By Larry Medwetsky Mobile Device Apps for People with Hearing Loss Expanding the Horizons of Hearing Access Here are some amazing apps for people with hearing loss that are now available for download to smartphones, tablets, and the Apple Watch.
In the July/August 2015 Hearing Loss Magazine, I wrote an article concerning hearing aid connectivity. This technological advance has allowed hearing aid users to connect their hearing aids directly by Bluetooth® or indirectly through an intermediary device to external sound sources like a cell phone or television. Connectivity can also allow hearing aid wearers to hear others across the room as if they were speaking right next to them. This is made possible through the use of the paired device as a remote microphone. In this article I will write about other significant advances for those who have a hearing loss; that is, the myriad of applications— “apps”—which have been developed for individuals with hearing loss for download to smartphones or tablets. It is estimated there are more than one billion users of tablets worldwide. By 2016 there will be more than two billion owners of smartphones. Much of the popularity of apps can be attributed to their lower cost than comparable commercial products. With a simple download of these apps, people with hearing loss have the ability to transform their smartphone or tablet for various hearing-related applications.
Apps by Their Function In this article, I have categorized the types of apps available by their functional purpose. Refer to the end of this article for a list of apps in these categories as well as the cost for downloading them. You might also want to search these category keywords online to find more offerings. Please note that I have not purchased or tested most of the apps I will be discussing nor is my mention of any of these products meant to imply any form of endorsement. I have however, researched and compiled a list of apps and used their website descriptions. There 20 Hearing Loss Magazine Visit us at hearingloss.org and follow @HLAA on Twitter are some app categories where I will measurements depends upon the note caveats to their usage based on my calibration of the headphones knowledge and experience. before administration of the test and the amount of noise in the Mobile Device Apps Serving background environment. If not as a Hearing Screening Device addressed, the latter can often Hearing screenings typically use calibrat- result in raised hearing thresholds ed audiometers for the purpose of iden- when conducting a hearing tifying whether one has a hearing loss, screening. This might, in turn, and possibly the extent of a hearing loss lead to a false referral for a via air conduction pure tone threshold comprehensive hearing test. testing. Recently, software for conduct- ing hearing screenings/air conduction To determine the exact level of threshold testing has been available for the background noise requires a Sound download to smartphones or tablets. Level Meter (SLM) app that can ensure Two uses for this type of app include: for the output meets a target standard hearing professionals to conduct hearing within an acceptable level. In my review screenings in remote or low-income areas; of many of the hearing screening apps and, for consumers who suspect they currently available, most of these do not might have a hearing loss to conduct incorporate or suggest calibration, nor their own initial screening. do they discuss the type of headphone In Third World countries, this that should be used. Consequently, software is used as a mobile hearing if one does not address these issues, Example of a hearing screening app screening device to easily screen a lot one has to be cautious relative to the (uHear 2.0 hearing screening software of people who might not have access results obtained, as they might result from Unitron). Photo courtesy of Unitron. to hearing screening. Professor De in inaccurate findings. Wet Swanepoel from the University However, I did note some hear- Amplifier Apps of South Africa along with colleagues ing screening apps that do incorporate Recently, apps have become available from other countries have developed a calibration process as well as a to transform a mobile device into a hearScreenTM, a mobile hearing means of addressing any background personal sound amplifier. Amplifier screening app, to conduct hearing noise present. The hearScreenTM apps typically use the microphone of screenings in community-based pro- app by Swanepoel and colleagues is the mobile device to pick up sounds grams in South Africa. In conducting now commercially available to the and then apply processing to the these hearing screenings, headphones public, while an app