Helen Henshaw - Academia.edu (original) (raw)

Papers by Helen Henshaw

Trends in Hearing

Tinnitus is the perception of sound in the absence of a corresponding external sound source, and ... more Tinnitus is the perception of sound in the absence of a corresponding external sound source, and bothersome tinnitus has been linked to poorer cognitive performance. This review comprehensively quantifies the association between tinnitus and different domains of cognitive performance. The review protocol was preregistered and published in a peer-reviewed journal. The review and analyses were reported according to Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Peer-reviewed literature was searched using electronic databases to find studies featuring participants with tinnitus who had undertaken measures of cognitive performance. Studies were assessed for quality and categorized according to an established cognitive framework. Random-effects meta-analyses were performed on various cognitive domains with potential moderator variables assessed where possible. Thirty-eight records were included in the analysis from a total of 1,863 participants. Analyses sh...

Trends in Hearing

This systematic review and meta-analysis examined the efficacy of auditory training and cognitive... more This systematic review and meta-analysis examined the efficacy of auditory training and cognitive training to improve cognitive function in adults with hearing loss. A literature search of academic databases (e.g., MEDLINE, Scopus) and gray literature (e.g., OpenGrey) identified relevant articles published up to January 25, 2018. Randomized controlled trials (RCTs) or repeated measures designs were included. Outcome effects were computed as Hedge's g and pooled using random-effects meta-analysis (PROSPERO: CRD42017076680). Nine studies, five auditory training, and four cognitive training met the inclusion criteria. Following auditory training, the pooled effect was small and statistically significant for both working memory (g ¼ 0.21; 95% CI [0.05, 0.36]) and overall cognition (g ¼ 0.19; 95% CI [0.07, 0.31]). Following cognitive training, the pooled effect for working memory was small and statistically significant (g ¼ 0.34; 95% CI [0.16, 0.53]), and the pooled effect for overall cognition was large and significant (g ¼ 1.03; 95% CI [0.41, 1.66]). However, this was dependent on the classification of training approach. Sensitivity analyses revealed no statistical difference between the effectiveness of auditory and cognitive training for improving cognition upon removal of a study that used a combined auditory-cognitive approach, which showed a very large effect. Overall certainty in the estimation of effect was ''low'' for auditory training and ''very low'' for cognitive training. High-quality RCTs are needed to determine which training stimuli will provide optimal conditions to improve cognition in adults with hearing loss.

BMJ Open

ObjectiveTo determine research priorities in hyperacusis that key stakeholders agree are the most... more ObjectiveTo determine research priorities in hyperacusis that key stakeholders agree are the most important.Design/settingA priority setting partnership using two international surveys, and a UK prioritisation workshop, adhering to the six-staged methodology outlined by the James Lind Alliance.ParticipantsPeople with lived experience of hyperacusis, parents/carers, family and friends, educational professionals and healthcare professionals who support and/or treat adults and children who experience hyperacusis, including but not limited to surgeons, audiologists, psychologists and hearing therapists.MethodsThe priority setting partnership was conducted from August 2017 to July 2018. An international identification survey asked respondents to submit any questions/uncertainties about hyperacusis. Uncertainties were categorised, refined and rephrased into representative indicative questions using thematic analysis techniques. These questions were verified as ‘unanswered’ through searche...

ABTRACT Introduction: Hearing loss is a chronic condition affecting 11 million individuals in the... more ABTRACT Introduction: Hearing loss is a chronic condition affecting 11 million individuals in the UK. People with hearing loss regularly experience difficulties interacting in everyday conversations. These difficulties in communication can result in a person with hearing loss withdrawing from social situations and becoming isolated. While hearing health loss research has largely deployed quantitative methods to investigate various aspects of the condition, qualitative research is becoming more widespread. Grounded theory is a specific qualitative methodology that has been used to establish novel theories on the experiences of living with hearing loss. Method and analysis: The aim of this systematic review is to establish how grounded theory has been applied to investigate the psychosocial aspects of hearing loss. Methods are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) 2015 checklist. Studies included in this revie...

