Problems hearing in noise in older adults: a review of spatial processing disorder

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

SUPPLEMENTAL MATERIAL

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

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

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

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

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

The impact of age-related hearing loss on cognitive decline: The mediating role of brain age gap

In recent years, the relationship between age-related hearing loss, cognitive decline, and the risk of dementia has garnered significant attention. The significant variability in brain health and aging among individuals of the same chronological age suggests that a measure assessing how one's brain ages may better explain hearing-cognition links. The main aim of this study was to investigate the mediating role of Brain Age Gap (BAG) in the association between hearing impairment and cognitive function. This research included 185 participants aged 20-79 years. BAG was estimated based on the difference between participant's brain age (estimated based on their structural T1-weighted MRI scans) and chronological age. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA) test while hearing ability was measured using pure-tone thresholds (PTT) and words-in-noise (WIN) perception. Mediation analyses were used to examine the mediating role of BAG in the relationship between age-related hearing loss as well as difficulties in WIN perception and cognition. Participants with poorer hearing sensitivity and WIN perception showed lower MoCA scores, but this was an indirect effect. Participants with poorer performance on PTT and WIN tests had larger BAG (accelerated brain aging), and this was associated with poorer performance on the MoCA test. Mediation analyses showed that BAG partially mediated the relationship between age-related hearing loss and cognitive decline. This study enhances our understanding of the interplay among hearing loss, cognition, and BAG, emphasizing the potential value of incorporating brain age assessments in clinical evaluations to gain insights beyond chronological age, thus advancing strategies for preserving cognitive health in aging populations.

Asymmetries and hemispheric interaction in the auditory system of elderly people

Age-related changes of asymmetries in the auditory system and decreasing efficiency of hemispheric interaction have been discussed for some time. This mini-review discusses recent neuroimaging studies on alterations in lateralization of cortical processing and structural changes concerning the division of labor and interaction between hemispheres during auditory processing in elderly people with the focus on people without severe hearing loss. Several changes of asymmetries in anatomy, function and neurotransmitter concentration were observed in auditory cortical areas of older compared to younger adults. It was shown that connections between left and right auditory cortex are reduced during aging. Functionally, aging seems to lead to a reduction in asymmetry of auditory processing. However, the results do not always point into the same direction. Furthermore, correlations between function, anatomy and behavior in the left and right hemisphere appear to differ between younger and older adults. The changes in auditory cortex asymmetries with aging might be due to compensation of declining processing capacities, but at the same time these mechanisms could impair the balanced division of labor between the two hemispheres that is required for the processing of complex auditory stimuli such as speech. Neuroimaging studies are essential to follow the slow changes with aging as in the beginning no behavioral effects might be visible due to compensation. Future studies should control well for peripheral hearing loss and cognitive decline. Furthermore, for the interpretability of results it is necessary to use specific tasks with well-controlled task difficulty.

Validity of the Italian adaptation of the Hearing Handicap Inventory for the Elderly (HHIE-It)

Objective

The aim of this study was to assess the validity and reliability of the Italian translation of the Hearing Handicap Inventory for the Elderly (HHIE).

Methods

A sample of 275 adults, aged > 65 years, filled out the Italian version of the HHIE (HHIE-It) together with the MOS 36-Item Short Form Health Survey (SF-36). Seventy-one participants answered the questionnaire a second time after six weeks. The internal consistency, test-retest reliability, construct and criterion validity were evaluated.

Results

Cronbach's alpha was 0.94 and suggested a high internal consistency. There was also a significant intraclass correlation coefficient (ICC) between test and retest scores. In addition, Pearson's correlation coefficient between the two scores was high and significant. High and significant correlation coefficients were also found between the HHIE-It score and the pure tone average threshold of the better ear and between the HHIE-It and the subscales Role-emotional, Social Functioning and Vitality of the SF-36. These latter results indicate good construct and criterion validity, respectively.

Conclusions

The HHIE-It maintained the reliability and validity of the English version suggesting its utility for both clinical and research purposes.

Adult Normative Data for the Adaptation of the Hearing in Noise Test in European French (HINT-5 Min)

Decreased speech-in-noise (SpIN) understanding is an early marker not only of presbycusis but also of auditory processing disorder. Previous research has shown a strong relationship between hearing disorders and cognitive limitations. It is therefore crucial to allow SpIN testing in subjects who cannot sustain prolonged diagnostic procedures. The objectives of this study were to develop a rapid and reproducible version of the Hearing in Noise Test (HINT-5 min), and to determine its adult normative values in free-field and monaural or binaural headphone conditions. Following an adaptive signal-to-noise ratio (SNR) protocol, the test used a fixed noise level, while the signal level varied to reach the 50% speech reception threshold (SRT50). The speech material consisted of five lists of 20 sentences each, all recorded in European French. The whole semi-automated procedure lasted 5 min and was administered to 83 subjects aged 19 to 49 years with no reported listening difficulties. Fifty-two subjects were retested between 7 and 8 days later. For the binaural free-field condition, the mean SRT50 was −1.0 dB SNR with a standard deviation of 1.3 dB SNR. There was no significant difference between the results obtained at test and retest, nor was there any effect of listening condition, sex, or age on SRT50. The results indicate that the procedure is robust and not affected by any learning phenomenon. The HINT-5 min was found to be both a fast and reliable marker of the ability to understand speech in background noise.

Feasibility of Virtual Reality Audiological Testing: Prospective Study

Background

It has been noted in the literature that there is a gap between clinical assessment and real-world performance. Real-world conversations entail visual and audio information, yet there are not any audiological assessment tools that include visual information. Virtual reality (VR) technology has been applied to various areas, including audiology. However, the use of VR in speech-in-noise perception has not yet been investigated.

Objective

The purpose of this study was to investigate the impact of virtual space (VS) on speech performance and its feasibility to be used as a speech test instrument. We hypothesized that individuals’ ability to recognize speech would improve when visual cues were provided.

Methods

A total of 30 individuals with normal hearing and 25 individuals with hearing loss completed pure-tone audiometry and the Korean version of the Hearing in Noise Test (K-HINT) under three conditions—conventional K-HINT (cK-HINT), VS on PC (VSPC), and VS head-mounted display (VSHMD)—at –10 dB, –5 dB, 0 dB, and +5 dB signal-to-noise ratios (SNRs). Participants listened to target speech and repeated it back to the tester for all conditions. Hearing aid users in the hearing loss group completed testing under unaided and aided conditions. A questionnaire was administered after testing to gather subjective opinions on the headset, the VSHMD condition, and test preference.

