Switch attention to listen

A biologically oriented algorithm for spatial sound segregation

Listening in an acoustically cluttered scene remains a difficult task for both machines and hearing-impaired listeners. Normal-hearing listeners accomplish this task with relative ease by segregating the scene into its constituent sound sources, then selecting and attending to a target source. An assistive listening device that mimics the biological mechanisms underlying this behavior may provide an effective solution for those with difficulty listening in acoustically cluttered environments (e.g., a cocktail party). Here, we present a binaural sound segregation algorithm based on a hierarchical network model of the auditory system. In the algorithm, binaural sound inputs first drive populations of neurons tuned to specific spatial locations and frequencies. The spiking response of neurons in the output layer are then reconstructed into audible waveforms via a novel reconstruction method. We evaluate the performance of the algorithm with a speech-on-speech intelligibility task in normal-hearing listeners. This two-microphone-input algorithm is shown to provide listeners with perceptual benefit similar to that of a 16-microphone acoustic beamformer. These results demonstrate the promise of this biologically inspired algorithm for enhancing selective listening in challenging multi-talker scenes.

Training with an auditory perceptual learning game transfers to speech in competition

Understanding speech in the presence of acoustical competition is a major complaint of those with hearing difficulties. Here, a novel perceptual learning game was tested for its effectiveness in reducing difficulties with hearing speech in competition. The game was designed to train a mixture of auditory processing skills thought to underlie speech in competition, such as spectral-temporal processing, sound localization, and auditory working memory. Training on these skills occurred both in quiet and in competition with noise. Thirty college-aged participants without any known hearing difficulties were assigned either to this mixed-training condition or an active control consisting of frequency discrimination training within the same gamified setting. To assess training effectiveness, tests of speech in competition (primary outcome), as well as basic supra-threshold auditory processing and cognitive processing abilities (secondary outcomes) were administered before and after training. Results suggest modest improvements on speech in competition tests in the mixed-training compared to the frequency-discrimination control condition (Cohen’s d = 0.68). While the sample is small, and in normally hearing individuals, these data suggest promise of future study in populations with hearing difficulties.

Comparison of Auditory, Language, Memory, and Attention Abilities in Children With and Without Listening Difficulties

Objectives School-age children with and without parent-reported listening difficulties (LiD) were compared on auditory processing, language, memory, and attention abilities. The objective was to extend what is known so far in the literature about children with LiD by using multiple measures and selective novel measures across the above areas. Design Twenty-six children who were reported by their parents as having LiD and 26 age-matched typically developing children completed clinical tests of auditory processing and multiple measures of language, attention, and memory. All children had normal-range pure-tone hearing thresholds bilaterally. Group differences were examined. Results In addition to significantly poorer speech-perception-in-noise scores, children with LiD had reduced speed and accuracy of word retrieval from long-term memory, poorer short-term memory, sentence recall, and inferencing ability. Statistically significant group differences were of moderate effect size; however, standard test scores of children with LiD were not clinically poor. No statistically significant group differences were observed in attention, working memory capacity, vocabulary, and nonverbal IQ. Conclusions Mild signal-to-noise ratio loss, as reflected by the group mean of children with LiD, supported the children's functional listening problems. In addition, children's relative weakness in select areas of language performance, short-term memory, and long-term memory lexical retrieval speed and accuracy added to previous research on evidence-based areas that need to be evaluated in children with LiD who almost always have heterogenous profiles. Importantly, the functional difficulties faced by children with LiD in relation to their test results indicated, to some extent, that commonly used assessments may not be adequately capturing the children's listening challenges. Supplemental Material https://doi.org/10.23641/asha.12808607.

Peripheral Auditory Involvement in Childhood Listening Difficulty

OBJECTIVES

This study tested the hypothesis that undetected peripheral hearing impairment occurs in children with idiopathic listening difficulties (LiDs), as reported by caregivers using the Evaluation of Children"s Listening and Processing Skills (ECLiPS) validated questionnaire, compared with children with typically developed (TD) listening abilities.

DESIGN

Children with LiD aged 6-14 years old (n = 60, mean age = 9.9 yr) and 54 typical age matched children were recruited from audiology clinical records and from IRB-approved advertisements at hospital locations and in the local and regional areas. Both groups completed standard and extended high-frequency (EHF) pure-tone audiometry, wideband absorbance tympanometry and middle ear muscle reflexes, distortion product and chirp transient evoked otoacoustic emissions. Univariate and multivariate mixed models and multiple regression analysis were used to examine group differences and continuous performance, as well as the influence of demographic factors and pressure equalization (PE) tube history.

