NAL Annual Impact Report 2023

Annual Impact Report

2023

Mission and Impact National Acoustic Laboratories’ mission is to lead the world in hearing research and evidence-based innovation to improve hearing health and transform the lives of people with hearing difficulties.

As one of the longest established hearing research organisations in the world, NAL’s work has delivered significant advancement in knowledge and practical tools for the hearing community since 1947.

Our team of world-class researchers and innovators focuses on projects that deliver impact and address unmet needs through truly translationalresearch.

NAL’s contemporary methodologies overcome traditional barriers to deliver research that benefits researchers, clinicians, industry experts, product developers and, most importantly, people with lived experience of hearing difficulties.

Life changing innovations developed by NAL include a counselling tool that is used by clinicians worldwide; the most commonly used hearing aids prescription around the world; and a validated questionnaire to evaluate child’s listening skills in the real world.

Acknowledgement of Country NAL would like to acknowledge and pay our respect to the Traditional Owners of the land on which we live and work.

We pay our respect to Elders past, present and emerging and acknowledge the longest continuing culture on Earth.

We extend our acknowledgement and respect to all Aboriginal and Torres Strait Islander peoples we work with and serve, now and into the future.

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NAL 2023 Annual Impact Report

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Contents Mission and Impact ......................................................................................................... 1 Acknowledgement of Country ...................................................................................... 1 Message from Dr Brent Edwards .................................................................................. 5 Message from Kim Terrell .............................................................................................. 6 2023: A Year of Global Impact ....................................................................................... 7 Outlook to the Future: Meeting Hearing Healthcare Challenges Head-on at NAL............................................................................................ 9 Application of AI in Hearing Healthcare ..................................................................... 11 Project Spotlight............................................................................................................ 13 Perceived Mild to Moderate Hearing Loss: An Under-served Segment for Hearing Aid Solutions................................................................... 13 Next Generation Hearing Goal Setting Tool .................................................... 15 World First Large Scale Multi-site Trial of Cochlear Implant Processor Upgrade Benefit................................................................................ 17 Behind the Innovation: Rapid Evaluation of Advanced Hearing Aid Technologies .................................................................................. 19 Acknowledgments......................................................................................................... 21

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NAL 2023 Annual Impact Report

NAL 2023 Annual Impact Report

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Message from Dr Brent Edwards NAL Director In 2023, we introduced NAL’s core pillars that define the different ways in which we deliver impact. They are: • Research that advances hearing health knowledge by providing insights into current and critical issues and that NAL is uniquely positioned to conduct.

• Innovation that creates evidence-based solutions for hearing health.

• Partnerships with organisations to generate impact through collaboration.

• Capabilities development to maximise the effectiveness of our ability to deliver outcomes and impact.

The National Acoustic Laboratories has had over 75 years of impact on hearing healthcare in not only Australia but around the world. That is a legacy that we take seriously, and in 2023 NAL more than met expectations for continuing to deliver impact to improve the lives of people with hearing difficulty.

A highlight of the 2023 for our Research pillar was our portfolio of projects for the Australia Department of Health and Aged Care (DoHAC) that will provide insights to assist with policy decisions on Australia’s impressive Hearing Services Program (HSP), which delivers hearing services and devices to hundreds of thousands of Australians each year. One such project was a large-scale multi-site study on the benefit of cochlear implant processor upgrades that you can read about later in this report. NAL also supported DoHAC’s National Hearing Awareness Campaign by developing a hearing screening tool that was embedded in the Spotify music app, and by developing a consumer-friendly glossary of hearing technology that became the NALguide, a clinical tool that aids audiologists in discussing hearing device options with individuals with hearing needs. Other key insights from our research in 2023 include an understanding of the difficulties that people with hearing loss face using videoconferencing services like Zoom, and the relationship that hearing loss and perceived hearing difficulty has on loneliness.

For many years, NAL has conducted research and developed tools that use machine learning, but 2023 saw the explosion of NAL’s adoption of artificial intelligence (AI) and the rapid development of several hearing healthcare solutions that have AI at its core. Over half of the solutions in our Innovation pipeline features an AI component in some way. There is considerable information on these AI efforts later in this report.

NAL’s adoption of agile principles and our build/measure/learn approach to innovation facilitated our solution development. Along with our Lean and Design Thinking methods, these core Capabilities ensure that our solutions address unmet needs and solve real-world problems in ways that can be adopted by hearing healthcare providers and people with hearing difficulty.

