Feasibility and Efficacy Study of an Integrated Computer-Based Auditory Training Program (MalGui) in Newly Fitted Hearing Aid Users

BackgroundSensorineural hearing loss is the most common sensory deficit among older adults. Some of the psychosocial consequences of this condition include difficulty in understanding speech, depression, and social isolation. Studies have shown that older adults with hearing loss show some age-related cognitive decline. Hearing aids have been proven as successful interventions to alleviate sensorineural hearing loss. In addition to hearing aid use, the positive effects of auditory training—formal listening activities designed to optimize speech perception—are now being documented among adults with hearing loss who use hearing aids, especially new hearing aid users. Auditory training has also been shown to produce prolonged cognitive performance improvements. However, there is still little evidence to support the benefits of simultaneous hearing aid use and individualized face-to-face auditory training on cognitive performance in adults with hearing loss.ObjectiveThis study will investigate whether using hearing aids for the first time will improve the impact of individualized face-to-face auditory training on cognition, depression, and social interaction for adults with sensorineural hearing loss. The rationale for this study is based on the hypothesis that, in adults with sensorineural hearing loss, using hearing aids for the first time in combination with individualized face-to-face auditory training will be more effective for improving cognition, depressive symptoms, and social interaction rather than auditory training on its own.MethodsThis is a crossover trial targeting 40 men and women between 50 and 90 years of age with either mild or moderate symmetric sensorineural hearing loss. Consented, willing participants will be recruited from either an independent living accommodation or via a community database to undergo a 6-month intensive face-to-face auditory training program (active control). Participants will be assigned in random order to receive hearing aid (intervention) for either the first 3 or last 3 months of the 6-month auditory training program. Each participant will be tested at baseline, 3, and 6 months using a neuropsychological battery of computer-based cognitive assessments, together with a depression symptom instrument and a social interaction measure. The primary outcome will be cognitive performance with regard to spatial working memory. Secondary outcome measures include other cognition performance measures, depressive symptoms, social interaction, and hearing satisfaction.ResultsData analysis is currently under way and the first results are expected to be submitted for publication in June 2018.ConclusionsResults from the study will inform strategies for aural rehabilitation, hearing aid delivery, and future hearing loss intervention trials.Trial RegistrationClinicalTrials.gov NCT03112850; https://clinicaltrials.gov/ct2/show/NCT03112850 (Archived by WebCite at http://www.webcitation.org/6xz12fD0B).

A Look at AR in the Last Decade

In this first section of a two-part article we offer an overview of research on listeners' abilities to learn to hear the spectral-temporal details of simple and complex sounds, both speech and non-speech. In the second article, to appear in the October issue of The Hearing Journal, we will describe a new training system based on that science that has recently completed clinical validation trials with users of hearing aids and of cochlear implants.1,2

Sheila is quietly listening to her audiologist discuss the next steps in the process of getting her first set of hearing aids. They have decided on the style and color of the devices and the audiol...

Background: Individuals with sensorineural hearing loss can regain some lost auditory function with the help of hearing aids, but it may be insufficient under non – optimal condition. Future research aspect lies in processing strategy and training to enhance effects of auditory training and rehabilitation of patients using hearing aids. So research is done to supplement the rehabilitation process with patient centric education, counseling and auditory training to help the listener compensate for loss of auditory signal and improve communication. Whether age-related hearing loss can be decreased by auditory training along with hearing aid is to be researched as it is not clear from previous scientific works whether the outcome is significantly better than those with hearing aid who have not received training. Aims and Objectives: The aim of the study was to determine the role of auditory training for improvement of auditory perception in aged patients with age-related sensorineural hearing loss using binaural hearing aid. Materials and Methods: This prospective observational study was conducted in Otorhinolaryngology department of Burdwan Medical College and Hospital, Burdwan, a rural based tertiary care hospital in Burdwan for 2 months from June 2022 to July 2022 and 50 aged patients with audiologically proven age related sensorineural hearing loss using hearing aid were included in this study after through history taking and meticulous clinical examination after getting institutional ethics committee clearance. Patients were divided in two groups, 25 in experimental group (with auditory training) and 25 in control group (without auditory training) and result was analyzed. Results: Formal auditory training was able to improve the central auditory skills of hearing aid users. Improvement was noted in an objective neurophysiologic correlate and perceived by patients, as revealed in a self-assessment questionnaire. Conclusion: Formal auditory training in adult hearing aid users promotes: Improvement in auditory skills for sound localization, memory for nonverbal sounds in sequence, auditory closure, and figure-to-ground for verbal sounds. Greater benefits with hearing aids in reverberant and noisy environments.

