The relationship of speech intelligibility with hearing sensitivity, cognition, and perceived hearing difficulties varies for different speech perception tests

A genome-wide association study reveals a polygenic architecture of speech-in-noise deficits in individuals with self-reported normal hearing

Speech-in-noise (SIN) perception is a primary complaint of individuals with audiometric hearing loss. SIN performance varies drastically, even among individuals with normal hearing. The present genome-wide association study (GWAS) investigated the genetic basis of SIN deficits in individuals with self-reported normal hearing in quiet situations. GWAS was performed on 279,911 individuals from the UB Biobank cohort, with 58,847 reporting SIN deficits despite reporting normal hearing in quiet. GWAS identified 996 single nucleotide polymorphisms (SNPs), achieving significance (p < 5*10-8) across four genomic loci. 720 SNPs across 21 loci achieved suggestive significance (p < 10-6). GWAS signals were enriched in brain tissues, such as the anterior cingulate cortex, dorsolateral prefrontal cortex, entorhinal cortex, frontal cortex, hippocampus, and inferior temporal cortex. Cochlear cell types revealed no significant association with SIN deficits. SIN deficits were associated with various health traits, including neuropsychiatric, sensory, cognitive, metabolic, cardiovascular, and inflammatory conditions. A replication analysis was conducted on 242 healthy young adults. Self-reported speech perception, hearing thresholds (0.25-16 kHz), and distortion product otoacoustic emissions (1-16 kHz) were utilized for the replication analysis. 73 SNPs were replicated with a self-reported speech perception measure. 211 SNPs were replicated with at least one and 66 with at least two audiological measures. 12 SNPs near or within MAPT, GRM3, and HLA-DQA1 were replicated for all audiological measures. The present study highlighted a polygenic architecture underlying SIN deficits in individuals with self-reported normal hearing.

American Cochlear Implant Alliance Task Force: Recommendations for Determining Cochlear Implant Candidacy in Adults

The indications for cochlear implantation have expanded over time due to evidence demonstrating identification and implantation of appropriate cochlear implant (CI) candidates lead to significant improvements in speech recognition and quality of life (QoL). However, clinical practice is variable, with some providers using outdated criteria and others exceeding current labeled indications. As a results, only a fraction of those persons who could benefit from CI technology receive it. This document summarizes the current evidence for determining appropriate referrals for adults with bilateral hearing loss into CI centers for formal evaluation by stressing the importance of treating each ear individually and a "revised 60/60 rule". By mirroring contemporary clinical practice and available evidence, these recommendations will also provide a standardized testing protocol for CI candidates using a team-based approach that prioritizes individualized patient care. This manuscript was developed by the Adult Cochlear Implantation Candidacy Task Force of the American Cochlear Implant Alliance using review of the existing literature and clinical consensus. LEVEL OF EVIDENCE: N/A Laryngoscope, 134:S1-S14, 2024.

Relationship between self-reported listening and communication difficulties and executive function: a protocol for a systematic review and meta-analysis

INTRODUCTION

Listening and communication difficulties can limit people's participation in activity and adversely affect their quality of life. Hearing, as well as listening and communication difficulties, can be measured either by using behavioural tests or self-report measures, and the outcomes are not always closely linked. The association between behaviourally measured and self-reported hearing is strong, whereas the association between behavioural and self-reported measures of listening and communication difficulties is much weaker, suggesting they assess different aspects of listening. While behavioural measures of listening and communication difficulties have been associated with poorer cognitive performance including executive functions, the same association has not always been shown for self-report measures. The objective of this systematic review and meta-analysis is to understand the relationship between executive function and self-reported listening and communication difficulties in adults with hearing loss, and where possible, potential covariates of age and pure-tone audiometric thresholds.

METHODS AND ANALYSIS

Studies will be eligible for inclusion if they report data from both a self-report measure of listening difficulties and a behavioural measure of executive function. Eight databases are to be searched: MEDLINE (via Ovid SP), EMBASE (via Ovid SP), PsycINFO (via Ovid SP), ASSIA (via ProQuest), Cumulative Index to Nursing and Allied Health Literature or CINAHL (via EBSCO Host), Scopus, PubMed and Web of Science (Science and Social Science Citation Index). The JBI critical appraisal tool will be used to assess risk of bias for included studies. Results will be synthesised primarily using a meta-analysis, and where sufficient quantitative data are not available, a narrative synthesis will be carried out to describe key results.

ETHICS AND DISSEMINATION

No ethical issues are foreseen. Data will be disseminated via academic publication and conference presentations. Findings may also be published in scientific newsletters and magazines.

PROSPERO REGISTRATION NUMBER

CRD42022293546.

Development of Mandarin Lexical Tone Identification in Noise and Its Relation With Working Memory

PURPOSE

This study aimed to examine the developmental trajectory of Mandarin tone identification in quiet and two noisy conditions: speech-shaped noise (SSN) and multitalker babble noise. In addition, we evaluated the relationship between tonal identification development and working memory capacity.

METHOD

Ninety-three typically developing children aged 5-8 years and 23 young adults completed categorical identification of two tonal continua (Tone 1-4 and Tone 2-3) in quiet, SSN, and babble noise. Their working memory was additionally measured using auditory digit span tests. Correlation analyses between digit span scores and boundary widths were performed.

RESULTS

Six-year-old children have achieved the adultlike ability of categorical identification of Tone 1-4 continuum under both types of noise. Moreover, 6-year-old children could identify Tone 2-3 continuum as well as adults in SSN. Nonetheless, the child participants, even 8-year-olds, performed worse when tokens from Tone 2-3 continuum were masked by babble noise. Greater working memory capacity was associated with better tone identification in noise for preschoolers aged 5-6 years; however, for school-age children aged 7-8 years, such correlation only existed in Tone 2-3 continuum in SSN.

CONCLUSIONS

Lexical tone perception might take a prolonged time to achieve adultlike competence in babble noise relative to SSN. Moreover, a significant interaction between masking type and stimulus difficulty was found, as indicated by Tone 2-3 being more susceptible to interference from babble noise than Tone 1-4. Furthermore, correlations between working memory capacity and tone perception in noise varied with developmental stage, stimulus difficulty, and masking type.

Polygenic Risk Score-Based Association Analysis of Speech-in-Noise and Hearing Threshold Measures in Healthy Young Adults with Self-reported Normal Hearing

PURPOSE

Speech-in-noise (SIN) traits exhibit high inter-subject variability, even for healthy young adults reporting normal hearing. Emerging evidence suggests that genetic variability could influence inter-subject variability in SIN traits. Genome-wide association studies (GWAS) have uncovered the polygenic architecture of various adult-onset complex human conditions. Polygenic risk scores (PRS) summarize complex genetic susceptibility to quantify the degree of genetic risk for health conditions. The present study conducted PRS-based association analyses to identify PRS risk factors for SIN and hearing threshold measures in 255 healthy young adults (18-40 years) with self-reported normal hearing.

METHODS

Self-reported SIN perception abilities were assessed by the Speech, Spatial, and Qualities of Hearing Scale (SSQ12). QuickSIN and audiometry (0.25-16 kHz) were performed on 218 participants. Saliva-derived DNA was used for low-pass whole genome sequencing, and 2620 PRS variables for various traits were calculated using the models derived from the polygenic risk score (PGS) catalog. The regression analysis was conducted to identify predictors for SSQ12, QuickSIN, and better ear puretone averages at conventional (PTA0.5-2), high (PTA4-8), and extended-high (PTA12.5-16) frequency ranges.

RESULTS

Participants with a higher genetic predisposition to HDL cholesterol reported better SSQ12. Participants with high PRS to dementia revealed significantly elevated PTA4-8, and those with high PRS to atrial fibrillation and flutter revealed significantly elevated PTA12.5-16.

CONCLUSION

These results indicate that healthy individuals with polygenic risk of certain health conditions could exhibit a subclinical decline in hearing health measures at young ages, decades before clinically meaningful SIN deficits and hearing loss could be observed. PRS could be used to identify high-risk individuals to prevent hearing health conditions by promoting a healthy lifestyle.

