Perceptions of Adults With Hearing Loss About the Communication Difficulties Generated by the COVID-19 Preventive Measures: A Qualitative Study.

PURPOSE: The COVID-19 pandemic led to the implementation of preventive measures that exacerbated communication difficulties for individuals with hearing loss. This study aims to explore the perception of adults with hearing loss about the communication difficulties caused by the preventive measures and about their experiences with communication 1 year after the adoption of these preventive measures. METHOD: Individual semistructured interviews were conducted via videoconference with six adults who have hearing loss from the province of Québec, Canada. Data were examined using qualitative content analysis. RESULTS: The study found that face masks and in-person work (i.e., in opposition to remote work) were important barriers to communication because of hindered lipreading and competing noise in many workplaces. In contrast, preventive measures that allowed visual information transmission (e.g., transparent face masks, fixed plastic partitions) were considered favorable for communication. Communication partners were perceived as playing an important role in communication success with preventive measures: Familiar communication partners improved communication, whereas those with poor attitude or strategies hindered communication. Participants found that videoconferences could provide satisfactory communication but were sometimes hindered by issues such as bad audiovisual quality or too many participants. CONCLUSIONS: This study identified reduced access to speech reading and lack of general awareness about hearing issues as key barriers to communication during the pandemic. The decreased communication capabilities were perceived to be most problematic at work and during health appointments, and tended to cause frustration, anxiety, self-esteem issues, and social isolation. Suggestions are outlined for current and future public health measures to better consider the experience of people with hearing loss.

Octave illusion: stimulation frequencies can modulate perception.

The octave illusion (Deutsch, 1974) is a well-known auditory illusion elicited by presenting a dichotic sequence of two tones separated by an octave during which the high and low tones alternate between both ears. This illusion engages an important mechanism of auditory perception, which is pitch perception. Previous studies used central frequencies of the useful musical spectrum to elicit the illusion. However, these studies did not cover part of that spectrum where musical pitch perception decreases (below 200 and above 1600 Hz). The present study aimed to investigate how the relative frequency distribution of percepts changes across a greater proportion of the musical scale to better understand the influence of pitch on illusion perception. Participants were presented with 7 pairs of frequencies from 40-80 Hz to 2000-4000 Hz and had to select a choice (octave, simple, complex) corresponding to their perception. When using pairs of stimuli towards the upper and lower boundaries of the selected range: (1) distributions of percepts significantly differ from the classic 400-800 Hz, (2) the octave percept was reported less frequently, particularly at very low frequencies. Results from this study revealed that the illusion perception differs significantly at the low and high limits of the musical spectrum where reduced accuracy of pitch perception is known to occur. These results support past studies who investigated pitch perception. Furthermore, these results support the model proposed by Deutsch where pitch perception is one of the central frameworks of illusion perception.

Communication during the COVID-19 pandemic: the hearing-impaired perspective.

OBJECTIVE: To understand the communicational and psychosocial effects of COVID-19 protective measures in real-life everyday communication settings. DESIGN: An online survey consisting of close-set and open-ended questions aimed to describe the communication difficulties experienced in different communication activities (in-person and telecommunication) during the COVID-19 pandemic. STUDY SAMPLE: 172 individuals with hearing loss and 130 who reported not having a hearing loss completed the study. They were recruited through social media, private audiology clinics, hospitals and monthly newsletters sent by the non-profit organisation "Audition Quebec." RESULTS: Face masks were the most problematic protective measure for communication in 75-90% of participants. For all in-person communication activities, participants with hearing loss reported significantly more impact on communication than participants with normal hearing. They also exhibited more activity limitations and negative emotions associated with communication difficulties. CONCLUSION: These results suggest that, in times of pandemic, individuals with hearing loss are more likely to exhibit communication breakdowns in their everyday activities. This may lead to social isolation and have a deleterious effect on their mental health. When interacting with individuals with hearing loss, communication strategies to optimise speech understanding should be used.

Use of Music Therapy as an Audiological Rehabilitation Tool in the Elderly Population: A Mini-Review.

