Listening Effort: How the Cognitive Consequences of Acoustic Challenge Are Reflected in Brain and Behavior

The contribution of short-term memory for sound features to speech-in-noise perception and cognition

Speech-in-noise (SIN) perception is a fundamental ability that declines with aging, as does general cognition. We assess whether auditory cognitive ability, in particular short-term memory for sound features, contributes to both. We examined how auditory memory for fundamental sound features, the carrier frequency and amplitude modulation rate of modulated white noise, contributes to SIN perception. We assessed SIN in 153 healthy participants with varying degrees of hearing loss using measures that require single-digit perception (the Digits-in-Noise, DIN) and sentence perception (Speech-in-Babble, SIB). Independent variables were auditory memory and a range of other factors including the Pure Tone Audiogram (PTA), a measure of dichotic pitch-in-noise perception (Huggins pitch), and demographic variables including age and sex. Multiple linear regression models were compared using Bayesian Model Comparison. The best predictor model for DIN included PTA and Huggins pitch (r2 = 0.32, p < 0.001), whereas the model for SIB included the addition of auditory memory for sound features (r2 = 0.24, p < 0.001). Further analysis demonstrated that auditory memory also explained a significant portion of the variance (28 %) in scores for a screening cognitive test for dementia. Auditory memory for non-speech sounds may therefore provide an important predictor of both SIN and cognitive ability.

Cross-Sectional Associations of Peripheral Hearing, Brain Imaging, and Cognitive Performance With Speech-in-Noise Performance: The Aging and Cognitive Health Evaluation in Elders Brain Magnetic Resonance Imaging Ancillary Study

PURPOSE

Population-based evidence in the interrelationships among hearing, brain structure, and cognition is limited. This study aims to investigate the cross-sectional associations of peripheral hearing, brain imaging measures, and cognitive function with speech-in-noise performance among older adults.

METHOD

We studied 602 participants in the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) brain magnetic resonance imaging (MRI) ancillary study, including 427 ACHIEVE baseline (2018-2020) participants with hearing loss and 175 Atherosclerosis Risk in Communities Neurocognitive Study Visit 6/7 (2016-2017/2018-2019) participants with normal hearing. Speech-in-noise performance, as outcome of interest, was assessed by the Quick Speech-in-Noise (QuickSIN) test (range: 0-30; higher = better). Predictors of interest included (a) peripheral hearing assessed by pure-tone audiometry; (b) brain imaging measures: structural MRI measures, white matter hyperintensities, and diffusion tensor imaging measures; and (c) cognitive performance assessed by a battery of 10 cognitive tests. All predictors were standardized to z scores. We estimated the differences in QuickSIN associated with every standard deviation (SD) worse in each predictor (peripheral hearing, brain imaging, and cognition) using multivariable-adjusted linear regression, adjusting for demographic variables, lifestyle, and disease factors (Model 1), and, additionally, for other predictors to assess independent associations (Model 2).

RESULTS

Participants were aged 70-84 years, 56% female, and 17% Black. Every SD worse in better-ear 4-frequency pure-tone average was associated with worse QuickSIN (-4.89, 95% confidence interval, CI [-5.57, -4.21]) when participants had peripheral hearing loss, independent of other predictors. Smaller temporal lobe volume was associated with worse QuickSIN, but the association was not independent of other predictors (-0.30, 95% CI [-0.86, 0.26]). Every SD worse in global cognitive performance was independently associated with worse QuickSIN (-0.90, 95% CI [-1.30, -0.50]).

CONCLUSIONS

Peripheral hearing and cognitive performance are independently associated with speech-in-noise performance among dementia-free older adults. The ongoing ACHIEVE trial will elucidate the effect of a hearing intervention that includes amplification and auditory rehabilitation on speech-in-noise understanding in older adults.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25733679.

Taking the Extra Listening Mile: Processing Spoken Semantic Context Is More Effortful for Older Than Young Adults

OBJECTIVES

Older adults use semantic context to generate predictions in speech processing, compensating for aging-related sensory and cognitive changes. This study aimed to gauge aging-related changes in effort exertion related to context use.

DESIGN

The study revisited data from Harel-Arbeli et al. (2023) that used a "visual-world" eye-tracking paradigm. Data on efficiency of context use (response latency and the probability to gaze at the target before hearing it) and effort exertion (pupil dilation) were extracted from a subset of 14 young adults (21 to 27 years old) and 13 older adults (65 to 79 years old).

RESULTS

Both age groups showed a similar pattern of context benefits for response latency and target word predictions, however only the older adults group showed overall increased pupil dilation when listening to context sentences.

CONCLUSIONS

Older adults' efficient use of spoken semantic context appears to come at a cost of increased effort exertion.

Metacognition for hearing in noise: a comparison between younger and older adults

Metacognition entails knowledge of one's own cognitive skills, perceived self-efficacy and locus of control when performing a task, and performance monitoring. Age-related changes in metacognition have been observed in metamemory, whereas their occurrence for hearing remained unknown. We tested 30 older and 30 younger adults with typical hearing, to assess if age reduces metacognition for hearing sentences in noise. Metacognitive monitoring for older and younger adults was overall comparable. In fact, the older group achieved better monitoring for words in the second part of the phrase. Additionally, only older adults showed a correlation between performance and perceived confidence. No age differentiation was found for locus of control, knowledge or self-efficacy. This suggests intact metacognitive skills for hearing in noise in older adults, alongside a somewhat paradoxical overconfidence in younger adults. These findings support exploiting metacognition for older adults dealing with noisy environments, since metacognition is central for implementing self-regulation strategies.

A Multimodal Approach to Measuring Listening Effort: A Systematic Review on the Effects of Auditory Task Demand on Physiological Measures and Their Relationship

OBJECTIVES

Listening effort involves the mental effort required to perceive an auditory stimulus, for example in noisy environments. Prolonged increased listening effort, for example due to impaired hearing ability, may increase risk of health complications. It is therefore important to identify valid and sensitive measures of listening effort. Physiological measures have been shown to be sensitive to auditory task demand manipulations and are considered to reflect changes in listening effort. Such measures include pupil dilation, alpha power, skin conductance level, and heart rate variability. The aim of the current systematic review was to provide an overview of studies to listening effort that used multiple physiological measures. The two main questions were: (1) what is the effect of changes in auditory task demand on simultaneously acquired physiological measures from various modalities? and (2) what is the relationship between the responses in these physiological measures?

DESIGN

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, relevant articles were sought in PubMed, PsycInfo, and Web of Science and by examining the references of included articles. Search iterations with different combinations of psychophysiological measures were performed in conjunction with listening effort-related search terms. Quality was assessed using the Appraisal Tool for Cross-Sectional Studies.

RESULTS

A total of 297 articles were identified from three databases, of which 27 were included. One additional article was identified from reference lists. Of the total 28 included articles, 16 included an analysis regarding the relationship between the physiological measures. The overall quality of the included studies was reasonable.

CONCLUSIONS

The included studies showed that most of the physiological measures either show no effect to auditory task demand manipulations or a consistent effect in the expected direction. For example, pupil dilation increased, pre-ejection period decreased, and skin conductance level increased with increasing auditory task demand. Most of the relationships between the responses of these physiological measures were nonsignificant or weak. The physiological measures varied in their sensitivity to auditory task demand manipulations. One of the identified knowledge gaps was that the included studies mostly used tasks with high-performance levels, resulting in an underrepresentation of the physiological changes at lower performance levels. This makes it difficult to capture how the physiological responses behave across the full psychometric curve. Our results support the Framework for Understanding Effortful Listening and the need for a multimodal approach to listening effort. We furthermore discuss focus points for future studies.

Continuous tracking of effort and confidence while listening to speech-in-noise in young and older adults

Reporting discomfort when noise affects listening experience suggests that listeners may be aware, at least to some extent, of adverse environmental conditions and their impact on listening experience. This involves monitoring internal states (effort and confidence). Here we quantified continuous self-report indices that track one's own internal states and investigated age-related differences in this ability. We instructed two groups of young and older adults to continuously report their confidence and effort while listening to stories in fluctuating noise. Using cross-correlation analyses between the time series of fluctuating noise and those of perceived effort or confidence, we showed that (1) participants modified their assessment of effort and confidence based on variations in the noise, with a 4 s lag; (2) there were no differences between the groups. These findings imply extending this method to other areas, expanding the definition of metacognition, and highlighting the value of this ability for older adults.

