Hearing aids for music: exploring the music listening behaviour of people with hearing impairments

Lead Research Organisation: University of Leeds
Department Name: Sch of Music


Today, people with mild, moderate, severe or even profound deafness are able to perceive music to some degree by using modern hearing aid (HA) technology. In this way, music can form a powerful personal, social and emotional aspect of their lives, enhancing physical and psychological well-being, just as it does for people with 'normal' hearing. Current research on music listening behaviour highlights the ways in which people use music to facilitate day-to-day activities (e.g. while doing housework, travelling or working), to manage mood and emotions (e.g. during exercise or when feeling particularly elated or depressed), and for therapeutic reasons (e.g. to manage pain or aid relaxation). This research, however, is usually carried out with 'normally' hearing adults and there is a lack of understanding about how mild, moderate, severe or profound deafness and the use of HAs affect music listening. There are currently over 10 million people with some level of deafness in the UK representing one in six of the population and this figure is set to rise dramatically to 14.5 million by 2031.

This three year project represents the first large-scale systematic investigation of how music listening experiences are affected by deafness and the use of HAs. This interdisciplinary research brings together academic researchers in fields of music psychology and audiology and is concerned with questions of auditory musical perception. By exploring the links between hearing impairments, HAs and music listening behaviours, this research seeks to improve the perception of music using HA technology. In-depth case studies exploring subjective experiences will set the context for a wider national survey of music listening among people with hearing impairments. Alongside this psychological research, audiometric data will be used to quantify levels of hearing impairment and amplification to provide a clear picture of musical auditory perception. A stakeholder report outlining the current and potential role of manufacturers, distributers, audiologists, and users with respect to the improved function of HAs for music listening, will be sent to all parties. It will outline fitting strategies of benefit to NHS and private sector clinics. It will also highlight priorities for research and development in new digital signal processing of benefit to manufacturers. The proposal includes resources for a bespoke website and discussion forum which will provide the general public with facts and figures, research findings, useful contacts, and a means to interact with the project and other HA users interested in music listening issues. The website and forum will be promoted though existing links with deafness organisations and through existing twitter feeds (@musicndeafness) and social media to maximise public engagement.

The research findings will directly benefit people with all levels of deafness and HA users, both in the UK and internationally through open access content on the website and forum, and via more traditional modes of dissemination including conferences. This growing population will benefit from knowledge exchange provided by psychological insights into aural musical rehabilitation. It will support audiologists in addressing music listening challenges presented by patients in their clinics in a field in which there exists no formal training. It will also provide an empirical basis for manufacturers of HAs to align their signal processing research and development activities with real-world problems and experiences of everyday music listening. Improved access to music using HAs will benefit people of all ages, facilitating music education for deaf children and young people, musical listening and performance in adulthood, and continued musical engagement into old age. This research has the potential to transform thousands of people's lives.

Planned Impact

The research will benefit the following three groups: people who use HAs, audiology professionals who fit HAs and commercial stakeholders who manufacture HAs.

First, and primarily, the research will benefit HA users (approximately 1.4million people) by enabling them to improve their access to music and their enjoyment of music listening and performance. This research will provide HA users in the UK and internationally access to an online website and discussion forum and a printed leaflet containing facts and advice about getting the best from hearing aids and music, which will also be of benefit to providers of hearing aids and aural rehabilitation. The leaflet will be hosted online and sent to NHS audiology clinics and private HA fitters throughout the UK, highlighting key facts and promoting the project website. In these ways, the research will allow HA users to extend the use of their technology into music-listening situations and ensure that a music listening program is provided to maximise the users' potential to listen to music. For D/deaf children, this will provide opportunities for musical development, learning and performance that would not exist otherwise. For adults and those with age-related presbycusis, improvements to HA technology fitting will allow music listening for enjoyment, benefiting the health, wellbeing and quality of life of users across the human life-span.