It is well known and documented that sensory perception decreases with age. In the elderly population, hearing loss and reduced vestibular function are among the most prevalently affected senses. Two important side effects of sensory deprivation are cognitive decline and decrease in social participation. Hearing loss, vestibular function impairment, and cognitive decline all lead to a decrease in social participation. Altogether, these problems have a great impact on the quality of life of the elderly. This is why a rehabilitation program covering all of these aspects would therefore be useful for clinicians. It is well known that long-term music training can lead to cortical plasticity. Behavioral improvements have been measured for cognitive abilities and sensory modalities (auditory, motor, tactile, and visual) in healthy young adults. Based on these findings, it is possible to wonder if this kind of multisensory training would be an interesting therapy to not only improve communication but also help with posture and balance, cognitive abilities, and social participation. The aim of this review is to assess and validate the impact of music therapy in the context of hearing rehabilitation in older adults. Musical therapy seems to have a positive impact on auditory perception, posture and balance, social integration, and cognition. While the benefits seem obvious, the evidence in the literature is scarce. However, there is no reason not to recommend the use of music therapy as an adjunct to audiological rehabilitation in the elderly when possible. Further investigations are needed to conclude on the extent of the benefits that music therapy could bring to older adults. More data are needed to confirm which hearing abilities can be improved based on the many characteristics of hearing loss. There is also a need to provide a clear protocol for clinicians on how this therapy should be administered to offer the greatest possible benefits.

Asymmetrical influence of bi-thermal caloric vestibular stimulation on a temporal order judgment task.

Recent evidences suggest that binaural vestibular stimulation affects tactile temporal processing. However, it remains difficult to determine the physiological mechanisms supporting the vestibular-somatosensory interactions observed during a TOJ task. Controlling the activation of the right or left vestibular system separately could allow to better understand the physiological bases of these findings and reconcile previous studies. The objective of the present study was to examine tactile temporal processing using a temporal order judgment task following selective stimulation of the right and left vestibular system with bi-thermal caloric vestibular stimulation (CVS). A total of 24 right-handed participants received bi-thermal CVS either in the right ear (n = 12) or the left ear (n = 12). Participants held vibrators in both hands which delivered a signal temporally separated by a variable asynchrony. Participants had to report the hand where the vibration was perceived first. The task was performed in three different CVS conditions: (1) baseline, (2) warm CVS, and (3) cold CVS. Analysis of the logistics curve parameters-just noticeable difference (JND) and point of subjective simultaneity (PSS)-for each participant in each CVS conditions revealed an increase in JND greater following warm CVS. A significant increase in JND following warm CVS was measured bilaterally. However, cold CVS increased JND only when CVS was applied in the left ear, but not in the right ear. Finally, no influence of CVS on PSS was observed.

Congenital Deafness Leads to Altered Overt Oculomotor Behaviors.

The human brain is highly cross-modal, and sensory information may affect a wide range of behaviors. In particular, there is evidence that auditory functions are implicated in oculomotor behaviors. Considering this apparent auditory-oculomotor link, one might wonder how the loss of auditory input from birth might have an influence on these motor behaviors. Eye movement tracking enables to extract several components, including saccades and smooth pursuit. One study suggested that deafness can alter saccades processing. Oculomotor behaviors have not been examined further in the deaf. The main goal of this study was to examine smooth pursuit following deafness. A pursuit task paradigm was used in this experiment. Participants were instructed to move their eyes to follow a target as it moved. The target movements have a possibility of four different trajectories (horizontal, vertical, elliptic clockwise, and elliptic counter-clockwise). Results indicate a significant reduction in the ability to track a target in both elliptical conditions showing that more complex motion processing differs in deaf individuals. The data also revealed significantly more saccades per trial in the vertical, anti-clockwise, and, to a lesser extent, the clockwise elliptic condition. This suggests that auditory deprivation from birth leads to altered overt oculomotor behaviors.

Enhanced tactile identification of musical emotion in the deaf.

Functional neuroimaging studies have demonstrated that following deafness, auditory regions can respond to tactile stimuli. However, research to date has not conclusively demonstrated the behavioral correlates of these functional changes, with most studies showing normal-like tactile capabilities in the deaf. It has recently been suggested that more cognitive and complex tactile processes, such as music perception, could help to uncover superior tactile capabilities in the deaf. Indeed, following deafness music seems to be perceived through vibration, but the extent to which they can perceive musical features though the tactile modality remains undetermined. The goal of this study was to investigate tactile identification of musical emotion in the deaf. Participants had to rate melodies based on their emotional perception. Stimuli were presented through an haptic glove. Data suggest that deaf and control participants were comparable in the identification of three of the four emotions tested (sad, fear/threat, peacefulness). However and most importantly, for the simplest emotion (happiness), significant differences emerged between groups, suggesting an improved tactile identification of musical emotion in the deaf. Results support the hypothesis that brain plasticity following deafness can lead to improved complex tactile ability.

Musicians Show Better Auditory and Tactile Identification of Emotions in Music.

