Training changes processing of speech cues in older adults with hearing loss

The Real-World Usability, Feasibility, and Performance Distributions of Deploying a Digital Toolbox of Computerized Assessments to Remotely Evaluate Brain Health: Development and Usability Study

BACKGROUND

An ongoing global challenge is managing brain health and understanding how performance changes across the lifespan.

OBJECTIVE

We developed and deployed a set of self-administrable, computerized assessments designed to measure key indexes of brain health across the visual and auditory sensory modalities. In this pilot study, we evaluated the usability, feasibility, and performance distributions of the assessments in a home-based, real-world setting without supervision.

METHODS

Potential participants were untrained users who self-registered on an existing brain training app called BrainHQ. Participants were contacted via a recruitment email and registered remotely to complete a demographics questionnaire and 29 unique assessments on their personal devices. We examined participant engagement, descriptive and psychometric properties of the assessments, associations between performance and self-reported demographic variables, cognitive profiles, and factor loadings.

RESULTS

Of the 365,782 potential participants contacted via a recruitment email, 414 (0.11%) registered, of whom 367 (88.6%) completed at least one assessment and 104 (25.1%) completed all 29 assessments. Registered participants were, on average, aged 63.6 (SD 14.8; range 13-107) years, mostly female (265/414, 64%), educated (329/414, 79.5% with a degree), and White (349/414, 84.3% White and 48/414, 11.6% people of color). A total of 72% (21/29) of the assessments showed no ceiling or floor effects or had easily modifiable score bounds to eliminate these effects. When correlating performance with self-reported demographic variables, 72% (21/29) of the assessments were sensitive to age, 72% (21/29) of the assessments were insensitive to gender, 93% (27/29) of the assessments were insensitive to race and ethnicity, and 93% (27/29) of the assessments were insensitive to education-based differences. Assessments were brief, with a mean duration of 3 (SD 1.0) minutes per task. The pattern of performance across the assessments revealed distinctive cognitive profiles and loaded onto 4 independent factors.

CONCLUSIONS

The assessments were both usable and feasible and warrant a full normative study. A digital toolbox of scalable and self-administrable assessments that can evaluate brain health at a glance (and longitudinally) may lead to novel future applications across clinical trials, diagnostics, and performance optimization.

Hearing Loss in Older People With Schizophrenia: Audiologic Characteristics and Association With Psychosocial Functioning

OBJECTIVE

The severity and impact of hearing deficits among adults with schizophrenia spectrum disorders may become increasingly relevant with advancing age. This study evaluated hearing ability and associated psychosocial functioning among older adults aged 50-70.

DESIGN

Cross-sectional analysis.

SETTING

Four outpatient psychiatry clinics in New York City.

PARTICIPANTS

Individuals aged 50-70 years with diagnoses of schizophrenia or schizoaffective disorder.

MEASUREMENTS

Unaided pure tone air conduction audiometry conducted using a portable audiometry system determined the pure tone average (PTA) hearing threshold across four frequencies: 500, 1k, 2k, and 4k Hz. Better ear PTA defined the hearing threshold. Audiometry data retrieved from the U.S. National Health and Nutrition Examination Survey aided interpretation of sample hearing loss rates. Standard measures evaluated psychiatric symptoms, perceived impact of hearing impairment, loneliness, and quality of life.

RESULTS

Among audiometry completers (N = 40), 35% (n = 14) demonstrated subclinical hearing loss (16-25 dB) and 35% (n = 14) had mild or worse hearing loss (≥26 dB). Rates were higher than expected based on age-based population data. Those who perceived hearing handicap rated it moderate (12.2%) or severe (7.3%); those who perceived tinnitus rated the impact as mild to moderate (12.2%) or catastrophic (2.4%). Neither psychiatric symptoms nor interviewer-rated quality of life was associated with hearing ability. Greater loneliness was significantly correlated with worse audiologic performance (r = 0.475, p <0.01) and greater perceived hearing handicap (r = 0.480, p <0.01).

CONCLUSION

Identifying the need for hearing loss treatment among aging adults with schizophrenia spectrum disorders is important given the potential implications for social functioning, cognitive, and mental health.

The Effect of Computer-Based Auditory Training on Speech-in-Noise Perception in Adults: a Systematic Review and Meta-Analysis

To investigate the effectiveness of computer-based auditory training on speech-in-noise perception in adults. With no language restriction, 11 databases were searched from 1990 to 2020. We included any clinical trial studies with concurrent comparison groups that examined the effectiveness of computer-based auditory training programs in adults. The primary outcome was a speech in noise perception that was estimated using the "difference pretest-posttest-control" index (dppc2). The risk of bias was assessed using the Cochrane collaboration tool for assessing the risk of bias in randomized trials. The certainty of the evidence was investigated using the GRADE in two primary outcomes. Twenty three studies were included in two subgroups based on primary outcome: 12 studies with speech perception threshold and 11 studies with speech-in-noise test scores. Computer-based auditory training resulted in a speech in noise perception improvement (dppc2:  -0.69, 95%CI:  -1.11 to  -0.26; I2 = 69.6%, p = 0.00) and (dppc2: 0.71, 95%CI: 0.38-1.03, I2: 17.8%, p = 0.27) respectively in both subgroups. 19 studies were judged to have a high risk of bias and 3 studies had a low risk of bias and the strength of the evidence was low in both primary outcomes. This finding indicates that computer-based auditory training can be a moderately effective intervention for speech-in-noise perception in adults. However, due to the low quality of primary studies and the low certainty of the evidence, the results are not yet definite. Prospero registration number: CRD42021233193.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03920-0.

Individual Differences in Auditory Training Benefits for Hearing Aid Users

The present study aimed to examine whether individual differences in baseline speech perception could serve as predictors for the effectiveness and generalization of auditory training (AT) to non-trained tasks. Twelve adults, aged 60-75 years with bilateral hearing loss, completed a two-month, home-based, computerized AT program, involving sessions four times per week. Training tasks included the identification of vowel frontal, height, manner of articulation, point of articulation, voicing, and open-set consonant-vowel-consonant (CVC) words. Non-trained speech perception tests were conducted one month before AT, prior to training, after one and two months of training, and during a two-month follow-up. The results showed that one month of AT improved performance in most trained tasks, with generalization observed in the CVC words test and HeBio sentences with speech-shaped noise (SSN). No evidence of spontaneous learning or added benefit from an extra month of training was found. Most importantly, baseline speech perception predicted improvements in both training and post-training generalization tasks. This emphasizes the significance of adopting an individualized approach when determining the potential effectiveness of AT, applicable in both clinical and research contexts.

Assessing the Development and Viability of an Android App for Auditory Training in Older Adults with Hearing Impairments

Purpose: This study aims to develop an android application that is more compatible and user-friendly for the older adult population with hearing impairment and validate the developed app. Method: The app's framework involved a training mode platform consisting of four levels with four sub-levels each. Every level includes stimuli of word-in-noise containing high and low-frequency words with three different noise types - traffic noise, competing for speech, and speech babble. The levels in the app increased in complexity to provide an efficient auditory training feature. The developed application was validated on older adults and professionals based on a questionnaire with both closed and open-ended questions. Results: Based on the validated responses of the participants, the app is a reliable tool for auditory training in older adults with hearing impairment. The app contains ease-of-use features for older adults and has been considered a platform for improvement in aural rehabilitation. Conclusion: The study marks as a tool in auditory training for older adults to provide the utmost benefit. Increase in the cases of the hearing-impaired population in a few years, a demand to set up a user-friendly management option is beneficiDigitizationtion of aural rehabilitation, especially for older adults, has thus been noted in the present study.

Remote Technologies to Enhance Service Delivery for Adults: Clinical Research Perspectives

There are many examples of remote technologies that are clinically effective and provide numerous benefits to adults with hearing loss. Despite this, the uptake of remote technologies for hearing healthcare has been both low and slow until the onset of the COVID-19 pandemic, which has been a key driver for change globally. The time is now right to take advantage of the many benefits that remote technologies offer, through clinical, consumer, or hybrid services and channels. These include greater access and choice, better interactivity and engagement, and tailoring of technologies to individual needs, leading to clients who are better informed, enabled, and empowered to self-manage their hearing loss. This article provides an overview of the clinical research evidence-base across a range of remote technologies along the hearing health journey. This includes qualitative, as well as quantitative, methods to ensure the end-users' voice is at the core of the research, thereby promoting person-centered principles. Most of these remote technologies are available and some are already in use, albeit not widespread. Finally, whenever new technologies or processes are implemented into services, be they clinical, hybrid, or consumer, careful consideration needs to be given to the required behavior change of the key people (e.g., clients and service providers) to facilitate and optimize implementation.