2023 also saw our Partnerships and collaborations with other research and industry organisations strengthen. Many of these partnerships have grown to become whole programs of research, and I value how we are able to help others bring their own impact to hearing healthcare. While many of these partnerships are with well-known hearing device companies, a growing number of our partnerships are with companies looking to enter the hearing healthcare space with innovative technology solutions—companies ranging from startups to some of the largest consumer electronics companies in the world.

In short, 2023 has been an amazing year for what NAL has been able to deliver to the hearing health community. Please enjoy the rest of this report on the accomplishments of our people, which will also give you a glimpse of what is to come in 2024!

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NAL 2023 Annual Impact Report

Message from Kim Terrell Hearing Australia Managing Director In an ever-evolving world, where the pace of change is relentless, we remain steadfast in our commitment to excellence in hearing care service delivery, research and innovation. National Acoustic Laboratories (NAL), our pioneering research division, stands at the forefront of this endeavour, championing the translation of evidence-based research and innovation to deliver practical solutions that meet the emerging needs of our community.

NAL has continued to lead with agility and foresight in 2023. Through defining mild to moderate hearing loss and understanding what it means to have a ‘perceived’ hearing loss while hearing test results show ‘normal hearing’, NAL has challenged the industry to think beyond traditional measures and focus on the unmet needs of every client with a hearing difficulty.

Collaboration has been a key theme of the year, with NAL strengthening its partnerships by working closely with government bodies, industry leaders, and the global scientific community. NALguide was launched to help clinicians and clients navigate through over 250 hearing aid features to empower and better address the hearing goals of individual clients.

These innovations have not only set new standards in the field but have also garnered international acclaim, reinforcing NAL’s status as a global leader in hearing research.

As we reflect on the accomplishments of 2023, we thank our team, our clients, and our partners. With a commitment to translational research and innovation, NAL is poised to continue its journey of transforming lives through improved hearing health. We are proud to share the achievements of the past year with you. Through our collective efforts, we are making a tangible difference in the lives of those we serve. Thank you for joining us on this journey of discovery and impact.

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2023: A Year of Global Impact

2023 PROJECTS

IMPACT CREATION:

55

10

25

GRANT TO DEVELOP INNOVATIVE DIAGNOSTIC TOOLS FOR CHILDREN

25 NEW PROGRAMS OF WORK ESTABLISHED TO ADVANCE HEARING RESEARCH

INTERNATIONAL AND MULTIYEAR COLLABORATIONS

$1,151,714 1 2 3

Pádraig Kitterick on Channel 9

SMART TECHNOLOGY APPLICATIONS IN HEARING

SOCIAL AND EMOTIONAL WELLBEING FOR HOLISTIC HEARING HEALTHCARE

NEUROMARKERS TO PREDICT PAEDIATRIC HEARING INTERVENTION SUCCESS

Nicky Chong-White on Channel 7 NAL booth at SXSW Sydney

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IMPACT DELIVERY:

200,000+ 54

PRESENTATIONS

IMPRESSIONS ON SOCIAL MEDIA

24

PUBLICATIONS

NALSCRIBE: REAL-TIME SPEECH CAPTIONING WINNER OF THE HEARING TECHNOLOGY INNOVATOR 2023 AWARD

32,000+

DOWNLOADS

INTERNATIONAL LAUNCH OF NALGUIDE

NALguide:

Hearing Aid Features Explained

“The NALguide has gotten me closer to both understanding the features of hearing aids and to being able to ask for the features that are important to me. I now have the vocabulary to research further than before. I know I may not find all the features I would like in one hearing aid model or brand but I think I can get much closer than I am now.” - MARGARET, USA “An excellent way of bridging the gap between the hearing device features and the client’s knowledge” - DEAFNESS FORUM AUSTRALIA MEMBER

“A really useful hearing aid discussion tool that allows individuals with hearing needs to understand how the recommended hearing aid technology helps with their personal listening needs.” - HEARING HEALTHCARE PROFESSIONAL

Paola Incerti and Pádraig Kitterick sharing NALguide in This Week in Hearing HHTM

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Outlook to the Future Meeting Hearing Healthcare Challenges Head-on at NAL Dr Brent Edwards, NAL Director From my startup days, I learned early in my career that the most important factor investors consider when deciding whether to invest in a company is the people there and not the idea the startup is based on. NAL’s current success is a perfect example of this maxim. The most important factor for the impact that NAL is having on hearing healthcare is our people, and NAL has an incredibly talented and dedicated leadership team that is setting our strategy agenda and driving our success.

