Behavioral Measures of Listening Effort in School-Age Children: Examining the Effects of Signal-to-Noise Ratio, Hearing Loss, and Amplification

Parent-Reported Ease of Listening in Preschool-Aged Children With Bilateral and Unilateral Hearing Loss

OBJECTIVES

Evidence from school-aged children suggests that the ease with which children listen varies with the presence of hearing loss and the acoustic environment despite the use of devices like hearing aids. However, little is known about the ease of listening in preschool-aged children with hearing loss-an age at which rapid learning occurs and increased listening difficulty or effort may diminish the required capacity to learn new skills. To this end, the objectives of the present study were to (i) assess parent-reported aided ease of listening as a function of hearing loss configuration (hearing loss in one versus both ears) and device configuration among children with hearing loss in one ear (unilateral hearing loss), and (ii) investigate factors that influence children's ease of listening.

DESIGN

Parents of 83 children with normal hearing, 54 aided children with bilateral hearing loss (hearing loss in both ears), and 139 children with unilateral hearing loss participated in the study. Of the 139 children with unilateral loss, 72 were unaided, 54 were aided with a device on the ear with hearing loss (direct aiding) and 13 were aided with a device that routed signals to the contralateral normal hearing ear (indirect aiding). Mean age of children was 40.2 months (1 SD = 2.5; range: 36 to 51). Parents completed the two subscales of the Parents' Evaluation of Aural/Oral Performance of Children+ (PEACH+) questionnaire, namely functional listening and ease of listening. Individual percent scores were computed for quiet and noisy situations. Linear mixed-effects models were used to assess the effect of hearing loss configuration and device configuration in children with unilateral hearing loss. Multiple regression was used to assess factors that influenced ease of listening. Factors included hearing thresholds, age at first device fit, consistency in device use, condition (quiet/noise), presence of developmental disabilities, and functional listening abilities.

RESULTS

Children with direct aiding for their hearing loss, either unilateral or bilateral, had similarly lower functional listening skills and ease of listening than their normal hearing peers. Unaided children with unilateral hearing loss had lower functional listening skills and ease of listening than their normal hearing peers in noise but not in quiet. All aided children with unilateral hearing loss, irrespective of direct or indirect aiding had lower functional listening skills and ease of listening relative to normal hearing children in both quiet and noise. Furthermore, relative to unaided children with unilateral hearing loss, those with indirect aiding had lower functional listening and ease of listening. Regression analyses revealed functional listening as a significant predictor of ease of listening in all children with hearing loss. In addition, worse degrees of hearing loss and presence of noise reduced ease of listening in unaided children with unilateral hearing loss.

CONCLUSIONS

Bilateral hearing loss is associated with poorer-than-typical ease of listening in preschoolers even when aided. The impact of unilateral hearing loss on ease of listening is similar to that observed in children with bilateral hearing loss, despite good hearing in one ear and aiding. Given increased difficulties experienced by children with unilateral loss, with or without a device, additional strategies to facilitate communication abilities in noise should be a priority.

Listening effort in children and adults in classroom noise

It is well known that hearing in noisy situations is more challenging than in quiet environments. This holds true for adults and especially for children. This study employed a child-appropriate dual-task paradigm to investigate listening effort in children aged six to ten years and young adults. The primary task involved word recognition, while the secondary task evaluated digit recall. Additionally, subjective perception of listening effort was assessed using a child-appropriate questionnaire. This study incorporated plausible sound reproduction and examined classroom scenarios including multi-talker babble noise with two signal-to-noise ratios (0 dB and -3 dB) in an anechoic and an acoustically simulated classroom environment. Forty-four primary school children aged six to ten (17 first- to second-graders and 18 third- to fourth-graders) and 25 young adults participated in this study. The results revealed differences in listening effort between the noise conditions in third- to fourth-graders and supported using the dual-task paradigm for that age group. For all three age groups, a greater subjective perception of listening effort in noise was found. Furthermore, a correlation between the subjective perception of listening effort and behavioural listening effort based on the experimental results was found for third- to fourth-graders and adults.

Empatica E4 Assessment of Child Physiological Measures of Listening Effort During Remote and In-Person Communication

PURPOSE

Telepractice is a growing service model that delivers aural rehabilitation to deaf and hard-of hearing children via telecommunications technology. Despite known benefits of telepractice, this delivery approach may increase patients' listening effort (LE) characterized as an allocation of cognitive resources toward an auditory task. The study tested techniques for collecting physiological measures of LE in normal-hearing (NH) children during remote (referred to as tele-) and in-person communication using the wearable Empatica E4 wristband.

METHOD

Participants were 10 children (age range: 9-12 years old) who came to two tele- and two in-person weekly sessions, order counterbalanced. During each session, the children heard a short passage read by the clinical provider, completed an auditory passage comprehension task, and self-rated their effort as a part of the larger study. Measures of electrodermal activity and blood volume pulse amplitude were collected from the child E4 wristband.

RESULTS

No differences in child subjective, physiological measures of LE or passage comprehension scores were found between in-person sessions and telesessions. However, an effect of treatment duration on subjective and physiological measures of LE was identified. Children self-reported a significant increase in LE over time. However, their physiological measures demonstrated a trend indicating a decrease in LE. A significant association between subjective measures and the passage comprehension task was found suggesting that those children who reported more effort demonstrated a higher proportion of correct responses.

CONCLUSIONS

The study demonstrated the feasibility of collection of physiological measures of LE in NH children during remote and in-person communication using the E4 wristband. The results suggest that measures of LE are multidimensional and may reflect different sources of, or cognitive responses to, increased listening demand.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.27122064.

Cross-Cultural Adaptation and Validation of the Listening Inventory for Education-Revised in Italian

BACKGROUND

Listening difficulties may frequently occur in school settings, but so far there were no tools to identify them for both hearing and hearing-impaired Italian students. This study performed cross-cultural adaptation and validation of the Listening Inventory for Education-Revised for Italian students (LIFE-R-ITA).

METHODS

The study procedure followed the stages suggested by the Guidelines for the Process of Cross-cultural Adaptation of Self-Report Measures. For the content validation, six cochlear implanted students (8-18 years old) pre-tested the initial version. Whenever any situation did not occur in Italy, the item was adapted to more typical listening situations in Italy. The final version of LIFE-R-ITA was administered to a sample of 223 hearing students from different school settings and educational degrees in order to collect normative data.

RESULTS

For the LIFE-R-ITA, hearing students showed an average score of 72.26% (SD = 11.93), reflecting some listening difficulties. The subscales (LIFE total, LIFE class, and LIFE social) indicated good internal consistency. All items were shown to be relevant. Most challenging situations happened when listening in large rooms, especially when other students made noise. LIFE social scores were significantly worse than those of LIFE class (p < 0.001).

CONCLUSIONS

The present study provides cross-cultural adaptation and validation for the LIFE-R-ITA along with the normative data useful to interpret the results of students with hearing loss. The LIFE-R-ITA may support teachers and clinicians in assessing students' self-perception of listening at school. Such understanding may help students overcome their listening difficulties, by planning and selecting the most effective strategies among classroom interventions.

Predictors of Listening-Related Fatigue in Adolescents With Hearing Loss

PURPOSE

Self-reported listening-related fatigue in adolescents with hearing loss (HL) was investigated. Specifically, the extent to which listening-related fatigue is associated with school accommodations, audiologic characteristics, and listening breaks was examined.

METHOD

Participants were 144 adolescents with HL ages 12-19 years. Data were collected online via Qualtrics. The Vanderbilt Fatigue Scale-Child was used to measure listening-related fatigue. Participants also reported on their use of listening breaks and school accommodations, including an Individualized Education Program (IEP) or 504 plan, remote microphone systems, closed captioning, preferential seating, sign language interpreters, live transcriptions, and notetakers.

RESULTS

After controlling for age, HL laterality, and self-perceived listening difficulty, adolescents with an IEP or a 504 plan reported lower listening-related fatigue compared to adolescents without an IEP or a 504 plan. Adolescents who more frequently used remote microphone systems or notetakers reported higher listening-related fatigue compared to adolescents who used these accommodations less frequently, whereas increased use of a sign language interpreter was associated with decreased listening-related fatigue. Among adolescents with unilateral HL, higher age was associated with lower listening-related fatigue; no effect of age was found among adolescents with bilateral HL. Listening-related fatigue did not differ based on hearing device configuration.

CONCLUSIONS

Adolescents with HL should be considered at risk for listening-related fatigue regardless of the type of hearing devices used or the degree of HL. The individualized support provided by an IEP or 504 plan may help alleviate listening-related fatigue, especially by empowering adolescents with HL to be self-advocates in terms of their listening needs and accommodations in school. Additional research is needed to better understand the role of specific school accommodations and listening breaks in addressing listening-related fatigue.

