A Multimodal Approach to Measuring Listening Effort: A Systematic Review on the Effects of Auditory Task Demand on Physiological Measures and Their Relationship.

OBJECTIVES: Listening effort involves the mental effort required to perceive an auditory stimulus, for example in noisy environments. Prolonged increased listening effort, for example due to impaired hearing ability, may increase risk of health complications. It is therefore important to identify valid and sensitive measures of listening effort. Physiological measures have been shown to be sensitive to auditory task demand manipulations and are considered to reflect changes in listening effort. Such measures include pupil dilation, alpha power, skin conductance level, and heart rate variability. The aim of the current systematic review was to provide an overview of studies to listening effort that used multiple physiological measures. The two main questions were: (1) what is the effect of changes in auditory task demand on simultaneously acquired physiological measures from various modalities? and (2) what is the relationship between the responses in these physiological measures? DESIGN: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, relevant articles were sought in PubMed, PsycInfo, and Web of Science and by examining the references of included articles. Search iterations with different combinations of psychophysiological measures were performed in conjunction with listening effort-related search terms. Quality was assessed using the Appraisal Tool for Cross-Sectional Studies. RESULTS: A total of 297 articles were identified from three databases, of which 27 were included. One additional article was identified from reference lists. Of the total 28 included articles, 16 included an analysis regarding the relationship between the physiological measures. The overall quality of the included studies was reasonable. CONCLUSIONS: The included studies showed that most of the physiological measures either show no effect to auditory task demand manipulations or a consistent effect in the expected direction. For example, pupil dilation increased, pre-ejection period decreased, and skin conductance level increased with increasing auditory task demand. Most of the relationships between the responses of these physiological measures were nonsignificant or weak. The physiological measures varied in their sensitivity to auditory task demand manipulations. One of the identified knowledge gaps was that the included studies mostly used tasks with high-performance levels, resulting in an underrepresentation of the physiological changes at lower performance levels. This makes it difficult to capture how the physiological responses behave across the full psychometric curve. Our results support the Framework for Understanding Effortful Listening and the need for a multimodal approach to listening effort. We furthermore discuss focus points for future studies.

Experienced Adult Cochlear Implant Users Show Improved Speech Recognition When Target Fitting Parameters Are Applied.

OBJECTIVES: The aim of the present study was to investigate whether prediction models built by de Graaff et al. (2020) can be used to improve speech recognition in experienced adult postlingual implanted Cochlear CI users. de Graaff et al. (2020) found relationships between elevated aided thresholds and a not optimal electrical dynamic range (<50 CL or >60 CL), and poorer speech recognition in quiet and in noise. The primary hypothesis of the present study was that speech recognition improves both in quiet and in noise when the sound processor is refitted to match targets derived from the prediction models from de Graaff et al. (2020). A second hypothesis was that subjectively, most of the CI users would find the new setting too loud because of an increase in C levels, and therefore, prefer the old settings. DESIGN: A within-participant repeated measures design with 18 adult Cochlear CI users was used. T- and C-levels were changed to "optimized settings," as predicted by the model of de Graaff et al. (2020). Aided thresholds, speech recognition in quiet, and speech recognition in noise were measured with the old settings and after a 4-week acclimatization period with the optimized settings. Subjective benefit was measured using the Device Oriented Subjective Outcome Scale questionnaire. RESULTS: The mean electrical dynamic range changed from 41.1 (SD = 6.6) CL to 48.6 (SD = 3.0) CL. No significant change in aided thresholds was measured. Speech recognition improved for 16 out of 18 participants and remained stable for 2 participants. Average speech recognition scores in quiet significantly improved by 4.9% (SD = 3.8%). No significant change for speech recognition in noise was found. A significant improvement in subjective benefit was found for one of the Device Oriented Subjective Outcome subscales (speech cues) between the old and optimized settings. All participants chose to keep the optimized settings at the end of the study. CONCLUSIONS: We were able to improve speech recognition in quiet by optimizing the electrical dynamic range of experienced adult CI users, according to the prediction models built by de Graaff et al. (2020). There was no significant change in aided thresholds nor in speech recognition in noise. The findings of the present study suggest that improved performance for speech recognition in quiet in adult Cochlear CI users can be achieved by setting the dynamic range as close as possible to values between 50 and 60 CL when the volume level is at 10.

Feasibility of the HEAR-aware App for Hearing Loss Self-Management: A Nonrandomized Intervention Study to Examine Intervention Acceptability and the Stages-of-Change Concept.

