The case for LACE: Listening and auditory communication enhancement training

Childhood Listening and Associated Cognitive Difficulties Persist Into Adolescence

OBJECTIVE

Listening difficulty (LiD) refers to the challenges individuals face when trying to hear and comprehend speech and other sounds. LiD can arise from various sources, such as hearing sensitivity, language comprehension, cognitive function, or auditory processing. Although some children with LiD have hearing loss, many have clinically normal audiometric thresholds. To determine the impact of hearing and cognitive factors on LiD in children with a clinically normal audiogram, we conducted a longitudinal study. The Evaluation of Children's Listening & Processing Skills (ECLiPS), a validated and standardized caregiver evaluation tool, was used to group participants as either LiD or typically developing (TD). Our previous study aimed to characterize LiD in 6- to 13-year-old children during the project's baseline, cross-sectional phase. We found that children with LiD needed a higher signal-to-noise ratio during speech-in-speech tests and scored lower on all assessed components of the NIH Cognition Toolbox than TD children. The primary goal of this study was to examine if the differences between LiD and TD groups are temporary or enduring throughout childhood.

DESIGN

This longitudinal study had three data collection waves for children with LiD and TD aged 6 to 13 years at Wave 1, followed by assessments at 2-year (Wave 2) and 4-year (Wave 3) intervals. Primary analysis focused on data from Waves 1 and 2. Secondary analysis encompassed all three waves despite high attrition at Wave 3. Caregivers completed the ECLiPS, while participants completed the Listening in Spatialized Noise-Sentences (LiSN-S) test and the NIH-Toolbox Cognition Battery during each wave. The analysis consisted of (1) examining longitudinal differences between TD and LiD groups in demographics, listening, auditory, and cognitive function; (2) identifying functional domains contributing to LiD; and (3) test-retest reliability of measures across waves. Mixed-effect models were employed to analyze longitudinal data.

RESULTS

The study enrolled 169 participants, with 147, 100, and 31 children completing the required testing during Waves 1, 2, and 3, respectively. The mean ages at these waves were 9.5, 12.0, and 14.0 years. On average, children with LiD consistently underperformed TD children in auditory and cognitive tasks across all waves. Maternal education, auditory, and cognitive abilities independently predicted caregiver-reported listening skills. Significant correlations between Waves 1 and 2 confirmed high, long-term reliability. Secondary analysis of Wave 3 was consistent with the primary analyses of Waves 1 and 2, reinforcing the enduring nature of listening difficulties.

CONCLUSION

Children with LiD and clinically normal audiograms experience persistent auditory, listening, and cognitive challenges through at least adolescence. The degree of LiD can be independently predicted by maternal education, cognitive processing, and spatial listening skills. This study underscores the importance of early detection and intervention for childhood LiD and highlights the role of socioeconomic factors as contributors to these challenges.

The lived experience of hearing loss - an individualised responsibility

OBJECTIVE

This study aimed to provide a conceptual model to understand what typifies the lived experience of hearing loss.

DESIGN

A grounded theory informed study of adults with hearing loss (n = 46) who participated in individual interviews. The data were analysed in line with the constant comparative approach of grounded theory. A substantial patient and public engagement (PPIE) strategy underpinned decisions and processes throughout.

STUDY SAMPLE

Adults were recruited from age bands (16-29; 30-49;50-79 and 80 upwards) to provide different lived experience. We recruited individuals from across the UK including urban, sub-urban and rural communities and included a typical constituency of each location including black and minority ethnic participants. Our PPIE groups included adults often marginalised in research including South Asian community groups, adults in residential care and those with additional disabilities.

RESULTS

We identified the consistent features of the lived experience with hearing loss, as the individualised responsibility that hearing loss confers. These are an individual auditory lifeworld; social comparison and social support; individual and patient-centred care and individual agency and capability.

CONCLUSIONS

This work provides new insights for those practising audiology and highlights the importance of building social support systems through implementation of family and peer support approaches.

Auditory, Visual, and Cognitive Abilities in Normal-Hearing Adults, Hearing Aid Users, and Cochlear Implant Users

OBJECTIVES

Speech understanding is considered a bimodal and bidirectional process, whereby visual information (i.e., speechreading) and also cognitive functions (i.e., top-down processes) are involved. Therefore, the purpose of the present study is twofold: (1) to investigate the auditory (A), visual (V), and cognitive (C) abilities in normal-hearing individuals, hearing aid (HA) users, and cochlear implant (CI) users, and (2) to determine an auditory, visual, cognitive (AVC)-profile providing a comprehensive overview of a person's speech processing abilities, containing a broader variety of factors involved in speech understanding.

