While the United States tends to be on the cutting edge of new technologies, sometimes it pays to looks to other parts of the world for the latest advances and ideas. The audiology profession is no different.
When Juliëtte Sterkens, AuD, originally from the Netherlands and currently residing in Oshkosh, WI, started introducing and popularizing hearing loop technology in her community, many people thought they were seeing the latest advance to help individuals with hearing loss. But in reality, the idea had been around for quite some time.
"I was learning about this in in my studies--back in the late 1970s--in the Netherlands," says Dr. Sterkens.
|LeRoy "Max" Maxfield and Juliëtte Sterkens, AuD, are combining his engineering background with her audiology experience to bring hearing loop technology to their Wisconsin community. Photo: Amanda L. Lauer.
But it wasn't until October 2008 that Dr. Sterkens realized hearing loops would not only be good for her patients; they also make great sense from an audiology practice point of view. Today, Juliëtte combines her audiology experience with the engineering background of her husband, LeRoy "Max" Maxfield, to bring hearing loop technology to the Fox Valley in Wisconsin.
Juliëtte and Max met while Max was stationed in Europe as a captain in the Army. Juliëtte's father was a Dutch military officer, and for an audiometry assignment his daughter tested his hearing.
|Max and Juliëtte have had great success in looping several local churches.
"I found my father had a tremendous high frequency hearing loss most likely due his almost 40 years of military service," she laments. "I guess you could say that really got me thinking about hearing loss and its effects on families."
Upon moving to the U.S. with her new husband, Juliëtte switched her focus from speech pathology to audiology. By 1988, she'd purchased a private practice in Oshkosh with a partner, Doreen Jensen, who recently sold her share of the business to Dr. Candy McGinnis Dahl. The duo owns and operates Fox Valley Hearing Center Inc., with offices in three locations.
In October 2008, Dr. Sterkens attended a Wisconsin Hearing Loss Association of America (HLAA) meeting and heard a presentation by David Myers, PhD, from Holland, MI, on the value of hearing loop technology. "While listening to Dr. Myers, all my audiology bells starting ringing," she laughs. Max offered to retire from a career at Oshkosh Corporation--something he had been wanting to do for a while--to help in her endeavor, and the couple set out to bring hearing loop technology to their community.
"My engineering background gives me the required expertise to do smaller
installations," says Max. "I can equip a house, smaller churches--but for the larger jobs, such as an opera house or a school auditorium, you need a dedicated crew and in-depth audio-engineering expertise to connect to the complicated digital existing PA systems."
OUTSIDE HER COMMUNITY:
Juliette Sterkens, AuD, serves on the "Get in the Hearing Loop" task force, a joint project of the Hearing Loss Association of America (HLAA) and the American Academy of Audiology (AAA). She will participate in the 2nd International Hearing Loop Conference, June 18-20, 2011, in Washington DC. Dr. Sterkens also has been invited to give presentations on hearing loops at the Georgia Academy of Audiology, January 2011 in Marietta, GA, and the annual AAA AudiologyNow meeting, April 2011 in Chicago.
Fortunately, a local audio company has gladly stepped in to complete those larger-scale installations.
How It Works
"When people come to see me in my practice," says Dr. Sterkens, "they don't come in be cause they have a hearing loss. They tell me, 'I can't hear my grandkids,' 'I can't hear my spouse' or 'I can't hear in church.'" The practice keeps a list of churches and places where patients complain of understanding difficulties.
Although hearing aids are available to improve individual situations, such devices still don't offer normal hearing. "What some of my clients require are signal-to-noise ratio improvements in the 10 to 20dB range, something even the most advanced digital hearing aids cannot deliver," Dr. Sterkens explains. "A hearing loop system does this beautifully and is simple to use. All my clients have to do is push a button."
"Even people with normal hearing often struggle with understanding in church or in an auditorium--places with lots of natural reverberations," adds Max. "Loop technology doubles the functionality of hearing aids and gives an individual their own personal PA system in their ear. So it's like listening in a private room--which is really what they need."
Max offers the scientific explanation for the process: "A hearing loop provides a magnetic, wireless signal that is picked up by the hearing aid's T-coil. The PA microphone signal is transformed into a current'," he begins. "These currents are rather weak, but they fluctuate according to the signal that's coming from the PA system. From there, the telecoil coil in the hearing aid generates voltage that the hearing aid's amplifier then amplifies according to the user's needs."
|Leroy "Max" Maxfield does hearing loop installations in homes and small churches. Dr. Sterkens says, "My husband deserves a lot of credit. Without him, his hard work and his dedication to make this effort work, it would never have happened. We have spent 40 to 50 hours a week over and above managing my practice to get this initiative off the ground."
