The new analysis, published in the , re-evaluated existing prevalence data to include people with hearing loss who were previously not taken into account by official statistics.

The study was based on new population estimates from the most recent censuses: the 2021 Scottish census and the 2022 England and Wales Census. Because of an increase in the UK population, this resulted in an increase to 4.6 million.

However, the new data shows if people with a milder degree of hearing loss in both ears are included, the estimate is 12.3 million, or 1 in 4 of the population aged 18-80.

The number is greater still—18 million or 1 in 3— if those with a hearing loss in only one ear are also included.

Co-author Professor Kevin Munro, National Institute for Health and Care Research (NIHR) Senior Investigator at The University of Manchester said: “These data more accurately reflect the number of adults in the UK who have impaired hearing that will cause listening difficulty, especially in background noise.

“Maintaining the hearing health of adults is a strong social responsibility. So it is important to acknowledge that millions of people’s experiences have effectively been dismissed by existing data which means they are effectively left out of the national conversation.”

Co-author NIHR Senior Investigator Professor Michael Akeroyd from the University of Nottingham said: “The way we define hearing loss puts us at odds with most other countries.

“By modernizing these numbers, we align with the latest international practice.  We hope it will encourage more people to realise how common hearing loss is.”

Hearing loss ranks third for Years Lived with Disability, first for sensory disorders, and first for those over age 70. That is why addressing hearing loss is an important component of healthy ageing, argue the researchers. 

Despite the revised estimate, the researchers stress a new study is required because there have been significant changes in factors that could affect the estimates.

These include potentially lower occupational hearing loss from reductions in heavy industry and greater population diversity since the 1980s on which these data are estimated. Some ethnic minorities at higher risk of hearing loss.

New studies could also determine if there is now greater hearing loss from recreational noise exposure.

The Chief Medical Officer (CMO) for England Professor Chis Whitty, in a 2023 report on healthy ageing reflected the call by the researchers for better data.

His report argued that available estimates of hearing impairment rely on outdated statistics from several decades ago and that sensory impairment is a major contributor to disability in older age.

It also argued that many components of the ageing process are significantly under-researched including hearing impairment.

Victoria Boelman, Director of Insight and Policy at RNID, said: “RNID welcomes this new insight as a step forward in our understanding of the UK’s community of people with hearing loss. The updated statistics now reflect and include the real-life experience of the 18 million people in the UK who have different and diverse experiences of deafness and hearing loss. By previously excluding people with milder hearing loss or hearing loss in a single ear, society had effectively dismissed millions of people’s experiences and not factored them into national conversations.

“We’re here for the 18 million people in the UK who are deaf, have hearing loss or tinnitus. With our communities, we’ll change society to make it more inclusive for everyone, help people hear better now and fund world-class research. If you need support or information, visit rnid.org.uk.”

The paper “Population estimates of the number of adults in the UK with a hearing loss updated using 2021 and 2022 census data” is available at

The anonymised study of 10 staff from 8 different care homes, published in the journal Disability and Rehabilitation, revealed how residents were largely unable to access audiology services.

The problem is particularly relevant in the UK, where around 70% of long-term care home residents have dementia and 85% have hearing loss.

“People with dementia already are some of the most vulnerable people in society,” said Lead author Dr Hannah Cross, “And because hearing loss in these people can exacerbate agitation, confusion, increase loneliness and social withdrawal, the task of providing high quality care is even more important.”

All the participants in the study said audiologists rarely visit care homes compared to other healthcare professionals; two said they had never had seen one at all.

Though most of the staff interviewed by the researchers believed hearing support was beneficial, lack of training meant they did not have the knowledge to implement it effectively.

Staff, for example, found it hard to recognise if residents’ communication difficulties are caused by dementia or hearing loss.

Training on hearing loss for care home staff is not mandatory in the UK.

But basic hearing support training, hearing aids, communication techniques and other tools such as flashcards, would make a difference to residents’ quality of life, argue the researchers.

Dr Cross said: “Often residents with dementia are expected to attend audiology clinics outside their care home, mostly in a hospital or clinic. That causes stress and confusion for residents, on the occasions they are able to attend.

“For care home residents with dementia, it is completely up to professional care staff and audiologists to support them and their hearing needs.

“Effectively treating their hearing problems can really improve the quality of life for residents and their carers.”

The study was conducted online at the height of the pandemic, when care homes were largely cut off from public access.

However the problems caused by the pandemic seemed to make little difference to audiology services received by residents-  who were already receiving minimal care.

She added: “We think a radical overhaul of training and service provision is needed if we are to help people living in care homes with dementia and hearing loss.

“Staff Hearing Champions’ have been recommended, though without proper incentivisation it’s not clear how much of an impact they would make for staff who already have a very high workload.

“But without a doubt, greater co-operation between care homes and audiology services is desperately needed, so residents have equitable access to healthcare services, ideally within the care home.

“And training for staff around hearing aid maintenance and communication techniques will also make a difference.”

The paper “We’re just winging it”. Identifying targets for intervention to improve the provision of hearing support for residents living with dementia in long-term care: An interview study with care staff is available

The virus has been blamed for a range of health problems including hearing loss and other auditory disorders.

However, the global prevalence of Covid-19, and the importance of hearing for human interaction, means it is important to understand whether and how the virus might affect hearing, say the research team.

Lead authors Dr Anisa Visram and Dr Iain Jackson from the University of Manchester and a team of scientists compared two groups of patients who had been hospitalised, one group with Covid-19 and the other without Covid-19.

After completing the most comprehensive assessment of hearing to date, using a range of lab-based behavioural and physiological measures as well as self-report they were able to show that there was almost no difference in hearing between the two groups.

The findings are published in the International Journal of Audiology.

The study was funded by gifts to The University of Manchester’s Covid-19 Research Appeal, and part funded by RNID, The Dowager Countess Eleanor Peel Trust, and NIHR 91ֱ�� Biomedical Research Centre (BRC).

Dr Anisa Visram said: “We know that viruses such as measles, mumps and meningitis can damage the auditory system. It is also well known that Covid-19 can affect our sense of smell and taste so it was reasonable to assume it might also affect our sense of hearing. Our study was well designed and executed, and we believe it is the most thorough assessment of hearing conducted in people with Covid-19.”

Kevin Munro, Professor of Audiology at The University of Manchester and 91ֱ�� BRC Hearing Health lead said: “There was an urgent need for this carefully conducted clinical and diagnostic study to investigate the long-term effects of Covid-19 on the auditory system. Many previous studies were published rapidly during the pandemic but lacked good scientific rigour.”

The World Health Organisation refer to the avalanche of information produced during the Covid-19 pandemic as an infodemic. The vast quantity of sometimes misleading data has the potential to undermine trust in health institutions and health research.

Dr Ralph Holme, Director of Research and Insight at RNID, the charity supporting people who are deaf, have hearing loss or tinnitus, said: “We were pleased to support this study because we know hearing loss can have a significant impact on people’s lives. The study provides important public health information andit is reassuring to know that for the majority of people, hearing loss is not a major long-term consequence of Covid-19.”

A small number of people with Covid-19 reported greater effort required to listen but no specific auditory abnormalities were noted. This is an intriguing finding and may be related to wider post-viral effects such as fatigue and cognitive impairment.

Professor Richard Ramsden, Trustee at the Dowager Countess Eleanor Peel Trust said: “There have been many reports of hearing loss following Covid-19. It hasn’t been clear if these are incidental findings or if Covid-19 is damaging the hearing system. While the study cannot rule out infrequent hearing loss as a result of Covid-19, we now know that for most people, there is nothing to be concerned about.”

The research team used a state-of-the art bespoke hearing research van to travel to the homes of patients after they were discharged from hospital, making the study accessible to people who might not otherwise have been able to participate.

This unique research facility has already been used by the team in a previous study to improve the accuracy of hearing aid fittings in babies.  Now that the Covid-19 study has been completed, the research van is being used to assess the feasibility of travelling to different locations to collect data from adults with tinnitus. 

Anyone interested in participating in research on hearing loss and auditory disorders can register with the volunteer database at the university’s 91ֱ�� Centre for Audiology and Deafness. 

The Cortical Auditory Evoked Potential test -  or Cortical test for short - was assessed on 103 babies aged three to seven months by University of Manchester scientists in a research van traveling across the UK.

In almost all cases, the cortical test showed a positive response to speech played through the baby’s hearing aids when the baby could hear the speech at a clear level, and showed a negative result when the baby could not hear the speech.

The study - which was carried out before the pandemic -   is published today in the journal Ear and Hearing and was funded by the National Institute for Health and care Research (NIHR)Research for Patient Benefit Programme, NIHR 91ֱ�� Biomedical Research Centre, the William Demant Foundation, the Marston Family Foundation, and the Owrid Foundation.

Though the cortical test has been used in Australia, the 91ֱ�� team in collaboration with the Interacoustics Research Unit (Lyngby, Denmark), developed a new protocol which used different types of sound stimuli. They also showed the benefit of repeat testing to improve its sensitivity.

Electrodes are placed on the scalp which then record activity in the brain to show whether the baby is perceiving the sound from their hearing aids.

All newborn babies have a hearing screening test when they are born. If they fail the screening test, they are given another test by audiologists, while the baby is asleep using, electrodes on the scalp.

If the follow up test - known as the ABR – shows a hearing loss, they are then fitted with hearing aids, a process which can take up to three months.

Currently, there is no reliable way of testing how well babies are hearing through their hearing aids between three and seven months - as infants are not yet able to consistently respond by showing behaviours such as turning their head in response to a sound.

Lead author Anisa Visram, a lecturer at The University of Manchester said: “One in a 1000 babies are born with hearing loss and go on to have hearing aids fitted in the first months of life.

“The problem is, it’s not until they are around 7-9 months old at the earliest when we can use traditional tests of hearing. This can leave parents concerned about whether or not their babies are hearing the sounds the hearing aids are providing.

“However, our findings show the Cortical Auditory Evoked Potential test can help reassure parents about how babies are hearing through their hearing aids.

“This study would not have been possible without our research van which enabled us to get to parents across the country – a brilliant innovation.”

Kevin Munro, Professor of Audiology at The University of Manchester and 91ֱ�� Biomedical Research Centre Hearing Health Theme Lead said: “The ability to treat and diagnose hearing loss from an early age is partly down to the research we carried out at 91ֱ�� over the last few decades.

“Now we think it’s likely audiologists will be able to test how well a baby is hearing through their hearing aid during that crucial period from between three and seven months where no testing is currently available.

“Not only does this give parents the reassurance their child’s hearing aid is working, but also in instances when the babies are still not hearing despite the hearing aids, it will set in motion the process of cochlear implantation more quickly.”

A cochlear implant is a hearing device surgically implanted in the inner ear to help restore hearing to people with severe-to-profound hearing loss.

Marsha Johnson, a parent who took part in the study said: “Having the research van come to our home has been hugely beneficial.

“When Logan was only a baby having to disrupt his routine to attend the hospital was a nightmare. So having the ladies come to me and work around us was amazing.

She added: “They had lots of toys available to entertain Logan too and if I felt he was getting tired we could take a break, they did everything to accommodate us.

“The project itself means so much to me as hearing loss in our family is hereditary, so this research will help massively not only for the future of infants with hearing loss but my son also.”

