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Bluetooth and Streaming Options

Most of us are now familiar with bluetooth technology, knowingly or not.  The folks walking around with something over their ear, talking or singing to the air, are probably connected wirelessly to their cell phone and/or their tunes.

Bluetooth is a form of ultra-high frequency sound transmission, similar to FM (Frequency Modulated) or DM (Digitally Modulated) radio waves.  Bluetooth can be used to improve communication access by connecting to various audio-visual devices (e.g., computers, TVs, etc.) or listening devices (e.g., Hearing Assistance Technologies, or HAT, Assistive Listening Devices, or ALDs).

Bluetooth is a wireless technology standard for exchanging data over short distances (using short-wavelength UHF radio waves in the ISM band from 2.4 to 2.485 GHz[2]) from fixed and mobile devices, and building personal area networks (PANs). Invented by telecom vendor Ericsson in 1994,[3] it was originally conceived as a wireless alternative to RS-232 data cables. It can connect several devices, overcoming problems of synchronization.

Remember, hearing aids (HA), including bone-anchored (BA) or osseo-integrated (OI) amplification and cochlear implants (CI) work best in a QUIET “communication bubble”, within a social distance of about an arm’s length, or about 3 feet (1 meter or 1 yard).  At greater distances, or when there is background noise, even very advanced hearing aids or implants can’t help as much.

Bluetooth - Widex

Bluetooth is less expensive than FM or DM (e.g., about $300 for bluetooth remote mic vs $1000 for FM/DM mic).  In some cases bluetooth may be used along with FM/DM (e.g,. Phonak’s Roger Pen), to connect to a variety of every-day communication technologies.

The devices to which the HA or CI connect must also be “blue-tooth compatible”, or contain a blue-tooth chip waiting to be activated or paired with the HA/CI.  E.g., most cell phones now are blue-tooth compatible.

In some cases, a remote control, “transceiver”, or “streamer ©” is needed as a relay station between the hearing instrument and the HAT/ALD.  This can be worn on a lanyard, inside a shirt, or outside.


Some of the devices to which HAs/CIs may connect via blue-tooth include:

  • Bluetooth - Phonak roger penRemote or “partner” microphones
    • Research shows they can provide the same SNR improvement as FM/DM
    • Great applications for use in a preschool, classroom, riding in the car, listening to TV, restaurants, sports arenas, museums, field trips/guided tours, etc.
  • TV devices (an additional remote or transducer may be needed)
  • Cell phones and land-lines
  • Bluetooth - Oticon streamer proSome cars
  • Computers

Some HA manufacturers use an “open” bluetooth signal which works with other manufacturers’ products. Other manufacturers use a “proprietary” wireless signal which only works with their own products.

Only ONE PERSON can wear a remote microphone at a time. The mic opening must be face up and it can be no more than one hand-length from the mouth – close is good!  HOWEVER, some bluetooth mics can be placed on a table or in the center of a work-group and continue to provide SNR (signal-to-noise ratio) improvement while picking up the team-members’ input. 

Some bluetooth mics can pair with multiple hearing instruments at a time (think of a parent with siblings in a busy home environment or road trip, or a teacher with 2-4 hard of hearing students in a small classroom, etc.) AND…some hearing aids can pair with multiple bluetooth microphones (e.g., school and home mics) as well as multiple other devices. However, some will require deleting a pairing in order to pair with a different device.  


Some thoughts on “connectivity”

  • What newborn infant does not have the phone held up to her ear to hear Grandma or Daddy at work?
  • Our babies “skype” with our relatives in another country, from 4 weeks of age.
  • Many babies are (or should be) listening to “Pandora” radio, or “Disney Kids”, etc. from a very early age.
  • Music and sound stimulation (at safe levels) is very important for auditory and cognitive development.
  • Communication Access to ALL sounds and activities in the NATURAL ENVIRONMENT is vital to normal communication and social development.  This begins in infancy.
  • Communication Access to the popular media (TV, radio, iTunes, Facebook, Pandora, Twitter…) is vital to normal social development for Tweens and Teens.
  • Communication Access is crucial for hard of hearing individuals with multiple disabilities.  Shorten the effective speaking-to-listening distance and improve the SNR for someone with mobility challenges, wheelchair-bound or bedridden.  Enhance the speech signal for someone who is sight impaired, and who has limited visual cues to support audition and localization.  


Some Pros and Cons to Bluetooth use with HAs/CIs:

  • Shorter working range (30-80 feet, the length of a typical classroom or home,  compared with perhaps a city block for FM/DM;
  • May be more prone to “dropping the signal” (e.g., walking out of range); may need to press a button on the hearing instrument to resume streaming;
  • There may be interference from other bluetooth devices in range while trying to pair devices.  Turn off other devices or turn off their bluetooth functionality while pairing.  
  • Not all transceivers have locking controls;  make sure there is a way to lock the controls.
  • Not all phones are compatible with every HA/CI.  Most HA/CI manufacturers have a consumer line and/or QR code to scan to see if an individual’s phone is compatible with their HA/CI or app.  
  • Devices may need to be identified and paired with the hearing aids within the HA/CI fitting software, then synced with the HAs/CIs before being used.
  • All the devices must be charged before/after use.  You can get a charger with a splitter so that multiple devices can be charged at one time.
  • Specific instructions for bluetooth pairing HAs/CIs with phones and other electronic devices may be found in the HA/CI user manual, Google and YouTube. 


A Real-Life Case Example:

A student in a high school transition program (12+) has cognitive impairment, in addition to their moderate sensorineural hearing loss for which they wear binaural rechargeable hearing aids. They have received significant benefit from an FM/DM system used with their hearing aids while in school.  They just got their first cell phone.  Their hearing aids were connected to their phone, and to their hearing aid manufacturer’s phone app via bluetooth.  They were able to stream and confirm that they were hearing and enjoying a phone call and a YouTube video, including Disney music.  They were able to do most of this with a little teacher/care-giver support and prompting, and they will work on this as one of their goals as a transition student.  It was important to note for this student and their parents/caregivers/teachers that: 

  • The phone app in this case only showed battery status and hours of HA use. Their phone app could not be used to adjust HA volume or change programs because the student’s HAs were programmed for automatic function (VC and Program button inactive). 
  • These particular hearing aids could only be paired to one bluetooth device at a time; the phone pairing would need to be deleted in order to pair with their tablet, and then re-paired later on to use the phone wirelessly/hands-free again. 
  • Their phone app did NOT turn the phone into a bluetooth remote mic. There may be other apps available (or other HA brands/models) which allow their phone to function as a remote mic. Thinking forward to graduation, a personal partner mic is recommended for use at home and at work. 

In spite of the above noted limitations, use of their bluetooth connectivity with their HAs provided this young-adult student with improved communication access, expanded options for electronic learning, entertainment and social media, and possibly improved self-esteem as they find themself engaging in activities similar to their hard of hearing and typically hearing peers.  


With great appreciation, this information was written by Vicki M. Anderson, AuD, educational and pediatric audiologist, Minneapolis MN. This information was posted July 2023.