Effects of age on auditory and cognitive processing: implications for hearing aid fitting and audiologic rehabilitation

Audiological ototoxicity monitoring guidelines: a review of current evidence and appraisal of quality using the AGREE II tool

OBJECTIVE

The effectiveness of audiological monitoring for detecting early hearing changes in patients receiving ototoxic medication could be limited by the lack of adequate audiological ototoxicity monitoring (OtoM) guidelines. This study aimed to evaluate existing OtoM guidelines using the AGREE II tool for guideline evaluation.

DESIGN

Guideline Review.

STUDY SAMPLE

Three audiological OtoM guidelines.

RESULTS

An online search identified three audiological OtoM guidelines published by the American Speech-Language and Hearing Association (ASHA), the American Academy of Audiology (AAA) and the Health Professionals Council of South Africa (HPCSA). Evaluation using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool found the HPCSA audiological OtoM guideline scored higher than the ASHA and AAA guidelines in five of the six tool domains. All guidelines received average domain ratings of less than 50% with each reviewer recommending all three guidelines for use following modification.

CONCLUSION

The findings of this study could partly explain the poor uptake of audiological OtoM practices internationally, further investigation is needed to identify the specific factors limiting the implementation of audiological OtoM in clinical practice.

Older adults do not show enhanced benefits from multisensory information on speeded perceptual discrimination tasks

Some research has shown that older adults benefit more from multisensory information than do young adults. However, more recent evidence has shown that the multisensory age benefit varies considerably across tasks. In the current study, older (65 - 80) and young (18 - 30) adults (N = 191) completed a speeded perceptual discrimination task either online or face-to-face to assess task response speed. We examined whether presenting stimuli in multiple sensory modalities (audio-visual) instead of one (audio-only or visual-only) benefits older adults more than young adults. Across all three experiments, a consistent speeding of response was found in the multisensory condition compared to the unisensory conditions for both young and older adults. Furthermore, race model analysis showed a significant multisensory benefit across a broad temporal interval. Critically, there were no significant differences between young and older adults. Taken together, these findings provide strong evidence in favour of a multisensory benefit that does not differ across age groups, contrasting with prior research.

Effect of concurrent exposure to noise and hand-transmitted vibration on auditory and cognitive attention under simulated work with construction tools

Objectives. This study aimed to investigate the effects of separate and concurrent exposure to occupational noise and hand-transmitted vibration (HTV) on auditory and cognitive attention. Methods. The experimental study was conducted with 40 construction workers who were exposed to noise (A-weighted equivalent sound pressure level of 90 dB) and to HTV (10 m/s2 at 31.5 Hz), and concurrent exposure to both for 30 min under simulated work with vibrating equipment used in construction. Cognitive performance aspects were then evaluated from each individual in two pre-exposure and post-exposure settings for each session. Results. The effect sizes of concurrent exposure (HTV + noise) and separate exposure to noise on auditory attention were very close (effect size = 0.648 and 0.626). The largest changes in the difference of response time in both types of attention (selective and divided attention) were related to the concurrent exposure scenario and then exposure to HTV, respectively. The highest effects for the correct response of selective and divided attention are related to concurrent exposure (HTV + noise) and then noise exposure, respectively. Conclusion. The HTV effect during concurrent exposure is hidden in auditory attention, and noise has the main effects. The divided attention was more affected than the selective attention in the different scenarios.

Can Music Enhance Working Memory and Speech in Noise Perception in Cochlear Implant Users? Design Protocol for a Randomized Controlled Behavioral and Electrophysiological Study

BACKGROUND

A cochlear implant (CI) enables deaf people to understand speech but due to technical restrictions, users face great limitations in noisy conditions. Music training has been shown to augment shared auditory and cognitive neural networks for processing speech and music and to improve auditory-motor coupling, which benefits speech perception in noisy listening conditions. These are promising prerequisites for studying multi-modal neurologic music training (NMT) for speech-in-noise (SIN) perception in adult cochlear implant (CI) users. Furthermore, a better understanding of the neurophysiological correlates when performing working memory (WM) and SIN tasks after multi-modal music training with CI users may provide clinicians with a better understanding of optimal rehabilitation.

METHODS

Within 3 months, 81 post-lingual deafened adult CI recipients will undergo electrophysiological recordings and a four-week neurologic music therapy multi-modal training randomly assigned to one of three training focusses (pitch, rhythm, and timbre). Pre- and post-tests will analyze behavioral outcomes and apply a novel electrophysiological measurement approach that includes neural tracking to speech and alpha oscillation modulations to the sentence-final-word-identification-and-recall test (SWIR-EEG). Expected outcome: Short-term multi-modal music training will enhance WM and SIN performance in post-lingual deafened adult CI recipients and will be reflected in greater neural tracking and alpha oscillation modulations in prefrontal areas. Prospectively, outcomes could contribute to understanding the relationship between cognitive functioning and SIN besides the technical deficits of the CI. Targeted clinical application of music training for post-lingual deafened adult CI carriers to significantly improve SIN and positively impact the quality of life can be realized.

Cochlear Implant Qualification in Noise Versus Quiet: Do Patients Demonstrate Similar Postoperative Benefits?

OBJECTIVE

To assess patient factors, audiometric performance, and patient-reported outcomes in cochlear implant (CI) patients who would not have qualified with in-quiet testing alone.

STUDY DESIGN

Retrospective chart review.

SETTING

Tertiary referral center.

METHODS

Adult CI recipients implanted between 2012 and 2022 were identified. Patients with preoperative AzBio Quiet > 60% in the implanted ear, requiring multitalker babble to qualify, comprised the in-noise qualifying (NQ) group. NQ postoperative performance was compared with the in-quiet qualifying (QQ) group using CNC, AzBio Quiet, and AzBio +5 dB signal-to-noise ratio. Speech, Spatial and Qualities of Hearing Scale (SSQ), Cochlear Implant Quality of Life scale (CIQOL-10), and daily device usage were also compared between the groups.

RESULTS

The QQ group (n = 771) and NQ group (n = 67) were similar in age and hearing loss duration. NQ had higher average preoperative and postoperative speech recognition scores. A larger proportion of QQ saw significant improvement in CNC and AzBio Quiet scores in the CI-only listening condition (eg, CI-only AzBio Quiet: 88% QQ vs 51% NQ, P < .001). Improvement in CI-only AzBio +5 dB and in all open set testing in the best-aided binaural listening condition was similar between groups (eg, Binaural AzBio Quiet 73% QQ vs 59% NQ, P = .345). Postoperative SSQ ratings, CIQOL scores, and device usage were also equivalent between both groups.

CONCLUSION

Patients who require in-noise testing to meet CI candidacy demonstrate similar improvements in best-aided speech perception and patient-reported outcomes as in-QQ, supporting the use of in-noise testing to determine CI qualification for borderline CI candidates.

rTMS of the auditory association cortex improves speech intelligibility in patients with sensorineural hearing loss

OBJECTIVE

Sensorineural hearing-loss (SHL) is accompanied by changes in the entire ear-brain pathway and its connected regions. While hearing-aid (HA) partially compensates for SHL, speech perception abilities often continue to remain poor, resulting in consequences in everyday activities. Repetitive transcranial magnetic stimulation (rTMS) promotes cortical network plasticity and may enhance language comprehension in SHL patients.

METHODS

27 patients using HA and with SHL were randomly assigned to a treatment protocol consisting of five consecutive days of either real (Active group: 13 patients) or placebo rTMS (Sham group: 14 patients). The stimulation parameters were as follows: 2-second trains at 10 Hz, 4-second inter-train-interval, and 1800 pulses. Neuronavigated rTMS was applied over the left superior temporal sulcus. Audiological tests were administered before (T0), immediately after (T1), and one week following treatment completion (T2) to evaluate the speech reception threshold (SRT) and the Pure Tone Average (PTA).

RESULTS

In the context of a general improvement likely due to learning, the treatment with real rTMS induced significant reduction of the SRT and PTA at T1 and T2 versus placebo.

CONCLUSIONS

The long-lasting effects on SRT and PTA observed in the Active group indicates that rTMS administered over the auditory cortex could promote sustained neuromodulatory-induced changes in the brain, improving the perception of complex sentences and pure tones reception skills.

SIGNIFICANCE

Five days of rTMS treatment enhances overall speech intelligibility and PTA in SHL patients.

The P300 Auditory Evoked Potential: A Physiological Measure of the Engagement of Cognitive Systems Contributing to Listening Effort?

OBJECTIVES

This study aimed to explore the potential of the P300 (P3b) as a physiological measure of the engagement of cognitive systems contributing to listening effort.

