Assistive listening device (ALD)/radio aid policy and fitting guidelines
- Introduction
These guidelines are written with reference to the NDCS Quality standards for the use of personal radio aids (2017)
and Ear Foundation Using radio aids with pre-school Deaf children (June 2017)
https://www.ndcs.org.uk/media/1822/ear_foundation_using_radio_aids_with_preschool_deaf_children.pdf
These quality standards have been developed with the Assistive Listening Technology Working Group – ALTWG – Quality Standards – BATOD, whose aims are to:
- promote the use of assistive listening devices among children and young people
- promote the knowledge base about assistive listening devices
- influence the policy framework for the provision of radio aids
- influence the quality and consistency of assistive listening device provision and practice.
- raise awareness of the importance of a positive acoustic environment.
- Rationale for using Assistive Listening Devices (ALDs)
Throughout this document Assistive Listening Devices (ALDs) will be inclusive of any radio aid system, remote microphone or streamer.
ALDs are a tool to enhance access to speech and is therefore a learning tool. Learning takes place in as many informal as formal settings and children have continuously busy lives where the opportunity to learn everyday skills such as sports, joining local groups – Bownies/Scouts etc, would be enhanced by sensitive use of an ALD. Restricting use of such equipment to school only, is limiting a child’s access to social activities, therefore home use is encouraged. (please also refer to section 8. Loss/damage to ALD)
Hearing aids and cochlear implants, whilst continuing to be increasingly sophisticated, can be poor in multiple-speaker situations and at distance. When used well, correctly fitted and maintained, ALD amplification can offer real opportunities for language enrichment, improving the audibility of speech in situations where distance, background noise and reverberation make listening difficult.
An ALD can improve the ‘signal-to-noise’ ratio (the signal being listened to over the background noise) to ensure that the deaf child or young person (DCYP) can receive a consistent speech signal over distance and reduce unwanted background noise that is interfering with speech. This enables the DCYP to hear spoken language more easily in the home/school/nursery environment. ALDs can be of benefit to all hearing aid users regardless of the degree of hearing loss.
- Candidacy for an assistive listening device (ALD)/radio aid
NDCS Quality Standard 1 states that ‘every Deaf child should be considered as a potential candidate for provision with a personal Radio aid.’
Therefore:
- the Teacher for Deaf Children and Young People (QToD) will consider reasons why a DCYP should not have an ALD and record this on their caseload.
- The DCYP may need ‘training’ to be able to feedback on the quality of the sound they hear. Activities should be carried out to ensure that they can identify when the good quality, clear sound of their amplification device is distorted or there is interference (FM training toolkit)
- If a request for an ALD is made or the QToD feel a DCYP is ready for this then the ‘checklist for fitting ALD’ (appendix 1) will be completed. If this indicates that and ALD is suitable then a request form should be completed (appendix 2) and a request sent to the Educational Audiologist with supporting evidence.
- An ALD aid will initially be trialled by the DCYP and the settings before it is supplied permanently.
- Following the trial an evaluation will be completed on the effectiveness of the system and the benefit gained. This may involve: observations; speech perception tests; and feedback from the DCYP; parent, teachers and other working with the DCYP.
An ALD will be authorised if the following criteria are met and upon completion of the appropriate loan form.
Any DCYP with a permanent bilateral hearing loss of greater than an average 41dBHL (in accordance with BATOD audiology descriptors) will be considered for the provision of an ALD, providing the DCYP meets the following criteria:
- The DCYP is a reliable hearing aid wearer.
- The DCYP is physically able to wear an ALD receiver without causing discomfort or possible harm to the DCYP (all under 5’s or those in the company of under 5’s will automatically be fitted with and integrated system with tamperproof kit fitted).
- All DCYP who are cochlear implant wearers, need agreement from the Cochlear Implant Team that the DCYP is ALD ready. The Cochlear Implant teams often want to have evidence that the DCYP is able to report back about the quality of sounds, they may want to complete a check list similar to the Assistive Listening Device Children’s Listening Profile – ChIP (appendix 3)
For a DCYP with a hearing loss of less than an average 41dBHL, provision of an ALD may be considered if:
- The DCYP is wearing hearing aids reliably and has difficulty discriminating speech in noise.
