Viewpoint on the Benefit of Hearing Care on Cognitive Health.

PURPOSE: The purpose of this article is to provide a viewpoint on the recently published results showing the positive effect hearing intervention can have on mitigating the risk of cognitive decline in elderly individuals with hearing impairment. We intend to trigger a broader discussion on the implications of these results from an implementation science perspective. METHODS: Recently published results were reviewed and contextualized. RESULTS: In our view, these recent findings provide a great opportunity for hearing care professionals to change the perspective on hearing care being an essential service that contributes not only to managing challenges with audibility but to enabling healthy living and aging. CONCLUSION: As exciting as these findings are, from our perspective, they are also a call to action for the audiology field in terms of clinical implementation science. The findings guide us toward a more interprofessional approach in order to develop and test new, more holistic models of hearing care.

Rehabilitation for unilateral deafness - Narrative review comparing a novel bone conduction solution with existing options.

Patients with single sided deafness (SSD) struggle with sound localization and speech in noise. Existing treatment options include contralateral routing of signal (CROS) systems, percutaneous bone conduction hearing devices (BCHDs), passive transcutaneous BCHDs, active BCHDs, and cochlear implants. Implanted devices provide benefits in speech in noise compared to CROS devices. Percutaneous BCHDs transmit sound efficiently but have aesthetic drawbacks and skin complications. Scalp attenuation impacts passive transcutaneous BCHD performance. Active BCHDs overcome these issues and provide benefits for speech in noise. Cochlear implantation is the only existing option that restores binaural input but introduces electrical rather than acoustic stimuli to the deaf ear. Active BCHDs have been designed to maintain efficient sound transmission and avoid chronic skin irritation and cosmetic concerns that may occur with percutaneous BCHDs. Cochlear implantation may be a superior option for recently deafened SSD patients, though this requires further study. The duration of deafness, patient age and comorbidities, and a shared decision-making model among patients, surgeons, and audiologists should be considered in device selection. The aim of this manuscript is to review available devices, discuss surgical considerations for implantable devices, review available published results for speech in noise and sound quality with each device, and provide an overview to guide shared decision making for patients and providers. This review consolidates available literature and reviews experience with a newer active transcutaneous active BCHD available for use in the SSD population.

Walk, Talk and Listen: a pilot randomised controlled trial targeting functional fitness and loneliness in older adults with hearing loss.

BACKGROUND: Age-related hearing loss (HL) is a prevalent disability associated with loneliness, isolation, declines in cognitive and physical function and premature mortality. Group audiological rehabilitation (GAR) and hearing technologies address communication and cognitive decline. However, the relationship between loneliness, physical function and GAR among older adults with HL has not been studied. OBJECTIVES: Explore the impact of a group exercise and socialisation/health education intervention and GAR on physical function and loneliness among older adults with HL. TRIAL DESIGN: A Young Men's Christian Association (YMCA)-based, 10-week, single-blind, pilot randomised controlled trial (RCT). PARTICIPANTS: Ambulatory adults aged 65 years or older with self-reported HL. INTERVENTIONS: Seventy-one participants were screened. Thirty-five were randomised to intervention (strength and resistance exercise, socialisation/health education) and GAR (hearing education, communication strategies, psychosocial support) or control (n=31): GAR only. OUTCOMES: Ninety-five per cent of eligible participants were randomised. GAR and exercise adherence rates were 80% and 85%, respectively. 88% of participants completed the study. Intervention group functional fitness improved significantly (gait speed: effect size: 0.57, 30 s Sit to Stand Test: effect size: 0.53). Significant improvements in emotional and social loneliness (effect size: 1.16) and hearing-related quality of life (effect size: 0.76) were related to GAR attendance and poorer baseline hearing-related quality of life. Forty-two per cent of participants increased social contacts outside the study. DISCUSSION: Walk, Talk and Listen was feasible and acceptable. Exercise and socialisation/health education improved loneliness and key fitness measures but provided no additional benefit to GAR only for loneliness. This is the first preliminary evidence about the benefits of exercise on fitness and GAR on loneliness among older adults with HL. IMPLICATIONS: This pilot trial provides key information on the sample size required for a larger, longer term RCT to determine the enduring effects of this holistic intervention addressing the negative psychosocial and musculoskeletal downstream effects of HL among older adults.

