There are several ways to optimise the clarity and volume of speech heard on the telephone, depending on whether or not you use a hearing aid, the type of hearing aid used and also on the model of telephone you are using.
If you do not use a hearing aid, or you wear one hearing aid but always put the phone to your 'other' ear, or you always take your hearing aid out to speak on the phone, then it's worth checking that you're holding the earpiece of the handset in the right place on the ear.
Most of us had good hearing when we were younger and we could afford to be fairly 'sloppy' about how we held the phone to our ear, often twisting the handset so that the earpiece was somewhat 'side-on' to our ear, but, because we had good hearing, we could still hear well enough. Inevitably, old habits die hard.
Look at the telephone earpiece for a moment and you will probably find that the holes or slots that the sound comes out of are concentrated in the centre of the earpiece.
It is very important, especially if our hearing is less than perfect (and everyone's hearing starts to deteriorate from the age of twenty – it's just the rate of deterioration that varies), to make sure that you place the holes in the earpiece directly in front of the entrance to your ear canal (ear-hole).
If the earpiece is mis-aligned, you will, to some extent, be directing the sound from the earpiece towards the solid skin of your ear and you will be relying on the sound being reflected into your ear canal, with the inevitable loss of volume.
Although it may seem obvious, it is also important that the earpiece is touching your ear – even a ½ inch gap can halve the volume heard – so make sure the earpiece is nestled onto your ear comfortably.
If, having checked all this, you still struggle a little to hear or you find that people 'mumble' when speaking to you, you can improve things by changing your phone to one with a speech amplifier and volume control, such as a Converse 225, a Converse 325 or a Big Button +, all of which are capable of overcoming quite pronounced hearing loss.
In general, the following notes refer to the more widely used traditional, analogue, 'behind the ear (BTE)' aids but any different techniques required for 'In the ear (ITE)' hearing aids and modern, programmable analogue hearing aids are referred to as necessary. Digital hearing aids are specifically referred to in section 3, which should be read in conjunction with the rest of these notes.
With 'BTE' hearing aids, there are two distinct ways of using the phone, depending on whether you use the microphone or 'the loop'.
When you are wearing your hearing aid your ear canal is blocked by the ear mould, which is a solid lump of acrylic or soft plastic.
When you are wearing your hearing aid your ear canal is blocked by the ear mould, which is a solid lump of acrylic or soft plastic.
All sound enters the hearing aid through the microphone, which, on all 'BTE' hearing aids, is at the front of the hearing aid, above your ear.
So, if you use your phone with the ear containing your hearing aid mould, there is no point whatsoever in putting the earpiece of the phone to your ear, as it's blocked by a lump of plastic! What you need to do is move the earpiece of the phone up to the top of your ear, right over the microphone.
When you do this you may find that your hearing aid oscillates or 'whistles', usually because the mould is no longer a perfect fit in your ear. The obvious reaction is to pull the phone away from you ear and wave it about in mid-air until you find a compromise position where you can still hear but your hearing aid doesn't whistle. Unfortunately, when you find that position, it doesn't last for long because your arm gets tired and you move it and then you have to start the whole performance again!
The top of your ear is level with your eyebrow – if you wear glasses, this is the line of the arm of your glasses. If your hearing aid whistles when you put the centre of the earpiece over the microphone, you should slide the earpiece forwards, against the side of your head, towards your eyebrow for up to, say, an inch, to your temple. Then twist the handset so that the earpiece is turned from your temple towards your ear and the sound is being projected back towards the microphone. You may then want to adjust the position of the earpiece to move it progressively nearer to the microphone until just before the whistling starts in order to get the loudest sound.
The above will work with any phone; it does not need to be fitted with an Inductive Coupler as the hearing aid is not switched to 'T'. Using a phone with an amplifier will increase the volume, as you would expect, although too much amplification may cause the hearing aid to start whistling.
Some, but by no means all phones are fitted with an inductive coupler, (the packaging will list this as a feature, sometimes calling it 'hearing aid compatible'), and if yours is, you may find you can hear even better by switching your hearing aid to 'T', which stands for Telecoil. All National Health Service and most private 'behind the ear' hearing aids have a 'T' position and it is always in the centre, between 'O' (Off) and 'M' (Microphone). The switch can be horizontally or vertically located on the hearing aid, depending on the model.
