Hearing impairment, cognition and speech understanding: exploratory factor analyses of a comprehensive test battery for a group of hearing aid users, the n200 study.

OBJECTIVE: The aims of the current n200 study were to assess the structural relations between three classes of test variables (i.e. HEARING, COGNITION and aided speech-in-noise OUTCOMES) and to describe the theoretical implications of these relations for the Ease of Language Understanding (ELU) model. STUDY SAMPLE: Participants were 200 hard-of-hearing hearing-aid users, with a mean age of 60.8 years. Forty-three percent were females and the mean hearing threshold in the better ear was 37.4 dB HL. DESIGN: LEVEL1 factor analyses extracted one factor per test and/or cognitive function based on a priori conceptualizations. The more abstract LEVEL 2 factor analyses were performed separately for the three classes of test variables. RESULTS: The HEARING test variables resulted in two LEVEL 2 factors, which we labelled SENSITIVITY and TEMPORAL FINE STRUCTURE; the COGNITIVE variables in one COGNITION factor only, and OUTCOMES in two factors, NO CONTEXT and CONTEXT. COGNITION predicted the NO CONTEXT factor to a stronger extent than the CONTEXT outcome factor. TEMPORAL FINE STRUCTURE and SENSITIVITY were associated with COGNITION and all three contributed significantly and independently to especially the NO CONTEXT outcome scores (R(2) = 0.40). CONCLUSIONS: All LEVEL 2 factors are important theoretically as well as for clinical assessment.

The Swedish Hayling task, and its relation to working memory, verbal ability, and speech-recognition-in-noise.

Cognitive functions and speech-recognition-in-noise were evaluated with a cognitive test battery, assessing response inhibition using the Hayling task, working memory capacity (WMC) and verbal information processing, and an auditory test of speech recognition. The cognitive tests were performed in silence whereas the speech recognition task was presented in noise. Thirty young normally-hearing individuals participated in the study. The aim of the study was to investigate one executive function, response inhibition, and whether it is related to individual working memory capacity (WMC), and how speech-recognition-in-noise relates to WMC and inhibitory control. The results showed a significant difference between initiation and response inhibition, suggesting that the Hayling task taps cognitive activity responsible for executive control. Our findings also suggest that high verbal ability was associated with better performance in the Hayling task. We also present findings suggesting that individuals who perform well on tasks involving response inhibition, and WMC, also perform well on a speech-in-noise task. Our findings indicate that capacity to resist semantic interference can be used to predict performance on speech-in-noise tasks.

Evaluation of the preliminary auditory profile test battery in an international multi-centre study.

OBJECTIVE: This paper describes the composition and international multi-centre evaluation of a battery of tests termed the preliminary auditory profile. It includes measures of loudness perception, listening effort, speech perception, spectral and temporal resolution, spatial hearing, self-reported disability and handicap, and cognition. Clinical applicability and comparability across different centres are investigated. DESIGN: Headphone tests were conducted in five centres divided over four countries. Effects of test-retest, ear, and centre were investigated. Results for normally-hearing (NH) and hearing-impaired (HI) listeners are presented. STUDY SAMPLE: Thirty NH listeners aged 19-39 years, and 72 HI listeners aged 22-91 years with a broad range of hearing losses were included. RESULTS: Test-retest reliability was generally good and there were very few right/left ear effects. Results of all tests were comparable across centres for NH listeners after baseline correction to account for necessary differences between test materials. For HI listeners, results were comparable across centres for the language-independent tests. CONCLUSIONS: The auditory profile forms a clinical test battery that is applicable in four different languages. Even after baseline correction, differences between test materials have to be taken into account when interpreting results of language-dependent tests in HI listeners.

Informational Masking and Listening Effort in Speech Recognition in Noise: The Role of Working Memory Capacity and Inhibitory Control in Older Adults With and Without Hearing Impairment.