DESIGN

Nineteen right-handed young adults (mean age: 24.79 years) and 20 right-handed older adults (mean age: 58.90 years) with age-appropriate hearing were included. The P300 was recorded at Fz, Cz, and Pz using a two-stimulus oddball paradigm with the Flemish monosyllabic numbers "one" and "three" as standard and deviant stimuli, respectively. This oddball paradigm was conducted in three listening conditions, varying in listening demand: one quiet and two noisy listening conditions (+4 and -2 dB signal to noise ratio [SNR]). At each listening condition, physiological, behavioral, and subjective tests of listening effort were administered. P300 amplitude and latency served as a potential physiological measure of the engagement of cognitive systems contributing to listening effort. In addition, the mean reaction time to respond to the deviant stimuli was used as a behavioral listening effort measurement. Last, subjective listening effort was administered through a visual analog scale. To assess the effects of listening condition and age group on each of these measures, linear mixed models were conducted. Correlation coefficients were calculated to determine the relationship between the physiological, behavioral, and subjective measures.

RESULTS

P300 amplitude and latency, mean reaction time, and subjective scores significantly increased as the listening condition became more taxing. Moreover, a significant group effect was found for all physiological, behavioral, and subjective measures, favoring young adults. Last, no clear relationships between the physiological, behavioral, and subjective measures were found.

CONCLUSIONS

The P300 was considered a physiological measure of the engagement of cognitive systems contributing to listening effort. Because advancing age is associated with hearing loss and cognitive decline, more research is needed on the effects of all these variables on the P300 to further explore its usefulness as a listening effort measurement for research and clinical purposes.

The effect of age on the hearing-related quality of life in normal-hearing adults

INTRODUCTION

Recently, a new holistic Patient Reported Outcome Measure (PROM) to assess hearing-related quality of life was developed, named the hearing-related quality of life questionnaire for Auditory-VIsual, COgnitive and Psychosocial functioning (hAVICOP). The purpose of the current study was to evaluate if the hAVICOP is sufficiently sensitive to detect an age effect in the hearing-related quality of life.

METHODS

One-hundred thirteen normal-hearing participants (mean age: 42.13; range: 19 to 69 years) filled in the entire hAVICOP questionnaire online through the Research Electronic Data Capture surface. The hAVICOP consists of 27 statements, across three major subdomains (auditory-visual, cognitive, and psychosocial functioning), which have to be rated on a visual analogue scale ranging from 0 (rarely to never) to 100 (almost always). Mean scores were calculated for each subdomain separately as well as combined within a total score; the worse one's hearing-related quality of life, the lower the score. Linear regression models were run to predict the hAVICOP total as well as the three subdomain scores from age and sex.

RESULTS

A significant main effect of age was observed for the total hAVICOP and all three subdomain scores, indicating a decrease in hearing-related quality of life with increasing age. For none of the analyses, a significant sex effect was found.

CONCLUSION

The hAVICOP is sufficiently sensitive to detect an age effect in the hearing-related quality of life within a large group of normal-hearing adults, emphasizing its clinical utility. This age effect on the hearing-related quality of life might be related to the interplay of age-related changes in the bottom-up and top-down processes involved during speech processing.

Age-related changes in auditory perception. Hearing loss in the elderly: aging ear or aging brain?

Hearing loss in the elderly is a very common disease: it is estimated to affect up to a third of the population aged 65 years or more, and 50% of people over 75 years old. There is a growing amount of data concerning the association between hearing loss and cognitive decline. Various possible mechanisms at the basis of this association have been proposed, such as the "common cause hypothesis," the "cascade hypothesis," and the "cognitive load hypothesis."Critically reviewing the data is essential to highlight the features of the relationship between hearing loss and cognitive decline. Most of the hearing tests available should take into account that dementia or even just mild cognitive impairment (MCI) may lead to poor performance during examination. On the other hand, clinicians should also remember that tests used to assess cognitive function require an adequate hearing capacity.In this article we propose to analyze current diagnostic tests, treatment options, auditory processing, and rehabilitation strategies for hearing loss in the elderly in order to facilitate the management of this handicap in this fragile population.

The relationship between age, acceptable noise level, and listening effort in middle-aged and older-aged individuals

Objective

The purpose of the study was to evaluate listening effort in adults who experience varied annoyance towards noise.

Materials and methods

Fifty native Kannada-speaking adults aged 41-68 years participated. We evaluated the participant's acceptable noise level while listening to speech. Further, a sentence-final word-identification and recall test at 0 dB SNR (less favorable condition) and 4 dB SNR (relatively favorable condition) was used to assess listening effort. The repeat and recall scores were obtained for each condition.

Results

The regression model revealed that the listening effort increased by 0.6% at 0 dB SNR and by 0.5% at 4 dB SNR with every one-year advancement in age. Listening effort increased by 0.9% at 0 dB SNR and by 0.7% at 4 dB SNR with every one dB change in the value of Acceptable Noise Level (ANL). At 0 dB SNR and 4 dB SNR, a moderate and mild negative correlation was noted respectively between listening effort and annoyance towards noise when the factor age was controlled.

Conclusion

Listening effort increases with age, and its effect is more in less favorable than in relatively favorable conditions. However, if the annoyance towards noise was controlled, the impact of age on listening effort was reduced. Listening effort correlated with the level of annoyance once the age effect was controlled. Furthermore, the listening effort was predicted from the ANL to a moderate degree.

Effect of age on lateralized auditory processing

The lateralization of processing in the auditory cortex for different acoustic parameters differs depending on stimuli and tasks. Thus, processing complex auditory stimuli requires an efficient hemispheric interaction. Anatomical connectivity decreases with aging and consequently affects the functional interaction between the left and right auditory cortex and lateralization of auditory processing. Here we studied with magnetic resonance imaging the effect of aging on the lateralization of processing and hemispheric interaction during two tasks utilizing the contralateral noise procedure. Categorization of tones according to their direction of frequency modulations (FM) is known to be processed mainly in the right auditory cortex. Sequential comparison of the same tones according to their FM direction strongly involves additionally the left auditory cortex and therefore a stronger hemispheric interaction than the categorization task. The results showed that older adults more strongly recruit the auditory cortex especially during the comparison task that requires stronger hemispheric interaction. This was the case although the task difficulty was adapted to achieve similar performance as the younger adults. Additionally, functional connectivity from auditory cortex to other brain areas was stronger in older than younger adults especially during the comparison task. Diffusion tensor imaging data showed a reduction in fractional anisotropy and an increase in mean diffusivity in the corpus callosum of older adults compared to younger adults. These changes indicate a reduction of anatomical interhemispheric connections in older adults that makes larger processing capacity necessary when tasks require functional hemispheric interaction.

Stability of neural representations in the auditory midbrain across the lifespan despite age-related brainstem delays

The extent to which aging of the central auditory pathway impairs auditory perception in the elderly independent of peripheral cochlear decline is debated. To cause auditory deficits in normal hearing elderly, central aging needs to degrade neural sound representations at some point along the auditory pathway. However, inaccessible to psychophysical methods, the level of the auditory pathway at which aging starts to effectively degrade neural sound representations remains poorly differentiated. Here we tested how potential age-related changes in the auditory brainstem affect the stability of spatiotemporal multiunit complex speech-like sound representations in the auditory midbrain of old normal hearing CBA/J mice. Although brainstem conduction speed slowed down in old mice, the change was limited to the sub-millisecond range and only minimally affected temporal processing in the midbrain (i.e. gaps-in-noise sensitivity). Importantly, besides the small delay, multiunit complex temporal sound representations in the auditory midbrain did not differ between young and old mice. This shows that although small age-related neural effects in simple sound parameters in the lower brainstem may be present in aging they do not effectively deteriorate complex neural population representations at the level of the auditory midbrain when peripheral hearing remains normal. This result challenges the widespread belief of 'pure' central auditory decline as an automatic consequence of aging, at least up to the inferior colliculus. However, the stability of midbrain processing in aging emphasizes the role of undetected 'hidden' peripheral damage and accumulating effects in higher cortical auditory-cognitive processing explaining perception deficits in 'normal hearing' elderly.

Considering Individuals' Hearing Ability Before Administering Cognitive Assessments

Sensory impairments such as age-related hearing loss and poor eyesight have been associated with a negative impact on cognitive screening test scores. Many researchers use cognitive tests and consider factors such as vision and cardiac issues but do not account for hearing loss. We reviewed published literature in the field of gerontology to determine if hearing loss was considered in human subjects research that involved the administration of a cognitive battery or screening test. We present evidence for the need to consider hearing loss when administering cognitive screening tests, as well as recommendations for practitioners and researchers.

