habilitation for hearing loss
TRANSCRIPT
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Habilitation for hearing loss
Mel Ferguson
Clinical Scientist (Audiology)
National Biomedical Research Unit in Hearing
NBRUH Launch 11.3.09
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• Degree of unmet need in SNHL
• Overview of auditory training studies
Outline
• Overview of auditory training studies
• Proposed studies
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Prevalence of SNHL in the UK
100%
Profound 149 thousand
0%
50%
Profound 149 thousand
Severe 549 thousand
Moderate 3439 thousand
Mild 4830 thousand
National Study of Hearing, MRC IHR
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NSH – some more stats
• 1 in 5 adults have hearing problems
• 1 in 10 would probably benefit from intervention• 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)
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40
50
60
70Prevalence %
Hearing loss gets worse with age
18-30 31-40 41-50 51-60 61-70 71-80
Age group
0
10
20
30
40
Better ear average (0.5-4kHz) ≥ 25 dB HL Davis (1995)
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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) • 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)
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Seeking advice about hearing
Davis et al (2007)
Reluctance to wear hearing aids
Would auditory training be more acceptable?
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Seeking advice about hearing
People make a joke of hearing loss – so you don’t admit it. Blind
people are not treated that way
My friends kept
mumbling
Davis et al (2007)
Reluctance to wear hearing aids
that way
I refused to accept I was going deaf – first
your hair then your ears!
Would auditory training be more acceptable?
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Hearing aid benefit outcomes
Glasgow Hearing Aid benefit Profile
80
100
Mea
n G
HA
BP
sco
re (%
)
Use
Benefit
Can auditory training provide additional benefit?
40
60
<25 25-34 35-44 >45
Better ear average (dB HL)
Mea
n G
HA
BP
sco
re (%
)
Residualdisability (rev)
Satisfaction
Davis et al (2007)
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What is auditory training?
Changes a person's ability to process sounds and improves auditory performance on the task
(tones, phonemes, words)
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Auditory training improveslistening task
10
20
Ton
e d
iscr
imin
ati
on
(%
)
Frequency discrimination
Amitay, Hawkey, & Moore (2005)
block #1 2 3 4 5 6 7
0.2
0.5
1
2
5
Training (days)
Ton
e d
iscr
imin
ati
on
(%
)
Young NH adults; 18-30 yo
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Ag
e eq
uiv
alen
t (y
rs)
Phonological Assessment Battery(word listening)
1212
1313
1414 p<0.0001 Training
Control
Auditory training improves language
Moore, Rosenberg & Coleman (2005))
Time of test
Ag
e eq
uiv
alen
t (y
rs)
66
77
88
99
1010
1111
Pre Post Delayed(4 weeks training) (5-6 weeks later)
8-10 yo NH children
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Auditory training as an adjunct to hearing aids
Nonsense syllable in noise test (NST)
Woods & Yung (2007)Mild to moderate hearing losses; 50-80yo
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• Benefits of auditory training in hearing impaired people
• Three groups of listeners (50-75 yrs)
Proposed studies
Hearing aid users Hearing loss
No Mild
New Mild and moderate
Existing Mild and moderate
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What are the benefits of auditory training, with and without HAs?
Are any benefits retained after training ceases?
Benefits of auditory training
Training (4w)Delay (4w)Gp 1
Training: 15-20 mins/day
Crossover design (test-retest effects)T2T1 T3
Training (4w)(4w)
Control (4w)
Gp 1
Gp 2 Training (4w)
Outcome measuresTraining stimulus (phonemes, words-in-noise)
Generalised learningSpeech intelligibility (Words and sentences in noise)Communication (SSQ, GHABP, Euroqual)Cognition (working memory, processing speed)
Delay (4w)
15-20 mins/day 4 weeks
T4
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• Is hearing aid usage (compliance) associated with a particular set of cognitive abilities?
• Profiles of compliant and non-compliant users
Cognition and compliance
• Profiles of compliant and non-compliant users
• Can we encourage/facilitate compliance by enrolling hearing impaired people on a cognitive training programme?
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Delivery of training
Well done!
Software drivenAdaptive
Appropriate interfaceInteractive
Feedback: motivation and rewardsHome-basedData logging
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• Web-based
Looking to the future
• Hearing screening