Below are NAL leadership team insights into current challenges facing hearing healthcare and the opportunities we have to make an impact.

Dr Pádraig Kitterick, Head of Adult Research Program Practice recommendations for managing hearing difficulties with minimal or no hearing loss are needed more than ever.

Over the past few years, we’ve been conducting research on the identification, diagnosis, and management of hearing difficulties for people with minimal hearing loss or who have ‘normal hearing’; that is, a hearing loss below the typical thresholds that many audiologists would consider appropriate for fitting hearing aids. A consistent finding from our research is that the degree of a person’s audiometric deficit is a poor predictor of the nature and size of benefit that they might receive from hearing aids.

Although most people who present at hearing clinics and are motived to take up hearing devices do have some level of audiometric loss, there is an increasing trend for people to present at clinics with hearing difficulties but minimal loss or normal hearing. Our research has shown that these people can benefit from hearing aids, particularly from the sophisticated directionality and noise reduction features that can help anyone hear in noisy situations. However, a question that we at NAL receive frequently is how should candidates for hearing devices be identified, if not by the audiogram, and how should hearing devices be fit to these individuals?

This is why a major focus of NAL is now to develop evidence-based recommendations to address these questions so that hearing health professionals can feel confident in managing the hearing needs of this underserved segment of people with hearing needs.

Dr Viji Easwar, Head of Paediatric Research Program Earlier and more personalised approaches to hearing intervention are crucial for children’s developmental milestones.

Diagnosis of hearing loss by 2-3 month of age is now routine with universal newborn hearing screening.

Despite early diagnosis and device fitting, children with even mild degrees of hearing loss are at-risk for delays in oral communication development by the time they join school. There is a need to evaluate and improve children’s hearing abilities, aided or unaided, before developmental delays are evident, but we currently lack clinical prognostic tools that can help determine who needs additional or alternative help before developmental delays become evident.

We are developing two types of clinical tools to help facilitate earlier decision-making for children with hearing loss. The first tool will use neural measures to gauge whether hearing aids provide adequate access to speech that is essential for speech and language development. These neural measures, being the only way to measure the hearing abilities of babies, will ensure optimal access to speech from the very first time hearing aids are fit. The second tool will entail a test that can measure the functional listening difficulties of children by closely mimicking everyday listening environment and demands.

Together, these solutions are expected to lead to a more personalized approach to intervention in children with hearing loss.

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Dr Jorge Mejia, Head of Technology Program AI-driven solutions are enhancing hearing services, diagnostics and patient autonomy.

Recent studies have highlighted disparities in hearing care services for underserved groups, emphasizing the need for specialised solutions that target their unique needs. Our research is focused on the development of sharper diagnostic and therapeutic tools for these overlooked demographics.

We’ve launched AI-focused projects to enhance hearing service standards, using big data and innovative methods to better understand and meet users’ needs. These efforts leverage AI to improve professional training, diagnosis accuracy, and patient autonomy in hearing aid management, while also allowing for individualised solutions. Responding to the shift towards remote and hybrid healthcare models, we are also developing technology solutions to make hearing care more accessible and personalized.

Phillip Nakad, Head of Operations and Finance Fostering a results-focused and innovative environment drives meaningful advancements in hearing healthcare.

Our Project Management Office ensures the efficient execution of all our projects, providing the necessary support to keep our initiatives on track and aligned with our goals. This support is vital for the success of our research and its translation into practical solutions that can make a real difference in people’s lives.

The operations function at NAL also facilitates strong collaborations with industry leaders, academic institutions, and healthcare providers. By managing these joint projects in these partnerships, we ensure that the capabilities, expertise and resources of each organisation are working effectively together to accomplish our joint goals to deliver impact.

Operations also focuses on building our internal capabilities to ensure that NAL researchers are equipped with the skills and knowledge necessary to tackle the complex challenges of hearing healthcare. This includes investing in training, adopting advanced technologies, and fostering a culture of continuous improvement.

Xiaoyin Shang, Head of Strategy and Innovation NAL translates research outcomes into valuable, real-world solutions – crossing the ‘valley of death’.

