Clinical Effectiveness of an At-Home Auditory Training Program: A Randomized Controlled Trial

The Effect of Computer-Based Auditory Training on Speech-in-Noise Perception in Adults: a Systematic Review and Meta-Analysis

To investigate the effectiveness of computer-based auditory training on speech-in-noise perception in adults. With no language restriction, 11 databases were searched from 1990 to 2020. We included any clinical trial studies with concurrent comparison groups that examined the effectiveness of computer-based auditory training programs in adults. The primary outcome was a speech in noise perception that was estimated using the "difference pretest-posttest-control" index (dppc2). The risk of bias was assessed using the Cochrane collaboration tool for assessing the risk of bias in randomized trials. The certainty of the evidence was investigated using the GRADE in two primary outcomes. Twenty three studies were included in two subgroups based on primary outcome: 12 studies with speech perception threshold and 11 studies with speech-in-noise test scores. Computer-based auditory training resulted in a speech in noise perception improvement (dppc2:  -0.69, 95%CI:  -1.11 to  -0.26; I2 = 69.6%, p = 0.00) and (dppc2: 0.71, 95%CI: 0.38-1.03, I2: 17.8%, p = 0.27) respectively in both subgroups. 19 studies were judged to have a high risk of bias and 3 studies had a low risk of bias and the strength of the evidence was low in both primary outcomes. This finding indicates that computer-based auditory training can be a moderately effective intervention for speech-in-noise perception in adults. However, due to the low quality of primary studies and the low certainty of the evidence, the results are not yet definite. Prospero registration number: CRD42021233193.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03920-0.

The effect of phoneme-based auditory training on speech intelligibility in hearing-aid users

OBJECTIVE

Hearing loss commonly causes difficulties in understanding speech in the presence of background noise. The benefits of hearing-aids in terms of speech intelligibility in challenging listening scenarios remain limited. The present study investigated if phoneme-in-noise discrimination training improves phoneme identification and sentence intelligibility in noise in hearing-aid users.

DESIGN

Two groups of participants received either a two-week training program or a control intervention. Three phoneme categories were trained: onset consonants (C1), vowels (V) and post-vowel consonants (C2) in C1-V-C2-/i/ logatomes from the Danish nonsense word corpus (DANOK). Phoneme identification test and hearing in noise test (HINT) were administered before and after the respective interventions and, for the training group only, after three months.

STUDY SAMPLE

Twenty 63-to-79 years old individuals with a mild-to-moderate sensorineural hearing loss and at least one year of experience using hearing-aids.

RESULTS

The training provided an improvement in phoneme identification scores for vowels and post-vowel consonants, which was retained over three months. No significant performance improvement in HINT was found.

CONCLUSION

The study demonstrates that the training induced a robust refinement of auditory perception at a phoneme level but provides no evidence for the generalisation to an untrained sentence intelligibility task.

American Speech-Language-Hearing Association Clinical Practice Guideline on Aural Rehabilitation for Adults With Hearing Loss

BACKGROUND

Hearing loss poses a significant public health challenge as a common chronic condition with many known side effects that are often worse when left untreated. Aural rehabilitation (AR) is an umbrella term that encompasses a range of interventions (e.g., informational counseling and perceptual training) designed to reduce deficits related to hearing loss that may stand alone or be used in combination as part of a holistic plan.

PURPOSE

This evidence-based clinical practice guideline is intended to inform the implementation of person-centered AR to adults with hearing loss. Given the well-known benefits of sensory management, it was not included within the scope of this guideline. The recommendations aim to help clinicians, individuals with hearing loss, and other stakeholders make evidence-informed treatment decisions and improve clinical outcomes, as well as provide payers and policymakers with information detailing a comprehensive approach to AR.

METHOD

The American Speech-Language-Hearing Association (ASHA) and a multidisciplinary panel of subject matter experts prioritized key clinical questions and outcomes that served as the foundation of the guideline. The clinical recommendations were based on a comprehensive systematic review and a meta-analysis of 85 studies published between 1978 and 2021.

RECOMMENDATIONS

Given the current state of the evidence, resource considerations, patient acceptability, clinical feasibility, and the overall balance of benefits and harms, ASHA developed several evidence-based recommendations for the provision of AR to adults with hearing loss. Each recommendation is accompanied by a series of key practice points to support its implementation within a person-centered framework.

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

OBJECTIVES

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

DESIGN

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

RESULTS

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

CONCLUSIONS

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

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

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

Comparing the Outcomes of a Personalized Versus Nonpersonalized Home-Based Auditory Training Program for Cochlear Implant Users

OBJECTIVES

Audiological rehabilitation includes sensory management, auditory training (AT), and counseling and can alleviate the negative consequences associated with (untreated) hearing impairment. AT aims at improving auditory skills through structured analytical (bottom-up) or synthetic (top-down) listening exercises. The evidence for AT to improve auditory outcomes of postlingually deafened adults with a cochlear implant (CI) remains a point of debate due to the relatively limited number of studies and methodological shortcomings. There is a general agreement that more rigorous scientific study designs are needed to determine the effectiveness, generalization, and consolidation of AT for CI users. The present study aimed to investigate the effectiveness of a personalized AT program compared to a nonpersonalized Active Control program with adult CI users in a stratified randomized controlled clinical trial.

