The World Health Organization (WHO) defines hearing loss as the inability to hear sounds of 25 decibels (dB) or less. According to this definition, one in five Americans over the age of 12 has hearing loss in at least one ear. This translates to roughly 52 million Americans in 2019. This number is expected to rise as the U.S. population grows and ages (Lin, et al., 2011; U.S. Census, 2019).
Hearing loss can affect people’s lives in diverse areas, including education, transition from school to work, employment, participation in the community, mental health, and general social and emotional well-being (Kochkin, 2010; Fellinger, et al., 2012). However, successful auditory enhancement technologies improve the quality of life of people who experience hearing loss (Kochkin, 2010).
Permanent binaural hearing loss occurs in about 1.3 per 1000 live births, which was roughly 5,200 children in 2017. Without early intervention, children with hearing loss have predictable, irreversible deficits in communication, psychosocial skills, cognition, and literacy. The child’s speech and language deficits are directly proportional to hearing loss severity and the time it takes to obtain a diagnosis and begin intervention. Newborn screening significantly lowers the age at which moderate to severe hearing loss is diagnosed (Korver et al, 2017; Patel & Feldman, 2011).
Hearing aids (HA) deliver processed sound to the ear to improve hearing function of people with moderate to severe hearing loss. In 2015, an estimated 28.8 million U.S. adults could benefit from HA (NIDCD, 2019a). A 2015 study of U.S. adults found that 10.6% of respondents reported “hearing difficulty”, 3.2% owned HA across age cohorts, and HA ownership increased to 26% by 85 years of age or older. More than 80% of HA owners reported being satisfied or very satisfied with their technology, and only three percent reported abandoning their technology (Abrams & Kihm, 2015). The Over-the-Counter (OTC) Hearing Aid Act seeks to improve the accessibility and affordability of HA by allowing “do-it-yourself” (DYI) distribution channels (e.g., local drug stores) through which people with hearing loss could self-assess, fit, verify the performance of, and acquire HA without the intervention of an audiologist (OTC, 2017).
Cochlear implants (CI) compensate for profound hearing loss by transforming sound information into electrical signals delivered via an electrode array to frequency-specific neural elements in the cochlea (Anandhan & Jolly, 2017). In 2012, about 58,000 adults and 48,000 children were already using CI (NIDCD, 2019b). Optimizing the features, functions, and performance of HA and CI, especially for use in noisy and complex hearing contexts remains an important objective (Abrams & Kihm, 2015, Peterson, et al., 2010).
Universal newborn hearing screening and intervention may account for an increased rate of HA adoption by children with moderate to severe hearing loss (HRSA, 2019; Abrams & Kihm, 2015). A similar increase of CI adoption by children with profound hearing loss might be expected. Understanding the relationship between the characteristics and timing of HA and CI interventions to children’s ability to hear and speak is a critical research task. (Tomblin, et al., 2014; Peterson, Pisoni, & Miyamoto, 2010; Robert & Ruben, 2018).
Wireless integration of HA and CI with carried or worn technologies (E.g., fobs, smart watches, cell phones, etc.) can provide a more usable control interface, and direct connection to sound sources such as computers, cell phones, and televisions. Wireless integration with portable adaptive beam-forming microphone arrays can enable small group conversation, and wireless integration between HAs and CIs can emulate binaural hearing (Hearing Health, 2019a; Hearing Health, 2019b).
Assistive listening systems (ALS) improve the “signal to noise ratio” of sound received and processed by HA and CI in noisy or complex hearing contexts, and ALS have been especially beneficial in places of worship, classrooms, theaters and concert halls, and courtrooms. However, ALS have significant limitations in their portability, usability, and performance, particularly during group discussions (Hearing Health, 2019; Harkins & Tucker, 2007; Wald, 2010).
Real-time speech to text (RT-S2T) capabilities may address important needs of people who are deaf or hard of hearing. For example RT-S2T on mobile devices can facilitate one-on-one communication in noisy contexts and provide captioning of television news or online podcasts (PHB, 2016; BT, 2012). The Internet Protocol (IP) Captioned Telephone Service (IPCTS) is an FCC approved form of Telecommunications Relay Service that provides critical emergency information to people who are deaf or hard of hearing. The FCC has approved action to allow IPCTS telephone captions to be RT-S2T generated (FCC, 2019; FCC, 2018). Overall, it is critical for RT-S2T technologies to be robust, reliable, and have low error rates across users and contexts.
The proposed Medicare Telehealth Parity Act of 2017 (H.R. 2550) identifies audiologists as “appropriate providers” of telehealth services (e.g., remote services benefitting people with hearing loss in rural and resource limited environments) and authorizes Medicare to reimburse audiologists for these services (TPA, 2017). To implement these important initiatives, innovative self-service and remote-provision paradigms and technology systems are required.
