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When hosting episodes of Unstoppable Mindset there is nothing more that I like than to get to learn from experts about subjects I have not addressed much before. This episode is one such endeavor and I bet most of you will feel the same way after hearing from our guest Dr. Juliëtte Sterkens. Juliëtte was born in the Netherlands and eventually relocated to the United States after doing her undergraduate work. You will hear how she moved her interests from speech language pathology to Audiology. On this episode Juliëtte will tell us much about the field of audiology, especially about ways to offer hard of hearing persons more access to audio information than what traditional hearing aids provide. For me, having a Master’s Degree got me the opportunity to understand much about the actual technology of loops and T-Coils. Dr. Sterkens is quite passionate about her work and how much of an affect her efforts are having for many who cannot hear information in movie theaters, at conferences and even from televisions. On our episode you will even get a demonstration of the difference between traditional hearing aids and T-Coil technology. You will even hear about a study that addresses how hearing loss may contribute to dementia. I look forward to hearing your thoughts once you finish this episode. About the Guest: Dr. Juliëtte Sterkens has over 40 years of experience in the field of audiology and hearing rehabilitation. Educated in the Netherlands as a Speech-Language Pathologist, she switched to the study of audiology after her marriage and move to Wisconsin in 1981. After attending a Hearing Loss Association of Wisconsin event, she discovered how hearing loops made a huge difference to her patients in Oshkosh WI and started the Oshkosh Hearing Loop Initiative in 2008. In 2012, now retired from private practice she became the Hearing Loss Association of America (HLAA) Professional Advisor for Hearing Loop Technology. Thanks to grant funding from a private family foundation, she has lectured in Norway, the UK, Canada, Hungary, Germany and extensively in the US, as well as authored articles on the topic of telecoils, hearing loops and hearing accessibility. Her efforts have led to nearly 900 hearing loop installations in Wisconsin and many more around the USA. For her efforts she received several awards, including the Wisconsin Audiologist of the Year, Arizona School of Health Sciences 2013 Humanitarian of the Year, and the American Academy of Audiology Presidential Awards. She serves on the Hear in Fox Cities board, a small non-profit organization that provides hearing aids to youth and children in North-East Wisconsin. Links for Dr. Sterkens: www.LoopWisconsin.com, www.hearingloop.org and www.hearingloss.org/GITHL For a 1 minute “What is a Hearing Loop?” video: www.youtube.com/watch?v=hlnx3ZImTw0 Hear for yourself how a loop makes a huge difference at Convention Center: www.youtube.com/watch?v=RcfqmVb-DmU To learn more about hearing loss, and dealing with hearing loss, hearing aids and hearing loops: www.youtube.com/watch?v=EHjXG4_Mi4Y https://accessibe.com/blog/news/hearing-loops-provide-hearing-access-for-people-with-hearing-loss- jsterkens@hearingloss.org About the Host: Michael Hingson is a New York Times best-selling author, international lecturer, and Chief Vision Officer for accessiBe. Michael, blind since birth, survived the 9/11 attacks with the help of his guide dog Roselle. This story is the subject of his best-selling book, Thunder Dog. Michael gives over 100 presentations around the world each year speaking to influential groups such as Exxon Mobile, AT&T, Federal Express, Scripps College, Rutgers University, Children’s Hospital, and the American Red Cross just to name a few. He is Ambassador for the National Braille Literacy Campaign for the National Federation of the Blind and also serves as Ambassador for the American Humane Association’s 2012 Hero Dog Awards. https://michaelhingson.com https://www.facebook.com/michael.hingson.author.speaker/ https://twitter.com/mhingson https://www.youtube.com/user/mhingson https://www.linkedin.com/in/michaelhingson/ accessiBe Links https://accessibe.com/ https://www.youtube.com/c/accessiBe https://www.linkedin.com/company/accessibe/mycompany/ https://www.facebook.com/accessibe/ Thanks for listening! Thanks so much for listening to our podcast! If you enjoyed this episode and think that others could benefit from listening, please share it using the social media buttons on this page. Do you have some feedback or questions about this episode? Leave a comment in the section below! Subscribe to the podcast If you would like to get automatic updates of new podcast episodes, you can subscribe to the podcast on Apple Podcasts or Stitcher. You can also subscribe in your favorite podcast app. Leave us an Apple Podcasts review Ratings and reviews from our listeners are extremely valuable to us and greatly appreciated. They help our podcast rank higher on Apple Podcasts, which exposes our show to more awesome listeners like you. If you have a minute, please leave an honest review on Apple Podcasts. Transcription Notes
Michael Hingson 00:00 Access Cast and accessiBe Initiative presents Unstoppable Mindset. The podcast where inclusion, diversity and the unexpected meet. Hi, I'm Michael Hingson, Chief Vision Officer for accessiBe and the author of the number one New York Times bestselling book, Thunder dog, the story of a blind man, his guide dog and the triumph of trust. Thanks for joining me on my podcast as we explore our own blinding fears of inclusion unacceptance and our resistance to change. We will discover the idea that no matter the situation, or the people we encounter, our own fears, and prejudices often are our strongest barriers to moving forward. The unstoppable mindset podcast is sponsored by accessiBe, that's a c c e s s i capital B e. Visit www.accessibe.com to learn how you can make your website accessible for persons with disabilities. And to help make the internet fully inclusive by the year 2025. Glad you dropped by we're happy to meet you and to have you here with us. Michael Hingson 01:20 Hi again, and welcome to unstoppable mindset. Today, we get to chat with Juliëtte Sterkens and Juliëtte started out as an audio pathologist. Well, she started out doing other things relating to audio, but now she's an expert in dealing with hearing loops, hearing aids and other things. And we're going to even get a demo in the course of today about what a hearing loop does, why it's better in a lot of cases, then a hearing aid and a number of other things. So I'm not going to give it all away. Where's the fun in that? So Juliëtte, welcome to unstoppable mindset. How are you? Dr. Juliëtte Sterkens 01:58 I'm doing well. Thanks, Michael, for inviting me. Michael Hingson 02:01 Well, thank you for coming on. I really appreciate you doing it. And I know that you have a lot to tell us about. So I'd love to start kind of at the beginning. You're from the Netherlands. So tell us a little bit about growing up there, what it was like school or anything else about your life, why you were in the Netherlands and why you went into what you went into and so on. Dr. Juliëtte Sterkens 02:22 Michael, I was born to two Dutch parents. So that's how I lived in the Netherlands. My father was in the military. And we moved around quite a bit during my youth. So the nice thing about that is I have friends all over the country. Of course, the Netherlands isn't very big. And in 1976, after I graduated from high school, I enrolled in a