Images:

• Researcher Jo brooks with Mum Marsha Johnson and baby Logan
• Researcher Jo brooks with Mum Marsha Johnson and baby Logan with Anisa Visram looking on
• The research team outside the van

This follows research led by Saint Mary’s Hospital, part of Manchester University NHS Foundation Trust (MFT), The University of Manchester and 91ֱ��-based firm genedrive Plc on the Pharmacogenetics to Avoid Loss of Hearing (PALOH) study. Together with 91ֱ�� based genedrive plc, they developed the pioneering, rapid bedside genetic test which was piloted at MFT in 2022.

Using a cheek swab, the test can identify in 26 minutes whether a critically ill baby admitted to intensive care has a gene change that could result in permanent hearing loss if they are treated with a common emergency antibiotic, Gentamicin.

While Gentamicin is used to safely treat approximately 100,000 babies a year, one in 500 babies carry the gene change that can lead to permanent hearing loss when given the drug.

The new test means that babies found to have the genetic variant can be given an alternative antibiotic within the ‘golden hour’ which could save the hearing of 200 babies in England every year.

PALOH study lead, Professor Bill Newman, Consultant in Genomic Medicine at MFT and Professor of Translational Genomic Medicine at The University of Manchester, said: “We are delighted that NICE has conditionally recommended the use of the test, which will be used in routine clinical practice in maternity settings across the country.

“We piloted the device at MFT in 2020 for 11-months and during that period we tested 750 babies and detected the genetic variant in three babies. Since being rolled out within our services at Saint Mary’s Hospital in November 2022, we have prevented the hearing loss of one baby.

“Our experience of using this test has been very positive. It’s straight-forward, non-invasive and will have a huge impact on our patients’ lives. The test will make a real difference, helping to ensure babies are not going to lose their hearing for a preventable reason.”

The system was developed in close collaboration with Professor Newman, Associate Lead, Hearing Health Genomic Solutions at National Institute for Health and Care Research (NIHR) 91ֱ�� Biomedical Research Centre (BRC) and his team at 91ֱ�� BRC.

The new swab test technique replaces a test that traditionally took several days and is the first use of a rapid point of care genetic test in acute neonatal care.

Evidence presented to the independent NICE committee from the PALOH study carried out in 91ֱ�� and Liverpool showed no statistically significant difference between the time to antibiotic treatment between standard care and when using the genedrive device. This suggests that introducing the test will not delay the time it takes to administer antibiotics.

Once in use, the NHS will collect further evidence to ensure the test can be put in place in a variety of different maternity settings. This additional evidence will also be scrutinised by the independent NICE committee as part of the full assessment.

David Budd, CEO of genedrive plc, said: We look forward to receiving the final NICE report and recommendations for the world’s first rapid point-of-care genetic test used to influence neonatal management in an acute care setting.”

Around 1,249 babies are born in England and Wales with the variant each year. At the moment, babies treated with gentamicin who go deaf are only discovered to have the genetic variant with DNA testing afterwards.

The estimated cost of treating hearing loss with a bilateral cochlear implant is around £65,000 in the first year.

Mark Chapman, interim director of Medical Technology at NICE, said: “Until now there has not been a test quick enough to ensure that newborn babies with a bacterial infection and the variant gene are treated with an appropriate antibiotic. Having this test available to NHS staff can avoid the risk of hearing loss in babies with the variant who need treatment with antibiotics. Hearing loss has a substantial impact on the quality of life of the baby and their family.

“The costs associated with hearing loss to the NHS are high, so driving an innovation like genedrive into the hands of health and care professionals to enable best practice can also ensure that we balance the best care with value for money, delivering both for individuals and society as a whole.”

The findings are published in the British Journal of General Practice as more and more people face the prospect of ear wax removal services being discontinued at their GP surgeries.

However, despite the withdrawal services, impacted ear wax is still a major reason for GP consultations; more than 2 million people in the UK needing ear wax requiring removal, say the research team led by Professor Kevin Munro at The University of Manchester and National Institute for Health and Care Research (NIHR) 91ֱ�� Biomedical Research Centre (BRC).

Ear wax is a particular problem in care homes, affecting up to 44% of residents with dementia.

The research team, surveyed 500 adults who used NHS ear wax removal services and found the most common and troubling symptom of blocked ears was hearing difficulty.

The study supported by the NIHR 91ֱ�� BRC found:

• 9 out of 10 of those surveyed said hearing difficulty was at least moderately bothersome.
• 6 out of 10 reported it to be very/extremely bothersome.
• After removal of the ear wax, more than 8 out of 10 people reported an immediate improvement.

Ear wax impacts on the ability to communicate with others but also affects listening to TV and monitoring sounds in the environment.

Additional symptoms caused by impacted ear wax includes discomfort and tinnitus (ringing in the ears).

Kevin Munro, Professor of Audiology at The University of Manchester and 91ֱ�� BRC Hearing Health Theme Lead said: “If anyone tries simulating the effect of impacted wax by walking around with their fingers plugging their ears for a few days, they’ll soon realise that it is a serious issue.

“The recommendations from the National Institute for Health and Care Excellence (NICE) could not be clearer- NHS ear wax removal services should be provided in the community.

“There are multiple reasons why GP surgeries are ceasing to provide ear wax removal services. The traditional method of syringing ears is no longer recommended but there are newer and safer methods for flushing wax out of the ear.

“There is also a misunderstanding that using ear drops to soften the wax will be enough to resolve the problem but there is little evidence to support this claim.   Once the wax has been softened, it needs to be flushed out of the ear or vacuumed up, neither of which can be done at home without expertise.

“Perhaps one solution is that GP surgeries could collaborate as a network as the portable nature of modern ear wax removal equipment is ideal for moving to different locations.”

Though there are a variety of home ear wax treatments on the market, NICE argues there is either no, or insufficient evidence, to support any of these.

Concerns over why people are being referred to hospital-based ear wax clinics - resulting in long waiting times and poor use of specialist services - have even been raised in parliament.

This and a 2022 Royal National Institute for Deaf People (RNID) report called Access blocked: the impact of cutting NHS ear wax removal services, described how many people are being forced to pay £50 to £100 every time they need the ear wax to be removed.

More than a quarter of people told RNID they couldn’t afford to get their ear wax removed privately.

Ear wax is a normal substance made by our body to clean, protect and keep our ears healthy. Movement of the jaw, as well as the skin that lines the ear canal, causes the wax to move to the entrance of the ear where it then flakes off or is carried away when we wash. Sometimes this doesn’t work, and the ear wax becomes impacted.

The paper, “Ear wax management in primary care: what the busy GP needs to know” is published in the British Journal of General Practice is available . 

Taking just 25 minutes, the bedside machine identifies whether a critically ill baby admitted to intensive care has a gene that could result in permanent hearing loss if they are treated with a common emergency antibiotic.

The new swab test technique would replace a test that traditionally took several days and could save the hearing of 180 babies in England alone every year.

People admitted to intensive care are usually given an antibiotic called Gentamicin within 60 minutes. While Gentamicin is used to safely treat about 100,000 babies a year, one in 500 babies carry the gene that can make it cause permanent hearing loss.

Developed in 91ֱ��, the new test means that babies found to have the genetic variant can be given an alternative antibiotic within the ‘golden hour.’

It is expected the test could save the NHS £5 million every year by reducing the need for other interventions, such as cochlear implants.

First-year nursing student Mary, from Preston, is mother to 18-month-old Khobi, who was born and treated at Saint Mary’s Hospital, part of Manchester University NHS Foundation Trust.

Mary said: “Khobi was born with her bowel outside her tummy, which put her at risk of infection - she needed antibiotics quickly but was given this new genetic test which showed she was susceptible to hearing loss from gentamicin.

“She was given an alternative antibiotic which didn’t affect her hearing, and it worked well. She’s doing fine and is such a happy, sociable baby.

“This test is great, and I think all babies should have it.”

NHS national medical director Stephen Powis said: “The successful trial of this bedside test is fantastic news for the hundreds of babies - and their parents - who would otherwise lose their hearing when given this common antibiotic in intensive care situations.

“Through world-class innovation, the NHS is delivering cutting edge treatments to save and improve patients’ lives as well as delivering on the commitments of the NHS Long Term Plan.”

Professor Bill Newman, a consultant in genomic medicine at 91ֱ�� University NHS Foundation Trust and Professor of Translational Genomic Medicine at the University of Manchester, led the Pharmacogenetics to Avoid Loss of Hearing (PALoH) study. He said: “I am absolutely thrilled with the success of the study, and that this testing is now going to be used in three of our Trust’s Neonatal Intensive Care Units -  it’s actually going to make a real difference so babies are not going to lose their hearing for a preventable reason.

“The trial demonstrated that you can deploy rapid genetic testing in a clinical setting, and that the tests can be carried out within the ‘golden hour’ when severely unwell babies should be treated with antibiotics.”

Following the completion of the ground-breaking study, the NHS Genomic Medicine Service Alliance and the NHS will be exploring how this technology can be launched as part of a clinical service through the NHS Genomic Medicine Service.

Around 300 nurses are being trained to use the machine across MFT at Saint Mary’s Hospital, Wythenshawe Hospital, and North 91ֱ�� General Hospital, and the test is expected to be routinely used in all the hospitals’ neonatal units within weeks, which are part of Saint Mary’s Managed Clinical Service within the Trust.

Professor Dame Sue Hill, Chief Scientific Officer for England and Senior Responsible Officer for Genomics in the NHS, said: “Genomic medicine is transforming healthcare, and this is a powerful example of how genetic testing can now be done extremely quickly and become a vital part of triage - not only in intensive care but across our services.

“It also shows the importance of thinking about how advances in technology can rapidly transform how we use genomics closer to care for our patients.”

Professor Newman, who is Associate Lead, Hearing Health Genomic Solutions at NIHR 91ֱ�� Biomedical Research Centre (BRC), said the team had successfully transferred the accuracy of the machine in the lab to working effectively in a ward. At the same time, clinicians adapted quickly to incorporate the test into their routine care for very sick children in the neonatal ward.

The idea for the test came five years ago, and trials started in 2020 with further adaptations and fine-tuning so that the current machine, which is called the Genedrive System, is now fully CE certified to be used in a clinical setting.

91ֱ�� – the top-ranked paediatrics journal in the world – last week.

Backed by £900,000 funding from the National Institute for Health Research (NIHR) and support from the charity Royal National Institute for Deaf People, the Genedrive System, which costs £80 per baby, was developed by Genedrive, a start-up based at the University of Manchester. It was developed in close collaboration with Professor Newman’s team at 91ֱ�� Biomedical Research Centre.

Mike Hobday, Director of Policy and Campaigns at the National Deaf Children’s Society, said: “The National Deaf Children’s Society welcomes the publication of this important study. The introduction of a rapid test to identify susceptibility to deafness caused by the antibiotic gentamicin will be greatly valued by many families of newborn babies.

“Up to now the genetic test has taken too long to return from the lab to be useful for babies requiring urgent treatment but a rapid test will be a game-changer.”

David Budd, CEO of Genedrive, said: “There is a significant drive within the NHS to alert healthcare professionals to the impact of antibiotic-induced hearing loss and encourage them to consider genetic testing prior to initiation of treatment. 

