 Once again, my name is Ann Thomas. I'm the president of the Hearing Laws Association of America, the Diablo Valley Chapter. And we'd like to welcome you to our meeting today. We'd also like to introduce you to our team members who work behind the scenes to ensure that our virtual meetings are fluid and very hopefully as the best we can possibly do for you. So I'd like to introduce Jill McFadden who's our secretary and Jill, can you just say hi so that your face gets highlighted so people can see who you are? Hi everybody. Our vice president isn't here yet this morning, he's planning on coming. Our treasurer is Walt Bateman. Walt, can you please say hi? Oh, well maybe Walt left. And our all around handyman who helps with everything and I don't know what I would do without him is Allen Katsura and Allen, can you say hi? Good morning everyone, there's Walt. Yeah, so Walt, could you please say hello cause I just introduced you a moment ago? Yes, hello, I had my mic off, I turned it on just now. So here I am, ready to count. Thanks Walt. So today we have a very special presentation and it's called Visualized Hearing. It's a whole new way of relating to your hearing loss and it's about looking at what you have rather than what you don't have. But before we get started, we always give directions on how to use Zoom because it really is still a new medium and it's really a wonderful way for all of us to participate anywhere in the United States for sure on meetings all over the country. But like anything else, you know, you have to learn how to use it. So we'll be giving directions about how to view Zoom on a desktop. The first thing everybody needs to know how to do obviously the most important thing for all of us is how to turn on the captions. If you look at the bottom of your screen, if the captions aren't automatically running, lots of times now they keep changing them, sometimes they just automatically start when we have enabled them on the side of the host. But if by some chance they're not, then click on the CC button, which I have highlighted with a red box and another pop-up window will open up. And in that pop-up window, you have three options. One is subtitles, one is subtitle settings and another one is full transcript. If the captions are not running, click on subtitles and that'll turn them on for you. If you want to increase the size of the font for the subtitles, the captions, click on subtitles settings and there's a slider bar there that you can just slide it to the right or to the left to make it bigger or smaller. I don't know if you're like me, but with my hearing loss frequently, when we're in Zoom meetings, I don't realize that I missed an important word or an important concept till after the captions are already gone from the screen. If you click on full transcript, you will see everything that is being transcribed in the meeting and it's in a scrolling screen. So you can very quickly just look back and see, oh, what did I miss here? Then come back to the meeting and it's still all in the same screen. Since we have a lot of people here and it's difficult to keep track of who wants to raise their hand and we don't want people to feel like they're being skipped over, we ask that you use the raise the hand feature. And if you look at your toolbar at the bottom of the screen, you'll see the happy face with a plus and it says reactions under it. When you click on that, the first item you'll see which is the image below that see it says raise hand. Well, when you click on that, what we see on our side in the participants window, a hand goes next to your name and it rearranges the order that people ask questions so you don't have to worry about somebody getting ahead of you. If you also like something that somebody says, you can also use any of the emoticons that are there, clap your hands, say, yes, that's great. Anything else you might wanna do. We have a new slide today. This slide was motivated by an East Bay chapter meeting last month. It was also originally some of the ideas for this came from a presentation in Washington state. And so people have had a hard time understanding where to turn their audio on and off. So if you look at this image, the orange box all the way to the left shows you where that audio button is and it's a microphone, it says mute under it. So when you mute it, a red line goes through it which means that it's not active. When you click it again, it becomes active. Sometimes people need to get up and do something else. Sometimes something happens to them and you want to hide your video for a moment. The way you do that is see the video camera. You click on that, you can turn the video camera on and off. If you wanna send a message to somebody, you just click on the chat and another little pop-up window will open up and you can say hello to your friends. You can do, ask a technical question. You could tell us that we're talking too fast, anything that you want. We have people monitoring that in the back. I've already showed you where the reactions is and the blue button on the bottom shows you where the captions are. You have an option in the view menu which is up in your upper right-hand corner. If you click on speaker, what you see there which is highlighted speaker, you see the speaker and the presentation. And in the middle of that, there are two white lines. If you take your cursor over those two white lines, you can adjust which side of the window is bigger. So for some of us, it may be more important that the presenter's image is bigger because it's much easier to enhance our hearing ability by reading lips. For others of us, we may have vision problems and we might decide, oh, I can see most of that but in the moment, there's something that's too little for me, I wanna make it bigger. So you can just slide it to the left, excuse me, slide it to the right and then the presentation becomes the largest piece on the screen. This is for me as well as anybody else when we get to Q&A and other parts of our meeting today, it's a reminder to speak slowly. So I know when I get excited or I get nervous, I talk faster and that makes it more difficult for us to lip read, it also makes it more difficult for us to understand auditorily and it also makes it more difficult for the captioner to caption accurately. If you have an external microphone, we'd like to remind everybody you don't have to get up and get it right now for this particular meeting but bring it out and use it. An external microphone is the creme de la creme for Zoom meetings because it improves the audio clarity which is what we need, it's what the captioner needs. So at this time, I'd like to introduce Jay Allen Zimmerman and Jay who has profound hearing loss decided that he wanted to think of another way of looking at his hearing rather than thinking about everything that was gone. Bray and Grau is an audiologist, he's in Washington state and the two of them have collaborated on this presentation and I would like to turn the meeting over to them at this time and Jay has asked that we start the meeting by showing the video that explains what the visualizer is all about. So let's see how well this works. Hello, I'm Jay Allen Zimmerman, sign name Jay. I'm a composer and musician who became deaf which inspired me to try to create new ways to see sound. Now I'm building on this experience to create a new way to see hearing. There are nearly eight billion people in this world with 16 billion years and personally nobody understands the hearing but we all understand the vision, right? If you can see near best, you're called near sight. If you can see far best, you're far sighted. If you can see 20 feet away, what the average person sees 20 feet away, you have 20, 20 vision. We understand seeing better because we use clear factual terms that describe the ability you have. But for hearing, we're still using sad, ambiguous terms to describe the ability you don't have. Hearing loss, hearing impaired, hard of hearing. And the weird thing is, most of this negative language comes entirely from a graph, a visualization of hearing data called an audiogram. Its basic framework is older than indoor plumbing. And so its design is based on the philosophy that the best way to measure hearing by comparing it to an average. So at the top of the graph, it defines some people as normal. And then everyone else becomes mildly, moderately, severely or profoundly abnormal. They don't say the abnormal part out loud but that's what this comparison means. This abnormality hierarchy is not only insulting but also confusing because it forces all your hearing data to get completely jumbled up in a way that conflicts with the basic understanding of sound. It makes your left ear an X and your right ear an O because the right side is for high pitch and the left side is for low pitch because the low part is for loud and the high part is for quiet. But the true natural curve of quiet has been straightened into a line for normal in order to better show how much loss you have from normal and define you as a loser. The resulting image then is not a picture of hearing. It is a picture of a loss. And because hearing has been grabbed this way for over a century, some of these pictures of loss have been given names and that's why a doctor might say to you that you have a ski slope loss or a cookie bite loss or you can't hear in the speech banana. Would we tell people with glasses they can't see in a lip apple? Now it's time for a more modern system which I'm calling the hearing visualizer. A method that is more inclusive and promotes successful outcomes by being focused not on loss but on ability. Want to combine computer accuracy with simple scientific truths because in truth there is no normal but there is a shared reality. And one thing all humans share is how our bodies react to intense sound waves. Intense sound waves can cause discomfort, pain, eruption, ultimately death even if you hear no sound at all. Truth one, too loud is the same for everybody. So