Translational Research, Auditory Training, and More: Interview with Melanie Ferguson, MSc
Douglas A. Beck, AuD, speaks with Ferguson about the research she is doing on APD, sensorineural hearing loss, auditory training, and more.
Academy: Hi, Melanie. Thanks for your time this morning.
Ferguson: Hi, Doug. Always nice to chat with you.
Academy: Melanie, I recall that you’ve recently changed positions. Can you elaborate a bit on your new responsibilities?
Ferguson: Sure. Well, I still do hearing research and I’ll continue collaborating with the MRC Institute of Hearing Research (IHR) on the APD research we’ve been working on for the past four years. Nonetheless, the new unit I’m working at, the National Biomedical Research Unit in Hearing, is more focused on translational research and I’ll be working on sensorineural hearing loss in adults.
Academy: Melanie, just to be clear, translational research means we’re trying to take lab-based and bench results to the patients as quickly as is reasonable—is that right?
Ferguson: Yes. We call it “bench-to-bed” but it’s the same idea. In essence, we might take some of the basic research, such as that from IHR (where I used to work) and re-think or re-work it into something that addresses “what are the pragmatic benefits?” that can be applied to patients in the clinic. The timing is less of an issue, though obviously the quicker the better.
Academy: So, the goal is to figure out which research projects and protocols might really resonate with the patients we address every day?
Ferguson: Exactly. Right at this moment, I’m looking at research related to auditory training. The question is: Does auditory training increase cognition, communication, and speech intelligibility in relatively young people (50 to 75 years) with mild-to-moderate hearing loss? So, initially we’re looking at benefits of auditory training in non-hearing aid users, then we’ll be moving onto those with hearing aids later.
Academy: This sounds exciting. In the past, professions (particularly medicine!) have tended to jump on things with good face validity, or good construct validity, and then we apply these tools and the results are usually consistent with what we expect. However, I absolutely agree that there is no substitute for the scientific method and well-designed translational research, to make sure we know the outcomes before engaging the treatment!
Ferguson: Yes, that’s the point. We need to validate our clinical tools, and undoubtedly, as we do that, some of them won’t be as strong and will fade away, whilst the strongest and best will thrive and we’ll all benefit from identifying the best tools and practices.
Academy: With regard to auditory training in particular, I’m a big fan of the LACE (Listening and Communication Enhancement) for a few reasons.
First, audiologists know that auditory training (i.e., aural rehabilitation) is an essential part of hearing and listening success. Unfortunately, in the United States, audiologists cannot actually bill for these services and professionals cannot afford to be giving away their time for free. So the LACE is an excellent tool, reasonably priced, and most patients can take it home, work with it for a month and develop important listening skills.
Ferguson: Yes, I’m familiar with the LACE and the way it’s used. We’re using our own software with similar home-based delivery of training at the moment and would like to develop it further to enable internet delivery. So many people with mild and moderate hearing losses are not wearing hearing aids and if we had a “take-home” educational or an Internet-based tool, hearing aid users and non-users could use these tools to learn about and develop their listening skills at home—when they’ve got the time and energy! But, again, before letting the program out the door for mass consumption, we need to validate it.
Academy: This sounds very exciting, Melanie. Another advantage of the take-home program is it would not be a drain on audiology services.
Ferguson: That’s right, and that’s very important for us here in the United Kingdom, as we do not want any of our interventions to over-burden existing NHS services. We would like to explore ways to improve service delivery methods as well as develop patient-relevant interventions within hearing services.
Academy: Very interesting and very important work. I am sure you’ll be successful and I applaud your willingness to evaluate and re-evaluate to develop excellent and efficient clinical protocols. And in many respects, I think that’s sort of the way you’ve approached APD?
Ferguson: Yes, well, historically it has been very difficult to identify children who have APD from those with ADD, ADHD, Dyslexia, Language Impairment and such like, as there’s no “gold standard” APD test.
At IHR, we thought we’d use a different tactic toward understanding APD by collecting data from a very large group of normal hearing children and take a “population” approach, rather than the usual “clinical case” approach. So, two years ago, my colleagues and I started collecting data on auditory processing along with speech perception and cognitive abilities from mainstream school children. We cast our net wide with the aim that we could catch some children with APD, we guessed about 5 percent. We tested over 1,600 children (1,638 to be precise!) who were 6 to 11 years old from four cities across the United Kingdom. We used a number of temporal and spectral psychoacoustic tests using non-speech stimuli to be consistent with the British Society of Audiology and ASHA’s definitions of APD.
Academy: That’s an interesting concept. So what are the results of this study?
Ferguson: In the final analysis, we’ve looked at not only threshold sensitivity of the auditory processing tests, but also the variability of the responses so as to give us a measure of auditory attention. The largest contributors to the hallmarks of APD, such as speech-in-noise perception, communication and listening abilities were the cognitive tests such as non-verbal IQ and memory tests. Another equally large contributor to the variance was auditory attention. It seems listening and attention matter a great deal—so we’re proposing that APD may actually be more of a cognitive processing disorder as a result of poor auditory attention.
Academy: Fascinating work, Melanie.
Ferguson: Thanks. We’re not done yet. We’ve still got more data to analyze, but it’s coming along nicely and we do have these findings that will be published shortly.
Academy: And so the next task?
Ferguson: Well, we really need to dig in and figure out what we mean by “auditory attention.” Maybe it’s a more global problem like ADHD or maybe it’s limited to the auditory system? We just don’t know at the moment.
Academy: I know we could talk about this all day, but I have to let you go. Thanks so much for your time.
Ferguson: My pleasure, Doug.
Melanie Ferguson, MsC, is a consultant clinical scientist (audiology) at the National Biomedical Research Unit in Hearing, Nottingham, England, and immediate past chair of the British Academy of Audiology Higher Training Committee.
Douglas L Beck, AuD, is the Web content editor for the American Academy of Audiology.