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Cochlear Service Report - January 2024

Cell Phones: Not Just for Texting

Cell Phones: Not Just for Texting
Linda Day, Donna Sorkin, MA
January 29, 2013
This article is sponsored by Cochlear Americas.

This text-based course is a transcript of the live seminar, “Cell Phones: Not Just for Texting,” presented by Linda Day, Senior Awareness Manager for Cochlear Americas.  Download supplemental materials:

Slides from course (PDF)
Assistive Listening Devices (PDF)
Telecoil Enabled Accessories (PDF)

Donna Sorkin:  Welcome to our session, Cell Phones: Not Just for Texting.  I am being joined today by Linda Day who is a Senior Awareness Manager at Cochlear Americas.  Our program today extends our reach to all the segments of the cochlear implant, Baha®, and hearing aid community including adults, parents, and professionals who serve all of those groups.  Linda has 30 years of experience working with hearing loss, and has had a cochlear implant since 2005.  Prior to joining us at Cochlear, Linda was the manager for solutions for people with hearing loss program at AT&T Wireless.  She is very knowledgeable about interfacing hearing technology and wireless phones.  She is an author and songwriter as well. 

I work with our HOPE program and am very honored to have the opportunity to work with people from across the United States and around the world on various topics regarding maximizing outcomes with cochlear implants and Baha®.  I am an advocate for parents and adults with hearing loss, and served as executive director of the Hearing Loss Association of America and AG Bell before joining Cochlear 10 years ago.  I am an avid technology user and I have had a cochlear implant even longer than Linda.  I had my 19-year anniversary of using a cochlear implant in December.  Not a day goes by when I do not marvel at the gift this technology provides including my ability to talk on the telephone, which I had not done in quite a long time before getting a cochlear implant. 

This presentation will be an introduction to the topic of cell phones and cochlear implants.  We will look at hearing technology issues.  We are going to look at the telephone, and then we are going to look at linking the hearing technology to the telephone in different ways to listen.  We will be talking about building confidence, and strategies and tips for learning to use a cell phone. 

The Telecommunications Revolution and People with Hearing Loss

Before the Telecommunications Revolution, a lack of telephone access was really one of the most limiting aspects of having a hearing loss.  I, personally, can remember very vividly what it was like before there was a relay service that was actually staffed by professionals, and before we had all of the technology options we have today.  This includes landline and wireless telephones that have volume control and telecoil compatibility, as well as the availability of e-mail, texting and instant messaging.  These were options that I did not have before I got a cochlear implant.  It made it very difficult to communicate.  Having captioning and Internet really makes it possible for adults, children, and teens in many areas to be on a par with our typically hearing peers.  This is pretty amazing and a real improvement for all of us. 

Ironically, the telephone was invented by Alexander Graham Bell.  Bell was a teacher of the Deaf, and his invention of the phone actually came about, in part, because of his interest in providing communication options for people with hearing loss.  This interest, along with his related interest in acoustics, and the fact this both his mother and his wife Mable, were both hard of hearing, motivated him to find a communication solution.  He was personally acquainted with hearing loss as well as involved in it professionally.  He was interested in the teletype machine as a way for people with hearing loss to be able to communicate.  It was particularly ironic that his invention of the telephone produced tremendous frustration and isolation for people with hearing loss for nearly a century.   Relatively recently changes came about because of the Telecommunications Revolution, and legislation was passed that opened up access to telephones and other modes of communication for people with hearing loss and other disabilities as well. 

Why is Using the Telephone so Difficult for Some CI Users?

Some people with cochlear implants (CI) have no difficulty using the phone.  They just hold the phone up to their ear and are able to communicate successfully.  Most people, however, find the need to make some adjustments to their hearing technology.  They need to be selective about the telephone they are using and also have to address linkage between the phone and their hearing technology.  We find that some adults may never have used a cell phone before, particularly if they have had a hearing loss for quite a long time.  Many, if not most, teens use other ways to communicate.  In a Zits comic strip that appeared a few years ago, the parents are looking at their teenage son Jeremy's yearbook and observing that all the kids’ school photos are of themselves texting.  I can identify with this as a mother of a 20-year-old son.  I find if I want to talk to my son on the phone, and I try to call him, he generally will not pick up.  Instead if I want to talk to him, I send him a text message and ask him to please call me.  This is what usually works. 

Teens and Telephones

Teens, typically hearing or those with hearing loss, are texting more than they are talking.  On the one hand, that is great for kids with hearing loss, because they can do just what their peers are doing and are on an equal playing field.  On the other hand, what we see is a lot of teens who have cochlear implants and excellent auditory skills have never mastered voice phones.  That may be okay when you are a teenager, but when you go out and enter the workforce, this is not such a good thing.  You do have to be selective about choosing a telephone.  You have to know how to link and starting out can be frustrating, if things do not go smoothly from the beginning. 