Effect of background noise and memory load on listening effort of young adults with and without hearing loss

OBJECTIVE

People with hearing loss often encounter difficulties in hearing under adverse conditions, such as listening in the presence of noise. Listening effort is an indicator used to assess listening difficulties in daily life. Although many studies on listening effort have been conducted in recent years, there is a notable gap in the exploration of how task load influences listening effort in young adults. This study compared the effects of background noise and memory load on task performance and subjective listening effort in young adults with and without hearing loss.

METHODS

The study included a group of 8 adults with hearing loss (mean age: 24.1 ± 6.0 years) and a group of 16 individuals with normal hearing (mean age: 27.9 ± 4.9 years). A number memorizing task was conducted, involving two types of auditory digits (either three or seven digits) presented under multi-talker babble noise conditions of signal-to-noise ratio of -5 dB [SN -5 dB] or SN +5 dB. Participants determined whether the number presented in the encoding interval matched the one presented in the retrieval interval. Subsequently, they were asked to complete a questionnaire using a Visual Analog Scale (VAS) to assess their subjective listening effort. Percentage of correct responses, reaction times, and VAS ratings were compared between adults with and without hearing loss.

RESULTS

Our results showed significant differences between the two groups in the percentage of correct responses and the reaction time under the SN -5 dB conditions, regardless of the memory load. Under the SN +5 dB conditions, a significant difference was found only in the percentage of correct responses for seven digits. In the normal hearing group, the percentage of correct responses and VAS ratings tended to decrease as the memory load increased, even under the same noise condition. Conversely, in the hearing loss group, a consistent trend could not be identified in the effects of noise and memory load on the percentage of correct responses and VAS ratings.

CONCLUSION

These results suggest that in conditions of high noise load, young adults with hearing loss show a higher tendency for listening effort to be affected by other loads. We confirmed that for some participants with hearing loss, the task exceeded a certain level of difficulty in the SN -5 dB and seven digits condition, leading to a change in their motivation and strategy used. Future research should examine ways to control for participants' motivations.

Strategic stabilization of arousal boosts sustained attention

Arousal and motivation interact to profoundly influence behavior. For example, experience tells us that we have some capacity to control our arousal when appropriately motivated, such as staying awake while driving a motor vehicle. However, little is known about how arousal and motivation jointly influence decision computations, including if and how animals, such as rodents, adapt their arousal state to their needs. Here, we developed and show results from an auditory, feature-based, sustained-attention task with intermittently shifting task utility. We use pupil size to estimate arousal across a wide range of states and apply tailored signal-detection theoretic, hazard function, and accumulation-to-bound modeling approaches in a large cohort of mice. We find that pupil-linked arousal and task utility both have major impacts on multiple aspects of task performance. Although substantial arousal fluctuations persist across utility conditions, mice partially stabilize their arousal near an intermediate and optimal level when task utility is high. Behavioral analyses show that multiple elements of behavior improve during high task utility and that arousal influences some, but not all, of them. Specifically, arousal influences the likelihood and timescale of sensory evidence accumulation but not the quantity of evidence accumulated per time step while attending. In sum, the results establish specific decision-computational signatures of arousal, motivation, and their interaction in attention. So doing, we provide an experimental and analysis framework for studying arousal self-regulation in neurotypical brains and in diseases such as attention-deficit/hyperactivity disorder.

Visual selective attention in individuals with age-related hearing loss

Evidence from epidemiological studies suggests that hearing loss is associated with an accelerated decline in cognitive function, but the underlying pathophysiological mechanism remains poorly understood. Studies using auditory tasks have suggested that degraded auditory input increases the cognitive load for auditory perceptual processing and thereby reduces the resources available for other cognitive tasks. Attention-related networks are among the systems overrecruited to support degraded auditory perception, but it is unclear how they function when no excessive recruitment of cognitive resources for auditory processing is needed. Here, we implemented an EEG study using a nonauditory visual attentional selection task in 30 individuals with age-related hearing loss (ARHLs, 60-73 years) and compared them with aged (N = 30, 60-70 years) and young (N = 35, 22-29 years) normal-hearing controls. Compared with their normal-hearing peers, ARHLs demonstrated a significant amplitude reduction for the posterior contralateral N2 component, which is a well-validated index of the allocation of selective visual attention, despite the comparable behavioral performance. Furthermore, the amplitudes were observed to correlate significantly with hearing acuities (pure tone audiometry thresholds) and higher-order hearing abilities (speech-in-noise thresholds) in aged individuals. The target-elicited alpha lateralization, another mechanism of visuospatial attention, demonstrated in control groups was not observed in ARHLs. Although behavioral performance is comparable, the significant decrease in N2pc amplitude in ARHLs provides neurophysiologic evidence that may suggest a visual attentional deficit in ARHLs even without extra-recruitment of cognitive resources by auditory processing. It supports the hypothesis that constant degraded auditory input in ARHLs has an adverse impact on the function of cognitive control systems, which is a possible mechanism mediating the relationship between hearing loss and cognitive decline.

Relations Among Multiple Dimensions of Self-Reported Listening Effort in Response to an Auditory Psychomotor Vigilance Task

PURPOSE

Listening effort is a broad construct, and there is no consensus on how to subdivide listening effort into dimensions. This project focuses on the subjective experience of effortful listening and tests if cognitive workload, mental fatigue, and mood are interrelated dimensions.

METHOD

Two online studies tested young adults (n = 74 and n = 195) and measured subjective workload, fatigue (subscales of fatigue and energy), and mood (subscales of positive and negative mood) before and after a challenging listening task. In the listening effort task, participants responded to intermittent 1-kHz target tones in continuous white noise for approximately 12 min.

RESULTS

Correlations and principal component analysis showed that fatigue and mood were distinct but interrelated constructs that weakly correlated with workload. Effortful listening provoked increased fatigue and decreased energy and positive mood yet did not influence negative mood or workload.

CONCLUSIONS

The findings suggest that self-reported listening effort has multiple dimensions that can have different responses to the same effortful listening episode. The results can help guide evidence-based development of clinical listening effort tests and may reveal mechanisms for how listening effort relates to quality of life in those with hearing impairment.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.26418976.

Dual-Task Interference in the Assessment of Listening Effort: Results of Normal-Hearing Adults, Cochlear Implant Users, and Hearing Aid Users

PURPOSE

The purpose of the current study was to assess dual-task interference (i.e., changes between the dual-task and baseline condition) in a listening effort dual-task paradigm in normal-hearing (NH) adults, hearing aid (HA) users, and cochlear implant (CI) users.

METHOD

Three groups of 31 participants were included: (a) NH adults, (b) HA users, and (c) CI users. The dual-task paradigm consisted of a primary speech understanding task in a quiet condition, and a favorable and unfavorable noise condition, and a secondary visual memory task. Dual-task interference was calculated for both tasks, and participants were classified based on their patterns of interference. Descriptive analyses were established and differences between the three groups were examined.

RESULTS

The descriptive results showed varying patterns of dual-task interference between the three listening conditions. Most participants showed the pattern of visual memory interference (i.e., worse results for the secondary task in the dual-task condition and no difference for the primary task) in the quiet condition, whereas the pattern of speech understanding priority trade-off (i.e., worse results for the secondary task in the dual-task condition and better results for the primary task) was most prominent in the unfavorable noise condition. Particularly, in HA and CI users, this shift was seen. However, the patterns of dual-task interference were not statistically different between the three groups.

CONCLUSIONS

Results of this study may provide additional insight into the interpretation of dual-task paradigms for measuring listening effort in diverse participant groups. It highlights the importance of considering both the primary and secondary tasks for accurate interpretation of results.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.26409088.

Listening handicap in tinnitus patients with normal extended high frequencies from the perspective of the autonomic nervous system-Effort or fatigue?

OBJECTIVE

In previous studies, the results regarding the presence of listening effort or fatigue in tinnitus patients were inconsistent. The reason for this inconsistency could be that extended high frequencies, which can cause listening handicap, were not within normal limits. Therefore, this study aimed to evaluate the listening skills in tinnitus patients by matching the normal hearing thresholds at all frequencies, including the extended high frequency.

METHODS

Eighteen chronic tinnitus patients and thirty matched healthy controls having normal pure-tone average with symmetrical hearing thresholds was included. Subjects were evaluated with 0.125-20 kHz pure-tone audiometry, Montreal cognitive assessment test (MoCA), Tinnitus Handicap Inventory (THI), Matrix Test, Pupillometry.

