Stine Klausen received a Bachelor degree in pedagocal audioloty from University of Southern Denmark in 2016 for her study: “Don’t you just need hearing aid? – a study of joint decision making and treatment preferences in relation to the alleviation of hearing loss”. In 2018, she received a Master degree in Audiology also from University of Southern Denmark, for her study on “Hearing Training – development of a computer-based hearing training program and a qualitative study of potentiel end users’ experiences and attitudes”.

Stine Klausen applied for the position as research assistent, because she is interested in science and passionate about patient-centered rehabilitation.

Welcome, Stine Klausen!

The Better Hearing Rehabilitation (BEAR) Project
Dorte Hammershøi, Dept. of Electronic Systems, Aalborg University, Denmark
(The presentationen will be given in English, May 13, 9:00-9:20)

The Better Hearing Rehabilitation (BEAR) Project – insights from 1961 patients treated with hearing aids
Jesper Hvass Schmidt, Dept. of Clinical Research, University of Southern Denmark
(The presentationen will be given in English, May 13, 9:20-9:55)

The BEAR project: Auditory profile-based hearing aid fitting
Tobias Neher, Dept. of Clinical Research, University of Southern Denmark
(The presentationen will be given in English, May 13, 11:30-12:00)

Due to the COVID-19 situation, the Nordic Audiological Society has post-poned the event til June 1-3, 2022.

Auditory profile-based hearing aid treatment:
Insights from the BEAR project

af
Tobias Neher, PhD
Associate Professor in Audiology, Institute of Clinical Research,
University of Southern Denmark
Præsentationen vil være på engelsk, 60 min

ENGLISH SUMMARY (from the PhD thesis by Raul Sanchez-Lopez):

In this thesis, the basis for “precision audiology” was explored. The prerequisites for implementing precision treatments are 1) that the diseases must be heterogenous, 2) that there exist multiple options for treatment and 3) that there are “markers” that associate certain characteristics of the patient to specific treatments. The sources and consequences of a sensorineural hearing loss (SNHL) are diverse and the hearing devices, especially hearing aids, have multiple configurations that can be adjusted for specific needs. The present thesis focused on the investigation of auditory biomarkers that allow the link between auditory perceptual deficits and hearing-aid settings. Data-driven auditory profiling has the potential to identify hidden patterns in the data and subpopulations of hearing-impaired people with distinct differences in terms of their perceptual hearing deficits.

The first study of this thesis showed that a method for auditory profiling can provide meaningful results. The results supported the hypothesis of having four profiles along two independent dimensions of perceptual deficits resulting from different auditory distortions. However, the main limitation for drawing strong conclusions was the selection of the analyzed datasets. In the second study, a new test battery for characterizing auditory deficits was proposed and tested on 75 listeners with various degrees of hearing loss and speech discrimination. The test battery assessed the auditory processing abilities of the listeners covering aspects such as audibility, loudness perception, binaural processing abilities, speech perception, spectro-temporal modulation sensitivity and spectro-temporal resolution. The dataset was then analyzed with an iterative data-driven profiling method based on the aforementioned profiling method. This robust auditory profiling yielded four clinically relevant subgroups of listeners. Importantly, the results were consistent with previous approaches of hearing loss characterization leading to the following conclusions: 1) The listeners’ hearing deficits were characterized by two independent auditory distortions, a “speech intelligibility related distortion”, that affected listeners with audiometric thresholds above 50 dB hearing level (HL) at high-frequencies, and a “loudness perception related distortion”, exhibited by listeners with audiometric thresholds above 30 dB HL at low frequencies; and 2) The four profiles (A-B-C-D), showed similarities to the audiometric phenotypes provided by Dubno et al. (2013) suggesting that Profile B might be considered a sensory loss and Profile D a metabolic loss.

Finally, a proof-of-concept study was performed, where listeners evaluated different compensation strategies using a realistic hearing-aid simulator. The results suggested that listeners belonging to different profiles might prefer different compensation strategies. Listeners with high degree of loudness-related deficits might benefit from different forms of gain prescription, whereas listeners with speech intelligibility-related deficits might benefit fromsignal-to-noise ratio improvement. Different approaches for precision audiology may be implemented in the near future, which should have implications for hearing-aid development, hearing loss characterization and the quality of service in the hearing-care clinic towards an evidence-based audiological practice.