OBJECTIVES: The HEAR-aware project targets adults ≥50 years who were recently diagnosed with hearing loss and declined hearing aids, but were open for support via a smartphone app on different target behaviors (TBs). The HEAR-aware app, based on Ecological Momentary Assessment and Ecological Momentary Intervention (EMA, EMI), contains educational materials ("snippets") tailored partly to the user's experienced listening situations. The app aims to increase adults' TB-specific readiness to take action on hearing problems. The present study focused on examining feasibility regarding three novel aspects: (1) the app's acceptability, mainly regarding its EMA and EMI elements (compliance, usability, usefulness, satisfaction), (2) psychometric properties of 10 new TB-specific stages-of-change (SoC) measures (test-retest reliability, construct validity), and (3) the potential of tailoring snippets on a person's SoC. DESIGN: A nonrandomized intervention study including four measurements with 2-week intervals (T0-T3). (1) The intervention period lasted 4 weeks. App usage data were collected throughout (T1-T3). Usability, usefulness, and satisfaction were measured at T3 (n = 26). (2) Reliability concerned T0 and T1 data, in between which no intervention occurred. Intraclass correlation coefficients (ICCs) were calculated (n = 29). Construct validity was examined by calculating correlations between the different TB-specific scales (at T0), and also between each of them and self-reported hearing disability (n = 29). (3) Person-tailoring by SoC was examined using T0 and T1 data. Linear mixed models were applied to test whether users rated snippets corresponding to their SoC as more interesting and useful than noncorresponding snippets (n = 25). RESULTS: (1) The percentage of participants that complied with the intended usage varied across the five predefined compliance criteria (lowest: 8%; highest: 85%). Median snippet satisfaction scores were reasonably positive (3.5 to 4.0 of 5). Usability was good (System Usability Score, mean = 72.4, SD = 14.3) and usefulness satisfactory (Intrinsic Motivation Inventory, mean = 4.4, SD = 1.4), but showed large variance. (2) The 10 TB-specific scales showed fair-to-excellent reliabilities (range ICCs = 0.51 to 0.80). Correlations between the TB-specific scales ranged between -0.17 ( p > 0.05) and 0.74 ( p < 0.001), supporting only partly overlap between their underlying constructs. Only the correlation between TB-specific readiness for hearing aid uptake and self-reported hearing disability was significant. (3) Correspondence of a snippet's SoC with the person's SoC significantly related to "interesting" ratings ( p = 0.006). Unexpectedly, for snippets with a lower SoC than the participant's, further deviation of the snippet's SoC from the participant's SoC, increased the participant's interest in the snippet. The relationship with "usefulness" was borderline significant. CONCLUSIONS: (1) Overall usability, usefulness, and satisfaction scores indicated sufficient app acceptability. The high variance and fairly low compliance showed room for improving the app's EMA/EMI parts for part of the participants. (2) The 10 new TB-specific SoC measures showed sufficient reliability, supporting that they measured different types of readiness to take action on hearing problems (construct validity). (3) The unexpected findings regarding tailoring educational app materials to individuals' SoC deserve further study.

Effectiveness of the HEAR-Aware App for Adults Not Ready for Hearing Aids, but Open to Self-Management Support: Results of a Randomized Controlled Trial.

INTRODUCTION: Recently, the HEAR-aware app was developed to support adults who are eligible for hearing aids (HAs) but not yet ready to use them. The app serves as a self-management tool, offering assistance for a range of target behaviors (TBs), such as communication strategies and emotional coping. Using ecological momentary assessment and intervention, the app prompts users to complete brief surveys regarding challenging listening situations they encounter in their daily lives (ecological momentary assessment). In response, users receive educational content in the form of "snippets" (videos, texts, web links) on the TBs, some of which are customized based on the reported acoustic environmental characteristics (ecological momentary intervention). The primary objective of this study was to assess the effectiveness of the HEAR-aware app in enhancing readiness to take action on various TBs and evaluate its impact on secondary outcomes. The secondary objective was to examine the app's usability, usefulness, and user satisfaction. METHODS: A randomized controlled trial design with two arms was used. Participants with hearing loss aged 50 years and over were recruited via an HA retailer and randomly assigned to the intervention group (n = 42, mean age = 65 years [SD = 9.1]) or the control group (n = 45, mean age = 68 years [SD 8.7]). The intervention group used the app during 4 weeks. The control group received no intervention. All participants completed online questionnaires at baseline (T0), after 4 weeks (T1), and again 4 weeks later (T2). Participants' readiness to take action on five TBs was measured with The Line Composite. A list of secondary outcomes was used. Intention-to-treat analyses were performed using Linear Mixed effect Models including group (intervention/control), time (T0/T1/T2), and Group × Time Interactions. In addition, a per protocol analysis was carried out to explore whether effects depended on app usage. For the secondary aim the System Usability Scale (SUS), the Intrinsic Motivation Inventory, item 4 of the International Outcome Inventory-Alternative Intervention (IOI-AI), and a recommendation item were used (intervention group only at T1). RESULTS: For objective 1, there was no significant group difference for The Line Composite over the course of T0, T1, and T2. However, a significant (p = 0.033) Group × Time Interaction was found for The Line Emotional coping, with higher increase in readiness to take action on emotional coping in the intervention group than in the control group. The intention-to-treat analyses revealed no other significant group differences, but the per protocol analyses showed that participants in the intervention group were significantly more ready to take up Assistive Listening Devices (The Line Assistive Listening Devices) and less ready to take up HAs (Staging Algorithm HAs) than the control group (p = 0.049). Results for objective 2 showed that on average, participants rated the app as moderately useful (mean Intrinsic Motivation Inventory score 5 out of 7) and its usability as "marginal" (mean SUS score 68 out of 100) with about half of the participants rating the app as "good" (SUS score >70) and a minority rating is as "unacceptable" (SUS score ≤50). DISCUSSION/CONCLUSIONS: This study underscores the potential of self-management support tools like the HEAR-aware app in the rehabilitation of adults with hearing loss who are not yet ready for HAs. The range in usability scores suggest that it may not be a suitable intervention for everyone.