program to become a logo pedorthist that is a speech pathologist speech language pathologist. But in the Netherlands, it also includes being a teacher for the deaf. So it also includes a Coupe de. But about a couple of weeks into my program, I met an American officer in the military, met him in a scuba diving club. And he and I dated two years while he was stationed in the Netherlands. And then he moved back to the states we dated long distance three years, I finished my schooling. My parents wanted me to work before just moving to the United States. I'm sure that we're hoping I would meet a lovely person in the Netherlands. But anyway, our love persisted. And I moved to the United States in 1981. And at that point, I had to choose whether I wanted to continue in speech language pathology, or whether I wanted to switch careers into audiology. And that's how come I switched and enrolled at the University of Wisconsin in their audiology program, and in 1983. I graduated as a newly minted American audiologist. Michael Hingson 04:21 Well, of course, one of the questions that has to come up is since you moved to the US, your parents have accepted love and and the two of you together. Dr. Juliëtte Sterkens 04:33 They sure have They sure have. I also am the proud. I don't want to call it owner. But we have two children and of my three sisters. I'm the only one with grandchildren. From my marriage. I have a sister who has bonus kids, but I have two children. And that meant that they came to visit me frequent ugly, of course. And we've also made the trek back to the Netherlands many times. Michael Hingson 05:07 Why did you have to switch from speech pathology into audiology? Dr. Juliëtte Sterkens 05:14 That's a good question. The ASHA the American Speech and Hearing the association certifies speech pathologists, as well as audiologist and they're two different fields of studies. And when I went to school, I had to get a master's degree. And I literally had to choose, do you want to become a speech pathologist? Do you want to become an audiologist. And at that time, I had already done some work at an audiology center in the Netherlands. I really enjoyed the field. I wanted to get more involved in the Netherlands, I didn't work with hearing aids and fit hearing aids. But in the US, audiologists not only do the hearing testing, but they also fit hearing aids. And that was just an area that fascinated me. So I switched. And I had it was a very small program at UW Oshkosh, but very involved in the community, and well known in Northeast Wisconsin for testing children. And that wasn't an area that I was very interested in. So I was very lucky, great professor, great fellow students, some of which are still friends to this day. Hard to believe it's almost 40 years ago since I graduated. What is the Michael Hingson 06:45 difference between speech, pathology and audiology? Dr. Juliëtte Sterkens 06:51 So speech pathologists are far more involved with speech, articulation, ameliorating the effects from strokes, helping kids that have cerebral palsy, have difficulty speaking, helping children in this country to acquire speech and language if they're hard of hearing, or deaf. And audiologists are far more involved with hearing with the ear. And in in some, not me, not me personally, but there's many audiologists involved in the testing of balance, as well. Balance and hearing. Michael Hingson 07:34 So, you said not you, what is it that you do? Dr. Juliëtte Sterkens 07:39 Well, back in 1983, I got hired as an audiologist in a private practice in Oshkosh. And in that office, we did hearing testing, industrial hearing testing, but we also did hearing aid fittings. And that's really the area that I eventually specialized in hearing aid fittings, helping people with hearing loss either acquired at or before birth, or acquired at a later age, to live successfully with hearing loss and help them adapt to hearing aids. Michael Hingson 08:19 And so, you've done a lot of work and a lot of research and you've done a lot of speaking, right, haven't you as far as traveling around to talk about this topic? Dr. Juliëtte Sterkens 08:29 I have. But really, what I probably should explain to the viewers or to the listeners first is that hearing loss is kind of misunderstood, right? In the sense that people think that hearing aids are like eyeglasses, if you have vision difficulties, unless it's macular degeneration, eyeglasses can essentially restore poor vision to near normal. And they think that hearing aids can restore hearing to normal. The problem is that hearing aids can't do that don't do that. Hearing aids at best correct for about half of the degree of hearing loss. And that means that people with hearing loss will continue to have difficulties hearing or understanding they see hearing, but in effect, they have difficulties understanding speech. When people speak fast, when there's background noise when people have accents. Hearing aids, in effect, pick up all the background noise and making it very difficult for that impaired ear to pick out the speech from the noise. So when a person wears or gets hearing aids, they're frequently surprised, you know, they think that they're gonna hear like they did when they were 25. For example, if I'm dealing with somebody who was worked in a lot of noise or farmed. And then as an audiologist, I would have to explain well, hearing aids can help, but they don't give you normal hearing. But, but there are workarounds, there are things that we can do to help overcome the limitations that your hearing loss imposes on you or that the hearing aids imposed on you. And just one simple example, on most hearing aids nowadays come or can come equipped with TV transmitters. So you plug in a little dongle in the back of your TV. And when you watch television, the TV sends the audio wirelessly to the hearing aids. So it's like you're hearing under earphones, it's fantastic, right? Hearing aids come with little microphones that you can clip on somebody's lapel, if you're driving in a car. And now you can hear that person very close to the microphone. But in public places people have trouble hearing. And could be a church could be a house of worship, could be a theater, could be a library meeting room, the hearing aids are really had their effective range is about three to six feet. For some people, it might be nine feet or 10 feet. But there is a limited range for hearing aids work well. And beyond that distance, they're going to pick up a lot of background noise and reverberation. And as a radio man, you know about that, you know, you know that you need to speak close to your microphone, because if you don't, your voice isn't gonna sound good on the recording. So for years, Miko, I explained to my patients that if they would go to the theater, if they would go to the church, they should pick up what is called an assistive listening device. And that's when people go, what the heck is an assistive listening device. Assistive Listening Devices, or systems or assistive listening systems are devices or systems mandated under the Americans with Disabilities Act, a law that you're very familiar with that law mandates that light switches have to be at a certain height in a room, that there needs to be enough clearance in the door so someone with a wheelchair can get in. And there's Braille signs installed in places so that people like you can read the Braille information and know whether to go right or left to the bathroom. Am I right? Michael Hingson 12:52 As far as it goes? Course you need to know where the Braille