Magnitude of extended high frequency hearing loss associated with auditory related tinnitus distress, when controlling for magnitude of hearing loss at standard frequenciesa).

Impaired thresholds at extended high frequencies (EHF) are tightly linked to the prevalence of tinnitus, but little is known about how EHF status relates to tinnitus characteristics. In the present study, 93 individuals with tinnitus underwent standard (from 0.125 to 8 kHz) and EHF (from 10 to 16 kHz) audiometry and indicated their degree of tinnitus distress by completing the tinnitus functional index and their perceived tinnitus loudness by using a numeric rating scale. Partial correlation analyses indicated that the magnitude of EHF loss was significantly associated with degree of auditory related tinnitus distress (r = 0.343, p < 0.001) when controlling for pure tone average at standard frequencies and compensating for multiple testing. It is concluded that EHF status is related specifically to auditory related tinnitus distress, but not to intrusive-, sense of control-, cognitive-, sleep-, relaxation-, quality of life-, emotional-related tinnitus distress, total tinnitus distress, or perceived tinnitus loudness.

Extended High Frequency Hearing, but Not Tinnitus, Is Associated With Every-Day Cognitive Performance.

Research into the potential associations between tinnitus and cognition has investigated specific cognitive domains in laboratory settings despite adults with tinnitus reporting broad cognitive difficulties in every-day life. To address this limitation, the present study compared performance and perceived exertion on a visual office-like task in 38 adults with tinnitus (19 with normal hearing and 19 with hearing loss) and 38 adults without tinnitus (19 with normal hearing and 19 with hearing loss) matched for age, sex and educational background. All participants were also assessed for hearing, anxiety and depression, and participants with tinnitus were also assessed for tinnitus handicap. No associations were found between presence of tinnitus and cognitive performance (mean total rate correct score on the visual office-like task being 2.9 for the tinnitus group, 2.8 for the control group, p = 0.612) and perceived exertion (mean ratings of perceived exertion on the Borg CR10-scale being 5.8 for the tinnitus group, 6.5 for the control group, p = 0.063) on the visual office-like task when corrected for standard (0.125 to 8 kHz) and extended high frequency (10 to 16 kHz) hearing thresholds, anxiety, and depression. The correction for extended high frequency average (10, 12.5, 14, and 16 kHz) hearing threshold was significant for performance (p = 0.009) but not perceived exertion on the visual office-like task. Overall, the results showed extended high frequency hearing, but not tinnitus, was associated with every-day cognitive performance. This indicates clinical testing of hearing thresholds above 8 kHz could support clinicians' identification and management of cognitive difficulties. One management method suggested by the current findings would include provision of auditory stimulation at frequencies exceeding the frequency response of many current hearing aids.

Perceived listening effort in children with hearing loss: listening to a dysphonic voice in quiet and in noise.

AIM: The present study investigates the effect of signal degradation on perceived listening effort in children with hearing loss listening in a simulated class-room context. It also examines the associations between perceived listening effort, passage comprehension performance and executive functioning. METHODS: Twenty-four children (aged 06:03-13:00 years) with hearing impairment using cochlear implant (CI) and/or hearing aids (HA) participated. The children made ratings of perceived listening effort after completing an auditory passage comprehension task. All children performed the task in four different listening conditions: listening to a typical (i.e. normal) voice in quiet, to a dysphonic voice in quiet, to a typical voice in background noise and to a dysphonic voice in background noise. In addition, the children completed a task assessing executive function. RESULTS: Both voice quality and background noise increased perceived listening effort in children with CI/HA, but no interaction with executive function was seen. CONCLUSION: Since increased listening effort seems to be a consequence of increased cognitive resource spending, it is likely that less resources will be available for these children not only to comprehend but also to learn in challenging listening environments such as classrooms.

Psychometric properties of the Norwegian translation of the Tinnitus Handicap Inventory (THI-NOR).

OBJECTIVE: To assess the psychometric properties of a Norwegian translation of the Tinnitus Handicap Inventory (THI-NOR). DESIGN: A survey was sent by post to patients referred with tinnitus as their main complaint to an audiology department. Patients completed a Norwegian version of the Tinnitus Handicap Inventory (THI-NOR), a Norwegian translation of two revised subscales of the Abbreviated profile of hearing aid benefit (APHAB), the General Health Questionnaire (GHQ-12) as well as questionnaires measuring coping expectancies (TOMCATS) and neuroticism (EPI). STUDY SAMPLE: Ninety-nine persons with tinnitus. RESULTS: No associations were found between THI-scores or pure-tone audiometry, gender or age. The proposed subscales of the original THI were not formed by responses from responders. The total scale shows good psychometric properties. Significant correlations were found between distress as measured by the GHQ-12, coping expectancies as measured by TOMCATS and neuroticism as measured by EPI and THI scores. CONCLUSIONS: THI-NOR has psychometric properties similar to those of the Danish translation (THI-DK), from which it was adapted, and to the original THI. THI-NOR seems to be a valid measure of the impact of tinnitus on a person's everyday life. Findings show that the suggested subscales of the questionnaire should be interpreted with caution.

