Decision criteria for pure-tone detection used by two age groups of normal-hearing and hearing-impaired listeners

Development and evaluation of a novel user-operated slider-based audiometry method

OBJECTIVE

To evaluate a novel user-operated audiometry method allowing users full control in determining their pure-tone hearing thresholds.

DESIGN

Comparative study. Participants were recruited from a hearing clinic after undergoing manual audiometry (six frequencies). They then performed test-retests of a new test (slider audiometry, eight frequencies) and completed the System Usability Scale questionnaire.

STUDY SAMPLE

37 adult participants, including 30 hearing-impaired and seven normal-hearing individuals.

RESULTS

Mean (SD) threshold differences for octave frequencies between 250 to 2000 Hz between manual and slider audiometry ranged from -7.8 (6.6) to -5.7 (6.5) dB and were significant. For 4000 and 8000 Hz mean differences were -0.3 (8.4) and 0.0 (9.7) dB and insignificant. Standard deviations ranged from 6.5 to 9.7 dB across six tested frequencies. Slider test-retest mean threshold differences ranged from -1.4 (4.7) to 0.3 (6.0) dB across eight tested frequencies, with standard deviations ranging from 4.1 to 8.5 dB. The average usability score for the slider audiometry was 88.3.

CONCLUSION

When compared to manual audiometry, the slider audiometry demonstrated validity at 4000 and 8000 Hz but found significantly lower thresholds for octave frequencies between 250 to 2000 Hz. Test-retests of the new method revealed small mean differences and acceptable SDs.

Age-related changes in auditory temporal processing assessed using forward masking

One of the main complaints of older adults is difficulty understanding speech in noise. For older adults with audiometric thresholds within the normal range this difficulty may partly reflect deficits in temporal processing. The purpose of this study was to evaluate the effect of age on the rate of recovery from forward masking. There were seven young participants (four females; mean age 26 years) and seven older participants (six females; mean age 62 years) with normal audiometric thresholds, designated YNH and ONH groups. Signal frequencies of 500, 1000, 2000, and 4000 Hz were used. The level of the 20-ms signal was fixed at 15 dB SL for each participant and frequency. The 200-ms masker was a band of noise centered at the signal frequency with a bandwidth equal to the center frequency. The masker level was varied to determine the masker-to-signal ratio (MSR) required for threshold for masker-signal intervals (MSIs) of 5, 10, 20, 30, and 50 ms. The MSRs were smaller for the ONH group than for the YNH group, perhaps indicating lower processing efficiency for the former. Importantly, there was a significant interaction between MSI and the group. The change in MSR with increasing MSI was greater for the YNH than for the ONH group, indicating poorer temporal resolution for the latter.

Longitudinal Changes in Auditory and Cognitive Function in Middle-Aged and Older Adults

Purpose This article aimed to document longitudinal changes in auditory function, including measures of temporal processing, and to examine the associations between observed changes in auditory and cognitive function in middle-aged and older adults. Method This was a prospective longitudinal study of 98 adults (66 women) with baseline ages ranging from 40 to 85 years. The mean interval between T1 baseline and T2 follow-up measurements was 8.8 years with a range of 7-11 years. Measures of hearing threshold, gap detection, and auditory temporal-order identification were completed at T1 and T2. Cognitive measures completed at T1 and T2 were the 13 scales of the Wechsler Adult Intelligence Scale-Third Edition. Three approaches were taken to analyze these data: (a) examination of changes over time in group performance, (b) correlations and slopes between auditory and cognitive measures to examine concomitant rates of decline over the 9-year T1-to-T2 period, and (c) regression analyses examining associations between auditory performance at T1 and cognitive performance 9 years later at T2. Results For the group data, there were significant declines in hearing loss, gap-detection thresholds at one frequency, and process-type measures of cognitive function from T1 to T2 matching the trends in the baseline cross-sectional data. Regression analyses of the longitudinal data revealed the strongest connection between auditory temporal-order processing and cognitive processing typically explaining 10%-15% of the variance. Conclusions A significant amount of variance in rates of cognitive decline, T1 to T2, and subsequent cognitive performance (T2) was explained by measures of auditory function. Although hearing loss occasionally emerged as a significant factor, auditory temporal-order identification emerged much more frequently as the auditory measure most strongly associated with cognitive function.

