New Study Evaluates Nuance Audio Glasses: Can They Improve Speech in Noise?

Speaker 1: If you’ve been diagnosed with hearing loss but keep putting off doing anything about it, you are not alone. Research shows that on average, nearly 9 years pass between a hearing loss diagnosis and hearing aid adoption. 9 years! And during that people, people during that time, people are quietly struggling, pulling back from conversations, exhausted from listening hard and withdrawing from social situations. And that was certainly the case for me. Today’s guest is working to change that, and she’s approaching it from an interesting angle, the intersection of hearing, vision, and aging. Dr. Tammy Harrell is Chief of Audiology at Nuance Audio, and she holds a PhD in gerontology and a trained audiologist. Specializing in speech perception in aging, meaning she thinks about hearing loss not just as an ear problem, but as part of how our whole sensory experience shifts as we get older. And after years of working directly with people with hearing loss, she’s moved into technology to help build solutions at scale. So thank you, Tammy, for coming and joining me on This Week in Hearing.

Speaker 2: Thank you, Shari, for inviting me.

Speaker 1: Absolutely. So you have a PhD in gerontology and you’re trained as an audiologist. Can you talk a little bit about how these two paths came together and how do they shape the work that you’re doing at Nuance Audio?

Speaker 2: Yes, certainly. So the story begins as an audiologist. I was working in clinics fitting hearing aids to people. And you know, you can, you fit hearing aids and you hear day to day, year to year, you hear the same stories. You hear people talking about how they are managing when it’s at home or in a quiet environment, but then the moment they step out to a noisy place, to a restaurant, to a family dinner, then they are just not managing enough. They are just, it’s it’s too difficult for them. And I kept hearing that and it felt like there’s always a, even with good technology fitted, there’s always a ceiling, always a ceiling there to prevent them from going up. And I wanted to be part of that ceiling. So I joined Nuance Audio, which is a company that started off with one goal to solve the cocktail party problem. And the idea was pretty simple to use the eyeglasses frames to host microphones and improve speech-in-noise understanding. But when we did it, we found out that we are actually dealing with something, actually solving another problem, which is the problem of hearing aid adoption. And coming and seeing all those people all these years, the people who are reluctant to use hearing aids, because of stigma, because of many other barriers. Taking these two worlds together, I really wanted to deep dive into this world of, of how the technology can assist those people in living the full life that, that they want. So this is basically how I ended up at Nuance Audio building this technology, and the PhD was to, to know more, to learn more about the challenges of these people.

Speaker 1: Yeah, no, that’s terrific. I mean, and there are many challenges, as I know as a person who lives with hearing loss. And so I guess you spent many years working directly with people with hearing loss right before moving into technology. And so was there a pattern that you kept seeing that made you decide you could create more impact from inside a company versus inside a clinic.

Speaker 2: Definitely, definitely, Shelley. It felt like people are coming and you treat them, and I see auditory rehabilitation as much more than technology. So when people come, it’s the communication strategies, it’s the spouse or the family members that are coming into this. And there was also only so far you can get. And I thought, what if we can do more? What if we can help improve more? So it was really important for me to find, to see if there are any options to improve the performance of those people and to increase their quality of life. So the move from being a clinician to building a product was done with all the clinical knowledge and the academic knowledge. And every time we do studies, every time we meet people, we are always holding all this knowledge within us. Yeah. And I believe that this approach, the academic approach and the clinical approach, is shaping a lot of what Nuance Audio is about today, because it’s not just a product. It’s a product made for people by people who know or at least want to understand exactly what those people are facing.

Speaker 1: Yeah. Well, I love how you said that technology alone is not really the answer, that there’s all these other strategies as well. And that’s something that we really talk about in our book, “Hear and Beyond,” is this three-legged stool of skills you need to live well with hearing loss. And technology is obviously a big piece of it. But like you said, the communication strategies, sort of the behaviors that you can take on, and then also your attitude about hearing loss, right? And part of that is sort of how stigmatized are you? Do you feel that, you know, what are hearing aids and hearing loss? What does that mean to you? And what does that make you feel about yourself? Is this part of the equation for Nuance Audio as well?

