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Apple Takes Another Step Toward Hearing Aid Functionality

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Apple Takes Another Step Toward Hearing Aid Functionality

 

Apple Takes Another Step Toward Hearing Aid Functionality

On Monday, June 22, Apple introduced its latest operating system, iOS14, which includes —among many new features—a substantial move towards its AirPod Pros becoming a hearing-aid-like device. Almost buried as an afterthought at the bottom of Apple’s IOS New Features Preview are identical entries in the “Airpods” and “Accessibility” sections that say:

Headphone Accommodations

This new accessibility feature is designed to amplify soft sounds and adjust certain frequencies for an individual’s hearing, to help music, movies, phone calls, and podcasts sound more crisp and clear. Headphone Accommodations also supports Transparency mode on AirPods Pro, making quiet voices more audible and tuning the sounds of your environment to your hearing needs.

Hmmm…sounds a lot like a basic description of wide dynamic frequency compression (WDRC) or AGC, doesn’t it? Abram Bailey of Hearing Tracker, who broke the news yesterday, stated “This is the extremely exciting part, as it indicates that AirPods can now essentially be used to provide typical hearing aid functionality; applying personalised amplification to make it easier to hear those around you.” Bailey went on to show how the headphone accommodations use a custom audio setup with a listening test that generates an “audiogram” from the Apple Health app that “seems to indicate that the AirPods Pro will be capable of providing a very fine-tuned custom amplification experience, based on the audiogram (pitch-by-pitch hearing abilities) unique to the user.”

It should be acknowledged that Apple has for many years been developing hearing-aid-related features, including Live Listen for hearing aids and cochlear implants in 2014 (and later for AirPods and the Earpods), in addition to speech audiometry and speech-in-noise packages for developers, noise warning apps for its WatchOS, and more. The company sold more than 60 million Airpods in 2019, compared to about 15 million hearing aids worldwide for the entire hearing industry (4.2 million units in the US). Apple’s Wearables, Home and Accessories division had the most significant year-on-year growth for the company last year, with its sales increasing 41% thanks to the Airpod and Apple Watch, and the tech-giant owns an enviable 36.5% of the wearables market, according to CompareCamp. Mind you, this includes the “hearables” market that Nick Hunn predicted earlier this year will reach $80 billion a year by 2025.

As Paul Dybala, PhD, AuD, of AudiologyDesign points out in a recent LinkedIn post about Apple and its threat to the hearing industry, “If none of this impresses you, buy a pair of AirPod Pros and turn on the Active Noise Cancelling feature. Then change them over to Transparency Mode and listen further. Once you wipe your jaw off the floor, continue reading. Take your time, I’ll wait…” However, he then goes on to point out that hearing loss is widely viewed as a healthcare problem that should be addressed by a hearing healthcare professional, as shown in a 2017 survey by a study he did with colleague Brande Plotnick at Healthy Hearing.

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As a side-note, I’ve personally tried several of the products and hearing tests available in some of the better PSAPs. As one example, Alango Technology’s BeHear app did an impressive job of replicating an audiogram of my own mild sloping hearing loss and tailoring the sound to suit my preferences. The idea of an app doing this also reminded me of a September 2018 Hearing Review article by James Jerger, PhD, who—after describing three basic forms of automated audiometry—wrote:

“The most important issue is to catch up with the rest of the automated world…In spite of the many examples of successful automated systems summarised above, I suspect that there will be little further progress in the actual clinical use of automated audiometry of any variety until clinicians become part of the solution. It goes back to their initial educational experience. If the only procedure they learn as students is the manual Hughson-Westlake method on a conventional audiometer, it is unlikely that they will be easily diverted from that familiar path, sophisticated technology notwithstanding. PhD and AuD students—in addition to practicing clinicians—need to understand that automated audiometry can be carried out by less credentialed personnel, resulting in time and cost savings in a clinical setting. It is apparent this testing is moving into the digital/consumer realm [with the link going to Apple’s WDDC 2018 video that includes a demonstration of speech audiometry].

The point is professional hearing healthcare is so much more than automated tests and apps. As Dr Dybala notes in his article, it’s about assessing an often-complex medical problem and applying all of the tools available to tailor an individual solution that works for the patient in all kinds of listening situations, including (and especially) noise. However, as shown by Apple and others, the world of hearables with their automated testing and applied amplification should help millions of consumers make their first moves toward professional hearing care.