The Classroom Communication and Collaboration Appraisal: A Comprehensive Tool for Assessing Communication and Collaboration in Classroom Environments

PURPOSE

The aim of this research note is to introduce a new appraisal form, the Classroom Communication and Collaboration (C3) Appraisal, designed to evaluate communication and collaboration within classroom settings.

METHOD

A comprehensive synthesis of the key skills from a broad range of publications on successful communication and collaboration in the classroom was conducted. The resulting appraisal comprises 39 items across six scales: crafting clear messages, appropriateness of communication exchange, active listening, pragmatics and discourse, communication breakdown, and collaboration. To demonstrate its application, an exemplar usage of the C3 Appraisal involving a hearing child and a child with hearing loss engaged in a collaborative learning task is presented.

RESULTS

The C3 Appraisal allowed for the quality and successfulness of the collaborative learning task between the two children to be assessed and quantified across the six scales.

CONCLUSIONS

These findings highlight the utility of the C3 Appraisal as a valuable tool for evaluating communication and collaboration in classroom environments. Next steps are to test the reliability and validity of the C3 Appraisal on a large data set.

Differences in Hearing Devices and Speech Therapy Utilization Between Children With Permanent Unilateral Versus Bilateral Hearing Loss

OBJECTIVES

In this study, we aimed to describe differences in diagnosis and both auditory and speech/language intervention utilization between children with permanent unilateral hearing loss as compared with bilateral hearing loss.

DESIGN

A retrospective cohort study was performed of children evaluated in a multidisciplinary hearing loss clinic at a tertiary care pediatric hospital. Children aged 0 to 18 years with either permanent unilateral or bilateral hearing loss were included.

RESULTS

One hundred fourteen children with unilateral hearing loss and 268 children with bilateral hearing loss were studied for a total of 382 children. There were no demographic differences between children with permanent unilateral versus bilateral hearing loss. Rates of newborn hearing screening and referred screening results were similar between those with unilateral and bilateral hearing loss. Despite similar rates of referred newborn hearing screening, those with bilateral hearing loss were diagnosed at a younger age (mean 3.6 years, SD 3.8 years) as compared with those with unilateral hearing loss (mean 5.0 years, SD 4.2 years). Children with unilateral hearing loss had similar severity of hearing loss in their poorer hearing ear as compared with children with bilateral hearing loss, yet they were significantly less likely to be fitted with hearing devices (53% versus 78%) or receive speech/language therapy (36% versus 54%) as compared with children with bilateral hearing loss. Multivariate analysis found that bilateral hearing loss and earlier age of hearing loss diagnosis were associated with hearing device use.

CONCLUSIONS

Early diagnosis and intervention for childhood hearing loss have a significant impact on a child's educational success and social relationships. However, little is known about differences in diagnosis and resource utilization between children with permanent unilateral hearing loss versus bilateral hearing loss. Children with unilateral hearing loss were diagnosed at a later age and were less likely to utilize hearing devices or speech/language therapy compared with those with bilateral hearing loss, despite having similar severity of hearing loss in the poorer hearing ear. There is a strong body of evidence that children with unilateral hearing loss have improved hearing outcomes with hearing devices, which suggests there is room for improvement in identifying unilateral hearing loss and providing adequate services to optimize educational success. However, speech therapy is generally implemented in response to language delays. Therefore, children with unilateral loss may have lower rates of language delays as compared with those with bilateral hearing loss, thereby explaining differences in speech therapy utilization.

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.

Spatial hearing training in virtual reality with simulated asymmetric hearing loss

Sound localization is essential to perceive the surrounding world and to interact with objects. This ability can be learned across time, and multisensory and motor cues play a crucial role in the learning process. A recent study demonstrated that when training localization skills, reaching to the sound source to determine its position reduced localization errors faster and to a greater extent as compared to just naming sources' positions, despite the fact that in both tasks, participants received the same feedback about the correct position of sound sources in case of wrong response. However, it remains to establish which features have made reaching to sound more effective as compared to naming. In the present study, we introduced a further condition in which the hand is the effector providing the response, but without it reaching toward the space occupied by the target source: the pointing condition. We tested three groups of participants (naming, pointing, and reaching groups) each while performing a sound localization task in normal and altered listening situations (i.e. mild-moderate unilateral hearing loss) simulated through auditory virtual reality technology. The experiment comprised four blocks: during the first and the last block, participants were tested in normal listening condition, while during the second and the third in altered listening condition. We measured their performance, their subjective judgments (e.g. effort), and their head-related behavior (through kinematic tracking). First, people's performance decreased when exposed to asymmetrical mild-moderate hearing impairment, more specifically on the ipsilateral side and for the pointing group. Second, we documented that all groups decreased their localization errors across altered listening blocks, but the extent of this reduction was higher for reaching and pointing as compared to the naming group. Crucially, the reaching group leads to a greater error reduction for the side where the listening alteration was applied. Furthermore, we documented that, across blocks, reaching and pointing groups increased the implementation of head motor behavior during the task (i.e., they increased approaching head movements toward the space of the sound) more than naming. Third, while performance in the unaltered blocks (first and last) was comparable, only the reaching group continued to exhibit a head behavior similar to those developed during the altered blocks (second and third), corroborating the previous observed relationship between the reaching to sounds task and head movements. In conclusion, this study further demonstrated the effectiveness of reaching to sounds as compared to pointing and naming in the learning processes. This effect could be related both to the process of implementing goal-directed motor actions and to the role of reaching actions in fostering the implementation of head-related motor 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.

Automated Measurement of Speech Recognition, Reaction Time, and Speech Rate and Their Relation to Self-Reported Listening Effort for Normal-Hearing and Hearing-Impaired Listeners Using various Maskers

In speech audiometry, the speech-recognition threshold (SRT) is usually established by adjusting the signal-to-noise ratio (SNR) until 50% of the words or sentences are repeated correctly. However, these conditions are rarely encountered in everyday situations. Therefore, for a group of 15 young participants with normal hearing and a group of 12 older participants with hearing impairment, speech-recognition scores were determined at SRT and at four higher SNRs using several stationary and fluctuating maskers. Participants' verbal responses were recorded, and participants were asked to self-report their listening effort on a categorical scale (self-reported listening effort, SR-LE). The responses were analyzed using an Automatic Speech Recognizer (ASR) and compared to the results of a human examiner. An intraclass correlation coefficient of r = .993 for the agreement between their corresponding speech-recognition scores was observed. As expected, speech-recognition scores increased with increasing SNR and decreased with increasing SR-LE. However, differences between speech-recognition scores for fluctuating and stationary maskers were observed as a function of SNR, but not as a function of SR-LE. The verbal response time (VRT) and the response speech rate (RSR) of the listeners' responses were measured using an ASR. The participants with hearing impairment showed significantly lower RSRs and higher VRTs compared to the participants with normal hearing. These differences may be attributed to differences in age, hearing, or both. With increasing SR-LE, VRT increased and RSR decreased. The results show the possibility of deriving a behavioral measure, VRT, measured directly from participants' verbal responses during speech audiometry, as a proxy for SR-LE.

A Comparison of Listening Skills of Autistic and Non-Autistic Youth While Using and Not Using Remote Microphone Systems

OBJECTIVES

The purposes of this study were to compare (a) listening-in-noise (accuracy and effort) and (b) remote microphone (RM) system benefits between autistic and non-autistic youth.

DESIGN

Groups of autistic and non-autistic youth that were matched on chronological age and biological sex completed listening-in-noise testing when wearing and not wearing an RM system. Listening-in-noise accuracy and listening effort were evaluated simultaneously using a dual-task paradigm for stimuli varying in type (syllables, words, sentences, and passages). Several putative moderators of RM system effects on outcomes of interest were also evaluated.

RESULTS

Autistic youth outperformed non-autistic youth in some conditions on listening-in-noise accuracy; listening effort between the two groups was not significantly different. RM system use resulted in listening-in-noise accuracy improvements that were nonsignificantly different across groups. Benefits of listening-in-noise accuracy were all large in magnitude. RM system use did not have an effect on listening effort for either group. None of the putative moderators yielded effects of the RM system on listening-in-noise accuracy or effort for non-autistic youth that were significant and interpretable, indicating that RM system benefits did not vary according to any of the participant characteristics assessed.

CONCLUSIONS

Contrary to expectations, autistic youth did not demonstrate listening-in-noise deficits compared to non-autistic youth. Both autistic and non-autistic youth appear to experience RM system benefits marked by large gains in listening-in-noise performance. Thus, the use of this technology in educational and other noisy settings where speech perception needs enhancement might be beneficial for both groups of children.

