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

世界卫生组织（世卫组织）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，并给失聪个人和更广泛的社会造成沉重的经济负担。目前，助听器是听力损失最常见的治疗干预形式。然而，即使在已建立以社会或保险为基础的卫生保健服务的高收入国家，助听器的使用和保留率仍然很低；尽管缺乏替代疗法和治疗方法，而且个人和社会成本巨大，但这一结果仍然存在。不考虑文化差异、医疗保健提供的经济状况，甚至是否为某人提供或购买了助听器，停止使用助听器（或一开始就不考虑使用助听器）的一个主要原因是，人们普遍认为助听器在理解背景噪音中的语音方面提供的帮助很少。由于这正是大多数听力受损的听众首先寻求帮助的问题，因此这种传递失败经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，间歇性使用可能损害听力大脑适应设备的程度，以及不可否认的事实，助听器虽然在放大声音方面发挥了足够的作用，但并没有使它们更容易区分；虽然助听器可以提供内耳受损时失去的额外的声音放大，但它们不能恢复频率分辨率（区分不同声音的能力），这伴随着对安静声音的敏感性的丧失。更复杂的是，助听器通常是为了提高纯音（纯音听力图）的可听性而安装的，很少或根本没有考虑到大多数听众需要表现的自然听音环境。虽然在一系列助听器中实施了许多提高噪音听力的假定策略，但人们对其原理和功效知之甚少，尤其是因为它们没有充分评估个人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名为“Over-Hear”的联盟，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。通过一系列的研讨会，Over-Hear将试图确定：-如何评估听力表现的最佳措施；聆听者在复杂的聆听环境中如何表现；确定助听器处理技术进步是否有效所需的证据；个别听者使用助听器的不同表现水平的范围。我们的联盟还将在一个特别设计的场所进行一项试点研究，该场所可以重现不同的声音和物理环境，同时测量行为（例如，朝向或远离声源的头部运动）和客观神经测量（例如，告诉我们助听器使用者听力和沟通能力的大脑活动）。例如，这可能会告知用户采用哪些可选择的信号处理策略（“设置”），这如何改变对复杂听力环境中语音和沟通策略的理解，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.