Radio aids – optimising listening opportunities - view as single page

Gill Weston, Pauline Cobbold, Cate Statham and Helen Maiden with contributions by James Mander, Gary Webster and Brian Copsey | View as single page | Feedback/Impact

Radio Aids - optimising listening opportunities Evidence What and Why? How? Technical Support Setting up BATOD Articles What are radio aids? Routine Checks Choosing a system Using a Test box Useful references: further reading Why use a radio aid? Use in educational Settings Troubleshooting With Cochlear Implants Case studies Criteria Use in everyday life Connecting to other technology With hearing aids Glossary Listening in noisy environments Costing and funding Frequencies and transmission With bone conduction aids etc Other contributors Supporting children with listening difficulties Insurance UK Children's’ Radio Aid Group Assessing the benefits of the radio aid Good practice Soundfield systems and radio aids Strength of Evidence Transferability Editor's Comments Areas for further research Online Community

This MESHGuide has been designed to cover a wide range of issues associated with personal radio aid systems.  It is a resource for anyone who works with  children and young people (CYP) with hearing difficulties who may benefit from a personal radio aid.  This would include parents, mainstream teachers as well as professionals in the field of deafness.  It focuses specifically on personal radio aid systems as a learning tool for deaf children, and the issues regarding their use.

The principles supporting the use of radio aids systems for deaf children remain constant; however the manufacturers are committed to developing and improving each device.  The technical advances in assistive listening technology enable deaf children, their families and staff in educational settings to develop the use of radio aid systems to maximum advantage.

It aims to be an unbiased source of the latest thinking and research and present relevant case studies on the use of radio aids.  It covers what radio aids are, why and how they are used; connection to other technologies; the various types and makes available, with links to manufacturers and other websites.

Radio aids are a specific form of the wider range of Assistive Listening Devices (ALDs) which are currently available.  Other forms of ALDs are beyond the scope of this particular MESHGuide.   Due to the wealth of different ALD devices available this MESHGuide will focus specifically on the personal radio aid systems, which are widely used for CYP for developing spoken language and in education.

The creation of this MeshGuide has been led by Gill Weston, Cate Statham, Helen Maiden and Pauline Cobbold, all who are (or have been) practising Educational Audiologists and/or Teachers of the Deaf.  They have a wealth of knowledge and been involved with research, setting up radio aids in homes and schools for children with hearing aids and Cochlear Implants and working closely with the manufacturers to solve any problems that have arisen.

Disclaimer - the authors have attempted to gather varied examples of research and articles and case studies and are not endorsing a specific viewpoint.

This guide is one in a series of Deaf Education MESHGuides.

 

In this column we list recent research and references on the benefits and uses of radio aids.  There is also a section on small scale case studies, showing how individuals have benefited from this technology.

A list of articles, related to radio aid systems and their use, that have appeared in the BATOD Association magazine since 2009 can be downloaded here.  For full access to the articles, you need to logged in as a BATOD member.

Listed below are useful references that are not included in the main texts.

Allen, S., Ng, Z.Y., Mulla, I.M. & Archbold, S. (2016). Using Remote Microphone technology with young children: the real-life experience of families in the UK, British Academy of Audiology, 10-11 November 2016, Glasgow, UK.

Boothroyd, A (2000). Management of hearing loss in children: No simple solutions. In RC Seewald (ed) A Sound Foundation through Early Amplification. Phonak AG: Stafa

Badrak, J. S. (2017). "Assistive listening systems in assembly spaces." The Journal of the Acoustical Society of America 141(5): 3781-3781  http://asa.scitation.org/doi/10.1121/1.4988319

Bradley, J. S., & Sato, H. (2008). The intelligibility of speech in elementary school classrooms. Journal of the Acoustical Society of America, 123(4), 2078-2086.

Busch, T., et al. (2017). "Auditory Environment Across the Life Span of Cochlear Implant Users: Insights From Data Logging." Journal of Speech Language & Hearing Research 60(5): 1362-1377.

Collins, J., et al. (2013). "Deafness and Hard of Hearing in Childhood: Identification and Intervention through Modern Listening Technologies and Other Accommodations." Communique 41(6): 4.

De Ceulaer, G., et al. (2016). "Speech understanding in noise with the Roger Pen, Naida CI Q70 processor, and integrated Roger 17 receiver in a multi-talker network." European Archives of Oto-Rhino-Laryngology 273(5): 1107-1114.

Eiten, L. R. and D. E. Lewis (2010). "Verifying frequency-modulated system performance: It's the right thing to do." Seminars in Hearing 31(3): 233-240.

Elkayam, J. (2010). "Management of amplification technology in school." Seminars in Hearing 31(3): 252-263.

Fitzpatrick, E., et al. (2016). "Children with Mild Bilateral and Unilateral Hearing Loss: Parents' Reflections on Experiences and Outcomes." Journal of Deaf Studies and Deaf Education 21(1): 34-43.

Furno, L. E. (2012). The Effects of Sound-Field Amplification on Children with Hearing Impairment and Other Diagnoses in Preschool and Primary Classes, ProQuest LLC.

Gabbard, S. A. (2003). The Use of FM Technology in Infants and Young Children. In Fabry D & Johnson CD Achieving Clear Communication Employing Sound Solutions.  Stafa: Phonak.

Jacob, R. T. S., et al. (2014). "Participation in regular classroom of student with hearing loss: Frequency modulation System use." CODAS 26(4): 308-314.

Kuppler, K., et al. (2013). "A review of unilateral hearing loss and academic performance: Is it time to reassess traditional dogmata?" International Journal of Pediatric Otorhinolaryngology 77(5): 617-622.

Moeller, M., Donaghy, K. F., Beauchaine, K. L.,Lewis, D. E., & Stelmachowicz, P. G (1996). Longitudinal Study of FM System Use in Nonacademic Settings: Effects on Language Development. Ear & Hearing 17(1), 28-41.

Mulla (2011) Pre-school use of amplification technology  PhD thesis, School of Psychological Sciences, University of Manchester.

