Understanding and alleviating hearing disability: the contribution of natural behaviours

Lead Research Organisation: University of Nottingham
Department Name: School of Medicine

Abstract

People use their hearing in all sorts of ways and in all sorts of situations. Our sense of hearing helps us to understand what is going on around us, and warns us of unseen dangers. Possibly more importantly, hearing is vital to social communication. For someone with hearing loss, their experience of hearing disability will depend on the mix of social activities they take part in, and the importance they assign to success in those activities. Very little is known about how such patterns of hearing activity differ from person to person, and between people with normal versus impaired hearing. Nor do we know whether using hearing aids changes the activities people take part in.
At a more 'microscopic' level of detail, people instinctively behave in certain ways when faced with challenges to their ability to hear. For example, if we cannot hear what someone is saying because of a noisy background, we typically move closer or turn one ear towards them. We know only a little about these behaviours. People with hearing loss face greater challenges than others, and they may use different behaviours, or maybe they could be trained to use more effective behaviours. Meanwhile, hearing aids are generally designed on the assumption that people remain static and face to face, regardless of the situation. This means not only that hearing aids miss out on the chance to take advantage of their wearer's natural behaviours, but that they sometimes undermine the effectiveness of those behaviours.
It is becoming increasingly recognised that in order for hearing aids to be more helpful, they must adapt to the moment-to-moment changes in situation which are part of people's everyday life. Furthermore, the clinical prescribing of hearing aids needs to take more account of each patient's individual lifestyle and activity patterns.
Our research will provide new knowledge and insights which can form the basis of future improved hearing aid technology and prescribing. We will do this by:
- Constructing a mathematical model describing how the acoustics of the environment, hearing impairment, sound processing in hearing aids and body movements all interact to affect people's hearing performance. To do this, we will carry out several experimental studies measuring how people move and change communication tactics when their hearing is challenged.
- Determining whether real-world hearing disability (and the relief from disability provided by hearing aids) is driven by isolated events which are crucial for the individual, or by a 'grand average' of events across time.
- Devising and testing hearing-aid fitting protocols which account for patients' insensitivity to acoustic changes.
- Developing prototype hearing aid technologies which exploit or support listeners' natural behaviour to provide benefits beyond those currently available, and evaluating them in the laboratory and in realistic conditions.
- Examining whether routine clinical data can support more individualised prescription of interventions for hearing loss. We will use a very large set of data accumulated as part of routine clinical care, which means the data are relatively loosely controlled. We will evaluate whether known relations are nevertheless reproduced. If so, we will then look for informative new patterns which might be used to improve the individualisation of treatment for hearing problems.

Technical Summary

People use their hearing in complex and diverse situations. An individual's experience of hearing disability, and benefit from hearing aids, will depend on a unique mix of social activities, importance of success in those activities, and how much hearing aids help in different situations. It remains unclear how these factors interact to drive the experience of disability or benefit for the individual.
In parallel, little is known about how people use low-level behaviours to maintain satisfactory auditory communication, and whether those behaviours change with hearing impairment and hearing aids.
These knowledge gaps hinder advances in hearing devices and rehabilitation, which increasingly target specific acoustic environments and listening needs.
Our research will:
-Assemble a model describing how ambient acoustics, hearing impairment, hearing-aid signal processing and body movements affect hearing performance.
-Determine whether real-world hearing disability/benefit is driven by key events for the individual or by a 'grand mean' of activities.
-Devise and test hearing-aid fitting protocols accounting for listeners' insensitivity to acoustic changes.
-Develop hearing device technologies which exploit or support listeners' natural behaviour to provide benefits beyond those currently available, and test them in the laboratory and in the field.
We will also test the utility of routine clinical data to inform the prescription of interventions for hearing loss. Using a very large clinical database, we will examine whether known predictive relations are reproduced. A datamining approach will indicate whether other plausible patterns are present.
Overall, the knowledge generated will facilitate the development of hearing devices and device fitting processes which provide improved benefits by taking account of individual behaviour at micro and macro-scales.

