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Windle R, Dillon H, Heinrich A. A review of auditory processing and cognitive change during normal ageing, and the implications for setting hearing aids for older adults. Front Neurol 2023; 14:1122420. [PMID: 37409017 PMCID: PMC10318159 DOI: 10.3389/fneur.2023.1122420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 06/02/2023] [Indexed: 07/07/2023] Open
Abstract
Throughout our adult lives there is a decline in peripheral hearing, auditory processing and elements of cognition that support listening ability. Audiometry provides no information about the status of auditory processing and cognition, and older adults often struggle with complex listening situations, such as speech in noise perception, even if their peripheral hearing appears normal. Hearing aids can address some aspects of peripheral hearing impairment and improve signal-to-noise ratios. However, they cannot directly enhance central processes and may introduce distortion to sound that might act to undermine listening ability. This review paper highlights the need to consider the distortion introduced by hearing aids, specifically when considering normally-ageing older adults. We focus on patients with age-related hearing loss because they represent the vast majority of the population attending audiology clinics. We believe that it is important to recognize that the combination of peripheral and central, auditory and cognitive decline make older adults some of the most complex patients seen in audiology services, so they should not be treated as "standard" despite the high prevalence of age-related hearing loss. We argue that a primary concern should be to avoid hearing aid settings that introduce distortion to speech envelope cues, which is not a new concept. The primary cause of distortion is the speed and range of change to hearing aid amplification (i.e., compression). We argue that slow-acting compression should be considered as a default for some users and that other advanced features should be reconsidered as they may also introduce distortion that some users may not be able to tolerate. We discuss how this can be incorporated into a pragmatic approach to hearing aid fitting that does not require increased loading on audiology services.
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Affiliation(s)
- Richard Windle
- Audiology Department, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | - Harvey Dillon
- NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom
- Department of Linguistics, Macquarie University, North Ryde, NSW, Australia
| | - Antje Heinrich
- NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom
- Division of Human Communication, Development and Hearing, School of Health Sciences, University of Manchester, Manchester, United Kingdom
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Stenbäck V, Marsja E, Hällgren M, Lyxell B, Larsby B. Informational Masking and Listening Effort in Speech Recognition in Noise: The Role of Working Memory Capacity and Inhibitory Control in Older Adults With and Without Hearing Impairment. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:4417-4428. [PMID: 36283680 DOI: 10.1044/2022_jslhr-21-00674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE The study aimed to assess the relationship between (a) speech recognition in noise, mask type, working memory capacity (WMC), and inhibitory control and (b) self-rated listening effort, speech material, and mask type, in older adults with and without hearing impairment. It was of special interest to assess the relationship between WMC, inhibitory control, and speech recognition in noise when informational maskers masked target speech. METHOD A mixed design was used. A group (N = 24) of older (Mage = 69.7 years) individuals with hearing impairment and a group of age normal-hearing adults (Mage = 59.3 years, SD = 6.5) participated in the study. The participants were presented with auditory tests in a sound-attenuated room and with cognitive tests in a quiet office. The participants were asked to rate listening effort after being presented with energetic and informational background maskers in two different speech materials used in this study (i.e., Hearing In Noise Test and Hagerman test). Linear mixed-effects models were set up to assess the effect of the two different speech materials, energetic and informational maskers, hearing ability, WMC, inhibitory control, and self-rated listening effort. RESULTS Results showed that WMC and inhibitory control were of importance for speech recognition in noise, even when controlling for pure-tone average 4 hearing thresholds and age, when the maskers were informational. Concerning listening effort, on the other hand, the results suggest that hearing ability, but not cognitive abilities, is important for self-rated listening effort in speech recognition in noise. CONCLUSIONS Speech-in-noise recognition is more dependent on WMC for older adults in informational maskers than in energetic maskers. Hearing ability is a stronger predictor than cognition for self-rated listening effort. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21357648.
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Affiliation(s)
- Victoria Stenbäck
- Disability Research Division, Department of Behavioural Sciences and Learning, Linköping University, Sweden
- Division of Education, Teaching and Learning, Department of Behavioural Sciences and Learning, Linköping University, Sweden
| | - Erik Marsja
- Disability Research Division, Department of Behavioural Sciences and Learning, Linköping University, Sweden
| | - Mathias Hällgren
- Department of Otorhinolaryngology in Östergötland and Department of Biomedical and Clinical Sciences, Linköping University, Sweden
| | - Björn Lyxell
- Disability Research Division, Department of Behavioural Sciences and Learning, Linköping University, Sweden
- Department of Special Needs Education, University of Oslo, Norway
| | - Birgitta Larsby
- Department of Otorhinolaryngology in Östergötland and Department of Biomedical and Clinical Sciences, Linköping University, Sweden
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Is Having Hearing Loss Fundamentally Different? Multigroup Structural Equation Modeling of the Effect of Cognitive Functioning on Speech Identification. Ear Hear 2022; 43:1437-1446. [PMID: 34983896 DOI: 10.1097/aud.0000000000001196] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Previous research suggests that there is a robust relationship between cognitive functioning and speech-in-noise performance for older adults with age-related hearing loss. For normal-hearing adults, on the other hand, the research is not entirely clear. Therefore, the current study aimed to examine the relationship between cognitive functioning, aging, and speech-in-noise, in a group of older normal-hearing persons and older persons with hearing loss who wear hearing aids. DESIGN We analyzed data from 199 older normal-hearing individuals (mean age = 61.2) and 200 older individuals with hearing loss (mean age = 60.9) using multigroup structural equation modeling. Four cognitively related tasks were used to create a cognitive functioning construct: the reading span task, a visuospatial working memory task, the semantic word-pairs task, and Raven's progressive matrices. Speech-in-noise, on the other hand, was measured using Hagerman sentences. The Hagerman sentences were presented via an experimental hearing aid to both normal hearing and hearing-impaired groups. Furthermore, the sentences were presented with one of the two background noise conditions: the Hagerman original speech-shaped noise or four-talker babble. Each noise condition was also presented with three different hearing processing settings: linear processing, fast compression, and noise reduction. RESULTS Cognitive functioning was significantly related to speech-in-noise identification. Moreover, aging had a significant effect on both speech-in-noise and cognitive functioning. With regression weights constrained to be equal for the two groups, the final model had the best fit to the data. Importantly, the results showed that the relationship between cognitive functioning and speech-in-noise was not different for the two groups. Furthermore, the same pattern was evident for aging: the effects of aging on cognitive functioning and aging on speech-in-noise were not different between groups. CONCLUSION Our findings revealed similar cognitive functioning and aging effects on speech-in-noise performance in older normal-hearing and aided hearing-impaired listeners. In conclusion, the findings support the Ease of Language Understanding model as cognitive processes play a critical role in speech-in-noise independent from the hearing status of elderly individuals.