Cortical-brainstem interplay during speech perception in older adults with and without hearing loss

Introduction

Real time modulation of brainstem frequency-following responses (FFRs) by online changes in cortical arousal state via the corticofugal (top-down) pathway has been demonstrated previously in young adults and is more prominent in the presence of background noise. FFRs during high cortical arousal states also have a stronger relationship with speech perception. Aging is associated with increased auditory brain responses, which might reflect degraded inhibitory processing within the peripheral and ascending pathways, or changes in attentional control regulation via descending auditory pathways. Here, we tested the hypothesis that online corticofugal interplay is impacted by age-related hearing loss.

Methods

We measured EEG in older adults with normal-hearing (NH) and mild to moderate hearing-loss (HL) while they performed speech identification tasks in different noise backgrounds. We measured α power to index online cortical arousal states during task engagement. Subsequently, we split brainstem speech-FFRs, on a trial-by-trial basis, according to fluctuations in concomitant cortical α power into low or high α FFRs to index cortical-brainstem modulation.

Results

We found cortical α power was smaller in the HL than the NH group. In NH listeners, α-FFRs modulation for clear speech (i.e., without noise) also resembled that previously observed in younger adults for speech in noise. Cortical-brainstem modulation was further diminished in HL older adults in the clear condition and by noise in NH older adults. Machine learning classification showed low α FFR frequency spectra yielded higher accuracy for classifying listeners' perceptual performance in both NH and HL participants. Moreover, low α FFRs decreased with increased hearing thresholds at 0.5-2 kHz for clear speech but noise generally reduced low α FFRs in the HL group.

Discussion

Collectively, our study reveals cortical arousal state actively shapes brainstem speech representations and provides a potential new mechanism for older listeners' difficulties perceiving speech in cocktail party-like listening situations in the form of a miss-coordination between cortical and subcortical levels of auditory processing.

Noise-Vocoded Sentence Recognition and the Use of Context in Older and Younger Adult Listeners

PURPOSE

When listening to speech under adverse conditions, older adults, even with "age-normal" hearing, face challenges that may lead to poorer speech recognition than their younger peers. Older listeners generally demonstrate poorer suprathreshold auditory processing along with aging-related declines in neurocognitive functioning that may impair their ability to compensate using "top-down" cognitive-linguistic functions. This study explored top-down processing in older and younger adult listeners, specifically the use of semantic context during noise-vocoded sentence recognition.

METHOD

Eighty-four adults with age-normal hearing (45 young normal-hearing [YNH] and 39 older normal-hearing [ONH] adults) participated. Participants were tested for recognition accuracy for two sets of noise-vocoded sentence materials: one that was semantically meaningful and the other that was syntactically appropriate but semantically anomalous. Participants were also tested for hearing ability and for neurocognitive functioning to assess working memory capacity, speed of lexical access, inhibitory control, and nonverbal fluid reasoning, as well as vocabulary knowledge.

RESULTS

The ONH and YNH listeners made use of semantic context to a similar extent. Nonverbal reasoning predicted recognition of both meaningful and anomalous sentences, whereas pure-tone average contributed additionally to anomalous sentence recognition. None of the hearing, neurocognitive, or language measures significantly predicted the amount of context gain, computed as the difference score between meaningful and anomalous sentence recognition. However, exploratory cluster analyses demonstrated four listener profiles and suggested that individuals may vary in the strategies used to recognize speech under adverse listening conditions.

CONCLUSIONS

Older and younger listeners made use of sentence context to similar degrees. Nonverbal reasoning was found to be a contributor to noise-vocoded sentence recognition. However, different listeners may approach the problem of recognizing meaningful speech under adverse conditions using different strategies based on their hearing, neurocognitive, and language profiles. These findings provide support for the complexity of bottom-up and top-down interactions during speech recognition under adverse listening conditions.

No Link Between Speech-in-Noise Perception and Auditory Sensory Memory - Evidence From a Large Cohort of Older and Younger Listeners

A growing literature is demonstrating a link between working memory (WM) and speech-in-noise (SiN) perception. However, the nature of this correlation and which components of WM might underlie it, are being debated. We investigated how SiN reception links with auditory sensory memory (aSM) - the low-level processes that support the short-term maintenance of temporally unfolding sounds. A large sample of old (N = 199, 60-79 yo) and young (N = 149, 20-35 yo) participants was recruited online and performed a coordinate response measure-based speech-in-babble task that taps listeners' ability to track a speech target in background noise. We used two tasks to investigate implicit and explicit aSM. Both were based on tone patterns overlapping in processing time scales with speech (presentation rate of tones 20 Hz; of patterns 2 Hz). We hypothesised that a link between SiN and aSM may be particularly apparent in older listeners due to age-related reduction in both SiN reception and aSM. We confirmed impaired SiN reception in the older cohort and demonstrated reduced aSM performance in those listeners. However, SiN and aSM did not share variability. Across the two age groups, SiN performance was predicted by a binaural processing test and age. The results suggest that previously observed links between WM and SiN may relate to the executive components and other cognitive demands of the used tasks. This finding helps to constrain the search for the perceptual and cognitive factors that explain individual variability in SiN performance.

Evaluation of deep marginal feedback cancellation for hearing aids using speech and music

Speech and music both play fundamental roles in daily life. Speech is important for communication while music is important for relaxation and social interaction. Both speech and music have a large dynamic range. This does not pose problems for listeners with normal hearing. However, for hearing-impaired listeners, elevated hearing thresholds may result in low-level portions of sound being inaudible. Hearing aids with frequency-dependent amplification and amplitude compression can partly compensate for this problem. However, the gain required for low-level portions of sound to compensate for the hearing loss can be larger than the maximum stable gain of a hearing aid, leading to acoustic feedback. Feedback control is used to avoid such instability, but this can lead to artifacts, especially when the gain is only just below the maximum stable gain. We previously proposed a deep-learning method called DeepMFC for controlling feedback and reducing artifacts and showed that when the sound source was speech DeepMFC performed much better than traditional approaches. However, its performance using music as the sound source was not assessed and the way in which it led to improved performance for speech was not determined. The present paper reveals how DeepMFC addresses feedback problems and evaluates DeepMFC using speech and music as sound sources with both objective and subjective measures. DeepMFC achieved good performance for both speech and music when it was trained with matched training materials. When combined with an adaptive feedback canceller it provided over 13 dB of additional stable gain for hearing-impaired listeners.

Age effects on cognitive functions and speech-in-noise processing: An event-related potential study with cochlear-implant users and normal-hearing listeners

A cochlear implant (CI) can partially restore hearing in individuals with profound sensorineural hearing loss. However, electrical hearing with a CI is limited and highly variable. The current study aimed to better understand the different factors contributing to this variability by examining how age affects cognitive functions and cortical speech processing in CI users. Electroencephalography (EEG) was applied while two groups of CI users (young and elderly; N = 13 each) and normal-hearing (NH) listeners (young and elderly; N = 13 each) performed an auditory sentence categorization task, including semantically correct and incorrect sentences presented either with or without background noise. Event-related potentials (ERPs) representing earlier, sensory-driven processes (N1-P2 complex to sentence onset) and later, cognitive-linguistic integration processes (N400 to semantically correct/incorrect sentence-final words) were compared between the different groups and speech conditions. The results revealed reduced amplitudes and prolonged latencies of auditory ERPs in CI users compared to NH listeners, both at earlier (N1, P2) and later processing stages (N400 effect). In addition to this hearing-group effect, CI users and NH listeners showed a comparable background-noise effect, as indicated by reduced hit rates and reduced (P2) and delayed (N1/P2) ERPs in conditions with background noise. Moreover, we observed an age effect in CI users and NH listeners, with young individuals showing improved specific cognitive functions (working memory capacity, cognitive flexibility and verbal learning/retrieval), reduced latencies (N1/P2), decreased N1 amplitudes and an increased N400 effect when compared to the elderly. In sum, our findings extend previous research by showing that the CI users' speech processing is impaired not only at earlier (sensory) but also at later (semantic integration) processing stages, both in conditions with and without background noise. Using objective ERP measures, our study provides further evidence of strong age effects on cortical speech processing, which can be observed in both the NH listeners and the CI users. We conclude that elderly individuals require more effortful processing at sensory stages of speech processing, which however seems to be at the cost of the limited resources available for the later semantic integration processes.

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

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 (M_age = 69.7 years) individuals with hearing impairment and a group of age normal-hearing adults (M_age = 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.