Musicians are better at processing sensory information and at integrating multisensory information in detection and discrimination tasks, but whether these enhanced abilities extend to more complex processes is still unknown. Emotional appeal is a crucial part of musical experience, but whether musicians can better identify emotions in music throughout different sensory modalities has yet to be determined. The goal of the present study was to investigate the auditory, tactile and audiotactile identification of emotions in musicians. Melodies expressing happiness, sadness, fear/threat, and peacefulness were played and participants had to rate each excerpt on a 10-point scale for each of the four emotions. Stimuli were presented through headphones and/or a glove with haptic audio exciters. The data suggest that musicians and control are comparable in the identification of the most basic (happiness and sadness) emotions. However, in the most difficult unisensory identification conditions (fear/threat and peacefulness), significant differences emerge between groups, suggesting that musical training enhances the identification of emotions, in both the auditory and tactile domains. These results support the hypothesis that musical training has an impact at all hierarchical levels of sensory and cognitive processing.

Improved tactile frequency discrimination in musicians.

Music practice is a multisensory training that is of great interest to neuroscientists because of its implications for neural plasticity. Music-related modulation of sensory systems has been observed in neuroimaging data, and has been supported by results in behavioral tasks. Some studies have shown that musicians react faster than non-musicians to visual, tactile and auditory stimuli. Behavioral enhancement in more complex tasks has received considerably less attention in musicians. This study aims to investigate unisensory and multisensory discrimination capabilities in musicians. More specifically, the goal of this study is to examine auditory, tactile and auditory-tactile discrimination in musicians. The literature suggesting better auditory and auditory-tactile discrimination in musicians is scarce, and no study to date has examined pure tactile discrimination capabilities in musicians. A two-alternative forced-choice frequency discrimination task was used in this experiment. The task was inspired by musical production, and participants were asked to identify whether a frequency was the same as or different than a standard stimulus of 160 Hz in three conditions: auditory only, auditory-tactile only and tactile only. Three waveforms were used to replicate the variability of pitch that can be found in music. Stimuli were presented through headphones for auditory stimulation and a glove with haptic audio exciters for tactile stimulation. Results suggest that musicians have lower discrimination thresholds than non-musicians for auditory-only and auditory-tactile conditions for all waveforms. The results also revealed that musicians have lower discrimination thresholds than non-musicians in the tactile condition for sine and square waveforms. Taken together, these results support the hypothesis that musical training can lead to better unisensory tactile discrimination which is in itself a new and major finding.

Auditory Event-Related Potentials Associated With Music Perception in Cochlear Implant Users.

A short review of the literature on auditory event-related potentials and mismatch negativities (MMN) in cochlear implant users engaged in music-related auditory perception tasks is presented. Behavioral studies that have measured the fundamental aspects of music perception in CI users have found that they usually experience poor perception of melody, pitch, harmony as well as timbre (Limb and Roy, 2014). This is thought to occur not only because of the technological and acoustic limitations of the device, but also because of the biological alterations that usually accompany deafness. In order to improve music perception and appreciation in individuals with cochlear implants, it is essential to better understand how they perceive music. As suggested by recent studies, several different electrophysiological paradigms can be used to reliably and objectively measure normal-hearing individuals' perception of fundamental musical features. These techniques, when used with individuals with cochlear implants, might contribute to determine how their peripheral and central auditory systems analyze musical excerpts. The investigation of these cortical activations can moreover give important information on other aspects related to music appreciation, such as pleasantness and emotional perception. The studies reviewed suggest that cochlear implantation alters most fundamental musical features, including pitch, timbre, melody perception, complex rhythm, and duration (e.g., Koelsch et al., 2004b; Timm et al., 2012, 2014; Zhang et al., 2013a,b; Limb and Roy, 2014). A better understanding of how individuals with cochlear implants perform on these tasks not only makes it possible to compare their performance to that of their normal-hearing peers, but can also lead to better clinical intervention and rehabilitation.

Deafness alters the spatial mapping of touch.

Auditory input plays an important role in the development of body-related processes. The absence of auditory input in deafness is understood to have a significant, and even irreversible, impact on these processes. The ability to map touch on the body is an important element of body-related processing. In this research, the crossed-arm temporal order judgment (TOJ) task was used to evaluate the spatial mapping of touch. This task elicits a conflict between visual and somatosensory body-related information through a change in posture. We used the crossed-arm TOJ task to evaluate the spatial mapping of touch in deaf participants. Results suggested that a change in posture had a greater impact on congenitally deaf participant TOJ than for hearing participants. This provides the first evidence for the role of early auditory exposure on spatial mapping of touch. More importantly, most deaf participants had auditory prosthetics which provided auditory input. This suggests an important, and possibly irreversible, impact of early auditory deprivation on this body-related process.

