Action on Hearing Loss – Written evidence (INQ0013)
Significant progress is being made towards developing a new generation of medicines that promise to prevent various types of acquired hearing loss, regenerate and restore hearing, and reduce tinnitus. Over 70% of people aged over 70 experience hearing loss impacting on quality of live and productivity. Hearing loss has also been linked to an increased risk of dementia. These emerging treatments will transform how hearing loss is managed, making a key contribution to extending quality of live by 2035.
A recent review of emerging hearing therapeutics shows that there are over 20 treatments already in clinical trials and many more at preclinical stages of development. The most advanced treatments are those to prevent or protect hearing with 37 treatments in development, followed by 16 regenerative therapies and 13 tinnitus treatments. Of course not all will progress to market, but assuming a similar attrition rate to other healthcare areas and the strength of the discovery pipeline, we expect there to be drug, gene and cell-based therapies available by 2035 to help reduce the incidence of age-related hearing loss and improve hearing amongst those already experiencing some degree of loss.
A specific example is a drug treatment being developed by Audion Therapeutics which is currently in phase II clinical trials in the UK. The drug triggers the regeneration of sensory hair cells within the cochlea. Degeneration of these cells is a common cause of hearing loss, including age-related. (https://www.regainyourhearing.eu/)
4.1. Demographic differences
The vast majority of people with hearing loss are over 50 years old and the prevalence increases with age. For example, more than 70% of those over 70 will have some degree of hearing loss.i Evidence suggests a higher incidence among not only older adults, but also men and those of lower socio-economic status.
4.2. Behavioural determinants
Globally, hearing loss is ranked second when it comes to conditions contributing to years lived with disability. There is strong evidence to suggest that hearing aid uptake improves health and wellbeing in later life. For example, if left untreated, hearing loss is associated with cognitive decline/dementia,ii increased risk of falls and poorer mental health. However, hearing aids have been shown to modify many of these risks, making hearing aid uptake an important determinant of health and wellbeing later in life. Despite this evidence, people wait on average 10-years before seeking help for their hearing loss. Understanding why this is, and which groups are least likely to engage with treatments is crucial to improving health and independence in old age. Existing literature suggests there are demographic differences in help-seeking behaviour and hearing aid uptake. For example, some research shows older lower SES males have lowest level of current hearing aid use.
5.1. Drug delivery devices, for existing or future treatments
Devices that can deliver drugs to a specific and localised area are much needed in the treatment of conditions such as hearing loss. Specifically, there is a need for technologies capable of delivering drugs to the inner ear. We have been funding a project with the company Otomagnetics (not a UK company) to develop a technology in which drugs can be linked to tiny iron particles and then pushed into the cochlea using magnets. The technology has not yet reached clinical trials, but we would expect it to do so in the next few years.
Similarly, there would be great benefit in developing methods for delivering drugs non-invasively. Currently inner ear drugs have to be administered via an injection through the ear drum which is expensive and painful. Delivering drugs to the inner ear using a different method would be more cost effective, eliminating the need for anaesthesia and operating rooms. It would also be less painful for patients, resulting in improved recovery time and better outcomes.
5.2. Technologies for monitoring conditions and providing personalised medical advice
There is great value to be gained from investing in the use of smartphones to monitor health and give advice. Currently there are several online hearing checks available. However, these are often provided by private companies to reach potential customers. Having an NHS hearing check available for use at home would give people with hearing loss access to trusted sources of information about their condition and they could be signposted to relevant services. It would also allow patients to avoid having to visit the GP and offer a direct route into services, reducing pressure on the health system whilst also reducing waiting times.
5.3. Technologies to improve diagnosis
Currently there are several barriers to people addressing their hearing loss, including low awareness of NHS hearing aid services amongst patients and GPs, and services being far away. Technology that provides a remote diagnostic service would remove these barriers and for those that are suitable, having a self-fitting option would increase the number of people who address their hearing loss.
Additionally, we need technologies better able to diagnose different types of hearing loss and indicate precisely what part of the auditory system is affected. These technologies will be vital in the future to ensure the right treatment is given to the right person (precision medicine). They are also needed to allow the right patients to be recruited into clinical trials of new treatments and monitor the outcomes of treatments being tested.
6. What technologies will be needed to help people to live independently for longer, with better health and wellbeing? What is the current state of readiness of these technologies, and what should be done to help older people to engage with them?
Technology has huge potential to assist in the delivery of healthcare and facilitate independent living for longer. For the growing number of older people living with age-related hearing loss, technology such as hearing loops can allow them to interact with public services, and digital communications offer an alternative for those who struggle to communicate via telephone. Having better access to reliable information in a range of formats has the potential to improve wellbeing and allow people to live independently for longer. As information on health and wellbeing becomes increasingly digital and inaccessible, care must be taken to engage older adults and empower them to be their own health advocates.
Physical infrastructure often fails to meet the needs of older people, especially with health conditions common to older age such as cognitive decline, reduced mobility and hearing loss. Health services can often be difficult to reach for older adults and transport can be prohibitively expensive. Telehealth has the potential to transform services, such as audiology, opening up access, especially to those who may live more rurally or be less mobile. It also presents an opportunity for cost savings, both to the service user and to the health and social care systems.
