Conference Report: Adult Hearing Screening (TEF & AoHL)

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

Be_Curious_1

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.

IMAG0775

IMAG0774IMAG0773

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’

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.

Dr Paul Whittaker OBE – ‘My hearing aids and music’

Paul Whittaker is a freelance speaker, musician, performer and workshop leader who is also profoundly deaf.

In this blog post, he talks about his experiences using hearing aids for music.

“As a professional musician my hearing aids are of vital importance to me. For probably over 20 years I had Phonak PPC-40 Superfront aids and I loved them: never had to turn the volume up very far at all, and they had so much power. For playing, for listening to music and for theatre interpreting they were just wonderful.

“Of course, all good things have to come to an end and they finally died. On visiting my regular NHS audiology department I was told that they could not be replaced, so I contacted Phonak and they told me they had some in stock. Regretfully, they were no longer NHS issue so when I returned to the hospital a couple of weeks later I was given two Phonak Naida digital aids and told they were the best available ones for music. I was also told that, because I was very specific about what I wished to hear, it would take ages to find the correct settings for me, if ever.

“It’s worth mentioning that, several years before, I had tried a couple of digital aids but, at that time, their power was nowhere near good enough for my hearing loss, so they were forgotten and I went back to my analogue ones.

“I’m well aware that the sound processing in a digital aid is very different from an analogue one, so was prepared for a change when I got the Naidas. Within a week I took them out and did without any aids for almost six weeks. To be honest, they were not properly programmed for me, but I found sounds to be too quiet, too compressed, too tinny and largely unrecognisable.

“What was particularly frustrating was that this happened in early December at time when, as a church musician and choir master, I really needed decent aids. Playing the piano and organ was so unpleasant, aurally, whilst I was simply unable to hear my choir properly and had to rely on them telling me if they were right or not.

“I no doubt tried to hide my frustrations yet suspect I failed miserably. For six weeks I did not wear any aids, the longest I have ever been without them since the age of seven. Eventually, having little faith in the hospital audiology department, I contacted Cubex in London, who I regularly visited when I was a child. They don’t usually see people who haven’t bought aids from them but agreed to see me.

“The first surprise I had was having an audiogram done and finding there was nothing at all on it. That made me realise just how much hearing aids do assist the little residual hearing I have. The second surprise was having the aids reprogrammed then stepping out into Oxford Street and hearing lots of strange noises, many for the first time.

“From London I went straight to Cornwall for work, where I kept asking people, “What’s that? What’s that sound?” for several days. I could hear things like fridges humming, kettles boililng and seals honking on the beach: all well and good if that’s what you want to hear, but I still found listening to music an unpleasant experience.

“It didn’t really get any more pleasant over the next few months. I stopped listening to music, found theatre interpreting increasingly hard and more tiring, rarely played the piano or organ for pleasure and still couldn’t cope with training the choir. All of this affected my confidence badly; probably affected every area of my life, really.

“I kept wearing the Naidas but eagerly sought a replacement. Conversations with various audiologists didn’t inspire confidence and I became increasingly aware that hearing aid manufacturers are not really interested in people who have been wearing aids for many years. Their target audience is people with acquired hearing loss and a disposable income.

“That was another problem. It was apparent that there was nothing available on the NHS that would suit me so whatever I did find would have to be paid for, somehow. After some time I found myself trying a pair of GN ReSound ‘Sparx’ aids. They sounded better than the Naidas, had more power and were clearer, so I got them.

“On the whole they do a decent job; better than anything else I’ve come across. They’re OK for playing the piano and organ, enable me to manage with the choir (though not to the extent of when I had analogue aids), I listen to music again (also partly because I bought a ‘Bose’ Bluetooth speaker – excellent), but they’re still not great for live concerts. Choral music and orchestral music are still too compressed and I no longer derive the pleasure from those that I use to.

