Threshold Estimation and Speech Perception Under Hearing Loss Simulation: Examination of the Immersive Hearing Loss and Prosthesis Simulator.

PURPOSE: Hearing loss simulation (HLS) has been recommended for clinical teaching and counseling of patients and their families, so that they can experience hearing impairment. However, few validated procedures for simulating hearing loss are available to instructors and practicing clinicians. The aim of this study was to assess the accuracy of the Immersive Hearing Loss and Prosthesis Simulator (I-HeLPS) on reducing hearing sensitivity and word recognition to determine its adequacy for educational and clinical use. METHOD: Thirty-seven young adults with normal hearing completed hearing threshold and word recognition testing under normal and simulated hearing losses. The accuracy of the nominal hearing threshold settings within the I-HeLPS software was assessed with behavioral detection of frequency-modulated pure tones presented in a calibrated sound field, while listeners wore I-HeLPS headphones. The impact of the HLSs on speech perception was measured using the California Consonant Test. Hearing thresholds, word identification accuracy, and sound confusions were compared across listening conditions. RESULTS: Hearing thresholds increased systematically with worse simulated hearing loss. Performance on the California Consonant Test worsened, and the number of phoneme confusions increased with simulated hearing loss severity. Most of the confusions were place confusions with near neighbors and manner confusions increased as a function of increasing severity of simulated hearing loss. CONCLUSIONS: The I-HeLPS accurately elevated hearing thresholds with increasing HLS severity and impacted word recognition in a manner consistent with sensorineural hearing loss. The simulations were considered reasonable for educational and clinical purposes. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24520966.

Perceptual, procedural, and task learning for an auditory temporal discrimination task.

Perceptual learning reflects experience-driven improvements in the ability to detect changes in stimulus characteristics. The time course for perceptual learning overlaps with that for procedural learning (acquiring general skills and strategies) and task learning (learning the perceptual judgment specific to the task), making it difficult to isolate their individual effects. This study was conducted to examine the role of exposure to stimulus, procedure, and task information on learning for auditory temporal-interval discrimination. Eighty-three listeners completed five online sessions that required temporal-interval discrimination (target task). Before the initial session, listeners were differentially exposed to information about the target task's stimulus, procedure, or task characteristics. Learning occurred across sessions, but an exposure effect was not observed. Given the significant learning across sessions and variability within and across listeners, contributions from stimulus, procedure, and task exposure to overall learning cannot be discounted. These findings clarify the influence of experience on temporal perceptual learning and could inform designs of training paradigms that optimize perceptual improvements.

Need for cognition is associated with the interaction of reward and task-load on effort: A verification and extension study.

Here, we work to provide nuance around the assumption that people will work for rewards. We examine whether individuals' inherent tendency to mobilize cognitive effort (need for cognition, NFC) moderates this effect. We re-analyzed our existing data to verify an effect reported by Sandra and Otto (2018) regarding the association between NFC and reward-induced cognitive effort expenditure, using a more ecological cognitive task design and adding a psychophysiological measure of effort. Specifically, distinct from their short time course visual task-switching paradigm, we used a relatively long course auditory comprehension task paradigm. We found that, consistent with the original study, increased cognitive effort in response to incentive reward depends on individual differences in cognitive motivation (need for cognition). We also found that, to observe consistent phenomena, different indices of effort (behavioral and psychophysiological) need to be considered when evaluating the relationship between the effort expenditure and cognitive motivation. Pupil dilation showed an advantage over reaction time in revealing mental effort mobilized over a prolonged cognitive task. Our results suggest that assessing cognitive motivation when planning a behavior-change program involving reward feedback for positive performance could help to optimize individuals' effort investment.

Hearing loss and risk of depressive symptoms in older adults in the Health ABC study.

