Occupational performance: Comparing normally-hearing and hearing-impaired employees using the Amsterdam Checklist for Hearing and Work

The Effort of Repairing a Misperceived Word Can Impair Perception of Following Words, Especially for Listeners With Cochlear Implants

OBJECTIVES

In clinical and laboratory settings, speech recognition is typically assessed in a way that cannot distinguish accurate auditory perception from misperception that was mentally repaired or inferred from context. Previous work showed that the process of repairing misperceptions elicits greater listening effort, and that this elevated effort lingers well after the sentence is heard. That result suggests that cognitive repair strategies might appear successful when testing a single utterance but fail for everyday continuous conversational speech. The present study tested the hypothesis that the effort of repairing misperceptions has the consequence of carrying over to interfere with perception of later words after the sentence.

DESIGN

Stimuli were open-set coherent sentences that were presented intact or with a word early in the sentence replaced with noise, forcing the listener to use later context to mentally repair the missing word. Sentences were immediately followed by digit triplets, which served to probe carryover effort from the sentence. Control conditions allowed for the comparison to intact sentences that did not demand mental repair, as well as to listening conditions that removed the need to attend to the post-sentence stimuli, or removed the post-sentence digits altogether. Intelligibility scores for the sentences and digits were accompanied by time-series measurements of pupil dilation to assess cognitive load during the task, as well as subjective rating of effort. Participants included adults with cochlear implants (CIs), as well as an age-matched group and a younger group of listeners with typical hearing for comparison.

RESULTS

For the CI group, needing to repair a missing word during a sentence resulted in more errors on the digits after the sentence, especially when the repair process did not result in a coherent sensible perception. Sentences that needed repair also contained more errors on the words that were unmasked. All groups showed substantial increase of pupil dilation when sentences required repair, even when the repair was successful. Younger typical hearing listeners showed clear differences in moment-to-moment allocation of effort in the different conditions, while the other groups did not.

CONCLUSIONS

For CI listeners, the effort of needing to repair misperceptions in a sentence can last long enough to interfere with words that follow the sentence. This pattern could pose a serious problem for regular communication but would go overlooked in typical testing with single utterances, where a listener has a chance to repair misperceptions before responding. Carryover effort was not predictable by basic intelligibility scores, but can be revealed in behavioral data when sentences are followed immediately by extra probe words such as digits.

Sensory Loss and its Association with Different Types of Departures from the Labor Force Among Older Adults in the US

To investigate the association between sensory loss and the timing and type of self-reported departures from the labor force, via retirement or disability, we used data from the Health and Retirement Study, cycles 2004-2018. Based on self-reported sensory loss, we classified individuals into four groups: no sensory loss, hearing loss only, vision loss only, and dual sensory loss (vision and hearing loss). We assumed that older adults could leave the labor force either by retirement or due to disability. Because once one type of exit is observed the other type cannot be observed, we implemented a competing risk approach to estimate the instantaneous rate of departure (sub-distribution hazard rate) for leaving the labor force due to disability, treating retirement as a competing risk, and for departures via retirement, with disability as the competing risk. We found that compared to older adults with no sensory loss, adults with vision loss are at a higher risk for leaving the labor force via disability (when treating retirement as a competing risk). Compared to no sensory loss, hearing loss was associated with a higher risk for retirement in models treating disability as a competing risk. Given the differences between disability and retirement benefits (before and after retirement age), policies intended to keep people with sensory loss from early labor force departures, such as accommodations in the workplace and/or hearing and vision care coverage, might contribute to better retiring conditions and healthy aging among older adults with sensory loss.

Changes in Listening Effort Through Pupil Response After Atresioplasty in Children With Congenital Aural Atresia

OBJECTIVES

This study aimed to determine whether the improvement of hearing by surgical treatment alleviates cognitive demands through pupil response in patients with unilateral congenital aural atresia (CAA).

DESIGN

A prospective study was performed on patients with unilateral CAA who were scheduled to undergo primary atresioplasty between November 2017 and May 2020. Pure-tone audiometry, auditory digit span test, Korean Speech Perception in Noise test, pupil measurement during speech tests, and questionnaires (Sound-Spatial-Qualities of Hearing Scale; subjective listening effort rating) were performed before and 6 months after surgery.

RESULTS

Of 30 consecutive patients who initially enrolled, only 18 patients (12 males and 6 females) were included in the analysis. When the improvement of the air-bone gap and interaural difference of air conduction within 30 dB was defined as a successful hearing outcome, successful hearing improvement was achieved in 50% of the 18 patients. In pupil measurement, the success group had a significantly smaller mean pupil dilation response than the nonsuccess group at 0 and -3 dB signal to noise ratio (SNR) (all p < 0.01). In addition, significant differences were identified between the two groups for peak dilation and peak latency at all noise levels (all p < 0.01). When analyzing the change in pupil response before and after surgery, the difference in relative mean pupil dilation in the success group was significantly greater than that in the nonsuccess group at -3 dB SNR ( p = 0.02). In addition, the success group showed a significantly greater change in peak latency than the nonsuccess group at the -3 dB SNR ( p < 0.01). The difference in peak dilation tended to be greater in the success group than in the nonsuccess group, but the difference was not statistically significant.

CONCLUSIONS

Patients with unilateral CAA who achieved surgically improved hearing had a smaller pupil dilation response than those who did not. These results suggest that successful hearing outcomes after surgery in patients with unilateral CAA may reduce the cognitive effort required to understand speech under difficult listening conditions.

Communication Under Sharply Degraded Auditory Input and the "2-Sentence" Problem

OBJECTIVES

Despite performing well in standard clinical assessments of speech perception, many cochlear implant (CI) users report experiencing significant difficulties when listening in real-world environments. We hypothesize that this disconnect may be related, in part, to the limited ecological validity of tests that are currently used clinically and in research laboratories. The challenges that arise from degraded auditory information provided by a CI, combined with the listener's finite cognitive resources, may lead to difficulties when processing speech material that is more demanding than the single words or single sentences that are used in clinical tests.

DESIGN

Here, we investigate whether speech identification performance and processing effort (indexed by pupil dilation measures) are affected when CI users or normal-hearing control subjects are asked to repeat two sentences presented sequentially instead of just one sentence.

RESULTS

Response accuracy was minimally affected in normal-hearing listeners, but CI users showed a wide range of outcomes, from no change to decrements of up to 45 percentage points. The amount of decrement was not predictable from the CI users' performance in standard clinical tests. Pupillometry measures tracked closely with task difficulty in both the CI group and the normal-hearing group, even though the latter had speech perception scores near ceiling levels for all conditions.

CONCLUSIONS

Speech identification performance is significantly degraded in many (but not all) CI users in response to input that is only slightly more challenging than standard clinical tests; specifically, when two sentences are presented sequentially before requesting a response, instead of presenting just a single sentence at a time. This potential "2-sentence problem" represents one of the simplest possible scenarios that go beyond presentation of the single words or sentences used in most clinical tests of speech perception, and it raises the possibility that even good performers in single-sentence tests may be seriously impaired by other ecologically relevant manipulations. The present findings also raise the possibility that a clinical version of a 2-sentence test may provide actionable information for counseling and rehabilitating CI users, and for people who interact with them closely.

How to remain in working life with hearing loss - health factors for a sustainable work situation

BACKGROUND

Persons with hearing loss (HL) are a vulnerable group in working life. Studies have shown that they are more likely than the general population to be in part-time work, to be unemployed, receive disability pension, and to be on sick leave. Many workers with HL also experience unhealthy work conditions, such as jobs where they experience high demands combined with low control as well as safety concerns and social isolation. There is a lack of studies that focus on factors that promote a healthy, sustainable work situation for the target group.

OBJECTIVE

To investigate health factors that contribute to a sustainable work situation for employees with HL.

METHODS

The current study was a comparative, observational study with a cross-sectional design including a clinical population of adults with HL. Comparisons were made between workers with HL "in work" and workers with HL on "HL-related sick leave".

RESULTS

Seven health factors were identified. Those "in work" experienced a healthier work environment as well as lower levels of mental strain, hearing-related work characteristics and content, cognitively demanding work content, hearing-related symptoms, energy-demanding activities, and bodily aches and pain than those on "HL-related sick leave".

CONCLUSION

The results demonstrate a clear pattern regarding health factors for a sustainable working life. The type of job was not related to whether an individual was on sick leave or working. Rather, the work climate and the content of the work mattered.

The Effects of Light Level and Signal-to-Noise Ratio on the Task-Evoked Pupil Response in a Speech-in-Noise Task

PURPOSE

There is increasing interest in the measurement of cognitive effort during listening tasks, for both research and clinical purposes. Quantification of task-evoked pupil responses (TEPRs) is a psychophysiological method that can be used to study cognitive effort. However, light level during cognitively demanding listening tasks may affect TEPRs, complicating interpretation of listening-related changes. The objective of this study was to examine the effects of light level on TEPRs during effortful listening across a range of signal-to-noise ratios (SNRs).

METHOD

Thirty-six adults without hearing loss were asked to repeat target sentences presented in background babble noise while their pupil diameter was recorded. Light level and SNRs were manipulated in a 4 × 4 repeated-measures design. Repeated-measures analyses of variance were used to measure the effects.