DESIGN

Off-task outcomes were sentence understanding in noise, executive functioning, and health-related quality of life. Participants were tested before and after 16 weeks of training and after a further 8 months without training. Participant expectations of the training program were assessed before the start of training.

RESULTS

The personalized and nonpersonalized AT programs yielded similar results. Significant on-task improvements were observed. Moreover, AT generalized to improved speech understanding in noise for both programs. Half of the CI users reached a clinically relevant improvement in speech understanding in noise of at least 2 dB SNR post-training. These improvements were maintained 8 months after completion of the training. In addition, a significant improvement in quality of life was observed for participants in both treatment groups. Adherence to the training programs was high, and both programs were considered user-friendly.

CONCLUSIONS

Training in both treatments yielded similar results. For half of the CI users, AT transferred to better performance with generalization of learning for speech understanding in noise and quality of life. Our study supports the previous findings that AT can be beneficial for some CI users.

Is a hybrid of online and face-to-face services feasible for audiological rehabilitation post COVID-19? Findings from three public health patients

Background: The global coronavirus disease 2019 (COVID-19) pandemic has pushed many audiologists to incorporate remote service delivery methods to adhere to mandatory health and safety protocols. The use of tele-audiology for audiological rehabilitation may provide a sustainable, cost-effective modality to suit the existing need, particularly in low-resourced countries.Objectives: This study aimed to investigate the feasibility of implementing a hybrid tele-rehabilitation programme in a South African public health context. An online auditory training (AT) programme was used to determine (1) compliance, (2) clinical benefit, (3) participant experience and (4) costs.Method: A convergent mixed methods design with a feasibility approach was utilised. Data collection was done through questionnaires, in-booth assessments, online AT, and face-to-face interviewing. Participants undertook online AT over 4 weeks. For pre- and post-online AT, the Abbreviated Profile of Hearing Aid Benefit (APHAB), QuickSIN, entrance and exit questionnaires, interviews and a system usability scale were administered.Results: Key findings of this study included (1) a high compliance rate (84.82%) with minimal clinician contact time at 3 h 25 min over 5–6-weeks; (2) improvement in perceived hearing aid (HA) benefit, and improvement in listening skills; (3) reported positive experiences; and (4) minimal programme costs at an average of R1350.00 per participant.Conclusion: The results showed positive indicators that the use of hybrid tele-rehabilitative strategies may provide a viable alternative to the traditional face-to-face modality. The hybrid approach showed clinical benefits, cost-effectiveness, minimal contact time as well as COVID-19 compliance. Further large-scale research is still needed.

Lipreading: A Review of Its Continuing Importance for Speech Recognition With an Acquired Hearing Loss and Possibilities for Effective Training

PURPOSE

The goal of this review article is to reinvigorate interest in lipreading and lipreading training for adults with acquired hearing loss. Most adults benefit from being able to see the talker when speech is degraded; however, the effect size is related to their lipreading ability, which is typically poor in adults who have experienced normal hearing through most of their lives. Lipreading training has been viewed as a possible avenue for rehabilitation of adults with an acquired hearing loss, but most training approaches have not been particularly successful. Here, we describe lipreading and theoretically motivated approaches to its training, as well as examples of successful training paradigms. We discuss some extensions to auditory-only (AO) and audiovisual (AV) speech recognition.

METHOD

Visual speech perception and word recognition are described. Traditional and contemporary views of training and perceptual learning are outlined. We focus on the roles of external and internal feedback and the training task in perceptual learning, and we describe results of lipreading training experiments.

RESULTS

Lipreading is commonly characterized as limited to viseme perception. However, evidence demonstrates subvisemic perception of visual phonetic information. Lipreading words also relies on lexical constraints, not unlike auditory spoken word recognition. Lipreading has been shown to be difficult to improve through training, but under specific feedback and task conditions, training can be successful, and learning can generalize to untrained materials, including AV sentence stimuli in noise. The results on lipreading have implications for AO and AV training and for use of acoustically processed speech in face-to-face communication.

CONCLUSION

Given its importance for speech recognition with a hearing loss, we suggest that the research and clinical communities integrate lipreading in their efforts to improve speech recognition in adults with acquired hearing loss.

Effect of Serious Gaming on Speech-in-Noise Intelligibility in Adult Cochlear Implantees: A Randomized Controlled Study

Listening in noise remains challenging for adults with cochlear implants (CI) even after prolonged experience. Personalized auditory training (AT) programs can be proposed to improve specific auditory skills in adults with CI. The objective of this study was to assess serious gaming as a rehabilitation tool to improve speech-in-noise intelligibility in adult CI users. Thirty subjects with bilateral profound hearing loss and at least 9 months of CI experience were randomized to participate in a 5-week serious game-based AT program (n = 15) or a control group (n = 15). All participants were tested at enrolment and at 5 weeks using the sentence recognition-in-noise matrix test to measure the signal-to-noise ratio (SNR) allowing 70% of speech-in-noise understanding (70% speech reception threshold, SRT70). Thirteen subjects completed the AT program and nine of them were re-tested 5 weeks later. The mean SRT70 improved from 15.5 dB to 11.5 dB SNR after 5 weeks of AT (p < 0.001). No significant change in SRT70 was observed in the control group. In the study group, the magnitude of SRT70 improvement was not correlated to the total number of AT hours. A large inter-patient variability was observed for speech-in-noise intelligibility measured once the AT program was completed and at re-test. The results suggest that serious game-based AT may improve speech-in-noise intelligibility in adult CI users. Potential sources of inter-patient variability are discussed. Serious gaming may be considered as a complementary training approach for improving CI outcomes in adults.

