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Research into novel ways to detect antibiotic-related hearing loss for people with CF
What happens when people have hearing loss?
We hear things by detecting sound waves at different frequencies, for example, higher frequencies are heard as higher pitched notes. When people develop hearing loss, it is usually the highest frequencies that they lose first. Before people can’t hear things altogether, they may lose the ability to distinguish speech, particularly if its noisy where they are – for example in a busy pub, or a crowded space.
There are different types of hearing test, which can test someone’s hearing at different ranges of frequencies. The hospital tests may pick up hearing loss before someone starts to notice any changes in their hearing – perhaps at the stage of not being able to make out what people are saying in noisy places, or before someone notices that anything is different at all.
Why are hearing tests necessary for people with CF?
Like everybody else, people with CF will experience age-related hearing loss. However, they may also develop hearing loss as a result of taking a group of antibiotics called aminoglycosides, prescribed for serious lung infections.
Tobramycin, amikacin and gentamycin are all examples of aminoglycosides, they are effective antibiotics to help manage serious CF infections such as those caused by Pseudomonas aeruginosa and NTM.
Many antibiotics have side effects, particularly those used to treat serious CF lung infections. A side effect of aminoglycoside antibiotics is that they can cause permanent hearing loss. However, screening for hearing loss is not conducted routinely in people with CF.
If you are concerned about developing hearing loss as a result of aminoglycosides antibiotics, please raise any questions or concerns with your CF team.
Why are hearing tests not routine for people with CF?
Hearing tests are not routinely conducted due to the practicalities and expense of carrying them out.
Generally, if someone with CF is asked to have a hearing test, it will take place in the Audiology Department of a hospital. The test will be conducted by a trained member of staff, in a specially adapted room and using specialized equipment. Audiology Departments may not be on the same site as the CF clinic, or the Department might be shared between two hospitals. Because of this, it requires an extra treatment burden, requiring a separate hospital appointment in a separate location to check the hearing of someone with CF who has just started, or might be about to start taking antibiotics. Often there are no drop-in appointments, so it might take a few weeks for an appointment to come through. This is at a time when someone will be feeling unwell from a lung infection.
What is being done to improve things?
When people with CF in Dr Anand Shah’s clinic were developing hearing loss, he wanted to make it easier and more feasible to do hearing tests.
“At first, we spoke to our audiology colleagues, thinking about getting a sound booth installed and having a visiting audiologist perform tests. We quickly realised, it was just not doable or practical logistically. So we thought a bit more creatively about how could we do this,” said Dr Anand Shah.
With support from a Trust Clinical Excellence and Innovation Award, Dr Shah worked with Dr Lorenzo Picinali and his team to test whether an iPad-based hearing test (Shoebox MD) was a valid way to assess hearing at an outpatient CF clinic appointment, under the supervision of a clinician. Dr Lorenzo, based at Imperial College, is a computer scientist, specializing in designing algorithms for audiology problems.
“I initially worked in music technology research, then I started working on spatial hearing and I did a masters degree in audiology to learn more about hearing,” Dr Picinali told us. “New applications of technology innovations is a great area to work in. I still like to work on core development of new algorithms. But if you don't then see what impact they can have, I feel that I've done half of the work.”
Their next step was to develop hearing screening that could be done at home.
Can virtual reality (VR) games be used to test hearing loss?
Dr Picinali is currently developing VR games to encourage children with cochlear implants to re-train their brains to make the most effective use of the implants. VR was chosen as a fun way to encourage people to do the tasks required at home to complete the training.
Using joint funding from the Trust and RNID, Dr Shah and Dr Picinali are conducting a feasibility study to adapt this VR approach to develop hearing screening tests at home for people with CF. The study is still ongoing. The importance of their research was emphasized during the COVID-19 pandemic, when all CF care was moved to online clinics and monitoring at home.
“Even with the tablet-based hearing test, people still needed to come into the clinic,” explained Dr Shah. “The tests are done with a member of the CF team, and the technology is quite expensive. With more and more people doing their IVs at home, and having virtual appointments rather than coming into the clinic, monitoring for hearing loss is much harder. The idea of using VR technology to develop a home-based test could be a solution”.
Where has the research got to so far?
The research is at an early stage, looking at the feasibility of developing VR hearing tests. The researchers want to know:
- if the tests can pick up any changes in hearing
- whether people like using the VR headsets and if it’s acceptable to do the hearing tests as often as required.
- if repeating these hearing tests can re-train the brain to process awareness of sounds.
How could this research make a difference to people with CF?
"There is enormous potential for the brain to adapt to hearing loss, and we should exploit this more to help people," said Dr Picinali. "For example, hearing aid technologies are now so developed that major research investments have to be made to gain a minimum advantage. In contrast, research on hearing training shows that significant improvements can be obtained through a limited number of sessions, for example, using specialised VR applications such as the ones we are developing."
Dr Shah added: "In the future, I hope we can develop ways to continually monitor people’s hearing from day-to-day activities, such as listening to music or the radio. We could spot if it starts to deteriorate at an early stage and intervene."
Let’s get to a life unlimited for everyone with CF – faster.
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