Consumers Still Need Telecoils and Hearing Loops–Even If They Have Bluetooth Hearing Aids
As an audiologist with over 40 years of experience, I have published numerous articles on the effectiveness and popularity of telecoil-enabled hearing aids and hearing loop systems that make them so valuable to consumers with hearing loss, particularly in public venue applications. More recent media attention has highlighted the development of new Bluetooth technologies, like Auracast, with a veiled implication that the venerable magnetic induction hearing loop systems are on the road to obsolescence.
A recent HearingTracker article by Linda Kozma-Spytek, Trends in Audio Streaming for Hearing Aids and Hearing Aid Compatibility for Wireless Phones, provides a good overview of employment of wireless technologies in hearing aids. Drawn from 10 years of HearingTracker data, it suggests more than half (54%) of new hearing aids purchased contain telecoils, while 4 in 5 (80%) contain some form of Bluetooth technology.
However, this could lead readers to jump to some mistaken conclusions. It is important that hearing care professionals, consumers, and members of the Hearing Aid Compatibility Task Force understand that while Bluetooth LE broadcast audio systems like Auracast show great promise for telephone compatibility and eventually for public assistive listening systems – the when, where, and how of this promise is yet to be delivered or determined.
 "Hearing Loop Symbol")
The international sign for availability of telecoil listening.
While the industry develops, tests, and ultimately deploys exciting new broadcast audio technologies, it is critical that hearing aid consumers continue to reap the benefits of hearing aids with proven telecoil technology to connect to telephones AND existing assistive listening systems TODAY.
In my view, misconceptions about connectivity include:
- That every user who has Bluetooth (BT) Connectivity in their hearing instruments actually uses it as their preferred way to couple to the telephone. In actuality, there are many public comments posted in Facebook groups by overwhelmed consumers who complain about their inability to pair, re-pair, or to keep iPhone or Android devices paired to their hearing aids. Additionally, not every hearing aid user owns a mobile phone, and older persons may struggle with new technology.
- That consumers specifically opted out of purchasing hearing aids with telecoils for some unexplained reason(s). In fact, there are many factors that contribute to people not getting telecoils in their hearing instruments, including: a) Their provider didn't understand or downplayed the benefits of telecoils in favor of BT coupling and rechargeable batteries; b) the brand sold by their provider did not offer a model that included both rechargeability AND telecoils,
or c) they were never told about telecoils in the first place. New HLAA chapter members report rarely being educated about the benefits of telecoils or given a demonstration by their provider. - That consumers do not want telecoils built into their hearing aids. In reality 1 in 3 consumers wanted the ability to access audio broadcasted by hearing loops as shown by another survey from HearingTracker (2018/19) that detailed the hearing aid feature preferences of nearly 15,000 consumers.
 "Lecturehall")
Lecture halls, theaters, and other large-area venues where hearing can be difficult due to distance and reverberation are greatly aided by loop systems for people with telecoil-enabled hearing aids and cochlear implants.
Existing universal system
Beyond connecting to a number of existing telephone models, telecoils connect to assistive listening systems that are in use the world over, and the value of using telecoils include:
- They do not affect the power consumption of the instrument;
- They come at very low or no cost to the user, and
- They deliver sound without audible latency, and are very easy to use.
The Americans with Disabilities Act (ADA) requires venues to provide hearing aid compatible assistive listening systems where there is audio amplification, such as government and civic venues, theaters, airports, and train stations, classrooms, etc. Existing ADA-compatible systems are hearing loop, FM, and IR systems—and each of these systems, in different ways, use telecoils to connect audio signals to a person’s hearing aid.
Hearing loops are the gold standard for assistive listening systems because they provide simplicity, immediacy, and reliability. Since 2012, I have worked for the Hearing Loss Association of America (HLAA) and its thousands of members with hearing loss as the National Hearing Loop Advocate. I have personally experienced the benefits of hearing loops (that meet the IEC 60118-4 standard) in hundreds of venues, and I have witnessed the joy and advantages loops provide its users and venues across the world. To connect to hearing loops directly, all users need is simple access to a telecoil inside their hearing device.