“I would give anything to have those PPC-40 aids back. As it is, I can see a time in the future when I will no longer wear aids, a view shared by my current audiologist. The aids I now have may have a total shelf life of 5 years, and I’ve had them for over 3 already. I can’t afford to keep buying new ones, and although hearing aid technology is changing rapidly I have it on good authority that those changes are not geared towards people like me, but towards new wearers.

“I know I’m not alone among deaf musicians in desiring analogue aids. Some are coping well (and love) their digital ones and I’m delighted for them. For me, however, it seems the future is more likely to be a silent one. Somehow the music will continue for me, but in what form, and with what aids, is unknown.”

PW

For more information about Paul Whittaker, please check out his website and twitter feed.

And please do continue to email the project team with your ideas and experiences: musicandhearingaids@leeds.ac.uk.

RF

Project Update – November 2015

ESCOM PosterA busy ten months!

Ten months into our AHRC-funded project, the ‘Hearing Aids for Music’ project team are reaching the end of a busy period of data collection.

Our initial study, a small-scale clinical questionnaire, was completed in August. We shared our initial findings at the Ninth Triennial Conference of the European Society for the Cognitive Sciences of Music.

Clinical survey

Hearing aid users reported that they frequently experience problems with music listening and almost half the sample reported that this negatively affects their quality of life. Most participants had never talked with their audiologist about music listening and, for those that had, outcomes had rarely been successful.

The results support the existing literature showing that hearing aids may negatively affect music listening. But we are also aware of positive, success stories about music listening using hearing aids.

In-depth interviews

In order to find out more about both positive and negative experiences, we are currently conducting an interview study. We have talked with people with varying levels of hearing impairment about their experiences. We had many questions but in particular we wanted to find out:

  • Why are some people more satisfied with their hearing aids when listening to music than other people?
  • Do live performances cause more issues than listening to CDs at home?
  • Do specially tailored ‘music programs’ help?
  • What are the pros and cons of using assistive listening devices (ALDs) for music listening?
  • What kinds of discussions are people having with their audiologists about music?

Next steps

We are now taking time to analyse the interview data along with participants’ audiometric data. In the New Year, we will begin work on our national survey to be conducted later in 2016.

Discussion forum and webinars

The team had a great meeting with Danny Lane, Artistic Director at the charity Music and the Deaf recently, exploring how best we can create networks of people to share knowledge and ideas about music listening using hearing aids.

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.

RF

Calling all Audiologists!

Audiology and Music Listening Survey

ha4m-logo-assistive

We are conducting research into the extent to which audiologists are presented with issues relating to music listening by their patients.

If you decide to take part in this study, you will be asked about your training level and background, your experiences of discussing music listening issues and optimising hearing aids for music listening, and your perceived confidence and ability to do so.

Questions are mainly fixed choice, with a few open ended questions. The whole survey should take no longer than 10 minutes to complete.

Please click here to access the survey.

Thanks for you time!

‘Music and Hearing Aids’ Project Team

‘Hearing Impairment and the Enjoyment and Performance of Music’

Conference at Institute of Acoustics, Kingston University, 9 July 2015

Only six months into our project, we were pleased to be invited to talk at an Institute of Acoustics (IoA) conference on the topic of hearing aids and music. Delegates included audiologists, music therapists, technical consultants, acousticians, psychologists and, of course, hearing aid users themselves.

Opening the conference was Mike Wright, Chair of the Musical Acoustics Group at the IoA, who began by reminding us that there is a longstanding need to understand music listening for people with hearing impairments. He cited a famous quote by the deaf percussionist, Evelyn Glennie, about the nature of our senses:

“…in the Italian language… the verb ‘sentire’ means to hear and the same verb in the reflexive form ‘sentirsi’ means to feel. Deafness does not mean that you can’t hear, only that there is something wrong with the ears. Even someone who is totally deaf can still hear/feel sounds”. (Glennie, 2010)