if we look at how the full spectrum of sound waves affect humans too loud is generally a straight line that's common for all and too quiet is generally a curved line that is different for all. So if you turn the curve of quiet into a straight line who just turned the straight line too loud into a curve? So the straight line of loud is restored and visually intersecting with your ears. So one of about it, this is dangerously loud no matter what you hear. Truth two, things that are closer sound louder before the diagram that does tested and measured hearing volumes in terms of distance, writing down how far you can hear. Six feet, 12 feet, 30 feet, 40 feet. So loud is shown right where you are and too quiet is shown far away from you and the distance between too loud and too quiet shows if you are far hearing or near hearing. Truth three, all hearing is important. The other thing I'll human share is music. It is a unique human experience embedded into all the rituals of life. But because the audiogram came into existence for the invention of a telephone, it still limits the field to only those tones that are needed to transmit speech over copper wire. The range of tones shown is so limited that the very highest and lowest sound I've left out including the entire lower half of a piano. The entire full spectrum of human hearing is shown. I'm displayed in alignment with how we think about sound. With a low sound shown low and high sound high and the tone most commonly heard in speech in the mouth area. No more speech banana. And the full spectrum is divided into three easy to understand sections. The bass, the treble and the high end where we find all those sounds that are too high for vocal chords to produce. Truth four, we hear in stereo. We don't have to stay trapped in this side view. The confusion of layered data can be eliminated by separating and mirroring the data for your other ear. This creates a widescreen view of your entire field of hearing. Seeing all your hearing data as a hearing field shape helps you understand your abilities quickly. The average person previously graphed as a straight line normal now sees a far hearing field that's wide and open. A person with a ski slope lost now sees a shape like a cave which shows an ability focused on the bass. A reverse ski slope lost now shows a shape like a valley which shows an ability focused on the high end. A deaf person like me previously graphed as severely or profoundly abnormal now sees a very near hearing field this narrow. And remember, hearing doesn't happen with just your ears. So we can also begin to graph your sensitivity to sound waves through touch and feeling. In fact, once the data is imported, we can do anything. We can layer multiple hearing fields to show how the hearing has changed over time. Layer the potential benefits of hearing technology. Use scientific formulas for sound decay to show for example how far away your phone can be if you want to hear it ring. This is just the beginning. No more negativity, no more confusion, no more defining people and levels of abnormality. Because in the hearing visualizer, your left ear is left and your right ear is right. High sounds are high, low sounds are low, too loud is too close, too quiet is far. Volumes represent actual sound wave intensities and the full spectrum of human hearing is shown including every note on the piano. I want all eight billion of us to understand our 16 band ears to make the best use of our hearing fields when choosing cell phones and headphones long before meeting any assistive hearing technology implants. Because the truth is eventually either one needs some hearing assistance, that's normal. Thank you, thank you. So can level one hear me okay? If so, give me a thumbs up. Yeah, okay, great. So I am actually deaf, so I do need you to like wave at me or put a note in the chat if you wanna get my attention, if you can't hear me if I'm speaking too quickly. So thank you so much for watching that video. I'm coming to you from New York City and we have Brad with us today and Brad, where are you? Well, Brad obviously, hang on, there we go. So it's funny that the audiologist forgets to unmute his microphone. I'm depending on the captions there, I have no idea what you just said. Okay, what was funny was I forgot to turn on my microphone. Oh, that's what happened. We made everybody deaf like me. Exactly, so I'm an audiologist. Now you know what it's like. So we thought the first thing we would start with today is a little poll, a poll about your first hearing test. So if you could bring up the poll first and the first poll is, I understood my first audiogram, if you've had more than one, try to remember the first one. You understood it just by looking at it or after my doctor explained it or after I studied it for a while or I still don't fully understand it. And you go ahead and vote on that. And while you're voting, I'm going to admit to you that I honestly did not understand my audiogram at all when I first saw it. And it just looked like some sort of horrific battle of tic-tac-toe to me. And I started selling my entire life because I'm a composer and musician, but here was this thing that was supposed to be about sound and I couldn't make any sense of it. It was very, very frustrating. Plus, for those of you who don't know, I actually became deaf in part because I was living about a thousand feet from the Twin Towers when I fell on September 11th. And if you want to see more about that experience that have footage of me in the new documentary on the History Channel called, I Was There. And if you want to try to understand how this event could have cost, including problems for people, you can see the epidemiological studies that they conducted on the World Trade Center Health Registry website. Let's see if we've got this. Captain World Trade Center Health Registry. Let's see, I'm sorry, it's a complicated words. Oops, I just put up a screen here, sorry. Anyway, so obviously, September 11th was a pretty horrific way to acquire deafness. And I found that then all that grief and sadness was magnified by the way that the medical community talks about and treats hearing and basically failed to help me at all. So it just definitely lost, thank you. So let's see if any of you have a similar experience. And if we have, everyone is voted and could you bring up the results for us? So it looks like there are a few people who were very lucky to understood it right away. That's fantastic. And then other people took longer, but the majority still don't understand it. And that seems to be true for most people. In fact, apparently four out of five people do not understand their hearing ability well enough to explain it to their family and friends. And 80% of what a person is told after hearing test is forgotten immediately. So those are pretty disheartening statistics. So now I want to explain what happened with this video. So what happened is I invented this after we were up at Rochester for HLAA. And I was discussing this with Brad and other people I've entered this a little before but started sharing it then. And then after I got the patent file then this video came out in March. And I have had an overwhelming positive response to this video except from a few audiologists. And so that's why we have an expert audiologist with us today. And Brad has actually been kindly answering all of my questions throughout this whole process. So Brad, do you wanna tell us a little bit about your experience you've been an audiologist for many years, right? That's correct, Jay. And let me explain the mask. I'm in the airport and on the way here my clear mask cracked, so I had to switch. So I'm gonna be doing- Why are you getting up slower? I'm gonna be putting my mask on and off. I'm an audiologist. I've been practicing for 30 years and have worked in all aspects including the Veterans Administration. And I have to say that, Jay, everything you're said in that video is interesting but it's completely opposite of everything I've ever learned. So I'm kinda interested to see what you have to say here. Okay, terrific. So I got a note in the chat but I need to speak slower. So just to recap a few important things that I've said so far. Basically, I am deaf. I don't know if anyone knows sign language here but I am deaf and I became deaf partly because of September 11th. And if you want to know more there is a documentary on the History Channel and there are epidemiological studies. This is the hard word. Thank you, captioning. Epidemiological studies available to explain how you could acquire hearing loss or deafness through September 11th. So, so no, Brad, in terms of the video the first topic I think we should talk about is loss. So many people in our community talk about stigma. The stigma of hearing loss. The stigma of hearing loss but rarely do we mention part of that stigma is because we call it loss. And so the loss framework that I showed you in the video I'm gonna try to hold this up for you. I apologize to people with terrific hearing if you hear paper rustling. Consider it a hearing test and you passed. So this is what the loss framework does is it defines some people as normal and everybody else as mildly, moderately, severely or profoundly abnormal. So the last thing I wanted after September 11th was to be labeled with loss and to be given an identity of profoundly abnormal. So I rejected that. I took on the label of deaf and what is interesting to me of deaf is the label of deaf. Thank you, thank you. My captions always get the word deaf wrong. It comes out deaf. So I actually like the label of deaf. I feel that label of deaf is empowering. And actually Brad, if we look at the history I'm gonna wait for the captions to catch up. Okay, if we look at the history of the term hearing loss actually everybody was called deaf before the early 1900s. So this label of a loss emerges in the same timeframe when they started to ban sign language in deaf schools. They would tie down the hands of