DESIGN

Three matched groups of subjects participated in this study: (1) 31 normal-hearing adults (mean age = 58.76), (2) 31 adults with moderate to severe hearing loss using HAs (mean age = 59.31), (3) 31 adults with a severe to profound hearing loss using a CI (mean age = 58.86). The audiological assessments consisted of pure-tone audiometry, speech audiometry in quiet and in noise. For evaluation of the (audio-) visual speech processing abilities, the Test for (Audio) Visual Speech perception was used. The cognitive test battery consisted of the letter-number sequencing task, the letter detection test, and an auditory Stroop test, measuring working memory and processing speed, selective attention, and cognitive flexibility and inhibition, respectively. Differences between the three groups were examined using a one-way analysis of variance or Kruskal-Wallis test, depending on the normality of the variables. Furthermore, a principal component analysis was conducted to determine the AVC-profile.

RESULTS

Normal-hearing individuals scored better for both auditory, and cognitive abilities compared to HA users and CI users, listening in a best aided condition. No significant differences were found for speech understanding in a visual condition, despite a larger audiovisual gain for the HA users and CI users. Furthermore, an AVC-profile was composed based on the different auditory, visual, and cognitive assessments. On the basis of that profile, it is possible to determine one comprehensive score for auditory, visual, and cognitive functioning. In the future, these scores could be used in auditory rehabilitation to determine specific strengths and weaknesses per individual patient for the different abilities related to the process of speech understanding in daily life.

CONCLUSIONS

It is suggested to evaluate individuals with hearing loss from a broader perspective, considering more than only the typical auditory abilities. Also, cognitive and visual abilities are important to take into account to have a more complete overview of the speech understanding abilities in daily life.

Effects of Auditory Training in Older Adults

PURPOSE

This study examines the effects of an auditory training program on the auditory and cognitive abilities of older adults. Auditory rehabilitation programs are generally designed for hearing aid users, and studies have demonstrated benefits for them. In this study, we seek to understand whether such a training program can also benefit older adults who do not wear hearing aids. We also examined if cognitive benefits can indeed be observed as a result of the training.

METHOD

Sixty-four older adults were recruited and assigned into three groups: the experimental group (n = 20), the active control group (n = 21), and the no-training control group (n = 23). The experimental group underwent an auditory training program (Listening and Communication Enhancement [LACE]) during the training phase. Meanwhile, the active control group listened to short audio clips and the no-training control group did not participate in any program. An auditory test (Quick Speech-in-Noise [QuickSIN]) and a battery of cognitive tests were conducted before and after the training to examine the participants' performance on auditory ability, short-term memory, and attention.

RESULTS

The results showed improvements in auditory and cognitive abilities during the training period. When assessing the training effects by comparing the pre- and the posttraining performances, a significant improvement on the QuickSIN task was found in the training group but not in the other two groups. However, other cognitive tests did not show any significant improvement. That is, the LACE training did not benefit short-term memory and attention. The improved performance on short-term memory during the training was not maintained in the posttraining session.

CONCLUSION

Overall, the study has extended the auditory benefit from the LACE training to the typical aging population in terms of improved communication ability, but the effect of training on auditory abilities did not transfer to gains in cognitive abilities.

Is a hybrid of online and face-to-face services feasible for audiological rehabilitation post COVID-19? Findings from three public health patients

Background: The global coronavirus disease 2019 (COVID-19) pandemic has pushed many audiologists to incorporate remote service delivery methods to adhere to mandatory health and safety protocols. The use of tele-audiology for audiological rehabilitation may provide a sustainable, cost-effective modality to suit the existing need, particularly in low-resourced countries.Objectives: This study aimed to investigate the feasibility of implementing a hybrid tele-rehabilitation programme in a South African public health context. An online auditory training (AT) programme was used to determine (1) compliance, (2) clinical benefit, (3) participant experience and (4) costs.Method: A convergent mixed methods design with a feasibility approach was utilised. Data collection was done through questionnaires, in-booth assessments, online AT, and face-to-face interviewing. Participants undertook online AT over 4 weeks. For pre- and post-online AT, the Abbreviated Profile of Hearing Aid Benefit (APHAB), QuickSIN, entrance and exit questionnaires, interviews and a system usability scale were administered.Results: Key findings of this study included (1) a high compliance rate (84.82%) with minimal clinician contact time at 3 h 25 min over 5–6-weeks; (2) improvement in perceived hearing aid (HA) benefit, and improvement in listening skills; (3) reported positive experiences; and (4) minimal programme costs at an average of R1350.00 per participant.Conclusion: The results showed positive indicators that the use of hybrid tele-rehabilitative strategies may provide a viable alternative to the traditional face-to-face modality. The hybrid approach showed clinical benefits, cost-effectiveness, minimal contact time as well as COVID-19 compliance. Further large-scale research is still needed.

