on to the webinar, Combining Wireless Technologies. We're so glad that you could be here today to learn more about how wireless technology is being used in modern hearing instrument technology. Your moderators for today are me, Ted Annis, Senior Marketing Specialist, and Fran Vincent, Marketing and Membership Manager. Our expert presenter today is Dr. Eric Branda. Eric is an audiologist and Director of Product Management for Savantos. For more than 15 years, Eric has provided audiological, technical, and product training support around the globe. He specializes in bringing new product innovations to market and helping Savantos fulfill its goal of creating advanced hearing solutions for all types and degrees of hearing loss. We're very excited to have Eric as our presenter today, but before we get started, we have just a few housekeeping items. Please note that we are recording today's presentation so that we may offer it on demand through the IHS website in the future. This webinar is available for one continuing education credit through the IHS website. We've uploaded the CE quiz to the handout section of the webinar dashboard, and you may download it at any time. You can also find out more about receiving continuing education credit at our website, ihsinfo.org. Click on the webinar menu on the homepage or choose webinars from the navigation menu. You'll find the CE quiz along with information on how to submit your quiz to IHS for credit. If you'd like a copy of the slideshow from today's presentation, you can download it from the handout section of the webinar dashboard, or you can access it from the webinar page on the IHS website. Feel free to download the slides now. Tomorrow, you will receive an email with a link to a survey on this webinar. It is brief, and your feedback will help us create valuable content for you moving forward. Today, we'll be covering the following topics. My wireless, current wireless solutions, and which wireless technology to choose. At the end, we'll move on to a Q&A session. You can send us a question for Eric at any time by entering your question in the question box on your webinar dashboard, usually located to the right or the top of your webinar screen. We'll take as many questions in the time we have available. Now, I'm gonna turn it over to Eric, who will guide you through today's presentation. Take it away, Eric. Great, thanks, Ted. So, hello, everybody. Thank you for joining today. And very excited to talk to you guys about wireless technology, because I've been doing hearing aid stuff for a while, and in the manufacturing side, wireless has really been interesting, and just watching the growth of wireless in hearing aids. So, over the years, you never think that wireless is something you're gonna have to be familiar with, and it was kind of groundbreaking when it came in and started looking at the way hearing aids can be connected to each other, or the way they can start connecting with other devices. And what seemed so new and kind of exotic in the world of hearing aids at that time is now standard and required. This is part of what a hearing aid does. It's the way the technology grows. So, it's been very exciting to see this being one of the many growths in the hearing aid technologies that we can work with. And what I find with wireless is that it's an area that people are familiar with. We use wireless technology every day. I mean, you're using it with your phones. You're using it with computers. We go into a coffee shop, and you're jumping on Wi-Fi. So, there's a lot of things happening wirelessly. And what I want to do today is really go into some of the details about how this works and how this is really applied in the hearing aids, because we see a lot of use with it. There's a lot of application for it. And I think the more comfortable and familiar with the pros and cons and how these pieces work together just helps us provide better patient care. So, the first thing I want to look at is really why wireless? Why did we start getting into this? And it comes back to that whole idea of patient care. So, I'm jumping to some MarketTrack data here. And MarketTrack, if you're familiar with it, MarketTrack sends out surveys to find out what patients are reporting, how they're doing with hearing aids, what do they want to see changed, what do they want better, always looking for data. And manufacturing-wise, we're always looking at this as how does this help us drive the next innovation? Where does this go? So, what I have is some earlier information on reasons for non-adoption. What are the problems that some of these hearing aid wearers have had? And I imagine most of you will be familiar with some of these topics, hopefully less so now than you have been in the past. The first one you see there, do not work in noise. And I always highlight the noise topic because we know that's a big complaint. And I think if you look through this list, you're going to see that resonate a little bit more. Because if I go over, okay, do not restore hearing to normal, but the third one right at the top there, pick up background noise. Again, a noise issue. Whistling and feedback, which we don't see as much in more current hearing aids, but the next one down on the list, number five, don't work in crowds. So, in the top five, three of those have to do with performance and noise. And those are issues we don't want our patients, that we don't want the hearing aid wearers to have to deal with. Even hassle. When we think about things with hassle, changing one hearing instrument, changing the other, there's added effort for them to operate the hearing aids. And that's the opposite of what we want for the hearing aid where especially if we look at how much sensory deprivation happens as people old, we get older and some of our sensory and cognitive skills go down. So, the more complicated we make these, the more troublesome it can be for them. We want to make it easy. So, we want to look at how the technologies can make it more hassle free. And that goes right into required adjustments. And also just jumping down a little bit further on the list in the middle there, cannot be used on phone. Phone is a big issue. We hear that from wearers all the time. They want to have better performance on phone. So, if I look at some of these, some of the earlier indications of non-adoption, you can see where these types of complaints drive what we want to do with wireless technology. And as we started introducing wireless technology and putting it into instruments, we start to see a lot of these things being addressed in ways that we can make them function better for the hearing aid wearer. And the next slide I want to look at now is some recent data from the Hearing Instrument