sign is. And if absolute route, you don't, you don't get the information. So there are limitations to all of that. But I hear what you're saying. Dr. Juliëtte Sterkens 13:03 Yes. And so these assistive listening systems were being installed. But they are, but the systems man required that the consumer would go to a service desk and pick up a listening device. And that means, you know, how do you know when you go to the theater that you have trouble hearing until the show starts right? So now you're going to go have to go back to the service desk, pick up a listening device and sit down? My experience was Michael, that my patients didn't bother with these systems. They didn't want to use these systems. Well, fast forward to 2008. I am at a meeting for consumers who are hard of hearing. And a professor from Hope College in Michigan came to speak about a topic called hearing loops. And I'm the only audiologist in the room and that it was familiar with hearing loops. They were already in schools for the deaf and hard of hearing in the Netherlands back in the 70s when I was going to school, but they were not being used in this country. And Dave Meyers started to explain how he had been able to foster hearing loops in Western Michigan, to great benefit of the users and maybe a little sidebar. A hearing loop is an assistive listening system that broadcasts the audio from the PA system wirelessly to the hearing aid as long as the hearing aid as a telecoil built in. Michael Hingson 14:52 What isn't so coil. Dr. Juliëtte Sterkens 14:53 It's a little copper coil, a little tiny coil that's maybe two millimeters. in height and millimeter in width, that is embedded in hearing aids and has been in hearing aids for 5060 years. And if you have a T coil in your hearing aid, and there is a hearing loop installed, when you go to the theater, you don't have to go to the front desk and pick up a system or a listening device, you can just sit, activate the telecoil on the hearing aid, generally, it means pushing a button on a hearing aid, and activate that feature in your hearing aid. And now the sound from the PAC system starts streaming direct in the hearing aid. And suddenly, the consumer, the user of the hearing aid, who was really struggling to hear voices from the stage, or from a lectern, or from an altar, can hear that audio wirelessly direct in their ear. And and if the hearing aid is programmed properly, it'll do so without any background noise. Michael Hingson 16:09 Oh, and that? Oh, go ahead. No, Dr. Juliëtte Sterkens 16:11 go ahead. Ask your question. Michael Hingson 16:13 How is that different? Or why is that more effective than what you described earlier, which is the person who gets a hearing aid that has technology that plugs into the television then broadcast to the hearing, Dr. Juliëtte Sterkens 16:28 ah, this technology that is used for little remote microphones or televisions is Bluetooth technology. But that it's the sound transmission is happening via Bluetooth. That technology cannot be used in live events, because there is a significant delay of the audio. Because of the processing that's happening, the sound has to come from a Bluetooth transmitter, go to a smartphone from the smartphone to the hearing aid. And if the Wi Fi in the building isn't very fast, the audio arrives in the ear at great latencies. So there is no at this time, public assistive listening systems that use Bluetooth that happen in real time. And for that reason, we use FM, infrared, or hearing loop technology for publicly installed assistive listening systems. Michael Hingson 17:45 So the the coil and the loop on the loop is actually transmitting FM then that's the coil receives is that what I'm gathering Dr. Juliëtte Sterkens 17:58 is what you're what's happening. The hearing loop, in its simplest form is a copper wire installed around the perimeter of a seated area. So let's say it's a meeting room, there's a hearing loop installed in the floor or in the ceiling. When an audio signal is is amplified through that wire, it creates changes in the magnetic field. And the coil, of course, can be magnetically induced, that signal can be picked up by the little coil in the hearing aid with the exact same clarity as the audio that's being broadcast by the Michael Hingson 18:43 wire. How does the information get to the loop Dr. Juliëtte Sterkens 18:49 from a microphone. So a hearing loop system needs to be connected to a microphone from a PA system that's installed in a room. So first and foremost, there has to be a PA system in the room, there has to be a microphone being used at the lectern, that signal isn't only sent to the speakers so that the audio is broadcast into the room. That signal is also broadcast to a hearing loop amplifier. And the amplifier is broadcasting the audio via electromagnetic waves into the room that the hearing aid can pick up. Michael Hingson 19:34 So that's even different than you'd mentioned FM before. So you're not even really using FM there. No you're not. Unless you have a microphone that that does FM that goes to the PA system that goes to the loop. Dr. Juliëtte Sterkens 19:47 Yes. So there are assistive listening systems that use FM technology. But that requires every user of the system to go and pick up an FM receiver, right. And frequently they come with headphones. Right and the headphones are generic, are not specifically programmed for the user's hearing aids. And the telecoil. And the hearing aid that the consumers wearing is programmed specifically for their hearing loss. So activating a telecoil, in a hearing aid and hearing in the loop means that the consumer hears the sound as it was meant for their individual prescription. So, in the grand scheme of things, if a consumer is either asked to go to a service desk and pick up a listening device, or just walk into a facility sit down, and when the show starts, turn on a telecoil. In the hearing aid, what do you suppose the consumer will choose? Michael Hingson 21:00 They're gonna choose the thing that will give them the greatest ability to hear or to get the information that is that is actually being provided. So of course, they're going to use the looping the coil, if they have Dr. Juliëtte Sterkens 21:14 they often they are, and it's, and it's so convenient. And so when I heard Dr. David Meyer speak in 2008, and he mentioned how hearing loops, were making a comeback, greater awareness of the ADEA and the requirement that these systems have to be hearing aid compatible. I just went, Oh, my God. I mean, there's the solution to my patient's problems. And basically, all I wanted to do Michael is helped my patients here in Oshkosh, Wisconsin, if I can get these loops installed in churches, and in the Oshkosh Grand Opera House, my patients are just going to think this is wonderful. And it was it blew my patients away how they could go to the church, and sit down and activate their telecoil. And here and from from starting what I initially call the Oshkosh hearing loop initiative, I also ended up seeing patients and Nina from Nina, I'm from Appleton and they want loops in their churches. So pretty soon it kind of blossomed out to the Fox Valley area, we are about an hour south of Green Bay, in Wisconsin. And then I also started educating audiologists in the state why this is good, not only for their patients, but it's also good for them. If your patients, if if the places where your patients do the most complaining about their hearing aids, if you can make them among their best places to hear, they're going to love you not only that, they're