ASHA Adaptacion y Monitoreo de Sist FM

7/30/2019 ASHA Adaptacion y Monitoreo de Sist FM

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Guidelines Fitting and Monitoring FM Systems 1999 / II - 151

ASHA Ad Hoc Committee on FM Systems

Guidelines for Fitting andGuidelines for Fitting andGuidelines for Fitting andGuidelines for Fitting andGuidelines for Fitting and

Monitoring FM SystemsMonitoring FM SystemsMonitoring FM SystemsMonitoring FM SystemsMonitoring FM Systems

GuidelinesGuidelinesGuidelinesGuidelinesGuidelines

Reference this material as: American Speech-Language-Hearing Association. (2002). Guidelines for fitting andmonitoring FM systems. ASHA Desk Reference.

Index terms: Amplification, assistive technology, audiologicrehabilitation, audiology, auditory training, FM sys-tems, FM transmitter with loop, hearing aid evaluation,hearing loss, personal FM system, sound field testing

Document type: Standards and guidelines

This document is a revision of the Guidelines forFitting and Monitoring FM Systems published by theAmerican Speech-Language-Hearing Association (ASHA)in 1994. The ASHA Ad Hoc Committee on FM Systemsdeveloped the present revision that was approved byASHAs Legislative Council in 1999 (LC 29-99). Members

of the committee are Arthur Boothroyd (chair), Dawna Lewis;Barbara R. Murphy; Richard Nodar (vice president forprofessional practices in audiology, monitoring officer);and Evelyn Williams (ex ofdficio). These guidelines, an of-ficial statement of the American Speech-Language-HearingAssociation, provide guidance on use of specific practiceprocedures but are not official standards of the Association.These guidelines supersede the Guidelines for the Fittingand Monitoring of FM Systems (ASHA, 1994).

PrefacePrefacePrefacePrefacePreface

The principal change is in the recommendation

for relative adjustment of the strengths of the signalsreceived via the local (hearing aid or environmental)microphone and the FM microphone. The earlierguidelines recommended that inputs of 65 dB intothe local microphone (representing speech at conver-sational distances) and 80 dB into the FM microphone(representing speech at a few inches) generate equaloutputs in the listeners ear. There are conditions un-der which this equal output condition is appropri-ate. There are two conditions, however, under whichit is not. The first is when conversational input to thelocal microphone does not generate a high enoughoutput for optimal audibility. This condition often is

in cases of profound hearing loss because of gain con-straints imposed by acoustic feedback. In such cases

advantage should be taken of the opportunity for in-creased output in the FM channel. The second condi-tion applies when the local microphone and FMmicrophone are active at the same time (and the sys-tem has no provision for FM precedence). In this con-dition, the local microphone determines the noise level

in the listeners ear. Equating the two output levels,therefore, equates the two signal-to-noise ratiosthereby eliminating the signal-to-noise advantage thatthe FM microphone was designed to provide. The writ-ers of the 1994 guidelines emphasized the complexityof the topic and acknowledged that there would beconditions under which the equal output recom-mendation would be inappropriate. In reviewing thoseguidelines, the present ad hoc committee felt that pro-found hearing loss and simultaneous use of local andFM microphones are common enough to warrant par-ticular attention. The committee is, therefore, recom-mending steps designed to conserve, in the listeners

ear, the signal level and signal-to-noise benefits of theFM microphone.

IntroductionIntroductionIntroductionIntroductionIntroduction

Frequency modulated (FM) systems/auditorytrainers have been standard equipment for childrenwith hearing loss in educational settings for manyyears. FM systems are sometimes called auditory train-ers. Traditionally the term auditory trainerhas beenused to refer to hard-wired, FM, infrared, or any am-plification system other than a personal hearing aid.Because of the ambiguous nature of the term, only FM

systemswill be used in these guidelines. Their merit liesin the fact that a microphone placed a few inches fromthe mouth of a talker receives speech at a much higherlevel than one placed several feet away. The increasein speech level also means an increase in signal-to-noise ratio. The FM link provides a wireless connec-tion to the listeners amplification system. The resultingimprovements of signal level and signal-to-noise ratioin the listeners ear are recognized as the primary ben-efits of FM use (Ross, 1992).


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ASHA 2002 Desk Reference Volume 2 AudiologyII - 152 / 1999

Although originally developed for children withhearing loss, application has been extended to adultswith hearing loss and to persons with normal hearingwho exhibit disorders of articulation, auditory process-ing, attention, learning, and language (ASHA, 1991c;Bess, Klee, & Culbertson, 1986; Blake, Field, Foster,

Platt, & Wertz, 1991; Cargill & Flexer, 1989; Loose,1984; Pfeffer, 1992; Ross, 1992; Smith, McConnell,Walter, & Miller, 1985). It should be noted, however,that the present guidelines only address applicationsto persons with hearing loss.

The availability and use of FM systems haveincreased as a result of Public Law 101-336, the Ameri-cans with Disabilities Act, and PL 105-17, the Indi-vidual with Disabilities Education Act (IDEA)Amendments of 1997, and Section 504 of theRehabilitation Act of 1973 (PL 93-112). All of these lawsmandate access to technology for persons with hear-ing/communication deficits in order to reduce commu-

nication barriers.

The signal level and signal-to-noise benefits of theFM microphone are, typically, in the range of 15 to 20dB (Hawkins, 1984). The resulting improvementsin the audibility and clarity of speech in the ear of achild with hearing loss can have positiveeffects on language development, speech understand-ing, and academic attainment (Ross & Giolas, 1971;Ross, Giolas, & Carver, 1973). Optimal benefits are tobe expected when an FM system is considered early inthe process of fitting amplification. In fact, the use ofan FM system as primary amplification, rather than as

a supplement, has been suggested (Madell, 1992a,1992b; Maxon & Smaldino, 1991). Reported additionalbenefits of an improved signal-to-noise ratio includeincreased attention span, reduced distractibility, andincreased sound awareness and discrimination (Blakeet al., 1991; Casterline, Flexer, & DePompei, 1989;Flexer, 1989; Stach, Loisell, & Jerger, 1987).

Although FM systems are of potential benefit formany listeners in a variety of settings and applications,the following issues need to be considered:

1. Little regulatory consumer protection has beenmandated because most states do not classify

these devices as hearing aids.2. FM systems are available commercially, and

many are purchased without consultation withan audiologist.

3. The American National Standards Institute hasnot yet issued a standard for performance mea-surements of FM systems.

4. No standards currently exist for the selection,evaluation, and fitting of FM systems forpersons with hearing loss or for use bypersons with normal hearing.

5. Researchers have raised concerns regardingspecific problems related to electroacoustic per-formance factorsfor example, variability,nonlinearity, lack of stability, coupling andmaintenance (Hawkins & Schum, 1985;Thibodeau, 1990; Thibodeau & Saucedo, 1991).

6. Candidacy, effectiveness, cost, lifestyles, needs,and aesthetics are important concerns and mustbe considered on an individual basis.

By addressing these issues, as well as the benefitsand limitations of FM systems, the audiologist facili-tates the successful use of FM amplification. For thebenefit of readers wishing to learn more about thistopic, a bibliography is provided in Appendix A.

ScopeScopeScopeScopeScope

This document provides guidelines for fitting andmonitoring of personal and self-contained FM systems

for children and adults with hearing loss. (See alsoASHA Ad Hoc Committee on Hearing Aid Selectionand Fitting, 1998. Guidelines for hearing aid fittingfor adults. American Journal of Audiology, 7(1), 513.Included are preselection and management consider-ations, as well as recommended procedures for perfor-mance measurement. The appropriate personnelresponsible for selecting, fitting, and monitoring aredefined. The committee acknowledges the complexityand the continuing evolution of FM technology. In thatit is not possible to consider every configuration ofdesign and implementation, these guidelines are in-tentionally limited in scope. In particular, the readeris reminded that the guidelines do not apply to theuse of FM amplification with persons who have nor-mal auditory thresholds but who might benefit fromimproved signal-to-noise ratio because of disordersin such areas as auditory processing or attention.

PersonnelPersonnelPersonnelPersonnelPersonnel

The audiologist is the professional who isuniquely qualified to select, evaluate, fit, anddispense FM systems. Section IIA of the ASHA Codeof Ethics (ASHA, 1992) states that Individuals shallengage in the provision of clinical services only whenthey hold the appropriate Certificate of ClinicalCompetence or when they are in the certification pro-cess and are supervised by an individual who holdsthe appropriate Certificate of Clinical Competence.For purposes of the present document, the ASHA Cer-tificate of Clinical Competence in Audiology is consid-ered to be the appropriate certification. IIB of the Codeof Ethics further states that Individuals shall engagein only those aspects of the profession that are withinthe scope of their competence, considering their level


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of education, training, and experience. Daily moni-toring checks by other personnel (including speech-language pathologists, teachers, etc.) are appropriate,however, after such personnel have received instruc-tion in monitoring techniques from an ASHA-certifiedaudiologist.