In the first talk, Graham Frost, an audiologist and technical consultant, introduced principles about the effects of deafness on music perception. Deafness affects intensity or ‘loudness’ perception, but it also affects how we perceive frequency or ‘pitch’ and temporal aspects such as ‘rhythm’ or timing. For example, we recognise different instruments because they have different harmonic profiles and onset rise times. Music can also cause people with hearing impairments to experience tinnitus (ringing or buzzing in the ears), hyperacusis (extreme sensitivity to sounds) or diplacusis (experiencing different pitches or timings in each ear). Graham argued that we cannot predict the effects of deafness on music perception from standard audiometry alone, only measure thresholds of sound intensity. Every hearing loss is unique and can only be partially compensated for.

Next, acoustician Peter Mapp (Peter Mapp Associates) talked about assistive listening devices (ALDs) for music and speech. At home, listening to the TV or radio, many people can simply turn the volume up. However, in live settings, this is not possible and many people experience issues with reverb, and background noise. The good news is that many venues use T-loop, infrared and new Wi-Fi technology to feed sound directly to the hearing aid. The bad news is that not all venues are using the best microphone technology and this can affect both speech and music intelligibility. Manufacturers may be wary of Noise Regulations as they do not want to be sued for causing hearing damage from over-amplification!

Acoustician Carl Hopkins (University of Liverpool) then talked about a project which aimed to help musicians with hearing impairments access music by feeling vibrations. Carl showed how our sense of touch is far more limited than hearing. For this reason, the team identified the best pitch range for feeling vibrations on the skin of the hands and feet and also showed that hearing people are no less sensitive that deaf people to vibrations. Perhaps vibrations could be used to help all musicians in group performance? The researchers demonstrated the musical power of vibrations by playing a Beatles song ‘Day Tripper’ in separate, acoustically isolated rooms where instead of hearing each other, they could feel the vibrations of each other’s instruments. Click here to see the video.

After lunch, Music Therapist and Educator, Christine Rocca (Nordoff Robbins / Mary Hare Schools), presented a number of case studies from her work with children with cochlear implants (CIs), some of whom also wear hearing aids. The children at Mary Hare explore pitch glides and interval imitation in the context of familiar songs like ‘Humpty Dumpty’, often exploring major and minor intervals. The therapists and teachers use both recorded and live accompaniments for the children which helps them pick out their part. Christine highlighted that music is ‘multi-sensory’ and even very young babies can learn social ‘turn-taking’ and imitation skills by playing musical games.

On a similar theme, Janet McKenzie, a Speech and Language Therapist (SLT) at the Cambridge Hearing Implant Centre spoke about musical development in children and adults with CIs. For CI users, music is often a positive, unexpected outcome; people who had never previously experienced music are suddenly able to access musical rhythms and melodic shapes. In fact, due to changes in candidacy criteria, some people are now being implanted just so that they can access music and environmental sounds.

Stephen Dance from the London South Bank University shared his research on the hearing acuity of music students at the Royal Academy of Music. So far, 2,576 students have completed audiometric tests and the team have identified patterns of hearing loss attributed to noise induced hearing loss (NIHL) in musical settings. The findings showed that players of certain instruments such as the organ, percussion and brass are most at risk of hearing loss. There were also some lateralised effects; violinists’ and horn players’ left ears are affected more than their right, and piano accompanists have worse hearing in the right ear potentially as a result of working with singers. The ‘notch’ in the audiogram as a result of music-induced hearing loss seems to be at 6kHz rather than 4kHz for musicians but this could be consistent with different kinds of hearing loss.

Finally, we presented initial findings from our patient survey of two UK audiology clinics, one NHS, one private. The short questionnaire asked hearing aid (HA) users about their music listening experiences, effects on quality of life, and the extent to which they had discussed music listening with their audiologist. So far, results showed that HA users frequently experience problems with music listening and almost half of the sample reported that this negatively affects their quality of life. The most common problems reported were a lack of fidelity, difficulty hearing words in songs, and issues hearing at live music performances.  The data also suggested that most participants had never talked with audiologist about music listening, and for those that had, the outcomes had rarely been successful.

