Working Memory and Speech Recognition in Noise Under Ecologically Relevant Listening Conditions: Effects of Visual Cues and Noise Type Among Adults With Hearing Loss

Relationships Between Auditory Processing and Cognitive Abilities in Adults: A Systematic Review

PURPOSE

The contributions from the central auditory and cognitive systems play a major role in communication. Understanding the relationship between auditory and cognitive abilities has implications for auditory rehabilitation for clinical patients. The purpose of this systematic review is to address the question, "In adults, what is the relationship between central auditory processing abilities and cognitive abilities?"

METHOD

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to identify, screen, and determine eligibility for articles that addressed the research question of interest. Medical librarians and subject matter experts assisted in search strategy, keyword review, and structuring the systematic review process. To be included, articles needed to have an auditory measure (either behavioral or electrophysiologic), a cognitive measure that assessed individual ability, and the measures needed to be compared to one another.

RESULTS

Following two rounds of identification and screening, 126 articles were included for full analysis. Central auditory processing (CAP) measures were grouped into categories (behavioral: speech in noise, altered speech, temporal processing, binaural processing; electrophysiologic: mismatch negativity, P50, N200, P200, and P300). The most common CAP measures were sentence recognition in speech-shaped noise and the P300. Cognitive abilities were grouped into constructs, and the most common construct was working memory. The findings were mixed, encompassing both significant and nonsignificant relationships; therefore, the results do not conclusively establish a direct link between CAP and cognitive abilities. Nonetheless, several consistent relationships emerged across different domains. Distorted or noisy speech was related to working memory or processing speed. Auditory temporal order tasks showed significant relationships with working memory, fluid intelligence, or multidomain cognitive measures. For electrophysiology, relationships were observed between some cortical evoked potentials and working memory or executive/inhibitory processes. Significant results were consistent with the hypothesis that assessments of CAP and cognitive processing would be positively correlated.

CONCLUSIONS

Results from this systematic review summarize relationships between CAP and cognitive processing, but also underscore the complexity of these constructs, the importance of study design, and the need to select an appropriate measure. The relationship between auditory and cognitive abilities is complex but can provide informative context when creating clinical management plans. This review supports a need to develop guidelines and training for audiologists who wish to consider individual central auditory and cognitive abilities in patient care.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24855174.

Preliminary Guidelines for Replacing Word-Recognition in Quiet With Speech in Noise Assessment in the Routine Audiologic Test Battery

OBJECTIVES

For decades, monosyllabic word-recognition in quiet (WRQ) has been the default test of speech recognition in routine audiologic assessment. The continued use of WRQ scores is noteworthy in part because difficulties understanding speech in noise (SIN) is perhaps the most common complaint of individuals with hearing loss. The easiest way to integrate SIN measures into routine clinical practice would be for SIN to replace WRQ assessment as the primary test of speech perception. To facilitate this goal, we predicted classifications of WRQ scores from the QuickSIN signal to noise ratio (SNR) loss and hearing thresholds.

DESIGN

We examined data from 5808 patients who underwent audiometric assessment at the Stanford Ear Institute. All individuals completed pure-tone audiometry, and speech assessment consisting of monaural WRQ, and monaural QuickSIN. We then performed multiple-logistic regression to determine whether classification of WRQ scores could be predicted from pure-tone thresholds and QuickSIN SNR losses.

RESULTS

Many patients displayed significant challenges on the QuickSIN despite having excellent WRQ scores. Performance on both measures decreased with hearing loss. However, decrements in performance were observed with less hearing loss for the QuickSIN than for WRQ. Most important, we demonstrate that classification of good or excellent word-recognition scores in quiet can be predicted with high accuracy by the high-frequency pure-tone average and the QuickSIN SNR loss.

CONCLUSIONS

Taken together, these data suggest that SIN measures provide more information than WRQ. More important, the predictive power of our model suggests that SIN can replace WRQ in most instances, by providing guidelines as to when performance in quiet is likely to be excellent and does not need to be measured. Making this subtle, but profound shift to clinical practice would enable routine audiometric testing to be more sensitive to patient concerns, and may benefit both clinicians and researchers.

Exploring neurocognitive factors and brain activation in adult cochlear implant recipients associated with speech perception outcomes-A scoping review

Background

Cochlear implants (CIs) are considered an effective treatment for severe-to-profound sensorineural hearing loss. However, speech perception outcomes are highly variable among adult CI recipients. Top-down neurocognitive factors have been hypothesized to contribute to this variation that is currently only partly explained by biological and audiological factors. Studies investigating this, use varying methods and observe varying outcomes, and their relevance has yet to be evaluated in a review. Gathering and structuring this evidence in this scoping review provides a clear overview of where this research line currently stands, with the aim of guiding future research.

Objective

To understand to which extent different neurocognitive factors influence speech perception in adult CI users with a postlingual onset of hearing loss, by systematically reviewing the literature.

Methods

A systematic scoping review was performed according to the PRISMA guidelines. Studies investigating the influence of one or more neurocognitive factors on speech perception post-implantation were included. Word and sentence perception in quiet and noise were included as speech perception outcome metrics and six key neurocognitive domains, as defined by the DSM-5, were covered during the literature search (Protocol in open science registries: 10.17605/OSF.IO/Z3G7W of searches in June 2020, April 2022).