RESULTS

Peak and mean dilation were typically larger in more adverse SNR conditions (except for SNR -6 dB) and smaller in higher light levels. Differences in mean and peak dilation between SNR conditions were larger in dim light than in brighter light.

CONCLUSIONS

Brighter light conditions make TEPRs less sensitive to variations in listening effort across levels of SNR. Therefore, light level must be considered and reported in detail to ensure sensitivity of TEPRs and for comparisons of findings across different studies. It is recommended that TEPR testing be conducted in relatively low light conditions, considering both background illumination and screen luminance.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25676538.

Towards sensory substitution and augmentation: Mapping visual distance to audio and tactile frequency

Multimodal perception is the predominant means by which individuals experience and interact with the world. However, sensory dysfunction or loss can significantly impede this process. In such cases, cross-modality research offers valuable insight into how we can compensate for these sensory deficits through sensory substitution. Although sight and hearing are both used to estimate the distance to an object (e.g., by visual size and sound volume) and the perception of distance is an important element in navigation and guidance, it is not widely studied in cross-modal research. We investigate the relationship between audio and vibrotactile frequencies (in the ranges 47-2,764 Hz and 10-99 Hz, respectively) and distances uniformly distributed in the range 1-12 m. In our experiments participants mapped the distance (represented by an image of a model at that distance) to a frequency via adjusting a virtual tuning knob. The results revealed that the majority (more than 76%) of participants demonstrated a strong negative monotonic relationship between frequency and distance, across both vibrotactile (represented by a natural log function) and auditory domains (represented by an exponential function). However, a subgroup of participants showed the opposite positive linear relationship between frequency and distance. The strong cross-modal sensory correlation could contribute to the development of assistive robotic technologies and devices to augment human perception. This work provides the fundamental foundation for future assisted HRI applications where a mapping between distance and frequency is needed, for example for people with vision or hearing loss, drivers with loss of focus or response delay, doctors undertaking teleoperation surgery, and users in augmented reality (AR) or virtual reality (VR) environments.

Cochlear-Implant Simulated Signal Degradation Exacerbates Listening Effort in Older Listeners

OBJECTIVES

Individuals with cochlear implants (CIs) often report that listening requires high levels of effort. Listening effort can increase with decreasing spectral resolution, which occurs when listening with a CI, and can also increase with age. What is not clear is whether these factors interact; older CI listeners potentially experience even higher listening effort with greater signal degradation than younger CI listeners. This study used pupillometry as a physiological index of listening effort to examine whether age, spectral resolution, and their interaction affect listening effort in a simulation of CI listening.

DESIGN

Fifteen younger normal-hearing listeners (ages 18 to 31 years) and 15 older normal-hearing listeners (ages 65 to 75 years) participated in this experiment; they had normal hearing thresholds from 0.25 to 4 kHz. Participants repeated sentences presented in quiet that were either unprocessed or vocoded, simulating CI listening. Stimuli frequency spectra were limited to below 4 kHz (to control for effects of age-related high-frequency hearing loss), and spectral resolution was decreased by decreasing the number of vocoder channels, with 32-, 16-, and 8-channel conditions. Behavioral speech recognition scores and pupil dilation were recorded during this task. In addition, cognitive measures of working memory and processing speed were obtained to examine if individual differences in these measures predicted changes in pupil dilation.

RESULTS

For trials where the sentence was recalled correctly, there was a significant interaction between age and spectral resolution, with significantly greater pupil dilation in the older normal-hearing listeners for the 8- and 32-channel vocoded conditions. Cognitive measures did not predict pupil dilation.

CONCLUSIONS

There was a significant interaction between age and spectral resolution, such that older listeners appear to exert relatively higher listening effort than younger listeners when the signal is highly degraded, with the largest effects observed in the eight-channel condition. The clinical implication is that older listeners may be at higher risk for increased listening effort with a CI.

Job satisfaction and quality of life in adult users of bone conduction hearing devices pre-and post-implantation: a 1-year follow-up study

OBJECTIVE

Hearing loss is a growing public health issue that significantly impacts both health-related quality of life and working life. This study investigates how hearing rehabilitation with bone conduction hearing implants impacts health-related quality of life and working life in adults of working age with hearing impairment.

DESIGN

This longitudinal study used data from Cochlear's Implant Recipient Observational Study to assess hearing disabilities and job satisfaction in 18-65-year-old recipients of bone conduction hearing implants. Baseline data were collected pre-implantation and patients were followed-up at 12-months post-implantation.

STUDY SAMPLE

Patient demographics, Health Utilities Index Mark 3, the Speech Spatial and Qualities of Hearing Scale, and self-reported employment data are presented for a sample ranging from 30 to 43 patients, pre-implantation and at 12-months follow-up following implantation with a bone conduction hearing implant.

RESULTS

Significant improvements in hearing and speech attribute, and overall health-related quality of life were observed between pre-and post-implantation. Overall hearing disability decreased post-implantation and job satisfaction improved.

CONCLUSIONS

Hearing rehabilitation using bone conduction hearing implants are shown to improve health-related quality of life, reduce hearing disability, and improve work performance and satisfaction. Results are representative of healthy and actively working users of bone conduction hearing implants.

Fatigue and Quality of Life in Children with Hearing Loss or Obstructive Sleep Apnea

OBJECTIVE

To investigate the fatigue levels of children with hearing loss (HL) and obstructive sleep apnea (OSA), hypothesizing that the fatigue experienced by children with HL is under-recognized.

STUDY DESIGN

Cross-sectional survey.

METHODS

We identified children aged 2-18 with HL, OSA, sleep-disordered breathing (SDB), and controls from a pediatric otolaryngology clinic and sleep center. Children and/or parents completed the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL MFS), Hearing Environments And Reflection on Quality of Life (HEAR-QL), and OSA-18.

RESULTS

Responses of 50 children with HL, 79 with OSA, and 18 with SDB were compared with those of 49 recruited controls (RC) and literature controls (LC). Children with HL or OSA had higher fatigue than controls in the PedsQL MFS self-reported (HL 65.4, OSA 54.7, RC 71.8, LC 80.5, p < 0.001) and parent-reported (HL 64.6, OSA 59.3, RC 75.2, LC 89.6, p < 0.001). Children with HL had Cognitive Fatigue similar to that of children with OSA (self 60.4 vs. 49.5, p = 0.170; parent 56.0 vs. 56.7, p = 0.998), though with decreased Sleep/Rest Fatigue (self 67.8 vs. 56.3, p = 0.033; parent 69.8 vs. 57.5, p = 0.001). Children with HL or OSA had lower disease-related quality of life (QOL) than controls in the HEAR-QL and OSA-18, respectively. Stratification with disease severity revealed no differences in fatigue.

CONCLUSION

Children with HL or OSA experience higher fatigue and lower QOL than controls. Similar Cognitive Fatigue in both groups suggests under-recognized fatigue in children with HL.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:443-451, 2024.

A Pragmatic Clinical Trial of Hearing Screening in Primary Care Clinics: Effect of Setting and Provider Encouragement

OBJECTIVES

The prevalence of hearing loss increases with age. Untreated hearing loss is associated with poorer communication abilities and negative health consequences, such as increased risk of dementia, increased odds of falling, and depression. Nonetheless, evidence is insufficient to support the benefits of universal hearing screening in asymptomatic older adults. The primary goal of the present study was to compare three hearing screening protocols that differed in their level of support by the primary care (PC) clinic and provider. The protocols varied in setting (in-clinic versus at-home screening) and in primary care provider (PCP) encouragement for hearing screening (yes versus no).

DESIGN

We conducted a multisite, pragmatic clinical trial. A total of 660 adults aged 65 to 75 years; 64.1% female; 35.3% African American/Black completed the trial. Three hearing screening protocols were studied, with 220 patients enrolled in each protocol. All protocols included written educational materials about hearing loss and instructions on how to complete the self-administered telephone-based hearing screening but varied in the level of support provided in the clinic setting and by the provider. The protocols were as follows: (1) no provider encouragement to complete the hearing screening at home, (2) provider encouragement to complete the hearing screening at home, and (3) provider encouragement and clinical support to complete the hearing screening after the provider visit while in the clinic. Our primary outcome was the percentage of patients who completed the hearing screening within 60 days of a routine PC visit. Secondary outcomes following patient access of hearing healthcare were also considered and consisted of the percentage of patients who completed and failed the screening and who (1) scheduled, and (2) completed a diagnostic evaluation. For patients who completed the diagnostic evaluation, we also examined the percentage of those who received a hearing loss intervention plan by a hearing healthcare provider.

RESULTS

All patients who had provider encouragement and support to complete the screening in the clinic completed the screening (100%) versus 26.8% with encouragement to complete the screening at home. For patients who were offered hearing screening at home, completion rates were similar regardless of provider encouragement (26.8% with encouragement versus 22.7% without encouragement); adjusted odds ratio of 1.25 (95% confidence interval 0.80-1.94). Regarding the secondary outcomes, roughly half (38.9-57.1% depending on group) of all patients who failed the hearing screening scheduled and completed a formal diagnostic evaluation. The percentage of patients who completed a diagnostic evaluation and received a hearing loss intervention plan was 35.0% to 50.0% depending on the group. Rates of a hearing loss intervention plan by audiologists ranged from 28.6% to 47.5% and were higher compared with those by otolaryngology providers, which ranged from 15.0% to 20.8% among the groups.