Ten-year association between change in speech-in-noise recognition and falls due to balance problems: a longitudinal cohort study.

BACKGROUND: This study examined the relationship between speech-in-noise recognition and incident/recurrent falls due to balance problems ten years later (RQ-1); 10-year change in speech-in-noise recognition and falls (RQ-2a), as well as the role of dizziness in this relationship (RQ-2b). The association between hearing aid use and falls was also examined (RQ-3). METHODS: Data was collected from the Netherlands Longitudinal Study on Hearing between 2006 and December 2022. Participants completed an online survey and digits-in-noise test every five years. For this study, data was divided into two 10-year follow-up time intervals: T0 (baseline) to T2 (10-year follow-up), and T1 (5-years) to T3 (15-years). For all RQs, participants aged ≥ 40 years at baseline, without congenital hearing loss, and non-CI users were eligible (n = 592). Additionally, for RQ-3 participants with a speech reception threshold in noise (SRTn) ≥ -5.5 dB signal-to-noise ratio were included (n = 422). Analyses used survey variables on hearing, dizziness, falls due to balance problems, chronic health conditions, and psychosocial health. Logistic regressions using General Estimating Equations were conducted to assess all RQs. RESULTS: Among individuals with obesity, those with poor baseline SRTn had a higher odds of incident falls ten years later (odds ratio (OR):14.7, 95% confidence interval (CI) [2.12, 103]). A 10-year worsening of SRTn was significantly associated with a higher odds of recurrent (OR: 2.20, 95% CI [1.03, 4.71]) but not incident falls. No interaction was found between dizziness and change in SRTn. Hearing aid use (no use/ < 2 years use vs. ≥ 2 years) was not significantly associated with incident nor recurrent falls. Although there was a significant interaction with sex for this association, the effect of hearing aid use on incident/recurrent falls was not statistically significant among males nor females. CONCLUSIONS: A longitudinal association between the deterioration in SRTn and recurrent falls due to balance problems after 10 years was confirmed in this study. This result stresses the importance of identifying declines in hearing earlier and justifies including hearing ability assessments within fall risk prevention programs. Mixed results of hearing aid use on fall risk warrant further investigation into the temporality of this association and possible differences between men and women.

Learning effects in speech-in-noise tasks: Effect of masker modulation and masking release.

Previous research has shown that learning effects are present for speech intelligibility in temporally modulated (TM) noise, but not in stationary noise. The present study aimed to gain more insight into the factors that might affect the time course (the number of trials required to reach stable performance) and size [the improvement in the speech reception threshold (SRT)] of the learning effect. Two hypotheses were addressed: (1) learning effects are present in both TM and spectrally modulated (SM) noise and (2) the time course and size of the learning effect depend on the amount of masking release caused by either TM or SM noise. Eighteen normal-hearing adults (23-62 years) participated in SRT measurements, in which they listened to sentences in six masker conditions, including stationary, TM, and SM noise conditions. The results showed learning effects in all TM and SM noise conditions, but not for the stationary noise condition. The learning effect was related to the size of masking release: a larger masking release was accompanied by an increased time course of the learning effect and a larger learning effect. The results also indicate that speech is processed differently in SM noise than in TM noise.

Measurement and optimisation of the perceptual equivalence of the Dutch consonant-vowel-consonant (CVC) word lists using synthetic speech and list pairs.

OBJECTIVES: (1) to determine whether the standard Dutch word lists for speech audiometry are equally intelligible in normal-hearing listeners (Experiment 1), (2) to investigate whether synthetic speech can be used to create word lists (Experiment 1) and (3) to determine whether the list effect found in Experiment 1 can be reduced by combining two lists into pairs (Experiment 2). DESIGN: Participants performed speech tests in quiet with the original (natural) and synthetic word lists (Experiment 1.). In Experiment 2, new participants performed speech tests with list pairs from the original lists constructed from the results of Experiment 1. STUDY SAMPLES: Twenty-four and twenty-eight normal-hearing adults. RESULTS: There was a significant list effect in the natural speech lists; not in the synthetic speech lists. Variability in intelligibility was significantly higher in the former, with list differences up to 20% at fixed presentation levels. The 95% confidence interval of a list with a score of approximately 70% is around 10%-points wider than of a list pair. CONCLUSIONS: The original Dutch word lists show large variations in intelligibility. List effects can be reduced by combining two lists per condition. Synthetic speech is a promising alternative to natural speech in speech audiometry in quiet.

