Audiology and Deafness: Research projects

The ManCAD research portfolio covers the lifecourse and spans basic discovery through to clinical applications in

  • Prevention
  • Assessment and Diagnosis
  • Treatment and Management 
  • Service Delivery


Investigating hearing health in early-career musicians

Musicians are at risk of developing hearing difficulties due to prolonged exposure to noise. However, only 6% of musicians use hearing protection devices (HPDs) on a regular basis. Recent evidence from animal research suggests that auditory nerve synapses may be particularly susceptible to noise damage (i.e. cochlear synaptopathy), which could be related to difficulties with speech perception in noise and tinnitus. Therefore, it is important to monitor hearing health in “at risk” individuals using measures sensitive to neural damage, and to promote the use of HPDs.

The aims of this research project are to i) assess hearing health of early-career musicians longitudinally, ii) formally determine the reasons for non-use of HPDs in musicians from a behavioural science perspective iii) develop and assess interventions to promote the uptake and retention of HPDs in early-career musicians.

Funder: The Colt Foundation, plus additional support from the Manchester NIHR BRC in Hearing Health.

Staff involved: Samuel Couth, Garreth Prendergast, Hannah Guest, Michael Loughran, Dave Moore, Kevin Munro, Chris Plack, Chris Armitage, Jane Ginsborg (Royal Northern College of Music) and Piers Dawes


Extended high-frequency hearing

Extended high-frequency (EHF) hearing, i.e. beyond the range of hearing thresholds that are currently measured in clinical audiometry, may be a sensitive predictor of age-related hearing loss that can identify individuals at risk of hearing loss much earlier in life. EHF hearing may be used to predict which individual young adults, adolescents or even children are likely to develop hearing loss in the conventional range of frequencies (0.25 – 8 kHz) later in life. This could lead to early prevention on an individualized basis. Preventative measures might include advice on protecting hearing or, in the future, taking certain drugs found to prevent hearing loss. We have also found that preventing access to EHF results in poorer performance (SRT) on speech-in-noise, as tested with the DIN.

Funder: Manchester NIHR BRC in Hearing Health, National Institutes of Health

Staff involved: David Moore

Assessment and Diagnosis

The Effects on Auditory Function of RADiotherapy and Chemotherapy Treatments for Head and Neck Tumours (EARAD)

The EARAD project is designed to evaluate the effects of radiotherapy (RT) and combined chemoradiotherapy treatments (CCRTs), both known to cause damage to the cochlea and auditory brainstem (ototoxicity). The overall aim is to provide data that will define the amount of RT needed to damage individual substructures of the auditory pathway so that a better balance can be made between ototoxic hearing loss and tumour control during RT for head and neck cancer.

Funder: Marston Scholarship (PhD Studentship), BRC Advanced Radiotherapy and Hearing Health themes.

Staff involved: Katie Foy, Chris Plack, Catharine West, Kevin Munro, Hannah Guest, Marianne Aznar, Lip Wai Lee


Listening Effort:  Quantifying an Important Dimension of Hearing Disability and Treatment Benefit

In most cases of adult hearing loss, the sensory damage is permanent and primarily managed via the prescription and fitting of hearing aids. Hearing aids work by amplifying sound, thereby improving access to sounds and particularly to speech. Hearing aids have been shown to be effective at improving general, and hearing-related, quality of life and listening ability. Despite the improvement afforded by hearing aids, it remains unclear whether hearing aids reduce the effort required to achieve listening success i.e. listening effort. Listening effort is high when listening is challenging and cognitively demanding e.g. when listening takes place in high levels of background noise, or in connection with hearing loss where speech is distorted and not always audible. 

Listening effort has been measured using a wide range of different methods (self-report, behavioural, physiological) but there is not always agreement between different measures.  We think this is because different measures of listening effort tap into different aspect of listening effort i.e. listening effort is a multi-dimentional construct.  The aims of this PhD are to identify measures of listening effort that are reliable and sensitive and might be able to be used in clinical assessments of hearing disability.

Funder: Manchester NIHR BRC in Hearing Health.