Second, the research will benefit audiology professionals by providing evidence-based clinical recommendations and strategies to improve the fitting of HAs for music listening, increasing clinicians' level of confidence and expertise. Strategies will extend to social and behavioural changes the user can make to improve music perception in different listening and performance situations. As HAs are not currently optimally designed for music perception, and formal training in this area is not mandatory, there exist challenges and opportunities for audiology professionals to extend their skills. This will be enabled by academic dissemination via UK audiology societies, supported by the patient advice leaflet in addition to development of a web based learning module which can be accredited for CPD by the BAA. By providing empirical and objective strategies, the recommendations will increase clinicians' ability to discuss patients' music-listening experiences and extend their use of existing outcome measures from both audiology and music psychology allowing them to better address patients' needs. Practitioners will be invited to engage with discussions on the website and forum connecting their expertise with HA users throughout the UK, helping patients access nearby clinics and allowing fitters to expand their practice.

Third, the research will benefit the commercial HA manufacturing industry, estimated to be worth £350-£375 million in the UK, by providing empirical, academic research into the usage patterns, problems and preferences of their user market with respect to music listening, via large-scale survey research. Manufacturers' in-house research and development (R&D) activity over recent decades has yielded significant advancements in digital signal processing solutions for speech perception using HAs, with music-listening solutions being a lower commercial priority. This research will provide an agenda for future R&D activity for HA manufacturers with respect to problems that need to be targeted by signal processing solutions for music listening, and enable manufacturers to focus their activity on confirmed trends. Manufacturers will also benefit from learning more about the issues faced by audiology professionals regarding fitting for music listening. The stakeholder report will be sent to all UK HA manufacturers directly and via the British Hearing Aid Manufacturers Association (BHAMA). Representatives of HA manufacturers will also be invited to contribute articles and discussion on the project website and forum.
Description The HAFM project was the first large-scale project to explore how hearing impairments and the use of hearing aid technology affect musical experiences. Data from >1,500 hearing aid users and >100 audiologists highlighted that:
1. While hearing aids are useful for music listening for most people, problems can be experienced such as distortion, difficulties picking out instruments or hearing lyrics. This can lead to a reduction in musical enjoyment which can negatively affect quality of life, and in some cases, disengagement with music
2. Audiologists are not routinely trained in fitting hearing aids for music, and identified a need for guidance on what they can do in clinic to improve music listening outcomes
A set of resources have been developed for hearing aid users and audiologists to raise awareness of the challenges of music listening through hearing aids, and suggest strategies that can help. These resources, which are freely available on our website (http://musicandhearingaids.org/resources), have significant potential to increase hearing aid users' satisfaction with their hearing aids and engagement in musical activities, and to increase the effectiveness of public services and policy by increasing clinicians' levels of confidence and expertise in fitting hearing aids for music.
Exploitation Route Findings may be used by a range of stakeholders including hearing aid users, deaf musicians, audiology practitioners, researchers and hearing aid manufacturers. Outside the academy, the general public (e.g. listeners, performers) can use the resources to increase their understanding of the benefits and challenges of music listening with hearing aids, and strategies that can help (e.g. listening practices, knowledge about assistive technologies, tools to facilitate discussions in clinic). Practitioners can use the resources to develop professional skills in supporting patients in clinic (e.g. guide to counselling and fitting hearing aids for music). Hearing aid manufacturers can use the findings to better understand hearing aid users' needs with regards to music, and to inform research and development activities. Within the academy, researchers can use the findings to develop future research proposals, emphasising the need for an interdisciplinary approach and collaborative partnerships with the public and private sectors for addressing the needs of hearing aid users, as a growing population.
Sectors Creative Economy,Healthcare,Manufacturing, including Industrial Biotechology

