From Healthy Hearing to Healthy Living: A Holistic Approach

Viewpoint on the Benefit of Hearing Care on Cognitive Health

PURPOSE

The purpose of this article is to provide a viewpoint on the recently published results showing the positive effect hearing intervention can have on mitigating the risk of cognitive decline in elderly individuals with hearing impairment. We intend to trigger a broader discussion on the implications of these results from an implementation science perspective.

METHODS

Recently published results were reviewed and contextualized.

RESULTS

In our view, these recent findings provide a great opportunity for hearing care professionals to change the perspective on hearing care being an essential service that contributes not only to managing challenges with audibility but to enabling healthy living and aging.

CONCLUSION

As exciting as these findings are, from our perspective, they are also a call to action for the audiology field in terms of clinical implementation science. The findings guide us toward a more interprofessional approach in order to develop and test new, more holistic models of hearing care.

Does social isolation mediate the association between hearing loss and cognition in adults? A systematic review and meta-analysis of longitudinal studies

Background

There has been extensive research on the relationship between hearing and cognitive impairment in older adults but little examination of the role of mediating factors. Social isolation is a potential mediator, occurring because of hearing loss, and contributing to accelerated cognitive decline. Previous systematic reviews on this topic area have not considered the temporal nature of hearing loss and cognitive impairment exclusively or examined potential mediators within a longitudinal study design.

Methods

A systematic review was conducted. Electronic searches were performed in Web of Science, PubMed (Medline), Scopus, EMBASE, PsychInfo, and ProQuest (PsychArticles and ProQuest Dissertation and Theses) based on a search string of keywords relating to hearing loss, social isolation, and cognitive impairment/dementia in June 2023. Papers were critically appraised using the CASP checklists for cohort studies. Risk of bias in the selected studies was assessed using the Item Bank for Assessment of Risk of Bias and Precision for Observational Studies of Interventions or Exposures.

Results

Eleven of the 15 included studies provide evidence of a dose-dependent association between hearing threshold (40 dB HL or greater) and later cognitive impairment or incident dementia. Only one study included social isolation as a mediator, which was found to not be a significant contributing factor. The meta-analysis of 5 studies pooled hazard ratio for cognitive impairment due to hearing loss is 1.11 (95% CI: 1.06 to 1.15, p < 0.001). The pooled hazard ratio for incident dementia due to hearing loss was HR 1.21 (95% CI: 1.11 to 1.31, p = 0.002).

Conclusion

The analysis of included studies indicate that hearing threshold level affects later cognitive status or dementia diagnosis. There is not enough evidence to determine the role of social isolation as a mediator. Future epidemiology studies need to measure different elements of social isolation and ensure that hearing and cognition are measured at multiple time points.

Variability in clinicians' prediction accuracy for outcomes of adult cochlear implant users

OBJECTIVE

The variability in outcomes among adult cochlear implant (CI) users poses challenges for clinicians in accurately predicting the benefits of the implant for individual candidates. This study aimed to investigate the accuracy and confidence of clinicians in predicting speech perception outcomes for adult CI users one-year post-implantation.

DESIGN

Participants were presented with comprehensive information on pre-implantation, one-month post-implantation, and six-month post-implantation data for 10 case studies. The cases encompassed a range of one-year post-implantation phoneme scores, from low performers (27%) to high performers (92%). Participants were tasked with predicting the speech perception outcomes for these cases one year after implantation.

STUDY SAMPLE

Forty-one clinicians completed the full outcome prediction survey.

RESULTS

Our findings revealed a significant over-prediction of low performance by clinicians. Interestingly, clinicians tended to predict average performance (73-76% phoneme score) even when provided with information suggesting lower-than-average performance. Most clinicians expressed confidence in their predictions, irrespective of their accuracy.

CONCLUSIONS

Identifying signs of low performance, particularly in the early post-implantation period, can enable clinicians to implement early interventions. Further research into accurate outcome prediction is essential for managing expectations, providing counselling, increasing CI adoption, and optimising clinical care for both high and low performers.

Association between hearing loss and trauma based on population data of Korea

BACKGROUND

Although several studies have been conducted to assess the association between hearing loss (HL) and trauma, no studies have analyzed trauma comprehensively based on population-based data.

OBJECTIVES

To investigate the association between HL and trauma in daily life using National Health Insurance Service National Sample Cohort data of Korea.

MATERIALS AND METHODS

People who were registered with severe or mild hearing disability by the Korean government from 2002 to 2015, were included in this study. Trauma was defined as an outpatient visit or admission under diagnostic codes associated with trauma. The risk for trauma was analyzed using multiple logistic regression model.

RESULTS

There were 5,114 subjects in the mild hearing disability group and 1,452 in the severe hearing disability group. The risk for trauma was significantly higher in the mild and severe hearing disability groups than in the control group. The risk was higher in the mild hearing disability group than in the severe hearing disability group.