CONCLUSIONS

The results of the pragmatic clinical trial showed that offering provider encouragement and screening facilities in the PC clinic led to a significantly higher rate of adherence with hearing screening associated with a single encounter. However, provider encouragement did not improve the significantly lower rate of adherence with home-based hearing screening.

The Impact of Hearing Aids on Listening Effort and Listening-Related Fatigue - Investigations in a Virtual Realistic Listening Environment

Participation in complex listening situations such as group conversations in noisy environments sets high demands on the auditory system and on cognitive processing. Reports of hearing-impaired people indicate that strenuous listening situations occurring throughout the day lead to feelings of fatigue at the end of the day. The aim of the present study was to develop a suitable test sequence to evoke and measure listening effort (LE) and listening-related fatigue (LRF), and, to evaluate the influence of hearing aid use on both dimensions in mild to moderately hearing-impaired participants. The chosen approach aims to reconstruct a representative acoustic day (Time Compressed Acoustic Day [TCAD]) by means of an eight-part hearing-test sequence with a total duration of approximately 2½ h. For this purpose, the hearing test sequence combined four different listening tasks with five different acoustic scenarios and was presented to the 20 test subjects using virtual acoustics in an open field measurement in aided and unaided conditions. Besides subjective ratings of LE and LRF, behavioral measures (response accuracy, reaction times), and an attention test (d2-R) were performed prior to and after the TCAD. Furthermore, stress hormones were evaluated by taking salivary samples. Subjective ratings of LRF increased throughout the test sequence. This effect was observed to be higher when testing unaided. In three of the eight listening tests, the aided condition led to significantly faster reaction times/response accuracies than in the unaided condition. In the d2-R test, an interaction in processing speed between time (pre- vs. post-TCAD) and provision (unaided vs. aided) was found suggesting an influence of hearing aid provision on LRF. A comparison of the averaged subjective ratings at the beginning and end of the TCAD shows a significant increase in LRF for both conditions. At the end of the TCAD, subjective fatigue was significantly lower when wearing hearing aids. The analysis of stress hormones did not reveal significant effects.

Comparisons of air-conduction hearing thresholds between manual and automated methods in a commercial audiometer

Objective

To investigate the correlation of air-conduction thresholds between automated audiometry in a non-isolated environment and manual audiometry in participants with normal hearing and different degrees of hearing loss.

Methods

Eighty-three participants aged 11-88 years old underwent automated pure-tone audiometry in a non-acoustically isolated environment, and the results were compared with those of manual pure-tone audiometry performed in a standard acoustically isolated booth, with the order of testing randomised. Six frequencies of 250, 500, 1,000, 2000, 4,000 and 8,000 Hz were tested.

Results

All 166 ears were completed and 996 valid hearing threshold data were obtained, with 28 data exceeding the 95% confidence interval in the Bland-Altman plot, accounting for 2.81% of all data. The means and standard deviations of the differences for the six frequencies from 250 to 8,000 Hz were, respectively, 0.63 ± 5.31, 0.69 ± 4.50, 0.45 ± 4.99, 0.3 ± 6.2, -0.15 ± 4.8, and 0.21 ± 4.97 dB. The correlation coefficients of the two test results for normal hearing, mild, moderate, severe and above hearing loss groups were 0.95, 0.92, 0.97, and 0.96, respectively. The correlation coefficient of the automated and manual audiometry thresholds for the age groups under 40 years, 40-60 years, and 60 years above, were 0.98, 0.97 and 0.97, respectively, with all being statistically significant (p < 0.01). The response time of the three age groups were 791 ± 181 ms, 900 ± 190 ms and 1,063 ± 332 ms, respectively, and there was a significant difference between the groups under 40 years and over 60 years.

Conclusion

There was good consistency between automated pure-tone audiometry in a non-acoustically isolated environment and manual pure-tone audiometry in participants with different hearing levels and different age groups.

The audiological rehabilitation of workers with hearing loss in the UK: a qualitative study of workers' perspectives

PURPOSE

Unaddressed hearing loss can adversely affect employment and day-to-day work-life. Efficient and effective audiology support can help optimise hearing in the workplace. This study explores the audiological rehabilitation experiences of workers with hearing loss (WHL).

MATERIALS AND METHODS

Twenty-four WHL with experience of a wide range of audiology services across the UK participated in semi-structured interviews. Interviews were analysed using inductive thematic analysis.

RESULTS

Three main themes were generated: Theme 1: mixed experiences with audiology services (subdivided into two subthemes and four sub-subthemes). Theme 2: audiology role in work support (subdivided into three subthemes). Theme 3: "I think support could be improved if…" (subdivided into two subthemes).

CONCLUSION

The audiological rehabilitation for working-age adults with hearing loss needs improvements to deliver sufficient support and quality care. Some of the barriers to having better-functioning hearing healthcare require fundamental standards in healthcare quality, such as access to services, staff (including audiologists) deaf awareness, information and technology support, and personalised care that considers work-life needs. Further research is required to evaluate the feasibility and cost-effectiveness of improvements, such as support that extends beyond hearing aid care, whether from audiology or non-audiology services.

Working-age first-time hearing aid users' self-reported outcomes

OBJECTIVE

To study patient-reported hearing aid (HA) rehabilitation outcomes, social-communicative functioning, and expectations/experiences during eight months of HA use.

DESIGN

Three self-reporting instruments, the International Outcome Inventory for Hearing Aids (IOI-HA), the Quantified Denver Scale of Communicative Function (QDS), and questionnaires tapping pre-rehabilitation expectations (HA-EXP-Q1) and post-rehabilitation experiences (HA-EXP-Q2) were administered.

STUDY SAMPLE

144 patients ages 23-66 with gradually acquired, adult-onset, mild-to-moderate sensorineural hearing loss affecting both ears who acquired their first HAs.

RESULTS

According to self-reports, HA rehabilitation outcomes were good, and everyday social-communicative functioning improved after one month and after eight months of HA use. When the effects from demographic and audiological variables were analysed, younger age and positive expectations of HAs were associated with better outcomes and social-communicative functioning. The form or hearing loss severity, and the type or number of HAs did not affect outcomes.

CONCLUSION

Working-age HA users reported better HA outcomes than older adults in previous studies. Coping in work life may be a strong motivator for active HA use. Considering that younger age and positive expectations resulted in better outcomes, early rehabilitation that supports positive and realistic expectations of HA performance is essential.

The relationship between hearing status, listening effort, and the need for recovery in employees of a manufacturing company

OBJECTIVE

Hearing screening can be used to detect hearing loss, but its value for identifying employees with work functioning difficulties is unclear. The objective of this study was to assess the association between the hearing status measured with an occupational hearing-in-noise screening test, Listening Effort (LE), and Need For Recovery (NFR) in employees of a manufacturing company, and to examine whether these associations depend on the perceived noise level at the workplace.

METHODS

Employees of coatings and paints manufacturing company were included. Their hearing status was assessed with an occupational hearing-in-noise screening test. An online survey was used to assess their LE, NFR, and the perceived noise level at the workplace. Responses from 143 employees were analyzed (mean age = 53 years) using hierarchical multiple regression analysis with the outcomes LE and NFR.

RESULTS

Regression analysis-with adjustments for gender, age, educational level, health status, pace/amount of work, job variety, and work pleasure-revealed that hearing status was significantly associated with LE, but the interaction between hearing status and the perceived noise level was not. Hearing status nor the interaction between hearing status and the perceived noise level was significantly associated with NFR.

CONCLUSION

The results confirm that poorer hearing is associated with higher LE, but not with higher NFR. These associations were unrelated to the perceived noise level at the workplace. Therefore, the value of occupational hearing screening appears to be early identification of hearing loss in employees, but not identification of work functioning difficulties.

Listening efficiency in adult cochlear-implant users compared with normally-hearing controls at ecologically relevant signal-to-noise ratios

Introduction

Due to having to work with an impoverished auditory signal, cochlear-implant (CI) users may experience reduced speech intelligibility and/or increased listening effort in real-world listening situations, compared to their normally-hearing (NH) peers. These two challenges to perception may be usefully integrated in a measure of listening efficiency: conceptually, the amount of accuracy achieved for a certain amount of effort expended.

Methods

We describe a novel approach to quantifying listening efficiency based on the rate of evidence accumulation toward a correct response in a linear ballistic accumulator (LBA) model of choice decision-making. Estimation of this objective measure within a hierarchical Bayesian framework confers further benefits, including full quantification of uncertainty in parameter estimates. We applied this approach to examine the speech-in-noise performance of a group of 24 CI users (M age: 60.3, range: 20-84 years) and a group of 25 approximately age-matched NH controls (M age: 55.8, range: 20-79 years). In a laboratory experiment, participants listened to reverberant target sentences in cafeteria noise at ecologically relevant signal-to-noise ratios (SNRs) of +20, +10, and +4 dB SNR. Individual differences in cognition and self-reported listening experiences were also characterised by means of cognitive tests and hearing questionnaires.

