Hope for hearing: Technology driving greater access
Posted on 28 June 2021
Hearing loss can be a very personal experience, where others around you are unable to understand the challenges of a reduced perception of the environment. It can potentially have an isolating impact on those experiencing the hearing loss – but the good news is that Dr Natalie Buttress, an audiologist at Mediclinic Durbanville, believes that rapidly advancing technology is addressing many of the challenges experienced in early hearing devices.
According to the World Health Organization, there are more than 466 million people worldwide with disabling hearing loss, and, if unmanaged, the figure is expected to rise to over 900 million in 2050. Ninety three percent of those with hearing loss are adults. Noise exposure, health issues and changing world demographics with a greater emphasis on older populations all contribute to driving figures upwards.
Buttress explains that many people with hearing loss experience difficulty in perceiving clarity of speech in groups or where background noise is present. However, advancing processors in hearing devices have become more effective in automatically identifying the user’s environment (outdoors, in a car, in a restaurant, or at a conference) and automatically adjusting the algorithms of sound processing, to optimise speech and reduce unwanted noise.
She explains that newer devices can empower those with all levels of hearing loss without making the wearer uncomfortable about ‘announcing’ their difficulty, because the devices are so discrete.
In addition, wireless technologies are now able to integrate with other electronics such as television, cell phones and music systems; and connect hearing aids ear-to-ear for a 360 degree ‘view’ of sound. In addition some can engage remote wireless microphones to direct-stream lectures, teachers, partners (in cars/noisy places) – leading to a more complete perception of the world for people with hearing loss. Learning or AI is also a recent addition towards optimising fittings.
Technology is playing a strong role in the development of hearing devices. According to Buttress, “The resolution of sound depends on the microchip inside the hearing aid, which classifies sound according to its frequency (pitch), intensity (loudness), time signature (duration, onset and offset), timbre (quality) and envelope (pattern).” The more sophisticated the microchip, the more processes it can handle in real time – less than 10 milliseconds processing speed is needed for one’s brain to ‘hear’ in real time without any delays.
Resolution is all about clarity, the primary complaint of most people with hearing loss. The more sophisticated the chip, the higher the resolution. For this reason, high resolution devices provide an opportunity to increase clarity, read the environment, detect the volume of incoming sound, classify the exact pitch of different speech sounds, assess the direction of the most important sounds around us, and detect the patterns of noise, and even learn from previous choices and environments via AI. The user’s experience is more natural, more comfortable, and considerably clearer than ever before, because of seamless adaptation to the vast variety of soundscapes we are in. While we will never be able to equal the incredible ability of a natural ear and a normal central auditory processing system, these devices are offering patients a new level of clarity, comfort, and confidence.
However, the audiologist is the key to making this technology work for the client. Buttress explains, “Regardless of the level of technology, devices arrive as ‘blank slates’ at the audiologist’s rooms. Without the skills of an audiologist, no hearing device can provide the best match to a person’s needs. Moreover, improved quality of life with one’s hearing is about much more than a hearing aid fitting. Proper patient-centred care extends to all manner of support for the transition that each patient will experience with their ‘new’ hearing, which can only be provided by a qualified professional.” This process involves understanding the patient and their unique needs, understanding the environment in which they function and understanding how the available device can optimise their experience.
Advancements in technology such as AI and Cloud technology are also allowing audiologists to improve their services further. New hearing devices can be integrated to the cloud via Bluetooth, Wi-Fi, cellphone apps and computer software. If activated, this automated process allows the wearer’s usage data stored on an individual’s device to be integrated globally with a bank of all user’s data. Users therefore anonymously contribute to cloud knowledge about the settings that people prefer, which allows manufacturers to define better algorithms and technology in current and future devices.
The storage on the device, or shared to Cloud, can also (with a patient’s permission) be accessed by their audiologist in the rooms or remotely via a telehealth solution. This allows an audiologist to assess hearing aid needs in environments that cannot be replicated in the audiologist’s rooms, and make remote adjustments for their patients. Some features can be enabled for the patient themselves, depending on how confident and comfortable the patients is with technologically. She explains that some devices even have fall detection and automated calling (via cellphone connection) of an emergency number.
Buttress concludes, “AI and Cloud technology can contribute to, or obtain information from the ‘group brain’, meaning that updates can improve the user’s experience without changing the actual device hardware. It really is a whole new world.”
In closing, Buttress explains that a tool is only as good as its setting, and this is something that needs to be measured. Hearing devices are tools that address hearing loss, amplifying sound in exactly the right quantity at exactly the right frequency (level of technology dependent). But simply asking a patient if they like the sound taps into a patient’s subjective perception, but does not ensure that the levels are as close to the ‘best’ that can be provided.
Good may be lovely, but best settings are created by a combination of objective measurement and subjective perception. Some audiology practices use sound probe measurements, or ‘Real Ear Measures’ (REM) which add to the clinical and practical picture by measuring the output of sound at the eardrum. This ensures that for soft, medium, and loud speech, the spectrum of sound being replicated and amplified by the hearing aid, is at optimum levels for audibility (the ability to hear the sound), and that all sounds are at safe and comfortable levels for the future safety of the inner ear or cochlea.
This gold standard of clinical technology delivers benefits in many forms: The REM protects a patient’s hearing from overamplification, but also ensures that the time and financial resources that a patient has spent on their devices are accurately set to provide their brains with a signal that matches researched targets, helping patients to optimally access their sound world. The only caveat is that individuals can subjectively tolerate different amounts of sound, so, good audiologists always consider the patient’s perspective about their own experience. Therefore, audiology is both art and science- all the science of medicine, mathematics and physics, with all the art of communication, psychology and empathy.
Dr Buttress is a shareholder and member of the Reconnect Audiology Network (Pty)(LTD), with members nationally, including several in other Mediclinic hospitals in South Africa.