Middle ear effusion and newborn hearing screening.

PURPOSE: Middle ear effusion (MEE) is one of the reasons for screening failure and may require prolonged follow-up due to conductive hearing loss. We aimed to examine at 1-year follow-up, the fate of MEE. METHODS: From medical charts, computerized data were collected retrospectively of newborns born in the years 2012-2013 in Rambam Health Care Campus, Haifa city, Israel, who failed the Universal Newborn Hearing Screening (UNHS), and follow-up hearing evaluation data were extracted. RESULTS: Of 9527 newborns born in 2012-2013 in our institution, 144 [1.5%] failed the UNHS, and 46 were eventually diagnosed with conductive hearing loss caused by MEE. Spontaneous MEE clearance was recorded in 12 [26%], while 26 [57%] patients had persistent effusion that required further follow-up (10 [22%] required insertion of ventilation tubes and 16 [35%] were referred for further follow-up); 8 [17%] were lost to follow-up. CONCLUSION: Congenital MEE causing conductive hearing loss and UNHS failure is persistent and resolves at lower rates than non-congenital MEE.

Predicting hearing thresholds in occupational noise-induced hearing loss by auditory steady state responses.

OBJECTIVES: Currently available behavioral tools for the assessment of noise-induced hearing loss (NIHL) depend on the reliable cooperation of the subject. Furthermore, in workers' compensation cases, there is considerable financial gain to be had from exaggerating symptoms, such that accurate assessment of true hearing threshold levels is essential. An alternative objective physiologic tool for assessing NIHL is the auditory steady state response (ASSR) test, which combines frequency specificity with a high level of auditory stimulation, making it applicable for the evaluation of subjects with a moderate to severe deficit. The primary aim of the study was to assess the value of the multifrequency ASSR test in predicting the behavioral warble-tone audiogram in a large sample of young subjects with NIHL of varying severity or with normal hearing. The secondary goal was to assess suprathreshold ASSR growth functions in these two groups. DESIGN: The study group included 157 subjects regularly exposed to high levels of occupational noise, who attended a university-associated audiological clinic for evaluation of NIHL from 2009 through 2011. All underwent a behavioral audiogram, and on the basis of the findings, were divided into those with NIHL (108 subjects, 216 ears) or normal hearing (49 subjects, 98 ears). The accuracy of the ASSR threshold estimations for frequencies of 500, 1000, 2000, and 4000 Hz was compared between groups, and the specificity and sensitivity of the ASSR test in differentiating ears with or without NIHL was calculated using receiver operating characteristic analysis. Linear regression analysis was used to formulate an equation to predict the behavioral warble-tone audiogram at each test frequency using ASSR thresholds. Multifrequency ASSR amplitude growth as a function of stimulus intensity was compared between the NIHL and normal-hearing groups for 1000 Hz and 4000 Hz carrier frequencies. RESULTS: In the subjects with NIHL, ASSR thresholds to various frequencies were significantly and highly correlated with the behavioral warble-tone thresholds; Pearson correlation coefficients ranged from 0.6 to 0.8 over the four frequencies tested. Differences between thresholds ranged from 10 to 13 dB. The configuration of the ASSR waveforms closely approximated the behavioral audiogram. The sensitivity for screening hearing thresholds was 92%; by frequency, sensitivity ranged between 92.7 and 98.4%, but specificity was lower, especially at the low frequencies. ASSR accurately predicted moderate and severe NIHL. The mean ASSR growth amplitude to increasing stimulus level for 1000 and 4000 Hz was significantly steeper in the NIHL than in the normal-hearing group, with no significant difference between frequencies. CONCLUSIONS: The ASSR test has a high sensitivity to detect moderate to severe hearing loss in subjects with NIHL. Its use can facilitate the early identification of noise-exposed workers with NIHL. It may also serve an important medico-legal function in cases of workers' compensation. The ASSR test is not, by itself, an appropriate tool for hearing screening in the general population.

Aging effects on the neural representation and perception of consonant transition cues.

