Auditory Training – A Familiar Value Proposition in an Era of Revolutionary Change

The many blogs from 2018—submitted by area experts—provided glimpses of opportunities and challenges that precede the profession. An opportunity that is at the crossroads between provider service-provision and patient self-provision is auditory perceptual training. In March 2018, Harvey Abrams, PhD, made the point that the value proposition of auditory perceptual training has the potential (research is still needed in this area) to enhance the cognitive processing capabilities of the aided listener beyond the hearing aid. While I strongly agree with this point, I would add that auditory perceptual training offers providers and patients—regardless of the amplification device and its point of sale—the opportunity to form a long-term professional bond of loyalty and trust based on aided benefit and satisfaction. This professional bond has the potential to lessen the expected blitzkrieg of product-centric marketing that is sure to overwhelm us, and place the value squarely back on the shoulders of the professional. 

–Amyn Amlani, PhD, Editor

In a recent HHTM post, guest bloggers Terry Mactaggart and Errol Davis identify several provocative challenges that hearing healthcare providers will likely face in a near future characterized by rapid technological changes and major shifts in healthcare delivery. We would be wise to seriously consider how we will respond to each of those challenges. Mactaggart and Davis refer to a recent article in the Economist entitled,  “A Revolution in Health Care is Coming” that describes a rapidly growing healthcare trend which places the patient in charge of their care through increased access to their own health data coupled with sophisticated algorithms that can transform that data into personalized healthcare decisions.

To many hearing health care providers whose livelihood is inextricably linked to the hearing aid, this prospect may seem threatening; indeed, the “legalization” of OTC hearing aids coupled with online hearing testing and increasingly sophisticated self-fitting algorithms is a hearing healthcare manifestation of this “revolution” and, for many in our profession, represents a serious existential crisis. But there is much more to hearing healthcare than just the device (despite the misguided focus of the PCAST report) and it is in this “alternative” space that our future and the value of our profession may be defined. Remember that the roots of the audiology profession are found in a rehabilitation model of healthcare, specifically the rehabilitation of returning WWII veterans, and returning to our rehabilitation roots may be our best path forward.

Unfortunately, many visualize the “rehabilitation” component of audiology as a group of elderly individuals sitting in a room with coffee and cookies enjoying their social interaction. But audiologic rehabilitation involves a comprehensive range of services we provide to our patients which begins when they first set foot in our office and continues throughout their lives to include patient-centered education, counseling, provision of sensory aids, and perceptual training. For the purposes of this post, however, I want to focus on the last of these –  perceptual training and, specifically, the utilization (prescription?) of commercially available auditory training programs in the context of placing the patient in charge of their own care.

Despite the impressive advancements in hearing aid technology in the last decade, the benefits of amplification are often limited by the cognitive consequences of aging and their subsequent Impact on working memory, processing speed and understanding speech in environments with competing messages – processes that, for many of our patients, hearing aids will not improve. Perceptual (i.e. auditory) training has been shown to improve some of these processes and the commercialization and gamification of these programs allow the patient to “self-diagnose” their baseline, progress and performance and to be engaged at a place and time convenient to them.  Below are some examples of these programs:

• Listening and Communication Enhancement (LACE) is available from Neurotone via the internet or downloads to iOS and Android devices. LACE purports to target the user’s ability to understand rapid speech, competing speech, work memory and speech in noise through a series of 4 training modules.  The difficulty of the tasks increases or decreases (i.e., adapts) as a function of the individual’s performance. Importantly, the patient’s performance, progress and time on task can be monitored and tracked by the clinician.
• clEAR, available here, is an “auditory brain training” program that is designed to improve speech-in-noise understanding through a number of games. The stimuli are customizable in the sense that the training stimuli can be male, female or children voices. There’s also an option to train using the recorded voice of a family member or communication partner. A key feature of the program is the prescriptive nature of the training plan which encourages continued communication between the provider and patient throughout the training process.
• Hear Coach is an example of a gamified auditory training program developed by the hearing aid industry available here from Starkey’s website or downloadable to an iOS of Android device. Listeners progress through a series of increasingly challenging levels in 3 different games designed to improve speech-in-noise understanding and working memory.
• ReadMyQuips, from Sense Synergy, is designed to improve speech-in-noise performance by engaging the listener in an adaptive audio-visual crossword puzzle whose clues are “quips” or witty expressions.  It’s the only auditory training program that incorporates audiovisual rather than auditory-alone targets. Unfortunately, ReadMyQuips is no longer available for purchase

Other perceptual training options include “brain fitness”’ programs that are not specifically designed for auditory training but focus on those cognitive processes – working memory, speed of processing and attention – that tend to compromise speech understanding particularly among older individuals with hearing loss. Examples include BrainHQ and Lumosity.

The keys to success with any of these auditory training programs are engagement and compliance though many audiologists report that their patients simply don’t engage with these programs for very long despite the fact they claim to enjoy them. The primary reason for their discontinuance and subsequent non-compliance is that no one is watching; no one is providing feedback; no one is coaching them.

The key to successful patient engagement and compliance is a continuing provider-patient relationship throughout the training process with the provider serving as a coach. Several of the products described above contain features that are designed to do just that.

One of the questions that Mactaggart and Davis plan to address in future HHTM posts is “What value proposition should the industry adopt to provide extraordinary value?” I suggest that the prescriptive provision of auditory training with the provider as coach is an added value that goes beyond the device and technology and is independent of whether technology is a part of your treatment plan or where and how that technology is obtained.

Harvey Abrams, PhD, is a consulting research audiologist in the hearing aid industry. Dr. Abrams has served in various clinical, research, and administrative capacities in the industry, the Department of Veterans Affairs and the Department of Defense. Dr. Abrams received his master’s and doctoral degrees from the University of Florida. His research has focused on treatment efficacy and improved quality of life associated with audiologic intervention. He has authored and co-authored several recent papers and book chapters and frequently lectures on post-fitting audiologic rehabilitation, outcome measures, health-related quality of life, and evidence-based audiologic practice.  Dr. Abrams can be reached at [email protected].

*featured image courtesy health.mil