WASHINGTON, DC The US Food and Drug Administration has approved labeling changes for erectile dysfunction (ED) drugs in the class that includes Cialis, Levitra, and Viagra to display more prominently the potential risk of sudden hearing loss, and to guide consumers on what to do if they experience sudden problems with their hearing.

In addition, the FDA plans to require the same changes in labeling for the drug Revatio, also a member of this drug dass known as phosphodiesterase type 5 (PDE5) inhibitors. Revatio is used to treat pulmonary arterial hypertension (PAH). PAN is a serious medical condition in which continuous high blood pressure in arteries of the lungs weakens the heart musde and often leads to right heart failure and death.

The FDA asked manufacturers of these drugs to revise product labeling after a very small number of patient taking the PDE5 inhibitors reported sudden hearing loss, sometimes accompanied by ringing In the ears and dizziness.

“Because some level of hearing loss Is usually associated with the aging process, patients on these drugs may not think to talk to their doctor about it, said Janet Woodcock, MD, FDA’s deputy commissioner for scientific and medical programs, chief Medical officer, and acting director of its Center for Drug Evaluation and Research.

Patients taking Cialis, Levitra, or Viagra who experience sudden hearing loss should immediately stop taking the drug and seek prompt medical attention. Those using Revatio should continue taking their medication but should contact their health care provider for further evaluation. Because Revatio is used to treat a potentially life-threatening condition, the FDA does not recommend patients abruptly stop taking this medication but should consult their physician if they experience sudden problems with their hearing.

A case report In the April 2007 issue of the Journal of Laryngology & Otology involving sudden hearing loss in a man taking Viagra prompted the FDA to search the FDA’s Adverse Events Reporting System for instances of hearing loss and PDE5 inhibitors.  The FDA found a total of 29 postmarketing reports of sudden hearing loss, both with and without accompanying ringing in the ears, vertigo, or dizziness. In most of the cases, the hearing loss involved one ear. The hearing loss was either a partial or complete loss of usual hearing. In approximately one third of cases, the event was temporary. In the remainder, the hearing loss was ongoing at the time of the report or the final outcome was not described.

SOURCE: FDA

When I first heard the words, …or your brain will rust, I felt angry and thought some unscrupulous practitioner was misleading patients. Well, that was 25 years ago and I’ve now seen many patients who do not want to wear their hearing aids. My feelings on how to deal with these people have changed. Some patients need strong encouragement; otherwise their hearing aids stay in the drawer and family and friends suffer.

How do you motivate recalcitrant patients who refuse to wear their hearing aids on a regular basis? What do you tell them? Do you use words phrases like or your brain will rust?

Some patients expect to hear well even if they don’t wear their hearing aids regularly. These are the ones who get my wear-your-hearing-aids speech, which goes something like this:

You don’t hear with your ears, you hear with your brain.

I then touch the patient’s finger with my hand and continue, ”You don’t feel with your fingers; your fingers make electricity, which is carried to your brain through nerves. You ‘feel’ with your brain.

”Your ears make electricity that is carried to your brain through your hearing nerves. You ‘hear’ with your brain, not your ears.

”Hearing aid use is like exercise. If you want to get your muscles in shape, you need to exercise them every day.

Let me ask you a silly question: How well would you dance if you stayed in bed all day, everyday, Monday through Friday. then went dancing Friday night?

I pause and wait for the patient to respond.

You would look pretty funny, wouldn’t you? Legs have to be used regularly or you can’t walk. Same with ears.

I go on to explain, Conditioning the auditory cortex of the brain is much like conditioning leg muscles. It’s impossible to sit on a couch and drink beer all week and get healthy leg muscles. What you get are a big stomach and weak legs. I pat my stomach for emphasis.

”When you wear your hearing aids, lots of good things happen. You get used to the feeling of wearing the hearing aids. You get used to all the funny sounds. You start hearing better.

”It takes time for the brain to learn to recognize words through the hearing aids. Learning to listen to amplified sound is like trying to understand people who speak with an unfamiliar accent, like the actors in British dramas on TV. At first, the words seem garbled. But slowly, they become clearer, easier to recognize.

Wearing hearing aids in noisy listening situations also takes time. It is not easy to listen to one person when lots of other people are talking at the same time. But with practice you get better.