Of 128 deep tech start-ups in the Cicada Tech23 report, only 11% spun out of research, highlighting the challenge of translating research into real-world solutions. A fundamental challenge for organisations aiming to commercialise research is to deeply embed innovation in the organisation culture, protected by process and structure, and supported by people and strategy. For research initiatives to be successfully translated into products, research teams must be focused on creating value to address unmet needs with disciplined impact planning from the very start of the initiative.

At NAL, innovation is not just a buzzword, it’s the essence of our strategy to focus on the delivery of valuable solutions for hearing healthcare. In the past few years, we have transformed our strategy, process, capabilities and embedded an innovation agenda alongside research programs. With a robust pipeline of ten innovation projects currently underway, our goal is to translate these projects into tangible and valuable products and bring them to market with and through our global partnerships.

Our innovation ecosystem unites experts in healthcare, management, start-ups, and incubators. As the research core of this vibrant network, NAL is dedicated to redefining the standards of hearing healthcare globally.

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Application of AI in Hearing Healthcare The Challenge The field of hearing healthcare stands at the threshold of significant change, driven by rapidly evolving capabilities of Artificial Intelligence (AI), with the potential of solving longstanding problems in hearing healthcare.

“NAL is actively exploring the opportunities AI presents to enhance the precision, efficiency, and customisation of hearing healthcare solutions.” Jorge Mejia, Head of Technology Research.

What’s on the horizon At NAL, we are leveraging AI, big data analytics and smart device technologies to develop personalized solutions and diagnostic tools for people experiencing hearing difficulties.

Furthermore, we are researching the application of wearable technologies and AR/VR into our solutions.

“This technological approach to innovation enables us to understand real-world experiences, driving the development of highly customised products and more effective solutions that benefit people with hearing loss and those who provide hearing health solutions.” Jessica Monaghan, Senior Research Scientist.

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FIND OUT MORE

Personalised Solutions One of the greatest promises of machine learning for healthcare is personalised solutions for treatment and diagnostics. Hearing devices, while beneficial, often fail to meet the unique needs of each user, leading to suboptimal experiences, especially in dynamic and noisy environments where they are most needed. By leveraging large comprehensive datasets, the unique needs of hearing device users have been better understood by scientists at NAL who developed a generative AI tool that provides personalised hearing goals tailored to individual needs and lifestyles.

Personalising solutions to the specific needs of hearing device users requires an understanding of their experiences during their daily lives. The NAL Ecological Momentary Assessment (NEMA) system allows researchers to survey users about their current hearing difficulties and experiences throughout their day while capturing acoustic information about their listening environment. By using machine learning with the NEMA data, NAL researchers have derived insights about where hearing aid and cochlear implant users are having the greatest difficulty.

“This innovative approach not only enhances understanding of user experiences in realworld environments but also guides the development of more effective hearing solutions.”

Nicky Chong-White, Principal Engineer.

Diagnostics In the field of diagnostics, NAL is focussed on creating advanced tools that employ AI to enhance the accuracy and efficiency of hearing screening and assessment.

Jessica Monaghan, Senior Research Scientist, is developing an AI-powered app that will be able to screen two-tofour-year-old children for hearing loss simply by analysing the acoustic features of their speech.

For older children, NAL researchers have recently developed an innovative AI tool that significantly enhances the ability to monitor and assess the clarity of speech produced by school-age children as an indicator of potential hearing problems. This approach offers the opportunity for ongoing monitoring of a child’s speech development without necessitating clinical expertise.

For adult assessments, NAL has developed a language-agnostic speech test that adopts an audio-visual testing approach and is powered by sophisticated statistical machine learning models to provide a precise and fast information-rich diagnosis of a person’s hearing ability.

“This test, which can be conducted by either the healthcare professionals or self-administered, offers enhanced diagnostic capabilities and equips clinicians with a powerful tool to assist with clinical decision-making.” David Meng, Senior Research Engineer.

Improving hearing care delivery NAL is pioneering the use of generative AI to enhance training across the hearing industry. Our AI-powered platform combines rich proprietary data and clinical insights to create diverse personas of people with hearing loss that users can converse with to understand their varied challenges. This empowers clinicians, product developers, and non-clinical healthcare professionals to gain deeper insights into the needs, attitudes and beliefs of people with hearing loss.