Staff involved: Peter Carolan, Rebecca Millman, Antje Heinrich and Kevin Munro


Machine-learning for clinical tests and scientific experiments

A limiting factor for clinical tests is the time that is available for doing them. That is why it is essential to use clinical time as efficiently as possible. Techniques like Bayesian active learning provide frameworks that can automatically pick parameters for the next trial or question to make it as informative as possible. Always querying for the most informative question results in more precise outcomes and reduces testing time. The latter is particularly important for tests that would be too long for clinical practice with conventional methods.

The hearing tests that we develop have the potential to reduce testing time from several hours to durations that are feasible in practice. This is also beneficial for scientific studies, especially when looking for correlates to phenomena that are difficult to detect or quantify, for example cochlear synaptopathy. Furthermore, hearing tests allow us to test and develop active-learning techniques that can be applied to more invasive healthcare tests as well.

Staff involved: Josef Schlittenlacher


The Effects of Female Sex Hormones on Auditory Funcation and Tinnitus.

Sex hormones fluctuate in level in women, both during the lifespan and during the ovarian cycle.  Recent research suggests that oestrogen is neuroprotective, and may affect auditory function.  Tinnitus may arise from the amplification of neural responses in the auditory system (increase in central gain), which might occur to compensate for the loss of neurons. Changes in central gain lead to the amplification of random activity, which can mistakenly be interpreted as sounds.

The aims of this project are to investigate i) the relationship between oestrogen, hearing loss and tinnitus (the perception of a phantom sound) and ii) to determine the efect of oestrogen on tinnitus.

The expected outcome of this project is increasted understanding of the protective influence of oestrogen on the auditory system, and the mechanisms underlying tinnitus and development of an objective method to study variations of central gain within a given subject during the ovarian cycle.  It also has the potential to influence a new generation of tinnitus interventions based on hormonal therapies.

Funder:  Saudi Royal Embassy (PhD Studentship)

Staff involved: Nada Aloufi, Karolina Kluk, Antje Heinrich, Kay Marshall


The "Ladies in the Van":  Objective assessment of hearing aid benefit in young children

The ‘Ladies in the van’ are a team of researchers from the University of Manchester travelling the country in their Mobile Research Unit, developing new hearing tests to help babies with hearing loss. We already have excellent tools to diagnose hearing loss in babies from just a few days old, so hearing aids can be fitted very early in life, helping babies to hear a range of sounds and develop language.  However, it’s not until babies are around 7-9 months old that we can do a reliable behavioural hearing test by getting them to turn towards a sound. The ladies in the van are working on new types of objective hearing test to help us understand how well babies of under seven months are hearing through their hearing aids, so we can really maximise the benefit these children get. The Mobile Unit lets the team reach out to families all around the country, and has been as far as Inverness and Truro.

Funders: National Institute for Health Research’s Research for Patient Benefit Programme, Oticon Foundation, the Marston Family Foundation, and the Manchester NIHR BRC in Hearing Health

Staff involved: Anisa Visram, Rhiannon Morgan, Amber Roughley, Kevin Munro, Michael Stone


Insight into auditory processing provided by non-standard stimuli

The majority of studies investigating auditory processing either use natural sounds, such as speech, or very simple well-controlled sounds where only a few parameters change. Previous work has demonstrated in both humans and animals, the specific characteristics of these simple sounds are important and that using slightly different, but still very simple sounds, can provide additional insights into our understanding of the auditory system. It may be that much of our understanding of auditory processing comes from sounds which are too simple, and too artificial to faithfully capture the nature of neural coding performed by the system. The aim of this study is to establish if such nonstandard stimuli can provide a comparable insight into human sub-cortical processing.

Staff involved: Garreth Prendergast


Internet-delivered UK adult hearing screening

One in six people in the United Kingdom (UK) has an audiometric hearing loss, and this proportion will increase to one in five by 2035. A systematic adult hearing screening program has the potential to reduce the burden of hearing loss by increasing rates of hearing aid use and promoting use at an earlier age. Hearing tests can now be delivered over the internet or telephone, facilitating low cost, high volume, reliable hearing assessment. Internet-based hearing testing offers a promising model for systematic screening because internet access and smartphone ownership are high.