Market trends indicating greater telecoil and hearing loop use
The recent article by Kozma-Spytek might lead some readers to conclude that the number of telecoil-equipped hearing aids will continue to dwindle. However, multiple market trends indicate the opposite reality.
Industry:
- “Superfecta” model hearing aids are increasingly being offered by the big 6 hearing aid manufacturers. Superfecta hearing aids are defined as having these four essential features: rechargeability, extremely small form factor, direct streaming to smartphone, and telecoil.
- Google Maps has recently begun adding hearing loops—alongside wheelchair access—as an accessibility attribute within Google Maps business profiles.
- The telecoil feature has been more prominently featured in hearing device advertising by manufacturers to hearing care professionals.
- Hearing aid manufacturers have developed accessories that permit direct streaming of telecoil signals permitting retroactive hearing aid compatibility to magnetic inputs.
Hearing Loops:
- Hearing loops are gaining momentum worldwide, with installations at more and more varied venues including worship places, auditoriums, transportation hubs, and even train cars, taxi cabs and subway stations.
Professional and Consumer Outreach:
- Telecoils have increasingly been the topic of professional continuing education in the form of web-based articles, podcasts, CEU and professional lectures.
- Consumer campaigns by HLAA and the Canadian Hard of Hearing Association promote hearing loops and telecoils as an easy-to-use assistive listening technology.
- Well-known consumer hearing aid information websites, such as HearingTracker, Hearing Aid Know and Healthy Hearing regularly discuss telecoils. YouTube influencer Dr. Cliff Olson who campaigns for Best Hearing Care Practices and consumer satisfaction frequently highlights telecoils.
Bluetooth LE timing and availability
Auracast Bluetooth LE-Audio is currently being hailed as a technology that will allow consumers to receive audio signals via their BT-enabled hearing aids from public address systems. That suggestion may be a little premature as no large-area Auracast transmitters have been developed, built, or installed yet.
While this technology appears promising, no in-depth testing with experienced users of hearing aids and/or cochlear implants has been started—as no Auracast compatible hearing aid devices are yet on the market. Recognized experts in this area, such as Nick Hunn and Peter Mapp, as well as Chuck Sabin from the BT SIG group, have all indicated that telecoils and BT-LE audio will co-exist in a duo-ecosystem for many years. Furthermore, multiple people mention a transition time for Auracast to be universally available of 5 to 10 years.
People with hearing loss need to hear now, and telecoils and hearing loops remain the best and simplest solution for the foreseeable future. Consumers will need access to both telecoils and Auracast for many years to come.
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As a long time advocate for people with hearing loss and especially for the availability of hearing loops, I believe that one of the most important points Dr. Sterkens makes is that telecoil technology and hearing loops are here – today – with a presence that is still expanding world-wide. Hearing loops give communication access to untold millions of people with hearing loss in hundreds of thousands of venues throughout the world.
Auracast appears to be a potential replacement not only for Hearing Loops but also for the existing or yet to be installed FM and InfraRed systems in every country. The consensus seems to be that it will be up to 10 years before the vast majority of hearing aid wearers will make a first time hearing aid purchase or will have replaced their existing telecoil equipped hearing aids with Auracast capable devices. My concern is how the needs of those who wear hearing aids will actually be met during that period of transition.
Although privately owned Auracast capable earbuds or earphones could be expected to be used with Auracast systems it appears to me that, to meet the requirements of the ADA, the system provider would also have to offer to loan them to those with hearing loss or who otherwise find hearing in a venue to be problematic. Since the Bluetooth signal itself will be compatible for some hearing aids, will the system provider still be required to offer a percentage of receivers with an electromagnetic signal capability as called for in section 706 of the ADA related Access Board standards?
