HEARING DEVICES

COMPONENTS OF A HEARING AID

Main components of any HA includes the (a) microphone to pick up the sound, (b) amplifier
to increase the gain of the hearing aids and (c) receiver to send the amplified signal to the ear.
The amplifier has the major role to play as it helps in modifying and deciding on the gain of
the HA.

There are two types of sound processing:

• Analog

• Digital

Analog hearing aids:

In analogue instruments, sound is processed as an electrical signal by a microphone. Analog

sound is like making a photocopy: the sound is registered and you get an overall picture. But
the actual processing is like recopying a photocopy – it can only be done to a certain extent
because it causes a deterioration of the original imprint.

Digital hearing aids:

In a digital hearing aid the acoustic signal is converted into digits (0, 1), processed within the
hearing aid, and then reconverted to an analogue acoustic signal for the listener. A digital
signal can be repeated endlessly without affecting the overall quality. It is like making copies
of a scanned image: each copy is a perfect duplicate of the original.

Hearing aids can be classified according to whether they are fully analog, analog with digital
control circuits for programming the aid or fully digital.

PRINCIPLE AND WORKING OF ANALOG HEARING AIDS:

SIGNAL PATH

FIG 1: Acoustical signal is converted first to an electrical waveform. This electrical

waveform is a direct analog of the instantaneous pressure variations picked up by the
microphone. This electrical analog of the acoustic signal is then filtered, amplified and
processed. In the final stage, the electrical signal, at the receiver is converted back to
acoustic signal and delivered in the ear canal.

Advantages of analog hearing aids:

Generally cost less than digital hearing aids

Are sometimes more powerful than digital hearing aids

Long time hearing aid users sometimes prefer analog over digital

PRINCIPLE AND WORKING OF DIGITALLY PROGRAMMABLE ANALOG

HEARING AIDS:

SIGNAL PATH

DIGITAL
CONTROLLER
AND MEMORY PROGRAMMING
INTERFACE

PROGRAMMING UNIT

FIG 2

Programmable aids overcome difficulties arising from trying to fit large number of controls
to small hearing aid. Digitally programmed analog hearing aid consists of analog path
similar to that of fully analog aids. The difference lies in how these paths are adjusted.
Digitally programmable analog aid uses digital control circuit, contained within hearing aid
to control characteristics of analog signal processing blocks.
Advantages of digitally programmable hearing aids:

1. Greater electroacoustic flexibility resulting in greater sound comfort and quality,

without needing to send the hearing aid back to the manufacturer.

2. Remote controls possible, enabling easier operation of the volume control, multiple
programs for listening needs.

3. Fewer mechanical parts, resulting in fewer breakdowns.

4. Hearing aid performance can be pre-set by the programming computer, resulting in

faster fitting (compared to non- programmable aids)

5. Paired comparisons of different settings can be used to fine tune the fittings

6. Lower manufacturing costs (eventually)

FIG 3: During digital signal processing, the microphone transduces acoustic i/p signal into
an electrical i/p signal. The electrical i/p signals are amplified by pre-amplifier and are
digitized by analog to digital converter. Digital signals are spectrally shaped by DSP and
are converted into analog electrical signals by digital to analog converter. Electrical signals
are then amplified by amplifier and transduced into an acoustic o/p signal by the receiver

There are two types of digital signal processors in hearing aids hard wired and general
arithmetic processor.

WHY TO USE DIGITAL HEARING AIDS??

In addition to basic amplification, it provides clean signals free of noise, ensures listener
comfort in all acoustic conditions and provides effective localisation and superior signal
quality. It enables hearing instrument specialist to also begin to develop solutions for non-
linear problems caused by damage to inner ear, auditory nerve and central processor in
cerebral cortex.

ADVANTAGES OF DIGITAL HEARING AIDS:

• Can be programmed with noise reduction algorithms to help reduce background noise

• Highly programmable for various listening environments

• Most flexible and adjustable for specific user needs

• Perform more complex processing than possible in analog hearing aids.

• Many operations can be done with less power and smaller circuit size if done
digitally.

• They have enough processing capacity , digital circuits containing a general

arithmetic processor can potentially be updated with new processing schemes as
knowledge advances or hearing loss changes.

• Another advantage of the digital processing is that with advances in technology, the
physical size and power consumption of the digital circuits is reducing at a faster rate
than analog aids.