Nelson, L. H., et al. (2013). "Preschool Teachers' Perception and Use of Hearing Assistive Technology in Educational Settings." Language, Speech, and Hearing Services in Schools 44(3): 239-251.

Norrix, L. W., et al. (2016). "The effects of FM and hearing aid microphone settings, FM gain, and ambient noise levels on SNR at the tympanic membrane." Journal of the American Academy of Audiology 27(2): 117-125.

Rekkedal, A. M. (2012). "Assistive Hearing Technologies among Students with Hearing Impairment: Factors that Promote Satisfaction." Journal of Deaf Studies and Deaf Education 17(4): 499-517.

Rekkedal, A. M. (2014). "Teachers’ use of assistive listening devices in inclusive schools." Scandinavian Journal of Disability Research 16(4): 297-315.

Rekkedal, A. M. (2015). "Students with Hearing Loss and their Teachers' View on Factors Associated with the Students' Listening Perception of Classroom Communication." Deafness & Education International 17(1): 19-32.

Reynolds, S., et al. (2015). "Systematic Review of the Effectiveness of Frequency Modulation Devices in Improving Academic Outcomes in Children With Auditory Processing Difficulties." American Journal of Occupational Therapy 70(1): 7001220030p7001220031-7001220030p7001220011.

Schafer, E. C., et al. (2014). "Fitting and verification of frequency modulation systems on children with normal hearing." Journal of the American Academy of Audiology 25(6): 584-591.

Schafer, E. C., et al. (2013). "Speech recognition and subjective perceptions of neck-loop FM receivers with cochlear implants." American Journal of Audiology 22(1): 53-64.

Statham, C., & Cooper, H. (2009). Our experiences of introducing FM systems in the early years. BATOD Association Magazine (January), 18-20.

Thibodeau, L. (2010). "Benefits of adaptive FM systems on speech recognition in noise for listeners who use hearing aids." American Journal of Audiology 19(1): 36-45.

Thibodeau, L. (2010). "Interfacing FM systems with implantable hearing devices." Seminars in Hearing 31(1): 47-72.

Thibodeau, L. (2014). "Comparison of speech recognition with adaptive digital and FM remote microphone hearing assistance technology by listeners who use hearing aids." American Journal of Audiology 23(2): 201-210.

Wolfe, J., Morais, M., Neumann, S., Schafer, E., Mülder, H., Wells, N., Hudson, M. (2013) ‘Evaluation of speech recognition with personal FM and classroom audio distribution systems’. Journal of Educational Audiology. 19, pp.65-79.

Zanin, J. and G. Rance (2016). "Functional hearing in the classroom: assistive listening devices for students with hearing impairment in a mainstream school setting." International Journal of Audiology 55(12): 723-729.

Case studies

1. FM for teens booklet 2014 Ear Foundation

A study of 20 teenagers and their views of the Radio Aid systems they use both at school and beyond. It shows their usefulness but also some of the challenges encountered by the young people using them.

2. Our experiences of introducing FM systems in the early years.   Cate Statham and Hannah Cooper trial the use of fitting radio aids to babies and toddlers.

3. Does Noise Susceptibility Using Headworn Microphones Suggest Earlier Radio Aid Fitting?

Poster format from research at the University of Southampton Auditory Implant Service - showing  that when a child is using a headworn microphone, listening in background noise is more difficult and indicates the possible need for earlier ALD fitting than would normally be suggested.

4. Carrión, M. and G. Cardona (2011). "Goldenhar syndrome with moderate hearing loss: An FM system in a school environment." International Journal of Pediatric Otorhinolaryngology Extra 6(4): 178-181.

A young girl with Goldenhar syndrome and bilateral, unbalanced, fluctuating and progressive hearing loss successfully employed an FM system during classroom activities.  Teacher and student questionnaires revealed overall satisfaction with the FM system, as well as a significant progress in the academic performance.  Schoolchildren with mild hearing loss often reject the use of conventional hearing aids during school hours, when acoustic inadequacies and social stigma eclipse any perceived benefit.  FM systems such as EduLinkTM are a viable alternative in those situations and, in some instances, may predispose reluctant patients to accept a more conventional hearing solution. © 2010 Elsevier Ireland Ltd.

5. Nguyen, H. T. T. (2011). The Impact of Frequency Modulation (FM) System Use and Caregiver Training on Young Children with Hearing Impairment in a Noisy Listening Environment, ProQuest LLC.

The two objectives of this single-subject study were to assess how an FM system use impacts parent-child interaction in a noisy listening environment, and how a parent/caregiver training affect the interaction between parent/caregiver and child.  Two 5-year-old children with hearing loss and their parent/caregiver participated.  Experiment 1 was conducted using an alternating design measured three communication behaviors (eg child's vocalization, parent/caregiver's initiation, and parent/caregiver's response) across four listening conditions (e.g., HA+Quiet, HA+Noise, FM+Quiet, and FM+Noise).  Experiment 2 was conducted using a comparison within and between conditions to re-measure the communicative behaviors across the listening conditions after the parent/caregiver training.  Findings of this study point to three major conclusions.  First, FM system use (ie FM-only mode) facilitated FM01 child's ability to maintain same level of interaction in a noisy as good as in a quiet environment.  Second, parent/caregiver training enhanced the impact of FM system use for one child (FM01), although parent/caregiver initiation increased for both.  Third, it is important to verify the function of both FM system and HA microphones to ensure access to FM advantage.  [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/products-services/dissertations/ ]

Oticon Foundation Report

In the Oticon Foundation Report - Study of FM in Real World Settings(2012) Wendy McCracken and others investigate the ‘real world’ use of radio aids, with a mixture of scientific measurements and the views of teachers and pupils.

ALD:  ‘Assistive Listening Device’ is used to describe personal devices which help overcome hearing loss.  These can be stand alone or used in conjunction with hearing devices such as hearing aids.

Assistive Listening Technology: You may also see Assistive Listening Device (ALD).  These are used to improve ability to hear in a variety of situations where it is difficult to distinguish speech in noise.  The three main technologies use induction loops, infrared and radio frequency (RF).  The latest ALDS are wireless and use the same 2.4GHz technology platform as is used with Bluetooth and Wi-Fi devices.