Effect of Auditory Distractors on Speech Recognition and Listening Effort

OBJECTIVES

Everyday listening environments are filled with competing noise and distractors. Although significant research has examined the effect of competing noise on speech recognition and listening effort, little is understood about the effect of distraction. The framework for understanding effortful listening recognizes the importance of attention-related processes in speech recognition and listening effort; however, it underspecifies the role that they play, particularly with respect to distraction. The load theory of attention predicts that resources will be automatically allocated to processing a distractor, but only if perceptual load in the listening task is low enough. If perceptual load is high (i.e., listening in noise), then resources that would otherwise be allocated to processing a distractor are used to overcome the increased perceptual load and are unavailable for distractor processing. Although there is ample evidence for this theory in the visual domain, there has been little research investigating how the load theory of attention may apply to speech processing. In this study, we sought to measure the effect of distractors on speech recognition and listening effort and to evaluate whether the load theory of attention can be used to understand a listener's resource allocation in the presence of distractors.

DESIGN

Fifteen adult listeners participated in a monosyllabic words repetition task. Test stimuli were presented in quiet or in competing speech (+5 dB signal-to-noise ratio) and in distractor or no distractor conditions. In conditions with distractors, auditory distractors were presented before the target words on 24% of the trials in quiet and in noise. Percent-correct was recorded as speech recognition, and verbal response time (VRT) was recorded as a measure of listening effort.

RESULTS

A significant interaction was present for speech recognition, showing reduced speech recognition when distractors were presented in the quiet condition but no effect of distractors when noise was present. VRTs were significantly longer when distractors were present, regardless of listening condition.

CONCLUSIONS

Consistent with the load theory of attention, distractors significantly reduced speech recognition in the low-perceptual load condition (i.e., listening in quiet) but did not impact speech recognition scores in conditions of high perceptual load (i.e., listening in noise). The increases in VRTs in the presence of distractors in both low- and high-perceptual load conditions (i.e., quiet and noise) suggest that the load theory of attention may not apply to listening effort. However, the large effect of distractors on VRT in both conditions is consistent with the previous work demonstrating that distraction-related shifts of attention can delay processing of the target task. These findings also fit within the framework for understanding effortful listening, which proposes that involuntary attentional shifts result in a depletion of cognitive resources, leaving less resources readily available to process the signal of interest; resulting in increased listening effort (i.e., elongated VRT).

Speech recognition in noise task among children and young-adults: a pupillometry study

Introduction

Children experience unique challenges when listening to speech in noisy environments. The present study used pupillometry, an established method for quantifying listening and cognitive effort, to detect temporal changes in pupil dilation during a speech-recognition-in-noise task among school-aged children and young adults.

Methods

Thirty school-aged children and 31 young adults listened to sentences amidst four-talker babble noise in two signal-to-noise ratios (SNR) conditions: high accuracy condition (+10 dB and  + 6 dB, for children and adults, respectively) and low accuracy condition (+5 dB and + 2 dB, for children and adults, respectively). They were asked to repeat the sentences while pupil size was measured continuously during the task.

Results

During the auditory processing phase, both groups displayed pupil dilation; however, adults exhibited greater dilation than children, particularly in the low accuracy condition. In the second phase (retention), only children demonstrated increased pupil dilation, whereas adults consistently exhibited a decrease in pupil size. Additionally, the children's group showed increased pupil dilation during the response phase.

Discussion

Although adults and school-aged children produce similar behavioural scores, group differences in dilation patterns point that their underlying auditory processing differs. A second peak of pupil dilation among the children suggests that their cognitive effort during speech recognition in noise lasts longer than in adults, continuing past the first auditory processing peak dilation. These findings support effortful listening among children and highlight the need to identify and alleviate listening difficulties in school-aged children, to provide proper intervention strategies.

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

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

The effect of telepractice on vocal turn-taking between a provider, children with cochlear implants, and caregivers: A preliminary report

OBJECTIVES

To examine the effect of telepractice on vocal turn-taking between one clinical provider and children with cochlear implants and their caregivers during child-centered auditory rehabilitation intervention.

METHODS

Seven dyads of children with cochlear implants (mean age 4:11 years) and their hearing mothers and one speech-language pathologist participated together in a telepractice session and an in-person intervention session. Dependent variables were vocalization rate, turn taking rate, rate of speech overlap per second, and between-speaker pause duration.

RESULTS

The speech-language pathologist and children had lower rates of vocalization in the telepractice session than the in-person session. However, maternal vocalization rate was higher in the telepractice than in-person session. The rate of turn-taking between the provider and children was lower in telepractice than in-person sessions but the rate of turn taking between mothers and children was higher in telepractice than in-person sessions. Between-speaker pause duration between children and the provider and between mothers and children was longer in telepractice than in-person sessions. Rate of speech overlap did not vary significantly by session type.

DISCUSSION

The quantity and temporal characteristics of vocal turn-taking were impacted by remote communication during tele-intervention suggesting a potential increase in the cognitive effort required of participants.

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

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

Exploring listening-related fatigue in children with and without hearing loss using self-report and parent-proxy measures

Children with hearing loss appear to experience greater fatigue than children with normal hearing (CNH). Listening-related fatigue is often associated with an increase in effortful listening or difficulty in listening situations. This has been observed in children with bilateral hearing loss (CBHL) and, more recently, in children with unilateral hearing loss (CUHL). Available tools for measuring fatigue in children include general fatigue questionnaires such as the child self-report and parent-proxy versions of the PedsQLTM-Multidimensional Fatigue Scale (MFS) and the PROMIS Fatigue Scale. Recently, the Vanderbilt Fatigue Scale (VFS-C: child self-report; VFS-P: parent-proxy report) was introduced with a specific focus on listening-related fatigue. The aims of this study were to compare fatigue levels experienced by CNH, CUHL and CBHL using both generic and listening-specific fatigue measures and compare outcomes from the child self-report and parent-proxy reports. Eighty children aged 6-16 years (32 CNH, 19 CUHL, 29 CBHL), and ninety-nine parents/guardians (39 parents to CNH, 23 parents to CUHL, 37 parents to CBHL), completed the above fatigue questionnaires online. Kruskal-Wallis H tests were performed to compare fatigue levels between the CNH, CUHL and CBHL. To determine the agreement between parent-proxy and child self-report measures, Bland-Altman 95% limits of agreement were performed. All child self-report fatigue measures indicated that CBHL experience greater fatigue than CNH. Only the listening-specific tool (VFS-C) was sufficiently able to show greater fatigue in CUHL than in CNH. Similarly, all parent-proxy measures of fatigue indicated that CBHL experience significantly greater fatigue than CNH. The VFS-P and the PROMIS Fatigue Parent-Proxy also showed greater fatigue in CUHL than in CNH. Agreement between the parent-proxy and child self-report measures were found within the PedsQL-MFS and the PROMIS Fatigue Scale. Our results suggest that CBHL experience greater levels of daily-life fatigue compared to CNH. CUHL also appear to experience more fatigue than CNH, and listening-specific measures of fatigue may be better able to detect this effect. Further research is needed to understand the bases of fatigue in these populations and to clarify whether fatigue experienced by CBHL and CUHL is comparable in nature and degree.

Children with hearing loss can use subject-verb agreement to predict during spoken language processing

Rapid processing of spoken language is aided by the ability to predict upcoming words using both semantic and syntactic cues. However, although children with hearing loss (HL) can predict upcoming words using semantic associations, little is known about their ability to predict using syntactic dependencies such as subject-verb (SV) agreement. This study examined whether school-aged children with hearing aids and/or cochlear implants can use SV agreement to predict upcoming nouns when processing spoken language. Although they did demonstrate prediction with plural SV agreement, they did so more slowly than their normal hearing (NH) peers. This may be due to weaker grammatical representations given that function words and grammatical inflections typically have lower perceptual salience. Thus, a better understanding of morphosyntactic representations in children with HL, and their ability to use these for prediction, sheds much-needed light on the online language processing challenges and abilities of this population.

Speech Understanding in Complex Environments by School-Age Children with Mild Bilateral or Unilateral Hearing Loss

Numerous studies have shown that children with mild bilateral (MBHL) or unilateral hearing loss (UHL) experience speech perception difficulties in poor acoustics. Much of the research in this area has been conducted via laboratory studies using speech-recognition tasks with a single talker and presentation via earphones and/or from a loudspeaker located directly in front of the listener. Real-world speech understanding is more complex, however, and these children may need to exert greater effort than their peers with normal hearing to understand speech, potentially impacting progress in a number of developmental areas. This article discusses issues and research relative to speech understanding in complex environments for children with MBHL or UHL and implications for real-world listening and understanding.

Subjective Fatigue in Children With Unaided and Aided Unilateral Hearing Loss

OBJECTIVES

Fatigue is frequently observed in children with chronic diseases and can affect the quality of life (QoL). However, research in children with unilateral hearing loss (UHL) is scarce. Subsequently, no studies investigated the effects of hearing aids on fatigue in children. This study investigates subjective fatigue and hearing-related QoL in children with UHL. Furthermore, it evaluates the influence of hearing aids, subject-specific factors, and respondent-type on subjective fatigue.

STUDY DESIGN

A cross-sectional study was conducted from June 2020 until September 2020 at the department of otorhinolaryngology in a tertiary referral center.

