ReSound LiNX Quattro: More Access to Sound; Rechargeable Convenience

By Dr. Laurel A. Christensen

In September, GN Hearing launched ReSound LiNX Quattro. Described as the world’s first “Premium Plus” hearing aid, ReSound LiNX Quattro has generated strong interest among the hearing loss community. As ReSound’s Chief Audiology Officer, I’ve answered many questions about this latest innovation in hearing to facilitate informed decision-making. Here are two of the most common questions I receive.

Can you share the latest features and improvements in ReSound LiNX Quattro? What makes it “Premium Plus”?

ReSound LiNX Quattro is the fourth generation of the LiNX hearing aid family. LiNX streamlined technology with Made for Apple hearing aids in 2014, and brought remote fine-tuning capabilities to audiology in 2017 with ReSound Assist, which allows for adjustment without an additional clinic visit. Both of these breakthrough features are included with ReSound LiNX Quattro, plus more.  

Built on a newly designed, powerful microchip platform, it brings users an unprecedented combination of benefits, while enabling hearing capabilities never before possible. Putting sound quality first, ReSound LiNX Quattro technology enables patients to hear more “Layers of Sound,” delivering an extended range of sounds never before heard clearly through hearing aids. The sound quality is natural; soft sounds are clear and loud sounds are rich, full, and distortion-free. Users enjoy an especially marked improvement when listening to music.

The powerful radio provides more reliable, faster streaming and connectivity to any wireless accessory or mobile device. Using the ReSound Smart 3D app, users can take advantage of on-the-go sound personalization such as changing hearing aid programs, adjusting volume, decreasing the level of background or wind noise in the environment, and adjusting streaming sounds from a mobile phone. Also included is a geo-tag function for frequently visited locations so users can return to their preferred location-specific settings as desired.

Finally, ReSound LiNX Quattro is the world’s most advanced rechargeable solution. As many hearing aid users know, changing batteries weekly can be cumbersome, especially for those with impaired dexterity and eyesight. The built-in lithium-ion batteries eliminate the weekly need to change batteries with a rechargeable battery that lasts up to 30 hours. The recharging case holds 90 hours of portable power, greatly reducing the fear of depleted batteries.

How does ReSound LiNX Quattro actually extend the range of hearing? 

ReSound LiNX Quattro introduces four newly designed microchips that combine to deliver twice the memory, 100 percent more speed, and 30 percent more computing power—with 20 percent power consumption reduction.

The new chipset allows for an increase to 116 dB of input dynamic range so that sounds enter the hearing aid without distortion. In addition, the frequency bandwidth has been extended to 9.5 kHz both for the hearing aids and for sounds streamed to the devices.

In many other hearing aids, sounds outside these ranges are not heard or are heavily distorted. With ReSound LiNX Quattro, sounds typically missed such as birds singing, higher-pitched speech, or music are clearly discerned.

And by expanding access to sounds, especially higher frequency sounds, we observe improved spatial perception in users, with more cues for localization.

Learn more about ReSound LiNX Quattro.

Laurel A. Christensen, Ph.D. is the Chief Audiology Officer of GN ReSound Group.  In this role, she leads Global Audiology & User Experience in Research and Development.  She holds adjunct faculty appointments at Northwestern and Rush Universities and is a former member of the Executive Board of the American Auditory Society and a member of the Advisory Board for the Au.D. Program at Rush University.  In 2015, she received the Distinguished Alumna Award from the Department of Speech and Hearing Sciences at Indiana University.

How to Buy Hearing Aids

By Barbara Jenkins, Au.D., BCABA

A friend’s mother needs hearing aids. She has a daughter in the hearing industry, she has insurance to cover hearing aids, she holds a Ph.D. in molecular biology, and she is still overwhelmed and confused by where to go, what the options are, and what is best for her.

Sound familiar? There is so much information—and disinformation—available about hearing aids that even some physicians are confused.