Adults and Cell Phones

As I mentioned before, many adults may not have used a cell phone before or they have used a wireless phone exclusively for e-mail, texting, and taking advantage of the data aspects of it, but not the audio aspects of it.  Then we also find that many seniors are just flustered by any technology.  Figure 1 is a picture of my mother's cell phone.  It is called a Snap phone.  We looked for a phone that was as unlike a cell phone and as much like a landline find that we could find so she would actually use it.  She is very flustered by technology.  After we got her this phone, she called me.  She was trying to call my sister on her cell phone because the facility where she lives has a landline phone that does not allow her to make language distance calls.  She called me to walk her through again how to use the phone.  The problem at that time was that she was using her COMCAST remote control instead of the phone to try to make a phone call.  That was just to give you an idea how flustered some seniors can get when they are using this cell phone technology. 

Snap phone

Figure 1.  Snap phone.

The rest of our talk is going to be devoted to a discussion of hearing technology, the telephone conversations and the linkage between the hearing technology and the telephone, also called the interface. 

Hearing Technology

Whether we are talking about cochlear implants or Baha®, or hearing aids, there are a number of ways that you can use your hearing technology to talk on the phone.  The first is just to couple acoustically.  You would hold the phone up to the microphone of the technology.  On my cochlear implant, that mic is pretty far up on the processor at the part where the processor curves around on my ears.  It is not where someone would ordinarily hold a phone.  If you do not have a hearing loss, you usually hold the phone at your ear canal.  We do not do that if we are using hearing technology.  I cannot tell you how many times when I have gone into a Sprint or AT&T store trying out phones and the helpful salesperson comes over to tell me I am holding the phone in the wrong place.  You do have to hold it where the mic is, which is not where someone ordinarily holds a phone, to couple acoustically.  You can use a speakerphone.  This can be a sit-on-the-table type of speaker or it can be a speaker in the car.  Many people have a setting on their cell phone where they can put themselves into speakerphone on their phone, which is another way to use the phone with your hearing technology.  Then you can use telecoil, and we will talk more about that in a minute. The fourth way is direct connection.  Some hearing aids and all Nucleus cochlear implants have a port that allows a cable connection which we will cover in more detail in Linda's section on the interface.  Those are the different ways that you can use your hearing technology when you talk on a cell phone. 

Pros and Cons

Let's just talk about the pros and cons of each of these different methods. 

          Couple Acoustically.  The first being coupling acoustically, where you are holding the phone up to your ear.  On the pro side, this is the easiest way.  It is the least likely to cause interference with the phone.  It works fine for many people.  You can also use the phone in your cochlear implant noise program.  If you are in a noisy place and you want to couple acoustically, you can use that.  I actually do this sometimes on an airplane right before they close the doors and I want to make one last telephone call.  I make sure that I am in my noise program and couple acoustically.  This will get rid of all the noise in the plane.  This is one way to do it.  On the negative side, background noise can be an issue that can make it hard for you to hear what you want to hear coming through the phone.  It may not provide as strong of a signal as the telecoil.  I personally find when I am in telecoil mode, I get a much stronger signal coming through the telephone.  Some people find that the voice is just not loud enough if they are coupling acoustically. 

          Speaker Phone.  Using a speaker phone can be nice, because it provides a way to listen with others in an office or another environment, and there is no need to address the phone placement issues because you are hearing that sound come out into the environment.  Some people like it because they can listen while they are using a computer or doing some other task.  Some people use speakerphone as a means of gaining help from a family member, for example, because then the family member can fill in if they are missing something.  That is a double edged sword, because many of us find that we actually do better and get a stronger signal-to-noise ratio if we are using the telecoil, direct connection, or even acoustic coupling where you are holding the phone up to your ear.  Be aware that the speakerphone may not be the best way for all people to listen.  Some people like speakerphone and use it, but have the issue with background noise which it will not really help.  The other thing that I personally find is that speaker phones are very much affected by the quality of the speakerphone.  You also may need to sit closer to the speakerphone to get a really clear signal. 

           Telecoil.  Let's talk a bit about telecoil, also called T-coil.  Telecoil is just a small copper wire that is built into some hearing aids and cochlear implants.  It can also be added externally with hearing technology as you can do with the Baha® device.  It boosts the electronic signal from the telephone hand set and also provides access to wide ranging assistive devices.  For example, when I go to the theater, I always use the infrared device in the theater that I access through the telecoil in my cochlear implant.  You turn it on or activate it via a t-switch on the cochlear implant.  Our latest is the Nucleus® 5 which has an AutoPhone feature.  You can have that turned on, and it automatically detects the phone and turns the telecoil on.  It is important to know that all landline and many cell phones are designed by Federal Law to be used with a telecoil so you do not have to do anything special when using the AutoPhone feature with a compatible phone.

