News

New Year Update

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Dear all,

Happy New Year to you!

Here at HAFM HQ we’ve been busy reflecting on our conference, looking at some initial findings from the online survey, and drafting various documents, including a revision of our patient leaflet, and drafts of a practitioner leaflet, glossary of terms and stakeholder report.

Conference materials

All of the abstracts, many of the powerpoint slides and some of the videos from the conference can now be downloaded on our conference webpage. This includes the concert by the FORTE Ensemble.

We are interested to hear your reflections on the conference four months on, so if you have two minutes, please answer three short questions here.

 

Extension until August 2018

Numerous NHS Trusts across the country have expressed a desire to be involved in the HAFM research, and so we have secured an extension to the project (until the end of August) to be able to do this. We have just started working with 20 Trusts, including  Aintree, Airedale, Birmingham, Durham and Darlington, Harrogate, Kingston, Manchester, Sheffield, South Tees, Southend, Sunderland, Tameside and Glossop, and Western Sussex to name a few! We are adding further sites this week. This is very exciting for us because it ensures that we can survey hearing aid users from all over the UK.

Working with the first N=1,000

We are currently analysing the first 1,000 responses to the online survey, and results summaries will be available in due course. Thanks to all who have taken the time to participate in this survey – your time is greatly appreciated.

If you know others who would be willing to complete the survey, do send on the link: http://tinyurl.com/musicandhearingaidssurvey

Your thoughts!

If you have any other reflections, or you would like to write a blogpost for our website, please do get in touch with us on musicandhearingaids@leeds.ac.uk

Best wishes from

Alinka, Harriet and Amy

University of Leeds, 23.01.18

Hearing Aids in Brass Bands

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In this blog post, Professor Pete Thomas describes how he and his wife use accessories alongside their hearing aids to help them enjoy playing in a brass band.

Despite being branded as tone deaf in schooldays, and suffering from moderate hearing loss too, seven years ago I started to play trombone. Now, aged 69, I play in a brass band. My wife, Carol, a lifelong musician who plays euphonium is afflicted with a severe hearing loss as well, a long term condition combined with severe tinnitus.

Playing music in a brass band presents a range of challenges for hearing aid users. Some opt in despair to abandon aids and make do with whatever residual hearing they have, or else to give up playing altogether. Sound levels may exceed 105dBA, although this can depend on seating position within the band, and most hearing aids do not work well in these conditions.

Pete Thomas Blogpost 2Players should be able to clearly hear neighbouring players, so as to be able to play in time and in tune with one another. They also need to hear other sections of the band to effect the overall tuning and timing of the music. As a trombone player, I need to be able to hear euphonium and baritone horns immediately in front, to perceive the higher pitched sounds of the cornets from the far side of the band, to be aware of the horns, all whilst not forgetting the basses (tubas) which are hard to ignore. And in rehearsal, it is important of course to hear the instructions from the conductor!

For me, playing without hearing aids is not a realistic option. With my high frequency loss, I am barely aware of the cornet sounds and much of the articulation is lost. The resultant dead and rather woolly musical environment, with no perception of commands from the conductor would preclude participation.

My aids were initially prescribed following diagnosis/treatment for benign positional vertigo; as a result the world became a more interesting place where many of the sounds diminished over the years were reinforced. Percussive sounds and cornet sounds became so much clearer and more vibrant.

However, with those first digital aids there was a major drawback. When the cornets played certain higher notes, this tended to excite feedback cancellation in the aids and it seemed as though some of the feature recognition aspects of those aids distorted the balance of the sound. Exploring this, I found that even on what was supposed to be the music setting, if I sat at home listening to my wife playing the piano, the ticking clock which is normally barely perceptible, would become a loud clacking, clearly audible above the piano. The squealing with the cornets was clearly a problem, especially as when it occurred it would take some considerable time for the aids to settle back to normal operation. I found the condition could be repeated in a quiet environment with a tone generator – a tone of approximately 2KHz from a loudspeaker would trigger it. I discussed the problem with audiologists who attempted changes of settings, changed ear moulds and generally puzzled over the problem, before concluding I was seeking the impossible.

Fortunately I encountered a more determined audiologist who appreciated the objective feedback and wanted to be of help. She prescribed some alternative aids for evaluation and following some adjustments they have proved remarkably effective. Initially, things were very confusing, as each aid made my custom-made trombone sound rather different and unpleasant to my ears. Fortunately, this was a transient situation as my brain adapted to the different hearing aids and within a few days I could switch between aids without any unpleasant perception of the sound. The new aids, whilst providing the necessary high frequency compensation, appeared less intrusive, such that apart from the useful improvement in music and comprehension of speech, I could be unaware of using them. Most importantly they were far less susceptible to excitement from those higher pitched cornet sounds!

Initially the aids were sometimes apparently overloaded by the mellow tones of the euphonium, but presumably due to the adaptive capabilities of the aids, even this problem rapidly diminished. The aids are not perfect and I will sometimes query as to whether the conductor wants to play from rehearsal mark ‘M’ or ‘N’, and it can be frustrating to miss out on the punch line of jokes from around the band. This leads on to the consideration of Carol’s more challenging problems of playing the euphonium.