As with any big purchase, selecting a hearing aid can be difficult and confusing if you don’t have the right information or know the correct questions to ask. Bring a copy of this checklist with you on your next appointment, and feel confident in your decision to improve your life through better hearing.

Hearing Healthcare Checklist

1. Where do I go for a hearing test?

Most hearing loss (up to 90 percent) is a result of non-medically treatable issues. But that means as many as one in 10 people will have a medical issue associated with their hearing loss. If this is your first hearing evaluation it would be prudent to see your primary care doctor first, then be referred to a specialist for a diagnostic audiogram (hearing evaluation).

Audiologists have a minimum of seven years of university training (master’s or doctorate level). Hearing instrument specialists can perform hearing tests but do not have the medical training to rule out medical issues—causes for hearing loss such as syndromes, Ménière’s disease, Usher Syndrome, sudden-onset, genetics, ototoxic drugs, etc.

If you know that there is no medically treatable issue associated with your hearing loss, either type of provider should be fine. If you’re in doubt, ask your physician which professional they recommend. They might refer you to an ENT (ear, nose, and throat specialist, or otolaryngologist).

2. Where do I buy my hearing aids?

Typically, once an audiologist or hearing instrument specialist has evaluated your hearing, you should be able to purchase your hearing aids from them. Requirements differ by state, but generally speaking the professional is trained in hearing aid selection, fitting, and care.

Make sure you are comfortable with the quality of care and the options offered by the provider. If only one brand of hearing aid is available, that’s a red flag. Be sure your provider offers a range of choices, in all styles and at all price points.

You can also opt to get a second opinion. This will give you additional provider choices, so you can go with the person with whom you feel most comfortable. After all, you will be starting a relationship that may last for years.

3. What style of hearing aid is best for me?

A hearing aid’s style (shape and configuration) is determined by the severity of hearing loss, manual dexterity and vision ability, comfort, and/or cosmetic appeal. Whether you get a larger, behind-the-ear hearing aid, or one that is nearly invisible in the ear canal, the cost is roughly the same. Discuss options with your provider and ask about the benefits and drawbacks to each type of device. Here is a brief overview of hearing aid styles, categorized from a larger size to smaller:

Behind-the-ear (BTE); receiver-in-canal (RIC) (also known as receiver-in-the-ear, RITE): These are currently the most popular due to durability, comfort, and cosmetic appeal. They may be a bit more difficult to put in the ears at first, but since less of the circuitry is inside the ear, they usually offer more natural sound. Also, RICs can be discreet, with only the speaker wire visible at the top of the outer ear.

In-the-ear (ITE); in-the-canal (ITC): This category is among the best for ease of use. Just one piece goes into the ear, with a portion of the device visible outside the ear. Many people like ITEs because they are easy to insert into the ear, and the battery
life is better than that of their smaller, ITC cousins.

Completely-in-the-canal (CIC); invisible-in-the-canal (IIC): These typically fit deeper into the ear and are a very good choice for people who wear helmets or use stethoscopes. Since they are deep in the canal (making them less visible), the most common complaint is that they may not feel as comfortable as the BTE styles, and depending on usage you must change the batteries once or twice a week. (BTEs and RICs often use larger batteries for more power, and last longer.)

4. Which fidelity level is best for me?

Once you have chosen your preferred style of device, you must choose the fidelity (technology) level of the computer chip in the hearing aid. This is where the cost differences in hearing aids become apparent.

Most manufacturers have three levels of fidelity in their newest hearing aids as well as in their economy-priced models. The higher the level of technology, the better and faster the hearing aid can separate noise from speech. This means the speech and sound information passed to your brain is more accurate. Every level will help one-on-one conversations in quiet environments; the more advanced chips will boost clarity and noise reduction even more effectively. In most cases, get the best hearing aid you can afford, but don’t feel pressured into a decision. Take advantage of the 30- to 60-day trial period that is required in most states (in some cases paying a small fee to return the devices).

