The use of FM systems with Cochlear Implants- How has research had an
impact on practice?
Sarah Flynn and Elizabeth Wood
South of England Cochlear Implant Centre
University of Southampton
Co - workers
• Julie Eyles
• Catherine Sammons
• Mark Lutman
• Paula Greenham
• Margie Harriott
Why use assistive listening devices?
• Listening conditions outside the clinic• Proven benefit of FM radio aids with
hearing aids in classroom situations• Direct rehabilitation at hearing deficit
rather than overcoming poor listening environment
Signal to noise ratio
Reduce speaker to ear distance
Desired sound predominates over background noise
Sound treat classroom
Reduce overall level of background noise
Research rationale
• Older children and adults for sound quality rating
• Word discrimination testing in pink noise simulates classroom conditions
• Testing at distances up to 10 metres to simulate teacher’s distance from child
• Standard conditions to compare different processor and radio aid combinations
• No change to processor sensitivity setting
McCormick Automated Toy Test (ATT)
• Word discrimination task for young children
• Adaptive technique allows comparison without doing many word lists
• 71% words correct in dB (A)
Results of earlier studies
In noise• All subjects benefited
from using an FM system
• Mean FM improvement in quiet = 7dB
• Mean FM improvement in noise = 15dB
Over distance• Sound quality reported
as good at 1m, 3m and 10m
• Mean FM improvement at 1m and 3m = 14dB
• Mean FM improvement at >10m = 10dB
Phonak Microlink MLXs
Initial results with ESPrit 3G
• 4/11 subjects reported problems with the clarity of the FM signal with MicroLink MLx
• Large variability between subjects • Identified a need for change in programming
parameters of processors - monitor earphone setting should not be enabled for the map suitable for FM / accessories
Follow-up study of FM radio aids with ESPrit 3G
• 3 radio aids MicroLink MLx, Genie and Solaris• 10 subjects• Each subject used the MLx and one other system• 2m in noise with and without FM• Distance –
• 3m in quiet no FM• 3m and 10m in quiet with FM
Results of FM radio aids with 3G
In noise• All 3 FM systems
performed well • Solaris 7.3dB
improvement• Genie 11.0dB
improvement• Microlink 8.3dB
improvement
Over distance• Sound quality was >83%
for all 3 systems • 3/10 preferred the
Microlink MLx for its ease of wearing
• 5/7 preferred the Genie due to louder sound
• ATT results were better with the Genie, than MLx
Further research questions
• Does the microphone option for the handy mic of the MLx system influence the results?
• Would the MLx be more acceptable to users if there was a higher gain option?
Microphone options
Handy mic with MLx Better performance
with the omni microphone setting in noise
Omni gave slightly better results than zoom and much better results than superzoom over distance
Campus S with MLxS
Slightly better performance with the omni microphone setting in noise and over distance
Campus S and MLxS with the 3G
• MLxS receivers with gains of 10, 16 and 20 gave a significant improvement in noise
• At 10 metres, a gain of 16 was significantly better than 10, but 20 was not better than 16
• 4/7 subjects said the 10 gain MLxS was too quiet although sound quality was rated as good
• 3/7 subjects said the 20db gain MLxS was too loud to listen to for a long time
Research conclusions
• All the FM radio aids tested can be used with cochlear implants
• MicroLink MLx – less gain for 9/10 subjects at 3m and 10m
• Microlink MLxS – – Gain of between10 and16dB appropriate for most
users but one level is unlikely to suit all users– Probable saturation at >16
• Need for patient feedback• Need for good communication between clinic
and education professionals
Radio Aids fitted at SOECIC January 2004
Genie27%
CRM22021%
No FM45%
Sennheiser1%
Solaris5%
Microlink1%
Soundfield FM
Either fixed in room or used as a desktop system
Teacher wears transmitter
Creates a uniform level of sound through the room
Can give approximately a 10 dB advantage
Soundfield FM Conclusions
• Soundfield does give benefit to children and teachers
• Users preferred the personal FM over personal FM and fixed soundfield
• Need to improve room acoustics before using fixed soundfield FM
• Ensure that the soundfield is optimally functioning
Fitting guidance
• Implant user able to indicate sound quality• Willingness to use radio aid with implant• Stable map• Use map with monitor earphones not enabled• Correct FM lead• Recommended transmission frequency• Wearing position• Communication with local professionals
Fitting the FM system
• Listening check of FM radio aid
• Set output of radio aid to be compatible with that from the cochlear implant on its own
• Validation of settings (McCormick ATT)
• FM booklet
Interference• Any unwanted non-signal noise• Can be caused by
– Interaction between cochlear implant RF signal and radio aid RF signal
– Monitor earphones enabled – Processor and radio aid worn too close together– Distance from transmitter– Receiver searching for signal when transmitter
turned off– Furniture eg metal objects– Smoke alarms, taxis, mobile phone masts
Simple checks
• Having monitor earphones to check processor on its own (use monitor earphones enabled map on 3G)
• With Sprint listen through monitor earphones to radio aid system and processor together
• Check radio aid system with processor on 0 sensitivity
• Check accessory adaptor is used with ESPrit 3G processor
• All connections fully engaged• Microphone of Campus S switched on
Helpful Hints for long term radio aid use
• Good communication between implant centre and local services
• Patient card with programme locations• Seating position in room• Processor + FM signal must be consistent
over time
References1 Benefit of FM study : Speech Discrimination in
Noise (January 2000)2 Speech Discrimination Ability and Sound
Quality with FM over distance (April 2000)3 FM survey (June 1999/ May 2000)4 Soundfield Systems used with Personal FM
and CI (2002)5 Benefit of FM with 3G - distance/noise (2003)6 Benefit of FM with 3G - 3 FM systems (2003)