Tech Topic | May 2014 Hearing Review

Hallenback author box By Stephen A. Hallenbeck, AuD, and Jennifer Groth, MA

The year 2014 marks a new era in the hearing aid industry. This is the year that hearing aids begin to connect wirelessly to consumer electronics with no adaptor or relay device required. In addition to the well-established benefits of amplification, users of this technology can receive sound directly from their smartphone and other devices (eg, tablets) to their hearing aids, as well as control their hearing aids and access other hearing aid relevant data and functionality.

While this may be a watershed year for hearing aid technology, hearing care professionals might be underwhelmed at the news in terms of relevance for their patients. “Not many of the people I see even have a cell phone,” “This would be a niche product for the young and tech-savvy,” and “This isn’t very important for my practice” are all common reactions.

To what degree are these valid objections? Not as much as you might think. A 2013 survey of 44,000 people over the age of 16 in the United States, Germany, and Japan by Kantar Worldpanel ComTech showed that:

  • Smartphone and tablet penetration is increasing rapidly across all age groups.
  • Nearly 1 in 5 people over the age of 70 is now a smartphone owner.
  • Tablet penetration is particularly significant for the 70+ age group in the United States, approaching the levels among the younger groups.

These findings mean that smart devices are becoming widespread among the typical clientele of a hearing aid dispensing practice. Smart devices have gained a foothold across demographic groups as tools for communication, entertainment, and more. They no longer are the domain of the “tech savvy” or so-called “early adopters.”  In this article, we present food for thought in keeping current and being successful with wireless hearing instrument technology.

1) This new technology will draw people to your practice.


Figure 1. Smartphone penetration is increasing across all age groups in the US, Germany, and Japan. Nearly 1 in 5 of 70-year-olds reported owning a smartphone in 2013. Source: Kantar Worldpanel ComTech.

More importantly, it will bring in people who otherwise would not come. In our experience, it is exceptional when hundreds of consumers contact the manufacturer prior to the launch of a new hearing aid; however, this is exactly what has been observed prior to the release of the ReSound LiNX hearing instrument. The availability of hearing aid technology that can be positioned as straddling consumer electronics and hearing assistance provides new opportunities for professionals to market their services. The unprecedented exposure given this new hearing aid capability in the general media can be leveraged by practitioners in attracting clients. The survey data shown in Figures 1 and 2 indicate that a sizeable number of patients in a typical practice are owners of a smart device. While it might be fun to surprise them with a product that can easily interface with other devices they use, how much more effective would it be if they came in asking for it?

Figure 2. Like smartphones, penetration of tablets is also increasing dramatically. In the US, penetration of tablet is almost as large among those over 70 years as in other age groups. Source: Kantar Worldpanel ComTech.

Figure 2. Like smartphones, penetration of tablets is also increasing dramatically. In the US, penetration of tablet is almost as large among those over 70 years as in other age groups. Source: Kantar Worldpanel ComTech.

2) Less might be more.

Clients might be attracted to your practice based on how you take advantage of the newest direct connectivity solutions in your marketing, but ultimately success hinges on understanding the environment surrounding your patients’ problems.

Consider this example: Two different patients write on an intake form that they can only hear the TV at levels that are uncomfortable for others. One of these patients is an 83-year-old woman whose daughters visit her regularly. The other is an 83-year-old man who travels a lot and meets at his neighbor’s house every Sunday to watch the big game. Do you recommend the same TV solution for both? Although they have age in common, in each of these cases, the problem has a significantly different context. A stationary streamer is probably best suited for the woman in this example. She does not require mobility when she listens to the TV and is likely to benefit from a one-time setup that does not need to be moved on a regular basis. On the other hand, the man in this example requires a TV solution that is mobile and can be flexible in many different environments. In his case a microphone that can be set close to the TV speaker and stream audio to the hearing aids can be a great way to provide this flexibility. In both cases, it is important for the clinician to dig deeper into the context of the solution and to think differently when choosing the best technology.

