NAL Annual Impact Report 2024

Annual Impact Report 2024

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 advancements 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 translational research.

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 aid prescription around the world; and a validated questionnaire to evaluate a child’s listening skills in the real world.

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NAL 2024 Annual Impact Report

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 respects to Elders past and present 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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Contents Mission and Impact..................................................................................................................1 Acknowledgement of Country...............................................................................................2 Message from Dr Brent Edwards...........................................................................................5 Message from Kim Terrell.......................................................................................................6 2024: Driving Global Impact...................................................................................................7 Focused on the Future: NAL’s Leadership’s Commitment to Advancing Hearing Research.............................................................................................9 Hearing Well in Early Life: Advancing Clinical Hearing Tests for Infants.................................................................................................................... 11 The Benefit of Providing Devices for Persistent Otitis Media in Aboriginal and Torres Strait Islander Children.................................................................. 13 Driving Innovation: NAL’s Agile Approach to Commercialisation and Impact Delivery.............................................................................................................. 14 Innovation centre: Transforming Hearing Care Through Collaboration and Agility..... 15 AirPods Pro as Hearing Aids: Evaluations of Evolving Capabilities................................ 17 Hearing Services Program - Minimum Specifications for Subsidised Devices............... 19 Exploring Sound Quality in Public Broadcasts: Auracast vs. Telecoil............................. 20 Improving Videoconferencing Communication for People with Hearing Loss.............. 21 Acknowledgements.............................................................................................................. 22

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NAL 2024 Annual Impact Report

NAL 2024 Annual Impact Report

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Message from Dr Brent Edwards NAL Director At NAL, we talk a lot about Impact. Having an impact on hearing healthcare not just in Australia but around the world.

Making sure that everything we choose to focus on has the potential for the highest level of impact on people with hearing difficulty, hearing care providers (HCPs) who provide treatments, and companies who develop solutions. We have even developed a special-purpose Impact Assessment to predict the impact potential at the beginning and measure the resulting impact at the end of every project we do.

2024 saw a significant advancement in our impact agenda with respect to innovation. It was great to see our early research into the hearing benefit of the Apple AirPods Pro Headphone Accommodation feature lead the world in understanding the AirPods Hearing Aid feature when released in October 2024. The work that we did in 2024 to provide advice on improving the Australian Government’s Hearing Services Program will also have a significant impact on improving the lives of people with hearing loss in Australia, and potentially around the world if other government hearing healthcare funding bodies follow suit.

Importantly, 2024 is the year that we focused on building our ability to bring viable customer-focused technology solutions to hearing healthcare by addressing unmet needs of people getting hearing treatment and the HCPs that provide hearing services. We leveraged Design Thinking principles and developed an agile Lean Startup approach to identify and build solutions. 2024 was the year that we matured our ability as a hearing health innovation incubator, and 2025 is when we will deliver on the promise of the innovation pipeline that we have created this year.

Looking forward, we have big ambitions for 2025. This will be the first year that we have a major presence at the AAA annual conference in the US, with a booth and two major presentations to reveal important improvements to widely used clinical tools from NAL. One of those is NAL-NL3, which will be a major advancement over the most used fitting prescription in the world, NAL-NL2. We will also be presenting on COSI 2.0, a much-needed upgrade to the original COSI that was developed by NAL over 25 years go. At AAA, we will also be showcasing in our booth a new tool for training audiologists on critical conversations with patients and clients, the NAL Virtual Personas. All three of these advances rely heavily on the use of AI, which NAL has been at the forefront in hearing research application for much of the past decade.

We are finding more and more that our focus on impact and innovation is attracting the attention of organisations around the world that have the same focus, commercial and otherwise. By aligning our efforts with those of other international organisations, we can amplify the impact that we bring to hearing healthcare beyond the capabilities of the 50 or so researchers that we have at NAL. I am grateful to all these organisations and the leaders within them who enable these partnerships. The leader of a company I previously worked at used to paraphrase Helen Keller’s famous quote as “Alone we can’t do much. Together we can change the world.” At NAL, we have ambitions to change the world and with our partners, we are doing just that.

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NAL 2024 Annual Impact Report

Message from Kim Terrell Hearing Australia Managing Director Throughout 2024, the National Acoustic Laboratories (NAL) continued to deliver meaningful research to address key challenges in hearing healthcare. With a strong focus on translational research, NAL has worked to ensure its findings and developments make a real difference in clinical settings and to the lives of people with hearing difficulties.

By harnessing the potential of artificial intelligence, NAL is developing tools that support people with hearing loss and clinicians. This includes the creation of tools that could compliment many existing areas of the field, from training students to improving our understanding of complex rehabilitation needs.