Treatment of Ménière’s Disease and Vertigo with Intranasal Betahistine

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Treatment of Ménière’s Disease and Vertigo with Intranasal Betahistine

 

Treatment of Ménière’s Disease and Vertigo with Intranasal Betahistine

Auris MedicalAuris Medical Holding AG, a Swiss-based clinical-stage public company  (NASDAQ: EARS) dedicated to developing therapeutics in otolaryngology, has announced it will develop betahistine dihydrochloride in a spray formulation (with the product name AM-125) for the intranasal treatment of Ménière’s disease and vestibular vertigo. This represents the third clinical-stage development program to Auris Medical’s pipeline, and an expansion by the company into the field of vestibular disorders. Auris is also developing a drug for idiopathic sudden sensorineural hearing loss (ISSNHL, sudden hearing loss) and acute inner ear tinnitus.

“We are excited to add AM-125 to our development pipeline as it addresses important unmet medical needs in vestibular disorders and serves as a strategic fit with our existing projects,” said Auris Medical’s Founder, Chairman and CEO Thomas Meyer in a press statement. “While oral betahistine has been a mainstay treatment for Ménière’s disease and vestibular vertigo for many years and in many countries around the world, we expect the novel approach of intranasal delivery to offer significant additional benefits in terms of efficacy and tolerability.”

Auris Medical reports that it has entered into an agreement with Otifex Therapeutics Pty Ltd to purchase various assets related to intranasal betahistine, including preclinical and clinical data, as well as certain intellectual property rights. In a Phase 1 trial conducted by Otifex, intranasal betahistine showed good tolerance and a significantly higher bioavailability than reported for oral betahistine administration. Auris Medical plans to initiate a second Phase 1 trial in 2017.

“As our treatment options for vestibular disorders are currently very limited in the United States, I am pleased to see that betahistine will be developed as a treatment for patients here who are suffering from Ménière’s disease or vestibular vertigo,” said Lawrence R. Lustig, MD, Chair, Department of Otolaryngology at Columbia University Medical Center in the press release. “The compound has an established track record for safety, and the clinical experience suggests that it may help control or ease vertigo attacks in Ménière’s disease. It will be exciting to have a new treatment for this disabling condition.”

According to Auris Medical, Betahistine is a small molecule drug that acts as a partial histamine H1-receptor agonist and a H3-receptor antagonist. The compound has demonstrated increased cochlear, vestibular, and cerebral blood flow, vestibular compensation, and the ability to inhibit neuronal firing in the vestibular nuclei.

Oral betahistine is approved for the treatment of Ménière’s disease and vestibular vertigo in more than 80 countries worldwide, and has been reportedly prescribed more than 130 million patients. However, betahistine has not been approved for marketing in the United States for the past few decades.

The brand Serc (betahistine) was approved by the FDA in the early 1970s as vestibular suppressant for Ménière’s disease, but that approval was withdrawn after about 5 years. Primarily, the drug has had issues surrounding its clinical trials and subsequent proof of efficacy. Even though studies have shown betahistine effective against vertigo attacks, most of these studies have been criticized for design flaws. The Cochrane Library concluded in 2001 that “Most trials suggested a reduction of vertigo with betahistine and some suggested a reduction in tinnitus but all these effects may have been caused by bias in the methods. One trial with good methods showed no effect of betahistine on tinnitus compared with placebo in 35 patients. None of the trials showed any effect of betahistine on hearing loss. No serious adverse effects were found with betahistine.”

Update on Auris Medical Tinnitus Trials

Auris Medical also announced last week that it has resumed patient enrollment in the TACTT3 Phase 3 trial of Keyzilen® (AM-101) in acute and post-acute inner ear tinnitus. According to Reuters, the company experienced a set-back in August when the drug missed the main goals of a late-stage study by failing to meet the two co-primary effectiveness goals of statistically significant changes in tinnitus loudness and tinnitus burden compared to a placebo.

“Following the swift approval by regulatory agencies and ethics committees, we are pleased to resume enrollment under the amended protocol in the TACTT3 Phase 3 clinical trial of Keyzilen,” said Meyer. “We have applied key learnings from the TACTT2 trial that we believe substantially strengthen TACTT3’s probability of success, and we look forward to top-line results in early 2018.”