Figure 2 shows the first hearing aid on the top on the left side to be a typical behind-the-ear hearing aid.  You can see I have pointed to the telecoil switch in the hearing aid.  It is difficult to see, but there is a little "T" which is what you will see in many hearing aids.  The second hearing aid on the right side is an open-fit hearing aid.  Many of them do have a telecoil switch, but some do.  Then on the left side you will see the Nucleus cochlear implant both the body worn and the behind-the-ear version.  This does have a t-switch that you can see at the bottom.  There is a little area that says P2 and underneath it says T.  Then on the body worn piece, the T is off to the right.  That indicates that the telecoil is turned on. 

Telecoils in hearing technology

Figure 2.  Telecoils in hearing technology.

With the N-5, there is also a telecoil switch and has a way to turn it on with a remote.  This can be seen in Figure 3.  If you want to use a telecoil with the Nucleus® N-5 Sound Processor, you can activate it manually.  On the actual processor, you can do a quick press on the upper button on the sound processor (shown in Figure 3 with a blue arrow) and turn on the telecoil.  There is also a button on the remote control, which is called the remote assistant.  A long press on that remote assistant means that the auto telecoil is enabled and you will see just below on the right side of the orange face on the remote an indication that the auto telecoil is enabled.  You can use your telecoil on the N-5 either manually or without auto telecoil feature which is very nice. 

Using t-coil with the Nucleus 5 sound processor

Figure 3.  Using t-coil with the Nucleus®5 sound processor.

On the pro side for telecoil, it reduces or eliminates background noise.  This is a huge benefit.  I can make a call anywhere and get rid of the background noise that can be so difficult for anyone with hearing loss.  In fact, I have settings that allow me to make a call in a very noisy environment, like an airport.  My poor husband who is 50-something now and probably has some high frequency hearing loss will sometimes have more difficulty in a noisy environment than I do with my telecoil on to make a call.  It boosts the strength of the telephone signal.  You can turn it on or you can have it off.  It does not have to be on all the time.  You can change the ratio of the T-coil to the microphone.  I have some settings that are quiet at 60/40 setting.  60% comes through the telecoil and 40% through my microphone.  Then I have a setting for a noisy environment which is 80/20.  This puts more of the sound through the telecoil and less through the microphone.  Also with the N-5, you can have that come on automatically. 

On the con side, it is an extra step to turn it on if there is no auto telecoil.  It can pick up electromagnetic fields from other sources.  You can get a buzz from some older computer monitors, for example. I do not get it from mine or from my LCD flat screen on my desk.  I can talk on my phone and be in front of my computer.  It is mostly some of the older models of computers.  Older fluorescent lighting and some household appliances like my microwave will give me a buzz if I am next to it with the T-coil on.  If you are on an airplane, this definitely can give you some interference.  You have to take more care in the selection of the cell phone for sure. 


We have talked about the technology side.  Now we are going to talk about the telephone side.  I would like to begin with just a basic definition of cell phones.  You might hear different terms used such as wireless, cellular, cell phone or mobile phone.  All of those are interchangeable, and basically we are talking about a telephone that communicates via radio waves rather than long cables or wires.  Do not confuse the cell phone with a cordless telephone which is a phone with a very short wireless connection to a local landline which many of us have in our homes.  Just a little history for those that are interested, the very first cellular phone for commercial use was approved by the FCC in 1983.  It was the Motorola DynaTAC 8000X, weighed 2 pounds and offered a half hour of talk time for every recharging.  It sold for $4000.  That is pretty amazing when you think of how far we have come in a relatively short amount of time. 

What is the Issue with Cell Phones and Hearing Technology? 

The very first cell phones were analog.  They did not create major access problems for people with hearing technology, but very few of these cell phones were hearing aid compatible or HAC.  HAC means providing the ability to internally connect with a telecoil through magnetic radiation from the phone to hearing aid or cochlear implants.  The Hearing Aid Compatibility Act of 1988, which was Federal Law, required landline phones to be HAC.  However at the time the law was passed in 1988, wireless was initially exempted from the law.  I think advocates had no idea that cell phones would be so important in the future.  They did not insist on it, and it was not included.  Wireless phones that were introduced around 2005 in this country do have the potential to interfere with hearing technologies unlike analog telephones.  This new technology, or new wireless phones, was introduced in 1995.  I was in Europe the year before where the digital GSM technology was first introduced.  I remember standing next to someone who was using their cell phone and getting a buzz from their cell phone.  I was experiencing what was called bystander interference.  Never did I dream those phones would be introduced into the United States.  Of course, the following year they were and those of us that were involved in advocating for people with hearing loss were just appalled that this was happening in the United States.  It took us almost 10 years of on-going advocacy by consumers and by professional organizations to get the Federal Communications Commission to lift the wireless exemption for phone companies and force the companies to produce telephones that did not interfere with hearing technology.  This was done via the adoption of specific standards and now every manufacturer of cell phones that receives a license in the United States must offer models of wireless phones that meet the standard for hearing aid compatibility.  That was a lot of advocacy over a really long amount of time by various organizations in the field. 