Preferred Practice Patterns for the Profession ofAudiology (ASHA, 1997), specifically 14.0(Audiologic Rehabilitation Assessment), 15.0(Audiologic Rehabilitation), 20.0 (Product Dispens-ing), 21.0 (Product Repair/Modification), 19.0(Hearing Aid Fitting), and 22.0 (Assistive ListeningSystem/Device Selection), are consistent with theseguidelines.

Other ASHA policies and reports haveaddressed the appropriateness of the audiologist asthe professional qualified to select, evaluate, and fitamplification devices. They include Amplification as

a Remediation Technique for Children With NormalPeripheral Hearing (ASHA, 1991a), The Use of FMAmplification Instruments for Infants and PreschoolChildren With Hearing loss (ASHA, 1991c), Scope ofPractice in Audiology (ASHA, 1996a), Scope ofPractice in Speech-Language Pathology (ASHA,1996b), Maximizing the Provision of AppropriateTechnology Services and Devices for Students inSchools (ASHA, 1998), Guidelines for GraduateEducation in Amplification (ASHA, 1991b), andGuidelines for Audiology Services in the Schools(ASHA, 1993). Federal regulations Part II, 34 CFR Sub-part A, d300.24(b)(1) (Federal Register1999) and PL 105-

17, Part A, Section 602(22) and Part C,Sections 632(4)(E), and 632(4)(F)(ii) (Public Law105-17, 1997) further define and support theaudiologists role in the evaluation and habilitation ofthe population between birth and age 21.

PreselectionPreselectionPreselectionPreselectionPreselection

Before selecting an FM system for personal use, itis necessary to assess auditory capacity and the cur-rent level of auditory and communicationfunction and to identify other factors related todevice use. Implicit in the preliminary stages is

determining whether to use a personal FM system(in which the output of the FM receiver is coupled topersonal hearing aids) or a self-contained FM system(in which the output of the FM receiver is amplifiedfor direct presentation to the ear). If a personal FMsystem is being considered, the personal hearing aidsmust have appropriate coupling capabilities andflexibility. For instance, the hearing aids should haveprovision for direct audio input, or, if neck loopcoupling is to be used, they should have sensitive

telecoils. In addition, hearing aid switch options (suchas Microphone/Telephone/Both) must be carefullyconsidered so as to provide flexibility of listeningarrangements. If a self-contained FM system is goingto be used, decisions must be made relative to thegain, frequency response, input/output functions,

and saturation sound pressure level requirementsfor the individual listener.

Other factors to be considered in the preselectionprocess include:

the persons ability to wear, adjust, andmanage the device;

support available in the educational setting (e.g.,in-service to teachers, classmates);

acceptance of the device;

appropriate situations and/or settings for use;

time schedule for use;

compatibility with personal hearing aids andother audio sources as well as options forcoupling;

individual device characteristics andaccessories;

external source interference (e.g., pagers,radio stations, computers, etc.);

cost and accessibility; and

legislative mandates.

During the preselection process, assessmentsmay include, but are not limited to, audiologicalevaluation, observation of auditory performance inrepresentative settings, consultation with the user orothers knowledgeable about the users performance,questionnaires and scales, hands-on demonstration,and a trial period.

The issue of potential damage to the auditorymechanism should be considered when fitting anyassistive listening device. This is of special concernwhen considering the fitting of a self-contained FMsystem to a person with near-normal hearing, mildhearing loss, or fluctuating hearing loss.

ManagementManagementManagementManagementManagement

OrientationOrientationOrientationOrientationOrientation

The users (and caregivers) ability to accept anduse an FM system depends on several factors, includ-ing but not limited to (a) a hands-on demonstrationof the FM system and its types and components, and(b) the training of personnel (e.g., speech-languagepathologists, teachers) in its appropriate use andtroubleshooting.


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Hands-on demonstration provides the user andfamily an opportunity to assess the components of theFM system(s) as they relate to specific needs. This pro-cess serves to establish the users/caregivers role in(re)habilitation.

The audiologist is responsible for the training of

individual(s) responsible for the use and maintenanceof the FM system (Johnson, Bensen, & Seaton, 1997).As part of this training, the audiologist should ensurethat the user, caregivers, and support personnel un-derstand the modes of use (i.e., FM only/FM plus Aid/Aid only).

Trial periods and return policies vary by manu-facturer and by state and local laws. Applicablepolicies should be investigated and discussed with theuser and family. Research on the trial use of FM sys-tems in the home with parents and toddlers (Benoit,1989) and with college students (Flexer, Wray, Black,

& Millin, 1987) suggests that acceptance and compli-ance may depend on the users knowledge of how thesystem works in relation to the hearing loss and theperception that the benefits outweigh the inconve-nience. In light of these factors, the audiologist maychoose to make available loaner and/or rental equip-ment.

MonitoringMonitoringMonitoringMonitoringMonitoring

A. Daily ChecksA. Daily ChecksA. Daily ChecksA. Daily ChecksA. Daily Checks

All amplification equipment is subject to failure(Bess, Sinclair, & Riggs, 1984; Hoverstein, 1981;

Maxon & Brackett, 1981). Daily checking is, therefore,required. The daily check can be performed by the par-ent, teacher, speech-language pathologist, or any onewho has received appropriate training by the audiolo-gist.

Generally, a daily check consists of visual inspec-tion of the device and its coupling, followed bylistening to the sound quality. In a sense, the usermonitors sound quality continuously and may welldetect such problems as intermittent function or a con-dition that doesnt sound normal. Indeed, one of thegoals of management should be to encourage self-monitoring. However, an individual with normal hear-ing should also perform a listening check. This ensuresdetection of problems that the user cannot identify. Ifpossible, the listening check should be performed inthe room(s) where the FM system will be used so thatany interference will be detected.

The user or other appropriate individuals shouldhave accessory supplies available to remedy routineproblems as they occur. These supplies typically

include such items as spare microphones, receivers,boots, batteries, cords, and neck loops. If a malfunctionpersists or otherwise cannot be identified and rem-edied through the daily check procedure, the audiolo-gist should be notified.

B. Comprehensive MonitoringB. Comprehensive MonitoringB. Comprehensive MonitoringB. Comprehensive MonitoringB. Comprehensive Monitoring

Periodic comprehensive monitoring of the FMsystem by the audiologist may include electroacousticanalysis, probe microphone measurements, and otherin-depth troubleshooting measures. These comprehen-sive procedures should also be performed wheneveran unresolved problem is identified during the dailycheck. In any event, they should be performed rou-tinely at least once a year for adults and children 5years of age or older. They should be performed morefrequently for children under 5 years of ageperhapsas often as every 3 to 6 months. At the time of writing,

there is no standard electroacoustic measurement pro-cedure for FM systems. However, many manufactur-ers make these measurements and provide the resultswith their devices. Therefore, until a measurement stan-dard procedure is available, devices should be evalu-ated at least according to the measurement proceduresused by the manufacturer, which are typically thoseof ANSI S3.22 (1987) Specifications of Hearing AidCharacteristics. Measurements such as full-on gain,SSPL90, and harmonic distortion should be obtainedand should be compared to the manufacturersvalues. Both the FM and environmental microphone(s)should be evaluated separately, with care taken to

properly position the FM microphone transmitter inrelation to the test signal source.

C. Audiologic ReevaluationC. Audiologic ReevaluationC. Audiologic ReevaluationC. Audiologic ReevaluationC. Audiologic Reevaluation

Periodic evaluations of hearing, and of perfor-mance with the FM device, are necessary to monitorstability of hearing, appropriate device settings,function, and degree of benefit. These evaluationsshould be performed at least annually for adults andchildren 5 years of age or older. They should beperformed more frequently for children under 5 yearsof age and for individuals with fluctuating or conduc-tive hearing loss.

These assessments may include, but are notlimited to, audiologic evaluations, real ear performancemeasurements, assessments of speech recognition,consultations, observations of performance in normal-use settings, questionnaires, and subjective scales ofperformance benefit.


