Editor’s note: Ear to the Ground is a new monthly column from Dr. Brian Taylor, offering timely reflections on research, technology, clinical practice, and emerging trends in hearing care. You can read last month’s column here.
Nothing is more frustrating than thoroughly guiding a new patient through the process of using new hearing aids, only to have them quickly abandon the devices a few days or weeks after the appointment.
To drive the point home, consider this: During the first-fit appointment, a clinician typically spends an hour fitting and counseling a new hearing aid wearer. But what happens during the other 23 hours—and in the subsequent days before the next face-to-face appointment—often determines success.
Today, smartphones and apps can extend care into these unseen hours, but several questions related to their effectiveness remain unanswered. Recent research does, however, shed light on the utility of smartphones and apps and their ability to extend care, increase patient benefit, and enhance the overall “stickiness” of care. The use of smartphones and apps to extend care is the focus of this month’s Ear to the Ground.
The Digital Therapeutics Alliance (DTA) describes digital therapeutics (DTx) as evidence-based software, most commonly delivered through smartphones and apps, used to prevent, identify, treat, and manage a broad spectrum of diseases and conditions. Some common examples of DTx include Noom for weight loss, Headspace for mental health, and Propeller Health for asthma and COPD.
Although it is tempting to think of DTx as direct-to-consumer, standalone tools, many DTx platforms are designed to be used in conjunction with traditional face-to-face care. DTx can be thought of as a remote extension of in-person care. This is certainly the case with the many remote care apps provided by hearing aid manufacturers, as well as the myriad auditory training and tinnitus apps that are now widely available.
Let’s take one example of DTx found in hearing care: auditory-cognitive training.
As many clinicians know, this type of training has been used in hearing care for generations. Over the past decade, however, it has transitioned from CD-ROM- and DVD-based programs to smartphones and apps. Intuitively, placing these tasks directly into patients’ hands would seem to be a positive change. So, what does the research actually say about the effectiveness of DTx in hearing care?
To explore this question, let’s look at three specific areas: patient satisfaction, gamification, and personalization.
1. Patient Satisfaction
Are patients who use DTx as part of their treatment plan more satisfied than those who do not?
Tye-Murray and colleagues (2022) evaluated a DTx platform, Amptify, in 30 first-time hearing aid wearers and compared survey results from this group with those of a control cohort that watched closed-captioned television for a similar period.
Participants using the DTx reported:
- 96%–97% reported receiving benefit.
- More than 50% said the DTx helped them adjust to their new hearing aids.
- Improved confidence in conversations.
- Better ability to engage socially.
- High satisfaction scores, averaging 5.8 out of 7, for both enjoyment of the program and willingness to recommend it to others.
Some of the reasons the DTx group reported higher levels of success compared with the control group may have been the on-demand availability of the following features within the Amptify program:
- Coaching and behavioral support.
- Ongoing engagement after hearing aid fitting.
- Education about hearing loss.
- Auditory training exercises.
- Communication strategies.
2. Gamification
Does making a therapeutic task more like a game improve its uptake or effectiveness?
We all know that playing games can be fun and rewarding in its own right. You might even know someone who is retired and plays hours of Candy Crush Saga or Wordle.
Sidenote: To learn more about the intrinsic value of what is called “striving play,” check out The Score by C. Thi Nguyen. The book’s central message is that humans are wired to play games.
When you take a careful look at the rewarding—and, dare I say, addictive—nature of video gaming, you can see how incorporating a fun and engaging activity into a therapeutic task can be satisfying.
Fun activities cause the brain to increase production of dopamine, a neurotransmitter associated with pleasurable emotions. There is substantial research showing that playing video games increases dopamine production. In turn, increased dopamine levels can enhance neural plasticity, and neural plasticity supports more efficient learning.
As a result, individuals who engage in gamified DTx may have greater potential to benefit from their intervention because they are participating in something intrinsically fun and rewarding.
A recent study illustrates this point. Ockelmann and colleagues (2025) evaluated a personalized, gamified digital auditory-cognitive training program in a randomized controlled trial involving 54 older adults with mild-to-moderate hearing loss.
Participants completed four weeks of home-based, adaptive training targeting auditory processing, attention, and working memory. The control group received an active comparison intervention consisting of computer-based foreign language training.
The DTx significantly improved naturalistic speech-in-noise comprehension and several cognitive functions, including working memory and selective attention, with some benefits maintained at the two-month follow-up.
Although subjective hearing ratings and standard speech-intelligibility measures did not improve, the findings support DTx as an effective adjunct to hearing aids for enhancing real-world communication.
3. Personalization
Can a personalized avatar used as part of a DTx platform enhance patient outcomes?
There is a growing body of evidence that personalized avatars, also known as embodied conversational agents, can improve engagement and, in some cases, clinical outcomes in DTx. However, the evidence is currently stronger in mental health than in chronic disease management or audiology.
Importantly, the benefit appears to come from personalization and therapeutic interaction, not simply from having an avatar.
Recent studies by Foran and colleagues and Shoshani and colleagues suggest that allowing patients to personalize an avatar may increase trust and engagement, which are mechanisms associated with better adherence to DTx.
Relatively few clinical trials, however, isolate avatar personalization as the independent variable. More work is therefore needed to better understand how avatars and chatbots might contribute to hearing-related patient outcomes.
For now, it appears that DTx platforms with personalized avatars could theoretically improve:
- Engagement with repeated training.
- Adherence to prescribed training schedules or doses.
- Motivation and self-efficacy.
- Functional outcomes through greater treatment completion.
Even though direct evidence in audiology remains limited, the mental health literature suggests that personalized, interactive avatars can enhance patient engagement and, in some interventions, improve clinical outcomes beyond conventional screen time on a phone.
What Comes Next?
While the face-to-face appointment remains the cornerstone of holistic hearing care, digital therapeutics offer a powerful, evidence-based way to extend support into patients’ daily lives.
Research demonstrates that gamified and personalized digital tools can improve engagement and adherence in areas ranging from hearing aid use to auditory-cognitive training. As the evidence base grows, clinicians should proactively consider integrating these digital adjuncts into treatment planning.
By embracing DTx, clinicians can help bridge gaps in care, empower patients, and increase the likelihood that prescribed treatment plans will remain “sticky.”
References
Foran HM, Kubb C, Mueller J, Poff S, Ung M, Li M, Smith EM, Akinyemi A, Kambadur M, Waller F, Graf M, Boureau YL. An Automated Conversational Agent Self-Help Program: Randomized Controlled Trial. Journal of Medical Internet Research. 2024;26:e53829.
Ockelmann J, Scherpiet S, Stropahl M, Giroud N. Personalized and gamified auditory-cognitive training improves naturalistic speech-in-noise comprehension in older adults with hearing loss. NPJ Science of Learning. 2025;10(1):80. https://doi.org/10.1038/s41539-025-00369-4
Shoshani A, Gurfinkel B, Kor A, et al. Efficacy of a Conversational AI Agent for Psychiatric Symptoms and Digital Therapeutic Alliance: A Randomized Clinical Trial. JAMA Network Open. 2026;9(4):e266713.
Tye-Murray N, Spehar B, Mauze E, Cardinal C. Hearing Health Care Digital Therapeutics: Patient Satisfaction Evidence. American Journal of Audiology. 2022;31(3S):905–913. https://doi.org/10.1044/2022_AJA-21-00236
Brian Taylor is a contributing editor to HHTM. He is also the VP of Clinical Research and Professional Relations for Neurotone. Opinions expressed here are his own. He can be contacted at brian.taylor@neurotone.com.
