Paola Incerti

Hearing loss affects approximately one in six Australians, representing around 3.6 million people or nearly 15% of the national population (Deloitte Access Economics 2017). While conventional heari...

NAL-NL2 (National Acoustic Laboratories Non-Linear 2) is an empirically grounded and clinically validated algorithm for hearing aid fitting. It was developed as the successor to NAL-NL1 to balance ...

Objective: To determine the potential feasibility and acceptability of combined screening for raised blood pressure (BP), atrial fibrillation (AF) and cognitive impairment (CI) in older adults within a setting of hearing health assessment for detection of hearing loss. Methods: We recruited participants aged 65 years or older ( n = 35; mean age 73 ± 6 years, 51% females) from the community to attend a single visit lasting approximately 60–90 min. Prior to a comprehensive hearing assessment, BP was measured with an automatic BP monitor with AF detection, and CI screening was conducted using the patient section of the General Practitioner Assessment of Cognition instrument. A subset of participants ( n = 16, 50% females) was interviewed post study to evaluate acceptability. Results: A total of 21 positive screens (six raised BP; two possible AF; 13 hearing loss) and 12 potential positive screens for possible CI were detected in 25 (71%) participants. Eight participants (23%) had more than one newly detected condition. Interviews revealed that combined screening was feasible and acceptable as participants felt it was ‘ convenient, ’ ‘ saves time ’ and ‘ more efficient .’ Conclusions: Combined screening for raised BP, AF and CI in older adults within a hearing health assessment setting appears feasible and was generally perceived positively by participants in this pilot study. Further implementation studies should be conducted with process and outcome evaluation embedded to confirm feasibility and acceptability as well as to evaluate cost‐effectiveness and health outcomes for combined screening in older adults.

To describe the development and evaluation of the NAL-NL3 Comfort in Noise Module; a new algorithm for determining hearing-aid gain that is part of the NAL-NL3 fitting system. Single-site multi-study design with each study and subsequent perceptual modelling informing refinements to module gain targets. Participants completed laboratory studies to investigate gain preferences and to evaluate the effect of the module on speech understanding in noise. Participants also completed real-world evaluations using a smartphone-based Ecological Momentary Assessment app with different brands of hearing aids. 83 adult hearing aid users with mild to severe hearing loss. The new module selectively reduced gain (compared with the NAL-NL3 Prescription) by imposing a limit on the total loudness. Iterative refinements led to progressive increases in user preferences favouring the new module over the NAL-NL3 Prescription in noise with respect to listening comfort. Laboratory-based testing identified no detrimental impact on speech perception in noise. Reducing the level of prescribed gain for hearing aid users in noise compared to in quiet improves comfort without significantly degrading speech understanding. This work supports the broader philosophy of the NAL-NL3 fitting system to provide specialised targets for different populations, situations and device technologies.