Trends in Hearing

Published studies assessing the association between cognitive performance and speech-in-noise (Si... more Published studies assessing the association between cognitive performance and speech-in-noise (SiN) perception examine different aspects of each, test different listeners, and often report quite variable associations. By examining the published evidence base using a systematic approach, we aim to identify robust patterns across studies and highlight any remaining gaps in knowledge. We limit our assessment to adult unaided listeners with audiometric profiles ranging from normal hearing to moderate hearing loss. A total of 253 articles were independently assessed by two researchers, with 25 meeting the criteria for inclusion. Included articles assessed cognitive measures of attention, memory, executive function, IQ, and processing speed. SiN measures varied by target (phonemes or syllables, words, and sentences) and masker type (unmodulated noise, modulated noise, >2-talker babble, and 42-talker babble. The overall association between cognitive performance and SiN perception was r ¼.31. For component cognitive domains, the association with (pooled) SiN perception was as follows: processing speed (r ¼.39), inhibitory control (r ¼.34), working memory (r ¼.28), episodic memory (r ¼.26), and crystallized IQ (r ¼.18). Similar associations were shown for the different speech target and masker types. This review suggests a general association of r&.3 between cognitive performance and speech perception, although some variability in association appeared to exist depending on cognitive domain and SiN target or masker assessed. Where assessed, degree of unaided hearing loss did not play a major moderating role. We identify a number of cognitive performance and SiN perception combinations that have not been tested and whose future investigation would enable further fine-grained analyses of these relationships.

Perspectives of the ASHA Special Interest Groups

Purpose The aim of this research was to develop and evaluate methods to address poor knowledge of... more Purpose The aim of this research was to develop and evaluate methods to address poor knowledge of hearing aids, hearing loss, and communication in patients, partners, and nonaudiologic health and social care professionals. Method An interactive multimedia educational program (C2Hear) has been co-produced with hearing aid users and audiologists to provide high-quality information and demonstrate complex concepts relating to hearing aids and communication. Results A randomized controlled trial showed numerous benefits for first-time hearing aid users that included better knowledge and skill, and increased hearing aid use and satisfaction. Patients reported that C2Hear was highly useful, enjoyable, and preferable to written information. C2Hear Online is now freely available on YouTube and has global reach, well in excess of 150,000 views. Further developments include a version for communication partners, which showed that joint-working between hearing aid users and their communication ...

Seminars in Hearing

More than a decade after Arthur Boothroyd published “Adult Aural Rehabilitation: What Is It and D... more More than a decade after Arthur Boothroyd published “Adult Aural Rehabilitation: What Is It and Does It Work?,” the four cornerstones of adult aural rehabilitation are re-examined in terms of research that we and others in the field have undertaken. The focus is on novel advances in high-quality research relating to interventions to support self-management for hearing aids and other listening devices (sensory management), knowledge and skill (instruction), auditory and cognitive training (perceptual training), and motivational engagement (counseling). Much of this new research has a theoretical underpinning (e.g., behavior change theory) to better guide the development and evaluation of interventions, with a focus on self-management and patient-centered approaches. New and emerging technologies that support e- and m-health delivery of interventions provide greater personalization and interactivity to promote self-management of hearing loss. Looking to the future, there remains a req...

BMJ open, Jan 13, 2018

Subjective tinnitus is very common and has a number of comorbid associations including depression... more Subjective tinnitus is very common and has a number of comorbid associations including depression, sleep disturbance and concentration difficulties. Concentration difficulties may be observable in people with tinnitus through poorer behavioural performance in tasks thought to measure specific cognitive domains such as attention and memory (ie, cognitive performance). Several reviews have discussed the association between tinnitus and cognition; however, none to date have investigated the association between tinnitus and cognitive performance through meta-analysis with reference to an established theoretical taxonomy. Furthermore, there has been little overlap between sets of studies that have been included in previous reviews, potentially contributing to the typically mixed findings that are reported. This systematic review aims to comprehensively review the literature using an established theoretical taxonomy and quantitatively synthesise relevant data to determine associations bet...

