Short summary

This project will seek to change the way we examine and treat hearing loss. Initially a thorough evaluation of the current examination and treatment paradigm will be done with the establishment of a database. The treatment is today more experienced based than evidence based. During the project new methods for hearing examination and evaluation of hearing aid treatment outcome will be developed. The new methods will be tested in a randomized controlled trial and compared to the existing paradigm. Furthermore, causes of suboptimal benefits of hearing aids will be analyzed and solutions suggested.

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Rationale

The overall vision of the project is to improve hearing rehabilitation in Denmark and around the world through an evidence-based renewal of clinical practice. While much research has been conducted to improve diagnostic techniques and hearing aid fitting practices, promising scientific results have not translated into new clinical practices because previous projects were scattered and lacked scale, structure and coordination. By bringing together all the key stakeholders to conduct a large-scale and comprehensive investigation, this project will be avoid these limitations and will change clinical practice. These changes will benefit society at many levels. Individuals with hearing impairment will receive an optimal treatment for their individual loss rather than the trial-and-error approach practiced today. This tailored approach will result in higher satisfaction, quality of life, and allow hearing-impaired individuals to remain in the workforce longer. As well, this individualized approach will improve the cost-efficiency of clinical practice by reducing the frequency of follow-up visits, increasing the effectiveness of public spending. Finally, the new diagnostic techniques and practices will increase the competitiveness of the Danish hearing industry, creating jobs and consequent tax revenue.

Many people with hearing loss in Denmark and elsewhere are fitted with hearing aids. However, a relatively large proportion (20%) of hearing-aid owners does not regularly use their hearing aids. While the underlying reasons for each individual are not well understood, it is clear that these users do not perceive the benefit they receive from their devices to be sufficient. The result is wasted clinical resources and lack of rehabilitation for the hearing-impaired person who sought help for a serious problem. The solution is to optimize the fitting for each individual so that everyone receives the best rehabilitation he or she can.

The purpose of the project is to promote research in clinical audiology, particularly in the

development and assessment of new clinical methods for diagnosis and hearing-aid fitting. The results will guide future clinical practice by determining the best methods to characterize and sort patients into different clinical populations and the best treatment strategies (e.g., device selection and hearing aid fitting techniques) available for each population. This will help ensure a better quality of service for the patient and a higher return on the clinical resources spent in the field of hearing rehabilitation.

Hearing-aid fitting is the process of selecting and adjusting all the features and parameters of a modern hearing aid. Currently, the initial fit is based completely on the pure-tone audiogram, which is a relatively crude assessment of a hearing disability determining only the softest tones a listener can hear. Many of the features and parameters in modern hearing aids are intended to improve speech intelligibility, especially in noise. Yet the audiogram provides little information to guide the choice of these features and feature parameters. The result is a fitting process that relies on trial-and-error methods, which leads to inconsistent practices and results, lack of satisfaction and inefficient service. In this project, we propose two complementary approaches to improve this situation. First, is the development of a test battery that will provide the clinician with a "hearing profile" for each individual. This profile can be used to guide the selection of devices along with the initial selection of features and parameter settings. Second, is to measure aided performance after each fit so that subsequent fits are guided by individual results rather than the current trial-and-error approach. Together, these two approaches will renew clinical practice in Denmark and round the world.

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Description of the cohort

All adult patients with hearing problems referred for audiological rehabilitation at public audiological departments will be included in the study. Patients are recruited from the Ear-Nose-Throat specialists who refer the patients to hearing aid treatment. All patients will be included in a database and their benefit of the hearing aid treatment will be registered.

Later on the patients in the database can participate in a randomized controlled trial testing the new treatment and evaluation paradigm towards the existing paradigm. Also, new patients without previous hearing aid experience is recruited for this trial.

Data and biological material

All patients will be examined with a standard audiometric test to establish the hearing thresholds. These data together with questionnaire data regarding hearing aid outcome and logging data from the hearing aid use are registered in the clinical database.

Later on the results from the developed audiological tests will also be included in the database for the purpose of the randomized controlled trial.

Retrospectively collected audiometric data as well as diagnoses will be collected from patient records and the Danish National Patient Register.

Collaborating researchers and departments

Department of Electronic Systems, Aalborg University

• Professor Dorte Hammershøi

Hearing Systems Group, Centre for Applied Hearing Research (CAHR) and Centre of Excellence for Hearing and Speech Sciences (CHeSS)

• Head of Centres/Group and professor Torsten Dau

Department of Otolaryngology, Head & Neck Surgery, Aalborg University Hospital

• Associate Professor and Chief Physician Michael Gaihede, MD, PhD
• Associate Professor and Chief Physician Dan Dupont Hougaard

Department of Audiology, Odense University Hospital

• Head of Department and Consultant Rikke Skovsted Schnack-Petersen

Research Department of Audiology, Odense University Hospital and Department of Clinical Research University of Southern Denmark

• Head of Research Department and Associate Professor Jesper Hvass Schmidt, MD PhD

Audiology & Hearing Aids. DELTA Danish Electronics, Ligth & Acoustics

• Senior Technology Specialist, Gert Ravn

GN ReSound A/S, Copenhagen , V.P

• External Relations Nikolai Bisgaard

Oticon Medical Denmark

• General Manager Karen Wibling Solgård

Widex A/S (WID) VP Electronics & Audiology

• Morten Kroman