During the year, NAL placed significant emphasis on advancing paediatric hearing care through improvements in clinical hearing tests and hearing screening approaches. These efforts are critical in developing solutions that further enhance care pathways for children with hearing loss.

The Innovation Centre has further accelerated research initiatives, fostering collaboration and advancing AIpowered solutions for personalized hearing healthcare. The centre is an example of a unique research and innovation ecosystem, with connections to clinicians and people with hearing loss.

Collaboration remained central to NAL’s work in 2024. By partnering with government, industry, and academic institutions, NAL has driven progress in areas such as client-centred care and healthcare delivery models. These efforts have facilitated impactful projects designed to improve both clinical practices and access to hearing care services.

I extend my thanks to the NAL team, the many people who support NAL’s research, and our collaborators for their efforts this year. Your contributions have been invaluable in advancing hearing research and care.

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2024: Driving Global Impact IMPACT CREATION

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ACTIVE PROJECTS

COLLABORATORS

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PRESENTATIONS

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PUBLICATIONS

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300,000+ IMPRESSIONS ON SOCIAL MEDIA

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Conferences

Exchanging insights with Judy Grobstein and Dave Fabry at ACAud Conference

Bec Bennett presenting at British Academy of Audiology

Brent Edwards at IHCON, moderating an expert panel on AI in Audiology

Exploring SMART Tech: Jessica Monaghan and Nicky Chong-White at INTERSPEECH 2024 in Kos, Greece

Nicky Chong-White presenting on hearing tech innovation at the ACAud Conference

Nicky Chong-White at the Health Research Summit at Apple in Cupertino

Viji Easwar presenting at IHCON 2024

Taegan Young presenting at Audiology Australia Online Conference

Bec Bennett at World Congress of Audiology, Paris

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Focused on the Future: NAL’s Leadership’s Commitment to Advancing Hearing Research Dr Brent Edwards, NAL Director NAL is committed to having as large a positive impact on hearing healthcare as we can.

Being a research and innovation organisation, this means that we must be at the forefront of every emerging opportunity in hearing health.

For years we have been leading insight and developing evidence to guide hearing care providers and hearing device manufacturers on transformative changes to our field. We have ten years of guidance on the challenges with direct-to-consumer hearing aids; we have years of understanding the benefit of hearing aid features on earbuds such as AirPods Pro; long before the introduction of ChatGPT, we were applying AI to hearing health challenges; we have led the understanding of the needs of and treatment strategies for the vastly underserved population of people with hearing difficulty but “normal” audiograms.

NAL will continue in these areas and any other emerging opportunities to have an impact on hearing healthcare, all with the goal of improving the lives of people with hearing difficulty.

Dr Pádraig Kitterick, Head of Audiological Science This year marks a significant and exciting time for adult hearing loss research and innovation at NAL. With the release of our new NAL-NL3 hearing aid fitting system later this year, we will make the most significant advancement in hearing aid prescriptions that the field has seen for over a decade. Most importantly, this system will provide validated solutions to help clinicians address unmet needs related to hearing aid fitting, including how to fit adults with minimal hearing loss or normal hearing who experience difficulties in noisy places.

We will also make major steps forward in developing and testing COSI2.0, the next generation of the Client Oriented Scale of Improvement from NAL, that will deliver a digital AI-powered client-driven hearing improvement scale to better meet the evolving needs of clients, clinicians, and businesses in the hearing healthcare space. We will also continue important research on how to support the wellbeing of adults accessing hearing services beyond the clinic by leveraging modern digital tools and evidence-based approaches. Most importantly of all, 2025 will be a year that we seek to have meaningful impacts on the field of hearing healthcare by putting these solutions into the hands of clinicians, clients, and hearing service providers around the world.

Dr Viji Easwar, Head of Paediatric Research Program In the upcoming year, we look forward to revealing the accuracy and utility of two diagnostic tools we have developed.

One of the tools is a novel EEG approach to evaluate hearing aid benefit in babies with hearing loss so we can optimise their hearing ability. The second is a listening test that assesses children’s ability to comprehend speech—a necessity for good communication—in environments they encounter every day. We also anticipate elucidating the benefit of early intervention in children with bilateral and unilateral hearing loss from the two longitudinal studies, the LOCHI (Longitudinal Outcomes of Children with Hearing Impairment) and CUHL (Children with Unilateral Hearing Loss), respectively.

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Dr Jorge Meija, Head of Signal Processing At the Signal Processing Department, we leverage AI and advanced signal processing to advance our understanding of hearing aids, assistive technologies, and hearables.

Our vision is to bridge the gap between traditional diagnostics and real-world hearing challenges by developing innovative solutions that personalize hearing care. In 2025, we are excited to collaborate with our commercial and research partners to accelerate the development of AI-based products designed to support clinicians and hearing care professionals.

