Getting the Best out of your Implant
Introduction
It is a fact of life that we live in a noisy world, and also a fact that for many implant users a quite modest amount of background noise will dramatically reduce their ability to pick out speech. Over the years the implant manufacturers have put a lot of effort into finding ways of enhancing their speech processing systems so as to improve speech perception in the presence of background noise, with varying degrees of success.
Despite these modest improvements in processing technology the best way of dealing with background noise is to try and find a way of reducing the amount of background noise that is fed into the speech processor in the first place. This is the goal of what are generically called Assistive Devices. The purpose of this article is to look at some of the more common types of Assistive Devices so that readers can refresh their memories on the options available to them. You will need to seek advice from your CI Centre on the current availability of any specific device for use with your particular model of implant.
External microphones
Most CI manufacturers can supply an external microphone which can be plugged into the auxiliary input socket on your speech processor to supplement or replace the signal from the built-in microphone. Whilst this is a fairly low-technology Assistive Device it can be surprisingly effective in the right circumstances. If for example you want to go out for an evening meal with your partner, but find the background noise in the restaurant upsetting, try using an external microphone and find some way of clipping it on within a few inches of your partner’s lips. This will dramatically reduce the amount of background noise you hear. Similarly if you are sharing a car journey with someone and find the tyre and wind noise obtrusive you could use an external microphone to get your “ear” much closer to the speaker’s lips.
My own hair style gives the microphone on my speech processor relatively little protection from the wind, and it only takes a quite gentle breeze to produce a surprisingly loud rustling noise which makes my implant virtually unusable. One solution to this problem is to plug in an external microphone, and then tuck the head of the microphone under your outer layers of clothing, where the sound can get to it but the wind can’t.
Radio-microphones
A more flexible - but much more expensive – variant on the external microphone theme is that of the Radio-microphone system – sometimes known as “FM systems”. The basic principle remains the same, i.e. of getting the microphone as close as possible to the speaker’s lips, but the use of a wireless connection makes this possible in situations where a wired system would be inappropriate. The receiver end of the system can either be directly connected into your speech processor through a suitable cord, or be used either to operate a neckloop which you can listen to using an inductive pick-up coil – see below. When attending evening classes I often ask the lecturer to wear the transmitter end of a Radio-microphone system, with the receiver driving a neckloop.
The snag to these systems is that they are quite expensive. [In the longer term I hope that Bluetooth based systems will be come available at lower prices, but as of today progress on this is disappointingly slow.] The RNID’s Sound Advantage subsidiary offers a basic system called the Conversor, but even this costs about £335 if you can qualify for a VAT exempt purchase, and nearly £400 if you need to pay VAT. The more upmarket products such as those developed by Connevans, and the Sennheiser Mikroport and Phonak Microlink ranges cost in the region of £1000 for a working system. Clearly at these prices it is imperative that you try out the system thoroughly before committing to a purchase. Connevans are a long established company with much experience in this field, and as well as selling a wide range of Radio-microphone systems they also carry an extensive stock of specialised cords to connect these systems to any specific model of implant.
Inductive pick-up coils
For many years most hearing aids have been fitted with a so-called “T” switch, which allows the user to listen to the output of a pick-up coil which detects an audio frequency magnetic field. This is why you will often see signs displayed at station ticket offices, bank counters etc inviting you to switch to the “T” setting. Unfortunately it is only very recently that the implant manufacturers have started to incorporate these pick-up coils in their behind-the-ear speech processors, and if you are using an older model of speech processor you may need to ask your CI Centre to give you an external pick-up coil which connects to the auxiliary input socket on your speech processor. You may also need to discuss with your CI Centre how best to programme up your processor to work with the pick-up coil: do you prefer having just the pick-up coil running on the “T” setting, or do you want it and the microphone working at once?
One key advantage of having an inductive pick-up coil facility is that numerous telephones are available which couple to your pick-up coil, which will usually give greatly improved speech perception. All of BT’s Payphones are equipped to work with an inductive pick-up coil, and if you find yourself wanting to use a Payphone on a noisy station concourse the improvement you get by switching to the “T” setting – and thence getting rid of all the background noise is quite unbelievable.