Planned Impact

We will seek to continue IHR's excellent track record of disseminating our scientific results and knowledge to wider communities (eg http://www.100yearsofamplifiedmusic.org/). In this programme we plan to deliver three non-academic impact goals: (1) increase public awareness of hearing and hearing impairment in general and communication behaviour in particular, (2) interact with hearing-device developers so that our science can lead to improved future devices that take advantage of natural behaviour instead of interfering with it, and (3) prepare the hearing healthcare community for the novel interventions and benefit domains which our research may stimulate.

To do this we will engage three audiences:
Public Engagement (goal 1): Our research will give new scientific knowledge of how people use their hearing, and how their behaviour is affected by hearing impairments or hearing aids. Our research will add to the wider public's knowledge of hearing. It will also encourage public awareness and discussion of just how important hearing impairment is as a health issue.
Industry Engagement (goal 2): Our results will be of great interest to the hearing-device industry, as both improving the 'situational awareness' of hearing aids and developing behaviourally-based hearing-aid algorithms are currently in focus in industrial research. We confidently hope that this programme will feed into improvements in future hearing devices, by identifying new phenomena which they can exploit or mitigate and indicating how hearing aids might be designed to deliver improved performance in specific types of communication situation.
Health Engagement (goal 3): We expect that the insights found in this programme will be of interest both to many of those with hearing impairment and to many health professionals in audiology and ENT. Though the results will not lead to an immediate improvement in hearing aids (but see Industry Engagement above for downstream effects) we expect that they will be of background benefit through increasing the understanding of daily-life hearing problems amongst healthcare professionals, and by raising awareness of the types of hearing device capabilities which are on the horizon.

Publications

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Dillard LK (2020) Insights Into Conducting Audiological Research With Clinical Databases. in American journal of audiology

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Browning GG (2021) Revised 15-item Glasgow Benefit Inventory with five factors based on analysis of a large population study of medical and surgical otorhinolaryngological interventions. in Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery

 
Title Radio Automata / Radiophrenia 
Description A radio performance comprised entirely of segments derived from machine-learning, that emulated traditional commercial radio formats while highlighting the common errors in big-data/machine-learning algorithms as their outputs if not tempered, result not just in regression to the mean, but reductio ad absurdia. 
Type Of Art Performance (Music, Dance, Drama, etc) 
Year Produced 2019 
Impact International listening audience, many comments on its effectiveness, plans for future development. 
URL http://radiophrenia.scot/may-23rd/
 
Description NICE Guidelines for Adult Hearing Loss
Geographic Reach National 
Policy Influence Type Participation in a national consultation
 
Description NICE Guidelines for Tinnitus
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description Scottish Tinnitus Advisory Group
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact First, a survey of audiological heads of service revealed certain inequalities in service across regions. Second, the development of a minimum protocol for tinnitus service across Scotland to address the survey results. These two outputs have resulted in awareness of inequalities, methods to reduce such inequalities, and knowledge of currently most efficient and effective tinnitus care. Third, a Quality Standard to improve for tinnitus service was published. Its impact is currently being measured (despite challenges in funding its assessment).
URL http://www.knowledge.scot.nhs.uk/sahscommunity/tinnitus-advisory-group.aspx
 
Description BrainBox Initiative Research Challenge
Amount £9,000 (GBP)
Organisation Brainbox Ltd. 
Sector Private
Country United Kingdom
Start 06/2020 
End 11/2020
 
Description Challenges To Revolutionise Hearing Device Processing
Amount £251,509 (GBP)
Funding ID EP/S031308/1 
Organisation Engineering and Physical Sciences Research Council (EPSRC) 
Sector Public
Country United Kingdom
Start 08/2019 
End 08/2024
 
Description Examination of response duration and prosodic pattern as measures of self-efficacy for speech understanding
Amount £32,000 (GBP)
Organisation Oticon Foundation 
Sector Charity/Non Profit
Country Denmark
Start 10/2019 
End 09/2020
 