deaf children to force them to speak. And then the abnormality language, abnormal, abnormal. This begins in the same period when eugenics became popular. Eugenics, that's E-U-G-E-N-I-C-S. Great, thank you, captioning. And eugenics are how the Nazis, how they justified killing, not just Jewish people and gay people, but also disabled people. So I realized this might sound extreme, but to me, this loss framework is not just negative. It is perpetuating ableism. Right, so Brad, could you tell us a little bit about why the medical community focuses on loss instead of hearing ability? Sure, that's very interesting, Jay. It really does come down to what we think we're good at. And what we think we're good at is fixing stuff. And so in order for us to determine how much of a fix we need to apply to a given person, we have to determine how different they are from a person who doesn't need a fix or normal, right? So I haven't really thought about your perspective in a long time, but you're right. My whole background, my whole education, my whole approach to hearing is to determine how far away you are in function from a person who doesn't need me at all, and then use that distance, that level of disability to define the kinds of treatments that I could give you. And we've done that for 100 years. And as far as I know, you're the first person to really offer an alternative to define hearing rather than define hearing loss. All right, thank you. Thank you, that makes a lot of sense. I mean, what you're saying about determining if someone is defective in a sense, it's because medicine uses the pathology model. Medicine, medicine uses the pathology model and pathology is disease. So I want to switch this. I feel a hundred years have been long enough. And so I started to really to investigate what is behind this label of normal. And that's where I found this. This might be difficult to see, but basically this is a collection of tests that we're done on people over many, many decades to find out what is the hearing ability of an average person. And so what is under that line of normal is actually this curve. So I'm gonna rotate it into my framework. And here you can see that it's quote unquote normal, it's actually an average and average person hearing on the quiet threshold is a curve on the quiet threshold is a curve. But at the same time I notice that the threshold for pain is actually a relatively straight line. And this really excited me because if we need to have some sort of baseline instead of using a baseline of normal we can use a baseline of loud, too loud because too loud is the same for everybody. So Brad, I actually know this from real life because I will be walking down the street and suddenly I will feel horrific pain in my ears and I will grab my ears and then I will turn and see that it was a fire engine. So I can actually sense the pain of a fire engine siren that I cannot hear. So I'll repeat that for the captioner. I can actually sense the pain of a fire engine siren that I cannot hear. Brad, how is that possible? Well, it's possible and thank you for bringing out that graph because you reminded me of my graduate school 30 years ago and you reminded me how old I am. So thank you. It's possible because what happens in your ear canal is not hearing. What happens in your ear canal is physics. Sound is the movement of air particles and the more intense the sound the harder and farther those air particles move. Our brain interprets that physical movement of air particles as sound but your eardrum is simply a microphone type of a vibrating system. So when that fire engine goes by it pushes the air molecules in your ear canal so hard that your eardrum stretches to the point of pain and even though your brain can't interpret that as a sound we've stretched your tissues to the point of pain. And so it absolutely makes sense that that average of the loudest sound that people can hear is a straight line because the human body reacts to somebody punching it the same way. So if I walked up to you and I hit you with a stick you would get a bruise because that stick is causing tissue damage. So that makes perfect sense. Okay, right. And at a certain point even if our body does not interpret a sound as hearing we can actually cause eardrum rupture. And so what I found from my research is even if you hear nothing your eardrum rupture at a sound of about 160 decibels and there are many different noise warnings you should avoid things that are 140 decibels. What is the threshold of pain Brad? What would you say in terms of decibels and sound pressure? Around 120 decibels of sound pressure level is going to be painful for most people. Remember, that's sound pressure level. That's the actual measurement of sound. Right, right. All that sound pressure level because that's actually what's happening in your canal. So I was really glad to discover basically we can find a commonality between hearing people and deaf people all humans will experience this threshold of pain. So I decided to use that as my new baseline perception. No, my new baseline of reality. So I want to graph reality first, which is sound pressure and then put a person's perception of that reality on top of the graph. Because what we have right now with the audiogram with this normal abnormal, normal is somebody else's perception of sound pressure and it's comparing their perception with your perception and that's why it says you're a loser. Instead, we're going to graph reality of the loud and now we can graph, okay, what is quiet? What is quiet? And so Brad, this was really, really fun to go back into history and discover how the first hearing doctors tested perception of sound and they did it by distance. So I found these old documents. So in these old documents, they would actually measure if you stand away 40 feet or you stand away 10 feet or six feet. So if a doctor was using a chicken watch and held it 40 feet away and you could hear it, that's really far hearing but after the chicken watch had to be close to you like two feet, then it was really clear that you are near hearing. I just feel this is so much clearer than what the audiogram does. Why did audiologists and hearing doctors stop measuring loudness by distance? Well, I think the, and I'm going to be giving my profession the benefit of the doubt here. We tried to get greater accuracy and one of the real pushes to get more accuracy was after World War II, when we first started to define hearing injury as a couple of years ago as an insatiable disability for veterans returning from the war. The first people who looked at hearing from that perspective of trying to quantify hearing were speech scientists and they were very detail oriented. And we also began to have technology like the ability to make a device that would create a very specific amount of sound in sound pressure level. And that would then allow us to document more precisely how much sound a person could hear. And that's great, except if we don't also be careful about the language we use to then describe that. So we did a good faith effort of documenting hearing better, but from what you're saying, it sounds like we might have gotten a little bit off track. Right, well, so when I look at the old research, the earliest doctors were actually using sound pressure. So I mean, the goal of being more accurate is a very worthy goal. But I feel like today's audiograms, starting in the 1960s or so, they became less accurate in a way because they're distorting the truth. So if you have the problem is if you have a natural curve of quiet and the natural straight line of loud, if you now straighten the curve of quiet, you've turned the straight line of loud into a curve. And I find this so, so very frustrating, Brad, because these numbers are not useful for anything. Hearing level, they're calling them hearing level decibels instead of sound pressure decibels. So when I try to check and see if a hearing device will be loud enough for me, I can't use the numbers on the audiogram because the numbers on the box are different. If I want to protect my hearing, I can't use the numbers from the CDC that says don't have a volume B this loud because those numbers don't match the numbers on the audiogram either. So it seems like the only purpose of turning that curve into straight line was to define me as a loser. Why do we even have them? Well, since you're not that old, I don't think they were trying to turn you, Jay Zimmerman into a loser, but I get your point. No, I think the reality is, is around the time that this calculation, this conversion to hearing level happened, we started to do more communication of hearing ability or disability to professions that were not audiologists. So people in insurance companies started to want to know how much hearing loss you have. And the people who calculate disability awards needed something, a very simple formula to say, if these levels reach this particular level of abnormality, we'll pay you this much or that much. And so while it's certainly possible to do that with sound pressure level, it was more confusing for the lay person. And I believe that that's where we took that right turn into dealing with hearing for the purposes of people other than the person with the hearing loss. Well, it seems like also this happened when they were trying to do everything on paper and they were trying to draw things on paper, now you should have the ability to export that information to these other people in different forms, but you don't have to give it to us like that because the other problem with defining that one line is normal, it's normal for who? And if you look at what is normal in terms of age, that line of normal really only represents people in their 20s, that is not normal for people who are 80. So this makes the audiogram not just ableist, but agist. It's a good thing I like you, Jay, because you're beating up my profession pretty bad here on a Saturday morning. I'm catching up, I'm sorry, well, you know, I'm