Results

From 5,668 retrieved articles, 54 articles were included and grouped into three categories using different measures to relate to speech perception outcomes: (1) Nineteen studies investigating brain activation, (2) Thirty-one investigating performance on cognitive tests, and (3) Eighteen investigating linguistic skills.

Conclusion

The use of cognitive functions, recruiting the frontal cortex, the use of visual cues, recruiting the occipital cortex, and the temporal cortex still available for language processing, are beneficial for adult CI users. Cognitive assessments indicate that performance on non-verbal intelligence tasks positively correlated with speech perception outcomes. Performance on auditory or visual working memory, learning, memory and vocabulary tasks were unrelated to speech perception outcomes and performance on the Stroop task not to word perception in quiet. However, there are still many uncertainties regarding the explanation of inconsistent results between papers and more comprehensive studies are needed e.g., including different assessment times, or combining neuroimaging and behavioral measures.

Systematic review registration

https://doi.org/10.17605/OSF.IO/Z3G7W.

Communication with face masks during the COVID-19 pandemic for adults with hearing loss

Face masks have become common protective measures in community and workplace environments to help reduce the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Face masks can make it difficult to hear and understand speech, particularly for people with hearing loss. An aim of our cross-sectional survey was to investigate the extent that face masks as a health and safety protective measure against SARS-CoV-2 have affected understanding speech in the day-to-day lives of adults with deafness or hearing loss, and identify possible strategies to improve communication accessibility. We analyzed closed- and open-ended survey responses of 656 adults who self-identified as D/deaf or hard of hearing. Over 80% of respondents reported difficulty with understanding others who wore face masks. The proportion of those experiencing difficulty increased with increasing hearing loss severity. Recommended practical supports to facilitate communication and social interaction included more widespread use of clear face masks to aid lip-reading; improved clarity in policy guidance on face masks; and greater public awareness and understanding about ways to more clearly communicate with adults with hearing loss while wearing face masks.

Symmetrical and asymmetrical directional benefits are present for talkers at the front and side

OBJECTIVE

The purpose of the study was to examine the effects of symmetrical and asymmetrical directional microphone settings on speech recognition, localisation and microphone preference in listening conditions with on- and off-axis talkers.

DESIGN

A within-subjects repeated-measure evaluation of three hearing aid microphone settings (bilateral omnidirectional, bilateral directional, asymmetrical directional) was completed in a moderately reverberant laboratory. An exploratory analysis of the potential relationship between microphone preference and unaided measures was also completed.

STUDY SAMPLE

Twenty adult listeners with mild to moderately severe bilateral hearing loss participated.

RESULTS

The directional and asymmetric microphone settings resulted in equivalent benefits for sentence recognition in noise, word recall, and localisation speed regardless of the speech loudspeaker location (on- or off-axis). However, localisation accuracy was significantly worse with the asymmetric fitting than the directional setting when speech was presented from the rear hemisphere. Listeners who always preferred directional microphones had significantly poorer unaided speech recognition than those who preferred the omnidirectional setting for one or more listening condition.

CONCLUSIONS

Benefits from directional and asymmetric processing were small in the current study, but generally similar to each other. Unaided speech recognition in noise performance may have utility as a clinical predictor of preference for directional processing.

The Effect of Background Noise on Immediate Free Recall of Words in Younger and Older Listeners with Hearing Loss

BACKGROUND

Auditory working memory is a crucial factor for complex cognitive tasks such as speech-in-noise understanding because speech communication in noise engages multiple auditory and cognitive capacities to encode, store, and retrieve information. An immediate free recall task of words has been used frequently as a measure of auditory working memory capacity.

PURPOSE

The present study investigated performance on the immediate free recall of words in quiet and noisy conditions for hearing-impaired listeners.

RESEARCH DESIGN

Fifty hearing-impaired listeners (30 younger and 20 older) participated in this study. Lists of 10 phonetically and lexically balanced words were presented with a fixed presentation rate in quiet and noise conditions. Target words were presented at an individually determined most comfortable level (MCL). Participants were required to recall as many of the words in an arbitrary order immediately after the end of the list. Serial position curves were determined from the accuracy of free recall as a function of the word position in the sequence.

DATA COLLECTION AND ANALYSIS

Three-way analyses of variance with repeated measures were conducted on the percent-correct word recall scores, with two independent within-group factors (serial position and listening condition) and a between-group factor (younger, older).

RESULTS

A traditional serial position curve was found in hearing-impaired listeners, yet the serial position effects depended on the listening condition. In quiet, the listeners with hearing loss were likely to recall more words from the initial and final positions compared with the middle-position words. In multi-talker babble noise, more difficulties were observed when recalling the words in the initial position compared with the words in the final position.

CONCLUSION

Without a noise, a traditional U-shaped serial position curve consisting of primacy and recency effects was observed from hearing-impaired listeners, in accord with previous findings from normal-hearing listeners. The adverse impact of background noise was more pronounced in the primacy effect than in the recency effect.