To best serve those with hearing loss, until the time comes when Auracast systems have a substantial presence in the “assembly areas” identified in the ADA as current Hearing Loop systems do, I believe that it is imperative that those existing loop systems be maintained and that telecoils continue to be included or available in hearing aids along with Bluetooth. Without them owners of Auracast capable hearing aids will not be able to access any of the millions of hearing loops installed around the world that will not have been paired with an Auracast systems. Also, it would be incumbent upon hearing care providers to explain the two technologies to all clients and that, without telecoils, he/she would still not be able to access the ALS in many, if not most, places of worship, theatres, lecture halls, legislative chambers and other places of assembly that are served by a hearing loop system without removing his or her hearing aids to don earbuds or earphones. Further, Auracast systems could and should be installed to run in tandem with existing loop systems during that transition rather than as a replacement if a venue wants to actually serve the needs of the hard of hearing rather than just meet the requirements of the ADA.
More and more hearing care providers are adding hearing loop/telecoil sections to their websites, looping fitting rooms, waiting rooms and reception desks They're taking the time to educate their clients on the technology. It will be years before even many (though still not most) venues have an Auracast ALS accessible via Bluetooth hearing aids so it's my hope providers will continue that counseling if they truly want to serve the communication access needs of their clients, and that they will be joined by their contemporaries who could still be mistakenly telling clients, “You don't need telecoils, you'll have Bluetooth.”
Amen to Dr. Sterkens. A huge benefit of hearing loops (via telecoils) is their utter simplicity. Without the need for any intervening technology, such as a smartphone, I need only push a button on my streamer or hearing aid and, voila!, my aids become wireless in-the-ear speakers--delivering customized sound (from a lecturer, a preacher, actors on stage, my TV, an airport announcement, or someone behind a subway booth window).
For older, not tech-savvy adults with hearing loss, this simplicity makes for a user-friendly listening assistance. (Besides, I'd be embarrassed, during worship, to have to open up my smartphone every time the service rotated between spoken words from the front and congregational signing or other participation.)
Dr. Sterkens, thank you for communicating the ongoing importance and usefulness of telecoils in hearing aids while broadcast audio technologies are being developed. I have progressive hearing loss and, in my 40+ years of wearing hearing aids, I have learned that it takes multiple technologies to hear in a variety of daily situations. While I see great promise for Bluetooth LE/Auracast, the technologies have simply not advanced to the point where they can replace the ease and reliability of telecoils. In my experience, telecoils are consistently the best feature for telephone and assistive listening system connectivity.
Telephone connectivity
I use both Bluetooth and telecoils in my hearing aids to connect to telephones. When the Bluetooth connection creates issues, like an echo which is common on a phone call, I switch to telecoil mode. If the Hearing Aid Compatibility Task Force replaces telecoil technology with Bluetooth as the HAC standard, I will lose this flexibility. Further, the Hearing Aid Compatibility Act of 1988 requires the FCC to ensure the availability of wireline and wireless telephones that are compatible with hearing aids and cochlear implants. For over thirty years, telecoils have made telephone compatibility possible. Consumers who do not have Bluetooth-compatible hearing aids continue to rely on telecoils for telephone connectivity.
Hearing loop and other ALS connectivity
Having a telecoil in my hearing aid and being able to easily connect to hearing loops opens a world of possibilities. I can enjoy theater at the Seattle Rep and events at Seattle Town Hall; I can participate equally in meetings at the Seattle City Council Chambers, travel more easily through Sea-Tac Airport, and so much more. And the benefits extend beyond my hometown. With a simple switch on my telecoil-enabled hearing aids, I can connect to hearing loops and enjoy the same simple, immediate, and reliable access to clear sound whether I’m in Seattle, Sarasota, or Sydney. In fact, discovering hearing loops on a trip to Ireland inspired me to found Let’s Loop Seattle. I get texts from people all the time thanking me for the loops in places across Washington.