Speaker 2: It’s a funny thing that you say because Nuance Audio is meant for people with perceived mild to moderate hearing loss. These are individuals that are usually not perceiving themselves as disabled. And this is where it became— here is where you have to be very delicate because tons of people can come to the clinics and say, I’m hearing amazing. It’s not that I’m not hearing well. I can hear everything in the road, but I just miss out on some words. And they don’t see it as a hearing problem. They try to find, you know, the person in the TV is mumbling and the children are talking too fast. Everyone but but the actual understanding that even losing some sounds of speech is hearing loss. So in this case, I think it’s much more challenging because we are approaching people who feel that what they have maybe is normal to the age when we know that it’s not. But It takes sometimes to understand that and to teach and to educate that what you are feeling, what you’re— when you’re missing out on some sounds of speech, you are missing out on communication, on connection. And this is a true loss.

Speaker 1: I agree with you. I mean, I think you’re talking about sort of this idea that mild hearing loss is often sort of dismissed, right? Not by the patients, by the family. You know, sometimes sometimes even by the clinicians themselves. I remember my first time I went to see an audiologist, my hearing loss was very mild. I was in business school and they kind of said, well, you know, come back when you have a problem. So do you think that that label, you know, mild hearing loss, is part of the issue with it? Or how do you think about that?

Speaker 2: I think that, you know, people can have difficulties in listening without even having audiometric thresholds that need correction, you know. So I think that we should look at it from a different angle of performance. So it doesn’t— I don’t need to name my blood pressure problems in a name, but I’m having difficulties, let’s say, I don’t know, waking up in the morning. Okay, so if I have some communication difficulties, it doesn’t matter how we call it. We can call it mild hearing loss. Moderate hearing loss, no hearing loss, there is a communication barrier and we must address it because if we don’t address it, you and I both know what are the consequences of not treating this.

Speaker 1: Yeah, absolutely. So you guys recently released some data that showed an average of nearly 9 years between the diagnosis and the adoption of hearing aids. So what’s actually happening during those 9 years?

Speaker 2: Yeah, well, it doesn’t come in a day, hearing loss. It’s a gradual decline. And, you know, you start missing out on some sounds of speech and you get adjusted and then you miss out on some other sounds and you get adjusted and it goes like this. And because you’re not waking up one day with a hearing loss, then it takes much more time to actually realizing that there is an issue. And in that time when you are struggling, it’s like— this is where it connects to my PhD— it’s a bit like you’re trying to fill in a missing blank, OK? Because you’re missing some words and you need to use— always you need to use contextual information to fill in. And this takes mental energy and we have limited resources, cognitive resources. So if I’m taking out all my cognitive resources to understanding, to filling in the gaps in your speech, then I have less mental energy to understand what you’re saying, to remember what you’re saying, to respond accordingly. And in those almost decade of procrastination, you are missing out on life, on connection. And this is really important for us. Nuance Audio sees themselves as stepping stone towards this world of auditory rehabilitation. So to be a part of the solution, the moment you feel it for situational conditions, to be, to be there for those people so that they won’t need to wait those 9, 10 years until they get it. Yeah.

Speaker 1: No, I love that because I feel like we need on-ramps for people, right? And meet them where they are. I know firsthand about listening fatigue. I definitely, you know, continue to struggle with that sometimes. And it’s just exhausting, like you said, to try and follow conversations sometimes, especially in noisy environments. And you’re doing the lip reading, you’re, you know, looking for context clues, you’re scanning the environment to see, you know, what might be happening. And it is a lot of mental energy that we’re all using, you know, with hearing loss to just have a normal conversation. So what does the research tell us about what’s happening during those moments and just a little bit more about the accumulating impact of that from all the heavy cognitive lifting. What’s sort of the impact longer term potentially?

Speaker 2: So, so a lot of people have linked hearing loss with cognitive decline, of course, with, with, with higher risk of fall, of falling, and of course with social isolation, depression, and reduced self-esteem, depression. All those things are accumulated to really to prevent a person from living to the fullest, living life to the fullest. So less well-being, less quality of life. And then of course, also the risks of the cognitive consequences that may arise also.

Speaker 1: Yeah, absolutely. So I know your work is highlighting the overlap between age-related hearing and vision changes as well, which is pretty unique, and sort of the compounded challenges when both are happening at once. And so why have those two historically been treated in such completely separate silos? And what is your concept here in sort of bringing them together?