Objective: Hearing loss (HL) is highly prevalent among older adults and may lead to increased risk of depressive symptoms. In both cross-sectional and longitudinal analysis, we quantified the association between HL and depressive symptoms, incorporating the variable nature of depressive symptoms and characterizing by race and gender. Methods: Data were from the Health, Aging, and Body Composition study. Depressive symptoms were measured using the Center for Epidemiologic Study Depression Scale short form (CES-D 10), defined as CES-D 10 score ≥10 or treatment for depression. Hearing was defined via four-frequency pure-tone average (PTA) decibel hearing level (dB HL), categorized as normal hearing (PTA ≤25 dB HL), mild HL (PTA26-40 dB HL), and ≥moderate HL (PTA > 40 dB HL). Associations at baseline were quantified using logistic regression, incident depressive symptoms using Cox proportional hazard models, and change in depressive symptoms over time using growth mixture models and multinomial logistic regression. Results: Among 2,089 older adults (1,082 women, 793 Black; mean age 74.0 SD: 2.8), moderate or greater HL was associated with greater odds of concurrent [Odds Ratio (OR):2.45, 95% CI:1.33, 4.51] and incident depressive symptoms [Hazard Ratio (HR):1.26, 95% CI:1.00, 1.58]. Three depressive symptom trajectory patterns were identified from growth mixture models: low, moderate increasing, and borderline high depressive symptom levels. Those with moderate or greater HL were more likely to be in the borderline high depressive-symptom trajectory class than the low trajectory class [Relative Risk Ratio (RRR):1.16, 95% CI:1.01, 1.32]. Conclusions: HL was associated with greater depressive symptoms. Although findings were not statistically significantly different by gender and race, estimates were generally stronger for women and Black participants. Investigation of psychosocial factors and amelioration by hearing aid use could have significant benefit for older adults' quality of life.

Investigation of Embodied Language Processing on Command-Swallow Performance in Healthy Participants.

Purpose During videofluoroscopic examination of swallowing, patients commonly are instructed to hold a bolus in their mouth until they hear a verbal instruction to swallow, which usually consists of the word swallow and is commonly referred to as the command swallow condition. The language-induced motor facilitation theory suggests that linguistic processes associated with the verbal command to swallow should facilitate the voluntary component of swallowing. As such, the purpose of the study was to examine the linguistic influences of the verbal command on swallowing. Method Twenty healthy young adult participants held a 5-ml liquid bolus in their mouth and swallowed the bolus after hearing one of five acoustic stimuli presented randomly: congruent action word (swallow), incongruent action word (cough), congruent pseudoword (spallow), incongruent pseudoword (pough), and nonverbal stimulus (1000-Hz pure tone). Suprahyoid muscle activity during swallowing was measured via surface electromyography (sEMG). Results The onset and peak sEMG latencies following the congruent action word swallow were shorter than latencies following the pure tone and pseudowords but were not different from the incongruent action word. The lack of difference between swallow and cough did not negate the positive impact of real words on timing. In contrast to expectations, sEMG activity duration and rise time were longer following the word swallow than the pure tone and pseudowords but were not different from cough. No differences were observed for peak suprahyoid muscle activity amplitude and fall times. Conclusions Language facilitation was observed in swallowing. The clinical utility of the information obtained in the study may depend on the purposes for using the command swallow and the type of patient being assessed. However, linguistic processing under the command swallow condition may alter swallow behaviors and suggests that linguistic inducement could be useful as a compensatory technique for patients with difficulty initiating oropharyngeal swallows.

Genome-wide association meta-analysis identifies five novel loci for age-related hearing impairment.

Previous research has shown that genes play a substantial role in determining a person's susceptibility to age-related hearing impairment. The existing studies on this subject have different results, which may be caused by difficulties in determining the phenotype or the limited number of participants involved. Here, we have gathered the largest sample to date (discovery n = 9,675; replication n = 10,963; validation n = 356,141), and examined phenotypes that represented low/mid and high frequency hearing loss on the pure tone audiogram. We identified 7 loci that were either replicated and/or validated, of which 5 loci are novel in hearing. Especially the ILDR1 gene is a high profile candidate, as it contains our top SNP, is a known hearing loss gene, has been linked to age-related hearing impairment before, and in addition is preferentially expressed within hair cells of the inner ear. By verifying all previously published SNPs, we can present a paper that combines all new and existing findings to date, giving a complete overview of the genetic architecture of age-related hearing impairment. This is of importance as age-related hearing impairment is highly prevalent in our ageing society and represents a large socio-economic burden.

The role of reward and task demand in value-based strategic allocation of auditory comprehension effort.

