[NFB-DB] Article: iHearit: a Review of MFi-Supported Hearing Aids From a VoiceOver User’s Perspective
Scott Davert
scottdavert at gmail.com
Thu Jun 13 22:35:17 UTC 2019
Following the link in this article will take you to the web version
which also contains links to some of the information discussed.
https://www.afb.org/aw/20/6/16680
For those who prefer the info in an audio form, I can post a podcast I
recorded a couple of months back with essentially the same info.
By Scott Davert
I used my first pair of programmable hearing aids in 1998. These
allowed audiologists to use computer software to tailor programs to
meet patients' specific needs. Using a remote control, users could
select the program best-suited to their current environment, adjust
the volume, turn the built-in t-coil on or off, and mute the hearing
aids. Today's hearing aids are adjusted using buttons on the hearing
aids themselves, which isn't the most discrete method, or by using a
mobile application, if available. In the 1990s, the slightest of
adjustments to a program required a trip to the audiologist. There was
no way to hear audio from external devices directly through your
hearing aids, individually control settings such as whether the t-coil
and microphone were active at the same time, or adjust the volume of
active components. The only way to connect to external devices like
telephones and radios was by using an FM system, placing the telephone
up to your ear when connected to the t-coil, or putting headphones
over your hearing aids. With an FM system, all sound was mono and
fidelity was quite poor. A t-coil had limited range, and the sound
quality wasn't good for anything other than an audiobook or phone
call. Headphones produced a lot of feedback when placed over hearing
aids.
In 2012, hearing aid manufacturers began using proprietary technology
to achieve a more direct connection to external devices. One such
option, reviewed in AccessWorld, was the ComPilot, which allowed
Phonak hearing aid users to receive a direct signal to their hearing
aids from various devices. It provided excellent fidelity and offered
stereo sound, making listening to music a pleasure. Just as when using
a Bluetooth headset to listen to a screen reader, keeping an active
Bluetooth connection with one of these devices is challenging, as the
connection drops after just seconds of inactivity. If you are using
the ComPilot or devices like it to listen to your screen reader over
Bluetooth, this means missing words until the connection is
reestablished. A Bluetooth connection is very sluggish, and there are
often delays of up to one second between the signal leaving the iOS
device and reaching your hearing aids. Connecting a 3.5 MM cable meant
almost no latency, and made for a much smoother experience. The
disadvantage, of course, is that a wire is required for a signal to
travel from an external device to your hearing aids. You also have to
wear this type of device around your neck.
Audiologists now have the ability to do the things mentioned above,
filter out certain sounds, and amplify certain frequencies more within
the audiological spectrum to offset a loss. Hearing aids connect to
external devices more directly than ever before, providing a much
clearer sound. Premium hearing aids from some manufacturers offer
audiologists the ability to make adjustments remotely, as long as the
hearing aids have an active connection to your iOS device. Hearing aid
manufacturers can also push software updates to your hearing aids,
eliminating the need to visit an audiologist. A user can adjust many
levels and settings with the use of MFi support and applications
developed by the manufacturer. A mobile application is always required
for an audiologist to make adjustments remotely. All of the
applications I have tried present various accessibility issues to
users of VoiceOver and braille. However, many options can be
configured by using Apple's built-in accessibility settings.
Are My Hearing Aids Supported?
Many manufacturers have models that are MFi-compatible. Check Apple's
official support page to see if your hearing aids are MFi-compatible.
This support article was last updated in October 2018, so it might not
list all supported models. You must have an iPhone 5S or later to use
supported hearing aids. If in doubt, consult your audiologist, or
complete the steps in the article to learn if your hearing aids are
compatible.
Getting Connected
MFi hearing aids are paired using the MFi Hearing Devices option
within Accessibility settings. Before pairing your hearing aids, turn
them off and back on again. After doing this, double tap on the
hearing aids you wish to pair, and then confirm the pairing request. A
second pairing request will come through your hearing aids if you have
VoiceOver running. After confirming this request, your hearing aids
will be paired, and VoiceOver audio will come through them, softening
all other sound. When VoiceOver finishes speaking, your hearing aids
will be return you to your normal sound settings. Until speech is
muted, the screen is locked, or audio routing is changed in Control
Center, you will remain cut off from everything around you whenever
VoiceOver is speaking. To continue hearing speech through your iOS
device, bring up the Control Center, select Routes Available, and
choose the iOS device.
After pairing your hearing aids, the Accessibility Shortcut will
include the option of MFi Hearing Devices. If VoiceOver is set as your
Accessibility Shortcut, you will be presented with multiple options
when triple clicking the Side or Home button. If you want to quickly
launch the MFi Hearing Devices menu, and want VoiceOver to be your
only Accessibility Shortcut, you can go to Settings > General >
Accessibility > Accessibility Shortcut, and choose your preference
accordingly. If you still want a quick way to access hearing devices,
you can do so by adding it to the Control Center. To add items to the
Control Center, go to Settings > Control Center > Customize Controls.
Under the More heading, select Hearing to add this menu to the Control
Center.
Setup
After pairing your hearing aids, there are numerous user-customizable
options. Many of these are independent of hearing aid manufacturer or
model, though some options are dependent on how the manufacturer has
configured the hearing aids to work with MFi support. After connecting
my ReSound hearing aids, I have the ability to specify whether I wish
to stream to one or both hearing aids, as well as whether I would like
to control them through my iOS device independently. I can also adjust
the volume of the hearing aids’ internal microphone along with the
level of any connected devices. I'm shown the programs my audiologist
set up, and can select one by double tapping it. To adjust the audio
levels, flick up or down with one finger on the touchscreen. Some
hearing aid manufacturers have chosen to put an equalizer in this
group of settings, so you can control the bass and treble of your
hearing experience.
