As an American college professor who sojourns periodically in Scotland, I recently flew across the Atlantic, leaving behind my home country in which assistive listening is largely hearing-aid-incompatible. As a person with hearing loss, if I go to a theater, place of worship or an auditorium in most of the United States, I can benefit from assistive listening only if I assert myself when entering a venue. I must locate and check out special equipment, remove my hearing aids, wear either ear buds that have been in others' ears or a visible headset, struggle to hear generic sound not customized for my ears and, afterwards, return the unit and replace my hearing aids.

It's small wonder that most assistive listening units sit unused in theatre closets and sanctuary cupboards. My community's biggest theatre complex follows the Americans for Disabilities mandate to have these headsets available. But they seldom get used-once per month per theatre, the manager estimates.

And if I asked a hearing professional about an assistive listening technology for my home TV that would enable me to hear without blasting other family members, I would likely be offered a product that is incompatible with (indeed, competes with) their primary hearing aid product. Moreover, it would plug my ears, making it difficult to hear the telephone or doorbell, or to converse with others in the room.

Arriving in Scotland 2 weeks ago, I found myself in a more supportive environment. After landing at Edinburgh Airport, I made my way to the baggage claim carousels and immediately noticed signage indicating that a hearing-aid-compatible hearing loop would broadcast any announcements via my hearing aid telecoils-effectively transforming my hearing aids into loudspeakers that deliver sound customized for my ears. The next morning, we ventured out to worship near our St. Andrews flat. Even after 2 years spent in Scotland, the accent is sometimes a challenge to pick up. But the task became much easier when I activated my telecoils and found the minister's voice broadcast by my in-the-ear loudspeakers. Picking up a Church of Scotland magazine, I noticed four audio firms advertising their services, marketing only hearing-aid-compatible assistive listening via induction loops.

Later that first week, I went to the town office to ask a parking question and then to the post office. In both venues the clerks' voices broadcast through small-area hearing loops. Thus, the postal clerk behind a glass window had her voice clearly broadcast by my hearing aids. In such transient venues, it's hearing-aid-compatible assistive listening or nothing. In the U.S., that effectively means no assistive listening. What a contrast in the UK, where assistive listening is becoming omnipresent-at tens of thousands of tourist information center counters, train station windows, pharmacy stations, virtually everywhere there is a PA system (including every cathedral I have visited), and in the back seats of all London taxis.

As I write this, I find myself off Scotland's west coast, where a decade ago I first discovered the joy of hearing-aid-compatible assistive listening at the historic abbey on the Isle of Iona. Once again, I found the sound, which would have been indecipherable to me after bouncing off the ancient stone walls, deliciously clear when I activated my hearing aids' M/T switch, which also enabled me to hear the singing around me. Venturing into the Abbey's gift shop, I saw the hearing loop sign on the door and found the cashier's voice broadcast to my hearing aids.

Looping My World

After that transformative earlier experience on Iona, I wondered if this user-friendly and virtually free (to users) technology might work in my world. After I returned home, I connected a small loop amplifier to my TV audio outport and encircled my seat with the thin loop wire. Eureka! My TV now broadcast at a volume of my choosing through my hearing aids and, thanks to the mic + telecoil option provided by my audiologist, without blocking room sound.

In 2002 I launched, with community support, an initiative to introduce hearing loops to my hometown of Holland, MI, and its adjacent communities and townships. Now, a half dozen years later, nearly all the major worship centers are looped, as are the community's auditoriums, high school performing arts centers and senior citizen facilities. Moreover, thanks to word of mouth and media publicity, hearing loops are now spreading throughout West Michigan. In Grand Rapids and its surrounding areas, looped facilities now include 80 churches, the new convention center meeting rooms and ballrooms, the symphony hall and, as of the summer of 2008, both concourses and all gate areas of Michigan's second largest airport. As a frequent flyer, I appreciate visual information displays, but I also now have more detailed information about boarding and flight delays wirelessly transmitted to my hearing aids.

Ergo, I love my hearing aids! In a variety of venues they serve me, and increasingly thousands of other West Michiganders, not only as sophisticated microphone amplifiers but also, with the mere push of a button, as personalized wireless loudspeakers. Indeed, it's a close call as to whether I love them more for their amplification of conversation or for their dual functionality as wireless, customized loudspeakers.

Spreading to Other Communities

Thanks to grassroots consumer advocacy, the hearing-aid-compatible assistive listening movement is now growing. The Hearing Loss Association of America-"the nation's voice for people with hearing loss"-has long urged that "telecoils be given the prominence they deserve as a valuable hearing aid feature that will allow the expanded use of assistive listening devices." American Academy of Audiology Career Award winner Mark Ross, PhD, concurs: "I would strongly recommend that just about every hearing aid include one," (preferably, he adds, with enough vertical orientation to support loop reception). HLAA has also been a kindred-spirited advocate of hearing-aid-compatible phones, which harness the same telecoil that receives magnetic signals from induction loops.

The Michigan and California Hearing Loss Associations are similarly advocating hearing-aid-compatible assistive listening. As the California association puts it: "In all new and extensively remodeled buildings, wherever there is a public address system, a loop should be permanently installed."

