Editor's Note: This is a transcript of a live course presented January 10, 2012. To view the full course, register here: /audiology-ceus/course/hearing-aids-adults-flip-your-expectations-introducing-miniric-19797
Good afternoon. Thank you for joining us today to learn about the new Flip miniRIC product from Sonic. This course provides an overview of Flip and discuss the main benefits. I'll also discuss the mechanical design of the product, as well as the technology, including what makes Flip sound so natural. Since Flip has wireless connectivity, I will talk about the various wireless options that are available. For the clinician, there are features in Flip that make it very easy to dispense and fit it. Finally, I will give you a quick overview of the different performance levels and the features that are available.
Unique Selling Points
I want to talk about the unique selling points of Flip that we think are beneficial to you as a dispenser and also to your patients. First of all, there is great technology in this product. Flip uses our new Speech Variable Processing platform, as well as our Speech Priority Noise Reduction. These features are designed to provide natural sound and to address speech intelligibility in the presence of background noise. Flip also has a new adaptive feedback cancelling system. The directional features in Flip address very challenging noise situations. As I mentioned, Flip has several wireless connectivity options, including connectivity to external audio sources, such as a cell phone, television and landline phone. There are some optional adapters for connectivity that I will discuss later in the presentation.
One of the features that makes Flip special is its size and case design. It is a mini receiver in the canal (RIC), but it uses a size 13 battery. When you hold Flip in your hand you would swear that it uses a size 312 battery. But yet, we have managed to fit in a size 13 battery, which of course provides longer battery life. The larger battery is also easier for the patient to handle than a 10A or 312 battery.
The way that the battery door opens (Figure 1) is also different, and provides improved usability for battery changes. You simply slide the door open, tip out the used battery, slide a new battery in, and close it. The battery door also has an integrated on/off switch; to turn the device off, you simply open it part way. This makes it much easier for the wearers to use, as they do not have to take the battery out every night in order to turn the device off.
Figure 1. Flip casing opened to expose the battery compartment. This unique design makes battery changes simple.
Flip includes a pushbutton for program changes located at the top of the product. Additionally, the entire bottom end of the case is a volume control wheel. These large controls make it simple for wearers to operate. As the wheel is turned, there are alerting tones to indicate to the wearer that the volume is being increased or decreased.
Because of Flip's size, it blends in very nicely when worn. It is available in four colors to match most skin and hair tones: beige, black, dark brown, and gray (Figure 2). Flip is also available in three different performance levels. It has a very broad fitting range to fit a variety of hearing losses. There are two receiver sizes that will be available, standard and power. The power receiver will be available in the Spring of 2012. The standard receiver can fit up to 85 dB HL in the high frequencies. The power receiver can accommodate up to 90 dB HL losses in the high frequencies with additional headroom, as well as more mid-frequency gain.
Figure 2. Flip color options.
Although Flip has an unusual design, it has been developed with optimal usability in mind for both the professional and the wearer. The receiver unit is the same that is used with other Sonic RIC products. The receiver units can be easily removed by pulling, and easily attached by plugging them in. No additional tools are required, and the attachment is very secure.
Flip has two microphones for directional performance. When worn, these microphones are in a horizontal position, which provides for better directional performance. They are covered with replaceable membranes that help to protect them from debris and moisture. Up to four listening programs on the Flip 100 premium-level product are accessible either via the memory button or remote control. Flip also features a phone coil, a telecoil that has been optimized for use on the telephone.
The auto-telephone feature provides easy hands-free switching to the telephone program. When the telephone is picked up and placed next to the ear wearing Flip, the hearing aid will automatically switch into the designated telephone program.
A right/left indicator is under the sliding battery door (Figure 1), for ease of use for the wearer. When the battery door is in the off position, that right/left indicator is shown very clearly. They are easily replaceable in your office should you need to change the orientation of the device.
The programming port is located under a panel that houses the microphone (Figure 3). The programming cable plugs directly into the port. There are no extra boots, shoes or flex strips to use. Once you are done programming, you put the cover back in place, and the patient never sees it.