Carol has played church pipe organ and piano since childhood, but during the last three or four years she has succumbed to pressure to join the band, playing a euphonium. The expectation was that this would be easy for someone of her musical experience, but with brass band pitch being transposed from concert pitch such that notes written as C sound as B-flat, there were additional challenges for her hearing. The single line of euphonium music might have paled into insignificance compared to the complexities of the Bach and Buxtehude, with pedals and multiple manuals to cope with; however in the brass band there is someone else (the conductor) setting the tempo and all those other players to fit in with.

Carol uses two Phonak Nathos SP aids with features such as the frequency translation of higher pitched sounds, enabling her to comprehend some of those missing high frequency sounds. Early experience with these aids suggested that she had trouble precisely pitching and playing in tune and this was particularly evident if playing in a small ensemble. Fortunately, the enabling of a music program, disabling some features of the aids, made a dramatic difference and in the small ensemble she was able to play far more reliably in tune. However, in band a major problem unfolded whereby when playing her euphonium, especially when accompanied by a neighbouring euphonium, she could hear virtually nothing of the rest of the band. This problem intrigued me and I set about trying to find why the euphonium was so troublesome!

Pete Thomas Blogpost5All brass instruments have characteristic spectral properties, whereby the fundamental of a note with a particular set of overtones gives the instrument its sound. The different instruments differ in size (from the tiny soprano cornet to the large B-flat tuba) and in construction with the size and degree of taper in the bore. The trombone is a parallel bore instrument, and this reflects in the sound which is rich in overtones – the FFT analysis here shows peaks extending to the 15th or even 20th harmonic of the note being played. Curiously, the trombone can seemingly be very light on the fundamental of the note being played. In contrast, the euphonium with its taper bore is very strong in the fundamental, with the overtones rapidly dying away. The similarly pitched baritone horn with a less tapered bore has a spectrum more like that of the trombone.

It is therefore no surprise when my wife encountered the problem with the euphonium and the musical director of the band suggested trying the baritone horn for a while, that Carol found this a great benefit. This enabled her to play in the band and still hear much of the music from other sections of the band. However it did not help with hearing direction from the conductor.

We therefore looked into the potential use of a microphone and loop system. Whilst this could have worked within the band room, it was clearly not a practical solution for performance venues. It was around this time we discovered the Phonak Roger pen system. Initial enquiries with a supplier were far from optimistic of its utility, but discussion with CamTAD suggested it might be worth further exploration. With a musical director keen to cooperate, a microphone and receivers were sourced. With Carol’s severe high frequency hearing loss, the bandwidth limitations of the telecoil loop interface was not seen to be a problem compared to the convenience of implementation without assistance from the NHS audiologist. However with my helpful NHS audiologist happy to enable such things we got some Roger receivers for my aids in the hope they might be a benefit.

The Roger pen proved to be a major benefit for Carol. She was able to clearly hear instruction from the musical director (wearing the microphone) and as a bonus could hear more of the cornet section music, which often provided the lead in the music. Somewhat disappointingly, we found that although I could hear the conductor more clearly with the microphone, due to the bandwidth limitations of the Roger pen and my open ear moulds, I perceived the rather tinny overlay of music rather unhelpful even with the wireless receivers giving direct audio to my aids. However I have at times found the mixed mode of normal aids and the Roger input useful. The wider benefits of the Roger pen are obvious.

Recently with more experience, Carol has been returned to playing euphonium. We have to conclude that from our experience, hearing aids and appropriate accessories can be a real benefit and enable hearing impaired users to successfully participate within a brass band. The recent HAFM conference at Leeds inspires us for further work.

 

Upcoming Conference 2017

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We’re excited to be organising our ‘Hearing Aids for Music’ conference which is taking place in Leeds this September.

The conference will allow hearing aid users, researchers, audiologists and manufacturers to get together and discuss current issues in listening to music with hearing aids.

There are four programmed strands of activity: conference presentations, an exhibition area, practical workshops, and an evening performance.

The conference presentations cover a range of topics and are presented in a variety of styles – study reports, applied research, practical work and personal experience from people based all over the globe.

There is ample time for networking in the exhibition space too, with the chance to meet representatives from some of the major hearing aid manufacturers and smaller companies alike.

The workshops are a fantastic opportunity to engage with a number of themes:

• Clinicians discussing service provision, rehabilitation and learning methods.
• Researchers presenting work using new technologies to improve music listening.
• Hearing aid developers discussing the state of the art, and issues still to be surmounted.

Finally, we are privileged too to have the FORTE Ensemble, a group of professional musicians who are deaf, join us on the Thursday evening to perform in the Clothworkers’ Centenary Concert Hall.

Registration is open now and it’s not too late to sign up… Please join us if you’re interested!

Related pages

An organist’s perspective

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In this blog post, Brian Henderson describes the trajectory of his hearing loss and how this has affected his experiences of playing the organ over time.

“I am a 70 year old church organist, now with moderate hearing loss in both ears.  I have played the organ from the age of 18.  Other relevant personal information includes a career of Physics teaching up to A level and a 10-year spell of helping a local organ builder after retiring from full time teaching.

