Adults who report difficulty hearing speech in noise: an exploration of experiences, impacts and coping strategies

Lower frequency range of auditory input facilitates stream segregation in older adults

The current study investigated the effect of lower frequency input on stream segregation acuity in older, normal hearing adults. Using event-related brain potentials (ERPs) and perceptual performance measures, we previously showed that stream segregation abilities were less proficient in older compared to younger adults. However, in that study we used frequency ranges greater than 1500 Hz. In the current study, we lowered the target frequency range below 1500 Hz and found similar stream segregation abilities in younger and older adults. These results indicate that the perception of complex auditory scenes is influenced by the spectral content of the auditory input and suggest that lower frequency ranges of input in older adults may facilitate listening ability in complex auditory environments. These results also have implications for the advancement of prosthetic devices.

Digits-in-Noise Test as an Assessment Tool for Hearing Loss and Hearing Aids

The aim of this study was to examine the relationship between an American English Digits in Noise (DIN) test and commonly used audiological measures to evaluate the DIN test's ability to detect hearing loss and validate hearing aid fitting. QuickSIN and DIN tests were completed by participants with untreated hearing loss (n = 46), prescription hearing aids (n = 15), and over-the-counter (OTC) hearing aids (n = 12). Performance on the QuickSIN showed moderate positive correlations with DIN for untreated hearing loss participants and prescription hearing aid users, but not for OTC hearing aid users. For untreated hearing loss participants, both QuickSIN and DIN tests showed positive moderate to strong correlations with high frequency puretone averages. In OTC users, DIN scores did not significantly change over a 6-month time period and were better when conducted remotely compared to in-person testing. Our results suggest that the DIN test may be a feasible monitoring option for individuals with hearing loss and those fitted with hearing aids. However, due to small sample size in this pilot study, future research is needed to examine DIN test's utility for fitting and validating OTC hearing aids.

A Comprehensive Review of Auditory and Non-Auditory Effects of Noise on Human Health

OBJECTIVE

Excessive noise is unpleasant and induces several physiological and psychological effects. Noise pollution is a potential threat to humans, particularly those continuously exposed for extended periods throughout the day over many years. This review aims to examine the various auditory and non-auditory outcomes associated with prolonged exposure to noise pollution.

MATERIALS AND METHODS

The review utilized a combination of relevant keywords to search the electronic databases. After screening based on the applied selection criteria for title, abstract, and full text, 44 articles were finally selected for critical review.

RESULTS

We identified and analyzed research findings related to noise-induced hearing loss, tinnitus, and sleep disturbances along with non-auditory issues such as annoyance, cognitive impairments, and mental stress associated with cardiovascular disorders. Furthermore, the existing studies were compared and collated to highlight the unique challenges and significance of noise pollution as a distinctive environmental concern and to explore the ongoing efforts in its research and prevention, including the early detection and potential reversal of noise-induced hearing loss.

CONCLUSION

The fundamental health consequences of noise pollution underscore the need for extensive research encompassing emerging noise sources and technologies to establish a health management system tailored to address noise-related health concerns and reduce noise exposure risk among populations. Finally, further research is warranted to ensure improved measurement of noise exposure and related health outcomes, especially in the context of occupational noise.

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.

The effect of age on the hearing-related quality of life in normal-hearing adults

INTRODUCTION

Recently, a new holistic Patient Reported Outcome Measure (PROM) to assess hearing-related quality of life was developed, named the hearing-related quality of life questionnaire for Auditory-VIsual, COgnitive and Psychosocial functioning (hAVICOP). The purpose of the current study was to evaluate if the hAVICOP is sufficiently sensitive to detect an age effect in the hearing-related quality of life.

METHODS

One-hundred thirteen normal-hearing participants (mean age: 42.13; range: 19 to 69 years) filled in the entire hAVICOP questionnaire online through the Research Electronic Data Capture surface. The hAVICOP consists of 27 statements, across three major subdomains (auditory-visual, cognitive, and psychosocial functioning), which have to be rated on a visual analogue scale ranging from 0 (rarely to never) to 100 (almost always). Mean scores were calculated for each subdomain separately as well as combined within a total score; the worse one's hearing-related quality of life, the lower the score. Linear regression models were run to predict the hAVICOP total as well as the three subdomain scores from age and sex.

RESULTS

A significant main effect of age was observed for the total hAVICOP and all three subdomain scores, indicating a decrease in hearing-related quality of life with increasing age. For none of the analyses, a significant sex effect was found.