The closing discussion that followed raised many issues. Hearing aid manufacturers have responded to demand from the user market to make HAs small and discreet. This has meant that batteries are also smaller and less powerful (< 3 volts), while conversely, the digital signal processing contained within them for optimising speech amplification has become more and more complex. Multi-channel compression requires a lot of processing power and therefore battery power. Perhaps simpler processing would be better for music? One idea would be to set up a person’s HA for each instrument or the type of music they listen to the most. But, as Evelyn Glennie once told me, every acoustical situation is different and even the same instrument never sounds the same.

The group also discussed the problem of uptake for hearing aid users. There are 6 million people who would benefit from hearing aids in the UK alone but only 1.4 million wear them regularly. Many people find it difficult to take the time to adjust to the new sound world provided by their new HAs, which audiologists know to be beneficial in the longer term. Perhaps if HAs were designed for amplifying music as well as speech, more people would wear them?

If you have any thoughts or questions, or would to share your experiences of listening to music with hearing aids, please email us musicandhearingaids@leeds.ac.uk or join our Discussion Forum.

RF

We are recruiting for a new research study

Do you use hearing aids?

shutterstock_110152409

We need participants for an interview study taking place between July – December 2015 about music listening.

We are recruiting hearing aid users interested in taking part in a study about music listening. Interviews will last for 1 hour and you will also receive an audiometric assessment at Sheffield Teaching Hospitals NHS Foundation Trust.

If you are interested, please email your answers to the following questions to musicandhearingaids@leeds.ac.uk:

  • What is your level of deafness?
  • Are you musically trained?
  • Has your hearing level changed over the last 2 months?
  • Have you experienced any of the following in the last 2 months: auditory processing disorders / auditory neuropathy / fluctuating hearing loss / recent acute hearing loss / ear infection / significant asymmetry in hearing loss / problematic tinnitus or hyperacusis?
  • Do you use one or two hearing aids?
  • Do you have a cochlear implant?
  • Is English your first language?

To take part, or if you have any questions, please email musicandhearingaids@leeds.ac.uk.

Many thanks,

Music and Hearing Aids Project Team

Music and Ménière’s Disease

Alan JacquesAlan Jacques is a musician based in Edinburgh. He was interested in talking about his experience of changes to his perception of music as a result of Ménière’s Disease, a rare progressive disorder of the inner ear. Read his story below:

 

 

“I am a retired psychiatrist living in Edinburgh.  I retired early with a view to pursuing a lifelong interest in music.  I am a pianist and gained the ATCL and LGSMD in Performance shortly after retiring.  My particular interests have always been in accompaniment and chamber music and I have considerable experience of public performance, both on the piano and as a choral singer and for a short period a not very competent choir conductor.  My musical abilities are circumscribed: I am a good sight-reader and enjoy the interpretative aspects of reproducing music, but I am poor at memorising, improvising, or creating music.  And I have never had much ability to ‘hear music in my head’.

“Looking back I wonder if I have always been hard of hearing in my right ear, since when Stereo arrived to the great excitement of musical teenagers I never could work out where the various instruments were.

“About twelve years ago (aged 58) I began to develop Ménière’s disease with all the usual symptoms of fullness in the ears, tinnitus, hearing impairment and severe dizzy turns, and the characteristic very variable course.  I am now moderately-to-severely deaf in both ears and constantly require hearing aids.  About two years into the illness I began to notice a problem with pitch perception – I wrongly accused a highly competent singer of singing the wrong note, for example.  I then noticed that I heard different pitches if I listened to a tuning fork in each ear.  I only recently learned that this is called diplacusis.  Like the illness, it was very variable.  At its worst, I couldn’t recognise music I was listening to because I was hearing all the wrong notes.  A striking example was a wedding I went to ten years ago where the choir sang Parry’s I Was Glad, which I have sung hundreds of times – I had to ask what it was they were singing.  At best there were times when everything got largely back to normal, though even then I noticed that when I moved from playing one piece to another it took me a few bars to register the tonality.

