FM and Cochlear Implants

2. Miranda Weidle, MS Pediatric and FM Specialist FM and Cochlear Implants

3. Must have something to do with the wireless technology!

4. Personal FM Systems & Cochlear Implants For many years, personal FM systems have been used to assist hearing aid users in hearing better in difficult environments. However, many clinicians working with cochlear implant users have been reluctant to consider personal FM because of: the cumbersome nature of hard-wired FM systems coupled to the patient’s processor multiple parameters that must be adjusted with many FM systems, including: ratio of the FM input to the processor mic input (i.e., Mixing Ratio) gain of the FM receiver Input Dynamic Range (IDR)

5. Try getting a teenager to wear this!!!!

6. History of FM technology generations • Birth of Bodyworn FM systems • Miniaturized FM (MicroLink) • Miniaturized Universal FM (MLx) • Multifrequency FM (MLxS) 2007 Dynamic FM

7. Dynamic FM: 7 World-First Features • Dynamic Speech Extractor • AutoConnect • Datalogging • Multitaker Network • Monitoring • Sound Check • Channel Finder

8. Dynamic Speech Extractor Automatic Brilliance • The Dynamic Speech Extractor is capable of extracting speech in the toughest environments and prioritizing it through the hearing instrument • Sub-features: • AFMA Adaptive FM Advantage • SNC Surrounding Noise Compensation • VAD Voice Activity Detector • EAFMA Easy Adjustment of FM Advantage

9. Dynamic Speech Extractor Adaptive FM Advantage Traditional FM: • The FM gain or FM Advantage is set to a fixed value • 10 dB FM Advantage is Rx by ASHA as a good compromise: • Optimum FM signal strength • Good environmental awareness • Audibility of the own voice • But it is a compromise between the different listening goals

10. Dynamic Speech Extractor Adaptive FM Advantage • AFMA (Adaptive FM Advantage): Adjusts the FM gain depending on the environmental noise level • Additional gain is added if the background noise level increases to significantly improve speech intelligibility • The switch to select FM only or FM + M becomes obsolete! • AFMA is not a compromise

11. Dynamic Speech ExtractorAdaptive FMAdvantage • Ambient noise levels are monitored continuously by the transmitter and measured in speech pauses • If the ambient noise rises to =/> 57 dB SPL, a command is sent from to the Dynamic FM receivers to increase the FM Advantage • This command is a digital code, sent with the FM signal at a different, inaudible audio frequency • If the noise level drops again, the FM Advantage follows smoothly

12. What happens in the hearing instrument? • The blue bar symbolizes the HI signal level • The FM level is usually louder • Dynamic FM increases the FM level in noisy situations • Compression will reduce both the HI and the FM signal FM Advantage FM FM HI HI HI output signal levels

13. SNR at ear level for different technologies No FM Traditional FM Dynamic FM 40 35 30 25 20 15 10 5 0 -5 -10 -15 -20 SNR (dB) 40 45 50 55 60 65 70 75 80 85 Surrounding Noise (dB SPL)

14. Dynamic Speech Extractor: Voice Activity Detector • No Speech • no useful information, and the transmitter informs the receivers by the same sub audio wireless data link that there is no need for amplification and the receiver is silent • Speech Present • As soon as the teacher is talking, the receivers instantaneously start transmitting the FM signal again

15. Dynamic Speech Extractor: benefits of the Voice Activity Detector 1st benefit: If a teacher is not talking, the input level at the FM microphone is low. That means without the VAD, the gain is relatively high and there may be ambient noise audible in the FM signal. With the VAD ambient noise is suppressed

16. Dynamic Speech Extractor: benefits of the Voice Activity Detector 2nd benefit: If the distance between talker and listener is larger, channel noise may become audible. This is especially noticeable when the teacher is not talking. With the VAD, the receivers are silent when speech is not present and FM channel noise is no longer audible

17. Dynamic Speech Extractor — Easy Adjustment of FM Advantage • The professional talks into the microphone of the transmitter, the child indicates if it is too soft or too loud • The range is ± 8 dB and the step size is 2 dB • The remote adjustment takes place via the wireless sub audio data link and is stored in receivers • The FM Advantage remains adaptive; this procedure just moves the dynamic behavior up or down

18. Dynamic Speech Extractor: Conclusions • Comprises: • Adaptive FM Advantage & Surrounding Noise Compensation • Voice Activity Detector • Easy Adjustment of FM Advantage • Biggest improvement in signal to noise ratio in the history of the industry • Fully automatic

19. AutoConnect – Always Right on Target • Universal FM receivers are connected to different HIs and CIs • The audio input of the device has a certain electrical resistance, the impedance • If the impedance is high, the FM signal level is high • If the impedance is low, the FM signal is low • One can program the desired FM Advantage to correct for off-sets and variations in the audio-input impedance.