Older listeners have difficulty processing temporal cues that are important for word discrimination, and deficient processing may limit their ability to benefit from these cues. Here, we investigated aging effects on perception and neural representation of the consonant transition and the factors that contribute to successful perception. To further understand the neural mechanisms underlying the changes in processing from brainstem to cortex, we also examined the factors that contribute to exaggerated amplitudes in cortex. We enrolled 30 younger normal-hearing and 30 older normal-hearing participants who met the criteria of clinically normal hearing. Perceptual identification functions were obtained for the words BEAT and WHEAT on a 7-step continuum of consonant-transition duration. Auditory brainstem responses (ABRs) were recorded to click stimuli and frequency-following responses (FFRs) and cortical auditory-evoked potentials were recorded to the endpoints of the BEAT-WHEAT continuum. Perceptual performance for identification of BEAT vs. WHEAT did not differ between younger and older listeners. However, both subcortical and cortical measures of neural representation showed age group differences, such that FFR phase locking was lower but cortical amplitudes (P1 and N1) were higher in older compared to younger listeners. ABR Wave I amplitude and FFR phase locking, but not audiometric thresholds, predicted early cortical amplitudes. Phase locking to the transition region and early cortical peak amplitudes (P1) predicted performance on the perceptual identification function. Overall, results suggest that the neural representation of transition durations and cortical overcompensation may contribute to the ability to perceive transition duration contrasts. Cortical overcompensation appears to be a maladaptive response to decreased neural firing/synchrony.

Implicit learning and individual differences in speech recognition: an exploratory study.

Individual differences in speech recognition in challenging listening environments are pronounced. Studies suggest that implicit learning is one variable that may contribute to this variability. Here, we explored the unique contributions of three indices of implicit learning to individual differences in the recognition of challenging speech. To this end, we assessed three indices of implicit learning (perceptual, statistical, and incidental), three types of challenging speech (natural fast, vocoded, and speech in noise), and cognitive factors associated with speech recognition (vocabulary, working memory, and attention) in a group of 51 young adults. Speech recognition was modeled as a function of the cognitive factors and learning, and the unique contribution of each index of learning was statistically isolated. The three indices of learning were uncorrelated. Whereas all indices of learning had unique contributions to the recognition of natural-fast speech, only statistical learning had a unique contribution to the recognition of speech in noise and vocoded speech. These data suggest that although implicit learning may contribute to the recognition of challenging speech, the contribution may depend on the type of speech challenge and on the learning task.

The Involvement of Listening Effort in Explaining Bilingual Listening Under Adverse Listening Conditions.

The current review examines listening effort to uncover how it is implicated in bilingual performance under adverse listening conditions. Various measures of listening effort, including physiological, behavioral, and subjective measures, have been employed to examine listening effort in bilingual children and adults. Adverse listening conditions, stemming from environmental factors, as well as factors related to the speaker or listener, have been examined. The existing literature, although relatively limited to date, points to increased listening effort among bilinguals in their nondominant second language (L2) compared to their dominant first language (L1) and relative to monolinguals. Interestingly, increased effort is often observed even when speech intelligibility remains unaffected. These findings emphasize the importance of considering listening effort alongside speech intelligibility. Building upon the insights gained from the current review, we propose that various factors may modulate the observed effects. These include the particular measure selected to examine listening effort, the characteristics of the adverse condition, as well as factors related to the particular linguistic background of the bilingual speaker. Critically, further research is needed to better understand the impact of these factors on listening effort. The review outlines avenues for future research that would promote a comprehensive understanding of listening effort in bilingual individuals.

Auditory Perceptual Exercises in Adults Adapting to the Use of Hearing Aids.