Therefore, if you switch your hearing aid to 'T', it is (obviously!) not switched to 'M' and the microphone is disconnected. So, with the microphone off, the hearing aid is not picking up sound. Instead, a pick-up, or receiver, within the body of the hearing aid, accepts a magnetic signal, commonly known as the 'loop'. This is the signal transmitted from the Inductive Coupler and is perfectly harmless.
It can be tricky to switch you hearing aid from 'M' to 'T' without having to take the hearing aid out and look at it. The main problem is that, when there is no 'loop' signal to detect, the hearing aid sounds 'dead' when switched to 'T'. It is, therefore, impossible to 'hear' whether you have switched to 'T' or overshot and switched to 'O'.
The failsafe method is to switch straight from 'M' to 'O' - the hearing aid will sound dead; then switch back half-way to 'T' - the hearing aid should still sound dead. If you overshoot back to 'M', the hearing aid will come on again and you will hear that it has - repeat the sequence until correct.
Programmable and Digital aids may also offer a loop option which can then be selected by altering the programme setting.
The volume of sound produced by the hearing aid when switched to 'T' can be lower than when switched to 'M' so turning up the hearing aid volume control can compensate for this and, because the microphone is switched off, the hearing aid won't whistle.
While the sound comes from the holes in the centre of the phone earpiece, the inductive coupler is an electro-magnet fitted round the rim of the earpiece which produces a low-power magnetic signal, or field, that varies in intensity to precisely match the changing sounds of the speech produced from the earpiece.
It is, therefore, important to get the rim of the earpiece as close as possible to the magnetic pick-up within the hearing aid, which, in most models, is between 3/8 and ½ inch (or about 1 centimetre) back from the microphone. There is no mark on the hearing aid to indicate where the pick-up point is. This may take a bit more practice to perfect – don't be afraid to experiment to get the position of the receiver right. Adjust the volume on the hearing aid and/or telephone to a comfortable level.
Magnets are strongest when they are closest to each other so it is essential that the rim of the earpiece is as close as possible to the pick-up point on the hearing aid, i.e. the plastic rim of the earpiece should be touching the plastic body of the hearing aid.
If you place the earpiece against your ear, the skin of your ear causes a gap between the rim of the earpiece and the side of the hearing aid. This can seriously reduce level of sound produced by the hearing aid, so it is best to start off by placing the earpiece on the side of your head, above your ear.
Now slide it down so that it rests on the 'shelf' of your ear, sandwiching the hearing aid between the portion of the earpiece rim nearest the centre of the handset and the side of your head. To do this, your ear will be gently forced outwards and you should now slowly slide the earpiece round the curve of the hearing aid until the loudest sound is heard.
You don't need to listen to conversation to do this – the constant sound of dialling tone will allow you to compare different positions easily. You will discover that the pick-up point is very precise and that by sliding the rim of the earpiece a ½ inch one way or the other from the best spot, you can loose the signal altogether.
This technique will only work if your phone is fitted with an inductive coupler. Phones will usually have a hard of hearing 'ear' symbol to show this or may say 'hearing aid compatible' on the packaging. All BT payphones and many non-digital cordless phones have inductive couplers fitted as standard.
All BT phones which feature speech amplification, such as the Converse 225, Converse 325 and the Big Button +, also have inductive couplers and the amplifier can also be used to further increase the speech volume when using your hearing aid on 'T'.
With 'ITE' hearing aids, the shape of the ear canal itself is an integral part of the hearing process, in so much as covering your ear, either with your hand or the phone earpiece, causes the aid to react and often oscillate (whistle).
Therefore, you should rest one edge of the phone earpiece against your ear, either just in front of, or just behind your ear canal, so that the sound from the earpiece flows across your ear canal. By pivoting the earpiece, you can 'open' or 'close' the earpiece over your ear canal until you find a comfortable position. This will work with any phone and those with built-in speech amplifiers can be used to good effect but may well prove to be unnecessary.