going to talk very positively about hearing aids, they're going to encourage their friends to look into this. So it's good PR, it's good advertising. Michael Hingson 23:18 So a hearing. But so a loop essentially goes around the whole room perimeter. Dr. Juliëtte Sterkens 23:27 It's there's different kinds of loop configurations. If a building doesn't have a lot of metal if it's an older structure, for example, now I'm just a Lutheran Church in Oshkosh. With a basement and community gathering space underneath the sanctuary. The loop can literally be installed as one big loop around the seated area in the church and the loop will not only broadcast the audio into the church itself into the sanctuary, but also into the basement. If a facility has a lot of metal, for example, a library meeting room with a lot of Reem steel reinforced concrete. That facility will require what is called a phased array loop. And it's an array of multiple wires in the shape of loops that are laid on top of each other in order to create a strong enough signal. So there's much more involved than me saying, Oh, you have to do a string or a wire around the perimeter of a room. And that's why train loop installers are so important in this process. Michael Hingson 24:47 How expensive is it to install? Whoop, yeah. You know, that's going to be a question that come it's Dr. Juliëtte Sterkens 24:54 absolutely going to be a question. Now. Do people ask you how expensive it is? To install real signs, or install wheelchair ramps, oh, sure. You get that question also. Okay, well, and Michael Hingson 25:15 it's even well, when it comes to wheelchair ramps, it's Oh, it's too expensive, I can't afford to do that now. And the ADEA, I won't say gives them an out. But the ADEA says, unless you're doing other major modification to a building, then you don't need to go off a modifier to install the ramp. But if you're modifying then you have to include the ramp. Of course, if you're building a new building, the cost to put in a ramp is negligible, if anything at all, because you just designed it in. So it's all in the after part after market part where those costs come in for Braille signs. Again, there are assumptions as to how expensive or not it really is, so that the questions do come up. Yeah, Dr. Juliëtte Sterkens 26:06 that's me know what, that's a very interesting perspective for me to learn about. In in Wisconsin, a lot of hearing loops are being installed in the price ranges of three 510 $1,000. It really again, it depends on the amount of metal in the building, the size of the facility, the size of the room that you want looped, and the cost of hiding the wire, the effort required to hide the wire. So if there's carpet tiles in the meeting room, they can just easily be pulled up. Sure, flat, flat wire can be installed underneath the carpet tiles, carpet tiles go down. And literally, it can be done in a day, in a couple of hours. They can also be installed in the ceiling. But you're absolutely right. If you're dealing with very large facilities, where there's permanent carpeting installed, now the carpeting has to be cut, right, and that people are leery of having that done. So in in Oshkosh, I found that the places that aren't even mandated to have this to have assistive listening systems installed, were the most receptive, and those were houses of worship. Because where do people go 5060 times a year, and want to hear need to hear, right. So a lot of my effort in the beginning, circled around places that I knew were remodeling. Places that I knew would be receptive. And those were the houses of worship my patients belong to. And, literally, I would go to meetings, if there was a new school in the process of being installed, I would reach out to the school or to the architects, a lot of my work has involved reaching out to architects who think that assist of all assistive listening systems are alike. And if that's the case, let's put in the cheapest one course. And that's an FM system. But there's much greater awareness among consumers. I have done a lot of work around the country educating hearing care professionals. And the Hearing Loss Association of America H L. A. They have started what is called a get in the hearing loop program. They are literally actively advocating on behalf of consumers with hearing loss. Michael Hingson 29:02 Well, it's interesting, this is truly all about, if you will, electrical or electronic induction. Yes, having grown up in a science oriented world, I understand what electric transformers are, you know, we hear all the time about transformers and now a lot of the technology is a little bit different but really a transformer the thing that you would plug in and you would then get a stepped up current or voltage or whatever was all about induction. And we won't go into transformer theory here but it's perfectly understandable. Anyone that studies electricity and electronics. Why this system kind of works because the Europe you're literally just creating a magnetic field and the coil is the other part of if you will the transformer that is integrated into a hearing aid Were into an assisted living device, and is picking up the magnetic pulse changes from the loop. So directly from an electronic standpoint, this is electrically trivial. There's nothing new that we haven't known for years. Dr. Juliëtte Sterkens 30:16 No, no, and but the issue has been that consumers aren't educated about this technology, they don't even know this type of accommodation exists. And there has been some resistance on behalf of the hearing care professionals who say, well, but putting a telecoil in a hearing aid makes it bigger, makes the hearing aid bigger. And while that is true, it also makes the hearing aid a lot more useful, a lot more beneficial. So it's, it's educating not just the consumer, but the hearing care professional that in the end, the consumer, where's the hearing aid to hear better, right. And it is up to the hearing care professionals to educate consumers, that these types of systems and technologies exist. So there's a lot of people who are walking on this earth with hearing aids that have built in telecoils. But the telecoil may have never been activated, it needs to be activated in the computer by the hearing care professional, the hearing care professional may have never demonstrated the benefit of a hearing loop. So I would love for the listeners to demonstrate what a hearing loop can do. And I have a little audio demonstration that if you would permit me, I'd be happy to play that so that the listeners can hear what the difference is all about. Sure, Michael Hingson 32:03 let's do that. And you go ahead and set that up. And I will just explain what Juliet is doing is she's going to share her screen. She's enabled her audio, so that we'll be able to hear this demo and what you're going to hear I have not heard it all the way through. But what you will hear is what essentially, a person not close to a stage will hear just with a hearing aid. And then as I understand it, the telecoil will be activated. Dr. Juliëtte Sterkens 32:33 Correct. So the first half is the audio as if it were coming through the hearing aids microphone, and the second half is as if it's coming through the loop. So let's see if technology works here we got right. She was dreading 32:52 getting older. What's the only way to avoid getting to die right now we all want to live a long life. We don't want to get older in order sitting there and are the young people in their 20s and 30s and 40s, making fun of older people making cracks about