Wearing hearing aids even helps short-term memory. If I tell you my name is Dr…ru..p., you’ll know you didn’t hear the name correctly so it won’t register in your brain. But if I say my name is Dr. Grump, you’ll think, ‘Wow, that’s a weird name!’ and you will probably remember it.

I conclude, The more you listen with hearing aids, the better your brain gets at recognizing words.

PRACTICE MAKES PERFECT

I don’t give this speech to all my patients, just those who are complaining about not being able to understand words and have not been wearing their hearing aids. The phrase Practice makes perfect embodies much wisdom. We rarely get good at any task without doing it over and over.

It is not obvious to all patients that they need to wear their hearing aids. So we need to encourage them, educate them. The phrase You need to wear your hearing aids or your brain will rust! is a simplistic overstatement. Yet it contains more truth than fiction. When a person does not hear sounds, the tonotopical mapping of the cortex in the brain begins to change. The longer people avoid wearing hearing aids, the more difficult it is for them to learn to hear through them.

There are many ways to tell patients that wearing hearing aids improves cortical conditioning. I try to find out what a patient wants to hear, then I stress that wearing the instruments will help you hear the baseball game on the radio, your grandchild’s voice, friends at your woman’s club meeting, etc. In truth, wearing hearing aids improves word understanding in almost all situations, and not wearing them results in an unnecessary loss of speech information.

The act of hearing and interpreting words is much more difficult than most of us realize. Just think about it. Most children are born with normally functioning ears and brain. Yet it takes thousands of hours of practice before the child can hear and understand a sentence like, Do you want some ice cream or a popsicle?

When people have poor hearing ability, they also tend to develop poor listening habits. Paying attention to difficult signals is frustrating for them, so they tend to shut themselves off from others and stop trying to hear. But, using hearing aids reconnects these people with family, friends, the rest of the world, and it makes all avenues of communication easier.

Results from this study show significantly better speech intelligibility for television watching with an Oticon TV adapter system and hearing aids over hearing aids alone.

The most common leisure activity of retirees is watching television. They spend more time watching television than listening to music, eating at restaurants, and going to church combined. It is the activity that increases the most after retirement; in fact, over half of the increased leisure time people have after retirement is spent watching television.1 According to a recent Nielsen television ratings report,2 US adults over 65 watch more television than any other segment of the population. They watch an average of over 6 hours of TV per day. Television provides not only entertainment; it is also a way to acquire information and to connect to local and world events.3

Unfortunately, hearing-impaired adults have difficulty accessing the spoken information from television. There are many factors that make the speech on television difficult to understand. These factors include the wide variety of speakers, rapid change of topics, rate of speech, background noise, and factors intrinsic to the listener.

Televised speech is often presented at twice the rate as conversational speech; this contributes to making TV difficult to understand.4 Many studies show that elderly and hearing-impaired people are particularly negatively impacted by increases in the speed of speech delivery.4-6

Background noise also affects understanding. When watching television, background noise comes from two significant sources. Noise may be part of the TV program itself (eg, music and other sound effects), and noise may come from other sound sources in the listener’s environment.

All of these factors contribute to making television understanding difficult for all listeners. There are also some intrinsic factors—namely, age and hearing loss—that contribute to greater difficulties understanding the speech in TV programming for some listeners. Research indicates that both age and hearing impairment contribute to reductions in the accuracy of speech recognition for rapid and highly variable speech.3,6

There is an easy, though often suboptimal, way to accommodate reduced hearing sensitivity when watching television: turn up the volume. Of course, one obvious problem with turning up the volume is that high TV volume is annoying to other people in the room (or, in some cases, even the neighbors). Excessive TV volume is one of the most common causes of stress in households with a hearing-impaired person, and it is one of the most common reasons for visiting a dispensing professional for the first time.3,7

At the first follow-up visit, the significant other often reports that he/she is happy both with the new hearing aids and with the new lower TV volume.7 However, many hearing-impaired people report that they still struggle to understand speech on TV, even after receiving new hearing aids.