[Phoneme discrimination training with experienced cochlear implant listeners]

BACKGROUND

Computer-based auditory training programmes seem to be a useful tool in the process of auditory rehabilitation after cochlear implantation (CI). Currently, little is known about the learning mechanism and efficiency of such programs. The aim of the study was to evaluate a specific auditory training programme for phoneme discrimination in experienced CI listeners.

MATERIALS AND METHODS

A total of 15 CI adult listeners with more than 2 years' CI experience participated in the auditory training. Over a period of 3 weeks they were instructed to train their phoneme discrimination via computer twice a week. Training material consisted of special syllables for consonants (vCv) and vowels (cVc) discrimination.

RESULTS

The discrimination abilities for consonants and vowels improved significantly over the training period for training group participants, whereas the changes for the consonants were higher. In addition, the improvement for voiced and unvoiced consonants was significant.

CONCLUSION

Computerised auditory training with phonemes improves CI listeners' discrimination abilities for consonants and vowels.

Temporal effects in priming of masked and degraded speech

When listeners know the content of the message they are about to hear, the clarity of distorted or partially masked speech increases dramatically. The current experiments investigated this priming phenomenon quantitatively using a same-different task where a typed caption and auditory message either matched exactly or differed by one key word. Four conditions were tested with groups of normal-hearing listeners: (a) natural speech presented in two-talker babble in a non-spatial configuration, (b) same as (a) but with the masker time reversed, (c) same as (a) but with target-masker spatial separation, and (d) vocoded sentences presented in speech-spectrum noise. The primary manipulation was the timing of the caption relative to the auditory message, which varied in 20 steps with a resolution of 200 ms. Across all four conditions, optimal performance was achieved when the initiation of the text preceded the acoustic speech signal by at least 400 ms, driven mostly by a low number of "different" responses to Same stimuli. Performance was slightly poorer with simultaneous delivery and much poorer when the auditory signal preceded the caption. Because priming may be used to facilitate perceptual learning, identifying optimal temporal conditions for priming could help determine the best conditions for auditory training.

Acquisition versus consolidation of auditory perceptual learning using mixed-training regimens

Learning is considered to consist of two distinct phases-acquisition and consolidation. Acquisition can be disrupted when short periods of training on more than one task are interleaved, whereas consolidation can be disrupted when a second task is trained after the first has been initiated. Here we investigated the conditions governing the disruption to acquisition and consolidation during mixed-training regimens in which primary and secondary amplitude modulation tasks were either interleaved or presented consecutively. The secondary task differed from the primary task in either task-irrelevant (carrier frequency) or task-relevant (modulation rate) stimulus features while requiring the same perceptual judgment (amplitude modulation depth discrimination), or shared both irrelevant and relevant features but required a different judgment (amplitude modulation rate discrimination). Based on previous literature we predicted that acquisition would be disrupted by varying the task-relevant stimulus feature during training (stimulus interference), and that consolidation would be disrupted by varying the perceptual judgment required (task interference). We found that varying the task-relevant or -irrelevant stimulus features failed to disrupt acquisition but did disrupt consolidation, whereas mixing two tasks requiring a different perceptual judgment but sharing the same stimulus features disrupted both acquisition and consolidation. Thus, a distinction between acquisition and consolidation phases of perceptual learning cannot simply be attributed to (task-relevant) stimulus versus task interference. We propose instead that disruption occurs during acquisition when mixing two tasks requiring a perceptual judgment based on different cues, whereas consolidation is always disrupted regardless of whether different stimulus features or tasks are mixed. The current study not only provides a novel insight into the underlying mechanisms of perceptual learning, but also has practical implications for the optimal design and delivery of training programs that aim to remediate perceptual difficulties.

