Effects of ageing and hearing thresholds on speech perception in quiet and in noise perceived in different locations

Elderly people with hearing loss and cognitive decline: speech perception performance in noise

PURPOSE

To verify the influence of verbal intellectual-cognitive skills on speech perception in noise, in elderly with sensorineural hearing loss, considering education, age, and degree of hearing loss.

METHODS

36 elderly between 60 and 89 years old with bilateral sensorineural hearing loss participated in the study. After psychological assessment using the Wechsler Intelligence Scale for Adults (WAIS-III), they were grouped into (GI) 24 elderly without cognitive alteration and (GII) 12 elderly with risk of cognitive alteration. They underwent otorhinolaryngological assessment, audiological interview, pure tone audiometry, and assessment of speech perception in noise using the Hearing in Noise Test (HINT-Brazil). The Mann-Whitney U statistical test compared the results between the groups, and the Spearman correlation verified the variable's age, degree of hearing loss, and level of education.

RESULTS

There was no difference between the groups in the ability to perceive speech in noise, except in the noise on the left condition, in which GII showed better performance in HINT-Brazil. The degree of hearing loss and level of education influenced the perception of speech in noise. The level of education was correlated with the WAIS-III results.

CONCLUSION

The decline in verbal intellectual-cognitive skills did not affect speech perception of noise in the elderly with hearing loss. The degree of hearing loss and level of education influenced the performance of the elderly in the speech perception test in noise. Performance in verbal cognitive skills varied according to the level of education.

Influence of Age on Speech Recognition in Noise and Hearing Effort in Listeners with Age-Related Hearing Loss

The aim of this study was to measure how age affects the speech recognition threshold (SRT50) of the Oldenburg Sentence Test (OLSA) and the listening effort at the corresponding signal-to-noise ratio (SNRcut). The study also investigated the effect of the spatial configuration of sound sources and noise signals on SRT50 and SNRcut. To achieve this goal, the study used olnoise and icra5 noise presented from one or more spatial locations from the front and back. Ninety-nine participants with age-related hearing loss in the 18-80 years age range, specifically in the 18-30, 31-40, 41-50, 51-60, 61-70, and 71-80 age groups, participated in this study. Speech recognition and listening effort in noise were measured and compared between the different age groups, different spatial sound configurations and noise signals. Speech recognition in noise decreased with age and became significant from the age group of 50-51. The decrease in SRT50 with age was greater for icra5 noise than for olnoise. For all age groups, SRT50 and SNRcut were better for icra5 noise than for olnoise. The measured age-related reference data for SRT50 and SNRcut can be used in further studies in listeners with age-related hearing loss and hearing aid or implant users.

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.

Controlled (re)evaluation of the relationship between speech perception in noise and contralateral suppression of otoacoustic emissions

In people with normal hearing (NH), speech perception in noise (SPIN) improves when the speech signal is presented not gated with noise but after a delay. The medial olivocochlear reflex (MOCR) was thought to be involved in the neural dynamic range adaptation (NDRA) responsible for this adaptive SPIN; however, some of the recent studies do not support this hypothesis and suggest that adaptive SPIN involves the NDRA to noise-level statistics, irrespective of MOCR activation. A plausible reason for this discrepancy could be the variations and limitations of the experimental designs used in different studies. Using a relatively controlled and comprehensive study design, this study attempts to verify whether a delay between the delivery of speech and the noise improves the SPIN and whether MOCR mediates such effects. The SPIN was estimated by measuring speech reception thresholds (SRT) in noise under simultaneous-onset and delayed-onset (noise precedes speech onset by 300 ms) conditions. The SPIN in both ears was independently examined for ipsilateral, contralateral, and bilateral noise in women with normal hearing (N = 18; age range, 18-25 years). Contralateral suppression of transient-evoked otoacoustic emissions (CSOAEs) was used to estimate the MOCR based cochlear gain reduction. Under all test conditions, SPIN was improved in delayed-onset than in simultaneous-onset conditions, and the mean improvement in the SRT ranged from 0.7±1.7 to 1.8±1.8 dB. No significant correlation was obtained between CSOAEs and the mean temporal improvement in SRT, suggesting that MOCR may not be a predominant mechanism for the temporal improvement in SPIN.

Clinical validation of the Russian Matrix test - effect of hearing loss, age, and noise level

OBJECTIVE

To validate the Russian matrix sentence test (RUMatrix) for the assessment of speech recognition in quiet and in noise in clinical praxis. The effect of hearing impairment, age, and masking-noise level on speech recognition was examined.

DESIGN

All participants underwent pure tone audiometry, a monosyllabic speech test in quiet, and speech recognition measurements with RUMatrix in quiet (SRT_Q) and in noise (SRT_N).

STUDY SAMPLE

One hundred and forty-two listeners divided into four groups: 1. Young normal-hearing listeners, 2. Older normal-hearing listeners, 3. Young hearing-impaired listeners, and 4. Older hearing-impaired listeners.