Callahan8 investigated televised speech understanding for elderly adults with and without hearing aids. She found that hearing aids did not significantly improve television speech recognition over no hearing aids for the participants in her study. Closed captioning did improve speech recognition; however, despite this improvement, most adults in the study reported that they preferred to watch television without closed captioning. For many individuals, particularly elderly people, it is difficult to keep up with reading captioned text. Others simply do not enjoy watching TV as much when they have to read.

Research in speech recognition indicates that increasing the volume does not allow hearing-impaired people to understand speech as well as normal-hearing people. Hearing-impaired individuals generally need a more positive signal-to-noise ratio (SNR) to have the same speech recognition as normal-hearing people. Typical hearing care counseling includes a range of techniques, such as face the talker, and ask the talker to speak slower and to rephrase. These techniques are ineffectual for the one-way communication environment of television listening. What can be done to improve television watching for hearing-impaired people?

This article describes an investigation of television speech understanding using hearing aids alone and with the Oticon TV adapter and Streamer. The TV adapter is an augmentative television-watching device that connects to the television. This allows audio information from the television to be sent digitally to the hearing aids via the Streamer. The Streamer is a communication device that relays data from external audio sources (via Bluetooth or a wired connection) to the hearing aids; this allows hearing aids to connect to external sound sources, such as cell phones, MP3 players, or the TV adapter. (In this article, the TV adapter and Streamer are referred to as the TV adapter system.)

The purpose of this study is to compare the speech recognition scores of hearing-impaired listeners for television programming under two conditions: 1) Epoq hearing aids alone, and 2) TV adapter system with Epoq hearing aids.

Materials and Methods

Subjects. A total of 10 people (four females, six males) with bilateral sensorineural hearing loss who are currently using bilateral hearing aids were recruited for this study. The mean age was 65 years and the range was 31 to 81 years. Participants had sensorineural hearing losses ranging from moderate-to-severe to profound hearing (Figure 1).

Amplification. Participants were tested with three styles of Epoq hearing aids: BTE, ITE, and the RITE Power. Each participant used a test Streamer and the TV adapter. A total of eight participants wore their own Epoq hearing aids with fine tuning, and two participants were fit with Epoq hearing aids on the test day because they wore hearing aids that were not compatible with the Streamer. The function of hearing aids was verified prior to the test by participant report, a listening check, and running an electroacoustic analysis of the hearing aids in an AudioScan test box.

Stimuli. The test material included sentences or parts of sentences from Danish television news broadcasts. Sentences were calibrated to have the same average sound level. After each sentence, 45 seconds of silence and blank screen was inserted to provide time for listeners to record their responses on an answer form provided.

Sentences were organized into four lists of 10 sentences each based on sentence difficulty, sex of speaker, and availability of lip-reading information. The objective was to have lists of comparably difficult sentences. The lists were pretested with four normal-hearing subjects. The total percent-correct based on the normal-hearing pretest was between 94% and 96% for each list. Lists had between 75 and 83 total words that were scored individually. Sentences were calibrated to play 62 dBC. This level was rated as comfortable for television watching by normal-hearing listeners.

Noise Competition. Testing was conducted with unmodulated noise playing from two speakers at 45° and 315° (Figure 2). The noise used was speech spectrum shaped unmodulated noise filtered to match the long-term spectrum of the television test material. The level of the noise was selected individually based on speech reception thresholds in noise. The better the participants’ speech reception threshold was, the louder the masking noise; the range of SNRs tested was 0 to +12 dB. The level of the masking noise was varied individually to avoid problems with floor and ceiling effects, which can be a problem for tests with a fixed SNR.
FIGURE 2. Test setup. Speech and visual came from television directly in front, and noise from speakers at 45° and 315°.

FIGURE 2. Test setup. Speech and visual came from television directly in front, and noise from speakers at 45° and 315°.

Procedure. Participants were tested with hearing aids alone, and with hearing aids and the TV adapter system. The order of the test conditions was randomized to avoid order effects. Participants wrote down the sentences they heard as accurately as they could during the pauses between sentences. Sentences were played from a television and masking noise was played from two separate speakers.

Before testing, the subject was informed that different settings for watching television were being tested and that his/her task was to write down as much from each sentence as they could. For all testing, the test person wore the Streamer, so the test person did not know which condition was being tested.