Description Identifying objective measures of conversation success
Amount £79,000 (GBP)
Organisation Widex A/S 
Sector Private
Country Denmark
Start 04/2020 
End 03/2023
 
Description MRC IMPACT award (Holman @ Vanderbilt)
Amount £2,080 (GBP)
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 09/2019 
End 09/2019
 
Description Sivantos pilot study 2018-19
Amount £25,634 (GBP)
Organisation Sivantos Group 
Sector Private
Country Singapore
Start 10/2018 
End 09/2019
 
Description The joy of hearing
Amount £130,000 (GBP)
Organisation Hearing Industry Research Consortium 
Sector Private
Start 02/2019 
End 01/2022
 
Description Workshop on communicative interaction and hearing disability
Amount £25,000 (GBP)
Organisation Sonova Holding AG 
Sector Private
Country Switzerland
Start 04/2020 
End 09/2020
 
Title EMA 
Description Ecological Momentary Assessment: Smartphone-based repetitive self-report of momentary daily-life circumstances. 
Type Of Material Physiological assessment or outcome measure 
Year Produced 2019 
Provided To Others? No  
Impact Established our capability in EMA techniques. Enabled us to engage more closely in dialogue with other teams using this technique. Forms basis for one completed and several planned studies. 
 
Title Mobile pupillometry 
Description Meaurement of pupil size using wearable glasses 
Type Of Material Physiological assessment or outcome measure 
Year Produced 2019 
Provided To Others? Yes  
Impact In use by partners in our HEAR-ECO consortium project. 
 
Title Multiple EEG 
Description Synchronized EEG measurements from two people simultaneously 
Type Of Material Improvements to research infrastructure 
Year Produced 2019 
Provided To Others? No  
Impact Allows us to pursue new research questions 
 
Title New Vicon and Nexus 
Description Upgrading of our motion-tracking hardware and software 
Type Of Material Improvements to research infrastructure 
Year Produced 2019 
Provided To Others? No  
Impact Facilitates much faster implementation of experimental paradigms, more robust data collection, and reduces analysis errors. 
 
Title PPI 
Description Patient and Public Involvement panel: Patients and public contribute to the development of our research questions, help us to ensure the usability of consent forms, information sheets etc., and assess the participant feasibility of study protocols. 
Type Of Material Improvements to research infrastructure 
Year Produced 2020 
Provided To Others? No  
Impact Improved clarity of participant-facing documents, improved calibration of participant burden in experiments, more relevant research questions. 
 
Title DA Tobii + SI integration 
Description Matlab scripts developed for the integration of the Tobii Pro eye-tracker with the Speech Intelligibility test provided by Eriksholm Oticon, leading to the collection of pupil data concurrently with the SI test. 
Type Of Material Data handling & control 
Year Produced 2019 
Provided To Others? No  
Impact Allows efficient and less error-prone collection of multimodal data. 
 
Title DA combination study data 
Description Dataset (pupil size + need for recovery scale, reading span test, experiment that includes sentence-final word identification and recall (SWIR) test performance results Danish HINT test with DAT sentences test performance results 
Type Of Material Database/Collection of data 
Year Produced 2020 
Provided To Others? No  
Impact Too early to say. 
 
Title DA groundwork data 
Description Dataset (pupil size, need for recovery scale, hearing in noise test performance, video recordings of the experiment session, audiogram) of 46 normal hearing participants 
Type Of Material Database/Collection of data 
Year Produced 2020 
Provided To Others? No  
Impact Lays groundwork for devising experiments studying fatigue, motivation and hearing impairment 
 
Title DA pupillometry processing 
Description Matlab scripts for the parsing, pre-processing, and analysis of the output from the Tobii Pro eye-tracker. 
Type Of Material Data analysis technique 
Year Produced 2019 
Provided To Others? Yes  
Impact Allows for automated derivation of outcome metrics from complex data stream, including error detection and removal and accommodation of variable-length stimuli. 
 