International journal of audiology, 2016

In recent years, there has been an increase in the application of behavioural models, such as soc... more In recent years, there has been an increase in the application of behavioural models, such as social cognition models, to the promotion of hearing health. Despite this, there exists a well-developed body of literature that suggests such models may fail to consistently explain reliable amounts of variability in human behaviours. This paper provides a summary of this research across selected models of health-related behaviour, outlining the current state of the evidence. Recent work in the field of behaviour change is presented together with commentary on the design and reporting of behaviour change interventions. We propose that attempts to use unreliable models to explain and predict hearing health behaviours should now be replaced by work which integrates the latest in behaviour change science, such as the Behaviour Change Wheel and Theoretical Domains Framework.

International journal of audiology, 2016

Background: Auditory training involves active listening to auditory stimuli and aims to improve p... more Background: Auditory training involves active listening to auditory stimuli and aims to improve performance in auditory tasks. As such, auditory training is a potential intervention for the management of people with hearing loss. Objective: This systematic review (PROSPERO 2011: CRD42011001406) evaluated the published evidence-base for the efficacy of individual computer-based auditory training to improve speech intelligibility, cognition and communication abilities in adults with hearing loss, with or without hearing aids or cochlear implants. Methods: A systematic search of eight databases and key journals identified 229 articles published since 1996, 13 of which met the inclusion criteria. Data were independently extracted and reviewed by the two authors. Study quality was assessed using ten pre-defined scientific and intervention-specific measures. Results: Auditory training resulted in improved performance for trained tasks in 9/10 articles that reported on-task outcomes. Although significant generalisation of learning was shown to untrained measures of speech intelligibility (11/13 articles), cognition (1/1 articles) and self-reported hearing abilities (1/2 articles), improvements were small and not robust. Where reported, compliance with computer-based auditory training was high, and retention of learning was shown at posttraining follow-ups. Published evidence was of very-low to moderate study quality. Conclusions: Our findings demonstrate that published evidence for the efficacy of individual computer-based auditory training for adults with hearing loss is not robust and therefore cannot be reliably used to guide intervention at this time. We identify a need for high-quality evidence to further examine the efficacy of computer-based auditory training for people with hearing loss.

International journal of audiology, Jan 12, 2016

This study explored the psychosocial experiences of adults with hearing loss using the self-regul... more This study explored the psychosocial experiences of adults with hearing loss using the self-regulatory model as a theoretical framework. The primary components of the model, namely cognitive representations, emotional representations, and coping responses, were examined. Individual semi-structured interviews were conducted. The data were analysed using an established thematic analysis procedure. Twenty-five adults with mild-moderate hearing loss from the UK and nine hearing healthcare professionals from the UK, USA, and Canada were recruited via maximum variation sampling. Cognitive representations: Most participants described their hearing loss as having negative connotations and consequences, although they were not particularly concerned about the progression or controllability/curability of the condition. Opinions differed regarding the benefits of understanding the causes of one's hearing loss in detail. Emotional representations: negative emotions dominated, although some e...

Background: Auditory training involves active listening to auditory stimuli and aims to improve p... more Background: Auditory training involves active listening to auditory stimuli and aims to improve performance in auditory tasks. As such, auditory training is a potential intervention for the management of people with hearing loss. Objective: This systematic review (PROSPERO 2011: CRD42011001406) evaluated the published evidence-base for the efficacy of individual computer-based auditory training to improve speech intelligibility, cognition and communication abilities in adults with hearing loss, with or without hearing aids or cochlear implants. Methods: A systematic search of eight databases and key journals identified 229 articles published since 1996, 13 of which met the inclusion criteria. Data were independently extracted and reviewed by the two authors. Study quality was assessed using ten pre-defined scientific and intervention-specific measures. Results: Auditory training resulted in improved performance for trained tasks in 9/10 articles that reported on-task outcomes. Although significant generalisation of learning was shown to untrained measures of speech intelligibility (11/13 articles), cognition (1/1 articles) and self-reported hearing abilities (1/2 articles), improvements were small and not robust. Where reported, compliance with computer-based auditory training was high, and retention of learning was shown at posttraining follow-ups. Published evidence was of very-low to moderate study quality. Conclusions: Our findings demonstrate that published evidence for the efficacy of individual computer-based auditory training for adults with hearing loss is not robust and therefore cannot be reliably used to guide intervention at this time. We identify a need for high-quality evidence to further examine the efficacy of computer-based auditory training for people with hearing loss.