Older adults with age-related hearing loss often use hearing aids (HAs) to compensate. However, certain challenges in speech perception, especially in noise still exist, despite today's HA technology. The current study presents an evaluation of a home-based auditory exercises program that can be used during the adaptation process for HA use. The home-based program was developed at a time when telemedicine became prominent in part due to the COVID-19 pandemic. The study included 53 older adults with age-related symmetrical sensorineural hearing loss. They were divided into three groups depending on their experience using HAs. Group 1: Experienced users (participants who used bilateral HAs for at least 2 years). Group 2: New users (participants who were fitted with bilateral HAs for the first time). Group 3: Non-users. These three groups underwent auditory exercises for 3 weeks. The auditory tasks included auditory detection, auditory discrimination, and auditory identification, as well as comprehension with basic (syllables) and more complex (sentences) stimuli, presented in quiet and in noisy listening conditions. All participants completed self-assessment questionnaires before and after the auditory exercises program and underwent a cognitive test at the end. Self-assessed improvements in hearing ability were observed across the HA users groups, with significant changes described by new users. Overall, speech perception in noise was poorer than in quiet. Speech perception accuracy was poorer in the non-users group compared to the users in all tasks. In sessions where stimuli were presented in quiet, similar performance was observed among new and experienced uses. New users performed significantly better than non-users in all speech in noise tasks; however, compared to the experienced users, performance differences depended on task difficulty. The findings indicate that HA users, even new users, had better perceptual performance than their peers who did not receive hearing aids.

Bilinguals' speech perception in noise: Perceptual and neural associations.

The current study characterized subcortical speech sound processing among monolinguals and bilinguals in quiet and challenging listening conditions and examined the relation between subcortical neural processing and perceptual performance. A total of 59 normal-hearing adults, ages 19-35 years, participated in the study: 29 native Hebrew-speaking monolinguals and 30 Arabic-Hebrew-speaking bilinguals. Auditory brainstem responses to speech sounds were collected in a quiet condition and with background noise. The perception of words and sentences in quiet and background noise conditions was also examined to assess perceptual performance and to evaluate the perceptual-physiological relationship. Perceptual performance was tested among bilinguals in both languages (first language (L1-Arabic) and second language (L2-Hebrew)). The outcomes were similar between monolingual and bilingual groups in quiet. Noise, as expected, resulted in deterioration in perceptual and neural responses, which was reflected in lower accuracy in perceptual tasks compared to quiet, and in more prolonged latencies and diminished neural responses. However, a mixed picture was observed among bilinguals in perceptual and physiological outcomes in noise. In the perceptual measures, bilinguals were significantly less accurate than their monolingual counterparts. However, in neural responses, bilinguals demonstrated earlier peak latencies compared to monolinguals. Our results also showed that perceptual performance in noise was related to subcortical resilience to the disruption caused by background noise. Specifically, in noise, increased brainstem resistance (i.e., fewer changes in the fundamental frequency (F0) representations or fewer shifts in the neural timing) was related to better speech perception among bilinguals. Better perception in L1 in noise was correlated with fewer changes in F0 representations, and more accurate perception in L2 was related to minor shifts in auditory neural timing. This study delves into the importance of using neural brainstem responses to speech sounds to differentiate individuals with different language histories and to explain inter-subject variability in bilinguals' perceptual abilities in daily life situations.

Learning and bilingualism in challenging listening conditions: How challenging can it be?

When speech is presented in their second language (L2), bilinguals have more difficulties with speech perception in noise than monolinguals do. However, how noise affects speech perception of bilinguals in their first language (L1) is still unclear. In addition, it is not clear whether bilinguals' speech perception in challenging listening conditions is specific to the type of degradation, or whether there is a shared mechanism for bilingual speech processing under complex listening conditions. Therefore, the current study examined the speech perception of 60 Arabic-Hebrew bilinguals and a control group of native Hebrew speakers during degraded (speech in noise, vocoded speech) and quiet listening conditions. Between participant comparisons (comparing native Hebrew speakers and bilinguals' perceptual performance in L1) and within participant comparisons (perceptual performance of bilinguals in L1 and L2) were conducted. The findings showed that bilinguals in L1 had more difficulty in noisy conditions than their control counterparts did, even when performed like controls under favorable listening conditions. However, bilingualism did not hinder language learning mechanisms. Bilinguals in L1 outperformed native Hebrew speakers in the perception of vocoded speech, demonstrating more extended learning processes. Bilinguals' perceptual performance in L1 versus L2 varied by task complexity. Correlation analyses revealed that bilinguals who coped better with noise degradation were more successful in perceiving the vocoding distortion. Together, these results provide insights into the mechanisms that contribute to speech perceptual performance in challenging listening conditions and suggest that bilinguals' language proficiency and age of language acquisition are not the only factors that affect performance. Rather, duration of exposure to languages, co-activation, and the ability to benefit from exposure to novel stimuli appear to affect the perceptual performance of bilinguals, even when operating in their dominant language. Our findings suggest that bilinguals use a shared mechanism for speech processing under challenging listening conditions.

