Associations between speech understanding and auditory and visual tests of verbal working memory: effects of linguistic complexity, task, age, and hearing loss

Associations Between Auditory Working Memory, Self-Perceived Listening Effort, and Hearing Difficulty in Adults With Mild Traumatic Brain Injury

OBJECTIVES

Mild traumatic brain injury (TBI) can have persistent effects in the auditory domain (e.g., difficulty listening in noise), despite individuals having normal pure-tone auditory sensitivity. Individuals with a history of mild TBI often perceive hearing difficulty and greater listening effort in complex listening situations. The purpose of the present study was to examine self-perceived hearing difficulty, listening effort, and performance on an auditory processing test battery in adults with a history of mild TBI compared with a control group.

DESIGN

Twenty adults ages 20 to 53 years old participated divided into a mild TBI (n = 10) and control group (n = 10). Perceived hearing difficulties were measured using the Adult Auditory Processing Scale and the Hearing Handicap Inventory for Adults. Listening effort was measured using the National Aeronautics and Space Administration-Task Load Index. Listening effort ratings were obtained at baseline, after each auditory processing test, and at the completion of the test battery. The auditory processing test battery included (1) dichotic word recognition, (2) the 500-Hz masking level difference, (3) the Listening in Spatialized Noise-Sentences test, and (4) the Word Auditory Recognition and Recall Measure (WARRM).

RESULTS

Results indicated that individuals with a history of mild TBI perceived significantly greater degrees of hearing difficulty and listening effort than the control group. There were no significant group differences on two of the auditory processing tasks (dichotic word recognition or Listening in Spatialized Noise-Sentences). The mild TBI group exhibited significantly poorer performance on the 500-Hz MLD and the WARRM, a measure of auditory working memory, than the control group. Greater degrees of self-perceived hearing difficulty were significantly associated with greater listening effort and poorer auditory working memory. Greater listening effort was also significantly associated with poorer auditory working memory.

CONCLUSIONS

Results demonstrate that adults with a history of mild TBI may experience subjective hearing difficulty and listening effort when listening in challenging acoustic environments. Poorer auditory working memory on the WARRM task was observed for the adults with mild TBI and was associated with greater hearing difficulty and listening effort. Taken together, the present study suggests that conventional clinical audiometric battery alone may not provide enough information about auditory processing deficits in individuals with a history of mild TBI. The results support the use of a multifaceted battery of auditory processing tasks and subjective measures when evaluating individuals with a history of mild TBI.

Effects on brain structural and functional in deaf children after aerobic exercise training: a pilot cluster randomized controlled study

Purpose: To examine effects of aerobic exercise interventions on brain via the structural Magnetic Resonance Imaging (MRI), as well as functional change during working memory (WM) task using fMRI in deaf children.Method: The study applied a cluster randomized controlled design. Twelve deaf children in the intervention group were required to complete an eleven-week aerobic exercise intervention, while other twelve age and gender matched deaf children in the control group were required to keep their normal daily life. Task fMRI images of each participant were acquired in the baseline and post intervention period. The surface-based morphometry (SBM) analysis and functional activation analysis were employed to probe the effects of 11-week aerobic exercise on cerebral structural and functional in deaf children, respectively.Results: The 11-week aerobic exercise intervention did not change brain structure in deaf children. However, behavior performance (reaction time and mean accuracy rate) presented significant improvements after the 11-week aerobic exercise intervention. Compared to the control group, the intervention group showed decreased reaction time in the 2-back (p < 0.001) and 2-0 back (p < 0.001), and increased mean accuracy rate during 2-back (p = 0.034). Furthermore, enhanced brain activations in the left supplementary motor cortex (p < 0.05, FDR-corrected) and left paracentral lobule (p < 0.05, FDR-corrected) were observed in the intervention group.Conclusion: 11-week aerobic exercise intervention may not be able to modulate brain structure in deaf children, but may have significantly positive effects on behavior performance and brain functional activation during WM task.

Evaluating Listening Effort in Unilateral, Bimodal, and Bilateral Cochlear Implant Users

OBJECTIVE

Evaluate listening effort (LE) in unilateral, bilateral, and bimodal cochlear implant (CI) users. Establish an easy-to-implement task of LE that could be useful for clinical decision making.

STUDY DESIGN

Prospective cohort study.

SETTING

Tertiary neurotology center.

METHODS

The Sentence Final Word Identification and Recall Task, an established measure of LE, was modified to include challenging listening conditions (multitalker babble, gender, and emotional variation; test), in addition to single-talker sentences (control). Participants listened to lists of sentences in each condition and recalled the last word of each sentence. LE was quantified by percentage of words correctly recalled and was compared across conditions, across CI groups, and within subjects (best aided vs monaural).

RESULTS

A total of 24 adults between the ages of 37 and 82 years enrolled, including 4 unilateral CI users (CI), 10 bilateral CI users (CICI), and 10 bimodal CI users (CIHA). Task condition impacted LE (P < .001), but hearing configuration and listener group did not (P = .90). Working memory capacity and contralateral hearing contributed to individual performance.

