Understanding disability

A participant with a hearing aid undertaking a study on a tablet

Projects encompassing understanding disability

Listening by individuals with hearing-related problems with or without hearing devices or cochlear implants, deep phenotyping, and determination of patients’ priorities.
The CHEAR logo

Covid-19 and Hearing (CHEAR): a study examining the effects of Covid-19 on hearing, tinnitus and balance

Project leads: Michael Akeroyd, Paul Bateman

Funders: NIHR Nottingham BRC; NIHR Clinical Research Facility, Interacoustics; Senior Investigator Award (Professor Deb Hall)

CHEAR has a primary objective is to determine the prevalence of hearing loss, tinnitus, and balance problems in cases of COVID-19 through in-person audiometric assessments using gold-standard diagnostic tests and/or online tasks to be completed at home.
This project is closed to recruitment and is now in follow-up.


A female clinician using an otoscope on a female participant

Nottingham Hearing BioResource

Project lead: Ian Wiggins

Funders: NIHR Nottingham BRC; CRN East Midlands Under-Served Communities

The Nottingham Hearing BioResource (NHB) represents our effort to begin leveraging the power of large, open, accessible datasets towards transforming the way treat and manage hearing loss and hearing-related conditions in future.
Large-scale datasets, such as the UK Biobank and the Human Connectome Project, have proved extremely powerful for facilitating research into mechanisms of human health and disease.  However, a limitation of existing datasets is that hearing health phenotypes are captured at a rudimentary level, with even basic pure-tone audiometry data rarely being available. This severely limits the scope of the questions that can be asked of these datasets from an auditory perspective. The Nottingham Hearing BioResource (NHB) represents our effort to begin leveraging the power of large, open, accessible datasets in a way that could transform how we treat and manage hearing loss and hearing-related conditions in future.


A person cuts some hair from the back of a person's head

Hair cortisol: a potential biomarker for stress

Project leads: Sally Thornton, Derek Hoare

Funder: NIHR Nottingham BRC 

Stress could plausibly derive from a sensory deficit such as hearing loss (HL). Yet hair cortisol concentration (HCC) in association with stress, depression or anxiety has not been measured in people with HL. We are measuring HCC alongside symptoms of anxiety, stress, depression in participants with and without HL.
Currently we are: 1) prospectively assessing HCC in people with and without HL, and; 2) investigating associations between HCC and psychological responses, as well as; 3) piloting paediatric work to assess if it's feasible to assess HCC in children.


Students at an outdoor rave

Understanding the consequences of recreational noise exposure

Project lead: Rebecca Dewey

Funder: Medical Research Council

Noise exposure can damage the cochlear nerve without immediately harming hearing, making it difficult to predict who will experience noise-induced hearing loss. This study uses MRI to understand the effects of noise exposure.
Noise exposure is the main cause of preventable hearing loss worldwide. Recent results suggest that even moderate noise exposure can cause substantial damage to the cochlear nerve, but it is not currently understood whether this damage extends further up the ascending auditory pathway. We can image the auditory pathway using MRI, including measures of the auditory nerve, and of nerve health and brain volume in the auditory brainstem and auditory cortex. We are conducting a large-scale study, recruiting 200 people, to investigate which of these many MRI measures are the best predictors of symptomatic noise-induced hearing loss.


Audio-vestibular Symptoms associated with Traumatic Brain Injury

Project lead: Kathryn Fackrell

PhD student: Kübra Bölükbaş

Funder: The Republic of Turkiye Ministry of National Education

The damage to the auditory system due to trauma causes many problems related to the hearing and vestibular system. The aim of this project is to comprehensively present the auditory and vestibular consequences of non-blast-related TBI. 
An online survey study to evaluate the experience and opinions of healthcare professionals dealing with this patient group, and recruitment was launched in May 2022 and data collection will be completed in December 2022. At the same time, a scoping review exploring and collating the auditory and vestibular problems reported in individuals with non-blast-related TBI is ongoing. Findings obtained from these studies will then be used to inform the structure of our clinical project. Our studies will provide clinicians and researchers with a useful framework for advanced research and clinical practice in the diagnosis and treatment of auditory and balance disorders associated with non-blast-related TBI.


CUSP (Comparing oUtcomes for Severely and Profoundly deaf children)

Project lead: Derek Hoare

PhD student: Catherine Killan

Funder: NIHR Nottingham BRC and Cochlear

This project compared parent-reported listening, tinnitus, and listening fatigue outcomes for children with severe hearing loss using hearing aids to children using cochlear implants. It also helped understand which children were impacted by the 2019 NICE guidance on cochlear implantation and explored the impact of hearing devices on early educational outcomes.
A project to understand the impact of NICE guidance TAG566 (2019) on children with severe or profound hearing loss, by comparing outcomes for children with severe hearing loss using hearing aids and those for children with cochlear implants.


Test methods for group conversation: Operationalising conversational success

Project leads: Lauren Hadley and Graham Naylor

PhD student: Raluca Nicoras

Funder: WSAudiology

A project dedicated to investigating the perception of conversation success as experienced by people with normal hearing and people with hearing loss in one-to-one and group conversations. 