Because many manufacturers’ TV streamers have the word “TV” in their name or are marketed for use with televisions, clinicians may risk choosing only these items as the solution when the TV problem is marked on the intake form. Likewise, companion microphones are often immediately viewed as “mini-FM” systems, and applications such as a “portable TV streamer” can be easily forgotten. These two examples are somewhat common and highlight the importance of understanding the context of the problem and the patient’s lifestyle when making recommendations, but there are other areas of crossover between different accessories as well.

Figure 3. The ReSound Smart App gives the user additional functionality compared to what is available for traditional remote controls. For example, bass and treble balance can be adjusted to the user’s preference. The user can even “geo-tag” their preferred adjustments so that they are remembered for that particular geographical location and can be recalled the next time the user is in that environment.

Figure 3. The ReSound Smart App gives the user additional functionality compared to what is available for traditional remote controls. For example, bass and treble balance can be adjusted to the user’s preference. The user can even “geo-tag” their preferred adjustments so that they are remembered for that particular geographical location and can be recalled the next time the user is in that environment.

Landline phones continue to be a source of trouble when trying to identify the right accessory solution. Phone intermediary devices that work via Bluetooth often fall into this same trap of being the “go-to” cell phone solution. However, stationary streamers can be connected to the output of the phone using some basic audio splitter cables and can be a fantastic solution for end users who work on the phone throughout the day.

In all of these cases, the key to delivering impactful user solutions hinges upon uncovering the context of how these solutions will be applied in the patient’s everyday life.

3) Remember that connectivity is more than audio streaming.

While one of the most demonstrable benefits of wireless connectivity is the streaming of audio to hearing aids, various forms of remote control options offer tremendous flexibility to personalize each individual hearing experience in a way that is both discreet and empowering. Dedicated remote controls provide a simple real-time solution to patients when difficult listening situations arise. Smartphone users also can install apps that duplicate remote control functionality via a Bluetooth compatible accessory, such as the ReSound Phone Clip+.

Today, direct connectivity between iOS devices and hearing aids offers even more ways  for users to interact with their hearing aids. The connectivity provided by Apple devices allows patients to obtain a deeper level of interaction with their hearing instruments. What makes this a truly remarkable development is that this level of interaction is being mediated by a technology that the patient carries with them on a regular basis (ie, their iPhone). Given that individuals often use their phones for many purposes throughout the day, the ease of adjusting the aids from the phone makes the process remarkably less noticeable. The subtlety of control changes and the ease of use provide a lasting reduction of the stigma typically associated with using hearing aids.

Additionally, the remote control functionality and automation provided by iPhones and apps are actually drawing new and excited users into clinics for the first time. Unlike traditional remote controls, the new features offered by an app can be discussed at the first fitting in a manner that inspires patients to dive into using their hearing aids at a far deeper level than has been seen previously in the hearing care industry.

For example, features that allow the patient to make some basic treble and bass adjustments to the frequency response can improve the bond that the patient has with their hearing aids. Now patients have a new language—with greater detail—they can use when they return to your office to help you make adjustments. As well, the graphical user interface that is clean, crisp, and intuitive presents the hearing aid features in a manner that empowers our patients to have a much deeper understanding of both their problems and the solutions that are intended to help.

Likewise, the ability to associate certain environments with specific settings through geo-tagging features gives patients a much deeper understanding of how our hearing aids can be more finely tuned to meet their needs. The fact that all of this technology is incorporated into their cell phone allows for a seamless integration to empower your patients. As this is the leading edge of technology in the hearing aid world, it is undoubtedly the #1 way to remain competitive in connectivity.

4) Learn a little about Bluetooth.