Development of Trivia Game for speech understanding in background noise

PURPOSE

Listening in noise is an everyday activity and poses a challenge for many people. To improve the ability to understand speech in noise, a computerized auditory rehabilitation game was developed. In Trivia Game players are challenged to answer trivia questions spoken aloud. As players progress through the game, the level of background noise increases. A study using Trivia Game was conducted as a proof-of-concept investigation in healthy participants.

METHOD

College students with normal hearing were randomly assigned to a control (n = 13) or a treatment (n = 14) group. Treatment participants played Trivia Game 12 times over a 4-week period. All participants completed objective (auditory-only and audiovisual formats) and subjective listening in noise measures at baseline and 4 weeks later.

RESULT

There were no statistical differences between the groups at baseline. At post-test, the treatment group significantly improved their overall speech understanding in noise in the audiovisual condition and reported significant benefits in their functional listening abilities.

CONCLUSION

Playing Trivia Game improved speech understanding in noise in healthy listeners. Significant findings for the audiovisual condition suggest that participants improved face-reading abilities. Trivia Game may be a platform for investigating changes in speech understanding in individuals with sensory, linguistic and cognitive impairments.

Masking Release and Modulation Interference in Cochlear Implant and Simulation Listeners

Purpose

To examine the effects of temporal and spectral interference of masking noise on sentence recognition for listeners with cochlear implants (CI) and normal-hearing persons listening to vocoded signals that simulate signals processed through a CI (NH-Sim).

Method

NH-Sim and CI listeners participated in the experiments using speech and noise that were processed by bandpass filters. Depending on the experimental condition, the spectra of the maskers relative to that of speech were set to be completely embedded with, partially overlapping, or completely separate from, the speech. The maskers were either steady or amplitude modulated and were presented at +10 dB signal-to-noise ratio.

Results

NH-Sim listeners experienced progressively more masking as the masker became more spectrally overlapping with speech, whereas CI listeners experienced masking even when the masker was spectrally remote from the speech signal. Both the NH-Sim and CI listeners experienced significant modulation interference when noise was modulated at a syllabic rate (4 Hz), suggesting that listeners may experience both modulation interference and masking release. Thus, modulated noise has mixed and counteracting effects on speech perception.

Conclusion

When the NH-Sim and CI listeners with poor spectral resolution were tested using syllabic-like rates of modulated noise, they tended to integrate or confuse the noise with the speech, causing an increase in speech errors. Optional training programs might be useful for CI listeners who show more difficulty understanding speech in noise.

Computer skills and internet use in adults aged 50-74 years: influence of hearing difficulties

BACKGROUND

The use of personal computers (PCs) and the Internet to provide health care information and interventions has increased substantially over the past decade. Yet the effectiveness of such an approach is highly dependent upon whether the target population has both access and the skill set required to use this technology. This is particularly relevant in the delivery of hearing health care because most people with hearing loss are over 50 years (average age for initial hearing aid fitting is 74 years). Although PC skill and Internet use by demographic factors have been examined previously, data do not currently exist that examine the effects of hearing difficulties on PC skill or Internet use in older adults.

OBJECTIVE

To explore the effect that hearing difficulty has on PC skill and Internet use in an opportunistic sample of adults aged 50-74 years.

METHODS

Postal questionnaires about hearing difficulty, PC skill, and Internet use (n=3629) were distributed to adults aged 50-74 years through three family physician practices in Nottingham, United Kingdom. A subsample of 84 respondents completed a second detailed questionnaire on confidence in using a keyboard, mouse, and track pad. Summed scores were termed the "PC confidence index." The PC confidence index was used to verify the PC skill categories in the postal questionnaire (ie, never used a computer, beginner, and competent).

RESULTS

The postal questionnaire response rate was 36.78% (1298/3529) and 95.15% (1235/1298) of these contained complete information. There was a significant between-category difference for PC skill by PC confidence index (P<.001), thus verifying the three-category PC skill scale. PC and Internet use was greater in the younger respondents (50-62 years) than in the older respondents (63-74 years). The younger group's PC and Internet use was 81.0% and 60.9%, respectively; the older group's PC and Internet use was 54.0% and 29.8%, respectively. Those with slight hearing difficulties in the older group had significantly greater odds of PC use compared to those with no hearing difficulties (odds ratio [OR]=1.57, 95% confidence interval [CI] 1.06-2.30, P=.02). Those with moderate+ hearing difficulties had lower odds of PC use compared with those with no hearing difficulties, both overall (OR=0.58, 95% CI 0.39-0.87, P=.008) and in the younger group (OR=0.49, 95% CI 0.26-0.86, P=.008). Similar results were demonstrated for Internet use by age group (older: OR=1.57, 95% CI 0.99-2.47, P=.05; younger: OR=0.32, 95% CI 0.16-0.62, P=.001).