- The DCYP has an asymmetric hearing loss where the average loss is less than 41dBHL in the better ear.
- The DCYP’s hearing loss is having an impact on their education.
For a DCYP with a long term hearing loss of less than an average 41dBHL, but which is having low impact on their education an ALD may be considered. However in this situation the school is responsible for supplying and maintaining the ALD after consultation with the advisory QToD.
Please note that:
- ALDs in some circumstances can be prone to interference; there can also be ‘interference’ or the equipment stops working because of a fault, therefore consideration should be given to the DCYP’s ability to detect interference and to alert an adult to this.
- It is also important to consider the support within the school as ALD equipment should be monitored regularly and independently from the DCYP.
Health and Safety considerations
All DCYP under 5 should have battery locks on their hearing aids, this also applies if the child or young person has younger siblings or are regularly with other children who are under 5.
Adherence to these guidelines and considering the environment in which DCYP under 5 are accessing should be considered. Appropriate equipment, integrated receivers with tamperproof locks will need to be fitted and may need to be specifically ordered. There may therefore, be a delay in setting up and ALD with these DCYP.
Preschool – Radio aid usage with children aged under 36 months
NDCS Briefing paper – 26th July 2018
The National Deaf Children’s Society do not believe that children of this age should be denied access to FM technologies when there are solutions available that can allow them to overcome barriers to language and communication in a safe and secure manner. We do not feel that cost for a tamperproof solution should be a justification for denying a child access to a radio aid, as we have demonstrated that there is very little difference in cost between different solutions.
We recommend that:
- Professionals fully explore the range of options available to allow deaf infants and young children to safely use radio aids.
- Wherever possible, deaf infants and young children are provided with integrated receivers and tamperproof battery locks to allow them to use FM systems safely.
- But if these aren’t available that parents are given clear and unbiased information on the risks and benefits that enables them to make an informed choice on using an alternative radio aid with their deaf child.
- Provision or type of ALD
An assistive listening device consists of two parts:
- The Transmitter
This is worn by the teacher with the microphone close to their mouth (about a handspan below the speakers mouth)
Please note that wearing the microphone lower will give less benefit to the DCYP.
The transmitter sends the teacher’s voice directly to the DCYP’s receivers. This enables the DCYP to hear the teacher as if the teacher is standing next to the DCYP, no matter where the teacher actually is within the classroom (or outside!).
ALD systems currently being loaned by Devon to DCYP in educational settings are:
- Roger Inspiro transmitter.
- Roger TouchScreen transmitters. These ALDs have not proved to be as robust as the Inspiro systems, they are currently being issued to top end (Yr 5/6) Junior DCYP.
- Roger ON transmitters. These transmitters can link to the myRogerMic app – Roger On™ – MyRogerMic app (youtube.com) and are currently being issued only where DCYP are allowed to have access to their phone within their educational setting.
- EduMic remote microphones are currently being used with the Oticon hearing aids or BCHD’s
For older DCYP who are fitted with cochlear implants and rejecting the use of a traditional ALD, they may be offered a loan of a Mini Mic 2+ if there are any available. This will be in close consultation with the secondary aged DCYP, QToD, school, Educational Audiologist and the Cochlear Implant Team.
- The Receiver(s)
These are worn by the DCYP.
Receivers currently being loaned by Devon to DCYP in educational settings are:
- Roger X. May be attached with a direct input audio (DAI) shoe or installed directly into the hearing aid/s
- Roger 18. These are integrated receivers – the receiver replaces the battery door of the hearing aid/s and can be made ‘tamper proof’
- Roger 14. For the older Cochlear N5 or N6 devices
- Roger 20. For newer Cochlear N7 or N8 devices
- Roger 17. For the older Advanced Bionics Naida devices, the newer Marvel devices can have the Roger X installed
- Roger 21. For the Medel Sonnet/Sonnet 2
Integrated Roger receivers may be issued if there is a health and safety concern around swallowing of small parts. Where the service is unable to completely tamperproof audiological equipment, parents and settings are made aware of this.
Many of the Phonak hearing aids now have the capability to have the Roger X directly installed to the hearing aids.