Attenuator:  This reduces the strength of an audio signal.  Used with a stetoclip when listening and checking powerful hearing aids so the listener’s hearing is not damaged.

Audible:  a sound which is able to be heard.

BAHA:  A bone anchored hearing device based on bone conduction.  It is suitable for CYP who have problems in the outer or middle ear or are unable to wear a behind the ear hearing aid.  Young children tend initially to wear it on a softband.  It can also be fixed to an implant in the skull which is inserted under surgery.

BATOD:  British Association of Teachers of the Deaf.  BATOD is the professional association for Teachers of the Deaf in the UK representing the interests of Teachers of the Deaf and other professionals working with deaf children and young people.

BATOD Foundation:  The BATOD Foundation is a research, training and information based charity dedicated to improving the life chances of deaf children and young people by disseminating the outcomes of research projects supported by the Foundation.

BKB sentence test:  Lists of 10 sentences, each containing 50 key words put together by Bamford Kowal and Bench for testing the ability of hearing-impaired children (usually >8 years old) to hear words in sentences.   The test is scored by asking the child to repeat the spoken sentence and identifying the correctly spoken target words.  The final score is the number of correctly identified words from the list of 50 expressed as a percentage.  The test can be administered in quiet conditions or in presence of background noise.

Cochlear Implant:  A Cochlear Implant provides a means of hearing for children and adults who otherwise receive no or limited benefit from conventional hearing aids.  It is an electronic medical device which replaces the function of the damaged inner ear (cochlea).  It consists of an internal receiver/electrode package which is surgically implanted under the skin, and an external speech processor worn behind the ear or on the body.

CYP:  Children and young people  (in context - child or young person)

dB:  A decibel is a measurement which indicates how loud a sound is.  The  healthy human ear can hear approximately between 0dB and about 140dB.  The smallest audible sound is about 0dB – silence, but a sound which is 1,000 times more powerful than silence is measured at 30dB.  Normal conversation is measured at about 60dB.

DCSF:  Department for Children, Schools and Families, a government department in England between 2007 and 2010 which was replaced by the DfE in 2010.

Direct Input shoe: This allows direct connection of a hearing aid to other audio equipment.  Often called a shoe or boot.  They are specific to the make and model of each hearing aid.  

Educational Audiologist:  A qualified Teacher of the Deaf who also has an additional qualification in audiology working in an education support service or school for the deaf.

ETSI:  The European Telecommunications Standards Institute (ETSI) is an independent, not-for-profit, standardisation organisation in the telecommunications industry.

FM:  Frequency modulation  A FM radio aid system works wirelessly on a similar basis to VHF radio.  It uses higher frequency bands than broadcast radio and does not require a license.  

FM ChIP:  The FM ChIP was originally developed to assess young cochlear implanted children’s readiness to have a radio aid fitted.

FM Working Group:  Now called the UK Children’s Radio Aid Working Group.  This was set up to encourage developments in the field of personal radio aids, promote good working practice and to share information.

Hearing:  Hearing, in humans, is the ability to detect and perceive sound using ears, which is then transmitted to the brain.

Hearing loss (temporary/permanent) also known as hearing impairment, is a partial or total inability to hear.  A deaf person has little to no hearing. Hearing loss may occur in one or both ears.  A temporary hearing loss, usually a conductive hearing loss, is caused by a problem in the ear canal, the eardrum or in the middle ear which prevents sound being effectively carried into the inner ear.  Some CYP may have more permanent conductive hearing losses which may fluctuate in hearing levels because of persistent infections.  A sensorineural hearing loss is a permanent hearing loss.  This is usually caused by damage to the hair cells in the cochlea or to the neural pathways of hearing.  

Inverse Square Law:  In this MESHGuide, this applies to the reduction in the volume of sound when the distance from the source is increased.  The sound intensity is reduced in an inverse proportion to the square of the change in distance.  For example: if the distance is doubled 22 = 4, the inverse of 4 is ¼ therefore the signal is one quarter of the original volume when it reaches the listener’s ear.

Intelligibility:  In the context of speech, intelligibility refers to the amount of the speaker’s output which can be understood.  This will be affected by background noise.

Listening:  Listening requires effort from the listener and is a conscious processing of sound.  It involves complex affective, behavioural and cognitive processes.

LA:  Local Authority is responsible for providing amongst other services, education, in a particular area of the UK.

Latency:  The time taken for a piece of electronic equipment to respond to commands or changes in conditions.  This can affect the user’s enjoyment.

MCHAS:  Modernising Children’s Hearing Aid Services.  Good Practice Guidelines.

NDCS:  The National Deaf Children's Society: a charity dedicated to creating a world without barriers for deaf children and young people

Parrot and Parrot plus:  Portable automated speech tests using digitally and balanced male and female human voices.

Personal radio aid:  A device comprising a transmitter, which the speaker wears, and receivers which the child or young person wears.  These make speech more audible in difficult listening conditions, such as background noise, reverberation and distance.

Quality Assurance:  The checks used to ensure that a product or service meets the specified requirements.

Receiver:  The part of the personal radio aid worn by the CYP.  It can be body worn, attached to hearing technology by wires; ear level, attached directly to the hearing technology; integrated, part of the hearing technology itself or  using a personal neckloop.

Reverberation:  The persistence of a sound after its source has stopped which is caused by bouncing of sound waves off hard surfaces before reaching the listener’s ear

SEN:   Special Educational Needs. The SEN Code of Practice suggests four main areas of special need; Cognition and Learning; behaviour, emotional and social development; communication and interaction; sensory and/or physical needs.

SEND:  Special Educational Needs and Disabilities

Soundfield system:  An amplification system that evenly distributes the teacher’s voice around the room, using a microphone and speakers thus enabling pupils to hear equally well regardless of where they are seated or which direction the teacher is facing.