also a theater person, I write musicals, so I can be a little dramatic, so I apologize. That's okay, you're absolutely correct. I think it's, what, sorry? You're absolutely correct. And that last graph that you showed is really important because normal, if we approach it from do I have the hearing I need to enjoy life, those people on the 80 year olds don't have all the hearing they need, so they're really average learners, not normal levels. And again, it's language that really, I think more than anything is confusing because if I was 20 years old and I had that bottom graph, then the audiologist would tell me I need a hearing aid because I'm not normal. But if I have an 80 year old with the same graph, I might say, well, you're normal, or he might say, I'm normal, but I still don't hear my wife, so that makes no sense. So I am beginning to agree with you that the problem is the language is really, really confusing. Right, so I mean, the thing is, someone who wants to hear better, and they've heard great the whole life and now they're 70 and 80 and they want to hear better, there's no need for them to walk in a doctor's office and be told they're not normal, or they're told that they are bad. You know, this language doesn't help them at all. So for people who want to try this at home, if you have your audiogram, if you have your audiogram and you want to just understand it on the basic level, then all you have to do is rotate it to the left. If you rotate it to the left and imagine yourself standing where loud is, then you can see that your ability is between your perception of loud and your perception of quiet. And since everyone's perception of loud is relatively the same, then we don't need these other comparisons. We've got all your sustained grants and everybody can be treated equally. So what this does then is what you've rotated, you've created a side view. So you can see between you and your threshold of hearing, that's how much dynamic range you have. So the next thing I want to talk to you about, this is super, super important to me as a composer, is the truth that all hearing is important. And I find it's so frustrating as a composer where they walk in and they say, you're deaf, you're deaf, you're deaf. And I'm like, but I hear an air conditioner. I've got to hear an air conditioner. So I tried hearing aids for years and years and nothing helped me. What I finally realized is that all my hearing ability was not even on the chart. I was not even measured. I would go to hearing doctors, I would go to hearing aid manufacturers and I would say, can you make me a hearing aid as good as what I can do with a phone app and my own earbuds? And they would say, no, because they don't even address the frequencies I can hear. I've not even been able to find an audiologist who would test me under 250 Hertz, which is just middle C on a piano, because I asked them and they said their machine could not do it. And then when I was told to try what are called frequency transposition aids to supposedly move sounds lower, I found out what they considered to be low, which actually lack a soprano's high C. So in the hearing visualizer, I've finally switched this around so that you can see what I would call the bass, which is the low notes on the piano, middle C, treble. And then the high end, which is those very, very high frequencies. But the audiogram, this picture, with the audiogram, if the last frequency they test is 250 Hertz, it's cutting off all this on the piano. So, Brad, why is the audiogram cutting off all this sound that I can hear? Why is it forcing people to call high notes low? Well, first of all, I'm not sure what's up with your audiologist because every commercial audiometer can test to 125 Hertz. And that's still not low enough, but that's a different conversation. I try not to throw my colleagues under the bus, but when they start out there, I feel I have to point out, I call malarkey, so let's put it that way. The reality is that it is certainly possible to create earphones and a sound system that will test all the way down to the end of the piano and all the way up to the top of the piano. However, hearing aids are very small devices. They have very small microphones and they have very small speakers. And what's happened unfortunately over the years is we went from first thinking that only the sound we could transmit over a telephone wire was important. And then we said only the sound of speech is important. And then in the last 40 or 50 years, the hearing aid industry has told us that people with hearing loss will only wear things that are very, very small. And therefore our entire conversation about hearing is dictated on what is available from six manufacturers, not what is possible in the world of electronics. And so, yes, absolutely, I have earphones that I'm using right now that have much better fidelity than the hearing aids that I sell for thousands of dollars and these earphones are $200. So it could possibly be that I could test your hearing all the way down to the low end of the piano and all the way to the top end of the piano. But since those six hearing aid companies don't make a product that works like that, they have convinced my profession, unfortunately, to only test within the range that they can make something to sell here. And I haven't really thought about it so much until this conversation, but I owe everybody with a hearing loss and apology for participating in that BS conversation. Well, thank you, Brad, thank you. I mean, I showed earlier that I carried these music visualizers and we started actually visualizing speech. And then what I was able to see is, the assumption of a hearing aid is that you need to understand speech and that's most important. And then to understand speech, you have to hear the consonants that are super high in pitch. But those are only the fundamental frequencies. When I look at this speech through a visualizer, it's actual undertones and there's noise artifacts and there's other things happening that I actually find useful. And so the way I've had to communicate is I go and I buy a musician in ear monitors that can amplify way lower than 20 hertz to 20,000 hertz. I can go all the way down to five hertz and they only cost 30 bucks for a pair. So I hear what you're saying about these manufacturers. I mean, could they possibly make hearing aids and CEIs that could do the frequencies that I wanna have? Absolutely they could. However, you'd have to convince the marketing people that there was a large enough population of people who would say, yes, I will buy that. Yes, I will wear that to change that. Now, interestingly enough, we're right now in the public comment period of something that might help us. And I think we're gonna talk about that later, but it's technically absolutely possible for somebody to create hearing enhancement products that provide a much wider range of capability, both in terms of frequency and in terms of intensity. My challenge is to stop thinking, my personal challenge is to stop thinking only of those six hearing aid companies when I look for solutions for my patients. Well, I think also, let's stop thinking that only speech is important. That all sound is important because I feel, for me, it's about sound to be about a pleasing experience. You know, some people use vibrations and other things just to feel better and a hearing aid in the way that those are when they're able to find those super high frequencies, I find them really painful and exhausting. So I want my listening experience to be pleasing. So I'm gonna skip forward here to the last truth, which is really obvious that we hear in stereo. And so by acknowledging that we hear in stereo, we shouldn't have to just be visualizing things in this layered manner. So that's why I took with my hearing visualizer and you can see a full view of your hearing field. If you want to try this at home, all you have to do is, so you rotate the audiogram to the left so that the high sounds the high and the low sounds are low. Now you take the data for your other ear and mirror it and that will give you a rough approximation of your hearing field. It's better if we can import this data into the visualizer and convert it into actual sound pressure decibels because that will be more true. But at least you will get an idea. And so Brad, what's that gave up trying to understand the audiogram? And I discovered that I could look at it in a completely new way. Oh my God, it blew my mind to finally see a thing called a hearing field which is a term that I basically made up because we talk about the field of vision. And suddenly instead of seeing a ski slope lost to nowhere, I could see my hearing is sort of a space. It's my personal space. Yes, my space is smaller than most people but it looks like a space instead of a ski slope. And when I did this for other people's hearing data, each of their personal hearing fields look like spaces, different kinds of spaces. So I'm wondering, you know, when I look back at the old audiogram, you know, and right is high and left is this and loud is low. I mean, it's just so baffling and what happens is it makes these pictures, makes these pictures of ski slopes and cookie bites and speech bananas. This just seems so nonsensical to me and hard to understand. And that might be why people give up even trying to understand because the reality is, as I said before, 80% of what a person is told after hearing tests is forgotten immediately. Four out of five people can't explain their hearing defender friends and 80% of people who need technology, hearing technology have nothing. So Brad, I know that these patterns, speech bites and cookie bites and ski slopes, is there some value? Is there some reason, some benefit to using these patterns or to having some sort of patterns and this wacky language? Why do we have it? Well, I think we have it for a lot of reasons. Whoops, we have it for a lot of reasons and I just found out my gate changed so I might have to go