CONCLUSION

This study adds to the growing body of literature on LE in challenging listening conditions for CI users and demonstrates feasibility of a simple behavioral task that could be implemented clinically to assess LE. This study also highlights the potential benefits of bimodal hearing and individual hearing and cognitive factors in understanding individual differences in performance, which will be evaluated through further research.

Measure of Auditory Working Memory Span Using Monosyllabic Word Recognition Test in Young Adults With Normal Hearing: A Preliminary Study

PURPOSE

Measuring working memory at hearing clinics is important. This study attempted to develop a test protocol that measures auditory working memory using a standardized monosyllabic word list in Korean Speech Audiometry (KSA).

METHOD

We included 25 young adults with normal hearing in this study. Participants conducted word recognition and word span tests concurrently using the KSA monosyllabic word lists. We designed four test conditions according to the presence or absence of background noise and word recall order: quiet-forward (QF), quiet-backward (QB), noise-forward, (NF), and noise-backward (NB). We implemented digit span tests in the Korean Wechsler Adult Intelligence Scale-IV (K-WAIS-IV) to determine the validity of the working memory outcomes.

RESULTS

Word recognition scores of QF and QB were significantly higher than those of NF and NB. The percentages of correctly recalled words and word recall span scores were highest in QF and lowest in NB. Overall, the Pearson correlation and multiple regression statistics showed that our word span test outcomes for QB and NF were highly associated with digit span scores on the K-WAIS-IV.

CONCLUSION

Our proposed test protocol showed the possibility of measuring auditory working memory and monosyllabic word recognition simultaneously by validating the results with K-WAIS-IV outcomes.

Relationships Between Auditory Processing and Cognitive Abilities in Adults: A Systematic Review

PURPOSE

The contributions from the central auditory and cognitive systems play a major role in communication. Understanding the relationship between auditory and cognitive abilities has implications for auditory rehabilitation for clinical patients. The purpose of this systematic review is to address the question, "In adults, what is the relationship between central auditory processing abilities and cognitive abilities?"

METHOD

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to identify, screen, and determine eligibility for articles that addressed the research question of interest. Medical librarians and subject matter experts assisted in search strategy, keyword review, and structuring the systematic review process. To be included, articles needed to have an auditory measure (either behavioral or electrophysiologic), a cognitive measure that assessed individual ability, and the measures needed to be compared to one another.

RESULTS

Following two rounds of identification and screening, 126 articles were included for full analysis. Central auditory processing (CAP) measures were grouped into categories (behavioral: speech in noise, altered speech, temporal processing, binaural processing; electrophysiologic: mismatch negativity, P50, N200, P200, and P300). The most common CAP measures were sentence recognition in speech-shaped noise and the P300. Cognitive abilities were grouped into constructs, and the most common construct was working memory. The findings were mixed, encompassing both significant and nonsignificant relationships; therefore, the results do not conclusively establish a direct link between CAP and cognitive abilities. Nonetheless, several consistent relationships emerged across different domains. Distorted or noisy speech was related to working memory or processing speed. Auditory temporal order tasks showed significant relationships with working memory, fluid intelligence, or multidomain cognitive measures. For electrophysiology, relationships were observed between some cortical evoked potentials and working memory or executive/inhibitory processes. Significant results were consistent with the hypothesis that assessments of CAP and cognitive processing would be positively correlated.

CONCLUSIONS

Results from this systematic review summarize relationships between CAP and cognitive processing, but also underscore the complexity of these constructs, the importance of study design, and the need to select an appropriate measure. The relationship between auditory and cognitive abilities is complex but can provide informative context when creating clinical management plans. This review supports a need to develop guidelines and training for audiologists who wish to consider individual central auditory and cognitive abilities in patient care.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24855174.

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.

A Glimpse of Memory Through the Eyes: Pupillary Responses Measured During Encoding Reflect the Likelihood of Subsequent Memory Recall in an Auditory Free Recall Test

The aim of the current study was to investigate whether task-evoked pupillary responses measured during encoding, individual working memory capacity and noise reduction in hearing aids were associated with the likelihood of subsequently recalling an item in an auditory free recall test combined with pupillometry. Participants with mild to moderately severe symmetrical sensorineural hearing loss (n = 21) were included. The Sentence-final Word Identification and Recall (SWIR) test was administered in a background noise composed of sixteen talkers with noise reduction in hearing aids activated and deactivated. The task-evoked peak pupil dilation (PPD) was measured. The Reading Span (RS) test was used as a measure of individual working memory capacity. Larger PPD at a single trial level was significantly associated with higher likelihood of subsequently recalling a word, presumably reflecting the intensity of attention devoted during encoding. There was no clear evidence of a significant relationship between working memory capacity and subsequent memory recall, which may be attributed to the SWIR test and RS test being administered in different modalities, as well as differences in task characteristics. Noise reduction did not have a significant effect on subsequent memory recall. This may be due to the background noise not having a detrimental effect on attentional processing at the favorable signal-to-noise ratio levels at which the test was conducted.

Altered regional activity and connectivity of functional brain networks in congenital unilateral conductive hearing loss

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Focal brain function and seed-based functional connectivity were first analyzed in congenital unilateral CHL.