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Fitting and AdjustmentFitting and AdjustmentFitting and AdjustmentFitting and AdjustmentFitting and Adjustment

General Principles in Assessment of FMGeneral Principles in Assessment of FMGeneral Principles in Assessment of FMGeneral Principles in Assessment of FMGeneral Principles in Assessment of FM

SystemsSystemsSystemsSystemsSystems

Although FM systems are amplification devices

similar to hearing aids, there are some distinctdifferences that need to be taken into account indeveloping measurement strategies. First, andperhaps most important, the input level of speech tothe FM microphone is more intense than to thehearing aid microphone. With the FM microphone ap-propriately located 68 inches from the talkers mouth,the overall level of speech is approximately8085 dB SPL (Cornelisse, Gagne, & Seewald, 1991;Hawkins, 1984; Lewis, 1991; Lewis, Feigin, Karasek,& Stelmachowicz, 1991). This is 1520 dB moreintense than the typically assumed 6070 dB SPLinput to the microphone of the personal hearing aid

12 meters from the talker. If output measurements arebeing made to adjust FM systems, then typical inputlevels should be used. This is particularlyimportant given that most FM microphone transmit-ters employ some type of input compression. The gainand output of the FM system may be quitedifferent if lower-level signals, which are not represen-tative of the speech input to the FM microphone, areused in the measurement procedure. It is for this rea-son that the recommended input level in these fittingguidelines is 15 dB higher for the FM microphone thanfor the local microphone.

A second issue relates to the increased complex-ity of the FM systems compared with hearing aids.Many FM systems have several microphone-inputpossibilities. These include lapel, lavaliere, boom, andconference microphones for the transmitter and ear-level or body-worn microphones at the receiver. Theremay be one or two environmental microphones, andthey and the FM microphone may be omnidirectionalor directional. It is important that each input channelin the FM system be evaluated and that the micro-phones be positioned in the proper manner. Input lev-els may also need to be altered for different microphonetypes and locations.

In a similar vein, the FM system may have morethan one volume control wheel (VCW). Some unitshave one VCW for the FM signal and one for the envi-ronmental microphone(s). On personal FMsystems, there will be one VCW for the FM system andone for the personal hearing aid. In addition, there maybe a VCW on the FM microphone transmitter. It is im-portant that careful thought be given to the setting ofthese VCWs, as certain combinations can produceundesired results (Hawkins & Schum, 1985; Hawkins& Van Tasell, 1982; Lewis, 1991, 1992).

Finally, modifications must be made in some test-ing procedures to account for the way certain systemsare physically arranged on the user. Forinstance, if a personal FM system with a neck loop isto be evaluated in a 2-cc coupler,then the hearing aidand neck loop must be in the same relative positions

and orientations as they would have on the listener.For self-contained FM systems that use earbuds orWalkman-type headsets, probe microphonemeasures may be preferred because those receiverscannot be coupled adequately to the 2-cc coupler. Thebest way to satisfy this criterion is to place the neckloop and hearing aid on a personpreferably the ac-tual user.

Typical electroacoustic evaluation includesmeasurement of output when using an input of 90 dBSPL. The result (SSPL90) is intended to provide a mea-sure of the maximum output of the system. The audi-ologist should note, however, that compression in the

FM microphone/transmitter will most likely preventthe hearing aid (or FM receiver/amplifier) from reach-ing its maximum output for FM input alone. A lowSSPL90 when testing with FM microphone input aloneshould not, therefore, be interpreted as a low SSPL90for the system as a whole. The true estimate of SSPL90for the system is that obtained with 90 dB SPL input tothe local (hearing aid or environmental) microphone.

General Goals for Fitting FM SystemsGeneral Goals for Fitting FM SystemsGeneral Goals for Fitting FM SystemsGeneral Goals for Fitting FM SystemsGeneral Goals for Fitting FM Systems

There are two aspects of fitting to be considered.First is the amplification of sounds received via the

local (environmental) microphone (which is some-times the microphone of the personal hearing aid).Second is the amplification of sounds received via theremote (FM) microphone.

Following are the general goals for amplificationvia the local microphone:

1. Gain and frequency response should be suchthat speech of average effort, produced at a dis-tance of between 3 and 6 feet from thelocal microphone, is brought to an optimal levelof audibility, over as wide a frequency range aspossible, consistent with comfort.

2. Saturation sound pressure levelshould be highenough to provide an adequate dynamic rangeabove the threshold of audibility but lowenough to avoid discomfort or damage fromunusually loud sounds.

3. Input/output characteristics should be suchthat a reduction of talker distance to a fewinches (as in self-generated speech) can beaccommodated without causing discomfort,or reducing intelligibility.


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4. If possible, input/output characteristicsshouldbe such that an increase of talkerdistance beyond 6 feet can be accommodatedwithout reducing intelligibility.

5. Acoustic feedback should be low enough topermit the gains called for in 2 and 4 without

causing instability (whistling).An additional goal relates to amplification via the

remote (FM) microphone:

6. Gainand input/output characteristics shouldbe such as to preserve, in the users ear, all ormost of the signal-to-noise benefits for speechproduced at a few inches from the remotemicrophone.

For purposes of these guidelines, it will beassumed that goals 1 through 5, relating to amplifica-tion via the users personal hearing aid havealready been met to the audiologists satisfaction. It

will also be assumed that, for a self-contained FM sys-tem, the characteristics for amplification via the local(environmental) microphone have been matched asclosely as possible to those of the users personal hear-

ing aid. It is important to use the same type of signal(such as pure tones or speech-weighted noise) whenmaking measurements on the hearing aid and FM sys-tem for comparison purposes. The remaining issuefaced by the audiologist, therefore, is adjustment ofgain in the FM channel so as to maintain an appropri-

ate FM advantage. These guidelines deal with this lastissue.

Operational Goal for Adjustment of Gain inOperational Goal for Adjustment of Gain inOperational Goal for Adjustment of Gain inOperational Goal for Adjustment of Gain inOperational Goal for Adjustment of Gain in

the FM Channelthe FM Channelthe FM Channelthe FM Channelthe FM Channel

The basic recommendation of these guidelines isthat a pure tone input of 80 dB SPL into the remote mi-crophone shall give an output that is 10 dB higher thanthat produced by an input of 65 dB SPL into the local(environmental or hearing aid) microphone as illus-trated in Figure 1. Note that the figure of 10 dB is of-fered only as a general guide. As will be

explained below, there are specific situations when alower or higher value may be appropriate. (See alsoAppendix B.)

Figure 1. The basic goal is that the FM system should increase the levelof the perceived speech, in the listeners ear, by approximately 10 dB.

Input

80 dB SPL

Output

105 dB SPL

FM

Input

65 dB SPL

Output

95 dB SPL

Difference= 10 dB


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Suggested Procedure for Adjusting Gain inSuggested Procedure for Adjusting Gain inSuggested Procedure for Adjusting Gain inSuggested Procedure for Adjusting Gain inSuggested Procedure for Adjusting Gain inthe FM Channel for a Personal FM Systemthe FM Channel for a Personal FM Systemthe FM Channel for a Personal FM Systemthe FM Channel for a Personal FM Systemthe FM Channel for a Personal FM SystemUsed as an Accessory to an ExistingUsed as an Accessory to an ExistingUsed as an Accessory to an ExistingUsed as an Accessory to an ExistingUsed as an Accessory to an Existing

Hearing AidHearing AidHearing AidHearing AidHearing Aid

1. Ensure that the Volume control, Tone control,Saturation Sound Pressure Level, and any com-pression characteristics of the hearing aid areadjusted as normally used and that the aid isfunctioning properly.

2. Measure output into a 2-cc coupler for aninput to the hearing aid microphone of 65 dBSPL at a frequency of 1000 Hzas illustratedin Figure 2(a).

3. Couple the FM receiver to the hearing aid in theappropriate manner that is to be used by thewearer. If using a standard neck loop, makesure the shape and orientation of the loop, andthe distance and orientation of the aid in rela-tion to the loop, are the same as in actual use.

4. Adjust the FM volume control of the FMreceiver so that a 65-dB SPL, 1000-Hz input tothe remote microphone generates the same out-put from the hearing aid as that measured withthe local microphone; see Figure 2 (b).

5. Increase the input to 80 dB SPL. You shouldfind that the output from the hearing aidincreases by at least 10 dB; see Figure 2(c). If so,then the adjustment can stand.

Figure 2. A suggested procedure for adjusting FM gain so as to preserve a10 dB FM advantage. a) Using a 1000 Hz tone, measure output for 65 dBSPL inputto the local microphone. b) Provide 65 dB SPL input to the remote microphone

and adjust FM gain to give the same output (the two channels now have equalgain). c) Increase input to 80 dB SPL. If the output increases by 10 dB, theprocess is complete. If it does not, increase FM gain to give an FM advantage of

between 5 and 7 dB (see text).