TECHNOLOGY OF NON- LINEAR AMPLIFICATION AND ITS APPLICATION IN

HEARING AIDS

HAs function to improve hearing threshold of client. Improving only the hearing threshold
does not satisfy a person with HI. It should be able to imitate function of OHCs, i.e. along
with improving hearing sensitivity; it should also restore normal loudness growth. To restore
normal loudness growth with HAs, soft input sounds need to be amplified by little or nothing.
This calls for need of HA to function in a non- linear manner.

Linearity versus Non- Linearity:

Linearity means providing same amount of amplification for different input levels, whereas
Non- linearity means providing different amount of amplification for different input levels.
.

COMPRESSION:

Compression is often referred to as automatic gain control (AGC) because it changes the gain
of the hearing aid as the input intensity SPL changes. Compression is the big word today in
the realm of hearing aids. Hearing aid specifications abound with all types of compression.
Many types of compression hearing aids are produced by most hearing aid manufacturers. All
of the recent developments in compression technology are tiny steps towards the goal of
imitating the cochlea and its functions.

Rationale of compression:
 • It helps in restoring normal loudness growth with the hearing aids in individuals with
reduced dynamic range. It limits or adjusts input or output sound levels so that it does
not reach patient’s uncomfortable level.

Avoiding discomfort, distortion and damage:

An increase in output of HA along with increase in input can result in discomfort.

Excessive increase in intensity of signal can cause damage to aid wearer’s residual
hearing ability. If there is no compressor, then other option is “peak clipping”, which
will lead to distortion of signal.

Normalizing loudness:

The main principle is to normalize perception of loudness. The HA user will also
perceive loudness as that of normal hearing individual. Compression is the main idea
behind this process

Maximizing intelligibility:

Multichannel compression modifies the gain in each frequency thus maximizing

audibility and intelligibility of speech.

Reducing noise:

Compression reduces effect of the background noise by decreasing low frequency

gain in high level environments.

CHARACTERISTICS OF A COMPRESSOR

The function and application of compression circuits are defined by their:

STATIC AND DYNAMIC FEATURES

STATIC FEATURES:

Eg. Compression threshold and compression ratio, indicate the behavior of the circuit in
response to steady input signals

(e.g., a running vacuum cleaner or the constant hub-bub of a noisy restaurant)

DYNAMIC FEATURES

Eg, Attack time and release time, describe the length of time required for the circuit to
respond to a changing input signal

(e.g., speech in a one-on-one conversation)

DYNAMIC COMPRESSION CHRACTERISTICS:

Static aspects of compression are Threshold kneepoint and Compression ratio, whereas
Dynamic aspects of compression are Attack and Release Times. They alter the envelope of a
signal.

A compression is intrinsically a dynamic device. Its job is to change gain depending on

changes in the signal level.

Attack time is defined as the time taken for the output to stabilize to within 2 dB or 3 dB of
its final level after the input to the hearing aid increases from 55 to 80 dB SPL.

A similar event happens when the input signal decreases in level. Again, the detector
progressively reacts to the new input level, so for a while the compressor amplifies the low-
level signal with the gain that was appropriate to the high level signal preceding it. The
control signal decreases gradually, and consequently, the gain and output signal increase
gradually. The release time is the time taken for the compressor to react to a decrease in input
level.

Release time is the time interval between sudden decrease in input signal and moment when
aid output sound pressure level stabilizes at the new steady state level ±2 dB. This is also
referred to as recovery time.

If the attack time is made extremely short and the release time long, then distortion will be
minimal. Attack times in hearing aids are commonly around 5 ms, but can be much longer.
Release times are rarely less than 20 ms, and may be much longer. Release times need to be
longer to prevent “fluttering” perception. Longer release time prevents distortion that can
occur with false release times. Quick attack times may prevent sudden transient sounds from
becoming too loud for listener.
 • Syllabic Compression

Syllabic Compression:

Envelope:

• imaginary line drawn through the extremities of waveform

• Shows the effect of compression

Slow:

 AT and RT much longer than syllable duration

Compressor starts to turn down or up the gain when new syllable starts
 But there is time for only a small gain change to occur before the syllable if
finished
 Gain is almost constant

Medium:

 AT and RT same as syllable duration

 Level of syllable is continually changing as the compressor adjusts the gain

Fast:

AT and RT much shorter than syllable duration

• Full effect of compressor is applied to for each syllable

• Overshoot and undershoot occur
 For the word /fafaf/, /f/ is weak sound whereas /a/ is 30dB louder than /f/, to make
weak sounds more audible, fast acting compression is required. It increases gain
during weak syllables and decreases gain during intense syllable. Hence, it helps in
reducing inter-syllabic intensity difference.

