Creating a health informatics data resource for hearing health research

BACKGROUND

The National Institute of Health and Social Care Research (NIHR) Health Informatics Collaborative (HIC) for Hearing Health has been established in the UK to curate routinely collected hearing health data to address research questions. This study defines priority research areas, outlines its aims, governance structure and demonstrates how hearing health data have been integrated into a common data model using pure tone audiometry (PTA) as a case study.

METHODS

After identifying key research aims in hearing health, the governance structure for the NIHR HIC for Hearing Health is described. The Observational Medical Outcomes Partnership (OMOP) was chosen as our common data model to provide a case study example.

RESULTS

The NIHR HIC Hearing Health theme have developed a data architecture outlying the flow of data from all of the various siloed electronic patient record systems to allow the effective linkage of data from electronic patient record systems to research systems. Using PTAs as an example, OMOPification of hearing health data successfully collated a rich breadth of datapoints across multiple centres.

CONCLUSION

This study identified priority research areas where routinely collected hearing health data could be useful. It demonstrates integration and standardisation of such data into a common data model from multiple centres. By describing the process of data sharing across the HIC, we hope to invite more centres to contribute and utilise data to address research questions in hearing health. This national initiative has the power to transform UK hearing research and hearing care using routinely collected clinical data.

Acoustic reflexes: should we be paying more attention?

OBJECTIVE

The clinical audiology test battery often involves playing physically simple sounds with questionable ecological value to the listener. In this technical report, we revisit how valid this approach is using an automated, involuntary auditory response; the acoustic reflex threshold (ART).

DESIGN

The ART was estimated four times in each individual in a quasi-random ordering of task conditions. The baseline condition (referred to as Neutral) measured the ART following a standard clinical practice. Three experimental conditions were then used in which a secondary task was performed whilst the reflex was measured: auditory attention, auditory distraction and visual distraction tasks.

STUDY SAMPLE

Thirty-eight participants (27 males) with a mean age of 23 years were tested. All participants were audiometrically healthy.

RESULTS

The ART was elevated when a visual task was performed at the same time as the measurements were taken. Performing an auditory task did not affect the ART.

CONCLUSIONS

These data indicate that simple audiometric measures widely used in the clinic, can be affected by central, non-auditory processes even in healthy, normal-hearing volunteers. The role of cognition and attention on auditory responses will become ever more important in the coming years.

Divergent effects of listening demands and evaluative threat on listening effort in online and laboratory settings

Objective

Listening effort (LE) varies as a function of listening demands, motivation and resource availability, among other things. Motivation is posited to have a greater influence on listening effort under high, compared to low, listening demands.

Methods

To test this prediction, we manipulated the listening demands of a speech recognition task using tone vocoders to create moderate and high listening demand conditions. We manipulated motivation using evaluative threat, i.e., informing participants that they must reach a particular "score" for their results to be usable. Resource availability was assessed by means of working memory span and included as a fixed effects predictor. Outcome measures were indices of LE, including reaction times (RTs), self-rated work and self-rated tiredness, in addition to task performance (correct response rates). Given the recent popularity of online studies, we also wanted to examine the effect of experimental context (online vs. laboratory) on the efficacy of manipulations of listening demands and motivation. We carried out two highly similar experiments with two groups of 37 young adults, a laboratory experiment and an online experiment. To make listening demands comparable between the two studies, vocoder settings had to differ. All results were analysed using linear mixed models.

Results

Results showed that under laboratory conditions, listening demands affected all outcomes, with significantly lower correct response rates, slower RTs and greater self-rated work with higher listening demands. In the online study, listening demands only affected RTs. In addition, motivation affected self-rated work. Resource availability was only a significant predictor for RTs in the online study.

Discussion

These results show that the influence of motivation and listening demands on LE depends on the type of outcome measures used and the experimental context. It may also depend on the exact vocoder settings. A controlled laboratory settings and/or particular vocoder settings may be necessary to observe all expected effects of listening demands and motivation.