FM

x+10dB

FM

65 dB SPL

65 dB SPL

80 dB SPL

a)

b)

c)

x dB

x dB


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6. If the increase was 15 dB, you may reduce theFM volume control of the FM receiver so that theoutput into the 2-cc coupler falls by 5 dB.

7. If the increase was only 5 dB, increase the FMvolume control of the FM receiver to provide anadditional 2 or 3 dB of output (giving a 7 or 8

dB FM advantage rather than a 10 dBadvantage).

8. If there was no increase of output when the in-put changed from 65 to 80 dB SPL, you may as-sume that the FM transmitter has a very lowcompression threshold. In this case, increasethe FM volume control of the FM receiver to pro-vide a 5 dB increase of output (giving a5 dB FM advantage).

When dealing with a self-contained FM system, inwhich the FM receiver and amplifier are in a singleunit, first adjust the characteristics of amplification via

the local (environmental) microphone to match thoseof the users personal hearing aid (which we assumeto have been fitted properly). Then follow the proce-dure just outlined.

Depending on the nature of the audiologists testequipment, it may be easier to carry out the above pro-cedure with a swept tone or speech-weighted noiseinput so as to produce a complete curve showing out-put as a function of frequency. In this case, the focusshould be on output in the 500 to 2000 Hz range ratherthan just at 1000 Hz.

Even if a single frequency is used for initial

adjustment, full response curves should be run toconfirm that the desired FM advantage is maintainedover the 500 to 2000 Hz range and further adjust-ments made if necessary. In addition, it is advisableto assess performance with a speech-weightedstimulus as input.

Some acoustic analysis systems offer 85 dB SPL asa signal representing input to the FM microphone. Evenif this higher signal is used, the recommended proce-dure should still be followed. That is, first equate out-puts for a 65-dB input so as to provide equal gain. Then,if necessary, increase gain in the FM channel so thatthe output increases by around 10 dB when the inputincreases from 65 to 85 dB SPL.

A 1000-Hz pure tone at 80 dB SPL was chosen forthe present guidelines as representative of the fre-quency and amplitude peak for vowels, in speech pro-duced at a distance of a few inches from the FMmicrophone. A primary concern of these guidelines isthe negative effect of compression in the FM transmit-ter on the speech level and signal-to-noise ratio in the

users ear. Compression is most likely to be activatedby the vowels.

Some FM systems automatically reduce gain viathe local microphone whenever the FM and localmicrophones are active at the same time. This featurehelps to maintain the signal-to-noise ratio benefits for

speech received via the FM microphone. Unfortu-nately, it also reduces audibility of other talkers whoare not wearing the FM microphone. If simultaneoususe of the FM and local microphones is the rule ratherthan the exception for a given individual, then theadjustment of gain via the local microphone should bemade with the FM channel turned on, but receiving noinput. Similarly, the local microphone must be turnedon, but receiving no input, when adjusting the FMvolume control.

ExceptionsExceptionsExceptionsExceptionsExceptions

1. If the proposed pattern of use does not involvesimultaneous activation of the local andremote microphones (i.e., if the local micro-phone is normally turned off when the remotemicrophone is in use) and if the usershearing loss is no greater than 80 dB, it isappropriate to turn down the FM volumecontrol so that 80 dB SPL input to the remotemicrophone gives the same output as 65 dBinput to the local microphone (as recommendedin the 1994 ASHA guidelines). The reasoningis: First, the users hearing is good enough thatadequate audibility of speech can be main-

tained via the remote microphone in spite of thereduced FM gain. Second, because the localmicrophone is turned off, the signal-to-noisebenefit for speech into the FM microphone is notcompromised by noise picked up at the localmicrophone.

2. An FM advantage of 0 dB is also appropriate ifthe FM system incorporates an automatic FMprecedence feature to reduce the sensitivity ofthe local microphone whenever close speechinput is detected in the FM channel.

3. At the other extreme, users with profound

hearing loss may need an FM advantage inthe region of 15 dB. The reasoning is: Whenthe hearing loss exceeds 90 dB itbecomes difficult to provide optimal audibilityfor speech received via the localmicrophone. Basically, the problem ofacoustic feedback prevents the audiologist fromproviding enough gain. Under thesecircumstances, a primary benefit of FM ampli-


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fication is that the increased input to the FM mi-crophone can provide greater audibility ofspeech at a distance. This will only happen,however, if the gain in the FM channel ismaintained at a high enough level (Boothroyd& Iglehart, 1998).

Electroacoustic ConfirmationElectroacoustic ConfirmationElectroacoustic ConfirmationElectroacoustic ConfirmationElectroacoustic Confirmation

At the time of fitting and during routinefollow-up, the audiologist should confirm that the elec-troacoustic fitting goals have been attained or main-tained.

Recommendations for 2-cc CouplerRecommendations for 2-cc CouplerRecommendations for 2-cc CouplerRecommendations for 2-cc CouplerRecommendations for 2-cc Coupler

AssessmentAssessmentAssessmentAssessmentAssessment

1. Attach the hearing aid, or the receiver/ampli-fier of a self-contained FM system, to the 2-cccoupler and place in the test box with themicrophone in the calibrated position.

2. Using swept tones or a complex noise,measure output as a function of frequencyfollowing standard procedures. The resultsshould include:

a. an estimate of maximum output as afunction of frequency

b. an estimate of full-on gain as a function offrequency

c. an estimate of actual gain as a function offrequency at user settings for conversationalinput (65 dB SPL)

d. if the aid incorporates full dynamic rangecompression, estimates of user gain asfunctions of frequency for low (50 dB SPL),

typical (65 dB SPL), and high (80 dB SPL) in-put levels

e. estimates of distortion as a function offrequency under normal conditions of use

3. Remove the hearing aid, still attached to thecoupler, from the test box.

a. If this is a personal FM system, couple theFM receiver to the personal hearing aid.Note that if Direct Audio Input is being used,the sensitivity of the hearing aidmicrophone may change. The systemshould, therefore, be retested with input to

the hearing aid microphone before assess-ing FM input.

b. If neck loop coupling is being used, makesure that the configuration of the loop, andthe position and orientation of the aid inrelation to the loop, represent real conditionsof use. The ideal way to meet thisrequirement is to place them on the actualuser (see Figure 3). An alternative is to use

FM

receiver

FM

transmitter

Testbox

Hearing Aid Analyzer

Neck loop

HearingAid

2-cccoupler

Figure 3. Suggested arrangement for electroacoustic assessment of a personal FMsystem that uses neck loop coupling.


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another person or a manikin. With all threeoptions, it may be necessary to support theweight of the coupler as it hangs in front ofthe ear.

4. Place the FM microphone in the test box in thecalibrated position.

a. If possible, turn off the local (environmen-tal or hearing aid) microphone. If it is notpossible, the measurements must be done ina quiet environment such as the audiomet-ric test booth. Note that when testing a self-contained FM system in which theenvironmental microphone can be turned offthe receiver/amplifier can remain in the testbox.

5. Set all volume controls to their normal use po-sitions.

6. Repeat the output measurements to obtain:

a. an estimate of gain, as a function of fre-quency, for a high input level (80 dB SPL).

b. an input-versus-output curve to obtain anestimate of compression threshold in the FMtransmitter.

Real-Ear AssessmentReal-Ear AssessmentReal-Ear AssessmentReal-Ear AssessmentReal-Ear Assessment

If electroacoustic confirmation is to be carriedout using output measurements in the ear canalof the user, rather than in a 2-cc coupler, the audiolo-gist should follow standard procedures for testingvia the local or hearing aid microphone. When testingvia the FM microphone, this should be placed as closeas possible to the location of the referencemicrophone. (See Hawkins, 1992, 1993; Seewaldet al., 1991; Sullivan, 1987.)