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PROJECT SPOTLIGHT - INSIGHTS

Perceived Mild to Moderate Hearing Loss: An Under-served Segment for Hearing Aid Solutions The Challenge

FIND OUT MORE Traditionally, hearing aids were exclusively available to individuals diagnosed with hearing loss by a hearing health care professional such as an audiologist. However, a paradigm shift is occurring, particularly with direct-to-consumer hearing aids, with hearing aids increasingly being offered directly to consumers with perceived hearing loss, without evidence that the person actually has a clinically diagnosable hearing loss.

There has been limited evidence to show whether people can benefit from hearing aids based solely on them selfidentifying as having hearing problems where they may or may not have a clinical hearing loss.

Our Approach We recruited 26 adult participants who had not been diagnosed with a hearing loss by a hearing health care professional, but who reported problems with their hearing. All but two of the participants had average hearing thresholds in the normal range, with those two having only mild hearing loss. They were invited to visit NAL where they were fitted with hearing aids. The fitting of the hearing aids did not follow the typical process that would be used in a clinic, but rather was designed to reflect how over-the-counter hearing aids would be personalised for an individual buying them online after completing a brief online hearing test. This involved only using limited information about their hearing to match them to one of several fixed hearing profiles and setting up the hearing aids according to that fixed hearing profile. Only limited adjustments were made for comfort following the fitting, again to reflect the kind of adjustments that users of over-the-counter hearing aid can make using a connected smartphone app.

In the two weeks following the fitting, participants used a smartphone app to track their experiences with the hearing aids. They were also asked to use the app for the two weeks immediately before the fitting appointment, when they did not yet have access to hearing aids. Their use of the app allowed for real-time insights into the perceived hearing challenges they faced in everyday life and if/how hearing aids provide benefit.

Outcomes and Impact The results of this study suggest that individuals with mild hearing problems can benefit from hearing aids.

Participants’ hearing loss, as measured by clinical pure-tone thresholds, was not a good predictor of whether their hearing was causing listening difficulty, which agrees with significant previous research that clinical measures of hearing loss are poor indicators of the real-world consequences of hearing problems.

Despite participants having normal or near-normal hearing, they reported benefits from using the hearing aids in everyday situations, particularly in noisy environments. They also reported satisfaction with the hearing aids, reduced listening difficulty, and reduced impact of hearing loss on their emotions and social life.

Individuals with mild hearing problems may struggle to recognize the improvements in the short term because they are only using the hearing aids some of the time and usually in the most challenging listening situations where they need the most help with their hearing problems. However, the results also show that technology such as smartphone apps are an important tool in helping users recognise the benefits that the hearing aids are providing, such as reducing listening effort and fatigue, and stay motivated to incorporate hearing aids into their daily lives.

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This work represents an important part of our broader priority of addressing the hearing needs of people who have hearing problems regardless of whether or not they have a clinically diagnosed hearing loss” - Pádraig Kitterick, Head of Audiological Sciences

Key project insights The audiogram is a poor predictor of everyday experiences of listening

People with normal hearing and near normal hearing reported benefit from using hearing aids, particularly in noisy environments The use of smartphone apps helped users recognise the benefits of hearing aids, especially in the short term after acquiring the devices

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PROJECT SPOTLIGHT - INNOVATION

Next Generation Hearing Goal Setting Tool The Challenge Audiological practice worldwide has radically changed over the past several decades, driven by advancements in technology, research, and changing client needs and expectations. Accordingly, the basic procedure outlined in the original Client Oriented Scale of Improvement (COSI) publications may not reflect the pattern of use currently implemented in Audiological clinical practice 27 years post publication. While the COSI is still widely used, audiologists have likely developed their own methods and approaches to using the tool based on their clinical experience and from the changing needs of their clients. Building on the evidence-based research and insights on contemporary Audiological practice, an evaluation and development of COSI is warranted to ensure that the hearing goal setting tool continues to meet the needs of audiologists and their clients in an ever-evolving field.

Our Approach A team at NAL deep dived into the current implementation of the COSI and highlighted where opportunities exist to improve hearing goal setting practice. This project took a dual-pronged approach, with retrospective analysis of over one million COSI goals as well as in-depth interviews with clinicians about their use of the COSI with their clients in the clinic.