METHODS

The primary outcome was the difference in subjective fatigue and hearing-related QoL between children with unaided UHL, aided UHL, and normal hearing. Subjective fatigue and hearing-related QoL were measured using the Pediatric Quality of Life Inventory™ Multidimensional Fatigue Scale (PedsQL™-MFS) and Hearing Environments and Reflection on Quality of Life (HEAR-QL™) questionnaires.

RESULTS

Along with 36 aided children with UHL, 34 unaided and 36 normal-hearing children were included. Child reports revealed significantly more cognitive fatigue in children with aided UHL than children with normal hearing (median difference 12.5, P = .013). Parents reported more fatigue in children with UHL compared to normal-hearing siblings. Especially children with aided UHL seemed at increased risk for fatigue. Children with UHL scored lower on hearing-related QoL than children with normal hearing. No apparent differences were found in fatigue and QoL between children with unaided and aided UHL.

CONCLUSION

Children with unaided and even aided UHL seem to experience more subjective fatigue and lower hearing-related QoL than children with normal hearing. Prospective longitudinal studies are required to investigate the influence of hearing aids on fatigue and QoL in individual patients.

LEVEL OF EVIDENCE

3 Laryngoscope, 2021 Laryngoscope, 133:189-198, 2023.

Self-reported listening effort in adults with and without hearing loss: the Danish version of the Effort Assessment Scale (D-EAS)

PURPOSE

Hearing-impaired individuals experience higher levels of listening effort in challenging situations, affecting their communication in daily life. The purpose of this study was to linguistically and culturally adapt the Effort Assessment Scale (EAS) into Danish (D-EAS) and to investigate its reliability and validity in normal-hearing and hearing-impaired listeners.

METHODS

The translation and cross-cultural adaptation of the EAS aligns with recommendations to adapt hearing-related questionnaires for different languages and cultures. Participants were 157 listeners (85 females) aged 20-86 years (M_age = 62.5, SD = 16.8), with (non-hearing aid and hearing aid users) and without hearing loss.

RESULTS

Reliability analysis showed good internal consistency for the six items in the D-EAS (Cronbach's α= 0.93). Exploratory and confirmatory factor analyses showed that D-EAS is a one-dimensional instrument. Significant differences were observed across items and overall scores between normal hearing (NH) and hearing loss groups.

CONCLUSIONS

The D-EAS reliably estimates self-perception of listening effort in adults with and without hearing loss and is sensitive to the impact of hearing loss. Thus, the D-EAS can provide hearing care professionals and hearing researchers with valuable insights into people's self-perception of listening effort to help guide clinical and other rehabilitation decisions.Implications for RehabilitationThe Effort Assessment Scale (EAS) into Danish (D-EAS) is a reliable tool to estimate self-perception of listening effort in hearing-impaired adults.The D-EAS could be a helpful tool providing insights about aspects of hearing disability that is not commonly addressed with the traditional hearing assessments.The D-EAS can be incorporated in the hearing rehabilitation process as a tool for evaluating self-perception of listening effort in daily life situations.The D-EAS is easy to administer and requires a short time to answer, allowing its use by clinicians and hearing researchers in different settings.

Effects of Critical Distance and Reverberation on Listening Effort in Adults

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Adaptive Hearing Aid Benefit in Children With Mild/Moderate Hearing Loss: A Registered, Double-Blind, Randomized Clinical Trial

OBJECTIVES

We completed a registered double-blind randomized control trial to compare acclimatization to two hearing aid fitting algorithms by experienced pediatric hearing aid users with mild to moderate hearing loss. We hypothesized that extended use (up to 13 months) of an adaptive algorithm with integrated directionality and noise reduction, OpenSound Navigator (OSN), would result in improved performance on auditory, cognitive, academic, and caregiver- or self-report measures compared with a control, omnidirectional algorithm (OMNI).

DESIGN

Forty children aged 6 to 13 years with mild to moderate/severe symmetric sensorineural hearing loss completed this study. They were all experienced hearing aid users and were recruited through the Cincinnati Children's Hospital Medical Center Division of Audiology. The children were divided into 20 pairs based on similarity of age (within 1 year) and hearing loss (level and configuration). Individuals from each pair were randomly assigned to either an OSN (experimental) or OMNI (control) fitting algorithm group. Each child completed an audiology evaluation, hearing aid fitting using physically identical Oticon OPN hearing aids, follow-up audiological appointment, and 2 research visits up to 13 months apart. Research visit outcome measures covered speech perception (in quiet and in noise), novel grammar and word learning, cognition, academic ability, and caregiver report of listening behaviors. Analysis of outcome differences between visits, groups, ages, conditions and their interactions used linear mixed models. Between 22 and 39 children provided useable data for each task.

RESULTS

Children using the experimental (OSN) algorithm did not show any significant performance differences on the outcome measures compared with those using the control (OMNI) algorithm. Overall performance of all children in the study increased across the duration of the trial on word repetition in noise, sentence repetition in quiet, and caregivers' assessment of hearing ability. There was a significant negative relationship between age at first hearing aid use, final Reading and Mathematical ability, and caregiver rated speech hearing. A significant positive relationship was found between daily hearing aid use and study-long change in performance on the Flanker test of inhibitory control and attention. Logged daily use of hearing aids related to caregiver rated spatial hearing. All results controlled for age at testing/evaluation and false discovery rate.

CONCLUSIONS

Use of the experimental (OSN) algorithm neither enhanced nor reduced performance on auditory, cognitive, academic or caregiver report measures compared with the control (OMNI) algorithm. However, prolonged hearing aid use led to benefits in hearing, academic skills, attention, and caregiver evaluation.

Development and Evaluation of Pediatric Versions of the Vanderbilt Fatigue Scale for Children With Hearing Loss

PURPOSE

Growing evidence suggests that fatigue associated with listening difficulties is particularly problematic for children with hearing loss (CHL). However, sensitive, reliable, and valid measures of listening-related fatigue do not exist. To address this gap, this article describes the development, psychometric evaluation, and preliminary validation of a suite of scales designed to assess listening-related fatigue in CHL: the pediatric versions of the Vanderbilt Fatigue Scale (VFS-Peds).

METHOD

Test development employed best practices, including operationalizing the construct of listening-related fatigue from the perspective of target respondents (i.e., children, their parents, and teachers). Test items were developed based on input from these groups. Dimensionality was evaluated using exploratory factor analyses (EFAs). Item response theory (IRT) and differential item functioning (DIF) analyses were used to identify high-quality items, which were further evaluated and refined to create the final versions of the VFS-Peds.

RESULTS

The VFS-Peds is appropriate for use with children aged 6-17 years and consists of child self-report (VFS-C), parent proxy-report (VFS-P), and teacher proxy-report (VFS-T) scales. EFA of child self-report and teacher proxy data suggested that listening-related fatigue was unidimensional in nature. In contrast, parent data suggested a multidimensional construct, composed of mental (cognitive, social, and emotional) and physical domains. IRT analyses suggested that items were of good quality, with high information and good discriminability. DIF analyses revealed the scales provided a comparable measure of fatigue regardless of the child's gender, age, or hearing status. Test information was acceptable over a wide range of fatigue severities and all scales yielded acceptable reliability and validity.

CONCLUSIONS

This article describes the development, psychometric evaluation, and validation of the VFS-Peds. Results suggest that the VFS-Peds provide a sensitive, reliable, and valid measure of listening-related fatigue in children that may be appropriate for clinical use. Such scales could be used to identify those children most affected by listening-related fatigue, and given their apparent sensitivity, the scales may also be useful for examining the effectiveness of potential interventions targeting listening-related fatigue in children.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19836154.

Listening Effort in Hearing Aid Users: Is It Related to Hearing Aid Use and Satisfaction?

BACKGROUND

 Listening effort is primarily reflective of real-world performance. Therefore, it is crucial to evaluate the listening effort to predict the performance of hearing aid (HA) users in their daily lives.

PURPOSE

 This study aimed to investigate the relationship between listening effort, daily HA use time, and HA satisfaction.

RESEARCH DESIGN

 This is a cross-sectional study.

STUDY SAMPLE

 Thirty-three bilateral behind-the-ear HA users (17 females and 16 males) between 19 and 37 years were participated. All participants had bilateral, symmetric, moderate sensorineural hearing loss and at least 6 months of experience using HAs. The pure-tone average thresholds (PTA) of the participants' left and right ears were 55.34 ± 4.38 and 54.85 ± 5.05, respectively.

DATA COLLECTION AND ANALYSIS

 First, daily HA use times of the last 30 days were derived from data logging. Second, participants were asked to fill in the Satisfaction with Amplification in Daily Life Scale questionnaire (SADL). Lastly, participants performed the dual-task paradigm to evaluate listening effort. The dual-task paradigm consisted of a primary speech recognition task that included three different individualized signal-to-noise ratio (SNR) conditions, that is, SNR100, SNR80, and SNR50, which the participant could understand 100, 80, and 50% of the speech, respectively. The secondary task was a visual reaction time task that required participants to press the key in response to a visual probe (an image of a white or red rectangle). Multiple linear regression analyses were used to model the effect of factors (daily HA use time and HA satisfaction) on reaction times (RT) of each three individualized SNR sessions.