“It’s a great example of using human genetics to guide specific therapy, which is now taking front and centre in clinical management globally. The application of Genedrive’s technology shows how a rapid, affordable, point-of-care test could impact patients’ treatment and quality of life across this as well as a wide range of fields.”

The University of Manchester, and the study, published in Frontiers of Public Health today (22/2/22), shows that symptoms – which by definition are not measurable – are a fertile ground for misinterpretation.

The study was supported by . Funding was received from 91ֱ�� BRC, the , the and Neuromod Devices Limited.

Reports of associations between COVID-19 and auditory symptoms such as hearing difficulty and tinnitus have been widely discussed in the media and academia.

However, most studies have relied on self-reporting and lacked baseline information from before the pandemic.

That makes it difficult to know whether symptoms occurred because the COVID-19 virus affected the ear itself, or whether they occurred because of psychosocial factors like living through a pandemic, fears about what the virus might do, or recall bias.

In a YouGov poll in 2019 of over 10,000 people, Professor Chris Armitage, Chair in Health Psychology at the University of Manchester, and 91ֱ�� BRC Hearing Health, Optimising Outcomes Programme Lead, asked, among other things, whether people had hearing difficulty and/or tinnitus.

In August 2021 the current study team commissioned YouGov to contact the same people about symptoms they had experienced during the pandemic and 6,881 responded.

The second survey asked about the onset and change in three types of symptoms:

• ·Type one: loss of smell, memory/concentration issues, persistent fatigue which have known association with COVID-19.
• ·Type two: auditory symptoms (hearing difficulty and tinnitus) which have an indeterminate association with COVID-19.
• ·Type three: toothache, a red herring with no established association with COVID-19.

Although there were twice as many reports of new hearing difficulties and tinnitus in people with confirmed and suspected COVID-19,compared to people who hadn’t had COVID-19, they found:

• The onset of new auditory symptoms coincided with COVID-19 in only a third of the people reporting the symptoms; a third didn’t know when their symptoms began; and a third said their symptoms began before the pandemic, even though all had said they didn’t have auditory symptoms in March 2019.
• More than 60 per cent of people with confirmed or suspected COVID-19 said that their toothache had also been affected by COVID-19 despite there being no evidence of an association.
• As expected, Type one symptoms were reported most commonly by the people with confirmed COVID-19. But Type two and Type three symptoms were reported most commonly by the people who suspected they had COVID-19.

The study also asked about challenges experienced during the pandemic, such as feeling lonely and anxious, lack of exercise, lack of space at home, caring for others.

They looked at the number of challenges reported relative to the number of symptoms experienced during the pandemic and found the higher the number of challenges, the more symptoms were reported.

Dr Gabrielle Saunders from The University of Manchester, who manages ,  was lead author on the study. She said: “Although there were more reports of auditory symptoms in people with confirmed or suspected COVID-19, our study provides evidence that psychosocial factors influenced what our respondents felt.

“We also found that respondents were inconsistent with their reporting of hearing symptoms over time. We think this is in part because their answers were affected by the context in which the question was asked.

“Even if the symptoms arose due to psychosocial factors, they are still real to the person experiencing them and so need to be managed – but using different therapeutic strategies than if they were directly caused by the virus.

“That is why we need to take great care in attributing any symptom to the effect of the virus, especially if we lack baseline data.

“We feel that studies which include control groups and use audiometric measures (hearing tests) in addition to self-reporting, to investigate change in auditory symptoms relative to pre-COVID-19, are urgently needed.”

They examined socio-spatial patterns of hearing health among older adults in England, using objective hearing data of 8,263 participants aged 50-89 years old from the English Longitudinal 91ֱ�� of Ageing (ELSA).

Published in the International , the findings show that people in the North of England are more likely to have worse hearing closer to fifty than those with similar age profiles living in the South.

The percentage of 71-80-year-olds living with disabling hearing loss were: 49.2% in the North East, 43% in the North West, and 46% in Yorkshire and the Humber. That compared to 35.7% in the South East and 37.4% London.

Similarly, for 61 to 70 year-olds the figures were: 24.6% in the North East, 21.8 in the North West, and 22.6 in Yorkshire and the Humber. That compared to 14.6% in the South East and 18% in London.

Though the figures for 51 to 60 year-olds and the over 80s showed little difference between the regions, the overall picture was stark.

Until now, the local estimates of hearing loss prevalence in England have been based on projected population age demographics and audiological data solely collected from Nottingham and Southampton in the 1980s.

The 91ֱ�� study updates the prevalence estimates of hearing loss in older adults in England after nearly four decades.

It is also the first study to calculate the prevalence of objectively identified hearing loss in older adults based on data from a nationally representative sample, and not population demographics, providing the best audiological data in England today.

They also discovered a weak correlation between hearing loss and the increasing age, which was unexpected, showing an accumulation of risk factors other than age which might be responsible for the increase in hearing loss in successive age groups.

, a postdoctoral researcher based in the University’s Division of Medical Education, and primary investigator of the study, said: “Hearing loss is an important public health issue that costs the English economy over £25 billion a year in productivity and unemployment.

“The measurement of hearing loss prevalence is an essential prerequisite for understanding population health. Despite the effects of hearing loss on mental health and social wellbeing, studies on the prevalence of hearing loss are sparse, making the understanding of who is most affected and where resources should be allocated difficult.

“Regular assessment of the extent and causality of the population’s different audiological needs is strongly supported by the updated evidence that our study has produced.

“We find, there is room for improvement in the estimates that currently inform the NHS hearing loss data tool for planning services on local authority and CCGs levels in England.”

, from The University of Manchester ‘Health and Care in the Wider Context’ Theme Co-lead in The Institute of Health Policy and Organisation (IHPO), and Senior author of the study, said: “Where people live plays an important role in their health, as the location shapes several environmental risks, as well as many other health effects.

“Applying a single percentage of prevalence estimates for all regions means that the northern part of the country with a history of socioeconomic and health disparities may be left behind in its needs.”

, from The University of Manchester, ‘Safer Care Systems and Transitions’ Theme Lead in the NIHR Greater 91ֱ�� Patient Safety Translational Research Centre, and co-author, added: “These findings have significant implications for health policy and planning for health services; the prevalence estimates of hearing loss should be calculated based on the actual populations’ needs and not purely on age demographics.

“The study also might have implications on global hearing health policy and practice: all countries currently use population’s age projections and not actual epidemiological data to inform hearing loss prevalence estimates and their hearing health policy. However, our study showed that this method is not accurate.

“The updated data on the prevalence of hearing loss in England underscore the need for establishing evidence-based programmes for hearing screening, a needed reform the World Health Organization also recommended to the Member States in the recently launched .”

And those in the lowest wealth groups, they found, had up to twice the relative risk of developing depression than those in the highest wealth quintiles, as hearing loss disproportionally affected their quality of life.

Published in , the landmark study goes some way in laying to rest more than 40 years of research on whether hearing loss causes depression.

The data also showed that hearing aids have a stronger effect in alleviating symptoms of depression in poorer socio-economic groups than in wealthy ones.

And improved symptoms of depression were more pronounced among those using their hearing aids ‘most of the time’ than those using them ‘some of the time’.

The researchers analysed longitudinally the entire dataset of participants aged 50–89 years in 8 Waves of the English Longitudinal 91ֱ�� of Ageing (ELSA), from 2002 to 2017, examining 74,908 people.

The findings for the first time revealed that hearing loss affected people according to their socioeconomic position.

, from The University of Manchester who led the study, said: “Our study shows that hearing loss poses a substantial risk for depressive symptoms in older adults, especially those who experience socioeconomic inequalities.

“We also think that hearing aids could support the most vulnerable people who already lacked life opportunities compared to the most affluent.

“That way they were able to take more control of their lives and keep participating actively in society.”

Dr Tsimpida, a Chartered Psychologist and postdoctoral researcher based in the University’s Division of Medical Education, added: “We think it’s reasonable to identify hearing loss as a causal factor because we used advanced statistical techniques called dynamic cross-lagged path models (CLPMs) to estimate hearing loss and depression's relationship over time.

“We argue the early detection of hearing loss by primary care professionals in routine assessments may not only promote better hearing health but also prevent or delay the onset of depression.

“Increasing the hearing loss treatment rate could be one effective strategy for risk reduction of depression, given the high prevalence of hearing loss in older age and its low treatment levels.”

Co-author Dr Maria Panagioti said: “The existing evidence on the association between hearing loss and depression was conflicting; our study now adds to this body of knowledge by identifying for the first time the socioeconomic pattern in their relationship.”

“Focusing primarily on the role of the socioeconomic position may satisfactorily explain the causal, temporal and graded relationship between hearing loss and depression over time, which differs according to people’s status in the social hierarchy.

“Our study has important and novel clinical implications, as it adds to the understanding of the interrelationship between hearing loss and depression, and the potential impact of interventions with hearing aids for people’s mental health.”

Dr Tsimpida’s study is co-authored by , , and .

 The Dynamic Relationship between Hearing Loss, Quality of Life, Socioeconomic Position and Depression and the Impact of Hearing Aids: Answers from the English Longitudinal 91ֱ�� of Ageing (ELSA) is .

Published in the team hope the model could impact on the estimated 466 million people worldwide who have disabling hearing loss, mostly affecting the elderly.

The study is the first to examine the mechanisms and explain the relationship between socioeconomic inequalities and hearing health over a lifetime.

Research has previously shown that people with hearing loss are more likely to have poorer educational achievement, higher rates of unemployment and lower annual family income than those with other health conditions.

They are also more likely to have long-term health conditions and a higher overall disease burden than older people without hearing loss.

, who led the study, said: “Hearing deterioration is a lifelong process but not an inevitable result of ageing. Understanding this process is an essential step in addressing the global burden of hearing loss.”

Dr Tsimpida, a postdoctoral researcher at the University’s , added: “The key determinants of poor hearing health in the course of a life and their interdependency as described by this model is a powerful way to intervene in this major problem.

“Our focus is not simply on the age of older adults but on factors which impact on people earlier in life, which if modified could reduce hearing loss in older age.”

“This approach in hearing health can lead to the development of appropriate interventions and public health strategies that can have significant health policy and practice implications.“

Dr Tsimpida’s study is co-authored by , , and .

Dr Maria Panagioti said: “This model provides now a visual representation of the several modifiable factors of hearing loss in distinct life stages and their evolution over time, which is new thinking in hearing loss research.

“Given the burden of adult-onset hearing loss, such a conceptual tool for hearing health inequalities has the potential of improving the physical, mental and social wellbeing of individuals.”

A video of Dr Tsimpida talking about the key messages of the model is available

A copy of the paper Conceptual Model of Hearing Health Inequalities (HHI Model): A Critical Interpretive Synthesis is also .

Professor Kevin Munro and PhD researcher Ibrahim Almufarrij found 56 studies that identified an association between COVID-19 and auditory and vestibular problems.

They pooled data from 24 of the studies to estimate that the prevalence of hearing loss was 7.6%, tinnitus was 14.8% and vertigo was 7.2%.

They publish their findings in the .

However, the team – who followed up their review carried out a year ago – described the quality of the studies as fair.

Their data primarily used self-reported questionnaires or medical records to obtain COVID- 7 19-related symptoms, rather than the more scientifically reliable hearing tests.