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Auditory and visual networks showed altered regional activity and functional connectivity.

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Abnormally high activity in the left ITG was positively correlated with duration of disease.

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Higher-order networks including frontoparietal regions and DMN demonstrated abnormal functional connectivity.

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GSR may produce spurious signals in SBFC analyses.

Neuroimaging studies have shown marked alterations in brain function after auditory deprivation, with these alterations mainly caused by sensorineural hearing loss. To date, however, little is known about the patterns of functional brain reorganization in conductive hearing loss (CHL). The effects of congenital unilateral CHL on human brain were assessed by resting-state functional magnetic resonance imaging in 24 patients with unilateral microtia (UM) and 25 healthy controls. Focal brain function and seed-based functional connectivity were analyzed to characterize spontaneous activity and network changes in UM. Patients with UM showed common alterations in focal brain activities in the left inferior temporal gyrus across different measurements, with these alterations significantly associated with the duration of hearing loss. Additionally, focal brain activities were decreased in the auditory system and increased in the visual system, with a disassociated pattern shown in the default-mode system. Using the left inferior temporal gyrus as the seed region, patients with UM showed lower connectivity with the default-mode system and right visual regions but higher connectivity with the left frontoparietal regions when compared with controls. These results indicate that congenital partial hearing deprivation, despite normal bone conduction hearing, can induce widespread reorganizations that continue into adolescence and adulthood.

Development of Abbreviated Versions of the Word Auditory Recognition and Recall Measure

OBJECTIVES

The objective of this study was to develop and evaluate abbreviated versions of the Word Auditory Recognition and Recall Measure (WARRM) as part of an iterative process in the development of a feasible test for potential future clinical use.

DESIGN

The three original WARRM (O-WARRM) randomizations were modified by altering the presentation paradigm. Instead of presenting 5 trials per set size with set size increasing from 2 to 6 as in the O-WARRM (n = 100 words), the experimental WARRM (E-WARRM) paradigm consisted of one trial from each of set sizes 2 to 6 to create a "run" (n = 20 words) with each randomization consisting of 5 runs (n = 100 words). A total of 24 younger listeners with normal hearing and 48 older listeners with hearing loss (OHL) were administered 1 randomization of the O-WARRM and 1 different randomization of the E-WARRM.

RESULTS

The recognition and recall performances on the O-WARRM and all versions of the E-WARRM (five individual runs and overall) were similar within each listener group, with the younger listeners with normal hearing outperforming the OHL listeners on all measures. Correlation analyses revealed moderate to strong associations between the abbreviated WARRM runs and the O-WARRM for the OHL listener group. Hierarchical regression modeling suggested that run 1 of the E-WARRM was a good predictor of O-WARRM performance and that adding additional runs did not improve the prediction. Taken together, these findings suggest that administering one run from the E-WARRM warrants further examination for clinical use. Additional analyses revealed equivalent scores on all five runs from the three E-WARRM randomizations for both listener groups.

CONCLUSIONS

Abbreviated versions of the O-WARRM were developed as part of this study. This was accomplished by modifying the original presentation paradigm and creating 15 unique "runs" among the original 3 randomizations. The resulting 15 runs could be considered 15 unique and abbreviated WARRM lists that have potential, in the future after further studies are conducted to establish important properties, for clinic use. The abbreviated WARRM lists may be useful for quantifying auditory working memory of listeners with hearing loss during the audiologic rehabilitation process.

Tracking Cognitive Spare Capacity During Speech Perception With EEG/ERP: Effects of Cognitive Load and Sentence Predictability

OBJECTIVES

Listening to speech in adverse listening conditions is effortful. Objective assessment of cognitive spare capacity during listening can serve as an index of the effort needed to understand speech. Cognitive spare capacity is influenced both by signal-driven demands posed by listening conditions and top-down demands intrinsic to spoken language processing, such as memory use and semantic processing. Previous research indicates that electrophysiological responses, particularly alpha oscillatory power, may index listening effort. However, it is not known how these indices respond to memory and semantic processing demands during spoken language processing in adverse listening conditions. The aim of the present study was twofold: first, to assess the impact of memory demands on electrophysiological responses during recognition of degraded, spoken sentences, and second, to examine whether predictable sentence contexts increase or decrease cognitive spare capacity during listening.

DESIGN

Cognitive demand was varied in a memory load task in which young adult participants (n = 20) viewed either low-load (one digit) or high-load (seven digits) sequences of digits, then listened to noise-vocoded spoken sentences that were either predictable or unpredictable, and then reported the final word of the sentence and the digits. Alpha oscillations in the frequency domain and event-related potentials in the time domain of the electrophysiological data were analyzed, as was behavioral accuracy for both words and digits.

RESULTS

Measured during sentence processing, event-related desynchronization of alpha power was greater (more negative) under high load than low load and was also greater for unpredictable than predictable sentences. A complementary pattern was observed for the P300/late positive complex (LPC) to sentence-final words, such that P300/LPC amplitude was reduced under high load compared with low load and for unpredictable compared with predictable sentences. Both words and digits were identified more quickly and accurately on trials in which spoken sentences were predictable.

