Habilitation for hearing loss

Mel Ferguson

Clinical Scientist (Audiology)

National Biomedical Research Unit in Hearing

NBRUH Launch 11.3.09

• Degree of unmet need in SNHL

• Overview of auditory training studies

Outline

• Overview of auditory training studies

• Proposed studies

Prevalence of SNHL in the UK

100%

Profound 149 thousand

0%

50%

Profound 149 thousand

Severe 549 thousand

Moderate 3439 thousand

Mild 4830 thousand

National Study of Hearing, MRC IHR

NSH – some more stats

• 1 in 5 adults have hearing problems

• 1 in 10 would probably benefit from intervention• 1 in 10 would probably benefit from intervention• Only 1 in 3 possess a hearing aid

- of whom many (~25%) do not use it at all

• Median age for getting first hearing aid = 74 years• Hearing difficulties present many years prior to this

Davis (1995)

40

50

60

70Prevalence %

Hearing loss gets worse with age

18-30 31-40 41-50 51-60 61-70 71-80

Age group

0

10

20

30

40

Better ear average (0.5-4kHz) ≥ 25 dB HL Davis (1995)

Acceptability and benefits of early screening for disability

• 55-74 year olds

• 12% have a hearing problem that causes moderate or severe worry, annoyance or upset

• Bilateral hearing impairment (0.5-4 kHz) • Bilateral hearing impairment (0.5-4 kHz) - 25+ dB HL n= 27%

• However, only 5.7% received intervention through hearing aids

• Hearing problems, mainly speech-in-noise, mean reported duration = 10 y

• So, why are people not accessing hearing services?

- many who see GP with hearing difficulties (47%) received no intervention

Davis, Smith, Ferguson, Stephens & Gianopoulos (2007)

Seeking advice about hearing

Davis et al (2007)

Reluctance to wear hearing aids

Would auditory training be more acceptable?

Seeking advice about hearing

People make a joke of hearing loss – so you don’t admit it. Blind

people are not treated that way

My friends kept

mumbling

Davis et al (2007)

Reluctance to wear hearing aids

that way

I refused to accept I was going deaf – first

your hair then your ears!

Would auditory training be more acceptable?

Hearing aid benefit outcomes

Glasgow Hearing Aid benefit Profile

80

100

Mea

n G

HA

BP

sco

re (%

)

Use

Benefit

Can auditory training provide additional benefit?

40

60

<25 25-34 35-44 >45

Better ear average (dB HL)

Mea

n G

HA

BP

sco

re (%

)

Residualdisability (rev)

Satisfaction

Davis et al (2007)

What is auditory training?

Changes a person's ability to process sounds and improves auditory performance on the task

(tones, phonemes, words)

Auditory training improveslistening task

10

20

Ton

e d

iscr

imin

ati

on

(%

)

Frequency discrimination

Amitay, Hawkey, & Moore (2005)

block #1 2 3 4 5 6 7

0.2

0.5

1

2

5

Training (days)

Ton

e d

iscr

imin

ati

on

(%

)

Young NH adults; 18-30 yo

Ag

e eq

uiv

alen

t (y

rs)

Phonological Assessment Battery(word listening)

1212

1313

1414 p<0.0001 Training

Control

Auditory training improves language

Moore, Rosenberg & Coleman (2005))

Time of test

Ag

e eq

uiv

alen

t (y

rs)

66

77

88

99

1010

1111

Pre Post Delayed(4 weeks training) (5-6 weeks later)

8-10 yo NH children

Auditory training as an adjunct to hearing aids

Nonsense syllable in noise test (NST)

Woods & Yung (2007)Mild to moderate hearing losses; 50-80yo

• Benefits of auditory training in hearing impaired people

• Three groups of listeners (50-75 yrs)

Proposed studies

Hearing aid users Hearing loss

No Mild

New Mild and moderate

Existing Mild and moderate

What are the benefits of auditory training, with and without HAs?

Are any benefits retained after training ceases?

Benefits of auditory training

Training (4w)Delay (4w)Gp 1

Training: 15-20 mins/day

Crossover design (test-retest effects)T2T1 T3

Training (4w)(4w)

Control (4w)

Gp 1

Gp 2 Training (4w)

Outcome measuresTraining stimulus (phonemes, words-in-noise)

Generalised learningSpeech intelligibility (Words and sentences in noise)Communication (SSQ, GHABP, Euroqual)Cognition (working memory, processing speed)

Delay (4w)

15-20 mins/day 4 weeks

T4

• Is hearing aid usage (compliance) associated with a particular set of cognitive abilities?

• Profiles of compliant and non-compliant users

Cognition and compliance

• Profiles of compliant and non-compliant users

• Can we encourage/facilitate compliance by enrolling hearing impaired people on a cognitive training programme?

Delivery of training

Well done!

Software drivenAdaptive

Appropriate interfaceInteractive

Feedback: motivation and rewardsHome-basedData logging

• Web-based

Looking to the future

• Hearing screening