Training was conducted with either hearing aids alone or hearing aids and TV adapter system, depending on the test condition being tested. After training, the person was tested with two lists of 10 sentences for each condition: 20 sentences with hearing aids alone and 20 sentences with hearing aids and TV adapter system. Participants had ample time to record the sentences. No repetition was allowed. The order of the lists was randomized to avoid order effects, and lists were not repeated to reduce potential learning effects.

Results

Mean speech recognition scores show significantly greater speech recognition (P < 0.01 using a Wilcoxon matched pair test) with the TV adapter system over hearing aids alone (Figure 3). Individual results showed that all 10 participants had a higher percent-correct score with the TV adapter system and hearing aids than with hearing aids alone. The range of improvement was between 15% and 66% with an average of 45% improvement.

Discussion

Results show that the TV adapter system significantly improves speech intelligibility for television. For participants in this study, the difference between hearing aids alone versus hearing aids plus TV adapter system was the difference between catching a few words (36% correct) to understanding almost everything (81% correct).

The key to improving speech understanding is improving the SNR. The TV adapter system improves the SNR for the television by providing a louder clearer signal that is not affected by the room noise. The signal is not affected by room noise because a digital signal is sent from the TV adapter to the Streamer, which then sends the signal to the hearing aids. Additionally, the volume can be adjusted to individual preferences using the Streamer; this does not affect the TV volume for others.

The TV adapter system is similar to FM systems in that it provides the listener with an improved SNR. The improved speech intelligibility results seen in this test are similar to the large improvements in speech intelligibility in noise with FM systems over hearing aids alone.9
FIGURE 3. Percent correct scores for individual and group with hearing aids and with hearing aids and TV adapter. *Group speech recognition scores were significantly improved (p > .01) with the TV adapter.

The results from this study indicate that, for many hearing-impaired people, the use of a TV adapter system can improve television understanding—particularly in situations with background noise.

An earlier trial with hearing-impaired listeners in situations with less background noise indicated user-perceived benefit with the TV adapter system over hearing aids alone (”Test of a TV Adaptor,” Oticon A/S, Copenhagen, Denmark, 2009; unpublished data). Participants in that study noted that they benefited from the greater clarity of sound with the TV adapter system over hearing aids alone, and that television volume was at a comfortable level for both family members and the hearing-impaired listener. Furthermore, participants reported that the improvement in speech understanding with the TV adapter system was greater than what could be achieved by just turning up the television volume.

Clinical Implications

Improving speech intelligibility for television watching is highly relevant, because understanding televised speech is not only a common problem but also a bothersome one for hearing-impaired people. Fitting patients with a TV adapter system has the potential to significantly improve both the hearing-impaired person and their family members’ enjoyment of television. Kochkin10 has found that hearing aid utility in multiple environments leads to greater customer satisfaction ratings. It follows that improving listening in one of the most-common listening situations for seniors is likely to improve overall hearing aid satisfaction.

Citation for this article:

Sjolander ML, Bergmann M, Hansen LB. Improving TV listening for hearing aid users. Hearing Review. 2009;16(11):44-47.

References

1. Gauthier AH, Smeeding TM. Historical trends in the patterns of time use of older adults. OECD Canada; June 2001. Available at: www.oecd.org/dataoecd/21/5/2430978.pdf.
2. Nielsen’s three screen report: Television, internet and mobile usage in the US. New York: Nielsen Co; 2008. Available at: www.nielsen.com/pdf/3_Screen_Report_May08_FINAL.pdf. Accessed February 15, 2009.
3. Sancho-Aldridge J, Davis A. The impact of hearing impairment on television viewing in the UK. Br J Audiol. 1993;27:163-173.
4. Wingfield A, McCoy SL, Peelle JE, Tun PA, Cox LC. Effects of adult aging and hearing loss on comprehension of rapid speech varying in syntactic complexity. J Am Acad Audiol. 2006;17:487-497.
5. Gordon-Salant S, Fitzgibbons PJ. Effects of stimulus and noise rate variability on speech perception by younger and older adults. J Acoust Soc Am. 2004;115:1808-1817.
6. Sommers MS. Stimulus variability and spoken word recognition. II. The effects of age and hearing impairment. J Acoust Soc Am. 1997;101:2278-2289.
7. Stark P, Hickson L. Outcomes of hearing aid fitting for older people with hearing impairment and their significant others. Int J Audiol. 2004;43:390-398.
8. Callahan JS. The Benefits of Closed Captioning for Elderly Hearing Aid Users. Doctoral dissertation. College Park, Md: University of Maryland: 2007. Available at: www.lib.umd.edu/drum/bitstream/1903/7302/1/umi-umd-4703.pdf. Accessed Sept 20, 2009.
9. Lewis SM, Crandell CC, Valente M, Horn JE. Speech perception in noise: directional versus frequency modulation (FM) systems. J Am Acad Audiol. 2004;15:426-439.
10. Kochkin S. MarkeTrak VII: Consumer satisfaction with hearing instruments in the digital age. Hear Jour. 2005;58(9):30-43.