Our mission is to ensure that technology and clinical practices align seamlessly with realworld patient needs.

Phillip Nakad, Operations and Finance Manager Our Operations teams play a vital role in delivering impactful outcomes across hearing healthcare.

Our dedicated professionals provide support NAL across project management, grant management, administration, financial oversight and strategic operations. We integrate governance with streamlined workflows to optimise efficiency, mitigate risks, and drive project success. By fostering collaboration between researchers, participants and industry partners, our operations team enables breakthrough solutions that improve lives.

In 2024, the operations team were instrumental in supporting NAL’s focus on product development, agility and innovation. We continue to refine our ways of working to stay ahead of stakeholder needs. In 2025 and beyond, we will continue this evolution, ensuring we support our researchers, innovators and partners by providing the foundation for transformative impact in hearing care.

Xiaoyin Shang, Head of Strategy and Innovation At NAL, innovation is a core strategy for translating research into real-world solutions that improve lives.

The NAL Innovation Agenda is embedded in everything we do, shaping how we work and the impact we create. We have built a commercialisation pathway to move discoveries into products, and an Innovation Centre to test ideas in real clinical settings.

In 2025, several products will reach the market, demonstrating our commitment to impact delivery. You can learn more about this process and our latest developments in this year’s Annual Impact Report. These achievements are only possible because of the dedication, resilience, and expertise of our team and collaborators. Looking ahead, we remain focused on delivering valuable solutions with and through our partners to improve the lives of those who rely on our innovations.

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Hearing Well in Early Life: Advancing Clinical Hearing Tests for Infants Viji Easwar, Head of Paediatric Hearing Loss One of NAL’s key research programs is to advance paediatric hearing healthcare through objective measures such as auditory evoked potentials (EEG) and otoacoustic emissions (OAEs). These measures have been instrumental in universal newborn hearing screening and hearing aid fitting because children cannot undergo standard behavioural hearing tests until they are ~8–10 months old. Over the past year, our research has driven two key advancements in this area: (1) Improving the utility of EEG to optimise infant hearing aid fittings early in life, and (2) Developing a more informative and efficient hearing screening using OAEs.

Using EEG to optimise infant hearing aid fittings Infants born with hearing loss are routinely fit with hearing aids by 2–3 months of age, but demonstrating their effectiveness at such a young age is challenging. Ensuring that hearing is optimised within the first 6 months of life is critical for age-appropriate listening, speech and language outcomes, and is hence a critical step in infant hearing aid management. In the past decade, clinics in Australia have benefitted from the routine use of HearLab—a cortical evoked potential test uses neural activity to short, speech-like sounds. HearLab has been pivotal in optimising hearing aids, ascertaining hearing aid benefit, and identifying candidates for cochlear implants. Building on this foundation, NAL,in collaboration with the National Center for Audiology (Western University, Canada), is now developing the next generation EEG method to evaluate hearing aid benefit with higher accuracy, reduced test times, and earlier in a child’s life to support better outcomes.

This novel EEG approach based on envelope following responses (EFRs) — a type of auditory evoked potential.

EFRs are valuable as they can be evoked by naturally spoken speech, and includes neural responses to the ~80-100 Hz fundamental frequency of voice and slower, ~1-4 Hz responses to rhythmic structures in speech. By leveraging both responses, we obtain a flexible toolkit that could accurately and efficiently infer frequency-specific audibility of speech in both sleeping and non-sleeping infants, including those with auditory neuropathy spectrum disorder.

Together with our industry partner Audioscan, we have been evaluating this technique in infants with hearing loss over this past year. As we continue to gather data, we are excited to further establish the clinical utility of this new technique, and to test further improve upon its utility, accuracy and efficiency.

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Teaching an old dog new tricks — OAE screeners to detect neural deficits Sriram Boothalingam, Senior Research Scientist The current gold standard of hearing screening using auditory brainstem responses (ABR) is expensive and out of reach for developing nations. To address this, we have developed an approach using otoacoustic emissions (OAEs) – energy generated by the ear in response to sound – with the ability to screen for hearing loss similar to ABRs. Additionally, the approach is more cost-effective and provides additional diagnostic insights, which are not routinely provided by existing screening paradigms.

Our patented OAE approach leverages brainstem reflex pathways to assess neural health – something that conventional OAEs alone cannot do. Further, it utilises sound energy reflected by the eardrum to also infer middle ear status – a common cause for failed new newborn hearing screenings.

This ongoing project is gathering data from infants and children with both normal hearing and various types of hearing loss, including those with neural deficits. Preliminary analyses demonstrate that the technique is effective at detecting hearing loss, as predicted. Additionally, in collaboration with Macquarie University, we are exploring ways to further improve test accuracy and efficiency through novel signal processing techniques, advanced sequential test strategies, and state-of-the-art machine learning.