mobile here. Anyway, so the reality is a lot of this started because as you said, we started on paper and the paper limited a lot of our ability to present data in different ways. But ultimately, I think that we can adapt if enough people who have hearing loss can understand this new model, get their data converted and then have a conversation with their audiologist to say, hey, look, find out about this. I wanna keep working with you but I no longer accept your language of describing my hearing. I only wanna talk about my hearing in this new way. Now, I am cautiously optimistic that audiologists could do this and this is a very skewed population that we're talking to. The audiologists of active HLAA members are probably going to be more responsive to this. However, I also think that we don't have to necessarily wait for the audiology community to come along because we have new legislation that is going to allow other groups of people to assist in hearing with over-the-counter products and those people already talk about sound in sound pressure. They already talk about things like fields of sound and so everything that you're talking about that is very, very logical, I believe is going to fit into the people who are not those six hearing aid manufacturers beginning to enter into the business of helping you hear better. So I'm actually very, very optimistic that this new framework can happen. I just am not wanting the people with hearing loss to wait for me as an audiologist to understand it, to start to use it. There's other people out there. Remember, Jay, only one out of five people with hearing problems come to see me. 80% of people who probably could benefit from some type of hearing enhancement have yet to get help. Maybe this is a new way that those people can have a conversation with somebody other than an audiologist to help. That would be my hope. Right, so I think the reason people don't come is because of all the stigma and all this baggage, this historical baggage. So on one hand, we have what sort of like a rights issue here or a disability rights issue because if you want to see our full spectrum, I'll call it 2020 hearing from 20 Hertz to 20,000 Hertz but if the audiogram is cutting off the low part, it's cutting off the tones of voices of men, which means it's not just ableist and agist but also sexist. So I think this is an argument to say, okay, we don't need that, we don't need that, we can look at it anyway. And what if you're saying we don't need to wait for you, what we need from you and from audiologists is we need our data. You're gonna test this, we're gonna have the data but we need to have power over our own data to give us our data. So we can visualize it in an entirely new way and then hopefully that will inspire further products. So this is a good segue to go into our last section before we do the QAA, which is to talk about the future. So I know there will be barriers, it will be hard to get some organizations and industry to change let's imagine that we could actually change things. So as I said before, the WHO estimates a percent of people who need hearing devices don't have them, that makes 350 million people in the world. They need better access, better tools and I feel better words. So the first thing I think we could change that would be the easiest and fastest change is just to stop using stigmatizing scary language. We can stop perpetuating the stigma of hearing loss by not calling it loss. Instead of talking about hearing loss, just talk about hearing ability or hearing difference. We can follow the model for eyesight. We can say we are far hearing or near hearing. We can talk about what is our frequency focus. My focus is on the base. So I'm very near hearing with a base focus. Now it is just factual information without judgment. And I think when you brought up the FDA rules, this is terrific timing to change this. We can start by taking the negative words out of the rules themselves. I just read all of it and it's just full of this historical baggage of these negative words. And then it's talking about how we're gonna label over the current devices. So we need to label products, not people. There's no reason to go in and see it says, oh, this is for our mild hearing loss person. If you want to use the word mild, let's do like we do with drugs and talk about what is the dosage or the treatment. So if it's mild, it's mild amplification. So this device will give you just a bit of amplification because that's all you need. If you moderate instead of moderate hearing loss, you can say moderate amplification. They could put that in the box for someone like me if they feel it's dangerous to have really loud products on the market, which they're really loud products everywhere. You can get them from other things but not for hearing devices. And someone like me maybe would need a prescription for maximum strength amplification. You know what I mean? So that would be really, really clear. It's about the treatment offered, not the identity, labeling the product, not the person. Do you think that we could just use better words to start normalizing hearing health care from cradle to elder care? I do, I do. We've seen it in speech pathology, for example. We used to talk about speech deficits and now we talk about speech differences. So that's already happening in some situations. And hang on one second. There was a very loud announcement I wanted to just stop for a second. So yes, we can absolutely do that. And the, I believe you're correct. If everybody in HLAA writes a letter in response to the FDA initial guidance and all they say is the stigmatizing language in this document must be addressed and you must contact HLAA and Jay Allen Zimmerman in order to do that. If every member of HLAA just did that, that would give the FDA notice that there's something wrong about the language. And that language is the key, I agree, to getting a better understanding of labeling and all of that. I would even argue that it doesn't even have to be mild amplification, but we could put the actual decibels. This product provides this many decibels of gain at these frequencies. And because we can learn patterns, we can simply say, here's a hearing visualizer. Here is would be the perfect normal hearing visualizer. This product will cover this range and then all you need to do as a consumer is graph your personal hearing space into that range on the product label and you'll know immediately whether that's an appropriate product for you. That's the easiest way to do it. And I think that that's absolutely possible, but it's critical that we put a halt to the FDA guidance to have further discussion on this. And the easiest way to do that is simply have every HLAA member write a very simple sentence. This language is inappropriate and outdated and before guidance is published, we must correct this language. Something very simple like that. Right, and I feel like, you know, it's a deaf person stop putting me in prison, stop saying I can't have products that can help me. They're saying these products are only for mild and moderate losses because the decibel amounts, they're going to limit to 115 dB. So I agree with you, we don't have to use mild and moderate, we can just stop using that. Let's say this one does 80 dB, this one does 100 dB. What I need would be 130, 140 dB. So then it's about what it can do. It's just like food. Now we need to see the ingredients on the box or the ingredients in this device. What is the frequency response of the microphone, the frequency response of the speaker. So I can do what you say, I can take my visualization, say this one will boost the base. Yay, this is the one that I need. This one will boost the treble or the high end. That might be what you need. So I think that could just make it so much clearer and give us what we need. I know we're running out of time and you need to get on the plane. So I'm going to try to skip through this so we can get to our next two polls. But basically once we have the data, we can have apps on our phones. We can scan things in the store. We can instantly see what this device offers us, whether or not we can hear our phones with this device. So let's move on to the very last thing. I think I explained to you all basically how you can convert your audiogram into this framework. So all you have to do is you take those access and hours that we're like here on the top and you separate them and put them on the sides. And now you can see if you are far hearing or near hearing. You will be able to see if the high pitches are higher if the low pitches are low, you'll be able to see which things you hear better. So a person who has normal will have very far hearing. A person with a cookie bite, you'll now have something more like mid-loss, probably straighter because real decibels are not curved the same way as seeing level decibels. And the combination shows you, you hear and feel. So I realized this was a lot of information to dump on you in this session. But we now wanted to do another poll. Do you feel after this talk that you understand your hearing ability, not your hearing loss? Do you understand your ability just a bit better? Do you understand if you were maybe far hearing or near hearing? So just true or false, did this talk help you understand your hearing ability? So Anna's gonna bring up that poll while we're bringing up this poll. J, do you see the poll? All two? So while we're bringing up this poll, I want you all to think about all the stuff that we discussed, things that we could do, that we could use better words for hearing, that we can think about hearing not as a loss but as an ability, that we can view our hearing as a hearing field instead of a loss. So we're gonna bring up the third poll. Is this poll two? Are we finished? Everyone voted? Then let's bring up the results there. Okay, that's terrific. So the person who said false, if you would just send me a message, what I could do, the better help you understand your