older people. They're making fun of what they themselves are going to become. Michael Hingson 33:18 And it's clearer what happened there because at first what we were hearing was the microphone in the hearing aid picking up not only the speaker from some distance away, but all the other ambient sounds. Yeah, and no matter how directional, you make a microphone, it's still going to pick up What's between you and the person speaking. But then when the the loop and the coil were activated, or the loop was activated all along. But when the coil was activated, now you're hearing just what comes from the loop. So the only way you would hear ambient noise besides the speaker speaking is if the speaker's microphone picked up that information, Dr. Juliëtte Sterkens 34:06 Michael II that's really perceptive. The hearing aid can be programmed to still pick up some ambient sound, because you can imagine, if you're very hard of hearing, and you switch your hearing aid to telecoil you stop being able to hear your own voice. You no longer hear the person sitting to your left or your right at that meeting. You're only hearing what's coming through the mic from the PA system. And that can be kind of isolating. And and in church, you can't hear yourself sing right. And so as an audiologist I can program the hearing aid to pick up ambient sound, but turn down the sensitivity by by five or by six or by 10 DESA Pulse so you can still hear, but it's a lot quieter. And that makes the sound from the loop stand out even more. So that the understanding the you know, the signal to noise ratio is improved to a level where you can just sit back and hear and follow the meeting with ease. And it blew my patients away. I mean, I had patients tell me, after they had an experience in a loop, one, one person told me and this is a gentleman who was very hard of hearing was only wearing one hearing aid, the other ear was deaf. And he said to me, I can hear so well in the loop. So that's what it must be like to be normal hearing. And he had been hard of hearing his whole life. But hearing in a loop can be life changing for people who have lost a lot of their hearing. And that's really what motivates me. And it was the reason I stepped out of my practice ankle. Back in 2012, I gave up my audiology practice, to become the H. L. A. 's national hearing loop advocate. And you know, Michael, of course, it helps that I like to talk. But I so I do a lot of consumer education, a lot of public speaking, professional meetings, lot of lectures, and then when the pandemic hits. It also gave me a new way to reach out to people via zoom. So I've done lots of zoom lectures about the technology, and just trying to reach more and more people. So you inviting me to this podcast is huge, because you've got a listenership different, you know, the more people hear of this technology, they go, wait, I may not use hearing aids, but my mom does. Or my dad or I have a neighbor, or I have a friend, or I belong to a church. And why do we have this in our church? No. And I'm really proud to tell you that we're almost at 500 churches in Wisconsin, almost 900 places have installed these hearing loop systems. And it's kind of moving by word of mouth, because they work. They work well. And once they're installed, it's like electrical wire. Once it's installed, you're done. Michael Hingson 37:40 Going back to something that you said earlier. Today, in our world with hearing aids being manufactured in an ever increasing number, how many of the hearing aids include the little telecoils? Dr. Juliëtte Sterkens 37:57 Yeah, the percentages vary for people who are severely hard of hearing. So these are people who without a hearing aid, can barely hear normal conversation or people to whom we have to shout in order to be barely heard. The numbers are between 50 and 90%. And frankly, it depends a little bit on the philosophy of the audiologist. My philosophy was, was really about giving my my patients as many tools in their hearing aid toolkit as I could give them. And some audiologists are perhaps working with manufacturers where the telecoil indeed makes the hearing aid a little bit larger. And in when that happens. They they may opt for the smaller hearing aid rather than ask the patient, where do you not want to hear? Right? I mean, you're getting a hearing aid to hear and the consumer doesn't really understand that the hearing aid is still a compromise. So a lot of my outreach has also been to educate consumers, how to buy hearing aids, what are the features that are important that they look at? And certainly if people are watching or listening to this recording, there's a website called hearing loss.org that is H L A's national website where there's lots of good information for consumers about hearing, living with hearing. We're living with hearing loss, how to buy hearing aids and there's also a website called hearing loop.org That is the website from Dr. David Myers at Hope College, it's only informational website so that consumers can learn more about hearing loops themselves. Michael Hingson 40:15 So, again, though, going back to the discussion of hearing aid, manufacturing, there are still a number of hearing aids that are being constructed without putting the coils in them. Dr. Juliëtte Sterkens 40:30 Correct? Alex some of it, why Michael Hingson 40:35 not? How expensive? How expensive? Is it? To truly put a coil in maybe a better way to put it as why don't we just do it at all hearing aids? Because you don't know where they're going to end up? Dr. Juliëtte Sterkens 40:45 Exactly. I wish you would come with me, when I talk to the hearing aid manufacturers and ask that common sense question. The coil itself has been estimated to add between two and $5 to the cost of a hearing aid. But to integrate it in the software in the programming of the device, obviously, there's a greater expense involved. And it's my understanding that there can be some interference with the coil, and the recharge ability of the hearing aid. So what we're seeing is that there are some rechargeable hearing aids on the market, where they don't add a telecoil to the device. But the manufacturers have heard me I've been very vocal at conferences, and meetings with manufacturers. And the manufacturers have now added telecoils to the remote microphones. So if you are listening to this broadcast, and you think I have a hearing aid, but I don't think I have a T coil all is not lost, you may be able to get access to the signals from hearing loops. If you ask if your audiologist can provide you with a remote control that has the T coil built in, it becomes a little bit more cumbersome, or a little bit trickier to use. Think of my mother who's 96. You know, she can find the push button on the hearing aid, but she would have a heck of a time with remote control and keeping a charge and all that other extra stuff that you have to do. Michael Hingson 42:32 Yeah, and that's understandable. So it gets back to ease of use. What do you think, is the ramification for all this of now the FDA saying that we don't need to have prescriptions for hearing aids, which I would think is going to cause prices to drop, but also numbers of hearing aids probably to increase. Dr. Juliëtte Sterkens 42:59 The good news is that there are some over the counter devices that have telecoils built in. So there aren't many. But there are a couple that have the T coil built in. And there's outreach being done to other manufacturers to include the telecoil. Again, because it doesn't add a lot to the expense of the devices. The over the