The study was funded by  gifts to the University's COVID-19 Research Appeal, along with support from RNIB, Dowager Countess Eleanor Peel Trust, and NIHR 91ֱ�� Biomedical Research Centre (BRC).

Kevin Munro, Professor of Audiology at The University of Manchester and 91ֱ�� BRC Hearing Health Lead said: “There is an urgent need for a carefully conducted clinical and diagnostic study to understand the long-term effects of COVID-19 on the auditory system.

“It is also well-known that viruses such as measles, mumps and meningitis can cause hearing loss; little is understood about the auditory effects of the SARS-CoV-2 virus.”

“Though this review provides further evidence for an association, the studies we looked at were of varying quality so more work needs to be done.”

Professor Munro, is currently leading a year-long UK study to investigate the possible long-term impact of COVID-19 on hearing among people who have been previously treated in hospital for the virus.

His team hope to accurately estimate the number and severity of COVID-19 related hearing disorders in the UK, and discover what parts of the auditory system might be affected

They will also explore the association between these and other factors such as lifestyle, the presence of one or more additional conditions and critical care interventions.

A recent study led by Professor Munro, suggested that more than 13 per cent of patients who were discharged from a hospital reported a change in their hearing.

Ibrahim Almufarrij said: “Though the evidence is of varying quality, more and more studies are being carried out so the evidence base is growing. What we really need are studies that compare COVID-19 cases with controls, such as patients admitted to hospital with other health conditions.

“Though caution needs to be taken, we hope this study will add to the weight of scientific evidence that there is a strong association between Covid-19 and hearing problems.”

Professor Munro added: “Over the last few months I have received numerous emails from people who reported a change in their hearing, or tinnitus after having COVID-19.

“While this is alarming, caution is required as it is unclear if changes to hearing are directly attributed to COVID-19 or to other factors, such as treatments to deliver urgent care.”

The paper One year on: an updated systematic review of sarscov-2, covid-19 and audio-vestibular symptoms is published in the

The study, published in the International Journal of Audiology, was carried out by experts at The University of Manchester, The University of Sheffield and Lancaster University.

Eighty people over seventy with mixed hearing abilities completed two detailed questionnaires, 12 weeks apart, during May and June 2020 when lockdown restrictions were in place.

The study was funded by Deafness Support Network (DSN), a Cheshire based charity, and supported by the (BRC) and NIHR Sheffield Biomedical Research Centre.

NIHR 91ֱ�� BRC bridges the gap between new discoveries and individualised care through pioneering research. The BRC’s Hearing Health theme is improving the lives of adults and children by preventing potentially devastating congenital deafness, diagnosing acquired age-related hearing deficits, and developing new treatments.

Lead author Dr Jenna Littlejohn from The University of Manchester, DSN and NIHR 91ֱ�� BRC said: “Hearing loss, one of the leading causes of disability in older adults, is already commonly associated with increased rates of depression, social isolation, and risk of dementia and cognitive decline.

“However this study shows that these problems are even more acute during the lockdown for people over 70, who were among the ‘clinically vulnerable’ people asked to shield.”

She added: “Because we were not able to conduct face to face interviews during the lockdown, this study was clearly not able to estimate the effects of the pandemic on the over seventies without internet access.

“However, it would be logical to suspect that these negative associations could be even stronger in people who do not have access to the internet as they may be even more socially isolated: video calls have been lifelines for many.”

Cancellation of medical appointments, the use of face masks and the limitation in the use of technology due to hearing loss are thought to all be important factors.

Many routine face-to-face audiology appointments have been postponed, suspended, or offered remotely.

Face masks act as a direct barrier to communication and are particularly problematic for people with hearing loss who also rely on lip reading and facial expression.

And the enforced social distancing means people with hearing loss might struggle to use telephone and video calls to stay in touch with family and friends.

Around 70 per cent of people over the age of 70 have hearing loss according to the World Health Organisation. The 8.3 million people in the UK with the condition are likely, argue the team, to be selectively disadvantaged by the coronavirus pandemic.

Dr Littlejohn said: “We suspect the use of face coverings and limited group meetings may remain for a while yet, and so our work into the longer-term collateral effects of the pandemic is ongoing.

“We need to ensure people with hearing loss get the correct support from health and social care professionals in terms of supporting mental health and investigating the risk of cognitive impairment due to the enforced social isolation on these people.

“The more data we have, the better we can inform the health and social care professionals who are responsible for them.”

The paper ‘Self-reported hearing difficulties are associated with loneliness, depression and cognitive dysfunction during the COVID-19 pandemic’ is published in the

The one-year study will be co-led by Professor Kevin Munro, 91ֱ�� BRC Hearing Health Lead and Professor of Audiology at the University of Manchester, and will investigate the long-term impact of COVID-19 on hearing among people who have been previously treated in hospital for the virus.

91ֱ�� BRC bridges the gap between new discoveries and individualised care through pioneering research. The BRC’s Hearing Health Theme is improving the lives of adults and children by preventing potentially devastating congenital deafness, diagnosing acquired age-related hearing deficits, and developing new treatments.

This research aims to accurately estimate the number and severity of COVID-19 related hearing disorders in the UK, discover what parts of the auditory system might be affected, and explore the association between these and other factors such as lifestyle, the presence of one or more additional conditions (comorbidities) and critical care interventions.

Detailed hearing tests will be carried out by researchers in over 100 patients previously hospitalised with COVID-19 and compared to a control group of people previously hospitalised for other conditions not thought to affect hearing. Professor Chris Plack, 91ֱ�� BRC Paediatric Diagnosis Associate Lead who will co-lead the study, said: “The research will be conducted in our bespoke hearing research van, with state-of-the art facilities that conform to clinical standards for COVID-19. With this ability we are uniquely placed to take this important research out on the road to make taking part as easy as possible.”

It is known that viruses such as measles, mumps and meningitis can cause hearing loss, but little is understood about the auditory effects of the SARS-CoV-2 virus.

Hearing loss has been reported anecdotally as a side effect of COVID-19, with a recent study led by Professor Munro, suggesting that more than 13 per cent of patients who were discharged from hospital reported a change in their hearing.

Professor Munro said: “Over the last few months I have received numerous emails from people who reported a change in their hearing, or tinnitus after having COVID-19. We know that viruses can damage hearing so the virus responsible for COVID-19 may also damage hearing. While this is alarming, caution is required when interpreting this finding as it is unclear if changes to hearing are directly attributed to COVID-19 or to other factors, such as treatments to deliver urgent care. Clearly there is an urgent need for a carefully conducted clinical and diagnostic study to understand the long-term effects of COVID-19 on the auditory system.”

Dr Ralph Holme, Executive Director of Research, RNID said: “We are delighted to co-fund this vital research so we can urgently understand if and how coronavirus might damage hearing and so people can be given the support they need to manage their hearing loss. Understanding which part of the auditory system is affected is the first step. We then need to find treatments to prevent the virus causing hearing loss.”

Professor Richard Ramsden, previously a 91ֱ�� based neuro-otologist, and now a Trustee of DCEPT said: “I welcome this important project which has major implications for those many survivors of coronavirus infection, and for clinicians who manage deaf and hard of hearing individuals.”

The study of 81 babies, assessed at three to seven months and again at seven to 21 months, shows hearing aid use was low compared to the number of hours an infant is expected to be awake.

Mean hearing aid use as a percentage of waking hours was 73% in the first few months of life falling to 44% when the babies were a little older, reported the study published in “Ear and Hearing”.

And that could have implications on their future ability to communicate, they argue.

The work was supported by the NIHR, as well as the Marston Family Foundation, William Demant Foundation.

Around one baby every in every thousand has permanent hearing loss, revealed by screening in the first two days of life.

The simple baby hearing check was rolled out across the NHS in 2006 following a research collaboration between Nottingham and 91ֱ�� universities.

As a result, the typical age at which infants with hearing loss now get hearing aids has reduced from around 12 months to 2.5 months.

The NIHR 91ֱ�� BRC bridges the gap between new discoveries and individualised care through pioneering research. The BRC’s Hearing Health Theme is improving the lives of adults and children by preventing potentially devastating congenital deafness, diagnosing acquired age-related hearing deficits, and developing new treatments.

Senior investigator on the team Kevin Munro, Professor of Audiology at the University of Manchester and 91ֱ�� BRC Hearing Health Lead said: “The challenges associated with hearing aid use have the potential to undermine the early detection of hearing loss from the highly successful national new-born hearing check.”

And infants are still not using hearing aids as much as they need, argues Dr Anisa Visram Research Fellow in Audiology from The University of Manchester; the study showed hearing aids use actually declined over the first few months of use.

The low use could be related to some parents seeing limited benefit from hearing aid use over time or possibly older babies pulling their hearing aids out, they found.

Though parents were usually well cared for by audiologists, speech and language therapists, teachers of the deaf and other clinical staff, many reported being overwhelmed by the amount of information given to them.

Frequent acoustic feedback and the hearing aids not working correctly also affected their frequency of use as did distractions from family life, the needs of other children, and difficulty getting into a set routine.

Many caregivers told the researchers it was easier to leave hearing aids out as their child would often remove them, constituting a choking hazard.

Dr Visram said: “Our study found a wide range of daily hearing aid use, though it was generally low compared with the number of hours the infants were is expected to be awake.

“When an infant is diagnosed with a hearing loss, caregivers must receive and understand a lot of information on hearing loss, hearing aids, how to manage them and the support services available.

“It is understandable that caregivers may be overwhelmed by this information and the need to manage hearing aids effectively, and this has the potential to have a negative impact on effective and consistent hearing aid use.”

Developmental psychologist Dr Ciara Kelly, who recently joined the university’s team said: “Early intervention, with hearing aids or cochlear implants, is associated with better outcomes for speech and language and better longer-term educational outcomes such as reading comprehension.”

“Newborns are fast developing auditory pathways and an understanding of language so any reduction in hearing aid use – even if it’s only partial – can impact the development of the auditory part of the brain, placing speech and language development at risk.

“We are now planning to work on an intervention by first developing a better understanding of the difficulties families face using hearing aids, to then explore how best to support families to increase hearing aid use.”

Instead the , published in BMC Geriatrics, found hearing loss could be linked to social and lifestyle differences in the north and south of the country.

The 74,699 people with hearing loss interviewed in 8 waves of the English Longitudinal 91ֱ�� of Ageing from 2002–2017, analysed by the team had similar age profiles over time.

The number of people with hearing loss increased by 10% over 15 years, however, the mean age of the people analysed stayed the same.

However, over the same period, the samples had markedly different hearing outcomes in terms of where respondents lived. Deprivation and alcohol misuse related to hearing loss were much more prevalent in the north, suggesting a possible hearing north south divide.

, who led the study, said a socio spatial approach is crucial for planning sustainable models of hearing care based on actual need, and for reducing hearing health inequalities.

Local estimates of hearing loss prevalence in England are currently based on projected population age demographics and audiological data solely collected from Nottingham and Southampton in the 1980s.

However the study is the first to investigate geographical patterns and trends of hearing loss based on a representative cohort of older adults and not through population age projections.

Ms Tsimpida, Research Associate in the Centre for Primary Care and Health Services Research said:  “Hearing loss has been labelled as something which is more likely to affect the elderly. However, this study shows for the first time that the increasing trend in hearing loss prevalence is not related to the ageing of the population, as widely believed, but potentially to social and lifestyle changes.