Auditory training is an intervention that aims to improve auditory performance and help alleviate... more Auditory training is an intervention that aims to improve auditory performance and help alleviate the difficulties associated with hearing loss. To be an effective intervention, any task-specific learning needs to transfer to functional benefits in real-world listening. A randomised controlled trial of 44 adults with mild sensorineural hearing loss showed significant on-task learning for a trained phoneme discrimination task (p<.001). Transfer of learning to improvements in untrained measures was shown for self-reported listening, particularly for a complex listening condition (p≤.001) and complex cognitive tasks that indexed executive function (divided attention p<.001, working memory updating p<.01). No improvements were shown for untrained sentences in modulated noise, nor for simple cognitive tasks. A second study aimed to identify optimal outcome measures to assess the benefits of auditory training for people with hearing loss. Thirty existing hearing aid users with mi...

Research has shown that speech-in-noise tasks are challenging to individuals with hearing loss (L... more Research has shown that speech-in-noise tasks are challenging to individuals with hearing loss (Lorenzi et al 2006). If people expose themselves to loud music, they could develop noise-induced hearing loss. This is important when we consider that young people regularly listen to music and may not appreciate the potential damage being caused to their hearing. It could be useful to educate the public on the risks of developing noise-induced hearing loss and enable people to understand the communication problems associated with hearing difficulties. We describe a pilot study and possible intervention which could be used within schools and universities to educate young people of the difficulties of understanding speech in noisy environments and potential risks they could face in developing noise-induced hearing loss. Thirty-one participants aged between 28 and 64 years were recruited at an open day at Nottingham University. All of the participants reported normal hearing. The speech stimuli were recorded in a soundproof booth. To listen to these, see file 1 (instructions 1^5). Participants heard a list of 5 instructions over Sennheiser HD 25-1 II headphones via a laptop computer. In the masked conditions, the noise was presented at 75 dB. In condition 1 (no masker), the speech was presented at 85 dB (AE5 dB). In condition 2 (moderate difficulty) and 3 (high difficulty), the speech was presented at 82 dB (AE5 dB) and 78 dB (AE5 dB), respectively. Participants were randomly allocated to one of the three conditions: fourteen in condition 1; ten in condition 2; ten in condition 3. The participants were told that they would hear a list of 5 instructions over headphones that would require them to draw an image. Participants in the masked conditions were told that they would hear a rushing sound whilst listening to the instructions. They were asked to ignore this and focus on what the speaker told them to draw. Once the drawings were completed, they were given the opportunity to hear the instructions again in the presence of the masker (if they were allocated to the no-masker condition) or without the masker (if they were allocated to the mediumdifficulty or high-difficulty condition). This gave participants in the masked conditions the opportunity to hear the instructions clearly and observe their performance. Figure 1 (top of the figure) shows a representation of the clock participants should have produced and was shown to them at the end of the study. Participants completed the task in approximately 5 min.

Journal of Medical Internet Research, 2012

Background: The use of personal computers (PCs) and the Internet to provide health care informati... more 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.

Ear and Hearing, 2014

The efficacy of phoneme discrimination training for enhancing hearing and related cognitive abili... more The efficacy of phoneme discrimination training for enhancing hearing and related cognitive abilities in a typical, pre-hearing aid population was evaluated. Significant and robust on-task learning was demonstrated. Benefits of training were seen in reduced hearing disability, particularly in complex listening environments, and in improved attention and working memory. These benefits were retained for at least four weeks post-training. Compliance with homedelivered training was high. Auditory training thus provided modest benefit for complex and challenging skills that are relevant for listening in realistic environments.