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Song F, Zhan Y, Ford JC, Cai DC, Fellows AM, Shan F, Song P, Chen G, Soli SD, Shi Y, Buckey JC. Increased Right Frontal Brain Activity During the Mandarin Hearing-in-Noise Test. Front Neurosci 2020; 14:614012. [PMID: 33390894 PMCID: PMC7773781 DOI: 10.3389/fnins.2020.614012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 11/26/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose Previous studies have revealed increased frontal brain activation during speech comprehension in background noise. Few, however, used tonal languages. The normal pattern of brain activation during a challenging speech-in-nose task using a tonal language remains unclear. The Mandarin Hearing-in-Noise Test (HINT) is a well-established test for assessing the ability to interpret speech in background noise. The current study used Mandarin HINT (MHINT) sentences and functional magnetic resonance imaging (fMRI) to assess brain activation with MHINT sentences. Methods Thirty native Mandarin-speaking subjects with normal peripheral hearing were recruited. Functional MRI was performed while subjects were presented with either HINT “clear” sentences with low-level background noise [signal-to-noise ratio (SNR) = +3 dB] or “noisy” sentences with high-level background noise (SNR = −5 dB). Subjects were instructed to answer with a button press whether a visually presented target word was included in the sentence. Brain activation between noisy and clear sentences was compared. Activation in each condition was also compared to a resting, no sentence presentation, condition. Results Noisy sentence comprehension showed increased activity in areas associated with tone processing and working memory, including the right superior and middle frontal gyri [Brodmann Areas (BAs) 46, 10]. Reduced activity with noisy sentences was seen in auditory, language, memory and somatosensory areas, including the bilateral superior and middle temporal gyri, left Heschl’s gyrus (BAs 21, 22), right temporal pole (BA 38), bilateral amygdala-hippocampus junction, and parahippocampal gyrus (BAs 28, 35), left inferior parietal lobule extending to left postcentral gyrus (BAs 2, 40), and left putamen. Conclusion Increased frontal activation in the right hemisphere occurred when comprehending noisy spoken sentences in Mandarin. Compared to studies using non-tonal languages, this activation was strongly right-sided and involved subregions not previously reported. These findings may reflect additional effort in lexical tone perception in this tonal language. Additionally, this continuous fMRI protocol may offer a time-efficient way to assess group differences in brain activation with a challenging speech-in-noise task.
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Affiliation(s)
- Fengxiang Song
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yi Zhan
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - James C Ford
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, NH, United States
| | - Dan-Chao Cai
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Abigail M Fellows
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Fei Shan
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Pengrui Song
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Guochao Chen
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | | | - Yuxin Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Jay C Buckey
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
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Megarbane L, Fuente A. Association between speech perception in noise and electrophysiological measures: an exploratory study of possible techniques to evaluate cochlear synaptopathy in humans. Int J Audiol 2020; 59:427-433. [DOI: 10.1080/14992027.2020.1718783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Lynn Megarbane
- Audiology Department, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK
- École d’orthophonie et d’audiologie, Faculté de médecine, Université de Montréal and Centre de recherche de l’Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
| | - Adrian Fuente
- École d’orthophonie et d’audiologie, Faculté de médecine, Université de Montréal and Centre de recherche de l’Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
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Rönnberg J, Holmer E, Rudner M. Cognitive hearing science and ease of language understanding. Int J Audiol 2019; 58:247-261. [DOI: 10.1080/14992027.2018.1551631] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Jerker Rönnberg
- Department of Behavioural Sciences and Learning, Linnaeus Centre HEAD, The Swedish Institute for Disability Research, Linköping University, Linköping, Sweden
| | - Emil Holmer
- Department of Behavioural Sciences and Learning, Linnaeus Centre HEAD, The Swedish Institute for Disability Research, Linköping University, Linköping, Sweden
| | - Mary Rudner
- Department of Behavioural Sciences and Learning, Linnaeus Centre HEAD, The Swedish Institute for Disability Research, Linköping University, Linköping, Sweden
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