“We don’t know why that might be – and this study does not and cannot imply a biological causality.

“But nevertheless, this is a significant milestone in hearing research and a breakthrough that gives us considerable insight into what is actually happening.

“The survey is representative of the English older population; the findings provide a good representation for England as a whole.”

Ms Tsimpida’s study is co-authored by her supervisors Dr Maria Panagioti, Professor Evangelos Kontopantelis and Professor Darren Ashcroft.

The Research Associate in the Centre for Primary Care and Health Services Research added: “These findings have important implications for health policy and planning for health services in England based on actual needs and not on the age of the populations through projections.

“People need to receive the full range of quality healthcare services that meet their needs; the current focus on age profiles alone is not suitable for planning sustainable models of hearing care.

“The Clinical Commissioning Groups (CCGs) who are currently responsible for the NHS audiology services in England should take into consideration socioeconomic factors and modifiable lifestyle behaviours for hearing loss, along with their spatial patterning in England.

“More informed modelling may have influenced North Staffordshire CCG’s 2015 decision to cease the free provision of hearing aids for people with mild or moderate hearing loss: an area where hearing loss burden is now one of the greatest in England”.

A copy of the paper Regional Patterns and Trends of Hearing Loss in England: Evidence from the English Longitudinal 91ֱ�� of Ageing (ELSA) and Implications for Health Policy is

Due to the COVID-19 pandemic the wearing of face masks/coverings (unless exempt) are now mandatory on public transport, in shops, hospitals and other situations in the UK. However, 91ֱ�� researchers Professor Kevin Munro and Dr Michael Stone from 91ֱ�� BRC have led the way in highlighting the challenges of face mask use for people with hearing impairment, writing the article “” in May this year.

The researchers want to improve the design of face masks/coverings used by health professionals and the public. The study ‘Improved face-worn PPE designs for use by the public and professionals to reduce audio-visual communication difficulties’ has been funded with a grant of approximately £127,000 by .

One of the outcomes the team is aiming for is to produce a new design for a re-usable mask that could be made freely available – allowing it to be manufactured widely. The project brings together experts from across the North West in hearing health, sound engineering, materials and manufacturing experts, as well as people from the d/Deaf* community, who will help to shape the research.

91ֱ�� BRC bridges the gap between new discoveries and individualised care through pioneering research. The BRC’s Hearing Health theme is improving the lives of adults and children by preventing potentially devastating congenital deafness, diagnosing acquired hearing deficits, and developing new treatments.

Professor Munro is the Hearing Health Lead for 91ֱ�� BRC and Director of the at The University of Manchester. He said: “Wearing a face mask may impair the ability for some people to communicate with ease because it can reduce the level of speech transmitted from the mouth and also prevents lip reading. At the very least, removing visual cues can make communication more taxing because of the mental exertion required to listen, especially when there is background noise.

“There are many people with hearing loss who were able to manage but will struggle with the widespread use of masks. According to the World Health Organization (WHO), there are 1.33 billion people globally with hearing loss. So, a huge section of society could be subjected to mask misery.”

Dr Gabrielle Saunders, Senior Research Fellow at the University of Manchester who manages 91ֱ�� BRC’s Hearing Device Centre has identified "style of communication" is also an overlooked factor which has affected communication when using masks. Her findings have been published in the International Journal of Audiology. Dr Saunders said: “Facial expressions are used extensively in communication, even among hearing people. People have reported to us a loss of connectedness, and less willingness to engage in conversation. Other effects reported were increased anxiety and stress, as well as fatigue, frustration and embarrassment. Interestingly, these altered emotions were recorded for both the speaker and the listener.”

Dr Michael Stone, Co-lead of the 91ֱ�� BRC Hearing Device Research Centre, said: “While the respirator masks for frontline health and care workers can filter 95 per cent of tiny particles, they are much more likely to distort and reduce the level of speech. This makes communication particularly difficult at a time of heightened anxiety and when the content of conversations is novel and unpredictable.

“Coronavirus tends to take a more severe form in older people, many of whom are likely to suffer from hearing loss. This means that those admitted to a hospital are especially vulnerable when it comes to communicating when using masks.

“We have identified a number of ways in which face mask/covering use is adversely affecting communication and note how this could lead to social isolation. With this research we want to tackle an urgent problem that affects everyone now; and will also outlast the current pandemic.”

Collaborators on the project include Professor Trevor Cox, Professor of Acoustic Engineering at the University of Salford and industry partners in the local cotton industry.

The study ‘Follow-up and structured monitoring for adults offered an NHS hearing aid for the first time (FAMOUS): a cluster randomised controlled trial’ is a major collaboration of the NIHR’s three BRCs with specialist hearing themes: 91ֱ��, Nottingham and University College London Hospital (UCLH). The key aim of the research is to understand and resolve the thousands of instances of low-use of hearing aids in adults with hearing loss.

91ֱ�� BRC bridges the gap between new discoveries and individualised care through pioneering research. The BRC’s Hearing Health theme is improving the lives of adults and children by preventing potentially devastating congenital deafness, diagnosing acquired age-related hearing deficits, and developing new treatments.

Professor Kevin Munro, NIHR 91ֱ�� BRC Hearing Health Lead and Professor of Audiology at The University of Manchester said: “Hearing loss is the most common sensory problem in the world, experienced by one in six people in the UK. Every year in the UK around 355,000 adults are fitted with hearing aids for the first time, at a cost of £450 million to the NHS.

“We know that hearing aids improve communication and quality of life in adults with hearing loss, however, our previous research has shown that 30 per cent of people given hearing aids don’t use them as often as recommended and a further 20 per cent don’t use them at all.”

Hearing loss has significant impact on communication, wellbeing, quality of life and economic independence (including employment) and left untreated may increase the risk of developing mental health and cognitive problems. This research aims to increase hearing aid use – testing efficient and cost-effective measures to encourage and support this.

To increase the amount of time that new users wear their hearing aids, the researchers, in collaboration with patient and public panels have devised a four step strategy (intervention) for audiologists and people with hearing loss. The strategy includes encouraging patients to reflect on situations in which hearing is difficult and where hearing aids may help, and an individualised action plan to reinforce where and when to use the hearing aids.

The three year, multi-centre study will recruit around 6,000 adults who will either follow the new strategy to improve hearing aid use or the current care plan, when fitted with a hearing aid. The primary aim is to learn if the intervention results in a higher level of hearing aid use one year after initial fitting compared to adults who receive the current standard care.

The research is sponsored by 91ֱ�� University NHS Foundation Trust and grant funded by the NIHR Health Technology Assessment (HTA) Programme. The HTA funds research around the clinical and cost-effectiveness and broader impact of healthcare treatments and tests for those who plan, provide or receive care from NHS and social care services.

Professor David Baguley, NIHR Nottingham BRC Deputy Hearing Theme Lead said: “This grant success represents a step-change in research into hearing aid provision in the UK, and the breadth and depth of the project is unprecedented in Audiology. The benefit of hearing aids come when worn in the ear, not when kept in a drawer, and this work to optimise pathways of NHS hearing aid follow-up holds great promise. The Nottingham Clinical Trials Unit, the BRC Hearing theme, and University of Nottingham Hearing Sciences will be working in close partnership with the NIHR 91ֱ�� and UCL BRC Hearing Themes to deliver this transformational and innovative trial.”

Anne Schilder Professor and Director NIHR UCLH BRC Hearing Theme and National Specialty Lead of the NIHR Clinical Research Network ENT said: “We are looking forward to working with audiologists from NHS hearing aid services across the UK. Their involvement will not only drive the success of this research but also the uptake of the evidence it produces into future hearing practice.”

The online survey of 460 people - the first of its kind- also showed that people with hearing loss were significantly more affected by face coverings than those without, especially when communicating with doctors, pharmacists and nurses.

The online survey which took place between June and July 2020, before face covering were made compulsory in shops, gains important insight into of the impact of face coverings on communication and our emotions.

At the time the survey was completed, 62% of participants had encountered a situation in which they had worn a face covering while communicating.

Sixty percent of them said they communicated differently as a result of wearing a face covering, and 46% said the nature of the conversation had differed, with a further 17% and 25% respectively saying ‘maybe’.

Many of the impacts applied both as a speaker wearing a face covering, and when listening to someone else who is wearing one.

The study is published in the International Journal of Audiology.

Principle Investigator Dr Gabrielle H. Saunders, a Senior Research Fellow at The University of Manchester, said: “The results of this survey illustrate that the impact of face coverings on the way we all communicate is far-reaching, going well beyond the acoustics of speech transmission.

“Though it is deeply important for the public to continue to wear face coverings, for our respondents, they had a profound impact on not only how we communicate, but on how connected we feel with someone, and how willing we are to engage in conversation.

“The face coverings increased anxiety and stress, and made communication fatiguing, frustrating and embarrassing - both as a speaker wearing a face covering, and when listening to someone else who is wearing one.”

By covering up the lower part of the face, experts say face coverings can restrict communication by limiting sound transmission – making speech sound muffled, removing visible cues from the mouth and lips.

That limits lipreading and the visibility of facial expressions, which provide a lot of information during speech.

Dr Saunders from the research team based at the   who also manages the NIHR 's  Hearing Device Centre said: “Although face coverings are an essential weapons in the fight to contain Covid-19, we were surprised by the depth of feeling they generated.

“It was clear that though the problems associated with face coverings were particularly relevant to people with hearing loss, people without hearing loss were also affected.”

Transparent face coverings are, say the team, potentially a good solution to the problem, despite blocking sound more than cloth or surgical masks. They can also steam up.

But they do make the whole face more visible, which will could make communication much easier.

Over time, the researchers hope some of the problems people reported in this study, like feeling socially awkward, embarrassed and unsure how to cope, will decrease as we all adjust to wearing face coverings.

Dr Saunders added: “Already many individuals said they used gestures, facial expressions and their eyes to enhance communication when they were wearing a face covering.

“This perhaps suggests with guidance and instruction, non-verbal cues might help us to improve the way we communicate while wearing a mask.

“But there is no doubt these findings represent a call to action to acousticians and industrial designers to develop communication-friendly face coverings, to healthcare providers to ensure they address the communication needs of their patients, and to the public to use good communication tactics.”

Following the first peak of the Covid-19 pandemic, experts have turned their attention to the long-term health consequences of the novel coronavirus.

Viruses can damage hearing, and so it is possible that the virus responsible for Covid-19 may also have this effect. Kevin Munro, Professor of Audiology, and his team have already published two relevant studies displaying a possible link between Covid-19 and hearing deterioration; both of which have attracted widespread media attention.

In one study, following up with adults diagnosed with Covid-19 eight weeks after hospital discharge, more than 1 in 10 self-reported a deterioration in their hearing or the presence of tinnitus (noises in their ears).

“We already know that viruses such as measles, mumps and meningitis can cause hearing loss and coronaviruses can damage the nerves that carry information to and from the brain”, said Professor Munro. “It is possible, in theory, that Covid-19 could cause problems with parts of the auditory system including the middle ear or cochlea.”