The great majority of mobile phones will not work with an inductive pick-up coil, but suppliers such as Connevans may be able to sell you a customised cord which allows you to connect the mobile to the auxiliary input socket on your speech processor.
The pick-up coil in Cochlear’s 3G processor is quite directionally sensitive, and you may need to experiment for a bit to find the optimal angle at which to hold the phone – and your head. Another issue is that the general standard of installation and maintenance of inductive loop systems in the UK is appalling, and a huge number of them simply don’t work. But when a loop has been correctly installed it can be a real boon, so it is well worth giving it a try. [And if it isn’t working, please complain vociferously to the hotel/university/bank etc.]
Home loop systems
If you have had some success with the inductive pick-up coil facility on your implant then you might find you can improve the quality of the sound you get from your TV or radio by fitting a home loop system. This takes the sound output from your TV – preferably via the SCART socket – through a very simple loop amplifier and feeds it into a loop coil tucked in under your lounge carpet. With your implant on the “T” setting you can then listen to the TV sound when seated anywhere in the room. An alternative arrangement is to have the loop amplifier driving a coil within a pad – similar to a thin cushion – which can be placed under your seat. With these systems you will generally get better basic sound quality than you do through the TV’s loudspeaker, and you may have the option of cutting out the room background noise if you wish. These systems cost in the region of £35-60, and can be readily obtained from suppliers such as Connevans or RNID Sound Advantage.
Conclusion
Not all of these arrangements work out equally well for everyone, but they cost a fraction of the price of the basic implant system, and if you can find one which improves your speech perception a bit this will be well worth the effort. Finally please remember – try before you buy!
Paul Tomlinson
A Personal Viewpoint
Studying with the aid of a Cochlear Implant
by Roger Powell
I am a mature student with the Open University and have studied with them on and off since the mid-80's, which is some 10 years before I received my cochlear implant.
In the past, I have had to use Sign Language Interpreters (SLI's), Lip-Speakers and Note Takers to meet my communication needs at tutorials and Summer School. Last year, for the first time, I decided to see if I could manage without such support and rely on the hearing I have with my implant. My main reason for making this decision was, as ex-Social Services employee, I am only too aware how thin on the ground such support is.
There is now a government allowance, the ¬Disabled Students Allowance that would enable me to obtain equipment to overcome difficulties presented by being both deaf and arthritic. I attended an assessment at the DSA centre based on the campus and the assessor helped me work out which equipment would be of benefit to me. She then compiled a very detailed report for authorization which was given within a month and the equipment was delivered six weeks later.
The most useful piece of equipment, as far as my deafness is concerned is my FM Genie radio aid system that is customised to work with my implant. In tutorials I wear the receiver plugged into my processor and the tutor or fellow student uses the transmitter so that I can hear everything they are saying. In the employment situation it can be used in team meetings and on training courses. There is another microphone that can be placed in the centre of a group so that people don't have to keep passing the transmitter around. I have also used mine in conjunction with a headset to hear what the other person is saying when Instant Messaging on my PC. It can also be used to enhance the performance of the implant when listen to the radio/TV and CD/DVD's and even do so without anyone else being able to hear what you can hear!
I was also given a Sony Walkman that I can take into tutorials/meetings, to record the proceeding and then play back the contents later whilst still being able to hear live with FM Genie in conjunction with my implant. Other equipment I acquired are an ergonomic keyboard, ergonomic mouse, ergonomic chair which are all to enable me to overcome the effects of sitting at my desk for long periods with arthritis. The bonus to acquiring all this equipment is that I free up a SLI/Lip-Speaker for someone more in need of one and, once acquired, all the equipment is yours even when you have finished studying.
All the equipment I have acquired would be of benefit in the work place but to obtain it specifically for that purpose, one would need to approach a Disablement Employment Adviser at one's local Job Centre Plus.
I also hope this article will have encouraged other implantees to take up full time or part time studies and apply to the DSA to enable them to acquire such equipment and make their studying experience more rewarding.