Trends in Hearing

Tinnitus is the perception of sound in the absence of a corresponding external sound source, and ... more Tinnitus is the perception of sound in the absence of a corresponding external sound source, and bothersome tinnitus has been linked to poorer cognitive performance. This review comprehensively quantifies the association between tinnitus and different domains of cognitive performance. The review protocol was preregistered and published in a peer-reviewed journal. The review and analyses were reported according to Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Peer-reviewed literature was searched using electronic databases to find studies featuring participants with tinnitus who had undertaken measures of cognitive performance. Studies were assessed for quality and categorized according to an established cognitive framework. Random-effects meta-analyses were performed on various cognitive domains with potential moderator variables assessed where possible. Thirty-eight records were included in the analysis from a total of 1,863 participants. Analyses sh...

Trends in Hearing

This systematic review and meta-analysis examined the efficacy of auditory training and cognitive... more This systematic review and meta-analysis examined the efficacy of auditory training and cognitive training to improve cognitive function in adults with hearing loss. A literature search of academic databases (e.g., MEDLINE, Scopus) and gray literature (e.g., OpenGrey) identified relevant articles published up to January 25, 2018. Randomized controlled trials (RCTs) or repeated measures designs were included. Outcome effects were computed as Hedge's g and pooled using random-effects meta-analysis (PROSPERO: CRD42017076680). Nine studies, five auditory training, and four cognitive training met the inclusion criteria. Following auditory training, the pooled effect was small and statistically significant for both working memory (g ¼ 0.21; 95% CI [0.05, 0.36]) and overall cognition (g ¼ 0.19; 95% CI [0.07, 0.31]). Following cognitive training, the pooled effect for working memory was small and statistically significant (g ¼ 0.34; 95% CI [0.16, 0.53]), and the pooled effect for overall cognition was large and significant (g ¼ 1.03; 95% CI [0.41, 1.66]). However, this was dependent on the classification of training approach. Sensitivity analyses revealed no statistical difference between the effectiveness of auditory and cognitive training for improving cognition upon removal of a study that used a combined auditory-cognitive approach, which showed a very large effect. Overall certainty in the estimation of effect was ''low'' for auditory training and ''very low'' for cognitive training. High-quality RCTs are needed to determine which training stimuli will provide optimal conditions to improve cognition in adults with hearing loss.

BMJ Open

ObjectiveTo determine research priorities in hyperacusis that key stakeholders agree are the most... more ObjectiveTo determine research priorities in hyperacusis that key stakeholders agree are the most important.Design/settingA priority setting partnership using two international surveys, and a UK prioritisation workshop, adhering to the six-staged methodology outlined by the James Lind Alliance.ParticipantsPeople with lived experience of hyperacusis, parents/carers, family and friends, educational professionals and healthcare professionals who support and/or treat adults and children who experience hyperacusis, including but not limited to surgeons, audiologists, psychologists and hearing therapists.MethodsThe priority setting partnership was conducted from August 2017 to July 2018. An international identification survey asked respondents to submit any questions/uncertainties about hyperacusis. Uncertainties were categorised, refined and rephrased into representative indicative questions using thematic analysis techniques. These questions were verified as ‘unanswered’ through searche...

ABTRACT Introduction: Hearing loss is a chronic condition affecting 11 million individuals in the... more ABTRACT Introduction: Hearing loss is a chronic condition affecting 11 million individuals in the UK. People with hearing loss regularly experience difficulties interacting in everyday conversations. These difficulties in communication can result in a person with hearing loss withdrawing from social situations and becoming isolated. While hearing health loss research has largely deployed quantitative methods to investigate various aspects of the condition, qualitative research is becoming more widespread. Grounded theory is a specific qualitative methodology that has been used to establish novel theories on the experiences of living with hearing loss. Method and analysis: The aim of this systematic review is to establish how grounded theory has been applied to investigate the psychosocial aspects of hearing loss. Methods are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) 2015 checklist. Studies included in this revie...