Relationship between self-reported listening and communication difficulties and executive function: a protocol for a systematic review and meta-analysis

INTRODUCTION

Listening and communication difficulties can limit people's participation in activity and adversely affect their quality of life. Hearing, as well as listening and communication difficulties, can be measured either by using behavioural tests or self-report measures, and the outcomes are not always closely linked. The association between behaviourally measured and self-reported hearing is strong, whereas the association between behavioural and self-reported measures of listening and communication difficulties is much weaker, suggesting they assess different aspects of listening. While behavioural measures of listening and communication difficulties have been associated with poorer cognitive performance including executive functions, the same association has not always been shown for self-report measures. The objective of this systematic review and meta-analysis is to understand the relationship between executive function and self-reported listening and communication difficulties in adults with hearing loss, and where possible, potential covariates of age and pure-tone audiometric thresholds.

METHODS AND ANALYSIS

Studies will be eligible for inclusion if they report data from both a self-report measure of listening difficulties and a behavioural measure of executive function. Eight databases are to be searched: MEDLINE (via Ovid SP), EMBASE (via Ovid SP), PsycINFO (via Ovid SP), ASSIA (via ProQuest), Cumulative Index to Nursing and Allied Health Literature or CINAHL (via EBSCO Host), Scopus, PubMed and Web of Science (Science and Social Science Citation Index). The JBI critical appraisal tool will be used to assess risk of bias for included studies. Results will be synthesised primarily using a meta-analysis, and where sufficient quantitative data are not available, a narrative synthesis will be carried out to describe key results.

ETHICS AND DISSEMINATION

No ethical issues are foreseen. Data will be disseminated via academic publication and conference presentations. Findings may also be published in scientific newsletters and magazines.

PROSPERO REGISTRATION NUMBER

CRD42022293546.

A review of auditory processing and cognitive change during normal ageing, and the implications for setting hearing aids for older adults

Throughout our adult lives there is a decline in peripheral hearing, auditory processing and elements of cognition that support listening ability. Audiometry provides no information about the status of auditory processing and cognition, and older adults often struggle with complex listening situations, such as speech in noise perception, even if their peripheral hearing appears normal. Hearing aids can address some aspects of peripheral hearing impairment and improve signal-to-noise ratios. However, they cannot directly enhance central processes and may introduce distortion to sound that might act to undermine listening ability. This review paper highlights the need to consider the distortion introduced by hearing aids, specifically when considering normally-ageing older adults. We focus on patients with age-related hearing loss because they represent the vast majority of the population attending audiology clinics. We believe that it is important to recognize that the combination of peripheral and central, auditory and cognitive decline make older adults some of the most complex patients seen in audiology services, so they should not be treated as "standard" despite the high prevalence of age-related hearing loss. We argue that a primary concern should be to avoid hearing aid settings that introduce distortion to speech envelope cues, which is not a new concept. The primary cause of distortion is the speed and range of change to hearing aid amplification (i.e., compression). We argue that slow-acting compression should be considered as a default for some users and that other advanced features should be reconsidered as they may also introduce distortion that some users may not be able to tolerate. We discuss how this can be incorporated into a pragmatic approach to hearing aid fitting that does not require increased loading on audiology services.

Sex differences and the effect of female sex hormones on auditory function: a systematic review

Aims

First, to discuss sex differences in auditory function between women and men, and whether cyclic fluctuations in levels of female sex hormones (i.e., estradiol and progesterone) affect auditory function in pre-menopausal and post-menopausal women. Second, to systematically review the literature concerning the discussed patterns in order to give an overview of the methodologies used in research. Last, to identify the gap in knowledge and to make recommendations for future work.

Methods for the systematic review

Population, Exposure, Control, Outcome and Study design (PECOS) criteria were used in developing the review questions. The review protocol follows the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was pre-registered in the Prospective Register of Systematic Reviews (PROSPERO; CRD42020201480). Data Sources: EMBASE, PubMed, MEDLINE (Ovid), PsycINFO, ComDisDome, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL) via Cochrane Library, and scanning reference lists of relevant studies, and internet resources (i.e., Mendeley) were used. Only studies published between 1999 and 2022, in English, or in English translation, were included. The quality of evidence was assessed using the Newcastle-Ottawa Scale (NOS).

Results

Sex differences: Women had more sensitive hearing (measured at the level of peripheral and central auditory system) than men. Cyclic fluctuations: Auditory function in women fluctuated during the menstrual cycle, while no such fluctuations in men over the same time period were reported. Hearing sensitivity improved in women during the late follicular phase, and decrease during the luteal phase, implying an effect of female sex hormones, although the specific effects of estradiol and progesterone fluctuations on the central auditory system remain unclear. Hearing sensitivity in women declined rapidly at the onset of menopause.