PURPOSE: The study aimed to assess the relationship between (a) speech recognition in noise, mask type, working memory capacity (WMC), and inhibitory control and (b) self-rated listening effort, speech material, and mask type, in older adults with and without hearing impairment. It was of special interest to assess the relationship between WMC, inhibitory control, and speech recognition in noise when informational maskers masked target speech. METHOD: A mixed design was used. A group (N = 24) of older (Mage = 69.7 years) individuals with hearing impairment and a group of age normal-hearing adults (Mage = 59.3 years, SD = 6.5) participated in the study. The participants were presented with auditory tests in a sound-attenuated room and with cognitive tests in a quiet office. The participants were asked to rate listening effort after being presented with energetic and informational background maskers in two different speech materials used in this study (i.e., Hearing In Noise Test and Hagerman test). Linear mixed-effects models were set up to assess the effect of the two different speech materials, energetic and informational maskers, hearing ability, WMC, inhibitory control, and self-rated listening effort. RESULTS: Results showed that WMC and inhibitory control were of importance for speech recognition in noise, even when controlling for pure-tone average 4 hearing thresholds and age, when the maskers were informational. Concerning listening effort, on the other hand, the results suggest that hearing ability, but not cognitive abilities, is important for self-rated listening effort in speech recognition in noise. CONCLUSIONS: Speech-in-noise recognition is more dependent on WMC for older adults in informational maskers than in energetic maskers. Hearing ability is a stronger predictor than cognition for self-rated listening effort. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21357648.

The Contribution of Age, Working Memory Capacity, and Inhibitory Control on Speech Recognition in Noise in Young and Older Adult Listeners.

Purpose The study aimed to investigate the relationship between speech recognition in noise, age, hearing ability, self-rated listening effort, inhibitory control (measured with the Swedish Hayling task), and working memory capacity (WMC; measured with the Reading Span test). Two different speech materials were used: the Hagerman test with low semantic context and Hearing in Noise Test sentences with high semantic context, masked with either energetic or informational maskers. Method A mixed design was used. Twenty-four young normally hearing (M age = 25.6 years) and 24 older, for their age, normally hearing individuals (M age = 60.6 years) participated in the study. Speech recognition in noise in both speech materials and self-rated effort in all four background maskers were correlated with inhibitory control and WMC. A linear mixed-effects model was set up to assess differences between the two different speech materials, the four different maskers used in the study, and if age and hearing ability affected performance in the speech materials or the various background noises. Results Results showed that high WMC was related to lower scores of self-rated listening effort for informational maskers, as well as better performance in speech recognition in noise when informational maskers were used. The linear mixed-effects model revealed differences in performance between the low-context and the high-context speech materials, and the various maskers used. Lastly, inhibitory control had some impact on performance in the low-context speech material when masked with an informational masker. Conclusion Different background noises, especially informational maskers, affect speech recognition and self-rated listening effort differently depending on age, hearing ability, and individual variation in WMC and inhibitory control.

The Swedish hearing in noise test for children, HINT-C.

OBJECTIVE: The aim of this study was to develop and evaluate a Swedish version of the Hearing In Noise Test for Children (HINT-C). DESIGN: In the first part, the Swedish HINT lists for adults was evaluated by children at three signal to noise ratios (SNRs), -4, -1 and +2 dB. Lists including sentences not reaching 50% recognition at +2 dB SNR were excluded and the rest constituted the HINT-C. In the second part, HINT-C was evaluated in children and adults using an adaptive procedure to determine the SNR for 50% correctly repeated sentences. Study Sample In the first part, 112 children aged 6-11 years participated while another 28 children and 9 adults participated in the second part. RESULTS: Eight out of 24 tested adult HINT lists did not reach the inclusion criteria. The remaining 16 lists formed the Swedish HINT-C which was evaluated in children 6-11 years old. A regression analysis showed that the predicted SNR threshold (dB) was 0.495-0.365*age (years + months/12) and the children reached the mean adult score at an age of 10.5 years. CONCLUSIONS: A Swedish version of HINT-C was developed and evaluated in children six years and older.

Cognitive development, reading and prosodic skills in children with cochlear implants.

This report summarizes some of the results of studies in our laboratory exploring the development of cognitive, reading and prosodic skills in children with cochlear implantation (CI). The children with CI performed at significantly lower levels than the hearing comparison group on the majority of cognitive tests, despite showing levels of nonverbal ability. The differences between children with CI and hearing children were most pronounced on tasks with relatively high phonological processing demands, but they were not limited to phonological processing. Impairment of receptive and productive prosody was also evident in children with CI. Despite these difficulties, 75% of the children with CI reached a level of reading skill comparable to that of hearing children. The results are discussed with respect to compensation strategies in reading.