Remote self-report and speech-in-noise measures predict clinical audiometric thresholds

Developments in smartphone technology and the COVID-19 pandemic have highlighted the feasibility and need for remote, but reliable hearing tests. Previous studies used remote testing but did not directly compare results in the same listeners with standard lab or clinic testing. This study investigated reliability of remote, self-administered digits-in-noise (remote-DIN) compared with lab-based, supervised (lab-DIN) testing. Predictive validity was further examined in relation to a commonly used self-report, Speech, Spatial, and Qualities of Hearing (SSQ-12), and lab-based, pure tone audiometry. DIN speech reception thresholds (SRTs) of adults (18-64 y/o) with normal-hearing (NH, N=16) and hearing loss (HL, N=18), were measured using English-language digits (0-9), binaurally presented as triplets in one of four speech-shaped noise maskers (broadband, low-pass filtered at 2, 4, 8 kHz) and two digit phases (diotic, antiphasic). High, significant intraclass correlation coefficients indicated strong internal consistency of remote-DIN SRTs, which also correlated significantly with lab-DIN SRTs. There was no significant mean difference between remote- and lab-DIN on any tests. NH listeners had significantly higher SSQ scores, and remote- and lab-DIN SRTs than listeners with HL. All versions of remote-DIN SRTs correlated significantly with pure-tone-average (PTA), with the 2-kHz filtered test the best predictor, explaining 50% of variance in PTA. SSQ total score also significantly and independently predicted PTA (17% of variance) and all test versions of the remote-DIN, except the antiphasic BB test. This study shows that remote SSQ-12 and remote-DIN are sensitive tools for capturing important aspects of auditory function.

A review of auditory processing and cognitive change during normal ageing, and the implications for setting hearing aids for older adults

Throughout our adult lives there is a decline in peripheral hearing, auditory processing and elements of cognition that support listening ability. Audiometry provides no information about the status of auditory processing and cognition, and older adults often struggle with complex listening situations, such as speech in noise perception, even if their peripheral hearing appears normal. Hearing aids can address some aspects of peripheral hearing impairment and improve signal-to-noise ratios. However, they cannot directly enhance central processes and may introduce distortion to sound that might act to undermine listening ability. This review paper highlights the need to consider the distortion introduced by hearing aids, specifically when considering normally-ageing older adults. We focus on patients with age-related hearing loss because they represent the vast majority of the population attending audiology clinics. We believe that it is important to recognize that the combination of peripheral and central, auditory and cognitive decline make older adults some of the most complex patients seen in audiology services, so they should not be treated as "standard" despite the high prevalence of age-related hearing loss. We argue that a primary concern should be to avoid hearing aid settings that introduce distortion to speech envelope cues, which is not a new concept. The primary cause of distortion is the speed and range of change to hearing aid amplification (i.e., compression). We argue that slow-acting compression should be considered as a default for some users and that other advanced features should be reconsidered as they may also introduce distortion that some users may not be able to tolerate. We discuss how this can be incorporated into a pragmatic approach to hearing aid fitting that does not require increased loading on audiology services.

Noise Exposure in Palestinian Workers Without a Diagnosis of Hearing Impairment: Relations to Speech-Perception-in-Noise Difficulties, Tinnitus, and Hyperacusis

PURPOSE

Many workers in developing countries are exposed to unsafe occupational noise due to inadequate health and safety practices. We tested the hypotheses that occupational noise exposure and aging affect speech-perception-in-noise (SPiN) thresholds, self-reported hearing ability, tinnitus presence, and hyperacusis severity among Palestinian workers.

METHOD

Palestinian workers (N = 251, aged 18-70 years) without diagnosed hearing or memory impairments completed online instruments including a noise exposure questionnaire; forward and backward digit span tests; hyperacusis questionnaire; the short-form Speech, Spatial and Qualities of Hearing Scale (SSQ12); the Tinnitus Handicap Inventory; and a digits-in-noise (DIN) test. Hypotheses were tested via multiple linear and logistic regression models, including age and occupational noise exposure as predictors, and with sex, recreational noise exposure, cognitive ability, and academic attainment as covariates. Familywise error rate was controlled across all 16 comparisons using the Bonferroni-Holm method. Exploratory analyses evaluated effects on tinnitus handicap. A comprehensive study protocol was preregistered.

RESULTS

Nonsignificant trends of poorer SPiN performance, poorer self-reported hearing ability, greater prevalence of tinnitus, greater tinnitus handicap, and greater severity of hyperacusis as a function of higher occupational noise exposure were observed. Greater hyperacusis severity was significantly predicted by higher occupational noise exposure. Aging was significantly associated with higher DIN thresholds and lower SSQ12 scores, but not with tinnitus presence, tinnitus handicap, or hyperacusis severity.

CONCLUSIONS

Workers in Palestine may suffer from auditory effects of occupational noise and aging despite no formal diagnosis. These findings highlight the importance of occupational noise monitoring and hearing-related health and safety practices in developing countries.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22056701.

Native Language Perceptual Sensitivity Predicts Nonnative Speech Perception Differently in Younger and Older Singaporean Bilinguals

PURPOSE

We investigate in this study how individual variability in native language speech perception (termed Perceptual Sensitivity) influences nonnative speech perception in Singaporean Tamil-English bilinguals. Further, we assess if and how contextual and demographic factors influence Perceptual Sensitivity in the acquired languages and if the influence of Perceptual Sensitivity on nonnative speech perception is different across younger and older bilinguals.

METHOD

Perceptual Sensitivity in the native languages was examined by implementing Tamil and English gating tasks in 87 Singaporean Tamil-English bilinguals from two age groups (younger: 19-33 years; older: 55-70 years). Mandarin lexical tone discrimination was implemented as a measure of nonnative speech perception.

RESULTS

There was a wide range of variability in Perceptual Sensitivity scores in both languages across both age groups. Perceptual Sensitivity in the first native language (L1 Tamil) was a robust predictor of nonnative speech perception across both age groups, especially for the older bilinguals. However, general intelligence emerged as a stronger predictor than Tamil Perceptual Sensitivity in younger bilinguals. The influence of Tamil Perceptual Sensitivity on lexical tone perception was not tone-specific, supporting a general enhancement of lexical tone perception with better Tamil Perceptual Sensitivity. There was an influence of demographic factors on English Perceptual Sensitivity in older bilinguals, but not for Tamil and not in younger bilinguals.

CONCLUSIONS

Our findings corroborate with previous studies in showing that native language Perceptual Sensitivity is positively associated with and predicts nonnative speech perception in younger and older adulthood regardless of language similarity but to varying degrees. Specifically, the influence of Perceptual Sensitivity on nonnative speech perception is stronger in older adulthood, suggesting a possible shift in reliance on crystallized language knowledge with age. Proficiency and use, among other demographic and language variables, do not appear to influence L1 Perceptual Sensitivity in a lesser used language (Tamil) as significantly as previously assumed.

Functional Hearing Difficulties in Veterans: Retrospective Chart Review of Auditory Processing Assessments in the VA Health Care System

PURPOSE

Approximately 23 million Americans might have functional hearing difficulties (FHDs) that are not well explained by their audiometric thresholds. Clinical management of patients with FHDs is the subject of considerable debate, with few evidence-based guidelines to direct patient care. A better understanding of the characteristics of patients who seek help for FHDs, as well as current audiological management practices, is needed to direct research efforts to the areas greatest opportunity for advancement of clinical care.

METHOD

A retrospective chart review was conducted examining the medical records of a random sample of 100 Veterans who underwent auditory processing assessments across the VA Health Care System between 2008 and 2020.

RESULTS

Patients were young to middle-age, often with previous traumatic brain injury or blast exposure. Mental health, sleep, and pain disorders were common. No consistent relationships emerged between specific patient factors and domains of auditory processing deficits. Low-gain hearing aids were provided to 35 patients, 69% of whom continued wearing their hearing aids for at least 2 years.

CONCLUSION

Future research should address the potential overlap in symptoms and treatment for comorbid health conditions and FHDs, as well as the conditions underlying successful hearing aid use in this patient population.