Results

Provision of visual information had a significant impact on speech performance between the normal hearing and hearing impaired groups. The Mann-Whitney U test showed statistical significance (P<.05) between the two groups under all test conditions. Hearing aid use led to better integration of audio and visual cues. Statistical significance through the Mann-Whitney U test was observed for –5 dB (P=.04) and 0 dB (P=.02) SNRs under the cK-HINT condition, as well as for –10 dB (P=.007) and 0 dB (P=.04) SNRs under the VSPC condition, between hearing aid and non–hearing aid users. Participants reported positive responses across almost all items on the questionnaire except for the weight of the headset. Participants preferred a test method with visual imagery, but found the headset to be heavy.

Conclusions

Findings are in line with previous literature that showed that visual cues were beneficial for communication. This is the first study to include hearing aid users with a more naturalistic stimulus and a relatively simple test environment, suggesting the feasibility of VR audiological testing in clinical practice.

The Spatial Selective Auditory Attention of Cochlear Implant Users in Different Conversational Sound Levels

In multi-speaker environments, cochlear implant (CI) users may attend to a target sound source in a different manner from normal hearing (NH) individuals during a conversation. This study attempted to investigate the effect of conversational sound levels on the mechanisms adopted by CI and NH listeners in selective auditory attention and how it affects their daily conversation. Nine CI users (five bilateral, three unilateral, and one bimodal) and eight NH listeners participated in this study. The behavioral speech recognition scores were collected using a matrix sentences test, and neural tracking to speech envelope was recorded using electroencephalography (EEG). Speech stimuli were presented at three different levels (75, 65, and 55 dB SPL) in the presence of two maskers from three spatially separated speakers. Different combinations of assisted/impaired hearing modes were evaluated for CI users, and the outcomes were analyzed in three categories: electric hearing only, acoustic hearing only, and electric + acoustic hearing. Our results showed that increasing the conversational sound level degraded the selective auditory attention in electrical hearing. On the other hand, increasing the sound level improved the selective auditory attention for the acoustic hearing group. In the NH listeners, however, increasing the sound level did not cause a significant change in the auditory attention. Our result implies that the effect of the sound level on selective auditory attention varies depending on the hearing modes, and the loudness control is necessary for the ease of attending to the conversation by CI users.

Speech audiometry in noise: SNR Loss per age-group in normal hearing subjects

OBJECTIVES

The present study aimed to determine normal SNR values per age group for the 50% speech reception threshold in noise (SNR Loss) on the VRB (Vocale Rapide dans le Bruit: rapid speech in noise) test.

MATERIAL AND METHODS

Two hundred patients underwent pure-tone threshold and VRB speech-in-noise audiometry. Six ages groups were distinguished: 20-30, 30-40, 40-50, 50-60, 60-70 and>70 years. All subjects had normal hearing for age according to ISO 7029. SNR Loss was measured according to age group.

RESULTS

Mean SNR Loss ranged from -0.37dB in the youngest age group (20-30 years) to +6.84dB in the oldest (>70 years). Range and interquartile range increased with age: 3.66 and 1.49dB respectively for 20-30 year-olds; 6 and 3.5dB for>70 year-olds. Linear regression between SNR Loss and age showed a coefficient R² of 0.83.

CONCLUSION

The present study reports SNR Loss values per age group in normal-hearing subjects (ISO 7029), confirming that SNR Loss increases with age. Scatter also increased with age, suggesting that other age-related factors combine with inner-ear aging to impair hearing in noise.

Hearing and Quality-of-Life Outcomes After Cochlear Implantation in Adult Hearing Aid Users 65 Years or Older: A Secondary Analysis of a Nonrandomized Clinical Trial

Importance

Hearing loss, especially moderate to severe forms, has the potential to negatively affect an individual's physical, social, emotional, and cognitive well-being. Moreover, having ineffective binaural hearing increases difficulty understanding speech in noise and leads to a greater degree of social isolation and loneliness and a reduced quality of life (QoL).

Objective

To explore the audiometric and holistic effects of cochlear implantation in a group of adults 65 years or older compared with an optimized bilateral hearing aid condition.

Design, Setting, and Participants

This ad hoc secondary analysis of a prospective, single-subject, repeated-measures nonrandomized clinical trial included 13 cochlear implantation centers across the United States. Participants 65 years or older with postlingual bilateral moderate-to-profound sensorineural hearing loss with aided Consonant-Vowel Nucleus-Consonant (CNC) word scores in quiet of 40% or less in the ear to undergo implantation and 50% or less in the contralateral ear were included in the analysis. Baseline QoL testing was performed after 1 month of optimized bilateral hearing aid use. Participants were enrolled from February 20, 2017, to May 3, 2018, and follow-up was completed December 21, 2018. Data were analyzed from March 25, 2019, to March 31, 2020.

Interventions

Unilateral implantation with a slim, modiolar cochlear implant device. Hearing aid use in the contralateral ear was required through the 6-month primary end-point interval.

Main Outcomes and Measures

The primary objective was to evaluate speech perception before and 6 months after activation of a new cochlear implant. Secondary objectives were QoL metrics in the everyday listening condition before and 6 months after implantation.

Results

Seventy participants (51 men [73%]) with a median age of 74 (range, 65-91) years were included in the analysis. No major adverse events occurred. Mixed-model analysis with estimated marginal means and 95% CIs compared preimplantation baseline performance with 6-month postimplantation performance. A clinically important improvement in CNC words was shown in the bimodal condition, with a mean difference of 37.2% (95% CI, 32.0%-42.4%), and in the unilateral (cochlear implant only) condition, with a mean difference of 44.1% (95% CI, 39.0%-49.2%). A clinically important improvement in noise (AzBio sentences signal-to-noise ratio of +10 dB) was also shown, with a mean difference of 21.6% (95% CI, 15.7%-27.5%) in the bimodal condition and 24.5% (95% CI, 18.3%-30.7%) in the unilateral condition. The Health Utilities Index Mark 3 multiple-attribute score improved by 0.186 (95% CI, 0.136-0.234); the Speech, Spatial, and Qualities of Hearing Scale total score improved by 2.58 (95% CI, 2.18-2.99); and a novel Device Use Questionnaire reported 94% of participants were satisfied with overall hearing in the everyday listening condition.

Conclusions and Relevance

This subgroup analysis of patients 65 years or older enrolled in a within-subject clinical trial of cochlear implantation demonstrated clinically meaningful audiometric and QoL benefit with an acceptable risk profile. These findings suggest that cochlear implantation in older adults may facilitate the concept of healthy aging.