Earlier this year, many supporters came together to donate towards The University of Manchester’s medical research response. As a result of donor generosity, the University has been able to establish a special research fund, which, along with generous contributions from charitable sources, will support Professor Kevin Munro’s crucial research investigating the impact of Covid-19 on hearing.

The is a powerhouse of hearing research spanning basic discovery science through to applied research and patient benefit. The University is currently leading the world on hearing-related Covid-19 research and is arguably the only UK centre with the facilities (including the UK’s only hearing research van), expertise and agility to take the next bold step to understanding the links between Covid-19 and hearing loss.

“Timely evidence for decision makers is urgently needed, so I am very grateful that philanthropic support has enabled us to begin this study and understand the longer term impact of Covid-19 on the auditory system”, said Professor Munro.

“There is still very little information about the long-term effects of Covid-19 and it is important that we understand the ongoing medical, psychological and rehabilitation needs of people impacted by the virus. Our results will help ensure that, in the future, Covid-19 patients receive appropriate hearing assessments and management for any hearing loss. Mitigating the impact of hearing loss will have consequent benefits to the quality of life for the individuals concerned.”

For more information on Professor Munro’s research and the findings so far, please visit this link.

Up to a third of older adults with hearing loss in England could be undetected and untreated, according to a new study by University of Manchester researchers.

The study, published in , might mean millions of people are not seeing ear specialists or given hearing aids when their hearing has considerably deteriorated.

Women, older people, with fewer qualifications and living in more deprived areas were the at higher risk of not recognising their hearing had deteriorated and thus were less likely to seek help, found the researchers.

The findings reveal many hearing loss cases remain undiagnosed in primary care, since people very often cannot recognise their hearing has been affected, and highlight gaps in the continuity of hearing care pathways.

, who led the study, said untreated hearing difficulty can have a negative impact on mental and physical health, and despite that, hearing loss among older people is underdiagnosed and undertreated.

The team examined patterns of health pathways among older adults in England, using hearing data of 8,529 participants aged 50-89 years old from the English Longitudinal 91ֱ�� of Ageing (ELSA).

The researchers said that as the survey is representative of the English older population, the findings provide a good representation for England as a whole.

Although participants had objectively been identified as having hearing loss, they did not self-identify their own difficulties correctly and reported themselves as having normal hearing.

Action on Hearing Loss estimates thar hearing loss affects over 12 million people in the UK and costs the UK economy around £25 billion a year in productivity and unemployment.

There is no accurate figure for England because of the absence of a screening programme.

By 2035, it is estimated that there will be more than 15 million people with hearing loss in the UK – a fifth of the population.

Diagnosis of hearing loss starts in primary care, where traditionally, people with hearing difficulties present to their GP to seek advice and investigation.

Ms Tsimpida, who is based at the University’s Institute for Health Policy and Organisation (IHPO) said: “ It is crucial that those with hearing loss are detected in a timely way, referred to ear specialists and given access to hearing aids. The early identification of hearing difficulties in primary care may be the key to tackling this major public health issue.

“However, more research is needed to understand why so many people are undiagnosed, though we feel making hearing loss part of a routine primary care examination among older adults would be beneficial.”

The study was carried out during Ms Tsimpida’s NIHR 91ֱ�� Biomedical Research Centre PhD Studentship, co-authored by her supervisors Dr Maria Panagioti, Professor Evangelos Kontopantelis and Professor Darren Ashcroft.

She added: “This lack of self awareness of hearing loss is a problem for many people”.

Clinical research often relies on a self-report measure of hearing loss. Our study showed that self-report measurement of hearing loss had limited accuracy and was not sufficiently sensitive to detect hearing loss.

“These findings may inform public health policies relevant to selection of appropriate and validated tools for detecting hearing problems among middle-aged and older adults.”

“The study also provides novel insights into the clinical practice and reinforces the importance of an effective and sustainable hearing loss screening strategy in primary care.”

A significant number of patients reported a deterioration in their hearing when questioned eight weeks after discharge from a hospital admission for COVID-19, according to University of Manchester audiologists, in a study supported by the NIHR 91ֱ�� Biomedical Research Centre (BRC).

One hundred and twenty one of the adults admitted to Wythenshawe Hospital, part of Manchester University NHS Foundation Trust, took part in the survey by telephone. When asked about changes to their hearing sixteen people (13.2%) reported their hearing was worse. Eight people reported deterioration in hearing and another eight reported tinnitus (hearing noises that are not caused by an outside source).

The results, published in a letter to the International Journal of Audiology, adds to a growing body of anecdotal evidence that the strain of coronavirus which causes COVID-19, SARS CoV-2, has long-term impacts on health, and possibly hearing.

Professor Kevin Munro, Professor of Audiology at The University of Manchester and NIHR 91ֱ�� BRC Hearing Health Theme Lead said: “We already know that viruses such as measles, mumps and meningitis can cause hearing loss and coronaviruses can damage the nerves that .”

“It is possible, in theory, that COVID-19 could cause problems with parts of the auditory system including the middle ear or cochlea.

“For example, auditory neuropathy, a hearing disorder where the cochlea is functioning but transmission along the auditory nerve to the brain is impaired could be a feature.”

People with auditory neuropathy have difficulty hearing when there is background noise, such as in a pub.

A condition called Guillain-Barre syndrome is also linked to auditory neuropathy which is also known to have an association with SARS CoV-2.

However, the researchers say more research is needed to be able to identify why there is an association between the virus and hearing problems.

Their observation follows a rapid systematic review of coronavirus and the audio-vestibular system by Professor Munro’s team in June.

The review identified reports of hearing loss and tinnitus, but there were only a small number of studies and the quality of evidence was low.

Professor Munro added: “While we are reasonably confident in the differentiation of pre-existing and recent changes in hearing and tinnitus, we urge caution.

“It is possible that factors other than COVID-19 may impact on pre-existing hearing loss and tinnitus.

“These might include stress and anxiety, including the use of face masks that make communication more difficult, medications used to treat COVID-19 that could damage the ear or other factors related to being critically ill.

“That is why we believe there is an urgent need for high-quality studies to investigate the acute and temporary effects of COVID-19 on hearing and the audiovestibular system.

“Timely evidence for decision-makers is urgently needed, so we need to be able to act quickly.”

The letter, ‘Self-reported changes in hearing and tinnitus in post-hospitalisation COVID-19 cases’ is published in .

Hearing damage which isn’t yet severe enough to be diagnosed as hearing loss is common in young adults who regularly attend loud music events, according to University of Manchester led research.

Early signs of damage to hearing are associated with exposure to loud recreational noise such as clubs and concerts, says Dr Sam Couth, who carried out the study published in the journal Hearing Research.

The study was funded by the Colt Foundation, which funds occupational and environmental health research, and was run in collaboration with the Royal Northern College of Music.

After carrying out a series of specialised hearing tests and interviews with 123 18-27 year-olds, it was found those who had the highest levels of recreational noise exposure had poorer functioning hair cells in the cochlear – a spiral shaped tube in the inner-ear involved in detecting sounds.

Humans are born with 12,000 hair cells – though this number decreases as part of the aging process.

Dr Couth, who is based at the University’s , said listening to loud music can damage and accelerate the loss of hair cells, and may have a cumulative effect on hearing later in life.

It was also found that the conduction of sound signals from the hearing nerve to the brain may be slowed down as a result of damage from noise.

He said: “This study shows that the normal activities of young people are likely to lead to early damage to hearing - and that could lead to more serious problems in the longer term.

“This study shows quite clearly that young people who regularly go to loud clubs and concerts are more likely to have a degree of noise damage to their ears compared to those who lead quieter lives.

“Musicians may be especially at risk as loud noise exposure is a daily occurrence as part of their profession.”

Experts say the best way to minimise the risk of hearing damage is to avoid noisy situations altogether or to reduce the volume at its source, but this may not always be practical.

Although considered a last resort, Dr Couth urges anyone frequently exposed to loud music to protect their hearing by wearing effective and safe earplugs and get their hearing tested regularly.

He also suggests audiologists need to closely monitor the health of the delicate hair cells in the cochlea and our ability to detect high-pitch sounds, which may reveal signs of early damage even when hearing appears to be normal.

Audiologists say the length of safe noise exposure is reduced by half for every 3 decibels increase in noise intensity.

That equates to 4 hours of daily exposure for 88 decibels of noise, 2 hours for 91 decibels, and so on.

“Most amplified concerts exceed 100 decibels, meaning that people shouldn’t be exposed to that level of noise for more than 15 minutes without proper hearing protection.

He added: “We know from previous research that only 6% of musicians consistently wear hearing protection.

“That is why we urge all musicians, clubbers and concert-goers to wear earplugs designed specifically for listening to music so that the quality of the sound remains high, while the risk of hearing damage is reduced.”

A study led by University of Manchester researchers has revealed that around 20% of people who have been issued with hearing aids do not use them.

The analysis was carried out on annual National Survey for Wales data – the largest sample on hearing aid use in the UK – and is published in the International Journal of Audiology today.

The study showed that approximately 20% of adults currently do not use their hearing aids at all, 30% use them some of the time and the remaining 50% most of the time.

However, the proportion of people who never use their hearing aids has been gradually reducing during the 15 years that the survey has been taking place.

There has also been a commensurate increase in the proportion who report using their hearing aids most of the time.

It was carried out jointly with audiologists from the Betsi Cadwaladr University Health Board in North Wales.

Professor Kevin Munro from The University of Manchester, a co-author of the study, is NIHR 91ֱ�� Biomedical Research Centre (BRC), Hearing Health Theme Lead.

He argues the results highlight an urgent need to tackle non-use and under-use.

“Hearing loss is the most common sensory problem in the world, experienced by one in six people in the UK,” he said.

“It has a well-known association with cognitive decline and dementia, and as hearing aids are the primary treatment, can have huge benefit to wearers.

“The NHS is the largest purchaser of hearing aids in the world so knowing that they are valued by many is great, but there is substantial room for improvement.

“This study was carried out in Wales, but as it’s such a comprehensive and reliable data set there’s no reason to believe the situation is much different in the rest of the UK.”

Previous data on hearing aid use, obtained from different countries, has been of varying quality with estimates of hearing aid non-use varying between 1% and 57% of those fitted.

The annually recurring hearing aid data from 10,000 to 16,000 people – who completed the National Survey of Wales – is carried out face-to-face by independent researchers – providing an unrivalled data set.

Since 2004, it has contained questions on self-perceived hearing difficulty, adoption and use of hearing aids, and the occurrence of difficulty with hearing while wearing hearing aids.

Reasons for non-use, says professor Munro vary from lack of perceived benefit to handling difficulties.

But, getting used to a hearing aid when you are relatively young, he says, will make it easier to use when you are frailer and older as it becomes second nature.

Professor Harvey Dillon, from The University of Manchester is lead author on the paper and is also funded by NIHR 91ֱ�� BRC.

He added: “Although under-use or non-use of treatments by some patients is by no means unique to hearing aids, achieving uniformly high use of hearing aids by those who need them would provide a major benefit to society.

“We already know that the largest predictor of hearing aid benefit is the quality of interaction with the health professional, rather than the degree of hearing loss.

“But it’s imperative that more research is done to understand why non-use can set in so quickly for some, and devise efficient procedures to prevent this from happening.

“We think there is a need for more prompt and proactive follow-up and monitoring once a hearing aid been prescribed and fitted by the NHS.”