RESULTS

 Mean daily HA use time of the participants was 5.72 ± 4.14 hours. Mean RTs of SNR50, SNR80, and SNR100 conditions were 1,050.61 ± 286.49, 893.33 ± 274.79, and 815.45 ± 233.22 ms, respectively. Multiple linear regression analyses showed that daily HA use time and HA satisfaction are significantly related to listening effort in all SNR conditions. For SNR80 condition; F (2,30) = 47.699, p < 0.001, with an adjusted R 2 of 0.745.

CONCLUSION

 As far as we know, this study is the first to demonstrate a strong link between listening effort, daily HA use time, and HA satisfaction. Evaluating listening effort following the HA fitting session may provide preliminary information about the treatment success of HA.

The Effects of Virtual Assessment on Capturing Skill Growth in Children With Hearing Loss

PURPOSE

The purpose of this study is to evaluate the effects of switching from in-person assessment to virtual assessment during the COVID-19 pandemic on the growth trajectories of children with hearing loss who are learning spoken language.

METHOD

Sixty-eight children with typical hearing, 44 children with cochlear implants, and 47 children with hearing aids were assessed with a norm-referenced measure of receptive vocabulary, a criterion-referenced measure of phonological awareness, and a criterion-referenced measure of conceptual print knowledge at least 4 times, at 6-month intervals, between the ages of 4 and 6 years. Of those participants, 26 children with typical hearing, 13 children with cochlear implants, and 13 children with hearing aids entered virtual testing as a result of the COVID-19 pandemic. The slopes of growth for children who entered virtual testing were compared to their own slopes prepandemic and to the growth slopes of children who completed all testing in-person, prepandemic.

RESULTS

Within-subject comparisons across all measures did not show a change in growth slopes prepandemic to postpandemic. For the measure of conceptual print knowledge, children who were tested during the pandemic showed slower overall growth than children who were tested prepandemic. No effects of hearing status were found across growth on any measure.

CONCLUSION

These preliminary data support the use of virtual assessment to measure growth in receptive vocabulary, phonological awareness, and conceptual print knowledge in children with hearing loss learning spoken language.

Are children with unilateral hearing loss more tired?

OBJECTIVE

To determine whether children with unilateral sensorineural hearing loss (USNHL) and unilateral conductive hearing loss (UCHL) have higher levels of fatigue than literature reported normal hearing (LRNH) children.

METHODS

This was a cross-sectional survey utilizing the PedsQL™ Multidimensional Fatigue Scale administered to children with unilateral hearing loss (UHL) and their parents at two tertiary care academic medical centers and a nationwide microtia/atresia conference. The PedsQL™ Multidimensional Fatigue Scale was used to compare child and parental proxy reports of fatigue among USNHL, UCHL, and LRNH children. ANOVA and post-hoc Tukey Honest Significant Difference testing were used for statistical analysis.

RESULTS

Of 69 children included in the study, 42 had UCHL (61%) and 27 (39%) had USNHL. Children with USNHL reported more total fatigue (mean 69.1, SD 19.3) than LRNH children (mean 80.5, SD 13.3; difference -11.4; 95% CI: -19.98 to -2.84) and children with UCHL (mean 78.0, SD 14.5; difference -8.95; 95% CI: -17.86 to 0.04). Children with UCHL reported similar levels of fatigue compared to LRNH children (difference -2.5; 95% CI: -9.95 to 5.03). Parents of children with USNHL reported greater levels of fatigue (mean 67.6, SD 22.6) in their children than parents of LRNH children (mean 89.6, SD 11.4; difference -22.0; 95% CI: -29.8 to -14.3) and parents of children with UCHL (mean 76.2, SD 17.3; difference -8.6; 95% CI: -17.5 to 0.21). Parents of children with UCHL also report higher levels of fatigue than parents of LRNH children (difference -13.4; 95% CI: -19.98 to -6.84).

CONCLUSIONS

Children with USNHL reported greater levels of fatigue than LRNH children and children with UCHL. Results implicate cognitive load as an important consideration in children with hearing loss. The measurement of fatigue may be a useful indicator to determine the benefit of intervention (e.g., amplification) for these children.

Clinical utility of response time in speech audiometry in elderly with mild cognitive impairment

OBJECTIVES

This study investigated whether verbal response time (RT) as a measure of listening effort in speech audiometry could be an indicator for identifying elderly individuals with mild cognitive impairment (MCI).

DESIGN

Korean sentence recognition tests were conducted in favourable (+5 dB signal-to-noise ratio [SNR]) and adverse (-5 dB SNR) conditions in the presence of noise. Sentence recognition scores (SRSs) and RTs for the two groups were measured and analysed with other demographic variables.

STUDY SAMPLES

Fourteen elderly adults who were diagnosed with MCI and 14 age-matched adults with normal cognition participated in this study.

RESULTS

No statistical difference was found between the SRSs of the two groups. RTs for the MCI elderly were significantly longer than the control group. We found significant correlations of RTs with SRSs, Korean Mini-Mental State Examination (K-MMSE) scores, and age at -5 dB SNR. Only the SRSs were correlated with the RTs at +5 dB SNR.

CONCLUSIONS

This study found that elderly individuals with MCI need a longer time for sentence recognition in noise. These findings suggest that measuring RT in speech audiometry could potentially be a cost-effective and time-saving method that could characterise elderly with MCI at hearing-care clinics.

Age and Hearing Ability Influence Selective Attention During Childhood

OBJECTIVES

The purpose of the present study was to determine whether age and hearing ability influence selective attention during childhood. Specifically, we hypothesized that immaturity and disrupted auditory experience impede selective attention during childhood.

DESIGN

Seventy-seven school-age children (5 to 12 years of age) participated in this study: 61 children with normal hearing and 16 children with bilateral hearing loss who use hearing aids and/or cochlear implants. Children performed selective attention-based behavioral change detection tasks comprised of target and distractor streams in the auditory and visual modalities. In the auditory modality, children were presented with two streams of single-syllable words spoken by a male and female talker. In the visual modality, children were presented with two streams of grayscale images. In each task, children were instructed to selectively attend to the target stream, inhibit attention to the distractor stream, and press a key as quickly as possible when they detected a frequency (auditory modality) or color (visual modality) deviant stimulus in the target, but not distractor, stream. Performance on the auditory and visual change detection tasks was quantified by response sensitivity, which reflects children's ability to selectively attend to deviants in the target stream and inhibit attention to those in the distractor stream. Children also completed a standardized measure of attention and inhibitory control.

RESULTS

Younger children and children with hearing loss demonstrated lower response sensitivity, and therefore poorer selective attention, than older children and children with normal hearing, respectively. The effect of hearing ability on selective attention was observed across the auditory and visual modalities, although the extent of this group difference was greater in the auditory modality than the visual modality due to differences in children's response patterns. Additionally, children's performance on a standardized measure of attention and inhibitory control related to their performance during the auditory and visual change detection tasks.

CONCLUSIONS

Overall, the findings from the present study suggest that age and hearing ability influence children's ability to selectively attend to a target stream in both the auditory and visual modalities. The observed differences in response patterns across modalities, however, reveal a complex interplay between hearing ability, task modality, and selective attention during childhood. While the effect of age on selective attention is expected to reflect the immaturity of cognitive and linguistic processes, the effect of hearing ability may reflect altered development of selective attention due to disrupted auditory experience early in life and/or a differential allocation of attentional resources to meet task demands.

Interdisciplinary Approaches to the Study of Listening Effort in Young Children with Cochlear Implants

Very early bilateral implantation is thought to significantly reduce the attentional effort required to acquire spoken language, and consequently offer a profound improvement in quality of life. Despite the early intervention, however, auditory and communicative outcomes in children with cochlear implants remain poorer than in hearing children. The distorted auditory input via the cochlear implants requires more auditory attention resulting in increased listening effort and fatigue. Listening effort and fatigue may critically affect attention to speech, and in turn language processing, which may help to explain the variation in language and communication abilities. However, measuring attention to speech and listening effort is demanding in infants and very young children. Three objective techniques for measuring listening effort are presented in this paper that may address the challenges of testing very young and/or uncooperative children with cochlear implants: pupillometry, electroencephalography, and functional near-infrared spectroscopy. We review the studies of listening effort that used these techniques in paediatric populations with hearing loss, and discuss potential benefits of the systematic evaluation of listening effort in these populations.