Manual switching between programs intended for specific real-life listening environments by adult cochlear implant users: do they use the intended program?

OBJECTIVE: The aim of the current study was to investigate the use of manually and automatically switching programs in everyday day life by adult cochlear implant (CI) users. DESIGN: Participants were fitted with an automatically switching sound processor setting and 2 manual programs for 3-week study periods. They received an extensive counselling session. Datalog information was used to analyse the listening environments identified by the sound processor, the program used and the number of program switches. STUDY SAMPLES: Fifteen adult Cochlear CI users. Average age 69 years (range: 57-85 years). RESULTS: Speech recognition in noise was significantly better with the "noise" program than with the "quiet" program. On average, participants correctly classified 4 out of 5 listening environments in a laboratory setting. Participants switched, on average, less than once a day between the 2 manual programs and the sound processor was in the intended program 60% of the time. CONCLUSION: Adult CI users switch rarely between two manual programs and leave the sound processor often in a program not intended for the specific listening environment. A program that switches automatically between settings, therefore, seems to be a more appropriate option to optimise speech recognition performance in daily listening environments.

The Effects of Tinnitus and Tinnitus Annoyance on Need for Recovery After Work: Results of the Netherlands Longitudinal Study on Hearing.

OBJECTIVES: The first aim of this study was to examine the relationship between having tinnitus and the need for recovery after work (NFR). The second aim was to investigate whether the level of tinnitus annoyance is associated with NFR. DESIGN: Data from the 5- and 10-year follow-up measurement rounds of the Netherlands Longitudinal Study on Hearing (NL-SH) were used in a cross-sectional analyses. The NL-SH is a web-based prospective cohort study and includes participants aged 18 to 70 years at baseline. For this study, we included only participants who worked at least 12 hours/week and were under the age of 65 years. Participants completed questionnaires on demographic, socioeconomic, psychosocial, hearing-related, and work-related characteristics. In addition, participants answered questions about hearing ability and tinnitus and performed an online digit-triplet speech recognition in noise test to measure the speech reception threshold (SRT) in noise. Participants were asked if (1) they suffer from tinnitus and (2) to rate tinnitus annoyance on a 0-100 numeric rating scale. A linear mixed model was used (1) to estimate the overall (i.e., cross-sectional) association between having tinnitus and NFR and (2) to estimate the overall association between the level of tinnitus annoyance and NFR. The models were checked for effect modification and confounding of factors known to be associated with either tinnitus or NFR and available in the NL-SH. RESULTS: The study sample comprised 770 unique participants in total; 686 and 335 participants at 5- and 10-year follow-up, respectively. Distress, somatization, and self-reported hearing disability appeared to be confounding factors in the analysis of having tinnitus and NFR. After adjusting for these factors, participants with tinnitus had a 2.5% higher NFR (95% confidence interval: -0.9 to 5.9; p = 0.15). In the analysis of tinnitus annoyance and NFR, SRT was an effect modifier. Distress, somatization, depression, and self-reported hearing disability were confounders. After adjustment for effect modification and confounding, tinnitus annoyance was not significantly associated with NFR ( p = 0.79 for tinnitus annoyance). CONCLUSIONS: This study showed that having tinnitus was not associated with a higher NFR. Also, higher levels of tinnitus annoyance were not associated with a higher NFR. NFR was associated with the psychological factors distress, somatization, and depression, which are known to be intricately related to tinnitus. A longitudinal study design is recommended as it can assess the sequence of events, which might help disentangle the association between tinnitus, NFR, and psychological factors.

Copresence Was Found to Be Related to Some Pupil Measures in Persons With Hearing Loss While They Performed a Speech-in-Noise Task.