Association and what they're putting out with Mark-Attract 9. And it's Mark-Attract 9, we're jumping several years ahead here. And these are just some direct quotes from Mark-Attract 9. More of the hearing aids purchased in the last year are wireless. So this is self-reported. So just in the past year, we see a growth in the number of wireless hearing aids being purchased. And that makes sense because if you think about what technology is going to do, it's a premium feature one day, and then next generation it's being more accessible in lower performance levels. And we see that with wireless too. We've seen an expansion and not just letting wireless be more available, but more functional as it's gone into different performance levels. And when they did this last Mark-Attract, when they looked at the past five years of purchases, it's even more in those last year that we see versus two to five years ago. And what's important with this also is that the people who are purchasing the wireless hearing aids are reporting higher levels of satisfaction. So certainly there's a lot of aspects to just technology in the hearing aids as well, and more of those higher performing hearing aids will have the wireless. But if we look at those who have purchased wireless hearing instruments and those who have purchased non-wireless hearing instruments, the satisfaction level for those with the wireless is higher. This is what we're finding in surveys with the wearers. And so I think that's also important for us to think about how we start growing that and applying that more in the goal of keeping our patients happy. So what are the current wireless solutions? Because there's a lot of terms that fly around. Some of them are synonymous, some of them are subsets of another, and there's no reason for it to be confusing, but it also can be challenging because every manufacturer is going to put out a proprietary term for their wireless system. But it really comes down to there are really just two main wireless systems that are being built into the hearing aids. And I say that because I think that's important in that, again, these are what are built inside of the hearing aid, because any requirement for wireless in the instrument means it has to function off the hearing aid's battery. So there are other wireless technologies out there that can be used with it, but the primary, and they may have higher power consumption, but the main ones that we work with in the hearing instruments are the 2.4 gigahertz realm and one called near-field magnetic induction. And I'm gonna take a little time and talk about each of these, because if I think about the top six manufacturers out there about five of them are now using the 2.4 gigahertz, and three of them, sorry, four of them have been using the near-field magnetic induction. So now we start to see some overlap, which is a key thing I wanna talk about later in this presentation, but let's break these apart first. So 2.4 gigahertz, and with 2.4 gigahertz, this is related to the ISM bands, so the industrial, scientific, medical, and radio bands. And this is really how we internationally start to regulate different frequencies that we see things operating on. And you see the word I use there, a radio frequency, RF, and RF isn't necessarily an old term, RF is just that this is radio frequency energy, and it's being transmitted from an antenna to a receiver. And typically, if you see 2.4 gigahertz, especially in hearing aids, 2.4 gigahertz is synonymous with saying that it's RF, it's just another, they can be used virtually interchangeably. So if somebody has an RF product, it's a 2.4 gigahertz product, they're working, it's the 2.4 gigahertz of the radio frequency band. And this is used for a lot of other things aside from telecommunications, and it's actually very well regulated because part of the purpose of this is there are different frequency bands that wireless transmissions can occur on, and what's been decided, you hear things like 900 megahertz, or you'll hear the 2.4 gigahertz, and there's a bunch that you probably don't hear as much about because they are regulated. And the reason being that you can have a lot of interference on these bands, so some are kind of isolated to prevent that kind of interference, but the 2.4 is kind of a more open area. And most of the requirements actually say that if you're functioning in this frequency band, that you should be open to being able to be interfered with. Now that doesn't mean we won't have security to prevent those interferences, but the antennas aren't blocking everything out necessarily. Places we see this are, we see this used in telephones, I'm sure several of you have had a 2.4 gigahertz or 900 megahertz phones in your homes. Car alarms work here, and surprisingly, the most common is probably microwave ovens. Microwave actually, it's kind of a, which came first, the chicken or the egg? Microwave ovens worked at 2.4 gigahertz, so when they were looking at how to regulate wireless, they looked at many homes had something already functioning in the 2.4 gigahertz realm, so that led to being the unlicensed area that they had a little more free room to work because it was already in a lot of homes, so that led to the more common use now that we see with the 2.4 gigahertz. Now, what's also important here is that 2.4 gigahertz is also where two other very common technology we hear with Bluetooth is functioning. So Bluetooth is actually working in the 2.4 gigahertz area, and there's several different innovations of Bluetooth. Bluetooth has changed a lot over the years, and this is probably what our patients are most familiar with is the term Bluetooth, and there's two specific aspects of Bluetooth I wanna focus on, Bluetooth VR, which is basic rate, and Bluetooth low energy. There's a couple more and some future advancements coming with Bluetooth because they're continually innovating, but the two that I wanna focus on because we start to see them in a lot of the accessory devices that we pair and work with with our hearing aids are the Bluetooth VR and the Bluetooth low energy. So with these two, Bluetooth VR, and again, that stands for basic rate, and then there's also EDR, which is enhanced data rate, and then that's more the standard Bluetooth we're familiar with, and then Bluetooth low energy is something that's seeing a lot more evolution. So for the Bluetooth VR, we go back to when Bluetooth came out, the whole idea of it was as a wire replacement system, just looking at ways that maybe a computer could send data to a printer and be wire free. So it was really just looking to replace wires, but it was found that it also can really do a nice high quality audio stream. So now we can get some nice sound and not transmitted