Functional changes in the auditory cortex and associated regions caused by different acoustic stimuli in patients with presbycusis and tinnitus

Presbycusis and tinnitus are the two most common hearing related pathologies. Although both of these conditions presumably originate in the inner ear, there are several reports concerning their central components. Interestingly, the onset of presbycusis coincides with the highest occurrence of tinnitus. The aim of this study was to identify age, hearing loss, and tinnitus related functional changes, within the auditory system and its associated structures. Seventy-eight participants were selected for the study based on their age, hearing, and tinnitus, and they were divided into six groups: young controls (Y-NH-NT), subjects with mild presbycusis (O-NH-NT) or expressed presbycusis (O-HL-NT), young subjects with tinnitus (Y-NH-T), subjects with mild presbycusis and tinnitus (O-NH-T), and subjects with expressed presbycusis and tinnitus (O-HL-T). An MRI functional study was performed with a 3T MRI system, using an event related design (different types of acoustic and visual stimulations and their combinations). The amount of activation of the auditory cortices (ACs) was dependent on the complexity of the stimuli; higher complexity resulted in a larger area of the activated cortex. Auditory stimulation produced a slightly greater activation in the elderly, with a negative effect of hearing loss (lower activation). The congruent audiovisual stimulation led to an increased activity within the default mode network, whereas incongruent stimulation led to increased activation of the visual cortex. The presence of tinnitus increased activation of the AC, specifically in the aged population, with a slight prevalence in the left AC. The occurrence of tinnitus was accompanied by increased activity within the insula and hippocampus bilaterally. Overall, we can conclude that expressed presbycusis leads to a lower activation of the AC, compared to the elderly with normal hearing; aging itself leads to increased activity in the right AC. The complexity of acoustic stimuli plays a major role in the activation of the AC, its support by visual stimulation leads to minimal changes within the AC. Tinnitus causes changes in the activity of the limbic system, as well as in the auditory AC, where it is bound to the left hemisphere.

Immediate Effects of (Simulated) Age-Related Hearing Loss on Cognitive Processing and Performance for the Backward-Digit-Span Task

The recall of auditorily presented sequences of digits in reverse order (also known as the Backward Digit Span, BDS) is considered to reflect a person's information storage and processing abilities which have been linked to speech-in-noise intelligibility. However, especially in aging research and audiology, persons who are administered the BDS task are often affected by hearing loss (HL). If uncorrected, HL can have immediate assessment-format-related effects on cognitive-test performance and can result, in the long term, in neuroplastic changes impacting cognitive functioning. In the present study, an impairment-simulation approach, mimicking mild-to-moderate age-related HLs typical for persons aged 65, 75, and 85 years, was used in 19 young normal-hearing participants to evaluate the impact of HL on cognitive performance and the cognitive processes probed by the BDS task. Participants completed the BDS task in several listening conditions, as well as several commonly used visual tests of short-term and working memory. The results indicated that BDS performance was impaired by a simulated HL representing that of persons aged 75 years and above. In the normal-hearing condition, BDS performance correlated positively with both performance on tests of short-term memory and performance on tests of working memory. In the listening condition simulating moderate HL (as experienced by the average 85-year-old person), BDS performance only correlated with performance on working-memory tests. In conclusion, simulated (and, by extrapolation, actual) age-related HL negatively affects cognitive-test performance and may change the composition of the cognitive processes associated with the completion of a cognitive task.

Effects of aging on neural processing during an active listening task

Factors affecting successful listening in older adults and the corresponding electrophysiological signatures are not well understood. The present study investigated age-related differences in attention and temporal processing, as well as differences in the neural activity related to signal degradation during a number comparison task. Participants listened to digits presented in background babble and were tested at two levels of signal clarity, clear and degraded. Behavioral and electrophysiological measures were examined in 30 older and 20 younger neurologically-healthy adults. Relationships between performance on the number comparison task, behavioral measures, and neural activity were used to determine correlates of listening deficits associated with aging. While older participants showed poorer performance overall on all behavioral measures, their scores on the number comparison task were largely predicted (based on regression analyses) by their sensitivity to temporal fine structure cues. Compared to younger participants, older participants required higher signal-to-noise ratios (SNRs) to achieve equivalent performance on the number comparison task. With increasing listening demands, age-related changes were observed in neural processing represented by the early-N1 and later-P3 time windows. Source localization analyses revealed age differences in source activity for the degraded listening condition that was located in the left prefrontal cortex. In addition, this source activity negatively correlated with task performance in the older group. Together, these results suggest that older adults exhibit reallocation of processing resources to complete a demanding listening task. However, this effect was evident only for poorer performing older adults who showed greater posterior to anterior shift in P3 response amplitudes than older adults who were good performers and younger adults. These findings might reflect less efficient recruitment of neural resources that is associated with aging during effortful listening performance.

DSLchild-Algorithm-Based Hearing Aid Fitting Can Improve Speech Comprehension in Mildly Distressed Patients with Chronic Tinnitus and Mild-to-Moderate Hearing Loss

Background: Patients with chronic tinnitus and mild-to-moderate hearing loss (HL) can experience difficulties with speech comprehension (SC). The present study investigated SC benefits of a two-component hearing therapy. Methods: One-hundred-seventy-seven gender-stratified patients underwent binaural DSL_child-algorithm-based hearing aid (HA) fitting and conducted auditory training exercises. SC was measured at four timepoints under three noise interference conditions each (0, 55, and 65 dB): after screening (t₀; without HAs), HA- fitting (t₁), additional auditory training (t₂), and at 70-day follow-up (t₃). Repeated-measure analyses of covariance investigated the effects of HAs (t₀–t₁), auditory training (t₁–t₂), and the stability of the combined effect (t₂–t₃) on SC per noise interference level and HL subgroup. Correlational analyses examined associations between SC, age, and psychological indices. Results: Patients showed mildly elevated tinnitus-related distress, which was negatively associated with SC in patients with mild but not moderate HL. At 0 dB, the intervention lastingly improved SC for patients with mild and moderate HL; at 55 dB, for patients with mild HL only. These effects were mainly driven by HAs. Conclusions: The here-investigated treatment demonstrates some SC-benefit under conditions of no or little noise interference. The auditory training component warrants further investigation regarding non-audiological treatment outcomes.

The effect of aging on context use and reliance on context in speech: A behavioral experiment with Repeat–Recall Test

Purpose

To elucidate how aging would affect the extent of semantic context use and the reliance on semantic context measured with the Repeat–Recall Test (RRT).

Methods

A younger adult group (YA) aged between 18 and 25 and an older adult group (OA) aged between 50 and 65 were recruited. Participants from both the groups performed RRT: sentence repeat and delayed recall tasks, and subjective listening effort and noise tolerable time, under two noise types and seven signal-to-noise ratios (SNR). Performance–Intensity curves were fitted. The performance in SRT50 and SRT75 was predicted.

Results

For the repeat task, the OA group used more semantic context and relied more on semantic context than the YA group. For the recall task, OA used less semantic context but relied more on context than the YA group. Age did not affect the subjective listening effort but significantly affected noise tolerable time. Participants in both age groups could use more context in SRT75 than SRT50 on four tasks of RRT. Under the same SRT, however, the YA group could use more context in repeat and recall tasks than the OA group.

Conclusion

Age affected the use and reliance of semantic context. Even though the OA group used more context in speech recognition, they failed in speech information maintenance (recall) even with the help of semantic context. The OA group relied more on context while performing repeat and recall tasks. The amount of context used was also influenced by SRT.

The Views and Experience of Audiologists Working in Flemish Hearing Aid Centers Concerning Cognition Within Audiological Practice

PURPOSE

This study aimed to get insight into the views and experience of audiologists, employed in Flemish hearing aid centers, concerning cognition within audiological practice.

METHOD

An online 49-item questionnaire was developed and subdivided into five categories: (a) work setting, (b) practical experience regarding hearing aid fitting linked to cognition, (c) knowledge regarding the auditory-cognitive perspective of speech understanding, (d) willingness and guidelines to implement cognitive measures within audiological practice, and (e) demographics. Respondents were surveyed during January and February 2021.

RESULTS

One hundred twenty-nine audiologists working in Flemish hearing aid centers responded to the entire questionnaire and showed a mean work experience of 8.0 years. Results revealed that cognition was taken into account, especially within the anamnesis interview and general communication strategy, whereas only a minority took cognition into account when actually fitting hearing aids. Knowledge and experience did not determine whether or not respondents took cognition into account. A willingness to implement cognitive measures in a time-efficient manner in audiological practice was observed among respondents.

CONCLUSION

Evidence-based guidelines regarding hearing aid fitting based on an individual's auditory-cognitive profile are needed to improve the quality of hearing rehabilitation.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19593388.

The electrophysiological masking level difference: effects of age and mediation of hearing and cognition

OBJECTIVE

Evaluate the conceptual framework that age effects on the electrophysiological binaural masking level difference (MLD) are partially mediated by age-related hearing loss and/or global cognitive function via mediation analysis.

DESIGN

Participants underwent a series of audiometric tests. The MLD was measured via cortical auditory evoked potentials using a speech stimulus (/ɑ/) in speech-weighted background noise. We used mediation analyses to determine the total effect, natural direct effects, and natural indirect effects, which are displayed as regression coefficients ([95% CI]; p value).