developed by incoming signal so that the individual were calibrated (the software was pro- Na and colleagues also shows much can hear more clearly and easily. There grammed to ensure the desired output promise. Note that the hearScreenTM are a wide variety of amplifier apps; levels), and real-noise monitoring app must be purchased with the however, some of these only increase was done to ensure that background Sennheiser headphones for which it the overall volume, while others provide noise would not interfere with the has been designed. In addition to these similar volume-control options found reliability of the results obtained. In aforementioned apps, a number of within a basic hearing aid. The more their field studies, Dr. Swanepoel and hearing aid manufacturers, including comprehensive apps also include his colleagues found that they were able Starkey and Unitron, also offer down- options that can focus on sounds that to obtain results comparable to those loadable hearing screening apps though are far away or those that are close up, obtained in an audiologist’s office. from what I can tell they do not while some of the sites also claim their In a paper examining hearing incorporate any calibration process. apps can decrease background noise. health care apps for mobile devices, Na An alternative for individuals who I will first describe some of (2015) indicated a number of factors do not feel they have the technological the many apps that are available for that need to be considered when using know-how to run a mobile app, or are download, starting with the simpler mobile technology to conduct hearing not ready to schedule an appointment ones. I will then offer my opinion as screening/testing. These include: with an audiologist, is hearing screening well as discuss a number of caveats to • the frequency response of the offered in the community from service their general usage. headphones used can affect the organizations such as the Lions Club TV Louder is one of the simplest accuracy of the hearing screening. and Sertoma or various hearing health- amplification apps. All one has to do • the accuracy of app-based hearing related practices. continued on page 22
Like HearingLossAssociation on Facebook September/October 2015 21 Apps continued from page 21 iPhone. Directional microphones pick up sounds more easily from in front of is plug in the headphones and tap the listener than from other directions the program-on button. To adjust the making it easier to hear a speaker in volume to one’s comfortable listening the presence of background noise—as level, one adjusts the volume on the long as the speaker is located in front side of the mobile device. of the directional microphone). There HearYouNow consists of a are many directional microphones simple interface where the overall in the marketplace that can be used volume can be adjusted per ear; the in conjunction with a smartphone, user can also adjust the volume in three although obviously some are better separate frequency bands (low, medium and more expensive than others. and high frequency range) and there is In reviewing the various apps, a focus feature that allows you to hone it is clear that many of them can in on a conversation held close by or assist individuals with hearing loss. farther away from you. Candidates for such apps include BioAid has been designed to individuals: enhance sound clarity and regulate the loudness of ambient noise. According • who have a mild hearing loss for to the website, one does not need a whom hearing aids are not yet hearing test prior to using this app. Example of an amplifier app (HearYouNow appropriate or necessary because Instead, the user chooses between amplifier app from ExSilent). Photo they just need some additional different settings associated with six courtesy of ExSilent. amplification, basic audiogram shapes and the listener • for whom finances are a major chooses the one that sounds best. The Recently, a new app has come on concern or they are not ready to user also has control of the overall the market, whereby the manufacturer commit to the expense entailed sound level and can vary the level indicates that it is the world’s first USA by hearing aids, in which background sounds can be Food and Drug Administration (FDA) • who live in poor areas of the world, suppressed. registered medical standalone software • who might be sedentary, such as Hearing Aid Replay Lite’s main hearing aid. The Jacoti ListenApp individuals residing in a nursing features include: a volume control; a has been designed to assist individuals home who can’t get out to get their balance control to adjust left or right with mild-to-moderate hearing loss and hearing tested, or, ear volume; an equalizer