HAC Rules and Cochlear Implants 

The standards were actually developed for hearing aids, but most cochlear implant users find that if a phone is rated as being HAC for hearing aids, it also works for the cochlear implant user.  As always, you should try the phone first with your individual device.  Cochlear implant manufacturers all design their devices knowing that people will want to use digital wireless phones.  The HAC act was updated in 2003, and includes requirements for cell phones to be hearing aid compatibility and for provisions on volume and interference.  Also each manufacturer and provider of cell phone service has to meet a specific interference standard for hearing aid users with at least two models of phones providing telecoil compatibility and at least 50% of all phones providing acoustic coupling. 

How do you Know if a Cell Phone Meets the Standard?

The standards are set forth in the American National Standards Institute (ANSI) Standard C63.19.  When you go to look for a phone in the store, those phones have to marked and have the rating on it.  Handsets have an M rating, based on performance using acoustic coupling utilizing the hearing technology in the microphone mode.  The M ratings are M1, M2, M3 or M4.  M3 meets the standard and M4 surpasses the standard.  Regarding the telecoil, handsets rated T3 or T4 have met standards, where T3 has met, and T4 has surpassed, the ANSI Standard for use with hearing aids in the telecoil mode.  Again, these standards were set for use with hearing aids, but because they are based on radio frequency interference, they should also be appropriate for cochlear implants. 

Always Try Before You Buy

I cannot emphasize enough to try before you buy, because the ratings are intended as a guide and different models of technology will provide different experiences for the user.  I personally am very picky.  Some of my colleagues at Cochlear may say they really like this one phone, and I try it.  For whatever reason, it does not work very well for me.  Sound quality is very personal and it is not measured by the interference rating.  When looking for phones and looking at that rating scheme, keep in mind that M4 and T4 are going to provide the best outcome in general.  M3 or T3 meet the standard.  Personally I like going with the 4s on both.  I use that as a starting point, and then I listen to the phone to see what I like.  Sometimes what we see is people look at a phone and they see the display on one is much nicer than another and they can do this that. 

If you are purchasing a phone that you want to be able to listen to and talk on, then you need to select that phone based on the audio qualities, not the data characteristics and features.  I actually have two telephones.  I have one phone to talk on and one phone that I do data on.  I have done that consciously so that I can maximize what I want in terms of the audio quality and still have all the features that I want for data.  Some people do great with one phone. I am just sharing with you my own personal preference, and the importance of having a really hot phone from the audio perspective.

Telecommunications Laws Impacting Cell Phone Access

The HAC act of 1988 was the first law on wire line and cordless phone and the second law was the HAC act of 2003 that extended the first law to wireless. I have added websites in my resources for you to see these laws online if you would like.  The third was the Telecommunications Act of 1996, sometimes known as Section 255, which requires companies to make their products accessible to and useable by people with disabilities if readily achievable.  Some of us who were involved in the passage of Section 255 of the Act thought it was going to solve our problems for us.  But, in fact, that language “if readily achievable” really did not work for us very well.  It did not have the teeth that the HAC rules had and we did not get the access feature that we needed until those changes were made in the HAC rule.  I have given you some references and sources at the end of the presentation.  In addition to these, we have some nice information on the Cochlear website.  I really like the Wireless Association's background materials on wireless access.  I recommend taking a look at that.  Hearing Loss Association of America has been very involved in this issue from the beginning and has lots of materials including a very nice piece that Lise Hamlin (2010) did called “Choosing and Using a Cell Phone with your Hearing Aid or Cochlear Implant” and that is on their website.  You can also Google this topic and find many articles on it. 

Our last topic is linking the hearing technology to the telephone or the interface, and I'm going to turn it back to Linda.  

Linking Hearing Technology to the Telephone (the Interface)

Linda Day:  I remember back in those days when we worked on those laws.  It has been fun to watch them progress and see more people have the opportunity to take advantage of the technology that is available.  We are going to look at a couple of different things here.  We are going to show some of the accessory type devices.  Donna has done a great job telling you what kind of phone to get and what to look for in the ratings, but what other things are out there that might make it easier for us to actually be able to hear better on the phone? 

Accessory Devices

There are a couple of accessory devices that are available on the marketplace.  They are all telecoil compatible.  They are assistive listening devices.  Each of these devices, seen in Figure 4, plugs directly into a jack or port on the cell phone itself. 