Funder: Manchester NIHR BRC in Hearing Health

Staff involved: Piers Dawes, Kevin Munro, David Moore, Harvey Dillon


Treatment and Management

Improving Quality of Life Through Addressing Communication Needs for People in Residential Care Living with Dementia

Dementia is the largest single health-related determinant of care home admission. Dementia and hearing loss are highly co-morbid: The majority of UK care home residents are affected by both dementia and hearing impairment. Managing hearing impairment in the care home setting is challenging but crucial. Hearing aids are the primary intervention for hearing loss but hearing aids are often underused in care homes. Hearing aids are relatively expensive and require fitting by a trained audiologist in a specialised audiological clinical setting. Personal Sound Amplification Products (PSAPs) are low cost (~£100), ear-worn, body-worn, or hand-held devices that deliver sound to the wearer via headphones (and sometimes the “loop setting” on a hearing aid). PSAPs increase the audibility of sounds and improve hearing in background noise. However, unlike hearing aids, PSAPs do not require a formal fitting process in an audiology clinic and are available over the counter and easy for care home residents and staff to use.

In this project we will assess PSAPs as a low cost, accessible therapeutic intervention to support care home residents with hearing impairment and dementia. Using qualitative and quantitative methods, as well as Patient and Participant Involvement (PPI), the research team will work with care home residents, relatives and care home staff to assess the impact of PSAPs in alleviating the symptomatic burden of dementia through improved quality of life, hearing, communication and social engagement in hearing-impaired care home residents with dementia.

Funder: Alzheimer’s Society

Staff involved: Hannah Cross, Rebecca Millman, Chris Armitage, Piers Dawes, Iracema Leroi


Outcomes in children and adolescents with vestibular dysfunction

In humans, the vestibular organs in the inner ear enable us to control our posture, maintain balance and keep our eyes steady as our body moves.  Disorders of the vestibular system can result in balance problems and dizziness.  In childen, such disorders may have a major impact on a child's development, their ability to balance and even on their reading ability.  However, although it is believed that most children with vestibular disorders will eventually catch up with their develoment, with only a few lingering problems, such a clumsiness, there is actually little research evidence about how long symptoms of balance disorders persist in children, how their quality of life is affected and how different types of disorders may lead to different outcomes.

Thus, this study follows up children and young people who have been identified with vestibular disorders to find out whether they have long-term symptoms related to the vestibular system and ask questions about their quality of life.  Results of the study will help healthcare professionals to advise young patients with vestibular disorders and decide which patients need specific rehabilitation to improve their recovery and function.

Funder:  The Ewing Foundation

Staff Involved: Ozgenur Cetinbag, Karolina Kluk, Antje Heinrich


The role of misidentification of own speech in developmental stuttering

The 80% recovery rate from childhood stuttering is not fully understood. Many studies indicate abnormal auditory function in stuttering.  We hypothesise that misidentification of self-gerated covalisation (SGV) contributes to stuttering.  There is no widely accepted mechanism for identification of SGV.  However, the vestibular system, a part of the ear important for balance, can detect sound. The vestibular apparatus is too insensitive to detect most environmental sounds, but is close to the laryns and may thus be able to detect the high sound pressures in the larynx during SGV.  This would be via conduction through the body (BC), rather than through air (AC), and is at present untested. 

The ear normally detects sound via the cochlea.  Thus, a study of SGV identification must evaluate three ascenting routes: air condution via the cochlea (ACC), and body conduction via both the cochlea and vestibular system (BCC/BCV).  We hypothesis that the vestibular system contributes to identification of SGV, and more precisely that SGV is identified from synchronour ACC, BCC and BCV auditory stimuli. 

This study is a first step towards an autitory training therapy for children who stutter.  Such a therapy could reduce the burden on speech and language therapists and parents, since current therapies are time-consuming, costly, and of questionable efficacy.  An auditory training therapy which improves recovery rates from stuttering could have life-changing consequences  for the 1% of children who develop persistent stuttering.

Funding:  ESRC (CASE Studentship with CASE partner Interacoustics).

Staff Involved:  Max Gattie, Karolina Kluk, Elena Lieven, Peter Howell


Reaction of people with mild hearing loss to affordable, self-fitted hearing aids

The average age of first-time wearers of hearing aids dispensed by the NHS is 74 years, by which time candidates typically have a moderate hearing loss and are struggling in many listening situations.  Corrected sensory losses reduce handicap, improve quality of life, reduce the number of years lived with a disability and are associated with better physical health. Earlier adoption of aiding, when the hearing loss is milder in degree, has the potential to produce better outcomes.