“My first experience of hearing loss was sudden and traumatic.  I was making a mobile phone call in 2011 in a busy shopping street and put the phone firmly to my ear to hear it answered.  At that exact instant someone called me and the phone rang while against my ear.  My head seemed to explode.  Luckily I was with family members who helped me to a seat and half an hour later I felt able to move on, but with the realisation that hearing in my left ear was damaged.  A visit to my GP the next day brought the news that my hearing might or might not recover.  It didn’t.  Hospital ENT consultation and an MRI scan followed but produced no answers, and an NHS hearing aid was soon supplied.  The loss was worst from 1kHz upwards, so consonants were missing from speech and the organ upperwork (the higher pitched stops) lost from my left ear.  But I still had a good right ear and I thought life was still mostly fine in spite of the chance in a million that had deafened me.

“I used the aid for conversation, but I took it out for playing as it distorted the organ sounds badly.  I read that one of the consequences of sudden hearing loss could be hyperacusis, increased sensitivity to some sounds.  This explained why organ notes in the tenor octave were now sounding thick and unpleasant, with tenor A and B booming out from what had been a well-regulated quiet flute stop.  After a year or so I realised I was not hearing this.  This was my first taste of the ability of the brain to gradually improve an initially troubling situation but little did I know that I would come to rely on this property of the brain to help me a few years on down the line.

“In mid 2015 I became aware that my right ear was not hearing as well as before.  It showed up most on the organ where I could no longer hear the highest notes of a 2 foot stop (a stop which plays 2 octaves above piano pitch) and I realised that sounds around 6 kHz and above were gone.  There was also a strange blocked feeling in my right ear, with intermittent popping, and I was aware that this right deafness did not feel the same as the left deafness.  A GP investigation started, I tried a nasal spray and inhalation.  I used olive oil and later sodium bicarbonate solution but the blocked feeling persisted even though the ear drum was visible.  I had an audiogram and a right aid was supplied for what was then described as slight deafness.

“The GP investigation into the blocked feeling continued (now 6 months after it started) and in February 2016 microsuction was performed to remove the small amount of wax that was visible.  Initially all seemed well, but 3 hours later I realised my right hearing had gone the same way as my left.  Organ experimentation showed a fall off at 2KHz, not quite as bad as the left but bad enough to make the organ sound dreadful.  The hearing loss was described now as moderate in both ears and I found conversation difficult and TV listening often unintelligible.  My life seemed to collapse around me.  To lose the left hearing had been an accident, but the right deafness seemed the direct result of a GP procedure.  I felt bitter and defeated.  And my greatest relaxation and my defining role – as church organist – was lost.

“There were two separate but overlapping strands to my life with hearing loss.  One was searching for advice about hearing loss and music.  The other was an NHS investigation into my sudden right hearing loss.  This investigation took the form of two hospital ENT consultations, several audiograms and an MRI scan.  The noisy MRI machine accentuated the hyperacusis now present in the right ear but revealed no reasons for my problems.  The three audiograms were wildly inconsistent, one even showing normal hearing in the right ear, possibly because my tinnitus and hyperacusis were masking the true situation.  This was a time of fear and frustration until in May I was finally passed on to a wonderful senior audiologist who listened intently to my descriptions.  I could tell from the way she conducted my hearing test  (with quick repetitions and surprising frequency jumps) that she was using her considerable experience to “catch me out”.  I was delighted that she produced an audiogram that matched the view I had gleaned from listening note by note on the organ.  The aids were reprogrammed and at least speech in a quiet space became easily intelligible.  Furthermore the senior audiologist understood the importance of music in my life and ordered for me a pair of Phonak Nathos S+ MW aids which she said had better musical capabilities than the standard NHS aids.

“I felt I was making real progress now with audiology, but frustration soon set in with delay in the delivery of the aids, the substitution by management of a locum at one appointment resulting in a mis-setting of the aids, and repeated difficulties in ensuring that future appointments were made with the senior audiologist who had rescued me (and actually asked that all appointments be made with her).  There is a real personal difficulty here – does one complain and risk alienating the organisation that is trying to help?  In the end I have been quietly persistent and have eventually seen the person I need, but the missed opportunities and time lost have led to a roller coaster of hopes and disappointments lasting over 6 months.

“On the musical side things have at least been more under my control.  When the right hearing loss occurred the unpleasant sound of the organ made it impossible to continue playing for services.  With hearing aids (even the later Phonak pair described above) the distortion was more than I could bear, and I tried playing with no aids.  Quiet music on 8’ flutes1  was similar to what I remembered.  Louder music on 8’ and 4’ diapasons2  sounded thick and muddy, and adding further upperwork (2’stops and mixtures) was simply frustrating because there was no change.  All the majesty of the brighter sounds was lost, but I persisted in playing to myself frequently and for short times using only the quiet foundation stops.  Over a period of time my musical memory and the adaptability of the brain enabled me to hear (or imagine) brighter sounds as the higher pitched stops were added.  Separately these stops were almost inaudible, and different notes had no discernible pitch difference.  But in the chorus there was an unmistakable element of brightness that enabled me to get some enjoyment from my playing and even contemplate returning to service playing a month or so after the sudden loss.  At this time I was still taking my aids out as I approached the organ, so my initial service playing showed up the inevitable problem – I did not know what was going on in the service.  I sometimes only knew when to play a hymn after a gesture from my wife in the front row of the congregation!