Results

At the group level, the CI group showed much lower listening efficiency than the NH group, even in favourable acoustic conditions. At the individual level, within the CI group (but not the NH group), higher listening efficiency was associated with better cognition (i.e., working-memory and linguistic-closure) and with more positive self-reported listening experiences, both in the laboratory and in daily life.

Discussion

We argue that listening efficiency, measured using the approach described here, is: (i) conceptually well-motivated, in that it is theoretically impervious to differences in how individuals approach the speed-accuracy trade-off that is inherent to all perceptual decision making; and (ii) of practical utility, in that it is sensitive to differences in task demand, and to differences between groups, even when speech intelligibility remains at or near ceiling level. Further research is needed to explore the sensitivity and practical utility of this metric across diverse listening situations.

Association between hearing loss and deprivation among Welsh adults: a cross-sectional observational study

OBJECTIVE

To index levels of hearing loss with respect to area-level indices of deprivation in a Welsh population.

DESIGN

A cross-sectional observational study of all adults (aged >18) that attended Abertawe Bro Morgannwg University (ABMU) Health Board audiology services between 2016 and 2018. Service access, first hearing aid fitting appointment rates and hearing loss at time of first hearing aid provision were used to index population hearing loss versus area-level indices of deprivation based on patient postcode.

SETTING

Primary and secondary care.

PARTICIPANTS

59 493 patient entries met the inclusion criteria. Patient entries were grouped by age (18-30, 31-40, 41-50, 51-60, 61-70, 71-80, >80 years) and deprivation decile.

RESULTS

The interaction between age group and deprivation decile predicted access rate to ABMU audiology services (b=-0.24, t(6858) = -2.86, p<0.01) with audiology services accessed more frequently by the most deprived versus the least deprived decile in every age group (p<0.05), except the >80 years. First hearing aid fitting rates were highest among the most deprived in the four youngest age groups (p<0.05). Severity of hearing loss at the time of first hearing aid fitting was worse among the most deprived in the five oldest age groups (p<0.01).

CONCLUSIONS

Hearing health inequalities are prevalent among adults accessing ABMU audiology services. Our findings suggest that deprivation increases the likelihood of developing hearing loss, brings earlier onset of hearing loss and is linked to delays in getting help for hearing problems. However, it is not possible to know the true scale of these disparities without knowing the hearing health of the Welsh adult population including those who do not seek help for hearing problems.

Test-Retest Reliability and the Role of Task Instructions when Measuring Listening Effort Using a Verbal Response Time Paradigm

Listening amidst competing noise taxes one's limited cognitive resources, leading to increased listening effort. As such, there is interest in incorporating a reliable test of listening effort into the clinical test battery. One clinically promising method for measuring listening effort is verbal response time (VRT) because it can be obtained using already-established clinical tasks. In order for widespread implementation of the VRT paradigm, a better understanding of the psychometric properties is needed. The purpose of this work was to improve the understanding of the reliability and sensitivity of the VRT listening task. Using within-subject study designs, we completed a pilot study to evaluate the test-retest reliability (Study 1) and the effects of task instructions and listening condition (Study 2). Preliminary results show that the VRT paradigm enjoys good to excellent test-retest reliability and that neither task instructions nor listening condition meaningfully influence VRT once measurement error is accounted for. Future studies should account for measurement error when considering statistically significant versus meaningful effects of experimental parameters when using listening effort tasks.

Cohort profile: Netherlands Longitudinal Study on Hearing (NL-SH)

PURPOSE

The Netherlands Longitudinal Study on Hearing (NL-SH) was set up to examine associations of hearing ability with psychosocial, work and health outcomes in working age adults.

PARTICIPANTS

Inclusion started in 2006 and is ongoing. Currently the sample comprises 2800 adults with normal and impaired hearing, aged 18-70 years at inclusion. Five-year follow-up started in 2011, 10-year follow-up in 2016 and 15-year follow-up in 2021. All measurements are web-based. Participants perform a speech-in-noise recognition test to measure hearing ability and fill out questionnaires about their hearing status, hearing aid use, self-reported hearing disability and coping, work status and work-related outcomes (work performance, need for recovery), physical and psychosocial health (depression, anxiety, distress, somatisation, loneliness), healthcare usage, lifestyle (smoking, alcohol), and technology use.

FINDINGS TO DATE

The NL-SH has shown the vast implications of reduced hearing ability for the quality of life and health of working-age adults. A selection of results published in 27 papers is presented. Age-related deterioration of hearing ability accelerates after the age of 50 years. Having a history of smoking is associated with a faster decline in hearing ability, but this relationship is not found for other cardiovascular risk factors. Poorer hearing ability is associated with increased distress, somatisation, depression and loneliness. Adults with impaired hearing ability are more likely to be unemployed or unfit for work, and need more time to recuperate from work effort.

FUTURE PLANS

Participant data will be linked to a national database to enable research on the association between hearing ability and mortality. Linking to environmental exposure data will facilitate insight in relations between environmental factors, hearing ability and psychosocial outcomes. The unique breadth of the NL-SH data will also allow for further research on other functional problems, for instance, hearing ability and fall risk.

TRIAL REGISTRATION NUMBER

NL12015.029.06.

Dual-Task Paradigm Measures of Listening Effort: To Include or Not to Include Secondary Task Responses with Incorrect Primary Task Responses

Response time–based dual-task paradigms are commonly adopted to measure behavioral listening effort. Most extant studies used an all-response approach that included secondary task responses under both correct and incorrect primary task responses during analysis. However, evidence supporting this strategy is limited. Therefore, the current study investigated the potential differences between including all responses versus only including correct responses. Data from two previous studies were reanalyzed. Experiment 1 included 16 listeners and used a dual-task paradigm to examine the effect of introducing background noise on listening effort. Experiment 2 included 19 participants and used a different dual-task paradigm to examine the effect of reverberation and loudspeaker-to-listener distance on listening effort. ANOVA results obtained using both analysis approaches were compared. The all-response and correct-only approaches revealed similar results. However, larger effect sizes and an additional main effect were found with the all-response approach. The current study supports the use of an all-response approach due to its greater sensitivity to changes in behavioral listening effort. However, a correct-only approach could be utilized to suit specific study purposes.

Short Implicit Voice Training Affects Listening Effort During a Voice Cue Sensitivity Task With Vocoder-Degraded Speech

OBJECTIVES

Understanding speech in real life can be challenging and effortful, such as in multiple-talker listening conditions. Fundamental frequency (fo) and vocal-tract length (vtl) voice cues can help listeners segregate between talkers, enhancing speech perception in adverse listening conditions. Previous research showed lower sensitivity to fo and vtl voice cues when speech signal was degraded, such as in cochlear implant hearing and vocoder-listening compared to normal hearing, likely contributing to difficulties in understanding speech in adverse listening. Nevertheless, when multiple talkers are present, familiarity with a talker's voice, via training or exposure, could provide a speech intelligibility benefit. In this study, the objective was to assess how an implicit short-term voice training could affect perceptual discrimination of voice cues (fo+vtl), measured in sensitivity and listening effort, with or without vocoder degradations.

DESIGN

Voice training was provided via listening to a recording of a book segment for approximately 30 min, and answering text-related questions, to ensure engagement. Just-noticeable differences (JNDs) for fo+vtl were measured with an odd-one-out task implemented as a 3-alternative forced-choice adaptive paradigm, while simultaneously collecting pupil data. The reference voice either belonged to the trained voice or an untrained voice. Effects of voice training (trained and untrained voice), vocoding (non-vocoded and vocoded), and item variability (fixed or variable consonant-vowel triplets presented across three items) on voice cue sensitivity (fo+vtl JNDs) and listening effort (pupillometry measurements) were analyzed.

RESULTS

Results showed that voice training did not have a significant effect on voice cue discrimination. As expected, fo+vtl JNDs were significantly larger for vocoded conditions than for non-vocoded conditions and with variable item presentations than fixed item presentations. Generalized additive mixed models analysis of pupil dilation over the time course of stimulus presentation showed that pupil dilation was significantly larger during fo+vtl discrimination while listening to untrained voices compared to trained voices, but only for vocoder-degraded speech. Peak pupil dilation was significantly larger for vocoded conditions compared to non-vocoded conditions and variable items increased the pupil baseline relative to fixed items, which could suggest a higher anticipated task difficulty.

CONCLUSIONS

In this study, even though short voice training did not lead to improved sensitivity to small fo+vtl voice cue differences at the discrimination threshold level, voice training still resulted in reduced listening effort for discrimination among vocoded voice cues.

Exploring the Correlations Between Measures of Listening Effort in Adults and Children: A Systematic Review with Narrative Synthesis

Listening effort (LE) describes the cognitive resources needed to process an auditory message. Our understanding of this notion remains in its infancy, hindering our ability to appreciate how it impacts individuals with hearing impairment effectively. Despite the myriad of proposed measurement tools, a validated method remains elusive. This is complicated by the seeming lack of association between tools demonstrated via correlational analyses. This review aims to systematically review the literature relating to the correlational analyses between different measures of LE. Five databases were used- PubMed, Cochrane, EMBASE, PsychINFO, and CINAHL. The quality of the evidence was assessed using the GRADE criteria and risk of bias with ROBINS-I/GRADE tools. Each statistically significant analysis was classified using an approved system for medical correlations. The final analyses included 48 papers, equating to 274 correlational analyses, of which 99 reached statistical significance (36.1%). Within these results, the most prevalent classifications were poor or fair. Moreover, when moderate or very strong correlations were observed, they tended to be dependent on experimental conditions. The quality of evidence was graded as very low. These results show that measures of LE are poorly correlated and supports the multi-dimensional concept of LE. The lack of association may be explained by considering where each measure operates along the effort perception pathway. Moreover, the fragility of significant correlations to specific conditions further diminishes the hope of finding an all-encompassing tool. Therefore, it may be prudent to focus on capturing the consequences of LE rather than the notion itself.