ability, I would really appreciate that. And I will try to help you next time. So let's do the third poll real fast so we can get some questions before we lose Brian. Going forward, what are you willing to do? What do you want to do? Are you willing to use positive words for your hearing? Are you willing to think of your hearing as an ability instead of an abnormality? Are you willing to view your hearing as a hearing field around you or all of the above? If you don't agree with any of these, just don't vote and we will find out how many people just don't like any of it. So thank you for doing that. And when everyone's voted, we will bring up the results and then we'll go to Q&A. Thank you so much for having us today. And do you think we have our results? Whenever you feel we have results and you can show that, I do want to thank you for having us here today. Oh, that is wonderful, wonderful news. It looks like the majority are willing to do all these things and that many are willing to do some of these things. So that is a terrific start. Anything you are willing to do can really make a difference for people who are acquiring a new hearing difference. They will have a better world than what we had to deal with. It will be easier for them. That's why I do this. So that is really terrific. Thank you so much for voting and for listening. And I'm going to now turn it over to whoever is going to leave the Q&A and we will do our best to include Brad. Do you ever went see the results of polls without you asking? So I saw the results of the polls. In general, the three polls, the first one, most people did not really understand the audiogram even today. The second poll, most people learned more about their hearing abilities today. And the third poll, most people are willing to do something different. Okay, so I can't tell who is talking. Maybe instead of that screen share, we can see whoever is talking and we're going to take a question from someone. So if you want to ask a question, please raise your hand. It's in the reactions and we're happy to call on you. So I see Dr. Mimi. So Dr. Mimi, can you please unmute yourself and ask your question? Good morning, everyone. Thank you for your presentation. It's... Can you turn on your video also because it helps me to be able to read you. I have trouble with my video. Okay, so everybody let me know if the captions are incorrect while you're answering the questions just so I don't answer the wrong thing. Go ahead. Okay, I wanted to thank you for your presentation. You brought us a different perspective of looking at hearing and hearing loss. And in majority, I agree with you. I am an audiologist and a scientist and I believe as a scientist, we have to keep our minds open to different way of thinking and different way of being. And I truly appreciate you brought us your perspective as a musician. I completely understand your need as a musician for having more base for your need and the type of hearing loss you have. But majority of the people we see in our clinics, they don't need that lower level of hearing amplification. And research has shown that if we amplify lower levels below 125 on a normal conversation day to day, people having trouble understanding. And it makes conversation difficult. This is just a comment that I want to make. And the second one, I would like you to show us the graph that you had, the original graph. I think the position of your high pitch and low pitch have been mixed, has been reversed. Can we look at that? You showed us a graph early on. So are you talking about, are you talking about the graph for the studies? The studies of the choir and the lab? Yes, yes, that's correct. I think the way you marked your high and low is reversed. Your graph is high? No, no, no, okay, okay, great. So actually, so if you see the way these charts are numbered, typically they would say a high frequency and this is high frequency. So high is over here. So the high is in the correct position. The second way though, they are measuring volume, they're not measuring volume like you do on an audiogram, they're measuring volume in terms of dynes, sound pressure and dB one dime per centimeter square. So when they do that, it is actually reversed that we have loud down here and we have high here. So now I have reorientated it so you can see that the high pitches, average person has better more frequency response in the higher frequency, it's around a thousand hertz and they have less response in the lower frequencies. I'm gonna let Brad answer some of this if he would, but first I do wanna mention, you mentioned studies that show that the lower frequencies do not help. I would love it if you would share those studies with me. You also said that most people coming to your office don't need or want the lower frequencies, are they even aware that's an option? So my point is, the belief here is that the most important thing is to understand speech and that assumes that people actually say what they mean. I find that most people don't say what they mean, what they're really trying to express is in the subtext and that comes out in the tone of the voice, the emotion in the voice, which is lower than the primary frequencies in the speech consonants. So I think there is stuff here to explore and instead of this thing with the old thinking, I appreciate so much a comment and I would love it if you'd share your research. Brad, do you wanna comment about this? Are you with us still? I think he may have left, he said. Yeah, I did know, I'm here, so I would agree to some extent, however, I do agree that Jay is correct on the graph, but I also feel that one reason patients don't want a lot of low-frequency information is hearing aids are really bad at providing that with good fidelity. Right, so most hearing aids, as far as I know, don't even boost 125 hertz, they usually top up at 250 hertz. So what you might be saying is I don't want low frequencies if what you're calling low is 250 hertz, that to me in the real world is not low at all. Low would be maybe 20 hertz, low would be five hertz, those things are low. So first we have to see if the device is even capable of producing those sounds. If nobody liked that, if they couldn't hear well with the lower frequencies, when I got to interviews and really expensive newsrooms and stuff that I put through their headphones on and I put these Macs on, those have so much resonance in the various because it is a warm, beautiful, expensive sound. And that ideally, if people were able to have things of that quality, they would hear better. Unfortunately, that is not offered. Please do share that research with me. I'd love to read it, thank you. And thank you for your comment, I appreciate it. I'm sorry folks, I'm gonna have to sign off. I see you have your hand up. John, can you? Wait, Ann, I'm gonna have to sign off. I'm getting on the plane. Thank you very much, Brad. Good job to me. Oh yeah, thanks, Jay. We'll see you soon. Thank you so much. I think Brad did send me a message. If there's anything you would like to ask, put it in the chat or have Ann send it to Ann and she can get it to me and I can get it to Brad or she can send it to Brad. We can get your questions answered. Yeah, so John or I see you have your hand up rather than raising your hand. And I just like to, I'll call on you right now. It's much easier if you do that. So see the reactions. See on your toolbar, the reactions, it's the head with the plus. If you click on that, it'll raise your hand. Okay, so John or you're on. I noticed through the presentation that the big six manufacturers are lumped together and limited in their product development by the deficit model of diagnosis that you suggest dominates the field of audiology. I'm wondering whether in your research and development of an alternative model, you have identified certain developments among the big six that bring at least potentially their product development more in conformance with your particular suggestions. I'll give you one example that will make my question more concrete. Oticon now brags that its research in development is based on brain studies that it is developing products that try to emulate and provide remediation within a model that takes account of how we actually approach hearing in our experience. Now, what do you think about that? Are there areas in research and product development that need to be supported and need to be applauded because with or without your rhetoric, they may be doing something that is responsive to your rhetoric. Okay, great. That's fantastic question. And I'm reviewing my notes here. I think we should in terms of the big six hearing aid manufacturers, that would be a question that Brad would be better able to answer. In my work, I work more with people who are developing technology outside of hearing aids. So that means Google. That means vibration wearables. That means, I haven't worked with Apple yet, I would like to, but we have Apple, we have Bose, we have Google, we have all these people who don't make hearing aids right now, they actually, they make earbuds, they make products. The phone, what I have used for 10 years is apps on my phone. Why? Because the typical phone has about seven microphones in it. Whereas a hearing aid will maybe have a maximum of two microphones. The quality of the microphone is much higher on the phone. The power, the battery power, the processing power is much better on the phone. So Google is just coming out with a new version full disclosure, I have worked for Google, but they have a new version of their sound amplifier that will be available on all Android products. And so those are free. The phones themselves, technically have the capability to do full spectrum. So that's where I would encourage more research. So the doctor spoke earlier, I would like to see more research and studies regarding the ability of using lower frequencies for speech comprehension. I feel they have been very, very limited because they've used limited devices