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

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

Binaural temporal coding and the middle ear muscle reflex in audiometrically normal young adults

Noise exposure may damage the synapses that connect inner hair cells with auditory nerve fibers, before outer hair cells are lost. In humans, this cochlear synaptopathy (CS) is thought to decrease the fidelity of peripheral auditory temporal coding. In the current study, the primary hypothesis was that higher middle ear muscle reflex (MEMR) thresholds, as a proxy measure of CS, would be associated with smaller values of the binaural intelligibility level difference (BILD). The BILD, which is a measure of binaural temporal coding, is defined here as the difference in thresholds between the diotic and the antiphasic versions of the digits in noise (DIN) test. This DIN BILD may control for factors unrelated to binaural temporal coding such as linguistic, central auditory, and cognitive factors. Fifty-six audiometrically normal adults (34 females) aged 18 - 30 were tested. The test battery included standard pure tone audiometry, tympanometry, MEMR using a 2 kHz elicitor and 226 Hz and 1 kHz probes, the Noise Exposure Structured Interview, forward digit span test, extended high frequency (EHF) audiometry, and diotic and antiphasic DIN tests. The study protocol was pre-registered prior to data collection. MEMR thresholds did not predict the DIN BILD. Secondary analyses showed no association between MEMR thresholds and the individual diotic and antiphasic DIN thresholds. Greater lifetime noise exposure was non-significantly associated with higher MEMR thresholds, larger DIN BILD values, and lower (better) antiphasic DIN thresholds, but not with diotic DIN thresholds, nor with EHF thresholds. EHF thresholds were associated with neither MEMR thresholds nor any of the DIN outcomes, including the DIN BILD. Results provide no evidence that young, audiometrically normal people incur CS with impacts on binaural temporal processing.

Assessment of Hearing-Related Lifestyle Based on the Common Sound Scenarios Framework

Purpose:

Auditory lifestyle can play a role in hearing care needs, and, as such, it needs to be considered when treating people with hearing loss. In this study, we propose a questionnaire consisting of 24 listening situations based on the Common Sound Scenarios (CoSS) framework.

Method:

Seventeen experienced hearing aid (HA) users filled out the Hearing-Related Lifestyle Questionnaire four times: Days 1, 2, 15, and 29. The questionnaire consisted of 24 listening situations that participants rated on frequency of occurrence, importance to hear well, difficulty to hear, and HA satisfaction. Four questionnaire outcomes were extracted from these ratings: richness of hearing-related lifestyle, hearing demand, hearing difficulty, and HA satisfaction. Additionally, the participants were asked whether any listening situations are not understandable or relatable, whether any situations are missing from the questionnaire, and whether the number of questions is acceptable. Test–retest reliability analyses were done to assess whether the questionnaire outcomes are reliable across the four reports. Correlation analyses were done to assess whether there is a relationship between the questionnaire outcomes.

Results:

The questionnaire outcomes have excellent reliability. The listening situations in the questionnaire are generally complete and relatable, and the number of questions is acceptable. Correlation analyses revealed that the questionnaire outcomes are related to each other.

Conclusions:

Currently, there are no other hearing-related lifestyle questionnaires that purely assess listening situations. The proposed questionnaire has the potential to add to our understanding of hearing-related lifestyle of people needing or undergoing hearing care.

Supplemental Material:

https://doi.org/10.23641/asha.21514044

Objective and Subjective Hearing Difficulties Are Associated With Lower Inhibitory Control

OBJECTIVE

Evidence suggests that hearing loss increases the risk of cognitive impairment. However, the relationship between hearing loss and cognition can vary considerably across studies, which may be partially explained by demographic and health factors that are not systematically accounted for in statistical models.

DESIGN

Middle-aged to older adult participants (N = 149) completed a web-based assessment that included speech-in-noise (SiN) and self-report measures of hearing, as well as auditory and visual cognitive interference (Stroop) tasks. Correlations between hearing and cognitive interference measures were performed with and without controlling for age, sex, education, depression, anxiety, and self-rated health.

RESULTS

The risk of having objective SiN difficulties differed between males and females. All demographic and health variables, except education, influenced the likelihood of reporting hearing difficulties. Small but significant relationships between objective and reported hearing difficulties and the measures of cognitive interference were observed when analyses were controlled for demographic and health factors. Furthermore, when stratifying analyses for males and females, different relationships between hearing and cognitive interference measures were found. Self-reported difficulty with spatial hearing and objective SiN performance were better predictors of inhibitory control in females, whereas self-reported difficulty with speech was a better predictor of inhibitory control in males. This suggests that inhibitory control is associated with different listening abilities in males and females.

CONCLUSIONS

The results highlight the importance of controlling for participant characteristics when assessing the relationship between hearing and cognitive interference, which may also be the case for other cognitive functions, but this requires further investigations. Furthermore, this study is the first to show that the relationship between hearing and cognitive interference can be captured using web-based tasks that are simple to implement and administer at home without any assistance, paving the way for future online screening tests assessing the effects of hearing loss on cognition.

Genetic Hearing Loss Affects Cochlear Processing

The relationship between speech recognition and hereditary hearing loss is not straightforward. Underlying genetic defects might determine an impaired cochlear processing of sound. We obtained data from nine groups of patients with a specific type of genetic hearing loss. For each group, the affected cochlear site-of-lesion was determined based on previously published animal studies. Retrospectively obtained speech recognition scores in noise were related to several aspects of supra-threshold cochlear processing as assessed by psychophysical measurements. The differences in speech perception in noise between these patient groups could be explained by these factors and partially by the hypothesized affected structure of the cochlea, suggesting that speech recognition in noise was associated with a genetics-related malfunctioning of the cochlea. In particular, regression models indicate that loudness growth and spectral resolution best describe the cochlear distortions and are thus a good biomarker for speech understanding in noise.

The cognitive hearing science perspective on perceiving, understanding, and remembering language: The ELU model

The review gives an introductory description of the successive development of data patterns based on comparisons between hearing-impaired and normal hearing participants’ speech understanding skills, later prompting the formulation of the Ease of Language Understanding (ELU) model. The model builds on the interaction between an input buffer (RAMBPHO, Rapid Automatic Multimodal Binding of PHOnology) and three memory systems: working memory (WM), semantic long-term memory (SLTM), and episodic long-term memory (ELTM). RAMBPHO input may either match or mismatch multimodal SLTM representations. Given a match, lexical access is accomplished rapidly and implicitly within approximately 100–400 ms. Given a mismatch, the prediction is that WM is engaged explicitly to repair the meaning of the input – in interaction with SLTM and ELTM – taking seconds rather than milliseconds. The multimodal and multilevel nature of representations held in WM and LTM are at the center of the review, being integral parts of the prediction and postdiction components of language understanding. Finally, some hypotheses based on a selective use-disuse of memory systems mechanism are described in relation to mild cognitive impairment and dementia. Alternative speech perception and WM models are evaluated, and recent developments and generalisations, ELU model tests, and boundaries are discussed.

The Effect of Lifetime Noise Exposure and Aging on Speech-Perception-in-Noise Ability and Self-Reported Hearing Symptoms: An Online Study

Animal research shows that aging and excessive noise exposure damage cochlear outer hair cells, inner hair cells, and the synapses connecting inner hair cells with the auditory nerve. This may translate into auditory symptoms such as difficulty understanding speech in noise, tinnitus, and hyperacusis. The current study, using a novel online approach, assessed and quantified the effects of lifetime noise exposure and aging on (i) speech-perception-in-noise (SPiN) thresholds, (ii) self-reported hearing ability, and (iii) the presence of tinnitus. Secondary aims involved documenting the effects of lifetime noise exposure and aging on tinnitus handicap and the severity of hyperacusis. Two hundred and ninety-four adults with no past diagnosis of hearing or memory impairments were recruited online. Participants were assigned into two groups: 217 "young" (age range: 18-35 years, females: 151) and 77 "older" (age range: 50-70 years, females: 50). Participants completed a set of online instruments including an otologic health and demographic questionnaire, a dementia screening tool, forward and backward digit span tests, a noise exposure questionnaire, the Khalfa hyperacusis questionnaire, the short-form of the Speech, Spatial, and Qualities of Hearing scale, the Tinnitus Handicap Inventory, a digits-in-noise test, and a Coordinate Response Measure speech-perception test. Analyses controlled for sex and cognitive function as reflected by the digit span. A detailed protocol was pre-registered, to guard against "p-hacking" of this extensive dataset. Lifetime noise exposure did not predict SPiN thresholds, self-reported hearing ability, or the presence of tinnitus in either age group. Exploratory analyses showed that worse hyperacusis scores, and a greater prevalence of tinnitus, were associated significantly with high lifetime noise exposure in the young, but not in the older group. Age was a significant predictor of SPiN thresholds and the presence of tinnitus, but not of self-reported hearing ability, tinnitus handicap, or severity of hyperacusis. Consistent with several lab studies, our online-derived data suggest that older adults with no diagnosis of hearing impairment have a poorer SPiN ability and a higher risk of tinnitus than their younger counterparts. Moreover, lifetime noise exposure may increase the risk of tinnitus and the severity of hyperacusis in young adults with no diagnosis of hearing impairment.