American Speech-Language-Hearing Association Clinical Practice Guideline on Aural Rehabilitation for Adults With Hearing Loss

BACKGROUND

Hearing loss poses a significant public health challenge as a common chronic condition with many known side effects that are often worse when left untreated. Aural rehabilitation (AR) is an umbrella term that encompasses a range of interventions (e.g., informational counseling and perceptual training) designed to reduce deficits related to hearing loss that may stand alone or be used in combination as part of a holistic plan.

PURPOSE

This evidence-based clinical practice guideline is intended to inform the implementation of person-centered AR to adults with hearing loss. Given the well-known benefits of sensory management, it was not included within the scope of this guideline. The recommendations aim to help clinicians, individuals with hearing loss, and other stakeholders make evidence-informed treatment decisions and improve clinical outcomes, as well as provide payers and policymakers with information detailing a comprehensive approach to AR.

METHOD

The American Speech-Language-Hearing Association (ASHA) and a multidisciplinary panel of subject matter experts prioritized key clinical questions and outcomes that served as the foundation of the guideline. The clinical recommendations were based on a comprehensive systematic review and a meta-analysis of 85 studies published between 1978 and 2021.

RECOMMENDATIONS

Given the current state of the evidence, resource considerations, patient acceptability, clinical feasibility, and the overall balance of benefits and harms, ASHA developed several evidence-based recommendations for the provision of AR to adults with hearing loss. Each recommendation is accompanied by a series of key practice points to support its implementation within a person-centered framework.

Effectiveness of Auditory Training in Experienced Hearing-Aid Users, and an Exploration of Their Health-Related Quality of Life and Coping Strategies

Hearing aids (HA) are a fundamental component in restoring auditory function; however, they cannot completely alleviate all problems encountered by adults with hearing impairment. The aim of this study is twofold. Firstly, we assess the health-related quality of life and coping strategies of experienced HA users. Secondly, we assess whether HA users can benefit from auditory training. To this end, 40 participants who had worn HAs for more than 6 months participated in this study. Half of the participants received auditory training, while the other half served as a passive control. The training consisted of a personalized training scheme, with outcome measures including speech in noise perception in free-field and via direct streaming to the HA, phoneme identification, cognitive control, and health-related quality of life. Results showed that experienced HA users reported a relatively good quality of life. Health-related quality of life was correlated with aided speech perception in noise, but not with aided pure tone audiometry. Coping strategies were adaptive, leading to improved communication. Participants showed improvements in trained tasks, consonant identification, and speech in noise perception. While both groups yielded improved speech in noise perception at the end, post hoc analysis following a three-way interaction showed a significantly larger pre-post difference for the trained group in the streaming condition. Although training showed some improvements, the study suggests that the training paradigm was not sufficiently challenging for HA users. To optimize daily life listening, we recommend that future training should incorporate more exercises in noise and focus on cognitive control.

Poor Performer: A Distinct Entity in Cochlear Implant Users?

INTRODUCTION

Several factors are known to influence speech perception in cochlear implant (CI) users. To date, the underlying mechanisms have not yet been fully clarified. Although many CI users achieve a high level of speech perception, a small percentage of patients does not or only slightly benefit from the CI (poor performer, PP). In a previous study, PP showed significantly poorer results on nonauditory-based cognitive and linguistic tests than CI users with a very high level of speech understanding (star performer, SP). We now investigate if PP also differs from the CI user with an average performance (average performer, AP) in cognitive and linguistic performance.

METHODS

Seventeen adult postlingually deafened CI users with speech perception scores in quiet of 55 (9.32) % (AP) on the German Freiburg monosyllabic speech test at 65 dB underwent neurocognitive (attention, working memory, short- and long-term memory, verbal fluency, inhibition) and linguistic testing (word retrieval, lexical decision, phonological input lexicon). The results were compared to the performance of 15 PP (speech perception score of 15 [11.80] %) and 19 SP (speech perception score of 80 [4.85] %). For statistical analysis, U-Test and discrimination analysis have been done.

RESULTS

Significant differences between PP and AP were observed on linguistic tests, in Rapid Automatized Naming (RAN: p = 0.0026), lexical decision (LexDec: p = 0.026), phonological input lexicon (LEMO: p = 0.0085), and understanding of incomplete words (TRT: p = 0.0024). AP also had significantly better neurocognitive results than PP in the domains of attention (M3: p = 0.009) and working memory (OSPAN: p = 0.041; RST: p = 0.015) but not in delayed recall (delayed recall: p = 0.22), verbal fluency (verbal fluency: p = 0.084), and inhibition (Flanker: p = 0.35). In contrast, no differences were found hereby between AP and SP. Based on the TRT and the RAN, AP and PP could be separated in 100%.

DISCUSSION

The results indicate that PP constitute a distinct entity of CI users that differs even in nonauditory abilities from CI users with an average speech perception, especially with regard to rapid word retrieval either due to reduced phonological abilities or limited storage. Further studies should investigate if improved word retrieval by increased phonological and semantic training results in better speech perception in these CI users.

Objective Detection of the Speech Frequency Following Response (sFFR): A Comparison of Two Methods

Speech frequency following responses (sFFRs) are increasingly used in translational auditory research. Statistically-based automated sFFR detection could aid response identification and provide a basis for stopping rules when recording responses in clinical and/or research applications. In this brief report, sFFRs were measured from 18 normal hearing adult listeners in quiet and speech-shaped noise. Two statistically-based automated response detection methods, the F-test and Hotelling’s T² (HT²) test, were compared based on detection accuracy and test time. Similar detection accuracy across statistical tests and conditions was observed, although the HT² test time was less variable. These findings suggest that automated sFFR detection is robust for responses recorded in quiet and speech-shaped noise using either the F-test or HT² test. Future studies evaluating test performance with different stimuli and maskers are warranted to determine if the interchangeability of test performance extends to these conditions.

Influence of Auditory Training on Acceptable Noise Level Scores in Elderly Persons with Hearing Impairment

Objective

To study the Influence of Auditory Training on acceptable noise level (ANL) scores in elderly persons with hearing impairment.

Design

Quasi-experimental study design.

Study sample

A total of 20 bilateral mild to moderately severe sensorineural hearing loss participants with "high" ANL scores were taken into the study and randomly allocated to experimental and control groups. In the time frame, the experimental group provided 12 sessions of speech in noise training with a hearing aid and the baseline measures were repeated in both groups.

Results

The Acceptable noise level and Speech in Noise scores significantly improved post-training only in the experimental group. They also showed a significant difference "Client Oriented Scale of Improvement (COSI)" scale in the domain "Conversation in Noise".

Conclusions

Acceptable noise level is susceptible to training similar to that of speech in noise score. It provides hope to the individuals who are poor candidates to the hearing aids.

Changes in cortical auditory evoked potentials in response to auditory training in elderly hearing aid users: A pilot study

OBJECTIVE

To compare the cortical auditory evoked potential responses pre-and post-Auditory Musical Training associated with hearing aid adaptation in elderly people with presbycusis.

DESIGN

This is a pilot, prospective, randomized, single-blind study.

STUDY SAMPLE

Eight presbiacusis elderly people between 65 and 80 years, new hearing aid users, divided into two groups participated in the study: Hearing Aid Group: use of hearing aid; and Auditory Training Group: use of hearing aid in addition to musical auditory training for 16 sessions. All participants were submitted to cortical auditory evoked potential tests with verbal stimulation in two different moments: Initial assessment, carried out before hearing aid adaptation and auditory training, and after three months, final assessment at the end of the auditory training sessions. All participants were adapted bilaterally with digital mini hearing aids.

RESULTS

There was a decrease in the P3a latency component for the Auditory Training Group when initial and final assessment were compared.

CONCLUSION

There was a change in the cortical auditory evoked potential in elderly people with presbycusis in response to the Musical Auditory Training associated with the use of hearing aids in elderly people with presbycusis.