In response to these multiple advances and related opportunities for further evolution of innovative technologies to enhance outcomes for people who are deaf or hard of hearing, NIDILRR aims to sponsor a Rehabilitation Engineering Research Center on technology for people who are deaf or hard of hearing.
Abrams, H.B. & Kihm, J. (2015). Introduction to the MarkeTrak IX: A new baseline for the hearing aid market. Research: MarkeTrak IX, June 2015 Hearing Review. Referenced March 11, 2019. URL: http://www.hearingreview.com/2015/05/introduction-marketrak-ix-new-base…
Anandhan, D & Jolly, C. (2017). An overview of cochlear implant electrode array designs. Hearing Research. 356 (12), 93-103.
BT (Spring 2012). Speech recognition for real-time closed captioning. Broadcast Technology (BT). Referenced March 15, 2019. URL: https://pdfs.semanticscholar.org/92ee/6df208ea923a7c569e101444bd30184c7…
FCC (2018). FCC approves action to reform Internet Protocol Captioned Telephone Service (IP CTS). Federal Communication Commission (FCC). Referenced March 20, 2019. URL: https://www.fcc.gov/fcc-approves-action-reform-internet-protocol-captio…
FCC (2019). Internet Protocol (IP) Captioned Telephone Service. Federal Communications Commission (FCC). Referenced March 15, 2019. URL: https://www.fcc.gov/consumers/guides/internet-protocol-ip-captioned-tel…
Fellinger, J., Holzinger, D., & Pollard, R. (2012). Mental health of deaf people. The Lancet, 379, 1037–1044.
Harkins, J., & Tucker, P. (2007). An internet survey of individuals with hearing loss regarding assistive listening devices. Trends in Amplification, 11(2), 91–100.
Hearing Health (2019a). Wireless hearing aids. Healthy Hearing. Referenced March 11, 2019. URL: https://www.healthyhearing.com/help/hearing-aids/wireless
Hearing Health (2019b). Wireless hearing aids. Hearing Health. Referenced March 11, 2019. URL: https://www.healthyhearing.com/help/hearing-aids/bluetooth
HRSA (2019). Universal Newborn Hearing Screening and Intervention Program. Health Resources and Services Administration. Referenced March 11, 2019. URL: https://mchb.hrsa.gov/maternal-child-health-initiatives/early-hearing-d…
Kochkin, S. (2010). MarkeTrak VIII: The efficacy of hearing aids in achieving compensation equity in the workplace. Hearing Journal, 63(10), 19–26.
Korver, A., Smith, R. Van Camp, G., Schleiss, M., Bitner-Glindzicz, M., Lustig, L., Usami, S. and An N. Boudewyns, A. (2017). Congenital hearing loss. Nature Reviews Disease Primers. 3: 16094.
Lin, F.R., Niparko, J.K., & Ferrucci, L. (2011). Hearing loss prevalence in the United States. Archives of Internal Medicine, 171(20), 1851–1853.
NIDCD (2019a). U.S. adults who could benefit from hearing aids in 2015. National Institute on Deafness and Other Communication Disorders (NIDOCD). Referenced March 11, 2019. URL: https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing
NIDCD (2019b). Quick statistics about hearing. National Institute on Deafness and Other Communication Disorders (NIDCD). Referenced March 11, 2019. URL: https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing
OTC (2017). Over-the-Counter (OTC) Hearing Aid Act of 2017 (S.670 and H.R.1652). American Academy of Audiology. Referenced March 11, 2019. URL: https://www.audiology.org/advocacy/federal/congressional-issues/over-co…
Patel, H., & Feldman, M. (2011). Universal newborn hearing screening. Position Statement: Canadian Paediatric Society, Community Paediatrics Committee. Referenced March 11, 2019. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114997/pdf/pch05301.pdf
Peterson, N.R., Pisoni, D.B., & Miyamoto, R.T. (2010). Cochlear implants and spoken language processing abilities: Review and assessment of the literature. Medicine, Clinical Neurology and Exercise & Occupational Therapy, 28(2), 237–250.
PHB (October 6, 2016). Speech to text apps for people with hearing loss. People Hearing Better (PHB). R eferenced March 15, 2019. URL: http://phb.secondsensehearing.com/content/speech-text-apps-people-heari…
Robert J. Ruben, R.J. (2018). Language development in the pediatric cochlear implant patient. Laryngoscope Investigative Otolaryngology. 3(3): 209–213.