5. What other special functions do I need for better hearing?

In the past few years, new features have emerged that have dramatically changed how we can interact with hearing aids.  

Rechargeable batteries: Rechargeable hearing aids are now available, requiring changing the battery only once every one to three years. These devices are recharged by placing the entire hearing aid unit on its charging dock. Not having to frequently manipulate the battery door is very helpful if you have vision or dexterity issues or if you tend to forget your batteries.

Almost waterproof hearing aids: There are now hearing aids that are so waterproof they actually dry themselves when they get wet. They are also dust- and shock-resistant. These are great for people who frequently spend time outdoors or who just perspire a lot. While it is not recommended swimming with them, these devices should survive taking a shower if you forget to take them out.

Bluetooth-enabled hearing aids: Many manufacturers now give you the ability to adjust your hearing aids with your smartphone, using Bluetooth wireless connectivity. You may even be able to stream sound directly to your hearing aids without the use of an additional device like a neck loop. If you’re tech-savvy, this may be for you.

Once you’ve gone through the items in this checklist, I hope you feel more confident about making decisions and improving your hearing.

Staff writer Barbara Jenkins, Au.D., BCABA, serves as Colorado’s professional state commissioner for people with hearing loss and was awarded the 2010 Leo Doerfler Award for Clinical Excellence by the Academy of Doctors of Audiology. Her office, Advanced Audiology, won the Most Humanitarian Hearing Care Office Award at the 2015 Signia Aspire Conference. For more, see advancedaudiology.com. This article also appeared in the Fall 2017 issue of Hearing Health.

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Understanding Individual Variances in Hearing Aid Outcomes in Quiet and Noisy Environments

By Elizabeth Crofts

Evelyn Davies-Venn, Au.D., Ph.D.

More than 460 million people worldwide live with some form of hearing loss. For most, hearing aids are the primary rehabilitation tool, yet there is no one-size-fits-all approach. As a result, many hearing aid users are frustrated by their listening experiences, especially understanding speech in noise.

Evelyn Davies-Venn, Au.D., Ph.D., of the University of Minnesota is currently focusing on two projects, one of which is funded by Hearing Health Foundation (HHF) through its Emerging Research Grants (ERG) program, that will enhance the customization of hearing aids. She presented the two projects at the Hearing Loss Association of America (HLAA) convention in June.

Davies-Venn explains that some of the factors dictating individual variance in hearing aid listening outcomes in noisy environments include audibility, spectral resolution, and cognitive ability. Audibility changes—how much of the speech spectrum is available to the hearing aid user—is the biggest factor. “Speech must be audible before it is intelligible,” Davies-Venn says. Another primary factor is spectral resolution, or your ear’s ability to make use of the spectrum or frequency changes in sounds. This also directly affects listening outcomes.

Secondary factors include the user’s working memory and the volume of the amplified speech. These impact how well someone can handle making sense of distortions (from ambient noise as well as from signal processing) in an incoming speech signal. Working memory is needed to provide context in the event of missing speech fragments, for instance. Needless to say, it is a challenge for conventional hearing aid technology to address all of these complex variables.

Davies-Venn’s highlights two emerging projects that take an innovative approach to resolving this challenge. The first project aims to improve hearing aid success focuses on an emerging technology called the “cognitive control of a hearing aid,” or COCOHA. It is an improved hearing aid that will analyze multiple sounds, complete an acoustic scene analysis, and separate the sounds into individual streams, she says.

Then, based on the cognitive/electrophysiological recordings from the individual, the COCOHA will select the specific stream that the person is interested in listening to and amplify it—such as a particular speaker’s voice. The cognitive recording is captured with a noninvasive, far-field measure of electrical signals emitted from the brain in response to sound stimuli (similar to how an electroencephalogram, EEG, captures signals).

Davies-Venn’s ERG grant from HHF will support research on the use of electrophysiology, far-field or distant (i.e. recorded at the scalp) electrical signals from the brain, to design hearing aid algorithms that can control individual variances due to level-induced (i.e. high intensity) distortions from hearing aids.