If your aid has a 'T' or loop switch, try switching over to 'T'. You should use the same technique but it may well be possible to close the earpiece completely over your ear canal. However, this technique will only work on 'T' if your phone is fitted with an inductive coupler. Such phones will usually have a hard of hearing 'ear' symbol to show this or may say 'hearing aid compatible' on the packaging. All BT payphones and many non-digital cordless phones have inductive couplers fitted as standard.
All BT phone which feature speech amplification, such as the Converse 225, Converse 325 and the Big Button +, also have inductive couplers and the amplifier can also be used to further increase the speech volume when using your hearing aid on 'T'.
All digital aids have been found to perform well with both digital and analogue telephones. However, if you switch your aid to the loop position when using a digital phone, it will cause interference and you will hear a loud buzzing noise, similar to that heard when trying to use an analogue aid with a digital phone.
As with analogue aids, there are two main styles of digital aids available - 'Behind the ear' (BTE) and 'In the ear' (ITE), and, just like their analogue counterparts, each requires a slightly different technique when using the phone.
The 'BTE' style digital aids are the style which are being increasingly supplied to NHS patients, although 'BTE', along with 'ITE' aids, are also widely available to private patients.
Some digital aids are able to automatically adjust their volume according to their environment to optimise the listener's hearing ability. However, this can be a hindrance when using the phone as the aid may try to quieten the phone's amplification, making it more difficult to hear.
Both BTE and ITE models can be supplied with a variety of different programs, depending on your preferences. Typically, in addition to the automatic mode, there will be programmes to enhance speech in both noisy surroundings and quiet surroundings and often a loop position. However, you may also have the choice of alternative programmes such as a music setting.
Different makes of digital aids have various settings and controls, so it is not possible to suggest specific adjustments when using the phone. However, when the aids are first fitted, details will be given to you about the various settings and how to use them - you need to check that you fully understand the programs available to you.
Your digital aid will have been supplied with different programmes, depending on your preference. Typically these will be:
- Automatic, Normal or Basic Mode. The sound level continually adjusts to the changing loudness of the sounds around you;
- Speech in Noisy Situations Mode. Background sound levels are suppressed to enable greater enhancement of sounds in the immediate vicinity;
- Loop / Telecoil Mode.
When using the phone, the earpiece should be held in exactly the same way as for both BTE and ITE analogue aids (see sections 1 and 2 above). However, Digital hearing aid wearers will also, unlike Analogue hearing aid wearers, be able to use Digital Cordless and Mobile phones, as long as the hearing aid is not on the loop mode.
Some privately supplied Digital aids have an additional programme available to optimise speech in quiet situations, where loud sounds are not suppressed, as they are in both the normal and noisy programmes. If available, this is best programme to use when on the phone, as, in the normal and noisy programmes, the aid reduces loud sounds, including the phone's amplification!
The Converse 325 also features 'loudspeaking' or 'handsfree' speech that allows you to hold a conversation without holding the handset. This can be particularly helpful if you wear two hearing aids, use a body-worn hearing aid or have very severe hearing loss. You hear the speech through a speaker in the phone and your voice is picked up through a microphone on the front edge of the phone. This enables you to receive a 'balanced' sound, which many people find easier to hear. As the speech is broadcast into the room it allows everyone in the room to share in, and contribute to, the conversation.
Please note that the Converse 325 uses batteries to improve the quality of the broadcast speech. Some handsfree phones are designed to work without any additional batteries but rarely offer the same performance as battery – assisted phones.
Digital cordless phones featuring Handsfree through the handset, as opposed to the base unit, such as the Synergy 3100, offer significant handset earpiece amplification if the handset is held close to your ear or Digital aid.
There is one further option that is available when using the Converse 225 or Converse 325. If the optional Headset is connected this can be used either directly on your ear or with your hearing aid microphone. However, if you then pick up the Handset before pressing the Headset button, you will be able to use both the headset and the handset earpiece, although the handset microphone remains disconnected. The amplifier will function on both earpieces and, while the headset does not have an inductive coupler (these are available, but not through BT), the handset earpiece can still be used with your hearing aid switched to 'T'.