OBJECTIVES: To assess if a manipulation of copresence was related to speech-in-noise task performance, arousal, and effort of persons with hearing loss. Task-related arousal and effort were measured by means of pupillometry. DESIGN: Twenty-nine participants (mean age: 64.6 years) with hearing loss (4-frequency pure-tone average [4F-PTA] of 50.2 dB HL [SD = 8.9 dB] in the right ear and 51.3 dB HL [SD = 8.7 dB] in the left ear; averaged across 0.5, 1, 2, and 4 kHz) listened to and repeated spoken Danish sentences that were masked by four streams of continuous speech. Participants were presented with blocks of 20 sentences, during which copresence was manipulated by having participants do the task either alone or accompanied by two observers who were recruited from a similar age group. The task was presented at two difficulty levels, which was accomplished by fixing the signal-to-noise ratio of the speech and masker to match the thresholds at which participants were estimated to correctly repeat 50% (difficult) or 80% (easy) of the sentences in a block. Performance was assessed based on whether or not sentences were repeated correctly. Measures of pupil size (baseline pupil size [BPS], peak pupil dilation [PPD], and mean pupil dilation [MPD]) were used to index arousal and effort. Participants also completed ratings of subjective effort and stress after each block of sentences and a self-efficacy for listening-questionnaire. RESULTS: Task performance was not associated with copresence, but was found to be related to 4F-PTA. An increase in BPS was found for copresence conditions, compared to alone conditions. Furthermore, a post-hoc exploratory analysis revealed that the copresence conditions were associated with a significantly larger pupil size in the second half of the task-evoked pupil response (TEPR). No change in PPD or MPD did was detected between copresence and alone conditions. Self-efficacy, 4F-PTA, and age were not found to be related to the pupil data. Subjective ratings were sensitive to task difficulty but not copresence. CONCLUSION: Copresence was not found to be related to speech-in-noise performance, PPD, or MPD in persons with HL but was associated with an increase in arousal (as indicated by a larger BPS). This could be related to premobilization of effort and/or discomfort in response to the observers' presence. Furthermore, an exploratory analysis of the pupil data showed that copresence was associated with greater pupil dilations in the second half of the TEPR. This may indicate that participants invested more effort during the speech-in-noise task while in the presence of the observers, but that this increase in effort may not necessarily have been related to listening itself. Instead, other speech-in-noise task-related processes, such as preparing to respond, could have been influenced by copresence.

Sensitivity of the antiphasic digits-in-noise test to simulated unilateral and bilateral conductive hearing loss.

OBJECTIVES: The objective of this study is (1) to assess whether the presentation level of the antiphasic digits-in-noise (DIN) test affects the speech recognition threshold (SRT), (2) to evaluate how accurately simulated unilateral and bilateral conductive hearing loss is detected (CHL) and (3) to determine whether increasing the presentation level normalises the antiphasic DIN SRT. DESIGN: Participants performed antiphasic and diotic DINs at different presentation levels with unilateral, bilateral or no earplugs. STUDY SAMPLE: Twenty-four and twelve normal hearing adults. RESULTS: Without earplugs, antiphasic DIN SRTs did not differ between 60 and 80 dB SPL. At 60 dB SPL, the antiphasic DIN correctly classified 92% of the unilateral earplug cases; the diotic DIN 25%. The binaural intelligibility level difference did not differ between the no-earplug condition and the condition with bilateral earplugs when the presentation was increased with the attenuation level. CONCLUSIONS: In normal hearing participants, diotic and antiphasic DIN SRTs are independent of presentation level above a minimum level of 60 dB SPL. The antiphasic DIN is more sensitive than the diotic DIN for detecting unilateral CHL; not for bilateral CHL. The effect of CHL on DIN SRTs can be largely compensated by increasing the presentation level. Audibility plays an important role in the antiphasic and diotic DIN.

A comparison of psychosocial health among individuals with different levels of hearing ability during the COVID-19 pandemic.

OBJECTIVE: This study assessed the impact of the COVID-19 pandemic on psychosocial health among individuals with different levels of hearing ability. DESIGN: For this cross-sectional study, adults completed an online digits-in-noise test and survey. Participants were categorised into "good", "insufficient", or "poor" hearing groups. Survey questions included topics on depression, anxiety, distress, somatisation, and loneliness levels. Multiple logistic, linear, and negative binomial regressions examined differences in psychosocial health between hearing groups. Moderation analyses identified vulnerable subgroups. Mediation analyses examined mediating effects of pandemic measures on hearing ability and psychosocial health. STUDY SAMPLE: Eight-hundred and sixty-five adults with or without hearing impairment. RESULTS: Individuals with poor hearing had a higher odds of having elevated anxiety levels and had higher somatisation levels compared to participants with good hearing. Chronic diseases significantly moderated the relationship between poor hearing ability and loneliness. Difficulties with communicating through facemasks, 1.5 m distance, plastic screens, and during video calls significantly mediated the relationships between hearing ability, anxiety and somatisation. CONCLUSIONS: Results highlight the elevated anxiety and somatisation levels experienced among individuals with hearing impairment during the COVID-19 pandemic. More awareness is needed of the negative impact pandemic measures can have on psychosocial health during future health crises.

The Importance of Extended High-Frequency Speech Information in the Recognition of Digits, Words, and Sentences in Quiet and Noise.