RESULTS

Pupil dilatation in the 'coding' phase of the sentence presented in tinnitus patients was less than in the control group (p < 0.05). There was no difference between the groups for Matrix test scores (p > 0.05) Also, there was no statistically significant correlation between THI and Pupillometry components nor between MoCA (p > 0.05).

CONCLUSION

Even though tinnitus patients had normal hearing in the range of 0.125-20 kHz, their autonomic nervous system responses during listening differed from healthy subjects. This difference was interpreted for potential listening fatigue in tinnitus patients.

Brain Network Interconnectivity Dynamics Explain Metacognitive Differences in Listening Behavior

Complex auditory scenes pose a challenge to attentive listening, rendering listeners slower and more uncertain in their perceptual decisions. How can we explain such behaviors from the dynamics of cortical networks that pertain to the control of listening behavior? We here follow up on the hypothesis that human adaptive perception in challenging listening situations is supported by modular reconfiguration of auditory-control networks in a sample of N = 40 participants (13 males) who underwent resting-state and task functional magnetic resonance imaging (fMRI). Individual titration of a spatial selective auditory attention task maintained an average accuracy of ∼70% but yielded considerable interindividual differences in listeners' response speed and reported confidence in their own perceptual decisions. Whole-brain network modularity increased from rest to task by reconfiguring auditory, cinguloopercular, and dorsal attention networks. Specifically, interconnectivity between the auditory network and cinguloopercular network decreased during the task relative to the resting state. Additionally, interconnectivity between the dorsal attention network and cinguloopercular network increased. These interconnectivity dynamics were predictive of individual differences in response confidence, the degree of which was more pronounced after incorrect judgments. Our findings uncover the behavioral relevance of functional cross talk between auditory and attentional-control networks during metacognitive assessment of one's own perception in challenging listening situations and suggest two functionally dissociable cortical networked systems that shape the considerable metacognitive differences between individuals in adaptive listening behavior.

Auditory Challenges and Listening Effort in School-Age Children With Autism: Insights From Pupillary Dynamics During Speech-in-Noise Perception

PURPOSE

This study aimed to investigate challenges in speech-in-noise (SiN) processing faced by school-age children with autism spectrum conditions (ASCs) and their impact on listening effort.

METHOD

Participants, including 23 Mandarin-speaking children with ASCs and 19 age-matched neurotypical (NT) peers, underwent sentence recognition tests in both quiet and noisy conditions, with a speech-shaped steady-state noise masker presented at 0-dB signal-to-noise ratio in the noisy condition. Recognition accuracy rates and task-evoked pupil responses were compared to assess behavioral performance and listening effort during auditory tasks.

RESULTS

No main effect of group was found on accuracy rates. Instead, significant effects emerged for autistic trait scores, listening conditions, and their interaction, indicating that higher trait scores were associated with poorer performance in noise. Pupillometric data revealed significantly larger and earlier peak dilations, along with more varied pupillary dynamics in the ASC group relative to the NT group, especially under noisy conditions. Importantly, the ASC group's peak dilation in quiet mirrored that of the NT group in noise. However, the ASC group consistently exhibited reduced mean dilations than the NT group.

CONCLUSIONS

Pupillary responses suggest a different resource allocation pattern in ASCs: An initial sharper and larger dilation may signal an intense, narrowed resource allocation, likely linked to heightened arousal, engagement, and cognitive load, whereas a subsequent faster tail-off may indicate a greater decrease in resource availability and engagement, or a quicker release of arousal and cognitive load. The presence of noise further accentuates this pattern. This highlights the unique SiN processing challenges children with ASCs may face, underscoring the importance of a nuanced, individual-centric approach for interventions and support.

Development of a Website for Disseminating Knowledge About listening Effort for Professionals

Introduction  Permanent education in health aims to ensure that professionals are constantly learning in the workplace and in the last few years institutions resorted to the technology-mediated education modality and new teaching possibilities were explored. In Brazil, between 2017 and 2021, only six articles and five monographs were published about listening effort. Objective  The objective of this study was to develop a website with scientific content on the topic listening effort for Speech -Language Therapist and Audiologist with free online access. Methods  The study was carried out in five stages: Analysis, contemplating the search for scientific materials to prepare the material. Design, in which the writing and design of the website was carried out. Development, carrying out the adequacy of the online material. Implementation, a stage in which professionals in the area evaluated the quality of the material after consenting to participation through a free and informed consent term. Review, stage in which the researcher analyzed the evaluators' responses. Results  The five stages of elaboration of the website were carried out, which was evaluated by professionals in the area. The average of responses to all applied questions rated the website as "superior". Conclusion  The website development was validated for online availability.

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.

Individual Differences Elucidate the Perceptual Benefits Associated with Robust Temporal Fine-Structure Processing

The auditory system is unique among sensory systems in its ability to phase lock to and precisely follow very fast cycle-by-cycle fluctuations in the phase of sound-driven cochlear vibrations. Yet, the perceptual role of this temporal fine structure (TFS) code is debated. This fundamental gap is attributable to our inability to experimentally manipulate TFS cues without altering other perceptually relevant cues. Here, we circumnavigated this limitation by leveraging individual differences across 200 participants to systematically compare variations in TFS sensitivity to performance in a range of speech perception tasks. TFS sensitivity was assessed through detection of interaural time/phase differences, while speech perception was evaluated by word identification under noise interference. Results suggest that greater TFS sensitivity is not associated with greater masking release from fundamental-frequency or spatial cues, but appears to contribute to resilience against the effects of reverberation. We also found that greater TFS sensitivity is associated with faster response times, indicating reduced listening effort. These findings highlight the perceptual significance of TFS coding for everyday hearing.

Hearing loss and psychosocial outcomes: Influences of social emotional aspects and personality

The aim of this study was to examine the effects of social isolation, loneliness, anxiety, depression, higher stress, and memory complaints interacting with personality traits as a function of hearing loss. Personality traits have previously been shown to correlate with anxiety and depression, as well as hearing loss, suggesting an effect of personality on the relationship between social emotional outcomes and hearing loss. A cross-sectional survey including validated screening measures was anonymously administered. Measures included personality (Big Five Index-2 Extra-Short Form), stress (Perceived Stress Scale), anxiety and depression (Patient Health Questionnaire for Depression and Anxiety), loneliness (Three-Item Loneliness Scale), social engagement (Lubben Social Network Scale-6), and self-perceived memory complaints (Subjective Cognitive Function). Eight hundred and ninety-one responses were obtained from adults between the ages of 18 and 90 years old (M = 50 years old). Hearing loss was positively correlated with subjective memory complaints only when not accounting for demographic variables, personality traits, psychosocial outcomes, and social emotional outcomes. There were additive effects of hearing loss and negative emotionality on increases in memory complaints in those who self-identified as maybe having hearing loss. Higher degrees of hearing loss also increased loneliness, with greater hearing loss negating the positive correlation between extraversion and social engagement. Overall, our results suggest that hearing loss significantly interacts with personality traits and other social emotional measures. Our results suggest that the impact of hearing loss on memory complaints, social isolation, and loneliness may differ across patients with hearing loss in comparison with those who think they maybe have hearing loss. Information from this study may provide insights for hearing healthcare and mental healthcare professionals to better serve persons with hearing loss who may require additional support or interventions.

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 Vocal Quality of the Sender is Able to Influence the Cognitive Performance and Cortisol Level of the Listener

OBJECTIVE

To verify the influence of the sender's vocal quality on performance in cognitive tests and on the receiver's cortisol level.

STUDY DESIGN

Observational, cross-sectional, and analytical study.

METHODS

Four voices were selected to represent adapted voice (AdV), and rough voice of discreet degree (DV), moderate (MV), and intense (IV). These participants recorded the stimuli used in the attention and memory tests, which included 139 undergraduate students as receivers. Saliva was collected from recipients for cortisol assessment one minute before and after 15, 30 and 45 minutes of the cognitive assessment.

RESULTS

Statistically significant differences were identified between the groups in the repetition test, with worse results in IV. Cortisol increased significantly in the MV group when compared with the other groups after 15 minutes of the cognitive test.

CONCLUSIONS

Emitters' rough voices can negatively influence performance in cognitive tests that require attention and working memory and leads to a short-term increase in the receiver's cortisol levels.

The effect of increased listening effort on the balance performance of patients with compensated vestibular lesion

OBJECTIVES

This study investigated the effects of listening effort (LE) on balance in patients with compensated vestibular deficits compared to healthy peers.

