Although the underlying drivers of tinnitus are still not completely clear, we believe that tinnitus is produced by pathological alterations in the activity of the auditory nerve and the consequent perception of phantom sound. This sound may be produced by the auditory equivalent of pain fibres causing a constant perception of phantom sound rather than pain. There are similarities between the biological processes involved in chronic pain and tinnitus. The chronic pain is produced by activation of HCN2 channels in nerve fibres and we are attempting to treat chronic tinnitus using drugs that have been effective in blocking chronic pain.

This project investigates whether transcranial direct current stimulation (tDCS) can offer relief from tinnitus. Tinnitus is thought to result from high levels of coordinated nerve cell (oscillatory) activity in particular regions of the brain. tDCS is a technique that uses a weak electric current to reduce that activity. The study is the first to record brain activity using magnetoencephalography (MEG) during tDCS in tinnitus participants. This represents an important step-change in this field in terms of objectively measuring what happens during tinnitus treatment. This project is a collaboration between NIHR Nottingham BRC and Sir Peter Mansfield Imaging Centre (SPMIC).

There are 12 million people in the UK with long-term hearing loss. Hearing loss isolates people, cutting them off from society. The standard treatment is to amplify quiet sounds using hearing aids, but listening also requires cognition (memory and attention), particularly in noisy and challenging everyday environments. Our research has shown that computer games designed to help people practice listening to speech can improve cognition and listening abilities for people with hearing loss and hearing aid users. These games, termed auditory training, could help patients better understand speech in noise, improving communication, which can improve quality of life.

In the future, we need a large clinical trial to understand all of the benefits of these games to patients. First, we need to find out if the large trial could work, and if so, how best to design it. To do this, we are carrying out a feasibility study. The feasibility study will help ensure any future clinical trial provides high-quality evidence and value for money. We will involve patients in designing the feasibility study, which in turn will make it easier for future patients to take part in the trial.

Conventional hearing aid fine-tuning relies on patients recalling and describing sound quality issues to clinicians. However, communication barriers and memory bias may render this practice ineffective. An alternative approach is to let patients adjust hearing aid settings themselves. Self-adjustment methods require mapping parameters to controls that are easily understood and perceptually relevant. This research investigates perceptual and operational aspects of different self-adjustment methods to assess their effects on self-adjustment choices and their effectiveness in hearing aid fine-tuning.

Self-management of long-term conditions was shown to have positive clinical outcomes. However, this is under researched in the case of hearing loss.

This study aims to gain further knowledge on self-management of hearing loss, directly from people with hearing loss and hearing healthcare clinicians. To plan for optimal self-management, it is important to evaluate the extent to which audiology appointments address the elements of self-management that are identified as most important and valuable to the individual with hearing loss. This will allow us to consider the potential form and content of interventions to optimise appointments and promote successful self-management.

How can we process and remix music so it sounds best for those with a hearing loss? The new Cadenza project aims to better define what music personalised for someone with a hearing loss should sound like and exploit the latest in machine learning to create improved music listening experiences. The improvement in music will be achieved by running a series of open competitions, which researchers from around the world will compete in. Competitors will be given music to enhance, through processing and/or remixing. They will be challenged to improve and personalise the music for listeners with hearing losses.

The Universities of Salford, Sheffield, Leeds and Nottingham have been awarded a grant from the Engineering and Physical Sciences Research Council (EPSRC) to investigate adaptations to music for those with a hearing loss. The grant of £1.6 million is a collaborative partnership with industrial partners BBC R&D, Google and Logitech and user engagement via Royal National Institute for the Deaf (RNID).

The Clarity Project is a 5-year UKRI-funded research project involving four UK Universities and associated industrial partners. Our aim is to organise open "challenges" for hearing aid algorithms and to champion novel machine learning approaches to hearing aid speech-in-noise processing. These challenges will focus on speech-in-noise listening, a situation in which hearing aid users report the most dissatisfaction. For each challenge, we will be providing simulation tools, datasets and baseline systems. Our data and code will all be open-sourced, with the aim of lowering barriers that currently prevent speech and audio researchers from considering hearing impairment. Our funding is also allowing us to evaluate challenge submissions by running listening tests with hearing impaired listeners.

To transform hearing care by 2050, we aim to completely re-think the way HAs are designed. Our transformative approach - for the first time - draws on the cognitive principles of normal hearing. Listeners naturally combine information from both their ears and eyes: we use our eyes to help us hear. We will create "multi-modal" aids which not only amplify sounds but contextually use simultaneously collected information from a range of sensors to improve speech intelligibility. For example, a large amount of information about the words said by a person is conveyed in visual information, in the movements of the speaker's lips, hand gestures, and similar. This is ignored by current commercial HAs and could be fed into the speech enhancement process. We can also use wearable sensors (embedded within the HA itself) to estimate listening effort and its impact on the person, and use this to tell whether the speech enhancement process is actually helping or not. Creating these multi-modal "audio-visual" HAs raises many formidable technical challenges which need to be tackled holistically. Making use of lip movements traditionally requires a video camera filming the speaker, which introduces privacy questions. We can overcome some of these questions by encrypting the data as soon as it is collected, and we will pioneer new approaches for processing and understanding the video data while it stays encrypted. We aim to never access the raw video data, but still to use it as a useful source of information. To complement this, we will also investigate methods for remote lip reading without using a video feed, instead exploring the use of radio signals for remote monitoring. 

The socioemotional consequences of hearing loss (and hearing-aid treatment) may play out differently for different people, dependent on their circumstances, personality, and daily activities. In this project we will help to identify individual differences in socioemotional well-being and the best way of measuring them. We will identify if existing measures can accurately and effectively measure the key components, and whether additional interventions could improve socioemotional well-being outcomes for those who need it. This project is the first step in developing understanding and interventions to increase the happiness and comfort of each person with hearing loss based on their individual needs.

The digital intervention aims to provide educational and self-help components to support adults experiencing hyperacusis. A advisory group for the project has been established to help guide the development and evaluation. To ensure acceptability, usability and feasibility of the intervention, interviews, surveys and piloting are being conducted throughout with the intended users (e.g., adults living with hyperacusis and healthcare professionals). 

This programme ran from 2018-2022. We have published 45 papers so far. Despite pandemic restrictions, we have also developed online methodologies to innovatively address the communication difficulties people with hearing loss face on virtual platforms. From detailing the micro-behaviours in one-to-one conversations to reshaping our understanding of hearing healthcare, our programme has generated new insights and methods, and laid the groundwork for new models of hearing disability to incorporate natural behaviours.

This is a collaboration with the National Center for Rehabilitative Auditory Research, Portland, Oregon, and the Manchester Biomedical Research Centre. We have scrutinised how the routine nature of the data collection affected its likely quality and structural characteristics, essential insights for anyone using such datasets in research. Using a novel measure of hearing-aid use persistence, we found several factors including prior in-patient care and multimorbidities to be predictive of persistence. We have also addressed the links between dementia and hearing-aid use. We have shown that (a) hearing-aid use reduces dementia risk and (b) dementia reduces hearing-aid use. These are the first quantitative results to demonstrate that cognitive decline leads to device disuse.

A build-up of earwax in the ear canal can cause hearing loss and discomfort and may contribute to infections. Irrigation and microsuction are two earwax removal methods available in the UK. The two methods differ in availability, contraindications, and cost. However, there is a lack of evidence comparing clinical and cost-effectiveness of these techniques.

In preparation for the future clinical trials, we are analysing the content and quality of the earwax removal websites and patients' experiences with each method shared within online forums. We are looking at preference for one method, pre- and post-treatment, outcomes and contraindications and complications.