Factors associated with change in the need for recovery and subjective listening effort in employees with hearing loss receiving aural rehabilitation

OBJECTIVE

Compared to normally-hearing employees, those with hearing loss suffer from higher Need For Recovery (NFR) after work. The aims of this study are to assess the NFR of employees with hearing loss before and after aural rehabilitation and to examine to what extent change in the NFR can be explained by changes in subjective listening effort, personal adjustments, communication strategies, auditory work demands, and self-reported hearing ability.

METHODS

We included patients who received aural rehabilitation in two audiological centers in the Netherlands because of hearing complaints in their work situation. Outcomes were measured by questionnaires at baseline and 3 month follow-up. The NFR before and after the rehabilitation was compared with a t test. Hierarchical multiple analyses were performed.

RESULTS

In total, 60 patients (aged 22-63, working hours ≥8 per week) participated in the study, of which 50 completed the follow-up questionnaires. The NFR was significantly lower after the aural rehabilitation (M = 45.03) compared to before the aural rehabilitation (M = 51.89), t = -3.43, p < 0.01). Change in NFR could best be explained by the change in personal adjustments (R² = 0.45, B = -1.23, p < 0.01).

CONCLUSION

The NFR of employees with hearing loss can be improved by aural rehabilitation, but this study shows that current practices reduce the NFR only in part of the employees. Therefore, improving current practices should be considered and evaluated, for example by applying a different combination of rehabilitation components. Especially, interventions that affect personal adjustments may be promising to further reduce the NFR in employees with hearing loss.

Workplace accommodation requests: Experiences of barriers and facilitators among deaf and hard-of-hearing

BACKGROUND

Despite the protections afforded by the Americans with Disabilities Act (ADA), workers who are deaf and hard-of-hearing (DHH) face workplace challenges that may require the aid of workplace resources and accommodations. Limited research has been conducted to understand the process of accommodation requests among DHH workers.

OBJECTIVE

This qualitative study examined barriers and facilitators to requesting accommodations among DHH workers.

METHODS

Fifty-nine DHH workers, recruited from organizations serving DHH workers across U.S., participated in the study. Participants' open-ended survey responses were analyzed and coded into themes representing barriers or facilitators to participants' decisions to request or withhold requests for accommodations.

RESULTS

Facilitators to accommodation request include an employee's effective use of self-efficacy and self-advocacy; supportive work environments; and the presence of peers with disabilities. Barriers to accommodation requests include the anticipation of negative perception of stigmatization in the workplace; lack of knowledge related to accommodations and ADA; absence of workplace support; ineffectual workplace structure, policies, or procedures; concerns surrounding costs; and physical and access barriers in the workplace.

CONCLUSION

To fulfill the workers' rights as guaranteed by the ADA, and to best serve the interests of the workplace, strategies are highlighted on how to assist DHH employees to take advantage of workplace accommodations with aims to promote job retention and success.

The Involvement of Listening Effort in Explaining Bilingual Listening Under Adverse Listening Conditions

The current review examines listening effort to uncover how it is implicated in bilingual performance under adverse listening conditions. Various measures of listening effort, including physiological, behavioral, and subjective measures, have been employed to examine listening effort in bilingual children and adults. Adverse listening conditions, stemming from environmental factors, as well as factors related to the speaker or listener, have been examined. The existing literature, although relatively limited to date, points to increased listening effort among bilinguals in their nondominant second language (L2) compared to their dominant first language (L1) and relative to monolinguals. Interestingly, increased effort is often observed even when speech intelligibility remains unaffected. These findings emphasize the importance of considering listening effort alongside speech intelligibility. Building upon the insights gained from the current review, we propose that various factors may modulate the observed effects. These include the particular measure selected to examine listening effort, the characteristics of the adverse condition, as well as factors related to the particular linguistic background of the bilingual speaker. Critically, further research is needed to better understand the impact of these factors on listening effort. The review outlines avenues for future research that would promote a comprehensive understanding of listening effort in bilingual individuals.

Effects of Critical Distance and Reverberation on Listening Effort in Adults

PURPOSE

Mixed historical data on how listening effort is affected by reverberation and listener-to-speaker distance challenge existing models of listening effort. This study investigated the effects of reverberation and listener-to-speaker distance on behavioral and subjective measures of listening effort: (a) when listening at a fixed signal-to-noise ratio (SNR) and (b) at SNRs that were manipulated so that word recognition would be comparable across different reverberation times and listening distances. It was expected that increased reverberation would increase listening effort but only when listening outside critical distance.

METHOD

Nineteen adults (21-40 years) with no hearing loss completed a dual-task paradigm. The primary task was word recognition and the secondary task was timed word categorization; response times indexed behavioral listening effort. Additionally, participants provided subjective ratings in each condition. Testing was completed at two reverberation levels (moderate and high, RT₃₀ = 469 and 1,223 ms, respectively) and at two listener-to-speaker distances (inside and outside critical distance for the test room, 1.25 and 4 m, respectively).

RESULTS

Increased reverberation and listening distances worsened word recognition performance and both behavioral and subjective listening effort. The effect of reverberation was exacerbated when listeners were outside critical distance. Subjective experience of listening effort persisted even when word recognition was comparable across conditions.

CONCLUSIONS

Longer reverberation times or listening outside the room's critical distance negatively affected behavioral and subjective listening effort. This study extends understanding of listening effort in reverberant rooms by highlighting the effect of listener's position relative to the room's critical distance.

Interaural speech asymmetry predicts bilateral speech intelligibility but not listening effort in adults with bilateral cochlear implants

Introduction

Bilateral cochlear implants (BiCIs) can facilitate improved speech intelligibility in noise and sound localization abilities compared to a unilateral implant in individuals with bilateral severe to profound hearing loss. Still, many individuals with BiCIs do not benefit from binaural hearing to the same extent that normal hearing (NH) listeners do. For example, binaural redundancy, a speech intelligibility benefit derived from having access to duplicate copies of a signal, is highly variable among BiCI users. Additionally, patients with hearing loss commonly report elevated listening effort compared to NH listeners. There is some evidence to suggest that BiCIs may reduce listening effort compared to a unilateral CI, but the limited existing literature has not shown this consistently. Critically, no studies to date have investigated this question using pupillometry to quantify listening effort, where large pupil sizes indicate high effort and small pupil sizes indicate low effort. Thus, the present study aimed to build on existing literature by investigating the potential benefits of BiCIs for both speech intelligibility and listening effort.

Methods

Twelve BiCI adults were tested in three listening conditions: Better Ear, Poorer Ear, and Bilateral. Stimuli were IEEE sentences presented from a loudspeaker at 0° azimuth in quiet. Participants were asked to repeat back the sentences, and responses were scored by an experimenter while changes in pupil dilation were measured.

Results

On average, participants demonstrated similar speech intelligibility in the Better Ear and Bilateral conditions, and significantly worse speech intelligibility in the Poorer Ear condition. Despite similar speech intelligibility in the Better Ear and Bilateral conditions, pupil dilation was significantly larger in the Bilateral condition.

Discussion

These results suggest that the BiCI users tested in this study did not demonstrate binaural redundancy in quiet. The large interaural speech asymmetries demonstrated by participants may have precluded them from obtaining binaural redundancy, as shown by the inverse relationship between the two variables. Further, participants did not obtain a release from effort when listening with two ears versus their better ear only. Instead, results indicate that bilateral listening elicited increased effort compared to better ear listening, which may be due to poor integration of asymmetric inputs.

Hearing healthcare for workers with hearing loss: audiologists' experiences and views

PURPOSE

This study explored audiologists' perspectives regarding their interactions with workers with hearing loss (WHL).

MATERIALS AND METHODS

Semi-structured interviews were conducted with twenty-five audiologists working in the National Health Service (NHS) and independent companies (IC) in the UK and were thematically analysed.

RESULTS

The developed themes and sub-themes (shown in parenthesis) are (1) Current practices and routines (Same approach for most patients; Variations between hearing care services; Audiologists' personal experience of hearing loss) (2) Perceived challenges (Non-routine and challenging cases; The role of hearing technology; Concerns about lack of awareness and knowledge; Communication difficulties between services, Limited funding and resources) (3) Scope for better support (Would like to be informed; Other potential service improvements).