RESULTS

Significant differences between groups of listeners were found in the SRT_Q and SRT_N. A strong correlation between hearing threshold and SRT_Q (R²=0.88, p < 0.001) indicates a strong link between speech recognition in quiet and audibility. The pure-tone average explained less variance in SRT_N (R²=0.67, p < 0.001), pointing out an additional influence of suprathreshold distortion. A high test sensitivity of 0.99 was found for SRT_N and SRT_Q. The monosyllabic test had a low sensitivity (0.21), indicating that the test is not suitable for separating normal-hearing and hearing-impaired listeners.

CONCLUSIONS

RuMatrix is a reliable speech recognition assessment tool with a high sensitivity and validity for the main aspects of hearing impairment.

[The role of mono- and binaural hearing aid in the rehabilitation of the adult patients presenting with hearing impairment]

The objective of the present study was to compare the effectiveness of mono- and binaural hearing aids in the rehabilitation of the adult patients of different age presenting with chronic symmetric hearing loss (CSHL). A total of 263 subjects at the age from 50 to 88 years complaining of moderate to severe (grade I-IV) chronic symmetric hearing impairment were available for the examination. Following the ENT examination with the application of pure tone audiometry and impedancometry, the participants of the study were supplied with the individually fitted digital behind-the-ear hearing instruments and underwent speech audiometry in the free sound field. The intelligibility of polysyllabic words in the calm and noisy environment was evaluated. A significant deterioration of the intelligibility was documented both under the quiet and noisy conditions. Its severity increased with the patients' age and the degree of hearing impairment. The comparison of the results of speech audiometry in the patients using either a single or two hearing aids gave evidence that binaural hearing aids were more efficient than monoaural ones in 86% of the patients. Re-examination of the same patients one year after the completion of the first study has demonstrated that 59% of them became permanent users of the hearing aids with 47% of them making regular use of simultaneously two hearing aids. It is concluded that speech audiometry in the free sound field can be recommended as a highly informative method that allows to substantiate the reasonable choice between the mono- and binaural hearing aids for the adult patients presenting with hearing impairment.

Shifts in Maximum Audiovisual Integration with Age

Listeners attempting to understand speech in noisy environments rely on visual and auditory processes, typically referred to as audiovisual processing. Noise corrupts the auditory speech signal and listeners naturally leverage visual cues from the talker’s face in an attempt to interpret the degraded auditory signal. Studies of speech intelligibility in noise show that the maximum improvement in speech recognition performance (i.e., maximum visual enhancement or VEmax), derived from seeing an interlocutor’s face, is invariant with age. Several studies have reported that VEmaxis typically associated with a signal-to-noise (SNR) of −12 dB; however, few studies have systematically investigated whether the SNR associated with VEmaxchanges with age. We investigated if VEmaxchanges as a function of age, whether the SNR at VEmaxchanges as a function of age, and what perceptual/cognitive abilities account for or mediate such relationships. We measured VEmaxon a nongeriatric adult sample () ranging in age from 20 to 59 years old. We found that VEmaxwas age-invariant, replicating earlier studies. No perceptual/cognitive measures predicted VEmax, most likely due to limited variance in VEmaxscores. Importantly, we found that the SNR at VEmaxshifts toward higher (quieter) SNR levels with increasing age; however, this relationship is partially mediated by working memory capacity, where those with larger working memory capacities (WMCs) can identify speech under lower (louder) SNR levels than their age equivalents with smaller WMCs. The current study is the first to report that individual differences in WMC partially mediate the age-related shift in SNR at VEmax.

Efficacy of Bone-Anchored Hearing Aids in Single-Sided Deafness: A Systematic Review

OBJECTIVES

Bone-anchored hearing aids (BAHAs) have been known to partially restore some of the functions lost in subjects with single-sided deafness (SSD). Our aims in this systemic review were to analyze the present capabilities of BAHAs in the context of SSD, and to evaluate the efficacy of BAHAs in improving speech recognition in noisy conditions, sound localization, and subjective outcomes.

DESIGN

A systematic search was undertaken until August 2015 by two independent reviewers, with disagreements resolved by consensus. Among 286 references, we analyzed 14 studies that used both subjective and objective indicators to assess the capabilities of a total of 296 patients in the unaided and aided situations.

RESULTS

Although there was "no benefit" of BAHA implantation for sound localization, BAHAs certainly improved subjects' speech discrimination in noisy circumstances. In the six studies that dealt with sound localization, no significant difference was found after the implantation. Twelve studies showed the benefits of BAHAs for speech discrimination in noise. Regarding subjective outcomes of using the prosthesis in patients with SSD (abbreviated profile of hearing aid benefit [APHAB] and the Glasgow hearing aid benefit profile [GHABP], etc.), we noticed an improvement in the quality of life.