CONCLUSIONS AND SIGNIFICANCE

Individuals with hearing disability are at a higher risk for trauma based on population-based data in Korea, which indicates that HL increases the risk for trauma.

Conversations about mental illness and health in adult audiological rehabilitation

OBJECTIVE

To understand the nature of mental health discussions in audiological rehabilitation, specifically, the types of conversations, when and how they are initiated, and the participant factors associated with discussing mental health.

DESIGN

A cross-sectional descriptive survey including quantitative (multiple choice) and qualitative (free-text) questions regarding mental health discussions between audiologists and clients.

STUDY SAMPLE

A convenience sample of 118 Australian audiologists working in adult audiological rehabilitation.

RESULTS

The majority of participants (95.8%) reported having engaged in discussions with clients about mental illness and health at some point throughout their career. The frequency of these discussions varied across participants: 7% rarely discuss, 50% discuss occasionally, 30% discuss with about half their clients and 13% have discussions with most clients. Many participants (85.6%) reported that clients would initiate these conversations, most often via disclosing the impacts of hearing loss on clients' lives.

CONCLUSIONS

Most audiologists will encounter clients with mental health concerns, and many will engage in conversations about psychological symptoms, therefore, training audiologists to recognise and address verbal and non-verbal cues regarding mental health may help to promote person-centred care and potentially improve outcomes.

Cellular autophagy, the compelling roles in hearing function and dysfunction

Sensorineural hearing loss (SNHL) is currently a major health issue. As one of the most common neurodegenerative diseases, SNHL is associated with the degradation of hair cells (HCs), spiral ganglion neurons (SGNs), the stria vascularis, supporting cells and central auditory system cells. Autophagy is a highly integrated cellular system that eliminates impaired components and replenishes energy to benefit cellular homeostasis. Etiological links between autophagy alterations and neurodegenerative diseases, such as SNHL, have been established. The hearing pathway is complex and depends on the comprehensive functions of many types of tissues and cells in auditory system. In this review, we discuss the roles of autophagy in promoting and inhibiting hearing, paying particular attention to specific cells in the auditory system, as discerned through research. Hence, our review provides enlightening ideas for the role of autophagy in hearing development and impairment.

Factors influencing the stages of frailty among Korean older adults focusing on objective and subjective social isolation

BACKGROUND

Although many studies have investigated the factors influencing frailty, few studies have confirmed the influence of social factors on the stages of frailty. This study was conducted to identify factors influencing the stages of frailty in Korean older adults, focusing on objective and subjective social isolation.

METHODS

This study analyzed the data of 10,041 older adults from the 2017 National Survey of Older Koreans. Two multiple logistic regression analyses were performed to identify the factors influencing the frailty stages. Frailty was calculated using the FRAIL scale with the five domains: fatigue, resistance, ambulation, illness, and loss of weight.

RESULTS

Among Korean older adults, 51.5% were in the robust stage, 42.5% in the pre-frail stage and 6.0% in the frail stage. As a multiple logistic regression analysis, participants with an intimate relationship (Odds ratio (OR) 0.93, 95% Confidential interval (CI) = 0.91-0.95) or objective social non-isolated participants were more likely to be in the robust group than the pre-frail group. Objective social-isolated participants were more likely to belong to the frail group than the pre-frail group: isolation from family member only (OR 1.57, 95% CI = 1.04-2.39), isolation from non-family member only (OR 1.75, 95% CI = 1.39-2.19), and isolation from both family and non-family member (OR 2.56, 95% CI = 1.67-3.92).

CONCLUSIONS

This cross-sectional study showed that social isolation was associated with the stage of frailty. Therefore, researchers need to consider issues of social isolation of older adults in the development of frailty prevention and management intervention.

Test Your Health at Home: Comparing Online Screening Tests of Hearing, Cognition, and Cardiovascular Health

PURPOSE

The purpose of this study was to investigate the extent to which validated online screening measures of cognitive impairment, psychosocial well-being, and cardiovascular health are associated with a validated hearing screener in a sample of adults based in the United Kingdom.

METHOD

Sixty-one adults (43 female; M _age = 44.7 years) participated in a cross-sectional study delivered remotely. Participants completed the hearWHO smartphone application, a digits-in-noise hearing screener, and the Modified Telephone Interview for Cognitive Status (TICS-M), a screening tool for cognitive impairment. Psychosocial well-being (social isolation and loneliness) and cardiovascular health were assessed through self-report.

RESULTS

Separate independent analyses of variance, with age, gender, and education as covariates, demonstrated participants who failed the hearWHO screener had poorer scores on the TICS-M, engaged in less physical activity, and reported more sedentary behavior and greater social isolation. Multivariate regression analyses revealed that lower TICS-M scores, having obtained less education, identifying as female, and reporting greater sedentary behavior and social isolation were the strongest predictors of lower hearWHO scores.