Conclusion

The review has shown the following. Consistent sex differences exist in auditory function across the auditory pathway with pre-menopausal women often showing better function than age-matched men. Moreover, pre-menopausal women show fluctuations in hearing function across the menstrual cycle with a better function during the peak of estradiol or when the ratio of estradiol to progesterone is high. Third, menopause marks the onset of hearing loss in women, characterized by a rapid decline in hearing sensitivity and a more pronounced loss than in age-matched men. Finally, the systematic review highlights the need for well-designed and -controlled studies to evaluate the influence of estradiol and progesterone on hearing by consistently including control groups (e.g., age-matched man), using objective tests to measure hormonal levels (e.g., in saliva or blood), and by testing participants at different points across the menstrual cycle.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020201480, identifier CRD42020201480.

Did Changes to Adult Hearing Aid Pathways Due to COVID-19 Affect Patient Outcomes? A Service Evaluation

Objective:

The objective of this study was to determine whether changes to adult hearing aid provision during COVID-19 affected patient outcomes or service efficiency.

Design:

A service evaluation compared three cohorts: patients who had hearing aid provision prior to the COVID-19 pandemic (the conventional pathway); patients who had hearing aid provision during the initial national lockdown (remote fittings); and patients who had hearing aid provision during the gradual reopening phase (a blended service with both face-to-face and remote service provision). Outcomes measured the effectiveness and efficiency of the service, using the Glasgow Hearing Aid Benefit/Difference Profiles (GHABP/DP) and number of follow-up appointments required. Results were assessed using descriptive statistics and error bars, separately for new and existing users.

Sample:

This study included 240 hearing aid users.

Results:

Remote fittings adversely impacted the effectiveness of provision for new hearing aid users with a reduction in all GHABP domains. While new users' benefit was equally as good for blended and conventional service provision, blended provision was less efficient and required more follow-up visits. For existing hearing aid users, no differences were seen in GHADP outcomes of different pathways and remote fittings increased service efficiency.

Conclusions:

Remote hearing aid fittings are less effective for new users than hearing aids fitted using standard face-to-face service provision or service provision using a blended model of remote and face-to-face care. Current pathways using a blended model of care are less efficient but equally effective for new hearing aid users compared with provision prior to COVID-19 and result in equivalent patient outcomes in terms of benefit.

Supplemental Material:

https://doi.org/10.23641/asha.21067585

[Clinical radiological evaluation of teeth-part 2 : Caries, inflammatory dental changes and important differential diagnoses]

Inflammatory diseases of the teeth and periodontium are widespread and are frequent secondary diagnoses in head and neck examinations. Periapical inflammation can be the cause of sinusitis or abscess formation in the oral and maxillofacial region. Early detection is important for the patient's course of treatment. For further diagnostics, a dental presentation should be carried out. Dental radiological examinations, such as panoramic radiographs and dental films are used for specific diagnostics. This article is intended to provide an overview of the different stages of caries, the most important inflammatory dental changes and their most frequent differential diagnoses.

[Clinical radiological evaluation of teeth-part 1 : Anatomy and anomalies]

Radiological assessment of the teeth and periodontium is often left to the dentist. Nevertheless, it is useful to know the anatomy and possible anomalies of the teeth in order to correctly assess pathological processes in both projection radiographic and slice imaging. Dental radiological examinations, such as panoramic slice imaging (PSA) and dental film are used for targeted diagnostics. In the case of incidental findings, a dental presentation should be made for further clarification. This article first provides an overview of the anatomy and anomalies of teeth.

The Effectiveness of Unilateral Cochlear Implantation on Performance-Based and Patient-Reported Outcome Measures in Finnish Recipients