STUDY SAMPLE

Twenty-eight individuals aged 19-87 years (mean [SD]: 53.3 [25.2]), recruited from the community.

RESULTS

Older age had a significant total effect on the MLD (-0.69 [95% CI: -0.96, -0.45]; p < 0.01). Neither pure tone average (-0.11 [95% CI: -0.43, 0.24; p = 0.54] nor global cognitive function (-0.02 [95% CI: -0.13, 0.02]; p = 0.55) mediated the relationship of age and the MLD and effect sizes were small. Results were insensitive to use of alternative hearing measures or inclusion of interaction terms.

CONCLUSIONS

The electrophysiological MLD may be an age-sensitive measure of binaural temporal processing that is minimally affected by age-related hearing loss and global cognitive function.

Prediction in the aging brain: Merging cognitive, neurological, and evolutionary perspectives

Although the aging brain is typically characterized by declines in a variety of cognitive functions, there has been growing attention to cognitive functions that may stabilize or improve with age. We integrate evidence from behavioral, computational, and neurological domains under the hypothesis that over the life span the brain becomes more effective at predicting (i.e., utilizing knowledge) compared to learning. Moving beyond mere description of the empirical literature—with the aim of arriving at a deeper understanding of cognitive aging—we provide potential explanations for a learning-to-prediction shift based on evolutionary models and principles of senescence and plasticity. The proposed explanations explore whether the occurrence of a learning-to-prediction shift can be explained by (changes in) the fitness effects of learning and prediction over the life span. Prediction may optimize (a) the allocation of limited resources across the life span, and/or (b) late-life knowledge transfer (social learning). Alternatively, late-life prediction may reflect a slower decline in prediction compared to learning. By discussing these hypotheses, we aim to provide a foundation for an integrative neurocognitive–evolutionary perspective on aging and to stimulate further theoretical and empirical work.

Lexical Effects on the Perceived Clarity of Noise-Vocoded Speech in Younger and Older Listeners

When listening to degraded speech, such as speech delivered by a cochlear implant (CI), listeners make use of top-down linguistic knowledge to facilitate speech recognition. Lexical knowledge supports speech recognition and enhances the perceived clarity of speech. Yet, the extent to which lexical knowledge can be used to effectively compensate for degraded input may depend on the degree of degradation and the listener's age. The current study investigated lexical effects in the compensation for speech that was degraded via noise-vocoding in younger and older listeners. In an online experiment, younger and older normal-hearing (NH) listeners rated the clarity of noise-vocoded sentences on a scale from 1 ("very unclear") to 7 ("completely clear"). Lexical information was provided by matching text primes and the lexical content of the target utterance. Half of the sentences were preceded by a matching text prime, while half were preceded by a non-matching prime. Each sentence also consisted of three key words of high or low lexical frequency and neighborhood density. Sentences were processed to simulate CI hearing, using an eight-channel noise vocoder with varying filter slopes. Results showed that lexical information impacted the perceived clarity of noise-vocoded speech. Noise-vocoded speech was perceived as clearer when preceded by a matching prime, and when sentences included key words with high lexical frequency and low neighborhood density. However, the strength of the lexical effects depended on the level of degradation. Matching text primes had a greater impact for speech with poorer spectral resolution, but lexical content had a smaller impact for speech with poorer spectral resolution. Finally, lexical information appeared to benefit both younger and older listeners. Findings demonstrate that lexical knowledge can be employed by younger and older listeners in cognitive compensation during the processing of noise-vocoded speech. However, lexical content may not be as reliable when the signal is highly degraded. Clinical implications are that for adult CI users, lexical knowledge might be used to compensate for the degraded speech signal, regardless of age, but some CI users may be hindered by a relatively poor signal.

Difficulties Experienced by Older Listeners in Utilizing Voice Cues for Speaker Discrimination

Human listeners are assumed to apply different strategies to improve speech recognition in background noise. Young listeners with normal hearing (NH), e.g., have been shown to follow the voice of a particular speaker based on the fundamental (F0) and formant frequencies, which are both influenced by the gender, age, and size of the speaker. However, the auditory and cognitive processes that underlie the extraction and discrimination of these voice cues across speakers may be subject to age-related decline. The present study aimed to examine the utilization of F0 and formant cues for voice discrimination (VD) in older adults with hearing expected for their age. Difference limens (DLs) for VD were estimated in 15 healthy older adults (65–78 years old) and 35 young adults (18–35 years old) using only F0 cues, only formant frequency cues, and a combination of F0 + formant frequencies. A three-alternative forced-choice paradigm with an adaptive-tracking threshold-seeking procedure was used. Wechsler backward digit span test was used as a measure of auditory working memory. Trail Making Test (TMT) was used to provide cognitive information reflecting a combined effect of processing speed, mental flexibility, and executive control abilities. The results showed that (a) the mean VD thresholds of the older adults were poorer than those of the young adults for all voice cues, although larger variability was observed among the older listeners; (b) both age groups found the formant cues more beneficial for VD, compared to the F0 cues, and the combined (F0 + formant) cues resulted in better thresholds, compared to each cue separately; (c) significant associations were found for the older adults in the combined F0 + formant condition between VD and TMT scores, and between VD and hearing sensitivity, supporting the notion that a decline with age in both top-down and bottom-up mechanisms may hamper the ability of older adults to discriminate between voices. The present findings suggest that older listeners may have difficulty following the voice of a specific speaker and thus implementing doing so as a strategy for listening amid noise. This may contribute to understanding their reported difficulty listening in adverse conditions.

The Longitudinal Association of Subclinical Hearing Loss With Cognition in the Health, Aging and Body Composition Study

Objectives

To examine the longitudinal association between subclinical hearing loss (SCHL) and neurocognitive performance.

Design

Longitudinal analyses were conducted among 2,110 subjects who underwent audiometric testing in a US multi-centered epidemiologic cohort study. The primary exposure was better ear hearing (pure tone average). SCHL was defined as hearing ≤ 25 dB. The primary outcome was neurocognitive performance, measured by Digit Symbol Substitution Test (DSST), Modified Mini Mental State Examination (3MS), and CLOX1. Linear mixed models were performed to assess the longitudinal association between hearing and cognitive performance, adjusting for covariates. Models were fit among all individuals and among individuals with SCHL only.

Results

Among 2,110 participants, mean (SD) age was 73.5 (2.9) years; 52.3% were women. Mean (SD) better ear pure tone average was 30.0 (13.1) dB. Mean follow-up was 9.1 years (range 3–16). Among all participants, worse hearing was associated with significantly steeper cognitive decline measured by the DSST [0.054-point/year steeper decrease per 10 dB worse hearing, 95% confidence interval (CI): 0.026–0.082] and 3MS (0.044-point/year steeper decrease per 10 dB worse hearing, CI: 0.026–0.062), but not CLOX1. Among those with SCHL, worse hearing was associated with significantly steeper cognitive performance decline as measured by DSST (0.121-point/year steeper decrease per 10 dB worse hearing, CI: 0.013–0.228), but not CLOX1 or 3MS.

Conclusion

Among those with SCHL, worse hearing was associated with steeper cognitive performance declines over time as measured by DSST. The relationship between hearing loss and cognition may begin at earlier levels of hearing loss than previously recognized.

Synchrony in Old Age: Playing the Mirror Game Improves Cognitive Performance

OBJECTIVES

Studies have shown that synchronized motion between people positively affects a range of emotional and social functions. The mirror-game is a synchrony-based paradigm, common to theater, performance arts, and therapy, which includes dyadic synchronized motion, playfulness, and spontaneity. The goal of the current study is to examine the effects of the mirror-game on subjective and cognitive indices in late life.

METHODS

Thirty-four older adults (aged 71-98) participated in a within-group study design. Participants conducted two sessions of 9-minute movement activities: the mirror-game and the control condition - a physical exercise class. Several measures were taken before and after experimental sessions to assess socio-emotional and attentional functions.

RESULTS

The mirror-game enhanced performance on the attention sub-scale and led to faster detections of spoken words in noise. Further, it enhanced perceived partner responsiveness and led to an increase in positive reported experience.

CONCLUSIONS

Our preliminary findings suggest that the mirror-game, rather than the exercise class, may have an immediate impact on mood and some attentional functions.

CLINICAL IMPLICATIONS

The mirror-game is a novel intervention, with potential benefits of social-emotional and cognitive functioning, which can be easily implemented into the daily routine care of older adults. Future studies should explore the effect of the mirror-game on additional cognitive and socio-emotional aspects.

Speech Perception in Older Adults: An Interplay of Hearing, Cognition, and Learning?