This article was submitted to HR by Anna Biggins, audiology manager at Phonak AG, in Stafa, Switzerland. Correspondence can be addressed to HR or Anna Biggins at Anna.Biggins@phonak.com.

A HiBAN (hearing instrument body area network) integrates a variety of accessories and two hearing instruments to form a wireless network. This article discusses how Phonak’s DirectTouch technology can be used in controlling directionality and telephone capabilities within hearing aids.
This article was submitted to HR by Anna Biggins, audiology manager at Phonak AG, in Stafa, Switzerland. Correspondence can be addressed to HR or Anna Biggins at Anna.Biggins@phonak.com.

The integration of wireless communication applications combined with the flexibility and computational power of new chip designs has created a huge opportunity in terms of the solutions that can now be offered to hearing-impaired people. They can now truly have hearing systems, not just hearing instruments.

The CORE platform is the chip at the center of Phonak’s latest generation of hearing systems that has allowed substantial progress to be made in wireless hearing aid communication technology. A HiBAN (hearing instrument body area network) integrates a variety of accessories and two hearing instruments to form a wireless network.

This wireless network has made it possible to introduce new applications and solutions for customers’ listening needs, the first of which were introduced with Exélia and Naída. Since then, Phonak has continued to develop the HiBAN to offer more benefits to wearers of hearing instruments.
Utilizing Wireless Technology

One of the main features that Phonak introduced with Exélia is ZoomControl.1 The speed and capacity of CORE wireless technology allow real-time streaming of the full audio signal between hearing instruments. In addition to directional microphone beamforming to the front and back, ZoomControl accesses this real-audio streaming capability to enable the end user to focus to the right and left side.

When an end user selects focus direction right or left, the signal of the hearing instrument on the chosen side is transferred to the opposite hearing instrument. The microphones of the hearing instrument on the non-focus side—receiving the streamed data—are attenuated. This avoids head-shadow and emphasizes the better signal-to-noise ratio (SNR) signal of the chosen hearing aid.
FIGURE 1. ZoomControl. When “Focus direction left” is selected, the left ear aid is amplified and the signal transmitted to the right aid, while the right ear is attenuated by 20 dB.
FIGURE 2. One of the five ZoomControl programs is now in use.

FIGURE 1. ZoomControl. When “Focus direction left” is selected, the left ear aid is amplified and the signal transmitted to the right aid, while the right ear is attenuated by 20 dB.

Originally, with Exélia, ZoomControl could be accessed only via the myPilot remote control. The new hearing instruments, Exélia Art and Naída IX, have been expanded to offer the benefits of wireless streaming and binaural features. One example of this is that focus direction can now be selected without the need of a remote control.

Additional benefits can be generated by utilizing the signal streaming from one side to the other for telephone conversations. Using the telephone for hearing instrument wearers has always provided challenges, and market research has shown that this is one of the listening situations where end users express most dissatisfaction.2

The impact from the introduction of digital technology in hearing instruments when used in telephone listening situations has been shown to increase satisfaction in this group by between 10% and 14%. Further improvement is still possible thanks to CORE wireless technology. The HiBAN allows real-time streaming between hearing instruments that, when applied to the new DuoPhone feature, enables hearing instrument wearers to hear the phone call in both ears while simultaneously reducing background noise levels. DuoPhone is available as a feature in any telephone program—for both acoustic and telecoil input. It is “on” by default for a program with acoustic input and “off” by default for T/MT input for binaural Exélia Art and Naída IX instrument fittings.