Understanding speech is essential for adequate social interaction, and its functioning affects health, wellbeing, and quality of life (QoL). Untreated hearing loss (HL) is associated with reduced social activity, depression and cognitive decline. Severe and profound HL is routinely rehabilitated with cochlear implantation. The success of treatment is mostly assessed by performance-based outcome measures such as speech perception. The ultimate goal of cochlear implantation, however, is to improve the patient’s QoL. Therefore, patient-reported outcomes measures (PROMs) would be clinically valuable as they assess subjective benefits and overall effectiveness of treatment. The aim of this study was to assess the patient-reported benefits of unilateral cochlear implantation in an unselected Finnish patient cohort of patients with bilateral HL. The study design was a prospective evaluation of 118 patients. The patient cohort was longitudinally followed up with repeated within-subject measurements preoperatively and at 6 and 12 months postoperatively. The main outcome measures were one performance-based speech-in-noise (SiN) test (Finnish Matrix Sentence Test), and two PROMs [Finnish versions of the Speech, Spatial, Qualities of Hearing questionnaire (SSQ) and the Nijmegen Cochlear Implant Questionnaire (NCIQ)]. The results showed significant average improvements in SiN scores, from +0.8 dB signal-to-noise ratio (SNR) preoperatively to −3.7 and −3.8 dB SNR at 6 and12 month follow-up, respectively. Significant improvements were also found for SSQ and NCIQ scores in all subdomains from the preoperative state to 6 and 12 months after first fitting. No clinically significant improvements were observed in any of the outcome measures between 6 and 12 months. Preoperatively, poor SiN scores were associated with low scoring in several subdomains of the SSQ and NCIQ. Poor preoperative SiN scores and low PROMs scoring were significantly associated with larger postoperative improvements. No significant association was found between SiN scores and PROMs postoperatively. This study demonstrates significant benefits of cochlear implantation in the performance-based and patient-reported outcomes in an unselected patient sample. The lack of association between performance and PROMs scores postoperatively suggests that both capture unique aspects of benefit, highlighting the need to clinically implement PROMs in addition to performance-based measures for a more holistic assessment of treatment benefit.

Quantifying the Effects of Motivation on Listening Effort: A Systematic Review and Meta-Analysis

Motivation influences the amount of listening effort (LE) exerted or experienced under challenging conditions, such as in high-noise environments. This systematic review and meta-analysis is the first to quantify the effects of motivation on LE. The review was pre-registered in PROSPERO, and performed in accordance with PRISMA guidelines. Eligible studies examined the influence of motivation or individual traits (related to motivation) on LE in adults. Motivational factors, coded as independent variables, included financial reward, evaluative threat, perceived competence, feedback, and individual traits. LE outcomes were categorized as subjective, behavioral, or physiological. The quality of evidence was assessed using an adaptation of the Cochrane Collaboration Risk of Bias Tool. Nested random-effects meta-analyses were performed to quantify and compare the influence of motivational factors across LE outcomes. After assessing 3,532 records, 48 studies met the inclusion criteria and 43 were included in the meta-analyses. Risk of bias was high, for example, many studies lacked sample size justification. Motivational factors had a small-to-medium effect (mean Cohen's d = 0.34, range: 0.11-0.72) on LE. When LE outcomes were considered collectively, an external manipulation of motivation (perceived competence) produced a larger mean effect size compared with individual traits. Some combinations of motivational factors and LE outcomes produced more robust effects than others, for example, evaluative threat and subjective LE outcomes. Although wide prediction intervals and high risk of bias mean that significant positive effects cannot be guaranteed, these findings provide useful guidance on the selection of motivational factors and LE outcomes for future research.

Clinical Trials and Outcome Measures in Adults With Hearing Loss

Clinical trials are designed to evaluate interventions that prevent, diagnose or treat a health condition and provide the evidence base for improving practice in health care. Many health professionals, including those working within or allied to hearing health, are expected to conduct or contribute to clinical trials. Recent systematic reviews of clinical trials reveal a dearth of high quality evidence in almost all areas of hearing health practice. By providing an overview of important steps and considerations concerning the design, analysis and conduct of trials, this article aims to give guidance to hearing health professionals about the key elements that define the quality of a trial. The article starts out by situating clinical trials within the greater scope of clinical evidence, then discusses the elements of a PICO-style research question. Subsequently, various methodological considerations are discussed including design, randomization, blinding, and outcome measures. Because the literature on outcome measures within hearing health is as confusing as it is voluminous, particular focus is given to discussing how hearing-related outcome measures affect clinical trials. This focus encompasses how the choice of measurement instrument(s) affects interpretation, how the accuracy of a measure can be estimated, how this affects the interpretation of results, and if differences are statistically, perceptually and/or clinically meaningful to the target population, people with hearing loss.

[The effect of mobile air filter systems on aerosol concentrations in large volume scenarios against the background of the risk of infection of COVID-19. Can classroom teaching be resumed?]