Older adults with age-related hearing loss exhibit substantial individual differences in speech perception in adverse listening conditions. We propose that the ability to rapidly adapt to changes in the auditory environment (i.e., perceptual learning) is among the processes contributing to these individual differences, in addition to the cognitive and sensory processes that were explored in the past. Seventy older adults with age-related hearing loss participated in this study. We assessed the relative contribution of hearing acuity, cognitive factors (working memory, vocabulary, and selective attention), rapid perceptual learning of time-compressed speech, and hearing aid use to the perception of speech presented at a natural fast rate (fast speech), speech embedded in babble noise (speech in noise), and competing speech (dichotic listening). Speech perception was modeled as a function of the other variables. For fast speech, age [odds ratio (OR) = 0.79], hearing acuity (OR = 0.62), pre-learning (baseline) perception of time-compressed speech (OR = 1.47), and rapid perceptual learning (OR = 1.36) were all significant predictors. For speech in noise, only hearing and pre-learning perception of time-compressed speech were significant predictors (OR = 0.51 and OR = 1.53, respectively). Consistent with previous findings, the severity of hearing loss and auditory processing (as captured by pre-learning perception of time-compressed speech) was strong contributors to individual differences in fast speech and speech in noise perception. Furthermore, older adults with good rapid perceptual learning can use this capacity to partially offset the effects of age and hearing loss on the perception of speech presented at fast conversational rates. Our results highlight the potential contribution of dynamic processes to speech perception.

Speech Perception in Noise Is Associated With Different Cognitive Abilities in Chinese-Speaking Older Adults With and Without Hearing Aids

Chinese-speaking older adults usually do not perceive a hearing problem until audiometric thresholds exceed 45 dB HL, and the audiometric thresholds of the average hearing-aid (HA) user often exceed 60 dB HL. The purpose of this study was to examine the relationships between cognitive and hearing functions (measured as audiometric or speech reception thresholds) in older Chinese adults with HAs and with untreated hearing loss (HL). Participants were 49 Chinese older adults who used HAs and had moderate to severe HL (HA group), and 46 older Chinese who had mild to moderately severe HL but did not use HAs (untreated; or UT group). Multiple linear regression analysis was employed to evaluate how well age, education level, audiometric thresholds, and speech perception in noise were related to performance on general cognitive function, working memory, executive function, attention, and verbal learning tests. Results showed that speech perception in noise alone accounted for 13–25% of the variance in general cognitive function, working memory, and executive function in the UT group, and 9–21% of the variance in general cognitive function and verbal learning in the HA group (i.e., medium effect sizes). Audiometric thresholds did not explain any proportion of the variance in cognitive functioning in the HA or UT group. Thus, speech perception in noise accounts for more variance in cognitive performance than audiometric thresholds, and is significantly associated with different cognitive functions in older Chinese adults with HAs and with untreated HL.

Face mask use in healthcare settings: effects on communication, cognition, listening effort and strategies for amelioration

Aim

To investigate mask use and the difficulties it may pose during communication in healthcare settings.

Methods

A survey utilizing a series of Likert scales was administered. Mask use challenges between clinicians and their patients were examined in the domains of communication, listening effort, cognition, and rehabilitation.

Results

Across 243 participants, mask use significantly increased listening effort, with hearing loss having an additive effect on listening effort. Listening effort was also significantly associated with more trouble understanding conversation, decreased interest in conversation, more difficulty connecting with patients, changes in cognition for both providers and patients, and changes in the clinical efficiency of providers. Hearing loss had an additive effect for trouble understanding conversations and changes in clinical efficiency.

Conclusion

These results provide information about the clinical strain introduced from mask use in healthcare settings. Overall, results show that in healthcare settings there is increased cognitive load and listening effort for both patients and providers, as well as changes in clinical efficiency for providers when utilizing masks. These effects are often greater with hearing loss. Results showed that patients reported written and visual instructions would be most beneficial to include in appointments among the other rehabilitative strategies which are discussed.

Revisiting Auditory Profiling: Can Cognitive Factors Improve the Prediction of Aided Speech-in-Noise Outcome?

Hearing aids (HA) are the most common type of rehabilitation treatment for age-related hearing loss. However, HA users often obtain limited benefit from their devices, particularly in noisy environments, and thus many HA candidates do not use them at all. A possible reason for this could be that current HA fittings are audiogram-based, that is, they neglect supra-threshold factors. In an earlier study, an auditory-profiling method was proposed as a basis for more personalized HA fittings. This method classifies HA users into four profiles that differ in terms of hearing sensitivity and supra-threshold hearing abilities. Previously, HA users belonging to these profiles showed significant differences in terms of speech recognition in noise but not subjective assessments of speech-in-noise (SIN) outcome. Moreover, large individual differences within some profiles were observed. The current study therefore explored if cognitive factors can help explain these differences and improve aided outcome prediction. Thirty-nine older HA users completed sets of auditory and SIN tests as well as two tablet-based cognitive measures (the Corsi block-tapping and trail-making tests). Principal component analyses were applied to extract the dominant sources of variance both within individual tests producing many variables and within the three types of tests. Multiple linear regression analyses performed on the extracted components showed that auditory factors were related to aided speech recognition in noise but not to subjective SIN outcome. Cognitive factors were unrelated to aided SIN outcome. Overall, these findings provide limited support for adding those two cognitive tests to the profiling of HA users.

The effects of stimulus modality, task complexity, and cuing on working memory and the relationship with speech recognition in older cochlear implant users

INTRODUCTION

The role of working memory (WM) in speech recognition of older cochlear implant (CI) users remains unclear. This study 1) examined the effects of aging and CI on WM performance across different modalities (auditory vs. visual) and cuing conditions, and 2) assessed how specific WM measures relate to sentence and word recognition in noise.

METHOD

Fourteen Older CI users, 12 Older acoustic-hearing (AH) listeners with age-appropriate hearing loss, and 15 Young normal-hearing (NH) listeners were tested. Participants completed two simple span tasks (auditory digit and visual letter span), two complex WM tasks (reading span and cued-modality WM with simultaneously presented auditory digits and visual letters), and two speech recognition tasks (sentence and word recognition in speech-babble noise).

RESULTS

The groups showed similar simple span performance, except that Older CI users had lower auditory digit span than Young NH listeners. Both older groups had similar reading span performance, but scored significantly lower than Young NH listeners, indicating age-related declines in attentional and phonological processing. A similar group effect was observed in the cued-modality WM task. All groups showed higher recall for auditory digits than for visual letters and the advantage was most evident without modality cuing. All groups displayed greater cuing benefits for visual recall than for auditory recall, suggesting that participants consistently allocated more attention to auditory stimuli regardless of cuing. For Older CI users, after controlling for the previously reported spectral resolution, auditory-uncued WM performance was significantly correlated with word recognition but not sentence recognition.

CONCLUSIONS

Complex WM was significantly affected by aging but not by CI. Neither aging nor CI significantly affected modality cuing benefits in the WM task. For Older CI users, complex auditory WM with attentional control may better reflect the cognitive load of speech recognition in noise than simple span or complex visual WM.

Investigating the Role of Auditory Processing Abilities in Long-Term Self-Reported Hearing Aid Outcomes among Adults Age 60+ Years

BACKGROUND

Self-reported hearing aid outcomes among older adults are variable and important to improve. The extent of the role of auditory processing in long-term hearing aid outcomes is not well understood.

PURPOSE

To determine how auditory processing abilities are related to self-reported hearing aid satisfaction and benefit along with either aided audibility alone or exploratory factors suggested by previous literature.

RESEARCH DESIGN

Descriptive analyses and multiple regression analyses of cross-sectional self-reported outcomes.

STUDY SAMPLE

Adult participants, >60 years (n = 78), fitted with bilateral hearing aids to treat symmetric, mild to moderate sensorineural hearing loss.

DATA COLLECTION AND ANALYSIS

Participants were recruited from a single audiology clinic to complete a series of questionnaires, behavioral assessments, and obtain data from their hearing aids, including real ear measures and data logging of hearing aid use. Multiple linear regressions were used to determine the amount of variance explained by predictive factors in self-reported hearing aid satisfaction and benefit. The primary predictive factors included gap detection threshold, spatial advantage score, dichotic difference score, and aided audibility. Exploratory factors included personality, self-efficacy, self-report of disability, and hearing aid use. All interpretations of statistical significance used p < 0.05. Effect sizes were determined using Cohen's f ² with a medium effect suggesting clinical relevance.

RESULTS

Gap detection threshold was a statistically significant predictor in both primary regression models with a medium effect size for satisfaction and a small effect size for benefit. When additional exploratory factors were included in the regression models with auditory processing abilities, gap detection and self-efficacy were both significant predictors of hearing aid satisfaction with medium effect sizes, explaining 10 and 17% of the variance, respectively. There were no medium effect sizes found for other predictor variables in either the primary or exploratory hearing aid benefit models. Additional factors were statistically significant in the models, explaining a small amount of variance, but did not meet the medium effect size criterion.