During Lipreading Training With Sentence Stimuli, Feedback Controls Learning and Generalization to Audiovisual Speech in Noise

PURPOSE

This study investigated the effects of external feedback on perceptual learning of visual speech during lipreading training with sentence stimuli. The goal was to improve visual-only (VO) speech recognition and increase accuracy of audiovisual (AV) speech recognition in noise. The rationale was that spoken word recognition depends on the accuracy of sublexical (phonemic/phonetic) speech perception; effective feedback during training must support sublexical perceptual learning.

METHOD

Normal-hearing (NH) adults were assigned to one of three types of feedback: Sentence feedback was the entire sentence printed after responding to the stimulus. Word feedback was the correct response words and perceptually near but incorrect response words. Consonant feedback was correct response words and consonants in incorrect but perceptually near response words. Six training sessions were given. Pre- and posttraining testing included an untrained control group. Test stimuli were disyllable nonsense words for forced-choice consonant identification, and isolated words and sentences for open-set identification. Words and sentences were VO, AV, and audio-only (AO) with the audio in speech-shaped noise.

RESULTS

Lipreading accuracy increased during training. Pre- and posttraining tests of consonant identification showed no improvement beyond test-retest increases obtained by untrained controls. Isolated word recognition with a talker not seen during training showed that the control group improved more than the sentence group. Tests of untrained sentences showed that the consonant group significantly improved in all of the stimulus conditions (VO, AO, and AV). Its mean words correct scores increased by 9.2 percentage points for VO, 3.4 percentage points for AO, and 9.8 percentage points for AV stimuli.

CONCLUSIONS

Consonant feedback during training with sentences stimuli significantly increased perceptual learning. The training generalized to untrained VO, AO, and AV sentence stimuli. Lipreading training has potential to significantly improve adults' face-to-face communication in noisy settings in which the talker can be seen.

Speech-Language Pathologists' Practice Patterns When Designing Home Practice Programs for Persons With Aphasia: A Survey

Purpose We aimed to describe the current practices of speech-language pathologists regarding the creation and implementation of home practice programs for persons with poststroke aphasia. Method Survey participants were American Speech-Language-Hearing Association-certified speech-language pathologists, had 30% of their caseload include persons with aphasia, and had recently created at least two home programs for persons with aphasia. Respondents completed a web-based survey on home program creation, training, technology, and methods for tracking adherence with closed and open-ended questions. Results We analyzed 80 complete surveys. Most of the participants (n = 56) created home programs for greater than 75% of their caseload. Common interventions in home programs addressed functional practice and spoken expression. Participants describe instructional techniques including building skill practice in daily routines and guided practice. Applications of technology and formal mechanisms to monitor adherence were less frequently reported. Various factors were identified as facilitators and barriers to home program creation with environmental support from others and client factors (i.e., motivation, impairments) most evident. Conclusions This study provides insight into speech-language pathologists' home program creation and implementation. Results can be used to consider mechanisms to improve use of and adherence to home programs to further support recovery. Supplemental Material https://doi.org/10.23641/asha.16840204.

Effect of Realistic Test Conditions on Spectral and Temporal Processing in Normal-Hearing Listeners

Purpose To measure the effect of testing conditions (in the soundproof booth vs. quiet room), test order, and number of test sessions on spectral and temporal processing in normal-hearing (NH) listeners. Method Thirty-two adult NH listeners participated in the three experiments. For all three experiments, the stimuli were presented to the left ear at the subjects' most comfortable level through headphones. All tests were administered in an adaptive three-alternative forced-choice paradigm. Experiment 1 was designed to compare the effect of soundproof booth and quiet room test conditions on amplitude modulation detection threshold and modulation frequency discrimination threshold with each of the five modulation frequencies. Experiment 2 was designed to compare the effect of two test orders on the frequency discrimination thresholds under the quiet room test conditions. The thresholds were first measured in the ascending and descending order of four pure tones, and then with counterbalanced order. For Experiment 3, the amplitude discrimination threshold under the quiet room testing condition was assessed 3 times to determine the effect of the number of test sessions. Then the thresholds were compared over the sessions. Results Results showed no significant effect of test environment. The test order is an important variable for frequency discrimination, particularly between piano tunes and pure tones. Results also show no significant difference across test sessions. Conclusions These results suggest that a controlled test environment may not be required in spectral and temporal assessment for NH listeners. Under the quiet test environment, a single outcome measure is sufficient, but test orders should be counterbalanced.