The Oticon hearing aids link with the EduMic remote microphone through low energy Bluetooth and therefore do not need DAI shoes. However where a student rejects the EduMic and shows a preference for using the Phonak Roger equipment, Oticon hearing aids can be fitted with direct audio input shoes and a Roger X receiver plugged into this.
If parents decide to purchase their own ALD systems then the Teacher of the Deaf will not be responsible for: maintenance, testing, repair and replacement of this equipment. The Roger Touchscreen is not compatible as a transmitter to be used as a multi-talker alongside the Roger Inspiro transmitter. Parents are made aware of this.
ALDs will be reviewed by Advisory Teachers of the Deaf regularly and upgrades considered as needed to ensure that the DCYP is receiving the optimal listening experience. If a DCYP has not been using the ALD and there is evidence to indicate that it hasn’t being used for more than a half a term, then the equipment will be withdrawn and returned.
- Setting up the ALD
The QToD will need to identify a named individual in the school to have overall responsibility for the DCYP’s use and management of equipment. Practical training and guidelines will be given.
The setting will be asked to sign the loan form (appendix 4) which will be saved in the child’s CASES file and in the Audiology folder Loan Form for ALD
The QToD should request the use of a quiet room or area for the fitting appointment, to reduce the effects of ambient noise on equipment performance. They should produce reference curves through an appropriate test box (following nationally agreed guidelines) and ensure that a DCYP’s amplification and ALD demonstrate transparency, to ensure the DCYP hears the speech at an optimum volume. These curves verify that the sound from the
ALD transmitter has an advantage over the general room noise picked up by the hearing aid/cochlear implant and that the overall complete system functions as intended. The curves will be an indication of meeting standards which will be of particular significance for young children and those with additional needs who may not be able to express a view on the quality or intensity of a sound through the system. Older DCYP may express a view on the signal heard and this may be a point of discussion to adjust the ALD settings.
A listening game/assessment should conclude the fitting to ensure the sound through the whole system is audible and comfortable.
The QToD may use the Evaluation of assistive listening technology (ALT/ALD radio aid) equipment – Observation and questionnaires (appendix 5)
The effectiveness of the ALD will be monitored by the school and the QToD. The nature of this will depend on the DCYP.
The DCYP’s views will be sought and taken into consideration.
- Connecting an ALD transmitter to other devices
The DCYP’s ALD can be connected to a range of electronic devices e.g. Digital Audio Players, portable DVD player, TV, iPads, phones. Please ask your DCYP’s QToD, if you would like information/help to do this.
There are some video guides that may help with connection issues:
Using your devices – video guides – Support for schools and settings (devon.gov.uk)
- Ongoing care and maintenance of ALD
It’s expected that the DCYP and educational setting, takes responsibility for the ALD, that the batteries are charged in good time for school usage and that a named adult has responsibility to ensure that the system is working each day. This person should be responsible for reporting to the QToD if there are any problems. The DCYP are supported through: Devon Hearing Aid; Cochlear Implant and ALD management levels, to develop independence around care and knowledge of their audiological equipment. Certificates are linked to achievement at each management level, allowing clear monitoring and acknowledgment of the DCYP’s progress.
Ongoing support will be given to the school from the QToD and they will undertake regular checks in school on the equipment, using a hearing aid test box with transparency through speech audiometry and observations.
- Loss/Damage of ALD
ALD systems are expensive with ear level systems costing around £2000. Faults, losses or breakages must be reported to the QToD immediately. The school will be asked to replace the equipment as stated on the loan form agreement which was signed by the school at the time of issue. Insurance can be purchased from Insurance for Radio Aid Systems | Aspen Associates
We reserve the right to issue any system as a replacement which may not be the same model as the original.
We reserve the right to withdraw ALDs that are repeatedly broken/damaged/not used effectively.
Assistive Listening Devices will be issued to DCYP according to these guidelines and in conjunction with discussions with parents, teachers and the DCYP.
For further information please contact:
Helen Maiden – Teacher for Deaf Children and Young People /Educational Audiologist
Mobile: 07395 600853 helen.maiden@devon.gov.uk
To be reviewed September 2025