CONCLUSION

This study provides initial evidence supporting the incorporation of measures of gap detection ability and hearing aid self-efficacy into clinical practice for the interpretation of postfitting long-term hearing aid satisfaction.

The Influence of Physical Environmental Factors on Older Adults in Residential Care Facilities in Northeast China

OBJECTIVES

To evaluate the aspects of the objective physical environments of five residential care facilities (RCFs) for older adults and the residents' subjective perceptions of these aspects.

BACKGROUND

The physical environment in RCFs impacts the health and comfort of the residents. However, the design standards for RCFs lack details which can result in insufficient living conditions.

METHODS

Through questionnaire surveys, older adults' satisfaction on the degree of the light, acoustic, and thermal environment in the facilities was obtained. Indoor lighting condition was measured by an illuminance meter in lux, sound pressure level (SPL) with sound level meters in dBA, and temperature in °C with a temperature data logger, and an audiometer was used to test the hearing of the older adults.

RESULTS

A total of 480 questionnaires were obtained. Results show that (a) older adults need an appropriate light environment to avoid the negative impact of limited light, (b) poor acoustic environment could affect their mood and health, and (c) when the room temperature is within the range of 20-26 °C (68-78.8 °F), they feel most comfortable. When the appropriate temperature and humidity, balanced illumination, and SPL meet the needs of older adults, it can provide a more comfortable physical environment for them.

CONCLUSION

Examining the interaction between the physical environmental factors that affect older adults in RCFs is important for the design of residential housing and provides more theoretical support for research on the influence of the physical environment on the quality of life of older adults.

Age-Related Difficulty of Listening Effort in Elderly

The present study identifies the combined effects of aging and listening environment related factors, such as directionality, types of stimuli, and the presence of background noise. A total of 50 listeners with normal hearing (25 older adults and 25 young adults) participated in a series of tasks. The detection task using tone and speech and a speech segregation task with two levels of background noise were conducted while sound was randomly presented via eight directional speakers. After completing each task, a subjective questionnaire using a seven-point Likert scale was asked to measure the amount of the subjects’ listening effort in terms of speech, spatial, and hearing quality. As expected, the amount of listening effort required in all the experiments for the older group was significantly higher than for their young counterparts. The effects of aging and types of stimuli (tone and speech) also showed different patterns of listening effort for the older adults and younger adults. The combined interaction of aging, directionality, and presence of background noise led to a significantly different amount of listening effort for the older group (90.1%) compared to the younger group (53.1%), even in the same listening situation. These current results, when summarized, indicated weak tone detection ability at high frequencies occurred in the elderly population but the elderly could improve their ability by using speech sounds with broad-band spectrum energy. We suggest that a warning signal when using speech rather than a single tone is more advantageous for the elderly in a public environment. It is also better to converse with the elderly by avoiding situations where noise from behind can interrupt.

Development of Abbreviated Versions of the Word Auditory Recognition and Recall Measure

OBJECTIVES

The objective of this study was to develop and evaluate abbreviated versions of the Word Auditory Recognition and Recall Measure (WARRM) as part of an iterative process in the development of a feasible test for potential future clinical use.

DESIGN

The three original WARRM (O-WARRM) randomizations were modified by altering the presentation paradigm. Instead of presenting 5 trials per set size with set size increasing from 2 to 6 as in the O-WARRM (n = 100 words), the experimental WARRM (E-WARRM) paradigm consisted of one trial from each of set sizes 2 to 6 to create a "run" (n = 20 words) with each randomization consisting of 5 runs (n = 100 words). A total of 24 younger listeners with normal hearing and 48 older listeners with hearing loss (OHL) were administered 1 randomization of the O-WARRM and 1 different randomization of the E-WARRM.

RESULTS

The recognition and recall performances on the O-WARRM and all versions of the E-WARRM (five individual runs and overall) were similar within each listener group, with the younger listeners with normal hearing outperforming the OHL listeners on all measures. Correlation analyses revealed moderate to strong associations between the abbreviated WARRM runs and the O-WARRM for the OHL listener group. Hierarchical regression modeling suggested that run 1 of the E-WARRM was a good predictor of O-WARRM performance and that adding additional runs did not improve the prediction. Taken together, these findings suggest that administering one run from the E-WARRM warrants further examination for clinical use. Additional analyses revealed equivalent scores on all five runs from the three E-WARRM randomizations for both listener groups.

CONCLUSIONS

Abbreviated versions of the O-WARRM were developed as part of this study. This was accomplished by modifying the original presentation paradigm and creating 15 unique "runs" among the original 3 randomizations. The resulting 15 runs could be considered 15 unique and abbreviated WARRM lists that have potential, in the future after further studies are conducted to establish important properties, for clinic use. The abbreviated WARRM lists may be useful for quantifying auditory working memory of listeners with hearing loss during the audiologic rehabilitation process.

Neural correlates of visual stimulus encoding and verbal working memory differ between cochlear implant users and normal-hearing controls

A common concern for individuals with severe‐to‐profound hearing loss fitted with cochlear implants (CIs) is difficulty following conversations in noisy environments. Recent work has suggested that these difficulties are related to individual differences in brain function, including verbal working memory and the degree of cross‐modal reorganization of auditory areas for visual processing. However, the neural basis for these relationships is not fully understood. Here, we investigated neural correlates of visual verbal working memory and sensory plasticity in 14 CI users and age‐matched normal‐hearing (NH) controls. While we recorded the high‐density electroencephalogram (EEG), participants completed a modified Sternberg visual working memory task where sets of letters and numbers were presented visually and then recalled at a later time. Results suggested that CI users had comparable behavioural working memory performance compared with NH. However, CI users had more pronounced neural activity during visual stimulus encoding, including stronger visual‐evoked activity in auditory and visual cortices, larger modulations of neural oscillations and increased frontotemporal connectivity. In contrast, during memory retention of the characters, CI users had descriptively weaker neural oscillations and significantly lower frontotemporal connectivity. We interpret the differences in neural correlates of visual stimulus processing in CI users through the lens of cross‐modal and intramodal plasticity.

EEG power spectral dynamics associated with listening in adverse conditions

Adverse listening conditions increase the demand on cognitive resources needed for speech comprehension. In an exploratory study, we aimed to identify independent power spectral features in the EEG useful for studying the cognitive processes involved in this effortful listening. Listeners performed the coordinate response measure task with a single-talker masker at a 0-dB signal-to-noise ratio. Sounds were left unfiltered or degraded with low-pass filtering. Independent component analysis (ICA) was used to identify independent components (ICs) in the EEG data, the power spectral dynamics of which were then analyzed. Frontal midline theta, left frontal, right frontal, left mu, right mu, left temporal, parietal, left occipital, central occipital, and right occipital clusters of ICs were identified. All IC clusters showed some significant listening-related changes in their power spectrum. This included sustained theta enhancements, gamma enhancements, alpha enhancements, alpha suppression, beta enhancements, and mu rhythm suppression. Several of these effects were absent or negligible using traditional channel analyses. Comparison of filtered to unfiltered speech revealed a stronger alpha suppression in the parietal and central occipital clusters of ICs for the filtered speech condition. This not only replicates recent findings showing greater alpha suppression as listening difficulty increases but also suggests that such alpha-band effects can stem from multiple cortical sources. We lay out the advantages of the ICA approach over the restrictive analyses that have been used as of late in the study of listening effort. We also make suggestions for moving into hypothesis-driven studies regarding the power spectral features that were revealed.

Differential interactions of age and sleep deprivation in driving and spatial perception by male drivers in a virtual reality environment

We determined the effects of age and sleep deprivation on driving and spatial perception in a virtual reality environment. Twenty-two young (mean age: 22 years, range: 18-35) and 23 old (mean age: 71 years, range: 65-79) participants were tested after a normal night of sleep and a night of sleep deprivation. The participants drove a virtual car while responding to uni- and bilateral visual and auditory stimuli. Driving errors (crossing the lane borders), reaction times and accuracy to visual and auditory stimuli, performance in psychological tests, and subjective driving ability and tiredness were measured. Age had no effect on the number of driving errors, whereas sleep deprivation increased significantly especially the number of left lane border crossings. Age increased the number of stimulus detection errors, while sleep deprivation increased the number of errors particularly in the young and in the auditory modality as response omissions. Age and sleep deprivation together increased the number of response omissions in both modalities. Left side stimulus omissions suggest a bias to the right hemispace. The subjective evaluations were consistent with the objective measures. The psychological tests were more sensitive to the effects of age than to those of sleep deprivation. Driving simulation in a virtual reality setting is sensitive in detecting the effects of deteriorating factors on both driving and simultaneous spatial perception.