Li-Tang Tsai has a Bachelor’s degree in physical therapy and took both her Master and PhD in Gerontology and Public Health, at the University of Jyväskylä, Finland. In 2017, she defended her PhD thesis on “Walking, physical activity and life-space mobility among older people”, a work that included accelerometer-assessed physical activity among 174 community-dwelling Finnish older adults. In the same year, she was appointed as postdoctoral researcher in the University of Southern Denmark, where she managed the EU-funded PROMISS project (Prevention of Malnutrition in Senior Subjects in the EU) work package 2 for 3.5 years.

In the BEAR project, Li-Tang Tsai will apply her knowledge in epidemiology and statistics on topics related to e.g. association between noise exposure during working life and audiogram configurations, tinnitus, and comorbidity in older age.

Welcome, Li-Tang!

Lotte Simone Emilie Petersen has a Bachelor in Technical Audiology (2018) from University of Southern Denmark. Her Bachelor thesis addressed ”Cleaned vs. uncleaned ears: A comparative in-ear dry-electrodes performance study”, from which the results were used in a poster presented by Eriksholm Research Center at the IHCON 2018 (the International Hearing Aid Research Conference, Lake Tahoe, USA). Lotte has worked two years as a fitting audiologist at a private hearing aid manufacturer.

In the BEAR project, Lotte Simone Emilie Petersen will primarily work with the challenges relating to the clinical validation of new methods in hearing aids rehabilitation.

Welcome, Lotte!

More men than women have a hearing loss, and the incidence of hearing loss increases with age. In a study from 2010, the Knowledge Center for Hearing Disabilities estimated that 800,000 Danes have disabling hearing loss. The population projection from Statistics Denmark (2018) shows that the Danish population is expected to grow, primarily due to a growth of the oldest portion of the population. This will result in more people in need of treatment for hearing loss in the future. The hearing threshold is the clinical measure most often used to determine whether there is hearing loss and, if so, how severe. This is measured by tone audiometry which tests how intense a given tone must be presented before it can be heard by the patient. Hearing loss can also manifest in the form of difficulty understanding and distinguishing words from one another. This is typically measured by speech audiometry in which a number of words are played and must be repeated by the patient.

The most frequent treatment for hearing loss is the fitting of hearing aids. The majority of treated patients benefit from the use of hearing aids. A hearing aid works by receiving and amplifying sound before sending the amplified sound signal to the ear. Described as such it may seem simple, yet both hearing and sound processing are complex tasks, and there still remains conditions that make successful hearing aid treatment a challenge to obtain across the hearing impaired population. More knowledge about what characterises these patients, who face challenges, as well as knowledge on those who do not, may form the basis of improved treatment in the future.

This dissertation is based on three articles which are based on the first clinical part of the Better hEAring Rehabilitation project (BEAR). BEAR is a five-year project whose goal is to improve hearing aid treatment in Denmark based on clinical research, and if favourable, evidence-based renewal of clinical practice. In the first part of the BEAR project, a database containing information on almost 2,000 patients was established. Patients were included over the course of a year when examined and treated for hearing loss at the Department of Audiology at Odense and Aalborg University Hospitals. The database contains data from questionnaires and audiometric data, as well as data from an objective measurement of the amplified sound delivered to each patient via HAs.

Manuscript 1 reports on quality of life improvements for first-time and experienced hearing aid users after two months of hearing aid use. It was shown that experienced hearing aid users had lower hearing-related quality of life compared to new users before renewing/fitting new hearing aids. Both groups achieved improvement in their hearing-related quality of life after two months of treatment. The overall quality of life score increased for the group of first-time users, whereas no change was observed for the experienced users.

Manuscript 2 reports on quality of life and speech understanding in patients with asymmetrical hearing loss, that is, a difference in hearing between the right and left ear, compared to patients with symmetrical hearing loss. There is no common standard for defining asymmetrical hearing loss and we therefore used three different definitions: 1) more than 15 dB interlateral difference in pure-tone average (PTA) over four frequencies, 2) more than 15% interlateral difference in word recognition score (WRS) and 3) interlateral difference in audiogram configuration. It was shown that no matter the definition of asymmetrical hearing loss, patients had poorer hearing-related quality of life and spatial hearing before treatment compared to patients with symmetric hearing loss. Two months of hearing aid treatment improved both groups’ hearing-related quality of life and speech comprehension, regardless of asymmetry definition.