Trends in Hearing

Published studies assessing the association between cognitive performance and speech-in-noise (Si... more Published studies assessing the association between cognitive performance and speech-in-noise (SiN) perception examine different aspects of each, test different listeners, and often report quite variable associations. By examining the published evidence base using a systematic approach, we aim to identify robust patterns across studies and highlight any remaining gaps in knowledge. We limit our assessment to adult unaided listeners with audiometric profiles ranging from normal hearing to moderate hearing loss. A total of 253 articles were independently assessed by two researchers, with 25 meeting the criteria for inclusion. Included articles assessed cognitive measures of attention, memory, executive function, IQ, and processing speed. SiN measures varied by target (phonemes or syllables, words, and sentences) and masker type (unmodulated noise, modulated noise, >2-talker babble, and 42-talker babble. The overall association between cognitive performance and SiN perception was r ¼.31. For component cognitive domains, the association with (pooled) SiN perception was as follows: processing speed (r ¼.39), inhibitory control (r ¼.34), working memory (r ¼.28), episodic memory (r ¼.26), and crystallized IQ (r ¼.18). Similar associations were shown for the different speech target and masker types. This review suggests a general association of r&.3 between cognitive performance and speech perception, although some variability in association appeared to exist depending on cognitive domain and SiN target or masker assessed. Where assessed, degree of unaided hearing loss did not play a major moderating role. We identify a number of cognitive performance and SiN perception combinations that have not been tested and whose future investigation would enable further fine-grained analyses of these relationships.

Perspectives of the ASHA Special Interest Groups

Purpose The aim of this research was to develop and evaluate methods to address poor knowledge of... more Purpose The aim of this research was to develop and evaluate methods to address poor knowledge of hearing aids, hearing loss, and communication in patients, partners, and nonaudiologic health and social care professionals. Method An interactive multimedia educational program (C2Hear) has been co-produced with hearing aid users and audiologists to provide high-quality information and demonstrate complex concepts relating to hearing aids and communication. Results A randomized controlled trial showed numerous benefits for first-time hearing aid users that included better knowledge and skill, and increased hearing aid use and satisfaction. Patients reported that C2Hear was highly useful, enjoyable, and preferable to written information. C2Hear Online is now freely available on YouTube and has global reach, well in excess of 150,000 views. Further developments include a version for communication partners, which showed that joint-working between hearing aid users and their communication ...

Seminars in Hearing

More than a decade after Arthur Boothroyd published “Adult Aural Rehabilitation: What Is It and D... more More than a decade after Arthur Boothroyd published “Adult Aural Rehabilitation: What Is It and Does It Work?,” the four cornerstones of adult aural rehabilitation are re-examined in terms of research that we and others in the field have undertaken. The focus is on novel advances in high-quality research relating to interventions to support self-management for hearing aids and other listening devices (sensory management), knowledge and skill (instruction), auditory and cognitive training (perceptual training), and motivational engagement (counseling). Much of this new research has a theoretical underpinning (e.g., behavior change theory) to better guide the development and evaluation of interventions, with a focus on self-management and patient-centered approaches. New and emerging technologies that support e- and m-health delivery of interventions provide greater personalization and interactivity to promote self-management of hearing loss. Looking to the future, there remains a req...

BMJ open, Jan 13, 2018

Subjective tinnitus is very common and has a number of comorbid associations including depression... more Subjective tinnitus is very common and has a number of comorbid associations including depression, sleep disturbance and concentration difficulties. Concentration difficulties may be observable in people with tinnitus through poorer behavioural performance in tasks thought to measure specific cognitive domains such as attention and memory (ie, cognitive performance). Several reviews have discussed the association between tinnitus and cognition; however, none to date have investigated the association between tinnitus and cognitive performance through meta-analysis with reference to an established theoretical taxonomy. Furthermore, there has been little overlap between sets of studies that have been included in previous reviews, potentially contributing to the typically mixed findings that are reported. This systematic review aims to comprehensively review the literature using an established theoretical taxonomy and quantitatively synthesise relevant data to determine associations bet...