Neural Plasticity Induced by Hearing Aid Use.

Age-related hearing loss is one of the most prevalent health conditions in older adults. Although hearing aid technology has advanced dramatically, a large percentage of older adults do not use hearing aids. This untreated hearing loss may accelerate declines in cognitive and neural function and dramatically affect the quality of life. Our previous findings have shown that the use of hearing aids improves cortical and cognitive function and offsets subcortical physiological decline. The current study tested the time course of neural adaptation to hearing aids over the course of 6 months and aimed to determine whether early measures of cortical processing predict the capacity for neural plasticity. Seventeen (9 females) older adults (mean age = 75 years) with age-related hearing loss with no history of hearing aid use were fit with bilateral hearing aids and tested in six testing sessions. Neural changes were observed as early as 2 weeks following the initial fitting of hearing aids. Increases in N1 amplitudes were observed as early as 2 weeks following the hearing aid fitting, whereas changes in P2 amplitudes were not observed until 12 weeks of hearing aid use. The findings suggest that increased audibility through hearing aids may facilitate rapid increases in cortical detection, but a longer time period of exposure to amplified sound may be required to integrate features of the signal and form auditory object representations. The results also showed a relationship between neural responses in earlier sessions and the change predicted after 6 months of the use of hearing aids. This study demonstrates rapid cortical adaptation to increased auditory input. Knowledge of the time course of neural adaptation may aid audiologists in counseling their patients, especially those who are struggling to adjust to amplification. A future comparison of a control group with no use of hearing aids that undergoes the same testing sessions as the study's group will validate these findings.

Rapid but specific perceptual learning partially explains individual differences in the recognition of challenging speech.

Perceptual learning for speech, defined as long-lasting changes in speech recognition following exposure or practice occurs under many challenging listening conditions. However, this learning is also highly specific to the conditions in which it occurred, such that its function in adult speech recognition is not clear. We used a time-compressed speech task to assess learning following either brief exposure (rapid learning) or additional training (training-induced learning). Both types of learning were robust and long-lasting. Individual differences in rapid learning explained unique variance in recognizing natural-fast speech and speech-in-noise with no additional contribution for training-induced learning (Experiment 1). Rapid learning was stimulus specific (Experiment 2), as in previous studies on training-induced learning. We suggest that rapid learning is key for understanding the role of perceptual learning in online speech recognition whereas longer training could provide additional opportunities to consolidate and stabilize learning.

Speech-evoked brainstem responses in Arabic and Hebrew speakers.

Based on studies in English speakers, it has been proposed that speech-evoked brainstem responses (ABRs) may be used clinically to assess central auditory function. Whether the same procedure can be used across speakers of different languages remains unclear, because recent findings suggest that language experience affects even subcortical processing of speech. The goal of the present study was to characterize brainstem responses to the syllable /da/ in Arabic and Hebrew speakers using the US developed BioMARK procedure. To that end, ABRs evoked by clicks and the syllable /da/ were collected from 37 normal-hearing students from the University of Haifa. Neither the transient nor the sustained components of the brainstem response differed significantly between Arabic and Hebrew speakers. Across the two groups, timing of the major components of the speech-evoked response as well as the correlations between the speech- and click indices were well within the US norms. Therefore, brainstem processing of the syllable /da/ does not differ between speakers of English and speakers of Semitic languages such as Arabic and Hebrew.

Objective evidence of temporal processing deficits in older adults.

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

Effects of Age, Cognition, and Neural Encoding on the Perception of Temporal Speech Cues.