Figure 3. The Flip programming port is easily accessed by the professional by simply lifting the microphone cover.
The receiver unit includes an integrated wax guard under the dome. It is a proven wax guard that has been used in the Touch product. It is dual system, where the wax basket and the dome provide excellent protection for the receiver from wax and other moisture. Six different sizes of open domes are available, two of which are extended open domes that sit a little deeper in the ear to help with retention. There is one size of a tulip dome and three power dome sizes available. We can also make custom ear molds for Flip.
Moisture protection is a buzz word in the industry today, and we took great pains in the development of Flip to ensure that it has excellent moisture protection. There is a molecular-level hydrophobic coating that has been applied to each of the individual parts of the product to repel moisture. The internal components are also coated with a silicon conformal coating during the assembly process. Inside and out, the product is set up to provide excellent moisture protection and to stay dry and safe.
Flip was designed based on Sonic's 4S Foundation: Sound that is natural, Speech understanding in noise, Simplicity in all we do, and Style that stands out.
I want to talk about the first two: sound that is natural and speech understanding in noise. Speech is a complex system that is dynamic in nature. There is a lot of variability in the volume of the parts of speech at the phonemic level. It is constantly changing, very quickly. Normal, healthy ears are able to process this complex signal. As hearing loss worsens, we start to lose some of the ability to do this naturally. A hearing device has the job of providing that sort of processing capability in a way that replicates what the ear does so quickly and precisely.
The challenge with technology is that it has to be able to preserve the fine details of speech, the variations in amplitude and the differences in individual phonemes, very quickly. The Speech Variable Processing system looks at the entire wideband sound pressure level (SPL) value coming in to the hearing aid and then operates on that signal. By looking at a wideband signal as opposed to splitting the input up into little bits, it preserves the speed of the processing, which in turn helps preserve the spectral contrast. By preserving the speed of the processing, it helps to keep conversations clear and makes the sound very natural.
Figure 4 shows a spectrogram of the phrase "the batter's box." The x-axis is time and the y-axis is amplitude. If you look at the amplitude, you can see the differences in the energy produced for the vowel /a/ versus the /s/ in "batter's box." The /s/ is a much softer sound.
Figure 4. Spectrogram of the phrase "the batter's box" as a function of time and amplitude.
We are going to take that same phrase, and look at the way different systems interpret the SPL level of those sounds. In the top graph in Figure 5, the gray line is a slow-acting system. A slow-acting system looks at the incoming signal very slowly, breaks it into individual components, encodes those pieces and then puts it all back together again. The gray line does not move very much, even though the amplitude differences in the phrase are quite different, because it is not able to keep up with what is going on in the signal. The blue line in both pictures shows the Speech Variable Processing algorithm and how quickly it is able to track and analyze the level differences in the words.
Figure 5. Hearing aid speech processing strategies, where the dark grey line indicates a slow-acting system and the blue line indicates Speech Variable Processing in the Flip product, which is able to keep up with dynamic variations in speech.
We can see that, in this case, both systems are actually pretty similar with the /a/ in "batter's box." But when we look at the /s/ in "batter's box" on the bottom graph, we can see that the slow-acting system in gray has not adjusted fast enough to recognize the reduced energy in this sound. Why does this matter? If you do not know what the input level is, you do not know how much amplification to apply. If you are overestimating the SPL level of a particular part of speech, then you are not providing enough gain. This is the advantage of Speech Variable Processing; it can preserve the spectral variations and nuances of speech.
Speech Variable Processing is the signal processing that everything else in Flip is based on. This technology helps to preserve this very natural quality of sound and it also provides an excellent foundation for other features such as Speech Priority Noise Reduction.
Speech or Noise?
At Sonic, dealing with noise has always been a high priority. In fact, we have four different systems for noise management: Speech Priority Noise Reduction, Soft Noise Reduction, Impulse Noise Reduction, and Wind Noise Reduction. Each of these four systems is set up to help manage different types of noise, and they work together to ensure that speech clarity is preserved by reducing or eliminating the noise.