wirelessly. So that was really where I think we started seeing a lot of growth in Bluetooth is that we started finding, I'm gonna pair a Bluetooth headset to my cell phone, you see a lot of growth in that. So Bluetooth becomes very common, very popular there. And we see that now a lot with automotives, you see that with headsets, you see that with phones, PC, the peripherals for the PC. So there's a lot of practical use with Bluetooth in the standard Bluetooth, the Bluetooth VR. Another important piece about it though, it does have a high power consumption. So what this means is that it's usually either a device that wants to be plugged in or is going to have kind of a larger battery. And even so, if you think about a Bluetooth headset, you're gonna get what, maybe six hours out of that. If you're lucky when the battery's fresh after it's a year old, you're down to what, four or three. So you'll see that you have higher power consumption or think of your mobile phone. If you have something connected to Bluetooth in your mobile phone, you're going to see the more that's connected, that it will start to have a higher drain on the phone's battery. Bluetooth needs energy. And I bring that up because as we start thinking forward a little bit to hearing aid applications, Bluetooth becomes one of those that's not, standard Bluetooth is not as practical for the little power cells that we're working with, those 312 zinc airs, the 13s. It's something that can start to drain them really quickly. So the other Bluetooth that I want to mention is Bluetooth Low Energy. And this we're starting to see a lot more use in, although there's probably, many people may not have heard of Bluetooth Low Energy. And this is really using smaller sensors and it's running off low power for longer periods of time. So it's really the power conservation piece. It's smaller, it's, again, it's really looking for data transfer, that's the whole idea of it. And with data transfer, it wants to send packets of information. And we see that a lot now with the internet of things. The internet of things just being, the way we start to be wirelessly connected to our world in terms of data. If you think about things like healthcare devices, wearable technology that's going to measure how many steps you've taken in a day, maybe some things that might start looking at heart information, different medical aspects that are going to start communicating that information to your phone or get that to a cloud-based storage. With the whole internet of things, it's data transfer from small devices. And you can already start to think about that. That seems more practical for what we're doing with hearing aids. So this is an area where we could see some growth, especially because there are some special applications that allow audio transfer. Not necessarily the original intent of it, but we do see some applications that allow audio transfer. And I'm going to talk about that in a little more detail. So kind of stepping back from the Bluetooth aspect and into, again, 2.4 gigahertz. Again, Bluetooth being a subset of 2.4 gigahertz. There's some benefits and challenges to 2.4 gigahertz. One aspect is that 2.4 is very much a convenience type of a feature when it comes to hearing technology. I'm going to focus on hearing aids on the next slide a little more, but in general, 2.4 is convenient. So now we have these RFs, so we have direct streaming capabilities. So whenever you're using 2.4 RF, think about, again, your phone in the house. You're getting a signal sent directly from the base to the handset, and you don't need any other types of pieces in between. That is the communication. Of course, those are bigger devices, but that is the communication piece. And if we start to look at that in healthcare devices, 2.4, people are aware of that. It's something they're familiar with. There's some commonality functionality with it, and that technology can really start to lend itself to what we're doing with the hearing instrument. So it really helps people be more aware of the advancements that we see in healthcare technologies. And what's also great with 2.4 is it does have these really short wavelengths, but that means those wavelengths can start to travel nicely in terms of transmission distance. So when we even have some small transmitters and receivers, we can see those travel a good distance from point A to point B. Of course, that does result in some challenges, and that ability to travel from point A to point B does start to have some high power consumption in and of itself. So we can use small batteries to drive these, but it is going to drain those batteries pretty quick because the 2.4, the RF, is a bit power hungry. So that can be a challenge for it. Also, with these short wavelengths, it has difficulty going through and around the body. So when it's trying to just get from, you know, imagine one side of the head to another, it can run into head shadow effect issues. So it doesn't get, it doesn't go around things really well. It likes a direct path. Also, if we're going to have something that's functioning on 2.4 RF, it is going to require some type of relay for Bluetooth devices, especially as we get into to hearing technologies. So that would mean that if I have something that's going to be Bluetooth related with the hearing aid, I'm going to need something in between. So I would go Bluetooth from the source to my Bluetooth relay, and there I'm going to convert it to a 2.4 gigahertz to send to a hearing device. And if we really think about it in terms of hearing devices, so where do we see this in hearing aid technology? And you see this very commonly in made for iPhone, although I must caution made for iPhone is a more general term that's usually a license that you buy, a permission to buy from Apple to say that something is made for iPhone. So we have hearing aids that are made for iPhone because they use the 2.4 in a means that can communicate directly with the iPhone. And when they communicate directly with iPhone, it's really that they're using that Bluetooth low energy. So again, Bluetooth functions under the 2.4 gigahertz, and when we're using the made for iPhone technology, it's using the Bluetooth low energy built into the iPhone. And we do have other devices that are classified as made for iPhone because they're permitted to work with iPhone, but when it's going to do direct streaming from the iPhone, we're working with that Bluetooth low energy. And what gets different with that with iPhone is that iPhone does have a protocol instead of doing just data transfer, because it will do data transfer to and from the iPhone, but it can do audio from the iPhone to the hearing aids. It usually goes one direction. So it's going to be