Effect of auditory-motor training on auditory processing of school children.

OBJECTIVE: To compare performance in Avaliação Simplificada do Processamento Auditivo Central and Scale of Auditory Behaviors scores before and after auditory and motor training. METHODS: Sample comprising 162 children aged 9 to 11 years and attending public schools in the city of São Paulo (SP), Brazil; 122 out of 162 children were allocated to one of three experimental groups: Multisensory; Auditory/Motor and Motor/Auditory. Experimental groups were submitted to 8 hours of auditory, visuospatial and motor stimulation over the course of 8 weeks. The remaining 40 children formed the Control Group and received no stimulation. RESULTS: Relation between child behavior as perceived by school teachers and auditory test responses revealed that the better the performance in auditory processing assessment, the higher the Scale of Auditory Behaviors scores. CONCLUSION: Auditory and motor training led to improvements in auditory processing skills as rated by Avaliação Simplificada do Processamento Auditivo Central and Scale of Auditory Behaviors; this intervention model proved to be a good tool for use in school settings.

Manipulation of Auditory Inputs as Rehabilitation Therapy for Maladaptive Auditory Cortical Reorganization.

Neurophysiological and neuroimaging data suggest that the brains of not only children but also adults are reorganized based on sensory inputs and behaviors. Plastic changes in the brain are generally beneficial; however, maladaptive cortical reorganization in the auditory cortex may lead to hearing disorders such as tinnitus and hyperacusis. Recent studies attempted to noninvasively visualize pathological neural activity in the living human brain and reverse maladaptive cortical reorganization by the suitable manipulation of auditory inputs in order to alleviate detrimental auditory symptoms. The effects of the manipulation of auditory inputs on maladaptively reorganized brain were reviewed herein. The findings obtained indicate that rehabilitation therapy based on the manipulation of auditory inputs is an effective and safe approach for hearing disorders. The appropriate manipulation of sensory inputs guided by the visualization of pathological brain activities using recent neuroimaging techniques may contribute to the establishment of new clinical applications for affected individuals.

Targeting the psychosocial and functional fitness challenges of older adults with hearing loss: a participatory approach to adaptation of the walk and talk for your life program.

OBJECTIVE: Explore the acceptability of a socialisation, health education and falls prevention programme (Walk and Talk for Your Life: WTL) as an adjunct to group auditory rehabilitation (GAR) and how it might be adapted for older adults with hearing loss (HL). DESIGN: Content theme analysis (CTA) of guided interviews explored the experience of HL, the acceptability of a WTL programme and suggestions on how to adapt the WTL programme to better suit the needs of older adults with HL. STUDY SAMPLE: Twenty-eight (20 women, 8 men) adults (>55 years of age) with HL were interviewed. Seventeen had participated in past WTL programmes and eleven were sampled from the community. RESULTS: Interviewees reported difficulty socialising and a tendency to withdraw from social interactions. Addition of GAR to a WTL programme was found to be highly acceptable. Interviewees suggested that to best suit their needs, sessions should take place in a location with optimal acoustics; include small groups integrating hearing-impaired and hearing-intact participants; include appropriate speaking ground rules; and include an option for partner involvement. CONCLUSIONS: The adapted WTL programme provides a holistic and unique approach to the treatment of HL that has the potential to positively impact the hearing-impaired elderly.

Defining interdisciplinary competencies for audiological rehabilitation: findings from a modified Delphi study.

