Over the 23 years that I’ve been a hearing aid wearer, I’ve been described by several of the audiologists I’ve worked with as a “challenging” patient. Hopefully, for the most part, it’s a description that’s offered with a wry smile. I can’t tell you if that’s the case though, since I’m totally blind.
It’s not possible for me to resort to lip reading in noisy environments, or otherwise use sight to supplement my hearing aid technology. So I need it to be as good as it can be, in as many listening environments as possible.
Totally blind hearing aid users like me are a tiny minority. Since the majority of people develop vision loss when they’re over the age of 80, those of us who are hearing aid users, totally blind and of working age are an even smaller subset of that tiny minority.
I hope that this article may help audiologists and hearing aid manufacturers understand the challenges I face as an active, employed totally blind person who wears hearing aids.
I don’t want this article to be perceived as a pity party or a rant. I’ve seen hearing technology evolve in remarkable ways over the last nearly quarter century, and I’m excited about what will be coming next. The aids and accessories I’ve used in that time have allowed me to travel the world unaided in a number of senior executive roles, continue my work as a broadcaster and podcaster, and helped me be a loving husband and dad.
Some of the senior roles I’ve held have been in assistive technology product management, and my work in broadcasting and podcasting, running my own home studio, means I know just enough about audio to be dangerous. So I write this post with optimism, in the hope that articulating my needs may lead to even more suitable products in future.
I don’t see where you’re coming from
The most important thing for an audiologist to understand about blind hearing aid wearers is that maintaining directionality is critical. I’m talking potentially life and death critical.
Fitting one hearing aid so there is a sound imbalance, or in any way not providing binaural hearing when that’s possible will affect a blind person’s spatial awareness and impede their quality of life.
Like everyone else, most of us who are blind hearing aid wearers want to play a full part in our communities. So we’ll travel independently with the aid of a white cane or guide dog. During our travels, we’ll encounter traffic. It’s not a trivial task to fit a hearing aid so that it helps a blind person to negotiate a busy intersection.
City streets can be noisy places, and hearing aid users want to be able to travel in comfort. That normally means eliminating a lot of background noise.
But when a blind person gets to an intersection to cross the street, traffic is no longer background noise, it’s essential information. Sometimes, a fellow pedestrian may offer assistance, or the blind person may ask for it. But assistance may not always be available, and for many of us, negotiating traffic is doable with appropriate fitting.
Often, the solution is to configure a separate hearing aid program specifically for traffic situations. Such a program is a middle ground between all the digital filtering that adds a lot of compression and otherwise makes a noisy environment comfortable, and a music program which may be too linear and could even cause further damage to hearing in a noisy traffic environment.
In meetings, noisy restaurants and when I want to converse with someone in a crowd, I use an FM microphone. I’m thankful for it every day, and since I obtained the current device I use, a Phonak Roger Pen, I’m less inclined to avoid difficult situations that I would have gone out of my way to avoid before. But there is one issue that I’ve struggled to convey to audiologists about every FM system I’ve used.
FM systems disadvantage blind people in certain situations, because they deprive us of directionality. None of the FM systems I’ve been offered feature a stereo option. When I’ve raised this with some audiologists, their immediate response has been that sound is coming through both hearing aids, so it’s stereo. It is not.
Stereo comprises two independent audio channels – a left channel and a right channel. In a crowd where noise isolation is the critical objective, listeners probably want a mono source, utilising all of the intelligent noise cancellation available.
But consider this common scenario for me as an executive. When I go into a meeting, it’s a pretty friendly hearing environment. Hopefully if the meeting is well-behaved, there’s only one person speaking at a time, and the acoustics are pretty good. Nevertheless, I’ll still benefit from amplification. So I’ll put my FM system microphone in the middle of the table, and switch it on. The trouble is, everything then becomes mono. I can’t face the person who’s talking, because using an FM system, everyone is perfectly centred. I can try to memorise where everyone is before I switch the FM on, but I may forget.
While blind people can’t make eye contact, we are capable of facing the general direction of the person we’re talking to, if only that information is conveyed. And it’s plain good manners to try and do so. I want a system that will give me mono in noisy crowds, stereo in meetings. This could be achieved by creating a device with a microphone at either end of it. One mic could be used for filtering background sounds in noisy environments, but they could provide standard left/right stereo functionality in quieter situations.