The interference of different background noises on speech processing in elderly hearing impaired subjects.

The objective of the investigation is to study the interference of different background noises on speech processing. For this purpose speech recognition with the Hagerman test and a test battery with speech comprehension tasks (SVIPS) were performed in speech-weighted background noises varying in temporal structure, signal-to-noise ratio (SNR), and meaningfulness. With different test criteria and a score of perceived effort, the aim was to get a more complete picture of speech comprehension under adverse listening situations. Twenty-four subjects, aged 56-83 years, with a bilateral sensorineural hearing impairment, participated in the study. Differences in performance between the different background noises varied depending on the speech processing task, SNR, and on quantitative versus qualitative outcome measures. Age effects were seen in the Hagerman test and especially in background conditions of modulated noises (speech and reversed speech). Findings are discussed in relation to a hypothesis suggesting that masking and distraction interference from background noises on speech processing at peripheral, central auditory, and cognitive levels depends on the SNR used and the noise type and the listening task.

Cognitive development in children with cochlear implants: relations to reading and communication.

The purpose of the present article is to present an overview of a set of studies conducted in our own laboratory on cognitive and communicative development in children with cochlear implants (CI). The results demonstrate that children with CIs perform at significantly lower levels on the majority of the cognitive tasks. The exceptions to this trend are tasks with relatively lower demands on phonological processing. A fairly high proportion of the children can reach a level of reading comprehension that matches hearing children, despite the fact that they have relatively poor phonological skills. General working memory capacity is further correlated with the type of questions asked in a referential communication task. The results are discussed with respect to issues related to education and rehabilitation.

Implicit memory bias for eating- and body appearance-related sentences in eating disorders: an application of Jacoby's white noise task.

Jacoby's white noise task and an explicit recognition task were used to investigate whether individuals with eating disorders demonstrate implicit memory bias and explicit memory bias, respectively, for information related to eating and body appearance. Included were 33 women with eating disorders (seven with anorexia nervosa and 26 with bulimia nervosa), 29 with nonclinical eating disorder-related concerns, and 36 healthy controls. Results showed partial support for implicit memory bias but no support for explicit memory bias. These findings suggest that eating disorders may be characterized by relative initial automatic bias for eating disorder-relevant information but not by bias at later stages of information processing. However, previous studies have demonstrated explicit memory bias in eating disorders, which is inconsistent with this interpretation. Future research is required to clarify the precise cognitive biases associated with eating disorders.

Assessing speech perception in Swedish school-aged children: preliminary data on the Listen-Say test.

To meet the need for a linguistic speech perception test in Swedish, the 'Listen-Say test' was developed. Minimal word pairs were used as speech material to assess seven phonetic contrasts in two auditory backgrounds. In the present study, children's speech discrimination skills in quiet and in four-talker (4T) speech background were examined. Associations with lexical-access skills and academic achievement were explored. The study included 27 school children 7-9 years of age. Overall, the children discriminated phonetic contrasts well in both conditions (quiet: Mdn 95%; 4T speech; Mdn 91% correct). A significant effect of 4T speech background was evident in three of the contrasts, connected to place of articulation, voicing and syllable complexity. Reaction times for correctly identified target words were significantly longer in the quiet condition, possibly reflecting a need for further balancing of the test order. Overall speech discrimination accuracy was moderately to highly correlated with lexical-access ability. Children identified as having high concentration ability by their teacher had the highest speech discrimination scores in both conditions followed by children identified as having high reading ability. The first wave of data collection with the Listen-Say test indicates that the test appears to be sensitive to predicted perceptual difficulties of phonetic contrasts particularly in noise. The clinical benefit of using a procedure where speech discrimination, lexical-access ability and academic achievement are taken into account is discussed as well as issues for further test refinement.

Working Memory, Sleep, and Hearing Problems in Patients with Tinnitus and Hearing Loss Fitted with Hearing Aids.