International journal of audiology, 2016

In recent years, there has been an increase in the application of behavioural models, such as soc... more In recent years, there has been an increase in the application of behavioural models, such as social cognition models, to the promotion of hearing health. Despite this, there exists a well-developed body of literature that suggests such models may fail to consistently explain reliable amounts of variability in human behaviours. This paper provides a summary of this research across selected models of health-related behaviour, outlining the current state of the evidence. Recent work in the field of behaviour change is presented together with commentary on the design and reporting of behaviour change interventions. We propose that attempts to use unreliable models to explain and predict hearing health behaviours should now be replaced by work which integrates the latest in behaviour change science, such as the Behaviour Change Wheel and Theoretical Domains Framework.

International journal of audiology, 2016

Background: Auditory training involves active listening to auditory stimuli and aims to improve p... more Background: Auditory training involves active listening to auditory stimuli and aims to improve performance in auditory tasks. As such, auditory training is a potential intervention for the management of people with hearing loss. Objective: This systematic review (PROSPERO 2011: CRD42011001406) evaluated the published evidence-base for the efficacy of individual computer-based auditory training to improve speech intelligibility, cognition and communication abilities in adults with hearing loss, with or without hearing aids or cochlear implants. Methods: A systematic search of eight databases and key journals identified 229 articles published since 1996, 13 of which met the inclusion criteria. Data were independently extracted and reviewed by the two authors. Study quality was assessed using ten pre-defined scientific and intervention-specific measures. Results: Auditory training resulted in improved performance for trained tasks in 9/10 articles that reported on-task outcomes. Although significant generalisation of learning was shown to untrained measures of speech intelligibility (11/13 articles), cognition (1/1 articles) and self-reported hearing abilities (1/2 articles), improvements were small and not robust. Where reported, compliance with computer-based auditory training was high, and retention of learning was shown at posttraining follow-ups. Published evidence was of very-low to moderate study quality. Conclusions: Our findings demonstrate that published evidence for the efficacy of individual computer-based auditory training for adults with hearing loss is not robust and therefore cannot be reliably used to guide intervention at this time. We identify a need for high-quality evidence to further examine the efficacy of computer-based auditory training for people with hearing loss.

International journal of audiology, Jan 12, 2016

This study explored the psychosocial experiences of adults with hearing loss using the self-regul... more This study explored the psychosocial experiences of adults with hearing loss using the self-regulatory model as a theoretical framework. The primary components of the model, namely cognitive representations, emotional representations, and coping responses, were examined. Individual semi-structured interviews were conducted. The data were analysed using an established thematic analysis procedure. Twenty-five adults with mild-moderate hearing loss from the UK and nine hearing healthcare professionals from the UK, USA, and Canada were recruited via maximum variation sampling. Cognitive representations: Most participants described their hearing loss as having negative connotations and consequences, although they were not particularly concerned about the progression or controllability/curability of the condition. Opinions differed regarding the benefits of understanding the causes of one's hearing loss in detail. Emotional representations: negative emotions dominated, although some e...

Background: Auditory training involves active listening to auditory stimuli and aims to improve p... more Background: Auditory training involves active listening to auditory stimuli and aims to improve performance in auditory tasks. As such, auditory training is a potential intervention for the management of people with hearing loss. Objective: This systematic review (PROSPERO 2011: CRD42011001406) evaluated the published evidence-base for the efficacy of individual computer-based auditory training to improve speech intelligibility, cognition and communication abilities in adults with hearing loss, with or without hearing aids or cochlear implants. Methods: A systematic search of eight databases and key journals identified 229 articles published since 1996, 13 of which met the inclusion criteria. Data were independently extracted and reviewed by the two authors. Study quality was assessed using ten pre-defined scientific and intervention-specific measures. Results: Auditory training resulted in improved performance for trained tasks in 9/10 articles that reported on-task outcomes. Although significant generalisation of learning was shown to untrained measures of speech intelligibility (11/13 articles), cognition (1/1 articles) and self-reported hearing abilities (1/2 articles), improvements were small and not robust. Where reported, compliance with computer-based auditory training was high, and retention of learning was shown at posttraining follow-ups. Published evidence was of very-low to moderate study quality. Conclusions: Our findings demonstrate that published evidence for the efficacy of individual computer-based auditory training for adults with hearing loss is not robust and therefore cannot be reliably used to guide intervention at this time. We identify a need for high-quality evidence to further examine the efficacy of computer-based auditory training for people with hearing loss.