The first thing that any noise reduction system has to do is determine what is speech and what is noise. Speech understanding in noise is part of the Sonic 4S Foundation; for us, speech intelligibility is a key goal. We do not want to apply a global reduction in gain and reduce the speech; we just want to reduce the noise. How do we know what is speech and what is noise? We can make some basic assumptions about speech. Speech tends to be modulated. Speech varies from moment to moment in terms of amplitude and spectrum, based upon the emotion and vocal characteristics of the talker. Speech intensity tends to occur between 50 and 85dB HL.
Steady-state noise is not as modulated. The sound of a fan, for example, is consistent. Environmental noise can happen at any input level. We also have what we call soft noise that typically falls below the intensity of speech, and it does not really matter what its modulation is. It is probably not something we want to hear or preserve.
Another way of looking at the relationship between speech and noise is shown in the graphic of Figure 6. Across the bottom, modulation increases from left to right, and on the vertical access is noise, from lower levels of noise at the bottom to higher noise levels at the top. You can see that speech has more of a modulation characteristic, and its noise level is in the middle of the range. Music is similar, although it sometimes has a higher noise level and it can be more modulated. In the white region is either environmental noise or soft noise that will mask out the speech. This is the area where we want to apply noise reduction to eliminate the noise.
Figure 6. Modulation and noise levels of speech and music.
The Speech Priority Noise Reduction algorithm looks for the modulation fingerprint of the incoming signal. Sounds that are highly modulated are likely speech; this signal should only be adjusted by the Speech Variable Processing system. Sounds that do not show a modulation characteristic are probably noise, and we can reduce that and clean it up.
Speech Priority Noise Reduction works very similarly to the way Sonic noise reduction algorithms have always worked with one exception. Because it is based on the Speech Variable Processing System, the speed of that system enhances the noise reduction. The speed enables a more accurate estimation of the SPL level of the noise at any given point in time. This way, we are able to apply the noise reduction algorithm more accurately, and this is a significant improvement.
Based on the signal-to-noise ratio, the algorithm makes the decision whether to attenuate or not. If the signal-to-noise ratio is poor, meaning that there is a lot of noise, then it will attenuate. If the signal-to-noise ratio is good, it does not attenuate. Sonic does not believe in processing sound that does not need to be processed, and in that way natural sound is preserved.
Flip also has Soft Noise Reduction that eliminates very soft noise, regardless of the modulation characteristic. Soft Noise Reduction is a form of speech-weighted expansion. Its purpose is to keep quiet sounds quiet. With these two systems engaged, you can clean up all of the noise which is going to leave speech and music clearer.
Impulse Noise Reduction is a new feature for Sonic. Patients frequently complain that while getting used to amplification, impulsive sounds are disturbing. Examples of impulse sounds include things like silverware clinks on plates or the jangling of keys. Those can be harsh sounds to someone using amplification, especially if they are a new user and hadn't heard these sounds at normal or near normal levels for some time. Impulse Noise Reduction identifies and reduces these types of sounds.
How does it identify an impulsive sound? There are three main characteristics of impulse sounds: they are an unexpected change to the input level of the signal; they come and go quickly, and their intensity is high relative to other sounds happening at the same time.
If you think about clanking a glass with a piece of silverware, it is very short, it starts fast and is over quickly, and it is typically loud. Once these sounds are identified as impulse sounds, they can be attenuated using very fast-acting compression.
In regards to wind noise, even people who are very active and participate in outdoor activities do not want to hear wind noise. Sound quality through amplification is poor in the presence of wind. Our Wind Noise Reduction algorithm detects wind, which is characterized as turbulence at the microphone. It sets the lowest frequencies to an omnidirectional response, and attenuates low frequencies in order to attenuate the wind noise.