TACTT3, which is being conducted in Europe, is a randomized, double-blind, placebo-controlled Phase 3 trial in inner ear tinnitus following traumatic cochlear injury or otitis media. The trial previously enrolled more than 300 patients during the acute tinnitus stage (Stratum A) and approximately 330 patients during the post-acute tinnitus stage (Stratum B). As previously announced, the TACTT3 protocol was amended based on analysis of the TACTT2 Phase 3 trial outcomes. The amended protocol elevates the Tinnitus Functional Index score from a key secondary endpoint to an alternate primary efficacy endpoint, includes certain patient subgroups in confirmatory statistical testing, and increases the trial size with the enrollment of an additional 60 patients in each of Stratum A and B.

How coronavirus lockdown hits deaf people harder than most

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How coronavirus lockdown hits deaf people harder than most

 

News article from the London Evening Standard

 

Coronavirus lockdown has been hard for everyone. People are worried about safety, stuck inside or going out to work in a pandemic – and cut off from family and friends.

Most people have the option of speaking to friends on the phone or with a video call at a moment’s notice. But for the 12 million people in the UK who are deaf or who have some kind of hearing loss, this option is much less viable.

Clara O’Shea, a trainee dentist with hearing loss, said the restrictions had left her feeling isolated.

She told the Standard: “Obviously we’re all in lockdown but it can probably be even lonelier for people with hearing loss. We can’t necessarily just pick up the phone and speak to our friends.

“When you struggle to hear, it makes you physically exhausted,” she added.

Conversations at a distance can be a challenge for people with hearing loss (AP)

Some of the social ties that help the deaf community combat loneliness in normal times have also been severed by the lockdown.

Liam O’Dell, a deaf activist and journalist, said: “Deaf social clubs, which are a big part of the community… have had to shut things down completely or move things online, which has had a really detrimental impact on people.”

But he added that another isolating factor for people with hearing loss was the lack of accessible information.

The BBC uses a British Sign Language interpreter overlaid on its broadcast of the daily coronavirus briefing and Scottish First Minister Nicola Sturgeon has one, but the Downing Street briefings were criticised for doing the same. Activists had claimed it breached an equalities law, and launched legal proceedings last month.

The Government has said it is committed to getting health information to everyone in the UK, regardless of disability.

“I think for a lot of people they probably don’t want to talk about the dreaded… coronavirus but we also have to talk about it.

“When other people…. have the privilege of getting the latest information, deaf people are probably still falling behind because they don’t have that access.”

Roger Wicks, policy and campaigns director for charity Action on Hearing Loss, agreed.

People with hearing loss may be feeling especially isolated during coronavirus lockdown(Getty Images)

He said: “Briefings have to be accessible – it’s very important that there’s a British Sign Language interpreter.”

“We have to make health services accessible to all.”

And a recent development may worsen the situation for the UK’s deaf people.

The UK has been slower than many other countries in asking people to wear face masks and coverings. But the Government recently advised people to cover their faces when in busy places, including public transport, and masks are becoming more and more visible on the street.

The usefulness of face masks remains unclear – but for many deaf people and those with hearing loss who rely on lipreading to hold a conversation, they present a new challenge.

Louise Goldsmith, a profoundly deaf blogger, told the Standard that the growing use of face masks – and the need to keep two metres away from other people – was limiting her independence.

She said: “I was waiting in the queue for the checkout at the supermarket and the person behind the till told me to come forward.

“But because they were wearing a mask, I couldn’t understand them and I was just standing there for ages. It was pretty embarrassing.”

Action on Hearing Loss is pushing the Government to clarify what kind of face coverings people can wear that will have less of an effect on people with hearing loss – including masks with clear panels over the mouth.

These clear masks are not appropriate for medical use and are not available in the UK at the moment, Action on Hearing loss said.

And Ms Goldsmith said that she doubted that the clear masks would be much use.

“I’ve heard that when people speak and breathe the masks can fog up and it gets much harder to read their lips,” she said.

She added: “But it’s a good start and hopefully something to build on in future.”

Deafness is sometimes called “the hidden disability” and the impact of coronavirus lockdown on people with hearing loss seems to have gone largely unnoticed.

But neither Action on Hearing Loss nor other deaf activists are demanding an end to the lockdown or for people to stop wearing face masks. They just want the Government and everyone else in the UK to speak more clearly.