CONCLUSIONS

The results from this study suggest that poorer hearing, as measured by the hearWHO screener, is independently associated with having worse cognitive function, more time spent being sedentary, and greater social isolation. Thus, this study demonstrates the potential of online screening measures to identify additional health conditions that confer risk to chronic disease as hearing loss manifests. This could help to inform the development of tailored treatment and support to improve an individual's readiness to seek help for and manage both their general and hearing health.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19251956.

The Virtual Reality Lab: Realization and Application of Virtual Sound Environments

To assess perception with and performance of modern and future hearing devices with advanced adaptive signal processing capabilities, novel evaluation methods are required that go beyond already established methods. These novel methods will simulate to a certain extent the complexity and variability of acoustic conditions and acoustic communication styles in real life. This article discusses the current state and the perspectives of virtual reality technology use in the lab for designing complex audiovisual communication environments for hearing assessment and hearing device design and evaluation. In an effort to increase the ecological validity of lab experiments, that is, to increase the degree to which lab data reflect real-life hearing-related function, and to support the development of improved hearing-related procedures and interventions, this virtual reality lab marks a transition from conventional (audio-only) lab experiments to the field. The first part of the article introduces and discusses the notion of the communication loop as a theoretical basis for understanding the factors that are relevant for acoustic communication in real life. From this, requirements are derived that allow an assessment of the extent to which a virtual reality lab reflects these factors, and which may be used as a proxy for ecological validity. The most important factor of real-life communication identified is a closed communication loop among the actively behaving participants. The second part of the article gives an overview of the current developments towards a virtual reality lab at Oldenburg University that aims at interactive and reproducible testing of subjects with and without hearing devices in challenging communication conditions. The extent to which the virtual reality lab in its current state meets the requirements defined in the first part is discussed, along with its limitations and potential further developments. Finally, data are presented from a qualitative study that compared subject behavior and performance in two audiovisual environments presented in the virtual reality lab-a street and a cafeteria-with the corresponding field environments. The results show similarities and differences in subject behavior and performance between the lab and the field, indicating that the virtual reality lab in its current state marks a step towards more ecological validity in lab-based hearing and hearing device research, but requires further development towards higher levels of ecological validity.

The Quest for Ecological Validity in Hearing Science: What It Is, Why It Matters, and How to Advance It

Ecological validity is a relatively new concept in hearing science. It has been cited as relevant with increasing frequency in publications over the past 20 years, but without any formal conceptual basis or clear motive. The sixth Eriksholm Workshop was convened to develop a deeper understanding of the concept for the purpose of applying it in hearing research in a consistent and productive manner. Inspired by relevant debate within the field of psychology, and taking into account the World Health Organization's International Classification of Functioning, Disability, and Health framework, the attendees at the workshop reached a consensus on the following definition: "In hearing science, ecological validity refers to the degree to which research findings reflect real-life hearing-related function, activity, or participation." Four broad purposes for striving for greater ecological validity in hearing research were determined: A (Understanding) better understanding the role of hearing in everyday life; B (Development) supporting the development of improved procedures and interventions; C (Assessment) facilitating improved methods for assessing and predicting ability to accomplish real-world tasks; and D (Integration and Individualization) enabling more integrated and individualized care. Discussions considered the effects of variables and phenomena commonly present in hearing-related research on the level of ecological validity of outcomes, supported by examples from a few selected outcome domains and for different types of studies. Illustrated with examples, potential strategies were offered for promoting a high level of ecological validity in a study and for how to evaluate the level of ecological validity of a study. Areas in particular that could benefit from more research to advance ecological validity in hearing science include: (1) understanding the processes of hearing and communication in everyday listening situations, and specifically the factors that make listening difficult in everyday situations; (2) developing new test paradigms that include more than one person (e.g., to encompass the interactive nature of everyday communication) and that are integrative of other factors that interact with hearing in real-life function; (3) integrating new and emerging technologies (e.g., virtual reality) with established test methods; and (4) identifying the key variables and phenomena affecting the level of ecological validity to develop verifiable ways to increase ecological validity and derive a set of benchmarks to strive for.

Changing the narrative for hearing health in the broader context of healthy living: a call to action

OBJECTIVE

To discuss the steps necessary to facilitate hearing health care in the context of well-being and healthy living.

DESIGN

Common themes among the articles in this special supplement of the International Journal of Audiology were used to identify issues that must be addressed if audiology is to move from being hearing-focussed to taking a holistic perspective of hearing care in the context of healthy aging. These are discussed within the context of other published literature.

RESULTS AND CONCLUSIONS

Three needs were identified: (i) Increased interdisciplinary education to raise awareness of the interplay between hearing and health. (ii) Increased emphasis on counselling education in audiology programs so that audiologists are equipped with the knowledge, competence and confidence to provide counselling and emotional support to their patients, beyond care. (iii) Redefinition of therapeutic goal setting and hearing outcomes to include aspects of well-being, so that audiologists can capture and patients realise that that good hearing outcomes can have a direct positive impact on a person's quality of life that extends beyond their improved ability to hear. It was emphasised that each of these needs to be considered within the context of the audiologists' scope of practice and audiologists' well-being.