Healthy heaAring for Healthy Ageing: Data-driven Hearing Rehabilitation Intervention to Promote Healthy Hearing (HAHA)

March 2, 2026 updated by: Kuopio University Hospital

Healthy Hearing for Healthy Ageing: a Proof-of-concept Randomized Controlled Trial of Data-driven Hearing Rehabilitation Versus Standard Care in Older Adults With Hearing Impairment.

The goal of the HAHA trial is to prove that the treatment of HI and prevention of HI-related cognitive decline are most likely to be effective if HI is approached as a broader neurodegenerative entity with multifaceted manifestations currently unaddressed in clinical practice and managed using a novel individualised data-driven protocol for early hearing rehabilitation. The main hypothesis is that, compared with standard care, the data-driven rehabilitation will likely have broader benefits manifested in three key areas: hearing, cognition, and quality of life and psychosocial outcomes.

Participants will be randomized 1:1 to either intervention (individualised data-driven hearing rehabilitation) or control group (standard care hearing rehabilitation). The primary objective of this study is to investigate the effect of an optimized data-driven hearing rehabilitation protocol versus standard care protocol on change in speech perception in noise (SPIN) in older adults with mild to moderately severe sensorineural HI and without dementia.

Study Overview

Detailed Description

Hearing impairment (HI) is a major public health problem. HI has also been identified as a significant potentially modifiable risk factor for dementia. Thus, hearing rehabilitation may contribute to dementia risk reduction, although a causal HI-dementia relation is not fully established.

The HAHA trial will test an individualised, data-driven hearing rehabilitation protocol based on the ongoing BREM (Benefits of Real-Ear Measurement) study at KUH (clinicaltrials.gov ID NCT05621798). HAHA will use a pragmatic approach incorporated into routine specialized care (Hearing Center at the Dept of Otorhinolaryngology of KUH), to facilitate optimisation of the current HI clinical pathway and treatment process. This study is a proof-of-concept, single-site, 2-arm parallel group 12-month randomized controlled trial with a 12-month extended follow-up.

The investigators will recruite 200 participants referred to the Kuopio University Hospital Hearing Center from primary care that are aged 65 to 84 years with mild to moderately severe sensorineural HI and are about to receive their first HAs.

The intervention group will receive individually fitted HAs based on preliminary results from the ongoing BREM study at KUH to ensure adequate amplification, with immediate SPIN-based benefit validation. HA selection and individual tailoring will also be based on hearing questionnaires data. Participants are invited to intervention-related monitoring appointments at 3, 6 and 12 months after the primary HA fitting.

The control group will receive the same HAs fitted according to the standard care protocol. Standard care follow-up includes a phone call check 3 months after the primary fitting. Additional monitoring/re-fitting may be offered based on the participant's feedback and hearing rehabilitator's clinical judgement.

A range of auditory, cognitive, quality of life and psychosocial measures as well as exploratory measures such as EEG, MRI and vision-related measures are assessed at 12-month and 24-month visits on both groups. These assessments are included to investigate potential mechanisms underlying associations between HI, hearing rehabilitation, vision and cognition. The overall duration of the this trial is 2 years.

Study Type

Interventional

Enrollment (Estimated)

200

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

      • Kuopio, Finland, 70210
        • Kuopio University Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Mild to moderately severe sensorineural HI (PTA (0,5-4kHz) between 20-64 dB (HL), as per Global Burden of Disease Expert Group on Hearing loss criteria)
  • Community-dwelling, i.e. living at home / not living in a care home or nursing home
  • Proficiency in Finnish language
  • First-time hearing aid user

Exclusion Criteria:

  • Conductive hearing loss (air-bone gap more than 20 dB HL in two consecutive frequencies)
  • Difference between hearing levels of the ears is more than 15dB (HL) in three consecutive frequencies
  • Hearing aid contraindication
  • Previously diagnosed dementia, or current use of cholinesterase inhibitors and/or memantine. If there is a current ongoing diagnostic process for suspected dementia, the decision on eligibility will be made by an experienced study physician based on medical records and clinical judgement.
  • Any health conditions severely impairing vision, mobility, communication, and/or ability to participate in study visits and complete study assessments, as judged by the study nurse and/or physician.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Individualised data-driven hearing rehabilitation
Participants in the intervention group will receive data-driven, regularly controlled hearing aid rehabilitation that is not part of the standard care protocol.

