Habilitation for hearing loss

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Habilitation for hearing loss

  1. 1. Habilitation for hearing loss Mel Ferguson Clinical Scientist (Audiology) National Biomedical Research Unit in Hearing NBRUH Launch 11.3.09
  2. 2. Outline • Degree of unmet need in SNHL • Overview of auditory training studies • Proposed studies
  3. 3. Prevalence of SNHL in the UK 100% Profound 149 thousand Severe 549 thousand Moderate 3439 thousand 50% Mild 4830 thousand 0% National Study of Hearing, MRC IHR
  4. 4. NSH – some more stats • 1 in 5 adults have hearing problems • 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)
  5. 5. Hearing loss gets worse with age Prevalence % 70 60 50 40 30 20 10 0 18-30 31-40 41-50 51-60 61-70 71-80 Age group Better ear average (0.5-4kHz) ≥ 25 dB HL Davis (1995)
  6. 6. 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) - 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)
  7. 7. Seeking advice about hearing Reluctance to wear hearing aids Would auditory training be more acceptable? Davis et al (2007)
  8. 8. Seeking advice about hearing People make a joke of hearing loss – so you My friends don’t admit it. Blind kept people are not treated mumbling that way I refused to accept I was going deaf – first your hair then your ears! Reluctance to wear hearing aids Would auditory training be more acceptable? Davis et al (2007)
  9. 9. Hearing aid benefit outcomes Glasgow Hearing Aid benefit Profile 100 Mean GHABP score (%) Use 80 Benefit Residual disability (rev) 60 Satisfaction 40 <25 25-34 35-44 >45 Better ear average (dB HL) Can auditory training provide additional benefit? Davis et al (2007)
  10. 10. What is auditory training? Changes a person's ability to process sounds and improves auditory performance on the task (tones, phonemes, words)
  11. 11. Auditory training improves listening task Frequency discrimination 20 Tone discrimination (%) 10 5 2 1 0.5 0.2 1 2 3 block #4 5 6 7 Training (days) Young NH adults; 18-30 yo Amitay, Hawkey, & Moore (2005)
  12. 12. Auditory training improves language Phonological Assessment Battery (word listening) 14 p<0.0001 Training 13 Control Age equivalent (yrs) 12 11 10 9 8 7 6 Pre Post Delayed (4 weeks training) (5-6 weeks later) Time of test 8-10 yo NH children Moore, Rosenberg & Coleman (2005) )
  13. 13. Auditory training as an adjunct to hearing aids Nonsense syllable in noise test (NST) Mild to moderate hearing losses; 50-80yo Woods & Yung (2007)
  14. 14. Proposed studies • Benefits of auditory training in hearing impaired people • Three groups of listeners (50-75 yrs) Hearing aid users Hearing loss No Mild New Mild and moderate Existing Mild and moderate
  15. 15. Benefits of auditory training What are the benefits of auditory training, with and without HAs? Are any benefits retained after training ceases? Crossover design (test-retest effects) T1 T2 T3 Training: Delay Training (4w) 15-20 mins/day Gp 1 (4w) 4 weeks T4 Gp 2 Control (4w) Training (4w) Delay (4w) Outcome measures Training stimulus (phonemes, words-in-noise) Generalised learning Speech intelligibility (Words and sentences in noise) Communication (SSQ, GHABP, Euroqual) Cognition (working memory, processing speed)
  16. 16. Cognition and compliance • Is hearing aid usage (compliance) associated with a particular set of cognitive abilities? • Profiles of compliant and non-compliant users • Can we encourage/facilitate compliance by enrolling hearing impaired people on a cognitive training programme?
  17. 17. Delivery of training Well done! Software driven Adaptive Appropriate interface Interactive Feedback: motivation and rewards Home-based Data logging
  18. 18. Looking to the future • Web-based • Hearing screening

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