OBJECTIVES: The aim of this study is to derive a consensus on an interdisciplinary competency framework regarding a holistic approach for audiological rehabilitation (AR), which includes disciplines from medicine, engineering, social sciences and humanities. DESIGN: We employed a modified Delphi method. In the first round survey, experts were asked to rate an initial list of 28 generic interdisciplinary competencies and to propose specific knowledge areas for AR. In the second round, experts were asked to reconsider their answers in light of the group answers of the first round. STUDY SAMPLE: An international panel of 27 experts from different disciplines in AR completed the first round. Twenty-two of them completed the second round. RESULTS: We developed a competency framework consisting of 21 generic interdisciplinary competencies grouped in five domains and nine specific competencies (knowledge areas) in three clusters. Suggestions for the implementation of the generic competencies in interdisciplinary programmes were identified. CONCLUSIONS: This study reveals insights into the interdisciplinary competencies that are unique for AR. The framework will be useful for educators in developing interdisciplinary programmes as well as for professionals in considering their lifelong training needs in AR.

The effect of tinnitus specific intracochlear stimulation on speech perception in patients with unilateral or asymmetric hearing loss accompanied with tinnitus and the effect of formal auditory training.

OBJECTIVES: Previous studies show that intracochlear electrical stimulation independent of environmental sounds appears to suppress tinnitus, even long-term. In order to assess the viability of this potential treatment option it is essential to study the effects of this tinnitus specific electrical stimulation on speech perception. DESIGN: A randomised, prospective crossover design. STUDY SAMPLE: Ten patients with unilateral or asymmetric hearing loss and severe tinnitus complaints. RESULTS: The audiological effects of standard clinical CI, formal auditory training and tinnitus specific electrical stimulation were investigated. Results show that standard clinical CI in unilateral or asymmetric hearing loss is shown to be beneficial for speech perception in quiet, speech perception in noise and subjective hearing ability. Formal auditory training does not appear to improve speech perception performance. However, CI-related discomfort reduces significantly more rapidly during CI rehabilitation in subjects receiving formal auditory training. Furthermore, tinnitus specific electrical stimulation has neither positive nor negative effects on speech perception. CONCLUSIONS: In combination with the findings from previous studies on tinnitus suppression using intracochlear electrical stimulation independent of environmental sounds, the results of this study contribute to the viability of cochlear implantation based on tinnitus complaints.

Integration of acoustic and electric hearing is better in the same ear than across ears.

Advances in cochlear implant (CI) technology allow for acoustic and electric hearing to be combined within the same ear (electric-acoustic stimulation, or EAS) and/or across ears (bimodal listening). Integration efficiency (IE; the ratio between observed and predicted performance for acoustic-electric hearing) can be used to estimate how well acoustic and electric hearing are combined. The goal of this study was to evaluate factors that affect IE in EAS and bimodal listening. Vowel recognition was measured in normal-hearing subjects listening to simulations of unimodal, EAS, and bimodal listening. The input/output frequency range for acoustic hearing was 0.1-0.6 kHz. For CI simulations, the output frequency range was 1.2-8.0 kHz to simulate a shallow insertion depth and the input frequency range was varied to provide increasing amounts of speech information and tonotopic mismatch. Performance was best when acoustic and electric hearing was combined in the same ear. IE was significantly better for EAS than for bimodal listening; IE was sensitive to tonotopic mismatch for EAS, but not for bimodal listening. These simulation results suggest acoustic and electric hearing may be more effectively and efficiently combined within rather than across ears, and that tonotopic mismatch should be minimized to maximize the benefit of acoustic-electric hearing, especially for EAS.

Targeting functional fitness, hearing and health-related quality of life in older adults with hearing loss: Walk, Talk 'n' Listen, study protocol for a pilot randomized controlled trial.