METHODS

The subjects included two main groups: a control group of 15 healthy subjects and a study group of 19 patients with compensated vestibular pathology. The computerized dynamic posturography test (CDP) was conducted without the speech-in-noise task as a baseline, then the participant was subjected to a dual task in which the auditory task (speech-in-noise sentences) was given as the primary task, and the balance function test was the secondary task.

RESULTS

WITHIN-GROUP ANALYSIS: The study group showed statistically significantly worse values of all body balance parameters under dual-task than the baseline in all conditions. These differences were much higher under the compliant platform conditions. However, these findings were not statistically significant in the control group.

BETWEEN-GROUP ANALYSIS

The study group showed a statistically significant decline in body balance reactions compared to the control group under dual-task with increased listening effort and the compliant platform. Study subgroup analysis revealed statistically significant differences between patients with unilateral vestibular loss (UVL) and those with bilateral vestibular loss (BVL) in the unstable platform condition.

CONCLUSION

Our study regarding implementing a dual-tasking paradigm as a measure of LE during the evaluation of chronic vestibular patients with CDP demonstrated how dual-tasking with increased LE affects postural stability. Because of this, patients will probably be more prone to tripping and falling in multitasking situations, as found in real-world settings. This fact should be taken into consideration while testing patients with chronic vertigo and compensated states at VNG. A dual-task paradigm helps uncover the unrevealed pathology.

Hearing difficulties and memory problems: the mediating role of physical health and psychosocial wellbeing

OBJECTIVE

To investigate whether the association between hearing difficulties and self-reported memory problems is mediated by physical health and psychosocial wellbeing.

DESIGN

A cross-sectional study. Path analyses were used to test potential theoretical models (psychosocial-cascade, common cause) of the association between hearing difficulties and memory problems, adjusting for age.

STUDY SAMPLE

A sample of 479 adults (18-87 years) completed self-reported outcome measures.

RESULTS

Half the participants reported clinically significant hearing difficulties and 30% self-reported memory problems. In the direct model, reporting hearing difficulties was associated with a greater likelihood of reporting memory problems (β = 0.17, p = 0.007, 95% Confidence Intervals [CI] = 0.00, 0.01). Hearing difficulties were also associated with poorer physical health, but this did not mediate the association with memory. Psychosocial factors, however, fully mediated the relationship between hearing difficulties and memory problems (β = 0.03, p = 0.019, 95% CI = 0.00, 0.01).

CONCLUSIONS

Adults with hearing difficulties may be more likely to self-report memory problems, irrespective of age. This study supports the psychosocial-cascade model, as the association between self-reported hearing and memory problems was explained entirely by psychosocial factors. Future studies should investigate these associations using behavioural measures, as well as explore whether interventions can reduce the risk of developing memory problems in this population.

The Costs (and Benefits?) of Effortful Listening for Older Adults: Insights from Simultaneous Electrophysiology, Pupillometry, and Memory

Although the impact of acoustic challenge on speech processing and memory increases as a person ages, older adults may engage in strategies that help them compensate for these demands. In the current preregistered study, older adults (n = 48) listened to sentences-presented in quiet or in noise-that were high constraint with either expected or unexpected endings or were low constraint with unexpected endings. Pupillometry and EEG were simultaneously recorded, and subsequent sentence recognition and word recall were measured. Like young adults in prior work, we found that noise led to increases in pupil size, delayed and reduced ERP responses, and decreased recall for unexpected words. However, in contrast to prior work in young adults where a larger pupillary response predicted a recovery of the N400 at the cost of poorer memory performance in noise, older adults did not show an associated recovery of the N400 despite decreased memory performance. Instead, we found that in quiet, increases in pupil size were associated with delays in N400 onset latencies and increased recognition memory performance. In conclusion, we found that transient variation in pupil-linked arousal predicted trade-offs between real-time lexical processing and memory that emerged at lower levels of task demand in aging. Moreover, with increased acoustic challenge, older adults still exhibited costs associated with transient increases in arousal without the corresponding benefits.

Bayesian Semiparametric Longitudinal Inverse-Probit Mixed Models for Category Learning

Understanding how the adult human brain learns novel categories is an important problem in neuroscience. Drift-diffusion models are popular in such contexts for their ability to mimic the underlying neural mechanisms. One such model for gradual longitudinal learning was recently developed in Paulon et al. (J Am Stat Assoc 116:1114-1127, 2021). In practice, category response accuracies are often the only reliable measure recorded by behavioral scientists to describe human learning. Category response accuracies are, however, often the only reliable measure recorded by behavioral scientists to describe human learning. To our knowledge, however, drift-diffusion models for such scenarios have never been considered in the literature before. To address this gap, in this article, we build carefully on Paulon et al. (J Am Stat Assoc 116:1114-1127, 2021), but now with latent response times integrated out, to derive a novel biologically interpretable class of 'inverse-probit' categorical probability models for observed categories alone. However, this new marginal model presents significant identifiability and inferential challenges not encountered originally for the joint model in Paulon et al. (J Am Stat Assoc 116:1114-1127, 2021). We address these new challenges using a novel projection-based approach with a symmetry-preserving identifiability constraint that allows us to work with conjugate priors in an unconstrained space. We adapt the model for group and individual-level inference in longitudinal settings. Building again on the model's latent variable representation, we design an efficient Markov chain Monte Carlo algorithm for posterior computation. We evaluate the empirical performance of the method through simulation experiments. The practical efficacy of the method is illustrated in applications to longitudinal tone learning studies.

Design and Methods of the Early Age-Related Hearing Loss Investigation Randomized Controlled Trial

OBJECTIVE

Hearing loss has been identified as a major modifiable risk factor for cognitive decline. The Early Age-Related Hearing Loss Investigation (EARHLI) study will assess the mechanisms linking early age-related hearing loss (ARHL) and cognitive impairment.

STUDY DESIGN

Randomized, controlled, single-site, early phase II, superiority trial.

SETTING

Tertiary academic medical center.

PARTICIPANTS

One hundred fifty participants aged 55 to 75 years with early ARHL (severity defined as borderline to moderate) and amnestic mild cognitive impairment will be included.

INTERVENTIONS

Participants will be randomized 1:1 to a best practice hearing intervention or a health education control.

MAIN OUTCOME MEASURES

The primary study outcome is cognition measured by the Alzheimer Disease Cooperative Study-Preclinical Alzheimer Cognitive Composite. Secondary outcomes include additional measures of cognition, social engagement, and brain organization/connectivity.

RESULTS

Trial enrollment will begin in early 2024.

CONCLUSIONS

After its completion in 2028, the EARHLI trial should offer evidence on the effect of hearing treatment versus a health education control on cognitive performance, social engagement, and brain organization/connectivity in 55- to 75-year-old community-dwelling adults with early ARHL and amnestic mild cognitive impairment.

Pupil Size and Eye Movements Differently Index Effort in Both Younger and Older Adults

The assessment of mental effort is increasingly relevant in neurocognitive and life span domains. Pupillometry, the measure of the pupil size, is often used to assess effort but has disadvantages. Analysis of eye movements may provide an alternative, but research has been limited to easy and difficult task demands in younger adults. An effort measure must be sensitive to the whole effort profile, including "giving up" effort investment, and capture effort in different age groups. The current study comprised three experiments in which younger (n = 66) and older (n = 44) adults listened to speech masked by background babble at different signal-to-noise ratios associated with easy, difficult, and impossible speech comprehension. We expected individuals to invest little effort for easy and impossible speech (giving up) but to exert effort for difficult speech. Indeed, pupil size was largest for difficult but lower for easy and impossible speech. In contrast, gaze dispersion decreased with increasing speech masking in both age groups. Critically, gaze dispersion during difficult speech returned to levels similar to easy speech after sentence offset, when acoustic stimulation was similar across conditions, whereas gaze dispersion during impossible speech continued to be reduced. These findings show that a reduction in eye movements is not a byproduct of acoustic factors, but instead suggest that neurocognitive processes, different from arousal-related systems regulating the pupil size, drive reduced eye movements during high task demands. The current data thus show that effort in one sensory domain (audition) differentially impacts distinct functional properties in another sensory domain (vision).

Investigation of the behavior of tinnitus patients under varying listening conditions with simultaneous electroencephalography and pupillometry

OBJECTIVE

This study aims to control all hearing thresholds, including extended high frequencies (EHFs), presents stimuli of varying difficulty levels, and measures electroencephalography (EEG) and pupillometry responses to determine whether listening difficulty in tinnitus patients is effort or fatigue-related.