sent from the iPhone to the instruments using, again, the Bluetooth low energy. And iPhone's had a lot to do with getting that technology out there, which is why you don't necessarily see that in Android devices. If we wanted to do something with Android devices with any kind of direct streaming, we would need to look at the Bluetooth VR, which again gets into high power consumption and just ways to zap the battery. So that's a little too power hungry there. But with iPhone, we have the Bluetooth low energy, so it is pretty energy efficient and good for sending audio from the phone to the hearing aids. And with 2.4 in general and hearing aids, that does mean direct transmission from a device to the instrument. Here's where we get into the convenience factor, because now I don't need any kind of relay. I can have a transmitter at the TV streaming directly into the hearing aids, and I can have my phone streaming directly into the hearing aids without the use of a relay. Except, of course, if I wanted to use standard Bluetooth, as I mentioned before, standard Bluetooth is not in the instrument. So anytime I want to use standard Bluetooth, I need a relay. Even if I have a 2.4 gigahertz type instrument that does direct, if I want to use standard Bluetooth, so if I want to use the regular Bluetooth in the iPhone or regular Bluetooth in an Android operated device, I will need to go through a relay to get that there. But when I have something like the iPhone or another direct streaming device, I can go with the 2.4 will give it direct streaming without a relay. Now also there, this does limit some of the wireless communication between instruments, because as I said before, it's very subject to like the head shadow effect. Those waves don't go around or through the head at all or very well. So what happens is that we can do limited steering. So what do I mean by that? Program change, volume control change, classification information can be shared, maybe some basic compression information. So the hearing aids can talk to each other, but it's only little bits of data packets. So if I turn up the right instrument, the left instrument can go up as well. If I'm changing the VC or changing a program, the other side can change. So it can sync or keep them synchronized. I'll think back to my first slide on some of the challenges. This is one of the ways to reduce the changes somebody has to make. Also take some of the hassle out of the instrument, because now one side can control both. So I'm looking at further applications of the wireless. So if I really kind of summarize what the 2.4 gigahertz does for the hearing aids, we're looking at that synchronized VC program basic processing, direct streaming without a relay from iOS devices and other devices that will transmit directly. But I can also still stream with other devices, but I will need a relay if I'm going to use standard Bluetooth. So we're going to come back to some of this information shortly. Now I want to talk a little more on near field magnetic induction and FMI, or also just referred to as magnetic induction. And you can kind of think this more in like what you see with a T-coil, that it's not a radio signal being transmitted, it is an inductive signal. So it's going to be emitting this wireless induction signal out there, and the coil is going to pick that up and kind of vibrate with that and collect the information. Now this works on a very short range, so we're talking less than two meters. In fact, most times we see it, you know, basically an arm's length, the signal is going to fall off. And you'll see the carrier frequencies where this operates is much lower than we see with the RF information. So now we're looking at 3 to 15 megahertz, so much lower information there, or lower frequencies at which it's working. And it actually has some really nice benefits, because this can be very low cost, and because it's using that lower energy, it can be very energy efficient. And it also does well propagating through things like body and water, so it really helps it transmit and not be diverted or reflected as well. That does lead to some challenges, being that it has short range for transmission. So as I've said, you know, it falls off at about two meters, so it's hard for me to send that over long distances, which is why I won't see direct streaming from a TV transmitter being very practical, because you would literally have to be sitting within six feet of your TV to have that work. So it does have challenges on the transmission. But near field really opens up a lot of opportunities because of the way it can go from a side to side, because where we see that a lot in hearing aid use is going back to when we first started seeing this in 2004. So 2004 is when we started seeing the first binaurally coupled instruments. So with the Siemens brand and with Signia, we use the term E2E is synonymous with near field magnetic induction, or is our version of applications of near field magnetic induction. So you'll hear other terms from other manufacturers, but to give some familiarity with what you may hear in the industry, E2E is one that you'll hear. And the first application was more limited. Again, volume control program changes, so basic steering information. But that took a big jump, and we saw several manufacturers started applying changes just a few years after that. We started looking at stereo transmission from external devices. So now we could start saying have a phone talk to a relay via Bluetooth and then have that relay use magnetic induction to the hearing aids. So now this really opened up the idea of streaming to the hearing aids. Also with TV transmitters, again sending a Bluetooth signal to the relay, and then the relay again sending the magnetic inductive signal up to the hearing instruments. And that's where we started seeing a break off from magnetic induction and the introduction of the 2.4 gigahertz. But where those who stay focused on magnetic induction, a couple companies have taken that to a third generation. And this is where we start to see audio transfer from instrument to instrument. And this is actually true audio transfer. And this becomes important because now I can take a signal from the right hearing aid and go directly over to the left hearing aid and not be blocked by the head. I can get that audio transfer sent. And that opens up a lot of other opportunities and applications. So the first one of those I want to talk about is how it can be applied for cross and bi-cross. So cross, bi-cross, I'll have one ear that's not aidable, so I'll use a transmitter on that side. And then I'll transmit that over to either the hearing instrument on the other side that will be either a normal hearing ear or a ear that needs to