Older adults commonly report difficulty understanding speech, particularly in adverse listening environments. These communication difficulties may exist in the absence of peripheral hearing loss. Older adults, both with normal hearing and with hearing loss, demonstrate temporal processing deficits that affect speech perception. The purpose of the present study is to investigate aging, cognition, and neural processing factors that may lead to deficits on perceptual tasks that rely on phoneme identification based on a temporal cue - vowel duration. A better understanding of the neural and cognitive impairments underlying temporal processing deficits could lead to more focused aural rehabilitation for improved speech understanding for older adults. This investigation was conducted in younger (YNH) and older normal-hearing (ONH) participants who completed three measures of cognitive functioning known to decline with age: working memory, processing speed, and inhibitory control. To evaluate perceptual and neural processing of auditory temporal contrasts, identification functions for the contrasting word-pair WHEAT and WEED were obtained on a nine-step continuum of vowel duration, and frequency-following responses (FFRs) and cortical auditory-evoked potentials (CAEPs) were recorded to the two endpoints of the continuum. Multiple linear regression analyses were conducted to determine the cognitive, peripheral, and/or central mechanisms that may contribute to perceptual performance. YNH participants demonstrated higher cognitive functioning on all three measures compared to ONH participants. The slope of the identification function was steeper in YNH than in ONH participants, suggesting a clearer distinction between the contrasting words in the YNH participants. FFRs revealed better response waveform morphology and more robust phase-locking in YNH compared to ONH participants. ONH participants also exhibited earlier latencies for CAEP components compared to the YNH participants. Linear regression analyses revealed that cortical processing significantly contributed to the variance in perceptual performance in the WHEAT/WEED identification functions. These results suggest that reduced neural precision contributes to age-related speech perception difficulties that arise from temporal processing deficits.

Neural and behavioral changes after the use of hearing aids.

OBJECTIVE: Individuals with age-related hearing loss (ARHL) can restore some loss of the auditory function with the use of hearing aids (HAs). However, what remains unknown are the physiological mechanisms that underlie how the brain changes with exposure to amplified sounds though the use of HAs. We aimed to examine behavioral and physiological changes induced by HAs. METHODS: Thirty-five older-adults with moderate ARHL with no history of hearing aid use were fit with HAs tested in aided and unaided conditions, and divided into experimental and control groups. The experimental group used HAs during a period of six months. The control group did not use HAs during this period, but were given the opportunity to use them after the completion of the study. Both groups underwent testing protocols six months apart. Outcome measures included behavioral (speech-in-noise measures, self-assessment questionnaires) and electrophysiological brainstem recordings (frequency-following responses) to the speech syllable /ga/ in two quiet conditions and in six-talker babble noise. RESULTS: The experimental group reported subjective benefits on self-assessment questionnaires. Significant physiological changes were observed in the experimental group, specifically a reduction in fundamental frequency magnitude, while no change was observed in controls, yielding a significant time × group interaction. Furthermore, peak latencies remained stable in the experimental group but were significantly delayed in the control group after six months. Significant correlations between behavioral and physiological changes were also observed. CONCLUSIONS: The findings suggest that HAs may alter subcortical processing and offset neural timing delay; however, further investigation is needed to understand cortical changes and HA effects on cognitive processing. SIGNIFICANCE: The findings of the current study provide evidence for clinicians that the use of HAs may prevent further loss of auditory function resulting from sensory deprivation.

Restoration of sensory input may improve cognitive and neural function.

Age-related hearing loss is one of the most prevalent health conditions among the elderly. Hearing loss may lead to social isolation, depression, and cognitive decline in older adults. The mechanistic basis for the association between hearing loss and decreased cognitive function remains unknown as does the potential for improving cognition through hearing rehabilitation. To that end, we asked whether the restoration of sensory input through the use of hearing aids would improve cognitive and auditory neural function. We compared a group of first-time hearing aid users with a hearing-matched control group after a period of six months. The use of hearing aids enhanced working memory performance and increased cortical response amplitudes. Neurophysiologic changes correlated with working memory changes, suggesting a mechanism for decreased cognitive function with hearing loss. These results suggest a neural mechanism for the sensory-cognitive connection and underscore the importance of providing auditory rehabilitation for individuals with age-related hearing loss to improve cognitive and neural function. Our findings of improved cognitive function with hearing aid use may lead to increased adoption of hearing loss remedies.

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

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