URL http://www.musicandhearingaids.org
Description Hearing aid users have reported positive changes in music listening practices as a result of participating in our work. Deaf musicians have reported increased knowledge of the capabilities of hearing aid and assistive listening technologies, and that they will share what they have learned with other musicians. Audiologists have gained insights that have informed their clinical practice. In particular, audiologists have reported more confidence in providing advice about music listening in clinic and in programming hearing aids for music. Hearing aid manufacturers have valued the opportunity for networking, and provided by our project, and have confirmed that they wish to be part of any further research that we undertake in the area. Impact evidence gathering is ongoing with patients and practitioners to map the ways in which our research changes practice over time.
First Year Of Impact 2016
Sector Education,Healthcare
Impact Types Cultural,Societal,Policy & public services

Description Influence on audiology practitioners (and subsequently the general public)
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact Audiologists have been trialling our resources in clinic, and have reported that these have raised their awareness and understanding of the challenges of listening to music through hearing aids, and of the clinical strategies that could help. Impact evidence gathering is ongoing, however those who have responded to date (c. 20 clinicians) have reported an improvement in their confidence in providing advice to patients about music, and in their programming hearing aids for music in clinic, as a direct results of our resources.
Description Influence on practice
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact The HAFM project has engaged > 100 audiologists in research, examining their experiences of and confidence in fitting hearing aids for music, and worked with 37 different NHS audiology departments across the country to implement the national survey. Audiologists have been given opportunities to engage with the findings through the website, international conference, public engagement event and resources. Audiology practitioners have told us that they have gained knowledge through the project and that they have used the knowledge to inform their practice (e.g. "I have used the skills that I learnt at the conference to advise musically inclined hearing aid users clinically and have shared my notes and experiences with my audiology colleagues. My hospital has also signed up to advertise the Hearing Aids for Music project to our patients as a result of my attendance at the conference."). In a follow-up survey taking place four months after our conference, 67% of audiologists reported that they had took action and/or changed their behaviour as a direct result of attending our meeting. Funding is currently being sought to carry out a resource evaluation study to assess the on-going impact of the findings on clinical practice.
Description Higher Education Innovation Funding
Amount £1,000 (GBP)
Organisation Higher Education Innovation Funding (HEIF) 
Sector Public
Country United Kingdom
Start 02/2016 
End 05/2016
Description Research Development Fund (for public engagement)
Amount £500 (GBP)
Organisation University of Leeds 
Sector Academic/University
Country United Kingdom
Start 09/2018 
End 05/2019
Description Harley Street Hearing 
Organisation Harley Street Hearing
Country United Kingdom 
Sector Private 
PI Contribution The research team collaborated with Harley Street Hearing (HSH), one of the leading independent audiology practices in the UK, to ensure that the project represent the views of hearing aid users from both the public and private sector. The research team provided expertise in conducting research among patients and practitioners.
Collaborator Contribution Harley Street Hearing in return provided access to hearing aid users attending their clinic, and a base and rooms at HSH in London for conducting in-depth interviews with hearing aid users. The director of HSH, Paul Checkley, also provided support in kind for the duration of the project through our advisory board.
Impact The following outputs were developed as a direct result of the data collected with the assistance of HSH clients and practitioners.
Start Year 2015
Description National Health Service (audiology departments) 
Organisation National Health Service
Country United Kingdom 
Sector Hospitals 
PI Contribution The HAFM project was a formal three-year collaboration between the University of Leeds and one NHS Trust (Sheffield Teaching Hospitals NHS Foundation Trust). However, the project generated significant interest from the public sector through our dissemination activities (industry talks, HAFM conference), such that by the end of the project we were collaborating with 37 NHS audiology departments across England to implement the national survey among hearing aid users. The research team provided the framework and materials (e.g. ethical review, audiologists FAQs, materials to be distributed to patients in clinic) and was responsible for accrual reporting across the different NHS sites.