We have a variety of directional features in Flip that work along with the noise reduction systems to help in noisy situations. The first directional option is a fixed directional mode, which is used when the soundscape is static, perhaps if someone is sitting still and the noise is not moving. There is also an adaptive directional feature for more dynamic, active environments where the noise might be moving. In this case, the frequency response is split into four different regions, and within those four different regions, the best polar pattern is implemented, depending on the noise characteristics of the environment. Adaptive directionality optimizes the signal-to-noise ratio in each of the frequency regions.
The premium Flip product, Flip 100, also includes a Hybrid Directionality mode. Hybrid Directionality combines adaptive directional technology in the three highest frequency regions with a fixed omnidirectional response in the lowest frequency region. The result is a directional system designed to reduce wind noise, with very effective directionality in environments with moderate noise levels.
Flip's new Adaptive Feedback Canceller reacts quickly, before audible feedback has a chance to occur.
The system classifies the incoming signal, like taking a fingerprint, before it applies any amplification. This allows the system to determine if a signal that has already been classified is coming back into the microphone. If a "fingerprinted signal" returns to the microphone within a short period of time, then the system detects the input as feedback. Once identified as feedback, these components are passed through an inverse phase cancellation system that quickly removes the offending signal before it enters the receiver and becomes audible feedback.
"Wireless" can mean so many things in hearing aids today. It could mean binaural coordination where when one aid is doing something like increasing volume, the other aid follows suit. It could mean enhanced telephone use: using the telephone without having to pick up the phone and adjust the hearing aid. It could mean connectivity to external audio sources like a cell phone or a television. It could also mean something as simple as using a remote control with the product. When we refer to "wireless connectivity," with Flip, we are referring to all four of these benefits.
Binaural coordination allows Flip hearing aids to communicate with each other. If you adjust the volume or change the program on one side, that happens automatically in the other hearing aid. All Flip instruments at all three technology levels include binaural coordination, which makes operation simple for the patient.
We can also use the aids together in our environmental classification system, and this is available on Flip 100 and Flip 80. Both aids will analyze the auditory scene, and they will compare the characteristics between each other and adjust in unison to keep the configuration the same for the Universal environment.
The highest priority is always speech, so if the aids detects two different environments, they will always adapt to provide the best settings for speech. If one Flip in a pair detects wind but the other does not, only the one that detects wind will adapt in that situation. Each aid can deal with those inputs individually.
The auto-telephone feature lets the hearing aid automatically switch to a predefined telephone program when you pick up a phone and you place it near the Flip instrument. When you are done and take the telephone away, Flip returns to the previous listening program. Flip 100 can be configured to automatically reduce the gain or mute the non-telephone side when the opposite ear engages the telephone program. This is a simple hands-free configuration that enables the listener to focus on the telephone call, and makes telephone listening easier.
Connectivity to external sound sources happens through SoundGate (Figure 7). The SoundGate is a small device worn around the neck, that acts as a gateway between the Flip devices and any sound source that uses Bluetooth transmission, including computers, laptops, and cell phones. The SoundGate also has a jack at the top to plug in a hardwired external audio device. Someone may have an older audio source such as a radio or portable CD player that does not use Bluetooth but has an audio out jack; you can plug that audio source directly into the SoundGate for direct audio input. You can also use the SoundGate as a simple remote control for volume changes and program changes.
Figure 7. Sonic wireless SoundGate device.
An optional TV adapter is also available (Figure 8). It can be connected to a television, and the television's audio signal will transmit to the Flip hearing instruments via the SoundGate. The patient will get binaural input from the television right in their ears, which helps with clarity.
Figure 8. Sonic TVAdapter (top) and Phone Adapter (bottom).
There is also an optional phone adapter that functions much like the TV adapter (Figure 8). This gets hooked up to a landline phone, and then it can stream the phone's audio signal directly to the hearing aids via the SoundGate as well.
Last but definitely not least, we have an RC-P remote (Figure 9), which is a very basic remote control with volume, program, and mute functionality.
Figure 9. Sonic RC-P remote control.