CONCLUSIONS

Hearing health care is of particular relevance to older adults because of the prevalence of age-related hearing loss. Our data show that older adults experiencing slight hearing difficulty have increased odds of greater PC skill and Internet use than those reporting no difficulty. These findings suggest that PC and Internet delivery of hearing screening, information, and intervention is feasible for people between 50-74 years who have hearing loss, but who would not typically present to an audiologist.

O uso de um software na (re)habilitação de crianças com deficiência auditiva

OBJETIVO: Verificar a aplicabilidade de um software na (re)habilitação de crianças com deficiência auditiva. MÉTODOS: A amostra foi composta por 17 crianças com deficiência auditiva, sendo dez usuárias de Implante Coclear (IC) e sete usuárias de Aparelho de Amplificação Sonora Individual (AASI). Foi utilizado o "Software Auxiliar na Reabilitação de Distúrbios Auditivos (SARDA)". Aplicou-se o protocolo de treinamento durante 30 minutos, duas vezes por semana, pelo tempo necessário para a finalização das estratégias que compõe software. Para mensurar a aplicabilidade do software no treinamento da habilidade de percepção da fala no silêncio e no ruído, foram realizadas avaliações com o Hearing in Noise Test (HINT) pré e pós o treinamento auditivo. Os dados foram analisados estatisticamente. RESULTADOS: O grupo de usuários de IC necessitou em média 12,2 dias para finalizar as estratégias e o grupo de usuários de AASI em média 10,14 dias. Os dois grupos apresentaram diferença entre as avaliações pré e pós no silêncio e no ruído. As crianças mais novas apresentaram maior dificuldade durante a execução das estratégias, porém não houve correlação entre a idade e o desempenho. Não houve influência do tipo do dispositivo eletrônico durante o treinamento. As crianças apresentaram maior dificuldade na estratégia que envolvia estímulos não verbais e na estratégia com estímulos verbais que treina a habilidade de atenção sustentada. A atenção e a motivação da criança durante a estimulação foram fundamentais para o bom rendimento do treinamento auditivo. CONCLUSÃO: O treinamento auditivo com o SARDA foi eficaz, pois propiciou melhora na habilidade de percepção da fala, no silêncio e no ruído, das crianças com deficiência auditiva.

Auditory Dysfunction in Alzheimer's Disease

Alzheimer's disease is neurodegenerative disorder which affects a growing number of older adults every year. With an understanding of auditory dysfunction in Alzheimer's disease, the speech-language pathologist working in the health care setting can provide better service to these individuals. The pathophysiology of the disease process in Alzheimer's disease increases the likelihood of specific types of auditory deficits as opposed to others. This article will discuss the auditory deficits in Alzheimer's disease, their implications, and the value of clinical protocols for individuals with this disease.

Treinamento auditivo: avaliação do benefício em idosos usuários de próteses auditivas

TEMA: a deficiência auditiva acarreta dificuldades na comunicação, as quais podem ser minimizadas por meio da adaptação de próteses auditivas e do treinamento auditivo. OBJETIVO: o objetivo geral deste estudo foi verificar a efetividade do treinamento auditivo em idosos novos usuários de próteses auditivas, quanto ao benefício no processo de adaptação. MÉTODO: foram selecionados 42 indivíduos, portadores de deficiência auditiva neurossensorial de grau leve a moderado, com idades entre 60 e 90 anos, novos usuários de próteses auditivas bilaterais, distribuídos em dois grupos: Grupo Experimental (GE) e Grupo Sham (GS). O GE foi submetido a um programa de treinamento auditivo em cabina acústica durante seis sessões. Ambos os grupos foram avaliados com os testes de Fala com Ruído, Escuta com Dígitos, e questionário de auto-avaliação Abbreviated Profile of Hearing Aid Benefit (APHAB), em três momentos: sem próteses (primeira avaliação), quatro semanas (segunda avaliação), e oito semanas (terceira avaliação), após a adaptação das próteses. RESULTADOS: houve diferença estatisticamente significante para os dois testes aplicados, e para o questionário Aphab (quanto ao benefício) na segunda e na terceira avaliações, nas subescalas: Facilidade de Comunicação, Reverberação e Ruído Ambiental. CONCLUSÃO: o programa de treinamento auditivo em cabina acústica foi efetivo com relação ao benefício durante o processo de adaptação das próteses auditivas.

