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iHearit: A Review of MFi-Supported Hearing Aids from a VoiceOver User’s Perspective
by Scott Davert, posted June 2019 on the website of American Foundation for the Blind
I used my first pair of programmable hearing aids in 1998. These allowed audiologists to use computer software to tailor programs to meet patients’ specific needs. Using a remote control, users could select the program best-suited to their current environment, adjust the volume, turn the built-in t-coil on or off, and mute the hearing aids. Today’s hearing aids are adjusted using buttons on the hearing aids themselves, which isn’t the most discrete method, or by using a mobile application, if available. In the 1990s, the slightest of adjustments to a program required a trip to the audiologist. There was no way to hear audio from external devices directly through your hearing aids, individually control settings such as whether the t-coil and microphone were active at the same time, or adjust the volume of active components. The only way to connect to external devices like telephones and radios was by using an FM system, placing the telephone up to your ear when connected to the t-coil, or putting headphones over your hearing aids. With an FM system, all sound was mono, and fidelity was quite poor. A t-coil had limited range, and the sound quality wasn’t good for anything other than an audiobook or phone call. Headphones produced a lot of feedback when placed over hearing aids.
In 2012, hearing aid manufacturers began using proprietary technology to achieve a more direct connection to external devices. One such option, reviewed in AccessWorld, was the ComPilot, which allowed Phonak hearing aid users to receive a direct signal to their hearing aids from various devices. It provided excellent fidelity and offered stereo sound, making listening to music a pleasure. Just as when using a Bluetooth headset to listen to a screen reader, keeping an active Bluetooth connection with one of these devices is challenging, as the connection drops after just seconds of inactivity. If you are using the ComPilot or devices like it to listen to your screen reader over Bluetooth, this means missing words until the connection is re-established. A Bluetooth connection is very sluggish, and there are often delays of up to one second between the signal leaving the iOS device and reaching your hearing aids. Connecting a 3.5 MM cable meant almost no latency, and made for a much smoother experience. The disadvantage, of course, is that a wire is required for a signal to travel from an external device to your hearing aids. You also have to wear this type of device around your neck.
Audiologists now have the ability to do the things mentioned above, filter out certain sounds, and amplify certain frequencies more within the audiological spectrum to offset a loss. Hearing aids connect to external devices more directly than ever before, providing a much clearer sound. Premium hearing aids from some manufacturers offer audiologists the ability to make adjustments remotely, as long as the hearing aids have an active connection to your iOS device. Hearing aid manufacturers can also push software updates to your hearing aids, eliminating the need to visit an audiologist. A user can adjust many levels and settings with the use of MFi support and applications developed by the manufacturer. A mobile application is always required for an audiologist to make adjustments remotely. All of the applications I have tried present various accessibility issues to users of VoiceOver and braille. However, many options can be configured by using Apple’s built-in accessibility settings.
Are My Hearing Aids Supported?
Many manufacturers have models that are MFi-compatible. Check Apple’s official support page to see if your hearing aids are MFi-compatible. This support article was last updated in October 2018, so it might not list all supported models. You must have an iPhone 5S or later to use supported hearing aids. If in doubt, consult your audiologist, or complete the steps in the article to learn if your hearing aids are compatible.
MFi hearing aids are paired using the MFi Hearing Devices option within Accessibility settings. Before pairing your hearing aids, turn them off and back on again. After doing this, double-tap on the hearing aids you wish to pair, and then confirm the pairing request. A second pairing request will come through your hearing aids if you have VoiceOver running. After confirming this request, your hearing aids will be paired, and VoiceOver audio will come through them, softening all other sound. When VoiceOver finishes speaking, your hearing aids will return you to your normal sound settings. Until speech is muted, the screen is locked, or audio routing is changed in Control Center, you will remain cut off from everything around you whenever VoiceOver is speaking. To continue hearing speech through your iOS device, bring up the Control Center, select Routes Available, and choose the iOS device.