CONCLUSION

The hAVICOP is sufficiently sensitive to detect an age effect in the hearing-related quality of life within a large group of normal-hearing adults, emphasizing its clinical utility. This age effect on the hearing-related quality of life might be related to the interplay of age-related changes in the bottom-up and top-down processes involved during speech processing.

Predicting speech-in-speech recognition: Short-term audibility and spatial separation

Quantifying the factors that predict variability in speech-in-speech recognition represents a fundamental challenge in auditory science. Stimulus factors associated with energetic and informational masking (IM) modulate variability in speech-in-speech recognition, but energetic effects can be difficult to estimate in spectro-temporally dynamic speech maskers. The current experiment characterized the effects of short-term audibility and differences in target and masker location (or perceived location) on the horizontal plane for sentence recognition in two-talker speech. Thirty young adults with normal hearing (NH) participated. Speech reception thresholds and keyword recognition at a fixed signal-to-noise ratio (SNR) were measured in each spatial condition. Short-term audibility for each keyword was quantified using a glimpsing model. Results revealed that speech-in-speech recognition depended on the proportion of audible glimpses available in the target + masker keyword stimulus in each spatial condition, even across stimuli presented at a fixed global SNR. Short-term audibility requirements were greater for colocated than spatially separated speech-in-speech recognition, and keyword recognition improved more rapidly as a function of increases in target audibility with spatial separation. Results indicate that spatial cues enhance glimpsing efficiency in competing speech for young adults with NH and provide a quantitative framework for estimating IM for speech-in-speech recognition in different spatial configurations.

Effectiveness of Auditory Training in Experienced Hearing-Aid Users, and an Exploration of Their Health-Related Quality of Life and Coping Strategies

Hearing aids (HA) are a fundamental component in restoring auditory function; however, they cannot completely alleviate all problems encountered by adults with hearing impairment. The aim of this study is twofold. Firstly, we assess the health-related quality of life and coping strategies of experienced HA users. Secondly, we assess whether HA users can benefit from auditory training. To this end, 40 participants who had worn HAs for more than 6 months participated in this study. Half of the participants received auditory training, while the other half served as a passive control. The training consisted of a personalized training scheme, with outcome measures including speech in noise perception in free-field and via direct streaming to the HA, phoneme identification, cognitive control, and health-related quality of life. Results showed that experienced HA users reported a relatively good quality of life. Health-related quality of life was correlated with aided speech perception in noise, but not with aided pure tone audiometry. Coping strategies were adaptive, leading to improved communication. Participants showed improvements in trained tasks, consonant identification, and speech in noise perception. While both groups yielded improved speech in noise perception at the end, post hoc analysis following a three-way interaction showed a significantly larger pre-post difference for the trained group in the streaming condition. Although training showed some improvements, the study suggests that the training paradigm was not sufficiently challenging for HA users. To optimize daily life listening, we recommend that future training should incorporate more exercises in noise and focus on cognitive control.

Performance on stochastic figure-ground perception varies with individual differences in speech-in-noise recognition and working memory capacity

Speech recognition in noisy environments can be challenging and requires listeners to accurately segregate a target speaker from irrelevant background noise. Stochastic figure-ground (SFG) tasks in which temporally coherent inharmonic pure-tones must be identified from a background have been used to probe the non-linguistic auditory stream segregation processes important for speech-in-noise processing. However, little is known about the relationship between performance on SFG tasks and speech-in-noise tasks nor the individual differences that may modulate such relationships. In this study, 37 younger normal-hearing adults performed an SFG task with target figure chords consisting of four, six, eight, or ten temporally coherent tones amongst a background of randomly varying tones. Stimuli were designed to be spectrally and temporally flat. An increased number of temporally coherent tones resulted in higher accuracy and faster reaction times (RTs). For ten target tones, faster RTs were associated with better scores on the Quick Speech-in-Noise task. Individual differences in working memory capacity and self-reported musicianship further modulated these relationships. Overall, results demonstrate that the SFG task could serve as an assessment of auditory stream segregation accuracy and RT that is sensitive to individual differences in cognitive and auditory abilities, even among younger normal-hearing adults.