It has short attack and release times. Release time varies from 50ms up to 150 ms. It allows
compressing or reducing gain for peaks of more intense speech by providing more uniformity
in intensity of ongoing speech syllables. Softer sounds (consonants) are made more audible
without allowing louder parts to become too loud. Short attack/ release times allow the
hearing aid to compress or reduce the gain for the peaks of more intense speech (usually the
vowel sounds). This provides more uniformity in the intensity of ongoing speech syllables as
it reduces the differences between the normally more intense vowels and the softer unvoiced
consonants such as /f/. This allows the hearing aid to make softer sounds of speech more
audible without simultaneously making the normally louder parts of speech from becoming
too loud.

Syllabic compression compresses the peak amplitudes of speech and makes the waveform of
ongoing speech more uniform, noise can easily fill in the small gaps that remain (Johnson,
1993). In noisy situations, a HA might amplify the noise that is situated between the peaks of
speech and compromises speech intelligibility. In order to improve aided speech recognition
BILL can be used along with syllabic compression
STATIC COMPRESSION CHARACTERISTICS:

The static characteristics apply only to signals of long duration. The hearing aid acts in an
increasingly linear manner when the intensity fluctuations become increasingly rapid. That is,
for rapidly changing signals, the effective compression ratio is less than the static
compression ratio. The effective compression ratio is defined as the change in input level
divided by the change in output level for a given signal containing high and low level
components following each other in rapid succession.

• COMPRESSION RATIO:

Compression ratio is defined as the change in input level needed to produce a 1 dB change in
output level. Compression is often referred to as automatic gain control (AGC) because gain
of hearing aid changes as input intensity SPL changes. This is the amount of compression
provided by hearing aid once compression begins. It is equal to the ratio of ΔI/ΔO and is
therefore the inverse of the slope of the I-O curve (Compression ratio can be visualized on an
input/output graph by slant of line after kneepoint).

Ex: A 10:1 compression ratio means that for every 10 dB increase of input SPL, there is only
a 1 dB corresponding increase to output SPL.

2:1 compression ratio means that for every 10dB increase of input SPL there is corresponding
5dB increase to output SPL of HA. Compression ratios in the range of 1.5:1 to 3:1 are
common in hearing aids with wide dynamic range compression.

Higher compression ratios indicate more compression, that is, progressively less gain than
linear gain.

• COMPRESSION THRESHOLD

The SPL above which the hearing aid begins compressing is referred to as the compression
threshold. For input levels below compression threshold, most hearing aids amplify linearly,
but some operate as expanders.

Compression threshold is usually defined as the input SPL at which compression commences,
but in some circumstances it is defined as the output SPL at which compression commences.

Below, figure shows that the onset of compression can be very gradual. Measurement
standards define compression threshold as the point at which the output deviates by 2 dB
from the output that would have occurred had linear amplification continued to higher input
levels.

Once compression commences the gain decreases with further increase in input level.
 • COMPRESSION LIMITING:

In the linear part of the curve (below the compression threshold), every 1dB increase in input
level results in a 1 dB increase in output level. Consequently, the compression ratio of a
linear amplifier is 1:1. The other extreme is compression limiting, such as that shown at the
highest input levels in the figure above. The slope of the I-O function here is close to zero
which means the compression ratio greater than about 8:1 would be considered to be
compression limiting. Compression ratios can thus have any value greater than 1:1.
Compression ratios less than 1:1 are also possible, but these correspond to dynamic range
expanders rather than compressors.
Most digital hearing aids incorporate use of input compression for soft inputs, along with
output compression for louder inputs.

TK CONTROL:

Two types:

• Output limiting compression control

• Threshold kneepoint (TK) control

Conventional compression and TK Control are the ‘Y’ dimension of compression.

Conventional compression affects KP and MPO. TK Control affects KP & gain for soft
sounds only.

