Award Title: Feasibility of a RCT to examine the effectiveness of auditory-cognitive training to improve hearing aid users' speech perception outcomes, compared with hearing aids alone
Funder: Department of Health and Social Care

Abstract: There are 11 million people in the UK (1 in 6 of the population) with a significant hearing loss (HL)4. The most common management strategy for HL is the provision of hearing aids (HAs). Although HAs substantially improve speech understanding through the amplification of quiet sounds, HA users face disproportional difficulties when listening to speech in noise5,6. Listening in noise is a frequent and complex real-world listening challenge that relies on peripheral hearing, central auditory processing and cognition7,8.   Auditory training (AT) can be described as training the brain to listen through active engagement with sounds. It is a low-cost intervention that can be tailored and delivered to individuals via computers and the Internet. Our previous systematic review of the published literature assessing this question showed robust evidence for improvements for trained auditory tasks9. However, transfer of learning to untrained outcomes was highly variable and evidence quality was very-low to moderate study quality, highlighting a need for further high-quality research. We have since published the results of a high-quality AT study for adults with mild HL10. Results showed significant post-training improvements for measures of self-reported hearing and cognition that index executive functions (higher-order cognition). A second study of HA users with mild to moderate HL showed a significant post-training improvement in performance for a cognitively demanding real-world listening task (competing speech) and improvements for a dual-task of listening and memory at a challenging signal-to-noise ratio (both executive tasks), following just 3 hours of phoneme discrimination in noise training11. Finally, with the aim of maximising these benefits, we asked whether training cognition directly (Cogmed working memory training)2,12 could offer greater improvements to HA user s real-world speech understanding2,. Although improvements were shown for trained span tasks, this type of learning did not transfer to generalised improvements in speech perception. These results suggest that it may not be possible to train the cognitive components of speech perception in isolation11. As such, any cognitive enhancement to aid HA users real-world speech understanding should be embedded within task-relevant (i.e. speech) training programs, which is the focus of this research.   We want to tailor auditory-cognitive training (ACT) programs designed specifically for HA users, with optimal training stimuli based on high-quality research evidence, that will be freely available to NHS patients. This study will examine the feasibility of delivering and evaluating a RCT of auditory-cognitive training (ACT). The RCT is required to provide high-quality evidence that ACT is an acceptable, effective and cost-effective intervention to improve speech perception, communication and quality of life for new HA users.   Using a mixed-methods approach, we will examine feasibility of the interventions (ACT delivery) and the research (RCT delivery), from the perspectives of new NHS HA users and audiologists. Rate and parameter estimates will be used alongside qualitative methodology to inform accessibility, acceptability and implementation of ACT and the RCT within the standard NHS audiology pathway. A total of 105 patients recruited across two sites (Nottingham and Kings Mill Hospital) will be randomised to one of three groups (treatment as usual (TAU)/TAU + phoneme discrimination n-back ACT/TAU + competing speech ACT; n=35 patients per group). We will assess the acceptability and completeness of pre- and post-training outcomes measures (speech perception [primary outcome], higher-order cognition, and hearing- and health-related quality of life) and identify any costs associated with ACT delivery to inform future cost-effectiveness analysis.   Findings of this study will be used to identify whether the pragmatic trial can be conducted effectively. The RCT is required to provide high-quality evidence that ACT is an acceptable, effective and cost-effective intervention to improve speech perception, communication and quality of life for NHS patients.

Lay Abstract: The problem  There are 11 million people in the UK with long-term hearing loss. Hearing loss isolates people, cutting them off from society. The standard treatment is to amplify quiet sounds using hearing aids, but listening also requires cognition (memory and attention), particularly in noisy and challenging everyday environments.   Our novel solution  Our research has shown that computer games designed to help people practice listening to speech can improve cognition and listening abilities for people with hearing loss and hearing aid users. These games, termed  auditory training , could help patients better understand speech in noise, improving communication, which can improve quality of life. In the future, we need a large research trial to understand all of the benefits of these games to patients. First, we need to find out if the large trial could work, and if so, how best to design it. To do this, we are carrying out a feasibility study.   Feasibility study  We will:    Carry out an 18-month study with 105 first-time hearing aid users recruited from two NHS audiology clinics. Understand how to provide the games to patients and the cost of doing this. Check the games can be delivered via the Internet to patients  in their own homes. Work with audiologists at NHS departments to check how many patients can take part in the feasibility study and how many will be needed for the trial. Find out what patients and clinicians think about the games and the research. Measure the time taken to collect and analyse research data. Publicise the results. If feasible, design the large trial.    The feasibility study will help ensure the trial provides high-quality evidence and value for money. We will involve patients in designing the feasibility study, which should make it easier for future patients to take part in the trial.

Research Activity Codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health Categories: EAR