In the first of our manufacturer insight series into the future of hearing technology, BIHIMA interviewed Thomas Behrens, Chief Audiologist and Director for the Centre for Applied Audiology Research at Oticon, who believes that brain health and cognitive processing will be at the centre of hearing care in years to come.
Where would you say the future of hearing technology lies?
Over the past few years we have been able to show that there are new kinds of benefits in hearing technology. It used to be all about speech understanding and sound amplification, but hearing loss is more than an audibility problem and now there is a new focus on reducing the level of effort for people with hearing loss. We know that this ‘effort’ made by the brain can be quantified objectively through pupillometry (measuring the size of the pupil in the eye – which gets larger when the brain is under strain). At Oticon we call it “Brain Hearing” and it is our entire philosophy, our strategy across the whole group. It is not just what we talk about, it’s the way we think.
We need to understand that hearing loss is a complex condition. Inside the inner ear there can be at least five different types of damage, any of which could be the origin of hearing loss. With current diagnostic methods we are not always able to discern the exact cause (I would add that better diagnostics are also part of our research).
But we do know that when the brain is struggling, it starts to compensate and it starts to guess at meaning, and this leads to immediate effort. This can lead to fatigue and people withdrawing from social interaction because a lot of social situations involve background noise where more effort is required. This behaviour change, the social isolation, is where we see big effects in terms of cognitive decline. We have shown that through new technology which reduces the stress levels on the brain, through noise cancellation, this then frees up brain capacity and people have been shown to remember 25% more.
This ties in with all the research being published recently linking hearing loss to dementia, doesn’t it?
We don’t yet know enough to say that hearing loss directly causes other conditions such as dementia and depression. The difficulty is that dementia studies that will tell us more take at least ten years to gain sufficient data. We prefer to talk about hearing loss causing behaviour change which is a contributing factor.
But yes we certainly need to understand hearing as a cognitive health issue. We are helping to establish centres at universities focussing on cognitive hearing science. Because we know that hearing keeps your brain fit – it is exercise for the brain that we need to keep doing. Did you know that half an hour of active conversation a day is better for your brain than playing Sudoku? I mean conversation where we are really listening, being responsive, reflecting and asking questions – this is what the brain needs. In this context, our best new hearing technology can free up cognitive resources to allow people to better engage in social decoding. From our clinical trials, people report being better able to tell the mood of others, which is important because the emotions are conveyed through subtleties in speech.
What is the role of smart technology in the Brain Hearing strategy?
We want to use smart solutions to support people adopting healthy behaviour and keeping their brains fit. It enables us to log the data in a cloud solution, so we can look at patterns and use this to improve and update the technology. And also the smart technology will tell users how their hearing develops and helps them utilize maximum functionality of their devices.
In our research we are starting to use hearing aids with sensors which directly sense the responses from the brain and measure the cognitive load – it will see if you are taking a nap, for example. This technology can even be used by health professionals for distance monitoring of people with severe hearing loss, without the need for face-to-face appointments. It can also be used as a brain-to-hearing interface, so as the brain starts to strain the technology can be adjusted.
And yet within these digital opportunities, we do not want to lose the role of hearing care professionals. We want to keep focussing on the role of audiologists.
That’s an important point in light of legislative changes in the US to make hearing devices available over the counter…
We have a firm belief that audiologists need to be at the centre of service delivery. We have a research clinic in South Africa at the moment where we are developing best practise methods for remote follow-up to fitting. The audiologist will continue to be important in this because there is so many aspects of how medical technology can be used to be optimally useful for the individual person with hearing loss. It takes professional insight and an understanding of how the hearing loss affects the situation of the individual in order to give optimal guidance.
This interview was conducted by BIHIMA. We represent the hearing instrument manufacturers of Britain and Ireland, working in partnership with other professional, trade, regulatory and consumer organisations within the health care and charitable sectors. We raise consumer awareness about the latest hearing technology, and aim to influence government and policy makers to improve the lives of people with hearing difficulties.
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