CONCLUSIONS

Results indicate that during a sentence-recognition task, both cognitive load and sentence predictability modulate electrophysiological indices of cognitive spare capacity, namely alpha oscillatory power and P300/LPC amplitude. Both electrophysiological and behavioral results indicate that a predictive sentence context reduces cognitive demands during listening. Findings contribute to a growing literature on objective measures of cognitive demand during listening and indicate predictable sentence context as a top-down factor that can support ease of listening.

An Automated Speech-in-Noise Test for Remote Testing: Development and Preliminary Evaluation

Purpose The aim of this study was to develop and evaluate a novel, automated speech-in-noise test viable for widespread in situ and remote screening. Method Vowel-consonant-vowel sounds in a multiple-choice consonant discrimination task were used. Recordings from a professional male native English speaker were used. A novel adaptive staircase procedure was developed, based on the estimated intelligibility of stimuli rather than on theoretical binomial models. Test performance was assessed in a population of 26 young adults (YAs) with normal hearing and in 72 unscreened adults (UAs), including native and nonnative English listeners. Results The proposed test provided accurate estimates of the speech recognition threshold (SRT) compared to a conventional adaptive procedure. Consistent outcomes were observed in YAs in test/retest and in controlled/uncontrolled conditions and in UAs in native and nonnative listeners. The SRT increased with increasing age, hearing loss, and self-reported hearing handicap in UAs. Test duration was similar in YAs and UAs irrespective of age and hearing loss. The test-retest repeatability of SRTs was high (Pearson correlation coefficient = .84), and the pass/fail outcomes of the test were reliable in repeated measures (Cohen's κ = .8). The test was accurate in identifying ears with pure-tone thresholds > 25 dB HL (accuracy = 0.82). Conclusion This study demonstrated the viability of the proposed test in subjects of varying language in terms of accuracy, reliability, and short test time. Further research is needed to validate the test in a larger population across a wider range of languages and hearing loss and to identify optimal classification criteria for screening purposes.

On the Possible Overestimation of Cognitive Decline: The Impact of Age-Related Hearing Loss on Cognitive-Test Performance

Individual differences and age-related normal and pathological changes in mental abilities require the use of cognitive screening and assessment tools. However, simultaneously occurring deficits in sensory processing, whose prevalence increases especially in old age, may negatively impact cognitive-test performance and thus result in an overestimation of cognitive decline. This hypothesis was tested using an impairment-simulation approach. Young normal-hearing university students performed three memory tasks, using auditorily presented speech stimuli that were either unprocessed or processed to mimic some of the perceptual consequences of age-related hearing loss (ARHL). Both short-term-memory and working-memory capacities were significantly lower in the simulated-hearing-loss condition, despite good intelligibility of the test stimuli. The findings are consistent with the notion that, in case of ARHL, the perceptual processing of auditory stimuli used in cognitive assessments requires additional (cognitive) resources that cannot be used toward the execution of the cognitive task itself. Researchers and clinicians would be well advised to consider sensory impairments as a confounding variable when administering cognitive tasks and interpreting their results.

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.

Spectral-Temporal Trade-Off in Vocoded Sentence Recognition: Effects of Age, Hearing Thresholds, and Working Memory

OBJECTIVES

Cochlear implant (CI) signal processing degrades the spectral components of speech. This requires CI users to rely primarily on temporal cues, specifically, amplitude modulations within the temporal envelope, to recognize speech. Auditory temporal processing ability for envelope modulations worsens with advancing age, which may put older CI users at a disadvantage compared with younger users. To evaluate how potential age-related limitations for processing temporal envelope modulations impact spectrally degraded sentence recognition, noise-vocoded sentences were presented to younger and older normal-hearing listeners in quiet. Envelope modulation rates were varied from 10 to 500 Hz by adjusting the low-pass filter cutoff frequency (LPF). The goal of this study was to evaluate if age impacts recognition of noise-vocoded speech and if this age-related limitation existed for a specific range of envelope modulation rates.

DESIGN

Noise-vocoded sentence recognition in quiet was measured as a function of number of spectral channels (4, 6, 8, and 12 channels) and LPF (10, 20, 50, 75, 150, 375, and 500 Hz) in 15 younger normal-hearing listeners and 15 older near-normal-hearing listeners. Hearing thresholds and working memory were assessed to determine the extent to which these factors were related to recognition of noise-vocoded sentences.

RESULTS

Younger listeners achieved significantly higher sentence recognition scores than older listeners overall. Performance improved in both groups as the number of spectral channels and LPF increased. As the number of spectral channels increased, the differences in sentence recognition scores between groups decreased. A spectral-temporal trade-off was observed in both groups in which performance in the 8- and 12-channel conditions plateaued with lower-frequency amplitude modulations compared with the 4- and 6-channel conditions. There was no interaction between age group and LPF, suggesting that both groups obtained similar improvements in performance with increasing LPF. The lack of an interaction between age and LPF may be due to the nature of the task of recognizing sentences in quiet. Audiometric thresholds were the only significant predictor of vocoded sentence recognition. Although performance on the working memory task declined with advancing age, working memory scores did not predict sentence recognition.