TK control has gain booster for soft sounds. TK control affects threshold kneepoint of
compression and also gain for soft input SPLs below 60dBSPL. It adjusts kneepoint of
compression over range of low input levels from 40- 60dBSPL. It affects amount of input
signal that arrives at compressor of circuit. HAs with TK control provide greater linear gain
below threshold kneepoint of compression

Because this kneepoint is found at soft inputs, TK control can be seen as gain booster for soft
sounds

TK control does not affect MPO. It is more appropriate for mild- mod SNHL attempts to
imitate function of OHCs.
OUTPUT LIMITING COMPRESSION:

• It is associated with adjusting compression in output compression HAs

• It has high compression kneepoint and high compression ratios

• Compression implies less gain than linear gain

• Higher compression ratios indicate more compression

• Limits output with less distortion to output signal

WIDE DYNAMIC RANGE COMPRESSION:

WDRC amplification strategy is that it amplifies soft sounds by more and loud sounds by
less, compensating for abnormal loudness growth. It has low Threshold kneepoint (below
60db SPL) and low compression ratios (less than 4:1). It is called WDRC because of low
kneepoint.
Output limiting compression has a high CR and high KP, linear gain is provided for soft to
medium level inputs and high degree of compression limits MPO. It limits the ceiling of
loudness tolerance.

WDRC has a low KP and low CR, provides linear gain for very soft inputs, weak degree of
compression occurs for medium to intense level outputs. It lifts the floor of hearing
sensitivity.

For mild- moderate SNHL re-establishing normal loudness growth is more easily achieved
with WDRC than with output limiting compression.

X axis represents intensity input and Y axis represents loudness perception.

Output Limiting has high KP and high CR. Here loud sounds are too loud

WDRC has low KP and low CR. Here the problem of loud sounds is taken care of.

TECHNOLOGY OF CHANNEL SEPARATION:

Hearing instruments must be able to separate incoming signals into different frequency
regions to compensate for variety in frequency configurations seen in HI. First function
performed by digital signal processor is frequency analysis of signal. Wideband input signal
is separated into frequency bands, done with bank of filters. Filter bank is characterized by
number of output channels, crossover frequencies between channels, and steepness of filter
slopes.

New multichannel compression systems allow different compression characteristics to be

selected for different frequency bands. Input signal is filtered into number of frequency
bands, and each band is amplified independently, with gain, MPO, compression threshold,
compression ratio, and attack and release times set separately for each band.

There are two basic reasons why we might want to compress. Different frequency regions by
different amounts:
 • Hearing loss usually varies with frequency

• Signals and noises in the environment have more energy in some frequency
regions than in others.

If the amount of compression required at any frequency depends on either the hearing loss at
that frequency or at the level of the signal in that frequency region, then the degree of
compression must also have to vary with frequency. Multichannel compression enables this
variation of compression with frequency to be achieved. The degree of compression is
greatest for high compression ratios and for low compression thresholds.

In a single channel compression hearing aid, when the compressor turns the gain down, signal
components at all frequencies are decreased in level. It might not be appropriate to have
signal components at one frequency being attenuated just because there is a strong signal, or a
limited dynamic range of hearing at another frequency. Multichannel compression avoids this
problem. Although there are many ways in which compression can vary from one channel to
the next, the degree of compression often either increases or decreases with frequency. BILL
and TILL technology is used in multichannel hearing aids. A big advantage of multichannel
sockets over a single channel WDRC socket involves clinical fitting flexibility. Either the
BILL or TILL channel can be adjusted to provide an optimal fitting for particular
configurations or shapes of mild-moderate hearing loss.

Channel separation in Analog Hearing Aids:

Analog multichannel HAs have 2 channels

• One representing low frequencies

• Other representing high frequencies

In multichannel HAs there is one microphone, followed by a band splitter which separates
incoming input sound into 2 frequency bands which passes through 2 separate channels. Each
separate channel has its own amplifier and compressor.

BILL and TILL represents 2 channels of analog HAs

BILL low frequency channel

TILL high frequency channel

Bass Increases at Low Levels (BILL):

It is also referred to as “AUTOMATIC SIGNAL PROCESSING”. BILL hearing aids have a

low kneepoint for low frequencies and of higher kneepoint for high frequencies. Low
frequency input will not have to be very intense to set the BILL hearing aid to compression,
but high frequency input will have to be greater to cause compression. This means that the
BILL circuit will go into compression very often with very low frequency inputs, and not as
often with high frequency inputs. The BILL hearing aid has a very broad, a flat frequency
response with soft inputs. (E.g: 40 dB SPL) if input sound is produced so that it is at 40 dB
SPL all across the frequency range, then the gain and frequency response of the BILL hearing
aid will look like the flat line on a graph. As the input across frequencies in increased in
intensity to 60 dB SPL, the gain and frequency response will show a decrease in gain for the
low frequencies. As the input intensity is increased to 80 dB SPL, the gain for the low
frequencies will drop even more.