One Size Does Not Fit All: Examining the Effects of Working Memory Capacity on Spoken Word Recognition in Older Adults Using Eye Tracking

Difficulties understanding speech form one of the most prevalent complaints among older adults. Successful speech perception depends on top-down linguistic and cognitive processes that interact with the bottom-up sensory processing of the incoming acoustic information. The relative roles of these processes in age-related difficulties in speech perception, especially when listening conditions are not ideal, are still unclear. In the current study, we asked whether older adults with a larger working memory capacity process speech more efficiently than peers with lower capacity when speech is presented in noise, with another task performed in tandem. Using the Eye-tracking of Word Identification in Noise Under Memory Increased Load (E-WINDMIL) an adapted version of the "visual world" paradigm, 36 older listeners were asked to follow spoken instructions presented in background noise, while retaining digits for later recall under low (single-digit) or high (four-digits) memory load. In critical trials, instructions (e.g., "point at the candle") directed listeners' gaze to pictures of objects whose names shared onset or offset sounds with the name of a competitor that was displayed on the screen at the same time (e.g., candy or sandal). We compared listeners with different memory capacities on the time course for spoken word recognition under the two memory loads by testing eye-fixations on a named object, relative to fixations on an object whose name shared phonology with the named object. Results indicated two trends. (1) For older adults with lower working memory capacity, increased memory load did not affect online speech processing, however, it impaired offline word recognition accuracy. (2) The reverse pattern was observed for older adults with higher working memory capacity: increased task difficulty significantly decreases online speech processing efficiency but had no effect on offline word recognition accuracy. Results suggest that in older adults, adaptation to adverse listening conditions is at least partially supported by cognitive reserve. Therefore, additional cognitive capacity may lead to greater resilience of older listeners to adverse listening conditions. The differential effects documented by eye movements and accuracy highlight the importance of using both online and offline measures of speech processing to explore age-related changes in speech perception.

Clinical Trials and Outcome Measures in Adults With Hearing Loss

Clinical trials are designed to evaluate interventions that prevent, diagnose or treat a health condition and provide the evidence base for improving practice in health care. Many health professionals, including those working within or allied to hearing health, are expected to conduct or contribute to clinical trials. Recent systematic reviews of clinical trials reveal a dearth of high quality evidence in almost all areas of hearing health practice. By providing an overview of important steps and considerations concerning the design, analysis and conduct of trials, this article aims to give guidance to hearing health professionals about the key elements that define the quality of a trial. The article starts out by situating clinical trials within the greater scope of clinical evidence, then discusses the elements of a PICO-style research question. Subsequently, various methodological considerations are discussed including design, randomization, blinding, and outcome measures. Because the literature on outcome measures within hearing health is as confusing as it is voluminous, particular focus is given to discussing how hearing-related outcome measures affect clinical trials. This focus encompasses how the choice of measurement instrument(s) affects interpretation, how the accuracy of a measure can be estimated, how this affects the interpretation of results, and if differences are statistically, perceptually and/or clinically meaningful to the target population, people with hearing loss.

Personality captures dissociations of subjective versus objective hearing in noise

Acoustic noise is pervasive in human environments. Some individuals are more tolerant to noise than others. We demonstrate the explanatory potential of Big-5 personality traits neuroticism (being emotionally unstable) and extraversion (being enthusiastic, outgoing) on subjective self-report and objective psycho-acoustic metrics of hearing in noise in two samples (total N = 1103). Under statistical control for demographics and in agreement with pre-registered hypotheses, lower neuroticism and higher extraversion independently explained superior self-reported noise resistance, speech-hearing ability and acceptable background noise levels. Surprisingly, objective speech-in-noise recognition instead increased with higher levels of neuroticism. In turn, the bias in subjectively overrating one's own hearing in noise decreases with higher neuroticism but increases with higher extraversion. Of benefit to currently underspecified frameworks of hearing in noise and tailored audiological treatments, these results show that personality explains inter-individual differences in coping with acoustic noise, which is a ubiquitous source of distraction and a health hazard.

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.

Cogmed Training Does Not Generalize to Real-World Benefits for Adult Hearing Aid Users: Results of a Blinded, Active-Controlled Randomized Trial

Objectives:

Performance on working memory tasks is positively associated with speech-in-noise perception performance, particularly where auditory inputs are degraded. It is suggested that interventions designed to improve working memory capacity may improve domain-general working memory performance for people with hearing loss, to benefit their real-world listening. We examined whether a 5-week training program that primarily targets the storage component of working memory (Cogmed RM, adaptive) could improve cognition, speech-in-noise perception and self-reported hearing in a randomized controlled trial of adult hearing aid users with mild to moderate hearing loss, compared with an active control (Cogmed RM, nonadaptive) group of adults from the same population.

Design:

A preregistered randomized controlled trial of 57 adult hearing aid users (n = 27 experimental, n = 30 active control), recruited from a dedicated database of research volunteers, examined on-task learning and generalized improvements in measures of trained and untrained cognition, untrained speech-in-noise perception and self-reported hearing abilities, pre- to post-training. Participants and the outcome assessor were both blinded to intervention allocation. Retention of training-related improvements was examined at a 6-month follow-up assessment.

Results:

Per-protocol analyses showed improvements in trained tasks (Cogmed Index Improvement) that transferred to improvements in a trained working memory task tested outside of the training software (Backward Digit Span) and a small improvement in self-reported hearing ability (Glasgow Hearing Aid Benefit Profile, Initial Disability subscale). Both of these improvements were maintained 6-month post-training. There was no transfer of learning shown to untrained measures of cognition (working memory or attention), speech-in-noise perception, or self-reported hearing in everyday life. An assessment of individual differences showed that participants with better baseline working memory performance achieved greater learning on the trained tasks. Post-training performance for untrained outcomes was largely predicted by individuals’ pretraining performance on those measures.

Conclusions:

Despite significant on-task learning, generalized improvements of working memory training in this trial were limited to (a) improvements for a trained working memory task tested outside of the training software and (b) a small improvement in self-reported hearing ability for those in the experimental group, compared with active controls. We found no evidence to suggest that training which primarily targets storage aspects of working memory can result in domain-general improvements that benefit everyday communication for adult hearing aid users. These findings are consistent with a significant body of evidence showing that Cogmed training only improves performance for tasks that resemble Cogmed training. Future research should focus on the benefits of interventions that enhance cognition in the context in which it is employed within everyday communication, such as training that targets dynamic aspects of cognitive control important for successful speech-in-noise perception.

Improvement of Working Memory and Processing Speed in Patients over 70 with Bilateral Hearing Impairment Following Unilateral Cochlear Implantation

Several studies demonstrated the association of hearing disorders with neurocognitive deficits and dementia disorders, but little is known about the effects of auditory rehabilitation on the cognitive performance of the elderly. Therefore, the research question of the present study was whether cochlear implantation, performed in 21 patients over 70 with bilateral severe hearing impairment, could influence their cognitive skills. The measuring points were before implantation and 12 months after the first cochlear implant (CI) fitting. Evaluation of the working memory (WMI) and processing speed (PSI) was performed using the Wechsler Adult Intelligence Scale 4th edition (WAIS-IV). The audiological assessment included speech perception (SP) in quiet (Freiburg monosyllabic test; FMT), noise (Oldenburg sentence test; OLSA), and self-assessment inventory (Oldenburg Inventory; OI). Twelve months after the first CI fitting, not only the auditory parameters (SP and OI), but also the WMI and PSI, improved significantly (p < 0.05) in the cohort. The presented results imply that cochlear implantation of bilaterally hearing-impaired patients over 70 positively influences their cognitive skills.

Effects of Cognitive Load on Pure-Tone Audiometry Thresholds in Younger and Older Adults

Supplemental Digital Content is available in the text.

Cognitive load (CL) impairs listeners’ ability to comprehend sentences, recognize words, and identify speech sounds. Recent findings suggest that this effect originates in a disruption of low-level perception of acoustic details. Here, we attempted to quantify such a disruption by measuring the effect of CL (a two-back task) on pure-tone audiometry (PTA) thresholds. We also asked whether the effect of CL on PTA was greater in older adults, on account of their reduced ability to divide cognitive resources between simultaneous tasks. To specify the mechanisms and representations underlying the interface between auditory and cognitive processes, we contrasted CL requiring visual encoding with CL requiring auditory encoding. Finally, the link between the cost of performing PTA under CL, working memory, and speech-in-noise (SiN) perception was investigated and compared between younger and older participants.