The remainder of this article will discuss the expansion and integration of this technology within Phonak hearing instruments, and demonstrate the ease of customizing the new program features and using the fitting software.
Directional Streaming Control

DirectTouch. DirectTouch is a feature that defines the directional and streaming behavior of a hearing aid via a tactronic switch. When DirectTouch is activated within a program, the signal from that hearing instrument is streamed to the other instrument; for example, when the left tactronic switch is pressed, the signal from the left instrument is streamed to the right instrument.

Currently, DirectTouch is available for ZoomControl programs and for the DuoPhone feature of any manual phone program. It can be selected and adjusted via the Phonak hearing instrument fitting software (iPFG 2.4 success ware).

ZoomControl with DirectTouch. When clients want the option of selecting different focus directions, the dispensing professional needs to establish if they want just one additional focus direction (eg, focus right only) or if they would like up to four focus directions (right, left, front, and back). If a client wants right and left focus directions, ZoomControl with DirectTouch can be the selected program (Figure 2). The main advantage to this is that only one program slot is used but two directions are available.

Within the normal program toggle sequence, when the ZoomControl program is activated on the right hearing instrument, the system focuses to the right. To select left-focus, the user scrolls through the program sequence until he/she returns to the ZoomControl program, selecting it via the left hearing instrument. In other words, the right button activates “zoom right” and the left button activates “zoom left,” but always within the structure of the normal program toggle sequence.

In the “program options” screen for a ZoomControl program with DirectTouch, a default direction can also be selected. This default direction is selected if the program is accessed via remote control instead of via the tactronic switch. Although it may not be a common-use case, the advantage here is that, if the client has a remote control, he/she can have the choice of three focus directions using only one program slot.3

Manual ZoomControl programs without DirectTouch can also be selected. It is important to remember that DirectTouch is “on” by default, so it must be deactivated in the “program options” screen. When DirectTouch is deactivated, the default direction will always be selected when this program is accessed via tactronic switch or remote control.
Phone Streaming Control

In a manual (not EasyPhone) phone program with DuoPhone active, DirectTouch is also available as a feature modifier (Figures 4 and 5). If DirectTouch is switched “on,” it means that the end user activates the telephone program via the right instrument when he/she wants to hold the phone to the right ear. The signal from the right instrument is then transferred in real time to the left instrument. Conversely, the wearer activates the telephone program via the left instrument when holding the phone to the left ear, causing the signal from the left instrument to be transferred to the right instrument. The microphone attenuation level of the instrument receiving the signal can be adjusted by the clinician in iPFG.

The dispensing professional can choose to turn DirectTouch on or off for any manual phone program with DuoPhone active. A DuoPhone default direction should also be set, and if DirectTouch is active, this default direction will be selected only when the manual phone program is accessed via remote control. When DirectTouch is deactivated, the default direction will always be selected when this program is accessed, via tactronic switch or remote control.
Summary

HiBAN technology offers innovative solutions that help clinicians enhance the benefit to wearers. The ongoing development of wireless technologies—combined with the more we learn about the listening needs people face in their daily auditory lives—provides an exceptional opportunity to increase hearing instrument end-user benefits.

Citation for this article:

Biggins A. Benefits of wireless technology. Hearing Review. 2009;16(11):40-43.

References

1. Nyffeler M, Dechant S. Field study on user control of directional focus: benefits of hearing the facets of a full life. Hearing Review. 2008;16(1):24-28.
2. Kochkin S. MarkeTrak VII: Consumer satisfaction in the digital age. Hear Jour. 2005;58:30-42.
3. Richars V, Launer S, Moore BCJM. Potential benefit of across aid communication for bilaterally aided people: listening in a car. Int J Audiol. 2006;45:182-189.

Source: www.hearingreview.com, by Anna Biggins

Ear Gear’s Mark Rosal with daughter Shameera, who was the inspiration for the device he developed to protect her hearing aid–and now thousands of others.

Hearing aid warranties are an important safeguard for your patient’s investment, but don’t overlook the value of those products that protect and extend the life of hearing aids.
Ear Gear’s Mark Rosal with daughter Shameera, who was the inspiration for the device he developed to protect her hearing aid–and now thousands of others.