counter devices, I think will make people more aware that something can be done. They may not be as adjustable to their specific hearing loss. They may not have the same sound. They may not be as durable. As some of the hearing aid devices. I mean, these hearing aid devices. I've worked with hearing aids that could easily last 6789 years. Imagine worn on your ears where you perspire, handled dirt and dust and what have you but these hearing aids keep on going. And I wonder about the durability of over the counter devices, are they going to be the same? And is the consumer going to know how to clean them how to maintain them what to do when they get earwax in them. The audiologist does a lot more than fitting the hearing aid. They counsel patients, you know how to live better with hearing loss or how they maintain the hearing aid. I used to see some people back every three or four months just because of the problems that they had with earwax and others I would only see once a year or only when they had a problem. But these over the counter devices, it means that the consumer has to become the expert. Right. And what are they going to do when the hearing aid malfunctions so they're going to take it back to Best Buy? Michael Hingson 44:58 Yeah, that's, of course is the issue isn't it? Dr. Juliëtte Sterkens 45:01 At this the issue, it is, you know, you can buy readers and they work for run of the mill difficulties with your eyes if you can no longer see fine print. But if you have great differences between eyes like I have, or if you have a astigmatism those glasses aren't going to work very Michael Hingson 45:24 well for you. Right. But in, in, in reality there are there other reasons why glasses won't help other than just with age related macular degeneration. But but the reality is that we haven't collectively chosen to deal with that either. And I think that's what I'm hearing is the same thing. Regarding hearing because we, we just don't yet consider it the priority, it probably needs to be Dr. Juliëtte Sterkens 45:56 now and and of course the baby boomers are aging, Michael, big time, you know, the oldest ones are turning is it's 77 this year. And we know that while hearing loss, its origins are going to start in your 30s and 40s. You know, with as far as hearing loss goes, it's important not to be exposed to noise. It's important to live a healthy life, it's also important to choose your parents wisely, because if they had hearing trouble, the odds are you are going to be dealing with it also. But hearing loss definitely accelerates in our 70s and 80s. I've seen this very clearly with my mother. And she's now to the point where she has to wear her hearing aids all the time. Otherwise, she misses out. And she does like to do that. And that means that as the baby boomers age, I think there will be more and more attention paid to the fact that hearing has a significant effect on our quality of life. And there's now also some studies to show that having hearing loss is a contributing factor to an earlier onset of dementia, it doesn't mean it's going to cause dementia, but it's going to contribute an untreated hearing loss has been identified as one of those risk factors. So Michael Hingson 47:38 I use this Do you have any notion if you don't Dr. Juliëtte Sterkens 47:41 hear well, if you kind of checkout, so to speak of conversation, if you're not involved with hearing, that part of the brain is no longer stimulated. And it means that you have to pay more attention to hearing you have to allocate if you will, more of your available brainpower to hear and that's taxing on a person. And so if you if you have it somewhere in your genetic makeup, the fact that you may be prone to dementia. If there is a family member with dementia, and you have beginning hearing loss, I would be the first person to go and do something about my hearing. Because I know that having hearing loss contributes accelerates the onset of dementia, if you will. So that's usually when people say, well, when should I start with hearing aids? I said if you have hearing loss, if there is a risk factor, if your parents have hearing loss, that means that you could be at risk for greater hearing loss as you age. And then if there's dementia in the family, I would start sooner rather than Michael Hingson 49:14 later. I'm curious to see if if you're aware of this in any way. Have any similar studies been done regarding the whole concept of eyesight and loss of eyesight? Do you know I don't. Dr. Juliëtte Sterkens 49:32 After a great question, though. Yes, yeah. Yes, I'm gonna make a note of it myself. So if I find anything, I'll let you know, Michael Hingson 49:40 please. It would be interesting to know about that. Because I think that my belief anyway, is that the reality is we get a lot more information. Each of us gets a lot more information from what We hear than what we see no matter how good our eyesight is, because eyesight is still only really? What about 100? If that much 180 degrees roughly. So you don't hear what's you don't see what's behind you, you don't see what's above you unless you look. And typically you look because you hear. And so yeah, go ahead. Dr. Juliëtte Sterkens 50:23 Yeah. All right ears, it just one example how incredible our ears are, right? First of all, they're attached to her brain, which is very important in the point that I'm trying to make, in that if you go to the beach, Michael, you don't have sight. But if I close my eyes, I can hear the birds flying up above. In front of me, I can hear the little children behind me, I can hear cars going to a parking lot. I can hear the waves, I can hear the wind. And I mean, it's a it's a complete scape. I can I can hear all this by just simply paying attention. And if I hear people talk, and I think they use the word Juliet in conversation, oh my God, my brain is just gonna go zoom, and try and focus on what these people are saying, because I think they're talking about me. When you were hearing aids, when you were hearing aids, Michael, all the sound is right in the ear, the ability to, to focus on sounds in the front and in the back. And the and up above and below, is diminished. And that's it's really it goes from 3d to maybe 2d or 1d. And that means that consumers really have a hard time picking out voices from background noise, no matter how good the hearing aids are, Michael Hingson 52:11 are there any technological advances coming that will be able to reintroduce that multi dimensional sound scape, so that people will be able to tell directionality again, Dr. Juliëtte Sterkens 52:28 not that I'm aware of what I am aware of, is that there is a lot of work being done on Bluetooth LE audio. And that's eventually going to allow somebody with a smartphone to share audio from their phone to multiple headsets. And the hope the hope it's not been accomplished yet, is that there will be a public assistive listening system available with Bluetooth LE audio as well. They've named the technology aura cast. And that might mean that the silent televisions at airports can be made audible if a consumer uses their smartphone and wireless ear plugs. But eventually, it would also mean that there could be audio broadcast from public places direct into hearing aids. Now, hearing aids are very small. They have very small antennas. We don't know what kind of audio delays they're going to be. But the Bluetooth special interest group is working very hard to try and include hearing aids as individual receivers for the broadcast of Bluetooth LE audio. And while they hope that this is