and limited thinking. So if we free this up and said, hello, let's set history aside for a moment. Let's try to get the very highest quality microphones on the planet. Now let's test how well the people here using full spectrum, using high audio for our quality devices. And then that will tell us whether or not there's something there. I do know that one study that Brad mentioned, people who categorize as deaf, people like me, obviously a lot of us have frequencies lower than we do on the phone. So that's where I would encourage more research is lower than a show than on audiogram that we can perceive because a lot of those frequencies are actually felt by your body. So it's a great deal of research and potential of understanding speech even. I know secretly some people exploring this use and vibrations but also the last study is about the higher end above what the audiogram tests. In the 1970s they found that there were deaf people, categorized as deaf, who actually had hearing way above 8,000 Hertz, which was also not being utilized. So I would say first, we need to look deeper. Right now you're only testing on particular pitches. Those pitches have been decided. There are arbitrary numbers, 1,000 Hertz, 2,000 Hertz. They have nothing to do with the sound that in your life, which would be more music, which would be 440 Hertz, discrete numbers. So I think if we could get more testing on more frequencies, this is my belief, we will discover what we discovered there are micro losses in between here. Well, we discovered there's a micro abilities. I think we're not maximizing the abilities people do have and then we're not providing them with the technology that can do it, but frustrating the technology is in their pockets already. But we're not allowing people to use it. So I see someone's put, I hope that that answered your question at all. Do you want to follow up? Yeah, yes and no. I guess what I'm asking you in your own work, do you turn to brain studies, brain science for information as to the experience within our brain as we attempt to maximize our hearing? I mean, I'm just, that's really what I'm asking because there, I take it at least in manufacture rhetoric, there is an equally radical alternative being suggested which is let's turn to brain studies as a partner for audiological service development and I don't hear you talking that way. Okay, all right. So I think I understand the question a little better and no, I don't think I'm qualified to answer back-point brain research regarding speech. I have a lot of... What? That's not a criticism. I'm trying to fit you into my, where you are, into the body of people that I listen to. Okay, no, I'm not taking it as a criticism for you. I'm sorry, I'm having a little bit trouble of making sure I'm understanding the exact words that are coming out of your mouth right now because I'm very deaf. I have, however, done a lot of research on my own and with other companies in terms of how the brain thinks about sound in general. So the musical that I just did and I not put it in my art, it's called Brain Storm and in that we talk a lot about auditory memories. So a great deal of the time when we talk about what a cochlear implant can do, sometimes the manufacturers are taking credit for what the brain is actually doing. If it is stimulating just a little bit, but it is triggering an auditory memory of something that you heard in your path, then you feel like you heard it, even though you're not actually hearing it. And so I do think in this area of maximizing auditory memories, particularly for deaf children, we could build up auditory memories, even if they can't hear by teaching them about vibration, and then you can utilize that to assist your hearing. If I'm following you correctly, my mind has to do with auditory memory. If what you're talking about is somehow like with the implant and skipping and going directly to the brain, you know, I'm not that kind of a scientist. Is that closer to answer your question? Yes, it is. Thank you. I like what you're doing, by the way, very much. Thank you. Okay, great. Thank you. Okay. And I see that Dr. Mimi posted about the research. It's not her personal research. I'm assuming that you are her, sorry. It's part of audiology and hearing and research. We found research in revelant channels in these areas. So I will talk to Brad and see what we can dig up on the frequencies in terms of what I was looking at in the research is that this has not really been studied very much in terms of what I've been able to find. Some of the studies are extremely old. So I would be really surprised to find new relevant research in this area that shows there's no benefit to low frequencies if those low-frequency research that I find adds below 250 Hertz. But I will do some searching and see what we can find. Anyone else have a question? I'm apologize. I apologize the caught captioner. Did I say something insulting? I must understand you after the note there. But I am looking at both your captions and I'm looking at my phone. So, and I'm looking at your lips. So. And you're muted. My life. Thank you, Jill. I know this part about when you mute yourself and then to keep the background noise from happening in a warble and then you forget. So we'd really like to thank you for this very, very thought-provoking new way of visualizing what our capabilities may be. And when I watched the video the first time, since then I've been thinking, you know, so many of the things that we do it's easy to frequently think about what we don't have rather than what we do have. And so even if I didn't look at this in relationship to hearing, it's just a reminder of a piece of focusing on what you have and feeling good about what you have and owning that. And I'm really very, very happy that both you and Brad could be here today and maybe we'll have you back in the future. I have some other contacts with some hearing aid manufacturers in another portion of my life that I'm dealing with about hearing loss. And I'm thinking that maybe you need to talk to them to see what kind of conversation we can stimulate. So after our meeting today, I'll email you about that. I've also received a request from hospitals. They're interested in using iPads instead of pocket, instead of personal amplifiers. And all of the apps that exist today. Maybe I'm putting into like an adversarial relationship when it doesn't need to be adversarial because people might be coming along to this in use. Jay, I didn't understand what you just said. Can you repeat it please? Oh, I'm sorry. I think I also interrupted you because I didn't realize that you weren't done speaking. I think when you were mentioning hearing aid manufacturers in hospitals, I guess I'm sort of apologizing myself in that I have been so frustrated for so long. I assume that this is an adversarial relationship but maybe things have changed enough in the industry and society that they might be open to considering other ways of thinking and that would be really wonderful. So I would love to speak to hearing aid manufacturers or anybody else that you think I should speak to. So Jay, it's okay that you interrupted me. We all do it. So, and I value what you had to say. So the piece that I stopped at was that I am in non-adversarial relationships with some hearing aid manufacturers as well as hospitals and we're trying to find possibilities and solutions that can benefit all of us. And one of the things that they're looking at because iPads during the pandemic have become the lifeblood for all of us and for the deaf community, they've had video remote interpreters available on those and now it's expanding to include things for the heart of hearing community. And one of the things that they've been asking me about is an app that you could use as a personal amplifier. And currently the apps that exist all have in the beginning component of them. You take a hearing test and then they set the app to your hearing test and really to have it be valuable in a hospital situation, it needs to be much simpler than that because you know if you're a nurse and you're taking care of somebody or if you're an emergency and you're taking care of somebody, the 80% who don't have hearing devices, you need something that's as easy to use as a pocket talker. So, Jay, I'm really excited about your comment that you made about Google and I will be talking to you about that after our meeting. We have a few additional announcements today. And also time for- I will say this quickly of what you just said with hospitals. The other thing that could really do is stop assuming that auditorial communication is the best because any time that they say, oh, that amplify that. Basically they're forcing us to come into their world and to try to listen and strain, to listen and ruin the world of mass. All they have to do is grab out a phone, speak into your phone, see if it says what you intended to say and now the problem's over. I just completely stopped using my voice when COVID happened and the math happened and I would just hold up my phone and then people would hold their phones back to me and it was unbelievably calming and relaxing. Whereas when I try to amplify it, it's just all stress. So yes, better amplifying apps, I would say the amplifying apps I use for 10 years, I still have to use a super old iPhone because no one ever embedded one better and it was able to zoom in on the speaker. And now I don't like the apps where they make you do a hearing test first because again, it's stuck in that mindset. They don't even offer the frequencies that I need. So I think there's a lot we can do with better amplifiers and I do consult with Google and other companies. So I'm constantly asking for things they know me pretty well there now. So Jay, I respect your opinion for yourself. I know that there are many people who have a broader range using your language of hearing ability rather than a narrower range who really could benefit from a personal amplifier. And I know