Outcomes and Impact The project identified a number of key insights about the current use of COSI for goal setting, including the fact that the client’s role in setting, attempting and achieving their goals is not well defined. Clinicians also reported that a particular pain point is the lack of tools to help clients identify suitable listening goals. The results of this project highlighted areas in the current COSI Goal Setting procedure that should be updated to enhance the client experience and bring the process more in line with the rehabilitation goal setting literature and best practice. The research team has adapted these insights into a new COSI goal setting framework (see below). Elements of this updated COSI framework will be tested with clinicians and clients to inform updated tools and procedures to aid the effective use of goal setting in audiological rehabilitation.

The eventual aim is to release the updated COSI tool and procedure that is more in line with rehabilitation goal setting best practice and client centred care.

New COSI Goal Setting Framework

Active

Aware

Agree

Attempt

Assess

Achieve

Clients are active participants in the goal setting process.

Clients are aware of their goals, the purpose of the goal setting process, and when progress will be reviewed.

Clients and clinicians make an agreement to work towards their goals with the guidance and support of their clinician.

Clients know how to attempt their goals with smaller, achievable tasks.

Clients are able to track and assess their progress between clinic visits.

Clients are able to achieve their goals and celebrate their progress with their clinician.

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About COSI The Client Oriented Scale of Improvement (COSI) was originally developed by NAL in 1997 as a way to measure hearing aid benefit and satisfaction in a clinical setting. The COSI enables clinicians to work with their client to develop ‘SMART’ goals – goals that are Specific to the client, Measurable, Attainable, Realistic and to be completed in a set Time. These goals are then revisited at subsequent appointments for review until they are ‘achieved’. In this way, the COSI is set apart from other measures of benefit and satisfaction, as the client chooses their own metrics based on the listening situations that are important to them, allowing for a more personal and client-centred approach.

In conversation with the NAL COSI project team Is goal setting still an important part of Audiological practice?

The setting and achievement of rehabilitation goals has proven time and again to be a critical part of the management of hearing loss and many other health conditions. Our research has extracted the lessons that have been learned from applying goal setting to patient rehabilitation across the healthcare field to identify the key concepts that are core to an effective goal setting practice in audiology.

What does the future hold for NAL’s COSI, the most widely used goal setting tool in Audiology?

Clinicians continue to tell us that COSI is a critical part of their patient-centred care. We are now focused on creating efficient and intelligence tools to support clinicians to integrate best practice goal setting into their everyday care.

Project lead: Dr Taegan Young Research Audiologist, winner of the NAL 2023 Above and Beyond Award A former clinician who joined NAL as a Research Audiologist in 2014, Taegan has worked on a variety of projects with adults and children, in areas including hearing assessment, hearing aid fitting and hearing rehabilitation. Taegan was also the project lead of The Rapid Evaluation of Novel Technology project in partnership with GN ReSound.

“Her experience and support has been valuable to the staff she manages as well as the multiple projects she has been involved in” - NAL Staff.

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PROJECT SPOTLIGHT - CAPABILITIES

World First Large Scale Multi-site Trial of Cochlear Implant Processor Upgrade Benefit The Challenge A cochlear implant system includes a part which is implanted in the inner ear, and a part that is worn on the head or behind the ear (the sound processor). Sound processors can be upgraded without the need for additional surgery, and cochlear implant manufacturers are regularly coming out with new models with additional features. Many individuals are relying on very old processors, some of which are no longer supported by manufacturers, because of lack of access to funding to upgrade them. There is a lack of evidence for the benefit of replacing older processors with the latest technology, which limits justification for upgrading them.

Our Approach In response to this challenge, NAL, supported by the Australian Government Department of Health and Aged Care, investigated the impact of upgrading the cochlear implant sound processors by recruiting and upgrading a large cohort of 304 adults aged 65 years or older in an Australian-wide study spanning 14 collaborating sites.

Participant Evaluation: Data was gathered on speech understanding in noise, cognition, listening effort, fatigue, device benefit, mental well-being, social participation, and empowerment before and after upgrading the processors. The study found that upgrading sound processors had a significant positive impact on the ability to understand speech in noisy environments and also significantly reduced listening effort, fatigue, and listening difficulties.

Semi-structured interviews provided additional insights into the lived experiences of adults pre and post upgrade. In particular, the use of obsolete technology created fears and anxiety about how they would cope with a total failure of their processor(s), and upgrading the processors alleviated these fears.

