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Hearing loss and the
associated comorbidities
A conversation with Sonova
SVP Stefan Launer
© 2019 Valencell Inc.
Healthy Hearing in the Context of Healthy Aging
Stefan Launer
Senior VP Science & Technology, Sonova AG, Switzerland
Adjun...
Content
1. Hearing loss – impact on quality of life beyond speech intelligibility
2. Do hearing instruments improve qualit...
Role of hearing in daily life
1
Hearing Health Care - Sound foundation for well-being4
Hearing, communication – the social sense
Hearing Health Care - Sound foundation for well-being5 11 / 2019, Valencell Webi...
Hearing – the un-conscious sense, well-being …
11 / 2019, Valencell Webinar,
S.Launer
Hearing Health Care - Sound foundati...
Hearing – the emotional sense
Hearing Health Care - Sound foundation for well-being7 11 / 2019, Valencell Webinar, S.Launer
Hearing the under-valued sense?!
11 / 2019, Valencell Webinar,
S.Launer
Hearing Health Care - Sound foundation for well-be...
Hearing loss – impact on quality
of life beyond speech
intelligibility
2
Hearing Health Care - Sound foundation for well-b...
Ecologic Momentary Assessment
• EMA – needs Assessment (PhD thesis B Timmer)
 Asses personal listening needs
 Create awa...
Impact of hearing loss on non-speech sound perception
• Music perception
• Perception of affective sounds, speech and non-...
• Emotional vitality
 High personal mastery, happiness, low depressive symptoms, low
annxiety
 Subjective questionnaires...
Impact of hearing loss on quality of life
• Impact on ability to communicate easily
confusion, difficulty, focusing, distr...
Hearing loss, depression, lonliness
• Correlation between hearing loss, lonliness, depression?
•  confounding factors, mu...
From «not hearing and poor speech intelligibility» to a more holistic perspective
Hearing loss – impact on quality of life...
Do hearing instruments improve
quality of life beyond speech
intelligibility?
3
Hearing Health Care - Sound foundation for...
Behavioral observation
Hearing Health Care - Sound foundation for well-being17
ISAAR 2016, Palluch, Latzel, Meis
11 / 2019...
Mental Fatigue
Goal
• Develop a method that measures fatigue
 Fatigue: reduction of function after excessive exertion
• D...
Trial Block
0 1 2 3 4 5 6
ReactionTime(inms)
250
300
350
400
450
500
Unaided
Aided Basic
Aided Advanced
Mental Fatigue:
• ...
Working Memory Task:
 After every two sentences recall name,
number or object
 Parallel: Recording of EEG signal
 After...
Less alpha band activity
11 / 2019, Valencell Webinar,
S.Launer
Hearing Health Care - Sound foundation for well-being21
SZ...
• Hearing instrument users report…
 Understand speech in quiet and challenging
listening conditions far better
 Better p...
Wearing time of the HI per day over various Generations
23
The distribution is skewed to the right. HIs mostly used somewh...
Impact of hearing instruments on quality of life
• Sound evidence supporting the notion that hearing instruments
improve q...
Hearing loss and multi-
morbidities
4
Hearing Health Care - Sound foundation for well-being25
• Hearing-well  being-well
Hearing loss Ability to
communicate
Emotional
functioning &
vitality
Social
withdrawl &
lonlin...
Hearing loss strongly correlated with multiple health issues
11 / 2019, Valencell Webinar, S.Launer Hearing Health Care - ...
Hearing loss and cognitive
decline
5
11 / 2019, Valencell Webinar, S.Launer Hearing Health Care - Sound foundation for well-being29
Hearing Loss precursor & potential risk factor for cognitive decline
Hearing Health Care - Sound foundation for well-being...
Correlation between hearing loss & various cognitive functions
Hearing Health Care - Sound foundation for well-being31
11 ...
Correlates of hearing loss and specific aspects of cognition
11 / 2019, Valencell Webinar,
S.Launer
Hearing Health Care - ...
Do hearing instruments slow
down cognitive decline?
6
11 / 2019, Valencell Webinar, S.Launer Hearing Health Care - Sound f...