OBJECTIVES: In pure-tone audiometry, hearing thresholds are typically measured up to 8 kHz. Recent research has shown that extended high-frequency (EHF; frequencies >8 kHz) speech information improves speech recognition. However, it is unclear whether the EHF benefit is present for different types of speech material. This study assesses the added value of EHF information for speech recognition in noise for digit triplets, consonant-vowel-consonant (CVC) words, and sentences; and for speech recognition in quiet for CVC. DESIGN: Twenty-four young adults with normal-hearing thresholds up to 16 kHz performed a listening experiment in quiet and in noise in a within-subject repeated measures design. Stimuli were presented monaurally. Steady state speech-shaped noise at a fixed signal to noise ratio was used for measurements in noise. Listening conditions varied only in terms of available EHF information. Stimuli were presented in three different conditions: (1) both speech and noise broadband, (2) speech broadband and noise low-pass filtered at 8 kHz, and (3) both speech and noise low-pass filtered at 8 kHz. In the speech-in-quiet experiment, stimuli (CVC) were high-pass filtered at 3 kHz and presented in two conditions: (1) with EHF information and (2) without EHF information. RESULTS: In the speech-in-noise experiment, for all speech material, the highest scores were achieved in the condition where the noise was low-pass filtered at 8 kHz and speech unfiltered; the lowest scores were obtained in the condition where both speech and noise were low-pass filtered at 8 kHz. Adding speech frequencies above 8 kHz improved the median recognition scores by 75.0%, 21.8%, and 23.8% for digit triplets, words, and sentences, respectively, at a fixed signal to noise ratio. In the speech-in-quiet experiment, median recognition scores were 7.8% higher in the condition where the EHF information was available, as opposed to when it was not. CONCLUSIONS: Speech information for frequencies above 8 kHz contributes to speech recognition in noise. It also contributes to speech recognition in quiet when information below 3 kHz is absent. Our results suggest that EHFs may be relevant in challenging listening conditions and should be measured in pure-tone audiometry to get a complete picture of a person's hearing. Further, results of speech recognition tests may vary when different recording and/or measurement equipment is used with different frequency responses above 8 kHz.

Factors Associated With the Development of Tinnitus and With the Degree of Annoyance Caused by Newly Developed Tinnitus.

OBJECTIVES: Tinnitus is highly prevalent, but only a few risk factors for developing tinnitus are known and little is known about factors associated with the degree of annoyance of new-onset tinnitus. Longitudinal analysis can reveal risk factors associated with the development of tinnitus and might lead to targeted prevention. The aim of this study is twofold. (1) To identify risk factors that are longitudinally associated with the odds of developing tinnitus 5 years later. (2) To identify factors that are cross-sectionally associated with tinnitus annoyance in adults with new-onset tinnitus. METHODS: Baseline, 5-year, and 10-year follow-up data of participants in the Netherlands Longitudinal Study on Hearing (NL-SH) were used. The NL-SH is a web-based prospective cohort study, which started in 2006 and includes both normal hearing and hearing-impaired adults aged 18 to 70 years at baseline. The NL-SH uses an online digit-triplet speech-in-noise test to asses speech recognition ability in noise, and online questionnaires on various aspects of life. At follow-up, participants are asked (1) if they suffer from tinnitus and (2) to rate tinnitus annoyance on a 0 to 100 numeric rating scale. We investigated whether demographic (age, sex, living arrangement, educational level), lifestyle (history of tobacco smoking, alcohol use), health (asthma, severe heart disease, hypertension, history of stroke, osteoarthritis, rheumatoid arthritis, epilepsy, multiple sclerosis, and migraine), hearing (speech recognition ability in noise, hyperacusis, and occupational noise exposure), and psychological variables (distress, somatization, depression, and anxiety) were potential risk factors for new-onset tinnitus, or associated with annoyance caused by new-onset tinnitus. Generalized estimating equations were used to longitudinally analyze the association between potential risk factors and new-onset tinnitus measured 5 years later. A multivariable association model was constructed using a forward selection procedure with p < 0.05 for model entry. Linear regression analysis was used to cross-sectionally analyze the association between potential factors and tinnitus annoyance in new-onset tinnitus. For this purpose, a multivariable association model was constructed using a forward selection procedure with p <0.05 for model entry. RESULTS: In total, 734 participants without tinnitus at baseline were included, from which 137 participants reported to suffer from new-onset tinnitus 5 or 10 years later. Risk factors for new-onset tinnitus were history of smoking (odds ratio 1.5, 95% confidence interval [CI] 1.0 to 2.2, p = 0.027) and higher levels of somatization (odds ratio 2.0, 95% CI 1.2 to 3.3, overall p = 0.024). Factors associated with the degree of tinnitus annoyance were increased levels of anxiety (ß = 11.6, 95% CI 2.3-20.8, overall p = 0.035) and poor speech recognition ability in noise (ß = 13.5, 95% CI, 4.4 to 22.6, overall p = 0.014). CONCLUSIONS: Higher levels of somatization and a history of smoking were found to be risk factors for new-onset tinnitus 5 years later. Anxiety and poor speech recognition ability in noise were associated with higher degrees of tinnitus annoyance in new-onset tinnitus. Somatization deserves to be addressed in future research and clinical practice as it might provide part of a model for the development of chronic tinnitus.

The Longitudinal Relationship Between Speech Recognition in Noise, Need for Recovery After Work, Job Demand, and Job Control Over a Period of 5 Years.