After pairing your hearing aids, the Accessibility Shortcut will include the option of MFi Hearing Devices. If VoiceOver is set as your Accessibility Shortcut, you will be presented with multiple options when triple-clicking the Side or Home button. If you want to quickly launch the MFi Hearing Devices menu, and
want VoiceOver to be your only Accessibility Shortcut, you can go to Settings > General > Accessibility > Accessibility Shortcut, and choose your preference accordingly. If you still want a quick way to access hearing devices, you can do so by adding it to the Control Center. To add items to the Control Center, go to Settings > Control Center > Customize Controls. Under the More heading, select Hearing to add this menu to the Control Center.
After pairing your hearing aids, there are numerous user-customizable options. Many of these are independent of hearing aid manufacturer or model, though some options are dependent on how the manufacturer has configured the hearing aids to work with MFi support. After connecting my ReSound hearing aids, I have the ability to specify whether I wish to stream to one or both hearing aids, as well as whether I would like to control them through my iOS device independently. I can also adjust the volume of the hearing aids’ internal microphone along with the level of any connected devices. I’m shown the programs my audiologist set up, and can select one by double-tapping it. To adjust the audio levels, flick up or down with one finger on the touchscreen. Some hearing aid manufacturers have chosen to put an equalizer in this group of settings, so you can control the bass and treble of your hearing experience.
Near the bottom of the screen Live Listen is found. This turns your iOS device’s microphone into an assistive listening device (ALD). With Live Listen, someone speaks into your iPhone, and the audio is sent to your hearing aids. Some who have used this feature report a delay of up to three seconds between
when the person speaks and the audio reaches your hearing aids. I experienced little delay using ReSound hearing aids unless multiple Bluetooth devices were in range, which resulted in a choppy connection, though the person using my iPhone was three feet away.
After activating the Back button, you are shown options that are not specific to the manufacturer. The first option, enabled by default, is to play ringtones through your hearing aids when a call comes in. The next option is Audio Routing. This allows you to specify what type of audio is sent to your hearing aids. The first setting controls call audio routing. Selecting this allows you to choose whether call audio goes to your hearing aids Always, Never, or Automatically. Choosing Automatically means that if a call is answered with the phone to your ear, audio comes through the earpiece instead of your hearing aids.
The other option in this menu is Streaming Media. The settings are the same as those found under the Call Audio Routing submenu. This controls where VoiceOver will be heard. There is no way to configure VoiceOver and other media separately.
The next two options are works in progress. If all devices are signed into the same iCloud account and on the same WiFi network, supposedly it is possible to control your hearing aids on iOS devices not paired to them. Sadly, no one I have spoken with has gotten this to work successfully. Handoff does not function reliably either. In theory, you should be able to start audio playback on an iOS device not paired to your hearing aids, and receive that audio through your hearing aids, as long as both devices are signed into the same account on the same network.
Though Apple says pairing your hearing aids with multiple iOS devices is a seamless process, I did not find this to be so. In an ideal situation, my hearing aids played the audio from one device in my left ear, and the other in the right.
Some hearing aid manufacturers allow control of your hearing aids from the Lock screen. The only thing displayed on my Lock screen is the battery status of my ReSound hearing aids. Unfortunately, the reading is inaccurate. My hearing aids always show 100% until they beep and suddenly drop to 10%. This problem is not specific to VoiceOver users, but seems to affect only those with hearing aids from certain manufacturers.
The Menu Accessed through the Control Center or Accessibility Shortcut
After activating the Hearing Devices menu, you can adjust the volume level of any of the active audio devices, or adjust the bass and treble on hearing aids that support this feature. In this menu, you can also switch programs, and turn Live Listen on or off. Any adjustments made are immediate. This can come in handy if you are listening to something using an assistive listening device and do not want to hear anything going on around you. Setting the internal microphone’s volume to 0% will allow you to hear only audio sent through the ALD. You can listen simultaneously to your environment and audio from a connected device, or turn the volume of the connected device down all the way. You can adjust the level of the internal microphone using your iOS device, but will need to adjust the iOS device’s level using its volume buttons.
There is one option within VoiceOver settings that some may find helpful. Navigate to Settings > General > Accessibility > VoiceOver > Audio, and scroll down to the bottom. You will find the option to control whether VoiceOver comes through the right, left, or both hearing aids.
How Well Do They Function?