Trial Registration

ClinicalTrials.gov Identifier: NCT03007472.

Crucial Music Components Needed for Speech Perception Enhancement of Pediatric Cochlear Implant Users: A Systematic Review and Meta-Analysis

BACKGROUND

Although many clinicians have attempted music training for the hearing-impaired children, no specific effects have yet been reported for individual music components. This paper seeks to discover specific music components that help in improving speech perception of children with cochlear implants (CI) and to identify the effective training periods and methods needed for each component.

METHOD

While assessing 5 electronic databases, that is, ScienceDirect, Scopus, PubMed, CINAHL, and Web of Science, 1,638 articles were found initially. After the screening and eligibility assessment stage based on the Participants, Intervention, Comparisons, Outcome, and Study Design (PICOS) inclusion criteria, 18 of 1,449 articles were chosen.

RESULTS

A total of 18 studies and 14 studies (209 participants) were analyzed using a systematic review and meta-analysis, respectively. No publication bias was detected based on an Egger's regression result even though the funnel plot was asymmetrical. The results of the meta-analysis revealed that the largest improvement was seen for rhythm perception, followed by the perception of pitch and harmony and smallest for timbre perception after the music training. The duration of training affected the rhythm, pitch, and harmony perception but not the timbre. Interestingly, musical activities, such as singing, produced the biggest effect size, implying that children with CI obtained the greatest benefits of music training by singing, followed by playing an instrument and achieved the smallest effect by only listening to musical stimuli. Significant improvement in pitch perception helped with the enhancement of prosody perception.

CONCLUSION

Music training can improve the music perception of children with CI and enhance their speech prosody. Long training duration was shown to provide the largest training effect of the children's perception improvement. The children with CI learned rhythm and pitch better than they did with harmony and timbre. These results support the finding of past studies that with music training, both rhythm and pitch perception can be improved, and it also helps in the development of prosody perception.

Encoding of a binaural speech stimulus at the brainstem level in middle-aged adults

OBJECTIVE

Binaural hearing is facilitated by neural interactions in the auditory pathway. Ageing results in impairment of localisation and listening in noisy situations without any significant hearing loss. The present study focused on comparing the binaural encoding of a speech stimulus at the subcortical level in middle-aged versus younger adults, based on speech-evoked auditory brainstem responses.

METHODS

Thirty participants (15 young adults and 15 middle-aged adults) with normal hearing sensitivity (less than 15 dB HL) participated in the study. The speech-evoked auditory brainstem response was recorded monaurally and binaurally with a 40-ms /da/ stimulus. Fast Fourier transform analysis was utilised.

RESULTS

An independent sample t-test revealed a significant difference between the two groups in fundamental frequency (F0) amplitude recorded with binaural stimulation.

CONCLUSION

The present study suggested that ageing results in degradation of F0 encoding, which is essential for the perception of speech in noise.

A binaural model implementing an internal noise to predict the effect of hearing impairment on speech intelligibility in non-stationary noises

A binaural model predicting speech intelligibility in envelope-modulated noise for normal-hearing (NH) and hearing-impaired listeners is proposed. The study shows the importance of considering an internal noise with two components relying on the individual audiogram and the level of the external stimuli. The model was optimized and verified using speech reception thresholds previously measured in three experiments involving NH and hearing-impaired listeners and sharing common methods. The anechoic target, in front of the listener, was presented simultaneously through headphones with two anechoic noise-vocoded speech maskers (VSs) either co-located with the target or spatially separated using an infinite broadband interaural level difference without crosstalk between ears. In experiment 1, two stationary noise maskers were also tested. In experiment 2, the VSs were presented at different sensation levels to vary audibility. In experiment 3, the effects of realistic interaural time and level differences were also tested. The model was applied to two datasets involving NH listeners to verify its backward compatibility. It was optimized to predict the data, leading to a correlation and mean absolute error between data and predictions above 0.93 and below 1.1 dB, respectively. The different internal noise approaches proposed in the literature to describe hearing impairment are discussed.

Listening in Spatialized Noise - Universal Test (LiSN-U) test-retest reliability study

OBJECTIVE

To assess test-retest reliability of the Listening in Spatialised Noise - Universal test (LiSN-U).

DESIGN

Test-retest reliability study. Participants completed the LiSN-U twice, four to eight weeks apart. Study sample: Test-retest reliability was analysed for 23 adults and 109 children.

RESULTS

ANOVA showed significant group average score improvement on LiSN-U spatially-separated and co-located conditions on retest (by 1.3 and 0.9 dB, respectively), but not on the difference between them (spatial advantage). Critical difference scores for children were -3.6 dB for the spatially-separated condition, -5.8 dB for the co-located condition, and 5.5 dB for spatial advantage. Critical difference scores for adults were -2.0 dB for the spatially-separated condition, -4.9 dB for the co-located condition, and 5.4 dB for spatial advantage. A correlation analysis was run to determine the relationship between test and retest speech reception thresholds. The correlation was r = 0.63, p < 0.001 for the spatially-separated condition, r = 0.50, p < 0.001 for the co-located condition, and r = 0.37, p < 0.001 for the spatial advantage measure.

CONCLUSIONS

The LiSN-U, which is potentially useable for speakers of any language, shows mean test-retest difference and test-retest reliability comparable to other tests that have proven useful in clinical practice.

Correlating performance on the Listening in Spatialised Noise - Sentences test (LiSN-S) with the Listening in Spatialised Noise - Universal test (LiSN-U)

Objective: The aim of this study was to correlate 6- to 7-year-old children's results on each condition of the Listening in Spatialised Noise - Sentences test (LiSN-S) with the new language-independent version, the Listening in Spatialised Noise - Universal test (LiSN-U), to examine the strength of the relationship between them and with memory in a small sample of typically developing children.Design: Correlational analysis.Study samples: Sixteen typically developing 6- to 7-year-old children completed the LiSN-S and LiSN-U as well as the Test of Auditory Processing Skills - Third Edition (TAPS-3) number memory forward and reversed subtests which assess short-term memory and working memory, respectively.Results: Moderate positive correlations were found between LiSN-S and LiSN-U spatially separated conditions (though this did not reach significance), and co-located conditions. Correlations between the LiSN-S and LiSN-U conditions and number memory forward and reversed subtests were not significant.Conclusion: This study shows a moderate relationship between the LiSN-S and LiSN-U when the distractors and target speech are co-located. A study with a larger sample of participants is needed to further understand the relationship between the two tests, especially for the spatially separated condition.