Ultimately, our innovative solutions and research aim to help young infants to hear better at this critical period in their development and to improve accessibility to universal hearing screening.

EEG team: Genevieve Olencewicz, Michael Chesnaye, Viji Easwar, Sanna Hou

Genevieve Olencewicz and Viji Easwar conducting infant hearing assessments in Perth

OAE Team: Sriram Boothalingam, Sanna Hou, Viji Easwar, Matt Croteau

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The Benefit of Providing Devices for Persistent Otitis Media in Aboriginal and Torres Strait Islander Children Meagan Ward, Project Lead The Challenge Aboriginal and Torres Strait Islander children in Australia experience the highest rates of otitis media in the world, especially during their early years of life. This condition often leads to hearing loss, which can affect speech and language development. To help manage this, bone conduction devices are prescribed routinely when hearing loss in the better ear is at least 30 dB HL. However, there is limited evidence to support this decision, and factors influencing the benefit of the device remain poorly understood. Our goal was to better understand how these devices are being used, identify factors that affect their effectiveness, and improve upon clinical guidelines and services.

Our Approach We reviewed clinical records of 729 children. In a subset of 200 children, we reviewed case files to infer device use, taken as a proxy for device benefit, and factors that positively influenced device benefit. This project received cultural guidance from NAL Aboriginal research leadership group.

Outcomes and Impact We found that hearing had improved for ~ 8% of the children after fitting. The age at which the device was fit did not influence device use, nor did geographical remoteness. However, shorter intervals between the fitting and follow-up appointment, as well as having a parent/carer at the fitting appointment, did facilitate device use. It was also observed that hearing levels at the time of fitting did not strongly predict whether children used their devices, but the persistence of hearing loss at the follow-up appointment did. In general, children were more likely to use their devices when both ears had hearing loss, and device use increased as hearing loss in the poorer ear became more severe. Even when the better ear thresholds were within normal hearing limits, larger asymmetries were associated with increased device use.

Key Highlights: • Children with persistent otitis media benefitted from prescribed devices.

• To optimize hearing aid effectiveness, fitting protocols should consider poorer ear hearing levels in addition to better ear hearing levels.

• Scheduling follow-up appointments within 2-3 months of fitting can help ensure consistency in device use.

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Driving Innovation: NAL’s Agile Approach to Commercialisation and Impact Delivery Phillip Nakad, Operations and Finance Manager NAL has embraced a new process for commercialisation and impact delivery, designed to drive innovation and deliver value to its customers. Grounded in agile principles and Lean Startup methodologies, this approach focuses on rapid Build-Measure-Learn cycles to refine offerings and align with market needs. By quickly developing prototypes, testing them with real-world feedback, and learning from measurable outcomes, the process ensures that every iteration is more customer-focused and impactful. This adaptability not only accelerates delivery timelines but also reduces risk by making data-driven decisions at every stage. The process is overseen by NAL’s product committee, which rapidly and regularly provides feedback into development teams.

Over the next year, the commercial process is set to achieve significant milestones, with the launch of new solutions, including: A new prescriptive formula, which will help clinicians address a range of unmet clinical needs with new evidence-based fitting rationale

Training tools that leverage AI to create realistic interactions for students and clinicians

Personalisation solutions that tailor training and education for enhanced wellbeing and communication to individual client needs

All products are tested with key customer groups and developed iteratively based on actionable insights. This approach ensures that NAL’s solutions will remain relevant in a competitive and evolving marketplace.

To support these goals, NAL is investing in the skills, tools, and processes needed to optimise this commercial framework. Ongoing training is equipping teams with expertise in rapid prototyping, and feedback integration.

We have also worked closely with key partners who help guide and execute development.

“As NAL seeks to broaden the impact of their innovative research through commercialization of products, the team is expanding their capabilities.

The world’s leader of hearing research is developing into a team who not only designs and produces world class research; they are becoming a team that focuses on market needs, opportunities, product design and the best ways to deliver these unique products to the evolving care models within hearing healthcare.”

- Susan Whichard, Hearing Industry Innovator

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Innovation Centre: Transforming Hearing Care Through Collaboration and Agility Kate Rutledge, Project Manager The Challenge The Innovation Centre, established in 2022, is a bold leap in hearing care innovation. Bridging cutting-edge ideas to real-world application, the Centre operates as both a functioning clinic and a hub for NAL to test groundbreaking solutions. With collaboration and agility at its core, it aims to redefine how hearing care challenges are addressed.

Innovation isn’t just about ideas; it’s about making those ideas work in the real world.”