Limitations of Aided Sound Field ThresholdLimitations of Aided Sound Field ThresholdLimitations of Aided Sound Field ThresholdLimitations of Aided Sound Field ThresholdLimitations of Aided Sound Field Threshold

as a Means to Estimate Gainas a Means to Estimate Gainas a Means to Estimate Gainas a Means to Estimate Gainas a Means to Estimate Gain

Although behavioral measurements of real-earperformance such as functional gain have beenrecommended by some investigators (Madell, 1992b;Turner & Holte, 1985; Van Tasell, Mallinger, & Crump,1986), several distinct limitations of this approachhave been described recently (Lewis et al., 1991;Seewald & Moodie, 1992). The major problem with thefunctional gain approach is that the input levels to theFM microphone at the aided threshold will typicallybe quite low during the measurement procedure. Theselower input levels would not be representative of thetalkers voice entering the FM microphone during ac-tual use of the FM system. These input level differences,combined with the fact that most FM microphone-transmitters incorporate input compression, make the

aided sound field threshold values difficult to inter-pret. The sound-field threshold values do represent thelowest intensity signal that the user can detect with theFM system. Unfortunately, they lead to an overestimateof both the amount of gain for the FM signal undernormal use conditions and the sensation level at which

speech is presented to the user (Lewis et al., 1991;Seewald, Hudson, Gagne, & Zelisko, 1992; Seewald& Moodie, 1992).

Behavioral ValidationBehavioral ValidationBehavioral ValidationBehavioral ValidationBehavioral Validation

At the time of fitting and during routinefollow-up it is imperative that the fitting be validatedbehaviorally.

Comfort and QualityComfort and QualityComfort and QualityComfort and QualityComfort and Quality

At the time of fitting and during routine follow-up,the audiologist should confirm that speech at both afew feet and a few inches from the localmicrophone, and speech at a few inches from the FMmicrophone, are within a comfortable range and ofacceptable quality. Any evidence of discomfort mustbe addressed immediately by adjustment of the SSPLand/or compression characteristics of the hearing aidor hearing aid/FM receiver. Older children and adultsmay be expected to provide verbal reports. For veryyoung children, the audiologist may be limited to con-firming the absence of aversive reactions to loudspeech at a few inches from the microphones.

Speech PerceptionSpeech PerceptionSpeech PerceptionSpeech PerceptionSpeech PerceptionAt the time of fitting and during routine

follow-up, the audiologist should measure speech per-ception under a set of representative conditions. Theseconditions should represent typical speech producedat a few inches and a few feet from the microphone andat a few inches from the FM microphone. They shouldbe made in quiet and in noise. And, ideally, theyshould be made by Aid alone, Aid plus FM, and FMalone. If time constraints preclude such comprehen-sive testing, priority should be given to testing in noiseunder the Aid plus FM conditionthis being the true

validation of the FM adjustment.Some writers have recommended placing the FM

microphone within a few inches of a loudspeaker inorder to simulate placement on an actual talker. Itshould be noted, however, that the pattern of radiationfrom a loudspeaker and a human talker are very dif-ferentespecially when the loudspeaker assemblycontains different elements for different parts of theacoustic spectrum. As a result, both the speech spec-trum and the input level may deviate considerably fromwhat is intended. This procedure is not, therefore, rec-


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ommended. An alternative is to test with monitored livevoice with the tester wearing the FM microphone in itsappropriate position.

For the hearing aid condition, it is recommendedthat speech perception be assessed with a speechsignal of 55 dB HL and a background noise of 50 dB

HL. The resulting signal-to-noise ratio of 5 dB istypical of many elementary school classrooms(Crandell & Smaldino, 1995; Finitzo-Hieber, 1988;Markides, 1986). Assuming the sound field has beencalibrated for a 45-degree azimuth, the intensity of thespeech would be 68 dB SPL, a level that should be typi-cal of the input to the hearing aid microphone. Insteadof using the plus and minus 45-degreeazimuth loudspeaker arrangement, the audiologistmay prefer that speech originate from 0 degrees andnoise from 180 degrees. This would eliminate the pos-sibility of a head shadow effect for either the speech ornoise in the case of monaural fitting. If the 0/180 ar-

rangement is used and the sound field is calibratedwith the appropriate 17 dB reference, then the speechsignal can be presented at 50 dB HL (67 dB SPL) andthe noise at 45 dB HL (62 dB SPL). A measure of speechperception should then be obtained with an age- andlanguage-appropriate test. When testing via the FMmicrophone, the noise should remain at 50 dB HL, butthe speech signal will increase from 55 dB HL to

around 70 dB HL (83 dB SPL) (Hawkins, 1984). Theeffective signal-to-noise ratio at the FM microphonewill now be +20 dB. Under the Aid plus FM condition,however, the signal-to-noise ratio in the users ear islikely to be less than 20 dB. If the goals of fitting havebeen attained, it will be in the region of 15 dB.

Recommendations for Monitored-Live-VoiceRecommendations for Monitored-Live-VoiceRecommendations for Monitored-Live-VoiceRecommendations for Monitored-Live-VoiceRecommendations for Monitored-Live-VoiceAssessment of Speech Perception With anAssessment of Speech Perception With anAssessment of Speech Perception With anAssessment of Speech Perception With anAssessment of Speech Perception With an

FM SystemFM SystemFM SystemFM SystemFM System

1. Select an appropriate speech recognition testgiving consideration to the users developmen-tal age, language skills, and primarylanguage.

2. Make sure that all controls on the FM systemare set for customary use and that the system isworking.

3. Place the FM microphone on yourself in the

position normally worn but turned off.

4. Place the hearing aid(s) and personal FMreceiver (or self-contained FM receiver/amplifier) on the client.

5. Place the user in the calibrated sound field andyourself at the audiometer controlsas shownin Figure 4. Note that the loudspeakers are lo-cated at plus and minus 45 degree azimuths.

Speech = 55 dB HL@ calibration point

Noise = 50 dB HL

@ calibration point

Speech = 70 dB HL@ FM microphone

HearingAids

NeckLoop

FMreceiver

FM microphone/transmitter

Figure 4. Suggested test arrangement for speech perceptionassessment with an FM system using monitored live voice


12/21


6. Measure speech perception in quiet and noisevia the local microphone(s):

a. Set the speech level to 55 dB HL (68 dB SPL)and obtain a speech perception scorethrough the loud speaker (FM microphoneoff).

b. Turn on speech-shaped noise at 50 dB HL(63 dB SPL), producing a S/N ratio of +5 dB.Obtain a second speech perception score.

7. Measure speech perception in quiet and noisevia the FM microphone(s):

a. Without making any other changes, turn ONthe FM microphone and obtain a thirdspeech perception score via Aid plus FM innoise.

b. Turn OFF the noise and obtain a final speechperception score via Aid plus FM in quiet.

8. Evaluate the results:

a. The score obtained in quiet by Aid aloneshould be commensurate with other speechperception scores for this client obtained ei-ther aided or under headphones.

b. The score obtained in noise by Aid aloneshould be poorer than that obtained in quiet.

c. When the FM microphone is turned on, thescore in noise should return to a value thatis not significantly lower (and may behigher) than that obtained in quiet by aidalone. If the score remains below thatobtained by Aid alone in quiet, the gain inthe FM channel is probably too low.

d. Turning off the noise in the Aid plus FMcondition should not produce a significantchange of score. If there is a significantincrease of score, the gain in the FMchannel is probably too low.

9. At all points in the test process, confirm withthe client that the speech levels are within anacceptable range of loudness and perceivedqualitymaking due allowance for thenegative effects of the noise.

SummarySummarySummarySummarySummary

1. FM amplification systems have much to offerthe person with hearing loss in terms ofimproved signal level and improved signal-to-noise ratio for speech produced at a consider-able distance.

2. Such systems should be selected, fitted, and ad-justed by ASHA-certified audiologists.

3. The decision to use FM amplification must bebased on both audiological and non-audiological factors.

4. Before fitting, the user and other affectedpersons should receive orientation andcounseling.

5. After fitting, performance must be monitoredon a regular basis.

6. The fitting goals for amplification via thelocal microphone do not differ from those forpersonal amplification.

7. The additional goal for amplification via theFM microphone is that the signal level and sig-nal-to-noise ratio advantage be preserved in theear of the listener.

8. At the time of fitting, and during subsequentmonitoring, the audiologist should confirmthat the electroacoustic goals of fitting have

been attained or maintained.9. At the time of fitting, and during subsequent

monitoring, the audiologist should confirm theappropriateness of the fitting throughbehavioral validation.

10. Functional gain measurement is not recom-mended as an appropriate technique for evalu-ating FM amplification systems.

11. This document includes specific recommen-dations for

a. adjustment of gain for signals received viathe FM microphone

b. electroacoustic assessment of an FMsystem using a 2-cc coupler

c. speech perception assessment as part of thebehavioral validation of an FM fitting

LimitationsLimitationsLimitationsLimitationsLimitations

These guidelines were developed to providedirection to audiologists in the selection and fittingof FM systems. The committee recognizes thecomplexity of the technology (including microphoneand coupling strategies and the use of FM with

digital and advanced signal-processing hearing aids)and the many unresolved issues of measurement(including input stimulus type and level). Theseguidelines should be viewed as a reflection of the cur-rent understanding of these issues. Future technologyand research will mandate consideration of other ap-proaches and tools.