Can’t we just get along?
The rest of this article discusses what is often a frustrating clash between two sets of assistive technologies – those I use as a blind person and those I use as a hearing impaired person.
I’ll begin with some background, and explain how it is that a totally blind guy is able to write a post like this.
Every major computer operating system can be used by a blind person, thanks to software called a screen reader. Screen readers provide verbal feedback about what is on the screen using text-to-speech technology. Optionally, it’s possible to connect a Braille display, so a blind person can read in Braille what’s on the screen. Braille allows me to proof my writing with a high degree of accuracy, and is a blind person’s equivalent to print. It also means that someone who is totally Deaf and blind can use a screen reader.
I have been using screen readers since the 1980s. The text-to-speech is second nature, and I can still read text at hundreds of words per minute.
Screen readers are now built-in to all major operating systems, with powerful third-party solutions available for Windows.
Any good touch typist will tell you that they never look at the keys when they’re writing. So contrary to popular belief, blind people don’t need dictation software to use a computer. Many of us are excellent typists.
Many of our lives have been changed for the better by the smartphone revolution. Even though you may pick up your iPhone or Android device and conclude that it must be impossible for a blind person to use a modern smartphone because of the touch screen, Apple’s brilliant software engineers solved this one seven years ago. VoiceOver, a tool built into every Apple iOS device, allows blind people effective access. It’s been a game changer, allowing us not just to use a range of blindness-specific apps, but mainstream apps as well. An equivalent product, TalkBack, is available for Android.
Many people think that personal assistants such as Siri have been the breakthrough. Some of us enjoy Siri, some of us don’t, just as is the case with sighted people. It is the screen reader, not the personal assistant, that makes the real difference.
With that background in mind, let’s talk about the challenges of trying to get two sets of assistive technology to play nice together.
I’m excited about the fact that hearing aids are being controlled increasingly by smartphone apps. It allows the user interface to be kept simple for those who prefer that, but manufacturers can now include more advanced features for geeks like me. So the possibilities are exciting, as long as blind people aren’t excluded. Sadly, a bit of thoughtlessness can make exclusion easy.
Both iOS and Android offer publicly accessible guidelines describing how to ensure that apps work optimally with their respective screen readers. If hearing aid manufacturers are reading this, I urge you, in the strongest possible terms, to follow them. Accessibility doesn’t detract from visual aesthetics. Making an app accessible requires minimal extra effort, particularly when it’s thought about when the app is developed. But when all’s said and done, it’s simply the right, the moral, thing to do.
When you think you have it right, test with real blind people in real-world environments. If you don’t depend on a screen reader as we do, then chances are good you’ll make erroneous assumptions. It is possible for an app to be too verbose, impeding efficiency.
Wires are wonderful
This may seem like heresy to some, but hear me out. Despite all the advances in wireless technology, and Apple’s self-proclaimed “bravery” in removing the 3.5 mm headphone jack from the iPhone 7, I remain wired and proud of it.
Perhaps it’s not very elegant-looking, but every waking hour, I have cables running from audio shoes in my hearing aids to a 3.5 mm plug. I use this to connect directly to my iPhone or iPad, to my laptop, and to the audio mixer in my studio. So why, in this age of wireless audio and streamer products, do I take this old-fashioned approach.
For the most part, the answer can be summed up in a single word, latency. With newer implementations of Bluetooth, latency and audio quality have now reached the point where a sighted person can enjoy music and make calls effectively via a Bluetooth solution. Even without hearing aids, digital cell phones have a tiny amount of latency, and we’ve become used to it because its effect on conversations is negligible or even non-existent. But blind users are in a unique position.
As I mentioned earlier, I have my screen reader speech cranked up very fast. When I run my finger over the virtual keyboard on my iPhone, VoiceOver, Apple’s screen reader, speaks what’s under my finger. Even fractional latency introduced by newer Bluetooth technology can make the phone feel sluggish, because it is not giving me absolutely immediate feedback about what I am touching. Of course I’ve not tried every product out there and the market keeps changing, but the feedback I’ve received is that latency for screen reader users remains a very big deal with many current products.