BACKGROUND

As a consequence of the corona pandemic, universities nationwide had stopped classroom teaching by the start of the summer semester 2020. As part of the second lockdown, in many states schools and day care centers were also closed or reduced to a minimum. In this context the effect of room air filters has already been discussed multiple times; however, mobile devices for air filtration are currently not recommended by the German Federal Environment Agency. The following investigation shows the real effects of mobile air filters on aerosol concentrations when used in lecture theaters, canteens or school learning centers.

METHODS

The effects of a mobile air purifier (DEMA-airtech, Stuttgart, Germany) were measured in three large rooms (a lecture theater, a company canteen and a learning center of a grammar school). Aerosol and carbon dioxide concentrations were determined with devices from the company Palas (Karlsruhe, Germany).

RESULTS

All three scenarios showed a relevant and permanent decrease in aerosol concentrations through the use of air filters. The effect partly even surpassed the effectiveness of simple ventilation by opening the windows.

CONCLUSION

In addition to social distancing and wearing highly efficient face masks, the use air filters is recommended. This measure could enable classroom teaching to be resumed.

Financial reward has differential effects on behavioural and self-report measures of listening effort

OBJECTIVES

To investigate the effects of listening demands and motivation on listening effort (LE) in a novel speech recognition task.

DESIGN

We manipulated listening demands and motivation using vocoded speech and financial reward, respectively, and measured task performance (correct response rate) and indices of LE (response times (RTs), subjective ratings of LE and likelihood of giving up). Effects of inter-individual differences in cognitive skills and personality on task performance and LE were also assessed within the context of the Cognitive Energetics Theory (CET).

STUDY SAMPLE

Twenty-four participants with normal-hearing (age range: 19 - 33 years, 6 male).

RESULTS

High listening demands decreased the correct response rate and increased RTs, self-rated LE and self-rated likelihood of giving up. High financial reward increased subjective LE ratings only. Mixed-effects modelling showed small fixed effects for competitiveness on LE measured using RTs. Small fixed effects were found for cognitive skills (lexical decision RTs and backwards digit span) on LE measured using RTs and correct response rate, respectively.

CONCLUSIONS

The effects of listening demands on LE in the speech recognition task aligned with CET, whereas predictions regarding the influence of motivation, cognitive skills and personality were only partially supported.

Forensic postmortem computed tomography in suspected unnatural adult deaths

PURPOSE

Our study sought to evaluate validity of forensic postmortem CT in establishing cause of death (COD) in suspected unnatural adult death based on the reference standard of autopsy.

METHODS

In our prospective, single-center study, 64 of 94 consecutive corpses (70.7 % male, mean age: 47.4 years) who underwent CT and autopsy between November 2013 and April 2019 were included in the analysis. Primary objective was agreement between CT and autopsy on primary COD using kappa statistics. Secondary objectives were competing COD and specific pathological findings.

RESULTS

Agreement on primary COD between forensic CT and autopsy without or in consideration of toxicological and histological findings was strong (85.9 % [55 of 64 corpses]; κ = 0.83 [95 %CI: 0.74 to 0.93] and 95.3 % [61 of 64 corpses]; κ = 0.94 [95 %CI: 0.84-1.04], respectively, McNemar p = 0.03). Sensitivity and specificity of CT in identification of acute heart failure, intracranial bleeding, burns and heat shocks, gunshot wounds, polytrauma, cranio-cerebral trauma, and strangulation or hanging was 100 %, each. Acute respiratory failure was detected with a sensitivity and specificity of 100 % and 96.8 %, cuts and stab wounds with 95.2 % and 100 %, and intoxication, pneumonia, or gastrointestinal bleeding with 60.0 % and 100 %, respectively. Agreement on competing COD was moderate (51.6 %, [33 of 64 corpses]; κ = 0.47 [95 %CI: 0.40 to 0.53], p < 0.001).

CONCLUSIONS

Forensic postmortem CT, complemented by external, toxicological, and histological examination was sufficiently valid to assess primary COD in the majority of suspected unnatural deaths with few restrictions.

[Chronic nonbacterial osteomyelitis : Imaging and differential diagnoses]

Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disease in childhood and adolescence with a preference for the female gender. It is manifested with multiple osseous lesions, with a predilection for the metaphyseal end zones of the long bones of the lower extremities. These bone lesions usually occur multifocally, can recur and develop a different appearance depending on the bone structure affected. Patients present with a longer disease history, changing clinical symptoms and unspecific paraclinical signs. Magnetic resonance imaging (MRI) is the imaging of choice and particularly as a whole body examination can speed up the diagnosis and is an important component of follow-up controls. Differential diagnoses include numerous inflammatory, benign and malignant bone diseases. Therefore, it is essential to know the diagnosis of CNO and to take it into consideration in cases of an unclear inflammatory bone process in young patients.