T-coil compatible ALDs for hearing aids or cochlear implants

Figure 4.  T-coil compatible ALDs for hearing aids or cochlear implants.

HATIS stands for Hearing Aid Telephone Inner Connect System and there are two different styles there.  You can see one has a single silhouette, and the other has two, which is obviously for someone who is wearing two devices that have telecoils in them.  This may be a hearing aid and a cochlear implant, or two of each that have telecoils.  As for the single unit, the silhouette which looks like a flat hearing aid, hooks over the ear next to the processor.  It does not matter which side you put it on.  The second little clip down or button that you see in Figure 4 on the single unit is actually a clip that you can use to attach it to your lapel.  Then the oval shape thing is the microphone and the end then plugs into the phone.  When you dial your phone number and you put your processor or hearing aid in the telecoil mode, that device will pick up the sound directly from the phone.  The NoizFree, on the right-hand side of Figure 4, is a very similar device, but it uses something called an ear hook which is much smaller.  Some people find it to be more comfortable than the flat silhouette-type devices.  There are many accessories available in the marketplace, so we are only showing you a few of these.  I encourage you to look around, learn more at the various websites that we will be giving you later, and see what other types of devices might be the best option for you. 

What is Bluetooth?

We get a lot of questions at Cochlear about Bluetooth.  According to Wikipedia, Bluetooth is a proprietary open wireless technology standard for exchanging data over short distances (using short wavelength radio transmissions in the ISM band from 2400 – 2480 MHz) from fixed and mobile devices, creating personal area networks (PANs) with high levels of security.  Created by Ericsson in 1994, it was originally conceived as a wireless alternative to RS-232 data cables.  It can connect several devices, overcoming problems of synchronization.  As Bluetooth has developed and been used into more products, it has become a much more useable and useful technology. 

So what does all of that really mean?  Basically, Bluetooth is a radio frequency that is transmitting in a small area, usually 30 to 40 feet from within the base unit.  We are going to be discussing some Bluetooth accessories that require you have to have a cell phone that is able to transmit the Bluetooth signal.  The accessories we are discussing will serve as a Bluetooth receiver.  There are a lot of options in the marketplace.  I am going to show you a few that we have actually tried and have very good success with.  These accessories require your hearing aid or your cochlear implant to have a telecoil in order to receive the signal from the Bluetooth receiver.  Let me explain.  It is similar to how FM works, in that you need a transmitter and you need a receiver.  Commonly as we look around, we see a lot of people using Bluetooth receivers with their cell phones.  For people who have normal hearing, these receivers will pick up the sound and then transmit it acoustically into their ear canal.  For those of us with hearing loss, unless we have some good residual hearing, we are really more dependent on our amplification device.  So we can use accessories that serve as Bluetooth receivers, that then transmit the signal to our amplification devices via the telecoil.

Figure 5 shows some of the Bluetooth Neckloop devices that are available.  There are more than this, but I am showing those with which I have personal experience.  The first one is called the LPS5 Bluetooth Neckloop and is made by Nokia.  They launched the very first Neckloop that connected to a telephone way back when I was working at AT&T Wireless.  I have had the good fortune of using a device similar to this over the years and it has worked very well.  At the time when I used the original one, I wore two hearing aids with telecoils, and it allowed me to hear the telephone in both ears.  That was a tremendous improvement for me to be able to understand on the phone.  The other one in Figure 6 is made by ClearSounds and it is a Quattro Bluetooth Neckloop.  Both of them work very similarly in that this device has to be paired with your cellular phone.  Each phone manufacturer will have instructions on how to pair to Bluetooth.  You generally set it in a Bluetooth mode and it will search for a Bluetooth device.  Each of the Neckloops also has a pairing process in their instructions on how to set the device in the mode so it can be found by the cell phone.  Once the cell phone finds the device, it will show on the screen of the phone and you accept that as the device that one you want to pair with.  They found each other.  You only have to do that once.  You do not have to do that each time you use the phone.  Now these two devices are paired together. 

Bluetooth neckloops

Figure 5.  Bluetooth neckloops. 

Each of the Neckloops you see comes apart and will fit around your neck to create a mini induction field.  When you switch your hearing device, either hearing aid or cochlear implant processor, to the T-coil mode, it will receive the signal which is electromagnetically sent to the telecoil.  This is another type of Bluetooth option.  Each of these devices has microphone built into it built in it as well.  It also has volume control.  You can use the volume control on your phone and/or the volume control on your hearing device as well.  You have a lot of options to be able to adjust how you sound and the end user is usually able to pick up your voice clearly.  Sometimes if I am in the car, I may just hold the little box up in front of my mouth a little more so that they are getting a more direct speech line, but generally people are able to hear very well. 