A New Speech-in-Noise Test for Measuring Informational Masking in Speech Perception Among Elderly Listeners

Introduction Elderly listeners have reported concerns about speech perception in noisy environments. This partly occurs because of their increased informational masking (IM). This study aimed to develop a Persian coordinate response measure (CRM) corpus and a novel speech-in-noise test for measuring IM. Material and methods A cross-sectional validation study was conducted in two parts. Part one was the determination of the validity and reliability of the Persian CRM corpus. Part two consisted of measuring the IM at five signal-to-noise ratio (SNR; -6,-3, 0, +3, and +6) in two conditions: one with the target and masker speaker of the same sex and one with the target and masker speaker of different sexes. In each condition, the IM measurements were performed at a 45° separation angle of target and maskers and as a co-location of the speakers. A group of young listeners aged 20 to 40 years and a group of elderly listeners aged 60 to 75 years were recruited (50 study participants in part one and 47 in part two). The study was conducted from July 2018 to March 2019 at the Iran University Medical Sciences audiology clinic. Content validity ratio, content validity index, impact score, Spearman's test, and Mann-Whitney's test were used for statistical analysis. Results The Persian CRM corpus showed acceptable validity and reliability in each group (p < 0.001). The results suggested that in both azimuth locations and at SNRs of 0, -3, and -6, the IM amount in the elderly group was significantly higher (p < 0.003) than in the young group at conditions of target and masker speakers of opposite-sex. However, in cases where both target and masker speakers were of the same sex, a significant difference was observed at an SNR of 0 in angular separation and SNRs of +3 and 0 at co-located situations (p < 0.001). Conclusion A validated Persian CRM corpus has been collected for use in IM measurement studies. Overall, the IM of elderly listeners was higher than younger listeners in low-cue situations such as lower SNR. Therefore, a novel speech-in-noise test for measuring IM was validated to use in speech perception studies in the elderly population.

English language and language-free detection of spatial processing disorders in Aboriginal and Torres Strait Islander children

OBJECTIVE

The aim of this study was to compare speech reception thresholds in noise measured with the Listening in Spatialised Noise - Universal test (LiSN-U; which requires no English knowledge) with those measured from the relevant conditions of the LiSN - Sentences test (LiSN-S; a test requiring knowledge of English) in Aboriginal and Torres Strait Islander children. A second aim was to compare the ability of the two tests to detect spatial processing disorder.

DESIGN

Participants completed audiometry, the LiSN-S, and the LiSN-U.

STUDY SAMPLE

90 Aboriginal and Torres Strait Islander children aged six to 14 years tested in a school setting.

RESULTS

Strong correlations were found between speech reception thresholds in noise for the two tests. A moderate correlation was found between the difference scores that each test uses to detect spatial processing disorder. Consistent diagnoses of whether a child had spatial processing disorder or not on both tests were found for 72% of children.

CONCLUSIONS

The moderate-to-strong relationships and agreement between diagnoses found for the LiSN-S and LiSN-U show promise for the LiSN-U being used as a tool to investigate spatial processing disorder in children, without requiring the test to use a language familiar to the children being tested.

The development of the listening in spatialised noise - universal test (LiSN-U) and preliminary evaluation in English-speaking listeners

Objective: To create a language independent version of the Listening in Spatialised Noise - Sentences test (LiSN-S) and evaluate it in an English-speaking population.Design: Test development and normative data collection. LiSN-Universal (LiSN-U) targets consisted of CVCV pseudo-words (e.g. /mupa/). Two looped distracter tracks consisted of CVCVCVCV pseudo-words. The listener's task was to repeat back the target pseudo-words. Stimuli were presented over headphones using an iPad. Speech reception thresholds were measured adaptively. In the co-located condition all stimuli came from directly in front. In the spatially-separated condition the distracters emanated from +90° and -90° azimuth. Perceived location was manipulated using head-related transfer functions. Spatial advantage was calculated as the difference in dB between the co-located and spatially separated conditions.Study samples: Stimulus intelligibility data were collected from 20 adults. Normative data were collected from native English speakers (23 adults and 127 children).Results: Children's spatially separated, co-located, and spatial advantage results improved significantly with age. Spatial advantage was 4-6 dB larger in the LiSN-U than LiSN-S depending on age group.Conclusion: Whereas additional research in non-native English populations is required, the LiSN-U appears to be an effective tool for measuring spatial processing ability.

Spatial release from informational masking declines with age: Evidence from a detection task in a virtual separation paradigm

Declines in spatial release from informational masking may contribute to the speech-processing difficulties that older adults often experience within complex listening environments. The present study sought to answer two fundamental questions: (1) Does spatial release from informational masking decline with age and, if so, (2) does age predict this decline independently of age-typical hearing loss? Younger (18-34 years) and older (60-80 years) adults with age-typical hearing completed a yes/no target-detection task with low-pass filtered noise-vocoded speech designed to reduce non-spatial segregation cues and control for hearing loss. Participants detected a target voice among two-talker masking babble while a virtual spatial separation paradigm [Freyman, Helfer, McCall, and Clifton, J. Acoust. Soc. Am. 106(6), 3578-3588 (1999)] was used to isolate informational masking release. The younger and older adults both exhibited spatial release from informational masking, but masking release was reduced among the older adults. Furthermore, age predicted this decline controlling for hearing loss, while there was no indication that hearing loss played a role. These findings provide evidence that declines specific to aging limit spatial release from informational masking under challenging listening conditions.

The effects of auditory spatial training on informational masking release in elderly listeners: a study protocol for a randomized clinical trial

Background: Regarding the strong auditory spatial plasticity capability of the central auditory system and the effect of short-term and long-term rehabilitation programs in elderly people, it seems that an auditory spatial training can help this population in informational masking release and better track speech in noisy environments. The main purposes of this study are developing an informational masking measurement test and an auditory spatial training program. Protocol: This study will be conducted in two parts. Part 1: develop and determine the validity of an informational masking measurement test by recruiting two groups of young (n=50) and old (n=50) participants with normal hearing who have no difficulty in understanding speech in noisy environments. Part 2 (clinical trial): two groups of 60-75-year-olds with normal hearing, who complain about difficulty in speech perception in noisy environments, will participate as control and intervention groups to examine the effect of auditory spatial training. Intervention: 8 sessions of auditory spatial training. The informational masking measurement test and Speech, Spatial and Qualities of Hearing Scale will be compared before intervention, immediately after intervention, and one month after intervention between the two groups. Discussion: Since auditory training programs do not deal with informational masking release, an auditory spatial training will be designed, aiming to improve hearing in noisy environments for elderly populations. Trial registration: Iranian Registry of Clinical Trials ( IRCT20190118042404N1) on 25 th February 2019.