One of the challenges I mentioned in my introduction was latency. With my ReSound hearing aids, and many newer models, this latency is down to less than a quarter of a second. Typing on a touchscreen with VoiceOver has become a more pleasant experience than when I last tried it using a ComPilot in 2015. One of the challenges I faced, though, was having several Bluetooth devices connected to my iOS device at once. If my hearing aids are connected, my braille display will not auto-connect as quickly. Some Bluetooth keyboards struggle more than others to keep up with typing when the hearing aids are paired. When setting up a new iPhone and using Bluetooth to transfer settings from an older device, the transfer failed repeatedly until I unpaired my hearing aids.
If you are composing a document on a Bluetooth keyboard or the touchscreen and pause for more than a second, the Bluetooth connection stops to conserve battery. This can be very disruptive to a VoiceOver user’s productivity, especially with hearing aids that do not preserve the second or so of audio between when the connection resumes and audio is once again being transmitted to your hearing aids. One way to prevent the connection from dropping is to start audio and leave it playing quietly in the background. Another option is to record silence and play it as long as you need the constant connection.
When I first paired my hearing aids, music sounded horrible through them because the MFi support respects the currently active hearing aid program when the connection is established. My audiologist worked with me to customize a hearing aid program specifically for music, which I switch to before listening to an audiobook or music to ensure the best sound.
The Bottom Line
Hearing aid technology has evolved in the last two decades. The ability to have control over one’s sound environment on demand is a very liberating thing. In many instances, the more simple adjustments that a user may want to make no longer require a trip to an audiologist and can be done on the fly. It would be helpful if Apple offered the option to have VoiceOver stream independently of other media.
The biggest concern for a blind hearing aid user is the inaccessibility of applications provided by hearing aid manufacturers that offer access to even more features for sighted users. I have tested applications from Oticon, Widex, and Phonak in demo mode and found several accessibility issues which others have confirmed exist when using hearing aids from these companies. One feature that is consistently inaccessible irrespective of manufacturer is the equalizer. It is my hope that hearing aid manufacturers will begin taking this feedback from blind users more seriously. I further hope these manufacturers will begin to use tools in the way Apple suggests, so that blind users can have equal access to all of the great options our sighted counterparts do. We are also paying customers and deserve nothing less than everyone else. Alternatively, hearing aid manufacturers can offer a discount to those who are prevented from taking full advantage of their products. As the prices for these hearing aids can be more than $3,500 per ear, a discount wouldn’t be unappreciated.
This article is made possible in part by generous funding from the James H. and Alice Teubert Charitable Trust, Huntington, West Virginia.
From The Washington Post:
Covid-19 update, 13 April 20:
Covid-19 and Deafblindness
Recommendations on inclusive policies from the global deafblind community.
In these times of turmoil, with the whole world severely affected by the Coronavirus (COVID-19) outbreak, combined with other critical incidents like the recent earthquake in Zagreb, Croatia, we must ensure that those who are the most left behind, neglected, vulnerable, and exposed to double isolation in any crisis, persons with deafblindness, are also equally protected according to Article 11 of the UN Convention of the Rights of Persons with Disabilities (CRPD).
Representing between 0.2% to 2% of the global population, an estimated 15 to 155 million persons on earth experience combined hearing and vision impairments – deafblindness. Adding dual sensory impairment due to aging, the number rises to 6%, implying as many as 467 million experience a degree of deafblindness during life. This group of persons with deafblindness must not be neglected and forgotten during this time of crisis.
Furthermore, we emphasise that the number of those persons rises with age, making the elderly in our society more vulnerable to the virus. Older persons with deafblindness experience a higher risk than most others as, in addition to being in the high-risk group due to age, they struggle to cope with both accessing and processing information, as well as resolving daily tasks such as shopping for essentials like basic food and/or medicine, a couple of examples among many issues being faced. The crucial fact is that the combination of their dual sensory impairment and age strongly impacts on and increases the complexity of their situation, increasing their need for proper services to reduce risk of serious and severe health complications due to COVID-19.
The General Comment No. 2 on Article 9: Accessibility of the CRPD commits state parties to enable persons with deafblindness to access information, communication, and other services in order to live independently and to effectively participate in society.