Predicting speech-in-speech recognition: Short-term audibility, talker sex, and listener factors

Speech-in-speech recognition can be challenging, and listeners vary considerably in their ability to accomplish this complex auditory-cognitive task. Variability in performance can be related to intrinsic listener factors as well as stimulus factors associated with energetic and informational masking. The current experiments characterized the effects of short-term audibility of the target, differences in target and masker talker sex, and intrinsic listener variables on sentence recognition in two-talker speech and speech-shaped noise. Participants were young adults with normal hearing. Each condition included the adaptive measurement of speech reception thresholds, followed by testing at a fixed signal-to-noise ratio (SNR). Short-term audibility for each keyword was quantified using a computational glimpsing model for target+masker mixtures. Scores on a psychophysical task of auditory stream segregation predicted speech recognition, with stronger effects for speech-in-speech than speech-in-noise. Both speech-in-speech and speech-in-noise recognition depended on the proportion of audible glimpses available in the target+masker mixture, even across stimuli presented at the same global SNR. Short-term audibility requirements varied systematically across stimuli, providing an estimate of the greater informational masking for speech-in-speech than speech-in-noise recognition and quantifying informational masking for matched and mismatched talker sex.

The hunt for hidden hearing loss in humans: From preclinical studies to effective interventions

Many individuals experience hearing problems that are hidden under a normal audiogram. This not only impacts on individual sufferers, but also on clinicians who can offer little in the way of support. Animal studies using invasive methodologies have developed solid evidence for a range of pathologies underlying this hidden hearing loss (HHL), including cochlear synaptopathy, auditory nerve demyelination, elevated central gain, and neural mal-adaptation. Despite progress in pre-clinical models, evidence supporting the existence of HHL in humans remains inconclusive, and clinicians lack any non-invasive biomarkers sensitive to HHL, as well as a standardized protocol to manage hearing problems in the absence of elevated hearing thresholds. Here, we review animal models of HHL as well as the ongoing research for tools with which to diagnose and manage hearing difficulties associated with HHL. We also discuss new research opportunities facilitated by recent methodological tools that may overcome a series of barriers that have hampered meaningful progress in diagnosing and treating of HHL.

Understanding Self-reported Hearing Disability in Adults With Normal Hearing

OBJECTIVES

Despite a diagnosis of normal hearing, many people experience hearing disability (HD) in their everyday lives. This study assessed the ability of a number of demographic and auditory variables to explain and predict self-reported HD in people regarded as audiologically healthy via audiometric thresholds.

DESIGN

One-hundred eleven adults (ages 19 to 74) with clinically normal hearing (i.e., audiometric thresholds ≤25 dB HL at all octave and interoctave frequencies between 0.25 and 8 kHz and bilaterally symmetric hearing) were asked to complete the 12-item version of the Speech, Spatial, and Qualities of Hearing Scale (SSQ12) as a measure of self-reported HD. Patient history and a number of standard and expanded measures of hearing were assessed in a multivariate regression analysis to predict SSQ12 score. Patient history included age, sex, history of noise exposure, and tinnitus. Hearing-related measures included audiometry at standard and extended high frequencies, word recognition, otoacoustic emissions, auditory brainstem response, the Montreal Cognitive Assessment, and FM detection threshold.

RESULTS

History of impulse noise exposure, speech-intelligibility index, and FM detection threshold accurately predicted SSQ12 and were able to account for 40% of the SSQ12 score. These three measures were also able to predict whether participants self-reported HD with a sensitivity of 89% and specificity of 86%.

CONCLUSIONS

Although participant audiometric thresholds were within normal limits, higher thresholds, history of impulse noise exposure, and FM detection predicted self-reported HD.

Listening-Based Communication Ability in Adults With Hearing Loss: A Scoping Review of Existing Measures

Introduction

Hearing loss in adults has a pervasive impact on health and well-being. Its effects on everyday listening and communication can directly influence participation across multiple spheres of life. These impacts, however, remain poorly assessed within clinical settings. Whilst various tests and questionnaires that measure listening and communication abilities are available, there is a lack of consensus about which measures assess the factors that are most relevant to optimising auditory rehabilitation. This study aimed to map current measures used in published studies to evaluate listening skills needed for oral communication in adults with hearing loss.

Methods

A scoping review was conducted using systematic searches in Medline, EMBASE, Web of Science and Google Scholar to retrieve peer-reviewed articles that used one or more linguistic-based measure necessary to oral communication in adults with hearing loss. The range of measures identified and their frequency where charted in relation to auditory hierarchies, linguistic domains, health status domains, and associated neuropsychological and cognitive domains.

Results

9121 articles were identified and 2579 articles that reported on 6714 discrete measures were included for further analysis. The predominant linguistic-based measure reported was word or sentence identification in quiet (65.9%). In contrast, discourse-based measures were used in 2.7% of the articles included. Of the included studies, 36.6% used a self-reported instrument purporting to measures of listening for communication. Consistent with previous studies, a large number of self-reported measures were identified (n = 139), but 60.4% of these measures were used in only one study and 80.7% were cited five times or fewer.

