Social isolation during lockdown is putting 15.5 million elderly individuals at increased risk of premature frailty due to fostering mental health deterioration (Armitage 2020). It is absolutely crucial that elderly individuals have ready access to audiology services so they have the strongest possible opportunity of rapidly returning to a socially-active lifestyle following lifting of the lockdown. Our vision is to increase access to care and eliminate waiting times by streamlining provision of hearing aids while simultaneously moving audiology services out of hospital departments and into the community, where the same quality of service can be delivered faster and with far reduced physical contact between patient and care provider, thereby reducing risk of audiology care contributing to continued COVID-19 circulation. We propose delivering this vision by developing technology for "over-the-counter audiometry", wherein hearing assessments and fitting of hearing aids becomes an over-the-counter (OTC) service provided by pharmacies, with referral to specialist audiology departments reserved for patients with severe or complex needs. This vision leverages the recent availability of OTC hearing aids (OTC-HAs). In delivering this vision, we will be addressing three specific themes of the call: healthcare, wellbeing, and community support services. During the project, we will develop an automated testing platform that: i) assesses patient hearing abilities, ii) rules out or responds with suitable referrals to other factors (sudden-onset hearing loss, cerumen impaction, etc), iii) assesses patient suitability for OTC-HAs, and iv) selects the most suitable pre-programmed OTC-HA or otherwise makes a referral to specialist audiology services if OTC care is contraindicated. The project work will be split between i) consolidation of our existing prototype hardware into a market-ready testing platform, ii) extending the software functionality of our existing hearing-screening paradigm to respond to the needs of OTC-audiometry, and iii) working with commercialisation partners to streamline commercialisation and roll-out. The outcomes of the project will take us to TRL 6, ready for regulatory approval and rapid piloting then roll-out with our commercialisation partners. The project builds upon our existing technology for hearing screening assessments, which has received strong interest from researchers and clinicians due to its novel paradigm enabling accuracy advances over incumbent products. The project's innovation is in addressing unmet needs in the emerging OTC-HA market. **ADDITIONAL SCOPE** The “extension for impact” funding will enable HD to develop a demonstration prototype that is based on the original projects’ software/hardware prototype deliverable. This will enable HD to demonstrate their technology to potential customers in early 2021. In parallel, the “extension for impact” funding will enable HD to drive forward their commercial negotiations with customers, and to agree on trialling protocols with the prospective customers, which are key to ensure HD’s product will be commercialised rapidly and broadly. The anticipated feedback from demoing the prototype will provide seminal feedback, which will be incorporated before initiating trials with customers, ensuring HD will be able to consolidate their business plan and maximise their products’ impact at launch.

Hearing loss affects 360 million people worldwide and 11 million people within the UK, with most of those affected being 65 years of age, or older. Un-managed hearing loss in the elderly commonly leads to social isolation and depression, and may cause or accelerate the progression of cognitive decline and dementia. Management is thus crucial, and is most effective if started early after the initial progression of the hearing loss. Routine screening is necessary in order to ensure early management, as without screening, patients often go un-diagnosed for a prolonged period of time after first experiencing the symptoms of hearing loss. However, current technology is inappropriate for widespread screening due to poor accuracy and high sensitivity to background noise. To address this, we are developing a new hearing screening product, Audimetroid, that will make innovative use of advanced algorithms in order to make screening for hearing loss more accurate and less sensitive to background noise. This will make widespread hearing screening programmes more cost efficient by reducing the number of normal-hearing patients who are erroneously referred to audiology services, and will allow hearing assessments to take place at primary care providers, including GP surgeries and pharmacies, where existing technology would be unreliable due to the presence of background noise. During the proposed feasibility study, we will validate the technological and scientific approaches underpinning the concept, and ensure Audimetroid's applicability as a tool for use in widespread hearing screening programmes.