Manuscript 3 reports on a study of quality of life changes compared to how the hearing aid is fitted, according to the individual patient’s hearing loss. The hearing aid amplification in each patient was measured with real ear measurements and compared to a curve expected from a standard prescription, targeted to provide optimal speech understanding. The amplification provided by the hearing aids when a speech signal was played from a loudspeaker was measured and compared to the target curve projected by the standard prescription. It was shown that there was no correlation between self-reported quality of life, and self-reported hearing handicap in relation to the measured gain curve being on or not on reference.

Overall, it was found that hearing aid treatment significantly improved patients’ hearing-related quality of life. However, some subgroups of patients achieved less improvement than others. Among others, it was shown that patients with asymmetrical hearing had lower self-reported hearing-related quality of life and self-reported hearing handicap than patients with symmetrical hearing. These results will hopefully inspire further research in the field working towards improving health-related quality of life through improved hearing care and rehabilitation.

Better hearing rehabilitation for adult first‐time users (the BEAR project)

Dorte Hammershøi
Department of Electronic Systems, Aalborg University, Aalborg, Denmark

First‐time adult hearing‐aids users do not always experience the debut with success, and it is known that some give up. For the professional fitting the hearing aid, it is often a difficult detective work to figure out, if the hearing aid is poorly fitted to the individual, or whether it is set for best performance. The purpose of the BEAR is to develop a stronger framework for the diagnostics, fitting an assessment of the aided performance that will allow for a more structured, and personalized approach. The project includes several scientific efforts, incl. 1) the collection of data for almost 2.000 patients fitted according to current practice, 2) development and assessment of new diagnostics for profiling and fitting strategies, as well as 3) development and assessment of methods for measurement of the aided performance. The on‐going work includes a proposal for a differentiated fitting based on extended auditory profiles, and is accompanied by both in‐ and out‐of‐clinic options for testing and/or reporting on the aided performance experience. Future results will include an experimental validation of the proposed differentiated fitting, as well as a separate effort to investigate common denominators for patients with poor compensation benefits, and options for out‐of‐clinic application of the proposed methods. The paradigm for auditory profiling will be presented along with tentative results simulated hearing aid. The presentation will also include key results from the analysis of the clinical database will be presented, as well as exemplar results from a field study of the aided performance.

Acknowledgement: Collaboration and support by Innovation Fund Denmark Grand Solutions 5164‐00011B, Oticon, GN Resound, Widex and other partners (University of Southern Denmark, Aalborg University, the Technical University of Denmark, Force, and Aalborg, Odense and Copenhagen University Hospitals) is sincerely acknowledged.

Predictive Factors for Hearing aid Satisfaction for Experienced and First-time Hearing aid Users: Using the International Outcome Inventory for Hearing aids

Sabina Storbjerg Houmøller¹, Anne Wolff², Vijay Narne³, Gérard Loquet⁴, Dan Dupont Hougaard⁵, Dorte Hammershøi⁶Jesper Hvass Schmidt⁷

¹Department of ORL – Head & Neck Surgery and Audiology Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
²Department of Otolaryngology, Head & Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
³Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
⁴Institute of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Electronic Systems, Aalborg University, Aalborg, Denmark;
⁵Department of Otolaryngology, Head & Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark; Institute of Clinical Medicine, Aalborg University, Aalborg, Denmark
⁶Department of Electronic Systems, Aalborg University, Aalborg, Denmark
⁷Institute of Clinical Research, Faculty of Health, University of Southern Denmark; Dept. of Oto-Rhino-Laryngology Head & Neck Surgery and Audiology, Odense University Hospital; OPEN, Odense Patient data Explorative Network, Odense University Hospital