OBJECTIVES: Listeners who fail to optimize their allocation of effort during auditory comprehension tasks can experience from compromised performance, fatigue and stress, which might result in reduced engagement in social communication activities. Strategically allocating effort based on costs and perceived benefits are commonly observed in the research of effortful physical and visual behaviors. Whether people manage their effort in a similar manner in audition remains unclear. As the listening performance of people with normal hearing often serves as the goal of auditory rehabilitation for people with hearing loss, this study evaluated how strategy-induced effort allocation, challenged by reward and task demand, interactively impacted auditory comprehension in normal hearing adults. DESIGN: A value-based strategic effort allocation paradigm was evaluated in 40 normal-hearing young adults. The paradigm included five levels of reward (motivation) and five levels of task demand (speech rate) that were independently manipulated. Effects of reward and task demand on performance accuracy and pupil dilation (a measure of auditory comprehension effort) were examined. RESULTS: There was a significant interaction effect of reward and task demand on both pupil dilation and comprehension accuracy. At the response stage of speech comprehension processing, pupil dilation significantly decreased as the task demand increased at high reward levels. In contrast, pupil dilation did not vary significantly as a function of task demand at low reward levels. Reward significantly improved performance accuracy at fast and extremely fast rate conditions, but not at the slower rates. CONCLUSIONS: Consistent with previous studies on effort regulation, reward and task demand appear to be associated with auditory comprehension effort allocation in an interactive manner when strategic effort control was required to achieve a reward goal. The young normal-hearing listeners in this study prioritized their effort to relatively easy task items over difficult ones at high levels of reward, suggesting a cost-effective value-based strategic effort allocation. Reward significantly improved task performance in terms of accuracy at difficult listening conditions. These findings support the incorporation of affective factors (e.g., reward) and the utility of the value-based strategic effort allocation paradigm in the experimental setting to understand how clinically relevant factors (such as hearing loss and age) might change strategic auditory comprehension behavior.

Profound Hearing Loss: Addressing Barriers to Hearing Healthcare.

The impact of profound hearing loss on infants and adults is variable and greatly influenced by improved audition derived from hearing aids and cochlear implants. However, barriers to healthcare, hearing healthcare in particular, can offset the benefits provided by these sensory devices. Common barriers include cost, location, availability of trained professionals, acceptance of the hearing loss, language and cultural differences, secondary disabilities, and mental health issues. These barriers and their distinct presentations vary somewhat by age, language, and where people live (urban vs. rural), and can interfere with receiving testing and devices in a timely manner. They also can limit auditory, speech and language therapies, and interfere with acceptance of the hearing loss and devices. Rehabilitation should focus on eliminating or reducing the adverse impact of these barriers on patients and their families. Some of which can be done through professional training and multidisciplinary activities, counseling, and community outreach.

Audiological Assessment of Word Recognition Skills in Persons With Aphasia.

PURPOSE: The purpose of this study was to evaluate the ability of persons with aphasia, with and without hearing loss, to complete a commonly used open-set word recognition test that requires a verbal response. Furthermore, phonotactic probabilities and neighborhood densities of word recognition errors were assessed to explore potential underlying linguistic complexities that might differentially influence performance among groups. METHOD: Four groups of adult participants were tested: participants with no brain injury with normal hearing, participants with no brain injury with hearing loss, participants with brain injury with aphasia and normal hearing, and participants with brain injury with aphasia and hearing loss. The Northwestern University Auditory Test No. 6 (NU-6; Tillman & Carhart, 1966) was administered. Those participants who were unable to respond orally (repeating words as heard) were assessed with the Picture Identification Task (Wilson & Antablin, 1980), permitting a picture-pointing response instead. Error patterns from the NU-6 were assessed to determine whether phonotactic probability influenced performance. RESULTS: All participants with no brain injury and 72.7% of the participants with aphasia (24 out of 33) completed the NU-6. Furthermore, all participants who were unable to complete the NU-6 were able to complete the Picture Identification Task. There were significant group differences on NU-6 performance. The 2 groups with normal hearing had significantly higher scores than the 2 groups with hearing loss, but the 2 groups with normal hearing and the 2 groups with hearing loss did not differ from one another, implying that their performance was largely determined by hearing loss rather than by brain injury or aphasia. The neighborhood density, but not phonotactic probabilities, of the participants' errors differed across groups with and without aphasia. CONCLUSIONS: Because the vast majority of the participants with aphasia examined could be tested readily using an instrument such as the NU-6, clinicians should not be reticent to use this test if patients are able to repeat single words, but routine use of alternative tests is encouraged for populations of people with brain injuries.

The effect of speaking rate on serial-order sound-level errors in normal healthy controls and persons with aphasia.

