[NFB-DB] Article: iHearit: a Review of MFi-Supported Hearing Aids From a VoiceOver User’s Perspective

[Scott Davert]

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.