Listening-Related Fatigue in Children With Hearing Loss: Perspectives of Children, Parents, and School Professionals

PURPOSE

Children with hearing loss (CHL) are considered at risk for listening-related fatigue and its negative consequences. We collected data via focus groups and interviews from three stakeholder groups-CHL, their parents, and teachers/school professionals-in order to define the construct of listening-related fatigue from the perspective of CHL and key stakeholders. This is an important first step in our long-term goal to construct and validate a measure (i.e., scale) of listening-related fatigue for the pediatric population, with a focus on CHL. This article provides an overview of the data gathering process, analysis of qualitative reports, and the development of a theoretical framework for understanding the experience of listening-related fatigue in CHL.

METHOD

We conducted focus groups and interviews in school-age children exhibiting bilateral, moderate-to-profound hearing loss (n = 43), their parents (n = 17), and school professionals who work with CHL (n = 28). The discussions were audio-recorded, transcribed, and coded using a hierarchical coding system. Qualitative analysis was conducted using an iterative inductive-deductive approach.

RESULTS

We identified primary themes from the focus group/interview discussions to develop a theoretical framework of listening-related fatigue in CHL. The framework demonstrates the complex interaction among situational determinants that impact fatigue, symptoms or manifestations of fatigue, and the utilization of, and barriers to, coping strategies to reduce listening-related fatigue.

CONCLUSIONS

Participant discussion suggests that listening-related fatigue is a significant problem for many, but not all, CHL. Qualitative data obtained from these stakeholder groups help define the construct and provide a framework for better understanding listening-related fatigue in children.

Perceived Listening Difficulty in the Classroom, Not Measured Noise Levels, Is Associated With Fatigue in Children With and Without Hearing Loss

PURPOSE

The purpose of this study was to examine if classroom noise levels and perceived listening difficulty were related to fatigue reported by children with and without hearing loss.

METHOD

Measures of classroom noise and reports of classroom listening difficulty were obtained from 79 children (ages 6-12 years) at two time points on two different school days. Forty-four children had mild to moderately severe hearing loss in at least one ear. Multiple regression analyses were conducted to evaluate if measured noise levels, perceived listening difficulty, hearing status, language abilities, or grade level would predict self-reported fatigue ratings measured using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale.

RESULTS

Higher perceived listening difficulty was the only predictor variable that was associated with greater self-reported fatigue.

CONCLUSIONS

Measured classroom noise levels showed no systematic relationship with fatigue ratings, suggesting that actual classroom noise levels do not contribute to increased reports of subjective fatigue. Instead, perceived challenges with listening appears to be an important factor for consideration in future work examining listening-related fatigue in children with and without hearing loss.

A comparison of simultaneously-obtained measures of listening effort: pupil dilation, verbal response time and self-rating

OBJECTIVE

The aim of this study was to assess to what extent simultaneously-obtained measures of listening effort (task-evoked pupil dilation, verbal response time [RT], and self-rating) could be sensitive to auditory and cognitive manipulations in a speech perception task. The study also aimed to explore the possible relationship between RT and pupil dilation.

DESIGN

A within-group design was adopted. All participants were administered the Matrix Sentence Test in 12 conditions (signal-to-noise ratios [SNR] of -3, -6, -9 dB; attentional resources focussed vs divided; spatial priors present vs absent).

STUDY SAMPLE

Twenty-four normal-hearing adults, 20-41 years old (M = 23.5), were recruited in the study.

RESULTS

A significant effect of the SNR was found for all measures. However, pupil dilation discriminated only partially between the SNRs. Neither of the cognitive manipulations were effective in modulating the measures. No relationship emerged between pupil dilation, RT and self-ratings.

CONCLUSIONS

RT, pupil dilation, and self-ratings can be obtained simultaneously when administering speech perception tasks, even though some limitations remain related to the absence of a retention period after the listening phase. The sensitivity of the three measures to changes in the auditory environment differs. RTs and self-ratings proved most sensitive to changes in SNR.

The Impact and Management of Listening-Related Fatigue in Children with Hearing Loss

There is mounting evidence to support the premise that children with hearing loss (CHL) are at increased risk for listening-related fatigue and its associated sequelae. This article provides an overview of the construct of listening-related fatigue in CHL, its importance, possible academic and psychosocial consequences, and recommendations for the identification and management of fatigue associated with pediatric hearing loss.

A Slight Increase in Reverberation Time in the Classroom Affects Performance and Behavioral Listening Effort

OBJECTIVES

The purpose of this study was to investigate the effect of a small change in reverberation time (from 0.57 to 0.69 s) in a classroom on children's performance and listening effort. Aiming for ecological listening conditions, the change in reverberation time was combined with the presence or absence of classroom noise. In three academic tasks, the study examined whether the effect of reverberation was modulated by the presence of noise and depended on the children's age.

DESIGN

A total of 302 children (aged 11-13 years, grades 6-8) with normal hearing participated in the study. Three typical tasks of daily classroom activities (speech perception, sentence comprehension, and mental calculation) were administered to groups of children in two listening conditions (quiet and classroom noise). The experiment was conducted inside real classrooms, where reverberation time was controlled. The outcomes considered were task accuracy and response times (RTs), the latter taken as a behavioral proxy for listening effort. Participants were also assessed on reading comprehension and math fluency. To investigate the impact of noise and/or reverberation, these two scores were entered in the statistical model to control for individual child's general academic abilities.

RESULTS

While the longer reverberation time did not significantly affect accuracy or RTs under the quiet condition, it had several effects when in combination with classroom noise, depending on the task measured. A significant drop in accuracy with a longer reverberation time emerged for the speech perception task, but only for the grade 6 children. The effect on accuracy of a longer reverberation time was nonsignificant for sentence comprehension (always at ceiling), and depended on the children's age in the mental calculation task. RTs were longer for moderate than for short reverberation times in the speech perception and sentence comprehension tasks, while there was no significant effect of the different reverberation times on RTs in the mental calculation task.

CONCLUSIONS

The results indicate small, but statistically significant, effects of a small change in reverberation time on listening effort as well as accuracy for children aged 11 to 13 performing typical tasks of daily classroom activities. Thus, the results extend previous findings in adults to children as well. The findings also contribute to a better understanding of the practical implications and importance of optimal ranges of reverberation time in classrooms. A comparison with previous studies underscored the importance of early reflections as well as reverberation times in classrooms.

Listening Effort in School-Age Children With Normal Hearing Compared to Children With Limited Useable Hearing Unilaterally

Objectives Children with limited hearing unilaterally might experience more listening effort than children with normal hearing, yet previous studies have not confirmed this. This study compared listening effort in school-age children with normal hearing and children with limited hearing unilaterally using behavioral and subjective listening effort measures. Design Two groups of school-age children (aged 7-12 years) participated: 19 with limited hearing unilaterally and 18 with normal hearing bilaterally. Participants completed digit triplet recognition tasks in quiet and in noise (-12 dB SNR) in three loudspeaker conditions: midline, direct, and indirect. Verbal response times during the recognition task were interpreted as behavioral listening effort. Subjective ratings of "task difficulty" and "hard to think" were interpreted as subjective listening effort. Participant age was included as a covariate in analysis of behavioral data. Results Noise negatively affected digit triplet recognition for both groups in the midline loudspeaker condition and for participants with limited hearing unilaterally in the direct and indirect conditions. Relative to their peers with normal hearing, children with limited hearing unilaterally exhibited significantly longer response times and higher ratings of effort only in the noisy, indirect condition. Differences between groups were evident even when age differences were controlled for statistically. Conclusions Using behavioral and subjective indices of listening effort, children with limited unilateral hearing demonstrated significantly more listening effort relative to their peers with normal hearing during the difficult indirect listening condition. Implications include classroom accommodations to limit indirect listening situations for children with limited useable hearing unilaterally and consideration of intervention options.

Engagement of Children who are Deaf or Hard-of-Hearing Attending Mainstream Schools

This study compared the observed and the self-reported engagement of 16 students who are Deaf or hard-of-hearing (DHH) attending mainstream schools to that of matched controls with typical hearing. Observed engagement was measured through observations in the classroom setting using the Mainstream Version of the Code for Instructional Structure and Student Academic Reponses. Self-reported engagement was measured using the Classroom Participation Questionnaire. The results revealed no significant differences for either observed or self-reported engagement between the DHH and the control groups; however, three individual DHH participants had lower levels of observed engagement compared to their matched controls. As such, including engagement in the evaluation of students who are DHH may be important for some individuals to provide a better understanding of the daily challenges they experience at school. Where needs are identified, the support that students who are DHH receive should include a specific focus on engagement to assist with their successful inclusion.