“This situation could not continue.  I persisted without aids but with the help of a small loudspeaker placed as close to my ear as possible.  It was driven from the church microphone system using its own amplifier with bass turned down and treble up to max.  In this way I played for some services although most were covered by pianists in the church doing a good job on the organ in spite of their initial fears.

“As time went on I got more used to the various programmes in the aids, and began to play to myself with aids in, music programme selected, volume set almost to lowest.  The distortions were many and varied.  All sounds above 500 Hz had a strange edge to them.  Soft flutes (with an almost pure sine waveform) had a curious repetitive hiccup caused I believe by the digital signal processing.  Rapid passages of music did not sound too bad, as individual notes did not last long enough for the distortion to offend, but slow sustained notes were horrid.  It was almost impossible to balance a solo stop with a suitable accompaniment on a different manual.  For instance an oboe stop did not sound as it used to because so much of its energy is in the upper harmonics.  The accompanying flute stop will have much of its energy within the fundamental, and the differing amplification of high and low frequencies, intended to correct my hearing, is not done precisely enough to judge the balance between a distorted oboe and a distorted flute.  Much of my playing is done by remembering combinations that used to work, but when I try a new piece (or harder still a different organ) it is almost impossible to judge whether I am producing reasonable sounds.

“There are some other aspects that make practising harder work than before.  Hyperacusis presents itself in odd and initially unsettling ways.  Treble F on a stopped flute is hugely louder than its neighbouring notes.  It actually shouts out and unbalances any chord containing it.  The same note played on a stop with a differing harmonic make up, such as a diapason rank, or an open flute, fits perfectly with its neighbouring notes.  Pitch discrimination has suffered.  Any given note sounds slightly sharper in one ear than in the other!  Chords which contain close harmonies can now set up a beating effect, presumably because of this discrepancy.  So all practice is now punctuated by repeated checks of strange out of tune sounds.  They are often caused by wrong notes, but they are equally often caused by my wrong ears.  In some cases repeated playing of a nasty sounding chord has taught my brain to accept it, and I can even return to a piece several weeks later and find that the chord I battled with and beat into submission has stayed reasonable.

“I do not expect the lost hearing to magically return, but I do hope that somehow in the future I will find better settings for the existing aids, or perhaps better aids, that might help me hear more of the organ as it really sounds.  The present problems are still considerable.  So should I have given in and stopped playing?  My answer is an emphatic no.  I am back to playing for about 3 services a month. I have dispensed with my local treble enhanced loudspeaker.  I use my aids on the music setting and have found a volume setting which is reasonably appropriate for organ sounds and much of the spoken word, and clergy have helped by giving clear announcement of hymns.  I do get satisfaction from playing the right notes in the right order, even if the practice has taken longer and even though the sound of the instrument has lost a lot of beauty and majesty.  I can still get my excitement from a loud conclusion with several ranks of mixture and pedal reeds.  And above all I once again get a buzz from leading a congregation which sings with enthusiasm and sensitivity as I play.

“And of course there is more to musical life than playing the organ.  I enjoy singing (although sometimes with difficulty) in a community choir.  Pitching notes is far more uncertain than it used to be, and the trick of checking by putting a finger in an ear is not possible with a hearing aid in the way!   I nearly stopped attending concerts in Birmingham Symphony Hall after a couple of disappointments, but then experimented with different seating positions.  Concerts have once more become enjoyable provided I pay for the best seats in the house.  Now that I can see the full orchestra clearly I find that I can hear and recognise individual instruments much better; another example of the brain’s remarkable ability to adapt and improve distressing situations.”

  1. the organist’s term 8’ means organ pipes at piano pitch (ie middle C key plays a middle C sound)
  2. 4’ refers to pipes sounding one octave above piano pitch. Diapasons are the family of open metal pipes which give the basic organ tone, and they have more harmonic development than organ flutes.

 

Brian Henderson

Bromsgrove

March 2017   

Networking November

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November has been a busy month of presentations, meetings and networking!

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In the first week, we presented a poster summarising the main themes from our interview study at the British Academy of Audiology Annual Conference in Glasgow. To access the poster, click here.

 

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We also took part in a webinar organised by Wendy Cheng, Founder of the Association of Adult Musicians with Hearing Loss. We heard talks by Marshall Chasin who described some of the limitations of hearing aid technology for listening to and performing music, and Brian Fligor who focused on ways in which musicians could optimise their experiences with their audiologists. Musicians Nancy Williams, Adam Schwalje and Charles Mokotoff presented personal stories, which led into a Q&A session for musicians to share their experiences and seek advice from the panel.

 

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Last week, at the Hearing Steering Committee, it was wonderful to hear that the Musicians Hearing Health Scheme is off to a flying start! Well over 1,000 applications have been received since the scheme started on 1st August and all agreed that this was a fine example of applied research that will benefit musicians for years to come. If you are a professional musician who would like to have access to specialist hearing assessment and bespoke hearing protection, click here.

