1. Habilitation for hearing loss
Mel Ferguson
Clinical Scientist (Audiology)
National Biomedical Research Unit in Hearing
NBRUH Launch 11.3.09

2. Outline
• Degree of unmet need in SNHL
• Overview of auditory training studies
• Proposed studies

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. 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. 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. 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. Seeking advice about hearing
Reluctance to wear hearing aids
Would auditory training be more acceptable? Davis et al (2007)

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. 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. What is auditory training?
Changes a person's ability to process sounds and
improves auditory performance on the task
(tones, phonemes, words)

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. 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. 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. 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. 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. 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. Delivery of training
Well done!
Software driven
Adaptive
Appropriate interface
Interactive
Feedback: motivation and rewards
Home-based
Data logging

18. Looking to the future
• Web-based
• Hearing screening