Effectiveness of Computer-Based Auditory Training for Adult Cochlear Implant Users: A Randomized Crossover Study

The aim of this study was to assess whether a computer-based speech-in-noise auditory training (AT) program would lead to short- and long-term changes in trained and untrained measures of listening, cognition, and quality of life. A secondary aim was to assess whether directly training the underlying cognitive abilities required for speech perception in noise, using a computer-based visual training (VT) program without the auditory component, would elicit comparable outcomes as the AT program. A randomized crossover study with repeated measures was conducted with 26 adult cochlear implant users. Participants completed either 6 weeks of speech perception in noise training followed by 6 weeks of masked text recognition training, or vice versa. Outcome measures were administered twice before each training program, as well as twice after the completion of each program. The test battery was designed to evaluate whether training led to improvements in listening abilities, cognitive abilities, or quality of life. Mixed-effects models were conducted to analyze whether changes occurred on the trained tasks and on untrained outcome measures after training. Statistically significant improvements were shown for verbal recognition performance during both training programs, in particular for consonants in words, and during the first 2 weeks of training. This on-task learning, however, did not lead to clear improvements in outcomes measured beyond the training programs. This suggests that experienced cochlear implant users may not show transfer of on-task learning to untrained tasks after computer-based auditory and visual training programs such as the ones used in this study.

Training with an auditory perceptual learning game transfers to speech in competition

Understanding speech in the presence of acoustical competition is a major complaint of those with hearing difficulties. Here, a novel perceptual learning game was tested for its effectiveness in reducing difficulties with hearing speech in competition. The game was designed to train a mixture of auditory processing skills thought to underlie speech in competition, such as spectral-temporal processing, sound localization, and auditory working memory. Training on these skills occurred both in quiet and in competition with noise. Thirty college-aged participants without any known hearing difficulties were assigned either to this mixed-training condition or an active control consisting of frequency discrimination training within the same gamified setting. To assess training effectiveness, tests of speech in competition (primary outcome), as well as basic supra-threshold auditory processing and cognitive processing abilities (secondary outcomes) were administered before and after training. Results suggest modest improvements on speech in competition tests in the mixed-training compared to the frequency-discrimination control condition (Cohen’s d = 0.68). While the sample is small, and in normally hearing individuals, these data suggest promise of future study in populations with hearing difficulties.

Benefit of Musical Training for Speech Perception and Cognition Later in Life

Purpose The aim of this study was to determine the long-term associations of musical training with speech perception in adverse conditions and cognition in a longitudinal cohort study of middle-age to older adults. Method This study is based on Epidemiology of Hearing Loss Study participants. We asked participants at baseline (1993-1995) about their musical training. Speech perception (word recognition in competing message; Northwestern University Auditory Test Number 6), cognitive function (cognitive test battery), and impairment (self-report or surrogate report of Alzheimer's disease or dementia, and/or a Mini-Mental State Examination score ≤ 24) were assessed up to 5 times over the 20-year follow-up. We included 2,938 Epidemiology of Hearing Loss Study participants who had musical training data and at least one follow-up of speech perception and/or cognitive assessment. We used linear mixed-effects models to determine associations between musicianship and decline in speech perception and cognitive function over time and Cox regression models to evaluate associations of musical training with 20-year cumulative incidence of speech perception and cognitive impairment. Models were adjusted for age, sex, and occupation and repeated with additional adjustment for health-related confounders and education. Results Musicians showed less speech perception decline over time with stronger effects in women (0.16% difference, 95% confidence interval [CI] [0.05, 0.26]). Among men, musicians had, on average, better speech perception than nonmusicians (3.41% difference, 95% CI [0.62, 6.20]) and were less likely to develop a cognitive impairment than nonmusicians (hazard ratio = 0.58, 95% CI [0.37, 0.91]). Conclusions Musicians showed an advantage in speech perception abilities and cognition later in life and less decline over time with different magnitudes of effect sizes in men and women. Associations remained with further adjustment, indicating that some degree of the advantage of musical training is independent of socioeconomic or health differences. If confirmed, these findings could have implications for developing speech perception intervention and prevention strategies. Supplemental Material https://doi.org/10.23641/asha.14825454.

A Game a Day Keeps Cognitive Decline Away? A Systematic Review and Meta-Analysis of Commercially-Available Brain Training Programs in Healthy and Cognitively Impaired Older Adults

The rising prevalence rates of age-related cognitive impairment are a worldwide public concern, bringing about a surge in the number of "brain training" programs commercially available to the general public. Numerous companies advertise that their products improve memory and protect against cognitive decline, though researchers have voiced concerns regarding the validity of such claims. To address this issue, the current meta-analytic investigation examined evidence from 43 studies (encompassing 2,636 participants) to evaluate the efficacy of commercial training programs within two separate populations: healthy older adults and older adults with mild cognitive-impairment (MCI). Seven programs were identified: BrainGymmer, BrainHQ, CogMed, CogniFit, Dakim, Lumosity, and MyBrainTrainer. Analyses yielded small, significant near-transfer effects for both healthy and MCI samples. Far-transfer was not observed for the MCI sample, whereas a small, significant effect was found for subjective but not objective measures of far-transfer in the healthy sample. Analyses of individual domains (combining near-and far-transfer outcomes) yielded significant transfer to executive-functioning, memory, and processing-speed in healthy older adults. After adjusting for publication bias, only the effect size for processing speed remained significant. Transfer to attention, objective everyday functioning, fluid-intelligence, and visuospatial domains was not significant. Thus, whilst "brain training" may be suitable for enjoyment and entertainment purposes, there is currently insufficient empirical evidence to support that such training can improve memory, general cognition, or everyday functioning. This area of research is still in its infancy and warrants further investigation to provide more substantial evidence regarding the efficacy of this rapidly expanding industry.

Cortical compensation for hearing loss, but not age, in neural tracking of the fundamental frequency of the voice

Auditory processing is affected by advancing age and hearing loss, but the underlying mechanisms are still unclear. We investigated the effects of age and hearing loss on temporal processing of naturalistic stimuli in the auditory system. We used a recently developed objective measure for neural phase-locking to the fundamental frequency of the voice (f0) which uses continuous natural speech as a stimulus, that is, "f0-tracking." The f0-tracking responses from 54 normal-hearing and 14 hearing-impaired adults of varying ages were analyzed. The responses were evoked by a Flemish story with a male talker and contained contributions from both subcortical and cortical sources. Results indicated that advancing age was related to smaller responses with less cortical response contributions. This is consistent with an age-related decrease in neural phase-locking ability at frequencies in the range of the f0, possibly due to decreased inhibition in the auditory system. Conversely, hearing-impaired subjects displayed larger responses compared with age-matched normal-hearing controls. This was due to additional cortical response contributions in the 38- to 50-ms latency range, which were stronger for participants with more severe hearing loss. This is consistent with hearing-loss-induced cortical reorganization and recruitment of additional neural resources to aid in speech perception.NEW & NOTEWORTHY Previous studies disagree on the effects of age and hearing loss on the neurophysiological processing of the fundamental frequency of the voice (f0), in part due to confounding effects. Using a novel electrophysiological technique, natural speech stimuli, and controlled study design, we quantified and disentangled the effects of age and hearing loss on neural f0 processing. We uncovered evidence for underlying neurophysiological mechanisms, including a cortical compensation mechanism for hearing loss, but not for age.

Auditory Training Supports Auditory Rehabilitation: A State-of-the-Art Review

OBJECTIVES

Auditory training (AT), which is active listening to various auditory stimuli, aims to improve auditory skills. There is evidence that AT can be used as a tool in auditory rehabilitation to improve speech perception and other auditory cognitive skills in individuals with hearing impairment. The present state-of-the-art review examines the effect of AT on communication abilities in individuals with hearing impairment. In particular, transfer of AT effects on performance in untrained speech perception tasks was evaluated.

DESIGN

PubMed, Medline, and Web of Science databases were searched using combinations of key words with restriction to the publication date from December 2012 until December 2018. The participant, intervention, control, outcome, and study design criteria were used for the inclusion of articles. Only studies comparing effects in an intervention group to a control group were considered. The target group included individuals with a mild to moderately severe hearing impairment, with and without hearing-aid experience. Out of 265 article abstracts reviewed, 16 met the predefined criteria and were taken for review.