The other project involves sensory substitution. This project explores the conversion of speech to another sense—for example, touch—through a mobile processing device or a “skin hearing aid.” For the device to function, a vibration is relayed to the brain for speech understanding. This technology seems cutting edge, but is believed to have been invented in the 1960s by Paul Bach-y-Rita, M.D., of the Smith-Kettlewell Institute of Visual Sciences in San Francisco. Even though it has not yet been incorporated into hearing aid technology intended for mass production, David Eagleman, Ph.D., of Stanford University and others are hoping to make this a reality.

Davies-Venn’s research motives are inspired by a personal connection to her work. “I have a conductive hearing loss myself,” she says. “I had persistent/chronic ear infections as a child that left me a bit delayed in developing speech, and still get ear infections as an adult and have ground accustomed to the low-frequency hearing loss that results until they resolve.” She also has family members with hearing loss and understands the importance of developing more advanced hearing assistance technology.

The projects are in the early stages, and it may take as long as a decade for them to reach the market from the concept. “The goal is to develop individualized hearing aid signal processing to improve treatment outcomes in noisy soundscapes,” Davies-Venn says. “We want to say, this is the most optimal treatment protocol, and it’s different from this person’s, even though you have the same hearing threshold.” Solving hearing aid variances in a precise, individual manner that accounts for variables such as age and cognitive ability will improve communication and quality of life for the millions with hearing loss who use hearing technology.

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We need your help supporting innovative hearing and balance science through our Emerging Research Grants program. Please make a contribution today.

Why So Many Can’t Afford to Hear Better

Only about 14 percent of Americans with hearing loss use hearing aids. For many others, this vital, life-changing treatment that facilitates participation in meaningful conversations with friends and family is out of reach financially.

Hearing Health Foundation (HHF)’s 2017 hearing loss survey, created to better understand our constituents’ opinions related to hearing loss, was cited by a WBUR-FM Here & Now radio segment highlighting the barriers to hearing loss treatment that Americans encounter.

The news story opens with commentary from retiree Betty Hauck, 72, who was shocked when her first pair of hearing aids cost her $5,600—with no assistance from Medicare.

“A price tag like that is often a surprise to people buying hearing aids for the first time. Four states—Arkansas, Connecticut, New Hampshire and Rhode Island—require health plans to cover hearing aids for children and adults,” explains reporter Peter O’Dowd.

“But those benefits are rare. A 2017 survey by the Hearing Health Foundation, a group that funds research and advocates for treatments and cures for hearing loss, found that 40 percent of the people they asked had no hearing aid coverage through health insurance.”

Kevin Franck, director of audiology at Massachusetts Eye and Ear, among other experts, are hopeful that the Over-the-Counter Hearing Aid Act of 2017 will reduce barriers—cost, stigma, and hassle—encouraging greater adoption.

You can access the full WBUR segment, here.

Note: The audio segment is not captioned but is summarized in print.

The Listening Project

By Vicky Chan and Lauren McGrath

“Most people still assume that if a person is deaf, they’re not able to speak,” narrates Jane Madell, Ph.D., in the opening moments of her documentary film “The Listening Project,” released in March 2018. Her statement sets the tone for the following 38 minutes of personal stories that shatter stigmas about hearing loss.

A New York City-based pediatric audiologist, speech language pathologist, and auditory verbal therapist, Madell created the documentary with award-winning filmmaker Irene Taylor Brodsky to reveal how technology has improved communication—and life—for people with hearing loss.  

Richard, a cochlear implant recipient, is one of the participants in "The Listening Project" who works as a software engineer.

Brodsky captured interviews of 15 individuals with hearing loss, most of whom Madell treated when they were children. Madell says filming  allowed her to reconnect with her former patients to “see what they had to say about growing up with a hearing loss and what advice they might have for parents of newly identified children with hearing loss.”