20. DataLogging FM Providing comprehensive insight • Usage time of the transmitter • Used audio input type: microphone or audio input • Average noise level in the classroom in 15 minute intervals • Microphone being muted for more than 15 Min • Monitoring with time stamp and result • Low battery

21. MultiTalker Network: A major breakthrough in team teaching There is a strong need for systems with more than one transmitter • Several teachers • Teacher and therapist • Teacher and audio or video equipment • Other students • 2 Parents

22. MultiTalker Network with inspiro Transmitter in control of the MultiTalker Network standby active Wireless data link networkat 2.4 GHz between all transmitters

23. Monitoring Parameters monitored: • Receiver channel • Audio shoe connection integrity • FM receiver settings • FM gain • Battery status • User name / serial number • Beeps presented to child

24. SoundCheck: Acoustical Awareness • Online measurement of ambient sound pressure level • Differentiates between background noise and level of teacher’s voice • Helps to optimize the microphone position • Helps to keep noise levels low in class

25. Dynamic FM is really easy • Dynamic Speech Extractor • Provides 50% improvement • AutoConnect • Available today with all CIs and HIs • DataLogging FM • Available today with all CIs and HIs • MultiTalker Network • Available today with all CIs and HIs • Monitoring • Available today with all CIs and HIs • SoundCheck • Available today with all CIs and HIs • ChannelFinder • Working properly with CIs abd HIs

26. Personal FM Systems & Cochlear Implants For many years, personal FM systems have been used to assist hearing aid users in hearing better in difficult environments. However, many clinicians working with cochlear implant users have been reluctant to consider personal FM because of: the cumbersome nature of hard-wired FM systems coupled to the patient’s processor multiple parameters that must be adjusted with many FM systems, including: ratio of the FM input to the processor mic input (i.e., Mixing Ratio) gain of the FM receiver Input Dynamic Range (IDR)

27. Mixing Ratio • Mixing Ratio: Controls the ratio of sound received from the processor microphone and the FM system (or other auxiliary source). • This allows the recipient to hear her own voice and environmental sounds while also listening to the primary signal from the FM system. • The relative strength between the signals from the processor microphone and the FM system can be controlled through adjustment of the mixing ratio. • The various mixing ratio options differ across cochlear implant manufacturers.

28. Advanced Bionics Corporation • Audio Mixing Ratio: Controls ratio of sound between processor microphone and auxiliary source. • Audio Mixing Ratio Options: • 50/50: The signal from the processor microphone and the signal from the FM system receive equal emphasis. • 30/70: The signal from the processor microphone is attenuated by 10 dB resulting in greater emphasis for the FM signal. • Auxiliary Input Only (Aux Only): The processor microphone is deactivated, so the FM signal is the only input the recipient receives (“FM only”).

29. Cochlear Corporation Nucleus Freedom • Accessory Mixing Ratio: Determines the ratio between signals from the processor microphone and auxiliary source. • Accessory Mixing Ratio Options: • 1:1 = No attenuation to speech processor microphone (equal emphasis for processor signal and FM signal). • 2:1 = Processor mic attenuated by 6 dB. • 3:1 = Processor mic attenuated by approx 10 dB. • 10:1 = Processor mic attenuated by 20 dB. • 3:1 is default setting (soon to be changed to 2:1?).

30. Speech Recognition in Noise Results – Advanced Bionics Wolfe et al., in press, J of Amer. Acad of Audiology

31. Does the DSE work when ASC is enabled for Freedom users? YES!

32. ZoomLink+ SmartLink+ Transmitter Options for Cochlear Implants EasyLink+ Inspiro

33. Compatible with Devices from All Manufacturers Advanced Bionics Cochlear Med-El

34. Auria and Harmony with iConnect

35. Inserting the Battery • iConnect adapter is powered by a Zeni Power size 10, zinc-air hearing aid battery • Battery can only be inserted in one direction • Users can expect 20-30 hours battery life with no reduction in PowerCel operating time

36. FM Check & Troubleshooting Plug MLxi into Headset FM Checker

37. Nucleus Freedom with MicroLink Freedom • Design-integrated and electronically-integrated for appearance and comfort. • Adds only 6 mm to Nucleus Freedom size • Cochlear style battery assembly –for efficiency and reliability • No audio shoe or interface. • Leave attached for convenience • All colors available 6 mm

38. Freedom Body Worn with MLxi • MLxS receiver attaches via accessory cable to Nucleus Freedom processor • In silver only to match MLxS • 4 cord lengths: 30, 50, 80 and 100 cm • Direct plug-in connection to Bodyworn controller • No audio shoe required

39. Attach MLxi 2 1 Plug in MLxS/i to Bodyworn FM cable Twist off and remove BTE controller 4 3 Set MLxS switch to two dot • • position Attach cable to processor and to bodyworn controller

40. Activate MicroLink Freedom • Turn on Nucleus Freedom Processor • Press and hold Select button for ~ 2 seconds • Program will appear in display • The Freedom Processor recognizes the accessory and applies the Accessory Mixing Ratio (default is now 2:1)

41. Using Freedom in M or T mode with MicroLink Freedom attached FM+M

42. Listening to FM and Troubleshooting • Plug monitoring phones into the headset jack on the bottom of the ML Freedom • Turn on Freedom speech processor • Listen for 45 sec to the input from the on-board mic and FM transmitter

43. 3G with MicroLink Adaptor and MLxi receiver

44. ESPrit 3G with MyLink

45. MED-EL Opus 2 • With the angled battery pack, the Opus 2 uses an FM battery cover for FM access • The MLxi plugs directly into the speech processor • No other accessories needed

46. In Summary • FM provides the most effective means of improving listening for soft speech, speech at a distance and speech in the presence of background noise • Dynamic FM is available for all speech processors that are compatible with a universal FM receiver (MLxi) • Dynamic FM offers similar benefits to CI recipients as to HI users- resulting in an additional 50% improvement in listening noise over traditional FM

47. www.eschooldesk.com • Configurator • Set up and user guide • How to use… • Videos • FM basics webinar (readings and resources) • Interactive troubleshooting • Variety of classroom cheat sheets, daily monitoring instructions, etc.