When Mark Rosal, a native Canadian, left his Toronto birthplace 20 years ago and eventually settled with his family at their rural home in Lake Country, British Columbia, he surely never imagined that one day he would be running a business from that home manufacturing hearing aid protection and security devices.

Located near the city of Kelowna, about halfway between Vancouver and Calgary, Alberta, the Rosal residence overlooks a horse farm and picturesque Okanagan Lake. No one would guess that this bucolic setting conceals 1,000 square feet of office space within the house, the site of his increasingly busy company, Ear Gear, a venture Rosal began because of his third and youngest child, daughter Shameera.

Unlike his two older children, Shameera was born with a condition called partial trisomy 18, a chromosome abnormality resulting in a condition that Rosal describes as similar to Down syndrome. There’s a broad range of disabilities associated with the condition, says Rosal. “Some people are seriously disabled and may even struggle to survive, while a few others have actually gone on to university.”

In Shameera’s case, the now 13-year-old “may never have a high IQ—at 6, she had the cognitive abilities of a 2-year old,” Rosal says. But she is an otherwise happy and very functional child. “She walks, she talks, she reads, she’s quite a character, really.”

One result, however, of Shameera’s affliction is hearing loss that resulted in the need for hearing aids before she turned 3. “She wouldn’t wear them much then, but her loss at that point was moderate, and we had so many other battles to fight with her, getting her walking, toilet trained, etc, that we decided to wait a while. By the time she reached 6 and about to start school, it became necessary to get them on her, and we got her first digital instrument,” Rosal says.

“At that age, however, she still didn’t really understand about hearing aids. It was ridiculous … we’d turn around and they’d be off her ears; she was throwing them, hiding them. There was no way of fully communicating to her the value of the instruments. When she’d take them off, she never really remembered where they were; she just didn’t care. They chafed, buzzed, and were uncomfortable for her.”

Rosal recalls one visit to Shameera’s grandmother. “We realized that she wasn’t wearing them. We searched everywhere and asked Shameera numerous times what she’d done with them, but she couldn’t tell us. Three weeks later, just when we’d given up, we found them. Shameera was going through her ‘pirate stage’ at that time and she had decided to bury the hearing aids in a treasure box and hide them under a cushion on the sofa.”

Rosal notes that unlike her initial analog hearing aids, which cost about a thousand dollars, “the Widex digital aids were four times that much.” So the need to protect them from loss and damage was naturally greater. “She still was hiding them, taking them off, doing all sorts of stuff. We went to see our audiologist who recommended a child’s clip that was the market standard security device at the time.”

Well, that didn’t work very well, Rosal explains, because “within 5 minutes she had bit those rings, ripped them apart, had her hearing aid off, and the thing was garbage. It didn’t work right, didn’t feel good, had sharp edges. So they said to use tape, use this, use that—I was going nuts, saying, ‘Is this all there is to protect a $4,000 instrument?’ ”

“Well, they said, ‘We don’t have anything else, this is the limit of what we have.’ ”

At this point in his life, Rosal had no experience whatsoever in hearing aid security and protection devices, or in business in general, having tried his hand at journalism and a few other things in what he modestly describes as a “checkered past.” But motivated by his daughter, he set out to solve the problem, beginning with some sketches he made that he showed to his audiologist and to Nicole Sorenson of Expert Hearing Solutions, a “well-regarded chain up here in British Columbia, the owner being Rob Reiter, who has a very good reputation among audiologists.

“It felt like a good thing. My wife and I like to help people, so we looked at each other and decided to give it a go. Our company is very strong in terms of customer relations … if they’re not happy, I’m not happy.”

The next step for Rosal was to go to a local seamstress with his drawings and explain what he wanted. “She said to get her the material I wanted to use and she’d make me one.”

And how did that first Ear Gear turn out? “Not bad. Pretty nice,” says Rosal. “I still have it.”

Rosal showed the prototype to the people at Expert Hearing Solutions and went from there, finding a way to manufacture it and bring it to market. The end result was a colorful pair of spandex boots that would cover his daughter’s hearing aids and, when attached to a cord and clip, keep them secure and safe.

Going on a shoestring budget, it took about a year and a half to develop the device, “buying a few meters at a time of spandex and a little cord.”