METHODS

Twenty-one chronic tinnitus patients and 26 matched healthy controls having normal pure-tone averages with symmetrical hearing thresholds were included. Subjects were evaluated with 0.125-20 kHz pure-tone audiometry, Montreal Cognitive Assessment Test (MoCA), Tinnitus Handicap Inventory (THI), EEG, and pupillometry.

RESULTS

Pupil dilatation and EEG alpha power during the "encoding" phase of the presented sentence in tinnitus patients were less in all listening conditions (p < .05). Also, there was no statistically significant relationship between EEG and pupillometry components for all listening conditions and THI or MoCA (p > .05).

CONCLUSION

EEG and pupillometry results under various listening conditions indicate potential listening effort in tinnitus patients even if all frequencies, including EHFs, are controlled. Also, we suggest that pupillometry should be interpreted with caution in autonomic nervous system-related conditions such as tinnitus.

Prediction Model for Cognitive Impairment among Disabled Older Adults: A Development and Validation Study

Disabled older adults exhibited a higher risk for cognitive impairment. Early identification is crucial in alleviating the disease burden. This study aims to develop and validate a prediction model for identifying cognitive impairment among disabled older adults. A total of 2138, 501, and 746 participants were included in the development set and two external validation sets. Logistic regression, support vector machine, random forest, and XGBoost were introduced to develop the prediction model. A nomogram was further established to demonstrate the prediction model directly and vividly. Logistic regression exhibited better predictive performance on the test set with an area under the curve of 0.875. It maintained a high level of precision (0.808), specification (0.788), sensitivity (0.770), and F1-score (0.788) compared with the machine learning models. We further simplified and established a nomogram based on the logistic regression, comprising five variables: age, daily living activities, instrumental activity of daily living, hearing impairment, and visual impairment. The areas under the curve of the nomogram were 0.871, 0.825, and 0.863 in the internal and two external validation sets, respectively. This nomogram effectively identifies the risk of cognitive impairment in disabled older adults.

Effects of hearing acuity on psychophysiological responses to effortful speech perception

In recent studies, psychophysiological measures have been used as markers of listening effort, but there is limited research on the effect of hearing loss on such measures. The aim of the current study was to investigate the effect of hearing acuity on physiological responses and subjective measures acquired during different levels of listening demand, and to investigate the relationship between these measures. A total of 125 participants (37 males and 88 females, age range 37-72 years, pure-tone average hearing thresholds at the best ear between -5.0 to 68.8 dB HL and asymmetry between ears between 0.0 and 87.5 dB) completed a listening task. A speech reception threshold (SRT) test was used with target sentences spoken by a female voice masked by male speech. Listening demand was manipulated using three levels of intelligibility: 20 % correct speech recognition, 50 %, and 80 % (IL20 %/IL50 %/IL80 %, respectively). During the task, peak pupil dilation (PPD), heart rate (HR), pre-ejection period (PEP), respiratory sinus arrhythmia (RSA), and skin conductance level (SCL) were measured. For each condition, subjective ratings of effort, performance, difficulty, and tendency to give up were also collected. Linear mixed effects models tested the effect of intelligibility level, hearing acuity, hearing asymmetry, and tinnitus complaints on the physiological reactivity (compared to baseline) and subjective measures. PPD and PEP reactivity showed a non-monotonic relationship with intelligibility level, but no such effects were found for HR, RSA, or SCL reactivity. Participants with worse hearing acuity had lower PPD at all intelligibility levels and showed lower PEP baseline levels. Additionally, PPD and SCL reactivity were lower for participants who reported suffering from tinnitus complaints. For IL80 %, but not IL50 % or IL20 %, participants with worse hearing acuity rated their listening effort to be relatively high compared to participants with better hearing. The reactivity of the different physiological measures were not or only weakly correlated with each other. Together, the results suggest that hearing acuity may be associated with altered sympathetic nervous system (re)activity. Research using psychophysiological measures as markers of listening effort to study the effect of hearing acuity on such measures are best served by the use of the PPD and PEP.

Age Impacts Speech-in-Noise Recognition Differently for Nonnative and Native Listeners

PURPOSE

The purpose of this study was to explore potential differences in suprathreshold auditory function among native and nonnative speakers of English as a function of age.

METHOD

Retrospective analyses were performed on three large data sets containing suprathreshold auditory tests completed by 5,572 participants who were self-identified native and nonnative speakers of English between the ages of 18-65 years, including a binaural tone detection test, a digit identification test, and a sentence recognition test.

RESULTS

The analyses show a significant interaction between increasing age and participant group on tests involving speech-based stimuli (digit strings, sentences) but not on the binaural tone detection test. For both speech tests, differences in speech recognition emerged between groups during early adulthood, and increasing age had a more negative impact on word recognition for nonnative compared to native participants. Age-related declines in performance were 2.9 times faster for digit strings and 3.3 times faster for sentences for nonnative participants compared to native participants.

CONCLUSIONS

This set of analyses extends the existing literature by examining interactions between aging and self-identified native English speaker status in several auditory domains in a cohort of adults spanning young adulthood through middle age. The finding that older nonnative English speakers in this age cohort may have greater-than-expected deficits on speech-in-noise perception may have clinical implications on how these individuals should be diagnosed and treated for hearing difficulties.

Evaluating Speaker-Listener Cognitive Effort in Speech Communication Through Brain-to-Brain Synchrony: A Pilot Functional Near-Infrared Spectroscopy Investigation

PURPOSE

We explore a new approach to the study of cognitive effort involved in listening to speech by measuring the brain activity in a listener in relation to the brain activity in a speaker. We hypothesize that the strength of this brain-to-brain synchrony (coupling) reflects the magnitude of cognitive effort involved in verbal communication and includes both listening effort and speaking effort. We investigate whether interbrain synchrony is greater in native-to-native versus native-to-nonnative communication using functional near-infrared spectroscopy (fNIRS).

METHOD

Two speakers participated, a native speaker of American English and a native speaker of Korean who spoke English as a second language. Each speaker was fitted with the fNIRS cap and told short stories. The native English speaker provided the English narratives, and the Korean speaker provided both the nonnative (accented) English and Korean narratives. In separate sessions, fNIRS data were obtained from seven English monolingual participants ages 20-24 years who listened to each speaker's stories. After listening to each story in native and nonnative English, they retold the content, and their transcripts and audio recordings were analyzed for comprehension and discourse fluency, measured in the number of hesitations and articulation rate. No story retellings were obtained for narratives in Korean (an incomprehensible language for English listeners). Utilizing fNIRS technique termed sequential scanning, we quantified the brain-to-brain synchronization in each speaker-listener dyad.

RESULTS

For native-to-native dyads, multiple brain regions associated with various linguistic and executive functions were activated. There was a weaker coupling for native-to-nonnative dyads, and only the brain regions associated with higher order cognitive processes and functions were synchronized. All listeners understood the content of all stories, but they hesitated significantly more when retelling stories told in accented English. The nonnative speaker hesitated significantly more often than the native speaker and had a significantly slower articulation rate. There was no brain-to-brain coupling during listening to Korean, indicating a break in communication when listeners failed to comprehend the speaker.

CONCLUSIONS

We found that effortful speech processing decreased interbrain synchrony and delayed comprehension processes. The obtained brain-based and behavioral patterns are consistent with our proposal that cognitive effort in verbal communication pertains to both the listener and the speaker and that brain-to-brain synchrony can be an indicator of differences in their cumulative communicative effort.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25452142.

Model-based reconstruction for looping-star MRI

PURPOSE

The aim of this study was to develop a reconstruction method that more fully models the signals and reconstructs gradient echo (GRE) images without sacrificing the signal to noise ratio and spatial resolution, compared to conventional gridding and model-based image reconstruction method.

METHODS

By modeling the trajectories for every spoke and simplifying the scenario to only echo-in and echo-out mixture, the approach explicitly models the overlapping echoes. After modeling the overlapping echoes with two system matrices, we use the conjugate gradient algorithm (CG-SENSE) with the nonuniform FFT (NUFFT) to optimize the image reconstruction cost function.

RESULTS

The proposed method is demonstrated in phantoms and in-vivo volunteer experiments for three-dimensional, high-resolution T2*-weighted imaging and functional MRI tasks. Compared to the gridding method, the high resolution protocol exhibits improved spatial resolution and reduced signal loss as a result of less intra-voxel dephasing. The fMRI task shows that the proposed model-based method produced images with reduced artifacts and blurring as well as more stable and prominent time courses.

CONCLUSION

The proposed model-based reconstruction results shows improved spatial resolution and reduced artifacts. The fMRI task shows improved time series and activation map due to the reduced overlapping echoes and under-sampling artifacts.