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ReferencesReferencesReferencesReferencesReferences

American National Standards Institute. (1987). Specificationsof hearing aid characteristics(ANSI 3.22). New York: ANSI.

American Speech-Language-Hearing Association. (1984).Definition of and competencies for aural rehabilitation.Rockville, MD: ASHA.

American Speech-Language-Hearing Association. (1991a,January). Amplification as a remediation technique forchildren with normal peripheral hearing. Asha, 33(Suppl. 3), 2224.

American Speech-Language-Hearing Association. (1991b,March). Guidelines for graduate education in amplifica-tion. Asha, 33(Suppl. 5), 3536.

American Speech-Language-Hearing Association. (1991c,March). The use of FM amplification instruments forinfants and preschool children with hearing loss. Asha,33(Suppl. 5), 12.

American Speech-Language-Hearing Association. (1991d,December). Issues in ethics. Asha,33, 51.

American Speech-Language-Hearing Association. (1992,March). Code of ethics. Asha, 34(Suppl. 9), 12.

American Speech-Language-Hearing Association. (1993,March). Guidelines for audiology services in the schools.Asha, 35(Suppl. 10), 2432.

American Speech-Language-Hearing Association. (1994,March). Guidelines for fitting and monitoring FMsystems. Asha, 36(Suppl. 12), 19.

American Speech-Language-Hearing Association. (1996a,Spring). Scope of practice in audiology. Asha, 38(Suppl.16), 1215.

American Speech-Language-Hearing Association. (1996b,Spring). Scope of practice in speech-language pathology.Asha, 38(Suppl. 16), 1620.

American Speech-Language-Hearing Association. (1997,March). Preferred practice patterns for the profession of audiology. Rockville, MD: Author.

American Speech-Language-Hearing Association. (1998).Maximizing the provision of appropriate technology servicesand devices for students in schools. Rockville, MD:Author.

Benoit, R. (1989). Home use of the FM amplificationsystems during the early childhood years. HearingInstruments, 40, 812.

Bess, F., Klee, T., & Culbertson, J. (1986). Identification,assessment and management of children withunilateral sensorineural hearing loss. Ear and Hearing,

7, 4351.Bess, F., Sinclair, J., & Riggs, D. (1984). Group amplification

in schools for the hearing impaired. Ear andHearing, 5, 138143.

Blake, R., Field, B., Foster, C., Platt, F., & Wertz, P. (1991).Effect of FM auditory trainers on attending behaviorsof learning-disabled children. Language, Speech, and Hear-ing Services in the Schools, 22, 111114.

Boothroyd, A., & Iglehart, F. (1988). Experiments with class-room FM amplification. Ear and Hearing, 19, 202217.

Cargill, S., & Flexer, C. (1989). Issues in fitting FM units tochildren with unilateral hearing losses: Two case stud-ies [monograph]. Journal of the EducationalAudiology Association, 1 (1), 3047.

Casterline, C., Flexer, C., & DePompei, R. (1989). Use ofassistive listening devices with head injured survivors. Pa-per presented at the meeting of the American Speech-

Language-Hearing Association, St. Louis, MO.Cornelisse, L. E., Gagne, J. P., & Seewald, R. C. (1991). Long-

term average speech spectrum at the chest level micro-phone location. Canadian Journal of Speech-Language Pathology and Audiology, 15(3), 712.

Crandell, C., & Smaldino, J. (1995). The importance of roomacoustics. In R. Tyler and D. Schum (Eds.), Assistive de-vices for persons with hearing loss. Boston: Allyn & Bacon.

Department of Education. (1999, March 12). Part II 34 CFRParts 300 and 303 Assistance to states for the educationof children with disabilities and the early interventionprogram for infants and toddlers with disabilities; Finalregulations. Federal Register, 64(48), 122423 122424.

Finitzo-Hieber, T. (1988). Classroom acoustics. InR. Roeser (Ed.), Auditory disorders in school children(2nded., pp. 221233). New York: Thieme-Stratton.

Flexer, C. (1989). Turn on sound: An odyssey of sound fieldamplification. Educational Audiology Association Newslet-ter, 5, 6.

Flexer, C., Wray, D., Black, T., & Millin, J. (1987). Amplifica-tion devices: Evaluating classroom effectiveness formoderately hearing-impaired college students. Volta Re-view, 89, 347357.

Hawkins, D. (1984). Comparisons of speech recognition innoise by mildly to moderately hearing-impaired chil-dren using hearing aids and FM systems.Journal of Speechand Hearing Disorders, 49, 409418.

Hawkins, D. (1987). Assessment of FM systems with probetube microphone system. Ear and Hearing, 8, 301303.

Hawkins, D. (1992). Selecting SSPL90 using probe-microphone measurements. In H. Mueller, D. Hawkins,& J. Northern (Eds.), Probe microphone measurements:Hearing aid selection and assessment(pp. 145158). SanDiego, CA: Singular Publishing.

Hawkins, D., & Schum, D. (1985). Some effects ofFM-system coupling on hearing aid characteristics.Jour-nal of Speech and Hearing Disorders, 50, 132141.

Hawkins, D., & Van Tasell, D. (1982). Electroacousticcharacteristics of personal FM systems.Journal of Speechand Hearing Disorders, 47, 335362.

Hawkins, D. B. (1993). Assessment of hearing aid maximumoutput. American Journal of Audiology, 2, 3637.

Hoverstein, G. H. (1981). A public school audiologyprogram: Amplification maintenance, auditorymanagement, and in-service education. In F. H. Bess, B.A. Freeman, & J. S. Sinclair (Eds.), Amplification in educa-tion(pp. 224247). Washington, DC: A.G. Bell.

Johnson, C. D., Bensen, P. V., & Seaton, J. B. (1997).Educational audiology handbook. San Diego, CA:Singular Publishing Group.


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Lewis, D. (1991). FM systems and assistive devices: Selec-tion and evaluation, In J. A. Feigin & P. G. Stelmachowicz(Eds.), Pediatric amplification: Proceedings of the 1991 Na-tional Conference(pp. 115138). Omaha, NE: Boys TownNational Research Hospital.

Lewis, D. (in press). Assistive devices for classroomlistening: FM systems. American Journal of Audiology.

Lewis, D., Feigin, J., Karasek, A., & Stelmachowicz, P.(1991). Evaluation and assessment of FM systems. Earand Hearing, 12, 268280.

Lewis, D. E. (1992). FM systems. Ear and Hearing, 13,290293

Loose, F. (1984). Learning disabled students use FM wirelesssystems. Rochester, MN: Telex Communications.

Madell, J. R. (1992a). FM systems as a primary amplifica-tion for children with profound hearing loss. Ear andHearing, 13, 102107.

Madell, J. R. (1992b). FM systems for children birth to age5. In M. Ross (Ed.), FM auditory training systems:Characteristics, selection, and use (pp. 157174).

Timonium, MD: York Press.Markides, A. (1986). Speech levels and speech-to-noise ra-

tios. British Journal of Audiology, 20, 115120.

Maxon, A. B., & Brackett, D. (1981). Mainstreaminghearing-impaired children. Audio Journal forContinuing Education, 6, 10.

Maxon, A. B., & Smaldino, J. (1991). Hearing aid manage-ment in children. In C. Flexer (Ed.), Current audiologicissues in educational management of children with hearingloss. New York: Seminars in Hearing.

Pfeffer, E. B. (1992). Alternate uses for FM systems. InM. Ross (Ed.), FM auditory training systems: Characteris-tics, selection, and use (pp. 211224). Timonium, MD:York Press.

Public Law 105-17. (1997). Individuals With DisabilitiesEducation Act Amendments of 1997.

Ross, M. (Ed.). (1992). FM auditory training systems: Charac-teristics, selection and use. Timonium, MD: York Press.

Ross, M., & Giolas, T. (1971). Effect of three classroomlistening conditions on speech intelligibility. AmericanAnnals of the Deaf, 116, 580584.

Ross, M., Giolas, T., & Carver, D. (1973). Effect of three class-room listening conditions on speech intelligibility. Areplication in part. Language, Speech, and Hearing Servicesin Schools, 4, 7276.

Seewald, R., Hudson, S., Gagne, J., & Zelisko, D. (1992).Comparison of two methods for estimating thesensation level of amplified speech. Ear and Hearing, 13,

142149.Seewald, R., & Moodie, K. (1992). Electroacoustic consid-

erations. In M. Ross (Ed.), FM auditory training systems:Characteristics, selection, and use(pp. 75102). Timonium,MD: York Press.