Telehealth technology already exists. Technology is rapidly developing to remotely fit hearing aids or to facilitate self-fitting. This includes remote otoscopy, hearing tests, hearing aid fittings and fine tuning. For example, some private hearing aid providers offer devices that can be adjusted remotely by a professional, avoiding the need to visit a service. There are also hearing aid devices capable of monitoring your activity levels, along with other indicators of health, and feeding this information into an app. While this technology has the potential to improve lives, costs are currently prohibitive for many and may exacerbate existing inequalities.
6.2. Smart homes
Smart homes offer the possibility to integrate accessibility solutions into everyday life, and monitor health and wellbeing with little effort. Assistive technology has the potential to help people to remain independent and in their own homes for longer. However, this shift requires sufficiently good internet access, as well as the ability to use the technology and troubleshoot any difficulties. In addition, adequate security measures must be taken to protect vulnerable people from having their data misused or keeping them safe from cybercrime.
6.3. Increasing engagement
Uptake of technology remains low among older populations when compared to other age groups, but there is currently little in place to develop the necessary skills to boost confidence. In addition, low income households and those living in rural areas are less likely to have the internet access that a lot of technology is reliant on. xiii
Addressing common age-related difficulties such as cognitive decline, hearing loss, and reduced mobility will be crucial in order to improve mental health and reduce social isolation. Unaddressed hearing loss in particular is linked to communication problems, exacerbating isolation and increasing the likelihood of mental ill-health.vii
Access to digital services improves a person’s ability to communicate with others. Basic digital skills can enable people to connect and communicate with family, friends and others in their community 14% more frequently. xiii This is especially important for older people who may not live near family.
Technologies, such as smartphones, assistive technology and AI, have enormous potential to overcome existing accessibility barriers that prevent older people, and in particular people with hearing loss, from interacting with services. Smart devices can provide vital visual information such as live speech to text transcription, making transport, entertainment and other services more accessible, which in turn reduces social isolation and modifies a person’s risk of developing cognitive impairments such as dementia.viii
Technologies such as smartphones and internet-based devices can be inaccessible to some older adults, who lack the confidence to use them or find them prohibitively expensive. This can leave many in this group without the tools to improve their health and reduce the social isolation they may be experiencing. Those who do have access to technology are less likely to be capable of upskilling themselves digitally and may be at higher risk of cybercrime as they are unfamiliar with internet security.
A large proportion of older people are still not online. This figure is declining but in 2018, 8% (4.3 million) of the population was estimated to have zero basic digital skills of which 76% were over the age of 65. A further 12% (6.4 million adults) were estimated to have limited abilities online. xiii In addition, disabled adults make up a large proportion of adults internet non-users. In 2017, 56% of adult non-users were disabled. xiii
b. To what extent do socio-economic factors affect access to, and acceptance of, scientific advice and use of technology by older people and those who care for them?
The UK has a strong research base in hearing science from which we expect to see new biotech start-ups emerge able to drive both economic development and to deliver technologies and medicines to increase health span. A recent example is Rinri Therapeutics which was spun out of Sheffield University to develop and commercialise a stem cell therapy for regenerating hearing (https://rinri-therapeutics.com/).
There are also opportunities for large pharmaceutical companies. These companies already recognise the commercial opportunities that exist for effective hearing treatments, and stand ready to invest in the late stage clinical development of such treatments and in bringing them to market.
Finally, there are opportunities for specialised contract research organisations able to provide drug development and clinical trials services to support the development of hearing therapeutics. CILcare is an example of a company that has exploited this opportunity in France (https://www.cilcare.com/ ).
The development of treatments and technologies to lessen the impact of hearing loss has huge potential to improve health span, stimulate economic growth and boost productivity. However, this is threatened by chronic underfunding of research in this area. The UK Health Research Analysis 2014, showed that the UK’s main public research funders spent just £12.3 million on research into ‘ear’ conditions in 2014. In comparison £22.7 million was invested in ‘eye’ conditions. Initiatives are needed to increase investment in UK hearing research in line with the scale of the issue. Such approaches have transformed the search for treatments for dementia. Similar action is now needed to ensure the UK can lead the discovery and development of therapeutics to address hearing loss and address a major healthcare issue.
There is a wealth of existing technology with the potential to allow people to live healthier, more independent lives for longer. However, there must be increased efforts to encourage better take up and engagement. For example, hearing aids are a highly cost-effective and readily-available technology, and their use is linked to reduced risk of dementia and cognitive decline, as well as improved mental health and wellbeing. Similarly, the technology exists to make homes more accessible for older adults with changing needs, and to help people with sensory loss to interact with services. Despite this, promotion of these technologies is inadequate, and many older people are simply unaware of their benefits.
a. What strategies will be needed to achieve the Government’s aim?
b. What policies would be required, and what are their potential costs and benefits?
11(b).1. Hearing screening programme for older adults (e.g. as part of the NHS Health Check)
11(b).2. Better use of telehealth (e.g. in audiology)
c. Which organisations need to be involved?
d. Who should lead the work?
The Department for Health and Social Care
12. To what extent are inequalities in healthy ageing, as well as differences in acceptance of technologies, a barrier to achieving the aims of the Government’s Ageing Society Grand Challenge?
13.1. Economic impacts
13.2. Time spent in work as opposed to in retirement
“I shared my deafness with my managers but they failed to understand my problems…. so I retired when I wanting to carry on working. I found it so stressful.”
- Action on Hearing Loss survey respondent (Action on Hearing Loss (2018), Survey of Workplace Experiences)
12 September 2019
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