personally for myself and I can speak for myself, the ability to hear a person's voice, there's a tremendous amount of information that's communicated with the quality of the voice. There's emotional feeling that's communicated with that. And I don't wanna pick, I wanna be able to have sound that can help me as well as captioning apps. Barbara, you have your hand up. Would you please unmute yourself and ask your question? Well, both, both, sorry. I'll just say the other thing we're asking for is to be able to have both the captioning on your phone and amplifier all together in one device and then we can have it because I do use amplification when I go to see musicals. When I want to hear those tones in the voice so you are correct, there's so much information in the voice and we need to have it. Okay, I will stop talking. Barbara was going to speak. Barbara, you have to unmute yourself. There we go. I thought I did. It is unmuted, I think. Now it is. You can, okay. For Jay, I lost, where is Jay's picture now? Jay, I lost you. Okay, Jay, this is Barbara Dagan. I hope the greetings from California. I hope you remember me from New York. And my question, my first place, I loved this presentation as I lost, as I love the last one also. So thank you so much. Secondly, in this entire presentation, I don't recall hearing the word pitch. And I don't know whether I missed it or whether it isn't part of your research per se. And so you chose not to talk about it in this presentation. But my major problem is with music. I have lost it totally because I have lost the ability to discriminate pitches. I couldn't tell you which pitch is higher or lower. And it affects, of course, not only pitch in melody, but it affects overtones and it affects musical instruments. And I'm wondering if any of your wonderful progress in this area touches on pitch in some way to give me some encouragement end of question. I'm catching up. Thank you. Barbara, I do remember you. I'm so happy to see you again. And thank you. I think you were one of the first people that I was doing my death musical early and we did a performance with HLA way back in the day. So it's wonderful to see you. So if I understand your comment about pitch, first of all, not mentioning pitch, I tended to use the word frequency when they talk because that's the word that they use on audiograms. But when we talk about middle C, that does have a pitch which we would call middle C is what we'd call the pitch roughly 250 Hertz. So part of that is a language thing. Another part of that is that actually pitch perception is quite complicated. And what we perceive as a pitch may not actually be the frequency. So that's why I get confused to go down that road just for my own knowledge. So you say you've lost your ability to perceive pitch but are you using a hearing aid or a cochlear implant? Are you using devices right now? Yes, an implant. You have a hearing aid, okay. No, no, no. I have a cochlear implant. Oh, we have a cochlear implant. Okay, so that is part of the reason that it's more difficult with pitch. So depending on your implant, yes, sadly cochlear implants do not do very well with pitch. Why? Because there's a limited number of electrodes. This is why I don't have a cochlear implant. That's when I was first became eligible to have a cochlear implant. They were also, if I got the CEI, would destroy the residual hearing I have. Now they are making the surgery better so that I can implant without destroying the residual hearing. However, still when I put in the electrode, they're putting the electrode into that sort of curl of the cochlear, you know? Yes. It's right out here, which is where the hearing heads cells for the very, very highest frequencies are. So we'll put the electrode in there in those very, very, very high frequencies. And then on the electrode, depending on how long of one you have, you may only have 11 electrodes. You might have, I don't know what the maximum is now, maybe 20 or 30. We depend on your device and how many electrodes it has, how spaced they are and where it has been implanted into the cochlear and to what exactly it is triggering. So at the time I said, wait, there's only 11 electrodes, but there are 88 keys on a piano. How am I gonna discriminate pitch? So now though, what they are doing is they are learning how to make virtual things in between so it might depend on your coding. They're adding more electrodes, as I understand it, they are using more software to try to give better pitch perception. But if the electrode is shortest during super high frequencies, my understanding is then it is asking your brain, your brain to learn, oh, hey, you were triggering that what I thought was a super high frequency, but it is actually a tuba. So now I have to tell my brain has to learn, oh, this is a tuba now, even though it is a different thing. Then in terms of discrimination on the piano, so on the piano, as you know, there's 12 tones and an octave. Most cooker implant users, I don't want to say anything incorrect, but basically they can't do anything. Okay, do you know what? I need to interrupt you because we have only 10 minutes left to our notes. We're several pitches. So what I would suggest is if you would just have a general sense, you can't understand the pitches. Jay? Or as soon as you have a tone generator and just try individual pitches and note down for yourself, where are you hearing a difference? And then maybe they can give you better coding so you can hear more difference. Jay? Thank you, Jay. Your brain to adapt to what you have. I think I may be in touch with you. Thank you, Jay. So we only have a few minutes left to our meeting and we have some announcements. Oh yeah, it's absolutely, that'd be great. Yeah, so there are two research studies that are available to people that are happening right now. One is at UCSF and it's for anybody who's contemplating getting a Med-L cochlear implant. The other one is from Stanford Medicine and they're recruiting people who have implants as well as people who are evaluating whether they would like to have an implant and they're trying to understand the perception of people in both of those situations. And this Stanford study also includes people who've had implants that have been removed. We'd like to remind everybody that the Medicare Hearing Aid Coverage Potential Bill is still here. If you have not contacted your legislators, you need to do so, just go to the HLAA website and put Medicare into the search window and all the directions for how to do that are there. I didn't mind months ago, I think I did all of my legislators in a half an hour. We'd like to remind everybody that communication access is guaranteed to us. It's a disability under the ADA and other federal civil rights laws as well as state laws. This is the 31st anniversary for the ADA. You may be wondering where they need to provide things and it's everywhere. So when you look at the icons on this particular slide, it's a reminder of where all of those places are. And please do not take no for an answer. If you get stuck and I get stuck and I go through waves of time where I'm really gung-ho and then I get kind of discouraged and then you have to come back and over time things will get better. And this is if you need to contact us and I didn't think about it, I'm sorry that I didn't include Jay and Brad's contact information on this slide. They decided that they wanted to do a mostly just a chatting presentation. So please accept my apology for that. Does anybody have any other news of something that's happening to them? An event that's happening, something else that's going on in the last few minutes that we have here. We have five minutes. Nobody has anything? Yeah, hi Anita. Yeah, I just say it's nice to see everybody, faces that I haven't seen for a long time. And this was absolutely fascinating and forward looking. As most of you may remember, my loss isn't as much as many of yours, but I have learned so much and HLAA has really been important. And the idea of changing the way that I even talk about my own loss is really thought provoking. So thank you. And good to see everybody. Thanks Anita. Susan has a question. Susan has a question. Oh, good. Susan Beck. Hi, I have a question. Does anybody have a recommendation for someone who can repair or reconnect? My life tone, eight of bedside fire alarm and clock, it somehow became disconnected. And I've tried electricians and handymen and no one seems to know or want to deal with that. So Susan, do you think it's broken? No, I don't think it's broken. I think it has to do with the connection, maybe the batteries ran down and when I replaced them and then I tried to test it, I wasn't able to make it respond is what it needed to. So Susan, I'm a tinkerer and let's get together and I will take your life tone and to my husband's chagrin, sometimes dismay. When he's done everything he can do and it doesn't work and he hands it to me and I fix it. It really sometimes irritates him. So I'd be happy to take a look at it and see what's going on. Maybe there are the batteries you have. I know that I have a couple of things that, they change the length of the battery just a hair. Sometimes if you take a piece of aluminum foil and fold it up and you stick it where it makes the contacts, sometimes it makes a better contact. But just email me next week and we'll figure out a way and I'll come by and pick it up. Okay, thank you, Anne. Yeah, my pleasure. I hope you enjoyed the presentation. So this is the last, we'll see each other before Thanksgiving. So I wanna wish everybody a very, very, very happy Thanksgiving and I don't know whether you're going to be this year able to get together with more of your family than you may have last year just it's a reminder for all of us to look out to see what Jay and Brad reminded us of as well to see what we have, be grateful and share joy. So thank you very much for coming. We'll see you next month. Bye. Bye. One sweet all of you, have a wonderful day.