The aim of this study was to assess whether a computer-based speech-in-noise auditory training (AT) program would lead to short- and long-term changes in trained and untrained measures of listening, cognition, and quality of life. A secondary aim was to assess whether directly training the underlying cognitive abilities required for speech perception in noise, using a computer-based visual training (VT) program without the auditory component, would elicit comparable outcomes as the AT program. A randomized crossover study with repeated measures was conducted with 26 adult cochlear implant users. Participants completed either 6 weeks of speech perception in noise training followed by 6 weeks of masked text recognition training, or vice versa. Outcome measures were administered twice before each training program, as well as twice after the completion of each program. The test battery was designed to evaluate whether training led to improvements in listening abilities, cognitive abilities, or quality of life. Mixed-effects models were conducted to analyze whether changes occurred on the trained tasks and on untrained outcome measures after training. Statistically significant improvements were shown for verbal recognition performance during both training programs, in particular for consonants in words, and during the first 2 weeks of training. This on-task learning, however, did not lead to clear improvements in outcomes measured beyond the training programs. This suggests that experienced cochlear implant users may not show transfer of on-task learning to untrained tasks after computer-based auditory and visual training programs such as the ones used in this study.

<p class="abstract"><strong>Background: </strong>The most common intervention prescribed for hearing impaired individuals is hearing aids. It has been noticed that in spite of using hearing aids, elderly individuals with hearing impairment, still struggle in hearing and understanding. Therefore, additional intervention is required for auditory rehabilitation to ease the adaptation of hearing aids. Evidence from studies published in the recent years suggests that, auditory training is likely a useful tool to improve speech perception and other cognitive skills in patients with hearing loss with and without the use of hearing aids. The aim of the study was to test the usefulness of our mobile app-based auditory training program to increase speech reception and communication and thereby improve hearing aid adaptability in patients with sensorineural hearing loss who have been fitted with a hearing aid.</p><p class="abstract"><strong>Methods: </strong>40 patients were selected for the study, they were divided into 2 groups: Group 1 consisted of 20 patients who received auditory training using Entina HearSmart Android App, Group 2 consisted of 20 patients who received no auditory training (Control group).</p><p class="abstract"><strong>Results: </strong>The results showed that performance on the vowel, consonant and sentence tests in noise was significantly increased in patients who used our app for auditory training compared with that of the Non-Training Group.</p><p class="abstract"><strong>Conclusions:</strong> Entina HearSmart is a free, standardized and easy way to improve the outcome of hearing aids in adults and must be prescribed when a hearing aid has been fitted. When used sincerely after hearing aids have been fitted, using our app can significantly improve communication and thereby improve hearing aid adaptability.</p>

BackgroundHearing rehabilitation with auditory training (AT) is necessary to improve speech perception ability in patients with hearing loss. However, face-to-face AT has not been widely implemented due to its high cost and personnel requirements. Therefore, there is a need for the development of a patient-friendly, mobile-based AT program.ObjectiveIn this study, we evaluated the effectiveness of hearing rehabilitation with our chat-based mobile AT (CMAT) program for speech perception performance among experienced hearing aid (HA) users.MethodsA total of 42 adult patients with hearing loss who had worn bilateral HAs for more than 3 months were enrolled and randomly allocated to the AT or control group. In the AT group, CMAT was performed for 30 minutes a day for 2 months, while no intervention was provided in the control group. During the study, 2 patients from the AT group and 1 patient from the control group dropped out. At 0-, 1- and 2-month visits, results of hearing tests and speech perception tests, compliance, and questionnaires were prospectively collected and compared in the 2 groups.ResultsThe AT group (n=19) showed better improvement in word and sentence perception tests compared to the control group (n=20; P=.04 and P=.03, respectively), while no significant difference was observed in phoneme and consonant perception tests (both P>.05). All participants were able to use CMAT without any difficulties, and 85% (17/20) of the AT group completed required training sessions. There were no changes in time or completion rate between the first and the second month of AT. No significant difference was observed between the 2 groups in questionnaire surveys.ConclusionsAfter using the CMAT program, word and sentence perception performance was significantly improved in experienced HA users. In addition, CMAT showed high compliance and adherence over the 2-month study period. Further investigations are needed to validate long-term efficacy in a larger population.