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Yesterday, we had the pleasure of being part of Music and the Deaf’s FREQUALISE dissemination event. Frequalise is a project to enable deaf children and young people to explore the potential technology offers in creating, performing and sharing music. We heard talks by Danny Lane (MatD, CEO) Ros Rowe (Project Manager), Ros Hawley (Project Evaluator), and Liz Dobson (Senior Lecturer in Music Technology, University of Huddersfield); demonstrations from the workshop leaders and participants (Danny Chadwin, Mohsin Ahmed); and a live musical performance from project participant Adam Butler. The event highlighted some of the challenges of the project including delivering workshops to children and young people of different ages, and with differing levels of hearing loss, and consideration of accessible and affordable technologies (e.g. Etherpad, Garageband) that participants could continue to use at home. The day closed with a discussion about developing collaborations to secure further funding to support this important work, and the recognition that a network of people interested in improving access to music for deaf children and young people needs establishing.

Watch this space…

AG

 

HAFM Online survey

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We are conducting research into the music listening behaviour of people (aged 18 and over) with hearing loss and who wear hearing aids for a minimum of one hour a day. As part of this study we have developed an online survey and would like to recruit as many participants as possible to take part.

To participate you will have

  • have a confirmed hearing loss (e.g. mild, moderate, severe or profound),
  • wear hearing aid(s) (but NOT a cochlear implant),
  • are between 18-90 years old

A BSL version of all the information and questions is available in the questionnaire

We will ask you about your

  • experiences of music in everyday life,
  • musical preferences
  • hearing
  • hearing aids

It should take about 30 minutes to complete and you will remain anonymous. If you leave your contact details, you will be entered into a prize draw to win one of three £75 cash prizes. Winners will be selected at random and notified in JANUARY 2017.

All the information we collect about you will be kept confidential and you will not be identifiable in any reports or publications.

The survey is available by clicking here

If you have any questions, please contact us at:

Email: musicandhearingaids@leeds.ac.uk

Text mobile: 07763648802

If you would be willing to follow us on Twitter @musicndeafness and retweet information about the survey that would be greatly appreciated.

If you do not wear hearing aids yourself, but know someone who does who might be willing to take part, please forward the following link: http://tinyurl.com/musicandhearingaids

Many thanks

‘Music and Hearing Aids team’

‘Hearing Aids for Music’ at ICMPC14 in San Francisco

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Earlier this month, I flew to San Francisco to attend and present at the 14th International Conference on Music Perception and Cognition which is a biennial conference covering fields such as acoustics and psychophysics, aesthetic perception and response, musical development, music education, and music, health and well-being.

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I presented findings from our first study (clinical questionnaire) which explored the extent of music listening issues and the frequency and success of discussions with audiologists about music. Data from 176 hearing aid (HA) users, aged 21 – 93 years old, showed that challenges with music listening were often experienced and almost half reported that this negatively affects their quality of life. Participants described issues listening to live music performances, hearing words in songs, the loss of music from their lives and associated social exclusion. The majority of participants had not discussed music with their audiologist. For those who had, some reported positive experiences wherein increased HA tailoring by the audiologist had enhanced music appreciation. Other experiences were less positive with no improvements reported. Results suggest that more could be done to help audiologists fit HAs for music and to inform HA users of their options. An overview of the results is available here.

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I then discussed preliminary findings from our second study (in-depth interviews, with collection of audiometric data). Data from 22 HA users, aged between 24-82 years old, with varying levels of hearing impairment, highlighted the complexities of listening to music with hearing aids. Some of the problems encountered mirrored those found in our first study and in previous work (e.g. Chasin & Hockley, 2014; Madsen & Moore, 2014) such as distortion (particularly at higher frequencies), a reduction in tone quality, and challenges listening to music in live contexts. However, there were less problems with feedback and distortion than anticipated, and positively, several interviewees reported that they did not experience any difficulties when listening to music with their hearing aids. These individuals tended to be non-musicians with milder levels of hearing loss, but nonetheless were highly engaged with music in everyday life.

Results show differences in hearing aid use according to people’s level of hearing impairment, level of musical engagement and training, the musical style(s) being listened to, and the context(s) in which the music is being heard. This supports theorising by Hargreaves and colleagues (e.g. Hargreaves et al., 2006) which stipulates that responses to music are a result of interactions between listener, music and contextual variables. However, our data provide new insights into how levels of hearing impairment, and the type and functionality of the HA technology affect musical experiences. There were differences in interviewees’ understanding of their HA technology (musicians stood out as being the most informed) and in the process of acclimatising to the new sound world. Problems experienced appear to be mediated by general attitudes towards the HA technology. Some were proactive in adjusting, adapting, and experimenting, whereas others were less inclined to explore the possibilities. Across all participants, the use of Assistive Listening Devices (ALDs) was low which suggests that HA users are not as aware as they could be about what tools are out there that could help. These are just some preliminary findings. We are conducting an in-depth analysis of the dataset and will be able to report a fuller analysis in due course.

This event was attended by Alinka Greasley.

Conference Report: Adult Hearing Screening (TEF & AoHL)

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Adult Hearing Screening Conference: Can we afford to wait any longer?