New guidelines for hearing impaired students

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New Guidelines Help Make Remote Learning More Accessible to Hearing Impaired Students

 

Honiton hearing

Several organisations have released guideline, resources, and tips to making remote learning more accessible to students with hearing and vision losses, an article in EdTech reports.

In particular, the article stresses the importance of making certain that captions for lectures are accurate; the accuracy rate of automatic captions can be as low as 80%, according to EdTech, with names and key terms commonly misspelled. Writing captions by hand can be a cumbersome process, and the authors recommend delegating the editing of automatic captions to a teacher’s aide or work-study student.

To read the article in its entirety, please click here.

Source: EdTech

The Challenge of BTE Hearing Aids with Masks

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The Challenge of BTE Hearing Aids with Masks

    

The Challenge of BTE Hearing Aids with Masks

Wearing masks have become common practice during the COVID-19 pandemic. For people who use behind-the-ear (BTE) hearing aids, however, this may be uncomfortable, according to a blog posting by audiologist Sheri Gostomelsky on the ChicagoNow website.

Gostomelsky suggests several creative solutions to the problem which include putting your hair in a bun and looping the elastic around the bun itself; sewing buttons onto a headband that the mask loops over; creating an extension for the mask, and sewing or purchasing a mask with ties instead of elastic.

To read the posting in its entirely, please click here. Hearing Review also recently published a study by Goldin, Weinstein, and Shiman about how medical masks essentially functioned as a low-pass acoustic filter for speech, attenuating the high frequencies (2000-7000 Hz) spoken by the wearer by 3 to 4 dB for a simple medical mask and close to 12 dB for the N95 masks.

Source: ChicagoNow

Starkey Expands Remote Programming Feature to More Hearing Aid Users

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Starkey Expands Remote Programming Feature to More Hearing Aid Users

Starkey Expands Remote Programming Feature to More Hearing Aid Users

In response to the ongoing challenges facing hearing care providers and their patients amid the COVID-19 pandemic, Starkey announced that it has made telehealth technology available to “even more hearing aid users.” Effective immediately, ‘Hearing Care Anywhere’ remote programming is now enabled across all technology tiers of Starkey’s Livio, Livio AI, and Livio Edge AI hearing aids. The change is said to allow more patients to receive care from their homes and gives hearing professionals the ability to conduct appointments despite social distancing.

“This is a very difficult time for the majority of us in the hearing industry,” said Starkey President Brandon Sawalich. “When we developed the Hearing Care Anywhere remote programming feature, we knew it would provide hearing healthcare providers with added convenience and efficiency, but we never imagined the important role it would play in such an unprecedented situation. We are so proud that our relentless dedication to staying on the cutting-edge of hearing technology is helping patients hear better at a time when clear communication is so critical.”

Through this latest update, even patients whose devices were not originally configured for remote programming are now able to access this feature. Using the Thrive app, patients can send requests to their hearing providers, who are then able to make fine-tuning adjustments to optimize hearing aid performance remotely. This new measure enhances patient safety by reducing the need for an in-office visit.

“For many clinics, up to 30% of appointments are for minor adjustments,” said Starkey’s Chief Innovation Officer Dave Fabry, PhD. “In the past, clinicians needed to initiate remote programming via the Inspire software during face-to-face visits. Today, those adjustments can be handled remotely through Hearing Care Anywhere.”

“Since early on during the COVID-19 pandemic, we’ve had to balance the dilemma of protecting our patients while ensuring their hearing devices are performing optimally,” said Terence Limb, AuD, of Kirkland, Wash. “In the past, we didn’t always enable Hearing Care Anywhere in Inspire. This update enables me to continue to engage with patients during this difficult time. Moreover, it will change the way that we can better serve patient needs in the future.”

For more information on these new updates to Hearing Care Anywhere remote programming, please click here.