CONCLUSIONS

This systematic review has indicated that BAHAs may successfully rehabilitate patients with SSD by alleviating the hearing handicap to a certain degree, which could improve patients' quality of life. This report has presented additional evidence of effective auditory rehabilitation for SSD and will be helpful to clinicians counseling patients regarding treatment options for SSD.

Lowest Oxyhemoglobin Saturation May Be an Independent Factor Influencing Auditory Function in Severe Obstructive Sleep Apnea

STUDY OBJECTIVES

The aims of this study were to determine if a correlation exists between the level of hypoxia induced by severe obstructive sleep apnea syndrome (OSAS) and the level of auditory dysfunction when verifying such a relationship using polysomnography (PSG).

METHODS

A retrospective review of 41 patients with severe OSAS was performed. Independent risk factors for hearing impairment included parameters of PSG, which were analyzed in two hearing groups at a level ≥ 40 decibels (dB).

RESULTS

Oxyhemoglobin saturation, especially the lowest oxyhemoglobin saturation level, showed lower thresholds in the hearing impairment group than in the control group (p = 0.039 at NREM stage; p = 0.029 at REM stage; p = 0.001 at total sleep stage). After adjusting for other risk factors, the sole variable that remained significant was lowest oxyhemoglobin saturation (total; p = 0.046). In the correlation analysis, a decreasing lowest oxyhemoglobin saturation (from all subjects, n = 41) correlated with a greater mean hearing threshold (R(2) = 0.297; p < 0.001).

CONCLUSION

Our results indicated that lowest oxyhemoglobin saturation in PSG is the only variable correlated with the hearing threshold. This finding could be predictive of possible hearing alternation in patients with severe OSAS.

COMMENTARY

A commentary on this article appears in this issue on page 641.

[The speech audiometry using the matrix sentence test]

The matrix sentence test in which the five-word semantically unpredictable sentences presented under the background noise conditions are used as the speech material was designed and validated for many languages. The objective of the present study was to evaluate the Russian version of the matrix sentence test (RuMatrix test) in the listeners of different ages with normal hearing. At the first stage of the study, 35 listeners at the age from 18 to 33 year were examined. The results of the estimation of the training effect dictated the necessity of conducting two training tracks before carrying out the RuMatrix test proper. The signal-to-noise ratio at which 50% speech recognition (SRT50) was obtained was found to be -8.8±0.8 dB SNR. A significant effect of exposure to the background noise was demonstrated: the noise level of 80 and 75 Db SPL led to a considerably lower intelligibility than the noise levels in the range from 45 to 70 dB SPL; in the subsequent studies, the noise level of 65 dB SPL was used. The high test-retest reliability of the RuMatrix test was proved. At the second stage of the study, 20 young (20-40 year old) listeners and 20 aged (62-74 year old) ones were examined. The mean SRT50 in the aged patients was found to be -6.9±1.1 dB SNR which was much worse than the mean STR50 in the young subjects (-8.7±0.9 dB SNR). It is concluded that, bearing in mind the excellent comparability of the results of the RUMat rix test across different languages, it can be used as a universal tool in international research projects.

Auditory Spatial Deficits in the Early Stage of Ischemic Cerebral Stroke

BACKGROUND

Clinical research, together with computed tomography/magnetic resonance imaging findings, proves that ischemic stroke (IS) that damages auditory pathways can cause hearing loss and impairment of higher auditory processes such as sound localization. The goal of the study was to find possible correlations between the IS risk factors, ischemic lesion volume and localization, neurologic status, and the sound localization capability in acute IS patients.

METHODS

We consecutively enrolled 61 IS patients into the study. The control group consisted of 60 healthy volunteers. All neuro-otological evaluations were performed up to 30 days from the incidence of stroke. All the subjects underwent the horizontal minimum audible angle test (HMAAT) and standard tonal and speech audiometric assessments.

RESULTS

HMMAT results were significantly worse in the IS patients and were present in 82.0% of the patients. There were more patients with unilateral disturbances than with bilateral ones (54.1% versus 27.9%). It was the characteristics of the ischemic lesions that correlated strongly with the sound localization deterioration, that is, their bilateral (the 90° azimuth, P = .018; the 180°, P = .002), multiple (the 45°, P = .020; the 180°, P = .007; the 225°, P = .047), and lacunar character (the 90°, P = .015; the 225°, P = .042). Differences in the types of HMAAT results were significant for lesions in the frontal and the temporal lobe (P = .018 and P = .040). In addition, worse sound localization ability was more common in patients with poor speech discrimination and the bilateral sensorineural hearing loss. We have not found statistically significant correlations for other analyzed factors such as the cortical/subcortical character of the lesions, the patients' neurologic status, and cerebrovascular risk factors.

CONCLUSIONS

Sound localization impairment is common in IS patients and it is the multiple, bilateral, and lacunar character of the ischemic lesions that seems to be strongly positively correlated with the disturbance of the sound localization ability.