Following the National Screening Committee’s rejection of the introduction of an adult screening programme in January 2016 The Ear Foundation and Action on Hearing Loss convened this conference to ensure that the debate remains current and in the public domain. The programme was designed to consider the potential benefits of early identification of age related hearing loss and the challenges presented by the implementation of an adult screening programme. Issues of social, emotional and mental health benefits were considered in addition to potential cost benefits to both individuals and the state.

In respect of the HAFM project we were particularly interested in the presentations regarding social, emotional and mental health issues as access to music plays a key role in these areas. Of particular relevance was the presentation by Susan Thompson and Dr Nicola Wright in raising the importance of ensuring that any screening was followed by appropriate and successful care pathways. Ensuring that interventions are able to meet the needs of the individuals is necessary and this includes managing their expectations of the current technologies available. Hearing aid technology is designed to amplify speech, not music so this further supports our aim to better understand the music listening experiences of hearing aid users to inform the development of potential post screen pathways. The importance of improving the quality of life for all individuals with all levels of deafness lies at the heart of The Action Plan on Hearing Loss which was presented by Fiona Carragher. Music is a key factor in many individuals’ quality of life.

The conference was opened by Professor Adrian Davis, OBE and chaired throughout the day by Brian Lamb, OBE.  Both spoke very passionately about the issues and importance of detecting hearing loss as early as possible to limit the potential difficulties it brings.

Chris Wood, Health Policy Manager for Action on Hearing loss provided the rationale and supporting evidence for early identification. He summarised research that has highlighted significant decreases in reported quality of life for those with a degenerative hearing loss including difficulties in communication that lead to increased social isolation, reduced self-confidence; nearly double the incidence of depression and an increased impact of dementia. Hearing loss was also reported to reduce access to health and social care, families and friends and lead to increased difficulties and satisfaction in the work place. He was also keen to dispel the notion that many people with hearing aids do not use them citing recent data which indicates that 90% of those provided with hearing aid use them the majority of the time.

Jon Day, Clinical Director for Audiology at Betsi Calwaladr University Health Board Wales presented the reasons given by the National Screening Committee for rejecting the proposal to introduce adult hearing screening. The committee considered there was insufficient evidence to indicate that such a programme would be of benefit to individuals in the long term or cost effective primarily because of the social stigma associated with hearing aid use and the level of non-use of the technology. In particular the lack of evidence generated through randomised controlled trails (RCT) was cited. RCT are considered to be the gold standard to demonstrate effectiveness of interventions in medical research. However the use of RCTs in the context of hearing aid use raises significant ethical issues as Brian Lamb Brian raised towards the end of the day –he suggested that it would not be appropriate to ask a person who would benefit from wearing a HAs not to do so.

This was followed by an informative contextual presentation by Susan Thompson, a council member of the Institute of Health Promotion and Education and Dr Nicola Wright, Course and Deputy Course Leaders respectively for the Graduate Entry Level Nursing course at the University of Nottingham who discussed the main challenges for any health screening programme. This includes ensuring that any screening programme is followed by appropriate care pathways and that expectations of the screening are managed effectively. They also discussed the importance of ensuring the sensitivity and specificity of the screening so limiting the identification of false positive and false negative results. Finally they raised the important issue of cost effectiveness.

Soren Hougard, Secretary General for the European Hearing Instrument Manufacturers Association presented the case that the cost of not implementing an adult hearing screening programme would far outweigh the cost of implementing one. He discussed the impact of hearing loss on productivity and employability citing evidence collected in Denmark. He provided figures that indicate the reduced tax revenue as a consequence of hearing loss far exceeded the cost of identifying and providing the appropriate technology and support for those with hearing loss. Importantly he also drew attention to the increased comorbidities that occur with hearing loss and that hearing aids have been demonstrated to have a significant impact on the rate of cognitive decline with old aged and particularly for those diagnosed with dementia.

Dr Sue Archbold, CEO of the Ear Foundation supported this argument. She suggested that the arguments presented for not introducing an adult screening programme: the lack of RCT evidence; the notion that adults frequently do not use hearing aids when they are provided and the additional pressures it would lead to on audiology services should not prevail. She suggested that recent work and publications indicated that tackling hearing loss is a “major public health issue” and that early identification is key to addressing it.

The Deputy Chief Scientific Officer for NHS England Fiona Carragher set out the remit of The Action Plan on Hearing Loss for which the Chief Scientific Officer (CSO) Professor Sue Hill OBE is ultimately responsible. The CSO’s role is to provide the clinical leadership, system oversight and stakeholder management in the delivery of the plan which requires:

 …a coordinated effort across all the stakeholders, patients, clinicians, the health and care system, the third sector and wider government to co-produce a commissioning framework that will inform the NHS. The aim of the plan is to improve the quality of life and services for people with all levels of deafness.

The plan is available to download here.

The final speaker of the morning was Jim Fitzpatrick, MP Chair of the All Party Parliamentary Group on Deafness (APPGD) who described the role of the group in raising awareness of the issues amongst other parliamentarians.