Tomblin, J.B., Oleson, J.J., Ambrose, S.E., Walker, E., & Moeller, M.P. (2014). The influence of hearing aids on the speech and language development of children with hearing loss. JAMA Otolaryngology Head Neck Surgery. 140(5): 403–409.
TPA (2017). Medicare Telehealth Parity Act (TPA) of 2017 (H.R. 2550). Referenced March 11, 2019. URL: https://www.congress.gov/bill/115th-congress/house-bill/2550
U.S. Census (2019). U.S. and world population clock. United States Census Bureau. Referenced March 11, 2019. URL: https://www.census.gov/popclock/
Wald, M. (2010). Synote: Accessible and assistive technology enhancing learning for all students. ICCHP 2010, Part II, LNCS 6180, 177–184.
The Administrator of the Administration for Community Living establishes a priority for a Rehabilitation Engineering Research Center (RERC) on Technology for People who are Deaf or Hard of Hearing. Under this priority, the RERC must conduct research, development, and evaluation activities toward understanding and optimizing technologies and services used by people who are deaf or have significant hearing impairments. The RERC must be designed to benefit people who are deaf or hard of hearing in one or more of the following outcome domains: community living and participation, health and function, and employment.
This RERC will focus on innovative technological solutions, new knowledge, and new concepts that are intended to improve the lives and outcomes of people who are deaf or hard of hearing. An applicant should consult the NIDILRR Long-Range Plan for Fiscal Years 2018-2023 when preparing its application. The Plan is organized around the following outcome domains: (1) community living and participation; (2) health and function; and (3) employment.
The RERC must conduct advanced engineering research and development activities in one or more of the following areas, to contribute to improved outcomes for people who are deaf or hard of hearing:
Hearing aid features, functions, and performance.
Cochlear implant features, functions, and performance.
Wireless integration of hearing aids with cochlear implants.
Advanced assistive listening systems.
Advanced speech-to-text capabilities.
Real time speech to text.
Technologies and services to optimize language acquisition and speech production by childhood users of hearing aids or cochlear implants.
Over-the-counter hearing aids.
Tele-provision of audiology and related services.
Requirements applicable to RERC priorities:
As a national center, the RERC must conduct high quality research, development, technical assistance, capacity building, knowledge translation, and dissemination activities that address significant needs, promote independence, and improve the quality of life and community living outcomes of people with disabilities. In order to optimize benefits to people with disabilities, the RERC must ascertain efficacy and safety of proposed strategies, technologies, or interventions, and collaborate with appropriate entities to facilitate the transfer and adoption of development products. The RERC must follow and understand emerging technologies, and communicate to NIDILRR, ACL, and other appropriate stakeholders about the potential opportunities and drawbacks associated with these technologies.
A RERC established under the priority in this notice must be designed to contribute to the following outcomes:
Increased technical and scientific knowledge relevant to its designated priority research area. The RERC must contribute to this outcome by conducting high-quality, rigorous research and development projects. When applicable, the RERC must utilize engineering knowledge and techniques to collect, analyze, and/or synthesize research data.
Increased innovation in technologies, products, environments, performance guidelines, or monitoring and assessment tools applicable to its designated priority research area. The RERC must contribute to this outcome through the development and testing of these innovations. When applicable, the RERC must apply engineering knowledge and techniques to achieve development objectives.
Improved research capacity in its designated priority research area. The RERC must contribute to this outcome by collaborating with the relevant industry, professional associations, and institutions of higher education, health care providers, or educators, as appropriate, to train research and development professionals in its designated priority research area.
Improved usability and accessibility of products and environments in the RERC’s designated priority research area. The RERC must contribute to this outcome by emphasizing the principles of universal design in its product research and development. For purposes of this priority, the term “universal design” refers to the design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design.
Improved awareness and understanding of cutting edge developments in technologies within its designated priority research area. The RERC must contribute to this outcome by identifying and communicating with NIDILRR, people with disabilities and their representatives, disability organizations, service providers, professional journals, manufacturers, and other interested parties regarding trends and evolving product concepts related to its designated priority research area.
Increased impact of research and development in the designated priority research area. The RERC must contribute to this outcome by providing technical assistance to relevant public and private organizations, people with disabilities, employers, and schools on policies, guidelines, and standards related to its designated priority research area.
Increased transfer of RERC-developed technologies to the marketplace. The RERC must contribute to this outcome by developing and implementing a plan for ensuring that all technologies developed by the RERC are made available to the public. The technology transfer plan must be developed in the first year of the project period in consultation with the NIDILRR-funded Initiative to Mobilize Partnerships for Successful Assistive Technology Transfer (IMPACT Center).