Source: Starkey

Phonak announced the launch of the Naída Marvel (M)

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Phonak announced the launch of the Naída Marvel (M)

Honiton hearing

Honiton hearing

Phonak announced the launch of the Naída Marvel (M), described as “a fully-connected, multifunctional super-power hearing aid for those with severe-to-profound hearing loss.” Naída Marvel reportedly delivers “rich, powerful sound and directly connects to virtually any Bluetooth device including smartphones, TVs, tablets, PCs, and much more,” according to Phonak. Integrated Marvel 2.0 technology like RogerDirect helps give wearers the flexibility to stream the Roger signal directly into both ears, resulting in almost 10x better-than-normal hearing in noisy situations and over distance.1 

Naída M: Power meets connectivity

Naída M is said to be “the world’s first super power hearing aid that directly connects to both iOS and Android, or virtually any other Bluetooth enabled audio device.” It’s also reportedly “the world’s only super-power hearing aid to allow hands-free phone conversations as well as the classification of streamed audio signals.” 2 With Naída M, super power wearers can use their hearing aids like wireless headsets, according to Phonak.

“Since the release of its first power hearing aid in 1978, the Phonak brand has been dedicated to creating powerful hearing solutions that deliver excellent hearing performance,” said Jon Billings, Vice President of Marketing at Phonak. “Now in its sixth generation, Naída M builds on this legacy with award-winning Marvel technology. The result is Naída becoming the most powerful Super Power3 multifunctional hearing solution that allows people with severe-to-profound hearing loss to connect to everyone and everything around them.”

Extending Marvel and increasing accessibility 

Per the World Health Organization (WHO), approximately 466 million people worldwide have disabling hearing loss.4 Left untreated, these individuals have extreme difficulty communicating with others, often relying on lip reading and/or sign language.5 One study found the societal costs of this degree of hearing loss in the US alone to be nearly $300,000 over the lifetime of each person, most of this attributed to reduced work productivity.6

Naída M’s combination of power with wireless connectivity was specifically engineered to address the unique communication needs of people with severe forms of hearing loss, Phonak says. According to the company’s announcement, StereoZoom helps to reduce listening effort in noise by 24% versus a non-directional program and even enhances memory recall with 10% more words recalled in noise.7 NaídaMarvel directly connects to Roger microphones to help improve speech understanding in noise and over distance1 while remaining 15% smaller and 14% lighter than previous versions that required an external receiver.

Finally, the myCall-to-Text app helps provide live transcription of phone calls from the other party in more than 80 languages. This is an ideal solution for people who would like to benefit from additional visual captions when using the phone.

Naída Marvel will be available to the public at the end of February through licensed hearing care professionals. For more information, please visit http://www.phonak.com/naidamarvel.

  1. Thibodeau L. Comparison of speech recognition with adaptive digital and FM remote microphone hearing assistance technology by listeners who use hearing aids. American Journal of Audiology. 2014;23(2):201-210.
  2. Rodrigues T, Liebe S. Phonak. AutoSense OS™ 3.0. The new & enhanced automatic operating system. https://www.phonakpro.com/content/dam/phonakpro/gc_ca/en/products_solutions/hearing_aid/Audeo_M/documents/Insight_btb_Audeo_Marvel_AutoSense_OS_30.pdf. Published July 2018.
  3. Phonak. Phonak NaídaTM M Technical Data. https://www.phonakpro.com/content/dam/phonakpro/gc_hq/en/products_solutions/hearing_aid/naida_marvel/documents/datasheet_naida_marvel_sp.pdf. Accessed January 13, 2020.
  4. Deafness and hearing loss fact sheet. World Health Organization (WHO). https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss. Published March 20, 2019.
  5. European Working Group on Genetics of Hearing Impairment. Biomedical and Health Research Programme (HEAR) Infoletter 2. November 1996; 8.
  6. Mohr PE, Feldman JJ, Dunbar JL, et al. The societal costs of severe to profound hearing loss in the United States. International Journal of Technology Assessment in Health Care. 2000;16(04):1120-1135.
  7. Winneke A, Schulte M, Latzel M. The effect of spatial noise processing in hearing aids on neural correlates of listening and memory effort: An EEG study. 2019. Manuscript in preparation.

Bluetooth® word mark is a registered trademark owned by Bluetooth SIG, Inc. and any use of such mark by Sonova AG is under license.

IOS is a trademark of Cisco Technology, Inc.

Android is a trademark of Google LLC.

Source: Phonak

Images: Phonak

Widex Launches Moment Hearing Device

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Widex Launches Moment Hearing Device

 

Widex Moment Hearing Device Honiton Hearing-Devon

Widex announced the launch of the Moment, a device that has “broken new ground by addressing one of the great unsolved challenges in the industry—no matter how good the sound, it still sounds like a hearing aid.”

