As executive chef at the Wayzata Country Club, Paul Neu listens all day.

In the kitchen he has to hear his crew over clattering pans, rumbling coolers and the hum of a hood vent. In the dining room, he visits with patrons while surrounded by background buzz and the murmur of nearby conversations.

For 14 years, Neu, 55, has relied on hearing aids to sharpen his aging ears. He's become ever more satisfied with updates to his in-ear devices; his newest iteration came complete with embedded sensors that utilize artificial intelligence to amplify sound.

"It automatically adjusts to the different environments I'm in. I don't have to do anything or even think about it," he says.

It's an exciting era for hearing innovation, and Minnesota is a hub for emerging options. It's at the center of advancements in developing high-tech hearing devices. It's also a research hot spot pioneering ways to not just manage lost hearing, but to embrace the bold goal of bringing it back.

The University of Minnesota is in the midst of a five-year, $9.7 million National Institutes of Health grant to develop a device that could be implanted directly into the auditory nerve to restore hearing.

Clinical trials for a medication that delays age-related hearing loss have been underway at the Mayo Clinic in Rochester. Elsewhere, research teams are working to regrow hair cells in the cochlea that translate vibrations into signals sent to the brain. Through aging or prolonged noise exposure, these microscopic hairs get damaged or destroyed.

"Nothing is approved for clinical practice yet but there's some promising evidence of regeneration in animal models. That gives us hope that regeneration could be achieved," says Gayla Poling, director of diagnostic audiology research at Mayo.

Poling is also excited about a new diagnostic tool she's using. It examines hair cell function and allows hearing professionals to detect changes at an earlier stage.

"Previously patients might have been told, you're fine. This test lets us intervene earlier and focus our treatment," Poling says. "We're leveraging a robust expansion of technology at the ear level."

Andrew Oxenham, professor in the departments of psychology and otolaryngology at the U and director of the Auditory Perception and Cognition Lab, studies how the brain interprets acoustic signals received from the ear. He's initiating a study at seven universities across the United States and Canada that will look at understanding how the subtleties of pitch perception might extend hearing.

"People with musical training learn to follow rising and falling pitch contours. We're looking at whether this skill could help people with hearing loss focus more critically and lead to less deficits in speech perception," he says.

"We're interested in the rigorous science to find out if this is applicable and worth pursuing. Long term, this could lead to different treatments — with a technique, not a device."

Hearing aid help

The best help for age-related hearing loss remains in-ear hearing aids; 3 million to 4 million Americans are fitted for them every year.

"Computational power in today's hearing aids is greater than that in a mainframe computer 20 years ago," says Oxenham.

Until a century ago, people living with hearing impairment had nothing but funnel-like ear trumpets to amplify sound. Cumbersome vacuum-tube hearing aids were first manufactured in the 1920s and wearable devices arrived in 1936; they relied on an amplifier hanging around a user's neck and a hand-held microphone for news-reporter-style conversations. With the post-World War II invention of the transistor, hearing aids shrunk significantly; they got smaller still with microprocessors and multichannel amplitude compression invented in the 1970s.

With digital technology, today's next generation of hearing aids are multifunctional microcomputers.

"These are not your grandmother's hearing aids. They are transitioning into high-tech devices that improve overall health and wellness," says Dave Fabry, chief innovation officer at Eden Prairie-based Starkey, the largest privately held American-owned hearing aid manufacturer.

Fabry calls this "the golden era for hearing health patients," pointing to Starkey's newest devices that use smartphone connections to track and monitor physical activity and diagnose conditions like high blood pressure. They can stream podcasts, directions and phone communication and can be programmed to detect falls or serve as virtual assistants that offer customized help like medication reminders.

"There's a lot of complexity in them but we want them to be seamless and effortless for someone who is 50 or 90," Fabry says.

The industry has gone to work to solve the most persistent complaint from users: the way ambient sound interferes with listening to a single voice.

"The devices in the new product family use artificial intelligence to scan a challenging environment. It takes an acoustic snapshot and optimizes for that situation," he says.

Answering the call

Paul Neu's hearing aids do more than amplify sound.

His Livio AI model by Starkey is customized to provide in-ear translation so he understands his Spanish-speaking cooks; it lets him seamlessly answer calls without touching his phone.

"It's improved my efficiency. I can cut fish while I call in an order," he says.

As important as the help is to performing his job, Neu finds his hearing aids enhance his most meaningful connections.

"I live in a house of girls, two daughters and my wife. With my hearing loss, I have deficiency in higher tones and can't hear women and children's voices well," he says. "They thought I was ignoring them but I couldn't hear them. Now I answer when they call me."