CONCLUSIONS

This study revealed that audiologists' perceived deficiencies in the hearing rehabilitation for WHL and identified ways to improve it. Key priorities for improvement were found to include addressing audiologists' informational and training needs, facilitating WHLs' access to appointments, improving communication between services, raising awareness in the workplace, developing relevant resources and extending funding for provision of longer appointments and hearing technologies. This is the first time this information has been reported in the literature. Opportunities for conducting further research in this area are suggested.Implications for rehabilitationWorkers with hearing loss face many challenges in work life and have the option of audiologic rehabilitation to alleviate their difficulties and improve their wellbeing; however, this study suggests that workers' audiological care needs improvements.Audiologists should assess and consider patients' work needs and psychosocial concerns in consultations to provide personalised care.Audiology educational programmes, services, and the healthcare system can assist audiologists in helping workers with hearing loss by providing updated knowledge, continuous training and improved interprofessional communication and patients' access to useful resources.

Socioeconomic position and hearing loss: current understanding and recent advances

PURPOSE OF REVIEW

The purpose of this review is to describe recent literature examining the relationship between socioeconomic position (SEP) and hearing loss, including the impact of hearing loss on several socioeconomic outcomes over the life course. Additionally, we highlight current policy advances in recent years and review alternative models of hearing care that aim to address disparities related to SEP and hearing healthcare.

RECENT FINDINGS

Applying a social epidemiologic lens to hearing health gives insight into the role of material and social contexts in understanding and improving hearing health outcomes. Recent studies investigating the intersection of SEP and hearing health highlight the disparities that exist for individuals with low SEP as well as the influence of hearing loss on SEP. Individuals with hearing loss are more likely to be unemployed, have lower educational attainment, lower income, and are less likely to use hearing aids and access hearing care. Legislation addressing cost and access to hearing care as well as transforming the current landscape of hearing care, is essential to creating equitable care for individuals, especially older adults, with low SEP.

SUMMARY

With the expected rise in prevalence of hearing loss over the next 40 years, hearing care that is affordable and accessible is a public health priority. As hearing loss is associated with negative outcomes for individuals with low SEP, advances in legislation and care delivery models are necessary in order to include populations traditionally unserved by current hearing healthcare.

Labor Force Participation and Hearing Loss Among Adults in the United States: Evidence From the National Health and Nutrition Examination Survey

PURPOSE

The purpose of this article was to study the association between hearing loss (HL) and labor force participation in the National Health and Nutrition Examination Survey (NHANES).

METHOD

This cross-sectional study used data from the 1999-2000, 2001-2002, 2003-2004, 2011-2012, and 2015-2016 cycles of the NHANES. The sample was restricted to adults aged 25-65 years with complete audiometric data. HL was defined based on the pure-tone average (PTA) of 0.5-, 1-, 2-, and 4-kHz thresholds in the better hearing ear as follows: no loss (PTA < 25 dB), mild HL (25 dB < PTA < 40 dB), and moderate-to-severe HL (PTA > 40 dB). The association between HL and labor force participation was estimated using weighted logistic regression adjusted for age, sex, race/ethnicity, education, living arrangements, and health status.

RESULTS

In a sample of 9,963 participants (50.6% women, 22.6% Black, 27% Hispanic), we found that compared with adults without HL, individuals with moderate-to-severe HL had greater odds of being outside of the labor force (odds ratio = 2.35; 95% confidence interval: 1.42-3.88). However, there were no differences by HL status in being employed or having a full- versus part-time job.

CONCLUSIONS

Moderate-to-severe HL, but not mild HL, was associated with higher odds of not participating in the labor force. However, there were no differences by HL status in being employed or having a full- versus part-time job. Further research is needed to better characterize how HL may affect labor force participation.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19858930.

Adding noise is a confounded nuisance

A wide variety of research and clinical assessments involve presenting speech stimuli in the presence of some kind of noise. Here, I selectively review two theoretical perspectives and discuss ways in which these perspectives may help researchers understand the consequences for listeners of adding noise to a speech signal. I argue that adding noise changes more about the listening task than merely making the signal more difficult to perceive. To fully understand the effects of an added noise on speech perception, we must consider not just how much the noise affects task difficulty, but also how it affects all of the systems involved in understanding speech: increasing message uncertainty, modifying attentional demand, altering affective response, and changing motivation to perform the task.

Speech to noise ratio improvement induces nonlinear parietal phase synchrony in hearing aid users

Objectives

Comprehension of speech in adverse listening conditions is challenging for hearing-impaired (HI) individuals. Noise reduction (NR) schemes in hearing aids (HAs) have demonstrated the capability to help HI to overcome these challenges. The objective of this study was to investigate the effect of NR processing (inactive, where the NR feature was switched off, vs. active, where the NR feature was switched on) on correlates of listening effort across two different background noise levels [+3 dB signal-to-noise ratio (SNR) and +8 dB SNR] by using a phase synchrony analysis of electroencephalogram (EEG) signals.

Design

The EEG was recorded while 22 HI participants fitted with HAs performed a continuous speech in noise (SiN) task in the presence of background noise and a competing talker. The phase synchrony within eight regions of interest (ROIs) and four conventional EEG bands was computed by using a multivariate phase synchrony measure.

Results

The results demonstrated that the activation of NR in HAs affects the EEG phase synchrony in the parietal ROI at low SNR differently than that at high SNR. The relationship between conditions of the listening task and phase synchrony in the parietal ROI was nonlinear.

Conclusion

We showed that the activation of NR schemes in HAs can non-linearly reduce correlates of listening effort as estimated by EEG-based phase synchrony. We contend that investigation of the phase synchrony within ROIs can reflect the effects of HAs in HI individuals in ecological listening conditions.

Hearing loss, sick leave, and disability pension: findings from the HUNT follow-up study

Background

Evidence on the association between hearing loss and sick leave or disability pension is to a great extent based on few cross-sectional studies and remains unclear. We aim to assess the associations in a long-term follow-up population study.

Methods

We used baseline data from a large population-based hearing study in Norway, the HUNT Hearing study (1996–1998). The sample included 21 754 adults (48.5% men, mean age at baseline 36.6 years). We used register data on sick leave and disability pension (1996–2011). Cox regression was used to assess the association between hearing loss at baseline (Pure tone average/PTA 0.5–4 kHz > 20 dB) and time to first physician-certified sick leave episode, as well as time to first disability pension payment.

Results

Hearing loss at baseline (yes/no) was weakly associated with time to first physician-certified sick leave episode: Hazard ratio (HR) 1.2 (95% confidence interval (CI) 1.1–1.3). Restricting the exposed group to people with both hearing loss and tinnitus, the HR was slightly increased: 1.3 (95% CI 1.1–1.6). Hearing loss in 1996–1998 was also associated with time to first received disability pension: HR 1.5 (95% CI 1.3–1.8). Stronger associations were found for disabling hearing loss (PTA > 35). Restricting the exposure to hearing loss and tinnitus, the HR was increased: 2.0 (95% CI 1.4–2.8).

Conclusions

This large population-based cohort study indicates that hearing loss is associated with increased risk of receiving disability pension, especially among younger adults and low educated workers. Hearing loss was weakly associated with sick leave.

The cost-effectiveness of unilateral cochlear implants in UK adults

OBJECTIVE

The National Institute for Health and Care Excellence (NICE) updated its eligibility criteria for unilateral cochlear implants (UCIs) in 2019. NICE claimed this would not impact the cost-effectiveness results used within its 2009 technology appraisal guidance. This claim is uncertain given changed clinical practice and increased healthcare unit costs. Our objective was to estimate the cost-effectiveness estimates of UCIs in UK adults with severe to profound hearing loss within the contemporary NHS environment.

METHODS

A cost-utility analysis employing a Markov model was undertaken to compare UCIs with hearing aids or no hearing aids for people with severe to profound hearing loss. A clinical pathway was developed to estimate resource use. Health-related quality of life, potential adverse events, device upgrades and device failure were captured. Unit costs were derived mostly from the NHS data. Probabilistic sensitivity analysis further assessed the effect of uncertain model inputs.

RESULTS

A UCI is likely to be deemed cost-effective when compared to a hearing aid (£11,946/QALY) or no hearing aid (£10,499/QALY). A UCI has an 93.0% and 98.7% likelihood of being cost-effective within the UK adult population when compared to a hearing aid or no hearing aid, respectively. ICERs were mostly sensitive to the proportion of people eligible for cochlear implant, discount rate, surgery and device costs and processor upgrade cost.

CONCLUSION

UCIs remain cost-effective despite changes to clinical practice and increased healthcare unit costs. Updating the NICE criteria to provide better access UCIs is projected to increase annual implants in adults and children by 70% and expenditure by £28.6 million within three years. This increased access to UCIs will further improve quality of life of recipients and overall social welfare.

Listening Over Time: Single-Trial Tonic and Phasic Oscillatory Alpha-and Theta-Band Indicators of Listening-Related Fatigue

Objectives

Listening effort engages cognitive resources to support speech understanding in adverse listening conditions, and leads to fatigue over the longer term for people with hearing loss. Direct, neural measures of listening-related fatigue have not been developed. Here, event-related or phasic changes in alpha and theta oscillatory power during listening were used as measures of listening effort, and longer-term or tonic changes over the course of the listening task were assessed as measures of listening-related fatigue. In addition, influences of self-reported fatigue and degree of hearing loss on tonic changes in oscillatory power were examined.

Design

Participants were middle-aged adults (age 37–65 years; n = 12) with age-appropriate hearing. Sentences were presented in a background of multi-talker babble at a range of signal-to-noise ratios (SNRs) varying around the 80 percent threshold of individual listeners. Single-trial oscillatory power during both sentence and baseline intervals was analyzed with linear mixed-effect models that included as predictors trial number, SNR, subjective fatigue, and hearing loss.