Effects of Background Noise and Linguistic Violations on Frontal Theta Oscillations During Effortful Listening

OBJECTIVES

Background noise and linguistic violations have been shown to increase the listening effort. The present study aims to examine the effects of the interaction between background noise and linguistic violations on subjective listening effort and frontal theta oscillations during effortful listening.

DESIGN

Thirty-two normal-hearing listeners participated in this study. The linguistic violation was operationalized as sentences versus random words (strings). Behavioral and electroencephalography data were collected while participants listened to sentences and strings in background noise at different signal to noise ratios (SNRs) (-9, -6, -3, 0 dB), maintained them in memory for about 3 sec in the presence of background noise, and then chose the correct sequence of words from a base matrix of words.

RESULTS

Results showed the interaction effects of SNR and speech type on effort ratings. Although strings were inherently more effortful than sentences, decreasing SNR from 0 to -9 dB (in 3 dB steps), increased effort rating more for sentences than strings in each step, suggesting the more pronounced effect of noise on sentence processing that strings in low SNRs. Results also showed a significant interaction between SNR and speech type on frontal theta event-related synchronization during the retention interval. This interaction indicated that strings exhibited higher frontal theta event-related synchronization than sentences at SNR of 0 dB, suggesting increased verbal working memory demand for strings under challenging listening conditions.

CONCLUSIONS

The study demonstrated that the interplay between linguistic violation and background noise shapes perceived effort and cognitive load during speech comprehension under challenging listening conditions. The differential impact of noise on processing sentences versus strings highlights the influential role of context and cognitive resource allocation in the processing of speech.

Electrophysiological Measures of Listening-in-Noise With and Without Remote Microphone System Use in Autistic and Non-Autistic Youth

OBJECTIVES

This study examined the neural mechanisms by which remote microphone (RM) systems might lead to improved behavioral performance on listening-in-noise tasks in autistic and non-autistic youth.

DESIGN

Cortical auditory evoked potentials (CAEPs) were recorded in autistic (n = 25) and non-autistic (n = 22) youth who were matched at the group level on chronological age ( M = 14.21 ± 3.39 years) and biological sex. Potentials were recorded during an active syllable identification task completed in quiet and in multi-talker babble noise with and without the use of an RM system. The effects of noise and RM system use on speech-sound-evoked P1-N1-P2 responses and the associations between the cortical responses and behavioral performance on syllable identification were examined.

RESULTS

No group differences were observed for behavioral or CAEP measures of speech processing in quiet or in noise. In the combined sample, syllable identification in noise was less accurate and slower than in the quiet condition. The addition of the RM system to the noise condition restored accuracy, but not the response speed, to the levels observed in quiet. The CAEP analyses noted amplitude reductions and latency delays in the noise compared with the quiet condition. The RM system use increased the N1 amplitude as well as reduced and delayed the P2 response relative to the quiet and noise conditions. Exploratory brain-behavior correlations revealed that larger N1 amplitudes in the RM condition were associated with greater behavioral accuracy of syllable identification. Reduced N1 amplitude and accelerated P2 response were associated with shorter syllable identification response times when listening with the RM system.

CONCLUSIONS

Findings suggest that although listening-in-noise with an RM system might remain effortful, the improved signal to noise ratio facilitates attention to the sensory features of the stimuli and increases speech sound identification accuracy.

Bluetooth Noise-Canceling Headphones Improve the Quality of Ophthalmic Exams in Patients With Hearing Loss: A Randomized Controlled Trial

INTRODUCTION

This study tests the utilization of Bluetooth noise-canceling headphones in improving the quality of eye exams in patients with hearing loss. This prospective study was approved on ethical standards by the University of Texas Medical Branch (UTMB) Institutional Review Board (Approval No. 22-0079) and registered with the National Institutes of Health (NCT05420038).

METHODS

UTMB patients above 55 years of age were screened for hearing loss using soundcheck audiometry. Twenty-nine subjects answered pre-recorded ophthalmic exam questions that solicited precise responses. As controls, subjects were randomly administered half of the questions via headphones and half via a smartphone at normal speech volume (60 decibels). Points were awarded for responses demonstrating comprehension, and a post-exam survey was collected.

RESULTS

Collectively, the mean score was 1.79 with headphones versus 0.96 with control on the Amsler grid segment and 1.90 with headphones versus 0.97 with control on education questions (p=0.001). Between red zone and yellow zone hearing loss patients, the more severe red zone group answered significantly better in both Amsler (1.78 versus 0.50; p=0.0003) and education questions (1.88 versus 0.44; p<0.0001) with headphones. The yellow zone group answered better with headphones overall but failed to reach significance. Post-exam survey indicated that 28 of 29 patients (97%) preferred the headphones during ophthalmic exams.

CONCLUSION

Patients with hearing loss demonstrated better comprehension with Bluetooth headphones. These low-cost devices show great promise at improving effective, compassionate communication between providers and hearing loss patients.

Associations Between Auditory Working Memory, Self-Perceived Listening Effort, and Hearing Difficulty in Adults With Mild Traumatic Brain Injury

OBJECTIVES

Mild traumatic brain injury (TBI) can have persistent effects in the auditory domain (e.g., difficulty listening in noise), despite individuals having normal pure-tone auditory sensitivity. Individuals with a history of mild TBI often perceive hearing difficulty and greater listening effort in complex listening situations. The purpose of the present study was to examine self-perceived hearing difficulty, listening effort, and performance on an auditory processing test battery in adults with a history of mild TBI compared with a control group.

DESIGN

Twenty adults ages 20 to 53 years old participated divided into a mild TBI (n = 10) and control group (n = 10). Perceived hearing difficulties were measured using the Adult Auditory Processing Scale and the Hearing Handicap Inventory for Adults. Listening effort was measured using the National Aeronautics and Space Administration-Task Load Index. Listening effort ratings were obtained at baseline, after each auditory processing test, and at the completion of the test battery. The auditory processing test battery included (1) dichotic word recognition, (2) the 500-Hz masking level difference, (3) the Listening in Spatialized Noise-Sentences test, and (4) the Word Auditory Recognition and Recall Measure (WARRM).

RESULTS

Results indicated that individuals with a history of mild TBI perceived significantly greater degrees of hearing difficulty and listening effort than the control group. There were no significant group differences on two of the auditory processing tasks (dichotic word recognition or Listening in Spatialized Noise-Sentences). The mild TBI group exhibited significantly poorer performance on the 500-Hz MLD and the WARRM, a measure of auditory working memory, than the control group. Greater degrees of self-perceived hearing difficulty were significantly associated with greater listening effort and poorer auditory working memory. Greater listening effort was also significantly associated with poorer auditory working memory.

CONCLUSIONS

Results demonstrate that adults with a history of mild TBI may experience subjective hearing difficulty and listening effort when listening in challenging acoustic environments. Poorer auditory working memory on the WARRM task was observed for the adults with mild TBI and was associated with greater hearing difficulty and listening effort. Taken together, the present study suggests that conventional clinical audiometric battery alone may not provide enough information about auditory processing deficits in individuals with a history of mild TBI. The results support the use of a multifaceted battery of auditory processing tasks and subjective measures when evaluating individuals with a history of mild TBI.

Bursts of vagus nerve stimulation paired with auditory rehabilitation fail to improve speech sound perception in rats with hearing loss

Hearing loss can lead to long-lasting effects on the central nervous system, and current therapies, such as auditory training and rehabilitation, show mixed success in improving perception and speech comprehension. Vagus nerve stimulation (VNS) is an adjunctive therapy that can be paired with rehabilitation to facilitate behavioral recovery after neural injury. However, VNS for auditory recovery has not been tested after severe hearing loss or significant damage to peripheral receptors. This study investigated the utility of pairing VNS with passive or active auditory rehabilitation in a rat model of noise-induced hearing loss. Although auditory rehabilitation helped rats improve their frequency discrimination, learn novel speech discrimination tasks, and achieve speech-in-noise performance similar to normal hearing controls, VNS did not enhance recovery of speech sound perception. These results highlight the limitations of VNS as an adjunctive therapy for hearing loss rehabilitation and suggest that optimal benefits from neuromodulation may require restored peripheral signaling.