The subjects of “The Listening Project” are vibrant young adults living and working all over the world—connected by their gratitude for the technologies and treatments that enable them to hear and talk. The majority are cochlear implant recipients, while the remainder wear hearing aids. They experienced similar anxieties, including not being able to hear everything in social settings, disclosing hearing loss to new acquaintances, and accepting their hearing loss.

If not for modern medical progress, the film’s subjects may not ever have been able to overcome these hurdles. When Madell began her career in audiology 45 years ago, hearing loss treatments were very restrictive. Only children with mild to moderate hearing loss could hear well with hearing aids, and the Food and Drug Administration had not yet approved cochlear implants. Such limitations challenged Madell emotionally early in her practice. Though she smiled and appeared optimistic in front of her patients and their families following a hearing loss diagnosis, she knew how hard they would need to work with inadequate accommodations for their children to succeed.

Madell’s former patients and millions of others are fortunate  changes in hearing technology and policies in recent decades have been dramatic. “We are so lucky we live now and not 30 years ago, 40 years ago,” says one. Another young man adds that the ability to communicate and feel comfortable doing so is “a core human value.” Advancements have made it possible for children with hearing loss to learn spoken language, which Madell believes is critical for educational, social, and professional development and gives them options they would not have otherwise.

Madell hopes the personal stories in “The Listening Project” will help parents of newly diagnosed children, as well as legislators, educators, and healthcare workers. “Parents of children with hearing loss have told me that if they had seen the film before the diagnosis, it would have been easier to deal with,” she says. It shows parents that with the resources and hearing technology available today, hearing and speech are possible for every child.

To learn more about the film for either personal or educational use, visit thelisteningprojectfilm.org.

Research Aims to Improve Fit and Increase Use of Hearing Aids in U.S.

By University of Maryland Department of Hearing and Speech Sciences

Photo Credit: Shutterstock

Although about 28.8 million Americans could benefit from wearing hearing aids, less than a third of that population actually uses them, according to the National Institutes of Health. While cost is a contributing factor, experts say many people with hearing loss choose not to wear hearing aids simply because they have difficulty adjusting to them. Researchers with the University of Maryland Department of Hearing and Speech Sciences (HESP) are hoping to improve those figures by developing better procedures for fitting people with hearing aids for the first time.

“Right now when someone is fitted with hearing aids, the focus is on increasing audibility of sounds reaching the ear,” says HESP Assistant Professor Samira Anderson, Au.D., Ph.D. “However, in order to actually understand what someone is saying, sound has to travel from the ear up to the brain. We’re interested in understanding how wearing a hearing aid affects that process.”

Dr. Anderson, University of Maryland Department of Hearing and Speech Sciences

In a study published recently in Ear & Hearing, Anderson and colleagues outfitted 37 older adults with mild to severe hearing loss with new, in-the-ear hearing aids donated by Widex USA. The researchers placed electrodes on the surface of the patients’ skin to measure electrical activity produced in response to sound in the auditory cortex and midbrain. They found that the brain’s processing of sounds improved while wearing hearing aids.

“There’s a growing body of research showing that hearing loss can lead to accelerated cognitive decline and isolation as people age,” Anderson says. “My hope is that we can develop enhanced testing procedures that will allow more people to benefit from hearing aids and enjoy a better quality of life.”

The UMD research team plans to continue evaluating the patients in their study during the first six months of hearing aid use. In future studies, researchers hope to investigate the effects of manipulating hearing aid parameters on neural processing. The study was funded by the UMD Department of Hearing and Speech Sciences, Hearing Health Foundation, and the National Institutes of Health (NIDCD Grant T32DC000046).

Samira Anderson, Au.D., Ph.D., is a 2014 Emerging Research Grants researcher generously funded by the General Grand Chapter Royal Arch Masons International. We thank the Royal Arch Masons for their ongoing support of research in the area of central auditory processing disorder. Read more about Anderson and her research in “A Closer Look,” in the Winter 2014 issue of Hearing Health.