Hearing instruments might contribute to slowing down cognitive decline
Hearing Health Care - Sound foundation for well-bei...
Limitations of previous studies – no controlled trials
• Accurate data on hearing loss not obtained in many cases; self-re...
Hearing loss and systemic &
physical health issues
7
Hearing Health Care - Sound foundation for well-being39
Hearing Health Care - Sound foundation for well-being40 11 / 2019, Valencell Webinar,
S.Launer
Hearing loss – difficult patient – physician communication
11 / 2019, Valencell Webinar,
S.Launer
Hearing Health Care - So...
Hearing Health Care - Sound foundation for well-being42 11 / 2019, Valencell Webinar,
S.Launer
Can hearing devices help with preventing falls?
Hearing Health Care - Sound foundation for well-being43 11 / 2019, Valence...
Summary
8
Hearing Health Care - Sound foundation for well-being44
Summary I
• Hearing is a very important sense for our social wellbeing
 Social sense, sub-concious/monitoring sense, emot...
Summary II: Translational aspects for hearing health care & audiology(sts)
• Psycho-social health considerations: hearing ...
Thanks You
THANK You for your attention!
11 / 2019, Valencell Webinar,
S.Launer
Hearing Health Care - Sound foundation for...
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Hearing loss and the associated comorbidities: A conversation with Sonova

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Around one billion people in the world today cannot hear well. In recent years, many studies have linked hearing loss to disabling conditions, such as cognitive decline and Alzheimer’s disease, clinical depression, diabetes, hypertension, heart disease, and more. These linkages are often referred to as comorbidities- the presence of two or more chronic conditions or diseases in a patient. Sonova, a leading provider of innovative hearing care solutions, this webinar explores the research linking hearing loss to many other diseases and disorders and the hearing health care management options available today.

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Hearing loss and the associated comorbidities: A conversation with Sonova

  1. 1. Hearing loss and the associated comorbidities A conversation with Sonova SVP Stefan Launer © 2019 Valencell Inc.
  2. 2. Healthy Hearing in the Context of Healthy Aging Stefan Launer Senior VP Science & Technology, Sonova AG, Switzerland Adjunct Professor University of Queensland, Brisbane, Australia Adjunct Professor University of Manchester, Manchester, UK Ulrike Lemke, Jana Besser, Gurjit Singh, Maren Stropahl, Emily Urry, Charlotte Vercammen, Mathias Latzel, Barbra Timmer,
  3. 3. Content 1. Hearing loss – impact on quality of life beyond speech intelligibility 2. Do hearing instruments improve quality of life? 3. Hearing loss and multi-morbidities 1. Cognitive decline 2. Systemic and physical comorbidities 4. Summary 11 / 2019, Valencell Webinar, S.Launer Hearing Health Care - Sound foundation for well-being3
  4. 4. Role of hearing in daily life 1 Hearing Health Care - Sound foundation for well-being4
  5. 5. Hearing, communication – the social sense Hearing Health Care - Sound foundation for well-being5 11 / 2019, Valencell Webinar, S.Launer
  6. 6. Hearing – the un-conscious sense, well-being … 11 / 2019, Valencell Webinar, S.Launer Hearing Health Care - Sound foundation for well-being6
  7. 7. Hearing – the emotional sense Hearing Health Care - Sound foundation for well-being7 11 / 2019, Valencell Webinar, S.Launer
  8. 8. Hearing the under-valued sense?! 11 / 2019, Valencell Webinar, S.Launer Hearing Health Care - Sound foundation for well-being8
  9. 9. Hearing loss – impact on quality of life beyond speech intelligibility 2 Hearing Health Care - Sound foundation for well-being9
  10. 10. Ecologic Momentary Assessment • EMA – needs Assessment (PhD thesis B Timmer)  Asses personal listening needs  Create awareness about hearing loss in the person and the significant others  Speech understanding is not the problem but increased listening effort Hearing Health Care - Sound foundation for well-being10 11 / 2019, Valencell Webinar, S.Launer