going to happen in a year or two, I think it's going to take much longer. But if that happens, people with hearing aids are going to be able to hear announcements at an airport, get the audio from their TV or their smartphone and in church if the church has this technology installed, the hear this technology in their hearing aids. But it will it's it's it's a heavy lift, if you will consumers will all need new hearing aids all need new smart phones. I mean these dongles have to be installed the world over while there are a lot of countries including the UK that have mandated hearing loop technology as the technology of choice. So there has to have been some change made some changes in the law for that too. happen, I estimate about 10 years or so, Michael Hingson 55:04 there is something called binaural sound and binaural microphones where you can have a microphone or two microphones that actually give you the ability to record directionality. And you can use earphones and actually hear the sound that sounds like, well, it could be coming from any direction. And I've seen and heard some really great demonstrations of binaural sound where listening through regular earphones, It even sounds like a person is behind me and talking. But they're using these microphones. They're not overly expensive. But it would be interesting to see how somebody could bring some of that binaural technology into what happens with hearing aids. Dr. Juliëtte Sterkens 55:53 Yeah. And of course, it would require the use of microphones. And everything hinges on Well, proper use of microphones, as you're Michael Hingson 56:03 sure. Yeah. But it's it is something to look at as the demand grows for being able to have technology that allows people to hear better. Yeah, so it will be interesting to see how good Dr. Juliëtte Sterkens 56:20 I am. My guess is, yeah, my guess is that the gaming industry will be all over this. Michael Hingson 56:27 So the gaming industry should, it would make it more possible for if they did it right. For me to be able to play games than it does. If you talk about virtual reality, if they truly did that, and built in the rest of the interfacing technology to allow me to be able to access games. You're right, it would be interesting, and it would be worth doing. I have a question that is unrelated somewhat to all this, you have used the term deaf and hard of hearing. And you have avoided hearing impaired why. Dr. Juliëtte Sterkens 57:08 Generally, and and you know, there's people who are hard of hearing, who don't like the term hard of hearing, they call themselves a person with hearing loss. Some people prefer the term hard of hearing. A lot of people don't like the term hearing impaired. And why I think it's it's much more a it's a sensitivity, you know, how they feel about their own hearing loss. So if you're born hard of hearing, it is what it is. But your hearing isn't impaired it if you were born that way. But if I have not used the word DEAF, is that in the in the heart of hearing community, Deaf implies that there is no ability to hear sound. And people like that generally don't wear hearing aids. They use sign language and estimates estimates are between one and 3% of all people with hearing loss are essentially deaf and use sign language to communicate. The other 97%. use hearing aids to hear speech. And so frequently they don't use the you use the term deaf although sometimes they will. Just to make it simple. You know, they say I am deaf. And then people think, oh, this person can't hear. No worries, I will wave to you when it's time to board the airplane, for example. Michael Hingson 58:55 Yeah, in our society, and this is why I asked the question, not setting you up. But just to make the dichotomy comparison, we still refer to people as blind or visually impaired and visually impaired has two connotation problems one visually, I don't think that overall, you can say I'm different, because I happen to not see so visually, I don't look different. And impaired. Again, the same thing. And I think that's exactly what you say. We're not impaired. But that's still what we use because people so greatly emphasize eyesight over anything else. And if we've heard something today, with you, that makes a lot of sense. It's in reality, we do get more information from what we hear, but we don't tend to focus on that because we are taught that without eyesight and to a degree without being able to hear we're just lost souls and that's just not the way it is at all. Now Dr. Juliëtte Sterkens 59:59 and A the Hearing Loss Association of America once a year has a conference. And it's you know, in different areas of the country, it's anywhere between, you know, 515 100 people who attend these conferences, and people with hearing loss. You know, it's a spectrum, I want to call it the spectrum disorder, some people have very mild hearing loss, but their ears have so much trouble discriminating speech, that they really struggle and almost function as if they're deaf. And there are people who are very hard of hearing, but as long as they're wearing a hearing aid, or a cochlear implant, they do quite well. But, you know, these, these come the conferences focuses on how to live better with hearing loss, what technology can do for you. I mean, there have been such tremendous changes, and improvements in technology, that IF listeners have family members who are very hard of hearing, or are really struggling with hearing aids, I encourage them to look into cochlear implants, they can be life changing. Cochlear implants can be of benefit of people who have lost almost all of their hearing, and with the implant are able to hear, again, at the three to six foot distance with great ease. So lots of technology upgrades, but there's still devices with microphones on the ears. And for that reason, they still need assistive technology. And that's why, you know, I won't be without work as a hearing loop advocate. Michael Hingson 1:01:53 For a long time. You mentioned to me somewhere on the line that you're doing some work with Google Maps? We are and that if you would Dr. Juliëtte Sterkens 1:02:01 well, but it's I'm very excited to tell to talk about this, because as a consumer, how do you know where a hearing loop is installed? Right. There are some websites that try and keep track of where these loops are installed. But Google Maps as part of his accessibility feature, are is now permitting businesses to list hearing loops as an accommodation. And you're probably familiar with the fact that Google Maps lists whether a place is accessible for wheelchair users, whether the bathrooms are accessible, or whether they have wheelchair ramps, while they now also permit the dimensioning of assistive hearing loops. And the best place at this time to go is the hearing loss. That org website and Google the word Kiddle. Git H L, which stands for get in the hearing loop, because the hearing loop advocates in the Hearing Loss Association have developed a complete toolkit and the Google Maps toolkit so that we can educate consumers how to find these hearing loops on the web. And if you don't find one, but you sure wish there was one. We teach people how to write reviews on Google Maps. Because you know, reviews work when you go to a restaurant, what do you do? I personally check the reviews before I make a reservation. And so if these reviews list that consumers love the hearing loop that they have installed, businesses are going to be more aware that this type of accommodation pays off is important, right? Michael Hingson 1:04:07 Absolutely. Before