Economic Analysis: A health economic analysis from the Australian health system perspective found that the economic benefit of upgrading sound processors came from avoiding scenarios where processors failed completely. If upgrading avoided these failures, then it prevented someone who relies on this hearing technology from experiencing a significant decrease in health-related quality of life.

Outcomes and Impact This was a first-in-the-world study of the benefit of upgrading sound processors on a very large cohort of older adults who use cochlear implants. Overall, the study provides evidence that upgrading sound processors offers significant benefits for the individual and is economically sound in cases where it avoids someone losing access to sound completely due to a total device failure. The findings extend beyond traditional clinical measures, providing new insights into patient-focused benefits of cochlear implant technology.

The evidence collected in this study should be helpful for policymakers around the world to make decisions on policies for cochlear implant processor upgrades in older adults.

Honestly, I feel it’s a lot clearer and... Well, I haven’t got to concentrate as much on hearing as I used to” The thing was 10 years old now and it started to get more and more difficult with it, [...]. And it was going to get harder as time went on, so that really was starting to worry me a little bit. What would happen?”

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FIND OUT MORE

304

340

PARTICIPANTS

3,000+

HOURS OF CLINICAL APPOINTMENTS

SOUND PROCESSORS UPGRADED

PROJECT AT A GLANCE

39,168

TESTS COMPLETED

600,000+

5,576

HOURS OF PROCESSOR USAGE LOGGED

QUESTIONNAIRES

Project lead: Dr Paola Incerti Senior Research Audiologist, winner of the NAL 2023 Research Excellence Award and Product Lead of NALguide Paola has worked as Senior Research Audiologist at NAL since 2009. Paola has extensive experience in hearing device rehabilitation research, with a focus on optimizing listening devices to improve outcomes in children and adults.

“The reason I enjoy collaborating with the Australian Government Department of Health and Aged Care projects is having the opportunity to provide research evidence that might guide policy, and design products to empower individuals throughout their hearing health journey.”

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PROJECT SPOTLIGHT - PARTNERSHIP

Behind the Innovation: Rapid Evaluation of Advanced Hearing Aid Technologies The Challenge Hearing aid technology is constantly changing, with new features being introduced regularly to the market by manufacturers. There is a need to develop methods to rapidly assess these new features to accurately understand the real-world benefit to the end user. One example of a recent technological development was the introduction by GN ReSound of a new hearing aid that has a microphone placed at the entrance to the ear. The conventional design of behind-the-ear hearing aids have microphones on the top side of the device, which removes any acoustic effects that the pinna has on the perception of sound. GN’s technology aims to better mimic the natural transmission of sound to the ear by locating the microphone where it can pick-up sound after the pinna has had its effect.

Our Approach Our rapid research evaluation tested whether this new technology leads to real-world benefits for the hearing aid wearer. Devices equipped with microphones in the ear canal were systematically compared to devices with conventional behind-the-ear microphones in various listening conditions. We used NAL facilities to recreate realistic listening experiences for end users, and our experiences with assessing outcomes to evaluate the effect on sound localisation, sound quality, speech understanding and listening effort in individuals with mild-to-moderate hearing loss.

Eleven participants with mild to moderate hearing loss underwent a hearing assessment and were fitted with multiple pairs of hearing aids. Subsequently, participants engaged in several challenging listening tasks designed to mimic real-world listening environments to assess the performance of the devices.

Outcomes and impact Our approach was effective at rapidly evaluating the benefits of the new technology by demonstrating significantly improved sound localization and fewer errors in determining the direction of sounds with the new technology compared to conventional behind-the-ear hearing aids. This improvement is important for representing an accurate auditory scene to the hearing aid wearer which should enable them to focus better with less effort. Using our stateof-the-art facilities, we were able to show that the new technology was preferred over conventional behind-the-ear hearing aids, especially in noisy scenarios.

This research demonstrates how NAL is leveraging its facilities and capabilities to assess the success of new technologies that aim to address the challenges associated with conventional hearing aid designs. Our approach aimed to identify whether there were tangible improvements in crucial aspects of hearing experience for the end user. The evidence gathered in this kind of rapid evaluation can contribute to shaping the future landscape of hearing aid design and usage by providing timely and meaningful feedback to manufacturers on their new technologies, and meaningful information to help guide consumers about how new technology may address their hearing needs.

