Redefining what music sounds like to someone with hearing loss
Alexander Chern, MD, is focusing his research on measuring music perception in people with hearing loss and developing methods to enhance their listening experience.
Music has had a profound influence on the life of Alexander Chern, MD. He grew up playing the violin. And in medical school, he worked in a music cognition lab.
Today, Chern, Assistant Professor of Otorhinolaryngology - Head and Neck Surgery at the Hospital of the University of Pennsylvania, is focusing his research on measuring the musical experience of people with hearing loss and developing methods to enhance their listening experience.
Hearing loss impacts not only the volume at which someone hears but also the clarity with which they distinguish sounds. While hearing aids and cochlear implants have enabled millions of people to hear better, or at all, they are primarily designed to heighten speech understanding, or speech processing.
The bar for music processing, Chern says, is significantly higher. And so, people who benefit from the use of hearing aids or cochlear implants often struggle with listening to music, namely the ability to perceive different elements of it, such as pitch or timbre, which is the ability to distinguish different instruments. For many, this lessens their appreciation of music, Chern says.
Capturing all aspects of music listening
Enhancing their music-listening experience starts with measuring the quality of it. However, there’s currently no standard method or unit of measurement. Much of the testing that’s done tends to be perception-based, Chern says, which is subjective and largely unreliable. Two people may register a pitch the same way, and one could report it as problematic while the other does not.
Chern says these tests are also limited. “There’s a lot more to music than enjoying these perceptual elements,” he says. “Everybody’s music-listening experience is very personal. For some, it’s a social experience. For others, it’s nostalgia. For many, it’s an emotional response. And the current tests don’t account for any of that.”
In response, he’s developing a “validated construct” to “better measure musical reward in people with hearing loss.” It will capture the many personal aspects of the music-listening experience and will ultimately, he says, be able to quantify how a person’s hearing loss impacts all of this.
In the meantime, Chern’s already exploring methods to enhance music listening for people with hearing loss. Much to his surprise, he’s found that people with musical training are generally the most capable of adapting on their own.
“You would think that these people would be the pickiest about music listening,” he says. “But we’ve done studies where we quantified people’s listening experience and interviewed them about it, and sometimes the ones with musical training are the ones that are still able to enjoy music the most despite having hearing loss.”
Chern says they told him that they used various exercises they learned through their training to help “rehabilitate” their hearing. Collectively, they also seemed more willing to embrace a diminished listening experience, the thinking being that something is preferable to nothing at all.
Hearing this, Chern says he realized how much of the music-listening experience is framed by an individual’s expectations of it. He’s using this knowledge to inform new enhancements, which include different forms of patient education, such as coaching people with newly implanted cochlear implants to allow themselves time to adapt before trying to fine tune their music processing. And encouraging people to invest in a quality pair of headphones and use them in a quiet environment.
Improving outcomes with minimally invasive approaches
In his clinical practice, which spans the full breadth of otology and neurotology, Chern is using minimally invasive approaches in the treatment of patients with chronic middle ear disease that are reducing their recovery time and improving their outcomes.
Historically, the surgical procedures that have been used to treat this spectrum of conditions, ranging from a perforated ear drum to persistent middle ear infections to cholesteatoma, relied on a microscope, where the lens and light source are a significant distance from the target. Chern employs an endoscope that’s 14 centimeters in length and three millimeters in diameter, which positions the lens and light source immediately next to the target, affording him a clear view of both it and the surrounding ear canal.
“The structures that I’m able to view through the endoscope were previously visible only after making an incision behind the ear or drilling through the mastoid,” Chern says. “And that degree of visibility enables me to be far more precise than I ever could be with a microscope.”
He also uses an endoscope to perform a stapedectomy, a procedure to repair or replace the stapes bone in the middle ear to treat hearing loss caused by otosclerosis.
Chern says he’s observed quicker and less painful recoveries and improved surgical outcomes with this approach.
Clinical consult and patient referral
Alexander Chern, MD, sees patients at Otorhinolaryngology - Head and Neck Surgery in Philadelphia, PA.
For a provider-to-provider consultation with Dr. Chern, please call 877-937-7366, or refer a patient online.