Background Cochlear implants (CIs) can be used to address severe to profound sensorineural hearing loss, which is more prevalent in older adults. CI system reliability depends on both internal implants and external sound processors. Over time, sound processors age and may experience failure or faults and need repairing. However, spare parts for obsolete sound processors are harder to access. Upgrading sound processors could help CI users benefit from technology improvements; however, this may be prohibitively expensive for users. This study assessed the cost effectiveness of upgrading obsolete or soon-to-be obsolete sound processors compared with not upgrading them in adults aged 65 years and over with existing CIs from the Australian health system perspective, including whether and when to upgrade sound processors. In doing so, we present a novel application of individual-level microsimulation models that track not only individuals, but ears fitted with CIs. Methods We developed two state-transition microsimulation models reflecting adults with (i) unilateral CIs, and (ii) bilateral CIs. We applied a microsimulation approach to track CI users’ age and each sound processor’s age (which affects failure and fault rates, and health-related quality of life [HRQoL]) over 35 years. Two models were developed as bilateral CI users may have two sound processors of differing ages, and because sound processors beyond replacement or repair result in no access to sound in that ear—although unilateral CI users may have residual hearing in the non-implanted ear. Inputs were based on the Australian Cochlear Upgrade Sound Processor (CUSP) study (N = 200), a survey of four clinics involved in the study, the published literature and administrative sources. We reported the incremental cost-effectiveness ratio (ICER) in terms of cost per quality-adjusted life year (QALY) gained and conducted extensive threshold, univariate, scenario and probabilistic sensitivity analyses. All costs were reported in 2022 Australian dollars (AUD). Results For unilateral CI users, if sound processors were beyond replacement or repair at 20 (15) years then upgrading sound processors when they reach the age of around 11 years (3 years) resulted in an ICER of AUD$50,000 per QALY gained when compared with not upgrading sound processors. When the scenarios were compared incrementally to each other, upgrading sound processors when they reach the age of 20 (15) years resulted in an ICER below AUD$50,000 per QALY gained. For bilateral CI users, if sound processors were beyond replacement or repair at 15 or 20 years then upgrading sound processors when they reach the end of warranty (3 years) would result in an ICER of AUD$50,000 per QALY gained when compared with not upgrading sound processors. When the scenarios were compared incrementally to each other, then upgrading sound processors when they reach 9 years resulted in an ICER below AUD$50,000 per QALY gained. The probability that upgrading would be cost effective versus not upgrading sound processors was 49–51%, reflecting that the upgrade frequencies were determined through threshold analysis. Updating sound processors less frequently reduced the ICERs and increased the probability that upgrading would be cost effective. Conclusions This study estimated the frequencies at which upgrading sound processors may be considered cost effective, assuming that sound processors were eventually beyond replacement or repair. This study also demonstrated the value of microsimulation models in tracking not only individuals, but each ear when assessing the cost effectiveness of hearing interventions. Further research is needed to explore this approach in other conditions and interventions, such as other neuroprosthetics.

To identify in a clinical hearing loss population (i) how, and to what extent, hearing-specific empowerment is associated with demographics (e.g. age, gender, employment), hearing factors, social isolation and loneliness, emotional and mental health, and cognition, and (ii) the impact of hearing aids on hearing-specific empowerment. A prospective, cross-sectional study collected data via an online survey (RedCAP). Multiple regression analyses used the 15-item Empowerment Audiology Questionnaire (EmpAQ-15) as the dependent variable. Adults (n = 693) who attended four audiology clinics or were invited from a research database. Across the whole sample, hearing aid use, social satisfaction, emotional and cognitive measures were most highly correlated with the EmpAQ-15. Similar results were seen for a subset of hearing aid users (n = 472), with additional effects seen for both hearing aid use and residual hearing disability. There was no relationship between EmpAQ-15 and measures of mental health, social isolation or loneliness, nor demographic variables. Hearing-specific empowerment in adults with hearing loss is predicted by social, emotional, and cognitive measures. Those who wore hearing aids were more empowered than those who did not. Measuring hearing-specific empowerment has potential to provide a holistic patient-centred approach to assessing adults attending audiology clinics.

Lack of standardised information about hearing aid technologies presents a barrier to individuals seeking to understand and make informed choices about the hearing aid features they may benefit from. (1) To identify features in contemporary hearing aids as described in publicly available materials. (2) To develop a lexicon of hearing aid features that informs consumers about available technologies. A synthesis of published information on the features of contemporary hearing aids from six major manufacturers was conducted by a multidisciplinary research team. The analysis and categorisation of these findings was an iterative, agile process involving five distinct phases, Scoping, Extracting/Decoding, Mapping, Synthesising and Consulting. 119 documents/publications were included in this review. These materials comprised 14 product guides and specification data sheets, and 105 white papers and technical articles. We identified 253 unique features (e.g. Feedback Management) across 12 hearing aid devices (including both premium and entry-level models). This resulted in the development of a lexicon describing the core capabilities of modern hearing aids. Data synthesis identified key features of contemporary hearing aids across device models and manufacturers to inform the design of a lexicon for use by consumers.