Speech in Noise Tests:  Evaluation of personal radio aids and hearing aid technology is important.  Speech testing in quiet and babble noise is used quite routinely.  There are a range of tests available for different age groups, each with its own standardised systematic approach.  

Speech intelligibility:  In speech communication, intelligibility is a measure of how comprehensive and understandable speech is in given conditions.  Intelligibility is affected by the quality of the speech signal, the type and level of background noise, reverberation and the properties of the communication system used.

SIN or Speech in Noise tests:  Speech is presented in quiet and with varying levels of background noise to ascertain the difficulty the child has in understanding the speech in the presence of noise.  Sentences or single words can be used.

Stetoclip:  A device which can be used by a hearing person to listen to a hearing aid to make sure it is working, see also attenuator.

Test Box:  This is a sound treated enclosure which gives accurate repeatable measurements of a hearing aid and its functioning.  It is also used by Teachers of the Deaf and Educational Audiologists to monitor the function of hearing aids and  to ensure that when a radio aid is fitted, it is balanced with the hearing aids, so the sound level received gives the desired advantage and the CYP has a good listening experience.

T programme: The T programme or setting on a hearing device works by activating a telecoil in the aid which works with induction loop systems to bring sound directly to the hearing aid via magnetic fields.  Cinemas, theatres, banks, shops etc may have loopstems installed, which a listener can access by switching to the T programme.

ToD /ToDs:  A Teacher of the Deaf is a qualified teacher who has an additional mandatory qualification in teaching deaf children.

Transmitter:  This is the part of a personal radio aid system which is worn or held by the person talking, it can also be plugged into a TV/audio source.

The UK Children's Radio Aid Working Group -  Formerly the FM Working Group  This was set up to encourage developments in the field of personal radio aids, promote good working practice and share information.

Gary Webster

Brian Copsey

James Mander

This column provides information on what radio aids are and how they can be used to support children’s learning.  The criteria for issuing such a system is discussed and suggestions on good practice are given.  This includes provision for babies and preschool children.

This column also looks at the listening environment for children and young people (CYP) and how radio aid systems can be used to support CYP in such environments that might otherwise be detrimental to their listening and to their learning.

A radio aid is a type of Assistive Listening Device (ALD).  There is a range of ALDs available but personal radio aids are recommended in educational settings.

Personal radio aids have the potential to greatly enhance deaf children’s listening experiences by making speech more audible in situations where distance, background noise and reverberation make listening difficult.  The radio aid works by making the sound/speech the CYP needs to hear, such as the teacher’s voice, clearer in relation to unwanted background noise and helps to overcome the problems of hearing speech at a distance.

A radio aid system consists of a transmitter, worn by a speaker, eg the teacher, and a receiver/s, worn by the CYP.

There are different types of receiver/s.

• Body-worn receivers which are usually worn by the CYP in a harness or on a belt and connect to the hearing device via a direct input lead.
• Ear-level receiver/s which attach directly via a direct input shoe to hearing aids and cochlear implant speech processor/s.
• Integrated receivers which are built into the hearing aid direct input shoe or the hearing aid itself.
• Neckloop receivers which require the T programme to be enabled on the CYPs hearing aids or speech processor/s.
• Ear-level receivers, headphones or personal soundfield for CYP who don’t use a hearing aid.

The NDCS have produced a comprehensive booklet designed for parents on radio aids.  How radio aids can help: a guide for families.

There are some ALDs, which are strictly not classified as radio aids, that are being used for the same functions in schools, eg Cochlear Wireless Mini Microphone.  It can have a receiver attached via euro socket and also be used as a transmitter.  (See a review by Colin Peake in BATOD Magazine May 2016 (p54), where he explains the pros and cons when being used as a radio aid.)

Modern hearing aids and cochlear implants allow most wearers to hear quiet speech when the listening situation is quiet and with a known speaker.   However, in reality, the world is a noisy place and a great deal of communication takes place in less than ideal listening situations.  There will be times when a CYP may struggle to hear.

Radio aids work with a CYP’s hearing aid or speech processor to make it easier for them to listen to and concentrate on the sounds or voices they need or want to hear, particularly when there is background noise or other distractions in the environment.

Radio aids help to overcome the problem of distance by bringing the speaker’s voice right into the listener’s ear.  Receivers on hearing aids and speech processors work best at a distance of around 1 metre but children are not often at this critical distance from the speaker.  Sound energy decreases the further away from the source one goes.  The doubling of the distance will result in a decrease in 6dB.  This is known as the Inverse Square Law.

Any deaf CYP should be considered a candidate for a Radio Aid.

The Quality Standards for the use of personal radio aids

Quality Standards 1 (QS1) states:

‘Every deaf child should be considered as a potential candidate for provision with a personal radio aid as part of their amplification package, at first hearing aid fitting.  This position requires that providers ask why a deaf child should not be considered as a potential candidate for a personal radio system, rather than which child should.  It also highlights the need for a close working relationship between health and education teams.  Some children who have normal hearing thresholds, and who don’t use hearing technology (for example, those with auditory processing difficulties), may also benefit from a personal radio aid. You should consider the following essential factors when determining a suitable candidate for a Radio Aid.

• Recent research suggests that even very young children and reluctant hearing aid users can get significant benefits from using radio aids.

• Children should be encouraged to understand the effect of distance on sound, and of localisation as part of their listening development whilst using radio aids.

• Appropriate support and training are needed to ensure those in the child’s environment can support the best use of radio aid technology. Contexts for candidacy and other factors for consideration can be found in the Good Practice Guide for radio aids.’

Using radio aids with preschool deaf children     

This is a study conducted by The Ear Foundation.  Twenty one families were recruited to explore the benefits and challenges of ALD use with a deaf child aged 4 years and under.  Findings provide strong evidence for the advantages of early fitting of ALD and support equitable access, consistent protocols and funding.

Ian Noon (NDCS) refers to this research in his article on Radio Aids in the Early Years, in the May 2018 BATOD Magazine. He also reports on the work of the NDCS to widen availability of radio aids in the early years.

