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When programming hearing aids, are audiologists accounting for blind hearing aid users who need to hear low frequencies for orientation and travel?

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I’m currently in an Orientation & Mobility (O&M) graduate program. It’s a field where I teach people with visual impairments how to travel safely, efficiently and independently. As someone who was born with mild sensorineural hearing loss, it has been fascinating learning about how blind people utilize their sense of hearing. They localize and track traffic sounds to align themselves at an intersection for street crossings. The traffic surge is vital for identifying a safe time to begin a street crossing when they can’t see the traffic/pedestrian lights. Because of this, professionals in my field are often the first identify a potential hearing loss in our clients and students.

With people living longer today, the aging population unfortunately has a double whammy both hearing and vision loss. When programming hearing aids, are audiologists also accounting for this population and the need to hear low frequencies for orientation and travel? Most hearing aids like mine are programmed to improve speech clarity since people typically have high-frequency hearing loss. As a hearing aid user going through the blindfold training in my O&M program, I had continuous difficulty with the mentioned auditory skills in the previous paragraph. Apparently, the traffic sounds that provide vital information for travel and orientation are in the low frequency range. I brought it up to my audiologist at my next appointment. She pressed some buttons in the hearing aid software, then bam, I could suddenly localize traffic sounds and walk straight under blindfold.

I’m not really sure how to word what I am asking, but I am very interested in this topic and would love to learn more in this area from the expertise of audiologists. I’m somewhat familiar with high-frequency sensorineural hearing loss, but I’ve had difficulty wrapping my head around cochlear implants and hearing aids with conductive hearing loss.

Out of curiousity, are there any topics that you audiologists would like to learn more about to understand your client population with visual impairments better and how you can support them? And vice versa, what is something not obvious, but important for Orientation & Mobility specialists like me to know for working with clients with hearing loss? I know as I gain more experience in my career as an O&M, there will be times I will have to help my clients advocate for hearing services.

Thank you in advance for taking them time to read through this lengthy post!

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Hearing Aids are programmed for one’s loss by way of an , if there’s no low frequency loss then this is not amplified, but what can easily be done is have a special program set up just for this type of situation, but manually, although Phonak could offer this as part of their “Autosense” so no real manual change but done automatically, I think it could be problematic for some having to do a manual change every time they are outside in the city/traffic, plus it would affect the speech comprehension as in sounding “booming” if not done right, should be interesting to hear what others offer in this regard.

Generally there are spacial clues for better orientation in the higher frenquencies, therefore IF THE cochlea is NOT DEAD, there will be more spacial awareness if the instrument for example has
10,000hz bandwith. I remember there was a white paper a while a go.

I don’t think much attention is paid to this when programming hearing aids, but I don’t know for sure. @Neville I was wondering if you could comment on this post. I found it a thoughtful question.

As someone who has low vision and profound hearing loss (bilateral ), I say “hooray” for your effort. I don’t use a white cane (yet), but boy is there a difference in mobility without CIs.
my asks for audiologists are pretty simple: please don’t ask me to respond to a chart that I have to read, like the loudness assessment or an audio gram. If pointing at something on your computer screen, verbalize what’s there. Don’t hand me print materials without verbalizing.
That said, I mostly think people forget about another person’s disabilities, and rightly so. Those of us who can’t see must simply say so whenever required, just like you have to about hearing.
I just tell people I’m almost ready to try out for the lead when they reopen the rock opera Tommy.

Edited

It hasn’t actually come up for me. That is, I personally have no blind or low vision patients at this time. I’ve been present for a fair number of discussions about considering options for hearing aids that are easy to feel, hacks to add to tactile cues to tell left and right hearing aids apart, considerations for cleaning ( management). There’s a bit more pressure on strong audibility because lip-reading cues aren’t there–I just say ‘a bit more pressure’ because we of course want strong audibility for all patients. I’m personally aware of the importance of traffic sounds during navigation, but only because I spent a bit of time working with the CNIB many years prior to becoming an audiologist. (I also probably benefit a bit from a lot of vision neuroscience in my backgound, although much was irrelevant to dysfunction.) I can’t think that specific gain considerations was something that came up during my audiology degree, nor something that I’ve seen many discussions about. It think it would be even less likely to come up for at school for a hearing instrument specialist certificate program.