RESULTS

There were no significant group differences between the LiD and TD groups for any of the auditory measures tested. However, analyses across all children showed that EHF hearing thresholds, wideband tympanometry, contralateral middle ear muscle reflexes, distortion product, and transient-evoked otoacoustic emissions were related to a history of PE tube surgery. The physiologic measures were also associated with EHF hearing loss, secondary to PE tube history.

CONCLUSIONS

Overall, the results of this study in a sample of children with validated LiD compared with a TD group matched for age and sex showed no significant differences in peripheral function using highly sensitive auditory measures. Histories of PE tube surgery were significantly related to EHF hearing and to a range of physiologic measures in the combined sample.

Comorbidity of Auditory Processing, Attention, and Memory in Children With Word Reading Difficulties

OBJECTIVES

To document the auditory processing, visual attention, digit memory, phonological processing, and receptive language abilities of individual children with identified word reading difficulties.

DESIGN

Twenty-five children with word reading difficulties and 28 control children with good word reading skills participated. All children were aged between 8 and 11 years, with normal hearing sensitivity and typical non-verbal intelligence. Both groups of children completed a test battery designed to assess their auditory processing, visual attention, digit memory, phonological processing, and receptive language.

RESULTS

When compared to children who were good readers, children with word reading difficulties obtained significantly lower average scores on tests of auditory processing, including the frequency pattern test, gaps in noise, frequency discrimination, Dichotic Digit difference Test, and Listening in Spatialized Noise. The two groups did not differ on the discrimination measures of sinusoidal amplitude modulation or iterated rippled noise. The results from children with word reading difficulties showed that 5 children (20%) had comorbid deficits in auditory processing, visual attention, and backward digit memory; whereas 12 children (48%) had comorbid auditory processing and visual attention deficits only, and 2 children (8%) had comorbid deficits in auditory processing and digit memory; the remaining children had only auditory processing, visual attention, or digit memory deficits.

CONCLUSION

The current study highlights the general co-existence of auditory processing, memory, and visual attention deficits in children with word reading difficulties. It is also noteworthy, however, that only one fifth of the current cohort had deficits across all measured tasks. Hence, our results also show the significant individual variability inherent in children with word reading difficulties.

Binaural sensitivity to temporal fine structure and lateralization ability in children with suspected (central) auditory processing disorder

OBJECTIVE

Previous studies have shown that a subgroup of children with suspected (central) auditory processing disorder (SusCAPD) have insufficient ability to use binaural cues to benefit from spatial processing. Thus, they experience considerable listening difficulties in challenging auditory environments, such as classrooms. Some researchers have also indicated the probable role of binaural temporal fine structure (TFS) in the perceptual segregation of target signal from noise and hence in speech perception in noise. Therefore, in the present study, in order to further investigate the underlying reason for listening problems against background noise in this group of children, their performance was measured using binaural TFS sensitivity test (TFS-LF) as well as behavioral auditory lateralization in noise test, both of which are based on binaural temporal cues processing.

METHODS

Participants in this analytical study included 91 children with normal hearing and no listening problems and 41 children (9-12 years old) with SusCAPD who found it challenging to understand speech in noise. Initially, the ability to use binaural TFS was measured at three frequencies (250, 500 and 750Hz) in both the groups, and the results of preliminary evaluations were compared between normal children and those with SusCAPD who participated in the study. Thereafter, the binaural performance of the 16 children with SusCAPD who had higher thresholds than the normal group at all three frequencies tested in TFS-LF test was examined using the lateralization test in 7 spatial locations.

RESULTS

Total 16 of the 41 children with SusCAPD who participated in this study (39%) showed poor performance on the TFS-LF test at all three frequencies, compared to both normal children and other children in the APD group (p<0.05). Furthermore, children in the APD group with binaural TFS coding deficits at all three frequencies revealed significant differences in the lateralization test results compared to normal children (p<0.05).

CONCLUSION

Findings of the current study demonstrated that one of the underlying causes for the difficulty understanding speech in noisy environments experienced by a subgroup of children with SusCAPD can be the reduced ability to benefit from binaural TFS information. This study also showed that a reduced ability to use binaural TFS cues in the group of children with SusCAPD was accompanied by reduced binaural processing abilities in the lateralization test which also admit the presence of binaural temporal processing deficits in this group of children.