We need your help supporting innovative hearing and balance science through our Emerging Research Grants program. Please make a contribution today.

The Gap Between Self-Reported Hearing Loss and Treatment Patterns

By Carol Stoll

Hearing loss is one of the most prevalent chronic conditions in the U.S. and has been associated with negative physical, social, cognitive, economic, and emotional consequences. Despite the high prevalence of hearing loss, substantial gaps in the utilization of amplification options, including hearing aids and cochlear implants (CI), have been identified. Harrison Lin, M.D., a 2016 Emerging Research Grants recipient, along with colleagues, recently published a paper in JAMA Otolaryngology–Head & Neck Surgery that investigates the contemporary prevalence, characteristics, and patterns of specialty referral, evaluation, and treatment of hearing difficulty among adults in the U.S.

Unlike this man who is having his hearing tested, a large number of individuals in the U.S. who experience hearing difficulties are not seeking treatment. Photo source: Bundesinnung Hörakustiker, Flickr.

The researchers did a cross-sectional analysis of responses from a nationwide representative sample of adults who participated in the 2014 National Health Interview Survey and responded to hearing health questions. The data collected included demographic information as well as self-reported hearing status, functional hearing, laterality (hearing ability in each ear), onset, and primary cause (if known) of the hearing loss. In addition, the team analyzed specific data regarding hearing-related clinician visits, hearing tests, referrals to hearing specialist, and utilization of hearing aids and CIs.

Overall, 36,690 records were included in the analysis, which extrapolated to an estimated 239.6 million adults in the U.S. Nearly 17 percent indicated their hearing was less than “excellent/good,” ranging from “a little trouble hearing” to “deaf.” Approximately 21 percent of respondents had visited a physician for hearing problems in the preceding five years. Of these, 33 percent were referred to an otolaryngologist and 27 percent were referred to an audiologist. Of the adults who indicated their hearing from “a little trouble hearing” to being “deaf,” 32 percent had never seen a clinician for hearing problems and 28 percent had never had their hearing tested.

The study shows that there are considerable gaps between self-reported hearing loss and patients receiving medical evaluation and recommended treatments for hearing loss. Increased awareness among clinicians regarding the burden of hearing loss, the importance of early detection and medically evaluating hearing loss, and available amplification and CI options can contribute to improved care for individuals with hearing difficulty. Future studies are warranted to further investigate the observed trends of this study.

Harrison W. Lin, M.D., is a 2016 Emerging Research Grants recipient. His grant was generously funded by funded by The Barbara Epstein Foundation, Inc.

We need your help supporting innovative hearing and balance science through our Emerging Research Grants program. Please make a contribution today.

Talk to Your Loved Ones About Hearing Loss, HHF Urges in Renew Magazine

Hearing Health Foundation (HHF) Board of Directors member Anil Lalwani, M.D. and Communications and Programs Manager Laura Friedman recently shared their expertise about untreated hearing loss and how to encourage a loved one—with compassion—to get help.

The story, "Heart of Hearing," is found on page 26 in the latest issue of Renew, a publication of United Healthcare and AARP. 

“Regardless of age, type of hearing loss, or cause, if left untreated or undetected, hearing loss can have negative effects on your well-being,” says the Hearing Health Foundation’s Laura Friedman. “Untreated hearing loss can lead to numerous negative social, psychological, cognitive and health effects, and can seriously impact professional and personal life, at times leading to isolation and depression.” 

As the consequences of untreated hearing loss can be devastating, Anil Lalwani urges readers to offer encouragement to their loved ones with untreated hearing loss. 

“Often the individual with hearing loss is unaware of what they cannot hear,” explains Lalwani. Whether you think your loved one is aware of his or her potential hearing loss or not, it’s important to approach the topic lovingly."

Read the full piece in Renew magazine on page 26.