Listener characteristics differentially affect self-reported and physiological measures of effort associated with two challenging listening conditions

Listeners vary in their ability to understand speech in adverse conditions. Differences in both cognitive and linguistic capacities play a role, but increasing evidence suggests that such factors may contribute differentially depending on the listening challenge. Here, we used multilevel modeling to evaluate contributions of individual differences in age, hearing thresholds, vocabulary, selective attention, working memory capacity, personality traits, and noise sensitivity to variability in measures of comprehension and listening effort in two listening conditions. A total of 35 participants completed a battery of cognitive and linguistic tests as well as a spoken story comprehension task using (1) native-accented English speech masked by speech-shaped noise and (2) nonnative accented English speech without masking. Masker levels were adjusted individually to ensure each participant would show (close to) equivalent word recognition performance across the two conditions. Dependent measures included comprehension tests results, self-rated effort, and electrodermal, cardiovascular, and facial electromyographic measures associated with listening effort. Results showed varied patterns of responsivity across different dependent measures as well as across listening conditions. In particular, results suggested that working memory capacity may play a greater role in the comprehension of nonnative accented speech than noise-masked speech, while hearing acuity and personality may have a stronger influence on physiological responses affected by demands of understanding speech in noise. Furthermore, electrodermal measures may be more strongly affected by affective response to noise-related interference while cardiovascular responses may be more strongly affected by demands on working memory and lexical access.

Long-Range Auditory Functional Connectivity in Hearing Loss and Rehabilitation

Background: Patients with age-related sensorineural hearing loss (HL) may benefit from auditory input amplification by using hearing aids (HAs). However, the impact of both HL- and HA-based rehabilitation on central auditory functional connectivity (FC) is not clear. Methodology: Sixty-two HL (22 females, aged 64.4 ± 7.6 years, pure-tone average 50.9 ± 14.7 dB right ear, 50.7 ± 12.9 dB left ear) and 32 normal hearing (NH) subjects (22 females, aged 59.3 ± 7.3 years) were examined in a 3T magnetic resonance imaging (MRI) study. HL patients were analyzed cross-sectionally at baseline (vs. NH subjects) and longitudinally at 6-month follow-up. Between the 2 scans, 31/62 patients used the HA 9.5 ± 3.8 h a day. Arterial spin labeling and blood oxygen level-dependent resting-state functional MRI were performed to measure regional perfusion in the primary auditory cortex and, from here to the whole brain, seed-based FC was performed. Before each scan, HL patients underwent audiological and neurological assessments. Results: At baseline, the HL condition was associated with regional hypoperfusion in right Heschl's gyrus (seed) and negative seed-based FC (anticorrelation) in posterior brain regions. Long-range FC in the precuneus correlated negatively with pure-tone and speech reception average thresholds. At 6-month follow-up, HA usage was associated with seed-based FC increase in the right superior frontal gyrus (SFG) and seed-based FC reduction in the right middle temporal gyrus. Long-range FC changes in the SFG correlated positively with executive function improvements. Conclusions: These findings suggest that HA-based rehabilitation may not reverse HL-related neural effects and yet carry neurological benefits by retuning long-range FC of the auditory system. Impact statement Age-related sensorineural hearing loss (HL) affects 40% to 60% of the worldwide population and a common, viable rehabilitation strategy is to provide auditory input amplification through hearing aids (HAs). By targeting metabolically depressed, auditory cortical centers, our work reveals a possible neural link between peripheral and central vulnerability in HL patients in the form of aberrant, long-range, functional connectivity effects. Similarly, we unveil how wearing HAs for 6 months may induce neuroplastic changes that positively correlate with improved neuropsychological performances.

Interactions between Cognition and Hearing Aid Compression Release Time: Effects of Linguistic Context of Speech Test Materials on Speech-in-Noise Performance

Recent research has established a connection between hearing aid (HA) users’ cognition and speech recognition performance with short and long compression release times (RT). Contradictive findings prevent researchers from using cognition to predict RT prescription. We hypothesized that the linguistic context of speech recognition test materials was one of the factors that accounted for the inconsistency. The present study was designed to examine the relationship between HA users’ cognition and their aided speech recognition performance with short and long RTs using materials with various linguistic contexts. Thirty-four older HA users’ cognitive abilities were quantified using a reading span test. They were fitted with behind-the-ear style HAs with adjustable RT settings. Three speech recognition tests were used: the word-in-noise (WIN) test, the American four alternative auditory feature (AFAAF) test, and the Bamford-Kowal-Bench speech-in-noise (BKB-SIN) test. The results showed that HA users with high cognitive abilities performed better on the AFAAF and the BKB-SIN than those with low cognitive abilities when using short RT. None of the speech recognition tests produced significantly different performance between the two RTs for either cognitive group. These findings did not support our hypothesis. The results suggest that cognition might not be important in prescribing RT.

Associations between pre-stimulus alpha power, hearing level and performance in a digits-in-noise task

OBJECTIVE

Baseline electroencephalography (EEG) alpha power, i.e. that measured prior to stimulus presentation, is a potential objective predictor of task performance. Here we assessed the predictive power of EEG alpha on performance accuracy in a digits-in-noise recognition task, factoring in hearing thresholds and age.

DESIGN

EEG alpha power, recorded while participants listened to target digits presented in a noise background, was analysed during two different baseline periods: i) a pre-stimulus baseline (pre-STIM) free from any acoustic stimulus, and ii) a pre-target baseline (pre-TARG) recorded in background noise only.

STUDY SAMPLE

Eighty-five participants with either normal hearing or aided hearing impairment (age range: 55-85 years old, 42 male).

RESULTS

Hierarchical multiple regression analyses indicated that i) lower hearing thresholds and, to a lesser extent, higher pre-STIM alpha power were associated with improved performance accuracy ii) alpha power in pre-STIM and pre-TARG were highly correlated across individuals but pre-TARG alpha power was not a significant predictor of performance accuracy.

CONCLUSION

Investigations of baseline EEG alpha power as a predictor of speech-in-noise performance accuracy should control for associations between hearing thresholds and measures of EEG baseline periods.

Hearing Impaired Participants Improve More Under Envelope-Transcranial Alternating Current Stimulation When Signal to Noise Ratio Is High

An issue commonly expressed by hearing aid users is a difficulty to understand speech in complex hearing scenarios, that is, when speech is presented together with background noise or in situations with multiple speakers. Conventional hearing aids are already designed with these issues in mind, using beamforming to only enhance sound from a specific direction, but these are limited in solving these issues as they can only modulate incoming sound at the cochlear level. However, evidence exists that age-related hearing loss might partially be caused later in the hearing processes due to brain processes slowing down and becoming less efficient. In this study, we tested whether it would be possible to improve the hearing process at the cortical level by improving neural tracking of speech. The speech envelopes of target sentences were transformed into an electrical signal and stimulated onto elderly participants' cortices using transcranial alternating current stimulation (tACS). We compared 2 different signal to noise ratios (SNRs) with 5 different delays between sound presentation and stimulation ranging from 50 ms to 150 ms, and the differences in effects between elderly normal hearing and elderly hearing impaired participants. When the task was performed at a high SNR, hearing impaired participants appeared to gain more from envelope-tACS compared to when the task was performed at a lower SNR. This was not the case for normal hearing participants. Furthermore, a post-hoc analysis of the different time-lags suggest that elderly were significantly better at a stimulation time-lag of 150 ms when the task was presented at a high SNR. In this paper, we outline why these effects are worth exploring further, and what they tell us about the optimal tACS time-lag.

Hearing Aid Uptake, Benefit, and Use: The Impact of Hearing, Cognition, and Personal Factors

Purpose The purpose of this study was to explore the effects of hearing, cognition, and personal factors on hearing aid (HA) uptake, use, and benefit. Method Eighty-five older adults aged 60-80 years (M = 70.23, SD = 5.17) participated in the study. Hearing was assessed using pure-tone audiometry and the Listening in Spatialised Noise-Sentences test. Cognition was measured using the Cogstate Brief Battery and the Cogstate Groton Maze Learning task. Personal demographics were recorded from participants' answers on a series of take-home questionnaires. HA benefit and use was subjectively reported at 3 and 6 months post HA fitting for those who chose to use HAs. Results Stepwise-regression and mixed-effects models indicated that stronger psychomotor function predicted greater reported use of HAs at 3 and 6 months post HA fitting. Greater family interaction scores also predicted greater HA use at 3 months after fitting. Participants who chose to be fitted with HAs had significantly poorer self-reported health and poorer audiometric thresholds. Poorer hearing was also significantly related with greater reported HA benefit. Conclusions A combination of cognitive, psychosocial factors and hearing impacted HA outcomes for the older Australians in this study. Self-reported HA use was significantly greater in participants with better psychomotor function. Furthermore, those with poorer self-reported health were more likely to choose to use HAs. These factors should be considered in audiological rehabilitation to best maximize patient HA outcomes.