Response to the Letter to the Editor From Moncrieff (2017) Regarding de Wit et al. (2016), "Characteristics of Auditory Processing Disorders: A Systematic Review"

PURPOSE

The purpose of this letter is to respond to Moncrieff's (2017) letter to the editor, "Response to de Wit et al., 2016, 'Characteristics of Auditory Processing Disorders: A Systematic Review,'" published in May 2017 by the Journal of Speech, Language, and Hearing Research.

CONCLUSION

We believe that our original conclusions are valid given the limited evidence that is currently available about the etiology of auditory processing disorders (APD). The focus of our systematic review was to identify the characteristics of children with a diagnosis of APD or a suspicion of APD. The results of our study showed that the characteristics of these children are not specific or limited to the auditory modality but are multimodal instead. In our view, it is incorrect to use the diagnosis APD, because there is not necessarily a specific auditory deficit in a large group of children suffering from listening difficulties. Before we start using any new diagnoses, a better insight into how bottom-up and top-down processes are precisely involved in listening needs to be developed. In addition, more insight is needed with respect to the similarities and differences between the different developmental disorders of children.

Children's Speech Perception in Noise: Evidence for Dissociation From Language and Working Memory

PURPOSE

We examined the association between speech perception in noise (SPIN), language abilities, and working memory (WM) capacity in school-age children. Existing studies supporting the Ease of Language Understanding (ELU) model suggest that WM capacity plays a significant role in adverse listening situations.

METHOD

Eighty-three children between the ages of 7 to 11 years participated. The sample represented a continuum of individual differences in attention, memory, and language abilities. All children had normal-range hearing and normal-range nonverbal IQ. Children completed the Bamford-Kowal-Bench Speech-in-Noise Test (BKB-SIN; Etymotic Research, 2005), a selective auditory attention task, and multiple measures of language and WM.

RESULTS

Partial correlations (controlling for age) showed significant positive associations among attention, memory, and language measures. However, BKB-SIN did not correlate significantly with any of the other measures. Principal component analysis revealed a distinct WM factor and a distinct language factor. BKB-SIN loaded robustly as a distinct 3rd factor with minimal secondary loading from sentence recall and short-term memory. Nonverbal IQ loaded as a 4th factor.

CONCLUSIONS

Results did not support an association between SPIN and WM capacity in children. However, in this study, a single SPIN measure was used. Future studies using multiple SPIN measures are warranted. Evidence from the current study supports the use of BKB-SIN as clinical measure of speech perception ability because it was not influenced by variation in children's language and memory abilities. More large-scale studies in school-age children are needed to replicate the proposed role played by WM in adverse listening situations.

Parental perception of listening difficulties: an interaction between weaknesses in language processing and ability to sustain attention

(Central) auditory processing disorder ((C)APD) is a controversial diagnostic category which may be an artefact of referral route. Yet referral route must, to some extent, be influenced by a child’s profile of presenting symptoms. This study tested the hypothesis that parental perception of listening difficulty is associated with weaknesses in ability to sustain attention while listening to speech. Forty-four children (24 with listening difficulties) detected targets embedded in a 16-minute story. The targets were either mispronunciations or nonsense words. Sentence context was modulated to separate out effects due to deficits in language processing from effects due to deficits in attention. Children with listening difficulties missed more targets than children with typical listening abilities. Both groups of children were initially sensitive to sentence context, but this declined over time in the children with listening difficulties. A report-based measure of language abilities captured the majority of variance in a measure capturing time-related changes in sensitivity to context. Overall, the findings suggest parents perceive children to have listening, not language difficulties, because weaknesses in language processing only emerge when stressed by the additional demands associated with attending to, and processing, speech over extended periods of time.

Evaluation of an objective listening effort measure in a selective, multi-speaker listening task using different hearing aid settings

Speaker recognition in a multi-speaker environment is a complex listening task that requires effort to be solved. Especially people with hearing loss show an increased listening effort in demanding listening situations compared to normal hearing people. However, a standardized method to quantify listening effort does not exist yet. Recently we have shown a possible way to determine listening effort objectively. The aim of this study was to validate the proposed objective measure in a challenging, true-to-life listening situation, and to get an insight on the influence of different hearing aid (HA) settings on the listening effort using the proposed measure. To achieve this we investigated the influence of four different HA settings and two different listening task difficulties (LTD) on the listening effort of people with hearing loss in a selective, real-speech listening task. HA setting A, B and C all had an adaptive compression with static characteristic, but differed in the gain and compression settings (more and less gain and more and less linear). Setting D had an adaptive compression whose characteristic was situation-dependent. To quantify the listening effort the ongoing oscillatory EEG activity was recorded as the basis to calculate the objective measure (OLEosc). By way of comparison a subjective listening effort score was determined on an individual basis (SLEscr). The results show that the OLEosc maps the SLEscr well in every of the tested conditions. Furthermore, the results also suggest that OLEosc might be more sensitive to small variances in listening effort than the employed subjective rating scale.