Yes/no and two-interval forced-choice tasks with listener-based vs observer-based responses

Observer-based procedures are used to assess auditory behavior in infants, often incorporating adaptive tracking algorithms. These procedures are reliable, but effects of modifications made to accommodate infant testing are not fully understood. One modification is that observation intervals are undefined for the listener, introducing signal-temporal uncertainty and increasing the likelihood that listener response bias will influence estimates of performance. The effect of these factors was evaluated by comparing threshold estimates obtained from adults using two tasks: (1) single-interval, yes/no and (2) two-interval, forced-choice. Detection thresholds were estimated adaptively for a 1000-Hz FM tone in quiet and for a word presented in two-talker speech masking. Trials were initiated and judged by the observer (observer-based) or the listener (listener-based). Thus, listening intervals were temporally uncertain in observer-based procedures and temporally defined in listener-based procedures. Thresholds were higher for observer-based relative to corresponding listener-based procedures. The magnitude of this difference was similar across the yes/no and two-interval tasks, and was larger for masked word detection than tone detection in quiet. Listeners adopted a conservative criterion when tested using the observer-based, yes/no procedure, but modeling results suggest that signal-temporal uncertainty accounts for the largest portion of the threshold difference between observer-based and listener-based procedures.

A user-operated audiometry method based on the maximum likelihood principle and the two-alternative forced-choice paradigm

OBJECTIVE

To create a user-operated pure-tone audiometry method based on the method of maximum likelihood (MML) and the two-alternative forced-choice (2AFC) paradigm with high test-retest reliability without the need of an external operator and with minimal influence of subjects' fluctuating response criteria. User-operated audiometry was developed as an alternative to traditional audiometry for research purposes among musicians.

DESIGN

Test-retest reliability of the user-operated audiometry system was evaluated and the user-operated audiometry system was compared with traditional audiometry.

STUDY SAMPLE

Test-retest reliability of user-operated 2AFC audiometry was tested with 38 naïve listeners. User-operated 2AFC audiometry was compared to traditional audiometry in 41 subjects.

RESULTS

The repeatability of user-operated 2AFC audiometry was comparable to traditional audiometry with standard deviation of differences from 3.9 dB to 5.2 dB in the frequency range of 250-8000 Hz. User-operated 2AFC audiometry gave thresholds 1-2 dB lower at most frequencies compared to traditional audiometry.

CONCLUSIONS

User-operated 2AFC audiometry does not require specific operating skills and the repeatability is acceptable and similar to traditional audiometry. User operated 2AFC audiometry is a reliable alternative to traditional audiometry.

Are age-related changes in cognitive function driven by age-related changes in sensory processing?

Although there has been keen interest in the association among measures of sensory function and cognitive function for many years, in general, measures of sensory function have been confined to one or two senses and measures of threshold sensitivity (acuity). In this study, rigorous psychophysical measures of threshold sensitivity, temporal gap detection, temporal order identification, and temporal masking have been obtained, in hearing, vision, and touch. In addition, all subjects completed 15 subtests of the Wechsler Adult Intelligence Scale, 3rd edition (WAIS-III). Data were obtained from 245 adults (18-87 years old) for the WAIS-III and for 40 measures of threshold sensitivity and temporal processing. The focus in this report is on individual differences in performance for the entire data set. Principal-components (PC) factor analysis reduced the 40 psychophysical measures to eight correlated factors, which were reduced further to a single global sensory processing factor. Similarly, PC factor analysis of the 15 WAIS-III scores resulted in three correlated factors that were further reduced to a single global cognitive function factor. Age, global sensory processing, and global cognitive function were all moderately and significantly correlated with one another. However, paired partial correlations, controlling for the third of these three measures, revealed that the moderate correlation between age and global cognitive function went to zero when global sensory processing was controlled for; the other two partial correlations remained intact. Structural models confirmed this result. These analyses suggest that the long-standing observation of age-related changes in cognitive function may be mediated by age-related changes in global sensory processing.