According to Widex, “hearing aids can sound ‘tinny’ and ‘artificial’—which often prevents their adoption by those with hearing loss—when sound processed in the hearing aid reaches the eardrum a split second later than the sound that travels directly through or around the hearing aid’s ear-tip.”

Widex is reportedly “the first in the industry to eliminate that ‘out of sync’ sound for patients with mild to moderate hearing loss, without sacrificing the trademark Widex natural sound—which already has the lowest time delay compared to competitors.”

According to Lise Henningsen, Global Head of Audiology at Widex, this launch marks a fundamental shift not just for the hearing aid industry, but also for a general consumer public plagued by hearing loss at increasingly young ages.

“To lose your sense of hearing is to lose a fundamental part of yourself, often resulting in increased social isolation, subsequent depression, and other downstream psychological and neurological effects,” she said. “Though the traditional hearing aid has made tremendous strides in areas such as speech intelligibility, active noise cancellation, and more, a key frontier has been left uncharted—until today. Widex Moment doesn’t just allow you to hear better, it restores one’s sense of perfectly natural hearing, as you remember it before any loss occurred.”

Moment hearing aids available at the Honiton hearing centre

The Widex Moment platform achieves this hearing experience by leveraging two distinct signal pathways. The ‘classic’ Widex signal pathway is paired with a second ultra-fast signal pathway that adds extra gearing to the platform, the company says.

Honiton hearing stock Widex hearing aids

The Widex ZeroDelay™ Accelerator reduces the processing delay between microphone and receiver to below 0.5 milliseconds, which Widex says enables the two sound signals to meet at virtually the same time in the eardrum, helping eliminate the artificial sound quality and creating a more natural sound experience. This new sound experience is called Widex PureSound™.

However, though Widex Moment “breaks new ground in the area of sound purity, it doesn’t do so at the expense of other cutting-edge features—such as rechargeability and smart streaming to electronic devices—found in the industry’s most state-of-the-art hearing aids and demanded by tech-savvy consumers.”

Widex Moment has what the company says is “the smallest lithium-ion rechargeable RIC on the market, ensuring that no matter one’s lifestyle users will never miss a moment.” Furthermore, Widex Moment’s smart streaming capabilities are said to offer “robust connectivity to the devices one uses every day (iOS and Android).”

Devon hearing aids

Widex Moment also comes compatible with the SoundSense Learn smartphone app, which leverages AI and machine learning to personalise one’s hearing experience and create hearing programs based on a user’s typical environments—a daily commute, an open-office floor plan, a favourite restaurant, and more.

The app gathers a variety of anonymous data such as how often the user adjusts the volume, which sound presets they most regularly use, and how many custom settings they create. Based on these real-world preferences, a complete personalised listening experience is created for the user. These adjustments and custom settings can then also be shared directly and securely with their hearing care professional, which helps the professional tailor their consultation more and improve their service.

Widex Moment hearing aids-Devon

“The future of hearing aids will be unlocked through the combination of perfectly natural sound with the latest in streaming, rechargeability, and customisation—and that’s exactly what we’ve created with Widex Moment,” said Henningsen. “We’re breaking down the hearing aid stigma, across all generations, by equipping users with a way to experience one’s natural hearing, customised for any environment, while enabling connectivity with all of your favour apps and devices. It’s a seminal moment for not just our hearing aid industry but for the technology industry, in general.”

Widex Moment is available in 13 colours and six different styles and is available for purchase. For more information on WIDEX, click here.

Source: Widex

Images: Widex

Researchers Find Two Biomarkers Involved in Speech in Noise

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Researchers Find Two Biomarkers Involved in Speech in Noise

 

Taken from The Hearing Review.com

 

A pair of biomarkers of brain function—one that represents “listening effort,” and another that measures ability to process rapid changes in frequencies—may help to explain why a person with normal hearing may struggle to follow conversations in noisy environments, according to a new study led by Massachusetts Eye and Ear researchers and summarized on the hospital’s website. Published online last week in the scientific journal eLife, the study could inform the design of next-generation clinical testing for hidden hearing loss, a condition that cannot currently be measured using standard hearing exams.