Listening effort and fatigue in native and non-native primary school children

Background noise makes listening effortful and may lead to fatigue. This may compromise classroom learning, especially for children with a non-native background. In the current study, we used pupillometry to investigate listening effort and fatigue during listening comprehension under typical (0 dB signal-to-noise ratio [SNR]) and favorable (+10 dB SNR) listening conditions in 63 Swedish primary school children (7-9 years of age) performing a narrative speech-picture verification task. Our sample comprised both native (n = 25) and non-native (n = 38) speakers of Swedish. Results revealed greater pupil dilation, indicating more listening effort, in the typical listening condition compared with the favorable listening condition, and it was primarily the non-native speakers who contributed to this effect (and who also had lower performance accuracy than the native speakers). Furthermore, the native speakers had greater pupil dilation during successful trials, whereas the non-native speakers showed greatest pupil dilation during unsuccessful trials, especially in the typical listening condition. This set of results indicates that whereas native speakers can apply listening effort to good effect, non-native speakers may have reached their effort ceiling, resulting in poorer listening comprehension. Finally, we found that baseline pupil size decreased over trials, which potentially indicates more listening-related fatigue, and this effect was greater in the typical listening condition compared with the favorable listening condition. Collectively, these results provide novel insight into the underlying dynamics of listening effort, fatigue, and listening comprehension in typical classroom conditions compared with favorable classroom conditions, and they demonstrate for the first time how sensitive this interplay is to language experience.

Children with hearing loss can predict during sentence processing

Listeners readily anticipate upcoming sentence constituents, however little is known about prediction when the input is suboptimal, such as for children with hearing loss (HL). Here we examined whether children with hearing aids and/or cochlear implants use semantic context to predict upcoming spoken sentence completions. We expected reduced prediction among children with HL, but found they were able to predict similarly to children with normal hearing. This suggests prediction is robust even when input quality is chronically suboptimal, and is compatible with the idea that recent advances in the management of pre-lingual HL may have minimised some of the language processing differences between children with and without HL.

Exposure to Spoken Communication in Children With Cochlear Implants During the COVID-19 Lockdown

Importance

The coronavirus disease 2019 (COVID-19) lockdowns in Ontario, Canada in the spring of 2020 created unprecedented changes in the lives of all children, including children with hearing loss.

Objective

To quantify how these lockdowns changed the spoken communication environments of children with cochlear implants by comparing the sounds they were exposed to before the Ontario provincial state of emergency in March 2020 and during the resulting closures of schools and nonessential businesses.

Design, Setting, and Participants

This experimental cohort study comprised children with hearing loss who used cochlear implants to hear. These children were chosen because (1) their devices monitor and catalog levels and types of sounds during hourly use per day (datalogs), and (2) this group is particularly vulnerable to reduced sound exposure. Children were recruited from the Cochlear Implant Program at a tertiary pediatric hospital in Ontario, Canada. Children whose cochlear implant datalogs were captured between February 1 and March 16, 2020, shortly before lockdown (pre-COVID-19), were identified. Repeated measures were collected in 45 children during initial easing of lockdown restrictions (stages 1-2 of the provincial recovery plan); resulting datalogs encompassed the lockdown period (peri-COVID-19).

Main Outcomes and Measures

Hours of sound captured by the Cochlear Nucleus datalogging system (Cochlear Corporation) in 6 categories of input levels (<40, 40-49, 50-59, 60-69, 70-79, ≥80 A-weighted dB sound pressure levels [dBA]) and 6 auditory scene categories (quiet, speech, speech-in-noise, music, noise, and other). Mixed-model regression analyses revealed main effects with post hoc adjustment of confidence intervals using the Satterthwaite method.

Results

A total of 45 children (mean [SD] age, 7.7 [5.0] years; 23 girls [51.1%]) participated in this cohort study. Results showed similar daily use of cochlear implants during the pre- and peri-COVID-19 periods (9.80 mean hours pre-COVID-19 and 9.34 mean hours peri-COVID-19). Despite consistent device use, these children experienced significant quieting of input sound levels peri-COVID-19 by 0.49 hour (95% CI, 0.21-0.80 hour) at 60 to 69 dBA and 1.70 hours (95% CI, 1.42-1.99 hours) at 70 to 79 dBA with clear reductions in speech exposure by 0.98 hour (95% CI, 0.49-1.47 hours). This outcome translated into a reduction of speech:quiet from 1.6:1.0 pre-COVID-19 to 0.9:1.0 during lockdowns. The greatest reductions in percentage of daily speech occurred in school-aged children (elementary, 12.32% [95% CI, 7.15%-17.49%]; middle school, 11.76% [95% CI, 5.00%-18.52%]; and high school, 9.60% [95% CI, 3.27%-15.93%]). Increased daily percentage of quiet (7.00% [95% CI, 4.27%-9.74%]) was most prevalent for children who had fewer numbers of people in their household (estimate [SE] = -1.12% [0.50%] per person; Cohen f = 0.31).

Conclusions and Relevance

The findings of this cohort study indicate a clear association of COVID-19 lockdowns with a reduction in children's access to spoken communication.

Individual Differences Offer Insight Into Clinical Recommendations for Directional and Remote Microphone Technology Use in Children

Purpose This study sought to evaluate the effects of common hearing aid microphone technologies on speech recognition and listening effort, and to evaluate potential predictive factors related to microphone benefits for school-age children with hearing loss in a realistic listening situation. Method Children (n = 17, ages 10-17 years) with bilateral, sensorineural hearing loss were fitted with hearing aids set to include three programs: omnidirectional, adaptive directional, and omnidirectional + remote microphone. Children completed a dual-task paradigm in a moderately reverberant room. The primary task included monosyllabic word recognition, with target speech presented at 60 dB A from 0° (front) or 180° (back) azimuth. The secondary task was a "go/no-go," visual shape-recognition task. Multitalker babble noise created a +5 dB SNR. Children were evaluated in two speaker conditions (front, back) using all three hearing aid programs. The remote microphone transmitter remained at the front speaker throughout testing. Speech recognition performance was calculated from the primary task while listening effort was measured as response time during the secondary task. Results Speech presented from the back significantly increased listening effort and caused a reduction in speech perception when directional and remote microphones were used. Considerable variability was found in pattern of benefit across microphones and source location. Clinical measures did not predict benefit patterns with directional or remote microphones; however, child age and performance with omnidirectional microphones did. Conclusions When compared to a traditional omnidirectional setting, the directional and remote microphone configurations evaluated in this study have the potential to provide benefit for some children and increase difficulty for others when used in dynamic environments. A child's performance with omnidirectional hearing aids could be used to better inform clinical recommendations for these technologies.

Listening Effort in School-Aged Children With Limited Useable Hearing Unilaterally: Examining the Effects of a Personal, Digital Remote Microphone System and a Contralateral Routing of Signal System

Technology options for children with limited hearing unilaterally that improve the signal-to-noise ratio are expected to improve speech recognition and also reduce listening effort in challenging listening situations, although previous studies have not confirmed this. Employing behavioral and subjective indices of listening effort, this study aimed to evaluate the effects of two intervention options, remote microphone system (RMS) and contralateral routing of signal (CROS) system, in school-aged children with limited hearing unilaterally. Nineteen children (aged 7-12 years) with limited hearing unilaterally completed a digit triplet recognition task in three loudspeaker conditions: midline, monaural direct, and monaural indirect with three intervention options: unaided, RMS, and CROS system. Verbal response times were interpreted as a behavioral measure of listening effort. Participants provided subjective ratings immediately following behavioral measures. The RMS significantly improved digit triplet recognition across loudspeaker conditions and reduced verbal response times in the midline and indirect conditions. The CROS system improved speech recognition and listening effort only in the indirect condition. Subjective ratings analyses revealed that significantly more participants indicated that the remote microphone made it easier for them to listen and to stay motivated. Behavioral and subjective indices of listening effort indicated that an RMS provided the most consistent benefit for speech recognition and listening effort for children with limited unilateral hearing. RMSs could therefore be a beneficial technology option in classrooms for children with limited hearing unilaterally.

Age-Related Changes in Listening Effort for Children and Teenagers With Normal Hearing and Cochlear Implants

OBJECTIVES

A clinically viable measure of listening effort is crucial in safeguarding the educational success of hard-of-hearing students enrolled in mainstream schools. To this end, a novel behavioral paradigm of listening effort targeting school-age children has been designed and reported in Hsu et al. (2017). The current article consists of two follow-up experiments investigating the effects of noise, processing depth, and age in a similar paradigm, first in a group of participants with normal hearing (NH) followed by a sample of school-age cochlear implant (CI) users. Research objectives include the construction of normative values of listening effort and comparing outcomes between age-matched NH and CI participants.

DESIGN

In Experiment 1, the listening effort dual-task paradigm was evaluated in a group of 90 NH participants with roughly even age distribution between 6 and 26 years. The primary task asked a participant to verbally repeat each of the target words presented in either quiet or noise, while the secondary task consisted of categorization true-or-false questions "animal" and "dangerous," representing two levels of semantic processing depth. Two outcome measures were obtained for each condition: a classic word recognition score (WRS) and an average response time (RT) measured during the secondary task. The RT was defined as the main listening effort metric throughout the study. Each NH participant's long-term memory retrieval speed and working memory capacity were also assessed through standardized tests. It was hypothesized that adding noise would negatively affect both WRS and RT, whereas an increase in age would see significant improvement in both measures. A subsequent Experiment 2 administered a shortened version of the paradigm to 14 school-age CI users between 5 and 14 years old at a university clinic. The patterns of results from the CI group were expected to approximate those of the NH group, except with larger between-subject variability.