In other words, this is another way of getting a signal to the hearing aid. "Think of the loop broadcasting the sound--wirelessly--to the hearing aid," says Dr. Sterkens. "I've used the term 'wi-fi'--that's not exactly what it is, but if you talk to people, they understand this concept."
Max also explains the home installation process. "Most modern televisions have an audio output--sometimes several of them. I simply connect the hearing loop to this RCA or line out from the TV or cable box. The home loop doesn't only improve the understanding of the person using the hearing aid. Sometimes I don't know who is happier, the hearing aid user or the spouse." Dr. Sterkens thinks audiologists should be routinely recommending these simple home loop amplifiers. "A handy grandson can put one in less than an hour," she explains.
"The connection for audiologists to hearing loops is very important--I am lucky that Max has been able to get the ball rolling in the Fox Valley but not everyone has to be able to install large hearing loops," she says. "I would like to see audiologists advocate for hearing loops in their communities. That way they can really maximize their patients' experiences with their hearing aids. Hearing loops are to hearing aid users what wheelchair ramps are to those in wheelchairs. One is no good without the other."
She is of the opinion that hearing loops make hearing aids so much more useful, especially in places where hearing aids were of limited benefit before.
Impact on Clients
Dr. Sterkens reports her clients have been amazed with the results. "I've literally seen people cry when they realize for the first time how easy it is to hear in a loop," she says. "They are also surprised to find out that a T-coil has been in their instruments all along, and that all it needed was activating!"
|Dr. Sterkens hopes this logo will be implemented across the United States. "We now dream of a looped America with accessibility for every T-coil-equipped hearing aid user," she says.
"I've heard stories of people using hearing loops in particularly reverberant venues," adds Max, "and report that they could hear the speaker better than a companion with normal hearing. I'm not saying it happens all the time, but we have heard that--and it's remarkable."
For audiologists who want to show the benefits of the hearing loop system--and help their clients in the process--Dr. Sterkens recommends installing a hearing loop in a waiting room. "Find an audiology supply company--you can get a small loop for well under $200," she says. "As a professional, you need to be able to demonstrate [the potential impact of the device]."
To illustrate her point, Dr. Sterkens often will take clients into her own practice's waiting room for an example of the improvements they will experience. "Once they understand what I'm doing, they gladly take hearing loop information to their church council or organizations or they tell me 'I want to loop my living room.'"
As previously mentioned, small, waiting-room type devices can be purchased from most supply companies at very reasonable prices. The prices of larger-scale installations vary according to size, complexity and other mitigating factors, but Max attempts to give some ballpark figures.
"A simple church can run around $2,500 to $5000--depending on the size, basement access as long as the church is mostly constructed of wood. Large, more complex venues or places with lots of metal or that lack basement access can quickly become more costly," he says. "Locally, we have a church that's a converted department store--that one cost around $13,000 because it required the wire to be installed in the grout of the tile floor." Max admits that he did not attempt that installation. "Some things are beyond my capability," he laughs.
Together with Dr. Myers from Michigan and other loop advocates around the country, Dr. Sterkens has reached out to other audiologists and hearing care providers as well as audio companies to help spread the technology beyond her own community. She serves on the "Get in the Hearing Loop" task force, a joint project of the Hearing Loss Association of America (HLAA) and the American Academy of Audiology (AAA). The task force has launched a campaign to encourage consumers, audiologists and other hearing professionals to "get in the loop" for hearing assistive technology, with a primary focus on hearing loops and telecoils, in order to improve accessibility for the 36 million Americans with hearing loss.
The campaign will culminate in the 2nd International Hearing Loop Conference,
June 18-20, 2011, in Washington DC, where attendees will learn about the technology, installation techniques, user perspective, integration of loop technology with FM and infrared systems, and the status of hearing loop installations in the United States and elsewhere. The conference is hosted by HLAA and overlaps the HLAA Annual Convention that runs June 16-19, 2011. There will be discounted registrations for attendees and exhibitors who attend both events, which will be located in the same facility.
Dr. Sterkens also has been invited to give presentations on hearing loops at the Georgia Academy of Audiology, January 2011 in Marietta, GA, and the annual AAA AudiologyNow meeting, April 2011 in Chicago.
"Our goal initially was to 'loop the Fox Valley' but it quickly grew into something much bigger," says Dr. Sterkens. "We now dream of a looped America with accessibility for every T-coil-equipped hearing aid user."
Rob Senior is managing editor at ADVANCE and can be reached at RSenior@advanceweb.com.