BACKGROUND: Hearing loss (HL) is a disability associated with poorer health-related quality of life including an increased risk for loneliness, isolation, functional fitness declines, falls, hospitalization and premature mortality. The purpose of this pilot trial is to determine the feasibility and acceptability of a novel intervention to reduce loneliness, improve functional fitness, social connectedness, hearing and health-related quality of life in older adults with HL. METHODS: This 10-week, single-blind, pilot randomized control trial (RCT) will include a convenience sample of ambulatory adults aged 65 years or older with self-reported HL. Following baseline assessments, participants will be randomized to either intervention (exercise, health education, socialization and group auditory rehabilitation (GAR)) or control (GAR only) groups. The intervention group will attend a local YMCA twice a week and the control group once a week. Intervention sessions will include 45 min of strengthening, balance and resistance exercises, 30 min of group walking at a self-selected pace and 60 min of interactive health education or GAR. The control group will attend 60-min GAR sessions. GAR sessions will include education about hearing, hearing technologies, enhancing communication skills, and psychosocial support. Pre-post trial data collection and measures will include: functional fitness (gait speed, 30-s Sit to Stand Test), hearing and health-related quality of life, loneliness, depression, social participation and social support. At trial end, feasibility (recruitment, randomization, retention, acceptability) and GAR will be evaluated. DISCUSSION: Despite evidence suggesting that HL is associated with declines in functional fitness, there are no studies aimed at addressing functional fitness declines associated with the disability of HL. This pilot trial will provide knowledge about the physical, mental and social impacts on health related to HL as a disability. This will inform the feasibility of a larger RCT and preliminary evidence about the initial effects of a novel, community-based, holistic intervention addressing both the negative psychosocial and functional physical effects of HL among older adults. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02662192 . Registered on 14 January 2016.

A preliminary report of music-based training for adult cochlear implant users: Rationales and development.

OBJECTIVE: This paper provides a preliminary report of a music-based training program for adult cochlear implant (CI) recipients. Included in this report are descriptions of the rationale for music-based training, factors influencing program development, and the resulting program components. METHODS: Prior studies describing experience-based plasticity in response to music training, auditory training for persons with hearing impairment, and music training for CI recipients were reviewed. These sources revealed rationales for using music to enhance speech, factors associated with successful auditory training, relevant aspects of electric hearing and music perception, and extant evidence regarding limitations and advantages associated with parameters for music training with CI users. This informed the development of a computer-based music training program designed specifically for adult CI users. RESULTS: Principles and parameters for perceptual training of music, such as stimulus choice, rehabilitation approach, and motivational concerns were developed in relation to the unique auditory characteristics of adults with electric hearing. An outline of the resulting program components and the outcome measures for evaluating program effectiveness are presented. CONCLUSIONS: Music training can enhance the perceptual accuracy of music, but is also hypothesized to enhance several features of speech with similar processing requirements as music (e.g., pitch and timbre). However, additional evaluation of specific training parameters and the impact of music-based training on speech perception of CI users is required.

Participatory design of a music aural rehabilitation programme.

OBJECTIVES: Many cochlear implant (CI) users wish to enjoy music but are dissatisfied by its quality as perceived through their implant. Although there is evidence to suggest that training can improve CI users' perception and appraisal of music, availability of interactive music-based aural rehabilitation for adults is limited. In response to this need, an 'Interactive Music Awareness Programme' (IMAP) was developed with and for adult CI users. METHODS: An iterative design and evaluation approach was used. The process began with identification of user needs through consultations, followed by use of mock-up applications in workshops. Feedback from these were used to develop the prototype IMAP; a programme of 24 interactive sessions, enabling users to create and manipulate music. The prototype IMAP was subsequently evaluated in a home trial with 16 adult CI users over a period of 12 weeks. RESULTS: Overall ratings for the prototype IMAP were positive and indicated that it met users' needs. Quantitative and qualitative feedback on the sessions and software in the prototype IMAP were used to identify aspects of the programme that worked well and aspects that required improvement. The IMAP was further developed in response to users' feedback and is freely available online. CONCLUSIONS: The participatory design approach used in developing the IMAP was fundamental in ensuring its relevance, and regular feedback from end users in each phase of development proved valuable for early identification of issues. Observations and feedback from end users supported a holistic approach to music aural rehabilitation.

Using singing to nurture children's hearing? A pilot study.