FIND OUT MORE

Bring hearing technology innovation to life – we all play a role During an era of rapid technological advances, consumers are increasingly demanding about having the latest features integrated in the hearing technology and into their daily lives.

NAL has observed an increase in new features introduced by manufacturers and are actively identifying whether these features have direct benefit for the hearing aid wearer. NAL sees this as an important part of our work to be a trustworthy independent source of high-quality research evidence that focuses on evaluating the realworld client centred benefits for new technology in hearing healthcare.

By working with manufacturers, clinics, start-ups and technology giants more broadly, NAL aims to facilitate and introduce more hearing innovation to market so that our industry continues to address the unmet needs of people with hearing difficulty.

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NAL IN ACTION

Angela Wong presenting LOCHI team’s award winning research poster at AudA conference

NAL Audiologists presenting at AudA conference

Pádraig Kitterick winner of the Best Presenter award at AudA conference

Taegan Young winner of Best Early Career Research Poster award at AudA conference

Andrew Bellavia, Stef Launer, Karl Strom and Brent Edwards at ADA AuDacity

David Meng presenting NAL tech innovation at Google

Jessica Monaghan presenting at Acoustics23

Pádraig Kitterick, Brent Edwards and Nicky Chong White at Acoustics23

Viv Marnane presenting at Hearing Australian Hub

NAL booth at SXSW Sydney

World leaders in hearing research at SXSW Sydney

Brent Edwards trying NAL VR demo at SXSW with Arun Sebastian

Matt Croteau Research Audiologist, winner of the NAL 2023 Rising Star Award.

Matt is a clinical audiologist with a strong science and technical background who has worked in the areas of hearing assessment and rehabilitation for adult, paediatric and complex cases.

“The work we do at NAL is designed to address critical areas of hearing healthcare while always increasing our capabilities for the future – by always building toward these goals, it never feels like we’re waiting to see progress, the impact of our work is ongoing.”

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Acknowledgments Our global connection of collaborators enables translational outcomes and allows us to pursue our mission of improving hearing health and transforming the lives of people with hearing difficulties.

Colleagues

Collaborators Cochlear Google GN Macquarie University NextSense

Nuance Audio Sonova UNSW Faculty of Medicine & Health WSA

Valued contributors to NAL research Amplify Hearing and Diagnostics

National Centre for audiology Canada

Australia Indigenous Doctors Association

Orange Aboriginal Medical Service

Clarity Hearing and Balance

Red Lily Health Board Aboriginal Corporation

Cochlear Care Centre

Royal Brisbane and Women’s Hospital

Department of Health ACT, NSW, NT, WA, and SA

Royal Flying Doctor Service

Drumbeat-ai

Royal Perth Hospital

Ear Science Institute

Royal Sir Charles Gairdner Hospital

Fiona Stanley Hospital

Royal Victorian Eye and Ear Hospital

George Institute for Global Health

Rural Doctors Network

Mater Health Services

South Australia Cochlear Implant Centre

Members of the Aboriginal and Torres Strait Islander research leadership group Murdoch Children’s Research Institute

Sydney University Faculty of Medicine

National Aboriginal Community Controlled Health Organisation (NACCHO)

Royal Hobart Hospital

Telethon Kids Institute Townsville Hospital University of Wisconsin, Audioscan Western Sydney University Yagbani Aboriginal Corporation

Special mention to: Members of NAL’s Aboriginal and Torres Strait Islander Research Leadership Group

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NAL 2023 Annual Impact Report

Our collaborators

A day at NAL. NAL leadership team and Jane McDonald , CEO of Hearing Business Alliance

Paola Incerti running the Cochlear Implant Processor Upgrade project workshop with representatives from 14 collaborating sites in the study

NAL leadership at a strategic offsite with Stefan Launer, Sonova VP of Audiology and Health Innovation

Isabel O’Keeffe, Meagan Ward, Jessma Nash collaborating with Ebony Hay at the Orange Aboriginal Medical Centre

Jorge Mejia, Andrew Dittberner, Brent Edwards and Xiaoyin Shang at NAL and GN mini-conference

A day at NAL with visiting international researchers: Torsten Dau, Andrew Oxenham, Ian Bruce, Karolina Smeds and Sunil Puria

NAL 2023 Annual Impact Report

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National Acoustic Laboratories Level 4, Australian Hearing Hub 16 University Avenue Macquarie University NSW 2109 Australia nal.gov.au