BACKGROUND: Tinnitus is a common condition and there is a need to evaluate effects of tinnitus management in relation to moderating factors such as degree of hearing loss. As it is possible that tinnitus influences concentration, and thus is likely to disturb cognitive processing, the role of cognitive functioning also needs to be investigated. PURPOSE: To compare a group of patients with sensorineural hearing loss and tinnitus to a control group with only sensorineural hearing loss (and no tinnitus). To investigate working memory, sleep, and hearing problems measured before and after hearing rehabilitation. RESEARCH DESIGN: A prospective study. STUDY SAMPLE: The sample consisted of 100 patients, 50 with hearing loss and tinnitus, and 50 controls with hearing loss but no tinnitus. All patients were between 40 and 82 yr old and had a pure-tone average (PTA; average of 0.5, 1, 2, and 4 kHz) <70 dB HL. INTERVENTION: Patients were tested before and after rehabilitation with hearing aids with regard to their working memory capacity, sleep quality, hearing problems, speech recognition, and tinnitus annoyance. DATA COLLECTION AND ANALYSIS: Eight patients dropped out of the study. Thus, a total of 92 patients were included for analysis, with 46 in each group. As a consequence of unplanned age and PTA differences between the groups, an age-matched subsample (n = 30 + 30) was selected for further analysis. Tests including the Reading Span, Hearing-in-Noise Test (HINT), Tinnitus Handicap Inventory (THI), Hearing Handicap Inventory for the Elderly (HHIE), and Pittsburgh Sleep Quality Index (PSQI) were administered before and after hearing aid rehabilitation. RESULTS: There were no between-group differences at baseline in the full sample (n = 92), with the exception of the THI (p < 0.001) and the PSQI (p < 0.002), on which the hearing loss and tinnitus group had significantly higher scores. Pre/post changes were significant for both groups on the Reading Span, and HHIE. However, these improvements were significantly larger for the patients in the hearing loss and tinnitus group on the Reading Span test (p < 0.001) and the PSQI (p < 0.001). Patients with tinnitus and hearing loss also exhibited significantly improved THI scores at follow-up, compared to baseline (p < 0.001). We conducted the same analyses for the age-matched subsample (n = 30 + 30). For the baseline data, only the THI (p < 0.001) and the PSQI (p < 0.015) difference remained significant. With regard to the pre/post changes, we found the same differences in improvement in Reading Span (p < 0.001) and the PSQI (p < 0.015) as in the full sample. CONCLUSIONS: Patients with tinnitus benefited from hearing aid rehabilitation. The observed differences in cognitive function were unexpected, and there were larger score improvements on the Reading Span test in the hearing loss and tinnitus group than in the hearing loss group. Patients with tinnitus and hearing loss may receive extra benefit in terms of cognitive function following hearing aid rehabilitation.

The Efficacy of Short-term Gated Audiovisual Speech Training for Improving Auditory Sentence Identification in Noise in Elderly Hearing Aid Users.

This study aimed to examine the efficacy and maintenance of short-term (one-session) gated audiovisual speech training for improving auditory sentence identification in noise in experienced elderly hearing-aid users. Twenty-five hearing aid users (16 men and 9 women), with an average age of 70.8 years, were randomly divided into an experimental (audiovisual training, n = 14) and a control (auditory training, n = 11) group. Participants underwent gated speech identification tasks comprising Swedish consonants and words presented at 65 dB sound pressure level with a 0 dB signal-to-noise ratio (steady-state broadband noise), in audiovisual or auditory-only training conditions. The Hearing-in-Noise Test was employed to measure participants' auditory sentence identification in noise before the training (pre-test), promptly after training (post-test), and 1 month after training (one-month follow-up). The results showed that audiovisual training improved auditory sentence identification in noise promptly after the training (post-test vs. pre-test scores); furthermore, this improvement was maintained 1 month after the training (one-month follow-up vs. pre-test scores). Such improvement was not observed in the control group, neither promptly after the training nor at the one-month follow-up. However, no significant between-groups difference nor an interaction between groups and session was observed. CONCLUSION: Audiovisual training may be considered in aural rehabilitation of hearing aid users to improve listening capabilities in noisy conditions. However, the lack of a significant between-groups effect (audiovisual vs. auditory) or an interaction between group and session calls for further research.