Figure 6 is another Bluetooth device called a Beetle.  It is a little different in that what you are seeing on the left is just like a little lapel clip that pins on to your shirt or your call collar and what I have in the circle is a connector.  You get to choose if you want to use the single ear hook or they have a bilateral ear hook.  You can use the Neckloop also, and Figure 6 is showing H-2ST or H-3ST units.  They function in the same way in that you pair the device and then you put the processor into telecoil to the signal to whichever accessory you prefer to use. 

NoizFree Beetle

Figure 6.  NoizFree Beetle.

How Do They Work? 

The phone has to have the Bluetooth capability turned on and you have to pair your accessory to the phone again as we described how to pair it.  Once it is paired, the cochlear implant has to be in or the processor has to be in the telecoil mode.  Your accessory would be turned on.  Calls can be answered directly at the accessory by pressing a button and it will actually engage your call.  For example, if I am in my office with my phone sitting on my desk, if I am set up and ready to go when the phone rings, I simply press a button on my Nucleus® 5 to activate the telecoil and I press the button on the Neckloop to answer call.  I am then able to talk hands-free if I need to take notes or whatever.  It is very convenient.  In many states, it is against the law now to hold a cell phone up to your ear while driving.  This can be a wonderful option for you as a hands-free device in the phone.  Although I do not encourage you to use the phone while driving, it is an option that you can use. 

Direct Connection

Direct connection is a little different in that this is something that will stream directly into the processor itself.  At this point, you are not using a telecoil any longer.  It is actually sending the signal directly into the processor.  I have not tried this device, but I have seen it advertised and have read several things about it.  I cannot give personal experience on this device.  As you can see in Figure 7, the little cable that comes down with the three prongs would fit into a Euro adapter pin for a Nucleus® 5 which you would have to purchase through the online store.  The device itself does not have the three prongs in it.  One thing I am not sure of is, Baha® has a three prong, and if Figure 7 shows a standard Euro adapter, this possibly could be an option to use with a Baha® if you have a Baha® device.  It is available through a company called Soundbites.  It would not be subject to interference because of the connection, and is not actually picking up electromagnetic energy. 

Direct Connect Option does not require a t-coil

Figure 7.  Direct Connect Option does not require a t-coil. 

Figure 8 on the top shows another option available at Cochlear Online Store which is a direct connection.  It is a personal phone cable for the N-5.  And I have talked to several people who are using this and really like it.  They actually use an adapter so they can use two of them and be bilateral.  The only problem is it does not have microphone on it so you are still subject to using the phone.  You have to use the phone microphone or speaker and hold that up to your mouth when you are talking. 

Personal phone cable for the Nucleus 5

Figure 8.  Personal phone cable for the Nucleus 5.

Some cell phones will disengage the microphone when you are using this, so the end users may not able to hear you.  Because of this, there is a second option on the bottom of Figure 9 called the Monster iSoniTalk microphone.  It is designed for you to plug in the personal phone cable to the processor.  It would plug into the bottom of the Monster iSoniTalk jack and that plugs into the phone.  It has microphone on it and provides the microphone, but you still have the direct connection to the processor itself.  This gives you better quality and clarity.  As Donna mentioned earlier, if you change your different programs, the noise program will help to filter out background noise when you are using this as well. 

Pros and Cons of Bluetooth

As I mentioned, being hands-free is very convenient whether you are washing dishes or taking notes or driving the car.  It does give you improved quality of sound, because it is a much clearer signal than just holding the phone up to the ear.  With the controls on your Nucleus® 5 remote assistant, you have the option to adjust your microphone and telecoil ratios on the remote itself.  You can be in the middle of a call and you can change how much telecoil you are hearing or how much microphone you are hearing to best improve that listening environment for you.  It is convenient to use.  There is no impact on the hearing device batteries.  It is not draining down your hearing aid or your processor batteries in the process.  Both of the devices that we showed are plugged into the wall to recharge them. 

The cons might be because you are dependent on the cell phone technology, it is possible to have a call drop.  If you move too far away from the cell phone with just the Neckloop on, and are at too big of a distance, from it, you could drop that call, also.  It is subject to the electromagnetic interference because of the telecoil.  If you find yourself hearing some buzzing or static noises, you might move away from whatever that source is and it should reduce that noise.  Also the direct connection on some of the other things we mentioned could impact battery life for the hearing device.  These are some things you need to monitor in how you use the device, if you see those differences.  We have some websites where you can purchase these accessories listed at the end of this presentation and in the handouts that we have provided. 