BACKGROUND: Although many speech errors can be generated at either a linguistic or motoric level of production, phonetically well-formed sound-level serial-order errors are generally assumed to result from disruption of phonologic encoding (PE) processes. An influential model of PE (Dell, 1986; Dell, Burger & Svec, 1997) predicts that speaking rate should affect the relative proportion of these serial-order sound errors (anticipations, perseverations, exchanges). These predictions have been extended to, and have special relevance for persons with aphasia (PWA) because of the increased frequency with which speech errors occur and because their localization within the functional linguistic architecture may help in diagnosis and treatment. Supporting evidence regarding the effect of speaking rate on phonological encoding has been provided by studies using young normal language (NL) speakers and computer simulations. Limited data exist for older NL users and no group data exist for PWA. AIMS: This study tested the phonologic encoding properties of Dell's model of speech production (Dell, 1986; Dell,et al., 1997), which predicts that increasing speaking rate affects the relative proportion of serial-order sound errors (i.e., anticipations, perseverations, and exchanges). METHODS & PROCEDURES: The effects of speech rate on the error ratios of anticipation/exchange (AE), anticipation/perseveration (AP) and vocal reaction time (VRT) were examined in 16 normal healthy controls (NHC) and 16 PWA without concomitant motor speech disorders. The participants were recorded performing a phonologically challenging (tongue twister) speech production task at their typical and two faster speaking rates. OUTCOMES & RESULTS: A significant effect of increased rate was obtained for the AP but not the AE ratio. Significant effects of group and rate were obtained for VRT. CONCLUSION: Although the significant effect of rate for the AP ratio provided evidence that changes in speaking rate did affect PE, the results failed to support the model derived predictions regarding the direction of change for error type proportions. The current findings argued for an alternative concept of the role of activation and decay in influencing types of serial-order sound errors. Rather than a slow activation decay rate (Dell, 1986), the results of the current study were more compatible with an alternative explanation of rapid activation decay or slow build-up of residual activation.

Apolipoprotein E Allele and Hearing Thresholds in Older Adults.

BACKGROUND: Whether apolipoprotein E (APOE) E4 allele status which is associated with an increased risk of cognitive decline is also associated with hearing impairment is unknown. METHODS: We studied 1833 men and women enrolled in the Health, Aging and Body Composition study. Regression models adjusted for demographic and cardiovascular risk factors were used to assess the cross-sectional association of APOE-E4 status with individual pure tone hearing thresholds and the 4-frequency pure tone average (0.5-4 kHz) in the better hearing ear. RESULTS: Compared to participants with no APOE-E4 alleles, participants with 1 allele had better thresholds at 4.0 kHz (ß = -2.72 dB, P = .013) and 8.0 kHz (ß = -3.05 kHz, P = .006), and participants with 2 alleles had better hearing thresholds at 1.0 kHz (ß = -8.56 dB, P = .021). CONCLUSION: Our results suggest that APOE-E4 allele status may be marginally associated with better hearing thresholds in older adults.

Reliability and validity of the computerized Revised Token Test: comparison of reading and listening versions in persons with and without aphasia.

PURPOSE: This study assessed the reliability and validity of intermodality associations and differences in persons with aphasia (PWA) and healthy controls (HC) on a computerized listening and 3 reading versions of the Revised Token Test (RTT; McNeil & Prescott, 1978). METHOD: Thirty PWA and 30 HC completed the test versions, including a complete replication. Reading versions varied according to stimulus presentation method: (a) full-sentence presentation, (b) self-paced word-by-word full-sentence construction, and (c) self-paced word-by-word presentation with each word removed with the onset of the next word. Participants also received tests of aphasia and reading severity. RESULTS: The listening version produced higher overall mean scores than each of the reading versions. Differences were small and within 1 standard error of measurement of each version. Overall score test-retest reliability among versions for PWA ranged from r=.89 to r=.97. Correlations between the listening and reading versions ranged from r=.79 to r=.85. All versions correlated highly with aphasia and reading severity. Correlations were generally low for the HC due to restricted variability. Factor analysis yielded a 2-factor solution for PWA and a single-factor for HC. CONCLUSIONS: Intermodality differences were small, and all 4 versions were reliable, concurrently valid, and sensitive to similar linguistic processing difficulties in PWA.

Unexpected intensity changes in the ear canal during a F(0)-shifted feedback experiment.

Effects of frequency-shifted feedback are typically examined using Eventide Harmonizer Series processors to shift the fundamental frequency (F0) of auditory feedback during vocalizations, eliciting compensatory shifts in speaker F0. Recently, unexpected intensity changes were observed in speakers' ear canals, corresponding with F0 shifts. An investigation revealed that feedback time delays introduced by the processor resulted in phase shifts between feedback and unprocessed voice signals radiating into the ear canal via bone conduction, producing combination waves with gains as high as 6 dB. Shifts of this magnitude potentially alter the interpretation of previously published results and should be controlled in future studies.

Impact of spectrally asynchronous delays on consonant voicing perception.