If you still struggle to hear clearly and have a friend with you, they can listen using the handset earpiece and repeat the speech to you by 'lip-speaking' or mouthing it.
The Converse 325 also allows the handset earpiece to function when using the handsfree option so that, if you use a body-worn aid, this will allow you to hold the handset to the microphone on your body aid so that you can speak into the handsfree microphone while the earpiece is down on your chest. Incidentally, the 'MT' position on most body aids allows you to pick up both sound and the magnetic signal from the earpiece at the same time.
There are two types of domestic cordless phone, Digital or DECT and Analogue. Both connect to your ordinary phone line and calls are charged at normal rates and they have a limited range of up to a couple of hundred yards.
However, if you wear an analogue hearing aid, do not use a Digital or DECT cordless phone because their electronic circuitry is designed in such a way that even holding the handset near your head will produce horrible interference in your hearing aid. Digital hearing aids have not been found to pick up this interference.
Analogue cordless phones tend to be white in colour, simpler to use and most do not have a screen, which displays the progress of the call among other features. All current BT analogue cordless phones have inductive couplers fitted and most have some speech volume adjustment. However the Freestyle 60 Big Button has the speech volume fixed at the higher level. The BT Quartet 3100 range, despite featuring a display screen, are Analogue.
Digital or DECT cordless phones tend to be dark grey in colour and all feature a small screen provided information about the call and directory lists etc. Many, such as the Studio, also feature amplification and several other advanced features such as Caller Display. Currently, there are no Digital or DECT cordless phones available with an inductive coupler fitted. Digital cordless phones featuring Handsfree through the handset, as opposed to the base unit, such as the Synergy 3100, offer significant handset earpiece amplification, if the handset is held close to your ear or Digital aid.
There are also some digital cordless phones that can send and receive SMS text messages to and from a mobile phone on any UK Network. These models all include SMS in the model name, such as the Synergy 3200 SMS.
The Verve 3010 Executive model comes complete with an In the Ear headset and can be used with other headsets or plug-in inductive loops (see mobile phones below) fitted with a standard 2.5mm jack plug.
All current mobile phones are digital and will cause interference if you wear an Analogue hearing aid. However, it is possible to buy Inductive Loops which also feature microphones and plug into the phone. These can overcome the problem by allowing you to hold a normal conversation while keeping the phone far enough away from your head, on your belt or in a pocket, to prevent interference occurring. Digital Hearing aids are not affected by this interference and you can hold your mobile normally against your aid.
SMS text messaging is an alternative way to contact friends or relatives and some domestic digital cordless phones can also send and receive SMS text.
Remember that when people ring you up, they want to speak to you and so it is in their interest to make it easier for you to hear them. Now that you can hear better, remind your friends that they have no need to shout, but that they should try speaking a little more slowly.
If the caller is a stranger, do explain to them that you have some hearing difficulties or that you use a hearing aid and if you're not sure what someone has said:
- ask them to repeat the sentence;
- ask them to say the sentence in a different way;
- ask them to spell important words;
- ask them to say the alphabet and stop at the correct letter;
- if it's a number or a date, ask them to count from No. 1 and stop at the correct date;
- and always repeat back the information you have heard to be sure it's correct.
If you sometimes miss phone calls, rather than having an answering machine which can have indifferent message playback quality, an answering service such as BT 1571 Answer, which is free, will allow you to hear callers' messages via the phone earpiece, so they will sound as clear as if you were speaking to that person.
Finally, and this is most important, callers should not speak directly into the mouthpiece of their phone but should, instead, hold the mouthpiece below their bottom lip, in front of, not below, their chin.
Modern mouthpieces are very sensitive and speaking too close to them causes speech to be distorted and 'breathy', whereas, with the mouthpiece shielded by the bottom lip, only the speech is picked up.
And, of course, you should do the same when talking to your friends!
Mike Docker, April 2003, who acknowledges the help and assistance of Kath Woolley, Audiology Manager, Fairfield General Hospital, Bury and her staff in the preparation of this information.