RESULTS

The majority of studies that were included in this state of- the-art review report at least one outcome measure that shows an improvement in non-trained tasks after a period of intense AT. However, observed shortcomings are that a comparison between studies remains difficult as training benefits were assessed with various outcome measures. Also, the sustainability of training benefits was not investigated sufficiently.

CONCLUSIONS

Recent evidence suggests that intensive auditory (-cognitive) training protocols are a valid tool to improve auditory communication skills. Individuals with hearing impairment seem to benefit the most using a combination of sensory rehabilitation with hearing aids and AT to enhance auditory rehabilitation. Long term benefits of AT are still not consistently observed and should be in the focus of future research.

The Influence of the Type of Background Noise on Perceptual Learning of Speech in Noise

Objectives

Auditory perceptual learning studies tend to focus on the nature of the target stimuli. However, features of the background noise can also have a significant impact on the amount of benefit that participants obtain from training. This study explores whether perceptual learning of speech in background babble noise generalizes to other, real-life environmental background noises (car and rain), and if the benefits are sustained over time.

Design

Normal-hearing native English speakers were randomly assigned to a training (n = 12) or control group (n = 12). Both groups completed a pre- and post-test session in which they identified Bamford-Kowal-Bench (BKB) target words in babble, car, or rain noise. The training group completed speech-in-babble noise training on three consecutive days between the pre- and post-tests. A follow up session was conducted between 8 and 18 weeks after the post-test session (training group: n = 9; control group: n = 7).

Results

Participants who received training had significantly higher post-test word identification accuracy than control participants for all three types of noise, although benefits were greatest for the babble noise condition and weaker for the car- and rain-noise conditions. Both training and control groups maintained their pre- to post-test improvement over a period of several weeks for speech in babble noise, but returned to pre-test accuracy for speech in car and rain noise.

Conclusion

The findings show that training benefits can show some generalization from speech-in-babble noise to speech in other types of environmental noise. Both groups sustained their learning over a period of several weeks for speech-in-babble noise. As the control group received equal exposure to all three noise types, the sustained learning with babble noise, but not other noises, implies that a structural feature of babble noise was conducive to the sustained improvement. These findings emphasize the importance of considering the background noise as well as the target stimuli in auditory perceptual learning studies.

Selective attention modulates neural envelope tracking of informationally masked speech in healthy older adults

Speech understanding in noisy situations is compromised in old age. This study investigated the energetic and informational masking components of multi‐talker babble noise and their influence on neural tracking of the speech envelope in a sample of healthy older adults. Twenty‐three older adults (age range 65–80 years) listened to an audiobook embedded in noise while their electroencephalogram (EEG) was recorded. Energetic masking was manipulated by varying the signal‐to‐noise ratio (SNR) between target speech and background talkers and informational masking was manipulated by varying the number of background talkers. Neural envelope tracking was measured by calculating temporal response functions (TRFs) between speech envelope and EEG. Number of background talkers, but not SNR modulated the amplitude of an earlier (around 50 ms time lag) and a later (around 300 ms time lag) peak in the TRFs. Selective attention, but not working memory or peripheral hearing additionally modulated the amplitude of the later TRF peak. Finally, amplitude of the later TRF peak was positively related to accuracy in the comprehension task. The results suggest that stronger envelope tracking is beneficial for speech‐in‐noise understanding and that selective attention is an important ability supporting speech‐in‐noise understanding in multi‐talker scenes.

The Listening Network and Cochlear Implant Benefits in Hearing-Impaired Adults

Older adults with mild or no hearing loss make more errors and expend more effort listening to speech. Cochlear implants (CI) restore hearing to deaf patients but with limited fidelity. We hypothesized that patient-reported hearing and health-related quality of life in CI patients may similarly vary according to age. Speech Spatial Qualities (SSQ) of hearing scale and Health Utilities Index Mark III (HUI) questionnaires were administered to 543 unilaterally implanted adults across Europe, South Africa, and South America. Data were acquired before surgery and at 1, 2, and 3 years post-surgery. Data were analyzed using linear mixed models with visit, age group (18–34, 35–44, 45–54, 55–64, and 65+), and side of implant as main factors and adjusted for other covariates. Tinnitus and dizziness prevalence did not vary with age, but older groups had more preoperative hearing. Preoperatively and postoperatively, SSQ scores were significantly higher (Δ0.75–0.82) for those aged <45 compared with those 55+. However, gains in SSQ scores were equivalent across age groups, although postoperative SSQ scores were higher in right-ear implanted subjects. All age groups benefited equally in terms of HUI gain (0.18), with no decrease in scores with age. Overall, younger adults appeared to cope better with a degraded hearing before and after CI, leading to better subjective hearing performance.

Frequency Following Response and Speech Recognition Benefit for Combining a Cochlear Implant and Contralateral Hearing Aid

Multiple studies have shown significant speech recognition benefit when acoustic hearing is combined with a cochlear implant (CI) for a bimodal hearing configuration. However, this benefit varies greatly between individuals. There are few clinical measures correlated with bimodal benefit and those correlations are driven by extreme values prohibiting data-driven, clinical counseling. This study evaluated the relationship between neural representation of fundamental frequency (F0) and temporal fine structure via the frequency following response (FFR) in the nonimplanted ear as well as spectral and temporal resolution of the nonimplanted ear and bimodal benefit for speech recognition in quiet and noise. Participants included 14 unilateral CI users who wore a hearing aid (HA) in the nonimplanted ear. Testing included speech recognition in quiet and in noise with the HA-alone, CI-alone, and in the bimodal condition (i.e., CI + HA), measures of spectral and temporal resolution in the nonimplanted ear, and FFR recording for a 170-ms/da/stimulus in the nonimplanted ear. Even after controlling for four-frequency pure-tone average, there was a significant correlation (r = .83) between FFR F0 amplitude in the nonimplanted ear and bimodal benefit. Other measures of auditory function of the nonimplanted ear were not significantly correlated with bimodal benefit. The FFR holds potential as an objective tool that may allow data-driven counseling regarding expected benefit from the nonimplanted ear. It is possible that this information may eventually be used for clinical decision-making, particularly in difficult-to-test populations such as young children, regarding effectiveness of bimodal hearing versus bilateral CI candidacy.

Objective evidence of temporal processing deficits in older adults

The older listener's ability to understand speech in challenging environments may be affected by impaired temporal processing. This review summarizes objective evidence of degraded temporal processing from studies that have used the auditory brainstem response, auditory steady-state response, the envelope- or frequency-following response, cortical auditory-evoked potentials, and neural tracking of continuous speech. Studies have revealed delayed latencies and reduced amplitudes/phase locking in subcortical responses in older vs. younger listeners, in contrast to enhanced amplitudes of cortical responses in older listeners. Reconstruction accuracy of responses to continuous speech (e.g., cortical envelope tracking) shows over-representation in older listeners. Hearing loss is a factor in many of these studies, even though the listeners would be considered to have clinically normal hearing thresholds. Overall, the ability to draw definitive conclusions regarding these studies is limited by the use of multiple stimulus conditions, small sample sizes, and lack of replication. Nevertheless, these objective measures suggest a need to incorporate new clinical measures to provide a more comprehensive assessment of the listener's speech understanding ability, but more work is needed to determine the most efficacious measure for clinical use.

Study of Acute and Sub-Acute Effects of Auditory Training on the Central Auditory Processing in Older Adults with Hearing Loss-A Pilot Study

Background: Impairment in speech perception is a common feature of older adults. This study aimed at evaluating the acute and sub-acute (after three months) effects of auditory training on central auditory processing in older people with hearing loss. Methods: A nonrandomized study was conducted enrolling 15 older adults with hearing loss and an average age of 78.6 ± 10.9 years. All participants underwent a baseline otoscopy, tympanogram, audiogram and speech-in-noise test with a signal-noise ratio (SNR) of 10 and 15 dB. Afterwards, auditory training intervention was implemented consisting of 10 training sessions over 5 weeks. Participants were divided into two groups: group 1 (G1) underwent auditory training based on a speech-in-noise test; group 2 (G2) underwent a filtered-speech test. Auditory processing was evaluated at baseline (T0) immediately after the intervention (T1) and 3 months after the intervention (T2). Results: Group 1 were quite efficient regardless of the SNR in the right ear with statistically significant differences from T0 to T1 (p = 0.003 and p = 0.006 for 10 dB and 15 dB, respectively) and T0 to T2 (p = 0.011 and 0.015 for 10 dB and 15 dB, respectively). As for the left ear, the increase of success was statistically significant for the SNR of 10 dB and 15 dB from T0 to T1 (p = 0.001 and p = 0.014, respectively) and from T0 to T2 (p = 0.016 and p = 0.003). In G2, there was a significant variation only from T0 for T1 in the left ear for an SNR of 10 dB (p = 0.001). Conclusion: Speech perception in noise significantly improved after auditory training in old adults.

