Staff Standpoint | April 2016 Hearing Review

KarlA collaborative project between Danish universities, hearing aid manufacturers, and other experts in Denmark will evaluate current hearing loss treatments in the country. The Better Hearing Rehabilitation (BEAR) project will be a collaboration between the University of Southern Denmark, Aalborg University, the Technical University of Denmark, independent tech company DELTA, Danish hearing aid manufacturers Oticon, Widex and GN ReSound, and the university hospitals in Odense and Aalborg, which will work together to improve the quality of treatment so that people with hearing loss can get more out of hearing aids.

The large-scale collaborative project has a budget of DKK 50 million kroner or US$7.3 million; of that, the industry is contributing $2.2 million while Innovation Fund Denmark is investing just under $4.3 million in the project.

Moving Beyond the Audiogram

According to a press statement from Oticon about the BEAR Project, the audiogram provides important knowledge when fitting and adjusting hearing aids, but often much more information is needed for someone to fully benefit from hearing aids. “The audiogram is a simplistic description of how your hearing works,” says Project Manager Dorte Hammershøi, a professor in the Department of Electronic Systems at Aalborg University. “You can have normal hearing thresholds, but, for example, find it difficult to understand what is being said when many people are talking in the same room.”

As the project leaders point out, hearing aids are adjusted by dispensing professionals almost exclusively using audiograms, which means many other important parameters get little attention. The actual hearing aid fitting and adjustment, as well as advice about using it, also play a role in acceptance and satisfaction. Likewise, the problem of customizing hearing aids has been a challenge for decades, and there are many alternative ways to conduct hearing tests and fittings. For example, research on speech-in-noise testing, as well as the emerging data surrounding cognition, aging, and audition (see the September 2015 special issue of Hearing Review on this subject), are making it increasingly apparent that the audiogram provides only a slight glimpse at an individual’s hearing and understanding capabilities.

“The reason we are so focused on audiograms is that right now we can’t put our finger on a specific measurement and say: that’s the test that could enable us to adjust hearing aids better,” says Hammershøi. “There are a whole battery of various tests and examinations, but they take time and may require special equipment or training. That is why we need to find out which methods work best.”

The Ongoing Scientific Revolution in Hearing Testing and Care

It seems that—now almost on a weekly basis—we’re witnessing significant new research findings that have the potential to completely change the way patients with hearing loss are assessed and treated. Besides the more obvious findings that show audiograms often have little insight relative to hearing in noise:

  • Speech recognition performance is lower for most older adults than for younger people—regardless of the presence of hearing loss and across all kinds of listening situations—and these cognitive changes may be starting as early as a person’s thirties.
  • Nina Kraus, PhD, and the Kraus Lab’s research at Northwestern is lending new insights into how the brain responds to auditory information and music—with great implications for both early education and hearing rehab.
  • Anu Sharma, PhD, and her team at the University of Colorado at Boulder is delving into brain reorganization in response to hearing loss—including mild hearing loss.
  • Douglas Beck, AuD, and colleagues on in April’s “Inside Clinical Research” column point out some of the challenges related to auditory processing disorders, and in last month’s issue Dr Beck and Kevin Munro, PhD, discussed dead regions in the cochlea and what it implies for fitting hearing aids.

Walt Whitman said “[I] am not contained between my hat and boots.” Similarly, the individual’s hearing loss and their hearing needs are not contained within an audiogram.