Seewald, R., Zelisko, D., Ramji, K., & Jamieson, D. (1991).DSL 3.0 users manual. London, Ontario, Canada:University of Western Ontario.

Smith, D., McConnell, J., Walter, T., & Miller, S. (1985). Ef-fect of using an auditory trainer on the attentional, lan-guage, and social behaviors of autistic children.

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systems used by children with central processing disorders.Paper presented at the annual convention of theAmerican Speech-Language-Hearing Association, NewOrleans, LA.

Sullivan, R. (1987). Aided SSPL90 response in the real ear:A safe estimate. Hearing Instruments, 38, 36.

Thibodeau, L. (1990). Electroacoustic performance ofdirect-input hearing aids with FM amplificationsystems. Language, Speech, and Hearing Services inSchools, 21, 4956.

Thibodeau, L., & Saucedo, K. (1991). Consistency ofelectroacoustic characteristics across components of FMsystems.Journal of Speech and Hearing Research, 34, 628635.

Turner, C., & Holte, L. (1985). Evaluation of FM amplifica-tion systems. Hearing Instruments, 36, 612, 56.

Van Tasell, D., Mallinger, C., & Crump, E. (1986).Functional gain and speech recognition with two typesof FM amplification. Language, Speech, and HearingServices in Schools, 17, 2837.


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Appendix A:Appendix A:Appendix A:Appendix A:Appendix A:Readings on FM AmplificationReadings on FM AmplificationReadings on FM AmplificationReadings on FM AmplificationReadings on FM Amplification

The following reading list includes, but is not re-stricted to, some of the publications referred to in theguidelines. It was prepared by Dawna Lewis.

Allen, L. (1993). Promoting the usefulness of classroomamplification. Educational Audiology Monograph, 3,32-33.

American Speech-Language Hearing Association. (1991,January). Amplification as a remediation technique forchildren with normal peripheral hearing. Asha, 33(Suppl. 3), 2224.

American Speech-Language-Hearing Association. (1994,March). Guidelines for fitting and monitoring FMsystems. Asha, 36(Suppl. 12), 19.

Bankoski, S., & Ross, M. (1984). FM systems effect onspeech discrimination in an auditorium. HearingInstruments, 35, 812, 49.

Benoit, R. (1989). Home use of FM amplification systemsduring the early childhood years. Hearing Instruments,40, 812.

Berg, F. (1987). FM equipment. In Facilitating classroom lis-tening: A handbook for teachers of normal and hard of hear-ing students(pp. 155190). Boston: College-Hill Press.

Berg, F. (1986). Classroom acoustics and signal transmis-sion. In J. Blair, S. Viehweg, & A. Wilson-Vlotman (Eds.),Educational audiology for the hard of hearing child(pp. 157180). New York: Grune & Stratton.

Berg, F. (1993). Acoustics and sound systems in schools. SanDiego: Singular Publishing Group, Inc

Berger, K., & Millin, J. (1989). Amplification/assistive de-

vices for the hearing impaired. In R. Schow & M.Nerbonne (Eds.), Introduction to aural rehabilitation(pp.3180). Austin, TX: Pro-Ed.

Bess, F., & Gravel, J. (1981). Recent trends in educationalamplification. Hearing Instruments, 32, 2429.

Bess, F., Klee, T., & Culbertson, J. (1986). Identification,assessment and management of children with unilateralsensorineural hearing loss. Ear and Hearing, 7, 4351.

Bess, F., & Sinclair, J. S. (1985). Amplification systems usedin education. In J. Katz (Ed.), Handbook of clinical audiol-ogy(pp. 970985). Baltimore: Williams & Wilkins.

Bess, F., Sinclair, J. S., & Riggs, D. (1984). Group amplifica-tion in schools for the hearing impaired. Ear and Hear-

ing,5, 138144.Bess, F., & Tharpe, A. M. (1986). An introduction to unilat-eral sensorineural hearing loss in children. Ear and Hear-ing,7, 313.

Blair, J. (1977, December). Effects of amplification, speechreading, and classroom environments on reception ofspeech. Volta Review, 443449.

Blair, J. (1990). Front-row seating is not enough for class-room listening. In C. Flexer, D. Wray, & R. Leavitt, Howthe student with hearing loss can succeed in college: A hand-book for students, families and professionals(pp. 6982).Washington, DC: A.G. Bell Association.

Blair, J., Myrup, C., & Viehweg, S. (1989). Comparison ofthe listening effectiveness of hard-of-hearing childrenusing three types of amplification. Educational Audiology

Monograph, 1, 4855.

Blake, R., Field, B., Foster, C., Plott, F., & Wertz, P. (1991).Effect of FM auditory trainers on attending behaviorsof learning-disabled children. Language, Speech, and Hear-

ing Services in Schools, 22, 111114.Blake, R., Torpey, C.,& Wertz, P. (1987). Preliminary find-

ings: Effect of FM auditory trainers on attending behaviorsof learning disabled children. Rochester, MN: Telex Com-munications.

Bracket, D., & Madell, J. (1983). FM systems for people withimpaired hearing. Hearing Rehabilitation Quarterly, 8(2),1012.

Bricault, M., Stinson, M., & Gauger, J. (1985). Young-adultstudents ratings of the relative performance of hear-ing aids, FM and loop amplification systems.Journal ofthe Academy of Rehabilitative Audiology, 18, 5572.

Boothroyd, A. (1981). Group hearing aids. In F. Bess, B.

Freeman, & J. Sinclair (Eds.), Amplification in education(pp. 123138). Washington, DC: A. G. Bell Association.

Boothroyd, A. (1992). The FM wireless link: An invisiblemicrophone cable. In M. Ross (Ed.), FM auditory train-ing systems: Characteristics, selection, and use(pp. 119).Timonium, MD: York Press, Inc.

Boothroyd, A., & Iglehart, F.(1998). Experiments with class-room FM amplification. Ear and Hearing,19, 202217.

Byrne, D., & Christen, R. (1981). Providing an optimal sig-nal with varied communication systems. In F. Bess, B.Freeman, & J. Sinclair (Eds.), Amplification in education(pp. 286 305). Washington, DC: Alexander Graham BellAssociation for the Deaf.

Callingham, L., Kormandy, M., & Weeks, S. (1983). An FMamplification system for conductive hearing loss (letter).

Medical Journal of Australia, 2, 542.

Cargill, S., & Flexer, C. (1989). Strategies for fitting FM unitsto children with unilateral hearing losses. Hearing Instru-ments, 42, 2627.

Clarke-Klein, S., Rousch, J., Roberts, J., Davis, K., & Med-ley, L. (1995) FM amplification for enhancement of con-versational discourse skills: Case study.Journal of theAmerican Academy of Audiology, 6, 230234.

Compton, C., Lewis, D., Palmer, C., & Thelan, M. (1994).Assistive technology: Too legit to quit. Pittsburgh, PA: Sup-port Syndicate for Audiology.

Cornelisse, L. E. (1989). The effect of microphone record-

ing position on the long-term average spectrum ofspeech [thesis]. London, Ontario, Canada: University ofWestern Ontario.

Davis, D. (1991). Utilizing amplification devices in the regu-lar classroom. Hearing Instruments, 42, 1822.

DeConde Johnson, C. (1994). Navigating amplificationoptions for children. Hearing Instruments,45, 24.

Donaghy, K. (1996) Evaluation and monitoring of FM usein educational settings. ASHA Special Interest Division 9Newsletter, 6, 912.


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Lewis, D. (1997). Selection and assessment of classroomamplification. In W. McCracken & S. Laoide-Kemp(Eds.). Audiology in education (pp. 323347).Manchester, UK: University of Manchester.

Lewis, D. (1998). Classroom amplification. In F. Bess (Ed.),Children with hearing loss: contemporary trends(pp. 277298). Nashville, TN: Bill Wilkerson Center Press.

Lewis, D. (1998). Improving communication access with FMamplification systems. International Federation of Hard ofHearing People Journal, 19 (1), 712.

Lewis, D., Feigin, J., Karasek, A., & Stelmachowicz, P. (1991).Evaluation and assessment of FM systems. Ear and Hear-ing, 12, 268280.

Logan, S., & Bess, F. (1985). Amplification for school-agehearing-impaired children. Seminars in Hearing, 6,309321.

Loose, F. (1984). Learning disabled students use of FMwireless systems. Rochester, MN: Telex Communica-tions.