Age-related hearing loss increases full-brain connectivity while reversing directed signaling within the dorsal-ventral pathway for speech

Speech comprehension difficulties are ubiquitous to aging and hearing loss, particularly in noisy environments. Older adults' poorer speech-in-noise (SIN) comprehension has been related to abnormal neural representations within various nodes (regions) of the speech network, but how senescent changes in hearing alter the transmission of brain signals remains unspecified. We measured electroencephalograms in older adults with and without mild hearing loss during a SIN identification task. Using functional connectivity and graph-theoretic analyses, we show that hearing-impaired (HI) listeners have more extended (less integrated) communication pathways and less efficient information exchange among widespread brain regions (larger network eccentricity) than their normal-hearing (NH) peers. Parameter optimized support vector machine classifiers applied to EEG connectivity data showed hearing status could be decoded (> 85% accuracy) solely using network-level descriptions of brain activity, but classification was particularly robust using left hemisphere connections. Notably, we found a reversal in directed neural signaling in left hemisphere dependent on hearing status among specific connections within the dorsal-ventral speech pathways. NH listeners showed an overall net "bottom-up" signaling directed from auditory cortex (A1) to inferior frontal gyrus (IFG; Broca's area), whereas the HI group showed the reverse signal (i.e., "top-down" Broca's → A1). A similar flow reversal was noted between left IFG and motor cortex. Our full-brain connectivity results demonstrate that even mild forms of hearing loss alter how the brain routes information within the auditory-linguistic-motor loop.

The effectiveness of an auditory temporal training program in children who present voiceless/voiced-based orthographic errors

Introduction

Studies on children’s written production of the Brazilian Portuguese have shown that one of the most frequent phonological-based orthographic errors is the one related to voiceless/voiced phonemes. Children who make this type of error may have auditory temporal processing disorders, which can harm the perception of phonemes with similar characteristics.

Aim

Verify the effectiveness of an auditory temporal training program based on activities adapted from the software Fast ForWord in the auditory temporal processing, i.e. the temporal ordering skill, and in reducing voiceless/voiced-based orthographic errors and the frequency of occurrence of these errors in the written production of the children.

Method

Twenty-five children participated on this study. They were divided in two groups: experimental group consisting of 16 participants, who engaged in the auditory temporal training activities; and a placebo group consisting of nine participants, who engaged in passive visual activities. The behavioral measures applied in the pre-training evaluation, post-training and placebo evaluations were: i) auditory skill of temporal ordering by the Pitch Pattern Sequence Test; and ii) analysis of the amount of voiceless/voiced-based orthographic errors and the frequency of occurrence of these errors by the use of dictation.

Results

No statistically significant differences were found concerning the placebo group in the pre-training and post-training evaluations, in all evaluation measures. However, statistically significant differences were found in the pre-training and post-training evaluations for the pitch pattern sequence test concerning the experimental group. These differences were specifically related to a reduction of the errors regarding fricative graphemes, and the frequency of occurrence of plosive and fricative graphemes.

Conclusions

The auditory temporal training program was effective in improving the temporal ordering skill and reducing errors in the writing of children who made voiceless/voiced-based orthographic errors.

Effects of Amplification on Neural Phase Locking, Amplitude, and Latency to a Speech Syllable

OBJECTIVE

Older adults often have trouble adjusting to hearing aids when they start wearing them for the first time. Probe microphone measurements verify appropriate levels of amplification up to the tympanic membrane. Little is known, however, about the effects of amplification on auditory-evoked responses to speech stimuli during initial hearing aid use. The present study assesses the effects of amplification on neural encoding of a speech signal in older adults using hearing aids for the first time. It was hypothesized that amplification results in improved stimulus encoding (higher amplitudes, improved phase locking, and earlier latencies), with greater effects for the regions of the signal that are less audible.

DESIGN

Thirty-seven adults, aged 60 to 85 years with mild to severe sensorineural hearing loss and no prior hearing aid use, were bilaterally fit with Widex Dream 440 receiver-in-the-ear hearing aids. Probe microphone measures were used to adjust the gain of the hearing aids and verify the fitting. Unaided and aided frequency-following responses and cortical auditory-evoked potentials to the stimulus /ga/ were recorded in sound field over the course of 2 days for three conditions: 65 dB SPL and 80 dB SPL in quiet, and 80 dB SPL in six-talker babble (+10 signal to noise ratio).

RESULTS

Responses from midbrain were analyzed in the time regions corresponding to the consonant transition (18 to 68 ms) and the steady state vowel (68 to 170 ms). Generally, amplification increased phase locking and amplitude and decreased latency for the region and presentation conditions that had lower stimulus amplitudes-the transition region and 65 dB SPL level. Responses from cortex showed decreased latency for P1, but an unexpected decrease in N1 amplitude. Previous studies have demonstrated an exaggerated cortical representation of speech in older adults compared to younger adults, possibly because of an increase in neural resources necessary to encode the signal. Therefore, a decrease in N1 amplitude with amplification and with increased presentation level may suggest that amplification decreases the neural resources necessary for cortical encoding.

CONCLUSION

Increased phase locking and amplitude and decreased latency in midbrain suggest that amplification may improve neural representation of the speech signal in new hearing aid users. The improvement with amplification was also found in cortex, and, in particular, decreased P1 latencies and lower N1 amplitudes may indicate greater neural efficiency. Further investigations will evaluate changes in subcortical and cortical responses during the first 6 months of hearing aid use.

Auditory and Cognitive Training for Cognition in Adults With Hearing Loss: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis examined the efficacy of auditory training and cognitive training to improve cognitive function in adults with hearing loss. A literature search of academic databases (e.g., MEDLINE, Scopus) and gray literature (e.g., OpenGrey) identified relevant articles published up to January 25, 2018. Randomized controlled trials (RCTs) or repeated measures designs were included. Outcome effects were computed as Hedge’s g and pooled using random-effects meta-analysis (PROSPERO: CRD42017076680). Nine studies, five auditory training, and four cognitive training met the inclusion criteria. Following auditory training, the pooled effect was small and statistically significant for both working memory (g = 0.21; 95% CI [0.05, 0.36]) and overall cognition (g = 0.19; 95% CI [0.07, 0.31]). Following cognitive training, the pooled effect for working memory was small and statistically significant (g = 0.34; 95% CI [0.16, 0.53]), and the pooled effect for overall cognition was large and significant (g = 1.03; 95% CI [0.41, 1.66]). However, this was dependent on the classification of training approach. Sensitivity analyses revealed no statistical difference between the effectiveness of auditory and cognitive training for improving cognition upon removal of a study that used a combined auditory–cognitive approach, which showed a very large effect. Overall certainty in the estimation of effect was “low” for auditory training and “very low” for cognitive training. High-quality RCTs are needed to determine which training stimuli will provide optimal conditions to improve cognition in adults with hearing loss.

Evidence-Based Interventions for Adult Aural Rehabilitation: That Was Then, This Is Now

More than a decade after Arthur Boothroyd published "Adult Aural Rehabilitation: What Is It and Does It Work?," the four cornerstones of adult aural rehabilitation are re-examined in terms of research that we and others in the field have undertaken. The focus is on novel advances in high-quality research relating to interventions to support self-management for hearing aids and other listening devices (sensory management), knowledge and skill (instruction), auditory and cognitive training (perceptual training), and motivational engagement (counseling). Much of this new research has a theoretical underpinning (e.g., behavior change theory) to better guide the development and evaluation of interventions, with a focus on self-management and patient-centered approaches. New and emerging technologies that support e- and m-health delivery of interventions provide greater personalization and interactivity to promote self-management of hearing loss. Looking to the future, there remains a requirement for a set of relevant and appropriate outcome measures to evaluate the effectiveness of interventions trialed in clinical studies. There is a continuing need for high-quality evidence, underpinned by contemporary theory, to increase the likelihood that translational adult aural rehabilitation research that aims to benefit patients will be applied in future clinical practice.