Speaker 2: Well, I’m not talking about the past. I’m happy they are now being treated together.

Speaker 1: Yeah.

Speaker 2: So there are two of our most prominent senses, and they are both critical for how we connect with the world and with each other. So as we age, both of them decline, and for many people, they decline together. And we call it dual sensory impairment, and it is much more common than most people realize. And the consequences of such impairment are going way beyond communication. So again, linked to cognitive decline, to depression, and reduced quality of life. When, when the senses that you rely on most for communication are sending unclear messages, then the perception of the world is changing. So, so it changes quietly. It will change gradually, as we discussed, but it changes profoundly. And the, the earlier you treat it, the better. So you don’t miss out on things. So you should do it for your hearing, you know, for your vision and, and for everything that depends on, on both of those senses.

Speaker 1: Absolutely. So let’s talk about the Nuance Audio glasses a little bit more. So for listeners who aren’t familiar with that, can you just sort of describe what they are and a little bit more about who they’re designed for?

Speaker 2: Okay, so Nuance Audio are a first-of-its-kind FDA-cleared open-ear hearing solution for perceived mild to moderate hearing loss. These are basically a normal pair of glasses, look like a normal pair of glasses. But what is interesting about them is that they have two technological pillars inside the glasses that makes them also hearing assistive device. So basically we have microphones that are over the temples, an array of microphones and open speakers, which means that the ear is completely open. This is not bone conduction. So in the past we had Bone conduction hearing aids. These are not bone conduction hearing aids. And there is a speaker that directs the sound directly to the ear canal. So this array of microphones is the reason why we actually started Nuance Audio, because we wanted to improve the performance in speech in noise. And hearing aids, traditional form factor of hearing aids, are very limited in their ability to segregate between sounds and competing— between speech and competing sounds. That are specially separated because the microphones are very close to one another. So here we used the real estate of the glasses to house more microphones, and it improves the ability of the user to follow the person they are looking at and ignoring the background noises. Neon Audio Glasses come paired with an app where you can choose if you want to listen only to the front or all around. You can choose between 4 amplification paradigms. You can change the noise reduction, and you can charge them on like a charge pad. It’s like a very elegant charging pad that you use.

Speaker 1: That’s very cool. So do patients need an audiogram? You know, how do— you said you can sort of adjust the different volume and all of these things. How do people know how to adjust them? Is it just sort of based on their perception? Their understanding, or is there some sort of hearing test that’s involved?

Speaker 2: So, so that, that there is, there is not a hearing test involved with this. This is an over-the-counter hearing aid currently, which, which people can choose one of 4 presets. So we instruct them to use based on what feels comfortable for them, and they can switch between them, of course. And they can also use an expert audiologist to help with the onboarding process.

Speaker 1: Excellent. So I know you’ve done some research about, you know, sort of the clinical findings, you know, what, what type of improvement in speech understanding in noise have there been? I mean, you know, I read the piece that said up to 29% improvement in speech understanding in noise, 32% reduction in listening effort, and 70% of participants reported improved communication after just a few hours. So those are pretty incredible statistics. Statistics, can you sort of walk me through, you know, what was measured there? You know, what is the actual thing that you were measuring and how did you do that to come up with those results?