be aided and needs amplification there as well in a bi-cross scenario. And with this application, we've had some wireless before and they were bigger clunky pieces if we go back 10, 15 years ago. With the applications now with magnetic induction, we can still keep them in very small hearing aids, keep it very small and get really nice quality. I mean, we've seen growth in acceptance and application and cross and bi-cross becomes a much more practical fitting solution where I think 10, 15 years ago you'd start to say, you know, majority of these are going to have return for credit. We see a lot more of them sticking now. So we see a lot more acceptance there. Other ways to take advantage of sending audio from side to side is with binaural wind noise reduction. And with binaural wind noise reduction, we can do something where if I've got wind blowing on, say, the right side, the wind comes in there, I reduce the channels where the wind is blowing, and then because of the audio transfer, I can take those same channels from the left side, wirelessly transmit that audio to the opposite side, and then still give the wearer a binaural sensation. Because it's really about building up that binaural aspect. And I would also say when you start to think about magnetic induction in hearing aids, it really leads you to thinking of the idea of binaural applications. So building up on hearing benefit for the wearer as opposed to what we've talked about with 2.4 as being more convenience based. Other ways that we see this with the audio transfer being used is with acoustic phone applications. And despite all these ways we have of getting a phone transmitted to the signal to the hearing aid wirelessly and such, a lot of people still like to hold their phones up to the ears. There's been some automotive studies looking at, you know, majority of people still like to do handheld devices. So we know that a lot of the wearers like to hold the phone up to the ear. And we also know that if I have a signal in both ears, both two ears are going to be better than one, so we want to keep that binaural advantage. So what we've started to do with magnetic induction is that if somebody holds a phone up to, say, the right ear, then we'll be amplifying it acoustically on that side, but then we can transmit that phone signal wirelessly to the opposite side, again providing the phone signal in both ears for the wearer. So just another application of the magnetic induction and making that available for the wearer. And then that same type of audio transfer leads into directional microphone applications. So with directional microphones, the first one I want to talk about is how we can use multiple azimuths or multiple directions for wireless directionality. And in this case, we can do wireless directional performance from, of course, front to back, but also back to front or from side to side. So if we think about a directional microphone, you've got the front mic and the rear mic, and it looks at what's coming from the front typically compared to what's coming from the back, so it can kind of reduce anything that hits the back mic first. Well, now with the wireless transmission, we can start to think in other ways with that in terms of left and right. If a signal actually hits the right instrument first and then the left instrument second, we can use that wireless transmission of information to treat the right mic like a front mic and get a true directional pattern for sounds coming from the side. Very useful in car applications. If I'm the driver in the car, my wife's sitting next to me, she's telling me I missed that turn, then I could shut out anything coming from my left side and make that like any wind noise there or any other traffic noise and have directional focus directly on my passenger. So really helpful in more difficult, noisy situations. And even using that same idea of using the left-right, we can even see it applicable in CICs and IICs. So now I've got instruments that are too small to have two microphones on them, but between the two of them, I do have two microphones. So now using wireless transmission and some very sophisticated algorithms, I can turn CICs and IICs into directional functioning products, not just relying only on the pin effect, but using the microphone and wireless processing to give more directional benefit, especially in noisy situations. So again, looking at ways to make this easier for the wearer and focusing on that number one issue for the wearers, noise. So magnetic induction opens up these directional options to help us address the noise situations. And I leave that into what I think is the really nice application of magnetic induction is binaural beamforming. Beamforming is another term for directional microphones. It gets into the more scientific term for what directional mics do is beamforming. And I got this illustration to really show what the binaural aspect of this can do, because now I'm using two hearing aids with magnetic induction to communicate between them, and they each have two microphones on them. So the top one there, we see it's a left hearing aid with the two mics coming in, and it'll first process the directionality monorally, and then it's going to send that information kind of to a next step on the same side where it's going to be waiting for some other information, but it will also send that wirelessly over to the right instrument. And the right instrument's doing the same thing. It's collecting its directional information, pushing it forward, as well as sending it over to the left instrument. And so then each instrument will receive its local or same side directional information, and the opposite side's information, and can start to merge and synchronize that information. So essentially each instrument is working with four microphones as opposed to two microphones, because it's getting the the data from both of them. What this means for us, and what it means for the hearing aid wearer, is that we can get what you'll see like Harvey Dillon at NAL will start to call like a super directionality. Our industry term is narrow directionality, and it means that instead of kind of covering you know just things in the front, it's narrowed down to a much tighter focus to the extent that you can even you know have two people sitting across from you at a table, and just by looking at one or the other help to suppress the person that's not the the point of a target or the interest in conversation. And this has actually led to the claim in the application of saying that we have better than normal hearing in cocktail party like situations. And I want to refer to a particular study on that, because we know that noise is a big problem for the hearing aid wearers. So how do