Spectrotemporal Modulation Sensitivity as a Predictor of Speech-Reception Performance in Noise With Hearing Aids.

The audiogram predicts <30% of the variance in speech-reception thresholds (SRTs) for hearing-impaired (HI) listeners fitted with individualized frequency-dependent gain. The remaining variance could reflect suprathreshold distortion in the auditory pathways or nonauditory factors such as cognitive processing. The relationship between a measure of suprathreshold auditory function-spectrotemporal modulation (STM) sensitivity-and SRTs in noise was examined for 154 HI listeners fitted with individualized frequency-specific gain. SRTs were measured for 65-dB SPL sentences presented in speech-weighted noise or four-talker babble to an individually programmed master hearing aid, with the output of an ear-simulating coupler played through insert earphones. Modulation-depth detection thresholds were measured over headphones for STM (2cycles/octave density, 4-Hz rate) applied to an 85-dB SPL, 2-kHz lowpass-filtered pink-noise carrier. SRTs were correlated with both the high-frequency (2-6 kHz) pure-tone average (HFA; R2 = .31) and STM sensitivity (R2 = .28). Combined with the HFA, STM sensitivity significantly improved the SRT prediction (ΔR2 = .13; total R2 = .44). The remaining unaccounted variance might be attributable to variability in cognitive function and other dimensions of suprathreshold distortion. STM sensitivity was most critical in predicting SRTs for listeners < 65 years old or with HFA <53 dB HL. Results are discussed in the context of previous work suggesting that STM sensitivity for low rates and low-frequency carriers is impaired by a reduced ability to use temporal fine-structure information to detect dynamic spectra. STM detection is a fast test of suprathreshold auditory function for frequencies <2 kHz that complements the HFA to predict variability in hearing-aid outcomes for speech perception in noise.

Native and Non-native Speech Perception by Hearing-Impaired Listeners in Noise- and Speech Maskers.

This study evaluated how hearing-impaired listeners perceive native (Swedish) and nonnative (English) speech in the presence of noise- and speech maskers. Speech reception thresholds were measured for four different masker types for each target language. The maskers consisted of stationary and fluctuating noise and two-talker babble in Swedish and English. Twenty-three hearing-impaired native Swedish listeners participated, aged between 28 and 65 years. The participants also performed cognitive tests of working memory capacity in Swedish and English, nonverbal reasoning, and an English proficiency test. Results indicated that the speech maskers were more interfering than the noise maskers in both target languages. The larger need for phonetic and semantic cues in a nonnative language makes a stationary masker relatively more challenging than a fluctuating-noise masker. Better hearing acuity (pure tone average) was associated with better perception of the target speech in Swedish, and better English proficiency was associated with better speech perception in English. Larger working memory and better pure tone averages were related to the better perception of speech masked with fluctuating noise in the nonnative language. This suggests that both are relevant in highly taxing conditions. A large variance in performance between the listeners was observed, especially for speech perception in the nonnative language.

Subjective ratings of masker disturbance during the perception of native and non-native speech.

The aim of the present study was to address how 43 normal-hearing (NH) and hearing-impaired (HI) listeners subjectively experienced the disturbance generated by four masker conditions (i.e., stationary noise, fluctuating noise, Swedish two-talker babble and English two-talker babble) while listening to speech in two target languages, i.e., Swedish (native) or English (non-native). The participants were asked to evaluate their noise-disturbance experience on a continuous scale from 0 to 10 immediately after having performed each listening condition. The data demonstrated a three-way interaction effect between target language, masker condition, and group (HI versus NH). The HI listeners experienced the Swedish-babble masker as significantly more disturbing for the native target language (Swedish) than for the non-native language (English). Additionally, this masker was significantly more disturbing than each of the other masker types during the perception of Swedish target speech. The NH listeners, on the other hand, indicated that the Swedish speech-masker was more disturbing than the stationary and the fluctuating noise-maskers for the perception of English target speech. The NH listeners perceived more disturbance from the speech maskers than the noise maskers. The HI listeners did not perceive the speech maskers as generally more disturbing than the noise maskers. However, they had particular difficulty with the perception of native speech masked by native babble, a common condition in daily-life listening conditions. These results suggest that the characteristics of the different maskers applied in the current study seem to affect the perceived disturbance differently in HI and NH listeners. There was no general difference in the perceived disturbance across conditions between the HI listeners and the NH listeners.