Reproducibility in Cognitive Hearing Research: Theoretical Considerations and Their Practical Application in Multi-Lab Studies

In this article, we consider the issue of reproducibility within the field of cognitive hearing science. First, we examine how retest reliability can provide useful information for the generality of results and intervention effectiveness. Second, we provide an overview of retest reliability coefficients within three areas of cognitive hearing science (cognition, speech perception, and self-reported measures of communication) and show how the reporting of these coefficients differs between fields. We argue that practices surrounding the provision of retest coefficients are currently most rigorous in clinical assessment and that basic science research would benefit from adopting similar standards. Finally, based on a distinction between direct replications (which aim to keep materials as close to the original study as possible) and conceptual replications (which test the same purported mechanism using different materials), we discuss new initiatives which address the need for both. Using the example of the auditory Stroop task, we provide practical illustrations of how these theoretical issues can be addressed within the context of a multi-lab replication study. By illustrating how theoretical concepts can be put into practice in empirical research, we hope to encourage others to set up and participate in a wide variety of reproducibility-related studies.

The role of cognition for speech-in-noise perception: Considering individual listening strategies related to aging and hearing loss

Listening to speech in a noisy background is difficult for everyone. While such listening has historically been considered mainly in the context of auditory processing, the role of cognition has attracted considerable interest in recent years. This has been particularly true in the context of life-span research and the comparison of younger and older listeners. This article will discuss three factors that are important to consider when investigating the nature of cognitive involvement in speech-in-noise (SiN) perception: (1) the listening situation, (2) listener variables, and (3) the role of hearing aids. I argue that a similar level of intelligibility can be achieved with the support of very different skills, or listening strategies, depending on the listening situation and listener. Age as a variable is particularly instructive for this type of research as it is accompanied by auditory as well as cognitive changes. As age-related changes are not uniform, using aging as a tool for the investigation can increase the opportunity to see individual differences in contributing processes and resulting compensation strategies. In addition to highlighting different interaction effects between hearing and cognition, I will argue that our conceptual understanding of the underlying processes can only be furthered if the selection of cognitive tests and experimental procedures in SiN studies follows accepted cognitive models, so that understanding can advance on a conceptual level without reliance on a particular test. Ultimately, a better understanding of the various listening strategies available to listeners, and the conditions under which they are used, may have theoretical as well as practical implications. Theoretically, it may help us better understand phenomena such as listening effort. Practically, it may guide us toward more effective diagnosis and intervention for listening difficulties in everyday life.

Visual Inhibition Measures Predict Speech-in-Noise Perception Only in People With Low Levels of Education

Inhibition-the ability to suppress goal-irrelevant information-is thought to be an important cognitive skill in many situations, including speech-in-noise (SiN) listening. Both inhibition and SiN perception are thought to worsen with age, but attempts to connect age-related declines in these two abilities have produced mixed results even though a clear positive relationship has generally been hypothesized. We suggest that these inconsistencies may occur because listener-based demographic variables such as educational attainment modulate the relationship between inhibition and SiN perception. We tested this hypothesis with a group of 50 older adults (61-86 years, mean: 69.5) with mild-to-moderate age-related hearing loss (8-53 average dB HL, mean: 25.3 dB HL). Participants performed a visual Stroop task and two SiN tasks. In a Stroop task one stimulus dimension is named while a second, more prepotent dimension is ignored. Results show a clear influence of educational attainment on the relationship of visual Stroop scores to SiN performance, but only for those with lower levels of education. These findings highlight for the first time the importance of considering potentially heterogeneous demographic listener variables when analyzing cognitive tasks and their relationship to SiN perception.