The effects of auditory spatial training on informational masking release in elderly listeners: a study protocol for a randomized clinical trial

Background: Regarding the strong auditory spatial plasticity capability of the central auditory system and the effect of short-term and long-term rehabilitation programs in elderly people, it seems that an auditory spatial training can help this population in informational masking release and better track speech in noisy environments. The main purposes of this study are developing an informational masking measurement test and an auditory spatial training program. Protocol: This study will be conducted in two parts. Part 1: develop and determine the validity of an informational masking measurement test by recruiting two groups of young (n=50) and old (n=50) participants with normal hearing who have no difficulty in understanding speech in noisy environments. Part 2 (clinical trial): two groups of 60-75-year-olds with normal hearing, who complain about difficulty in speech perception in noisy environments, will participate as control and intervention groups to examine the effect of auditory spatial training. Intervention: 15 sessions of auditory spatial training. The informational masking measurement test and Speech, Spatial and Qualities of Hearing Scale will be compared before intervention, immediately after intervention, and five weeks after intervention between the two groups. Discussion: Since auditory training programs do not deal with informational masking release, an auditory spatial training will be designed, aiming to improve hearing in noisy environments for elderly populations. Trial registration: Iranian Registry of Clinical Trials ( IRCT20190118042404N1) on 25 th February 2019.

Peripheral and central hearing impairment and their relationship with cognition: a review

Objective: To consider the relationships between both peripheral and central hearing impairment and cognition. Design: Narrative review. Study sample: Numerous studies exploring the relationship between hearing impairment and cognitive function, particularly in an older population. Results: In addition to the well-documented relationship between peripheral hearing loss and cognition highlighted in previous comprehensive reviews, there is also some evidence to suggest that there is a relationship between central hearing impairment and cognition. Further research is required to better understand this relationship and its effects on hearing aid benefit in people with both peripheral hearing loss and central hearing impairment. Conclusions: To fully understand the relationship between hearing impairment and cognitive impairment, not only peripheral but central hearing needs to be considered. Such knowledge could be of benefit in the clinical management of people with both peripheral hearing loss and central hearing impairment.

Binaural sensitivity to temporal fine structure and lateralization ability in children with suspected (central) auditory processing disorder

OBJECTIVE

Previous studies have shown that a subgroup of children with suspected (central) auditory processing disorder (SusCAPD) have insufficient ability to use binaural cues to benefit from spatial processing. Thus, they experience considerable listening difficulties in challenging auditory environments, such as classrooms. Some researchers have also indicated the probable role of binaural temporal fine structure (TFS) in the perceptual segregation of target signal from noise and hence in speech perception in noise. Therefore, in the present study, in order to further investigate the underlying reason for listening problems against background noise in this group of children, their performance was measured using binaural TFS sensitivity test (TFS-LF) as well as behavioral auditory lateralization in noise test, both of which are based on binaural temporal cues processing.

METHODS

Participants in this analytical study included 91 children with normal hearing and no listening problems and 41 children (9-12 years old) with SusCAPD who found it challenging to understand speech in noise. Initially, the ability to use binaural TFS was measured at three frequencies (250, 500 and 750Hz) in both the groups, and the results of preliminary evaluations were compared between normal children and those with SusCAPD who participated in the study. Thereafter, the binaural performance of the 16 children with SusCAPD who had higher thresholds than the normal group at all three frequencies tested in TFS-LF test was examined using the lateralization test in 7 spatial locations.

RESULTS

Total 16 of the 41 children with SusCAPD who participated in this study (39%) showed poor performance on the TFS-LF test at all three frequencies, compared to both normal children and other children in the APD group (p<0.05). Furthermore, children in the APD group with binaural TFS coding deficits at all three frequencies revealed significant differences in the lateralization test results compared to normal children (p<0.05).

CONCLUSION

Findings of the current study demonstrated that one of the underlying causes for the difficulty understanding speech in noisy environments experienced by a subgroup of children with SusCAPD can be the reduced ability to benefit from binaural TFS information. This study also showed that a reduced ability to use binaural TFS cues in the group of children with SusCAPD was accompanied by reduced binaural processing abilities in the lateralization test which also admit the presence of binaural temporal processing deficits in this group of children.

Development of Improved Software Intelligent System for Audiological Solutions

Of late, there has been an increase in hearing impairment cases and to provide the most advantageous solutions to them is an uphill task for audiologists. Significant difficulty faced by the audiologists is in effective programming of hearing aids to provide enhanced satisfaction to the users. The main aim of our study was to develop a software intelligent system (SIS): (i) to perform the required audiological investigations for finding the degree and type of hearing loss, and (ii) to suggest appropriate values of hearing aid parameters for enhancing the speech intelligibility and the satisfaction level among the hearing aid users. In this paper, we present a Neuro-Fuzzy based SIS to automatically predict and suggest the hearing-aid parameters such as gain values, compression ratio and threshold knee point, which are needed to be fixed for different octave frequencies of sound inputs during the hearing-aid trial. The test signals for audiological investigations are generated through the standard hardware present in a personal computer system and with the aid of a software algorithm. The proposed system was validated with 243 subjects' data collected at the Government General Hospital, Chennai, India. The calculated sensitivity, specificity and accuracy of the proposed audiometer incorporated in the SIS were 98.6%, 96.4 and 98.2%, respectively, by comparing its interpretations with those of the 'gold standard' audiometers. Furthermore, 91% (221 of 243) of the hearing impaired subjects attained satisfaction in the first hearing aid trials itself with the gain values as recommended by the improved SIS. The proposed system reduced around 75% of the 'trial and error' time spent by audiologists for enhancing satisfactory usage of the hearing aid. Hence, the proposed SIS could be used to find the degree and type of hearing loss and to recommend hearing aid parameters to provide optimal solutions to the hearing aid users.