Effects of Phase-Locking Deficits on Speech Recognition in Older Adults With Presbycusis

Objective: People with presbycusis (PC) often report difficulties in speech recognition, especially under noisy listening conditions. Investigating the PC-related changes in central representations of envelope signals and temporal fine structure (TFS) signals of speech sounds is critical for understanding the mechanism underlying the PC-related deficit in speech recognition. Frequency-following responses (FFRs) to speech stimulation can be used to examine the subcortical encoding of both envelope and TFS speech signals. This study compared FFRs to speech signals between listeners with PC and those with clinically normal hearing (NH) under either quiet or noise-masking conditions.

Methods: FFRs to a 170-ms speech syllable /da/ were recorded under either a quiet or noise-masking (with a signal-to-noise ratio (SNR) of 8 dB) condition in 14 older adults with PC and 13 age-matched adults with NH. The envelope (FFR_ENV) and TFS (FFR_TFS) components of FFRs were analyzed separately by adding and subtracting the alternative polarity responses, respectively. Speech recognition in noise was evaluated in each participant.

Results: In the quiet condition, compared with the NH group, the PC group exhibited smaller F0 and H3 amplitudes and decreased stimulus-response (S-R) correlation for FFR_ENV but not for FFR_TFS. Both the H2 and H3 amplitudes and the S-R correlation of FFR_ENV significantly decreased in the noise condition compared with the quiet condition in the NH group but not in the PC group. Moreover, the degree of hearing loss was correlated with noise-induced changes in FFR_TFS morphology. Furthermore, the speech-in-noise (SIN) threshold was negatively correlated with the noise-induced change in H2 (for FFR_ENV) and the S-R correlation for FFR_ENV in the quiet condition.

Conclusion: Audibility affects the subcortical encoding of both envelope and TFS in PC patients. The impaired ability to adjust the balance between the envelope and TFS in the noise condition may be part of the mechanism underlying PC-related deficits in speech recognition in noise. FFRs can predict SIN perception performance.

Innovation in the Context of Audiology and in the Context of the Internet

PURPOSE

This article explores different meanings of innovation within the context of audiology and the Internet. Case studies are used to illustrate and elaborate on the new types of innovation and their levels of impact.

METHOD

The article defines innovation, providing case studies illustrating a taxonomy of innovation types.

RESULTS

Innovation ranges from minor changes in technology implemented on existing platforms to radical or disruptive changes that provide exceptional benefits and transform markets. Innovations within the context of audiology and the Internet can be found across that range. The case studies presented demonstrate that innovations in hearing care can span across a number of innovation types and levels of impact. Considering the global need for improved access and efficiency in hearing care, innovations that demonstrate a sustainable impact on a large scale, with the potential to rapidly upscale this impact, should be prioritized.

CONCLUSIONS

It is unclear presently what types of innovations are likely to have the most profound impacts on audiology in the coming years. In the best case, they will lead to more efficient, effective, and widespread availability of hearing health on a global scale.

Efficacy of auditory training using the Programa de Escuta no Ruído (PER) software in students with auditory processing disorders and poor school performance

PURPOSE

Investigate the efficacy of auditory training in students with auditory processing disorders and poor school performance using the software Programa de Escuta no Ruído (PER), which addresses auditory processing skills, specifically listening in noise.

METHODS

Eighteen children aged 8-10 years, of both genders, participated in this study. All individuals participated in the following stages: pre-intervention assessment, intervention (consisting of placebo training, re-evaluation of auditory processing, and auditory training), and post-intervention assessment, so that the same individual is self-control.

RESULTS

No statistically significant difference was observed between the pre-intervention assessment and the post-training auditory processing re-evaluation of the placebo, but statistically significant difference was found between the pre- and post-auditory training conditions.

CONCLUSION

The present study achieved its general objective. The PER software proved to be effective for the auditory training of students with auditory processing disorders and poor school performance.

Neural and behavioral changes after the use of hearing aids

OBJECTIVE

Individuals with age-related hearing loss (ARHL) can restore some loss of the auditory function with the use of hearing aids (HAs). However, what remains unknown are the physiological mechanisms that underlie how the brain changes with exposure to amplified sounds though the use of HAs. We aimed to examine behavioral and physiological changes induced by HAs.

METHODS

Thirty-five older-adults with moderate ARHL with no history of hearing aid use were fit with HAs tested in aided and unaided conditions, and divided into experimental and control groups. The experimental group used HAs during a period of six months. The control group did not use HAs during this period, but were given the opportunity to use them after the completion of the study. Both groups underwent testing protocols six months apart. Outcome measures included behavioral (speech-in-noise measures, self-assessment questionnaires) and electrophysiological brainstem recordings (frequency-following responses) to the speech syllable /ga/ in two quiet conditions and in six-talker babble noise.

RESULTS

The experimental group reported subjective benefits on self-assessment questionnaires. Significant physiological changes were observed in the experimental group, specifically a reduction in fundamental frequency magnitude, while no change was observed in controls, yielding a significant time × group interaction. Furthermore, peak latencies remained stable in the experimental group but were significantly delayed in the control group after six months. Significant correlations between behavioral and physiological changes were also observed.

CONCLUSIONS

The findings suggest that HAs may alter subcortical processing and offset neural timing delay; however, further investigation is needed to understand cortical changes and HA effects on cognitive processing.

SIGNIFICANCE

The findings of the current study provide evidence for clinicians that the use of HAs may prevent further loss of auditory function resulting from sensory deprivation.

Do "Brain-Training" Programs Work?

In 2014, two groups of scientists published open letters on the efficacy of brain-training interventions, or "brain games," for improving cognition. The first letter, a consensus statement from an international group of more than 70 scientists, claimed that brain games do not provide a scientifically grounded way to improve cognitive functioning or to stave off cognitive decline. Several months later, an international group of 133 scientists and practitioners countered that the literature is replete with demonstrations of the benefits of brain training for a wide variety of cognitive and everyday activities. How could two teams of scientists examine the same literature and come to conflicting "consensus" views about the effectiveness of brain training?In part, the disagreement might result from different standards used when evaluating the evidence. To date, the field has lacked a comprehensive review of the brain-training literature, one that examines both the quantity and the quality of the evidence according to a well-defined set of best practices. This article provides such a review, focusing exclusively on the use of cognitive tasks or games as a means to enhance performance on other tasks. We specify and justify a set of best practices for such brain-training interventions and then use those standards to evaluate all of the published peer-reviewed intervention studies cited on the websites of leading brain-training companies listed on Cognitive Training Data (www.cognitivetrainingdata.org), the site hosting the open letter from brain-training proponents. These citations presumably represent the evidence that best supports the claims of effectiveness.Based on this examination, we find extensive evidence that brain-training interventions improve performance on the trained tasks, less evidence that such interventions improve performance on closely related tasks, and little evidence that training enhances performance on distantly related tasks or that training improves everyday cognitive performance. We also find that many of the published intervention studies had major shortcomings in design or analysis that preclude definitive conclusions about the efficacy of training, and that none of the cited studies conformed to all of the best practices we identify as essential to drawing clear conclusions about the benefits of brain training for everyday activities. We conclude with detailed recommendations for scientists, funding agencies, and policymakers that, if adopted, would lead to better evidence regarding the efficacy of brain-training interventions.

A Randomized Control Trial: Supplementing Hearing Aid Use with Listening and Communication Enhancement (LACE) Auditory Training

OBJECTIVE

To examine the effectiveness of the Listening and Communication Enhancement (LACE) program as a supplement to standard-of-care hearing aid intervention in a Veteran population.