Building Confidence, Strategies and Tips, Practice Tools

Donna Sorkin:  Thanks so much, Linda.  That was really great.  Let’s put this all together, and then we want to share some of our tricks.  We both use different strategies for different situations and different telephones.  In my case, my husband's cell phone gives me a bit of a buzz if I am ever using his with my telecoil on.  I use it in acoustic mode which is not my favorite, but it works fine.  I have learned to make different adaptations in different situations and of course we have talked about being selective about the audio quality of the cell phone that you purchase.  Linda also talked about some of the different options for connecting in different ways.  One thing you may find is that you may like a little more volume on your cochlear implant when you use the phone.  If I am going to be on a conference call for half an hour or so, I might actually switch it to a higher volume on the phone, just to be sure I can hear all the different speakers that come up.  In situations where your T-coil is not possible like on airplanes, you can try using your noise program.  We also talked a bit about using different mixing ratios in different settings so that you can achieve the ability to get rid of noise in very noisy environments.  We cannot emphasize enough how important practice is, in helping you combine all your technology, knowledge and all the tools with building confidence.  You certainly want to try to practice and get this down pat before you make an important call, so the practice sessions will really pay off.  It helps you find the best combination of the processor setting, telephone, and interface that works for you and you can certainly do that in many different ways with different tools and different settings. 

Seek Help from Others

We encourage you to seek help from other people.  Talk to your audiologist.  He or she can give you help on your processor settings and on the phone.  Linda is a Cochlear Awareness Manager, and there are people like Linda in different geographic areas of the country.  If you go on our website, you can find the awareness manager closest to you.  We encourage you to talk to other recipients, if you are a recipient or a professional wanting to get more information from recipients.  You are welcome to come on the community website as well.  We also have a very nice YouTube video which we have given you the link to as well. 

Other Practice Tools

It is very helpful to practice with a patient family member or friend every day until you are comfortable.  That is what I did 19 years and five processors ago, before I got my current processor.  I learned to use the phone by practicing.  In those days, you had a totally different way of plugging in between your processor and the telephone.  If you are having difficulty initially, you can begin with an agreed upon topic and use closed set or limited number of response options.  For example, you might talk about a dinner party that you are going to have next week and the various food options.  This way you know ahead what the topic is going to be and the limited number of possible answers there are.  Try ordering take out.  Call recorded numbers.  We also have some very specific practice tools for talking on the phone.  One is Sound and WAY Beyond, which is an interactive software product that you can order from Cochlear and that has a telephone tool on it.  Our favorite is Phone with Confidence and we are going to talk a little bit about that right now and actually demonstrate it for you. 

Telephone with Confidence

It was actually developed by a bilateral recipient, Scott Rinehart, who wanted to have a tool to address his own feelings about using the phone and helping gain confidence in using the phone.  Scott actually developed this tool which is a free service from Cochlear to help people develop listening skills and confidence.  You call into a free 800 number that has word lists and a reading that is accessible on the website.  There is a listening part and a reading part.  You can use it without the reading once you get better at it or use it with the reading as you are getting accustomed to it.  The phone number is available on the website. 

Questions and Answers

There are several of you who have asked similar questions about the auto telecoil and to set the auto telecoil.

You set this from your remote assistant.  This only applies to those of you who have a Nucleus® 5.  A long press on the left side of your remote assistant will bring up a greenish colored box that is hollow, not solid.  It is like an outline in there.  That indicates that you are in the auto T-mode.  When you are in auto T and the phone rings, you put the receiver up to your processor.  You would answer the call and once the processor hears speech, it will kick in to the telecoil mode.  That may take 1 to 3 seconds.  Be aware there is that slight time delay, but by the time you say something, it is starting to activate as well.  If you do a press again on the left side, you will see on the screen of the remote assistant, a black box appears and that indicates that you are just in telecoil, so you will know that you have your device is set to telecoil.  I would like to mention is we have had a number of processors come back to Cochlear, because people said that they were making static noises, cutting out, or picking up strange sounds.  What we found is that people had accidentally set the processor in the telecoil mode, but did not realize it and then they may have done that on the ear level.  If you put your processor on T on the ear level, when you look at your remote assistant that black box will be there behind the center screen.  This is something to be aware of. 

Another question that we had from people was about changing the microphone and T-coil ratio.  One person had mentioned that this was something only their audiologist could do.

This is true if you have any generation processor prior to the Nucleus® 5.  If you had a Freedom and on most of your hearing aids, this is something that your audiologist would be able to adjust for those different ratios.  What we are referring to is how much microphone you are going to have in combination with how much telecoil you are going to have.  On the remote assistant, when you click on your center button and at the very top soft keys where you see the little icon for the processor, if you open this, it is the first or second tab down.  You will see it will look like a little hearing with microphone.  It will say probably one to three or three to one.  The ratios are basically 50/50.  If you use the left key of your remote assistant, you will see the numbers increase to the left.  When it reaches 6, you are almost at 100% T.  The next setting, which would be 7, would give you the letter T and that would put your processor in 100% telecoil.  Some people like that.  Other people like to be able to hear their own voice a little to monitor it.  You can play with those adjustments while you are on the call.  Also if you are using a Personal Audio Cable with an iPod®, you can change your ratio of how much microphone versus the accessory you are receiving.  I have found this very handy on airplanes if I am using my computer to watch a movie or to listen to something on my computer.  I can put that accessory to 100% T-coil and I am not bothered by all of the noise of the people on the airplane.  That has been very helpful. 