Collaborator Contribution Each Trust* provided clinical audiologists to assist in the collection of data for the national survey (data from > 1,500 hearing aid users). The lead practitioner in each NHS Trust briefed his/her team of audiologists about the study and practitioners introduced the research study to patient in clinic. *Participating Trusts: 1. Sheffield Teaching Hospitals NHS Trust 2. Aintree University Hospital NHS Foundation Trust 3. Airedale NHS Foundation Trust 4. University Hospitals Birmingham NHS Foundation Trust 5. Blackpool Teaching Hospitals NHS Foundation Trust 6. Cambridge University Hospitals Foundation Trust (Addenbrookes Hospital) 7. Chesterfield Royal Hospital NHS Foundation Trust 8. County Durham & Darlington NHS Foundation Trust 9. East Sussex Healthcare Trust 10. East Cheshire 11. Hinchingbrooke Hospital / North West Anglia NHS Foundation Trust 12. Harrogate District Foundation Trust 13. Ipswich 14. Isle of Wight NHS Trust 15. James Paget University Hospitals NHS Foundation Trust, Gorleston 16. Kingston 17. Leeds Teaching Hospitals NHS Foundation Trust 18. Leicester Royal Infirmary 19. Manchester University NHS Foundation Trust 20. Medway NHS Foundation Trust 21. Milton Keynes University Hospital NHS Foundation Trust 22. Rotherham NHS Foundation Trust 23. Royal Cornwall Hospitals NHS Trust 24. Salford Royal NHS Foundation Trust and The Pennine Acute Hospitals NHS Trust 25. Shrewsbury and Telford Hospital NHS Trust 26. Southend 27. South Tees 28. Stockport NHS Foundation Trust 29. Sunderland 30. Tameside and Glossop Integrated Care NHS Foundation Trust 31. University College London Hospitals 32. Walsall Healthcare NHS Trust 33. Western Sussex 34. West Suffolk NHS Foundation Trust 35. Wythenshawe Hospital, part of Manchester University NHS Foundation Trust 36. Wrightington Hospital, Wrightington, Wigan and Leigh NHS Foundation Trust 37. Yeovil District Hospital NHS Foundation Trust
Impact This partnership combines research expertise in music psychology with clinical expertise in audiology. The patient and practitioner resources, and stakeholder report were developed from this collaboration with NHS audiology departments.
Start Year 2017
Description Sheffield Teaching Hospitals NHS Foundation Trust 
Organisation Sheffield Teaching Hospitals NHS Foundation Trust
Country United Kingdom 
Sector Public 
PI Contribution The HAFM project was a formal three-year collaboration between the University of Leeds and Sheffield Teaching Hospitals NHS Foundation Trust. The research team brought expertise in the disciplines of music psychology, auditory perception, deaf education, computer science and research methods to implement a series of clinical studies.
Collaborator Contribution Sheffield Teaching Hospitals Trust provided expertise in clinical audiology, and access to hearing aid users and practitioners.
Impact In order to understand the various factors affecting music listening behaviour in populations with hearing impairments, an multidisciplinary approach was required. The partnership combined research expertise in music psychology (PI_Greasley) with practical expertise in clinical audiology (Co-I, Crook), and through the advisory panel, the fields of auditory perception, deaf education, hearing therapy and computer science. The following outputs are a direct result of the collaborative partnership between academy and the NHS: 1) Stakeholder report (Greasley et al., 2018) - final report outlining aims/method/findings and recommendations for hearing aid users, audiologists, manufacturers and researchers 2) A glossary of terms for music listening with hearing aids (Chasin et al., 2018) - a glossary of terms to facilitate greater understanding of key terms in audiology and music 3) A patient leaflet (Greasley et al., 2018) - a leaflet which provides advice on the challenges of listening to music through hearing aids and the strategies that might help 4) A practitioner leaflet (Crook et al., 2018) - this provides advice to audiologists on counselling and fitting hearing aids for music 5) A quickguide for clinic (Crook et al., 2018) - this provides technical advice for programming hearing aids for music for use in clinic
Start Year 2015
Description Hearing Aids for Music conference 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact The purpose of the conference was to bring together hearing aid users, researchers, audiologists and manufacturers to examine current issues and potential solutions in the perception of music through hearing aids.