Minimal and Mild Hearing Loss in Children: Association with Auditory Perception, Cognition, and Communication Problems

OBJECTIVES

"Minimal" and "mild" hearing loss are the most common but least understood forms of hearing loss in children. Children with better ear hearing level as low as 30 dB HL have a global language impairment and, according to the World Health Organization, a "disabling level of hearing loss." We examined in a population of 6- to 11-year-olds how hearing level ≤40.0 dB HL (1 and 4 kHz pure-tone average, PTA, threshold) is related to auditory perception, cognition, and communication.

DESIGN

School children (n = 1638) were recruited in 4 centers across the United Kingdom. They completed a battery of hearing (audiometry, filter width, temporal envelope, speech-in-noise) and cognitive (IQ, attention, verbal memory, receptive language, reading) tests. Caregivers assessed their children's communication and listening skills. Children included in this study (702 male; 752 female) had 4 reliable tone thresholds (1, 4 kHz each ear), and no caregiver reported medical or intellectual disorder. Normal-hearing children (n = 1124, 77.1%) had all 4 thresholds and PTA <15 dB HL. Children with ≥15 dB HL for at least 1 threshold, and PTA <20 dB (n = 245, 16.8%) had minimal hearing loss. Children with 20 ≤PTA <40 dB HL (n = 88, 6.0%) had mild hearing loss. Interaural asymmetric hearing loss ( left PTA - right PTA ≥10 dB) was found in 28.9% of those with minimal and 39.8% of those with mild hearing loss.

RESULTS

Speech perception in noise, indexed by vowel-consonant-vowel pseudoword repetition in speech-modulated noise, was impaired in children with minimal and mild hearing loss, relative to normal-hearing children. Effect size was largest (d = 0.63) in asymmetric mild hearing loss and smallest (d = 0.21) in symmetric minimal hearing loss. Spectral (filter width) and temporal (backward masking) perceptions were impaired in children with both forms of hearing loss, but suprathreshold perception generally related only weakly to PTA. Speech-in-noise (nonsense syllables) and language (pseudoword repetition) were also impaired in both forms of hearing loss and correlated more strongly with PTA. Children with mild hearing loss were additionally impaired in working memory (digit span) and reading, and generally performed more poorly than those with minimal loss. Asymmetric hearing loss produced as much impairment overall on both auditory and cognitive tasks as symmetric hearing loss. Nonverbal IQ, attention, and caregiver-rated listening and communication were not significantly impaired in children with hearing loss. Modeling suggested that 15 dB HL is objectively an appropriate lower audibility limit for diagnosis of hearing loss.

CONCLUSIONS

Hearing loss between 15 and 30 dB PTA is, at ~20%, much more prevalent in 6- to 11-year-old children than most current estimates. Key aspects of auditory and cognitive skills are impaired in both symmetric and asymmetric minimal and mild hearing loss. Hearing loss <30 dB HL is most closely related to speech perception in noise, and to cognitive abilities underpinning language and reading. The results suggest wider use of speech-in-noise measures to diagnose and assess management of hearing loss and reduction of the clinical hearing loss threshold for children to 15 dB HL.

The Role of Lexical Tone Information in the Recognition of Mandarin Sentences in Listeners With Hearing Aids

OBJECTIVES

Lexical tone information provides redundant cues for the recognition of Mandarin sentences in listeners with normal hearing in quiet conditions. The contribution of lexical tones to Mandarin sentence recognition in listeners with hearing aids (HAs) is unclear. This study aimed to remove lexical tone information and examine the effects on Mandarin sentence intelligibility in HA users. The second objective was to investigate the contribution of cognitive abilities (i.e., general cognitive ability, working memory, and attention) on Mandarin sentence perception when the presentation of lexical tone information was mismatched.

DESIGN

A text-to-speech synthesis engine was used to manipulate Mandarin sentences into three test conditions: (1) a Normal Tone test condition, where no alterations were made to lexical tones within sentences; (2) a Flat Tone test condition, where lexical tones were all changed into tone 1 (i.e., the flat tone); and (3) a Random Tone test condition, where each word in test sentences was randomly assigned one of four Mandarin lexical tones. The manipulated sentence signals were presented to 32 listeners with HAs in both quiet and noisy environments at an 8 dB signal to noise ratio.

RESULTS

Speech intelligibility was reduced significantly (by approximately 40 percentage points) in the presence of mismatched lexical tone information in both quiet and noise. The difficulty in correctly identifying sentences with mismatched lexical tones among adults with hearing loss was significantly greater than that of adults with normal hearing. Cognitive function was not significantly related to a decline in speech recognition scores.

CONCLUSIONS

Contextual and other phonemic cues (i.e., consonants and vowels) are inadequate for HA users to perceive sentences with mismatched lexical tone contours in quiet or noise. Also, HA users with better cognitive function could not compensate for the loss of lexical tone information. These results highlight the importance of accurately representing lexical tone information for Mandarin speakers using HAs.

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

OBJECTIVE

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

DESIGN

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

STUDY SAMPLE

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

RESULTS

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

CONCLUSION

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

Psychometric function for speech-in-noise tests accounts for word-recognition deficits in older listeners

Speech-in-noise (SIN) understanding in older age is affected by hearing loss, impaired central auditory processing, and cognitive deficits. SIN-tests measure these factors' compound effects by a speech reception threshold, defined as the signal-to-noise ratio required for 50% word understanding (SNR50). This study compared two standard SIN tests, QuickSIN (n = 354) in young and older adults and BKB-SIN (n = 139) in older adults (>60 years). The effects of hearing loss and age on SIN understanding were analyzed to identify auditory and nonauditory contributions to SIN loss. Word recognition in noise was modelled with individual psychometric functions using a logistic fit with three parameters: the midpoint (SNRα), slope (β), and asymptotic word-recognition deficit at high SNR (λ). The parameters SNRα and λ formally separate SIN loss into two components. SNRα characterizes the steep slope of the psychometric function at which a slight SNR increase provides a considerable improvement in SIN understanding. SNRα was discussed as being predominantly affected by audibility and low-level central auditory processing. The parameter λ describes a shallow segment of the psychometric function at which a further increase in the SNR provides modest improvement in SIN understanding. Cognitive factors in aging may contribute to the SIN loss indicated by λ.

Contributions of Age-Related and Audibility-Related Deficits to Aided Consonant Identification in Presbycusis: A Causal-Inference Analysis

The decline of speech intelligibility in presbycusis can be regarded as resulting from the combined contribution of two main groups of factors: (1) audibility-related factors and (2) age-related factors. In particular, there is now an abundant scientific literature on the crucial role of suprathreshold auditory abilities and cognitive functions, which have been found to decline with age even in the absence of audiometric hearing loss. However, researchers investigating the direct effect of aging in presbycusis have to deal with the methodological issue that age and peripheral hearing loss covary to a large extent. In the present study, we analyzed a dataset of consonant-identification scores measured in quiet and in noise for a large cohort (n = 459, age = 42-92) of hearing-impaired (HI) and normal-hearing (NH) listeners. HI listeners were provided with a frequency-dependent amplification adjusted to their audiometric profile. Their scores in the two conditions were predicted from their pure-tone average (PTA) and age, as well as from their Extended Speech Intelligibility Index (ESII), a measure of the impact of audibility loss on speech intelligibility. We relied on a causal-inference approach combined with Bayesian modeling to disentangle the direct causal effects of age and audibility on intelligibility from the indirect effect of age on hearing loss. The analysis revealed that the direct effect of PTA on HI intelligibility scores was 5 times higher than the effect of age. This overwhelming effect of PTA was not due to a residual audibility loss despite amplification, as confirmed by a ESII-based model. More plausibly, the marginal role of age could be a consequence of the relatively little cognitively-demanding task used in this study. Furthermore, the amount of variance in intelligibility scores was smaller for NH than HI listeners, even after accounting for age and audibility, reflecting the presence of additional suprathreshold deficits in the latter group. Although the non-sense-syllable materials and the particular amplification settings used in this study potentially restrict the generalization of the findings, we think that these promising results call for a wider use of causal-inference analysis in audiology, e.g., as a way to disentangle the influence of the various cognitive factors and suprathreshold deficits associated to presbycusis.

Speech intelligibility with various head-related transfer functions: A computational modelling approach

Speech intelligibility (SI) is known to be affected by the relative spatial position between target and interferers. The benefit of a spatial separation is, along with other factors, related to the head-related transfer function (HRTF). The HRTF is individually different and thus, the cues that affect SI might also be different. In the current study, an auditory model was employed to predict SI with various HRTFs and at different angles on the horizontal plane. The predicted SI threshold was found to be largely different across HRTFs. Thus, individual listeners might have different access to SI cues, dependent on their HRTF.