Kate Rutledge, Project Manager Healthcare innovation faces numerous barriers, including the disconnect between research and clinical application and the slow adoption of new practices.

These hurdles are significant in hearing care, where solutions must integrate seamlessly into clinical workflows and different models of care that can be difficult to change. The Innovation Centre was created to address these challenges head-on, fostering an environment where experimentation and iterative learning thrive without disrupting daily operations.

The Innovation Centre bridges the gap between research and clinical practice by integrating researchers into real-world testing environments.

This collaboration ensures that every innovation is grounded in practicality and tailored to address genuine client and clinician needs.

This approach not only accelerates innovation but also empowers clinicians and clients alike by fostering trust and engagement.

The Centre’s culture of collaboration amplifies its impact, connecting researchers, clinicians, and external partners to co-create solutions. This approach fosters shared ownership, enriching problem-solving through diverse perspectives

We’re not just researchers in an ivory tower—we’re actively engaging with the people who know the problems firsthand. This ensures our solutions are relevant and impactful.”

– Bec Bennett, Senior Research Audiologist

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The Innovation Centre is a platform that allows researchers, clinical staff and clients to establish a deep understanding of the unmet need and co-create the solution; a key to bridging the gap between research and real-world adoption. The Innovation Centre exemplifies NAL’s commitment to translating evidencebased research into meaningful healthcare solutions. I am proud of our team, whose dedication, resilience, and innovative mindset fuels this transformative process.”

- Xiaoyin Shang, Head of Strategy and Innovation

The Centre’s dual-track approach blends rapid experimentation with the validation provided by structured research.

• Innovation Sprints: These short cycles enable quick hypothesis testing and immediate feedback, paving the way for faster iterations.

• Traditional Research: Parallel studies validate findings, ensuring robust data supports broader implementation.

The Centre employs an agile, collaborative methodology that drives innovation while ensuring practical feasibility: • Agility: Two-to-four-week testing cycles enable rapid iteration, learning, and adjustment.

• Cross-Functional Collaboration: Teams comprising researchers, clinicians, and external stakeholders co-create solutions tailored to real-world needs.

• Integrated Testing: Pilots are conducted within fully operational clinics, ensuring the relevance and effectiveness of new tools.

Project Highlights Profiling and Triage Tool This Tool, developed through a combination of predictive algorithms and clinician insights, demonstrates the power of research-driven innovation. This tool analyses client data to predict their specific hearing care needs before appointments, enabling clinicians to prepare personalised solutions. During national pilot testing, the tool showed promise in streamlining client pathways and enhancing service delivery. Researchers worked closely with clinicians to refine the algorithms, ensuring they captured meaningful insights while remaining intuitive for everyday use.

Client Empowerment Survey This innovative survey was designed to support client-centred care by helping clinicians assess clients’ readiness for hearing solutions. During trials, researchers observed clinicians adapting the tool to involve clients’ significant others, transforming it into a family-focused framework for engagement. The iterative testing process helped empower clinicians to have deeper client conversations and build trust in the care journey.

“Listen to This” Campaign NAL is a partner on the Listen to This campaign, which aims to ensure hearing health is recognised as a factor in good cognitive health. In this test, campaign materials were integrated into the clinic waiting and clinical rooms. The research team collected qualitative data from the clinic staff and identified that the materials drove engagement with several clients. Subsequently this testing has been expanded to several other clinics, with promising results continuing to emerge.

By breaking down silos, we’re driving smarter solutions and delivering better outcomes for clients and clinicians alike.”

LISTEN TO THIS

Maintaining good hearing may help protect cognitive health

– Julie Till, Innovation Centre Manager

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AirPods Pro as Hearing Aids: Evaluations of Evolving Capabilities Nicky Chong-White, Principal Engineer Introduction Since Apple introduced Live Listen support for AirPods in 2018, these consumer earbuds have evolved into a comprehensive hearing solution. Initially providing basic broadband amplification, AirPods Pro now incorporate personalised frequency- and level-dependent gain, directional beamforming, active noise cancellation, integrated hearing tests, and even FDA-approved hearing aid software. As a result, they can measure hearing deficits and deliver tailored amplification, offering an accessible route to improved hearing for individuals with mild-tomoderate challenges.

Over the past several years, NAL has led the way, conducting extensive evaluations of these devices in both controlled settings and everyday use. This article summarizes NAL’s key findings and highlights recent developments that may further expand the reach of accessible hearing support.

