Perceived Listening Difficulties of Adult Cochlear-Implant Users Under Measures Introduced to Combat the Spread of COVID-19

Uncovering the effects of pandemic conditions on hearing aid experiences: a dual perspective from audiologists and hearing aid users

Purpose: This study examines the effects of the pandemic on hearing aid experiences from the perspectives of audiologists and patients, as well as communication challenges faced by both users and non-users of hearing aids.

Materials and Methods: The study consisted of two phases: a longitudinal study examining the services provided by audiologists during the peak of the COVID-19 pandemic and after the first vaccination dose. The second phase involved a survey of 120 elderly individuals with hearing loss, divided into hearing aid users and non-users for assessing communication challenges. Data was collected from comprehensive audiology clinics using a series of checklists.

Results: Analysis of the frequency of services related to hearing aids revealed that during the peak period, the majority of visits were for acquiring batteries and hearing aids, while fewer visits were for fitting and fine-tuning the devices. After vaccination the pattern was changed. In the second phase, significant differences were observed between the hearing aid users and non-users with regards to their ability to comprehend speech while wearing mask, communicating at a safe distance, and following TV news.

Conclusions: The distribution of requested services differed during the peak period and the post-vaccination period. There was a noticeable increase in the purchase and fitting of hearing aids after vaccination. However, patients encountered difficulties due to the limited availability of tele-audiology services and delayed services from hearing aid companies. The benefits of hearing aids were impacted by the pandemic as many people did not seek adjustments for their devices.

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

SUPPLEMENTAL MATERIAL

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

Improved speech intelligibility in the presence of congruent vibrotactile speech input

Vibrotactile stimulation is believed to enhance auditory speech perception, offering potential benefits for cochlear implant (CI) users who may utilize compensatory sensory strategies. Our study advances previous research by directly comparing tactile speech intelligibility enhancements in normal-hearing (NH) and CI participants, using the same paradigm. Moreover, we assessed tactile enhancement considering stimulus non-specific, excitatory effects through an incongruent audio-tactile control condition that did not contain any speech-relevant information. In addition to this incongruent audio-tactile condition, we presented sentences in an auditory only and a congruent audio-tactile condition, with the congruent tactile stimulus providing low-frequency envelope information via a vibrating probe on the index fingertip. The study involved 23 NH listeners and 14 CI users. In both groups, significant tactile enhancements were observed for congruent tactile stimuli (5.3% for NH and 5.4% for CI participants), but not for incongruent tactile stimulation. These findings replicate previously observed tactile enhancement effects. Juxtaposing our study with previous research, the informational content of the tactile stimulus emerges as a modulator of intelligibility: Generally, congruent stimuli enhanced, non-matching tactile stimuli reduced, and neutral stimuli did not change test outcomes. We conclude that the temporal cues provided by congruent vibrotactile stimuli may aid in parsing continuous speech signals into syllables and words, consequently leading to the observed improvements in intelligibility.

Listening efficiency in adult cochlear-implant users compared with normally-hearing controls at ecologically relevant signal-to-noise ratios

Introduction

Due to having to work with an impoverished auditory signal, cochlear-implant (CI) users may experience reduced speech intelligibility and/or increased listening effort in real-world listening situations, compared to their normally-hearing (NH) peers. These two challenges to perception may be usefully integrated in a measure of listening efficiency: conceptually, the amount of accuracy achieved for a certain amount of effort expended.

Methods

We describe a novel approach to quantifying listening efficiency based on the rate of evidence accumulation toward a correct response in a linear ballistic accumulator (LBA) model of choice decision-making. Estimation of this objective measure within a hierarchical Bayesian framework confers further benefits, including full quantification of uncertainty in parameter estimates. We applied this approach to examine the speech-in-noise performance of a group of 24 CI users (M age: 60.3, range: 20-84 years) and a group of 25 approximately age-matched NH controls (M age: 55.8, range: 20-79 years). In a laboratory experiment, participants listened to reverberant target sentences in cafeteria noise at ecologically relevant signal-to-noise ratios (SNRs) of +20, +10, and +4 dB SNR. Individual differences in cognition and self-reported listening experiences were also characterised by means of cognitive tests and hearing questionnaires.

Results

At the group level, the CI group showed much lower listening efficiency than the NH group, even in favourable acoustic conditions. At the individual level, within the CI group (but not the NH group), higher listening efficiency was associated with better cognition (i.e., working-memory and linguistic-closure) and with more positive self-reported listening experiences, both in the laboratory and in daily life.

Discussion

We argue that listening efficiency, measured using the approach described here, is: (i) conceptually well-motivated, in that it is theoretically impervious to differences in how individuals approach the speed-accuracy trade-off that is inherent to all perceptual decision making; and (ii) of practical utility, in that it is sensitive to differences in task demand, and to differences between groups, even when speech intelligibility remains at or near ceiling level. Further research is needed to explore the sensitivity and practical utility of this metric across diverse listening situations.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

DISCUSSION

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

Outcomes from 7 years of a direct to audiology referral pathway

Background

The direct to audiology via ENT referral pathway was designed to enhance patient access to audiology services. The pathway is recommended in the Otolaryngology Head & Neck Surgery: a model of care for Ireland report, published in 2019.

Aims

This study aimed to review the outcomes of all patients that attended our institution over the last seven years.

Methods

A retrospective review of the direct to audiology referral service from March 2014 to December 2021 was conducted. Outcomes were defined by the pathway each patient took following attendance at the audiology clinic. Patients were either (i) discharged, (ii) referred for hearing aid(s) or (iii) identified as candidates for further diagnostic assessments, including a follow-up at the ENT outpatient clinic.

Results

During the time frame, 419 patients were triaged to the pathway. The average wait time was 13 days. The average age was 53 years (range 16–96 years, SD = 6.1). Approximately 34% (n = 143) of all patients referred were discharged back to the GP by the audiologist, but 66% (n = 276) presented with ‘red flags’ and needed further investigation in the ENT clinic, with 30% (n = 73) ultimately requiring imaging studies. Over half (n = 254, 61%) were referred for hearing aids.

Conclusion

The direct to audiology initiative has proven effective at reducing waiting times for ENT patients solely in need of audiological intervention. Approximately one-third of these referrals to the ENT service can be assessed comprehensively in the audiology clinic, thereby reducing the demand for ENT clinics, enhancing service provision and expediting onwards referral for amplification.