Interview with Bill Christman, Product Manager, Unitron

Topic: Tandem™ CROS/BiCROS system

CAROLYN SMAKA: This is Carolyn Smaka from AudiologyOnline and today I'm speaking with Bill Christman, Product Manager at Unitron about Unitron's new release, Tandem™. Bill, this is a CROS/BiCROS device, correct?



Bill Christman, Unitron Product Manager

BILL CHRISTMAN: Yes, Tandem™ is our new wireless CROS/BiCROS technology and it is offered in two different levels of technology, Tandem™ 16 and Tandem™ 4. This allows clinicians to choose the level best suited for each patient depending on the person's lifestyle and listening needs.

Tandem™ is the next step in the evolution of wireless CROS/BiCROS technology from Unitron.

We launched our first wireless CROS/BiCROS technology, the WiFi Mic system, in 2004. It quickly became a go-to product in the industry for wireless CROS and BiCROS technology. Now with Tandem™, we've taken the foundation that we built and improved upon it, adding features and functionality.

We also made enhancements to the software to help make fitting even easier for professionals, because we understand that CROS/BiCROS fittings are not something that they necessarily do as a routine part of their daily practice, and they might want a little extra support.



SMAKA: Who are the candidates for a wireless CROS or BiCROS?

CHRISTMAN: Usually, the defining characteristic is one unaidable ear or no usable hearing in one ear, because the goal of a CROS device is to improve awareness of sounds that originate from the unaidable side. The choice then of whether a CROS or BiCROS fitting is best is driven by the level of hearing in the better ear.

SMAKA: If a patient is a borderline candidate for amplification in the better ear, meaning only a slight loss, would you suggest selecting a CROS or BiCROS for the fitting?

CHRISTMAN: One of the nice aspects of the Tandem™ is that you don't have to decide that when ordering. You're not committed to the decision of CROS or BiCROS at the time of the order like you were with analog products, as this decision is made when you program the system. With Tandem™, you can fit it as a CROS instrument if the person starts with normal or near-normal hearing in the better ear. Then, if the hearing in that ear changes over time, you can refit it as a BiCROS instrument to provide amplification for that better ear as well.



Tandem can be fit as CROS or BiCROS - the professional makes the decision and then uses the fitting software to program the system accordingly.

SMAKA: Excellent. What style is Tandem™ available in, and what type of retention do you recommend for the unaidable ear?

CHRISTMAN: Tandem™ is a BTE-to-BTE system. It uses the same proven BTE housing as the original WiFi Mic system. For the unaidable ear, you can keep the ear open with a slim tube or similar coupling for retention purposes to hold the off-side microphone on the person's ear. We have a retention hook available, which is just a regular earhook with a piece that extends further toward the opening of the canal, but a slim tube with or without a dome also works well.

For the better ear, you have a choice of coupling depending on the degree of hearing loss in that ear.

If it's a mild high-frequency hearing loss, you can fit it open with a slim tube. If there is a more significant hearing loss and you need a BiCROS fitting, you can fit it with a traditional ear hook, earmold and standard tubing.

SMAKA: It sounds like a very flexible system.

CHRISTMAN: Yes, it is. The clinician and the patient have a lot of options with this system.

SMAKA: Could you tell us more about the improvements in the Tandem™ system over your original wireless CROS and BiCROS?

CHRISTMAN: Sure. One of the improvements is the addition of an automatic listening program in the Tandem™ 16. The Tandem™ 16 has AutoPro™ 3, a three-destination automatic program that adds hands-free user convenience. Even if the hearing aid is in BiCROS mode, the frequency response, noise reduction, speech enhancement, AntiShock™, and other adaptive features all adjust according to the environment that the person is in.

As mentioned, Tandem™ has AntiShock™, which was not available in the WiFi Mic system. It was introduced in the Element™ product line in 2006 and has become a staple feature in our product line because it helps improve listening comfort in a variety of different listening situations.

We also offer Speech Enhancement as part of the Tandem™ product, which helps to improve the audibility for frequency regions where speech is the dominant signal. This is particularly advantageous for helping improve the audibility of speech signals originating from the poor ear side.

Tandem™ 16 also has a multiband adaptive directional microphone when it is in hearing instrument-only mode. It's important to remember that people with no usable hearing in one ear can have more difficulty in noisy situations because their brain cannot take advantage of the natural benefits of binaural processing when listening in noise. Therefore technology such as directional microphones can be even more important for listening in noisy situations.

With one unaidable ear, it is a challenge to deliver hearing aid benefit in a noisy environment. This has to do not only with the microphone strategy of the instrument but with the actual spatial positioning of the person. That is, where the person is in the environment and where the noise is relative to the target signal. Without hearing aids, people with one unaidable ear typically position themselves with noise to the poorer ear. With a CROS or BiCROS system, if noise is positioned on their bad side, a CROS or BiCROS system will bring that noise over to the better ear and they will have more noise coming to the better ear than they would have unaided.