Development of an Auditory Passage Comprehension Task for Swedish Primary School Children of Cultural and Linguistic Diversity.

Purpose This study reports on the development of an auditory passage comprehension task for Swedish primary school children of cultural and linguistic diversity. It also reports on their performance on the task in quiet and in noise. Method Eighty-eight children aged 7-9 years and showing normal hearing participated. The children were divided into three groups based on presumed language exposure: 13 children were categorized as Swedish-speaking monolinguals, 19 children were categorized as simultaneous bilinguals, and 56 children were categorized as sequential bilinguals. No significant difference in working memory capacity was seen between the three language groups. Two passages and associated multiple-choice questions were developed. During development of the passage comprehension task, steps were taken to reduce the impact of culture-specific prior experience and knowledge on performance. This was achieved by using the story grammar principles, universal topics and plots, and simple language that avoided complex or unusual grammatical structures and words. Results The findings indicate no significant difference between the two passages and similar response distributions. Passage comprehension performance was significantly better in quiet than in noise, regardless of language exposure group. The monolinguals outperformed both simultaneous and sequential bilinguals in both listening conditions. Conclusions Because the task was designed to minimize the effect of cultural knowledge on auditory passage comprehension, this suggests that compared with monolinguals, both simultaneous and sequential bilinguals have a disadvantage in auditory passage comprehension. As expected, the findings demonstrate that noise has a negative effect on auditory passage comprehension. The magnitude of this effect does not relate to language exposure. The developed auditory passage comprehension task seems suitable for assessing auditory passage comprehension in primary school children of linguistic and cultural diversity.

Importance of personality and coping expectancy on patient-reported hearing disability, quality of life and distress level: a study of patients referred to an audiology service.

PURPOSE: According to the World Health Organization (WHO), hearing loss (HL) affects up to 15% of the world's adult population. Coping and personality are hypothesized to underlie quality of life (QoL) and distress scores. We aimed to study the importance of personality and coping in persons with HL for self-reported hearing disability, QoL, and distress. METHODS: A cross-sectional survey was carried out, including one hundred and fifty-eight adults seeking hearing aids. Pure-tone average hearing thresholds (PTA) were determined for each ear. A revised version of the Abbreviated Profile of Hearing Aid Benefit (APHAB) served as a measure of self-reported hearing disability. Further, the generic part of the European Organization for Research and Treatment (EORTC) QoL questionnaire and the General Health Questionnaire (GHQ) (distress measure) were answered. Levels of neuroticism and the Theoretically Originated Measure of the Cognitive Activation Theory of Stress (TOMCATS) coping expectancy were determined. RESULTS: Hearing disability was determined by PTA (better ear) and level of neuroticism. Distress and QoL were determined by neuroticism and coping. CONCLUSION: More neuroticism was associated with worse outcome for the variables hearing disability, distress, and QoL. Helplessness and hopelessness were associated with worse hearing disability, increased distress, and lowered QoL. Patient reported hearing disability was also associated with PTA (better ear). There is a need to investigate further the associations between hearing disability and QoL to psychosocial parameters.

Listening effort and fatigue in native and non-native primary school children.

Background noise makes listening effortful and may lead to fatigue. This may compromise classroom learning, especially for children with a non-native background. In the current study, we used pupillometry to investigate listening effort and fatigue during listening comprehension under typical (0 dB signal-to-noise ratio [SNR]) and favorable (+10 dB SNR) listening conditions in 63 Swedish primary school children (7-9 years of age) performing a narrative speech-picture verification task. Our sample comprised both native (n = 25) and non-native (n = 38) speakers of Swedish. Results revealed greater pupil dilation, indicating more listening effort, in the typical listening condition compared with the favorable listening condition, and it was primarily the non-native speakers who contributed to this effect (and who also had lower performance accuracy than the native speakers). Furthermore, the native speakers had greater pupil dilation during successful trials, whereas the non-native speakers showed greatest pupil dilation during unsuccessful trials, especially in the typical listening condition. This set of results indicates that whereas native speakers can apply listening effort to good effect, non-native speakers may have reached their effort ceiling, resulting in poorer listening comprehension. Finally, we found that baseline pupil size decreased over trials, which potentially indicates more listening-related fatigue, and this effect was greater in the typical listening condition compared with the favorable listening condition. Collectively, these results provide novel insight into the underlying dynamics of listening effort, fatigue, and listening comprehension in typical classroom conditions compared with favorable classroom conditions, and they demonstrate for the first time how sensitive this interplay is to language experience.