The afternoon focused on more detailed and personal consideration of the issues associated with hearing loss. Carol Riggs presented a very eloquent reflection of her own experience with a congenital deteriorating hearing loss. She has recently been fitted with a cochlear implant following many years of hearing aid use. She feels strongly that society needs to have a more open and positive attitude to hearing loss that includes an adult screening programme.

The subsequent presentations discussed the outcomes of four different projects examining aspects of potential screening pathways. Zheng Ng, researcher at TEF presented results of a survey in which the views of adults’ with age related hearing loss on the implementation of an adult hearing screening programme. 76% of the 188 participants were in favour of such a scheme. Dr Sheetal Athalye, audiologist TEF described existing screening tools that are available through various different initiatives whilst Professor Adrian Davis and Dr Jagit Sethi presented the findings from a recent project designed using a small scale RCT, that aimed to stream line the process of screening and fitting hearing aids. The findings indicated that the screen and fit pathway they established is highly efficient and indicates a cost effective route for implementing an adult screening programme. The final project undertaken by Krishan Ramdoo has developed smartphone technology ear care (e.g. wax removal) and hearing screening which is both portable and cheap and therefore again potentially cost effective.

The afternoon ended with contributions from Stephen Lloyd, ex MP and formally chair of APPGD and Lillian Greenwood MP for Nottingham adding their voices to the support the launch of a report Adult Hearing Screening Conference: Can we afford to wait any longer? compiled by Brian Lamb OBE and Dr Sue Archbold.

The report is available to download from The Ear Foundation here

This conference was attended by Jackie Salter.

 

Team engage public at ‘Be Curious’ event

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On Saturday 19th March, the Hearing Aids for Music team took part in the ‘Be Curious’ Festival, which gave the general public an opportunity to learn about research projects being undertaken at the University of Leeds through talks and interactive activities.

The theme of the Wellcome Trust funded university-wide event was ‘Health and Well-being’ and was intended for those curious about how the human body works, and factors affecting health and well-being. We focused on conveying information about how we hear, how easily our hearing can be damaged, and what speech (conversation) and music (classical, popular) sound like with differing levels of hearing loss. We also set up a booth so that people could take an online hearing test.

How we hear

How loud is too loud?

Hearing loss – what it sounds like (conversation)

Hearing loss – what it sounds like (music)

Hearing test

We’d like to thank audiology@leeds for providing us with model ears, Alex Santos for designing our hearing awareness posters, and Action on Hearing Loss and Hear the World Foundation organisations for supplying us with leaflets and online resources.

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Feedback

As part of the event, feedback was collected from visitors. Respondents included children and adults (age range 4-66 years old) and their responses indicated that our activities were effective in raising awareness of the prevalence and causes of hearing loss, and of healthy hearing behaviour.

What did you like best?

“Ear workshop” [Aged 12]

“Ears!” [Aged 4]

Did you learn anything new today?

“Hearing aids info” [Aged 39]

“Hearing – how it is damaged.” [Aged 44]

“Lots about hearing impairments and how to prevent hearing loss” [Aged 45]

“Extent and causes of hearing loss” [Aged 35]

Will it change anything you do? If so, in what way(s)?

“It will change how loud I listen to music through headphones” [Aged 14]

“Yes, iPads will be turned down and will buy ear defenders for my son playing drums” [Aged 44]

“Get my hearing checked more regularly!” [Aged 50]

How likely are you to tell someone else what you’ve learnt?

64% reported that they were ‘Very Likely’ to tell someone else what they had learnt.

Visitors were intrigued by the microscopic pictures of hair cells, and were surprised to learn how easily hair cells can be damaged. The hearing simulations, including the opportunity to listen to Sting’s Fields of Gold, and Eros Ramazzotti’s Sei Un Pensiero Speciale with different severities of hearing impairment, were popular with both younger and older visitors as they contemplated what their lives would be like with hearing loss. Several visitors who got their ears tested in our booth reported that it had prompted them to go and get their ears tested by a professional. Overall, feedback suggested that the activities were very informative!

This event was led by Alinka Greasley and Jackie Salter.

‘Effects of Advanced Hearing aid settings on Music Perception’

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Cardiff event 21st Jan

Some practical tips for audiologists and listeners

In January 2016 we attended a seminar on the effects of advanced hearing aid features at Cardiff Metropolitan University.  This was a useful opportunity to hear from world renowned speakers on the science behind challenges with listening to music with hearing aids, feedback and practical tips from the clinical world and also insights into the benefits and limitations of hearing aid technology.

We heard from Professor Brian Moore on the effects of both hearing loss and hearing aids on music perception and from Marshall Chasin on fitting aids for musicians.  We were reminded that damage to the inner ear is not always obvious in relation to the audiogram. The Audiogram (a hearing test) is a very broad way of testing hearing and for Noise induced hearing loss (NIHL), a person may even have a normal audiogram but with underlying damage to the inner ear that causes difficulties in discriminating sounds (for more on Hidden Hearing Loss, see Chris Plack’s recent BSA seminar).  To perceive music well we need to be able to discriminate a much wider range of frequencies than is tested with an average hearing test.

Another relevant point for listening is that with hearing loss, as well as losing the ability to pick out specific sounds we also have poorer localisation skills or abilities to tell where sound is coming from.  For music this can be really important in separating sounds out from a mixed musical signal of several instruments or voices.