If you’re looking to make an impact, I think there’s certainly room for more inter-professional communication and education in this area. If you have an audiology program at your school, you could connect with those students and brainstorm with them, give a presentation. If you like to write, there are publications that would be interested–up here it would probably be Candian Audiologist.

And there are areas to cover throughout the journey, beyond the fitting. Considerations that we had when building our clinic involved lighting and contrast to try to make the clinic visually friendly. We think about font types on written hand-outs. We think about clear verbal instructions throughout appointments, magnifying devices widely available in the clinic. For hearing aids, in addition to considering the gain a bit more carefully and providing programs that don’t try to automatically focus on speech or reduce background noise and that don’t use asymmetrical beam forming (which is detrimental to localization), we should be offering solid options to stream screen reader audio from computers directly to hearing aids with appropriate battery life. We may need to consider different types of alerting systems. As clinics move more into building social media we need to be careful about our alt-text for photos. I admit to not knowing which manufacturer’s current app is the most blind-friendly and I would love someone to tell me. It would probably also be worthwhile discussing different types of vision loss and the expected individual impacts (e.g. colour loss versus peripheral loss versus foveal loss) and how it might impact how patients should be orriented when seated, etc.

So yes, I think how much a particular clinician knows or thinks about this stuff is probably really variable and will have a lot to do with their experience and interest, but it is certainly a special population that needs special considerations, just like musicians or doctors or meniere’s, etc.

As for the other question—what is non-obvious that O&M specialists would benefit from knowing? Hum. Probably a lot of the same things that aren’t obvious to anyone with normal hearing. Off the top of my head, maybe how limited hearing aids are in their ability to preserve localization cues and what types of hearing loss make this worse (big asymmetries, for example). That hearing aids really only function optimally within the near-field (much shorter distance limitation than the natural ear). That two patients with apparently similar hearing losses may have dramatically different speech-in-noise function and that even premium hearing aids may be (regularly) insufficient in noise. The raising your voice distorts it and as hearing loss progresses you need to focus more on slow and clear rather than loud. I can think up more when it’s not so late at night, but I bet the forum members can also come up with a long list of things they wish non-hearing-aid-users were more aware of/sensitive to.

@Neville

I’m so grateful you wrote this

At 77 I’ve worn for about 20 years. Hearing is more difficult for me Seeing is too. I have trouble when light is bad
And I’m colour blind.

I just discovered my iPhone can distort colour depending on the colourblind type a person has

Tonight I responded to my wife in a conversation. She gave me the “you’re crazy look”. I talked about her brother in law. She had spoken about an incident caused by her grand nephew. Conversation ended as clearly I was ignoring her and didn’t care

I appreciate the thought you put into your response. Thank you

Dave

In reply to @Neville

Something that is obvious to me, but obviously not obvious to most is to get the listener’s attention before one starts trying to communicate. I think this would be doubly important for visually impaired people as they’d have no visual clues.

I am not visually impaired (other than mild prescription) but orientation and travel, especially now with so many EVs, does actually affect me with my loss, unilateral mild low frequency loss. This is not something most audiologists understand or even people with hearing loss, unless they have the same. It took 10 years for someone, an , to mention I should try a hearing aid because of orientation (and also because I’m a musician). I just thought I was a bit strange.

For those old enough here, I remember the Epoq XW (oticon ) they made a white paper, how extended bandwidth (10,000hz ) and compressions where key for spacial orientation

@user421 check this video, unfortunately this are feature on expensive hearing aids. Note this video is a VERY OLD when Oticon first introduced binaural compression + extended bandwidth

@user421 I think, low frequency amplification DOES NOT contribute to spacial awareness. In fact,
to much low frequency amplification could lead to upward spread masking.

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