In addition, a RERC established under this priority must—
Have the capability to design, build, and test prototype devices and assist in the technology transfer and knowledge translation of successful solutions to relevant production and service delivery settings.
Evaluate the efficacy and safety of its new products, instrumentation, or assistive devices.
Provide as part of its proposal, and then implement, a plan that describes how it will include, as appropriate, people with disabilities or their representatives in all phases of its activities, including research, development, training, dissemination, and evaluation.
Provide as part of its proposal a plan to disseminate its research results to people with disabilities and their representatives, disability organizations, service providers, professional journals, manufacturers, and other interested parties. If funded, the RERC must consult with the Center on Knowledge Translation for Disability and Rehabilitation Research and other relevant NIDILRR-sponsored KT Centers to implement this dissemination plan.
Conduct a state-of-the-science conference on its designated priority research area in the fourth year of the project period, and publish a comprehensive report on the final outcomes of the conference in the fifth year of the project period.
Coordinate research projects of mutual interest with relevant NIDILRR-funded projects, as identified through consultation with the NIDILRR project officer.
Specify the stage or stages of proposed research projects. If the applicant proposes to conduct research that can be categorized under more than one stage, including research that progresses from one stage to another, those stages must be clearly specified. These stages, exploration and discovery, intervention development, intervention efficacy, and scale-up evaluation, are defined in this section of the funding opportunity announcement.
Specify the stage or stages of the proposed development projects. If the applicant proposes to conduct development that can be categorized under more than one stage, those stages must be clearly specified. These stages, proof of concept, proof of product, and proof of adoption are defined in this section of the funding opportunity announcement.
Definitions - Stages of Research:
Exploration and discovery means the stage of research that generates hypotheses or theories through new and refined analyses of data, producing observational findings and creating other sources of research-based information. This research stage may include identifying or describing the barriers to and facilitators of improved outcomes of people with disabilities, as well as identifying or describing existing practices, programs, or policies that are associated with important aspects of the lives of people with disabilities. Results achieved under this stage of research may inform the development of interventions or lead to evaluations of interventions or policies. The results of the exploration and discovery stage of research may also be used to inform decisions or priorities.
Intervention development means the stage of research that focuses on generating and testing interventions that have the potential to improve outcomes for people with disabilities. Intervention development involves determining the active components of possible interventions, developing measures that would be required to illustrate outcomes, specifying target populations, conducting field tests, and assessing the feasibility of conducting a well-designed intervention study. Results from this stage of research may be used to inform the design of a study to test the efficacy of an intervention.
Intervention efficacy means the stage of research during which a project evaluates and tests whether an intervention is feasible, practical, and has the potential to yield positive outcomes for people with disabilities. Efficacy research may assess the strength of the relationships between an intervention and outcomes, and may identify factors or people characteristics that affect the relationship between the intervention and outcomes. Efficacy research can inform decisions about whether there is sufficient evidence to support “scaling-up” an intervention to other sites and contexts. This stage of research may include assessing the training needed for wide-scale implementation of the intervention, and approaches to evaluation of the intervention in real-world applications.
Scale-up evaluation means the stage of research during which a project analyzes whether an intervention is effective in producing improved outcomes for people with disabilities when implemented in a real-world setting. During this stage of research, a project tests the outcomes of an evidence-based intervention in different settings. The project examines the challenges to successful replication of the intervention, and the circumstances and activities that contribute to successful adoption of the intervention in real-world settings. This stage of research may also include well-designed studies of an intervention that has been widely adopted in practice, but lacks a sufficient evidence base to demonstrate its effectiveness.
Definitions - Stages of Development:
Proof of concept means the stage of development where key technical challenges are resolved. Stage activities may include recruiting study participants, verifying product requirements; implementing and testing (typically in controlled contexts) key concepts, components, or systems, and resolving technical challenges. A technology transfer plan is typically developed and transfer partner(s) identified; and plan implementation may have started. Stage results establish that a product concept is feasible.
Proof of product means the stage of development where a fully-integrated and working prototype, meeting critical technical requirements, is created. Stage activities may include recruiting study participants, implementing and iteratively refining the prototype, testing the prototype in natural or less-controlled contexts, and verifying that all technical requirements are met. A technology transfer plan is typically ongoing in collaboration with the transfer partner(s). Stage results establish that a product embodiment is realizable.
Proof of adoption means the stage of development where a product is substantially adopted by its target population and used for its intended purpose. Stage activities typically include completing product refinements, and continued implementation of the technology transfer plan in collaboration with the transfer partner(s). Other activities include measuring users' awareness of the product, opinion of the product, decisions to adopt, use, and retain products, and identifying barriers and facilitators impacting product adoption. Stage results establish that a product is beneficial.