Listening effort, fatigue, and streamed voice quality during online university courses

Understanding the impact of listening effort (LE) and fatigue has become increasingly crucial in optimizing the learning experience with the growing prevalence of online classrooms as a mode of instruction. The purpose of this study was to investigate the LE, fatigue, and voice quality experienced by students during online and face-to-face class sessions. A total of 110 participants with an average age of 20.76 (range 18-28) comprising first year undergraduate students in Speech and Language Therapy and Audiology programs in Turkey, rated their LE during the 2022-2023 spring semester using the Listening Effort Screening Questionnaire (LESQ) and assessed their fatigue with the Multidimensional Fatigue Inventory (MFI-20). Voice quality of lecturers was assessed using smoothed cepstral peak prominence (CPPS) measurements. Data were collected from both online and face-to-face sessions. The results revealed that participants reported increased LE and fatigue during online sessions compared to face-to-face sessions and the differences were statistically significant. Correlation analysis showed significant relationships (p < 0.05) between audio-video streaming quality and LE-related items in the LESQ, as well as MFI sub-scales and total scores. The findings revealed a relationship between an increased preference for face-to-face classrooms and higher levels of LE and fatigue, emphasizing the significance of these factors in shaping the learning experience. CPPS measurements indicated a dysphonic voice quality during online classroom audio streaming. These findings highlight the challenges of online classes in terms of increased LE, fatigue, and voice quality issues. Understanding these factors is crucial for improving online instruction and student experience.

Pupil Dilation Reflects Perceptual Priorities During a Receptive Speech Task

OBJECTIVES

The listening demand incurred by speech perception fluctuates in normal conversation. At the acoustic-phonetic level, natural variation in pronunciation acts as speedbumps to accurate lexical selection. Any given utterance may be more or less phonetically ambiguous-a problem that must be resolved by the listener to choose the correct word. This becomes especially apparent when considering two common speech registers-clear and casual-that have characteristically different levels of phonetic ambiguity. Clear speech prioritizes intelligibility through hyperarticulation which results in less ambiguity at the phonetic level, while casual speech tends to have a more collapsed acoustic space. We hypothesized that listeners would invest greater cognitive resources while listening to casual speech to resolve the increased amount of phonetic ambiguity, as compared with clear speech. To this end, we used pupillometry as an online measure of listening effort during perception of clear and casual continuous speech in two background conditions: quiet and noise.

DESIGN

Forty-eight participants performed a probe detection task while listening to spoken, nonsensical sentences (masked and unmasked) while recording pupil size. Pupil size was modeled using growth curve analysis to capture the dynamics of the pupil response as the sentence unfolded.

RESULTS

Pupil size during listening was sensitive to the presence of noise and speech register (clear/casual). Unsurprisingly, listeners had overall larger pupil dilations during speech perception in noise, replicating earlier work. The pupil dilation pattern for clear and casual sentences was considerably more complex. Pupil dilation during clear speech trials was slightly larger than for casual speech, across quiet and noisy backgrounds.

CONCLUSIONS

We suggest that listener motivation could explain the larger pupil dilations to clearly spoken speech. We propose that, bounded by the context of this task, listeners devoted more resources to perceiving the speech signal with the greatest acoustic/phonetic fidelity. Further, we unexpectedly found systematic differences in pupil dilation preceding the onset of the spoken sentences. Together, these data demonstrate that the pupillary system is not merely reactive but also adaptive-sensitive to both task structure and listener motivation to maximize accurate perception in a limited resource system.

Children build their vocabularies in noisy environments: The necessity of a cross-disciplinary approach to understand word learning

Research within the language sciences has informed our understanding of how children build vocabulary knowledge especially during early childhood and the early school years. However, to date, our understanding of word learning in children is based primarily on research in quiet laboratory settings. The everyday environments that children inhabit such as schools, homes, and day cares are typically noisy. To better understand vocabulary development, we need to understand the effects of background noise on word learning. To gain this understanding, a cross-disciplinary approach between researchers in the language and hearing sciences in partnership with parents, educators, and clinicians is ideal. Through this approach we can identify characteristics of effective vocabulary instruction that take into account the background noise present in children's learning environments. Furthermore, we can identify characteristics of children who are likely to struggle with learning words in noisy environments. For example, differences in vocabulary knowledge, verbal working memory abilities, and attention skills will likely influence children's ability to learn words in the presence of background noise. These children require effective interventions to support their vocabulary development which subsequently should support their ability to process and learn language in noisy environments. Overall, this cross-disciplinary approach will inform theories of language development and inform educational and intervention practices designed to support children's vocabulary development. This article is categorized under: Psychology > Language Psychology > Learning Psychology > Theory and Methods.

Input-related demands: vocoded sentences evoke different pupillometrics and subjective listening effort than sentences in speech-shaped noise

OBJECTIVES

The Framework for Effortful Listening (FUEL) suggests five input-related demands can alter listening effort: source, transmission, listener, message and context factors. We hypothesised that vocoded sentences represented a source factor degradation and sentences in speech-shaped noise represented a transmission factor degradation. We used pupillometry and a subjective scale to examine our hypothesis.

DESIGN

Participants listened to vocoded sentences and sentences in speech-shaped noise at several difficulty levels designed to produce similar word recognition abilities; they also listened to unprocessed sentences. Within-participant pupillometrics and subjective listening effort were analysed. Post-hoc analyses were performed to examine if word recognition accuracy differentially influenced pupil responses.

STUDY SAMPLES

Twenty young adults with normal hearing.

RESULTS

Baseline pupil diameter was significantly smaller, peak pupil dilation was significantly larger, peak pupil dilation latency was significantly shorter, and subjective listening effort was significantly greater for the vocoded sentences than the sentences-in-noise. Word recognition ability also affected pupillometrics, but only for the vocoded sentences.

CONCLUSIONS

Our findings suggest that source factor degradations result in greater listening effort than transmission factor degradations. Future research should address how clinical interventions tailored towards different input-related demands may lead to reduced listening effort and improve patient outcomes.

Enhancing Cochlear Implant Outcomes across Age Groups: The Interplay of Forward Focus and Advanced Combination Encoder Coding Strategies in Noisy Conditions

Background: Hearing in noise is challenging for cochlear implant users and requires significant listening effort. This study investigated the influence of ForwardFocus and number of maxima of the Advanced Combination Encoder (ACE) strategy, as well as age, on speech recognition threshold and listening effort in noise. Methods: A total of 33 cochlear implant recipients were included (age ≤ 40 years: n = 15, >40 years: n = 18). The Oldenburg Sentence Test was used to measure 50% speech recognition thresholds (SRT50) in fluctuating and stationary noise. Speech was presented frontally, while three frontal or rear noise sources were used, and the number of ACE maxima varied between 8 and 12. Results: ForwardFocus significantly improved the SRT50 when noise was presented from the back, independent of subject age. The use of 12 maxima further improved the SRT50 when ForwardFocus was activated and when noise and speech were presented frontally. Listening effort was significantly worse in the older age group compared to the younger age group and was reduced by ForwardFocus but not by increasing the number of ACE maxima. Conclusion: Forward Focus can improve speech recognition in noisy environments and reduce listening effort, especially in older cochlear implant users.

Effects of linguistic context and noise type on speech comprehension

Introduction

Understanding speech in background noise is an effortful endeavor. When acoustic challenges arise, linguistic context may help us fill in perceptual gaps. However, more knowledge is needed regarding how different types of background noise affect our ability to construct meaning from perceptually complex speech input. Additionally, there is limited evidence regarding whether perceptual complexity (e.g., informational masking) and linguistic complexity (e.g., occurrence of contextually incongruous words) interact during processing of speech material that is longer and more complex than a single sentence. Our first research objective was to determine whether comprehension of spoken sentence pairs is impacted by the informational masking from a speech masker. Our second objective was to identify whether there is an interaction between perceptual and linguistic complexity during speech processing.

Methods

We used multiple measures including comprehension accuracy, reaction time, and processing effort (as indicated by task-evoked pupil response), making comparisons across three different levels of linguistic complexity in two different noise conditions. Context conditions varied by final word, with each sentence pair ending with an expected exemplar (EE), within-category violation (WV), or between-category violation (BV). Forty young adults with typical hearing performed a speech comprehension in noise task over three visits. Each participant heard sentence pairs presented in either multi-talker babble or spectrally shaped steady-state noise (SSN), with the same noise condition across all three visits.

Results

We observed an effect of context but not noise on accuracy. Further, we observed an interaction of noise and context in peak pupil dilation data. Specifically, the context effect was modulated by noise type: context facilitated processing only in the more perceptually complex babble noise condition.