Title EOG data 
Description Data covering electro-oculography signals and gaze directions 
Type Of Material Database/Collection of data 
Year Produced 2018 
Provided To Others? Yes  
Impact Not known 
 
Title LVH dyads data 
Description 7h of dyad conversation data including motion capture, eye tracking, and speech parameters. 
Type Of Material Database/Collection of data 
Year Produced 2019 
Provided To Others? Yes  
Impact Has been used by at least one other research group 
 
Description EarLens 2016 still active 
Organisation Earlens
Country United States 
Sector Private 
PI Contribution Expertise, methodology, access to equipment and facilities
Collaborator Contribution Access to equipment, expertise
Impact Ongoing - no output yet
Start Year 2016
 
Description NHSGGC Audiology 
Organisation NHS Greater Glasgow and Clyde (NHSGGC)
Country United Kingdom 
Sector Public 
PI Contribution Patient characterization
Collaborator Contribution Access to patient database, contact routes to patients.
Impact DOI: 10.18154/RWTH-CONV-238997 https://doi.org/10.1177/2331216519886684 http://dx.doi.org/10.1038/s41598-019-46416-0 http://dx.doi.org/10.1177/2331216519876795 http://dx.doi.org/10.1080/14992027.2019.1597284 http://dx.doi.org/10.1177/2331216519886684 http://dx.doi.org/10.1038/s41598-019-46416-0
Start Year 2018
 
Description National Center for Rehabilitative Auditory Research, Portland, Oregon - 'Patient Characteristics and Hearing Aid Satisfaction - A Retrospective Data Analysis' 
Organisation National Centre for Rehabilitiative Auditory Research (NCRAR)
Country United States 
Sector Public 
PI Contribution Statistical expertise. Audiological expertise.
Collaborator Contribution Access to US nationwide databases of clinical data. Resources for data management. Knowledge of circumstances surrounding data collection.
Impact No outputs yet
Start Year 2015
 
Description Oticon EOG 
Organisation William Demant Holding Group
Country Denmark 
Sector Private 
PI Contribution Expertise, methodology, access to equipment and facilities
Collaborator Contribution Expertise
Impact https://doi.org/10.1371/journal.pone.0190420
Start Year 2015
 
Description Sivantos pilot 2018 - still active 
Organisation Sivantos Group
Country Singapore 
Sector Private 
PI Contribution Expertise, intellectual input, access to equipment, methodology and facilities.
Collaborator Contribution Access to equipment, training of staff, expertise
Impact Ongoing, no outputs yet
Start Year 2018
 
Description Sonova big data 
Organisation Sonova Holding AG
Country Switzerland 
Sector Private 
PI Contribution Expertise
Collaborator Contribution Access to data
Impact Ongoing - no outputs yet
Start Year 2018
 
Description VUmc general 
Organisation VU University Medical Center
Country Netherlands 
Sector Academic/University 
PI Contribution Expertise
Collaborator Contribution Expertise
Impact doi 10.1177/2331216518799437
Start Year 2017
 
Description Vanderbilt Fatigue 
Organisation Vanderbilt University
Department School of Medicine
Country United States 
Sector Academic/University 
PI Contribution Data collection, cross-validation.
Collaborator Contribution Pre-release version of a new Patient Reported Outcome Measure. Expert consultation on experimental design.
Impact No outputs so far.
Start Year 2016
 
Description GN Complex Needs Educational Days 2019 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Presented an hour-long talk about hearing-aid fitting research from our lab to NHS audiologists across the UK at six events sponsored by hearing-aid manufacturer GN Resound in London (14th May), Bristol (15th), York (21st), Knutsford (22nd), Stirling (4th June), Leicester (7th). Ran a scoping exercise of current professional practice to bolster our current outputs and future research. In-depth discussion at all sites (esp. Stirling), and unprompted testimony in Leicester of our research's efficacy in practice - success!
Year(s) Of Engagement Activity 2019
 
Description HEAR-ECO newsletter 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Online Newsletter, regularly updated.
Year(s) Of Engagement Activity 2019,2020
URL http://hear-eco.eu/news-events/
 