This article reports a pilot study of the potential benefits of a sustained programme of singing activities on the musical behaviours and hearing acuity of young children with hearing impairment (HI). Twenty-nine children (n=12 HI and n=17 NH) aged between 5 and 7 years from an inner-city primary school in London participated, following appropriate ethical approval. The predominantly classroom-based programme was designed by colleagues from the UCL Institute of Education and UCL Ear Institute in collaboration with a multi-arts charity Creative Futures and delivered by an experienced early years music specialist weekly across two school terms. There was a particular emphasis on building a repertoire of simple songs with actions and allied vocal exploration. Musical learning was also supported by activities that drew on visual imagery for sound and that included simple notation and physical gesture. An overall impact assessment of the pilot programme embraced pre- and post-intervention measures of pitch discrimination, speech perception in noise and singing competency. Subsequent statistical data analyses suggest that the programme had a positive impact on participant children's singing range, particularly (but not only) for HI children with hearing aids, and also in their singing skills. HI children's pitch perception also improved measurably over time. Findings imply that all children, including those with HI, can benefit from regular and sustained access to age-appropriate musical activities.

Music therapy as specific and complementary training for adults after cochlear implantation: A pilot study.

OBJECTIVES: Although cochlear implant (CI) users achieve good speech comprehension, they experience difficulty perceiving music and prosody in speech. As the provision of music training in rehabilitation is limited, a novel concept of music therapy for rehabilitation of adult CI users was developed and evaluated in this pilot study. METHODS: Twelve unilaterally implanted, postlingually deafened CI users attended ten sessions of individualized and standardized training. The training started about 6 weeks after the initial activation of the speech processor. Before and after therapy, psychological and musical tests were applied in order to evaluate the effects of music therapy. CI users completed the musical tests in two conditions: bilateral (CI + contralateral, unimplanted ear) and unilateral (CI only). RESULTS: After therapy, improvements were observed in the subjective sound quality (Hearing Implant Sound Quality Index) and the global score on the self-concept questionnaire (Multidimensional Self-Concept Scales) as well as in the musical subtests for melody recognition and for timbre identification in the unilateral condition. Discussion Preliminary results suggest improvements in subjective hearing and music perception, with an additional increase in global self-concept and enhanced daily listening capacities. CONCLUSIONS: The novel concept of individualized music therapy seems to provide an effective treatment option in the rehabilitation of adult CI users. Further investigations are necessary to evaluate effects in the area of prosody perception and to separate therapy effects from general learning effects in CI rehabilitation.

Retrospective audiological analysis of bone conduction versus round window vibratory stimulation in patients with mixed hearing loss.

OBJECTIVE: To compare audiological outcomes in mild-to-moderate mixed hearing loss patients treated with a bone-anchored hearing aid or an active middle-ear implant. Analysis aimed to refine criteria used in preoperative selection of implant type. DESIGN: Retrospective comparative analysis of audiological data. Follow-up time ranged between 0.55 and 8.8 years. STUDY SAMPLE: For detailed comparative analysis, 12 patients (six in each group) with comparable bone conduction thresholds and similar clinical characteristics were selected. A larger cohort of 48 patient files were used to evaluate overall audiological indication criteria (24 per group). RESULTS: In free-field tone audiometry, Baha patients showed mean aided thresholds between 40-48 dB, whereas hearing thresholds for VSB patients were 25-43 dB. Baha and VSB users had mean WRS of 56% and 82%, respectively, at 65 dB. Better speech understanding in noise was seen with the VSB. CONCLUSION: Analysis of the main cohort (n = 48) showed that treatment with round window vibroplasty leads to better hearing performance than treatment with a bone-anchored hearing device, if the bone conduction pure-tone average (0.5 to 4 kHz) is poorer than 35 dB HL. Audiological analysis in the smaller comparative analysis showed similar findings.

Hearing-aid use and its determinants in the UK National Health Service: a cross-sectional study at the Royal Surrey County Hospital.

OBJECTIVES: The aim of this study was to investigate the rate of and factors contributing to non-adherence to hearing-aid use in the UK National Health Service. DESIGN: A cross-sectional postal questionnaire survey. STUDY SAMPLE: A questionnaire, including the International Outcome Inventory for Hearing Aids, was sent to all patients fitted with hearing aids at the Royal Surrey County Hospital between 2011 and 2012 (N = 1874). A total of 1023 questionnaires were completed and returned (response rate of 55%). RESULTS: A total of 29% of responders did not use their hearing aids on a regular basis (i.e. used them less than four hours per day). Non-regular use was more prevalent in new (40%) than in existing patients (11%). Factors that reduced the risk of non-regular use included bilateral versus unilateral amplification, and moderate or severe hearing loss in the better ear. 16% of responders fitted with bilateral amplification used only one of their hearing aids. CONCLUSIONS: The level of non-regular use of hearing aids in NHS found in this study was comparable to those for other countries. Additional support might be needed for patients at a higher risk of non-regular use.