Pre-school Use of FM amplification technology Mulla, Imran PhD 2011  

This research evaluates and explores the benefits of advanced integrated FM amplification technology with preschool hearing aided children.  Six main themes were identified: access to speech, listening, communication, wellbeing, engagement/ownership and practicalities of FM use if a CYP is referred for Cochlear Implantation, introduction of a radio aid will be advised by the Cochlear Implant Centre.  This is explained more fully in the ‘With Cochlear Implants’ section.

The aim is to ensure that all CYP and especially those who may have a temporary or permanent hearing loss, can listen and learn effectively in their educational setting.  How intelligible speech is to a CYP will depend on the how background noise can be reduced or eliminated and the acoustic quality of the educational setting, ie how much sound reverberates (or echoes) around the room.  The greater the reverberation, the less CYP will be able to hear the person speaking.  Speech intelligibility will also depend how teaching styles are changed to the listening requirements of CYP.

The benefits of using a radio aid in a noisy classroom are demonstrated in this video.

It is important that the listening environment is as good acoustically as is possible.  The evidence column of the Acoustics: hearing, listening and learning MESHGuide gives further information and research on the importance of good acoustics within classrooms.

Soundfield systems can be used in the classroom, as a benefit to all children listening in noisy situations.  Radio aids can be connected to a Soundfield system to further enhance speech intelligibility of the deaf CYP.

Bertachni et al (2015) reviewed the literature on the benefits regarding speech perception of children with hearing aids and Cochlear Implants in the classroom.  They found the best results were those who used Radio Aid devices with Soundfield Systems.

Bertachini, A. L. L., et al. (2015). "Frequency Modulation System and speech perception in the classroom: A systematic literature review." CODAS 27(3): 292-300.

 

There are some CYP who do not have a measurable hearing loss, but find listening to and processing information difficult.  Radio aids can be a useful tool for these CYP.  The research below gives examples.

This video shows how hearing aids and a radio aid helped a girl with auditory neuropathy

Bantwal, A. R. and J. W. Hall Iii (2011). "Pediatric speech perception in noise." Current Pediatric Reviews 7(3): 214-226 © 2011 Bentham Science Publishers Ltd

Bantwal, A. R. and J. W. Hall Iii (2011) in their study of pediatric speech perception in noise state that ‘an acceptable acoustical environment is necessary for effective communication and listening’.  They conclude that children with normal hearing sensitivity, whose performance on tests using competing acoustic signals is below normal, can benefit from specific intervention and the use of signal enhancing devices such as FM (or Radio Aid) systems’

Hanschmann, H., et al. (2010). "Speech perception in noise with and without FM technology." HNO 58(7): 674-679.

A study showing the benefit of using Radio Aid systems in the classroom with those with Auditory Processing Disorder Hornickel, J., et al. (2012). "Assistive listening devices drive neuroplasticity in children with dyslexia." Proceedings of the National Academy of Sciences of the United States of America 109(41): 16731-16736.  This study showed an improvement in the the neural representation of speech and impact reading-related skills by enhancing acoustic clarity and attention, reducing variability in auditory processing, by those children who used a Radio Aid system.

Rance, G. (2014). "Wireless technology for children with autism spectrum disorder." Seminars in Hearing 35(3): 217-226.

The UK Children's Radio Aid Working Group, working with the NDCS, have produced the Quality Standards for the use of personal radio aids.  This is a resource for those who commission services for deaf children, practitioners who work with them and manufacturers.  It aims to provide realistic and attainable quality standards and describe good practice for the selection, fitting, management and evaluation of radio aid systems for CYP.

There is also a Good Practice Guide, accessible on the website, on the ‘Quality Standards 2017’ tab which gives practical ideas on how to attain the Quality Standards.

See also ‘Routine Checks’, ‘Use in Educational settings’ and ‘Use in everyday life’ in this MESHGuide.

This column is intended for parents and mainstream professionals.  It explains how to ensure that you and the deaf CYP get maximum benefit from their radio aid.  It is recommended that you seek training from a qualified professional prior to use.

The hearing aids, BAHAs, speech processors and radio aids should be checked at least daily, particularly if the child is not yet able to report faults with the system.  This will ensure that they have the best possible signal to hear the speaker's voice.

1. Look at the hearing aid and radio aid, is there any damage?

2. Check the batteries in the radio aid and hearing aids.

3. Listen to the hearing aid using a stetoclip with an attenuator.

4. Attach the radio aid.

5. Give the transmitter to another person or place by a sound source.

6. Listen to the sound through the whole system.

7. If you are concerned go to the troubleshooting section in the next column

How radio aids can help - A guide for families by the NDCS, gives a full description (pages 29-32) of how to check the systems daily, how to look after the system, and how to explain the use to mainstream teachers.  People registered with the free NDCS website can also find this information and also have free access to a range of information resources, support services and events.

The NDCS have also produced a video on how to check your radio aid system.

Hearing loss in the classroom  is a video that demonstrates the effect of using a radio aid in the classroom.

Before the lesson begins

1. Ensure teacher is wearing transmitter and it is charged and switched on.
2. Ensure pupil is wearing receivers and they are connected correctly.
3. Check that the microphone is in the correct position - 15 cm from mouth.
4. Discreetly check with the pupil that the system is working.
5. If using more than one transmitter, check the others are working too.
6. Connect to soundfield system if using one.

During the lesson

1. Hearing-impaired pupils still need to see your face while you are talking.  Avoid being in shadow as this makes lip reading difficult.
2. Only one person should speak at a time.
3. Pupils contributing to the lesson should use the transmitter.  If this is not possible the teacher should repeat the contribution to ensure the hearing-impaired pupil has heard clearly.
4. Mute the microphone when not talking to the HI pupil, to avoid them overhearing irrelevant topics or coursework.
5. If appropriate, pass the transmitter to other pupils for small group work.
6. Keep background noise to a minimum.  The noise will still be picked up by the microphones on the child's hearing aids and conflict with your voice.