Lovas, D. (1986, Summer). Preschool sound field

amplification. Directive Teacher, 2223.Lybarger, S. (1981). Standard acoustical measurements on

auditory training devices. In F. Bess, B. Freeman, &J. S. Sinclair (Eds.), Amplification in education (pp.305315). Washington, DC: Alexander Graham BellAssociation for the Deaf.

Madell, J. (1990). Managing classroom amplification. In M.Ross (Ed.), Hearing-impaired children in themainstream(pp. 95118). Parkton, MD: York Press.

Madell, J. (1993). FM systems for children birth to age five.In M. Ross (Ed.), FM auditory training systems:Characteristics, selection and use. Timonium, MD: YorkPress.

Maxon, A. (1993). FM selection and use for school-age chil-dren. In M. Ross (Ed.), FM auditory training systems:Characteristics, selection and use. Timonium, MD: YorkPress.

Maxon, A., Brackett, D., & van den Berg, S. (1991).Classroom amplification use: A national long-termstudy. Language, Speech, and Hearing Services in Schools,22, 242253.

Medwetsky, L. (1993). Maximizing the potential benefitsfrom FM systems. ASHA Special Interest Division 9 News-letter, 3, 46.

Moeller, M. P., Donaghy, K. F., Beauchaine, K. L., & Lewis,D. E., (1996). Longitudinal study of FM system use innon-academic settings: Effects on language develop-

ment. Ear and Hearing, 17, 2841.Nabelek, A., & Donahue, A. (1986). Comparison of

amplification systems in an auditorium.Journal of theAcoustical Society of America,79, 20782082.

Nabelek, A., Donahue, A., & Letowski, T. (1986).Comparison of amplification systems in a classroom.

Journal of Rehabilitation Research and Development,23, 4152.

Nemes, J. (1994). Classroom amplification unlocks doorsto effective education. Hearing Journal,47(2), 1322.

Neuss, D., Blair, J., & Viehweg, S. (1991). Sound field am-plification: Does it improve word recognition in a back-ground of noise for students with minimal hearinglosss? Educational Audiology Monograph, 2, 4352.

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At the FM microphone.Speech = 80 dB SPLNoise = 60 dB SPL

At the Aid microphone.Speech = 65 dB SPLNoise = 60 dB SPL

In the listeners earSpeech:

from FM = 105 dB SPL

from Aid = 105 dB SPL

Noise:from FM = 85 dB SPL

from Aid = 100 dB SPLtotal = 100 dB SPL

Signal-to-total noise

for FM = 5 dB SPL

for aid = 5 dB SPL

Gain = 25 dB Gain = 40 dB

Equal

output

Figure A1. Adjustment of FM gain under the equal output criterion.

1 When adding two sounds, the appropriate equation is:

C = log10

(10A/10 + 10^B/10)where A and B are the two sound levels and C is thecombined level, all expressed in dB. If A and B differ bymore than 6 dB, C is very close to the higher of the two.If A and B are equal, C is only 3 dB higher than A.

Appendix B:Appendix B:Appendix B:Appendix B:Appendix B:Signal-to-Noise Ratio in the ListenersSignal-to-Noise Ratio in the ListenersSignal-to-Noise Ratio in the ListenersSignal-to-Noise Ratio in the ListenersSignal-to-Noise Ratio in the ListenersEar During Simultaneous Use of FMEar During Simultaneous Use of FMEar During Simultaneous Use of FMEar During Simultaneous Use of FMEar During Simultaneous Use of FMand Local Microphonesand Local Microphonesand Local Microphonesand Local Microphonesand Local Microphones

During simultaneous use of the FM and local

microphones, the noise level in the listeners earwill, essentially, be the more intense of the noiselevels coming from the two microphones.1 Considerthe situation in which the background noise in aclassroom is a uniform 60 dB SPL, and make thefollowing assumptions:

1. The teachers speech reaches the FM micro-phone at a level of 80 dB SPL, giving a 20 dBsignal-to-noise ratio.

2. The teachers speech reaches the students hear-ing aid microphone at a level of 65 dB SPL, giv-ing a 5 dB signal-to-noise ratio.

3. The gain in the students hearing aid is 40 dB.

When amplified by the hearing aid, the level of theteachers speech in the students ear is 105 dB SPL (i.e.,65 +40); the level of the noise is 100 dB SPL (i.e. 60 +40);and the signal-to-noise ratio is 5 dB, as illustrated (re-spectively) in Figures A1, A2, and A3.

Now consider three different criteria for adjust-ment of gain in the FM channel:

1. The equal output criterion (see Figure A1).Under this criterion, FM gain is set to 25 dB sothat the teachers speech at the FM microphonegenerates 105 dB SPL in the students ear (i.e.,the same as that generated by 65 dB SPL intothe hearing aid microphone). The noise at theteachers microphone generates only 85 dB SPLin the students ear, apparently preserving thedesired 25 dB signal-to-noise ratio. However,because the hearing aid microphone is still ac-

tive, the noise in the students ear is actually 100dB SPL, and the signal-to-noise ratio for theteachers speech is still 5 dB even though it hasbeen transmitted via the FM link. Clearly, thiscriterion is appropriate only if the hearing aidmicrophone is turned off (or, at least, desensi-tized) when the FM microphone is in use.


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2. The equal gain criterion (see Figure A2).Under this criterion, FM gain is made identicalto that of the hearing aid (i.e., 40 dB).Assuming linear amplification, the level of theteachers speech in the students ear is now 120dB SPL, and the noise received via the FM chan-nel is 100 dB SPL (i.e., the same as that receivedvia the hearing aid microphone). The combinednoise level is in the region of 103 dB SPL. Un-der this condition activation of the FM micro-phone raises the levels of the teachers speech

and the signal-to-noise ratio in the studentsear by 15 dB and 12 dB, respectively. Althoughthe equal gain criterion appears to providethe maximum FM advantage, it is not alwaysappropriate. Many students, for example, findthe level of speech received via the FM micro-phone to be unacceptably high. Moreover, theequal gain adjustment has been made in thepresence of realistic inputs into the teachersmicrophone. Under this condition, most FM

At the FM microphone.

Speech = 80 dB SPLNoise = 60 dB SPL

At the Aid microphone.

Speech = 65 dB SPLNoise = 60 dB SPL

In the listeners ear

Speech:from FM = 115 dB SPL


Noise:from FM = 95 dB SPLfrom Aid = 100 dB SPL

total = 101 dB SPL

Signal-to-total noisefor FM = 14 dB SPLfor aid = 4 dB SPL


10 dB FM

benefit

Figure A3. Adjustment of FM gain under the 10 dB FM benefit criterion.

At the FM microphone.Speech = 80 dB SPLNoise = 60 dB SPL

At the Aid microphone.Speech = 65 dB SPLNoise = 60 dB SPL

In the listeners earSpeech:

from FM = 120 dB SPL


Noise:from FM = 100 dB SPL

from Aid = 100 dB SPLtotal = 103 dB SPL

Signal-to-total noisefor FM = 17 dB SPL

for aid = 2 dB SPL


Equalgain

Figure A2. Adjustment of FM gain under the equal gain criterion.


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microphone transmitters will be operating withconsiderable compression. In actual use, there-fore, the FM gain will rise above the equal gaincriterion whenever there is no speech input tothe FM microphone, leading to an increase innoise level in the students ear and degradation

of signal-to-noise ratio for conversationalspeech received via the hearing aid micro-phone.

3. The 10 dB FM advantage criterion (seeFigure A3). Under this compromise, FM gainis adjusted to 35 dB (i.e., 105 +1080) so thatthe level of the teachers speech received viathe FM microphone is 10 dB higher than thatof conversational speech received via thehearing aid microphone. The level of theteachers speech in the students ear is 115 dBSPL and the level of noise received via theFM channel is 95 dB SPL. The level of noise

received via the hearing microphone, however,is still 100 dB SPL, giving a combined noiselevel of 101 dB SPL. The signal-to-noise ratio

for the teachers speech is now 14 dB.Although not ideal, this signal-to-noise ratiorepresents a considerable improvement over

that obtained in the equal output criterion.It was the foregoing considerations that led the Ad

Hoc Committee on FM Systems to recommend a 10dB FM advantage criterion as the basis foradjusting gain in the FM channel. At the same time,the committee acknowledges the many situations inwhich departures from this goal are appropriate. Thecommittee also acknowledges that the foregoinganalysis is theoretical and that there has been muchdiscussion of this issue in the literature. The need forgood empirical research on this and other issuesrelated to FM amplification is acute.

ASHA Adaptacion y Monitoreo de Sist FM

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