There were five presentations from the BEAR project at the 14th Congress of the European Federation of Audiology Societies (EFAS), on May 22-25, 2019 in Lisbon, Portugal;
A study of better hearing rehabilitation in Denmark (the BEAR project)
Department of Electronic Systems, Aalborg University, Aalborg, Denmark
Background: The overall vision of the project is to improve hearing rehabilitation through an evidence-based renewal of clinical practice. The structured approach comprise studies of the current practice in Denmark, considerations for new methods, experimental application and refinement of this, evaluation and implementation of the most promising renewals.
Method: The reference for existing practice is based on data for almost 2,000 patients, which have been fitted with hearing aids during 2017-2018 in two of the participating clinics. The considerations for new profiling methods are based on the analysis of prior studies incl. more diverse diagnostics than used currently. New fitting strategies are preliminarily tested using hearing-aid simulations in laboratory settings, in parallel to test trials of new aided-performance tests and paradigms for assessing user experiences in the field. These studies are all on going and will be reported in more detail in accompanying presentations. The experimental application of the novel fitting strategies is currently being planned, and will include the experimental application of the prospective strategy in real hearing aids. The refinement of novel strategies includes studies of the clinical efficiency, socio-economic trade-offs, options of out-of-clinic application, and attention to populations with low benefits. The evaluation and implementation includes proposals for future standardization, and the collection of any additional reference data for this effort.
Results: A clinical database for almost 2,000 patients has been established, which includes standard data supplemented with widely used questionnaires for the assessment of outcome. The clinical practice has been examined for tacit knowledge in validation and assessment of user outcomes. A proposal for four differing hearing profiles has been developed, and six different fitting strategies is examined for their potential. A test battery for aided listening performance has been developed.
Acknowledgements: This work was supported by Innovation Fund Denmark Grand Solutions 5164-00011B (Better hEAring Rehabilitation project), 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). The funding and collaboration of all partners is sincerely acknowledged.
Better Hearing Rehabilitation (BEAR) Study in Denmark: Introducing the Centralized Clinical Database
G. Loquet1,2, V. Narne3, T. Piechowiak3, A. Wolff5, S. Storbjerg Houmøller3,6,7, D. Dupont Hougaard1,5, J. Hvass Schmidt3,6,7, D. Hammershøi2
1Department of Clinical Medicine, Aalborg University, Aalborg, Demark
2Department of Electronic Systems, Aalborg University, Aalborg, Denmark
3Department of Clinical Research, University of Southern Denmark, Odense, Denmark
4GN Hearing Danmark A/S (GN ReSound A/S), Ballerup, Denmark
5Department of Otolaryngology, Head & Neck Surgery and Audiology, Aalborg University hospital, Aalborg, Denmark
6Department of ORL – Head & Neck Surgery and Audiology Odense University Hospital, Odense, Denmark
7OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
Background: The purpose of the BEAR project is to improve hearing loss management by revising diagnostic techniques and hearing aid fitting practices based on individual hearing profiles, expectations and lifestyle. As a starting point, a large clinical database has been prepared to better characterize the current clinical status in Denmark. The analysis will be used to identify the main challenges faced by hearing aid users in order to develop appropriate tools to improve performances.
Method: The study is a multicentre, prospective, open, non-randomized, single-arm trial with sequential enrolment of all qualified patients, conducted under a common clinical investigation plan. Up to almost 2,000 evaluable patients have been enrolled from two Danish clinics. After having undergone medical and audiological examination and other assessments (health related and quality of life questionnaires), the patients were prescribed a hearing aid and got a fitting. Approximately 2 months later, a follow-up visit took place and whenever needed an adjustment was offered (plus other assessments). An across-center database, hosted independently from clinics, universities and hearing-aid manufacturers but accessible by all parties, was created to gather the data (access granted to each partner if data managers adhere to ethical permissions and requirements for data security).
Results: The investigation generated approximately 30’000 patient records and we started by characterizing the general distribution of audiometric data (air and bone conductions, speech tests) and questionnaires (health, speech, hearing aids, tinnitus and quality of life related). The analysis focused specifically on correlations detection between demographics, audiometric tests and questionnaires in order to classify patients into subsets.
Conclusion: The present clinical database should be seen as a starting point for other BEAR work packages. We believe that such large variety of data generated will lead to a more comprehensive picture of the hearing-aid user and will bring benefits to both clinicians and manufacturers. Indeed, this first step represents the baseline against which new fitting strategies will be tested. Alternatively, clinically relevant subpopulations with low hearing-aid benefit will be identified and studied to tentatively bring alternatives in rehabilitation.
How professionals assess outcome in clinical hearing rehabilitation
K. Lund and D. Hammershøi
Department of Electronic Systems, Aalborg University, Aalborg, Denmark
Background: Denmark has currently no formal requirements for testing and documenting the aided listening performance and outcome obtained with hearing aids rehabilitation. Yet most professionals both validate and assess the aided listening experience in various ways as part of the fitting procedure and in follow-up assessments. The goal of the present study was to observe standard clinical practice and identify methods and actions currently used, and examine their potential for formalization and inclusion in guidelines, or replacement by existing formalized procedures.