A person with a CROS or BiCROS needs to be counseled on the situations that the system will be most beneficial for them, and how to position themselves to optimize use of the system.

SMAKA: Good point. Is Tandem™ compatible with the Smart Control?



Tandem is compatible with Unitron's Smart Control.

CHRISTMAN: It is. The patient has the option to have a volume control on the better-ear side (the receiver side) or the option of having a remote control.

The remote will not adjust the volume on the transmitter microphone on the poorer ear;that side will always have a volume control on it. If someone doesn't want the volume control option on that side, the fitter can set the volume and cover it using a VC cover to prevent changes.

SMAKA: Can wearers turn the mic on the bad ear off while they're wearing it?

CHRISTMAN: They can. They can either just turn the volume down on that side, or they can change programs on the better ear, because it's a multi-memory instrument. For instance, the clinician can set up a "noise program" that turns off the off-side microphone to take advantage of the directional microphone for their better ear if more noise is coming from the bad ear than they want transmitted.

SMAKA: There are not a lot of CROS and BiCROS options on the market today, are there?

CHRISTMAN: That's correct, and we definitely have the best available option for the reasons that we've discussed. Additionally, factors such as low power consumption and near-instantaneous signal transmission avoid signal latency issues that can have a negative impact on overall sound quality.



SMAKA: You mentioned before that CROS and BiCROS aren't fittings you do routinely in the clinic.

CHRISTMAN: Right, the number of fittings is probably comparable to the number of Super Power BTE fittings that a practice would do. They're not fittings that you do every day, and they do present with certain challenges for the audiologist, so flexibility in a product is important.

Because most clinicians do not reoutinely fit a lot of CROS/BiCROS instruments, there is often hesitation about the fitting process - what steps they need to follow to ensure the product is fit successfully. One of the extra improvments for fitters is the step-by-step on-screen help that has been incorporated into the fitting software to facilitate the fitting process.

One of the other improvements that were made with this system is that we added a test in the fitting software to help personalize the transmission from the mic on the bad-side to the receiver side.

The system is calibrated for an approximately 6 1/2-inch distance between the transmitter microphone and the receiver. However, some patients may have a little bit of a larger head and some may have an ear shape or head shape where the two devices may not be parallel when sitting on the ears. These factors could have a negative impact on the amount of signal that's picked up in the receiver unit and affect the overall sound quality.

With Tandem™, there's a tool incorporated in the software that allows the fitter to optimize the signal transmission based on that person's head to improve the overall sound quality and performance of the system.

SMAKA: What are patient reactions so far to Tandem™?

CHRISTMAN: Several of the people that we fit initially with Tandem™ were people that had worn the WiFi Mic system, and they have commented on the overall improvements in the sound quality of the system.

With the new hardware platform, Tandem™ provides better processing capability. People are also noticing the extra features like AntiShock and the convenience of the remote so they don't need to be reaching up and fiddling with controls on the system.

In addition, clinicians have told us how the software definitely helps make the fitting easier as it streamlines the fitting process. As a result, they spend less time tweaking the software and have more time for counseling the patient.

SMAKA: For the better ear, when do you draw the line that a person really is not a BiCROS candidate anymore, that they need a Super Power BTE on that ear?

CHRISTMAN: Tandem™ provides either 55 or 60 dB of peak gain, depending on the model. The model with the optional VC has a peak gain of 60 dB, and the other model without VC has a 55 dB peak gain.

The fitting range is therefore up to an 80 - 85 dB loss. However, with the years of experience that we have with the WiFi Mic system, we have found that the more severe the hearing loss in the better ear, the less likely the patient is to see the benefit of the off-side microphone. These patients tend to get a bigger bang for the buck by just wearing a power hearing aid. So, it's more of a case-by-case basis whether the BiCROS adds enough additional benefit over having amplification just on the better ear when the hearing loss is more severe in the better ear.



The Unitron Tandem™ with and without a VC option

SMAKA: I like the name Tandem™ because it speaks to the product.

CHRISTMAN: Exactly - it represents the concepts of several parts working together. Tandem™ is a system, and we've focused on that in the marketing and educational materials as well. It's not just a hearing aid and an accessory. All parts in the system have been optimized to work together as a whole.

SMAKA: When will Tandem™ be available?

CHRISTMAN: Tandem™ was released in mid-July.

I think it's exciting that we're offering this next step in the evolution of the technology for the wireless CROS/BiCROS, and we have had many clinicians eagerly awaiting Tandem's release.

SMAKA: Thank you for your time, Bill.

For more information on Tandem™ please visit www.unitron.com or the Unitron Web Channel on AudiologyOnline.