DESIGN

A multisite randomized controlled trial was conducted to compare outcomes following standard-of-care hearing aid intervention supplemented with (1) LACE training using the 10-session DVD format, (2) LACE training using the 20-session computer-based format, (3) placebo auditory training (AT) consisting of actively listening to 10 hr of digitized books on a computer, and (4) educational counseling-the control group. The study involved 3 VA sites and enrolled 279 veterans. Both new and experienced hearing aid users participated to determine if outcomes differed as a function of hearing aid user status. Data for five behavioral and two self-report measures were collected during three research visits: baseline, immediately following the intervention period, and at 6 months postintervention. The five behavioral measures were selected to determine whether the perceptual and cognitive skills targeted in LACE training generalized to untrained tasks that required similar underlying skills. The two self-report measures were completed to determine whether the training resulted in a lessening of activity limitations and participation restrictions. Outcomes were obtained from 263 participants immediately following the intervention period and from 243 participants 6 months postintervention. Analyses of covariance comparing performance on each outcome measure separately were conducted using intervention and hearing aid user status as between-subject factors, visit as a within-subject factor, and baseline performance as a covariate.

RESULTS

No statistically significant main effects or interactions were found for the use of LACE on any outcome measure.

CONCLUSIONS

Findings from this randomized controlled trial show that LACE training does not result in improved outcomes over standard-of-care hearing aid intervention alone. Potential benefits of AT may be different than those assessed by the performance and self-report measures utilized here. Individual differences not assessed in this study should be examined to evaluate whether AT with LACE has any benefits for particular individuals. Clinically, these findings suggest that audiologists may want to temper the expectations of their patients who embark on LACE training.

Audiomotor Perceptual Training Enhances Speech Intelligibility in Background Noise

Sensory and motor skills can be improved with training, but learning is often restricted to practice stimuli. As an exception, training on closed-loop (CL) sensorimotor interfaces, such as action video games and musical instruments, can impart a broad spectrum of perceptual benefits. Here we ask whether computerized CL auditory training can enhance speech understanding in levels of background noise that approximate a crowded restaurant. Elderly hearing-impaired subjects trained for 8 weeks on a CL game that, like a musical instrument, challenged them to monitor subtle deviations between predicted and actual auditory feedback as they moved their fingertip through a virtual soundscape. We performed our study as a randomized, double-blind, placebo-controlled trial by training other subjects in an auditory working-memory (WM) task. Subjects in both groups improved at their respective auditory tasks and reported comparable expectations for improved speech processing, thereby controlling for placebo effects. Whereas speech intelligibility was unchanged after WM training, subjects in the CL training group could correctly identify 25% more words in spoken sentences or digit sequences presented in high levels of background noise. Numerically, CL audiomotor training provided more than three times the benefit of our subjects' hearing aids for speech processing in noisy listening conditions. Gains in speech intelligibility could be predicted from gameplay accuracy and baseline inhibitory control. However, benefits did not persist in the absence of continuing practice. These studies employ stringent clinical standards to demonstrate that perceptual learning on a computerized audio game can transfer to "real-world" communication challenges.

Application of a computer-based neurocognitive assessment battery in the elderly with and without hearing loss

INTRODUCTION

Due to demographic changes, the number of people suffering not only from dementia illness but also from hearing impairment with the need for hearing rehabilitation have increased noticeably. Even with the association between hearing, age, and cognitive decline being well known, this issue has so far not played an important role in daily clinical Ear Nose Throat settings. The aim of the present study was to evaluate the use of a computer-based battery of tests of neurocognitive abilities in older patients with and without hearing loss.

PATIENTS AND METHODS

A total of 120 patients aged 50 years and older were enrolled in this prospective clinical study: 40 patients suffered from severe bilateral hearing loss and were tested before cochlear implantation and 80 patients showed normal hearing thresholds between 500 and 4,000 Hz bilaterally. The test battery covered a wide range of cognitive abilities such as long- and short-term memory, working memory (WM), attention, inhibition, and other executive functions. Individuals with severe depression or cognitive impairment were excluded.

RESULTS

Hearing status was a significant predictor of performance on delayed recall (P=0.0082) and verbal fluency after adjusting for age (P=0.0016). Age predominantly impacted on inhibition (P=0.0039) and processing speed (P<0.0001), whereas WM measured by the Operation Span task (OSPAN) and the attention were influenced by both age and hearing. The battery of tests was feasible and practical for testing older patients without prior computer skills.

CONCLUSION

A computerized neurocognitive assessment battery may be a suitable tool for the elderly in clinical practice. While it cannot replace a thorough neuropsychological examination, it may help to draw the line between cognitive and hearing impairment in the elderly and enable the development of individual strategies for hearing rehabilitation.

Neural Correlates of Early Sound Encoding and their Relationship to Speech-in-Noise Perception

Speech-in-noise (SIN) perception is a complex cognitive skill that affects social, vocational, and educational activities. Poor SIN ability particularly affects young and elderly populations, yet varies considerably even among healthy young adults with normal hearing. Although SIN skills are known to be influenced by top-down processes that can selectively enhance lower-level sound representations, the complementary role of feed-forward mechanisms and their relationship to musical training is poorly understood. Using a paradigm that minimizes the main top-down factors that have been implicated in SIN performance such as working memory, we aimed to better understand how robust encoding of periodicity in the auditory system (as measured by the frequency-following response) contributes to SIN perception. Using magnetoencephalograpy, we found that the strength of encoding at the fundamental frequency in the brainstem, thalamus, and cortex is correlated with SIN accuracy. The amplitude of the slower cortical P2 wave was previously also shown to be related to SIN accuracy and FFR strength; we use MEG source localization to show that the P2 wave originates in a temporal region anterior to that of the cortical FFR. We also confirm that the observed enhancements were related to the extent and timing of musicianship. These results are consistent with the hypothesis that basic feed-forward sound encoding affects SIN perception by providing better information to later processing stages, and that modifying this process may be one mechanism through which musical training might enhance the auditory networks that subserve both musical and language functions.

Neuromodulatory Effects of Auditory Training and Hearing Aid Use on Audiovisual Speech Perception in Elderly Individuals

Although audiovisual (AV) training has been shown to improve overall speech perception in hearing-impaired listeners, there has been a lack of direct brain imaging data to help elucidate the neural networks and neural plasticity associated with hearing aid (HA) use and auditory training targeting speechreading. For this purpose, the current clinical case study reports functional magnetic resonance imaging (fMRI) data from two hearing-impaired patients who were first-time HA users. During the study period, both patients used HAs for 8 weeks; only one received a training program named ReadMyQuips^TM (RMQ) targeting speechreading during the second half of the study period for 4 weeks. Identical fMRI tests were administered at pre-fitting and at the end of the 8 weeks. Regions of interest (ROI) including auditory cortex and visual cortex for uni-sensory processing, and superior temporal sulcus (STS) for AV integration, were identified for each person through independent functional localizer task. The results showed experience-dependent changes involving ROIs of auditory cortex, STS and functional connectivity between uni-sensory ROIs and STS from pretest to posttest in both cases. These data provide initial evidence for the malleable experience-driven cortical functionality for AV speech perception in elderly hearing-impaired people and call for further studies with a much larger subject sample and systematic control to fill in the knowledge gap to understand brain plasticity associated with auditory rehabilitation in the aging population.

Longitudinal auditory learning facilitates auditory cognition as revealed by microstate analysis

The current study investigates cognitive processes as reflected in late auditory-evoked potentials as a function of longitudinal auditory learning. A normal hearing adult sample (n=15) performed an active oddball task at three consecutive time points (TPs) arranged at two week intervals, and during which EEG was recorded. The stimuli comprised of syllables consisting of a natural fricative (/sh/,/s/,/f/) embedded between two /a/ sounds, as well as morphed transitions of the two syllables that served as deviants. Perceptual and cognitive modulations as reflected in the onset and the mean global field power (GFP) of N2b- and P3b-related microstates across four weeks were investigated. We found that the onset of P3b-like microstates, but not N2b-like microstates decreased across TPs, more strongly for difficult deviants leading to similar onsets for difficult and easy stimuli after repeated exposure. The mean GFP of all N2b-like and P3b-like microstates increased more in spectrally strong deviants compared to weak deviants, leading to a distinctive activation for each stimulus after learning. Our results indicate that longitudinal training of auditory-related cognitive mechanisms such as stimulus categorization, attention and memory updating processes are an indispensable part of successful auditory learning. This suggests that future studies should focus on the potential benefits of cognitive processes in auditory training.

