Exploring Differences in Speech Processing Among Older Hearing-Impaired Listeners With or Without Hearing Aid Experience: Eye-Tracking and fMRI Measurements

Functional neuroimaging in hearing research and audiology

The various methods of medical imaging are essential for many diagnostic issues in clinical routine, e.g., for the diagnostics and localisation of tumorous diseases, or for the clarification of other lesions in the central nervous system. In addition to these classical roles both positron emission tomography (PET) and magnetic resonance imaging (MRI) allow for the investigation of functional processes in the human brain, when used in a specific way. The last 25 years have seen great progress, especially with respect to functional MRI, in terms of the available experimental paradigms as well as the data analysis strategies, so that a directed investigation of neurophysiological correlates of psychoacoustic performance is possible. This covers fundamental measures of sound perception like loudness and pitch, specific audiological symptoms like tinnitus, which often accompanies hearing disorders, but it also includes experiments on speech perception or on virtual acoustic environments. One important aspect common to many auditory neuroimaging studies is the central question at what stage in the human auditory pathway the sensory coding of the incoming sound is transformed into a universal and context-dependent perceptual representation, which is the basis for what we hear. This overview summarises findings from the literature as well as a few studies from our lab, to discuss the possibilities and the limits of the adoption of functional neuroimaging methods in audiology. Up to this stage, most auditory neuroimaging studies have investigated basic processes in normal hearing listeners. However, the hitherto existing results suggest that the methods of auditory functional neuroimaging - possibly complemented by electrophysiological methods like EEG and MEG - have a great potential to contribute to a deeper understanding of the processes and the impact of hearing disorders.

Effects of age-related hearing loss and hearing aid experience on sentence processing

Age-related hearing loss typically affects the hearing of high frequencies in older adults. Such hearing loss influences the processing of spoken language, including higher-level processing such as that of complex sentences. Hearing aids may alleviate some of the speech processing disadvantages associated with hearing loss. However, little is known about the relation between hearing loss, hearing aid use, and their effects on higher-level language processes. This neuroimaging (fMRI) study examined these factors by measuring the comprehension and neural processing of simple and complex spoken sentences in hard-of-hearing older adults (n = 39). Neither hearing loss severity nor hearing aid experience influenced sentence comprehension at the behavioral level. In contrast, hearing loss severity was associated with increased activity in left superior frontal areas and the left anterior insula, but only when processing specific complex sentences (i.e. object-before-subject) compared to simple sentences. Longer hearing aid experience in a sub-set of participants (n = 19) was associated with recruitment of several areas outside of the core speech processing network in the right hemisphere, including the cerebellum, the precentral gyrus, and the cingulate cortex, but only when processing complex sentences. Overall, these results indicate that brain activation for language processing is affected by hearing loss as well as subsequent hearing aid use. Crucially, they show that these effects become apparent through investigation of complex but not simple sentences.

When Hearing Does Not Mean Understanding: On the Neural Processing of Syntactically Complex Sentences by Listeners With Hearing Loss

Purpose Adults with mild-to-moderate age-related hearing loss typically exhibit issues with speech understanding, but their processing of syntactically complex sentences is not well understood. We test the hypothesis that listeners with hearing loss' difficulties with comprehension and processing of syntactically complex sentences are due to the processing of degraded input interfering with the successful processing of complex sentences. Method We performed a neuroimaging study with a sentence comprehension task, varying sentence complexity (through subject-object order and verb-arguments order) and cognitive demands (presence or absence of a secondary task) within subjects. Groups of older subjects with hearing loss (n = 20) and age-matched normal-hearing controls (n = 20) were tested. Results The comprehension data show effects of syntactic complexity and hearing ability, with normal-hearing controls outperforming listeners with hearing loss, seemingly more so on syntactically complex sentences. The secondary task did not influence off-line comprehension. The imaging data show effects of group, sentence complexity, and task, with listeners with hearing loss showing decreased activation in typical speech processing areas, such as the inferior frontal gyrus and superior temporal gyrus. No interactions between group, sentence complexity, and task were found in the neuroimaging data. Conclusions The results suggest that listeners with hearing loss process speech differently from their normal-hearing peers, possibly due to the increased demands of processing degraded auditory input. Increased cognitive demands by means of a secondary visual shape processing task influence neural sentence processing, but no evidence was found that it does so in a different way for listeners with hearing loss and normal-hearing listeners.