CONCLUSIONS

Younger listeners outperformed older listeners for recognizing noise-vocoded sentences in quiet. The negative impact of age was reduced when ample spectral information was available. Age-related limitations for recognizing vocoded sentences were not affected by the temporal envelope modulation rate of the signal, but instead, appear to be related to a generalized task limitation or to reduced audibility of the signal.

Prefrontal-Temporal Pathway Mediates the Cross-Modal and Cognitive Reorganization in Sensorineural Hearing Loss With or Without Tinnitus: A Multimodal MRI Study

Objective: Hearing loss, one main risk factor of tinnitus and hyperacusis, is believed to involve significant central functional abnormalities. The recruitment of the auditory cortex in non-auditory sensory and higher-order cognitive processing has been demonstrated in the hearing-deprived brain. The dorsolateral prefrontal cortex (dlPFC), which has dense anatomical connections with the auditory pathway, is known to play a crucial role in multi-sensory integration, auditory regulation, and cognitive processing. This study aimed to verify the role of the dlPFC in the cross-modal reorganization and cognitive participation of the auditory cortex in long-term sensorineural hearing loss (SNHL) by combining functional and structural measurements.

Methods: Thirty five patients with long-term bilateral SNHL and 35 matched healthy controls underwent structural imaging, resting-state functional magnetic resonance imaging (rs-fMRI), diffusion tensor imaging (DTI), and neuropsychological assessments. Ten SNHL patients were with subjective tinnitus.

Results: No differences in gray matter volume, spontaneous neural activity, or diffusion characteristics in the dlPFC were found between the SNHL and control groups. The functional connectivity (FC) between the dlPFC and the auditory cortex and visual areas, such as the cuneus, fusiform, lingual cortex, and calcarine sulcus was increased in patients with SNHL. ANOVA and post hoc tests revealed similar FC alterations in the SNHL patients with and without tinnitus when compared with the normal hearing controls, and SNHL patients with and without tinnitus showed no difference in the dlPFC FC. The FC in the auditory cortex was associated with the symbol digit modality test (SDMT) scores in the SNHL patients, which reflect attentional function, processing speed, and visual working memory. Hearing-related FC with the dlPFC was found in the lingual cortex. A tract-based spatial statistics (TBSS) analysis revealed decreased fractional anisotropy (FA) values, mainly in the temporal inferior fronto-occipital fasciculus (IFOF), which showed remarkable negative correlations with the mean hearing thresholds in SNHL.

Conclusion: Higher functional coupling between the dlPFC and auditory and visual areas, accompanied by decreased FA along the IFOF connecting the frontal cortex and the occipito-temporal area, might mediate cross-modal plasticity via top-down regulation and facilitate the involvement of the auditory cortex in higher-order cognitive processing following long-term SNHL.

Dysconnectivity of Multiple Resting-State Networks Associated With Higher-Order Functions in Sensorineural Hearing Loss

Objects: Sensorineural hearing loss (SNHL) involves wide-ranging functional reorganization, and is associated with accumulating risk of cognitive and emotional dysfunction. The coordination of multiple functional networks supports normal brain functions. Here, we aimed to evaluate the functional connectivity (FC) patterns involving multiple resting-state networks (RSNs), and the correlations between the functional remodeling of RSNs and the potential cognitive or emotional impairments in SNHL.

Methods: Thirty long-term bilateral SNHL patients and 39 well-matched healthy controls were recruited for assessment of resting-state functional magnetic resonance imaging and neuropsychological tests.

Results: Using independent component analysis, 11 RSNs were identified. Relative to the healthy controls, patients with SNHL presented apparent abnormalities of intra-network FC involving right frontoparietal network, posterior temporal network, and sensory motor network. Disrupted between-network FC was also revealed in the SNHL patients across both higher-order cognitive control networks and multiple sensory networks. Eight of the eleven RSNs showed altered functional synchronization using a seed network to whole brain FC method, particularly in the ventromedial prefrontal cortex. In addition, these functional abnormalities were correlated with cognition- and emotion-related performances.

Interpretations: These findings supported our hypotheses that long-term SNHL involves notable dysconnectivity of multiple RSNs. Our study provides important insights into the pathophysiological mechanisms of SNHL, and sheds lights on the neural substrates underlying the possible cognitive and emotional dysfunctions following SNHL.

Assessing Cognitive Abilities in High-Performing Cochlear Implant Users

Despite being considered one of the most successful neural prostheses, cochlear implants (CIs) provide recipients with a wide range of speech perception performance. While some CI users can understand speech in the absence of visual cues, other recipients exhibit more limited speech perception. Cognitive skills have been documented as a contributor to complex auditory processing, such as language understanding; however, there are no normative data for existing standardized clinical tests assessing cognitive abilities in CI users. Here, we assess the impact of modality of presentation (i.e., auditory-visual versus visual) for the administration of working memory tests in high-performing CI users in addition to measuring processing speed, cognitive efficiency and intelligence quotient (IQ). Second, we relate performance on these cognitive measures to clinical CI speech perception outcomes.