Deep Neural Network Model of Hearing-Impaired Speech-in-Noise Perception

Many individuals struggle to understand speech in listening scenarios that include reverberation and background noise. An individual's ability to understand speech arises from a combination of peripheral auditory function, central auditory function, and general cognitive abilities. The interaction of these factors complicates the prescription of treatment or therapy to improve hearing function. Damage to the auditory periphery can be studied in animals; however, this method alone is not enough to understand the impact of hearing loss on speech perception. Computational auditory models bridge the gap between animal studies and human speech perception. Perturbations to the modeled auditory systems can permit mechanism-based investigations into observed human behavior. In this study, we propose a computational model that accounts for the complex interactions between different hearing damage mechanisms and simulates human speech-in-noise perception. The model performs a digit classification task as a human would, with only acoustic sound pressure as input. Thus, we can use the model's performance as a proxy for human performance. This two-stage model consists of a biophysical cochlear-nerve spike generator followed by a deep neural network (DNN) classifier. We hypothesize that sudden damage to the periphery affects speech perception and that central nervous system adaptation over time may compensate for peripheral hearing damage. Our model achieved human-like performance across signal-to-noise ratios (SNRs) under normal-hearing (NH) cochlear settings, achieving 50% digit recognition accuracy at -20.7 dB SNR. Results were comparable to eight NH participants on the same task who achieved 50% behavioral performance at -22 dB SNR. We also simulated medial olivocochlear reflex (MOCR) and auditory nerve fiber (ANF) loss, which worsened digit-recognition accuracy at lower SNRs compared to higher SNRs. Our simulated performance following ANF loss is consistent with the hypothesis that cochlear synaptopathy impacts communication in background noise more so than in quiet. Following the insult of various cochlear degradations, we implemented extreme and conservative adaptation through the DNN. At the lowest SNRs (<0 dB), both adapted models were unable to fully recover NH performance, even with hundreds of thousands of training samples. This implies a limit on performance recovery following peripheral damage in our human-inspired DNN architecture.

Association Between Tinnitus Pitch and Consonant Recognition in Noise

Purpose Difficulties in speech-in-noise understanding are often reported in individuals with tinnitus. Building on our previous findings that speech-in-noise performance is correlated with subjective loudness of tinnitus, this study aimed to investigate the effect of tinnitus pitch on consonant recognition in noise. Method Pure-tone audiometry and the Quick Speech-in-Noise Test were conducted on 66 participants categorized into four groups by their hearing sensitivity and self-report of tinnitus. Consonant recognition scores at various frequency ranges were obtained at the 5 dB SNR condition of the Quick Speech-in-Noise Test. Participants with tinnitus also completed a tinnitus pitch-matching procedure. Correlation analyses were conducted between tinnitus pitch and the frequency of the worst consonant recognition, and the error rates based on word and sentence position were compared. Results Regardless of hearing sensitivity, tinnitus pitch did not correlate with the frequency of the worst consonant recognition. Sentence-initial word recognition was affected by hearing loss, whereas sentence-final word recognition was not affected by hearing loss or tinnitus. In contrast to individuals with normal hearing, participants with hearing loss varied in full-sentence recognition, with those reporting tinnitus exhibiting significantly higher error rates. Conclusions The findings suggest that the effect of tinnitus on consonant recognition in noise may involve higher level functions more than perceptual characteristics of tinnitus. Furthermore, for individuals with speech-in-noise concerns, clinical evaluation should address both hearing sensitivity and the presence of tinnitus. Future speech-in-noise studies should incorporate cognitive tests and, possibly, brain imaging to parse out the contribution of cognitive factors, such as cognitive control, in speech-in-noise in tinnitus.

Bimodal cochlear implantation in elderly patients

OBJECTIVE

Bimodal stimulation is a standard option for asymmetric hearing loss in adults. Questions have been raised whether receiving two stimulations may conflict in elderly listeners where the central integration of an acoustic/electrical signal may be very important to obtain benefit in terms of speech perception.

DESIGN

Clinical retrospective study.

STUDY SAMPLE

The outcomes from 17 bimodal cochlear implant (CI) users were analysed. The test material consisted of speech audiometry in quiet and in noise (STARR and Matrix).

RESULTS

Bimodal PTA and speech perception both in quiet and in noise were significantly better than CI or HA alone. Age showed a significant effect on bimodal STARR outcomes. Similarly, bimodal STARR scores improved significantly in comparison to Better Ear.

CONCLUSION

Both Matrix and STARR tests were very difficult for many elderly CI listeners from the present study group, especially in unilateral listening condition. The performance improved significantly, emphasising a good integration of acoustic and electric hearing in this group of elderly bimodal listeners. Overall results highlighted how a specific study, based on speech perception in noise in the elderly listeners, might shed light on the effect of speech test modality on bimodal outcomes.

Attentional modulation of neural entrainment to sound streams in children with and without ADHD

To extract meaningful information from complex auditory scenes like a noisy playground, rock concert, or classroom, children can direct attention to different sound streams. One means of accomplishing this might be to align neural activity with the temporal structure of a target stream, such as a specific talker or melody. However, this may be more difficult for children with ADHD, who can struggle with accurately perceiving and producing temporal intervals. In this EEG study, we found that school-aged children's attention to one of two temporally-interleaved isochronous tone 'melodies' was linked to an increase in phase-locking at the melody's rate, and a shift in neural phase that aligned the neural responses with the attended tone stream. Children's attention task performance and neural phase alignment with the attended melody were linked to performance on temporal production tasks, suggesting that children with more robust control over motor timing were better able to direct attention to the time points associated with the target melody. Finally, we found that although children with ADHD performed less accurately on the tonal attention task than typically developing children, they showed the same degree of attentional modulation of phase locking and neural phase shifts, suggesting that children with ADHD may have difficulty with attentional engagement rather than attentional selection.

Speech-in-noise detection is related to auditory working memory precision for frequency

Speech-in-noise (SiN) perception is a critical aspect of natural listening, deficits in which are a major contributor to the hearing handicap in cochlear hearing loss. Studies suggest that SiN perception correlates with cognitive skills, particularly phonological working memory: the ability to hold and manipulate phonemes or words in mind. We consider here the idea that SiN perception is linked to a more general ability to hold sound objects in mind, auditory working memory, irrespective of whether the objects are speech sounds. This process might help combine foreground elements, like speech, over seconds to aid their separation from the background of an auditory scene. We investigated the relationship between auditory working memory precision and SiN thresholds in listeners with normal hearing. We used a novel paradigm that tests auditory working memory for non-speech sounds that vary in frequency and amplitude modulation (AM) rate. The paradigm yields measures of precision in frequency and AM domains, based on the distribution of participants’ estimates of the target. Across participants, frequency precision correlated significantly with SiN thresholds. Frequency precision also correlated with the number of years of musical training. Measures of phonological working memory did not correlate with SiN detection ability. Our results demonstrate a specific relationship between working memory for frequency and SiN. We suggest that working memory for frequency facilitates the identification and tracking of foreground objects like speech during natural listening. Working memory performance for frequency also correlated with years of musical instrument experience suggesting that the former is potentially modifiable.

Adaptation of the Connected Speech Test: Rerecording and Passage Equivalency

Purpose The original Connected Speech Test (CST; Cox et al., 1987) is a well-regarded and often utilized speech perception test. The aim of this study was to develop a new version of the CST using a neutral North American accent and to assess the use of this updated CST on participants with normal hearing. Method A female English speaker was recruited to read the original CST passages, which were recorded as the new CST stimuli. A study was designed to assess the newly recorded CST passages' equivalence and conduct normalization. The study included 19 Western University students (11 females and eight males) with normal hearing and with English as a first language. Results Raw scores for the 48 tested passages were converted to rationalized arcsine units, and average passage scores more than 1 rationalized arcsine unit standard deviation from the mean were excluded. The internal reliability of the 32 remaining passages was assessed, and the two-way random effects intraclass correlation was .944. Conclusion The aim of our study was to create new CST stimuli with a more general North American accent in order to minimize accent effects on the speech perception scores. The study resulted in 32 passages of equivalent difficulty for listeners with normal hearing.