“Things have got steadily worse particularly in the last two or three years and I appear to be now permanently at the worst level.  If I play a note several times I can sing an approximation to it, but if a tune is played I cannot recognise it unless by inspired guesswork.  I cannot recognise chords, can’t tell major from minor, cannot understand modulations, and have great difficulty even in guessing what instrument is playing in broadcast or recorded music.  Concerts are a no-go area, because they just sound like an awful cacophony. This is not just a problem caused by my hearing impairment itself, for I hear the noise of music.  It’s that my cochlea is sending the wrong messages to my brain.  Interestingly I sometimes hear a note related to the note I am playing (e.g. a fifth out), but more often it is just a pitch-less noise.

“My musical brain is as far as I know working perfectly well, indeed possibly overworking.  MRI scans and neurological tests confirm that this is a purely cochlear problem.  What I am noticing about the mental element in ‘hearing’ music is that my brain is, as it were, ironing out the messages it is getting, so simplifying what I appreciate.  When the music modulates I ‘hear’ it in the first key until it finally gets through that I’m in the wrong zone.  The other example of my brain being creative is in the difference between familiar and unfamiliar music I am playing.  With very familiar music I somehow imagine that I am hearing the tunes and some of the harmony, but if I try to play an unfamiliar score it is completely meaningless.

“I have continued to play throughout my illness and my teachers say I am producing a more than acceptable and improving musical performance.  To me it is a noisy clatter.  I had to give up all ensemble playing two years ago, but this was actually more to do with the fact that I had had to cancel two performances because of Ménière’s dizzy spells and, the last straw, had a dizzy attack in the middle of a public recital and had to terminate the performance.  I am now concentrating on solo playing and for example am now on my fourth cycle of studying the Beethoven sonatas and am performing them one at a time at a local little music club.  In the past year I have found it necessary to stick almost entirely to music that I know to some extent – I simply can’t make sense of unfamiliar music.  I surprise myself with how much I enjoy playing, though I do wonder how much of that is a lifelong habit rather than present experience.

“I would be interested in meeting or corresponding with other musicians with similar problems.  I gather that diplacusis is a much commoner problem than I thought – a survey of British orchestral musicians is said to have reported it in 5% of respondents with 12% experiencing distortion (Laitinen & Poulsen, 2008). I know that the needs of hard-of-hearing and deaf musicians are at last being addressed, but I guess I am not the only musician who has this severe form of ‘cochlear amusia’.  I have only located one other person with the problem through the Ménière’s Society (he had felt forced to give up his musical life), but I intend to try again.

Alan Jacques

June 2015

Laitinen, H., & Poulsen, T. (2008). Questionnaire investigation of musicians’ use of hearing
protectors, self reported hearing disorders, and their experience of their working environment. International Journal of Audiology, 47(4), 160-168.

It seems to me that music perception is a very complex process. Our brain works hard to make sense of musical information and, when things go wrong, our auditory brain can to some extent ‘fill in the gaps’ but not perfectly.

Alan’s story reminded me that the amplification of acoustic sound and music using hearing aids is only one part of the process – there is always a person at the end of the technology.

If you want more information about Ménière’s disease, please see the Ménière’s Society website.

Or to share your experiences, click to our Discussion Forum and tell us more.

RF

Hearing aids at the Thackray Medical Museum

Thackray logoGoing back in time: hearing aids through the decades

In March this year, just a few weeks into our project ‘Hearing aids for music’, the project team visited the Thackray Medical Museum in Leeds.

We wanted to learn something about the history of hearing aids from the important collection of amplification and audiology equipment housed there.

But we also had another agenda… We wanted to see if there was any evidence in the collection of hearing aids having been used to amplify music – not just speech.

Read moreHearing aids at the Thackray Medical Museum