  11. 11. Impact of hearing loss on non-speech sound perception • Music perception • Perception of affective sounds, speech and non-speech, Singh et al 2017, Picou et al 2017 • Identification of environmental sounds Hearing Health Care - Sound foundation for well-being11 • Hearing impaired subjects have difficulties identifying affective speech 11 / 2019, Valencell Webinar, S.Launer
  12. 12. • Emotional vitality  High personal mastery, happiness, low depressive symptoms, low annxiety  Subjective questionnaires to assess «emotional vitatliy» • 3’000+ subjects from Health ABC study 70-79 years of age • Audiometric assessment in year 5, emotional vitality year 6 • Hearing loss increases the odds of low emotional vitality • Hearing instruments did not improve scores on emotional vitality  Study may have been underpowered, few HI users Hearing loss & emotional vitality Hearing Health Care - Sound foundation for well-being12 11 / 2019, Valencell Webinar, S.Launer
  13. 13. Impact of hearing loss on quality of life • Impact on ability to communicate easily confusion, difficulty, focusing, distracting thoughts, • Effort, fatigue, … • Emotional perception • Emotional vitality • Emotional functioning anger, frustration, depression, anxiety, anger, guilt, embaressment • Social isolation, lonliness, self-esteem, distress • Depression? Mixed results, control of confounding factors • Impact on activities of daily living, particularly “social”  Incl eg grocery shopping… • Impact on ability to work  educational level, salary • Third party disability (spouses - yes, children - yes, all SOs?)  Activity limitations and participation restrictions reported by significant others  Impaired relationships • Third party disability – patient-physician communication Hearing Health Care - Sound foundation for well-being13 11 / 2019, Valencell Webinar, S.Launer
  14. 14. Hearing loss, depression, lonliness • Correlation between hearing loss, lonliness, depression? •  confounding factors, multi-factorial • LASA study in Netherlands  Longitudinal study: various health conditions incl hearing loss over several years  Considering confounding factors • No correlation found between hearing loss and depression • Hearing loss and lonliness  yes, for specific subgroups • Hearing loss and lonliness  depends on rate of decline of HL  Not for mild HL  Yes for decline beyond moderate HL Hearing Health Care - Sound foundation for well-being14 Pronk, PhD thesis 2013 11 / 2019, Valencell Webinar, S.Launer
  15. 15. From «not hearing and poor speech intelligibility» to a more holistic perspective Hearing loss – impact on quality of life Hearing Health Care - Sound foundation for well-being15 Impact on overall quality of life Emotional functioning Distress, fatigue Social isolation, lonliness Activities of daily living Third-party disability 11 / 2019, Valencell Webinar, S.Launer
  16. 16. Do hearing instruments improve quality of life beyond speech intelligibility? 3 Hearing Health Care - Sound foundation for well-beingPage 16
  17. 17. Behavioral observation Hearing Health Care - Sound foundation for well-being17 ISAAR 2016, Palluch, Latzel, Meis 11 / 2019, Valencell Webinar, S.Launer
  18. 18. Mental Fatigue Goal • Develop a method that measures fatigue  Fatigue: reduction of function after excessive exertion • Does hearing aid technology reduce fatigue? Method • Testing in a reverberation chamber (RT60 ~450 ms)  Noise: 5 speaker cafeteria babble fixed @ 55 dBA • Listen to and repeat NU6 words in noise (individualized SNR ~70% correct)  Present strings of 8-12 words (random length) • Store last 5 words in memory for recall • While doing this remain vigilant for a visual signal Speech 108° 180° 252° 324° 36° Hornsby, 2013 Hearing Health Care - Sound foundation for well-being18 11 / 2019, Valencell Webinar, S.Launer
  19. 19. Trial Block 0 1 2 3 4 5 6 ReactionTime(inms) 250 300 350 400 450 500 Unaided Aided Basic Aided Advanced Mental Fatigue: • Unaided multi-task Reaction time (RT)s increased over time  Onset of fatigue • No change in aided RTs over time  No fatigue • Conclusion: Hearing aids can reduce mental fatigue from extended listening to speech in noise  Patients less exhausted after an hour of socializing  Patients can engage more with family and friends Hornsby, 2013 Hearing Health Care - Sound foundation for well-being19 11 / 2019, Valencell Webinar, S.Launer