Evolving the concept of APD

OBJECTIVE

To consider the evolving concept of auditory processing disorder (APD).

DESIGN

Narrative review and opinion piece.

STUDY SAMPLE

Eight approaches to APD described in the literature and its definitions by ten societies or groups from around the world.

RESULTS

The dominant conceptualisation of APD remains one of disorders (or at least deficits) in the bottom-up processing of sound in the primary auditory nervous system that are not due to higher order (top-down) language or cognitive deficits. Challenges to this conceptualisation question the relevance of (bottom-up) AP to listening, learning and language. These challenges are rejected by some groups who maintain the dominant bottom-up conceptualisation of APD, but accepted by others who suggest APD be reconceptualised to include top-down processing of sound or attempts to define APD be de-emphasised in favour of a hierarchical approach to listening difficulties.

CONCLUSIONS

To reconcile these challenges, the concept of APD could be better evolved by considering it as a spectrum disorder spanning from bottom-up AP to the top-down cognitive processes (particularly attention) that affect it.

Characteristics of Auditory Processing Disorders: A Systematic Review

PURPOSE

The purpose of this review article is to describe characteristics of auditory processing disorders (APD) by evaluating the literature in which children with suspected or diagnosed APD were compared with typically developing children and to determine whether APD must be regarded as a deficit specific to the auditory modality or as a multimodal deficit.

METHOD

Six electronic databases were searched for peer-reviewed studies investigating children with (suspected) APD in comparison with typically developing peers. Relevant studies were independently reviewed and appraised by 2 reviewers. Methodological quality was quantified using the American Speech-Language-Hearing Association's levels of evidence.

RESULTS

Fifty-three relevant studies were identified. Five studies were excluded because of weak internal validity. In total, 48 studies were included, of which only 1 was classified as having strong methodological quality. Significant dissimilarities were found between children referred with listening difficulties and controls. These differences relate to auditory and visual functioning, cognition, language, reading, and physiological and neuroimaging measures.

CONCLUSIONS

Methodological quality of most of the incorporated studies was rated moderate due to the heterogeneous groups of participants, inadequate descriptions of participants, and the omission of valid and reliable measurements. The listening difficulties of children with APD may be a consequence of cognitive, language, and attention issues rather than bottom-up auditory processing.

Long-term influence of recurrent acute otitis media on neural involuntary attention switching in 2-year-old children

BACKGROUND

A large group of young children are exposed to repetitive middle ear infections but the effects of the fluctuating hearing sensations on immature central auditory system are not fully understood. The present study investigated the consequences of early childhood recurrent acute otitis media (RAOM) on involuntary auditory attention switching.

METHODS

By utilizing auditory event-related potentials, neural mechanisms of involuntary attention were studied in 22-26 month-old children (N = 18) who had had an early childhood RAOM and healthy controls (N = 19). The earlier and later phase of the P3a (eP3a and lP3a) and the late negativity (LN) were measured for embedded novel sounds in the passive multi-feature paradigm with repeating standard and deviant syllable stimuli. The children with RAOM had tympanostomy tubes inserted and all the children in both study groups had to have clinically healthy ears at the time of the measurement assessed by an otolaryngologist.

RESULTS

The results showed that lP3a amplitude diminished less from frontal to central and parietal areas in the children with RAOM than the controls. This might reflect an immature control of involuntary attention switch. Furthermore, the LN latency was longer in children with RAOM than in the controls, which suggests delayed reorientation of attention in RAOM.

CONCLUSIONS

The lP3a and LN responses are affected in toddlers who have had a RAOM even when their ears are healthy. This suggests detrimental long-term effects of RAOM on the neural mechanisms of involuntary attention.