HA fittings will be conducted with the Real-Ear Measurements (REM) method that is recommended by the latest ISO-standard (21388:2020) and by the preliminary results of the BREM study at KUH. After the fitting of the HAs, participants' auditory-related outcomes will be immediately assessed using DigiKuulo and re-fitting is performed if needed based on the following criteria:

  1. The absolute improvement in the DIN test is less than 1,5dB (SNR), OR
  2. The absolute result of the DIN test is more than -8,5 dB (SNR) OR
  3. The participant is unsatisfied with the HA fitting

Participants are invited to intervention-related monitoring appointments at 3, 6 and 12 months after the primary HA fitting. At these visits, auditory outcomes of the rehabilitation are assessed via DigiKuulo and re-fittings are performed as needed.

Active Comparator: Standard care hearing rehabilitation
The participants in the control group will receive the standard care HA rehabilitation currently conducted at the KUH Hearing Center.
HA will be fitted with automatic algorithms by HA manufacturers and REM-fitting is only applied in complex cases based on the hearing rehabilitator's clinical judgement. Three months after the HA fitting, participants will be contacted via phone call to inquire about the status of the rehabilitation. Additional monitoring visits may be offered based on the participant's feedback. After the 3-month monitoring phone call participants will be advised to further contact the study team if they are dissatisfied with the amplification or for any other problem with their device.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Finnish Matrix Sentence Test (FMST)
Time Frame: Change measures: 0 months, 12 months, 24 months
A Speech-in-Noise test, validated for the Finnish language. In the test participants will listen to five-word sentences chosen out of a standardized and optimized word matrix under stationary background noise (65dB SPL). The result of the FMST is the signal-to-noise ratio (SNR) at which the participant identifies 50% of the presented word items correctly, this is called the speech reception threshold (SRT50).
Change measures: 0 months, 12 months, 24 months
Digits in Noise test (DIN)
Time Frame: Change measures: 0 months, 12 months, 24 months
A Speech-in-Noise test, validated for the Finnish language. The word material of the test consists of digit triplets presented under stationary background noise (65dB SPL). The result of the DIN is the signal-to-noise ratio at which the participant identifies 50% of the presented triplets correctly, this is called the speech reception threshold (SRT50).
Change measures: 0 months, 12 months, 24 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Hearing in real-life environment - HERE
Time Frame: Change measures: 0 months, 12 months, 24 months
The HERE questionnaire is self-reporting hearing questionnaire validated in Finnish language (28). It includes 15 items with a numeric rating scale from 0 to 10 for each item and allows the assessment of hearing with and without hearing aids.
Change measures: 0 months, 12 months, 24 months
Speech, Spatial and Quality questionnaires - SSQ
Time Frame: Change measures: 0 months, 12 months, 24 months
The SSQ questionnaire is a self-reporting hearing questionnaire that comprises 49 questions divided into three subdomains: Speech Perception (SP), Spatial Hearing (SH) and other qualities of Hearing (SQ) (18). The answers are provided on an 11-point Likert scale, ranging from 0 to 10.
Change measures: 0 months, 12 months, 24 months
Hearing aid usage (self-report and HAs log data)
Time Frame: Change measures: 0 months, 12 months, 24 months