Results

Alpha and theta power in both sentence presentation and baseline intervals increased as a function of trial, indicating listening-related fatigue. Further, tonic power increases across trials were affected by hearing loss and/or subjective fatigue, particularly in the alpha-band. Phasic changes in alpha and theta power generally tracked with SNR, with decreased alpha power and increased theta power at less favorable SNRs. However, for the alpha-band, the linear effect of SNR emerged only at later trials.

Conclusion

Tonic increases in oscillatory power in alpha- and theta-bands over the course of a listening task may be biomarkers for the development of listening-related fatigue. In addition, alpha-band power as an index of listening-related fatigue may be sensitive to individual differences attributable to level of hearing loss and the subjective experience of listening-related fatigue. Finally, phasic effects of SNR on alpha power emerged only after a period of listening, suggesting that this measure of listening effort could depend on the development of listening-related fatigue.

Hearing impairment among workers and satisfaction with the use of hearing aids

BACKGROUND: Hearing problems can have adverse effects on an individual’s job performance, as well as on unemployment or underemployment and increased risk of stress-related sick leave. OBJECTIVE: To investigate hearing impairment among workers and satisfaction with the use of hearing aids. METHODS: Cross-sectional study with workers who are hearing aid users. Subjects underwent pure tone audiometry and answered the Hearing Handicap Inventory for Adults and the Satisfaction with Amplification in Daily Life questionnaires. RESULTS: Participants were 36 workers between 36 and 75 years old, with an average age of 53.47 years, 52.7% male and 47.3% female. There was a mild to moderate hearing handicap perception, with worse results for women in the emotional domain. As hearing loss increased, workers’ frustration increased when talking to coworkers. Everyone was satisfied with the use of their hearing aids. Satisfaction increased with increasing age and decreased with increasing hearing loss. The greater the frustration when talking to co-workers, the lower the overall satisfaction with hearing aid use; the lower the satisfaction with the competence of the professional who assisted in adapting the hearing aid; the lower the satisfaction in environments with background noise and overall worse personal image. The worse the attitudes and emotional responses of workers regarding their hearing impairment, the lower the overall satisfaction with the hearing aid. CONCLUSIONS: Despite the use of hearing aids, workers perceive having a hearing impairment, especially women. As hearing loss and frustration in talking with co-workers increased, satisfaction decreased.

Weaker association between hearing loss and non-employment in recent generations: the HUNT cohort study

OBJECTIVES

To examine the prevalence of hearing loss (HL) among employed persons, the association between HL and non-employment, assessing whether this has changed over the last two decades. To identify susceptible groups for HL-related work problems and examine the association between HL and co-worker relations.

DESIGN

Cross-sectional analyses of working-age participants (20-66 years). HL was defined as the pure-tone average threshold of 0.5-4 kHz in the better hearing ear: 20-34 dB (mild) or ≥35 dB (disabling). Associations were assessed with logistic regression.

STUDY SAMPLE

Data from two waves of the Trøndelag Health Study (HUNT): HUNT2 1996-1998 (N = 38,603), HUNT4 2017-2019 (N = 19,614).

RESULTS

The nationally weighted prevalence of HL among employees was 5.8%. HL was associated with non-employment, more strongly in HUNT2 (odds ratio (OR) 2.2, 95% confidence interval (CI) 2.0-2.4) than HUNT4 (OR 1.9, CI 1.7-2.1). HL was not associated with poorer co-worker relations. The association between HL and non-optimal work performance was stronger among white-collar workers than blue-collar workers.

CONCLUSIONS

Our study shows that HL is common in the employed population. It also indicates a weakened association between HL and non-employment in recent generations. White-collar workers appear to be more vulnerable to HL-related work problems than blue-collar workers.

Perceived Listening Difficulties of Adult Cochlear-Implant Users Under Measures Introduced to Combat the Spread of COVID-19

Following the outbreak of the COVID-19 pandemic, public-health measures introduced to stem the spread of the disease caused profound changes to patterns of daily-life communication. This paper presents the results of an online survey conducted to document adult cochlear-implant (CI) users’ perceived listening difficulties under four communication scenarios commonly experienced during the pandemic, specifically when talking: with someone wearing a facemask, under social/physical distancing guidelines, via telephone, and via video call. Results from ninety-four respondents indicated that people considered their in-person listening experiences in some common everyday scenarios to have been significantly worsened by the introduction of mask-wearing and physical distancing. Participants reported experiencing an array of listening difficulties, including reduced speech intelligibility and increased listening effort, which resulted in many people actively avoiding certain communication scenarios at least some of the time. Participants also found listening effortful during remote communication, which became rapidly more prevalent following the outbreak of the pandemic. Potential solutions identified by participants to ease the burden of everyday listening with a CI may have applicability beyond the context of the COVID-19 pandemic. Specifically, the results emphasized the importance of visual cues, including lipreading and live speech-to-text transcriptions, to improve in-person and remote communication for people with a CI.

Predictive Sentence Context Reduces Listening Effort in Older Adults With and Without Hearing Loss and With High and Low Working Memory Capacity

OBJECTIVES

Listening effort is needed to understand speech that is degraded by hearing loss, a noisy environment, or both. This in turn reduces cognitive spare capacity, the amount of cognitive resources available for allocation to concurrent tasks. Predictive sentence context enables older listeners to perceive speech more accurately, but how does contextual information affect older adults' listening effort? The current study examines the impacts of sentence context and cognitive (memory) load on sequential dual-task behavioral performance in older adults. To assess whether effects of context and memory load differ as a function of older listeners' hearing status, baseline working memory capacity, or both, effects were compared across separate groups of participants with and without hearing loss and with high and low working memory capacity.

DESIGN

Participants were older adults (age 60-84 years; n = 63) who passed a screen for cognitive impairment. A median split classified participants into groups with high and low working memory capacity. On each trial, participants listened to spoken sentences in noise and reported sentence-final words that were either predictable or unpredictable based on sentence context, and also recalled short (low-load) or long (high-load) sequences of digits that were presented visually before each spoken sentence. Speech intelligibility was quantified as word identification accuracy, and measures of listening effort included digit recall accuracy, and response time to words and digits. Correlations of context benefit in each dependent measure with working memory and vocabulary were also examined.

RESULTS

Across all participant groups, accuracy and response time for both word identification and digit recall were facilitated by predictive context, indicating that in addition to an improvement in intelligibility, listening effort was also reduced when sentence-final words were predictable. Effects of predictability on all listening effort measures were observed whether or not trials with an incorrect word identification response were excluded, indicating that the effects of predictability on listening effort did not depend on speech intelligibility. In addition, although cognitive load did not affect word identification accuracy, response time for word identification and digit recall, as well as accuracy for digit recall, were impaired under the high-load condition, indicating that cognitive load reduced the amount of cognitive resources available for speech processing. Context benefit in speech intelligibility was positively correlated with vocabulary. However, context benefit was not related to working memory capacity.

CONCLUSIONS

Predictive sentence context reduces listening effort in cognitively healthy older adults resulting in greater cognitive spare capacity available for other mental tasks, irrespective of the presence or absence of hearing loss and baseline working memory capacity.

Sustainable employability of teachers with hearing loss

OBJECTIVE

In many countries the retirement age is rising. Consequently, age-related hearing loss is an increasing occupational health problem. This study examined the association between hearing loss and sustainable employability of teachers.

DESIGN

For this cross-sectional study a survey and an online hearing screening test were used. Sustainable employability was measured with the Capability Set for Work Questionnaire (CSWQ), examining seven work values. CSWQ-scores of teachers with poor, insufficient, and good hearing were investigated with ordinal regression analyses. Work values and discrepancies between the importance and achievement of the values were examined by chi-square tests.

STUDY SAMPLE

Dutch teachers (N = 737) of whom 146 (20%) had insufficient and 86 (12%) poor hearing.

RESULTS

Teachers with insufficient (OR = 0.64; 95% CI 0.46-0.89) and poor (OR = 0.55; 95% CI 0.36-0.83) hearing had lower CSWQ-scores compared with good hearing teachers. Adjustment for covariates, in particular for self-rated health, attenuated the associations. Compared with good hearing teachers, teachers with poor hearing reported more discrepancies in using their knowledge and skills and setting their own goals at work.

CONCLUSIONS

Hearing loss was negatively associated with sustainable employability of teachers. This emphasises the importance of assessing the hearing status of teachers.

Computational Audiology: New Approaches to Advance Hearing Health Care in the Digital Age

The global digital transformation enables computational audiology for advanced clinical applications that can reduce the global burden of hearing loss. In this article, we describe emerging hearing-related artificial intelligence applications and argue for their potential to improve access, precision, and efficiency of hearing health care services. Also, we raise awareness of risks that must be addressed to enable a safe digital transformation in audiology. We envision a future where computational audiology is implemented via interoperable systems using shared data and where health care providers adopt expanded roles within a network of distributed expertise. This effort should take place in a health care system where privacy, responsibility of each stakeholder, and patients' safety and autonomy are all guarded by design.