  20. 20. Working Memory Task:  After every two sentences recall name, number or object  Parallel: Recording of EEG signal  After complete run (2*8 sentences)  Objective Measure:  Correct Answer Subjective Measures:  Listening Effort (LE)  Memory Effort (ME)  Noise Annoyance (NA) Working Memory paradigm 11 / 2019, Valencell Webinar, S.Launer Hearing Health Care - Sound foundation for well-being20 OLSA Sentences (1)Wolfgang kauft fünf weiße Autos (2)Nina hat zwölf nasse Sessel INSTRUCTION „Please repeat the numbers of the two sentences you just have heard!“
  21. 21. Less alpha band activity 11 / 2019, Valencell Webinar, S.Launer Hearing Health Care - Sound foundation for well-being21 SZ (SNRHIGH) RES (SNRHIGH) SZ (SNRLOW) RES (SNRLOW) AlphaBand
  22. 22. • Hearing instrument users report…  Understand speech in quiet and challenging listening conditions far better  Better perceive environmental sounds  Participate more in social life  Feel less exhausted  Feel less depressed  Feel less forgetfull  Sleep better • Hearing instruments significantly improve quality of life Hearing instruments improve quality of life Hearing Health Care - Sound foundation for well-being EuroTrak, EHIMA 2016, 2019 In the evenings I often feel physically exhausted 22 11 / 2019, Valencell Webinar, S.Launer
  23. 23. Wearing time of the HI per day over various Generations 23 The distribution is skewed to the right. HIs mostly used somewhere between 9 to 20 hours. 650’000+ users Hearing Health Care - Sound foundation for well-being 11 / 2019, Valencell Webinar, S.Launer Devices in a drawer Average usage time per day + 1.5 h
  24. 24. Impact of hearing instruments on quality of life • Sound evidence supporting the notion that hearing instruments improve quality of life • Different methods  Lab studies (subjective and objective (EEG, pupillometry, RTS) measures…)  Subjective questionnaires in daily life • Benefit dimensions  Effort  Fatigue  Cognition  General aspects of quality of life • Open:  Perception of emotional content?  Impact on third-party disabilities?  Social integration  …. 11 / 2019, Valencell Webinar, S.Launer Hearing Health Care - Sound foundation for well-being24 Trial Block 0 1 2 3 4 5 6 ReactionTime(inms) 250 300 350 400 450 500 Unaided Aided Basic Aided Advanced Hornsby, 2013 In the evenings I often feel physically exhausted
  25. 25. Hearing loss and multi- morbidities 4 Hearing Health Care - Sound foundation for well-being25
  26. 26. • Hearing-well  being-well Hearing loss Ability to communicate Emotional functioning & vitality Social withdrawl & lonliness Cognitive function & decline Depression? Ability to learn, work, Impact on familiy Perception of environmental sounds Emotion perception Increased effort & fatigue Impact on quality of life
  27. 27. Hearing loss strongly correlated with multiple health issues 11 / 2019, Valencell Webinar, S.Launer Hearing Health Care - Sound foundation for well-being27
  28. 28. Hearing loss and cognitive decline 5
  29. 29. 11 / 2019, Valencell Webinar, S.Launer Hearing Health Care - Sound foundation for well-being29
  30. 30. Hearing Loss precursor & potential risk factor for cognitive decline Hearing Health Care - Sound foundation for well-being30 11 / 2019, Valencell Webinar, S.Launer • Weak but significant correlation • Causal relation? • Modifiable? • Hearing loss most likely is a pre-cursor
  31. 31. Correlation between hearing loss & various cognitive functions Hearing Health Care - Sound foundation for well-being31 11 / 2019, Valencell Webinar, S.Launer
  32. 32. Correlates of hearing loss and specific aspects of cognition 11 / 2019, Valencell Webinar, S.Launer Hearing Health Care - Sound foundation for well-being32
  33. 33. Do hearing instruments slow down cognitive decline? 6 11 / 2019, Valencell Webinar, S.Launer Hearing Health Care - Sound foundation for well-being33
  34. 34. Hearing instruments might contribute to slowing down cognitive decline Hearing Health Care - Sound foundation for well-being35 11 / 2019, Valencell Webinar, S.Launer