This will help you immensely in navigating the various products on the market and recommending the best one to do the job, as well as avoiding misinforming patients. For example, a doctor who purchased hearing aids and the ReSound Phone Clip+ Bluetooth cell phone accessory recently was very disappointed to find that he could not receive sound from his Bluetooth stethoscope. In fact, his audiologist had advised him that this would be possible since “If the stethoscope transmits a Bluetooth signal, then why wouldn’t the telephone clip pick up that signal?”

It is important to understand that Bluetooth, an open standard for many types of wireless communication covering tens of thousands of different products, is not just for audio streaming; not every Bluetooth device is set up to communicate with every other Bluetooth device. For example, a wireless mouse that uses Bluetooth does not open a garage door that also uses Bluetooth. In the case of the stethoscope, the reason that the stethoscope and Phone Clip+ did not communicate was that they are not using the same Bluetooth profile. The profile specifies an aspect of the wireless communication between devices that manufacturers follow to use Bluetooth in a particular manner. Generally, the “headset profile” needs to be supported in order for a Bluetooth device to work with hearing aid phone accessories. Information regarding the supported profiles can be obtained from the manufacturer of the product.

In 2011, Bluetooth version 4.0 was introduced. This version contains a low-energy feature that has enabled a new breed of products that can communicate wirelessly for long periods of time without requiring much power. These so-called Bluetooth Smart products include fitness monitors, toothbrushes, home security systems, and many others. Bluetooth Smart products can transmit data to Bluetooth Smart Ready devices, such as PCs, tablets, and smartphones. Bluetooth Smart Ready devices can communicate with both Bluetooth Smart and traditional Bluetooth devices. The low-energy feature of Bluetooth version 4.0 is what has made direct communication between hearing instruments, such as the ReSound LiNX, and Apple devices possible. Traditional Bluetooth consumes too much power to make direct implementation in hearing instruments feasible.


Figure 4. Overview of Bluetooth wireless communication.

Figure 4 provides an overview of Bluetooth wireless communication. Until now, digital wireless hearing instruments could communicate via Bluetooth only by using a separate accessory, such as the ReSound Phone Clip+ or the body-worn streamers offered by other manufacturers. These types of accessories would fall into the circle on the left in Figure 4. With Bluetooth 4.0 and Bluetooth Smart, digital wireless hearing instruments that operate in the 2.4 GHz band, such as the ReSound LiNX, can communicate directly with Bluetooth Smart Ready devices. Thus, the ReSound LiNX would fall into the circle on the right.

One key way in which ReSound LiNX differs from other Bluetooth Smart devices is that it can receive streamed audio from the iPhone®, iPad®, or iPod Touch®. Apple, the manufacturer of these devices, prioritizes accessibility features in their devices. Thus, they developed a proprietary high-quality audio streaming protocol for their devices that takes advantage of the low-power feature of Bluetooth 4.0. This made it feasible to work directly with hearing aids that have digital wireless capacity in the 2.4 GHz band.

Products like the ReSound LiNX can thus tap into the iPhone audio streaming capability by implementing the Apple proprietary communication protocol. In this way, a power-efficient, high-quality, digital stereo audio experience is accessible directly from iPhone, iPad, and iPod touch devices to the ReSound LiNX. This is a listening experience that delivers audio streams from your iPhone or iPod touch with outstanding sound quality and power efficiency for phone calls, music, FaceTime calls, and other activities.

5) Don’t forget about telecoils.

Thanks to the awareness raised by the “Loop America” campaign and the efforts of many audiologists who have installed loops in their communities, the telecoil has reemerged as an integral tool to increase connectivity for end users in the United States. While European countries have long embraced the use of induction loops in public places, implementation in the US is not as widespread. Recent looping initiatives in the US have caused the telecoil to remain an indispensable component in modern hearing aids. Even better, telecoils and digital wireless hearing instruments are not mutually exclusive. Many hearing instruments are available that have both.

Original citation for this article: Hallenbeck S, Groth J. Staying competitive in connectivity: 5 things you need to know. Hearing Review. 2014;21(5): 24-26.