BACKGROUND: A possible voicing cue used to differentiate voiced and voiceless cognate pairs is envelope onset asynchrony (EOA). EOA is the time between the onsets of two frequency bands of energy (in this study one band was high-pass filtered at 3000 Hz, the other low-pass filtered at 350 Hz). This study assessed the perceptual impact of manipulating EOA on voicing perception of initial stop consonants, and whether normal-hearing and hearing-impaired listeners were sensitive to changes in EOA as a cue for voicing. PURPOSE: The purpose of this study was to examine the effect of spectrally asynchronous auditory delay on the perception of voicing associated with initial stop consonants by normal-hearing and hearing-impaired listeners. RESEARCH DESIGN: Prospective experimental study comparing the perceptual differences of manipulating the EOA cues for two groups of listeners. STUDY SAMPLE: Thirty adults between the ages of 21 and 60 yr completed the study: 17 listeners with normal hearing and 13 listeners with mild-moderate sensorineural hearing loss. DATA COLLECTION AND ANALYSIS: The participants listened to voiced and voiceless stop consonants within a consonant-vowel syllable structure. The EOA of each syllable was varied along a continuum, and identification and discrimination tasks were used to determine if the EOA manipulation resulted in categorical shifts in voicing perception. In the identification task the participants identified the consonants as belonging to one of two categories (voiced or voiceless cognate). They also completed a same-different discrimination task with the same set of stimuli. Categorical perception was confirmed with a d-prime sensitivity measure by examining how accurately the results from the identification task predicted the discrimination results. The influence of EOA manipulations on the perception of voicing was determined from shifts in the identification functions and discrimination peaks along the EOA continuum. The two participant groups were compared in order to determine the impact of EOA on voicing perception as a function of syllable and hearing status. RESULTS: Both groups of listeners demonstrated a categorical shift in voicing perception with manipulation of EOA for some of the syllables used in this study. That is, as the temporal onset asynchrony between low- and high-frequency bands of speech was manipulated, the listeners' perception of consonant voicing changed between voiced and voiceless categories. No significant differences were found between listeners with normal hearing and listeners with hearing loss as a result of the EOA manipulation. CONCLUSIONS: The results of this study suggested that both normal-hearing and hearing-impaired listeners likely use spectrally asynchronous delays found in natural speech as a cue for voicing distinctions. While delays in modern hearing aids are less than those used in this study, possible implications are that additional asynchronous delays from digital signal processing or open-fitting amplification schemes might cause listeners with hearing loss to misperceive voicing cues.

Prevalence and risk factors of hearing impairment among primary-school children in Shebin El-kom District, Egypt.

PURPOSE: This study examined the feasibility of screening hearing loss in rural and urban schools in Egypt, and investigated the prevalence and causes of hearing impairment (HI) in Egyptian primary-school students. METHOD: A total of 555 children (6-12 years of age) from a rural and an urban school in the Shebin El-Kom District of Egypt were screened for HI at their schools. A 2-stage screening procedure was used, and positive cases were referred for a diagnostic hearing assessment at a regional medical facility. Risk factors were investigated through a parent questionnaire and an environmental study consisting of noise, ventilation, and crowding measurements at the schools. RESULTS: The screening failure rate was 25.6%, and the prevalence of confirmed HI was 20.9%. The rate of HI did not differ across the schools. Conductive hearing loss of minimal to mild severity was the most common type of HI. The most important predictors for HI were parent suspicion, otitis media, household smoking, low socioeconomic status, and postnatal jaundice. CONCLUSIONS: The prevalence of HI did not differ across settings and was more common than reported in children from developed countries. The screening results also suggest that professionals with limited audiology background can be trained to implement hearing screening programs in Egyptian schools.

Prevalence of hearing loss in Black and White elders: results of the Cardiovascular Health Study.

PURPOSE: The goal of this study was to determine the impact of age, gender, and race on the prevalence and severity of hearing loss in elder adults, aged 72-96 years, after accounting for income, education, smoking, and clinical and subclinical cardiovascular disease. Methods Air-conduction thresholds for standard and extended high-frequency pure-tones were obtained from a cohort of 548 (out of 717) elderly adults (ages 72-96 years) who were recruited during the Year 11 clinical visit (1999-2000) of the Cardiovascular Health Study (CHS) at the Pittsburgh, Pennsylvania site. Participant smoking, income, education, and cardiovascular disease histories were obtained from the CHS database and were included as factors. RESULTS: Hearing loss was more common and more severe for the participants in their 80s than for those in their 70s-the men more than the women and the White participants more than the Black participants. The inclusion of education, income, smoking, and cardiovascular disease (clinical and subclinical) histories as factors did not substantively impact the overall results. CONCLUSION: Although the data reported in this article were cross-sectional and a cohort phenomenon might have been operational, they suggested that hearing loss is more substantive in the 8th than the 7th decade of life and that race and gender influence this decline in audition. Given the high prevalence in the aging population and the differences across groups, there is a clear need to understand the nature and causes of hearing loss across various groups in order to improve prevention and develop appropriate interventions.