RESULTS

For NH participants, while WRS was significantly affected by age and noise levels, RT was significantly affected by age, noise levels, and depth of processing. RT was significantly correlated with long-term memory retrieval speed but not with working memory capacity. There was also a significant interaction effect between age and noise levels for both WRS and RT. The RT data set from the NH group served as a basis to establish age-dependent 95% prediction intervals for expected future observations. For CI participants, the effect of age on the two outcome measures was more visible when target words were presented in quiet. Depending on the condition, between 35.7% and 72.7% of the children with CI exhibited higher-than-norms listening effort as measured by categorization processing times.

CONCLUSION

Listening effort appears to decrease with age from early school-age years to late teenage years. The effects of background noise and processing depth are comparable with those reported in Hsu et al. (2017). Future studies interested in expanding the paradigm's clinical viability should focus on the reduction of testing time while maintaining or increasing the sensitivity and external validity of its outcome measures.

The Cost of Intrinsic and Extrinsic Cognitive Demands on Auditory Functioning in Older Adults With Normal Hearing or Using Hearing Aids

OBJECTIVES

We investigated the impact of both intrinsic and extrinsic cognitive demands on auditory and secondary task performance in older adults with normal hearing (NH) and adults using hearing aids (HAs) in an ecologically relevant listening environment.

DESIGN

Fifteen adults with NH and 15 adults using HAs (60 to 72 years of age) were recruited to perform the "Audiovisual True-to-Life Assessment of Auditory Rehabilitation"-paradigm (AVATAR), which combines an auditory-visual speech-in-noise task with three secondary tasks on either auditory localization or visual short-term memory in a preload multitask paradigm. Intrinsic demands were altered by presenting speech either at equivalent speech accuracy levels of 50% correct (SPIN50%) or equivalent speech-to-noise ratios of +5dB SNR (SPIN+5dB). We manipulated the amount of extrinsic cognitive demands by including one (dual condition) or three secondary tasks (quadruple condition). Performance decrements on the secondary tasks were considered to reflect an increase in resource allocation to speech understanding and thus an increase in listening effort. In addition, we administered a cognitive test battery as well as a questionnaire on self-reported hearing difficulties and subjective measures of effort and motivation.

RESULTS

Speech understanding and secondary task performance on the visual short-term memory task were lower in the SPIN50% condition compared to SPIN+5dB. Whereas speech understanding at SPIN50% was equally high in the dual and quadruple conditions, the quadruple condition resulted in lower secondary task performance on the visual short-term memory task, higher levels of self-reported effort, and lower motivation compared to the dual-task condition. The same was true for experimental conditions at SPIN+5dB. Additionally, adults with NH outperformed adults using HAs on speech understanding, auditory localization, and self-reported hearing abilities, but no group differences were observed on secondary task costs or cognitive measures.

CONCLUSIONS

This study showed that, irrespective of the hearing status of the listener, speech performance was not affected by the amount of extrinsic cognitive demands, but was worse and required more effort under conditions with a more negative SNR. Also, increasing the extrinsic cognitive demands resulted in lower performance on one of the secondary tasks, suggesting that more complex listening environments require more effort. Although adults with NH outperformed HA users on speech understanding and auditory localization, the two groups did not differ with respect to secondary task costs.

Noise and a Speaker's Impaired Voice Quality Disrupt Spoken Language Processing in School-Aged Children: Evidence From Performance and Response Time Measures

Purpose Our aim was to investigate isolated and combined effects of speech-shaped noise (SSN) and a speaker's impaired voice quality on spoken language processing in first-grade children. Method In individual examinations, 53 typically developing children aged 5-6 years performed a speech perception task (phoneme discrimination) and a listening comprehension task (sentence-picture matching). Speech stimuli were randomly presented in a 2 × 2 factorial design with the factors noise (no added noise vs. SSN at 0- dB SNR) and voice quality (normal voice vs. impaired voice). Outcome measures were task performance and response time (RT). Results SSN and impaired voice quality significantly lowered children's performance and increased RTs in the speech perception task, particularly when combined. Regarding listening comprehension, a significant interaction between noise and voice quality indicated that children's performance was hindered by SSN when the speaker's voice was impaired but not when it was normal. RTs in this task were unaffected by noise or voice quality. Conclusions Results suggest that speech signal degradations caused by a speaker's impaired voice and background noise generate more processing errors and increased listening effort in young school-aged children. This finding is vital for classroom listening and highlights the importance of ensuring teachers' vocal health and adequate room acoustics.

Listening Effort in Native and Nonnative English-Speaking Children Using Low Linguistic Single- and Dual-Task Paradigms

Purpose It is not clear if behavioral indices of listening effort are sensitive to changes in signal-to-noise ratio (SNR) for young children (7-12 years old) from multilingual backgrounds. The purpose of this study was to explore the effects of SNR on listening effort in multilingual school-aged children (native English, nonnative English) as measured with a single- and a dual-task paradigm with low-linguistic speech stimuli (digits). The study also aimed to explore age effects on digit triplet recognition and response times (RTs). Method Sixty children with normal hearing participated, 30 per language group. Participants completed single and dual tasks in three SNRs (quiet, -10 dB, and -15 dB). Speech stimuli for both tasks were digit triplets. Verbal RTs were the listening effort measure during the single-task paradigm. A visual monitoring task was the secondary task during the dual-task paradigm. Results Significant effects of SNR on RTs were evident during both single- and dual-task paradigms. As expected, language background did not affect the pattern of RTs. The data also demonstrate a maturation effect for triplet recognition during both tasks and for RTs during the dual-task only. Conclusions Both single- and dual-task paradigms were sensitive to changes in SNR for school-aged children between 7 and 12 years of age. Language background (English as native language vs. English as nonnative language) had no significant effect on triplet recognition or RTs, demonstrating practical utility of low-linguistic stimuli for testing children from multilingual backgrounds.

Listening-Related Fatigue in Children With Unilateral Hearing Loss

Purpose Listening-related fatigue is an understudied construct that may contribute to the auditory, educational, and psychosocial problems experienced by children with unilateral hearing loss (UHL). Herein, we present an overview of listening-related fatigue in school-age children with hearing loss (CHL), with a focus on children with UHL. Method Following a review of research examining listening-related fatigue in adults and CHL, we present preliminary findings exploring the effects of unilateral and bilateral hearing loss on listening-related fatigue in children. For these exploratory analyses, we used data collected from our ongoing work developing and validating a tool, the Vanderbilt Fatigue Scale, for measuring listening-related fatigue in children. Presently, we are assessing 3 versions of the fatigue scale-child self-report, parent proxy, and teacher proxy. Using these scales, data have been collected from more than 900 participants. Data from children with unilateral and bilateral hearing loss and for children with no hearing loss are compared with adult Vanderbilt Fatigue Scale data. Results Results of our literature review and exploratory analyses suggest that adults and CHL are at increased risk for listening-related fatigue. Importantly, this increased risk was similar in magnitude regardless of whether the loss was unilateral or bilateral. Subjective ratings, based on child self-report and parent proxy report, were consistent, suggesting that children with unilateral and bilateral hearing loss experienced greater listening-related fatigue than children with no hearing loss. In contrast, results based on teacher proxy report were not sensitive to the effects of hearing loss. Conclusions Children with UHL are at increased risk for listening-related fatigue, and the magnitude of fatigue is similar to that experienced by children with bilateral hearing loss. Problems of listening-related fatigue in school-age CHL may be better identified by CHL themselves and their parents than by teachers and specialists working with the children.

Impact of Background Noise Fluctuation and Reverberation on Response Time in a Speech Reception Task

Purpose This study examines the effects of reverberation and noise fluctuation on the response time (RT) to the auditory stimuli in a speech reception task. Method The speech reception task was presented to 76 young adults with normal hearing in 3 simulated listening conditions (1 anechoic, 2 reverberant). Speechlike stationary and fluctuating noise were used as maskers, in a wide range of signal-to-noise ratios. The speech-in-noise tests were presented in a closed-set format; data on speech intelligibility and RT (time elapsed from the offset of the auditory stimulus to the response selection) were collected. A slowing down in RTs was interpreted as an increase in listening effort. Results RTs slowed down in the more challenging signal-to-noise ratios, with increasing reverberation and for stationary compared to fluctuating noise, consistently with a fluctuating masking release scheme. When speech intelligibility was fixed, it was found that the estimated RTs were similar or faster for stationary compared to fluctuating noise, depending on the amount of reverberation. Conclusions The current findings add to the literature on listening effort for listeners with normal hearing by indicating that the addition of reverberation to fluctuating noise increases RT in a speech reception task. The results support the importance of integrating noise and reverberation to provide accurate predictors of real-world performance in clinical settings.