Do all cell phones have the same size and design of the plugs to connect the Neckloops?

Remember the Bluetooth Neckloop does not connect to anything on the phone itself.  It is wirelessly beeping sending the information using the Bluetooth signal.  I showed some accessories which do have to plug directly into the phone.  Most cell phones have a 2.5-millimeter jack; however, we have seen over the years there have been changes to what those ports may look like.  You can generally ask your cell phone provider to check with the manufacturer, because they should be providing an adapter if they are using other than a 2.5-millimeter jack.  They have an adapter that will plug in to their port for their phone and then allow you to plug that 2.5 jack into that adapter.  Those are not going to be available at some place like RadioShack as would some other kinds of adapter that we find. 

There is a question about captioned telephones. 

This is a topic that is probably a little beyond the scope of this call today.  I know there are many caption phones that you can pick up the signals on a cell phone, but I do not have information that I could readily share.  What I would suggest is because your phone can interface with a computer, you can actually have access to the captioning via your data port. 

Will the N-5 processor have Bluetooth built in? 

As you all know, designers are always working on integrating new technology.  I certainly would not put that past anybody's future options, but I do not have any updates on this being offered to you today. 

Emily has an N-5 on one side and a Freedom 22 on the other.  She has been told that the orientation is different in each processor. Is there any problem to using a neckloop and having different devices on each side?

I can only tell you I am not wearing two different processors, but I have talked to a number of people who wear both a hearing aid and a cochlear implant processor, or they do have two different generations of processors. They are picking up sound from each side of their ear as that blends in their brain.  It really sounds like one audio source of information.  I do not know that you would be experiencing any sense of difference between having the two devices separately. 

Is the HATIS with a mic and Monster iSoniTalk one that works with a cable? 

The Monster iSoniTalk works with a direct cable much like a Personal Audio Cable, only it is designed to work with the phones.  However, when plugging that into some phones, it disengages the microphone so the end user is not able to hear you when you are talking.  That is what the Monster iSoniTalk is designed to do.  It provides you with a microphone in addition and you plug your cable into that. 

Jessica asks about different ratios in her son's Freedom device. 

I have different ratios, but I have them on different programs.  I have one ratio in my first program and a different ratio in my second program.  That is how I switch with a Freedom device. 

Please remember you can go to the Cochlear website and click on support center, and go down to cochlear implant support.  There is a whole section on N-5 instructional videos where you can see how to change those ratios, how to plug in accessories, and for each of the Cochlear brand products there are videos that will walk you through that.  If you are not familiar with that, it is an excellent place to go and a tool to remember.  This again is called the support center on the Cochlear home page.  You will also find information there about the MT ratings that Donna discussed earlier and some additional tips on accessories. 

Supplemental Links

References and Sources

Cite this content as:

Sorkin, D., and Day, L. (2013, January). Cell phones: Not just for texting. AudiologyOnline, Article 11239. Retrieved from


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Linda Day

Senior Awareness Manager

Linda Day
Linda joined the Cochlear Americas staff as a Cochlear Awareness Network Manager in July 2006 and has worked in the disability field for more than 15 years.  Prior to joining Cochlear she managed a national program to ensure that people with disabilities could have access to wireless technology.   Linda was born with normal hearing and began losing her hearing in her mid 20s.  By the age of 47, speech reading was her only means of communication and hearing aids were of little help. Linda received a cochlear implant in November 2005 with immediate results. Now a Senior Awareness Manager she is responsible for generating awareness about cochlear implants and building a network of recipients and parents of recipients who share their experience and serve as mentors for cochlear implant candidates in Northern California and the Pacific Northwest.

donna sorkin

Donna Sorkin, MA

Vice President for Consumer Affairs, Cochlear Americas

Donna Sorkin, M.A. is Vice President, Consumer Affairs at Cochlear Americas.  In that capacity, she leads a range of activities at Cochlear aimed at the broad life needs of people with hearing loss including Cochlear’s widely acclaimed HOPE program on (re)habilitation for children and adults and their families.  Donna was executive director of Self Help for Hard of Hearing People (now Hearing Loss Association of America) and she also served as executive director of the Alexander Graham Bell Association for the Deaf and Hard of Hearing.  She was appointed by President Clinton to the U.S. Access Board in 1994 and served two terms. She served on the National Institute on Deafness (National Institutes of Health) Advisory Board and has advised numerous U.S. businesses on accessibility for people with disabilities.   Donna currently serves on the Advisory Boards of Gallaudet University and Colorado Neurological Institute.

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