Envelope-based inter-aural time difference localization training to improve speech-in-noise perception in the elderly

Background: Many elderly individuals complain of difficulty in understanding speech in noise despite having normal hearing thresholds. According to previous studies, auditory training leads to improvement in speech-in-noise perception, but these studies did not consider the etiology, so their results cannot be generalized. The present study aimed at investigating the effectiveness of envelopebased interaural time difference (ITD ENV) localization training on improving ITD threshold and speech-in-noise perception. Methods: Thirty-two elderly males aged 55 to 65 years with clinically diagnosed normal hearing at 250-2000 Hertz, who suffered from speech-in-noise perception difficulty participated in this study. These individuals were randomly divided into training and control groups: 16 elderlies in the experimental group received envelope-based interaural time difference localization training in 9 sessions, but 16 matched elderlies in the control group did not receive any training. The ITD ENV threshold and spatial word recognition score (WRS) in noise were analyzed before and after the localization training. Results: Findings demonstrated that following the training program, the interaural time difference envelope threshold and spatial word recognition score (WRS) in noise were improved significantly in the experimental group (p≤ 0.001). Moreover, a significant difference was detected in interaural time difference envelope threshold and spatial word recognition score (WRS) in noise (p≤ 0.001) before and after the training in the experimental group. Conclusion: The results of the present study revealed the effectiveness of envelope- based interaural time difference localization training in localization ability and speech in noise perception in the elderlies with normal hearing up to 2000 Hz who suffered from speech-in-noise perception difficulty.

Cortical Measures of Binaural Processing Predict Spatial Release from Masking Performance

Binaural sensitivity is an important contributor to the ability to understand speech in adverse acoustical environments such as restaurants and other social gatherings. The ability to accurately report on binaural percepts is not commonly measured, however, as extensive training is required before reliable measures can be obtained. Here, we investigated the use of auditory evoked potentials (AEPs) as a rapid physiological indicator of detection of interaural phase differences (IPDs) by assessing cortical responses to 180° IPDs embedded in amplitude-modulated carrier tones. We predicted that decrements in encoding of IPDs would be evident in middle age, with further declines found with advancing age and hearing loss. Thus, participants in experiment #1 were young to middle-aged adults with relatively good hearing thresholds while participants in experiment #2 were older individuals with typical age-related hearing loss. Results revealed that while many of the participants in experiment #1 could encode IPDs in stimuli up to 1,000 Hz, few of the participants in experiment #2 had discernable responses to stimuli above 750 Hz. These results are consistent with previous studies that have found that aging and hearing loss impose frequency limits on the ability to encode interaural phase information present in the fine structure of auditory stimuli. We further hypothesized that AEP measures of binaural sensitivity would be predictive of participants' ability to benefit from spatial separation between sound sources, a phenomenon known as spatial release from masking (SRM) which depends upon binaural cues. Results indicate that not only were objective IPD measures well correlated with and predictive of behavioral SRM measures in both experiments, but that they provided much stronger predictive value than age or hearing loss. Overall, the present work shows that objective measures of the encoding of interaural phase information can be readily obtained using commonly available AEP equipment, allowing accurate determination of the degree to which binaural sensitivity has been reduced in individual listeners due to aging and/or hearing loss. In fact, objective AEP measures of interaural phase encoding are actually better predictors of SRM in speech-in-speech conditions than are age, hearing loss, or the combination of age and hearing loss.

The role of interaural differences on speech intelligibility in complex multi-talker environments

Interaural differences in time (ITDs) and interaural differences in level (ILDs) contribute to a listener's ability to achieve spatial release from masking (SRM), and help to improve speech intelligibility in noisy environments. In this study, the extent to which ITDs and ILDs contribute to SRM and the relationships with aging and hearing loss were examined. SRM was greatest when stimuli were presented with consistent ITD and ILD, relative to ITD or ILD alone, all of which produced greater SRM than when ITD and ILD cues were in conflict with each other. This pattern was independent of age and hearing loss.

The Spatial Release of Cognitive Load in Cocktail Party Is Determined by the Relative Levels of the Talkers

In a multi-talker situation, spatial separation between talkers reduces cognitive processing load: this is the "spatial release of cognitive load". The present study investigated the role played by the relative levels of the talkers on this spatial release of cognitive load. During the experiment, participants had to report the speech emitted by a target talker in the presence of a concurrent masker talker. The spatial separation (0° and 120° angular distance in azimuth) and the relative levels of the talkers (adverse, intermediate, and favorable target-to-masker ratio) were manipulated. The cognitive load was assessed with a prefrontal functional near-infrared spectroscopy. Data from 14 young normal-hearing listeners revealed that the target-to-masker ratio had a direct impact on the spatial release of cognitive load. Spatial separation significantly reduced the prefrontal activity only for the intermediate target-to-masker ratio and had no effect on prefrontal activity for the favorable and the adverse target-to-masker ratios. Therefore, the relative levels of the talkers might be a key point to determine the spatial release of cognitive load and more specifically the prefrontal activity induced by spatial cues in multi-talker situations.

Coding deficits in hidden hearing loss induced by noise: the nature and impacts

Hidden hearing refers to the functional deficits in hearing without deterioration in hearing sensitivity. This concept is proposed based upon recent finding of massive noise-induced damage on ribbon synapse between inner hair cells (IHCs) and spiral ganglion neurons (SGNs) in the cochlea without significant permanent threshold shifts (PTS). Presumably, such damage may cause coding deficits in auditory nerve fibers (ANFs). However, such deficits had not been detailed except that a selective loss of ANFs with low spontaneous rate (SR) was reported. In the present study, we investigated the dynamic changes of ribbon synapses and the coding function of ANF single units in one month after a brief noise exposure that caused a massive damage of ribbon synapses but no PTS. The synapse count and functional response measures indicates a large portion of the disrupted synapses were re-connected. This is consistent with the fact that the change of SR distribution due to the initial loss of low SR units is recovered quickly. However, ANF coding deficits were developed later with the re-establishment of the synapses. The deficits were found in both intensity and temporal processing, revealing the nature of synaptopathy in hidden hearing loss.

Chronic suppurative otitis media, middle ear pathology and corresponding hearing loss in a cohort of Greenlandic children

BACKGROUND

Otitis media (OM) has been observed at elevated prevalence rates in Greenlandic children. OM associated hearing loss (HL) may compromise the children's linguistic skills, social development and educational achievements.

OBJECTIVES

We investigated the prevalence of chronic suppurative otitis media (CSOM), otitis media with effusion (OME) and tympanic membrane sequelae of OM, and compared the corresponding hearing thresholds.

METHODS

In 2010 we examined a cohort of 223 Greenlandic children aged 4-10 years by video otoscopy, tympanometry and tested hearing thresholds for the low-frequencies: 500, 1000 and 2000Hz and the high-frequencies: 4000 and 6000Hz. HL was categorized according to the worst hearing ear and was compared within the groups: CSOM, OME, tympanic membrane sequelae of OM and normal.

RESULTS

Of 207 children, 5.8% had CSOM, 13.9% had OME and 55.6% had tympanic membrane sequelae of OM. The median pure tone average in low-frequencies/high-frequencies were: CSOM: 34.2/31.3dB, OME: 23.3/22.5dB, Sequelae of OM: 13.3/15dB and normal ears: 11.7/12.5dB. We found a significant difference (p<0.05) between the four groups. In 56.5% of all children a HL>15dB in any frequency was found, while 6.5% suffered from a bilateral low-frequency HL>25dB.