The paper: "Adoption, use and non-use of hearing aids: a robust estimate based on Welsh national survey statistics" is published in 

The use of facemasks to limit the spread of COVID-19 could replace social distancing with social isolation for people with hearing difficulties, a University of Manchester professor has warned.

Professor Kevin Munro says though masks may prevent the wearer from infecting others, they may prevent lip/speech reading and impair speech transmission.

The audiologist makes 5 suggestions to improve communication if wearing a face mask is unavoidable, which are:

1. Reduce background noise as much as possible.
2. Talk slowly, and don’t shout.
3. Wear your hearing aid.
4. Consider using portable hearing amplifiers if available.
5. Hearing aid apps can provide amplification or translate speech into text in real time.

Around 1 in 6 adults in the UK have hearing loss, the leading cause of years lived with disability in the UK.

It is associated with poor social interactions, isolation, depression and anxiety, increased risk of dementia and reduced quality of life.

The use of face masks by the general public is a controversial topic and not currently supported by the World Health Organisation or the UK government.

Current evidence suggests that while face coverings and surgical masks (the variety typically worn by dentists) might prevent large particles spreading from an infected person wearing a mask to someone else, it doesn’t trap tiny particles like coronavirus.

Furthermore, there are concerns that even if fitted correctly, a mask may increase your risk by encouraging you to touch your face more often with hands that may be contaminated.

However, wearing a mask may provide a favour to others by preventing the wearer from infecting them, and there is growing interest by the UK public to use face masks.

Professor Munro said: “At the very least, removing visual cues can make communication more difficult because of the exertion required to listen, especially when there is background noise.

“As a result, even if a person can follow what is said, they have fewer mental resources left to think about and recall what they heard.

And elderly people in hospital who are frail, frightened and distressed with a likely a hearing loss - may have to cope with the background hiss of oxygen to contend with when communicating with others who have their mouths covered.

“An unintended consequence of wearing a face mask might be that social distancing is replaced with social isolation and poor mental wellbeing in older adults with hearing loss.”

He added: “Because the consequences of coronavirus is more common in older people, who are likely to have a hearing loss, this means that those admitted to hospital are especially vulnerable.

“The N95 and FFP3 respirator masks for frontline health and care professionals can filter 95% of tiny particles but they are much more likely to distort and reduce the level of speech.

“This makes communication particularly problematic at a time of heightened anxiety and when the content of conversations are novel and unpredictable.

“Imagine the apprehension of being greeted by someone in full PPE wearing a fitted mask and muffled speech competing with the hiss of oxygen from a breathing mask or nasal cannula.

“Research studies have shown the beneficial effects of surgical masks with a transparent material that allows the mouth to be visualised; however, these are not widely available.”

“An alternative to face masks might be for the public to use transparent face shields, which allow facial expressions and the mouth to be visualised, but these have yet to be evaluated in a clinical trial.

“As governments search for a sure-footed transition to whatever the new norm will be, there is a danger that a policy of encouraging the public to wear face masks may precede the evidence and result in facemask misery for many.”

People working in the music industry are nearly twice as likely to develop Tinnitus as people working in quieter occupations, according to a new study led by researchers at The University of Manchester

The study, published in , analysed 23,000 people from the UK Biobank, an online database of medical and lifestyle records of half a million Britons.

The researchers compared levels of hearing difficulties and tinnitus in people working in noisy ‘high-risk’ construction, agricultural and music industries compared to people working in finance, a quiet ‘low-risk’ industry.

Tinnitus is a potentially devastating condition in which people hear ringing, buzzing or whistling noises in the absence of any external sounds.

The list of high-profile musicians who reportedly suffer from Tinnitus continues to grow, including Liam and Noel Gallagher, Chris Martin, Ozzy Osbourne and Bob Dylan.

However, classical music players are at risk too: earlier this year, the Royal Opera House lost its appeal over the life-changing hearing damage caused to a viola player at a single rehearsal of Wagner's Die Walkure.

Dr Sam Couth, who is based at the University’s, said: “Our research shows that people working in the music industry are at considerable risk of developing tinnitus, and this risk is largely due to exposure to loud noise.

“This includes performing musicians, music directors and production staff for all genres of music.

“Musicians are advised to wear hearing protection when noise levels exceed 85 decibels, which is roughly equivalent to the noise produced by a passing diesel truck.”

Experts say the length of safe noise exposure is reduced by half for every 3 decibels increase in noise intensity.

That equates to 4 hours of daily exposure for 88 decibels of noise, 2 hours for 91 decibels, and so on.

“Most amplified concerts exceed 100 decibels, meaning that musicians shouldn’t be exposed to that level of noise for more than 15 minutes without proper hearing protection,” added Dr Couth.

“Changes to legislation have increased hearing protection use and reduced levels of hearing problems in the construction industry, but the music industry lags behind.

“We know from previous research that only 6% of musicians consistently wear hearing protection.

“Part of our work is to try to understand why so few musicians use hearing protection, and to devise different ways to encourage them to change their behaviour.

“Musicians should wear earplugs designed specifically for listening to music so that the quality of the sound remains high, whilst the risk of hearing damage is reduced.”

The research team found that health and lifestyle factors had relatively little impact on Tinnitus and hearing difficulties. Noise exposure was by far the biggest risk.

The findings confirm what industry insiders have long been saying about the impact their workplace has on their hearing.

Joe Hastings, Head of Health and Welfare at Help Musicians  said: “We welcome this research undertaken by Dr Couth’s department which supports our insights into the risks posed to musicians’ hearing arising from prolonged exposure to noise.

“We are currently working in partnership with British Tinnitus Association to investigate the potentially devastating impact of tinnitus in musicians.”

Help Musicians have developed the hugely successful Musicians Hearing Health Scheme which has already provided preventative support to thousands of musicians since 2016.

Hearing aids and cataract surgery are strongly linked to a slower rate of age-related cognitive decline, according to new research by University of Manchester academics.

According to and , cognitive decline- which affects memory and thinking skills- is slowed after patient’s hearing and sight are improved.

The rate of decline was halved following cataract surgery and was 75% less following the adoption of hearing aids.

The research on cataract surgery - which is published in  today– was carried out using 2,068 individuals who underwent cataract surgery between Wave 2 and Wave 6 of the English Longitudinal 91ֱ�� of Ageing survey from between 2002 to 2014.

They were compared with 3,636 individuals with no cataract surgery.

And the research on hearing aids, published in the Journal of the American Geriatrics Society in July, was carried out using 2040 participants in the American Health and Retirement survey from 1996 to 2014

Both surveys assess cognitive decline by testing memory, asking participants to recall 10 words immediately and then at the end of the cognitive function module.

The researchers compared the rates of decline before and after the patients had surgery or started wearing a hearing aid.

Dr Dawes said: “These studies underline just how important it is to overcome the barriers which deny people from accessing hearing and visual aids.

“It’s not really certain why hearing and visual problems have an impact on cognitive decline, but I’d guess that isolation, stigma and the resultant lack of physical activity that are linked to hearing and vision problems might have something to do with it.

“And there are barriers to overcome: people might not want to wear hearing aids because of stigma attached to wearing them, or they feel the amplification is not good enough or they’re not comfortable.

“Perhaps a way forward is adult screening to better identify hearing and vision problems and in the case of hearing loss, demedicalising the whole process so treatment is done outside the clinical setting. That could reduce stigma.

“Wearable hearing devices are coming on stream nowadays which might also be helpful. They not only assist your hearing, but give you access to the internet and other services

Dr Maharani said: “Age is one of the most important factors implicated in cognitive decline. We find that hearing and vision interventions may slow it down and perhaps prevent some cases of dementia, which is exciting- though we can’t say yet that this is a causal relationship.

“Other studies have attempted to look at rates of cognitive decline- but have not really succeeded as it’s hard to take into account demographic factors.

“But the beauty of this study is that we’re comparing the progress of the same individuals over time.”

‘’ is published in Plos One.

‘’ is published in the Journal of the American Geriatrics Society

This research is funded by the European Commission’s Horizon 2020 Framework

Today history has been made as a single 91ֱ�� bid has been awarded £28.5m from the NIHR, bringing lifesaving tests and treatments a step nearer for millions of people.

The bid has only been made possible through bringing together the recognised clinical and research expertise from across health and academia, which demonstrates the connectivity and collaboration that is central to making Greater 91ֱ�� devolution a success.

The successful bid has been hosted by Central 91ֱ�� University Hospitals NHS Foundation Trust, in partnership with The University of Manchester and the partnership also involves The Christie NHS Foundation Trust, Salford Royal NHS Foundation Trust, University Hospital of South 91ֱ�� NHS Foundation Trust and is supported by . It will see 91ֱ�� granted prestigious NIHR Biomedical Research Centre status.

This will drive forward pioneering research into new tests and treatments in the areas of musculoskeletal disease, hearing health, respiratory disease and dermatology and three themes (prevention, radiotherapy and precision medicine).

91ֱ��’s researchers impressed an international panel of experts with their unique proposals that will accelerate the translation of early stage research into new diagnostic tests and treatments to benefit patients of all ages and backgrounds in Greater 91ֱ�� and beyond. This will make 91ֱ�� ideally placed to attract further research investment that will give our patients early access to new and ground-breaking treatments and will deliver wider value to the economy.

Jon Rouse, Chief Officer of , the body overseeing the devolution of the £6bn health and social care budget, said:

"The new partnership approach under devolution means that we have both the opportunity – and the means – to combine the talents of people from a whole range of areas to benefit our population. This hugely welcome funding is recognition that in Greater 91ֱ�� we can combine the best clinical skills with the best research, innovation and academic talent to take huge steps in improving the health and wellbeing of our people.’

, Director of the NIHR 91ֱ�� BRC, added: “Working closely with patients, we will use the latest advances in biology, medicine and health technology to better predict disease and likely treatment response. The new diagnostic tests and therapies we develop will enable doctors to offer a more tailored approach and to better personalise treatments to the individual. We are also working on better ways to prevent disease developing in the first place.”

Sir Mike Deegan, Chief Executive of Central 91ֱ�� University Hospitals NHS Foundation Trust, explained: “The achievement of a BRC for 91ֱ�� is a landmark moment which will see £28.5m directly invested into finding new ways of preventing, predicting and treating some of the major causes of premature death and disability,” commented “Bringing together our research expertise has only been made possible by the unique connectivity which devolution provides.”

Professor Dame Nancy Rothwell, President and Vice-Chancellor of The University of Manchester, said: “The BRC focuses the research efforts of the University and NHS Partners so that we can address the considerable health needs of Greater 91ֱ��. As the areas of research being targeted by the BRC represent complex global health issues our work also has the potential to have an impact much further afield.”

Roger Spencer, Chief Executive of The Christie, said: “Having a BRC that focuses on three areas of cancer research is to be warmly welcomed. Together with cutting edge advances in treatment such as the new proton beam therapy unit, The Christie is improving research into cancer which means we will be even better able to serve the health needs of this region.”

Professor Ian Greer, Vice-President and Dean of The University of Manchester's commented: “This award presents us with a fantastic opportunity to build on our existing, very successful relationships with our NHS partners in MAHSC to help deliver a real step-change in health research across 91ֱ��.