Methods: Twenty one post-lingually deafened, high-performing, adult CI users [age range: 52–88 years; 3 unilateral CI, 13 bimodal (i.e., CI with contralateral hearing aid), 5 bilateral CI] with clinical speech perception scores (i.e., AzBio sentences in quiet for the first-ear CI) of ≥60% were recruited. A cognitive test battery assessing auditory-visual working memory (AVWM), visual working memory (VWM), processing speed, cognitive efficiency and IQ was administered, in addition to clinical measures of speech perception in quiet (i.e., AzBio sentences in quiet). AzBio sentences were assessed in two conditions: first-ear CI only, and best-aided everyday wearing condition. Subjects also provided self-reported measures of performance and benefit from their CI using standardized materials, including the Glasgow Benefit Inventory (GBI) and the Nijmegen Cochlear Implant questionnaire (NCIQ).

Results: High-performing CI users demonstrated greater VWM than AVWM recall. VWM was positively related to AzBio scores when measured in the first-ear CI only. AVWM, processing speed, cognitive efficiency, and IQ did not relate to either measure of speech perception (i.e., first-ear CI or best-aided conditions). Subjects’ self-reported benefit as measured by the GBI predicted best-aided CI speech perception performance.

Conclusion: In high-performing CI recipients, visual presentation of working memory tests may improve our assessment of cognitive function.

Inner Ear Hair Cell Protection in Mammals against the Noise-Induced Cochlear Damage

Inner ear hair cells are mechanosensory receptors that perceive mechanical sound and help to decode the sound in order to understand spoken language. Exposure to intense noise may result in the damage to the inner ear hair cells, causing noise-induced hearing loss (NIHL). Particularly, the outer hair cells are the first and the most affected cells in NIHL. After acoustic trauma, hair cells lose their structural integrity and initiate a self-deterioration process due to the oxidative stress. The activation of different cellular death pathways leads to complete hair cell death. This review specifically presents the current understanding of the mechanism exists behind the loss of inner ear hair cell in the auditory portion after noise-induced trauma. The article also explains the recent hair cell protection strategies to prevent the damage and restore hearing function in mammals.

Working Memory and Auditory Processing in School-Age Children

Purpose

Our goal is to present the relationships between working memory (WM) and auditory processing abilities in school-age children.

Review and Discussion

We begin with an overview of auditory processing, the conceptualization of auditory processing disorder, and the assessment of auditory processing abilities in children. Next, we describe a model of WM and a model of auditory processing followed by their comparison. Evidence for the relationships between WM and auditory processing abilities in school-age children follows. Specifically, we present evidence for the association (or lack thereof) between WM/attention and auditory processing test performance.

Clinical Implications

In conclusion, we describe a new framework for understanding auditory processing abilities in children based on integrated evidence from cognitive science, hearing science, and language science. We also discuss clinical implications in children that could inform future research.

Measuring Listening Effort: Convergent Validity, Sensitivity, and Links With Cognitive and Personality Measures

PURPOSE

Listening effort (LE) describes the attentional or cognitive requirements for successful listening. Despite substantial theoretical and clinical interest in LE, inconsistent operationalization makes it difficult to make generalizations across studies. The aims of this large-scale validation study were to evaluate the convergent validity and sensitivity of commonly used measures of LE and assess how scores on those tasks relate to cognitive and personality variables.

METHOD

Young adults with normal hearing (N = 111) completed 7 tasks designed to measure LE, 5 tests of cognitive ability, and 2 personality measures.

RESULTS

Scores on some behavioral LE tasks were moderately intercorrelated but were generally not correlated with subjective and physiological measures of LE, suggesting that these tasks may not be tapping into the same underlying construct. LE measures differed in their sensitivity to changes in signal-to-noise ratio and the extent to which they correlated with cognitive and personality variables.

CONCLUSIONS

Given that LE measures do not show consistent, strong intercorrelations and differ in their relationships with cognitive and personality predictors, these findings suggest caution in generalizing across studies that use different measures of LE. The results also indicate that people with greater cognitive ability appear to use their resources more efficiently, thereby diminishing the detrimental effects associated with increased background noise during language processing.

Children's Speech Perception in Noise: Evidence for Dissociation From Language and Working Memory

PURPOSE

We examined the association between speech perception in noise (SPIN), language abilities, and working memory (WM) capacity in school-age children. Existing studies supporting the Ease of Language Understanding (ELU) model suggest that WM capacity plays a significant role in adverse listening situations.

METHOD

Eighty-three children between the ages of 7 to 11 years participated. The sample represented a continuum of individual differences in attention, memory, and language abilities. All children had normal-range hearing and normal-range nonverbal IQ. Children completed the Bamford-Kowal-Bench Speech-in-Noise Test (BKB-SIN; Etymotic Research, 2005), a selective auditory attention task, and multiple measures of language and WM.

RESULTS

Partial correlations (controlling for age) showed significant positive associations among attention, memory, and language measures. However, BKB-SIN did not correlate significantly with any of the other measures. Principal component analysis revealed a distinct WM factor and a distinct language factor. BKB-SIN loaded robustly as a distinct 3rd factor with minimal secondary loading from sentence recall and short-term memory. Nonverbal IQ loaded as a 4th factor.