we close, I thought it would be fun to do one more demo with something that we did before we started. And I do it because I want people to understand why we do the podcast the way we do because I always ask people who come on to provide us with them using a microphone and not just a built in laptop microphone, and I'm going to show you why. It's important that like you did today your audio was great. You use a headset. Here's what it sounds like. If you're listening or if you're speaking to me and you're just using your laptop computer microphone, check this out. Okay, I have now switched to the microphone built into my camera, and you can hear what the total difference is. It's one Trouble. And this is what we don't ever like to get on podcasts. Because what we want people to be able to do is to hear our patch podcasts Well, right? Dr. Juliëtte Sterkens 1:05:11 That's right. That's right. And you know, and Michael, I have done that same demonstration just by removing my headset and moving it about two feet. This is about as far as my arms reach. And now I'll put the microphone back on my ears. And people go, Whoa, that's a huge Michael Hingson 1:05:31 difference. Well, huge difference. And even the reverberations are less from your microphone than they are from the laptop microphone, which is omnidirectional and supposed to be able to pick things up from a distance. But it sounds horrible. Dr. Juliëtte Sterkens 1:05:46 It sounds horrible. And because we've all been on Zoom, we are far more aware. But people with as a normal hearing person, one can accommodate for those changes, it takes more effort. But I could listen to you if I had to, right. But a person with hearing loss, who is already hanging on by their fingertips, so to speak, in order to hear you because maybe you talk fast, or maybe you have an accent. If you talk through your video microphone, that person will fall off the cliff, their fingers, they're gonna have to let go, because they struggle already so much. And I'll be honest, I didn't realize how much my patients were struggling in those public places until I got involved with hearing loops. And then it was the quarter dropped just like, well, of course, they can hear better in the loop. And so that just motivated me to go at this even harder. And I'm happy to say it's a message that's resonating around the world around the country, and people are listening and your podcast. Thank you, Michael is going to make a difference. Michael Hingson 1:07:16 Well, I hope so. And we really appreciate you being here as well tell me and tell the folks listening, how can they maybe reach out to you and learn more about this, contact you and so on? Yep, Dr. Juliëtte Sterkens 1:07:31 I have a little website called loopWisconsin, www dot loopwisconsin.com. And my email, my contact information is right on the website. They can also reach out to the get in the hearing loop committee from H L A. And again, if they go to the hearingloss.org website and click on hearing loop resources, they'll be able to find an email address there. And then a whole group of hearing loop advocates will jump into gear. So if people have questions about loops, or about whether their hearing aids have telecoils, we are all very willing to help. If you don't ask, you won't get the help. Michael Hingson 1:08:21 Right. Exactly right. And I also know that we met you through Sheldon Lewis at accessibe we did. So where does accessibly fit into what you do. Dr. Juliëtte Sterkens 1:08:33 I reached out to accessibe to see what I could do to make my website accessible for people with disabilities. And accessibe got me in touch with Sheldon and I can't say enough about the context that I have made through accessibe and how accessibe has helped to kind of get that message out there. I think they've been very focused on people with who are blind or people who are a mobility impaired but I don't think they had given hearing loss and hearing accessibility a lot of thought and I tell you they've pulled out all stops so I want to thank accessibe for doing what it's done for this technology and I just had a blog post it and I will send you the link Michael so that you can add it to your notes. We I was just posted last week by accessibe Michael Hingson 1:09:39 actually I think accessibe has given a lot of thought but some of the things that accessibe does with the artificial intelligent widget and so on are not as easy to add present. Bring into the automated world from a standpoint of deaf or hard of hearing that It is still technology that has to catch up a lot. So it has to be done more through manual remediation, but accessibe is aware of it. So it's great that you and accessibe have established a relationship that I think will help. Well, I want to thank you again for being here. We were supposed to do this for an hour. And we are now up to 70 minutes, because we're having way too much fun here, right? Yes, Dr. Juliëtte Sterkens 1:10:25 yes. Well, you and I could probably talk for another half hour. But Michael Hingson 1:10:30 yeah, I think they might get bored with us. So I want to thank you again for being here. And I want to thank you for listening to us. Please reach out. I'd love to hear your thoughts and comments about this today. Juliette has been wonderful. You can reach me at Michaelhi at accessibe A C C E S S I B E.com. I also invite you to go to my podcasts page, which is www dot Michael hingson h i n g s o n.com/podcast. And wherever you're listening to the podcast today, like on Apple, iTunes or wherever, please give us a five star review. We appreciate your reviews. We appreciate your thoughts. But I would really appreciate you reaching out to me and telling me what you thought things that we ought to improve or if you love us, that's great, too, then if you know of more guests that we ought to have and Juliette you as well, if you know of other people who we ought to have honest guests on unstoppable mindset. We would love to hear from you about that. So again, Juliette, I want to thank you for being here and educating us a whole lot today. This has been absolutely enjoyable, and fun. Dr. Juliëtte Sterkens 1:11:44 Thank you very much, Michael. Michael Hingson 1:11:51 You have been listening to the Unstoppable Mindset podcast. Thanks for dropping by. I hope that you'll join us again next week, and in future weeks for upcoming episodes. To subscribe to our podcast and to learn about upcoming episodes, please visit www dot Michael hingson.com slash podcast. Michael Hingson is spelled m i c h a e l h i n g s o n. While you're on the site., please use the form there to recommend people who we ought to interview in upcoming editions of the show. And also, we ask you and urge you to invite your friends to join us in the future. If you know of any one or any organization needing a speaker for an event, please email me at speaker at Michael hingson.com. I appreciate it very much. To learn more about the concept of blinded by fear, please visit www dot Michael hingson.com forward slash blinded by fear and while you're there, feel free to pick up a copy of my free eBook entitled blinded by fear. The unstoppable mindset podcast is provided by access cast an initiative of accessiBe and is sponsored by accessiBe. Please visit www.accessibe.com. accessiBe is spelled a c c e s s i b e. There you can learn all about how you can make your website inclusive for all persons with disabilities and how you can help make the internet fully inclusive by 2025. Thanks again for listening. 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