we make the wireless technology and directional microphones improve that scenario? Well what the study looked looked at, and this was looking at two separate sites, one in the U.S. in Colorado, and another in Oldenburg in Europe in Germany area. And they were set up the same, although they use some different speech tests. But essentially what we did is put the put the wearer in the middle of a sound booth. Eight speakers were set around them all at even intervals. So the front speaker was the target speaker, and this is what I'm describing now is called the HINT, the hearing and noise test. And basically the way this will work is that they've got the target speech coming from the front, and then all seven speakers had had different speech babble coming out. So there were just different sentences, nose gaps in between coming out of all the different speakers. And what has to happen is the listener has to repeat the target sentence back, and you find the point what the signal to noise ratio is where they get 50% of that sentence correct. And so the way we read it on the chart here is the lower that that threshold is, the better they did. So we did that with people using the narrow directionality, and then also normal hearing listeners in that same situation. And those with the narrow directionality, you see they got the minus 3.1 dB is that threshold. So the speech signal could be 3.1 dB softer than the noise signal for them to get 50% of that sentence correct. For the normal hearing listeners, it was at minus 0.2, which if you ever listen to that, I mean the noise is basically as loud as the speech, so you've really got to try to pick that information out. It's a difficult task. And for the hearing impaired listeners with the directional microphones, with the narrow directionality, we saw a 2.9 dB improvement over the normal listeners. The other side shows the results with the, using the ALSA, which is a similar concept, similar type of test, just different norms and different sentences, because obviously in German. But with both of those, we see comparable results. 1 dB of SRT corresponds to 11% improvement for the HINT and 17% of improvement for the ULSA. So, at the end of the day, using this wireless technology with the narrow directionality, we see better than normal hearing for these listeners. And in another study we did recently, we also wanted to look at how does that apply to listening effort? Because, again, this is hard. Listening in noise is not easy. That's why they complain about it. So, we did EEG measurements, so electroencephalography, to measure how challenging or difficult, how hard they were working to listen in these situations with the feature on and the feature off. And the SpeechMaster feature is the main one I want to focus on, the blue bar here. And in this chart, higher is poorer. Higher is more effort. Lower is less effort. And SpeechMaster is utilizing some other aspects of processing as well as the wireless narrow directionality. And we see with the feature off to the feature on, we do see that the EEG measurements showed a decrease in the listening effort with that. Now, you may ask, okay, we measured that. What's the patient think of that? They were also asked to fill this out subjectively. So, what did they think of the difficulty with the feature off and with the feature on? They just had to rate how hard they thought the task was. Again, listening to a similar scenario of speech coming out of the front speaker and noise out of the others. And when they rated this, again, you'll see that the results correlated very closely that with the feature off, they acknowledged that it was more difficult and they felt it was easier with the feature activated. So, we do see noticeable benefit for the wearer when we apply these features. So, if I summarize the magnetic induction, what we're looking at is it's capable of synchronizing VC program and basic processing. It will stream via a relay. In fact, it always needs to stream via a relay because, again, those short waves, it's going to need something to send a Bluetooth signal to it. So, anything using magnetic induction as a primarily transmission frequency is going to need a relay to talk with, say, a Bluetooth device. Also, it opens up the option now for exchange of microphone signals for things like cross and bi-cross. And where I think most importantly, again, for benefit for the wearer is exchange of microphone signals for that true binaural processing. And this is where we can see things like the narrow directionality. And these are how we kind of look at those. So, with what you know now about magnetic induction and the 2.4 gigahertz processing, which do you choose? If you look at something like the direct-to-iPhone, that's attractive. Wearers are going to see that I have an iPhone. I want to have a hearing aid that goes directly to my iPhone. On the other hand, you see this guy walk in the door. You know that noise is going to be one of the biggest challenges he's going to be facing. And you have a solution available to help him address performance in noise. So, which way do you go? That's why you've seen manufacturers go different directions. Some going with the direct-to-iPhone aspect. Some going with the 2.4. You're going with the magnetic induction. Which way do you go? Because really, let's put them here. What's going to give us synchronized volume control and program and basic processing? They both can do that. Both of them are going to be able to send basic information side to side. Who's going to give us direct streaming without a relay? So, that's going to be using the RF, the 2.4 gigahertz. Streaming via a relay? Well, they'll both do that because still to talk to some of those Android-based phones, you're going to need a relay for the standard Bluetooth for that. For that exchange of microphone signals, cross and bi-cross, the 2.4 gigahertz is not going to do that. So, now I need to use something that's going to use magnetic induction. So, that's the application I need to look at there. Now, if I want to get also for those directional microphones, get that performance for true binaural processing, that other audio exchange. Again, RF's not going to do it. It's generally been a choice, a decision to make. But fortunately, with innovation and miniaturization, we can now put all this together in the same instrument. So, we can now find a way of putting both of those in the same technology and getting the best of both worlds, meaning that a hearing aid can have magnetic induction and RF at the 2.4 gigahertz level. So, if we combine both technologies, we can give them all those convenience features and give them that audiological, that hearing benefit, and more, without making compromises. So, it