"All seven research themes are led by academics based in the Faculty of Biology, Medicine and Health; and our ability to deliver tangible benefits under each of the seven areas has undoubtedly been enhanced by the closer alignment of discovery, clinical and health sciences during the creation of FBMH. As each BRC theme becomes established, there will be many opportunities for colleagues across the Faculty to make a contribution and to establish new collaborations with our partner organisations.

“The seven BRC themes, led by Faculty academics, will also help to realise our ambition of developing a truly translational approach to biology, medicine and health, and ultimately have a very real and positive impact on people’s lives.”

The seven research themes

Cancer

Theme 1: Cancer Prevention and Early Detection
Lead:

Around 50% of people in the UK will be diagnosed with cancer in their lifetime. Cancer prevention and early detection strategies are not currently fully leveraged despite having an important role to play in the fight against cancer.

The BRC will help to improve the targeting of these strategies, by developing the early markers needed to diagnose cancer sooner and rapidly identify whether a treatment is having the desired response.

Theme 2: Advanced radiotherapy
Lead:

Radiotherapy has an important role to play in the fight against cancer. Around 40% of those patients cured of cancer have received radiotherapy as part of their treatment.

The BRC will improve the delivery of radiation and develop markers to predict the benefit of different types of radiation and drug-radiation combinations, as well as the risk of long-term side effects,”

Theme 3: Cancer precision medicine
Lead:

The BRC will help the NHS to deliver a more personalised and proactive approach to caring for patients with cancer. Through the precise characterisation of tumours, its research will enable us to develop the diagnostic tests needed to match an individual’s cancer with the drug most likely to have the desired therapeutic effect.

Work will also focus on helping clinicians to anticipate and appropriately manage drug resistant relapse, a common problem faced by patients with cancer.

Musculoskeletal diseases

Theme 4: Musculoskeletal disease
Lead:

Musculoskeletal disorders, such as arthritis and connective tissue diseases, account for over 20% of all GP consultations and are the second most common cause of disability worldwide.

Building on the work of our NIHR 91ֱ�� Musculoskeletal Biomedical Research Unit, the BRC will focus on strategies to prevent arthritis developing in the first place. We are also developing new treatment approaches to arthritis in adults and children and new tests to improve our ability to personalise treatments used. .

Hearing health

Theme 5: Hearing health
Lead:

Hearing loss will soon be the 7^th largest global disease burden. It represents a major public health issue with substantial economic and societal costs. The BRC is focused on the rapid adoption of discoveries into routine clinical practice to improve health and wellbeing, reduce inequalities and provide value for money.

The BRC will help deliver effective and efficient hearing health across the lifespan – from preventing potentially devastating inherited deafness through to age-related deafness.

Respiratory diseases

Theme 6: Respiratory disease
Lead:

Respiratory diseases are the third most common cause of death and the second most common cause of hospital admissions in the UK.

The BRC will build a better understanding of the underlying causes of respiratory conditions and test new drug compounds aimed at novel targets to modify the disease processes involved and improve symptom control in patients.

Research will focus on earlier diagnosis and more targeted treatment, to maximise the likelihood of a good treatment response for an individual whilst minimising the risks of harm from therapies such as antimicrobial resistance.

Dermatology

Theme 7: Cutaneous inflammation and repair
Lead:

Skin conditions and poor wound healding have a considerable impact on many people’s quality of life.

The BRC will identify markers and tools, which can be used to personalise treatment plans and identify opportunities to address unmet clinical need for patients suffering from complex wounds, psoriasis, hair loss and light-sensitive conditions.

The podcast, which is presented in British Sign Language (BSL), is being used to promote a event in Oxford on 18 June where will present stories gathered from a decade of work with deaf people in Europe, America and Africa, to which she is now adding by studying deaf lives in the UK.

Their empowering stories have been told in different signed languages, through narratives and creative methods such as drama, and Dr De Clerck will be using these examples to talk about the possibilities for both women and deaf people to forge careers in the sciences.

The podcast features a mix of BSL, pictures, video, subtitles and audio, and is designed to be accessible for all.

One of 12 academics taking part in the event in the centre of Oxford, Dr De Clerck is the first and only scholar to present her work in British Sign Language and through BSL interpreting services. She said: “It means a lot to me that this helps BSL become visible as a language of science. I think it is important for deaf children and young people to grow up knowing that research is currently being done in and on BSL, with deaf people, and by deaf scholars.”

Soapbox Science is a public outreach platform for promoting women scientists and their research. Modelled on Speaker’s Corner in London’s Hyde Park, it offers the chance for public debate, and this year will see 14 events taking place throughout the UK.

Dr De Clerck’s Soapbox Science presentation is part of her much wider project documenting the life stories of deaf people and using these collected thoughts to inspire others and transform services such as mental health. It is hoped that this collection can be produced in a number of formats, including an app on deaf life stories and wellbeing which is currently in development.

She said: “I have found that deaf life storytelling is a cultural practice around the world, and now as a Marie Curie Fellow at the Social Research with Deaf People group at The University of Manchester, I am looking into how deaf people in the UK, both natives and migrants, can use it to gain more insight into their wellbeing. I am still as fascinated by deaf people’s lives as I was in the beginning. I have been especially compelled and inspired by the strength and vitality that deaf people and sign language communities find in storytelling.”

More information about the Soapbox Science event on 18 June in Oxford, including an interview with Dr De Clerck, can be found .

Researchers from 91ֱ�� are taking to the road in a unique research van that will travel up and down the country, visiting the homes of infants with hearing problems.

Hearing loss can be a devastating long-term condition for children, but early intervention can reduce its negative impact on development. For this reason, babies in the UK are offered a hearing check soon after birth and hearing aids are typically prescribed and fitted by 2-3 months of age. However, there are currently no reliable tests that can provide information about how well young infants hear through their hearing aids.

Previous research has identified a promising solution to this problem called Cortical Auditory Evoked Potentials (CAEPs), which tests if sounds are being detected by the brain using recording leads attached to the head. Research led by , Ewing Professor of Audiology at The University of Manchester will now seek to validate the procedure in babies who use hearing aids.

Professor Munro and his team took into consideration the pressures on families that can make participation in research extremely difficult and made sure that they were involved in the design of the study. These families explained that if the research could be carried out at their home, it would make it much easier than having to travel to their local hospital or the university.

The £350,000 -funded study will recruit 200 infants with hearing aids from across the country. Each child will be visited by a mobile hearing research van which has been bought and kitted out through the generous funding of the Marston Family Foundation. The van, which is the first of its kind, is fitted with the necessary testing equipment and appropriate noise attenuating treatment.

Professor Munro, who is also an Honorary Consultant Clinical Scientist at , says: “The unique mobile hearing van will allow us to take our research to the families and this should mean more of them will be able to participate in this much needed study.”

The van will travel across the country visiting infants at 3-6 months of age; the same babies will then be revisited at 7-9 months so that the research findings can be compared with the traditional hearing test, which works by rewarding babies who turn their head and look for sounds. The results are expected to be published 2018 and the researchers hope that their findings provide evidence that the test can be used nationwide.

Sarah Bolton, 30 from Preston, has experienced the difficulties in the provision of support as being both a previous hearing aid wearer herself and having a child diagnosed with hearing loss. Using her knowledge and experience she helped develop this research study.

She said: “As a parent of a child with hearing loss, I know that this research is of paramount importance to many families who feel the gap between hearing aid fitting at 2-3 months and then nothing until 7-8 months. This is a time when babies need reliable access to all the sounds around them in order to learn and grow.”

A representative of the Marston Family Foundation said: “We are honoured to support this innovative research study at The University of Manchester. It is our hope that through its work, the mobile hearing research unit will help to ensure early intervention for children with hearing impairment and reduce the devastating impact that hearing loss can have on a child’s early development.”

The combined impact of dementia, age-related hearing and vision impairment is to be investigated by a new multi-million European research consortium led by The University of Manchester.

Seven in ten Europeans over the age of 65 suffer from either sight or hearing problems and over two thirds suffer from depression or dementia. When combined together the cumulative impact of these dual or triple impairments is far greater than the individual conditions. The scale of combined sensory and cognitive problems is substantial but poorly understood.

The five year project, led by The University of Manchester, has been funded with €6.5m from the European Commission’s research programme. The project aims to investigate this combined impact and develop new tools that could improve quality of life and optimise health and social care budgets across Europe.

, an academic psychiatrist from The University of Manchester, who is the lead researcher on the project, said: “In combination these problems have a much greater effect than each one individually. Imagine if you have dementia which affects your memory or interferes with your recognition of familiar people. When you add visual impairment to that, you can understand why those affected may experience even greater cognitive difficulty or even experience altered behaviour such as agitation or hallucinations.

“The burden on carers – often family members – is also increased as they are required to do much more on a daily basis and we see a greater number of these suffering from burn-out.”

The project seeks to define the scale of the challenges so that authorities across the continent can allocate resources more optimally. At the same time, researchers will also develop online tests, guides and multi-lingual training manuals to help medical professionals diagnose and treat the combined problems more effectively.

Minority groups are particularly disadvantaged with respect to diagnosis and treatment of mental and sensory problems, so researchers will be seeking out people from these groups to participate in the research.

The programme will also trial an intervention of at-home support for people with dual- and triple-impairments. This will be supported by specialist sensory therapists based at and will focus around pragmatic solutions to support both the affected person and their carer.

, a University of Manchester audiologist and co-lead of the SENSE-Cog project said: “Millions of people in the UK and wider EU are affected by this combination of problems and it’s only going to get more prevalent as the population ages. That’s why we have to understand the scale of the problem and then equip the public, carers and health care workers with the tools they need to deal with it. If we could reduce disability due to hearing and vision impairment, there is huge potential to improve mental well-being and even delay the deterioration of dementia.”

A study of up to 433,390 UK adults, led by The University of Manchester, has linked being under and overweight at birth with poorer hearing, vision and cognition in middle age.

Researchers in 91ֱ��, Nottingham, Cincinnati and Madison, Wisconsin analysed data from up to 433,390 UK adults from study.

Associations with birth weight – an index of prenatal growth – were complex.  Larger babies falling within the 10^th and 90^th percentile of weight had better hearing, vision and cognition in adulthood.

But very small and very large babies had the poorest hearing, vision and cognitive function.  Better growth during childhood (as indexed by adult height) was associated with better hearing, vision and cognition in adulthood.

Dr Piers Dawes, a lecturer in audiology at The University of Manchester’s led the study.  He said: “Sensory problems and illness such as dementia are an increasing problem but these findings suggest that issues begin to develop right from early life.

“While interventions in adulthood may only have a small effect, concentrating on making small improvements to birth size and child development could have a much greater impact on numbers of people with hearing, vision and cognitive impairment.”

The data was taken from the UK Biobank study which contains detailed information on UK adults aged between 40-69 years in 2006-2010 from across the country. The researchers used statistical techniques to correct for other sources of impairment such as smoking, economic deprivation and other existing health decisions.

As a result they suggest in the research paper that under-nutrition may impact on development of the brain and sensory systems. Alternatively, growth hormones and changes in genetic regulation may be affected by experiences early in life and impact on neurosensory development.

The paper, ‘’ was published in the journal PLOS One.  The study was facilitated by the 91ֱ�� Biomedical Research Centre.