Introduction: The objective of this study was to evaluate the effectiveness of a new auditory training (AT) program on the speech recognition in the noise and on the auditory event-related potentials in elderly hearing aid users. Methods: Thirty-three elderly individuals using hearing aids aged from 60 to 80 years participated. A new AT program was developed for the study. AT program lasts for 8 weeks and includes sound discrimination exercises and cognitive exercises. Seventeen individuals (mean age 72.17 ± 6.94) received AT and 16 individuals (mean age 71.75 ± 6.81) did not receive AT. The mismatch negativity (MMN) test and matrix test were used to evaluate the effectiveness of AT. Tests were conducted for the study group before and after the AT. The tests were carried out for the control group at the same times with the study group and the results were compared. Results: In comparison with the first evaluation, the last evaluation of the study group demonstrated a significant difference regarding the decrease of mean latency in the MMN wave (p = 0.038), and regarding the improving score of matrix test (p = 0.004), there was no difference in the control group. Conclusion: The AT program prepared for the study was effective in improving speech recognition in noise in the elderly, and the efficiency of AT could be demonstrated with MMN and matrix test.

Hearing aid intervention typically occurs after significant delay, or not at all, resulting in an unmet need for many people with hearing loss. Computer-based auditory training (CBAT) may provide generalized benefits to real-world listening, particularly in adverse listening conditions, and can be conveniently delivered in the home environment. Yet as with any intervention, adherence to CBAT is critical to its success. The main aim of this investigation was to explore motivations for uptake, engagement and adherence with home-delivered CBAT in a randomized controlled trial of adults with mild sensorineural hearing loss (SNHL), with a view to informing future CBAT development. A secondary aim examined perceived benefits of CBAT. Participants (n = 44, 50–74 years olds with mild SNHL who did not have hearing aids) completed a 4-week program of phoneme discrimination CBAT at home. Participants' experiences of CBAT were captured using a post-training questionnaire (n = 44) and two focus groups (n = 5 per group). A mixed-methods approach examined participants' experiences with the intervention, the usability and desirability of the CBAT software, and participants' motivations for CBAT uptake, engagement and adherence. Self-Determination Theory (SDT) was used as a theoretical framework for the interpretation of results. Participants found the CBAT intervention easy to use, interesting and enjoyable. Initial participation in the study was associated with extrinsic motivation (e.g., hearing difficulties). Engagement and adherence with CBAT was influenced by intrinsic (e.g., a desire to achieve higher scores), and extrinsic (e.g., to help others with hearing loss) motivations. Perceived post-training benefits included better concentration and attention leading to improved listening. CBAT also prompted further help-seeking behaviors for some individuals. We see this as an important first-step for informing future theory-driven development of effective CBAT interventions.

Purpose: The present study examines auditory training outcomes in terms of speech perception in noise, working memory, reasoning ability, and subjective hearing aid satisfaction. Methods: Ten older adults who wear hearing aids (mean age: 71.6) voluntarily participated in the study. For the training material, 78 sentence sets composed of 3 to 5 sentences were used. During the auditory training, participants tried to remember the order of sentences. Among the 78 sentence sets, 45 contained clues and the rest did not. Each participant underwent assessments including speech perception in noise and digit spans and reasoning test and completed a self-report hearing aid satisfaction questionnaire both pre- and post-auditory training. The participants completed eight sessions of the auditory training. Results: The results showed a statistically significant increase in speech recognition ability in noise, short-term memory, and working memory, as well as satisfaction with hearing aid use. Despite a slight increase on the reasoning test, there was no statistically significant improvement.Conclusion: The results of this study suggested that the auditory training in remembering the order of sentences improved speech perception in noise, sensory and working memory, and subjective satisfaction with hearing aids. Future research can investigate more effective auditory training tools to improve the various cognitive skills and communication ability of older adults who wear hearing aids.