OBJECTIVE: Hearing impairment may lead to an increased need to recover from fatigue and distress after a day of work. Also, hearing impairment may negatively affect the balance between workload and control over it (job demand and job control). The uptake of hearing solutions may have a positive effect on these outcomes. We aimed to assess the longitudinal relationship between change in speech recognition in noise and changes in need for recovery after work and job demand and job control, and the influence of hearing solutions on these relationships over a period of 5 years. Research questions (RQs) were as follows: (1) Is a 5-year change in speech recognition in noise associated with a change in need for recovery after work over that same 5-year period?; (2) Is a 5-year change in speech recognition in noise associated with a change in job demand and job control over that same 5-year period?; (3) What is the effect of hearing solution uptake in the 5-year period on the change in these outcomes in that same 5-year period? METHOD: Data of the Netherlands Longitudinal Study on Hearing, collected between 2006 and January 2019, were divided into two 5-year follow-up intervals: T0 (baseline) to T1 (5-year follow-up) and T1 (5-year follow-up) to T2 (10-year follow-up). An online digit-triplet in noise test was used to assess speech recognition in noise. Online questionnaires on demographic, socioeconomic, and work-related characteristics were administered. For RQ1-RQ2, the study sample included adults working ≥12 hours per week, with at least two consecutive measurements (n = 783). For RQ3, employees who had not yet obtained hearing solutions at baseline, but who would be eligible based on a speech reception threshold in noise ≥ -5.5 dB signal-to-noise ratio (SNR), were included (n = 147). Longitudinal linear regression analyses using mixed models were performed to assess RQ1-RQ3. RESULTS: After adjusting for baseline values, 5-year change in speech recognition in noise showed a statistically significant association with 5-year change in need for recovery. A worsening of 1 dB SNR in speech recognition in noise in an individual was associated with an increase of 0.72 units in need for recovery (scale range 0 to 100). A 5-year change in speech recognition in noise was not significantly associated with a 5-year change in job demand or job control. The uptake of hearing solutions in the 5-year period did not have a significant effect on change in need for recovery in that same 5-year period. CONCLUSION: The significant longitudinal association between 5-year worsening in speech recognition in noise and increase in need for recovery over the same time period strengthens the evidence for the importance of early detection of a worsening in speech recognition in noise to identify employees with an increase in need for recovery. The absence of an effect of the uptake of a hearing solution on need for recovery indicates that additional alternative interventions may be needed to foster beneficial use of hearing solutions as well as to mitigate the increased need for recovery in case of worsening speech recognition in noise.

User characteristics associated with use of wrist-worn wearables and physical activity apps by adults with and without impaired speech-in-noise recognition: a cross-sectional analysis.

Objective: To study weekly use of smartwatches, fitness watches and physical activity apps among adults with and without impaired speech-in-noise (SIN) recognition, to identify subgroups of users. Design: Cross-sectional study. Study sample: Adults (aged 28-80 years) with impaired (n = 384) and normal SIN recognition (n = 341) as measured with a web-based digits-in-noise test, from the Netherlands Longitudinal Study on Hearing. Multiple logistic regression analyses were used to study differences and to build an association model. Results: Employed adults in both groups are more likely to use each type of fitness technology (all ORs >3.4, all p-values < 0.004). Specific to fitness watch use, adults living with others use it more (OR 2.5, 95%CI 1.1;5.8, p = 0.033) whereas those abstaining from alcohol (OR 0.3, 95%CI 0.1;0.6) or consuming >2 glasses/week (OR 0.4, 95%CI 0.2;0.81, overall p = 0.006) and hearing aid users (OR 0.5, 95%CI 0.2;0.9, p = 0.024) make less use. Conclusions: Subgroups of adults more and less likely to use fitness technology exist, but do not differ between adults with and without impaired SIN recognition. More research is needed to confirm these results and to develop interventions to increase physical activity levels among adults with hearing loss.

Association of beta blocker use and hearing ability in adults: a cross-sectional study.

OBJECTIVES: To investigate the potential association between beta blocker use and hearing ability in adults and to discern whether this effect is dose-dependent. DESIGN: Cross-sectional analyses. Multiple linear regression was performed with hearing ability as the dependent variable and beta blocker use as the independent variable. The independent variable was classified into three dose categories for secondary analysis. Adjustments were made for age, gender, educational level, and tobacco smoking status. STUDY SAMPLE: 1636 adults, 75 of whom reported being on beta blockers, from the internet-based Netherlands Longitudinal Study on Hearing (NL-SH). RESULTS: No significant association was found between beta blocker use and hearing ability in noise. In the adjusted regressions, beta blocker use changed the speech reception threshold in noise (SRT) by -0.04 dB signal-to-noise ratio (SNR) (95%CI [-0.67 to 0.58], p = 0.890). Medium dose beta blocker use changed SRT by -0.42 dB SNR (95%CI [-1.38 to 0.71], p = 0.433), while a high dose changed it by -0.26 dB SNR (95%CI [-1.74 to 1.4], p = 0.767). CONCLUSIONS: No evidence was found for beta blocker-induced changes in hearing ability. Future studies on this topic should favour case-control and cohort study designs, while focussing on a hypertensive population to minimise confounding by indication.