Discussion

Current measures used in published studies to assess listening abilities relevant to oral communication target a narrow set of domains. Concepts of communicative interaction have limited representation in current measurement. The lack of measurement consensus and heterogeneity amongst the assessments limit comparisons across studies. Furthermore, extracted measures rarely consider the broader linguistic, cognitive and interactive elements of communication. Consequently, existing measures may have limited clinical application if assessing the listening-related skills required for communication in daily life, as experienced by adults with hearing loss.

Management of Auditory Processing Difficulties Virtually: A Case Study

Difficulty hearing in the presence of background noise is a common complaint heard by audiologists. This can be accompanied by additional difficulty in classrooms and other difficult listening situations. This was recently exacerbated by the coronavirus disease 2019 (COVID-19) shutdowns and the accompanying mask usage and virtual meetings. This article describes one such patient seen during the recent shutdown. This patient reported difficulty hearing during her college coursework for her music performance major. She was an established otology patient with an extensive middle ear history including multiple surgeries. During the shutdown, she virtually consulted with the auditory processing disorders clinic at the recommendation of her otologist to discuss her college-related difficulty and pursue educational accommodations. Challenges and solutions for seeing this patient and other, similar patients virtually are discussed as well as a review of how this patient proceeded and how the knowledge gained from this patient could apply to others with similar concerns.

Coping with the social challenges and emotional distress associated with hearing loss: a qualitative investigation using Leventhal's self-regulation theory

OBJECTIVE

To explore the lived experience of social challenges and emotional distress in relation to hearing loss and the coping mechanisms employed to manage them.

DESIGN

Two focus groups and two one-on-one semi-structured interviews were conducted during February 2020. Transcripts were first inductively analysed to identify experiential categories of social and emotional difficulty, and then deductively analysed using Leventhal's self-regulation model to identify how individuals conceptualised these experiences and the coping mechanisms employed to manage them.

STUDY SAMPLE

Adults with hearing loss and self-reported emotional distress due to their hearing loss (n = 21) and their significant others (n = 9).

RESULTS

Participants described their social and emotional experiences of hearing loss in terms of negative consequences (social overwhelm, fatigue, loss, exclusion), identity impact (how they perceive themselves and are perceived by others), and emotional distress (frustration, grief, anxiety, loneliness, and burdensomeness). While many participants described a general lack of effective coping strategies, others described employing coping strategies including avoidance (helpful and unhelpful), controlling the listening environment, humour, acceptance, assertiveness, communication repair strategies, and accepting support from significant others.

CONCLUSION

Many participants described a lack of effective coping strategies and tended to rely on avoidance of social interaction,deepening their isolation and loneliness.

The Effect of Cognition on the Aided Benefit in Terms of Speech Understanding and Listening Effort Obtained With Digital Hearing Aids: A Systematic Review

Purpose Hearing aids are the primary rehabilitation devices used to compensate for presbycusis, though large intersubject variability in hearing aid benefit has been reported. This systematic review aimed to investigate how intersubject differences in cognition could influence the aided benefit for speech understanding and listening effort with bilateral digital hearing aids. Method Articles were selected through systematic searches in MEDLINE, Embase, Central, and reference lists. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Results The initial search resulted in 1,092 unique hits, of which 16 were included. The effect of cognition on the aided benefit in terms of speech understanding and listening effort was examined in 12 and four studies, respectively. The aided speech and listening effort benefit obtained from hearing aid use in general or from a specific digital feature (i.e., microphone directionality, noise reduction, amplitude compression, and frequency compression) was associated with four cognitive functions (i.e., working memory, processing speed, selective attention, and executive functions). Conclusions Hearing aid users with poorer cognitive functioning derived more aided benefit in terms of speech understanding from hearing aid settings facilitating the matching process between the incoming auditory signal and representations stored in long-term memory. However, since the number of included studies was limited, this trend should be interpreted with caution. Supplemental Material https://doi.org/10.23641/asha.13626509.

Methodological Considerations for Auditory Training Interventions for Adults With Hearing Loss: A Rapid Review

Purpose The aim of this study was to evaluate literature on auditory training published since 2013. Method A rapid review or a streamlined approach to systematically identify and summarize relevant studies was performed. Selected health sciences databases were searched using a search strategy developed with the PICO (population, intervention, comparison, and outcome) framework. Studies eligible for inclusion had older adult participants with hearing loss and utilized technology-based auditory training in laboratory or home settings. Results The study quality of most studies was found to be low to moderate, with concentrations between low and moderate. Major issues were related to study design and reporting, such as the need for blinding and a control group, larger sample sizes, and a follow-up for long-term outcomes of auditory training interventions. Wide variability in training approaches, participant backgrounds (e.g., audiograms, hearing aid use), and outcome measures are also noted. Conclusions Evidence on the effectiveness of auditory training is mixed. Future research should include high-quality randomized controlled trials with representative populations; follow-up periods to study long-term effects; and exploration of behavioral, electrophysiological, and self-reported outcome measures. Recommendations for study designs and methodologies are also discussed.