Ten Top Tips for mainstream teachers using a radio aid transmitter in the classroom  This is downloadable as a PDF

1. Switch the transmitter on when talking to the whole class or group in which the deaf child is taking part
2. Remember to switch the transmitter off if you or the child leaves the room.  Otherwise the child will still be able to hear you or there may be interference as the receivers try to ‘find’ the transmitter.
3. Help the child to choose an appropriate place to sit without unnecessary disturbances or distractions.
4. If using a soundfield system along with the radio aid, make sure both are working and that they are connected to each other.
5. Test the range of the radio aid system with the child so you can be sure that they can always hear you and so that you are aware of any limitations in your classroom.
6. Switch the radio aid off, or mute the microphone/transmitter, if you go to speak to a group of other children which does not include the deaf child, or when having a conversation that the deaf pupil doesn’t need to hear (the signal can travel some distance and even through walls), when going on a comfort break or when leaving the classroom.
7. Avoid standing in a noisy place, close to any noisy equipment or near an open window, as the microphone can pick up background noise and transmit this to the deaf child
8. Avoid letting the microphone knock against your clothing or jewellery as this will create noise through the system, this can affect the child's listening skills if this happens often.  They stop listening and the effectiveness of the system diminishes.
9. Remember to put equipment on charge at the end of the day, even if it has not been used for every session that day.  It is more effective to charge equipment routinely every night rather than ‘only when it needs to be’.  This could also can result in it not being charged ready for the morning or running out of power in the middle of the day!  
10. Remember not to go home wearing the radio aid transmitter (it is surprisingly easy to do).

(Adapted from the NDCS booklet - ‘How radio aids can help - A guide for families’)

Oticon Foundation report

In the Oticon Foundation Report - Study of FM in Real World Settings(2012) Wendy McCracken and others investigate the ‘real world’ use of radio aids, with a mixture of scientific measurements and the views of teachers and pupils.

Radio aids can be very useful in everyday life.  Deaf CYP often find themselves in difficult listening environments eg horse riding, bike riding, the car, supermarket, music and drama rehearsals, listening to music, phone, TV, restaurant, cafe, the park.

This poster gives some examples of parents using radio aids with their children in everyday life and includes some of their comments.

Top tips

1. Seek advice from a qualified professional prior to use, to ensure the system is set up appropriately.
2. Check battery is charged and the system is switched on and working.
3. Wear the microphone 15cm from your mouth.
4. Remember to mute the microphone when you don't want the child to hear what you are saying.
5. Remember that the microphone is sensitive and that rubbing from jewellery, lanyards and clothing can cause unwanted noise.
6. Remember the child will not be able to tell where the voice is coming from, unless they can see you talking.
7. Call the child’s name to get their attention before talking to them.
8. The signal may be poor if there is an obstruction between the transmitter and receiver.
9. Be aware that the system works best within a certain distance.  See manufacturer's’ recommendations.

The NDCS explains about your rights in the UK, for getting a Radio Aid for your child.  Children in independent schools who are not supported by the LA, may have to fund it themselves.

As the equipment is getting smaller and easier to lose, discuss with your provider about replacements and insurance.  This should not be a barrier to fitting and use.

The NDCS issued a Position Statement in 2018, entitled ‘Charging and insurance to cover the cost of replacing or repairing of all hearing and listening equipment provided by NHS and local authorities’.

Further information about insurance will be added when it is confirmed.

This column gives information about different systems and how to manage them.

There are a variety of Radio Aid systems available.  It is a good idea to discuss the choice with your Teacher of the Deaf or Educational Audiologist as there are a number of considerations.

1. Some systems are incompatible with some hearing aids.
2. Some systems are not compatible with other systems and this can lead to complications for your child at school.
3. Systems have different features that make them more or less suitable.
4. The technology is improving all the time so it is advisable to check the latest models.
5. The  different manufacturers have websites which give the relevant information.
6. Have a practical demonstration of the system.

Manufacturer websites

Oticon Amigo  

Comfort Audio

Connevans Genie

Phonak Roger 

NDCS loan products

NDCS 'Borrow to buy' test drive for Phonak products

To connect your hearing device to a radio aid, you may need a lead, a connecting shoe, neckloop or a streamer to attach or connect to the receiver.   Your visiting professional or manufacturer will be able to advise on the most suitable for your CYP.

The NDCS created some comparison charts to compare the different types of radio aids, and what choice of components are available.  Produced in 2015 there are some systems that are not included.  NDCS radio aid combination chart and NDCS radio aid comparison table

Here are some suggestions for when things go wrong.

1. Turn it off and on again.
2. Check the batteries in system, adaptors and hearing device.
3. Check the receiver is connected to the transmitter...  Is it on the right channel/frequency?
4. Is there another transmitter nearby which could cause interference?
5. Is there anything blocking the way between the transmitter and the receiver?
6. Are the receiver and the transmitter within the transmission range?
7. Change the shoe/connecter.
8. Check transmitter is not on mute.
9. Check the cable and connections.  Are they in good order?  Are they the right ones for your device?
10. See the manufacturer's user guide.

For further troubleshooting, see Sounding Board website   Although written in 2008, the basic principles are still the same.

FM hearing systems have a useful guide for troubleshooting Phonak Roger Pen and related equipment.

Synchronisation units

Some manufacturers of radio aids produce synchronisation units which automatically pair the pupils receivers to the transmitter when they enter the room.  This is useful if there is a large number of Radio Aid users in one school.  The radio signal of the synchronisation unit is strong enough to provide full coverage for the children in the same room.

However, in the case where a child goes into a corner of the classroom away from that room’s synchronisation unit, it is possible for the synchronisation unit from an adjacent room to pair that child to the transmitter of the teacher in the adjacent room.  This way the affected children will then hear the wrong teacher.  In which case, seek the advice of the manufacturer.

Hearing devices can be connected to a variety of other technology to give the hearing aid wearer direct access to eg Phones, TV, iPad or tablet, mobile phones, smart board.

Some radio aids can be used to do this, either by bluetooth or using direct input leads

The Connevans website allows you to see the technology that is compatible with your hearing aids

The NDCS has a loan service so that you can try out the different technology before you buy it. 