Serial Recall Predicts Vocoded Sentence Recognition Across Spectral Resolutions

Purpose The goal of this study was to determine how various aspects of cognition predict speech recognition ability across different levels of speech vocoding within a single group of listeners. Method We tested the ability of young adults (N = 32) with normal hearing to recognize Perceptually Robust English Sentence Test Open-set (PRESTO) sentences that were degraded with a vocoder to produce different levels of spectral resolution (16, eight, and four carrier channels). Participants also completed tests of cognition (fluid intelligence, short-term memory, and attention), which were used as predictors of sentence recognition. Sentence recognition was compared across vocoder conditions, predictors were correlated with individual differences in sentence recognition, and the relationships between predictors were characterized. Results PRESTO sentence recognition performance declined with a decreasing number of vocoder channels, with no evident floor or ceiling performance in any condition. Individual ability to recognize PRESTO sentences was consistent relative to the group across vocoder conditions. Short-term memory, as measured with serial recall, was a moderate predictor of sentence recognition (ρ = 0.65). Serial recall performance was constant across vocoder conditions when measured with a digit span task. Fluid intelligence was marginally correlated with serial recall, but not sentence recognition. Attentional measures had no discernible relationship to sentence recognition and a marginal relationship with serial recall. Conclusions Verbal serial recall is a substantial predictor of vocoded sentence recognition, and this predictive relationship is independent of spectral resolution. In populations that show variable speech recognition outcomes, such as listeners with cochlear implants, it should be possible to account for the independent effects of spectral resolution and verbal serial recall in their speech recognition ability. Supplemental Material https://doi.org/10.23641/asha.12021051.

Auditory Working Memory Explains Variance in Speech Recognition in Older Listeners Under Adverse Listening Conditions

Introduction

Older listeners have difficulty understanding speech in unfavorable listening conditions. To compensate for acoustic degradation, cognitive processing skills, such as working memory, need to be engaged. Despite prior findings on the association between working memory and speech recognition in various listening conditions, it is not yet clear whether the modality of stimuli presentation for working memory tasks should be auditory or visual. Given the modality-specific characteristics of working memory, we hypothesized that auditory working memory capacity could predict speech recognition performance in adverse listening conditions for older listeners and that the contribution of auditory working memory to speech recognition would depend on the task and listening condition.

Methods

Seventy-six older listeners and twenty younger listeners completed four kinds of auditory working memory tasks, including digit and speech span tasks, and sentence recognition tasks in four different listening conditions having multi-talker noise and time-compression. For older listeners, cognitive function was screened using the Mini-Mental Status Examination, and audibility was assured.

Results

Auditory working memory, as measured by listening span, significantly predicted speech recognition performance in adverse listening conditions for older listeners. A linear regression model showed speech recognition performance for older listeners could be explained by auditory working memory whilst controlling for the impact of age and hearing sensitivity.

Discussion

Measuring working memory in the auditory modality facilitated explaining the variance in speech recognition in adverse listening conditions for older listeners. The linguistic features and the complexity of the auditory stimuli may affect the association between working memory and speech recognition performance.

Conclusion

We demonstrated the contribution of auditory working memory to speech recognition in unfavorable listening conditions in older populations. Taking the modality-specific characteristics of working memory into account may be a key to better understand the difficulty in speech recognition in daily listening conditions for older listeners.

Extended high-frequency hearing enhances speech perception in noise

Young healthy adults can hear tones up to at least 20 kHz. However, clinical audiometry, by which hearing loss is diagnosed, is limited at high frequencies to 8 kHz. Evidence suggests there is salient information at extended high frequencies (EHFs; 8 to 20 kHz) that may influence speech intelligibility, but whether that information is used in challenging listening conditions remains unknown. Difficulty understanding speech in noisy environments is the most common concern people have about their hearing and usually the first sign of age-related hearing loss. Digits-in-noise (DIN), a widely used test of speech-in-noise perception, can be sensitized for detection of high-frequency hearing loss by low-pass filtering the broadband masking noise. Here, we used standard and EHF audiometry, self-report, and successively higher cutoff frequency filters (2 to 8 kHz) in a DIN test to investigate contributions of higher-frequency hearing to speech-in-noise perception. Three surprising results were found. First, 74 of 116 "normally hearing," mostly younger adults had some hearing loss at frequencies above 8 kHz. Early EHF hearing loss may thus be an easily measured, preventive warning to protect hearing. Second, EHF hearing loss correlated with self-reported difficulty hearing in noise. Finally, even with the broadest filtered noise (≤8 kHz), DIN hearing thresholds were significantly better (P < 0.0001) than those using broadband noise. Sound energy above 8 kHz thus contributes to speech perception in noise. People with "normal hearing" frequently report difficulty hearing in challenging environments. Our results suggest that one contribution to this difficulty is EHF hearing loss.

[Hearing and cognition: neurocognitive test batteries in otorhinolaryngology]

BACKGROUND

Hearing and cognition are closely related to each other. Particularly in suboptimal listening situations, cognitive abilities become important to enable speech comprehension. Besides, studies have indicated that hearing impairment is associated with a more rapid mental decline compared to persons with normal hearing. However, hearing loss also has an impact on neurocognitive testing, which is generally based on auditive stimuli. With increasing age, the risk of sensory but also of cognitive impairments increases. So far this comorbidity receives little consideration in otorhinolaryngology.

MATERIALS AND METHODS

The paper presents an overview and evaluation of widely used German neurocognitive test batteries for older patients, with regard to the different test modalities and their focus.

RESULTS

A multitude of different neurocognitive screening tests and detailed test batteries are available, particularly in the field of dementia. So far, sensory deficits have not been considered in neurocognitive testing, neither concerning application nor interpretation. Normative data adapted to the hearing impaired are still missing.

CONCLUSION

With regard to demographic changes and the well-known bias between hearing and cognition, screening of neurocognitive functions should be implemented in basic otorhinolaryngologic diagnostics. More comprehensive test batteries might be useful for research purposes or speech therapy.

[Hearing rehabilitation with cochlear implants and cognitive abilities]

The relevance of assessing cognitive functioning is increasing against the background of the continuing demographic changes. Up to a few years ago the focus was on the effects of cochlear implantation in children born deaf in comparison to healthy individuals. Currently, the question arises whether hearing rehabilitation in the elderly, e.g. by postlingual cochlear implantation, has a protective effect on cognitive functioning and therefore on the risk of onset of dementia. This review describes the association of cognitive functioning with hearing disorders and cochlear implantation. Historical aspects of intelligence testing are illustrated. Knowledge on cognitive aspects in elderly persons with hearing disorders and cochlear implants is rare in the currently available literature. Initial findings indicate a positive correlation between hearing improvement and cognitive functioning. Further studies are urgently required in order to elucidate appropriate guidelines for the treatment of patients with cognitive deficits and hearing impairment.

Card playing enhances speech perception among aging adults: comparison with aging musicians

Speech perception and auditory processing have been shown to be enhanced among aging musicians as compared to non-musicians. In the present study, the aim was to test whether these functions are also enhanced among those who are engaged in a non-musical mentally challenging leisure activity (card playing). Three groups of 23 aging adults, aged 60-80 years, were recruited for the study: Musicians, Card players, and Controls. Participants were matched for age, gender, Wechsler Adult Intelligence Scale-III Matrix Reasoning, and Digit Span scores. Their performance was measured using auditory spectral and spatial temporal order judgment tests, and four tasks of speech perception in conditions of: no background noise, background noise of speech frequencies, background noise of white noise, and 60% compressed speech. Musicians were better in auditory and speech perception than the other two groups. Card players were similar to Controls in auditory perception tasks, but were better in the speech perception tasks. Non-musician aging adults may be able to improve their speech perception ability by engaging in leisure activity requiring cognitive effort.

Speech Recognition Abilities in Normal-Hearing Children 4 to 12 Years of Age in Stationary and Interrupted Noise

Objectives:

The main purpose of this study was to examine developmental effects for speech recognition in noise abilities for normal-hearing children in several listening conditions, relevant for daily life. Our aim was to study the auditory component in these listening abilities by using a test that was designed to minimize the dependency on nonauditory factors, the digits-in-noise (DIN) test. Secondary aims were to examine the feasibility of the DIN test for children, and to establish age-dependent normative data for diotic and dichotic listening conditions in both stationary and interrupted noise.