The aims of this study were to determine if a remotely delivered, Internet-based auditory training (AT) program improved speech-in-noise understanding and if the number of hours spent engaged in the program influenced postintervention speech-in-noise understanding. Twenty-nine first-time hearing aid users were randomized into an AT group (hearing aids + 3 week remotely delivered, Internet-based auditory training program) or a control group (hearing aids alone). The Hearing in Noise Test (Nilsson, Soli, & Sullivan, 1994) and the Words-in-Noise test (Wilson, 2003) were administered to both groups at baseline + 1 week and immediately at the completion of the 3 weeks of auditory training. Speech-in-noise understanding improved for both groups at the completion of the study; however, there was not a statistically significant difference in postintervention improvement between the AT and control groups. Although the number of hours the participants engaged in the AT program was far fewer than prescribed, time on task influenced the postintervention Words-in-Noise but not Hearing in Noise Test scores. Although remotely delivered, Internet-based AT programs represent an attractive alternative to resource-intensive, clinic-based interventions, their demonstrated efficacy continues to remain a challenge due in part to issues associated with compliance.

Purpose: The purpose of this study was to identify the demand for auditory training provision and survey beneficiary experience.Methods: A total of 161 participants (80 hearing professionals and 81 elderly hearing aid users) were surveyed online or in-person. Both groups completed 26 questions related to their experience of providing or receiving auditory training, awareness of need, and preference.Results: The hearing professional group was strongly aware of the need to provide auditory training to improve communication problems in elderly individuals using hearing aids, and the absence of a systematic auditory training program was the biggest factor in not providing auditory training. The elderly hearing aid user group also recognized the need for auditory training to improve communication problems, but they responded that the hassle of visiting a clinic for training and lack of training time were factors that made participation in auditory training difficult.Conclusion: Hearing professionals should expand the scope of aural rehabilitation services to provide effective auditory training programs that fit the concept of rehabilitation, rather than simply providing hearing aid fitting management services to improve communication skills. Therefore, hearing professionals should conduct an intervention program after hearing aid fitting for elderly hearing aid users so that hearing rehabilitation can be comprehensively performed according to auditory and cognitive perceptual changes. In addition, efforts are required to solve limitations that make it difficult for elderly individuals who use hearing aids to participate in auditory training, such as the development of a web-based auditory training program.

Hearing aid outcomes with open- and closed-canal fittings

When individuals have hearing loss, physiological changes in their brain interact with relearning of sound patterns. Some individuals utilize compensatory strategies that may result in successful hearing aid use. Others, however, are not so fortunate. Modern hearing aids can provide audibility but may not rectify spectral and temporal resolution, susceptibility to noise interference, or degradation of cognitive skills, such as declining auditory memory and slower speed of processing associated with aging. Frequently, these deficits are not identified during a typical "hearing aid evaluation." Aural rehabilitation has long been advocated to enhance communication but has not been considered time or cost-effective. Home-based, interactive adaptive computer therapy programs are available that are designed to engage the adult hearing-impaired listener in the hearing aid fitting process, provide listening strategies, build confidence, and address cognitive changes. Despite the availability of these programs, many patients and professionals are reluctant to engage in and complete therapy. The purposes of this article are to discuss the need for identifying auditory and nonauditory factors that may adversely affect the overall audiological rehabilitation process, to discuss important features that should be incorporated into training, and to examine reasons for the lack of compliance with therapeutic options. Possible solutions to maximizing compliance are explored. Only a small portion of audiologists (fewer than 10%) offer auditory training to patients with hearing impairment, even though auditory training appears to lower the rate of hearing aid returns for credit. Patients to whom auditory training programs are recommended often do not complete the training, however. Compliance for a cohort of home-based auditory therapy trainees was less than 30%. Activities to increase patient compliance to auditory training protocols are proposed.