The Sound Activity Meter (SAM) is a new tool which records the quantity and quality of sounds a client/patient listens to as they go about their daily activities. This is important for two reasons. First, the hearing healthcare professional cannot personally experience the hearing difficulties the client/patient has in their daily lives. Second, although some clients/patients may do an excellent job explaining their perception of sounds, each of us perceives things differently. Some people may describe a particular sound as soft or loud, while others may say that exact same sound is comfortable.
The SAM allows the hearing healthcare professional to accurately review and characterize the sounds the client/patient listens to. This is a new and important step in understanding the individuals listening needs.
After SAM listens for a few days, the information collected is sent to the professionals computer. From there, the professional and the client/patient (and their loved ones) can view the quantity and quality of sounds the individual experiences. The SAM is a tiny tie-tack sized device designed to be worn on the collar or pinned to exterior clothing (see Figures 1 and 2 below).
The SAM has many uses. It can be used to estimate daily noise exposure and it can help explain speech difficulties in noisy environments. The SAM can help determine the need (or not) for advanced hearing aid technologies and SAM is beneficial to the counseling process. Importantly, for those wearing or acquiring hearing aids, SAM can help guide adjustments and fine-tuning of advanced technology hearing aids to maximally meet the needs of individuals.
Figure 1. Close-up of SAM
Figure 2. SAM as worn by the user.
Hearing loss is an invisible disability. Although we may not always be aware of it, its all around us. In the USA, there are some 31 million hard-of-hearing (HOH) people. Across the world, there are some 560 million people with hearing loss (Hearing Review 2006).
For those that acquire hearing aids customer satisfaction ratings are excellent. As digital hearing aids have increased in popularity, so too, have customer satisfaction ratings. MarkeTrak VII recently (Kochkin, 2005) reported customer satisfaction with new hearing aids (less than one year old) at 78% -- similar to the top third of all products and services in the USA. Consumers were not only impressed with their new hearing aids, but they rated their hearing care professionals with a 92% satisfaction rating. Digital signal processing (DSP) technology has essentially replaced analog technology in some 90 percent of hearing aid fittings, and DSP allows modern hearing aids to perform multiple tasks simultaneously for nearly three million HOH users of DSP hearing aids (Kochkin, 2005).
Successful advanced hearing aid technology and highly-rated professionals are good news for HOH clients/patients, hearing healthcare professionals and the hearing aid industry. As professionals strive to achieve even greater success, they have focused their energies more on the individual HOH client/patient and how to best address their unique listening needs. Tools and protocols which allow the hearing healthcare professional to maximally understand and manage the unique hearing needs of the individual client/patient are emerging, facilitating efficient and welcome changes to hearing healthcare.
Sound Activity Meter (SAM):
The Sound Activity Meter (SAM) was introduced by Oticon to hearing healthcare professionals in 2005. SAM doesnt actually record words or conversations -- it records the quantity of sound (in loudness and in percentage of time) and the quality of sound (with respect to quiet, noise, speech, and speech-in-noise).
Using the SAM is simple. The client/patient simply wears it on their collar or outer clothing for a week or so (as indicated above). When they return SAM to their hearing healthcare professional, the information gathered by SAM is sent to the in-office computer, resulting in an Envirogram (see below). The Envirogram details the loudness and the types of listening situations experienced while wearing the SAM, thus removing the guesswork related to day-to-day sound experiences and individual listening needs.
Figure 3. The ENVIROGRAM: Percentage of time is on the vertical axis, Loudness is on the horizontal axis. Noise, Speech-in-Noise, Speech and Quiet are demonstrated via color coding (red, orange, blue, green, respectively).
The Envirogram is a personal sound map which allows the client/patient and the professional to objectively review the sounds experienced while wearing the SAM. Sounds are documented with respect to quantity and quality and they provide objective and important information. The unique individual information gathered via SAM helps the hearing healthcare professional and the client/patient better understand and meet the needs of the individual client/patient.
Response from Hearing Professionals:
After almost 40 years as a hearing aid specialist, Pat Bombino BC-HIS, ACA (Otohealth Hearing Care Specialists, Brooklyn, New York) reported his clients/patients were surprised and delighted to learn about SAM. Even though Pat couldnt be with them to review and record their daily sound environments, SAM did accompany them. Pat was able to use the information gathered by SAM to do an even better job selecting advanced hearing aid circuitry to meet their daily listening needs. Mr. Bombino noted, Sometimes even reluctant patients with hearing loss are surprised to learn the details of their own daily listening environments. When I review the results from SAM with them, theyre surprised to see how much noise theyre experiencing. After we document their listening environment with SAM, were in a much better position to select the most appropriate hearing aid technologies to handle their needs.
Mr. Bombino said many working people experience far more difficult listening situations than they realize, and SAM is able to document those situations. There are also situations in which SAM documents very little background noise with rare speech-in-noise experiences. Individual SAM reports may suggest the need for sophisticated hearing aid technology, or may suggest basic digital technology will address the client/patients needs.
The important thing for the consumer is to understand that SAM is not a hearing test or a hearing aid. Bombino noted, SAM is a tool that allows the professional to understand your personal listening needs and make appropriate recommendations based on the SAM report. SAM allows me to have accurate and detailed insight into my clients world of sound. For patients who already have excellent digital hearing aids, SAM helps me adjust the hearing aids, to better fit their listening needs.
Dr. Debra Brewer, lead audiologist at the Emory Clinic, Division of Audiology in Atlanta, reported she recently used the SAM device to help evaluate the listening needs of a local physician. The physician was interested in acquiring hearing aids, but before proceeding, he was curious to analyze the sound environments he worked in. He wore the SAM for three days and was surprised at the findings. As it turned out, he was actually in quiet some 35 percent of the time but he had perceived he was almost always in a noisy environment. In other words, the percentage of time he was in noise was so bothersome to him, that it took on a greater relevance. Although his speech-in-noise exposure was less than anticipated, it was very bothersome to him, indicating the need for advanced hearing aid features such as automatic adaptive directionality and noise reduction circuitry, which can be found in instruments like the Syncro which employ artificial intelligence. Dr. Brewer reported The doctor was confident after we reviewed the SAM results on the Envirogram. He knew I fully understood his listening needs and that allowed me to recommend a more appropriate amplification system.
Another patient wore the SAM for a few days and found her speech-in-noise exposure was greater than anticipated, Dr. Brewer reported. This woman was actually in the classroom lecturing and when she wasn't there, her office was quite noisy, too. The SAM revealed she was almost never in quiet during her work day and thats why her situation was so challenging for her. The computers, printers, radio, fax machines and co-workers actually created quite a bit of noise, even when she was working at her desk. She was pleasantly surprised to have her observations validated by SAM. In particular, she had perceived that her office was quiet and she was frustrated that she couldnt hear her students when they came to the office. She was delighted to learn that the problem had more to do with the noisy environment, rather than additional hearing loss.
The SAM and the individual client-based Envirogram represent the next step in advanced hearing aid fittings. These tools allow the client and the hearing healthcare professional to accurately document, review and address the unique hearing and listening needs of the HOH client.
For more information about the Sound Activity Meter, please contact your local hearing care professional (audiologist or hearing instrument specialist) or please contact Oticon at www.oticon.com for a referral in your area.
Hearing Review (2006). Associations in Action Symposium Reviews 25 Years of Binaural Hearing Research. Hearing Review, 13(2), 19.
Kochkin, S. (2005). Consumer Satisfaction with Hearing Instruments in the Digital Age - MarkeTrak VII. The Hearing Journal, 58(9), 30-43.
For more information on Oticon, visit www.Oticon.com