is a no-compromise solution. You don't have to choose one or the other. Give them everything. And there's one product on the market now that offers this, and this is the Pure 13BT. There are some that do have both of them combined, but the wire, the magnetic induction, is not that third generation. They're using more comparable to a second generation. So, Primax Pure 13BT combines both of these, giving them the direct streaming as well as that high-definition ear-to-ear information so we can get things like that narrow directionality. And this is something that will work with an app, so we give them app control from the phone and wireless programmability via NOAA Link wireless. And at multiple performance levels, so going with more premium or working down in the performance level options. So, I'll just kind of give you a picture of what's inside. You see that we've got the microphone set up in there. We have the Bluetooth antenna because it is Bluetooth low energy. You also see, though, that there is the E2E magnetic induction coil, so both of those built into the same instrument. And that's what lets us start to make that work together with our proprietary ASIC, the chip that kind of brings all this information together for how it's going to work. So, really, if we start to look at how these play out, we focus on the E2E, the magnetic induction, to send audio and data from instrument to instrument. We want to start to reach out to other aspects in their environment. Now we're using the Bluetooth low energy and RF audio. So, you can see for programming devices or for aspects with the phone that are going to be data driven, that will use Bluetooth low energy in both directions. For audio streaming from the other devices, it's using Bluetooth low energy. So, from a TV transmitter or for taking phone calls or listening to music on their phone, it will take that in one direction. So, if we think about that kind of audio transfer, now we've got really good sound quality for calls and music. It's a reliable connection. Importantly, it's stereo. So, now you're listening to different signals on each side because it is a stereo signal coming in and really nice on the power consumption. In fact, if we look at this, if they're using heavy streaming, so up to around six hours a day, which I think that's... Think about how much you use the phone for a day or how much you might listen to music from your phone. I think six hours is a reasonably heavy day for that. And out of a 16-hour day, we can still look at getting seven days before they need to change battery using a 13-size battery here. So, some very practical application there. And what I think is also exciting with this is we get to take the direct streaming aspect and the use of the iPhone to another level of not being just a convenience factor, but let's give them some hearing benefit as well. Because this is the first device using the iPhone's motion sensors as a source of input for decision-making in the instrument. So, what that means is that when the phone is in motion, that motion sensor will send a signal to the instrument to let them know it's in motion. And that helps in a couple different ways. Most importantly is how it contributes to classification in noisy environments. So, if I look at a situation, I'm out with my wife, we're in an outdoor cafe, you've got street noise, you've got people talking, you've got restaurant noise happening. So, we're sitting there face-to-face having a conversation, the hearing aid says this is noisy, it goes into a narrow directionality, shuts down the competing signals, and we can have our conversation. Now, we decide it's time to go to the car, we get up and start moving. At this point, the acoustic situation has not changed, but we're not going to walk to the car face-to-face. We need to look where we're going, be more aware of what's going on around us, so one of us is not going to walk backward, we're not going to sidestep while we're looking at each other. The acoustic situation hasn't changed, but our listening need has changed. And this is when the motion sensor, now being in motion, will send a signal to the hearing aids indicating that it's in motion, and the hearing aids can say, okay, the acoustic situation says I need to be narrow, but I know that I need to open this up more, so it will relax the directionality and bring in more spatial awareness and communication ability even when we're walking side-by-side. So, it's using that to help in that scenario, and also using it for the car scenario. The device is very good at classifying when it's in a car, but now if you add in the motion plus its car detection, it improves the accuracy to help, again, make sure that it's doing what's necessary for a car scenario. And also, because it's using 2.4 gigahertz technology, it allows direct streaming from the streamlined TV to the hearing aids. So, quick, easy pair, sends Dolby stereo sounds from the TV directly into the instruments, again, making it very easy and accessible for them. So, coming at the end of the time here, to kind of summarize, if we look at what the top complaints and challenges that hearing aid wearers have faced, wireless technology finds solutions for those and really makes it more convenient and beneficial for the hearing aid wearer. And unlike in times before, we've had to choose in the past, which way do you want to treat the patient for what's most appropriate, but there's not a need to choose anymore. We now have technology, especially in the Signia Pure 13BT, to do a no-compromise solution using near-field magnetic induction and RF technology and giving them the best of both worlds. So, with that, I do want to open this up for questions. Great. Thank you, Eric. Eric, it was an excellent presentation, and we're so excited that we've had over 100 of your fellow colleagues that have joined us today on this webinar. As Eric said, we do have some time for questions. If you have a question for Eric, please enter it in the question box on the webinar dashboard. And, Eric, our first question comes from Henry, and Henry asks, are there concerns about using wireless technology with pacemakers? So, actually, it's a great question, because whenever wireless technology comes up, pacemakers are always a concern for people, because we've got wireless pieces going around. We test these. We test the Streamline TV. We test the wireless there. And what's nice is pacemakers follow certain requirements from things like ANSI and such. So if they're meeting the more current ANSI standards, it's 14117-2012, then we don't see any interference with the pacemakers. So we work with those standards. And the majority of pacemakers for years have been working to that standard. But it's always something