“Between the increased use of personal listening devices or the simple fact that the world is a much noisier place than it used to be, patients are reporting as early as middle age that they are struggling to follow conversations in the workplace and in social settings, where other people are also speaking in the background,” said senior study author Daniel B. Polley, PhD, director of the Lauer Tinnitus Research Center at Mass. Eye and Ear and Associate Professor of Otolaryngology Head-Neck Surgery at Harvard Medical School. “Current clinical testing can’t pick up what’s going wrong with this very common problem.”

Daniel B. Polley, PhD

“Our study was driven by a desire to develop new types of tests,” added lead study author Aravindakshan Parthasarathy, PhD, an investigator in the Eaton-Peabody Laboratories at Mass. Eye and Ear. “Our work shows that measuring cognitive effort in addition to the initial stages of neural processing in the brain may explain how patients are able to separate one speaker from a crowd.”

Hearing loss affects an estimated 48 million Americans and can be caused by noise, aging, and other factors. Hearing loss typically arises from damage to the sensory cells of the inner ear (the cochlea), which convert sounds into electrical signals, and/or the auditory nerve fibers that transmit those signals to the brain. It is traditionally diagnosed by elevation in the faintest sound level required to hear a brief tone, as revealed on an audiogram, the gold standard test of hearing sensitivity.

Aravindakshan Parthasarathy, PhD

Hidden hearing loss, on the other hand, refers to listening difficulties that go undetected by conventional audiograms and are thought to arise from abnormal connectivity and communication of nerve cells in the brain and ear, not in the sensory cells that initially convert sound waves into electrochemical signals. Conventional hearing tests were not designed to detect these neural changes that interfere with our ability to process sounds at louder, more conversational levels.

In the eLife report, the study authors first reviewed more than 100,000 patient records over a 16-year period, finding that approximately 1 in 10 of these patients who visited the audiology clinic at Mass. Eye and Ear presented with complaints of hearing difficulty, yet auditory testing revealed that they had normal audiograms.

Motivated to develop objective biomarkers that might explain these “hidden” hearing complaints, the study authors developed two sets of tests. The first measured electrical EEG signals from the surface of the ear canal to capture how well the earliest stages of sound processing in the brain were encoding subtle but rapid fluctuations in sound waves. The second test used specialized glasses to measure changes in pupil diameter as subjects focused their attention on one speaker while others babbled in the background. Previous research shows changes in pupil size can reflect the amount of cognitive effort expended on a task.

They then recruited 23 young or middle-aged subjects with clinically normal hearing to undergo the tests. As expected, their ability to follow a conversation with others talking in the background varied widely despite having a clean bill of hearing health. By combining their measures of ear canal EEG with changes in pupil diameter, they could identify which subjects struggled to follow speech in noise and which subjects could ace the test. The authors are encouraged by these results, considering that conventional audiograms could not account for any of these performance differences.

“Speech is one of the most complex sounds that we need to make sense of,” Polley said. “If our ability to converse in social settings is part of our hearing health, then the tests that are used have to go beyond the very first stages of hearing and more directly measure auditory processing in the brain.”

In addition to Drs Polley and Parthasarathy, co-authors on the eLife report include Kenneth E. Hancock of Mass. Eye and Ear/Harvard Medical School, Kara Bennett of Bennett Statistical Consulting, Inc, and Victor DeGruttola of the Harvard T. H. Chan School of Public Health. This study was supported by the National Institutes of Health (NIDCD P50-DC015857).

Original Paper: Parthasarathy A, Hancock KE, Bennett K, DeGruttola V, Polly DB. Bottom-up and top-down neural signatures of disordered multi-talker speech perception in adults with normal hearing. eLife. 2020;9:e51419.

Source: Mass. Eye and Ear, eLife

Hearing Aids May Lead to Lower Rates of Dementia, Depression, and Anxiety

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Hearing Aids May Lead to Lower Rates of Dementia, Depression, and Anxiety

 

According to a report, hearing Aids May Lead to Lower Rates of Dementia, Depression, and Anxiety

 

This article appeared September 2019 in the Hearing review

 

Older adults who get a hearing aid for a newly diagnosed hearing loss have a lower risk of being diagnosed with dementia, depression, or anxiety in the following three years, and a lower risk of suffering fall-related injuries, than those who leave their hearing loss uncorrected, a new study finds. A summary of the study’s findings were published on the University of Michigan’s website.

Devon hearing

Yet only 12% of those who have a formal diagnosis of hearing loss actually get the devices—even when they have insurance coverage for at least part of the cost, the study shows. It also reveals gaps in hearing aid use among people of different racial and ethnic backgrounds, geographic locations, and genders.