The Effect of Hearing Loss on Localization of Amplitude-Panned and Physical Sources

BACKGROUND

Clinics are increasingly turning toward using virtual environments to demonstrate and validate hearing aid fittings in "realistic" listening situations before the patient leaves the clinic. One of the most cost-effective and straightforward ways to create such an environment is through the use of a small speaker array and amplitude panning. Amplitude panning is a signal playback method used to change the perceived location of a source by changing the level of two or more loudspeakers. The perceptual consequences (i.e., perceived source width and location) of amplitude panning have been well-documented for listeners with normal hearing but not for listeners with hearing impairment.

PURPOSE

The purpose of this study was to examine the perceptual consequences of amplitude panning for listeners with hearing statuses from normal hearing through moderate sensorineural hearing losses.

RESEARCH DESIGN

Listeners performed a localization task. Sound sources were broadband 4 Hz amplitude-modulated white noise bursts. Thirty-nine sources (14 physical) were produced by either physical loudspeakers or via amplitude panning. Listeners completed a training block of 39 trials (one for each source) before completing three test blocks of 39 trials each. Source production method was randomized within block.

STUDY SAMPLE

Twenty-seven adult listeners (mean age 52.79, standard deviation 27.36, 10 males, 17 females) with hearing ranging from within normal limits to moderate bilateral sensorineural hearing loss participated in the study. Listeners were recruited from a laboratory database of listeners that consented to being informed about available studies.

DATA COLLECTION AND ANALYSIS

Listeners indicated the perceived source location via touch screen. Outcome variables were azimuth error, elevation error, and total angular error (Euclidean distance in degrees between perceived and correct location). Listeners' pure-tone averages (PTAs) were calculated and used in mixed-effects models along with source type and the interaction between source type and PTA as predictors. Subject was included as a random variable.

RESULTS

Significant interactions between PTA and source production method were observed for total and elevation errors. Listeners with higher PTAs (i.e., worse hearing) did not localize physical and panned sources differently whereas listeners with lower PTAs (i.e., better hearing) did. No interaction was observed for azimuth errors; however, there was a significant main effect of PTA.

CONCLUSION

As hearing impairment becomes more severe, listeners localize physical and panned sources with similar errors. Because physical and panned sources are not localized differently by adults with hearing loss, amplitude panning could be an appropriate method for constructing virtual environments for these listeners.

Brain Processing of Complex Geometric Forms in a Visual Memory Task Increases P2 Amplitude

We study the cognitive processing of visual working memory in three different conditions of memory load and configuration change. Altering this features has been shown to alter the brain's processing in memory tasks. Most studies dealing with this issue have used the verbal-phonological modality. We use complex geometric polygons to assess visual working memory in a modified change detection task. Three different types of backgrounds were used to manipulate memory loading and 18 complex geometric polygons to manipulate stimuli configuration. The goal of our study was to test whether the memory load and configuration affect the correct-recall ratios. We expected that increasing visual items loading and changing configuration of items would induce differences in working memory performance. Brain activity related to the task was assessed through event-related potentials (ERP), during the test phase of each trial. Our results showed that visual items loading and changing of item configuration affect working memory on test phase on ERP component P2, but does not affect performance. However frontal related ERP component-P3-was minimally affected by visual memory loading or configuration changing, supporting that working memory is related to a filtering processing in posterior brain regions.

Degree of Hearing Loss Affects Bilateral Hearing Aid Benefits in Ecologically Relevant Laboratory Conditions

Purpose Previous evidence supports benefits of bilateral hearing aids, relative to unilateral hearing aid use, in laboratory environments using audio-only (AO) stimuli and relatively simple tasks. The purpose of this study was to evaluate bilateral hearing aid benefits in ecologically relevant laboratory settings, with and without visual cues. In addition, we evaluated the relationship between bilateral benefit and clinically viable predictive variables. Method Participants included 32 adult listeners with hearing loss ranging from mild-moderate to severe-profound. Test conditions varied by hearing aid fitting type (unilateral, bilateral) and modality (AO, audiovisual). We tested participants in complex environments that evaluated the following domains: sentence recognition, word recognition, behavioral listening effort, gross localization, and subjective ratings of spatialization. Signal-to-noise ratio was adjusted to provide similar unilateral speech recognition performance in both modalities and across procedures. Results Significant and similar bilateral benefits were measured for both modalities on all tasks except listening effort, where bilateral benefits were not identified in either modality. Predictive variables were related to bilateral benefits in some conditions. With audiovisual stimuli, increasing hearing loss, unaided speech recognition in noise, and unaided subjective spatial ability were significantly correlated with increased benefits for many outcomes. With AO stimuli, these same predictive variables were not significantly correlated with outcomes. No predictive variables were correlated with bilateral benefits for sentence recognition in either modality. Conclusions Hearing aid users can expect significant bilateral hearing aid advantages for ecologically relevant, complex laboratory tests. Although future confirmatory work is necessary, these data indicate the presence of vision strengthens the relationship between bilateral benefits and degree of hearing loss.