“Over-the-counter” devices (OTCs) are simpler, more affordable hearing aids available without a prescription. They may promote earlier adoption by being more accessible and reducing the stigma often associated with conventional hearing aids (cHAs). Nevertheless, questions remain as to their technical efficacy and suitability, acceptability, and success rates as measured by adherence and other outcome measures. Interest in OTCs has also been driven by pressure to reduce costs from health service commissioners by limiting the provision of conventional hearing aids and reducing contact with medical professionals. Self-funding and self-fitting of simpler devices, such as OTCs, may therefore become the delivery method for at least some patients as an interim intervention before a hearing loss becomes more severe.

This PhD will explore factors that determine the acceptability of OTCs compared to hearing aids.  These factors are likely to be multiple and complex and may include cosmetic, functional, client-oriented (age, personality, health literacy, familiarity with technology), and service delivery (professional support) issues.

Funder: Manchester NIHR BRC in Hearing Health.

Staff involved: Ibrahim Almufarrij, Michael Stone, Harvey Dillon, David Moore


SEQaBOO Manchester:  SEQuencing a Baby for an Optimal Outcome

SEQaBOO Manchester is a questionnaire survey to ascertain attitudes and public knowledge of genetics and genomics in the setting of newborn hearing screening. An underlying goal is to assess clinical management and patient outcomes when an etiologic diagnosis for a baby’s deafness is known as early as possible. Genetic testing of 115 genes in which variants are well recognized to cause deafness will be available through the NHS Genomic Medicine service in 2020. Parents of babies who refer from newborn hearing screening for diagnostic audiometry and who are diagnosed to be either deaf or hearing will have an opportunity to enroll in SEQaBOO Manchester. Parents will receive annual surveys to evaluate evolving attitudes and knowledge of genetics and genomics, family medical history and their child’s general health. In addition, parents of deaf babies will answer questions specifically about development and medical management of their baby’s hearing. Lessons to be learned include insight into the potential value of genetic and genomic testing more broadly in the future of newborn screening.

Funder: Manchester NIHR BRC in Hearing Health.

Staff involved: Andrea Short, Cynthia C. Morton, William Newman, Iain Bruce, Cath Wright, Martin O’Driscoll, Rachel Ward, Rachel Boyd, Veronica Kennedy, Adam Walker, Kathryn Lewis, Gina Wilkinson, Sobia Sheikh, Steven Woods


Service Delivery

Improving Language Skills in Children with Hearing Loss by Developing a Parent-Delivered Training Programme based on Theory of-Mind Skills

Hearing loss is the most prevalent sensory deficit in children. In the UK alone, more than 45000 children have a hearing loss. Often, it is managed via the prescription and fitting of hearing devices such as hearing aids and cochlear implants. Hearing loss, especially when it occurs early in life, can greatly affect development – not only of speech and language but also of cognitive functions. One cognitive function that appears to be closely intertwined with language development is Theory of Mind (ToM), ie the ability to correctly attribute mental states such as beliefs, intents, desires, and emotions to oneself and to others. ToM is fundamentally important for the social functioning of an individual. Whilst we know that ToM development is generally affected by hearing loss, many of details of this relationship are still unclear. In this project we investigate the roles of such potentially important factors such as age of identification of hearing impairment (HI), the severity of the HI, mode of treatment, the fluency in other modes of communication (e.g., sign language), additional disabilities to the development of basic and advanced ToM skills, and explore potential routes to intervention.

Funder: The Libyan Government 

Staff involved: Ibtihal Sambah, Antje Heinrich, Helen Chilton and Cathy Adams


Improving patient experience, service access and outcomes for Deaf adults who use British Sign Language

Improving patient experience, service access and outcomes for Deaf adults who use British Sign Language  Anecdotally, there appears to be an increase in the use of hearing aid services and little evidence exists of BSL users’ experiences.  This project will collect evidence to identify what makes an effective adult hearing aid service from a BSL user perspective.  The results may impact guidelines that will improve service quality, patient satisfaction, impact policies and audiology training. 

Funder: Manchester NIHR BRC in Hearing Health.

Staff involved: Celia Hulme, Alys Young, Kevin Munro and Katherine Rogers