A toolbox of technologies
Successfully managing hearing loss requires a toolbox of different technologies and communication strategies. I think it is imperative that the industry look to expand our options rather than limit our tools for effective communications and access. Consumers will benefit from having access to telecoil- and Bluetooth-enabled hearing aids. For example, it is normal for me to use my T-coil setting at the theatre or meetings and then use BT on my phone to call my daughter on the way home.
In Washington State, we recently passed legislation requiring hearing health providers to tell consumers—prior to fitting—about telecoil and Bluetooth capabilities. I hope all states will adopt similar consumer-focused legislation. Consumers cannot be expected to ask the right questions; they must be provided with user-friendly information that helps them make informed decisions.
In an era where connectivity is essential to our way of life, no hearing aid is complete if it can’t connect easily to our telephones, computers, and assistive listening systems.
I am excited to see how Bluetooth LE/Auracast will improve the lives of people with hearing loss. The ubiquity of Bluetooth earbuds is already helping to alleviate the stigma of wearing hearing aids—when everyone is wearing something in their ears, hearing aids are no big deal. This can be huge for people seeking hearing help sooner. But ubiquitous Bluetooth solutions will not be the sole answer for years to come. Telecoils and hearing loops remain essential to helping consumers hear in different situations.
Thank you,
Cheri Perazzoli
President, HLAA-Washington State Association
Founder, Let’s Loop Seattle
Excellent article by Dr. Sterkens! As a consumer with hearing loss, I totally agree that consumers need both Bluetooth AND telecoils for years to come.
Hearing aids alone are not enough. Currently, I love using Bluetooth with my smartphone and TV (personal devices). I love using my telecoil in public places using hearing loops (my favorite), FM, and IR. Both give me direct sound which at times can make me misty-eyed because of the clarity. I love the leadership at venues that meet the ADA and then work hard to go above and beyond with public outreach and create environments for me to fully participate.
I’d like to offer some additional comments on Kozma-Spytek’s recent article, Trends in Audio Streaming for Hearing Aids and Hearing Aid Compatibility for Wireless Phones. Since Kozma-Spytek’s article is only a snapshot, I hope the following would be included in future articles:
Since telecoils and Bluetooth will co-exist for years to come, it is important that:
I only wish I had the grace and patience that Dr. Sterkens has. I think it is unconscionable that manufacturers do not include telecoils in ALL hearing aids, and that audiologists do not consistently encourage patients to select hearing aids WITH telecoils. If one looks beyond just their local jurisdictions, one would find that venues, taxis, elevators, train stations, subways, cathedrals, public meeting halls all over the world, and increasingly in the US, are equipped with telecoils. The reason is that they work. They provide clear, understandable sound to those of us who desperately want to hear......now. With my severe hearing loss, I don't have time to wait for something that might happen in 5-10 or 15 years when we have a technology that works beautifully today. When I got my first pair of hearing aids 26 years ago, I had no idea that they would not suddenly make it possible for me to hear perfectly again. What I have learned (now on my 6th pair) is that it requires ALL of the possible tools out there in order to hear better. Of course, Bluetooth is one of those tools, but there are downsides --- latency, pairing issues, and so on. When I connect with a hearing loop, those downsides disappear. I use my portable loop every single day - for audio on my computer, for conversing with my family members, when I go to my book group, when we have friends over to socialize.......I would be silent and disengaged if I did not have access to loops of all sizes - personal/portable, at airport kiosks, at library desks, in city meeting rooms, at performance venues - anywhere where I want to hear. This message needs to be heard by manufacturers, audiologists and any venue that serves the public.
Sue,
Agreed, Dr. Sterkens has the grace and patience of a saint and, fortunately, she also has a good deal of grit. It's an honor to know her and witness the work she does for patients, friends, colleagues and then some!