The effects of dosage and duration of auditory training for older adults with hearing impairment.

This study explored a range of training dosages and durations for a word-based auditory-training procedure for older adults with hearing impairment. Three groups received a different "dose": 2x/week; 3x/week; no training. Fifteen training sessions comprised a "cycle" which was repeated three times for each dosage. Groups that completed training performed significantly better than controls for speech-in-noise materials included in the training regimen, with no significant difference observed between the 2x or 3x/week training groups. Based on these results, as well as prior literature on learning theory, training 2x or 3x/week for 5-15 weeks appears to be sufficient to yield training benefits with this training regimen.

[Which colours can we hear?: light stimulation of the hearing system]. / Welche Farben könnten wir hören?: Lichtstimulation des Hörsystems.

The success of conventional hearing aids and electrical auditory prostheses for hearing impaired patients is still limited in noisy environments and for sounds more complex than speech (e. g. music). This is partially due to the difficulty of frequency-specific activation of the auditory system using these devices. Stimulation of the auditory system using light pulses represents an alternative to mechanical and electrical stimulation. Light is a source of energy that can be very exactly focused and applied with little scattering, thus offering perspectives for optimal activation of the auditory system. Studies investigating light stimulation of sectors along the auditory pathway have shown stimulation of the auditory system is possible using light pulses. However, further studies and developments are needed before a new generation of light stimulation-based auditory prostheses can be made available for clinical application.

Music mixing preferences of cochlear implant recipients: a pilot study.

OBJECTIVE: Music perception and appraisal are generally poor in cochlear implant recipients. Simple musical structures, lyrics that are easy to follow, and clear rhythm/beat have been reported among the top factors to enhance music enjoyment. The present study investigated the preference for modified relative instrument levels in music with normal-hearing and cochlear implant subjects. DESIGN: In experiment 1, test subjects were given a mixing console and multi-track recordings to determine their most enjoyable audio mix. In experiment 2, a preference rating experiment based on the preferred relative level settings in experiment 1 was performed. STUDY SAMPLE: Experiment 1 was performed with four postlingually deafened cochlear implant subjects, experiment 2 with ten normal-hearing and ten cochlear implant subjects. RESULTS: A significant difference in preference rating was found between normal-hearing and cochlear implant subjects. The latter preferred an audio mix with larger vocals-to-instruments ratio. In addition, given an audio mix with clear vocals and attenuated instruments, cochlear implant subjects preferred the bass/drum track to be louder than the other instrument tracks. CONCLUSIONS: The original audio mix in real-world music might not be suitable for cochlear implant recipients. Modifying the relative instrument level settings potentially improves music enjoyment.

An Australian version of the acceptable noise level test and its predictive value for successful hearing aid use in an older population.

OBJECTIVE: The acceptable noise level (ANL), a measure of noise tolerance, has been proposed as a predictor for successful hearing aid use. The aims of this study were to obtain normative data, and to evaluate the clinical feasibility and predictive value of an Australian version of the ANL test in an older population. DESIGN: Repeated ANL measurements were presented diotically using earphones. All participants provided demographic information and hearing aid owners were asked about their aid use. STUDY SAMPLE: A total of 290 older adults were assessed; 166 participants had a hearing impairment and 96 owned a hearing aid. RESULTS: The mean ANL was lower than previously reported. While age and gender had no effect on ANL, a significant, but weak, correlation was found between ANL and hearing loss. The test-retest reliability showed the results were clinically unreliable. In addition, the ANL did not predict hours or pattern of hearing aid use. CONCLUSIONS: While the Australian ANL test showed several similar characteristics to previous versions of the test, low test-retest reliability raised questions about its clinical value as a predictor for long-term hearing aid use.