Discussion

These findings suggest that when perceptual complexity arises, listeners make use of the linguistic context to facilitate comprehension of speech obscured by background noise. Our results extend existing accounts of speech processing in noise by demonstrating how perceptual and linguistic complexity affect our ability to engage in higher-level processes, such as construction of meaning from speech segments that are longer than a single sentence.

WITHDRAWN: Listening handicap in tinnitus patients by controlling extended high frequencies - Effort or fatigue?

This article has been withdrawn: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/policies/article-withdrawal). This article has been withdrawn at the request of the editor and publisher. The publisher regrets that an error occurred which led to the premature publication of this paper. This error bears no reflection on the article or its authors. The publisher apologizes to the authors and the readers for this unfortunate error.

A qualitative study assessing the barriers and facilitators to physical activity in adults with hearing loss

OBJECTIVES

Growing epidemiological evidence has shown hearing loss is associated with physical inactivity. Currently, there is a dearth in evidence investigating why this occurs. This study aimed to investigate the barriers and facilitators to physical activity in middle-aged and older adults with hearing loss.

DESIGN

Individual semi-structured qualitative interviews.

METHODS

A phenomenological approach was taken. Ten adults (≥40 years) were interviewed via videoconferencing. The interview schedule was underpinned by the capability, opportunity, motivation and behaviour (COM-B) model. Reflexive thematic analysis was used to generate themes, which were subsequently mapped onto the COM-B model and behaviour change wheel.

RESULTS

Nine hearing loss specific themes were generated, which included the following barriers to physical activity: mental fatigue, interaction with the environment (acoustically challenging environments, difficulties with hearing aids when physically active) and social interactions (perceived stigma). Environmental modifications (digital capabilities of hearing aids), social support (hearing loss-only groups) and hearing loss self-efficacy were reported to facilitate physical activity.

CONCLUSIONS

Middle-aged and older adults with hearing loss experience hearing-specific barriers to physical activity, which has a deleterious impact on their overall health and well-being. Interventions and public health programmes need to be tailored to account for these additional barriers. Further research is necessary to test potential behaviour change techniques.

Neural hyperactivity and altered envelope encoding in the central auditory system: Changes with advanced age and hearing loss

Temporal modulations are ubiquitous features of sound signals that are important for auditory perception. The perception of temporal modulations, or temporal processing, is known to decline with aging and hearing loss and negatively impact auditory perception in general and speech recognition specifically. However, neurophysiological literature also provides evidence of exaggerated or enhanced encoding of specifically temporal envelopes in aging and hearing loss, which may arise from changes in inhibitory neurotransmission and neuronal hyperactivity. This review paper describes the physiological changes to the neural encoding of temporal envelopes that have been shown to occur with age and hearing loss and discusses the role of disinhibition and neural hyperactivity in contributing to these changes. Studies in both humans and animal models suggest that aging and hearing loss are associated with stronger neural representations of both periodic amplitude modulation envelopes and of naturalistic speech envelopes, but primarily for low-frequency modulations (<80 Hz). Although the frequency dependence of these results is generally taken as evidence of amplified envelope encoding at the cortex and impoverished encoding at the midbrain and brainstem, there is additional evidence to suggest that exaggerated envelope encoding may also occur subcortically, though only for envelopes with low modulation rates. A better understanding of how temporal envelope encoding is altered in aging and hearing loss, and the contexts in which neural responses are exaggerated/diminished, may aid in the development of interventions, assistive devices, and treatment strategies that work to ameliorate age- and hearing-loss-related auditory perceptual deficits.

Intracranial electrophysiology of spectrally degraded speech in the human cortex

Introduction

Cochlear implants (CIs) are the treatment of choice for severe to profound hearing loss. Variability in CI outcomes remains despite advances in technology and is attributed in part to differences in cortical processing. Studying these differences in CI users is technically challenging. Spectrally degraded stimuli presented to normal-hearing individuals approximate input to the central auditory system in CI users. This study used intracranial electroencephalography (iEEG) to investigate cortical processing of spectrally degraded speech.

Methods

Participants were adult neurosurgical epilepsy patients. Stimuli were utterances /aba/ and /ada/, spectrally degraded using a noise vocoder (1-4 bands) or presented without vocoding. The stimuli were presented in a two-alternative forced choice task. Cortical activity was recorded using depth and subdural iEEG electrodes. Electrode coverage included auditory core in posteromedial Heschl's gyrus (HGPM), superior temporal gyrus (STG), ventral and dorsal auditory-related areas, and prefrontal and sensorimotor cortex. Analysis focused on high gamma (70-150 Hz) power augmentation and alpha (8-14 Hz) suppression.

Results

Chance task performance occurred with 1-2 spectral bands and was near-ceiling for clear stimuli. Performance was variable with 3-4 bands, permitting identification of good and poor performers. There was no relationship between task performance and participants demographic, audiometric, neuropsychological, or clinical profiles. Several response patterns were identified based on magnitude and differences between stimulus conditions. HGPM responded strongly to all stimuli. A preference for clear speech emerged within non-core auditory cortex. Good performers typically had strong responses to all stimuli along the dorsal stream, including posterior STG, supramarginal, and precentral gyrus; a minority of sites in STG and supramarginal gyrus had a preference for vocoded stimuli. In poor performers, responses were typically restricted to clear speech. Alpha suppression was more pronounced in good performers. In contrast, poor performers exhibited a greater involvement of posterior middle temporal gyrus when listening to clear speech.

Discussion

Responses to noise-vocoded speech provide insights into potential factors underlying CI outcome variability. The results emphasize differences in the balance of neural processing along the dorsal and ventral stream between good and poor performers, identify specific cortical regions that may have diagnostic and prognostic utility, and suggest potential targets for neuromodulation-based CI rehabilitation strategies.

Sound localization in noisy contexts: performance, metacognitive evaluations and head movements

Localizing sounds in noisy environments can be challenging. Here, we reproduce real-life soundscapes to investigate the effects of environmental noise on sound localization experience. We evaluated participants' performance and metacognitive assessments, including measures of sound localization effort and confidence, while also tracking their spontaneous head movements. Normal-hearing participants (N = 30) were engaged in a speech-localization task conducted in three common soundscapes that progressively increased in complexity: nature, traffic, and a cocktail party setting. To control visual information and measure behaviors, we used visual virtual reality technology. The results revealed that the complexity of the soundscape had an impact on both performance errors and metacognitive evaluations. Participants reported increased effort and reduced confidence for sound localization in more complex noise environments. On the contrary, the level of soundscape complexity did not influence the use of spontaneous exploratory head-related behaviors. We also observed that, irrespective of the noisy condition, participants who implemented a higher number of head rotations and explored a wider extent of space by rotating their heads made lower localization errors. Interestingly, we found preliminary evidence that an increase in spontaneous head movements, specifically the extent of head rotation, leads to a decrease in perceived effort and an increase in confidence at the single-trial level. These findings expand previous observations regarding sound localization in noisy environments by broadening the perspective to also include metacognitive evaluations, exploratory behaviors and their interactions.

Combining Cardiovascular and Pupil Features Using k-Nearest Neighbor Classifiers to Assess Task Demand, Social Context, and Sentence Accuracy During Listening

In daily life, both acoustic factors and social context can affect listening effort investment. In laboratory settings, information about listening effort has been deduced from pupil and cardiovascular responses independently. The extent to which these measures can jointly predict listening-related factors is unknown. Here we combined pupil and cardiovascular features to predict acoustic and contextual aspects of speech perception. Data were collected from 29 adults (mean  =  64.6 years, SD  =  9.2) with hearing loss. Participants performed a speech perception task at two individualized signal-to-noise ratios (corresponding to 50% and 80% of sentences correct) and in two social contexts (the presence and absence of two observers). Seven features were extracted per trial: baseline pupil size, peak pupil dilation, mean pupil dilation, interbeat interval, blood volume pulse amplitude, pre-ejection period and pulse arrival time. These features were used to train k-nearest neighbor classifiers to predict task demand, social context and sentence accuracy. The k-fold cross validation on the group-level data revealed above-chance classification accuracies: task demand, 64.4%; social context, 78.3%; and sentence accuracy, 55.1%. However, classification accuracies diminished when the classifiers were trained and tested on data from different participants. Individually trained classifiers (one per participant) performed better than group-level classifiers: 71.7% (SD  =  10.2) for task demand, 88.0% (SD  =  7.5) for social context, and 60.0% (SD  =  13.1) for sentence accuracy. We demonstrated that classifiers trained on group-level physiological data to predict aspects of speech perception generalized poorly to novel participants. Individually calibrated classifiers hold more promise for future applications.