Over-Hear: assessing functionality of hearing aids in complex listening environments

世界卫生组织（WHO）估计，全世界约有3.6亿人患有致残性听力损失，对个人及其家庭的社会和情感健康产生重大负面影响，失去教育和就业机会，并为聋人个人和更广泛的社会带来巨大的经济负担。目前，助听器是听力损失最常见的治疗干预形式。尽管如此，即使是在高收入国家，即使有既定的基于社会或保险的医疗保健提供，助听器的使用和保留率仍然很低;尽管缺乏替代治疗和疗法以及巨大的个人和社会成本。与文化差异、医疗保健提供的经济状况或甚至是否有人已经获得或购买助听器无关，停止使用助听器（或首先不考虑使用助听器）的主要原因是人们普遍认为助听器在理解背景噪音中的语音方面作用不大。由于这正是大多数听力受损的听众首先寻求帮助的问题，因此这种失败通常导致不使用助听器也就不足为奇了。有几个原因可能导致对助听器的失望，包括对设备功能的不切实际的期望、间歇性使用可能会损害听力大脑适应设备的程度，以及不可否认的事实，即助听器虽然在放大方面发挥了足够的作用声音，但并不能使它们更容易区分彼此;虽然助听器可以提供额外的声音放大，当内耳受损时，声音会丢失，但它们不能恢复频率分辨率（区分一种声音与另一种声音的能力），这是伴随着对安静声音的敏感性丧失而发生的。这是由以下事实加剧的：助听器通常是关于增加纯音的可听度（纯音听力图）而很少或根本不考虑大多数听众需要执行的自然听力环境。虽然许多公认的增强噪声中听力的策略在一系列助听器中实施，但它们的原理和功效仅知之甚少，尤其是因为它们没有充分评估个体用户的听力和沟通策略。我们将建立一个由研究人员，工程师和临床医生组成的联盟，称为“Over-Hear”，以了解和开发评估个人听众如何在复杂的听力环境中使用助听器的最佳方法。通过一系列研讨会，Over-Hear将寻求确定：如何评估听力表现的最佳措施;听众在复杂的听力环境中的行为;确定助听器处理技术进步是否有效所需的证据;个别听众使用助听器的不同性能水平的范围。我们的合作伙伴还将在一个特别设计的竞技场进行试点研究，该竞技场可以重现不同的声音和物理环境，同时测量行为（例如头部朝向或远离声源的运动）和客观的神经测量（例如大脑活动，告诉我们助听器使用者的听力和沟通情况）。例如，这可能会告知用户使用哪些可选的信号处理策略（“设置”），这如何改变复杂听力环境中对语音和通信策略的理解，并可能导致对用户听力意图敏感的“智能”助听器的开发。

The World Health Organization (WHO) estimates around 360 million people world-wide have a disabling hearing loss, with significant negative impact on the social and emotional health of individuals and their families, lost education and employment opportunities, and a substantial economic burden for deaf individuals and broader society. Currently, hearing aids are the most common form of therapeutic intervention for hearing loss. Nonetheless, even in high-income countries with established social- or insurance-based health care provision, the uptake and retention of hearing aids remains low; this is despite the lack of alternative treatments and therapies and the enormous personal and societal cost. Independent of differences in culture, economics of health-care provision or even whether or not someone has been provided with or purchased a hearing aid, a principle reason given for stopping using them (or not considering them in the first place) is the broadly held view that they provide little in terms of understanding speech in background noise. Since this is precisely the problem for which most hearing-impaired listeners seek help in the first place, it is unsurprising that this failure to deliver often leads to non-use of hearing aids. Several reasons likely contribute to disappointment with hearing aids, including unrealistic expectations of the devices' capabilities, intermittent use potentially compromising the extent to which the hearing brain adapts to the device, and the undeniable fact that hearing aids, whilst performing an adequate job in terms of amplifying sounds, do not make them very much easier to distinguish from each other; although hearing aids can provide the extra amplification of sounds that is lost when the inner ear is damaged, they cannot restore the frequency resolution (the ability to distinguish one sound from another) that accompanies the loss of sensitivity to quiet sounds. This is compounded by the fact that hearing aids are generally fitted with respect to increasing the audibility of pure tones (the pure-tone audiogram) with little or no regard to the natural listening environments in which most listeners need to perform. Although many putative strategies for enhancing listening in noise are implemented across a range of hearing aids, their rationale and their efficacy are only poorly understood, not least because they are inadequately assessed with respect to individual users' listening and communication strategies. We will establish a consortium of researchers, engineers and clinicians called 'Over-Hear' in order to understand and develop the best means of assessing how individual listeners utilise their hearing aids in complex listening environments. Through a series of Workshops, Over-Hear will seek to determine:- how best measures of listening performance can be assessed; how listeners behave in complex listening environments; the evidence needed to determine whether technological advances in hearing-aid processing are effective; the range of different performance levels in hearing-aid use by individual listeners. Our consortium will also conduct a Pilot Study in a specially designed arena that can recreate different sound and physical environments whilst simultaneously measuring behavioural (e.g. head movements towards or away from sound sources) and objective neural measures (e.g. brain activity that informs us as to how well hearing-aid users are listening and communicating). This might inform, for example, which selectable signal-processing strategies ('settings') a user employs, how this alters understanding of speech and communication strategies in complex listening environments, and could lead to the development of 'smart' hearing aids sensitive to users' listening intentions.