That is why the European Deafblind Union (EDbU), according to the received inputs from its national members, compiled the following recommendations which are essential in providing the same standard of services and support to the deafblind persons in everyday life and in severe crises such as this pandemic.
The European Deafblind Union (EDbU), the African Federation of the Deafblind (AFDB), the Latin American Federation of the Deafblind (FLASC), and the World Federation of the Deafblind (WFDB) urge the UN, WHO, EU bodies, state parties and governments across the world to ensure:
1) The importance of media access – All media communication should be in plain language and accessible for persons with deafblindness through (but not limited to) closed captioning, national sign language, clear-speech translation, high contrast and large print publications. It must also be made available at the same time while information is given.
2) Dissemination of official information – Official Covid-19 instructions, guidance, and guidelines should be provided in accessible formats for deafblind persons that includes large print and braille.
3) Access to Service Providers – All services provided to the public due to the Covid-19 outbreak, like Red Cross services, telephone helplines, and other providers of support and/or psychological help, are accessible to all persons with deafblindness.
4) Access to Digital Media – Digital media should include accessible formats in plain language for deafblind persons. Special online access should also be given in plain text format (without any pictures and advertising) which may need adjusting if required. It is also essential for text and/or email messages to be sent with such information upon request.
5) Access to Personal Protection Equipment (PPE) – Urgent priority should be considered to ensure that all persons with deafblindness can be given priority access to protective gear such as masks and gloves due to the extreme difficulty of doing so because of mobility limits during lockdowns, or impossibility of finding help.
6) Protecting the Deafblind interpreters (interpreter-guides) – The nature of our unique disability of deafblindness encourages close proximity and touching of hands with deafblind interpreters (interpreter-guides) which allows them to follow information on the environment surrounding them and translations from spoken/written language. Therefore, deafblind interpreters (interpreter-guides) who work in emergency and health settings should be given the same health and safety protections as other health care workers dealing with Covid-19.
7) Awareness raising – Immediate awareness raising on support to deafblind persons is essential and should be established, together with national organisations who should also have a key role in protection campaigns.
8) Access to services while in quarantine or in need of medical help – During quarantine or when in need of health services, deafblind persons must have access to deafblind interpreting services (including interpreter-guides), support services, personal assistance as well as physical accessibility. As such, persons with deafblindness cannot be deprioritised on the basis of their disability.
9) Access to work and education – Remote work or education services must be equally accessible to all employees/students with deafblindness.
10) Restrictions during Covid-19 crisis – Measures of public restrictions, such as gatherings limited to 2 persons in some places, must consider persons with deafblindness on an equal basis with others. This is due to the fact that most, if not all, deafblind persons still need a deafblind interpreter to help them get all necessary instructions and information when they do not have family support or where alternative communication methods have failed; therefore, it is vital that our unique disability is treated with respect under such restrictions.
11) For DPOs representing persons with deafblindness, we advise a reduction of all direct services and organise work from home if possible while still ensuring and continuing:
- Organisation of the deafblind interpreting (interpreter-guide) services for persons with deafblindness, so that they can urgently reach out and help elderly and lonely persons with deafblindness
- The vital task to make sure that the most isolated deafblind persons receive the most urgent information, all conveyed in their preferred mode of communication, while also ensuring that they have prioritized access to food and medicines
- Recognition of deafblind persons – advise them to use red-white canes so they are more visible and/or hold at least an official card that indicates their deafblindness to the authorities and emergency services.
The European Deafblind Union (EDbU), the African Federation of the Deafblind (AFDB), the Latin American Federation of the Deafblind (FLASC), and the World Federation of the Deafblind (WFDB) are available to assist authorities and other organisations with guidance and information regarding the equal and accessible services as well as information for persons with deafblindness.
Please share any information and good practices from your country with us that you consider relevant on providing quality services and support of persons with deafblindness, currently severely impacted by the Covid-19 outbreak.
Helen Keller Day, 27 June, was celebrated around New Zealand!
The Waikato Deafblind Support group had a wonderful day at Clock World and Longitude Café in Ohaupo.
Peter and Christine were fantastic hosts and treated us to fascinating facts about the clocks, and we shared a lovely morning tea.