CONCLUSION

The severity of OM significantly corresponded to increased HL. The burden of CSOM and HL remains high in young Greenlandic children. Aggressive treatment with antibiotics, improved hearing rehabilitation, sound field amplification in classrooms and otosurgical capacity should be further promoted in Greenland.

The benefit of head orientation to speech intelligibility in noise

Spatial release from masking is traditionally measured with speech in front. The effect of head-orientation with respect to the speech direction has rarely been studied. Speech-reception thresholds (SRTs) were measured for eight head orientations and four spatial configurations. Benefits of head orientation away from the speech source of up to 8 dB were measured. These correlated with predictions of a model based on better-ear listening and binaural unmasking (r = 0.96). Use of spontaneous head orientations was measured when listeners attended to long speech clips of gradually diminishing speech-to-noise ratio in a sound-deadened room. Speech was presented from the loudspeaker that initially faced the listener and noise from one of four other locations. In an undirected paradigm, listeners spontaneously turned their heads away from the speech in 56% of trials. When instructed to rotate their heads in the diminishing speech-to-noise ratio, all listeners turned away from the speech and reached head orientations associated with lower SRTs. Head orientation may prove valuable for hearing-impaired listeners.

How Age, Linguistic Status, and the Nature of the Auditory Scene Alter the Manner in Which Listening Comprehension Is Achieved in Multitalker Conversations

PURPOSE

We investigated how age and linguistic status affected listeners' ability to follow and comprehend 3-talker conversations, and the extent to which individual differences in language proficiency predict speech comprehension under difficult listening conditions.

METHOD

Younger and older L1s as well as young L2s listened to 3-talker conversations, with or without spatial separation between talkers, in either quiet or against moderate or high 12-talker babble background, and were asked to answer questions regarding their contents.

RESULTS

After compensating for individual differences in speech recognition, no significant differences in conversation comprehension were found among the groups. As expected, conversation comprehension decreased as babble level increased. Individual differences in reading comprehension skill contributed positively to performance in younger EL1s and in young EL2s to a lesser degree but not in older EL1s. Vocabulary knowledge was significantly and positively related to performance only at the intermediate babble level.

CONCLUSION

The results indicate that the manner in which spoken language comprehension is achieved is modulated by the listeners' age and linguistic status.

Validity and reliability of the Persian version of spatial hearing questionnaire

BACKGROUND

Our hearing ability in space is critical for hearing speech in noisy environment and localization. The Spatial Hearing Questionnaire (SHQ) has been devised to focus only on spatial haring tasks (e.g., lateralization, distance detection and binaural detection). The aim of the present study was to determine the reliability and validity of the Persian translation of the SHQ (Spatial Hearing Questionnaire).

METHODS

Translation and back-translation, reliability, content and construct validity were investigated. Eighty patients with sensory neural hearing loss (SNHL) (52.50% female and 47.5 % male) with the mean±SD age of 49.02±13.60 years completed SHQ, and they were categorized into mild, moderate, moderate to severe and severe groups based on their hearing threshold. Inclusion criteria in this study were the MMSE questionnaire score of higher than 21, good general health, no history of psychiatric disorders, dizziness or vertigo, dementia or alcohol abuse.

RESULTS

The reliability was assessed by Cronbach's alpha and found to be 0.99. Item-total correlation was between r= 0.84 and 0.92. There was a significant difference between the mean score of PSHQ in the four groups. Based on the factor analysis, two factors were extracted from the questions in P-SHQ: sound localization; and music and speech understanding in noise and quiet. These factors could explain 82.1% and 9.3% of the total variance, respectively.

CONCLUSION

The present study proved the reliability and validity of the Persian version of SHQ (PSHQ). This provides a suitable tool for spatial hearing assessment in clinical/research environments.

Effects of ageing and hearing thresholds on speech perception in quiet and in noise perceived in different locations

Background and Objectives

This study investigated the effect of ageing on speech perception in quiet and in noise, with noise directed from front, right and left.

Subjects and Methods

Sixty Malay native adults with normal or near normal hearing comprising of 20 young adults (21 to 39 years old), 20 middle aged (40 to 59 years old) and 20 older adults (60 to 74 years old) participated in this study. Their speech perception ability was measured using the Malay Hearing in Noise Test (HINT) in four test conditions; 1) in quiet (HINT Q), 2) with noise from front (HINT NF), 3) with noise from right (HINT NR), and 4) with noise from left (HINT NL). Reception thresholds for sentences (RTSs) were measured in each of the aforementioned conditions using an adaptive method.

Results

The results showed that, 1) genuine age-related decline was found in speech perception performance in HINT (NF), 2) hearing threshold was a major determinant differentiating speech perception performance for HINT (Q) and HINT (NL) conditions, and 3) speech perception performance for HINT (NR) was determined by both age and hearing threshold.

Conclusions

This study suggests that, in older adults, while hearing thresholds affect speech perception in quiet, other factors such as central auditory processing and cognitive functions might be more important determinant factors for speech perception performance in noise.

Middle ear impedance studies in elderly patients implications on age-related hearing loss

INTRODUCTION

Controversies arise with respect to functioning of the middle ear over time.

OBJECTIVE

To assess changes in middle ear impedance that may be related to aging, and/or if there was an association of these changes with those of the inner ear in the elderly patients.

METHODS

Cross-sectional, comparative study of elderly patients managed in ear, nose and throat clinics. A structured questionnaire was administered to obtain clinical information. Pure tone audiometry, tympanometry, and acoustic reflexes were performed. Comparative analyses were performed to detect intergroup differences between clinico-audiometric findings and middle ear measures, viz. tympanograms and acoustic reflexes.

RESULTS

One hundred and three elderly patients participated in the study; 52.4% were male, averagely 70.0±6.3 years old, age-related hearing loss in 59.2%, abnormal tympanograms in 39.3%, absent acoustic reflex in 37.9%. There was no association between age and gender in patients with abnormal tympanograms and absent acoustic reflex. Significantly more patients with different forms and grades of age-related hearing loss had abnormal tympanometry and absent acoustic reflex.

CONCLUSION

Some abnormalities were observed in the impedance audiometric measures of elderly patients, which were significantly associated with parameters connected to age-related hearing loss.