Clinical Application and Psychometric Properties of a Swedish Translation of the Abbreviated Profile of Hearing Aid Benefit.

BACKGROUND: The impact of hearing loss on the individual and his/her everyday life can be assessed using questionnaires with the purpose to improve rehabilitation quality. The Abbreviated Profile of Hearing Aid Benefit (APHAB) can be used to evaluate disability in everyday life associated with hearing loss. Previous studies have examined APHAB outcomes in sensorineural hearing loss and we do not know whether the type of hearing loss influence questionnaire outcomes. PURPOSE: The purpose was to evaluate the psychometric properties of a Swedish translation of the APHAB and the influence of demographic variables on the outcome in a clinical sample. RESEARCH DESIGN: A descriptive, cross-sectional study in a clinical sample. STUDY SAMPLE: Forty-eight participants with no hearing aid experience seeking audiological rehabilitation for the first time. These participants represented different degrees of hearing loss and three types of hearing loss: monaural mixed, binaural mixed, and binaural sensorineural hearing loss. DATA COLLECTION AND ANALYSIS: Pure-tone audiometry was conducted and the participants completed the unaided APHAB during their first appointment at the clinic. Psychometric properties of the questionnaire were examined and the influence of age, gender, type of hearing loss, and degree of hearing loss on APHAB scores were studied. RESULTS: The psychometric properties indicate high test-retest reliability but there seems to be some potential issues with the properties of the reverberation (RV) subscale. The items from the RV subscale failed to load as a separate component and the internal consistency of the subscale improved by removing four items (items 1, 9, 11, and 16). With few exceptions, APHAB scores were not influenced by age, gender, or type of hearing loss. APHAB scores were generally influenced by degree of hearing loss in both the best and the worst ear. CONCLUSION: This Swedish version of the APHAB can be additionally improved by addressing the inconsistencies found in the RV subscale by rephrasing or removing some items. The degree of hearing loss has some influence on questionnaire outcomes but not age, gender, and type of hearing loss.

Hearing thresholds and cognitive flexibility in young healthy individuals with normal hearing.

Objective: Pure tone audiometry may seem to be a relatively easy task for the participant but it may involve cognitive as well as sensory abilities. The aim of this study is to examine the relationship between hearing thresholds in the frequency range 0.125-8 kHz and the core executive function cognitive flexibility in healthy individuals with normal hearing.Design: Experimental study measuring correlations between different pure-tone hearing threshold measures and cognitive flexibility. Pure tone air conduction audiometry (frequencies 0.125-8.0 kHz) and two tests of cognitive flexibility (information updating and shifting ability) were conducted.Study sample: Seventy-two subjects (aged between 21 and 36) with normal hearing (<20 dB HL) for the tested frequencies.Results: Four measures of average pure tone hearing thresholds were negatively correlated with cognitive flexibility.Conclusions: Pure-tone air conduction hearing thresholds seem to be related to cognitive flexibility in healthy individuals with normal hearing.

Passage comprehension performance in children with cochlear implants and/or hearing aids: the effects of voice quality and multi-talker babble noise in relation to executive function.

Purpose: Speech signal degradation such as a voice disorder presented in quiet or in combination with multi-talker babble noise could affect listening comprehension in children with hearing impairment. This study aims to investigate the effects of voice quality and multi-talker babble noise on passage comprehension in children with using cochlear implants (CIs) and/or hearing aids (HAs). It also aims to examine what role executive functioning has for passage comprehension in listening conditions with degraded signals (voice quality and multi-talker babble noise) in children using CI/HA. Methods: Twenty-three children (10 boys and 13 girls; mean age 9 years) using CI and/or HA were tested for passage comprehension in four listening conditions: a typical voice or a (hoarse) dysphonic, voice presented in quiet or in multi-talker babble noise. Results: The results show that the dysphonic voice did not affect passage comprehension in quiet or in noise. Multi-talker babble noise decreased passage comprehension compared to performance in quiet. No interactions with executive function were found. Conclusions: In conclusion, children with CI/HA seem to struggle with comprehension in poor sound environments, which in turn may reduce learning opportunities at school.