Sometimes there can be interference or a break in the transmission when using radio aids.

• A clear line of sight between the transmitter and receiver(s) will give best results.
• Hiding the transmitter (if not body worn) behind books, tins etc will decrease coverage dramatically irrespective of frequency of transmission.  
• Be aware when using the system outdoors, that obstructions can get in the way of the signal from transmitter to receiver.
• Within a room, blind spots will occur if a metal structure or other obstructions are between the transmitter and receiver.

Below are some frequently asked questions - and answers - about radio aids and transmission of signals.

1. The  building has a mobile phone mast on top.   a)  will it cause a health hazard?         No  b) will it interfere with the radio aid?        No
2. Will the radio aid present a health hazard?      No
3. Will the WiFi interfere with the radio aid?      Extremely unlikely but the radio aid system may cause the WiFi reception to reduce.  In which case move the WiFi.
4. Can I run radio aid systems in adjacent rooms/classrooms: YES but discuss with your supplier as minor technical adjustments may be required.
5. Are all manufacturers systems compatible? Not in every case. Also some accessories may not be compatible with all ALDs made by the same manufacturer: always check.
6. I have completed all the checks but I still cannot hear through the system.  Check you are not shielded from the transmitter aerial location.
7. Does the signal drop as batteries decline?   No - the radio aid has a battery limiter which shuts off the system when the battery level drops below a certain point (normally there is a bleep to warn that the battery is fading).
8. Does the signal normally fade away at a distance, cause distortion of ‘voice’ or just drop off?  A Digital transmission has a cliff edge drop off when it goes out of range.  An FM signal fades gracefully.
9. Why do by batteries run down so quickly?   Radio aids and ALDs mainly use small single cell batteries with a limited capacity.  If the ALD is used only as a hearing aid, the batteries last a reasonable time but the battery life is shortened when streaming music or phone conversations as these require extra power from the battery.

Click here to read a full description and explanation of analogue v digital, frequency spectrums, regulations and physics used in radio aid and ALD technology by Brian Copsey.

The UK Children's Radio Aid Working Group (formerly the FM working group) came into being in 2004 and is made up of professionals from Education, Health, Academia Charities and Manufacturers with specific interest in hearing-impaired children.  They meet twice a year.  The Group’s principal aims are:

• to promote the use of radio aid systems among children and young people

• to promote the knowledge base about radio aids
• to influence the policy framework for the provision of radio aids
• to influence the quality and consistency of radio aid provision and practice
• to raise awareness of the importance of a positive acoustic environment.

The UK Children's Radio Aid Working Group is a useful website - the home of the Quality Standards and the Good Practice Guide for radio aids.

This column gives the more technical side of setting up the system to ensure that it works optimally and gives the desired signal advantage.  There are links to videos and instructions on how to set up radio aids with various hearing devices.

The FM Quality Standards sets the standards for good Radio Aid fitting and setting up.  QS3 states ‘the personal radio aid must be set up with the child’s individual hearing aids or implants to ensure that the radio signal provides the desired advantage’.

A test box or hearing aid analyser is a means of analysing the output and performance of the hearing device, both with and without the radio aid.  This is done by putting the hearing device along with the radio aid through the test box; you can print off the graph as a visual record.  It is therefore a means of seeing the effect of the additional device and ensuring that the performance of the hearing device is not altered and that the child gets the maximum benefit from using the 2 together.  The test box will give you the ability to print off a visual record of what the two systems are doing together.

The performance of radio aids and hearing aids can be measured and recorded over time.  This is in accordance with MCHAS protocols.  Examples of portable test boxes used by deaf professionals in the UK  are Frye Fonix FP35 or the newer Aurical HIT hearing aid test box.

The Ewing Foundation have produced some videos demonstrating the use of the FP35 test box.

There may some some differences in using the test box with different devices.

The Good Practice Guide produced by the FM Working Group, explains and expands the Quality Standards. Scroll down the page to find the Good Practice Guide. Section 8 is concerned with Electro acoustic checks.

There are three main manufacturers of Cochlear Implants and each provide specific wireless devices to go with their product.

Cochlear  

Nucleus with     Cochlear mini microphone 

Advanced Bionics

Naida  connecting wirelessly to Naida

Med-el  

Sonnet and Rondo     Wireless connectivity is explained on the Med-el website

Each of these devices can be connected to a radio aid.  Some Cochlear Implant devices will only connect to certain radio aid systems and in some cases, an upgrade of a speech processor may mean a change of radio aid system is needed.  Each manufacturer has different ways of connecting a radio aid.  In some instances, they also have their own system that may not be compatible with other systems. (This is something to consider when there is more than one radio aid user in one setting).

It is important that the family, Teacher of the Deaf, and the Cochlear Implant Centre all work together on this.  The audiologists at the CI Centre will need to enable the speech processor to work with a radio aid and make adjustments to the internal settings through the manufacturer’s software.  

The Ear Foundation Sounding Board website gives information on different systems and how they are set up with the different Cochlear Implant devices.  This is especially useful for some of the older systems, but see also the websites of the Cochlear Implant devices above and the manufacturers of the radio aid systems.

Radio aid readiness for CI users

The fitting a radio aid with a Cochlear Implant user needs careful timing and planning.  It may seem unusual that an older child who has previously been using a radio aid, post CI surgery may need to wait before resuming the use of a radio aid.  This is because in the first six months post-implant, the CYP will have many tuning appointments at the Implant Centre.  If the CYP is unhappy with their listening experience after a tuning appointment it would be difficult to know if was due to changes to the mapping of the speech processor(s) or the addition of a radio aid, therefore a stable map is needed.  There may be the occasional exception where a CYP can report accurately on their listening experience.

The Cochlear Implant FM training tool  and  the FM ChIP are useful tools which can help with ascertaining the CYP's readiness to be fitted with a radio aid.

Further details on connecting radio aids to Cochlear Implant devices can be downloaded here. 

Whyte, Bealing and Cross from University of Southampton Auditory Implant Service gave a presentation on Cochlear Implants and Radio Aids at the BATOD 2017 conference.