How age and linguistic competence alter the interplay of perceptual and cognitive factors when listening to conversations in a noisy environment

Multi-talker conversations challenge the perceptual and cognitive capabilities of older adults and those listening in their second language (L2). In older adults these difficulties could reflect declines in the auditory, cognitive, or linguistic processes supporting speech comprehension. The tendency of L2 listeners to invoke some of the semantic and syntactic processes from their first language (L1) may interfere with speech comprehension in L2. These challenges might also force them to reorganize the ways in which they perceive and process speech, thereby altering the balance between the contributions of bottom-up vs. top-down processes to speech comprehension. Younger and older L1s as well as young L2s listened to conversations played against a babble background, with or without spatial separation between the talkers and masker, when the spatial positions of the stimuli were specified either by loudspeaker placements (real location), or through use of the precedence effect (virtual location). After listening to a conversation, the participants were asked to answer questions regarding its content. Individual hearing differences were compensated for by creating the same degree of difficulty in identifying individual words in babble. Once compensation was applied, the number of questions correctly answered increased when a real or virtual spatial separation was introduced between babble and talkers. There was no evidence that performance differed between real and virtual locations. The contribution of vocabulary knowledge to dialog comprehension was found to be larger in the virtual conditions than in the real whereas the contribution of reading comprehension skill did not depend on the listening environment but rather differed as a function of age and language proficiency. The results indicate that the acoustic scene and the cognitive and linguistic competencies of listeners modulate how and when top-down resources are engaged in aid of speech comprehension.

Screening for hearing, visual and dual sensory impairment in older adults using behavioural cues: a validation study

OBJECTIVE

This study investigated the psychometric properties of the Severe Dual Sensory Loss screening tool, a tool designed to help nurses and care assistants to identify hearing, visual and dual sensory impairment in older adults.

DESIGN

Construct validity of the Severe Dual Sensory Loss screening tool was evaluated using Crohnbach's alpha and factor analysis. Interrater reliability was calculated using Kappa statistics. To evaluate the predictive validity, sensitivity and specificity were calculated by comparison with the criterion standard assessment for hearing and vision. The criterion used for hearing impairment was a hearing loss of ≥40 decibel measured by pure-tone audiometry, and the criterion for visual impairment was a visual acuity of ≤0.3 diopter or a visual field of ≤0.3°. Feasibility was evaluated by the time needed to fill in the screening tool and the clarity of the instruction and items. Prevalence of dual sensory impairment was calculated.

RESULTS

A total of 56 older adults receiving aged care and 12 of their nurses and care assistants participated in the study. Crohnbach's alpha was 0.81 for the hearing subscale and 0.84 for the visual subscale. Factor analysis showed two constructs for hearing and two for vision. Kappa was 0.71 for the hearing subscale and 0.74 for the visual subscale. The predictive validity showed a sensitivity of 0.71 and a specificity of 0.72 for the hearing subscale; and a sensitivity of 0.69 and a specificity of 0.78 for the visual subscale. The optimum cut-off point for each subscale was score 1. The nurses and care assistants reported that the Severe Dual Sensory Loss screening tool was easy to use. The prevalence of hearing and vision impairment was 55% and 29%, respectively, and that of dual sensory impairment was 20%.

CONCLUSIONS

The Severe Dual Sensory Loss screening tool was compared with the criterion standards for hearing and visual impairment and was found a valid and reliable tool, enabling nurses and care assistants to identify hearing, visual and dual sensory impairment among older adults.

Age-related deterioration of the representation of space in human auditory cortex

One of the principal auditory disabilities associated with older age is difficulty in locating and tracking sources of sound. This study investigated whether these difficulties are associated with deterioration in the representation of space in the auditory cortex. In psychophysical tests, half of a group of older (>60 years) adults displayed spatial acuity similar to that of young adults throughout the frontal horizontal plane. The remaining half had considerably poorer spatial acuity at the more peripheral regions of frontal space. Computational modeling of electroencephalographic responses to abrupt location shifts demonstrated marked differences in the spatial tuning of populations of cortical neurons between the older adults with poor spatial acuity on the one hand, and those with good spatial acuity, as well as young adults, on the other hand. In those with poor spatial acuity, cortical responses contained little information with which to distinguish peripheral locations. We demonstrate a clear link between neural responses and spatial acuity measured behaviorally, and provide evidence for age-related changes in the coding of horizontal space.

An energetic limit on spatial release from masking

This study tested the hypothesis that energetic masking limits the benefits obtained from spatial separation in multiple-talker listening situations, particularly for listeners with sensorineural hearing loss. A speech target was presented simultaneously with two or four speech maskers. The target was always presented diotically, and the maskers were either presented diotically or dichotically. In dichotic configurations, the maskers were symmetrically placed by introducing interaural time differences (ITDs) or infinitely large interaural level differences (ILDs; monaural presentation). Target-to-masker ratios for 50 % correct were estimated. Thresholds in all separated conditions were poorer in listeners with hearing loss than listeners with normal hearing. Moreover, for a given listener, thresholds were similar for conditions with the same number of talkers per ear (e.g., ILD with four talkers equivalent to ITD with two talkers) and hence the same energetic masking. The results are consistent with the idea that increased energetic masking, rather than a specific spatial deficit, may limit performance for hearing-impaired listeners in spatialized speech mixtures.

Efficacy of the LiSN & Learn auditory training software: randomized blinded controlled study

Children with a spatial processing disorder (SPD) require a more favorable signal-to-noise ratio in the classroom because they have difficulty perceiving sound source location cues. Previous research has shown that a novel training program - LiSN & Learn - employing spatialized sound, overcomes this deficit. Here we investigate whether improvements in spatial processing ability are specific to the LiSN & Learn training program. Participants were ten children (aged between 6;0 [years;months] and 9;9) with normal peripheral hearing who were diagnosed as having SPD using the Listening in Spatialized Noise - Sentences test (LiSN-S). In a blinded controlled study, the participants were randomly allocated to train with either the LiSN & Learn or another auditory training program - Earobics - for approximately 15 min per day for twelve weeks. There was a significant improvement post-training on the conditions of the LiSN-S that evaluate spatial processing ability for the LiSN & Learn group (P=0.03 to 0.0008, η²=0.75 to 0.95, n=5), but not for the Earobics group (P=0.5 to 0.7, η²=0.1 to 0.04, n=5). Results from questionnaires completed by the participants and their parents and teachers revealed improvements in real-world listening performance post-training were greater in the LiSN & Learn group than the Earobics group. LiSN & Learn training improved binaural processing ability in children with SPD, enhancing their ability to understand speech in noise. Exposure to non-spatialized auditory training does not produce similar outcomes, emphasizing the importance of deficit-specific remediation.