My two cents: KISS (keep it simple, silly) is the name of the game for people who need to overcome hearing loss. Whether you are the one who wears hearing aids now or will wear them at a later date -- the goal is to navigate life being able to communicate, as effectively as possible, with each other.
“I didn’t give you a telecoil because nothing is looped around here,” is the answer we hear all too often, implying that there never will be any loops and that their patients won’t be traveling anywhere that does have loops. We also hear, “I’ll activate your telecoil after you learn to use your Bluetooth.” That’s like buying a car and being told that you have to learn to use your headlights before they teach you to use your windshield wipers. They are different, and you need both capacities at the same time, even if it isn’t raining at that very moment! We looped our large performance and cultural center so that a listener can go from a looped ticket office, to a looped meeting, a looped lecture/film, a looped concessions stand, and on to a looped concert. We had board members wanting to step away because they couldn’t hear adequately in board meetings – until we looped the board room. We couldn’t afford to lose that “brain trust” simply due to unsatisfactory acoustics. It is absolutely seamless to move from one space to another. But we find that community members don’t know if they have telecoils, or if their program works. Hey, there’s something wrong with this picture – as a venue, we did our part!!! What will the magic number be that persuades hearing specialists that there are now “lots of loops in our area” and tips the scale to them advocating, insisting even, that all their clients have a working telecoil? The problem with the specialists waiting until more things are looped is that it leaves it up to us venues to teach THEIR patients how to use their telecoils if they have them, or to go back and demand them. Our company is doing that education as a community service, but we can’t expect all congregations or other businesses to take that on. It only takes one CI user exiting an unamplified, classical concert saying, “I never thought I would hear violins again,” to convince me that telecoils must be included – and activated -- in all hearing devices. You never know when you will need it. We have been able to assist some of our patrons lucky enough to have an activated telecoil program that they had never used to experience hearing through our loops. But the frustration is palpable if their program hasn’t been activated. Lastly, we encourage our friends to take charge of their own hearing life by asking “Where else do you want to hear well?” and then go do something about it. They educate their attorney, their doctor, their car mechanic about counter loops or portables. They loop their own business, their living rooms, their grocery store, their pharmacy, their parties, their YMCA, their museum. Suddenly lots of local places are looped. If we “Loop People” they become empowered to “Loop Places” that matter most to them. And everybody with hearing devices should have, and know about, telecoils to support and encourage their own friends with hearing loss.
Progress is coming and that is exciting for people with hearing loss! But for the moment, as Gael Hannan and I say in our book Hear & Beyond: Live Skillfully with Hearing Loss, "Two must-have features in hearing aids are T-coils and streaming capability via Bluetooth, both of which bring sound directly into your devices.
Your HCP may promote Bluetooth over T-coils (and may neglect to mention telecoils at all), but you need both technologies since they are used in different situations. Bluetooth works for streaming via personal devices like laptops, smartphones, and TV sets, or for public devices such as the audio-guides used in museums and art galleries. But hearing loop systems for T-coils are more commonly found in public places like theaters or at conferences and lecture halls, and T-coils are in most public telephones—if you can find one!
It is important to ask your HCP to activate the T-coil and explain how to use it in a variety of settings. If your current hearing aid doesn’t have one, you may be able to get a telecoil-equipped accessory that works with your hearing aid. Ask your provider to include a T-coil in your new or next round of hearing aids.”
I have bilateral hearing loss. The importance of hearing loops can not be emphasized enough. We have installed hearing loop systems at every check out counter of my small grocery store, because people need to actually hear what their cashier is saying to them.
I use hearing loops and Bluetooth every day, they serve different functions in different situations. We, the members of the hearing loss community need, and want access to both.
Telecoils and hearing loops are crucial to both my happiness and quality of life as a person with hearing loss. Two key advocacy tasks are to let new hearing users know about hearing loops and to ensure more and more venues offer looped environments. Oh, and a third! Hearing healthcare professionals need to promote this simple, life-changing technology. Thanks for listening, because we will continue to keep shouting about it!