Near the bottom of the screen Live Listen is found. This turns your
iOS device's microphone into an assistive listening device (ALD). With
Live Listen, someone speaks into your iPhone, and the audio is sent to
your hearing aids. Some who have used this feature report a delay of
up to three seconds between when the person speaks and the audio
reaches your hearing aids. I experienced little delay using ReSound
hearing aids unless multiple Bluetooth devices were in range, which
resulted in a choppy connection, though the person using my iPhone was
three feet away.
After activating the Back button, you are shown options that are not
specific to the manufacturer. The first option, enabled by default, is
to play ringtones through your hearing aids when a call comes in. The
next option is Audio Routing. This allows you to specify what type of
audio is sent to your hearing aids. The first setting controls call
audio routing. Selecting this allows you to choose whether call audio
goes to your hearing aids Always, Never, or Automatically. Choosing
Automatically means that if a call is answered with the phone to your
ear, audio comes through the earpiece instead of your hearing aids.
The other option in this menu is Streaming Media. The settings are the
same as those found under the Call Audio Routing submenu. This
controls where VoiceOver will be heard. There is no way to configure
VoiceOver and other media separately.
The next two options are works in progress. If all devices are signed
into the same iCloud account and on the same WiFi network, supposedly
it is possible to control your hearing aids on iOS devices not paired
to them. Sadly, no one I have spoken with has gotten this to work
successfully. Handoff does not function reliably either. In theory,
you should be able to start audio playback on an iOS device not paired
to your hearing aids, and receive that audio through your hearing
aids, as long as both devices are signed into the same account on the
same network.
Though Apple says pairing your hearing aids with multiple iOS devices
is a seamless process, I did not find this to be so. In an ideal
situation, my hearing aids played the audio from one device in my left
ear, and the other in the right.
Some hearing aid manufacturers allow control of your hearing aids from
the Lock screen. The only thing displayed on my Lock screen is the
battery status of my ReSound hearing aids. Unfortunately, the reading
is inaccurate. My hearing aids always show 100% until they beep, and
suddenly drop to 10%. This problem is not specific to VoiceOver users,
but seems to only affect those with hearing aids from certain
manufacturers.
The Menu Accessed Through the Control Center or Accessibility Shortcut
After activating the Hearing Devices menu, you can adjust the volume
level of any of the active audio devices, or adjust the bass and
treble on hearing aids that support this feature. In this menu, you
can also switch programs, and turn Live Listen on or off. Any
adjustments made are immediate. This can come in handy if you are
listening to something using an assistive listening device and do not
want to hear anything going on around you. Setting the internal
microphone’s volume to 0% will allow you to hear only audio sent
through the ALD. You can listen simultaneously to your environment and
audio from a connected device, or turn the volume of the connected
device down all the way. You can adjust the level of the internal
microphone using your iOS device, but will need to adjust the iOS
device’s level using its volume buttons.
VoiceOver Specifics
There is one option within VoiceOver settings that some may find
helpful. Navigate to Settings > General > Accessibility > VoiceOver >
Audio, and scroll down to the bottom. You will find the option to
control whether VoiceOver comes through the right, left, or both
hearing aids.
How Well Do They Function?
One of the challenges I mentioned in my introduction was latency. With
my ReSound hearing aids, and many newer models, this latency is down
to less than a quarter of a second. Typing on a touchscreen with
VoiceOver has become a more pleasant experience than when I last tried
it using a ComPilot in 2015. One of the challenges I faced, though,
was having several Bluetooth devices connected to my iOS device at
once. If my hearing aids are connected, my braille display will not
auto-connect as quickly. Some Bluetooth keyboards struggle more than
others to keep up with typing when the hearing aids are paired. When
setting up a new iPhone and using Bluetooth to transfer settings from
an older device, the transfer failed repeatedly until I unpaired my
hearing aids.
If you are composing a document on a Bluetooth keyboard or the
touchscreen and pause for more than a second, the Bluetooth connection
stops to conserve battery. This can be very disruptive to a VoiceOver
user's productivity, especially with hearing aids that do not preserve
the second or so of audio between when the connection resumes and
audio is once again being transmitted to your hearing aids. One way to
prevent the connection from dropping is to start audio and leave it
playing quietly in the background. Another option is to record silence
and play it as long as you need the constant connection.
When I first paired my hearing aids, music sounded horrible through
them because the MFi support respects the currently active hearing aid
program when the connection is established. My audiologist worked with
me to customize a hearing aid program specifically for music, which I
switch to before listening to an audiobook or music to ensure the best
sound.
The Bottom Line
Hearing aid technology has evolved in the last two decades. The
ability to have control over one’s sound environment on demand is a
very liberating thing. In many instances, the more simple adjustments
that a user may want to make no longer require a trip to an
audiologist and can be done on the fly. It would be helpful if Apple
offered the option to have VoiceOver stream independently of other
media.
The biggest concern for a blind hearing aid user is the
inaccessibility of applications provided by hearing aid manufacturers
that offer access to even more features for sighted users. I have
tested applications from Oticon, Widex, and Phonak in demo mode and
found several accessibility issues that others have confirmed exist
when using hearing aids from these companies. One feature that is
consistently inaccessible irrespective of manufacturer is the
equalizer. It is my hope that hearing aid manufacturers will begin
taking this feedback from blind users more seriously. I further hope
these manufacturers will begin to utilize tools in the way Apple
suggests, so that blind users can have equal access to all of the
great options our sighted counterparts do. We are also paying
customers and deserve nothing less than everyone else. Alternatively,
hearing aid manufacturers can offer a discount to those who are
prevented from taking full advantage of their products. As the prices
for these hearing aids can be over $3,500 per ear, a discount wouldn’t
be unappreciated.
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