Early Evaluations: Headphone Accommodations & Transparency Mode Our initial studies evaluated AirPods Pro with Headphone Accommodations in Transparency mode, released in 2021. Unlike earlier app-based methods that relied on the phone’s microphone and processing power – causing notable Bluetooth delays - AirPods Pro processed ambient sounds directly in the earbuds. Our acoustic measurements assessed the amount of applied gain and compression. Results showed that while AirPods Pro tended to under-amplify soft sounds and over-amplify loud ones compared to professional hearing aid fitting targets (e.g., NAL-NL2), they matched well at typical speech levels and provided meaningful frequency-dependent gain for mild-to-moderate hearing losses. This demonstrated that AirPods Pro could improve audibility and hearing for some users, marking an important early step in bridging consumer audio products and hearing devices.

Conversation Boost & Ambient Noise Reduction Subsequent work evaluated Conversation Boost (CB) and Ambient Noise Reduction (ANR) features introduced with iOS 15 in 2022. Objective testing measured improvements in SII-weighted signal-to-noise ratio (SNR) with a frontal target talker and surrounding background noise. Activating CB and setting ANR to 100% yielded up to a 7 dB improvement – comparable to conventional hearing aid directional microphones. CB contributed most of this advantage by using beamforming and audio processing to focus on sounds coming from the front, while ANR reduced overall noise levels for greater listening comfort. These findings indicate that AirPods Pro can enhance speech understanding in noisy settings, potentially improving everyday communication.

Active Noise Cancellation & Hearing Protection With AirPods Pro 2 release in 2023, we examined the improved active noise cancellation (ANC) capabilities to understand its potential for hearing protection and clearer listening in noisy environments. Laboratory measurements showed around 27 dB of noise reduction across frequencies, including an additional 12 dB improvement in low-frequency attenuation compared to the first generation AirPods Pro. This enhanced ANC lowers exposure to harmful loud sound levels and may reduce the risk of noise-induced hearing loss. Adaptive Transparency further helps by automatically softening sudden loud sounds while allowing other environmental sounds to pass through, maintaining the user’s awareness of their surroundings. Together, these features improve listening comfort, reduce the need to increase volume in noisy places, and provide added hearing protection.

Figure: Headphone Accommodations Gain, AirPods Pro 1, 2021

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NAL 2024 Annual Impact Report

Figure: Real Ear Insertion Gain, AirPods Pro 2, 2024

Hearing Assistance for Individuals with Subclinical Hearing Loss in Noise In 2022, a clinical study was conducted to evaluate how Apple AirPods Pro could support individuals with normal audiograms who experience difficulties understanding speech in noisy environments. Seventeen participants used AirPods Pro– configured with their audiogram - across laboratory tests, real-world field trials with Ecologically Momentary Assessment (EMA), and questionnaires.

In the laboratory, wearing AirPods Pro improved speech intelligibility in noise by approximately 12% compared to unaided listening. Participants also reported reduced mental effort and improved speech understanding during challenging listening tasks. In real-world situations, participants generally rated their overall hearing experience and speech understanding as “a bit better” with AirPods Pro. However, while 29% would continue using the earbuds as a hearing support tool, many reported barriers, including limited benefit in very noisy situations, discomfort, and social acceptability. These findings demonstrate that AirPods Pro can provide meaningful, albeit situational, support for individuals struggling with speechin-noise difficulties. However, further refinements are needed to enhance usability and acceptance for everyday use.

New Hearing Aid Features in AirPods Pro 2 In October 2024, Apple introduced FDA-approved over-the-counter (OTC) hearing aid capabilities for AirPods Pro 2, accompanied by a built-in iPhone hearing test. This significant advancement allows the earbuds to function as hearing aids for mild-to-moderate losses by tailoring amplification based on Apple’s integrated test or an uploaded audiogram. The streamlined setup process and user-friendly design have the potential to encourage earlier engagement with hearing support and expand access to hearing assistance.

Acoustic Measurements of Apple’s Hearing Aid Software Our most recent evaluations examined the insertion gain, media streaming amplification, and beamforming-related SNR improvements provided by Apple’s hearing aid software. Preliminary findings show that AirPods Pro 2 achieve amplification patterns closer to NAL-NL2 targets, better matching both soft and loud speech levels while offering modest but meaningful improvements in SNR through beamforming. A detailed report will be published soon.

Conclusion Over several years, NAL’s evaluations have followed the steady progression of AirPods Pro from simple consumer earbuds to increasingly capable hearing aids. While they don’t match the precision and performance of professionally fitted hearing aids, AirPods Pro can serve as an accessible first step for people hesitant to seek traditional care. These devices may help broaden awareness of hearing health, reduce the stigma of hearing loss, and improve everyday communication for a wide range of users.

Our research shows that AirPods Pro 2 provide effective amplification for mild-to-moderate hearing loss, aligning closely with NAL-NL2 targets, and serving as a valuable entry point into hearing care by fostering greater awareness and acceptance of hearing solutions.”