Speaker 2: Okay, so I’d love to. So first of all, I would like to thank the two research partners that were working on these two studies. So one of them is Bettina Turnbull and Jorge Mejia from NAL, National Acoustic Laboratories in Australia. And the other team is Suzanne Scully and Paula Falkert from Western University in Canada. We took like the far ends of the world, of the earth, right? Maybe with the notion that if we manage there, probably all the rest is covered. But I will talk about both studies together because they share the same framework that we use when we build a product and when we validate products. So we ask basically, it’s a model that we use that is, we call it the need, performance, benefit, and preference. Okay, so we start off with assessing the need. And this was something that the team at NAL did, and they used the COSI questionnaire to understand what people with perceived mild to moderate hearing loss need the most. And not surprisingly, but the biggest pain point was noisy social context. So this is where people want help. And after we know this, then we have to deliver a device that is performing well to meet those cases. So the first thing we do is to test it in the lab. Now we move to Canada to the study by Western, and they did speech-in-noise testing. They used the Connected Speech Test to see how people perceive how people perceive speech in noise. And this is where we found 29% improvement for speech-in-noise understanding. And we know that it’s not just the— it’s not just the performance of the speech-in-noise, but also how effortful it is, as you mentioned before, that you notice fatigue. So we also asked them to rate their subjective— they also asked them to rate their subjective listening effort. And there we saw that people were seeing a 32% reduction in subjective listening effort. So we know that what they need, we know that we perform, and now we go to the benefit. And then really after 3 hours of use in the, in the NAL study, 70% of people reported improved communication with the glasses. But that’s not the end because Last but not least is the preference, because we know that hearing aids are providing a great benefit. We’ve known this for decades, but still we know that sometimes people prefer the ITD version of them, you know, the in-the-draw version of the hearing aid. So for us, it was really important to know that our product is actually being used, being preferred. So the team at NAL also took people for a guided walk and let them try aided and unaided in all kinds of contexts. And the more challenging the environment was, the more people preferred using the glasses over the unaided condition. So these are people without hearing aids, people with perceived mild to moderate hearing loss. So for us, this was the strongest evidence that people want to use the glasses. They prefer to use it. And I think this tells the entire story of those, of this evidence to the best.

Speaker 1: That’s great. So are you wearing them right now?

Speaker 2: Is that what they— no, I’m not allowed to wear the new generation that I’m wearing on a daily basis now because it’s still it’s still not out. But so these are just other glasses, but they look kind of similar. They did not do a green one for me yet.

Speaker 1: Is that coming? Are they going to come out with a green one?

Speaker 2: They’re going to come out with more interesting colors. And there’s stuff to stay tuned for, definitely.

Speaker 1: Excellent. So you mentioned a new generation. Is there anything that you can talk about on that front, or is that sort of for the future?

Speaker 2: I can say that we are committed to continue providing innovative solutions for people. We are working on the second generation and it will be out by the end of this year. So, so yes.

Speaker 1: That’s exciting. Okay. And so what for the people who have the original version, what will that mean for them?

Speaker 2: Both, both will exist, will coexist. That’s important to know because these are similar, but maybe with different functions. So let’s, let’s talk again close to the end of the year and we can discuss more about it.

Speaker 1: Let’s do it. That sounds very exciting. I love— there’s just so much focus and innovation in hearing solutions right now. There’s just so many new products and so many new form factors that are coming out. And as a person with hearing loss, I’m just so grateful to see them and so excited to see them. So I’m glad to hear there’s more on the horizon as well. That’s wonderful. Yeah. So for someone who’s listening right now who maybe has been sitting with a mild hearing loss or perceived mild hearing loss, or maybe they have a diagnosis that they’ve had for years and they keep putting it off. What do you want them to hear from you today?

Speaker 2: I want them to, to hear that, first of all, what they’re feeling is real. So if someone is having difficulties understanding speech in noise, it’s not normal to the age. It’s not their imagination. If they find noisy situations exhausting, if they find themselves asking people to repeat themselves, if they start avoiding situations they love because they are having difficulties following conversation, then these are information that it’s worth paying attention to. The more that— the earlier that they treat it, the better. There is no need to wait a decade until your hearing loss has real consequences. You don’t need to wait to, to, to feel that it’s serious enough. And as you just said, technology is changing all the time. There are so many options that go beyond the traditional form factor of hearing aids. So the options can meet you exactly where you are. And please don’t wait until it’s serious enough because you are missing out on, on a lot of, of things in life, like communication and connection. So just don’t wait, do something about it, and it’s worth it.

Speaker 1: Well said. I agree. Well said. So as we’re wrapping up here, are there any final thoughts that you’d like to share? And maybe you can talk about how people can learn more about the research that we’ve been talking about as well.

Speaker 2: Yes, yes, sure. So one of the studies was published, the NAL study was published a few months ago in the Journal of ENT, otolaryngology ENT research. And the Western study will be published in the next few days in Frontiers of Audiology and Otology. So this is a good way to read the studies. And they could always go into, into the Nuance Audio website to learn more things and to understand more. And follow us, of course, on social media, where we also publish a lot of things.

Speaker 1: Excellent. Well, thank you so much, Tammy, for being on the podcast today and sharing your insights on this very important topic. It’s been a pleasure to talk to you.

Speaker 2: Thank you. Same, same here. Thanks.