Specifically with hearing aids, multi-channel aids can flatten the spectrum of the musical signal which can make it harder to identify instruments.  A recent paper by Madsen, Stone, McKinney, Fitz & Moore (2015) explored the effects of wide dynamic range compression on identifying instruments and identified lower reports of clarity when using WDRC versus linear amplification.  The effects of slow versus fast compression are more complex and may relate to the type of music being listened to.

There are pros and cons of both fast acting and slow compression. Slow acting compression can facilitate being able to pick out the main tune/instrument when louder backing sounds are there, which otherwise might cause the hearing aid to cut sounds levels down too quickly.  However, it does not restore loudness perception to ‘normal’ and is not good if various sources are at different levels.  In the time it takes to recover, we can miss dynamic changes in music. Overall the consensus of opinion was that there seems to be a preference for slow compression versus fast acting compression for music but this is very dependent on setting and type of music being listened to (Moore & Sek, forthcoming).

Other Considerations for fitting aids:

In terms of microphones, directional microphones can be useful, and can help to pick out specific instruments in the presence of competing sounds.  However, they can also make things worse by reducing ability to hear the separation of sounds (where sounds are located and that they are coming from separate sources); again, this depends on the listening setting.

Low Frequency (LF) gain:  The limited LF in the Hearing aid bandwidth can also be a problem as we don’t get amplification of the lower pitches and the LF range of music exceeds the typical range we are concerned with for speech.  The LFs are limited on purpose for speech to prevent LF masking where the low frequency sounds potentially cover over the speech sounds.

In this regard consider open fitting where possible as a preference so there is natural acoustic use of LF where hearing is good for these frequencies. Music tends to be louder than speech so even with some mild LF loss we may well still hear the LF cues effectively without needing amplification from the hearing aid. Go for as wide a bandwidth as possible in the aid, again as the range of musical sounds tends to exceed that of speech.

Many aids have frequency lowering technology available but this can introduce inharmonicity where high and low harmonics are out of tune. This was considered manageable over 2 kHz as listeners with high frequency (HF) hearing loss may be unlikely to detect the mistuning with high harmonics.

Smoothing the peaks in frequency response during the fitting may help, though more evidence is needed for this.  Feedback cancellation can also be problematic as it can mistake musical tones for feedback.  Where there is frequency shifting involved this may potential alter perception of pitch and or harmonics.

The peak input limiting level of aids are a significant problem; we know music typically has a wider and higher dynamic range than speech and peak input limiting levels below 105dB simply mean we lose some of the input signal for music resulting in poor sound quality.  We were played examples of this in the seminar down to 92dB peak input limiting and the effects were very obvious.  Whilst for speech anything above 85dB is likely not to be problematic, this is not the case for music and we cut out an awful lot by the aid being optimised for speech (to hear for yourself, click here)

One issue for these factors in hearing aid fittings is that we don’t always have access to all these areas transparently in the fitting software or on the specification sheet.  In some cases it is hard to know exactly what and how the aid is affecting input or rather what algorithms are in use. Changes to compressions that used to be more obvious may be in the fitting tools but without specific parameters and it may be that clinicians will need to ask manufacturers more about what the aid is doing so that we can optimise for individual listeners.

Strategies for fitting:

NB: remember in the music program not the speech program

Consider slow compression

Higher input peak limiting

Take off feedback manager

Use open fitting where possible

Turn off frequency transpositions

Turn off noise reduction algorithms

Set OSPL90 6dB lower than for speech

If possible, play some musical scales in the clinic and check listener can hear each note

Choose the widest available bandwidth for mild losses;  consider using a narrower HF bandwidth for HL >60dB HL, and for steeper slopes to test for cochlear dead regions where patients are reporting specific discrimination problems.

Strategies for listening

When listening to recorded music – lower volume on the sound source and increase the volume on the aid

Consider use of Assistive Listening Devices (ALDs) such as using FM system as input or streamers, loop or direct audio input (DAI). Connevans have a range of ALDs that may be helpful.

Use scotch tape to cover the hearing aid microphone (this provides 10-12dB attenuation up to 4,000Hz)

Also consider whether a listener with lower degrees of loss is actually better without hearing aids for music listening given the overall louder dynamics of music.

This event was attended by Harriet Crook and Alinka Greasley.

References

Chasin, M. & Hockley, N. S. (2014). Some characteristics of amplified music through hearing aids. Hearing Research, 308, 2-12.

Madsen, S. M. K., Stone, M. A., McKinney, M. F., Fitz, K. & Moore, B. C. J. (2015). Effects of wide dynamic-range compression on the perceived clarity of individual musical instruments. Journal of the Acoustic Society of America, 137, 1867-1876.

Moore, B.C.J.  & Sek, A. (2015). Comparison of the CAM2A and NAL-NL2 hearing-aid fitting methods for participants with a wide range of hearing losses. International Journal of Audiology, 55(2), 1-8.

Get in touch

If you have any thoughts, please email the project team:

musicandhearingaids@leeds.ac.uk

You can also get updates about the project and information about music and deafness on our twitter feed @musicndeafness.