Can the Lateralized Readiness Potential Detect Suppressed Manual Responses to Pure Tones?

BACKGROUND: Willfully not responding to auditory stimuli hampers accurate behavioral measurements. An objective measure of covert manual suppression recorded during response tasks may be useful to assess the veracity of responses to stimuli. PURPOSE: To investigate whether the lateralized readiness potential (LRP), an electrophysiological measure of corticomotor response and suppression, may be of use in determining when participants hear but do not respond to pure tones. RESEARCH DESIGN: Within-subject repeated measures with a Go-NoGo paradigm. STUDY SAMPLE: Five males and five females (mean age = 38.8 years, standard deviation = 8.8) underwent electrophysiology testing. All had normal hearing, except one. INTERVENTION: Participants were tested in a condition where they consistently responded to tonal stimuli, and in a condition where intensity cued whether they should respond or not. Scalp-recorded cortical potentials and behavioral responses were recorded, along with a question that probed the perceived effort required to suppress responses to the stimuli. DATA COLLECTION AND ANALYSIS: Electrophysiology data were processed with independent component analysis and epoch-based artifact rejection. Averaged group and individual LRPs were calculated. RESULTS: Group averaged waveforms show that suppressed responses, cued by NoGo stimuli, diverge positively at approximately 300 msec poststimulus, when compared with performed (Go) responses. LRPs were comparable when Go responses were recorded in a separate condition in which participants responded to all stimuli, and when Go and NoGo trials were included in the same condition. The LRP was not observed in one participant. CONCLUSIONS: Subsequent to further investigation, the LRP may prove suitable in assessing the suppression of responses to audiometric stimuli, and, thereby, useful in cases where functional hearing loss is suspected.

The Impact of Tinnitus on N-Back Performance in Normal Hearing Individuals.

BACKGROUND: Tinnitus sufferers commonly report concentration difficulties. Despite several previous studies investigating this, the underlying cause and the role of hearing status remains unclear. PURPOSE: To investigate whether there are any differences between normal hearing individuals with and without tinnitus in terms of working memory capacity, and whether working memory capacity correlates with high-frequency hearing thresholds. RESEARCH DESIGN: Participants had their hearing thresholds measured (0.125-16 kHz) and performed a visual n-back test. All participants completed the Hospital Anxiety and Depression Scale, in addition tinnitus participants filled out the Tinnitus Questionnaire. STUDY SAMPLE: Sixty-two individuals participated, 31 had tinnitus (tinnitus group) and 31 did not have tinnitus (control group). Groups were age- and sex matched, and all participants had normal hearing thresholds (20 dB HL or better at 0.125-8 kHz). DATA ANALYSIS: Friedman test of differences among repeated measures was conducted on the collected data of n-back performance, and Mann-Whitney U-test was used to compare groups. Age-corrected correlations were calculated for high-frequency hearing and each n-back condition. RESULTS: We found no significant differences between the groups in terms of n-back task performances, except for the 2-back condition where the tinnitus group performed significantly better than the controls (p = 0.007). Furthermore, we found high-frequency hearing thresholds of the best ear (10-16 kHz) to correlate with performances at more demanding n-back conditions (p = 0.029 for 1-back and p = 0.015 for 2-back). CONCLUSION: This suggests that presence of tinnitus might not imply poorer working memory capacity and that deteriorated high-frequency hearing thresholds.

Listening Effort: Order Effects and Core Executive Functions.