Usage rates of HAs (hours per day) are regularly checked via the HAs' log-data source and recorded during every clinical visit. In addition, participants' own estimation of usage rates is inquired and recorded.
Change measures: 0 months, 12 months, 24 months
Listening effort questionnaire
Time Frame: Change measures: 0 months, 12 months, 24 months
Listening effort will be self-reported by the participant for listening tasks of varying difficulties (i.e., different signal-to-noise ratios) on a 10-point VAS scale.
Change measures: 0 months, 12 months, 24 months
Response time (DIN test)
Time Frame: Change measures: 0 months, 12 months, 24 months
Response time for the answers given by the participant will be calculated and recorded automatically
Change measures: 0 months, 12 months, 24 months
Tinnitus Handicap Inventory (THI)
Time Frame: Change measures: 0 months, 12 months, 24 months
The THI is a 25-item self-report questionnaire for tinnitus that has Functional, Emotional and Catastrophic subscales. It has excellent convergent validity, construct validity and test-retest reliability. The THI takes 10min to complete. Scoring takes 5 min with a score of 4 for a 'yes', 2 for 'sometimes' and 0 for 'no'.
Change measures: 0 months, 12 months, 24 months
CERAD-nb (global and domain scores)
Time Frame: Change measures: 0 months, 12 months, 24 months
The Finnish version of the CERAD (Consortium to Establish a Registry for Alzheimer´s Disease) test battery is recommended for assessment of memory disorders in the national Current Care Guidelines developed by the Finnish Medical Society Duodecim (www.kaypahoito.fi).
Change measures: 0 months, 12 months, 24 months
Clinical Dementia Rating Sum of Boxes (CDR-SoB)
Time Frame: Change measures: 0 months, 12 months, 24 months
CDR (Clinical Dementia Rating) is used to assess the influence of cognitive impairment on the ability to conduct everyday activities in people with AD and gives a global clinical impression of the functioning level of the study participant. The assessor will interview the participant regarding their cognitive performance on six domains: memory, orientation, judgment and problem solving, community affairs, home and hobbies, and personal care. Each domain is rated on level of impairment: 0 (none), 0.5 (questionable), 1 (mild dementia), 2 (moderate dementia) or 3 (severe dementia). The total Sum of Boxes ranges from 0 (no impairment) to 18 (severe impairment on all domains).
Change measures: 0 months, 12 months, 24 months
15D questionnaire
Time Frame: Change measures: 0 months, 12 months, 24 months
A generic, comprehensive, standardized, self-administered questionnaire of health-related quality of life developed in Finland. It includes 15 questions providing a numerical score for patient-perceived health status. It can be used both as a profile and single index score measure. It is commonly used in Finland to assess quality of life in standard care.
Change measures: 0 months, 12 months, 24 months
EQ5-D-5L questionnaire
Time Frame: Change measures: 0 months, 12 months, 24 months
A concise, generic measure of self-reported health which is accompanied by weights reflecting the relative importance to people of different types of health problems
Change measures: 0 months, 12 months, 24 months
Beck Depression Inventory (BDI)
Time Frame: Change measures: 0 months, 12 months, 24 months
A short, self-administered questionnaire to quantify psychological and physical symptoms of depression. It includes 21 items, and participants are asked to rate each item using a 4-point Likert scale. The BDI is one of the most frequently used questionnaires for the assessment of depression in clinical practice, including in older adults.
Change measures: 0 months, 12 months, 24 months