to adjust is audiogram-based (i.e., the hearing • who simply are just not ready the degree of amplification across testing must be conducted by a hearing to try a hearing aid. frequencies, which in turn, allows the professional). The app consists of: left user to create two saved profiles; and and/or right ear programming; four The Facts about PSAP an option to reduce background noise. different settings—natural sound, Personal Sound Amplification Devices The app is always in a recording mode, speech, music and movie listening (PSAP) are defined by the U.S. Food thus, one can play back the last 30 modes; and an overall volume control and Drug Administration as “wearable seconds if the user has missed any key all of which are set by the consumer. electronic products that are intended information. In addition to the amplifier apps to amplify sounds for people who are In the above cases, the amplifier discussed above, there is an additional not hearing impaired.” Until recently, apps provide either an overall linear option that can be used to enhance the these devices consisted of portable boost of amplification; require the capability of a mobile device when used amplifying systems, but with the advent user to choose from various amplifier as a hearing amplifier. I first became of downloadable amplifying software settings; or, allow for adjusting aware of this when reading an article this category has broadened to include the degree of amplification across by HLAA Board member, Richard mobile devices with amplifier apps. frequencies via the use of an equalizer Einhorn (Hearing Loss Magazine, Consequently, guidelines from (i.e., in separate frequency bands, the May/June 2012). To improve his the FDA indicate that advertising on user has the ability to alter the degree ability to hear in noise, rather than websites should not imply that these of amplification provided within each relying on the built-in microphone devices are for individuals with hearing band). However, none of these apps of his smartphone, Mr. Einhorn loss, unless specifically approved by the require entering thresholds based on an purchased and attached a directional FDA—such as the Jacoti ListenApp. actual audiogram. microphone to the audio jack of his However, because these are guidelines
22 Hearing Loss Magazine Visit us at hearingloss.org and follow @HLAA on Twitter Understanding the Terms Smartphone Apps for People with Hearing Loss Air-conduction thresholds—the lowest level that an individual can For the website addresses for the hear a pure tone stimulus through headphones or earphones. apps listed below, go to the online Audiometer—the electronic piece of equipment employed by a hear- version of this article at hearingloss. org>HearingLossMagazine>Current ing health care professional to assess the hearing thresholds and speech Issue. Click on Dr. Medwetsky’s awareness and/or processing ability of an individual. article and you will see the live Calibration—the process of determining that an audiometer produces links at the end. the desired signals, at the proper intensities. Hearing Screening Apps Pure tone—a sound that has only one frequency. Hearing-Check (iPhone) Threshold of hearing—the lowest level that a particular sound’s Free presence can be perceived by an individual more than half the time. hearScreenTM (Android) No information on cost and not enforceable regulations, many point, and that it is the skill and Play it Down (iPhone) manufacturers seem to have taken commitment of the audiologist in Free liberty with following this. working with a client over time and multiple sessions that ultimately Siemens Hearing Test (iPhone) Caveats with PSAP results in the best fitting possible. If Free § I feel that prior to using a mobile the only goal is to achieve an increase Starkey SoundCheck PSAP application, an individual in overall volume level, then the (Android and iPhone) should receive a comprehensive individual will likely derive benefit Free hearing test to not only ascertain and satisfaction from the mobile one’s thresholds, but to also ensure app. However, if one is truly having Test Your Hearing (Android) there are no possible underlying difficulty hearing in many listening Free medical contraindications present. situations, then simply downloading Unitron uHear (iPhone) If so, then the individual should see an amplifier app is unlikely to Free their primary care or ear, nose and provide the desired results. throat doctor for assistance. Amplifier Apps § Reviews have shown that many Therefore, prior to downloading amplifier apps are not very good an app it is important to review these BioAid (iPhone) because they reveal significant sound apps carefully. If you are truly seeking Free