Costs of switching auditory spatial attention in following conversational turn-taking

Following a multi-talker conversation relies on the ability to rapidly and efficiently shift the focus of spatial attention from one talker to another. The current study investigated the listening costs associated with shifts in spatial attention during conversational turn-taking in 16 normally-hearing listeners using a novel sentence recall task. Three pairs of syntactically fixed but semantically unpredictable matrix sentences, recorded from a single male talker, were presented concurrently through an array of three loudspeakers (directly ahead and +/−30° azimuth). Subjects attended to one spatial location, cued by a tone, and followed the target conversation from one sentence to the next using the call-sign at the beginning of each sentence. Subjects were required to report the last three words of each sentence (speech recall task) or answer multiple choice questions related to the target material (speech comprehension task). The reading span test, attention network test, and trail making test were also administered to assess working memory, attentional control, and executive function. There was a 10.7 ± 1.3% decrease in word recall, a pronounced primacy effect, and a rise in masker confusion errors and word omissions when the target switched location between sentences. Switching costs were independent of the location, direction, and angular size of the spatial shift but did appear to be load dependent and only significant for complex questions requiring multiple cognitive operations. Reading span scores were positively correlated with total words recalled, and negatively correlated with switching costs and word omissions. Task switching speed (Trail-B time) was also significantly correlated with recall accuracy. Overall, this study highlights (i) the listening costs associated with shifts in spatial attention and (ii) the important role of working memory in maintaining goal relevant information and extracting meaning from dynamic multi-talker conversations.

Attention, memory, and auditory processing in 10- to 15-year-old children with listening difficulties

PURPOSE

The aim of this study was to examine attention, memory, and auditory processing in children with reported listening difficulty in noise (LDN) despite having clinically normal hearing.

METHOD

Twenty-one children with LDN and 15 children with no listening concerns (controls) participated. The clinically normed auditory processing tests included the Frequency/Pitch Pattern Test (FPT; Musiek, 2002), the Dichotic Digits Test (Musiek, 1983), the Listening in Spatialized Noise-Sentences (LiSN-S) test (Dillon, Cameron, Glyde, Wilson, & Tomlin, 2012), gap detection in noise (Baker, Jayewardene, Sayle, & Saeed, 2008), and masking level difference (MLD; Wilson, Moncrieff, Townsend, & Pillion, 2003). Also included were research-based psychoacoustic tasks, such as auditory stream segregation, localization, sinusoidal amplitude modulation (SAM), and fine structure perception. All were also evaluated on attention and memory test batteries.

RESULTS

The LDN group was significantly slower switching their auditory attention and had poorer inhibitory control. Additionally, the group mean results showed significantly poorer performance on FPT, MLD, 4-Hz SAM, and memory tests. Close inspection of the individual data revealed that only 5 participants (out of 21) in the LDN group showed significantly poor performance on FPT compared with clinical norms. Further testing revealed the frequency discrimination of these 5 children to be significantly impaired.

CONCLUSION

Thus, the LDN group showed deficits in attention switching and inhibitory control, whereas only a subset of these participants demonstrated an additional frequency resolution deficit.

Sources of pathology underlying listening disorders in children

Some children referred to audiology and developmental disability services have listening difficulties, despite normal audiograms. These children may be tested for 'auditory processing disorder' (APD), a controversial construct suggesting that neural dysfunction in the central auditory system leads to impaired auditory perception. An important question, not currently tested in clinical evaluation, is whether listening difficulties result from problems with bottom-up auditory sensory processing or top-down modulating cognition. Perceptual variability and poor performance on standardized tests suggest that listening difficulties are primarily cognitive in origin. However, evidence for impaired olivocochlear function and temporal processing deficits may implicate peripheral or central auditory dysfunction in some cases. Wide-spread, top-down modulation of auditory cortical, brainstem and ear function suggests that afferent and efferent control systems may not be simple to segregate. During normal maturation, hearing appears to develop in proportion to the complexity of both stimuli and tasks. But some younger individuals have mature hearing, highlighting individual differences that suggest APD may be due to a generalized developmental delay. Recent studies have investigated specific hypotheses showing, for example, that spatial hearing and executive function are compromised in some children with listening difficulties. Using speech stimuli (e.g. consonant-vowel syllables) to examine auditory brainstem responses, and psychophysiological relations between dichotic hearing and cortical physiology, various effects of auditory experience and development point the way to promising approaches for further studies of APD. Newer technology, from genetic sequencing to MRI, may have the sensitivity to test whether and how frequently APD is associated with impaired processing in the auditory system.