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
EEG-derived cortical auditory evoked potentials (CAEPs)
Time Frame: Change measures: 0 months, 12 months, 24 months
The possible cortical changes related to the use of HA will be measured through EEG-derived cortical auditory evoked potentials (CAEPs) assessed while administering the DIN test.
Change measures: 0 months, 12 months, 24 months
Structural MRI
Time Frame: Change measures: 0 months, 12 months, 24 months
sMRI will provide measures of neurodegeneration (e.g., cortical thickness, brain volumes) and cerebrovascular pathology (e.g., white matter lesions, clinically "silent" infarcts). The scans will include T1, T2, FLAIR, and diffusion weighted sequences (~45 min).
Change measures: 0 months, 12 months, 24 months
Functional MRI
Time Frame: Change measures: 0 months, 12 months, 24 months
Task-based fMRI scans (~20 min) will be conducted on at least of 30 participants from both groups (60 altogether) closely mimicking the EEG-paradigm (section 3.3.1). To minimize the possible masking effect of scanner noise, the sounds will be presented during silent periods between scans.
Change measures: 0 months, 12 months, 24 months
Ultra-short echo time MRI / Zero echo time MRI
Time Frame: Change measures: 0 months, 12 months, 24 months
Task-based ultra-short- and zero echo time MRIs (UTE, ZTE) (~20 min) will also be conducted on the same group of participants having the fMRI described previously. The tasks will closely mimic the EEG-paradigm (section 3.3.1). Short echo time sequences are less sensitive to susceptibility and motion artifacts and the sequences are silent.
Change measures: 0 months, 12 months, 24 months
Measures related to active lifestyle
Time Frame: Change measures: 0 months, 12 months, 24 months
Participants will receive a self-administered questionnaire covering several lifestyle domains potentially affected by HI and relevant for dementia risk, e.g. physical, cognitive and social activities. An active lifestyle index will be calculated as a composite score based on these domains.
Change measures: 0 months, 12 months, 24 months
Digital cognitive test battery
Time Frame: Change measures: 0 months, 12 months, 24 months
The cognitive test battery includes tests covering different cognitive domains, and available within the public domain. It was adapted and already tested for persons with HI by Prof. Vincent Lin at Sunny Brook University Hospital, Canada, by converting all original verbal instructions into a visual PowerPoint presentation shown on a computer screen. In the HAHA trial, the cognitive test battery will be self-administered by the participant on the DigiKuulo screen at the study site.
Change measures: 0 months, 12 months, 24 months
1: Vision-related outcomes
Time Frame: Change measures: 0 months, 24 months
Best-corrected visual acuity
Change measures: 0 months, 24 months
2: Vision-related outcomes
Time Frame: Change measures: 0 months, 24 months
Slit-lamp examination
Change measures: 0 months, 24 months
3: Vision-related outcomes
Time Frame: Change measures: 0 months, 24 months
Retinal imaging
Change measures: 0 months, 24 months
4: Vision-related outcomes
Time Frame: Change measures: 0 months, 24 months
Eye geometrics and biometric values
Change measures: 0 months, 24 months
Blood samples
Time Frame: Change measures: 0 months, 24 months
Frozen and stored for future assessment of HI or dementia- related markers (e.g. genetic, amyloid, tau, neurodegeneration)
Change measures: 0 months, 24 months
Intervention-related acitivities, standard group
Time Frame: Change measures: 0 months
Amplification of HAs
Change measures: 0 months
Intervention-related acitivities, intervention group
Time Frame: Change measures: 0 months, 3 months, 6 months, 12 months
Amplification of HAs
Change measures: 0 months, 3 months, 6 months, 12 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Principal Investigator: Aarno Dietz, prof., Kuopio University Hospital and University of Eastern Finland
  • Principal Investigator: Alina Solomon, prof., University of Eastern Finland

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

October 1, 2024

Primary Completion (Estimated)

February 29, 2028

Study Completion (Estimated)

February 29, 2028

Study Registration Dates

First Submitted

July 2, 2024

First Submitted That Met QC Criteria

July 2, 2024

First Posted (Actual)

July 10, 2024

Study Record Updates

Last Update Posted (Actual)

March 4, 2026

Last Update Submitted That Met QC Criteria

March 2, 2026

Last Verified

February 1, 2026

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

The HAHA Steering Committee and Management Group are open to requests from external researchers for data collected in this study. Applicants will be asked to submit a study protocol, including the research question, planned analysis, and data required. Committee will evaluate this plan (i.e., relevance of the research question, suitability of data, quality of proposed analyses, planned/ongoing HAHA analyses, and other matters) on a case-by-case basis and provide the data or reject the request. Shared data will encompass the data dictionary and de-identified data only. Any analysis will be conducted in collaboration with the HAHA Management Group. Access is subject to the HAHA legal framework. An access agreement will be prepared and signed by both parties.

IPD Sharing Time Frame

The trial Steering Committee and Management Group will consider applications for data after the trials results have been published and data will be made available according to the terms of the access agreement.

IPD Sharing Access Criteria

As described above in the Plan Description.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP
  • ICF

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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