- Nicky Chong-White, Principal Engineer Source: Apple news release.

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Hearing Services Program - Minimum Specifications for Subsidised Devices Paola Incerti, Senior Research Audiologist The Challenge The Australian Government’s Hearing Services Program (HSP) funds over A$600 million for hearing services and hearing devices to eligible individuals with hearing loss. The existing specifications for which devices the Program would subsidise had not been revised in a decade, and did not incorporate advancements in hearing aid and assistive technology. This created an opportunity to improve access to newer innovations for clients, ensuring that device options better meet their evolving needs. The project was initiated to address these challenges by reviewing and updating the minimum specifications for subsidised devices under the Program, ensuring they reflect both contemporary and emerging technologies while maintaining essential legacy features for clients of the Program who continue to rely on them.

Our Approach The project, led by Paola Incerti and conducted by a multidisciplinary team from NAL, employed a systematic and collaborative methodology, including: 1. Comprehensive Scoping and Review: A detailed evaluation of current features in fully and partially subsidized hearing aids, assistive listening devices (ALDs), cochlear implant processors, and other specialised technologies was conducted. Devices representing over 90% of those supplied under the program in 20222023 were analyzed.

2. Stakeholder Engagement: Regular meetings with the Department of Health and Aged Care (DoHAC) and industry stakeholders ensured transparency and iterative feedback integration. This approach streamlined alignment with policy objectives and ensured the final recommendation specifications were feasible to implement.

3. Feature and Category Development: New device categories and feature requirements were proposed, balancing innovation with accessibility. Specific focus was placed on ensuring newer technologies like rechargeable batteries were prioritized while retaining key legacy features like telecoil and manual controls for those who need them.

4. Impact Framework: The outcomes were assessed using NAL’s Impact Assessment Tool, focusing on knowledge advancement, implementation readiness, and delivery potential.

Outcomes and Impact The project successfully delivered a comprehensive report that addressed the Program’s need for updated device specifications. Key highlights of the recommendations include: • Expanded Features: All subsidized devices should now meet a broader range of features reflective of current technological advancements, such as adaptive noise reduction and rechargeable options.

• New Device Categories: New standard categories should be established for devices that were previously considered specialised devices, were previously excluded, or inconsistently listed in the existing specifications. In particular, we recommended that hearing aid suppliers be required to offer receiver-in-thecanal devices, which represent the global standard for hearing aid technology, to the Program.

• Balancing Innovation and Legacy: The recommendations ensure clients have access to cutting-edge technologies while preserving essential features for those relying on traditional solutions.

• Stakeholder Validation: Industry stakeholders validated the feature reviews, enhancing the credibility and acceptance of the specifications.

In summary, this project established a modernized framework for hearing device specifications for the Australian Government, enhancing accessibility of innovative technology to Australians and fostering innovation in the industry. The successful completion underscores the importance of adaptive, innovative, and stakeholder-driven approaches to policymaking in healthcare technology.

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Exploring Sound Quality in Public Broadcasts: Auracast vs. Telecoil Matthew Croteau, Research Audiologist The Challenge For individuals with hearing loss who use hearing aids, the sound quality of audio broadcasts/streams in public settings remains a persistent issue. Conventional technologies like telecoil and older streaming methods often fall short in delivering clear and immersive audio experiences, especially in noisy environments. Telecoil systems, despite being widely adopted, are limited to a single channel of audio (and therefore do not support stereo) and are prone to interference from other electronic devices and systems. With the rapid evolution of technology, the need for an advanced and reliable solution that can bridge this gap is becoming increasingly urgent.

Our Approach To address these challenges, we explored Auracast as a modern alternative to telecoil and other public audio broadcast systems. Built upon Bluetooth Low Energy (LE) Audio, Auracast offers extended bandwidth, stereo sound, and robustness against electromagnetic interference. We compared sound quality across three streaming technologies: Auracast, a proprietary last-generation 2.4 GHz hearing aid streamer, and telecoil.

Participants (N=49), ranging in age from 23 to 81, evaluated sound quality in various scenarios—speech in quiet, speech in noise, and music. All listening conditions were normalized to the same loudness level and the output of hearing aids receiving the various streams was captured using an acoustic mannequin, allowing participants to switch seamlessly between streaming modes so that they could be compared directly. Our study design ensured real-world relevance, focusing on current Auracast-compatible hearing aids, a range of legacy and novel streaming technologies, and a range of listening experiences.

Outcomes and Impact Auracast consistently outperformed both telecoil and the last-generation 2.4 GHz hearing aid streaming technology in delivering superior sound quality. Participants reported significantly higher scores for Auracast when listening to speech in noise and music, where clarity and immersive sound are critical.