The main idea behind the BILL circuit is to provide better listening for speech while in
background noise. i.e, the hubbub of low frequency background noise will be suppressed by
compression, while high frequency sounds that render clarity for speech still receive a full
measure of gain. The hearing aid most commonly brought to mind when BILL is mentioned
today is the oticon multifocus.

Treble Increases at Low Levels (TILL):

It is confined to treble frequencies. Knee point is set at low input level for high frequencies.
Compression occurs for high- frequency inputs. At low intensity input SPLs of 40dB more
gain is seen for high frequencies. As input increases, high frequency gain decreases. It is
mainly useful for individuals with high frequency HL who has reduced dynamic range for
HF.

In analog multichannel HA, circuit has gain controls for low and high frequency channels
which is adjusted by compression ratio (CR) for each channel. CR helps in deciding how
much compression is needed. As CR increases, more gain can be provided by HA without
causing loudness discomfort.

Smaller Dynamic Range requires greater amount of gain to restore normal loudness.
Multichannel HA is WDRC i.e., it provides different amounts of gain for 40dB vs 80dB
inputs. CR is adjusted for each channel.
Wide Dynamic Range Compression (WDRC):

WDRC almost always is associated with input compression hearing aids. However, not all
input compression is WDRC. WDRC is associated with low threshold kneepoints (below 55
dBSPL) and low compression ratios (less than 5:1). The WDRC hearing aid is almost always
in compression. It can be seen that many different input levels, from very soft speech to very
loud speech, will put the hearing aid into compression. It is called ‘wide dynamic range
compression’ because of its low kneepoint, which allows compression to take place over a
wide range of input levels.

It improves audibility of soft speech sounds by applying more gain to soft sounds. Loud
sounds, which may be uncomfortable, are reduced. It also reduces chance of damaging
wearer’s hearing if hearing aid volume is worn higher than the recommended level. As soft
level sounds are made louder, aid wearer may find that many low level environmental noises
are audible.

APPLICATION:

• For mild-moderate SNHL individuals a WDRC hearing aid can be used to reduce a
normally large DR into the smaller one. But a client with mild to moderate hearing
loss maybe accustomed to wearing linear hearing aids. For this person, a sudden
switch to WDRC maybe too great a hurdle, and WDRC might be rejected, because it
is not too loud enough. Although WDRC will amplify soft inputs by a considerable
amount, it will not amplify average intensity inputs by the same amount, and it is this
hearing aid performance that the client accustomed to linear amplification may find
frustrating. In this case, WDRC must be introduced gradually, and with considerable
counselling about what to expect from WDRC hearing aids.

• Bass increase at low levels (BILL) and treble increase at low levels (TILL) are two
types of WDRC. There are other names that pertain to these categories, such as LDFR
(Level Dependent Frequency Response), FTC (Frequency Dependent Compression),
and ASP (Automatic Signal Processing). Compression in these circuits is more
dominant in some frequency ranges than in others. BILL and TILL are hearing aids
 where the kneepoint of compression occurs at very different input SPL for different
frequencies.

SUMMARY:

Expansion WDRC Compression Ratio

Soft squelch Between 1st and 2nd KP
Increased between 2nd and
3rd KPs
st
Below 1 KP 25dBSPL Between 25- 45 dBSPL Between 45- 65 dBSPL
Reduce audible internal Increase audibility of soft Provides less gain for these
noise below intensity of speech inputs
speech

REFERNCES:

• http://www.helpuhear.com/audiology-news/difference-between-analog-and-digital-
hearing-aids

• https://en.wikipedia.org/wiki/History_of_hearing_aids

• https://audicus.com/from-trumpet-to-iphone-a-visual-history-of-hearing-aids/

• http://theinstitute.ieee.org/technology-focus/technology-history/the-history-of-
hearing-aid

• Textbook of Hearing Aid Amplification (Robert E. Sandlin)

• Hearing aids, Harvey Dillon-Thieme Publications(Boomerang press)

• Compression for Clinicians (2nd edition),H.Venema-Delmar learning publications.

• Handbook of hearing aid Amplification (Vol I),Robert A. Sandlin