do this. Right. You know, for licensure reasons. I just I wanted to mention that. Good.

Dave Kemp 57:29
That’s a good point. All right, cool. Well, thank you so much. Thanks for everybody who tuned in here to the end and we will chat with you next time. Thank you. Cheers.