Auditory training is an intervention that aims to improve auditory performance and help alleviate... more Auditory training is an intervention that aims to improve auditory performance and help alleviate the difficulties associated with hearing loss. To be an effective intervention, any task-specific learning needs to transfer to functional benefits in real-world listening. A randomised controlled trial of 44 adults with mild sensorineural hearing loss showed significant on-task learning for a trained phoneme discrimination task (p<.001). Transfer of learning to improvements in untrained measures was shown for self-reported listening, particularly for a complex listening condition (p≤.001) and complex cognitive tasks that indexed executive function (divided attention p<.001, working memory updating p<.01). No improvements were shown for untrained sentences in modulated noise, nor for simple cognitive tasks. A second study aimed to identify optimal outcome measures to assess the benefits of auditory training for people with hearing loss. Thirty existing hearing aid users with mi...

Research has shown that speech-in-noise tasks are challenging to individuals with hearing loss (L... more Research has shown that speech-in-noise tasks are challenging to individuals with hearing loss (Lorenzi et al 2006). If people expose themselves to loud music, they could develop noise-induced hearing loss. This is important when we consider that young people regularly listen to music and may not appreciate the potential damage being caused to their hearing. It could be useful to educate the public on the risks of developing noise-induced hearing loss and enable people to understand the communication problems associated with hearing difficulties. We describe a pilot study and possible intervention which could be used within schools and universities to educate young people of the difficulties of understanding speech in noisy environments and potential risks they could face in developing noise-induced hearing loss. Thirty-one participants aged between 28 and 64 years were recruited at an open day at Nottingham University. All of the participants reported normal hearing. The speech stimuli were recorded in a soundproof booth. To listen to these, see file 1 (instructions 1^5). Participants heard a list of 5 instructions over Sennheiser HD 25-1 II headphones via a laptop computer. In the masked conditions, the noise was presented at 75 dB. In condition 1 (no masker), the speech was presented at 85 dB (AE5 dB). In condition 2 (moderate difficulty) and 3 (high difficulty), the speech was presented at 82 dB (AE5 dB) and 78 dB (AE5 dB), respectively. Participants were randomly allocated to one of the three conditions: fourteen in condition 1; ten in condition 2; ten in condition 3. The participants were told that they would hear a list of 5 instructions over headphones that would require them to draw an image. Participants in the masked conditions were told that they would hear a rushing sound whilst listening to the instructions. They were asked to ignore this and focus on what the speaker told them to draw. Once the drawings were completed, they were given the opportunity to hear the instructions again in the presence of the masker (if they were allocated to the no-masker condition) or without the masker (if they were allocated to the mediumdifficulty or high-difficulty condition). This gave participants in the masked conditions the opportunity to hear the instructions clearly and observe their performance. Figure 1 (top of the figure) shows a representation of the clock participants should have produced and was shown to them at the end of the study. Participants completed the task in approximately 5 min.

Journal of Medical Internet Research, 2012

Background: The use of personal computers (PCs) and the Internet to provide health care informati... more 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.

Ear and Hearing, 2014

The efficacy of phoneme discrimination training for enhancing hearing and related cognitive abili... more The efficacy of phoneme discrimination training for enhancing hearing and related cognitive abilities in a typical, pre-hearing aid population was evaluated. Significant and robust on-task learning was demonstrated. Benefits of training were seen in reduced hearing disability, particularly in complex listening environments, and in improved attention and working memory. These benefits were retained for at least four weeks post-training. Compliance with homedelivered training was high. Auditory training thus provided modest benefit for complex and challenging skills that are relevant for listening in realistic environments.