Conversations Worth Hearing

Last week we hosted an evening of dinner and professional discussion at La Fromagerie.It was wonderful to be part of a gathering of so many health professionals including, Otologists, Psychologists, Neurologists and General Practitioners. We sat together to explore the links between cognitive neuroscience, otology and audiology so that we can better serve the health and wellbeing of our patients and we learned so much.

Thank you Adam & Jerusha for organising such a most interesting and stimulating evening.

- Mr David Garfield Davies, Consultant ENT Surgeon

So many thanks to all of you at Cubex, for a splendid evening & great conversation. Clearly, you had put such a lot of thought and time into preparing the most interesting talks and forward-thinking discussions. A feast for the mind and the body!

- Mrs Elspeth Morley, Psychotherapist

Moving away from thinking linearly about audiological health

There is so much happening in the field of Audiological Science right now. So much that allows us the opportunity to move away from thinking linearly about audiological health. We were excited to share with our guests some of the work and research that inspires our belief to think more laterally and more importantly, to introduce some of the people behind it.In general, the hearing care industry focuses on hearing and hearing loss as an entity. It is standard practice to look at reduced hearing ability on an audiogram as the primary ‘problem’ to be solved and to then provide amplification to “mirror” the audiogram. The same can be said for balance disorders. Specialists mainly concentrate on assessing and treating basic reflexive functions. There is rudimentary consideration of cognitive function and psychological and perception issues even though we are working with a population that is at a higher risk of accelerated health problems like depression, anxiety, fatigue, social withdrawal and issues with recalling and remembering information. Over ten years ago, Cubex began to step away from the traditional biomedical 'impairment focused' model where the goal is to find an impairment and to fix it, which has a detached demeanour. From an audiological health point of view, the purpose of a traditional biomedical model perspective is to improve hearing with amplification. In this case, the goals are clinician driven. The communication flow is unidirectional & the clinician tells the patient what they need based on a measure of hearing sensitivity or in the case of balance, basic reflexive function.There is little consideration for persons:

• Cognitive Function
• Mental Health & Emotional Wellbeing
• Social Wellbeing
• Communication Relationships & Wellbeing
• Functional Hearing Ability
• Individual Perspectives
• Readiness to engage in the treatment process

In other words, it does not consider the whole person. Individual differences are over-looked and so too are the needs of their families.

Considering the whole person

At Cubex, our goal is to address the needs of each patient. We see our role as a partnership with our patients and their loved ones, providing the tools and skills which ensure they have the very best opportunity to live well. The evening's discussions went more in-depth into why it is essential to place a strong emphasis on these 'whole person' considerations.We want to extend a massive thank you to all who took the time to join us for dinner & discussion. It meant a lot to see so many familiar faces and to finally put a face to the people who we communicate with regularly but never get a chance to meet and this is what the evening was all about. It was an opportunity to come together as a community of health care professionals to share, learn and grow so that we can support the health and wellbeing of our patients better.If you missed the evening, below is a summary of some of the topics and discussions that flowed.[vision_divider style="hr-solid"]

Discussion Highlights

Special thank you to Thomas for joining us from Denmark and for sharing his insights and evidence from Eriksholm and Oticon on what hearing loss is, why it is such a complex neural disorder and how it impacts higher-order cognitive processing in the brain.Thomas shared research that shows that hearing loss makes cognitive processing more taxing. Hearing loss changes the cortical structure of our brains and our perception of the world (by impairing selective attention). Speech is encoded differently in the brain of people with normal hearing vs persons with hearing loss, in complex environments. These cognitive consequences of acoustic challenges are reflected in the brain and in behaviour.Thomas' talks also explored a whole new way of processing sounds in hearing aids and the innovative approach that ensures that Oticon hearing aids can deliver a much more consistent sound to the listener across the day. He shared the documentation of new levels of Brain Hearing benefits tested with improved outcomes across speech understanding, objective and subjective listening effort, as well as memory recall.He also discussed a study whereby 2040 hearing aid users aged 50 and above took part in research to test what helps preserve the ability to remember what is heard. It turned out that hearing aid use was the second 2nd largest factor after education to preserve the formation of new memories as we age. After starting hearing aid use, the ability to remember what is heard is less impacted by ageing compared to before.We especially loved Thomas’s discussion on the Future of BrainHearing, which explored recent research findings on the nature and complexity of hearing loss. He shared examples of what future hearing aid signal processing driven by Deep Neural Networks can do and discussed the benefits that we expect to observe. Deep learning is a branch of ML that uses neural network models to understand large amounts of data. It can accelerate processes like speech recognition and natural language, and it's closer than you think! Jeremy discussed his research on the effects of balance disorders on higher cognition. He started his research in 2012, and his goal was to enhance the mechanistic explanations for the cognitive consequences of balance disorders.His discussions referred to the links between Otology and cognitive neuroscience and focussed on the effects of balance disorders on cognition.The findings of his research sent a rather strong message;

We healthcare professionals should pay more attention to the cognitive functioning of patients with otological problems. If the disruption of higher cognition is not always secondary to or explained by the dizziness, unsteadiness, nystagmus and other cardinal features of balance disorders, we shouldn’t just concentrate on those features and think that we’ve got patients’ cognitive issues covered.

Jeremy's work blew us away, and we are incredibly fortunate to have him as part of our team.A very big thank you to Jerusha Shulberg for curating such great topics and for organising an evening that was stimulating both for the mind and the taste buds.During the evening's discussions, Jerusha provided a real-world perspective about the application of these 'whole person' considerations into daily practice. She discussed the role of person-centred consultations and cognitive hearing assessments at Cubex and how it influences decisions regarding onward care and hearing technology.Jerusha also discussed the CALM programme, a cognitive-based approach to hearing healthcare.CALM is a programme that was developed by Jerusha Shulberg and provides 'TOP DOWN' support for people experiencing reduced hearing ability, distressing tinnitus and balance disorders. CALM can also function as a transdisciplinary management plan which may incorporate support from other specialists including psychotherapy, nutrition and neurology.CALM stands for:

• Cognitive Education and Training
• Audiological Awareness
• Lifestyle Strategies
• Mindfulness & Meditation

While discussing CALM, Jerusha focused explicitly on working memory and the critical role that it plays in hearing. It is extremely important to incorporate evidence-based cognitive training programmes in conjunction with hearing technology as a means to support people to create a platform to learn new skills, including auditory skills to effectively change the way the brain functions to perform at its maximum capacity.She also covered the importance of teaching meditation and mindfulness-based techniques to support the overall wellbeing of people with hearing, tinnitus and balance disorders. Establishing a daily mindfulness-based practice can impact positively on all of the critical whole person considerations including, cognition, emotional & mental health, social wellbeing, relationships and individual perspectives.[vision_divider style="hr-solid"]If you would like links to some of the papers discusses or more information about the work mentioned above, feel free to get in touch and we will be more than happy to share this with you. Read about how Cubex push forward the limits and expectations of the Hearing Care Professional to facilitate and provide a better quality of life for the patient in The Hearing Review.