Developmental hearing loss impedes auditory task learning and performance in gerbils

The consequences of developmental hearing loss have been reported to include both sensory and cognitive deficits. To investigate these issues in a non-human model, auditory learning and asymptotic psychometric performance were compared between normal hearing (NH) adult gerbils and those reared with conductive hearing loss (CHL). At postnatal day 10, before ear canal opening, gerbil pups underwent bilateral malleus removal to induce a permanent CHL. Both CHL and control animals were trained to approach a water spout upon presentation of a target (Go stimuli), and withhold for foils (Nogo stimuli). To assess the rate of task acquisition and asymptotic performance, animals were tested on an amplitude modulation (AM) rate discrimination task. Behavioral performance was calculated using a signal detection theory framework. Animals reared with developmental CHL displayed a slower rate of task acquisition for AM discrimination task. Slower acquisition was explained by an impaired ability to generalize to newly introduced stimuli, as compared to controls. Measurement of discrimination thresholds across consecutive testing blocks revealed that CHL animals required a greater number of testing sessions to reach asymptotic threshold values, as compared to controls. However, with sufficient training, CHL animals approached control performance. These results indicate that a sensory impediment can delay auditory learning, and increase the risk of poor performance on a temporal task.

Examination of Individual Differences in Outcomes From a Randomized Controlled Clinical Trial Comparing Formal and Informal Individual Auditory Training Programs

PURPOSE

The purpose of this study was to determine if patient characteristics or clinical variables could predict who benefits from individual auditory training.

METHOD

A retrospective series of analyses were performed using a data set from a large, multisite, randomized controlled clinical trial that compared the treatment effects of at-home auditory training programs in bilateral hearing aid users. The treatment arms were (a) use of the 20-day computerized Listening and Communication Enhancement program, (b) use of the 10-day digital versatile disc Listening and Communication Enhancement program, (c) use of a placebo "books-on-tape" training, and (d) educational counseling (active control). Multiple linear regression models using data from 263 participants were conducted to determine if patient and clinical variables predicted short-term improvement on word-recognition-in-noise abilities, self-reported hearing handicap, and self-reported hearing problems.

RESULTS

Baseline performance significantly predicted performance on each variable, explaining 11%-17% of the variance in improvement. The treatment arm failed to emerge as a significant predictor with other clinical variables explaining less than 9% of the variance.

CONCLUSION

These results suggest that hearing aid users who have poorer aided word-recognition-in-noise scores and greater residual activity limitations and participation restrictions will show the largest improvement in these areas.

The Neural Consequences of Age-Related Hearing Loss

During hearing, acoustic signals travel up the ascending auditory pathway from the cochlea to auditory cortex; efferent connections provide descending feedback. In human listeners, although auditory and cognitive processing have sometimes been viewed as separate domains, a growing body of work suggests they are intimately coupled. Here, we review the effects of hearing loss on neural systems supporting spoken language comprehension, beginning with age-related physiological decline. We suggest that listeners recruit domain general executive systems to maintain successful communication when the auditory signal is degraded, but that this compensatory processing has behavioral consequences: even relatively mild levels of hearing loss can lead to cascading cognitive effects that impact perception, comprehension, and memory, leading to increased listening effort during speech comprehension.

Effect of signal to noise ratio on the speech perception ability of older adults

BACKGROUND

Speech perception ability depends on auditory and extra-auditory elements. The signal- to-noise ratio (SNR) is an extra-auditory element that has an effect on the ability to normally follow speech and maintain a conversation. Speech in noise perception difficulty is a common complaint of the elderly. In this study, the importance of SNR magnitude as an extra-auditory effect on speech perception in noise was examined in the elderly.

METHODS

The speech perception in noise test (SPIN) was conducted on 25 elderly participants who had bilateral low-mid frequency normal hearing thresholds at three SNRs in the presence of ipsilateral white noise. These participants were selected by available sampling method. Cognitive screening was done using the Persian Mini Mental State Examination (MMSE) test.

RESULTS

Independent T- test, ANNOVA and Pearson Correlation Index were used for statistical analysis. There was a significant difference in word discrimination scores at silence and at three SNRs in both ears (p≤0.047). Moreover, there was a significant difference in word discrimination scores for paired SNRs (0 and +5, 0 and +10, and +5 and +10 (p≤0.04)). No significant correlation was found between age and word recognition scores at silence and at three SNRs in both ears (p≥0.386).

CONCLUSION

Our results revealed that decreasing the signal level and increasing the competing noise considerably reduced the speech perception ability in normal hearing at low-mid thresholds in the elderly. These results support the critical role of SNRs for speech perception ability in the elderly. Furthermore, our results revealed that normal hearing elderly participants required compensatory strategies to maintain normal speech perception in challenging acoustic situations.

Auditory Perceptual Learning in Adults with and without Age-Related Hearing Loss

Introduction : Speech recognition in adverse listening conditions becomes more difficult as we age, particularly for individuals with age-related hearing loss (ARHL). Whether these difficulties can be eased with training remains debated, because it is not clear whether the outcomes are sufficiently general to be of use outside of the training context. The aim of the current study was to compare training-induced learning and generalization between normal-hearing older adults and those with ARHL. Methods : Fifty-six listeners (60-72 y/o), 35 participants with ARHL, and 21 normal hearing adults participated in the study. The study design was a cross over design with three groups (immediate-training, delayed-training, and no-training group). Trained participants received 13 sessions of home-based auditory training over the course of 4 weeks. Three adverse listening conditions were targeted: (1) Speech-in-noise, (2) time compressed speech, and (3) competing speakers, and the outcomes of training were compared between normal and ARHL groups. Pre- and post-test sessions were completed by all participants. Outcome measures included tests on all of the trained conditions as well as on a series of untrained conditions designed to assess the transfer of learning to other speech and non-speech conditions. Results : Significant improvements on all trained conditions were observed in both ARHL and normal-hearing groups over the course of training. Normal hearing participants learned more than participants with ARHL in the speech-in-noise condition, but showed similar patterns of learning in the other conditions. Greater pre- to post-test changes were observed in trained than in untrained listeners on all trained conditions. In addition, the ability of trained listeners from the ARHL group to discriminate minimally different pseudowords in noise also improved with training. Conclusions : ARHL did not preclude auditory perceptual learning but there was little generalization to untrained conditions. We suggest that most training-related changes occurred at higher level task-specific cognitive processes in both groups. However, these were enhanced by high quality perceptual representations in the normal-hearing group. In contrast, some training-related changes have also occurred at the level of phonemic representations in the ARHL group, consistent with an interaction between bottom-up and top-down processes.

Electrophysiologic Assessment of Auditory Training Benefits in Older Adults

Older adults often exhibit speech perception deficits in difficult listening environments. At present, hearing aids or cochlear implants are the main options for therapeutic remediation; however, they only address audibility and do not compensate for central processing changes that may accompany aging and hearing loss or declines in cognitive function. It is unknown whether long-term hearing aid or cochlear implant use can restore changes in central encoding of temporal and spectral components of speech or improve cognitive function. Therefore, consideration should be given to auditory/cognitive training that targets auditory processing and cognitive declines, taking advantage of the plastic nature of the central auditory system. The demonstration of treatment efficacy is an important component of any training strategy. Electrophysiologic measures can be used to assess training-related benefits. This article will review the evidence for neuroplasticity in the auditory system and the use of evoked potentials to document treatment efficacy.

How Does Auditory Training Work? Joined-Up Thinking and Listening

Auditory training aims to compensate for degradation in the auditory signal and is offered as an intervention to help alleviate the most common complaint in people with hearing loss, understanding speech in a background noise. Yet there remain many unanswered questions. This article reviews some of the key pieces of evidence that assess the evidence for whether, and how, auditory training benefits adults with hearing loss. The evidence supports that improvements occur on the trained task; however, transfer of that learning to generalized real-world benefit is much less robust. For more than a decade, there has been an increasing awareness of the role that cognition plays in listening. But more recently in the auditory training literature, there has been an increased focus on assessing how cognitive performance relevant for listening may improve with training. We argue that this is specifically the case for measures that index executive processes, such as monitoring, attention switching, and updating of working memory, all of which are required for successful listening and communication in challenging or adverse listening conditions. We propose combined auditory-cognitive training approaches, where training interventions develop cognition embedded within auditory tasks, which are most likely to offer generalized benefits to the real-world listening abilities of people with hearing loss.