From Tucson, Albuquerqueand Silicon Valley to Wisconsin in the Midwest to New York City in the East, consumer initiatives are promoting hearing loops for people with hearing loss. Recent installations include rooms in the U.S. Congress (including the main chamber of the U.S. House of Representatives), the Museum of Modern Art classrooms, the Kentucky Derby Museum, the world's largest Jewish house of worship, and various National Park Service venues. As the research director of one loop manufacturer wrote recently on the Yahoo! "Loops and Telecoils" discussion board, "A retired audiologist who recently set up a [hearing loop] practice commented to me that his timing was right. I responded that if he were embarking on such a venture 10 years ago, he'd have been frustrated. But thanks to the activism of passionate and talented people. awareness and acceptance are at a height that I personally have not seen in my many years in the field."

Responding to the growing consumer wish for assistive listening that is affordably hearing-aid-compatible, the last half of 2008 has witnessed the advent of two new American loop manufacturers. One is a partnership with the UK firm, which pioneered the London taxi loop and has sold tens of thousands of small loop systems for transient venues. The other is an offshoot of a West Michigan audio engineering firm which has designed and installed hundreds of institutional loop systems in Michigan and beyond. Both are introducing newly engineered products for the national market. The existing loop manufacturers have also introduced a variety of new products, including looped clipboards, behind-the-ear silhouettes that connect with cell phones and plug-and-play countertop loop units.

Serving Patients and the Public

The success of our West Michigan initiative can be credited partly to our wonderfully supportive area hearing professionals, who soon began encouraging our efforts, equipping most of their patients with telecoils and witnessing the beneficial results. As Jerry Owens, AuD, the former owner of my city's largest audiology practice explained, "Never in my audiology career has something so simple helped so many people at so little cost."

Many audiologists have written me via www.hearingloop.org to indicate their eagerness to introduce hearing loops to their offices, to offer home loops to their patients, and to promote the looping of their communities. One early pioneer, Santa Rosa, CA, audiologist Bill Diles, has for several years equipped nearly all his new patients-more than 1,500 so far-with home TV room loops, which come bundled with the hearing aid purchase. The installations initially were done by his 17-year-old son, who often used fish tape to snake wire under carpet. When Diles surveyed a sample of his patients (both those with and without installed loops) he found a striking result. Three percent of those without a home loop system reported the highest level of satisfaction with their hearing aids, compared to 53 percent of those with home loops. The end result, thanks to happy patients and word-of-mouth, has meant "tremendous growth" for his practice.

Following Diles' lead, engineer Terry Simon, who is married to a West Michigan audiologist, is working with a colleague to train hearing professionals nationwide who wish to strengthen their practice and service by installing hearing loops in the homes of their patients and in community facilities. His firm anticipates having 180 trained installers by the end of 2009.

Looking to the Future

Sergei Kochkin, PhD, director of the Better Hearing Institute, argues that the way to increase adoption of hearing aids, and to reduce returns, is to increase their utility. Amen! Double their functionality-with simply operated wireless receivers in every hearing aid-and then word-of-mouth advertising will promote hearing aids, with a subsequent lessening of the stigma of hearing instruments (a stigma that, sadly, some hearing professionals have accentuated with ads promoting the cosmetic benefits of CIC aids that hide supposedly embarrassing hearing loss).

Thanks to the increased popularity of BTE aids, to the spread of hearing-aid-compatible phones, and now to the increasing adoption of hearing-aid-compatible assistive listening, the percentage of new hearing aids coming with telecoils has soared. A decade ago, 30 percent of hearing aids reportedly included telecoils. Today, according to two recent practitioner surveys, 62 percent do. Among those with the greatest need for hearing assistance, such as the HLAA members surveyed, more than 8 in 10 have telecoils. And the momentum continues. With joint support from both hearing professionals and consumers, the Arizona legislature recently enacted a bill requiring hearing professionals to explain telecoil usefulness to people purchasing hearing aids.

Might some future technology supplant telecoils and loops by providing an even better wireless option? If so, bring it on. But to be widely applicable, an effective alternative technology will need to be:

• low power (so as not to drain batteries),

• wide range (and workable not just over short Bluetooth®-like distances),

• inconspicuous (for those who are resistant to visible headsets),

• miniaturized (and able to fit in most hearing aids),

• cochlear-implant-compatible (which hearing loops are, thanks to telecoil inclusion in today's CIs), and

• inexpensive (or essentially free, as are the telecoils that most of us-especially those of us with the greatest hearing loss-already have for phone use).

For now and the near-term future, hearing loop technology is the only game in town that meets these criteria. ReSound USA President Bjørn Christ reports being "hard-pressed to come up with competing technologies that will seriously challenge the performance/price equation of loops in even the next 5 years," adding, "And from a cosmetic/stigma point of view, telecoils are even finding their way into micro-BTEs."

Given a) the growing consumer demand for hearing-aid-compatible assistive listening, b) the advent of new loop products and marketing, and c) audiologists' increasing desire to enhance the functionality of their core product (rather than compete with it), I am optimistic that we may achieve seamless hearing aid compatibility for both phones and assistive listening. If we can double the utility of hearing aids, then surely we will also decrease the stigma of hearing loss and hearing aids, increase public support for insurance and Medicare/Medicaid reimbursement and ultimately double the proportion of Americans who benefit from hearing technology. And that will be a happy future for both people with hearing loss and those of you who serve us.

Social psychologist David G. Myers, PhD, (davidmyers.org) is a professor at Hope College, Holland, MI, author of 17 books (including A Quiet World: Living with Hearing Loss, Yale University Press) and creator of the nonprofit, public service Web site www.hearingloop.org.