Hearing loss and cognitive decline in older adults

BACKGROUND Whether hearing loss is independently associated with accelerated cognitive decline in older adults is unknown. METHODS We studied 1984 older adults (mean age, 77.4 years) enrolled in the Health ABC Study, a prospective observational study begun in 1997-1998. Our baseline cohort consisted of participants without prevalent cognitive impairment (Modified Mini-Mental State Examination [3MS] score, ≥80) who underwent audiometric testing in year 5. Participants were followed up for 6 years. Hearing was defined at baseline using a pure-tone average of thresholds at 0.5 to 4 kHz in the better-hearing ear. Cognitive testing was performed in years 5, 8, 10, and 11 and consisted of the 3MS (measuring global function) and the Digit Symbol Substitution test (measuring executive function). Incident cognitive impairment was defined as a 3MS score of less than 80 or a decline in 3MS score of more than 5 points from baseline. Mixed-effects regression and Cox proportional hazards regression models were adjusted for demographic and cardiovascular risk factors. RESULTS In total, 1162 individuals with baseline hearing loss (pure-tone average >25 dB) had annual rates of decline in 3MS and Digit Symbol Substitution test scores that were 41% and 32% greater, respectively, than those among individuals with normal hearing. On the 3MS, the annual score changes were -0.65 (95% CI, -0.73 to -0.56) vs -0.46 (95% CI, -0.55 to -0.36) points per year (P = .004). On the Digit Symbol Substitution test, the annual score changes were -0.83 (95% CI, -0.94 to -0.73) vs -0.63 (95% CI, -0.75 to -0.51) points per year (P = .02). Compared to those with normal hearing, individuals with hearing loss at baseline had a 24% (hazard ratio, 1.24; 95% CI, 1.05-1.48) increased risk for incident cognitive impairment. Rates of cognitive decline and the risk for incident cognitive impairment were linearly associated with the severity of an individual's baseline hearing loss. CONCLUSIONS Hearing loss is independently associated with accelerated cognitive decline and incident cognitive impairment in community-dwelling older adults. Further studies are needed to investigate what the mechanistic basis of this association is and whether hearing rehabilitative interventions could affect cognitive decline.

Hearing loss and cognition in the Baltimore Longitudinal Study of Aging

OBJECTIVE

To determine the relationship between hearing loss and cognitive function as assessed with a standardized neurocognitive battery. We hypothesized a priori that greater hearing loss is associated with lower cognitive test scores on tests of memory and executive function.

METHOD

A cross-sectional cohort of 347 participants ≥ 55 years in the Baltimore Longitudinal Study of Aging without mild cognitive impairment or dementia had audiometric and cognitive testing performed in 1990-1994. Hearing loss was defined by an average of hearing thresholds at 0.5, 1, 2, and 4 kHz in the better-hearing ear. Cognitive testing consisted of a standardized neurocognitive battery incorporating tests of mental status, memory, executive function, processing speed, and verbal function. Regression models were used to examine the association between hearing loss and cognition while adjusting for confounders.

RESULTS

Greater hearing loss was significantly associated with lower scores on measures of mental status (Mini-Mental State Exam), memory (Free Recall), and executive function (Stroop Mixed, Trail Making B). These results were robust to analyses accounting for potential confounders, nonlinear effects of age, and exclusion of individuals with severe hearing loss. The reduction in cognitive performance associated with a 25 dB hearing loss was equivalent to the reduction associated with an age difference of 6.8 years.

CONCLUSION

Hearing loss is independently associated with lower scores on tests of memory and executive function. Further research examining the longitudinal association of hearing loss with cognitive functioning is needed to confirm these cross-sectional findings.

Auditory evoked field at threshold

Auditory evoked responses are widely used for estimating electrophysiological thresholds, but the relationships to psychophysical thresholds are not necessarily straightforward. Among the aspects that are not well understood is the near-threshold intensity dependence of the evoked response. Here, we investigated wave N100m of the auditory evoked field. The stimulus was a 1-kHz tone with an effective duration of about 110 ms. Up to 10 dB above the psychophysical threshold, the level was varied in steps of 2dB; further measurements were done at 15, 20, 30, and 40 dB SL. Lower levels were presented with higher probability, to partially compensate for the expected signal-to-noise ratio reduction with decreasing level. The latency of the N100m could be characterized as a transmission delay and an integration time. The level dependence of the latter was consistent with the assumption of an almost perfectly operating sound-pressure integrator. The N100m amplitude increased roughly linearly with the level in dB (thus, as a logarithmic function of intensity), showing signs of saturation at higher levels.

Effects of word predictability, child development, and aging on time-gated speech recognition performance

This study examined the interaction of acoustic-phonetic information with higher-level linguistic contextual information during the real-time speech perception process in child, young adult, and older adult listeners. Five age groups were studied: (a) young children ranging in age from 5 to 7 years, (b) older children aged 8 to 10 years, (c) young adults aged 18 to 23 years, (d) older adults aged 60 to 69 years, and (e) older adults aged 70 to 83 years. All subjects were presented with time-gated monosyllabic target words presented in sentence contexts containing contrasting levels of word predictability. Findings indicated that target word predictability influenced the timing and nature of the real-time recognition process including the listeners' use of initial word sounds. Predictability-high (PH) words were recognized earlier and with greater confidence than predictability-low (PL) words. PH recognition performance was more influenced by child development and aging than PL recognition performance. Older adult listeners required more PH-gated word stimuli to produce accurate responses than younger adults. Older children showed more effective use of PH contexts than younger children.