delays and/or poor sound quality). a starter system to use primarily in HearYouNow (iPhone) They might also present sound quiet settings and have been cleared Free at very loud levels that could be medically, then this can be a way to damaging to one’s ears (Atcherson, go—especially if the price tag varies Hearing Aid Replay Lite (Android) 2012). from free to low cost. Cost $3.30 § Amplification provided through mobile apps is quite limited Hearing Aid Remote Apps Jacoti ListenApp (iPhone) compared to the excellent hearing As mentioned earlier, mobile devices Free aid products in the marketplace. can now be paired to hearing aids via TV Louder (iPhone) Thus, they may be useful in quiet Bluetooth® or some other transmission Free environments, but if one is looking mode. Among the options that to address hearing in a variety of this pairing allows is the ability of Hearing AId Remote Apps listening settings, these simplistic a smartphone or tablet to serve as ReSound Smart (Android amplifier app systems leave much a remote control device to adjust and iPhone) to be desired. hearing aid settings (for example: left/ Free § Perhaps most importantly, I have right volume, program memory). Starkey always felt that the purchase of Some manufacturers, like Siemens hearing aids is only the starting continued on page 24
Like HearingLossAssociation on Facebook September/October 2015 23 Apps continued from page 23 users to adjust preferred volume levels, then it may be worth your while to do so. and change audio profiles as they move In the next issue of Hearing Loss and ReSound, use an intermediary through different sound environments. Magazine, I will conclude this two-part to connect a smartphone or tablet article by discussing other downloadable wirelessly with their hearing aids. Summary applications. These include apps for cap- By downloading the manu- I have discussed some of the amazing tioning, hearing assistive technology, facturer’s respective app to the mobile apps for individuals with hearing loss tinnitus relief, and more. I hope that many device, it converts the screen of the that are now available for download to of you will take advantage of some of the mobile device to a remote control. smartphones, tablets, and the Apple apps discussed in these articles. HLM ReSound and Starkey have developed Watch. The low cost and functionality hearing aid lines that allow for direct of these apps make them attractive Larry Medwetsky, connectivity via Bluetooth® transmission options for individuals who are seeking Ph.D., associate of the smartphone or tablet, and they to conduct a hearing screening or looking professor, can be have even developed apps that allow for a basic hearing amplifier. Some caveats contacted at Gallaudet the Apple Watch to serve as a remote to their general use were mentioned, but University at control for their hearing aids. For if you are within one of the categories I larry.medwetsky@ example, the ReSound Linx and Starkey mentioned in which people with hearing gallaudet.edu. Halo apps for the Apple Watch allow loss can benefit from such applications,
24 Hearing Loss Magazine Visit us at hearingloss.org and follow @HLAA on Twitter Downloadale Apps for Captioning, Hearing Assistive Technology and More
Hearing Screening Operating Apps System Website Cost
Hearing- iPhone https://itunes.apple.com/us/app/hearing-check/id485312957?mt=8 Free Check hearScreenTM Android hearscreen.co.za Email [email protected] Cost not provided
Play it Down iPhone http://playitdown.org/ Free
Siemens iPhone https://itunes.apple.com/us/app/siemens-hearing-test/id394674665?mt=8 Free Hearing Test
Starkey Android https://play.google.com/store/apps/details?id=soundcheckmono.androidapp SoundCheck and iPhone https://itunes.apple.com/us/app/sound/id427587943?mt=8 Free
Test Your Android https://play.google.com/store/apps/details?id=net.epsilonzero.hearingtest&hl=en Free Hearing
Unitron iPhone http://unitron.com/uhearapp Free uHear
Amplifier Apps
BioAid iPhone bioaid.org.uk/project Free
HearYourNow iPhone https://itunes.apple.com/us/app/hearyounow-your-personal-sound/id569522474?mt=8 Free
Hearing Aid Android https://play.google.com/store/apps/details?id=com.ls.iris.apps.hearingaid $3.30 Replay Lite
Jacoti ListenApp iPhone https://itunes.apple.com/gd/app/jacoti-listenapp/id720203800?mt=8 Free
TV Louder iPhone https://itunes.apple.com/us/app/tv-louder/id795853896?mt=8 Free
Hearing Aid Remote Apps
ReSound Android resound.com/en-US/hearing-aids/apps/smart-app Free Smart and iPhone play.google.com/store/apps/details?id=com.resound.smart https://itunes.apple.com/us/app/resound-smart/id816203976?mt=8
Starkey iPhone http://starkey.com/blog/2015/04/halo-and-apple-watch-now-compatible No info copy did state