BACKGROUND: Listening effort seems to depend on input-related listening demands and several factors internal to the individual listener. Input-related demands may be listening in noise compared with listening in quiet, and internal factors may be cognitive functions. PURPOSE: The purpose was to apply measures of listening effort and perceived listening effort in participants with normal hearing, to determine if there are any presentation order effects, and to explore the relationship between listening effort measured as accuracy, response times, efficiency of information encoding into long-term memory, perceived listening effort, and core executive functions. RESEARCH DESIGN: A within-subject design with repeated measures was used and a study of relationships between variables was made. STUDY SAMPLE: Thirty-two healthy adults with normal hearing. DATA COLLECTION AND ANALYSIS: Participants were tested individually by a listening task using a dual-task paradigm. The listening task was performed in quiet and in multitalker babble noise at 10 dB signal-to-noise ratio (SNR). Perceived listening effort and core executive functions (working memory, inhibitory control, and cognitive flexibility) were also assessed. RESULTS: The measures of listening effort (correct responses, response times, and immediate and delayed listening comprehension) failed to demonstrate increased listening effort in multitalker babble noise (10 dB SNR) compared with quiet, although a significant test order effect was seen for correct responses indicating that participants who first listened in noise did not improve in quiet. Perceived listening effort increased significantly in noise compared with quiet. No relationship was found between measures of listening effort and ratings of perceived listening effort. Working memory and cognitive flexibility were not related to ratings of perceived listening effort. In contrast, better inhibitory control was related to higher ratings in both quiet and in noise. CONCLUSIONS: It is possible that the SNR and measures used were not as sensitive as required to measure listening effort behaviorally. In the present experimental setup, prior noise exposure impedes the beneficial effects of performing a task in quiet. Self-reports seem to provide a valid measure of perceived listening effort that is related to the individual's inhibitory control. The present findings suggest that participants with better inhibitory control are more susceptible to the task demand level both in quiet and in noise.

Extended high-frequency pure tone hearing thresholds and core executive functions.

OBJECTIVE: To examine the relationship between extended high-frequency pure tone hearing thresholds (frequencies 10 to 14 kHz) and working memory capacity (WMC), inhibitory control, and cognitive flexibility. DESIGN: Experimental study measuring correlations between different high-frequency hearing threshold measures and cognitive measures. STUDY: Pure tone audiometry was assessed in the extended high-frequency (frequencies 10, 12.5 and 14 kHz). Subjects were also tested regarding WMC, inhibitory control (response inhibition), and cognitive flexibility (information updating and shifting ability). SAMPLE: Forty-three subjects between 20 and 29 years old with normal hearing (≤ 20 dB HL) in the frequency range between 0.125 to 8 kHz. RESULTS: No significant correlations were seen between high-frequency hearing thresholds defined as average best and worst ear high-frequency hearing thresholds and the cognitive measures. Differences between the best and the worst ear showed significant negative correlations with inhibitory control and global executive function (combination score for WMC, inhibitory control and cognitive flexibility). CONCLUSIONS: The present study suggests that global executive functions, more specifically response inhibition, and hearing threshold asymmetry in the extended high-frequency range are interrelated.

Reading Comprehension in Quiet and in Noise: Effects on Immediate and Delayed Recall in Relation to Tinnitus and High-Frequency Hearing Thresholds.

BACKGROUND: A common complaint by people with tinnitus is that they experience that the tinnitus causes attention and concentration problems. Previous studies have examined how tinnitus influences cognitive performance on short and intensive cognitive tasks but without proper control of hearing status. PURPOSE: To examine the impact tinnitus and high-frequency hearing thresholds have on reading comprehension in quiet and in background noise. RESEARCH DESIGN: A between-group design with matched control participants. STUDY SAMPLE: One group of participants with tinnitus (n = 20) and an age and gender matched control group without tinnitus (n = 20) participated. Both groups had normal hearing thresholds (20 dB HL at frequencies 0.125 to 8 kHz). DATA COLLECTION AND ANALYSIS: Measurements were made assessing hearing thresholds and immediate and delayed recall using a reading comprehension test in quiet and in noise. All participants completed the Swedish version of the Hospital Anxiety and Depression Scale, and participants with tinnitus also completed the Tinnitus Questionnaire. RESULTS: The groups did not differ in immediate nor delayed recall. Accounting for the effect of age, a significant positive correlation was found between best ear high-frequency pure tone average (HF-PTA; 10000, 12500, and 14000 Hz) and the difference score between immediate and delayed recall in noise. CONCLUSIONS: Tinnitus seems to have no effect on immediate and delayed recall in quiet or in background noise when hearing status is controlled for. The detrimental effect of background noise on the processes utilized for efficient encoding into long-term memory is larger in participants with better HF-PTA. More specifically, when reading in noise, participants with better HF-PTA seem to recall less information than participants with poorer HF-PTA.

Increasing Cognitive Interference Modulates the Amplitude of the Auditory Brainstem Response.