Design:

In experiment 1, a newly designed pediatric DIN (pDIN) test was compared with the standard DIN test. Major differences with the DIN test are that the pDIN test uses 79% correct instead of 50% correct as a target point, single digits (except 0) instead of triplets, and animations in the test procedure. In this experiment, 43 normal-hearing subjects between 4 and 12 years of age and 10 adult subjects participated. The authors measured the monaural speech reception threshold for both DIN test and pDIN test using headphones. Experiment 2 used the standard DIN test to measure speech reception thresholds in noise in 112 normal-hearing children between 4 and 12 years of age and 33 adults. The DIN test was applied using headphones in stationary and interrupted noise, and in diotic and dichotic conditions, to study also binaural unmasking and the benefit of listening in the gaps.

Results:

Most children could reliably do both pDIN test and DIN test, and measurement errors for the pDIN test were comparable between children and adults. There was no significant difference between the score for the pDIN test and that of the DIN test. Speech recognition scores increase with age for all conditions tested, and performance is adult-like by 10 to 12 years of age in stationary noise but not interrupted noise. The youngest, 4-year-old children have speech reception thresholds 3 to 7 dB less favorable than adults, depending on test conditions. The authors found significant age effects on binaural unmasking and fluctuating masker benefit, even after correction for the lower baseline speech reception threshold of adults in stationary noise.

Conclusions:

Speech recognition in noise abilities develop well into adolescence, and young children need a more favorable signal-to-noise ratio than adults for all listening conditions. Speech recognition abilities in children in stationary and interrupted noise can accurately and reliably be tested using the DIN test. A pediatric version of the test was shown to be unnecessary. Normative data were established for the DIN test in stationary and fluctuating maskers, and in diotic and dichotic conditions. The DIN test can thus be used to test speech recognition abilities for normal-hearing children from the age of 4 years and older.

Effects of frontal-executive dysfunction on self-perceived hearing handicap in the elderly with mild cognitive impairment

It is increasingly agreed upon that cognitive and audiological factors are associated with self-perceived hearing handicap in old adults. This study aimed to compare self-perceived hearing handicap among mild cognitive impairment (MCI) subgroups and a cognitively normal elderly (CNE) group and determine which factors (i.e., demographic, audiometric, or neuropsychological factors) are correlated with self-perceived hearing handicap in each group. A total of 46 MCI patients and 39 hearing threshold-matched CNE subjects participated in this study, and their age ranged from 55 to 80 years. The MCI patients were reclassified into two groups: 16 with frontal-executive dysfunction (FED) and 30 without FED. All subjects underwent audiometric, neuropsychological, and self-perceived hearing handicap assessments. The Korean version of the Hearing Handicap Inventory for the Elderly (K-HHIE) was administered to obtain the hearing handicap scores for each subject. After controlling for age, years of education, and depression levels, we found no significant differences in the K-HHIE scores between the MCI and the CNE groups. However, after we classified the MCI patients into the MCI with FED and MCI without FED groups, the MCI with FED group scored significantly higher than did both the MCI without FED and the CNE groups. In addition, after controlling for depression levels, significant partial correlations of hearing handicap scores with frontal-executive function scores and speech-in-noise perception performance were found in the MCI groups. In the CNE group, the hearing handicap scores were related to peripheral hearing sensitivity and years of education. In summary, MCI patients with FED are more likely to experience everyday hearing handicap than those without FED and cognitively normal old adults. Although educational level and peripheral hearing function are related to self-perceived hearing handicap in cognitively normal old adults, speech-in-noise perception and frontal-executive function are mainly associated with hearing handicap in patients with MCI.

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.

Auditory temporal processing, reading, and phonological awareness among aging adults

Auditory temporal processing (ATP) has been related in the literature to both speech perception as well as reading and phonological awareness. In aging adults, it is known to be related to difficulties in speech perception. In the present study, we aimed to test whether an age-related deficit in ATP would also be accompanied by poor reading and phonological awareness. Thirty-eight aging adults were compared to 55 readers with dyslexia and 42 young normal readers on temporal order judgment (TOJ), speech perception, reading, and phonological awareness tests. Aging adults had longer TOJ thresholds than young normal readers, but shorter than readers with dyslexia; however, they had lower speech perception accuracy than both groups. Phonological awareness of the aging adults was better than readers with dyslexia, but poorer than young normal readers, although their reading accuracy was similar to that of the young controls. This is the first report on poor phonological awareness among aging adults. Suprisingly, it was not accompanied by difficulties in reading ability, and might instead be related to aging adults' difficulties in speech perception. This newly discovered relationship between ATP and phonological awareness among aging adults appears to extend the existing understanding of this relationship, and suggests it should be explored in other groups with ATP deficits.

Hearing in Real-Life Environments (HERE): Structure and Reliability of a Questionnaire on Perceived Hearing for Older Adults

Supplemental Digital Content is available in the text.

Objectives:

The ability to hear in a variety of social situations and environments is vital for social participation and a high quality of life. One way to assess hearing ability is by means of self-report questionnaire. For questionnaires to be useful, their measurement properties, based on careful validation, have to be known. Only recently has consensus been reached concerning how to perform such validation and been published as COSMIN (consensus-based standards for the selection of health status measurement instruments) guidelines. Here the authors use these guidelines to evaluate the measurement properties of the “Hearing in Real-Life Environments” (HERE) questionnaire, a newly developed self-report measure that assesses speech perception, spatial orientation, and the social-emotional consequences of hearing impairment in older adults. The aim is to illustrate the process of validation and encourage similar examinations of other frequently used questionnaires.

Design:

The HERE questionnaire includes 15 items with a numeric rating scale from 0 to 10 for each item and allows the assessment of hearing with and without hearing aids. The evaluation was performed in two cohorts of community-dwelling older adults from Finland (n = 581, mean 82 years) and the United Kingdom (n = 50, mean 69 years). The internal structure of the questionnaire and its relationship to age, hearing level, and self-reported and behavioral measures of speech perception was assessed and, when possible, compared between cohorts.

Results:

The results of the factor analysis showed that the HERE’s internal structure was similar across cohorts. In both cohorts, the factor analysis showed a satisfactory solution for three factors (speech hearing, spatial hearing, and socio-emotional consequences), with a high internal consistency for each factor (Cronbach’s α’s for the factors from 0.90 to 0.97). Test–retest analysis showed the HERE overall mean score to be stable and highly replicable over time (intraclass correlation coefficient = 0.86, standard error of measurement of the test score = 0.92). The HERE overall mean score correlated highly with another self-report measure of speech perception, the Speech Spatial Qualities of Hearing questionnaire (standardized regression coefficient [β] = −0.75, p < 0.001), moderately highly with behaviorally assessed hearing level (best-ear average: β = 0.45 to 0.46), and moderately highly with behaviorally measured intelligibility of sentences in noise (β = −0.50, p < 0.001).

Conclusions:

Using the COSMIN guidelines, the authors show that the HERE is a valid, reliable, and stable questionnaire for the assessment of self-reported speech perception, sound localization, and the socio-emotional consequences of hearing impairment in the context of social functioning. The authors also show that cross-cultural data collected using different data collection strategies can be combined with a range of statistical methods to validate a questionnaire.

Exploring the Link Between Cognitive Abilities and Speech Recognition in the Elderly Under Different Listening Conditions

Elderly listeners are known to differ considerably in their ability to understand speech in noise. Several studies have addressed the underlying factors that contribute to these differences. These factors include audibility, and age-related changes in supra-threshold auditory processing abilities, and it has been suggested that differences in cognitive abilities may also be important. The objective of this study was to investigate associations between performance in cognitive tasks and speech recognition under different listening conditions in older adults with either age appropriate hearing or hearing-impairment. To that end, speech recognition threshold (SRT) measurements were performed under several masking conditions that varied along the perceptual dimensions of dip listening, spatial separation, and informational masking. In addition, a neuropsychological test battery was administered, which included measures of verbal working and short-term memory, executive functioning, selective and divided attention, and lexical and semantic abilities. Age-matched groups of older adults with either age-appropriate hearing (ENH, n = 20) or aided hearing impairment (EHI, n = 21) participated. In repeated linear regression analyses, composite scores of cognitive test outcomes (evaluated using PCA) were included to predict SRTs. These associations were different for the two groups. When hearing thresholds were controlled for, composed cognitive factors were significantly associated with the SRTs for the ENH listeners. Whereas better lexical and semantic abilities were associated with lower (better) SRTs in this group, there was a negative association between attentional abilities and speech recognition in the presence of spatially separated speech-like maskers. For the EHI group, the pure-tone thresholds (averaged across 0.5, 1, 2, and 4 kHz) were significantly associated with the SRTs, despite the fact that all signals were amplified and therefore in principle audible.