Material and methods: The relevant professionals receive a major part of their training through supervised internships, and it is anticipated that much of their knowledge is tacit and informal. The general methods for the study therefore comprise a combination of interviews with and observations of professionals during hearing-aid fitting and at two-month follow-up. Observations and contextual inquiries of the clinical practice were made in three public hearing clinics in Denmark including 17 professionals, which were either medical audiologists (ENT doctors), audiology assistants or professionals in audiologopedics. These are the main categories of professionals involved in hearing-aid fitting in public clinics in Denmark. Each professional participated between two and ten hours in the present study.
Results: The results show that professionals assess outcome using methods, which are often individually and tacitly anchored covering 1) validation of basic hearing aid functionality, 2) patient awareness on gain with hearing aids, 3) access to knowledge on patient experiences through sound descriptions, 4) assessment of aided performance in real life and 5) non-auditory assessments.
Conclusion: Some of the informal methods observed may be formalized as a part of a more patient-centered communication strategy – other need further examination or may be replaced by existing, already validated formal frameworks, or by test batteries under development.
Acknowledgement: The collaboration within the BEAR project and funding by Innovation Fund Denmark and partners of the BEAR project (incl. Oticon, GN Resound and Widex) is sincerely appreciated.
Auditory profiling as a tool for characterizing individual hearing deficits: Data-driven analysis of the results of the BEAR Test Battery
R. Sanchez-Lopez1, S. G. Nielsen1, M. El-Haj-Ali2, O. Cañete1, M. Wu2, M. Fereczkowski1, F. Bianchi1, T. Neher2, T. Dau1, and S. Santurette1,3
1Hearing Systems Section, Dept. of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
2Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
3Oticon A/S, Smørum, Denmark
Background: One aim of the Better hEAring Rehabilitation (BEAR) project is to define a new clinical profiling tool, a test-battery, for individualized hearing loss characterization. Whereas the loss of sensitivity can be efficiently assessed by pure-tone audiometry, it still remains a challenge to address supra-threshold hearing deficits using appropriate clinical diagnostic tools. In contrast to the classical attenuation-distortion model, the proposed BEAR approach is based on the hypothesis that any listener’s hearing can be characterized along two dimensions reflecting largely independent types of perceptual distortions. Recently, a data-driven approach (Sanchez-Lopez et al., 2018) provided evidence consistent with the existence of two independent sources of distortion, and thus different auditory profiles.
Method: Based on considerations of feasibility, time efficiency and evidence from literature, 11 tests were selected for the clinical test battery. The proposed tests were divided into six categories: audibility, middle-ear analysis, speech perception, binaural-processing abilities, loudness perception, and spectro-temporal resolution. Fifty-seven listeners with symmetric, mild-to-severe sensorineural hearing loss were selected from a clinical population of hearing-aid users who completed all tests included in the battery. The participants were tested in a clinical environment and did not receive systematic training for any of the tasks.
Results: The analysis of the preliminary results will focus on the ability of each test to pinpoint individual differences among the participants, relationships among the different tests, and determining their potential use in clinical settings. Importantly, a parallel study will evaluate the extent to which the outcomes of these tests can be used for hearing-aid fitting.
Conclusion: Based on the results of a data-driven analysis for auditory profiling, the test battery will be refined and implemented as a clinical profiling tool in audiology clinics.
Hearing aid processing strategies for listeners with different auditory profiles: Insights from the BEAR project
M. Wu1, R. Sanchez-Lopez2, M. El-Haj-Ali1, S. G. Nielsen2, M. Fereczkowski2, F. Bianchi2, T. Dau2, S. Santurette2,3, and T. Neher1
1Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
2Hearing Systems Group, Dept. of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
3Oticon A/S, Smørum, Denmark
Background, The Better hEAring Rehabilitation (BEAR) project pursues the development and evaluation of new, clinically feasible strategies for individual hearing loss diagnosis and hearing aid (HA) fitting. Two essential elements of this research are the design of a new diagnostic test battery for identifying different auditory profiles and linking those profiles to different HA processing strategies. The current study focused on establishing links between four auditory profiles and the benefit from six HA processing strategies.
Material and methods, Sixty older individuals with bilateral mild-to-severe sensorineural hearing losses from a clinical population of HA users participated. Speech-in-noise stimuli were generated with the help of a HA simulator that included directional processing, noise reduction and dynamic range compression. Stimulus presentation was via headphones. Six HA settings differing in terms of signal-to-noise ratio (SNR) improvement and temporal and spectral speech distortions were selected for testing based on a comprehensive technical evaluation of different HA parameter settings. Speech-in-noise perception was assessed at fixed SNRs that were chosen based on individual speech reception threshold measurements. In addition, overall preference and noise annoyance were assessed using a multiple stimulus comparison paradigm.
Results, We hypothesize that the perceptual outcomes from the six HA settings will differ across the different auditory profiles. More specifically, we expect listeners showing high sensitivity to temporal and spectral signal changes to perform best with and/or to prefer HA settings that preserve those cues. In contrast, we expect listeners showing low sensitivity to temporal and spectral signal changes to perform best with settings that maximize SNR improvement, independent of any additional signal distortions.
Conclusions, We anticipate that the findings from the current study will provide the basis for the implementation of more individualized HA fitting strategies to be tested subsequently in wearable HAs.
BEAR participants at EFAS 2019, from left: Katja Lund, Gert Ravn, Tobias Neher, Dorte Hammershøi, Gérard Loquet