Though originally proposed as a national conference, the event was truly international in reach. Academic specialists in music and deafness attended from around the globe (including US, Canada, AU, NZ and Europe), and 120 delegates attended including audiology patients and their carers, audiology practitioners, hearing aid manufacturers and researchers, ENT surgeons, hearing therapists and musicians.

Feedback from the conference highlighted both the success of the conference itself, and the need for further research to be done in this area.

Across 40 responses to our 4-month follow up survey,

• 94% of audiologists agreed or strongly agreed with the statement that they had learnt something new at the conference. For example, one commented "I lecture and provide training to Audiologists - both in private and public sectors and found the information invaluable."
• 94% of manufacturers/researchers reported that they found the networking opportunities useful. One stated "[I] Met a number of useful contacts through the conference, with some of whom I now have a working relationship."
• More than half of people agreed that they took action and/or changed their behaviour as a result of the conference (67% of audiologists; 53% of hearing aid users; 56% of those with musical training; 56% of those working in research/manufacturing). Interestingly, 35% of people reported that they need further help in applying what they learnt. This group included hearing aid users, musicians, audiologists and manufacturers.
• However, under half of HA users (46%) felt the event had an impact on their musical practise. While some reported specific benefits e.g. "I left the conference with more knowledge, and with confirmation that I was doing the right thing in continuing to play", others found the current state of research unable to assist them in their music engagement, e.g. "I felt that perhaps my hearing loss is too severe to be helped. I have had to stop singing."
• Finally, 93% of respondents agreed or strongly agreed with the statement that they would like to attend a similar event in the future.

The conference took great care to engage the target population of hearing aid users (with all levels of deafness), and delegates from across all stakeholder groups reported that they were impressed with how accessible the conference had been. Presentations were interpreted live (in British or International Sign Language, depending on audience preferences), were live captioned to screen, and were supported by a lip-reading camera in addition. The main conference room was fitted with a large hearing loop, and breakout sessions reinforced presentations using additional soundfield systems. Materials from the conference have been made available online (including abstracts, presentation slides and 10 fully captioned videos). This includes an archive of the concert given by a group of deaf musicians which was live streamed during the conference itself.

The conference has sparked debate and will undoubtedly lead to future collaborations with other academics, practitioners and device manufacturers interested in enhancing the experience of music listening and performance with hearing aids.
Year(s) Of Engagement Activity 2017
URL http://musicandhearingaids.org/conference/
Description Hearing Futures II 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Patients, carers and/or patient groups
Results and Impact The Hearing Futures II event at the V&A in London brought together a wide range of stakeholders including hearing aid users, deaf musicians, audiology practitioners and hearing aid manufacturers to discuss the findings of the HAFM research and the future of hearing devices for music listening, looking at the future in terms of technology and practice.
Year(s) Of Engagement Activity 2018
URL https://www.vam.ac.uk/event/BleyEalE/hearing-futures-ii
Description Project website (incl. blog) and twitter feed 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact The project website (www.musicandhearingaids.org) and twitter feed (@musicndeafness) have generated numerous enquiries from the general public; people have contacted us to share their experiences, offer to take part in research studies, and request to be kept informed of the research findings. We have added those who have contacted us to a list to be kept informed of research findings and future developments, and we will invite them to participate in the research as appropriate. The responses to date show a clear need for more information about listening to music for hearing aid (HA) users of all ages - a central aim of the project as a whole.
Year(s) Of Engagement Activity 2015,2016
URL http://www.musicandhearingaids.org
Description Talk to Patient and Public Involvement (PPI) audiology group, University Hospitals Birmingham 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Patients, carers and/or patient groups
Results and Impact Principal Investigator (AG) gave a talk to around 50 patients who were members of the Panda Patient and Public Involvement (PPI) group on 25 June 2019. Outlined main project findings and discussed strategies for improving musical experiences for those with hearing loss. Some PPI members followed up afterwards (emailed) to say how informative they had found it and to engage in further discussion about possible strategies for improving their experience as hearing aid users.
Year(s) Of Engagement Activity 2019