Development and efficacy of a frequent-word auditory training protocol for older adults with impaired hearing

OBJECTIVES

The objective of this study was to evaluate the efficacy of a word-based auditory-training procedure for use with older adults who have impaired hearing. The emphasis during training and assessment is placed on words with a high frequency of occurrence in American English.

DESIGN

In this study, a repeated-measures group design was used with each of the two groups of participants to evaluate the effects of the word-based training regimen. One group comprised 20 young adults with normal hearing and the other consisted of 16 older adults with impaired hearing. The group of young adults was not included for the purpose of between-group comparisons. Rather, it was included to demonstrate the efficacy of the training regimen, should efficacy fail to be demonstrated in the group of older adults, and to estimate the magnitude of the benefits that could be achieved in younger listeners.

RESULTS

Significant improvements were observed in the group means for each of five measures of post-training assessment. Pretraining and post-training performance assessments were all based on the open-set recognition of speech in a fluctuating speech-like background noise. Assessment measures ranged from recognition of trained words and phrases produced by talkers heard during training to the recognition of untrained sentences produced by a talker not encountered during training. In addition to these group data, analysis of individual data via 95% critical differences for each assessment measure revealed that 75 to 80% of the older adults demonstrated significant improvements on most or all of the post-training measures.

CONCLUSIONS

The word-based auditory-training program examined here, one based on words having a high frequency of occurrence in American English, has been demonstrated to be efficacious in older adults with impaired hearing. Training on frequent words and frequent phrases generalized to sentences constructed from frequently occurring words whether spoken by talkers heard during training or by a novel talker.

Formal auditory training in elderly hearing aid users

It is of paramount importance to install hearing rehabilitation programs for the elderly. Aim: to check the efficacy of a forma auditory training program for elderly patients fitted with hearing aids for at least three months, by means of speech recognition tests and self-assessment questionnaires. Methods: longitudinal contemporary cohort study. We selected 13 elderly hearing aid users, using intra-canal hearing aids in both ears, from both genders, with average age of 65.3 years. This group was randomly divided in Experiment Group and Control Group. The Experiment Group underwent seven formal auditory training sessions, aiming at stimulating their hearing skills for hearing closing, memory, attention, background figure and binaural integration. The participants were assessed by three behavioral tests and one self assessment questionnaire. Results: The elderly from the Experiment Group had significantly better performance in the assessments after auditory training in comparison to the Control Group. Conclusion: the formal auditory training program in a soundproof booth, associated with the use of hearing aids, improves speech recognition performance and reduces the perception of auditory handicap for the elderly who use intra-canal hearing aids.

Variables predicting outcomes on listening and communication enhancement (LACE) training

Results from a large study of adults who completed a randomized crossover study of listening and communication enhancement (LACE) training were analysed to observe trends. The objective of this study was to determine predictors for greatest improvement following this four-week adaptive auditory training and aural rehabilitation program. Subjects with the poorest scores on the baseline tests, particularly those with the greatest degree of hearing loss, poorest scores on measures of degraded and competing speech, and those with the highest hearing handicap scores, were more likely to have greater improvement overall. However, there was considerable variability among the subjects, and some subjects' positive subjective reports belie smaller overall measured gains. Information collected from both the testing and the counseling of the patient should be taken into consideration when determining whether to proceed with LACE training.

The future of hearing aid technology

Hearing aids have advanced significantly over the past decade, primarily due to the maturing of digital technology. The next decade should see an even greater number of innovations to hearing aid technology, and this article attempts to predict in which areas the new developments will occur. Both incremental and radical innovations in digital hearing aids will be driven by research advances in the following fields: (1) wireless technology, (2) digital chip technology, (3) hearing science, and (4) cognitive science. The opportunities and limitations for each of these areas will be discussed. Additionally, emerging trends such as connectivity and individualization will also drive new technology, and these are discussed within the context of the areas given here.