The effects of dyslipidemia on noise-induced hearing loss in a petrochemical workers in the Southwest of Iran

BACKGROUND

Research has shown that the decrease in the inner diameter of vessels caused by hyperlipidemia lowers the capacity for blood oxygen delivery to the cochlea. This leads to impaired cochlear metabolism and causes hearing problems.

OBJECTIVE

The effects of dyslipidemia on noise-induced hearing loss in workers were examined.

METHODS

This descriptive cross-sectional study was performed on 692 male employees in a petrochemical industry in the southwest of Iran exposed to 85 dB noise. Clinical audiometry and blood sample tests were used to evaluate the hearing and prevalence indices of dyslipidemia (cholesterol, triglyceride, HDL and LDL). The data were analyzed using SPSS software version 25 (p = 0.05).

RESULTS

The results showed that the prevalence of dyslipidemia was 24.5%with abnormal relative triglyceride frequency of 49.5%, HDL of 28%, LDL of 33%, and total blood cholesterol level of 37.8%. There was no significant relationship between NIHL and dyslipidemia (p >  0.09). However, the major NIHL drops at different frequencies were in the individuals with dyslipidemia. The parameters age and dyslipidemia increased NIHL odds ratio (95%C.I.). by 1.130 (1.160-1.100) and 1.618 (2.418-1.082) respectivelyCONCLUSION:The rate of hearing loss in individuals with dyslipidemia increases at different frequencies and it leads to an increase of the OR of NIHL in individuals with dyslipidemia. We can control dyslipidemia and its effective factors. The NIHL is more common in people exposed to noise.

The Longitudinal Relationship Between Speech Recognition in Noise, Need for Recovery After Work, Job Demand, and Job Control Over a Period of 5 Years

OBJECTIVE

Hearing impairment may lead to an increased need to recover from fatigue and distress after a day of work. Also, hearing impairment may negatively affect the balance between workload and control over it (job demand and job control). The uptake of hearing solutions may have a positive effect on these outcomes. We aimed to assess the longitudinal relationship between change in speech recognition in noise and changes in need for recovery after work and job demand and job control, and the influence of hearing solutions on these relationships over a period of 5 years. Research questions (RQs) were as follows: (1) Is a 5-year change in speech recognition in noise associated with a change in need for recovery after work over that same 5-year period?; (2) Is a 5-year change in speech recognition in noise associated with a change in job demand and job control over that same 5-year period?; (3) What is the effect of hearing solution uptake in the 5-year period on the change in these outcomes in that same 5-year period?

METHOD

Data of the Netherlands Longitudinal Study on Hearing, collected between 2006 and January 2019, were divided into two 5-year follow-up intervals: T0 (baseline) to T1 (5-year follow-up) and T1 (5-year follow-up) to T2 (10-year follow-up). An online digit-triplet in noise test was used to assess speech recognition in noise. Online questionnaires on demographic, socioeconomic, and work-related characteristics were administered. For RQ1-RQ2, the study sample included adults working ≥12 hours per week, with at least two consecutive measurements (n = 783). For RQ3, employees who had not yet obtained hearing solutions at baseline, but who would be eligible based on a speech reception threshold in noise ≥ -5.5 dB signal-to-noise ratio (SNR), were included (n = 147). Longitudinal linear regression analyses using mixed models were performed to assess RQ1-RQ3.

RESULTS

After adjusting for baseline values, 5-year change in speech recognition in noise showed a statistically significant association with 5-year change in need for recovery. A worsening of 1 dB SNR in speech recognition in noise in an individual was associated with an increase of 0.72 units in need for recovery (scale range 0 to 100). A 5-year change in speech recognition in noise was not significantly associated with a 5-year change in job demand or job control. The uptake of hearing solutions in the 5-year period did not have a significant effect on change in need for recovery in that same 5-year period.

CONCLUSION

The significant longitudinal association between 5-year worsening in speech recognition in noise and increase in need for recovery over the same time period strengthens the evidence for the importance of early detection of a worsening in speech recognition in noise to identify employees with an increase in need for recovery. The absence of an effect of the uptake of a hearing solution on need for recovery indicates that additional alternative interventions may be needed to foster beneficial use of hearing solutions as well as to mitigate the increased need for recovery in case of worsening speech recognition in noise.

Uptake of Hearing Aids and Hearing Assistive Technology in a Working Population: Longitudinal Analyses of The Netherlands Longitudinal Study on Hearing

OBJECTIVE

To identify predictors of the 5-year uptake of hearing aids (HAs) and hearing assistive technology (HAT) in a sample of Dutch employees eligible for HAs and/or HAT. The potential predictors included demographic factors (age, sex, marital status, and living situation), education, hearing factors (ability to recognize speech in noise and self-reported hearing disability), distress, self-efficacy, and work-related factors (job demand, job control, and need for recovery).

DESIGN

Five-year follow-up data of the Netherlands Longitudinal Study on Hearing (NL-SH) collected until January 2019 were included. An online digit-triplet in noise test, the National Hearing Test (NHT), was used to assess speech-recognition-in-noise ability. In addition, online questionnaires on demographic, socioeconomic, self-reported hearing disability, health, and work-related characteristics were administered. Adults who worked over 12 hours per week, who had not yet taken up HAs or HAT, but who would be eligible for HAs/HAT based on their NHT score (insufficient or poor hearing ability), were included in the study. The 5-year uptake of HAs/HAT was defined as a dichotomous variable of self-reported HA/HAT use reported 5 years later. Generalized Estimating Equations analyses were performed to analyze the associations between potential predicting factors and the 5-year uptake of HAs/HAT, taking into account the repeated measurements of the predicting factors and the 5-year uptake of HAs/HAT.

RESULTS

Data of 218 participants were included. The cumulative incidence of the 5-year uptake of HAs/HAT was 15 to 33%, of which 52 employees took up HAs and 11 employees took up HAT. Married participants had increased odds for 5-year uptake of HAs/HAT compared with unmarried participants (odds ratio [OR] = 2.13, 95% confidence interval [CI] = 1.05 to 4.35). Higher self-reported hearing disability (per one unit, scale range 0 to 74) was associated with increased odds for 5-year uptake of HAs/HAT (OR = 1.05, 95% CI = 1.03 to 1.07). Job demand showed a significant interaction with sex (p = 0.002), and therefore, stratified analyses were performed. In male participants, participants with higher job demand scores (per one unit, scale range 12 to 48) had increased odds for 5-year uptake of HAs/HAT (OR = 1.18, 95% CI = 1.05 to 1.35). No difference was seen in females.

CONCLUSION

This study confirms that factors predicting the uptake of HAs/HAT in the general or older populations, including marital status and self-reported hearing disability, also extend to the working population. The identification of job demand as a predictor of the uptake of HAs/HAT (in males only) was a novel finding. It demonstrates the importance of considering work-related factors in aural rehabilitation.

Daily-Life Fatigue in Mild to Moderate Hearing Impairment: An Ecological Momentary Assessment Study

OBJECTIVES

Previous research has indicated an association between hearing impairment (HI) and daily-life fatigue. However, the temporal and contextual correlates of such fatigue are largely unexplored. The present study used ecological momentary assessment (EMA) to examine (1) whether people with HI are more fatigued than people with normal hearing, (2) whether individuals with HI and normal hearing (NH) show similar diurnal patterns of fatigue, (3) whether people with HI spend less time in challenging listening situations compared with NH controls, and (4) whether more challenging listening situations are associated with more fatigue and whether hearing ability influences any observed association.

DESIGN

After excluding 22 participants with self-reported fatiguing health conditions from analyses, the participant sample consisted of 24 adults with HI and 20 adults with NH, aged 44 to 77 years (M = 65.4, SD = 7.5). Data were collected using smartphones and a commercially available EMA app, which ran the specified EMA protocol for this study. Participants responded to six smartphone surveys per day for two weeks. "In-the-moment" questions asked participants to report on their listening situation and to rate their current level of fatigue ("momentary fatigue") at quasi-random time points throughout the day. Data were analyzed using multilevel modeling.

RESULTS

Hearing group (HI versus NH) was unrelated to trait, daily, and momentary fatigue; both participants with HI and NH became increasingly fatigued throughout the day and at a similar rate. Challenging listening situations occurred infrequently both for HI and NH groups. Participants with NH were more likely to report that there were people speaking in the background whom they were trying to ignore, but participants with HI were more likely to report a greater number of background speakers. No associations were found between within-person listening situations and momentary fatigue, but person-mean listening activity and conversational status were related to momentary fatigue. Notably, having tinnitus was positively related to momentary fatigue, after controlling for other covariates. Finally, having a fatiguing health condition was a strong predictor of both trait and momentary fatigue.

CONCLUSIONS

This is the first study to explore and compare fatigue across HI and NH groups using EMA. Contrary to expectations, the groups showed similar levels and diurnal patterns of fatigue, and fatigue was mostly unrelated to aspects of the listening environment. Between-person differences, although statistically significant, produced small effect sizes and therefore must be accepted cautiously. Issues with group matching, the measurement of fatigue, and perceived hearing-related difficulties among participants with NH are notable limitations. However, this study makes a novel contribution to both EMA and hearing research and demonstrates the importance of screening for fatiguing health conditions. Further research is warranted, particularly with individuals with more severe HI.