An article by Stuart Whyte in the May 2018 BATOD Magazine explains about setting up cochlear implants with radio aids and the protocol to validate the settings.

Hearing aids can be connected to radio aids either through direct input leads, and connecting shoes, through connecting shoes which directly attach the receivers, via a neck loop or bluetooth streamer.

Hearing aids will either automatically connect to the radio aid, or need to be set up by an audiologist.  There may be a specific programme which is used for the radio aid.  To connect via a loop, the hearing aid needs to have a T or induction loop enabled.

The manuals that come with the systems explain how to use them.

 

Below are some links where you can find instructions and videos for setting up and ensuring that the levels are correct - balancing - using a test box.

Using Comfort Audio systems  - Roberts Audio solutions training materials

Quick User Guide to Balancing with FP35 test box

Using Genie, Amigo and Phonak Inspiro  - Ewing Foundation training videos

Using a Genie system  - Training video by Mary Hare and Ewing Foundation in conjunction with Connevans

Using Phonak Roger systems  -The Roger Verification Guide

The principles of setting up bone conduction aids and BAHAs with a radio aid are exactly the same as with a hearing aid.  However, you do need to have the correct adaptor to connect it in the test box.

The NDCS booklet 'How radio aids can help - a guide for Families' has a section on connecting radio aids to bone conduction aids (page 15).

If you’re not already an NDCS member, you’ll can sign up for free to access the guide. NDCS members also have free access to a range of information resources, support services and events.

The purpose of a radio aid is to make speech accessible in difficult listening environments for hearing aids and CIs, by reducing the effect of distance and background noise.  The radio aid is set up and balanced before being subjectively assessed by the wearer.  Objective evaluation using speech discrimination tests assesses the benefit the wearer gains as well as their functional use of their listening package.

Is it worth it? Measuring benefit in noise by Joyce Sewell Rutter and Richard Vaughan is an outline of measuring the benefit of using radio aids in noise.

The Quality Standards for the use of personal radio aids recommends in QS4 that  the child’s listening response must be checked with the complete system in place.

These evaluations are usually done in ideal listening conditions with the typical mainstream classroom  noise introduced, enabling the signal and noise to be be measured.

Section 4 of the Quality Standards Good Practice Guide 2008 details the way the information that can be used, available tests and methods of administering the tests.

Gary Webster, County Educational Audiologist from Northamptonshire in Speech-in-Noise (SIN) assessments and radio aids, details his rationale and procedure for assessing how the child accesses speech with and without a radio aids and in typical classroom noise.  He also highlights the importance of choosing the right assessment and method of presentation.

The Ewing Foundation have produced a SIN Toolkit for undertaking Speech in Noise testing.  The leaflet that comes with the test explains how the test can be set up and performed.  Joyce Sewell-Rutter and Trish Cope delivered a workshop on speech perception testing at the 2018  BATOD National Conference to show one of the ways to gather and use evidence – speech in noise testing. Their article in the May 2108 BATOD magazine considered 'Why speech perception tests?' and dealt with what evidence we want, how do we get it and how do we use the information.  Two case studies were used to demonstrate this.

 

Some small scale research

2004 Pilot study of procedures for evaluating benefit from fm systems using a speech in noise test and a questionnaire by Carina Newman and Mary Hostler.

 

Eiten, L. R. and D. E. Lewis (2010). "Verifying frequency-modulated system performance: It's the right thing to do." Seminars in Hearing 31(3): 233-240.

This article discusses some current recommended practices for verifying a radio aid system using different options

Radio Aid systems can be used in conjunction with a Soundfield System.  The teacher uses the soundfield microphone and the Radio Aid transmitter is connected into the soundfield.  The sound is rebroadcast from the soundfield through the transmitter to the hearing device used by the CYP.

The Quality Standards for the use of personal radio aids QS12 states that:

‘There can be a number of advantages for a deaf child when a personal radio system is combined with a soundfield system.  However, such systems must be regularly and sensitively evaluated to ensure optimum use and benefit’. This can be undertaken using the test box and by speech in noise assessments.

Mary Atkin, in her study, 'Soundfield systems and radio aids: exploring the effects of rebroadcasting’  (2017) states:

‘The research concludes that Soundfield systems support the provision of a good acoustic environment within the classroom.  It also finds that the process of rebroadcasting a Soundfield system through a Radio Aid system requires careful management.  The research supports the need to develop guidance on the use of electro-acoustic balance and speech discrimination testing when rebroadcasting.  The verification process should also include due consideration of the individual user’s preferences to support the most effective use of Assistive Listening Devices’.

The Quality Standards Good Practice Guide 2008, section 5 details how to set up and balance radio aids with soundfield systems.  Although technology has advanced since this was written, the principles are the same.

 

There is collective research, knowledge and practice from BATOD members and others involved in deaf education, in the UK and throughout the world, showing the benefit of radio aid technology.  Advances in technology have helped to overcome the problems of listening to speech in background noise and at a distance.  The evidence presented shows how this has improved the access to speech for deaf CYP.

The collected information and advice is intended to encourage and provide evidence for the provision of the use of radio aids for all deaf children.

Although there are difficulties worldwide, regarding financial constraints, availability and sustainability of technology, the evidence shows that hearing devices alone are not giving full access to speech intelligibility for deaf children.  Whatever device or system is used, the basic principles are the same.

Deafness and Hearing Impairment affect children's access to education all over the world.  We have strived to remain unbiased against any one make or type of system, and tried to provide a range of evidence from across the range  We welcome further case studies, using any system and device.  Please send these to meshguides@batodfoundation.org.uk   Please also include areas you would like researched.

Research to gather evidence for fitting radio aids when first issuing hearing aids

Research on using radio aids in the wider community

Research on the use of other Assisted Listening Devices with deaf CYP

There are various online forums for Teachers of the Deaf and parents of deaf children, in the UK and other parts of the world.  BATOD manages an email forum.

You are welcome to join the online community here https://khub.net/group/open-door-teachers-of-the-deaf to keep in touch.