CONCLUSIONS

Results did not support an association between SPIN and WM capacity in children. However, in this study, a single SPIN measure was used. Future studies using multiple SPIN measures are warranted. Evidence from the current study supports the use of BKB-SIN as clinical measure of speech perception ability because it was not influenced by variation in children's language and memory abilities. More large-scale studies in school-age children are needed to replicate the proposed role played by WM in adverse listening situations.

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.

Role of working memory and lexical knowledge in perceptual restoration of interrupted speech

The role of working memory (WM) capacity and lexical knowledge in perceptual restoration (PR) of missing speech was investigated using the interrupted speech perception paradigm. Speech identification ability, which indexed PR, was measured using low-context sentences periodically interrupted at 1.5 Hz. PR was measured for silent gated, low-frequency speech noise filled, and low-frequency fine-structure and envelope filled interrupted conditions. WM capacity was measured using verbal and visuospatial span tasks. Lexical knowledge was assessed using both receptive vocabulary and meaning from context tests. Results showed that PR was better for speech noise filled condition than other conditions tested. Both receptive vocabulary and verbal WM capacity explained unique variance in PR for the speech noise filled condition, but were unrelated to performance in the silent gated condition. It was only receptive vocabulary that uniquely predicted PR for fine-structure and envelope filled conditions. These findings suggest that the contribution of lexical knowledge and verbal WM during PR depends crucially on the information content that replaced the silent intervals. When perceptual continuity was partially restored by filler speech noise, both lexical knowledge and verbal WM capacity facilitated PR. Importantly, for fine-structure and envelope filled interrupted conditions, lexical knowledge was crucial for PR.

Working Memory and Speech Comprehension in Older Adults With Hearing Impairment

PURPOSE

This study examined the relationship between working memory (WM) and speech comprehension in older adults with hearing impairment (HI). It was hypothesized that WM would explain significant variance in speech comprehension measured in multitalker babble (MTB).

METHOD

Twenty-four older (59-73 years) adults with sensorineural HI participated. WM capacity (WMC) was measured using 3 complex span tasks. Speech comprehension was assessed using multiple passages, and speech identification ability was measured using recall of sentence final-word and key words. Speech measures were performed in quiet and in the presence of MTB at + 5 dB signal-to-noise ratio.

RESULTS

Results suggested that participants' speech identification was poorer in MTB, but their ability to comprehend discourse in MTB was at least as good as in quiet. WMC did not explain significant variance in speech comprehension before and after controlling for age and audibility. However, WMC explained significant variance in low-context sentence key words identification in MTB.

CONCLUSIONS

These results suggest that WMC plays an important role in identifying low-context sentences in MTB, but not when comprehending semantically rich discourse passages. In general, data did not support individual variability in WMC as a factor that predicts speech comprehension ability in older adults with HI.

Working Memory and Speech Recognition in Noise Under Ecologically Relevant Listening Conditions: Effects of Visual Cues and Noise Type Among Adults With Hearing Loss

PURPOSE

This study evaluated the relationship between working memory (WM) and speech recognition in noise with different noise types as well as in the presence of visual cues.

METHOD

Seventy-six adults with bilateral, mild to moderately severe sensorineural hearing loss (mean age: 69 years) participated. Using a cross-sectional design, 2 measures of WM were taken: a reading span measure, and Word Auditory Recognition and Recall Measure (Smith, Pichora-Fuller, & Alexander, 2016). Speech recognition was measured with the Multi-Modal Lexical Sentence Test for Adults (Kirk et al., 2012) in steady-state noise and 4-talker babble, with and without visual cues. Testing was under unaided conditions.

RESULTS

A linear mixed model revealed visual cues and pure-tone average as the only significant predictors of Multi-Modal Lexical Sentence Test outcomes. Neither WM measure nor noise type showed a significant effect.

CONCLUSION

The contribution of WM in explaining unaided speech recognition in noise was negligible and not influenced by noise type or visual cues. We anticipate that with audibility partially restored by hearing aids, the effects of WM will increase. For clinical practice to be affected, more significant effect sizes are needed.

Speech-in-speech perception and executive function involvement

This present study investigated the link between speech-in-speech perception capacities and four executive function components: response suppression, inhibitory control, switching and working memory. We constructed a cross-modal semantic priming paradigm using a written target word and a spoken prime word, implemented in one of two concurrent auditory sentences (cocktail party situation). The prime and target were semantically related or unrelated. Participants had to perform a lexical decision task on visual target words and simultaneously listen to only one of two pronounced sentences. The attention of the participant was manipulated: The prime was in the pronounced sentence listened to by the participant or in the ignored one. In addition, we evaluate the executive function abilities of participants (switching cost, inhibitory-control cost and response-suppression cost) and their working memory span. Correlation analyses were performed between the executive and priming measurements. Our results showed a significant interaction effect between attention and semantic priming. We observed a significant priming effect in the attended but not in the ignored condition. Only priming effects obtained in the ignored condition were significantly correlated with some of the executive measurements. However, no correlation between priming effects and working memory capacity was found. Overall, these results confirm, first, the role of attention for semantic priming effect and, second, the implication of executive functions in speech-in-noise understanding capacities.