The findings, made by a University of Michigan team using data from nearly 115,000 people over age 66 with hearing loss and insurance coverage through a Medicare HMO between 2008 and 2016, are published in the Journal of the American Geriatrics Society.

Unlike traditional Medicare, Medicare HMOs typically cover some hearing aid costs for members diagnosed with hearing loss by an audiologist.

Elham Mahmoudi, MBA, PhD, the U-M Department of Family Medicine health economist who led the study, says it confirms what other research has shown among patients studied at a single point in time—but the new findings show differences emerging as time goes on.

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“We already know that people with hearing loss have more adverse health events, and more co-existing conditions, but this study allows us to see the effects of an intervention and look for associations between hearing aids and health outcomes,” she says.

“Though hearing aids can’t be said to prevent these conditions, a delay in the onset of dementia, depression, and anxiety, and the risk of serious falls, could be significant both for the patient and for the costs to the Medicare system.”

Long-term Tracking

Mahmoudi and her colleagues at the U-M Institute for Healthcare Policy and Innovation looked at anonymous insurance data to perform the study, and looked at the data for each person with hearing loss one year before their diagnosis, and three years after, so they could see only newly diagnosed dementia, depression, anxiety, and fall injuries.

They intend to keep studying further data from this population, to see if the differences in health outcomes continue beyond three years.

The study shows that men with hearing loss were more likely to receive a hearing aid—13.3% compared with 11.3% of women. Only 6.5% of people of Latino heritage received a hearing aid for their hearing loss, compared with 9.8% of African-Americans and 13.6% of whites.

Nearly 37% of people with hearing loss who lived in the north-central part of the country, as designated by the Census Bureau, used a hearing aid, compared with just 5.9% of people in the mountain states.

Differences in Diagnosis

When the researchers looked at the path that patients who received hearing aids took over three years, compared with those who didn’t get the devices, significant differences emerged.

In all, the relative risk of being diagnosed with dementia, including Alzheimer’s disease, within three years of a hearing loss diagnosis was 18% lower for hearing aid users. The risk of being diagnosed with depression or anxiety by the end of three years was 11% lower for hearing aid users, and the risk of being treated for fall-related injuries was 13% lower.

The study also confirms previous studies’ findings that people with hearing loss had much higher rates of dementia, depression, and fall injuries than the general population.

The reasons for this are complicated, and can include loss of social interaction, loss of independence, loss of balance, and less stimulation to the brain. Some researchers also believe that the loss of nerve impulses from the ear to the brain, and loss of cognitive ability leading to dementia, could be part of the same ageing process.

What’s to Come

The study only included individuals who billed their insurance company for part of the cost of their hearing aid, Mahmoudi notes. The coming of FDA-approved over-the-counter hearing aids in 2020 for people with mild to moderate hearing loss could make the devices much more accessible for many people.

But those new devices could also complicate researchers’ ability to study the effects of hearing aids on other health outcomes, if people don’t use insurance coverage and researchers can’t tell if they have one.

“Correcting hearing loss is an intervention that has evidence behind it, and we hope our research will help clinicians and people with hearing loss understand the potential association between getting a hearing aid and other aspects of their health,” says Mahmoudi.

She notes that Medicaid in the state of Michigan is now covering hearing aid testing, fitting, and purchase, since a policy change in 2018, and that it will be important to study impacts in this population as well.

In addition to Mahmoudi, the new study’s authors are IHPI statisticians Tanima Basu, MS and Neil Kamdar, MA, and IHPI members Kenneth Langa, MD, PhD, Michael M. McKee, MD, MPH, Phillip Zazove, MD, and Neil Alexander, MD. Langa and Alexander are professors in the U-M Department of Internal Medicine; McKee and Zazove are assistant professor and chair, respectively, of the U-M Department of Family Medicine. Langa also holds faculty positions in the U-M Institute for Social Research and the VA Ann Arbor Center for Clinical Management Research.

Original Paper: Mahmoudi E, Basu T, Langa K, et al. Can hearing aids delay time to diagnosis of dementia, depression, or falls in older adults? Journal of the American Geriatrics Society. 2019. DOI: https://doi.org/10.1111/jgs.16109

Source: University of Michigan, Journal of the American Geriatrics Society