The impact of vestibular status prior to cochlear implantation on postural control: A multiple case study.

OBJECTIVE: The goal of the present study was to investigate the impact of unilateral cochlear implantation on postural control in relation to the vestibular status before CI surgery. METHODS: We recruited 17 participants (four CI candidates and 13 hearing controls) and performed complete vestibular evaluation (cVEMP, oVEMP, vHIT) and postural evaluation using a force platform, prior and following unilateral cochlear implant surgery. RESULTS: Our study suggests that an increase in postural sway following cochlear implant was present only for the participants that received the implant in the ear with the better vestibular function. cVEMP and oVEMP measures in the implanted ear prior to unilateral cochlear implantation may help to predict postural control performance following surgery. DISCUSSION: A thorough evaluation of the vestibular function, as described in the present study, could not only be helpful to make a more accurate prognosis of the risks of fall following cochlear implantation, but also to provide proper vestibular rehabilitation for at-risk patients.

Congenital Deafness Alters Sensory Weighting for Postural Control.

OBJECTIVES: The aim of this study was to examine sensory reweighting for postural control in congenitally deaf individuals. DESIGN: We studied 14 controls and 14 deaf age-matched individuals using a force platform and the modified clinical test of sensory interaction and balance protocol. Both groups performed the postural tasks without auditory cues (with hearing protectors for controls or without hearing devices for the deaf). RESULTS: The results confirmed poorer postural stability in the deaf. More importantly, the data suggest that congenitally deaf individuals rely more on somatosensory information for postural control than controls. CONCLUSIONS: This increased somatosensory reliance may increase postural sway when it comes to more challenging postural conditions.

Sensory reweighting after loss of auditory cues in healthy adults.

We maintain our balance using information provided by the visual, somatosensory, and vestibular systems on the position of our body in space. Recent evidence has suggested that auditory input also plays a significant role for postural control, yet further investigations are required to better understand the contributions of audition to this process in healthy adults. To date, the process of sensory reweighting when auditory cues are disturbed during postural control has been overlooked. The aim of this study is to determine the impact of hearing protection on sensory reweighting for postural control in healthy adults. For this, we studied 14 healthy adults on a force platform using four different postural conditions either with or without attenuation of auditory cues. Our results suggest that disturbing auditory cues increases the reliance on visual cues for postural control. This is the first study to demonstrate such a sensory reweighting occurs in the event of a sudden disturbance of auditory cues in healthy adults.

Temporal and spectral audiotactile interactions in musicians.

Previous investigations have revealed that the complex sensory exposure of musical training alters audiovisual interactions. As of yet, there has been little evidence on the effects of musical training on audiotactile interactions at a behavioural level. Here, we tested audiotactile interaction in musicians using the audiotactile illusory flash and the parchment-skin illusion. Significant differences were only found between musicians and non-musicians for the audiotactile illusory flash. Both groups had similar task-relevant unisensory abilities, but unlike non-musicians, the number of auditory stimulations did not have a statistically important influence on the number of perceived tactile stimulations for musicians. Musicians and non-musicians similarly perceived the parchment-skin illusion. Spectral alterations of self-generated palmar sounds similarly altered the perception of wetness and dryness for both groups. These results suggest that musical training does not seem to alter multisensory interactions at large. The specificity of the sensory enhancement suggests that musical training specifically alters processes underlying the interaction of temporal audiotactile stimuli and not the global interaction between these modalities. These results are consistent with previous unisensory and multisensory investigations on sensory abilities related to audiotactile processing in musicians.

Short-term visual deprivation can enhance spatial release from masking.

This research aims to study the effect of short-term visual deprivation on spatial release from masking, a major component of the cocktail party effect that allows people to detect an auditory target in noise. The Masking Level Difference (MLD) test was administered on healthy individuals over three sessions: before (I) and after 90min of visual deprivation (II), and after 90min of re-exposure to light (III). A non-deprived control group performed the same tests, but remained sighted between sessions I and II. The non-deprived control group displayed constant results across sessions. However, performance in the MLD test was improved following short-term visual deprivation and performance returned to pre-deprivation values after light re-exposure. This study finds that short-term visual deprivation transiently enhances the spatial release from masking. These data suggest the significant potential for enhancing a process involved in the cocktail party effect in normally developing individuals and adds to an emerging literature on the potential to enhance auditory ability after only a brief period of visual deprivation.