Sadly, not every blind hearing aid wearer is going to be able to articulate this clearly. All they’ll know is that when they started using hearing aids, their phone became sluggish when texting or swiping through items, and was therefore much more difficult to use.
What most users will be able to discern, is that after a period of inactivity, the Bluetooth connection powers down to save battery. It can take a second or two for the connection to be re-established once audio is detected again. For a screen reader user, this can result in missing a lot of information. Two seconds may not sound like a big deal, but for experienced screen reader users, a lot of information can be conveyed in that time.
There are streamers out there that offer a 3.5 mm jack, so why not use one of those? The answer is battery life. On a busy day, I might be awake for 18 hours, and I need reliable access to a 3.5 mm source that will last the day. Remember, I can’t glance at a screen. Every interaction I have with a computerised device requires me to be able to hear text-to-speech. No streamer I’ve found can cut it.
In an attempt to conserve battery life, many streamers connected to a 3.5 mm jack go into a hibernation mode after a few seconds of inactivity, just as they do with Bluetooth. Since there’s no Bluetooth connection to re-establish, recovering from this hibernation mode takes a shorter time when using analogue. But it’s still noticeable. I’m an author, so I’m often at my keyboard. I write a little, then stop to think. When I start writing again, the audio fades in as the streamer wakes up. It’s a frustrating distraction and an inadequate solution. The direct audio input from the audio shoes solves all these issues.
Bluetooth continues to get faster and consume less energy. I look forward to further findings on what, if any, impact Apple’s W1 chip has on latency for VoiceOver users, and whether hearing aid manufacturers will adopt it. But for now, latency issues for screen reader users are a serious, and little-understood disadvantage of wireless solutions.
In Disney’s movie Pinocchio, Jiminy Cricket accompanies Pinocchio everywhere, serving as his conscience. We haven’t quite got the conscience function working yet, but many blind travellers are now accompanied by smartphones running navigation technology. This may comprise mainstream technologies such as the maps applications from Apple and Google, but those apps are often supplemented by blindness-specific apps. A sighted traveller can look around and see the names of businesses they’re passing, and read street signs. A blind person cannot, so blindness-specific apps provide such information.
Blind people who don’t require hearing aids often use wrist-worn speaker bands, light-weight headphones, or the increasingly popular choice, bone conduction headsets such as those manufactured by AfterShokz. The key here is to get the travel information required, without covering one’s ears and impeding the vital auditory clues necessary for navigation.
Depending on the severity and nature of the hearing loss, bone conduction headsets may be viable for some hearing aid wearers. Others will need a way of getting this information via their hearing aids. This can be quite a challenge depending on the hearing aid being used. The key to success here is being able to hear audio from a smartphone clearly, without affecting the program being used by the microphones in the aid. To be effective, the connection between the hearing aid and the smartphone needs to be always on. If it is not, by the time the connection has detected that audio is being sent from the smartphone, the street or business name will have been missed.
Now, perhaps, you can appreciate why I’ve been called a “challenging” audiology patient.
I’ve been fortunate to work with audiologists who rise to the challenge. Audiologists who are willing to learn about my blindness assistive technology and how they can assist me to maintain my busy life using the best available hearing technology for my needs. They’ve worked closely with representatives of hearing aid manufacturers.
Sadly, I’ve not been able to talk with people at the product management level of any hearing aid company, despite having had assistive technology product management experience myself. My door is always open. Hearing aid manufacturers are overlooking a treasure-trove of useful information by not engaging closely with blind hearing aid wearers. We totally depend on the aids, without any visual backup. Many of us have learned to make the most of what hearing we have, and are critical listeners.
But most important of all, I believe our needs are too often overlooked, because they are not understood. I hope that this article may help to change that.
About Jonathan Mosen
Jonathan Mosen is a New Zealand-based advocate, author, podcaster, and assistive technology consultant. He has held senior roles in blindness assistive technology companies. Totally blind since birth, Jonathan has progressive hearing loss and constantly searches for the best hearing technology to allow him to be productive.
Last modified: November 2, 2016