  35. 35. Limitations of previous studies – no controlled trials • Accurate data on hearing loss not obtained in many cases; self-report is unreliable. • Change in hearing loss not followed over time. • Information about treatment, ie. frequency of device use or benefit from device not collected. • A limited number of other factors likely to influence cognitive outcomes not considered, eg. loneliness, social isolation, cardiovascular health, exercise & diet. • Many cohort studies not longitudinal. • Limited tools have been used to assess cognitive function. This has been conducted in most studies using screening tools - insensitive and verbal instructions not appropriate for people with hearing loss (eg. MMSE). 11 / 2019, Valencell Webinar, S.LaunerHearing Health Care - Sound foundation for well-being38
  36. 36. Hearing loss and systemic & physical health issues 7 Hearing Health Care - Sound foundation for well-being39
  37. 37. Hearing Health Care - Sound foundation for well-being40 11 / 2019, Valencell Webinar, S.Launer
  38. 38. Hearing loss – difficult patient – physician communication 11 / 2019, Valencell Webinar, S.Launer Hearing Health Care - Sound foundation for well-being41 Consultation content – misunderstanding 35 % Communication breakdown – 16 %
  39. 39. Hearing Health Care - Sound foundation for well-being42 11 / 2019, Valencell Webinar, S.Launer
  40. 40. Can hearing devices help with preventing falls? Hearing Health Care - Sound foundation for well-being43 11 / 2019, Valencell Webinar, S.Launer
  41. 41. Summary 8 Hearing Health Care - Sound foundation for well-being44
  42. 42. Summary I • Hearing is a very important sense for our social wellbeing  Social sense, sub-concious/monitoring sense, emotional sense • Hearing loss has a very strong impact on quality of life extending beyond speech intelligibility  Often hearing problems can be compensated by investing more cognitive effort • Hearing instruments improve quality of life: Reduce listening effort avoid fatigue, improve quality of life  More evidence from daily life situations!  eAudiology – EMA – learn more about hearing instrument benefit in daily life from users and significant others • Hearing instruments turn into vital sign and health monitoring devices?  Implications for health care model in general?! Hearing Health Care - Sound foundation for well-being45 11 / 2019, Valencell Webinar, S.Launer Systemic & physical health Cognitive health Social- emotional health
  43. 43. Summary II: Translational aspects for hearing health care & audiology(sts) • Psycho-social health considerations: hearing loss contributes to psycho-social functioning, e.g. causes depression, loneliness, …  hearing instruments contribute to improved quality of life and well-being beyond speech intelligibility  revisit some old but still open problems, eg Tinnitus … • Cognitive decline - dementia: strong correlation, hearing loss supposedly accelerates cognitive decline  new indication for hearing instruments???? • Increased risk of falls in hearing impaired subjects: hearing loss is a pre-cursor to problems with balance and posture  new service and product: screen hearing impaired for postural stability and offer training incl. a device • Diabetes, cardio-vascular issues: co-occur with hearing loss, the diagnosis of one is an indicator for the other  counselling, collaborate with other HCP, help improve communication • Autism and speech communication problems (pediatric and adults)  new indication for assistive listening devices (e.g. Roger) Hearing Health Care - Sound foundation for well-being46 11 / 2019, Valencell Webinar, S.Launer Systemic & physical health Cognitive health Social- emotional health Put hearing & audiological rehabilitation in a different context: sound foundation for well being!
  44. 44. Thanks You THANK You for your attention! 11 / 2019, Valencell Webinar, S.Launer Hearing Health Care - Sound foundation for well-being47

Around one billion people in the world today cannot hear well. In recent years, many studies have linked hearing loss to disabling conditions, such as cognitive decline and Alzheimer’s disease, clinical depression, diabetes, hypertension, heart disease, and more. These linkages are often referred to as comorbidities- the presence of two or more chronic conditions or diseases in a patient. Sonova, a leading provider of innovative hearing care solutions, this webinar explores the research linking hearing loss to many other diseases and disorders and the hearing health care management options available today.

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