A big step along the way was taking the product to the AAA Convention in Washington in 2005, showing it and getting industry reaction. Rosal was fortunate enough to get an endorsement from Randy Morgan of Westone, who said that his company would seriously consider distributing it.

“Randy and Ed Lockwood worked with us and helped us quite a bit with our first brochure, and marketed us to their buying group. At the same conference, we met Maureen Doty Tomasula, the marketing manager of pediatrics at Oticon, who immediately saw the value of Ear Gear and was another major endorsement for us. Westone and Oticon took our product and gave us credibility, and Westone was our first major order. Because of them, audiologists were not likely to view Ear Gear as merely some kind of gizmo.”

The actual manufacturing process went through a couple of stages. “First,” says Rosal, “we were manufactured locally. We found a fellow here in Canada who made them for us and that lasted for a while, and from there we were fortunate enough through our connections in the industry to find a manufacturer in Taiwan, which gives us the capacity we need to grow.”

A distinct advantage of the Taiwan factory, says Rosal, is that it is able to work with spandex in small sizes, which is not an easy thing to do. “Some of our products have a sleeve only an inch long; most manufacturers won’t even touch it. We tried a few companies in the United States and even others in Asia that couldn’t handle it—it was just a nightmare; they made a mess of it. But with the help of our American partner, we were very lucky to find a factory in Taiwan that could do it right.”

After 4 years in the business, Rosal is confident in the future growth of his company because “We know that 10% of all BTE wearers should have hearing aid security and protection devices. With BTE hearing aid sales of more than 1 million annually, you’re looking at a minimum of about 120,000 protection/security units per year sold in the United States alone to meet the need, and that’s just for new hearing aids. There are another 3 to 4 million hearing aids already out there that will also need their share of the hearing instrument protection and security device market.”

And, Rosal continues, “We think there’s another 10% out there—a softer market of people who need these devices for sports, for working in dirty environments. We think a full 20% of the BTE market could be tapped, easily a few hundred thousand units a year of these types of devices that audiologists should be and could be selling to their clients.”

“Every time,” Rosal believes, “that something breaks down in the hearing instrument, there’s a huge problem. The client is dissatisfied, the audiologist has to deal with an upset customer who doesn’t have his hearing instrument. It has to go back to the company. Everybody’s incurring cost and irritation all the way along the line.”

Rosal agrees that the available insurance and warranties for hearing instruments are commendable, “but the fact is that people wear their hearing aids all day and need protection on them while they’re wearing them. We have clients who within 5 minutes of going outside on a hot day find that their hearing aids are shorting out. The audiologists can’t have them coming back to their office every week or two with a problem, taking time away from seeing new clients.

“So we see it as a win-win situation all the way. The problem is that the hearing professionals haven’t fully recognized that these devices are an important part of their practice. We’re trying to get them to see that if you have a $5,000 to $6,000 instrument on somebody, you better make sure they get protection if they need it. And those one out of 10 who need it shouldn’t be leaving the audiologist’s office without it.”

Rosal strongly believes that this area has been overlooked because traditionally these devices have been lower quality, and have been aimed largely at young children. “With Ear Gear, we want to raise the bar on quality and applicability for hearing aid users of all ages.”

In its relatively brief history, Ear Gear has created an impressive array of products, ranging from the Original Ear Gear that fits all BTEs measuring 1.5-2.5 inches (available with or without cords, as with all the models), to units that accommodate hearing aids with FM units and are larger than 2.75 inches, to Ear Gear-C, which is designed to provide protection and security for cochlear processors. All models can be modified for eyeglass wearers, and a plethora of colors and designer patterns are available to suit any taste.

“One thing that separates us from our competitors is our 1-year guarantee.: He also states that his company will send multiple samples to any hearing professional, and does so on a regular basis. “We’re very strong in support for hearing professionals.”

Most importantly, he feels, is that “at this time Ear Gear is the only HIPS (Hearing Instrument Protection and Security) device that is endorsed and carried by two major hearing aid companies, Widex in Canada and Oticon in the United States, and Oticon distributes it free with all their pediatric kits. I think that in terms of credibility, that says a lot about our product.”

Source: Hearing Review Products, by Alan Ruskin

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