Based on studies showing that hearing aid (HA) ownership among people with a hearing deficit is surprisingly low, it stresses the importance of improving the likelihood of achieving a successful HA treatment. The level of satisfaction with the HA treatment is assessed using the self-administered International Outcome Inventory of Hearing Aids (IOI-HA) questionnaire. The aims of the current study were to investigate the level of HA satisfaction for experienced and first-time HA users, and further to investigate which factors significantly associated with satisfaction of the HA treatment. Moreover, the study aimed to evaluate any difference between self-reported and objectively measured HA usage time (through data logging). The study population (n=1649) comprised of both experienced (n=458) and first time HA users (n=1191). The study design was a selfreported questionnaire survey and a part of the national BEAR project. Patients were enrolled from January 2017 to January 2018, and answered several questionnaires, including the IOI-HA questionnaire. The IOI-HA consists of seven items, each targeting different hearing outcome domains and scored from 1-5. A higher score indicates a better perceived outcome of the HA treatment. Data logged HA usage time was obtained at two months follow-up visits and compared to the self-reported usage time obtained from the initial IOI-HA questionnaire item. Experienced users answered the IOI-HA before and two months following HA fitting. First-time users answered two months following HA fitting. Results showed that experienced HA users reported a mean total IOI-HA score of 27.8, and first-time HA users a mean total IOI-HA score of 28.2, indicating a high level of satisfaction with the HA treatment in current clinical practice in Denmark. Total mean IOI-HA scores for experienced HA users increased significantly by 0.36 (SD=0.92) (p< 0.001), which indicated a higher satisfaction with the new HAs. This argues that it is meaningful to renew HAs after four years following Danish standards. Motivation was shown to be significantly associated with level of HA satisfaction among the first-time users, whereas HA usage time, monosyllabic word scores and type of hearing class were shown to be significantly associated with HA satisfaction for both groups of HA users. Data logging for experienced users showed an average HA use time of 10.4 hours (SD=5.10) and 8.35 hours (SD=1.02) of use for first time users and this difference was significant (p< 0.001).

Auditory Profiling and Profile-based Hearing-aid Processing Strategies

Raul H. Sanchez-Lopez¹, Michal Fereczkowski², Sébastien Santurette³, Tobias Neher², Torsten Dau⁴

¹Hearing Systems Section, Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
²Institute of Clinical Research, University of Southern Denmark, 5230 Odense M, Denmark
³Oticon A/S, Denmark
⁴Hearing Systems Section, Technical University of Denmark, Kgs. Lyngby, Denmark

Currently, clinical characterization of hearing deficits for hearing-aid fitting is based on the pure-tone audiogram only. Implicitly, this assumes that the audiogram can predict performance on complex, supra-threshold tasks. Sanchez-Lopez et al. (Trends in Hearing, Vol. 22, 2018) hypothesized that the hearing deficits of a given listener, both at threshold and supra-threshold levels, result from two independent types of auditory distortion. In their study, a data-driven method for classifying the listeners into four auditory profiles was proposed and validated. However, the definition of the two types of distortion was challenged by differences between the two datasets in terms of the tests and listeners used. In the current study, a refined method and definition of the auditory profiles is proposed. A new dataset was generated with the aim of overcoming the limitations of the previous study. A heterogeneous group of listeners was tested across three locations using a test-battery designed to tap into different aspects of hearing, including speech perception in quiet and noise, loudness perception, binaural processing abilities, and spectro-temporal resolution. The collected data were analyzed using the data-driven analysis developed by Sanchez-Lopez et al. (2018). Furthermore, a profile-based hearing-aid fitting differing in terms of gain prescription and signal-to-noise ratio improvement was proposed and tested with listeners belonging to the four proposed auditory profiles. Using a hearing-aid simulator, the listeners’ subjective preference for the proposed hearing-aid processing strategies was assessed in various realistic sound scenarios. The results suggested that the different auditory profiles are associated with different preferences in terms of amplification, compression and signal-to-noise ratio improvement. Altogether, the developed method for profile-based HA fitting shows promise with respect to individualizing HA signal processing. Future work will be concerned with testing it in a large field study with wearable devices. Moreover, profile-based hearing-aid fitting may be extended to new paradigms of hearing loss compensation and advanced signal processing.

Collaboration and support by Innovation Fund Denmark (Grand Solutions 5164-00011B), Oticon, GN Resound, Widex and other partners (University of Southern Denmark, Aalborg University, the Technical University of Denmark, Force, and Aalborg, Odense and Copenhagen University Hospitals) is sincerely acknowledged.

Amalie Tage Stubberup received her Bachelor of Science degree in Audiology from the University of Southern Denmark, Denmark in 2016. She subsequently received her Master of Science degree in Technical Audiology from the University of Southern Denmark in 2019 for her work “A questionnaire survey of hearing aid treatment for adults in the Region of Southern Denmark”. She has since March 2019 worked as a technical audiologist at Odense University Hospital.

In the BEAR project, Amalie Tage Stubberup will primarily work with the challenges relating to the clinical validation of new methods in hearing aids rehabilitation.

Welcome, Amalie!