The Type of Noise Influences Quality Ratings for Noisy Speech in Hearing Aid Users

Purpose The overall goal of the current study was to determine whether noise type plays a role in perceptual quality ratings. We compared quality ratings using various noise types and signal-to-noise ratio (SNR) ranges using hearing aid simulations to consider the effects of hearing aid processing features. Method Ten older adults with bilateral mild to moderately severe sensorineural hearing loss rated the sound quality of sentences processed through a hearing aid simulation and presented in the presence of five different noise types (six-talker babble, three-talker conversation, street traffic, kitchen, and fast-food restaurant) at four SNRs (3, 8, 12, and 20 dB). Results Everyday noise types differentially affected sound quality ratings even when presented at the same SNR: Kitchen and three-talker noises were rated significantly higher than restaurant, traffic, and multitalker babble, which were not different from each other. The effects of noise type were most pronounced at poorer SNRs. Conclusions The findings of this study showed that noise types differentially affected sound quality ratings. The differences we observed were consistent with the acoustic characteristics of the noise types. Noise types having lower envelope fluctuations yielded lower quality ratings than noise types characterized by sporadic high-intensity events at the same SNR.

Discovering the Unmet Needs of People With Difficulties Understanding Speech in Noise and a Normal or Near-Normal Audiogram

Purpose A proportion of people with a normal audiogram or mild hearing loss (NA-MHL) experience greater-than-expected difficulty hearing speech in noise. This preliminary exploratory study employed a design thinking approach to better understand the clinical pathway and treatment options experienced by this population. Method Exploratory survey data were analyzed from 233 people with NA-MHL who had consulted a clinician and 47 clinicians. Qualitative analysis was performed on interview data from 21 people with NA-MHL and seven clinicians. Results Results revealed that noisy environments, such as restaurants, were where many people experienced listening difficulties. Most people with NA-MHL were not offered a treatment option at their audiology appointment, and their satisfaction with the appointment was diverse. Many clients reported frustration at being told that their hearing was "normal." Data from clinicians showed that there is no standard test protocol for this population, and most felt that they did not have adequate training or resources to help NA-MHL clients. Conclusion This study discusses the research needs regarding the experience of those with NA-MHL, their help-seeking behaviors, and treatment options. Understanding these needs is the first step to designing projects to improve the quality of life of this population.

The importance of different frailty domains in a population based sample in England

BACKGROUND

The aim was to estimate the prevalence of frailty and relative contribution of physical/balance, nutritive, cognitive and sensory frailty to important adverse health states (falls, physical activity levels, outdoor mobility, problems in self-care or usual activities, and lack of energy or accomplishment) in an English cohort by age and sex.

METHODS

Analysis of baseline data from a cohort of 9803 community-dwelling participants in a clinical trial. The sample was drawn from a random selection of all people aged 70 or more registered with 63 general practices across England. Data were collected by postal questionnaire. Frailty was measured with the Strawbridge questionnaire. We used cross sectional, multivariate logistic regression to estimate the association between frailty domains and known correlates and adjusted for age. Some models were stratified by sex.

RESULTS

Mean age of participants was 78 years (sd 5.7), range 70 to 101 and 47.5% (4653/9803) were men. The prevalence of overall frailty was 20.7% (2005/9671) and there was no difference in prevalence by sex (Odds Ratio 0.98; 95% Confidence Interval 0.89 to 1.08). Sensory frailty was the most common and this was reported by more men (1823/4586) than women (1469/5056; Odds Ratio for sensory frailty 0.62, 95% Confidence Interval 0.57 to 0.68). Men were less likely than women to have physical or nutritive frailty. Physical frailty had the strongest independent associations with adverse health states. However, sensory frailty was independently associated with falls, less frequent walking, problems in self-care and usual activities, lack of energy and accomplishment.

CONCLUSIONS

Physical frailty was more strongly associated with adverse health states, but sensory frailty was much more common. The health gain from intervention for sensory frailty in England is likely to be substantial, particularly for older men. Sensory frailty should be explored further as an important target of intervention to improve health outcomes for older people both at clinical and population level.

TRIAL REGISTRATION

ISRCTN71002650.