to discuss with their physician. Great. Thanks, Eric. Eric, our next question is from Kelly, and Kelly asks, is there any word if Android will introduce similar technology to Apple? So this is kind of a hot topic, because looking to see what Android can do, because as I've always understood, Android has kind of some proprietary algorithms on that audio transfer with the Bluetooth low energy. And Apple has a great advantage that Apple has that. It's on the iOS platform, and that goes in all the Apple products that are using their iOS platform. Android is a platform that's being used across the hardware from many different manufacturers. So it would not just be a matter of Android using it, but it would be a matter of those manufacturers being able to use Apple's proprietary information for that Bluetooth low energy. So realistically, I don't see that happening. What could happen would be if somebody, you could do standard Bluetooth, but again, that's too big, and that's very power hungry. So even if that were to come on the market, I think that would be high risk for anybody and difficult for the patients. Or there has been talk about looking at more uniformity down the road with phones to find a more standard that would be used across all the phones. And there's been talks on that, but that's still a few years out. So for right now, it's going to be Bluetooth low energy for direct audio from iPhone to the hearing aids. And then for Android, it would still use a relay. Great. Thanks, Eric. Eric, our next question comes from Jeff. Jeff asks, are there any restrictions with air travel when it comes to hearing aids that are using this technology? So from what I've seen and what I've heard, I don't see any restrictions with air travel because most of this is still working on smaller aspects. And you do have a capability in the app for the RF portion to go into like an airplane mode, but that's also just to limit any communication with the phone. But for like the instrument-to-instrument communication especially, we don't see any concern there. Great. Thanks, Eric. Eric, our next question is from Jessica. And Jessica asks, are there any security measures that are built into hearing aids using Bluetooth for instances with maybe say hacking? Is that a concern? So for hacking concerns, what's going to typically happen with the Bluetooth is that it already has some of its own secure privacy aspects. Now, I think many celebrities will tell you that nothing is completely secure from hacking. They've had less than desirable things published. But Bluetooth already uses some security aspects because it's basically they have a handshake to make sure that what's going from the Bluetooth device to transmitter to receiver, that they're able to work together. In the past, they've used some things like frequency hopping where they would bounce around on different frequencies within the band. So overall, it's generally very secure and most importantly, prevents a lot of interference from jumping in there and confusing the signal. Great. Thank you, Eric. Eric, our next question is from Alan. Alan asks, will hearing aids using Bluetooth work with Apple Live Link? So, great question. Apple Live Link is actually I think pretty interesting because Apple Live Link is part of the native app in the Apple phone. Native app meaning that it's part of the Apple, not necessarily any manufacturer's information. And what Live Link will do, and we use that with the Pure 13 BT, and I've seen it in other applications as well, that the Live Link will turn the wearer's phone into a remote microphone. It doesn't mean they have to give up their phone, but what will happen is that if I select Live Link and my phone is paired with the hearing aids, I can be sitting across the table from my spouse. I can hand them my phone or maybe a business meeting, set the phone at one end of the table, and then that will act as a remote microphone picking up the signal and sending it directly to the hearing aids. Great. Thank you, Eric. Eric, our next question is from Justine. And Justine asks, if the patient has two TVs and two TV streamers, would they need to do anything special when watching one TV or the other? So, with this, what they would need to do, so looking at a TV streamer and looking at two uses, because, you know, think about it, maybe you have a TV in the bedroom, TV in the family room, and they would have one option. Of course, it would be to unplug a streamer, take it back and forth. But to pair the instruments with the streamer, we close the battery door and set them right on the streamer, and within a matter of seconds, they're paired. And I can actually pair multiple hearing aids to one streamer because the streamer is sending out the signal. It's not receiving anything back from the hearing aids. So when they pair it, it's giving the hearing aids the code to work with that streamer. So I could actually take a husband and wife and have them both get the same signal from the same streamer. They could even have friends wearing the same instruments and have all the same thing being transmitted. So it gives me a one-to-many aspect. But because it does do that specific pairing and encoding between the devices, if they go up to the TV in, say, the bedroom now and want to listen to that, they would need to repair that. But again, it's just open and close the battery door, put them on the streamer, and then it has them paired again using that special coding. So they have to repair them, but it's a simple open and close the battery door process and ensures they're going to get the reliable signal. Great. Thank you, Eric. Eric, I'd like to thank you for an excellent presentation today, and I'd like to thank everyone for joining us today on the IHS webinar, Combining Wireless Technologies. If you'd like to get in contact with Eric, you may email him at e.blanda.savantos.com. For more information about receiving a continuing education credit for this webinar through IHS, visit the IHS website at IHSinfo.org. Click on the webinar banner or find more information on the Webinar tab on the navigation menu. IHS members receive a substantial discount on CE credits, so if you're not already an IHS member, you will find more information at IHSinfo.org. To keep an eye out for the feedback survey that you'll receive tomorrow via email, we ask that you take just a moment to answer a few brief questions about the quality of today's presentation. Thank you again for being with us today, and we will see you at the next IHS webinar.

wireless technology

hearing instrument technology

2.4 gigahertz

near-field magnetic induction

direct streaming

cross and bi-cross hearing aids

binaural beamforming

no-compromise solution

Bluetooth technology