Neural markers of language processing in typically developed children and children with developmental language disorder (DLD)

Project lead: Douglas Hartley

PhD student: Efstratia Papoutselou

Funder: NIHR Nottingham BRC

We are exploring the neural networks supporting language processing in typical development and DLD. Our goal is to identify neural markers of atypical neural activity in children with DLD compared to typically developed children.  



Socioemotional Well-being As An Individual Factor In The Assessment And Amelioration Of Hearing Loss

Project lead: Jack Holman

Funder: Medical Research Foundation

Developing understanding and reliable measurement of individual socioemotional well-being differences for adults with hearing loss, with the aim of facilitating better assessment of individual needs and better outcomes.
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.


Development and evaluation of a digital intervention: Internet Self-Help, Understanding and Support for Hyperacusis (iSHUSH) 

Project lead: Kathryn Fackrell

Funder: NIHR Post-Doctoral Fellowship

The development and evaluation of a digital intervention for hyperacusis which incorporates adults living with hyperacusis and healthcare professionals experiences, challenges and views of hyperacusis, theory and evidence. 
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). 


Emotional responses in daily-life listening situations for people with hearing loss, and emotional adaptation after a first hearing-aid fitting

Project leads: Graham Naylor and Jack Holman

Funder: Hearing Industry Research Consortium

We aim to better understanding of the specific causes of positive and negative emotional reactions to hearing-dependent situations and hearing devices.
Using research techniques such as semi-structured interviewing and smartphone based ecological momentary assessment we hope to pave the way for improved clinical assessment and counselling; provide narratives for efforts to promote the uptake of hearing help; identify situations which are especially likely to trigger negative emotions, enabling better targeting of interventions and setting of expectations; identify novel risk factors for the discontinuation of hearing aid use, and thereby inspire work to address those risks.


Developing a questionnaire measure for use with children with hearing loss: YBHRQL-Y

Project leads: Sarah Somerset and Adam Pedley

Funder: NIHR

Developing, validating and scoring an adapted version of the YBHRQL, used in adults with severe and profound hearing loss.  Putting severe and profoundly deaf children at the heart of questionnaire development.  
We have taken an existing measure the York Binaural Hearing Related Quality of Life System (YBHRQL) and adapted the pre-existing domains for use with young people aged 8 to 16 years with a severe or profound hearing loss.  we have used the qualitative pre-test interview approach to put the young people at the heart of our questionnaire adaptation.  A questionnaire can only be as good as the questions it asks.  For these questions to be good they must be both relatable to those completing them and reliable.  We have adapted the existing measure with young people as co-experts.  We are now in the process of validation and scoring.  By developing our questionnaire in this way we have designed it to be a patient reported outcome measure (PROM) which means a health utility value can be calculated from it's score.  This in turn can then be used for health economic calculations of quality and costs associated with care participants receive.  This has been designed to be used in the wider BEARS trial.


Understanding and alleviating hearing disability: A cognitive-behavioural model of miscommunication in everyday conversation

Project lead: Graham Naylor

Funders: Medical Research Council

This programme develops a comprehensive account of how, in everyday conversation, the perceptual impairments due to hearing loss can trigger activity limitations and participation restrictions
Difficulty engaging in conversation is the most often-reported problem of hearing loss, but currently treatment with hearing aids does not adequately fix this. There is a clear and unmet need for understanding why and how older adults with hearing loss experience problems in conversation. With such understanding, better treatments will become possible, improving the social participation of people with hearing loss. In this programme we will develop an in-depth explanation of how miscommunications happen in everyday conversation, and how people behave in response to them.


Incorporating active strategies in speech testing to predict communication performance

Project lead: Tim Beechey

Funder: Medical Research Foundation

This project investigates how the inclusion of active communication behaviours in hearing testing may affect measures of hearing impairment and device benefit and improve predictions of individual rehabilitation outcomes.
Conversation is central to humans’ capacity to communicate, maintain relationships, and fulfil requirements of daily living. A person’s capacity for successful spoken conversation relies on both hearing sensitivity and the use of active communication strategies, such as asking for repetitions or moving closer to a talker. This project incorporates active communication strategies into controlled assessment of speech comprehension to quantify the benefit of these strategies and the extent to which taking account of these strategies can improve the prediction of the impact of hearing impairment and amplification on speech understanding.


Exploring the potential of large-scale routine clinical data in audiology

Project lead: Graham Naylor

Funders: Medical Research Council, Chief Scientist Office 

By interrogating the medical records of 700,000+ US Veterans, we discover relations between hearing-aid use and other health conditions, and learn about the utility of routine audiological data for research.
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.


Hearing Sciences

Mental Health & Clinical Neuroscience
School of Medicine
University of Nottingham
Medical School, QMC
Nottingham, NG7 2UH

telephone: University Park +44 (0) 115 74 86900
Ropewalk House +44 (0) 115 82 32600
Glasgow +44 (0) 141 242 9665
email: hearing-research@nottingham.ac.uk