Description Invited talk at B-Audio (Belgian Audiological Society) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Invited talk on research relevant to Belgian audiological practice and policy, which received much discussion and was highlighted during the round-up as a key component to future practice. Invitations to smaller private-practice meetings were considered.
Year(s) Of Engagement Activity 2018
URL http://b-audio.eu/images/5/5e/B-Audio_Flyer_Spring_Symposium_260518_%281%29.pdf
 
Description Invited talk at British Academy of Audiology 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Presented research (just-noticeable differences in gain, work with MRC PhD Benjamin Caswell-Midwinter) with relevance to audiological practice as well as protocols and policies of the Academy to consider for adoption. Received many questions and comments highlighting the impact
Year(s) Of Engagement Activity 2018
URL https://www.baaudiology.org/files/3315/4089/2080/WEBSITE_VERSION_-_BAA_Conf_Handbook_2018.pdf
 
Description Invited talk at Erlanger Kolloquium 2020 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Industry/Business
Results and Impact Plenary talk at the 47th Erlanger Kolloquium in Erlangen, Germany entitled "A psychophysical hearing-aid fitting." Generated much interest both in terms of general practice, and taking bold steps towards a new practice, as well as industrial interest. Also liaised with private and academic researchers on collaboration.
Year(s) Of Engagement Activity 2020
 
Description Invited talk at Glasgow Phonetics Lab 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Postgraduate students
Results and Impact Presented research to Glasgow University Laboratory of Phonetics, resulting in discussion for future projects
Year(s) Of Engagement Activity 2018
 
Description Invited talks (2) at BSA Annual Meeting 2017 (Harrogate) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Presented two invited talks at the British Society of Audiology's 2017 Annual Conference in Harrogate, UK, on (1) the activities of the Scottish Tinnitus Audiology Group, which prompted much discussion on the next steps and potential collaborations with NHS England & Wales efforts, and (2) on basic research from our Institute with impact in audiological fittings and standards.
Year(s) Of Engagement Activity 2017
URL https://fitwise.eventsair.com/bsa2017/homepage
 
Description Invited talks at New Zealand Audiological Society 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Three plenary talks at the 43rd Annual New Zealand Audiological Society Conference in Queenstown. Talk were greeted with many questions and discussions thereafter. Received requests for further information after the conference, and requests for research guidance.
Year(s) Of Engagement Activity 2019
URL http://www.cvent.com/events/43rd-annual-nzas-conference/archived-0c8495ca406247a5963ad5a7abea2db4.as...
 
Description Lockerbie Academy 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact Engagement with schoolteachers and their pupils. Co-designing, implementing and supporting execution of a school-wide project on leisure noise exposure and risk to hearing "Hear today - gone tomorrow", included pupils testing their own hearing and measuring their mp3 players' output sound levels via apparatus designed and built by us.
Year(s) Of Engagement Activity 2017,2018
 
Description Seminar at University of Southampton 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Postgraduate students
Results and Impact Presented a seminar on our recent work towards improving hearing-aid fittings to the University of Southampton's Institute of Sound and Vibration Hearing and Balance Centre, comprised of many MSc students in audiology as well as postgraduates, lecturers and professors.
Year(s) Of Engagement Activity 2020
URL https://www.southampton.ac.uk/engineering/news/seminars/2020/02/26-isvr-hearing-and-balance-centre-r...
 
Description Speech in Noise Workshop 2018 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Hosted, organised and chaired 10th Annual Speech in Noise Workshop with over one hundred attendees, 12 plenary talks and 52 poster presentations. Many new connections were made across research sites, and new avenues of investigation and consideration were established.
Year(s) Of Engagement Activity 2018
URL https://spin2018.eu/
 
Description Tinnitus and Hearing Show 2018 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Presented an overview of research at the Institute, including work with Universities of Strathclyde and Stirling. Also presented as part of a panel
Year(s) Of Engagement Activity 2018
URL https://invizear.com/tinnitus-and-hearing-this-scotland-2018/