A comparison of the impact of the COVID-19 pandemic on communication among individuals with and without hearing impairment.

Objective: This study assessed the impact of coronavirus disease-2019 (COVID-19) preventative measures on hearing and communication among individuals with normal and impaired hearing. We also evaluated the use of digital communication tools between these groups.Design: For this cross-sectional study, participants completed an online digits-in-noise test and survey. Survey topics included understanding through masks, behind plastic screens, from a 1.5-m distance, and use of social network sites/apps, direct messaging, and video calling. Logistic regressions assessed the odds of disagreeing versus agreeing with survey statements.Study Sample: A total of 880 adults from the National Longitudinal Study on Hearing completed a survey and hearing test. Based on speech reception threshold scores, participants were categorised into "good" (reference group for all analyses), "insufficient", or "poor" hearing groups.Results: Those with insufficient and poor hearing had more difficulty understanding others through facemasks, plastic screens, and from 1.5 m. Those with poor hearing had a higher odds of video calling more to contact family/friends/acquaintances during the pandemic, but also had more difficulty hearing sufficiently through video calls.Conclusions: This study addresses methodological weaknesses in previous studies. Results strengthen current evidence of the burden COVID-19 measures place on individuals with hearing impairment.

Effectiveness of a web-based SUpport PRogramme (SUPR) for communication partners of persons with hearing loss: results of a two-arm, cluster randomised controlled trial and process evaluation.

OBJECTIVES: To examine the effects of web-based SUpport PRogram (SUPR) for communication partners (CPs) of persons with hearing loss (PHLs) in a HA dispensing setting. DESIGN: Cluster randomised controlled trial (cRCT) with two arms (SUPR: Booklet, online videos; care as usual: no support) plus process evaluation. Measurements: baseline, and immediately-, six, and 12 months post-intervention. Outcomes: Significant Other Scale for Hearing Disability (SOS-HEAR), International Outcome Inventory for HAs/Alternative Interventions for Significant Others (IOI-HA/AI-SO). Process evaluation: dose-received, satisfaction, and benefit. STUDY SAMPLE: The cRCT included 73 (SUPR) and 57 (care as usual) CPs. In the process evaluation study, 41 CPs (SUPR) participated. RESULTS: There were no significant effects of SUPR for third-party disability (SOS-HEAR), the proxy report (IOI-HA-SO item "use"), and third-party disability (IOI-HA-SO items "satisfaction", and "quality of life"). SUPR-videos were watched by 15-22% of the CPs. SUPR materials were rated as moderately beneficial and useful. CONCLUSIONS: Low baseline disability (floor effect) and low intervention dose-received may explain the findings. Directly targeting CPs rather than via their PHLs and providing intervention materials specifically for CPs may improve their engagement and contribute to SUPR's value supplementary to standard HA care.

Association between Speech Recognition in Noise and Risk Factors of Cardiovascular Disease.

INTRODUCTION: Risk factors for cardiovascular disease (CVD) are associated with sensorineural hearing loss. CVD risk factors are known to cluster and interact, thereby increasing the cumulative risk for CVD. Previously, using the database of the Netherlands Longitudinal Study on Hearing (NL-SH), an association was found between a history of smoking and an increased decline in speech recognition in noise over 10 years of follow-up. Prospectively limited data are available on the association between CVD risk factors, interactions of these risk factors, and hearing loss. In this study, data from the NL-SH were used to study the association between CVD risk factors and speech recognition in noise longitudinally. METHODS: Baseline, 5-year, and 10-year follow-up data of the NL-SH were included. The NL-SH is a web-based prospective cohort study which started in 2006. Participants were aged 18-70 years at baseline. Speech recognition in noise was determined with an online digit-triplet speech-in-noise test. In addition, participants completed online questionnaires on demographic, lifestyle, and health-related characteristics. The association of the ability to recognize speech in noise with CVD risk factors (i.e., obesity, rheumatoid arthritis [RA], hypertension, diabetes mellitus, and dyslipidemia) was analyzed longitudinally. We also analyzed the interaction between these risk factors (including age, sex, and history of smoking) and speech recognition in noise. RESULTS: None of the CVD risk factors or interactions of 2 CVD risk factors was significantly associated with a decline in SRT over time. Obesity (p = 0.016), RA (p = 0.027), and hypertension (p = 0.044) were associated with overall higher (more unfavorable) SRTs. No overall interactions between CVD risk factors were found. CONCLUSION: Obesity, RA, and hypertension were overall associated with a higher SRT, but no longitudinal associations between these or other CVD factors with SRTs were found. Also, no interactions between 2 CVD risk factors and SRTs were found. Although no longitudinal associations between CVD risk factors and decline in SRTs were found, clinicians should be alert about the concurrent association between CVD risk factors and hearing loss.