Different Measures of Auditory and Visual Stroop Interference and Their Relationship to Speech Intelligibility in Noise

Inhibition-the ability to suppress goal-irrelevant information-is thought to be an important cognitive skill in many situations, including speech-in-noise (SiN) perception. One way to measure inhibition is by means of Stroop tasks, in which one stimulus dimension must be named while a second, more prepotent dimension is ignored. The to-be-ignored dimension may be relevant or irrelevant to the target dimension, and the inhibition measure-Stroop interference (SI)-is calculated as the reaction time difference between the relevant and irrelevant conditions. Both SiN perception and inhibition are suggested to worsen with age, yet attempts to connect age-related declines in these two abilities have produced mixed results. We suggest that the inconsistencies between studies may be due to methodological issues surrounding the use of Stroop tasks. First, the relationship between SI and SiN perception may differ depending on the modality of the Stroop task; second, the traditional SI measure may not account for generalized slowing or sensory declines, and thus may not provide a pure interference measure. We investigated both claims in a group of 50 older adults, who performed two Stroop tasks (visual and auditory) and two SiN perception tasks. For each Stroop task, we calculated interference scores using both the traditional difference measure and methods designed to address its various problems, and compared the ability of these different scoring methods to predict SiN performance, alone and in combination with hearing sensitivity. Results from the two Stroop tasks were uncorrelated and had different relationships to SiN perception. Changing the scoring method altered the nature of the predictive relationship between Stroop scores and SiN perception, which was additionally influenced by hearing sensitivity. These findings raise questions about the extent to which different Stroop tasks and/or scoring methods measure the same aspect of cognition. They also highlight the importance of considering additional variables such as hearing ability when analyzing cognitive variables.

The Association Between Cognitive Performance and Speech-in-Noise Perception for Adult Listeners: A Systematic Literature Review and Meta-Analysis

Published studies assessing the association between cognitive performance and speech-in-noise (SiN) perception examine different aspects of each, test different listeners, and often report quite variable associations. By examining the published evidence base using a systematic approach, we aim to identify robust patterns across studies and highlight any remaining gaps in knowledge. We limit our assessment to adult unaided listeners with audiometric profiles ranging from normal hearing to moderate hearing loss. A total of 253 articles were independently assessed by two researchers, with 25 meeting the criteria for inclusion. Included articles assessed cognitive measures of attention, memory, executive function, IQ, and processing speed. SiN measures varied by target (phonemes or syllables, words, and sentences) and masker type (unmodulated noise, modulated noise, >2-talker babble, and ≤2-talker babble. The overall association between cognitive performance and SiN perception was r = .31. For component cognitive domains, the association with (pooled) SiN perception was as follows: processing speed ( r = .39), inhibitory control ( r = .34), working memory ( r = .28), episodic memory ( r = .26), and crystallized IQ ( r = .18). Similar associations were shown for the different speech target and masker types. This review suggests a general association of r≈.3 between cognitive performance and speech perception, although some variability in association appeared to exist depending on cognitive domain and SiN target or masker assessed. Where assessed, degree of unaided hearing loss did not play a major moderating role. We identify a number of cognitive performance and SiN perception combinations that have not been tested and whose future investigation would enable further fine-grained analyses of these relationships.

Only Behavioral But Not Self-Report Measures of Speech Perception Correlate with Cognitive Abilities

Good speech perception and communication skills in everyday life are crucial for participation and well-being, and are therefore an overarching aim of auditory rehabilitation. Both behavioral and self-report measures can be used to assess these skills. However, correlations between behavioral and self-report speech perception measures are often low. One possible explanation is that there is a mismatch between the specific situations used in the assessment of these skills in each method, and a more careful matching across situations might improve consistency of results. The role that cognition plays in specific speech situations may also be important for understanding communication, as speech perception tests vary in their cognitive demands. In this study, the role of executive function, working memory (WM) and attention in behavioral and self-report measures of speech perception was investigated. Thirty existing hearing aid users with mild-to-moderate hearing loss aged between 50 and 74 years completed a behavioral test battery with speech perception tests ranging from phoneme discrimination in modulated noise (easy) to words in multi-talker babble (medium) and keyword perception in a carrier sentence against a distractor voice (difficult). In addition, a self-report measure of aided communication, residual disability from the Glasgow Hearing Aid Benefit Profile, was obtained. Correlations between speech perception tests and self-report measures were higher when specific speech situations across both were matched. Cognition correlated with behavioral speech perception test results but not with self-report. Only the most difficult speech perception test, keyword perception in a carrier sentence with a competing distractor voice, engaged executive functions in addition to WM. In conclusion, any relationship between behavioral and self-report speech perception is not mediated by a shared correlation with cognition.