Auracast’s stereo capabilities and extended bandwidth proved transformative, particularly compared to telecoil’s mono-only broadcasts. Additionally, the lack of electromagnetic interference in Auracast systems ensured a consistent and reliable listening experience, which is particularly relevant in less-than-ideal environments.

As Auracast-enabled hearing aids are now on the market, users can experience these benefits today as Auracast transmitters begin to be installed in public spaces. This advancement has profound implications, not only enhancing individual experiences but also setting a new standard for hearing aid technology. Moreover, our findings underline the scalability of Auracast as more transmitters and devices become available in public and private settings, which include non-prescription hearing buds/earphones and other consumer audio products.

In summary, this project demonstrates that Auracast provides a clear pathway to superior sound quality, addressing long-standing limitations of traditional public broadcast technologies and achieving better access to clear and immersive audio experiences for all.

Auracast represents a significant enhancement in wireless technology, not just for hearing aid users but for anyone who could benefit from high quality audio streaming technology. It opens up many opportunities to use audio broadcasts in creative and accessible ways, and finally brings public broadcast audio into the modern age.”

– Padraig Kitterick, Head of Audiological Science

Watch the video here

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Improving Videoconferencing Communication for People with Hearing Loss Vicky Zhang, Senior Research Audiologist The Challenge People with hearing loss face significant challenges in understanding and participating in videoconferencing calls. Existing solutions, such as hearing aids, provide some benefit but fail to fully bridge the gap in speech understanding and ease of communication compared to those with normal hearing. This issue is exacerbated in professional and personal settings where video calls are increasingly the norm. A key question remains unanswered: Which technical solutions, such as Bluetooth streaming or sound-enhancing software, could enhance communication during video calls and provide the best overall experience for an individual hearing aid user?

Our Approach This project tested five listening setups to evaluate their effectiveness: free-field audio from a loudspeaker, using headphones, listening via either loudspeaker or headphones but with the SonicCloud software activated, or Bluetooth streaming directly to hearing aids. The SonicCloud software allows participants to customize audio settings to match their hearing profiles. Twenty-five hearing aid users, aged 20-63, underwent speech perception tests and self-reported their experiences across these configurations to assess their level of speech understanding, listening effort, sound quality, and user preference.

The research design emphasized ecological validity by allowing participants to use their own hearing aids and adjust volume levels to their preferences, reflecting real-life scenarios. This pragmatic approach ensured the findings were relevant and applicable to daily use of videoconferencing.

Outcomes and Impact While no single listening configuration consistently delivered the best results for all participants, Bluetooth streaming and headphones with SonicCloud were most effective for improving speech understanding and reducing listening effort for the majority. Notably, 83% of participants preferred one of these setups. Individual preferences and performance varied, highlighting the need for users to be aware of and explore different solutions to find what works best for them personally.

Participants reported the highest satisfaction and lowest mental workload with SonicCloud and Bluetooth streaming setups. These configurations significantly improved two-talker conversation comprehension and were rated highly for sound quality and speech understanding. Participants also expressed strong intentions to adopt these solutions for future video calls.

This project’s outcomes have important implications for workplaces and individuals with hearing loss. Ensuring that hearing aid users have access to sound enhancing software like SonicCloud or have computer equipment that supports Bluetooth streaming to their hearing aids could transform their experience of video calls, making communication more inclusive and less effortful.

The findings align with NAL’s mission to improve lives through innovative hearing solutions. They pave the way for future research into advanced communication technologies and strategies, while also opening opportunities for partnerships with developers of sound-enhancing platforms.

Improving videoconferencing communication for people with hearing loss isn’t about a onesize-fits-all solution—it’s about empowering individuals with the right tools. Our research shows that Bluetooth streaming and personalised audio software may significantly improve speech understanding and reduce listening effort.”

- Vicky Zhang, Senior Research Audiologist

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Acknowledgments Our global network 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

Our collaborators

NAL IN ACTION

Susan Whichard and Lindsay Prusick exploring the Anechoic Chamber at NAL

Strengthening collaborations at ACAud Conference with Kat Penno and Andrew Bellavia

Andrew Bellavia presenting at the Innovation Forum, NAL

Brent Edwards at GN HQ, Denmark

Dr Shelly Chadha, WHO Medical Director at NAL

Developing bot-building skills at the Build-a-Bot workshop at NAL

Brent Edwards at The Royal Victorian Eye and Ear Hospital, Melbourne

Nicky Chong-white visiting Sonova HQ in Switzerland, with Maren Stropahl, Charlotte Vercammen and Angela Pelosi

Jane MacDonald exploring NALGuide at HBA Conference

NAL’s Day out

Design Thinking Workshop conducted by NAL at Audiology Australia

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