Auditory Verbal Working Memory as a Predictor of Speech Perception in Modulated Maskers in Listeners With Normal Hearing

PURPOSE

Background noise can interfere with our ability to understand speech. Working memory capacity (WMC) has been shown to contribute to the perception of speech in modulated noise maskers. WMC has been assessed with a variety of auditory and visual tests, often pertaining to different components of working memory. This study assessed the relationship between speech perception in modulated maskers and components of auditory verbal working memory (AVWM) over a range of signal-to-noise ratios.

METHOD

Speech perception in noise and AVWM were measured in 30 listeners (age range 31-67 years) with normal hearing. AVWM was estimated using forward digit recall, backward digit recall, and nonword repetition.

RESULTS

After controlling for the effects of age and average pure-tone hearing threshold, speech perception in modulated maskers was related to individual differences in the phonological component of working memory (as assessed by nonword repetition) but only in the least favorable signal-to-noise ratio. The executive component of working memory (as assessed by backward digit) was not predictive of speech perception in any conditions.

CONCLUSIONS

AVWM is predictive of the ability to benefit from temporal dips in modulated maskers: Listeners with greater phonological WMC are better able to correctly identify sentences in modulated noise backgrounds.

Linguistic Factors Influencing Speech Audiometric Assessment

In speech audiometric testing, hearing performance is typically measured by calculating the number of correct repetitions of a speech stimulus. We investigate to what extent the repetition accuracy of Dutch speech stimuli presented against a background noise is influenced by nonauditory processes. We show that variation in verbal repetition accuracy is partially explained by morpholexical and syntactic features of the target language. Verbs, prepositions, conjunctions, determiners, and pronouns yield significantly lower correct repetitions than nouns, adjectives, or adverbs. The reduced repetition performance for verbs and function words is probably best explained by the similarities in the perceptual nature of verbal morphology and function words in Dutch. For sentences, an overall negative effect of syntactic complexity on speech repetition accuracy was found. The lowest number of correct repetitions was obtained with passive sentences, reflecting the cognitive cost of processing a noncanonical sentence structure. Taken together, these findings may have important implications for the audiological practice. In combination with hearing loss, linguistic complexity may increase the cognitive demands to process sentences in noise, leading to suboptimal functional hearing in day-to-day listening situations. Using test sentences with varying degrees of syntactic complexity may therefore provide useful information to measure functional hearing benefits.

Hearing impairment, cognition and speech understanding: exploratory factor analyses of a comprehensive test battery for a group of hearing aid users, the n200 study

OBJECTIVE

The aims of the current n200 study were to assess the structural relations between three classes of test variables (i.e. HEARING, COGNITION and aided speech-in-noise OUTCOMES) and to describe the theoretical implications of these relations for the Ease of Language Understanding (ELU) model.

STUDY SAMPLE

Participants were 200 hard-of-hearing hearing-aid users, with a mean age of 60.8 years. Forty-three percent were females and the mean hearing threshold in the better ear was 37.4 dB HL.

DESIGN

LEVEL1 factor analyses extracted one factor per test and/or cognitive function based on a priori conceptualizations. The more abstract LEVEL 2 factor analyses were performed separately for the three classes of test variables.

RESULTS

The HEARING test variables resulted in two LEVEL 2 factors, which we labelled SENSITIVITY and TEMPORAL FINE STRUCTURE; the COGNITIVE variables in one COGNITION factor only, and OUTCOMES in two factors, NO CONTEXT and CONTEXT. COGNITION predicted the NO CONTEXT factor to a stronger extent than the CONTEXT outcome factor. TEMPORAL FINE STRUCTURE and SENSITIVITY were associated with COGNITION and all three contributed significantly and independently to especially the NO CONTEXT outcome scores (R(2) = 0.40).

CONCLUSIONS

All LEVEL 2 factors are important theoretically as well as for clinical assessment.

On The (Un)importance of Working Memory in Speech-in-Noise Processing for Listeners with Normal Hearing Thresholds

With the advent of cognitive hearing science, increased attention has been given to individual differences in cognitive functioning and their explanatory power in accounting for inter-listener variability in the processing of speech in noise (SiN). The psychological construct that has received much interest in recent years is working memory. Empirical evidence indeed confirms the association between WM capacity (WMC) and SiN identification in older hearing-impaired listeners. However, some theoretical models propose that variations in WMC are an important predictor for variations in speech processing abilities in adverse perceptual conditions for all listeners, and this notion has become widely accepted within the field. To assess whether WMC also plays a role when listeners without hearing loss process speech in adverse listening conditions, we surveyed published and unpublished studies in which the Reading-Span test (a widely used measure of WMC) was administered in conjunction with a measure of SiN identification, using sentence material routinely used in audiological and hearing research. A meta-analysis revealed that, for young listeners with audiometrically normal hearing, individual variations in WMC are estimated to account for, on average, less than 2% of the variance in SiN identification scores. This result cautions against the (intuitively appealing) assumption that individual variations in WMC are predictive of SiN identification independently of the age and hearing status of the listener.