BACKGROUND: Despite the presence of efferent neural pathways from the cortex to brainstem, evidence for cognitive inhibition and sensory gating on the auditory brainstem has been mixed. Some previous studies have suggested auditory brainstem responses (ABR) can be affected by cognitive load whereas others have not. PURPOSE: The present study explores if the ABR recorded from adults with normal hearing was affected by increased cognitive load involving cognitive interference. RESEARCH DESIGN: Within-subject repeated measures. STUDY SAMPLE: Twenty young adults with normal hearing (ten females and ten males, aged 21-26 yr). DATA COLLECTION AND ANALYSIS: ABRs were collected with and without cognitive load (a visual Stroop task). Two measures of cognitive interference, that is, the ability to suppress task-irrelevant input, were derived from the performance on the Stroop task. RESULTS: No main effect of cognitive load on ABR wave V amplitudes was found. Participants with higher cognitive interference showed increased response times and larger decreases in ABR wave V amplitudes from the no cognitive load to cognitive load conditions. CONCLUSIONS: The present study showed that ABR wave V amplitudes did not change with increased overall cognitive load (cognitive load with and without cognitive interference), but ABR amplitude was related to cognitive interference. Increased cognitive load in the form of increased cognitive interference could trigger cognitive inhibition and/or sensory gating to suppress the processing of task-irrelevant information at the level of the brainstem. This suppression could present as reduced ABR wave V amplitudes.

Immediate Passage Comprehension and Encoding of Information Into Long-Term Memory in Children With Normal Hearing: The Effect of Voice Quality and Multitalker Babble Noise.

PURPOSE: This study examines how voice quality and multitalker babble noise affect immediate passage comprehension and the efficiency of information encoding into long-term memory in children with normal hearing. METHOD: Eighteen children (mean age = 9 years) with normal hearing participated. Immediate passage comprehension performance and delayed performance (after 5 to 8 days) were assessed for 4 listening conditions: a typical voice in quiet, a typical voice in noise, a dysphonic voice in quiet, and a dysphonic voice in noise. RESULTS: Multitalker babble noise had a significant effect on immediate and delayed performance. This effect was more pronounced for delayed performance. No significant main effect of voice quality was seen on immediate or delayed performance. CONCLUSIONS: Multitalker babble noise impairs immediate passage comprehension and encoding of information into long-term memory for later recall in children with normal hearing. In learning situations where competing speech signals are present, background noise may reduce the prerequisites for optimal learning.

Is children's listening effort in background noise influenced by the speaker's voice quality?

The present study aims at exploring the influence of voice quality on listening effort in children performing a language comprehension test with sentences of increasing difficulty. Listening effort is explored in relation to gender ( = cisgender). The study has a between-groups design. Ninety-three mainstreamed children aged 8;2 to 9;3 with typical language development participated. The children were randomly assigned to two groups (n = 46/47) with equal allocation of boys and girls and for the analysis to four groups depending of gender and voice condition. Working memory capacity and executive functions were tested in quiet. A digital version of a language comprehension test (the TROG-2) was used to measure the effect of voice quality on listening effort, measured as response time in a forced-choice paradigm. The groups listened to sentences through recordings of the same female voice, one group with a typical voice and one with a dysphonic voice, both in competing multi-talker babble noise. Response times were logged after a time buffer between the sentence-ending and indication of response. There was a significant increase in response times with increased task difficulty and response times between the two voice conditions differed significantly. The girls in the dysphonic condition were slower with increasing task difficulty. A dysphonic voice clearly adds to the noise burden and listening effort is greater in girls than in boys when the teacher speaks with dysphonic voice in a noisy background. These findings might mirror gender differences as for coping strategies in challenging contexts and have important implications for education.

The effect of voice quality and competing speakers in a passage comprehension task: perceived effort in relation to cognitive functioning and performance in children with normal hearing.

The study investigates the effect of voice quality and competing speakers on perceived effort in a passage comprehension task in relation to cognitive functioning. In addition, it explores if perceived effort was related to performance. A total of 49 children (aged 7:03 to 12:02 years) with normal hearing participated. The children performed an auditory passage comprehension task presented with six different listening conditions consisting of a typical voice or a dysphonic voice presented in quiet, with one competing speaker, and with four competing speakers. After completing the task, they rated their perceived effort on a five-grade scale. The children also performed tasks measuring working memory capacity (WMC) and executive functioning. The results show that voice quality had no direct effect on perceived effort but the children's ratings of perceived effort were related to their executive functioning. A significant effect was seen for background listening condition indicating higher perceived effort for background listening conditions with competing speakers. The effects of background listening condition were mainly related to the children's WMC but also their executive functioning. It can be concluded that the individual susceptibility to the effect of the dysphonic voice is related to the child's executive functioning. The individual susceptibility to the presence of competing speakers is related to the child's WMC and executive functioning.