The Flip is very easy to work with and program. Again, at Sonic simplicity is important to us. To make fitting easy, we set up pre-configured environments in the EXPRESSfit fitting software that you can select based upon each patient's needs. In each of these environments, features and amplification are combined that are specific to the scenario described by the environment name. The Universal environment has been configured to be very dynamic in the way that it adapts to different listening environments. It is a hands-free program that requires no user-intervention. It continuously scans incoming signals and determines what type of listening situation the patient is in. It then quickly and seamlessly adjusts the features and amplification optimally for each situation.
When fitting a binaural Flip 100 or Flip 80, the aids will adjust using the binaural coordination feature. With Flip 60, each hearing aid in a binaural fitting will analyze the incoming signal and adjust the features independently. Figure 10 provides a list of all environments available for programming the Flip. As you can see, this covers a wide range of different situations that people typically find themselves in.
Figure 10. Environment program options available in the Flip miniRIC.
There are also special programs including SG phone, SG entertainment, and auto-telephone. SG stands for SoundGate. These are special programs that are only accessed when a patient gets an incoming call through the SoundGate or when they are using the TV adapter with SoundGate. That would be a SoundGate entertainment program. Auto-telephone, of course, is triggered by a telephone's magnetic field when the wearer places the telephone next to their ear.
Flip also has data logging. Many different factors are analyzed that the clinician can then use to make better fine-tuning decisions. Exclusive to Flip 100 in Data Learning. Data Learning keeps track of the patient's preferred volume control settings over time. Then, based on how the patient is adjusting the volume control, it will set default amplification to more closely match the patient's preferences. This can occur in each of the four listening programs separately. Data Learning records patient preferences over a 20-hour period. At the end of the 20-hour period, it will apply the user preference settings. The adjustments are small, because we do not want the patients to have a greatly varied experience the next time they power on their devices or change their program. If the average volume control change is less than 1 dB, no change is made. At most, the change will be +/- 2 dB per automatic adjustment. For example, if the patient typically changes the volume +/- 4 dB, the data learning feature will make a 2 dB automatic adjustment so that the patient will only be changing it 2 dB. At most, we only apply up to a +/- 6 dB adjustment overall.
For hearing aids synchronized through binaural coordination, the learning adjustments are not necessarily synchronized between the aids. If the patient is using the volume control on one aid to adjust both aids, those adjustments would be the same, so therefore they would have the effect of being synchronized.
As the hearing care professional, you are notified that there are data learning changes available when you connect the devices to EXPRESSfit during a follow-up fitting session. You can choose whether you want to accept the learning changes or reject them. If you reject them, the aids are re-set and all of the learning is lost. If you accept the learning changes, then the gain change that was last learned is going to become the new normal, so to speak. The new gain setting will be the new starting point for any further fine tuning changes. You can accept or reject the changes on a per-program basis.
Let's take a closer look at the three different performance levels. Flip hardware comes in three performance levels: 100, 80, 60. Every performance level has the benefit of the size 13 battery, with an estimated battery life of up to 238 hours. Wireless connectivity is standard on every product, so every product is ready to use with the SoundGate accessory or the RC-P remote, and all Flip instruments have binaural coordination.
As you would expect, you will find more premium features and more fitting flexibility as you go higher in performance level. Flip 100 is the premium-level product, Flip 80 is an advanced product, and Flip 60 is a mid-level product; there is more flexibility with fitting and adjustment with the Flip 100 as compared to the Flip 60.
For More Information
All of the product information for the Flip can be obtained by calling our customer care department. They would be happy to send you Flip materials or answer any further questions. In the United States, you can call Customer Care at 888-423-7834. If you are working internationally, please contact your international office for more information, marketing materials, or if you would like to schedule training. I want to encourage you to watch the EXPRESSfit 2012 presentation, which is the software platform that is used to program the Flip product. We hope you give Flip a try. It is a fantastic product. Thank you for your time this afternoon.
Flip Your Expectations: Introducing the Sonic Flip miniRICFlip Your Expectations: Introducing the Sonic Flip miniRIC
March 9, 2012
This article is sponsored by Sonic.
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