The influence of non-native language proficiency on speech perception performance.

The present study examined to what extent proficiency in a non-native language influences speech perception in noise. We explored how English proficiency affected native (Swedish) and non-native (English) speech perception in four speech reception threshold (SRT) conditions, including two energetic (stationary, fluctuating noise) and two informational (two-talker babble Swedish, two-talker babble English) maskers. Twenty-three normal-hearing native Swedish listeners participated, age between 28 and 64 years. The participants also performed standardized tests in English proficiency, non-verbal reasoning and working memory capacity. Our approach with focus on proficiency and the assessment of external as well as internal, listener-related factors allowed us to examine which variables explained intra- and interindividual differences in native and non-native speech perception performance. The main result was that in the non-native target, the level of English proficiency is a decisive factor for speech intelligibility in noise. High English proficiency improved performance in all four conditions when the target language was English. The informational maskers were interfering more with perception than energetic maskers, specifically in the non-native target. The study also confirmed that the SRT's were better when target language was native compared to non-native.

Gated auditory speech perception in elderly hearing aid users and elderly normal-hearing individuals: effects of hearing impairment and cognitive capacity.

This study compared elderly hearing aid (EHA) users and elderly normal-hearing (ENH) individuals on identification of auditory speech stimuli (consonants, words, and final word in sentences) that were different when considering their linguistic properties. We measured the accuracy with which the target speech stimuli were identified, as well as the isolation points (IPs: the shortest duration, from onset, required to correctly identify the speech target). The relationships between working memory capacity, the IPs, and speech accuracy were also measured. Twenty-four EHA users (with mild to moderate hearing impairment) and 24 ENH individuals participated in the present study. Despite the use of their regular hearing aids, the EHA users had delayed IPs and were less accurate in identifying consonants and words compared with the ENH individuals. The EHA users also had delayed IPs for final word identification in sentences with lower predictability; however, no significant between-group difference in accuracy was observed. Finally, there were no significant between-group differences in terms of IPs or accuracy for final word identification in highly predictable sentences. Our results also showed that, among EHA users, greater working memory capacity was associated with earlier IPs and improved accuracy in consonant and word identification. Together, our findings demonstrate that the gated speech perception ability of EHA users was not at the level of ENH individuals, in terms of IPs and accuracy. In addition, gated speech perception was more cognitively demanding for EHA users than for ENH individuals in the absence of semantic context.

Cognitive and linguistic skills in Swedish children with cochlear implants - measures of accuracy and latency as indicators of development.

The purpose of the present study was to examine working memory (WM) capacity, lexical access and phonological skills in 19 children with cochlear implants (CI) (5;7-13;4 years of age) attending grades 0-2, 4, 5 and 6 and to compare their performance with 56 children with normal hearing. Their performance was also studied in relation to demographic factors. The findings indicate that children with CI had visuospatial WM capacities equivalent to the comparison group. They had lower performance levels on most of the other cognitive tests. Significant differences between the groups were not found in all grades and a number of children with CI performed within 1 SD of the mean of their respective grade-matched comparison group on most of the cognitive measures. The differences between the groups were particularly prominent in tasks of phonological WM. The results are discussed with respect to the effects of cochlear implants on cognitive development.

A Swedish version of the Hearing In Noise Test (HINT) for measurement of speech recognition.

A Swedish Hearing In Noise Test (HINT), consisting of everyday sentences to be used in an adaptive procedure to estimate the speech recognition thresholds in noise and quiet, has been developed. The material consists of 250 sentences, with a length of five to nine syllables, normalized for naturalness, difficulty and reliability. The sentences were recorded with a female speaker. From the sentences, 25 phonemically balanced lists were created. All lists fluctuate less than 1 dB of the overall mean. The standard deviation of the test-retest difference is 0.94 dB when testing with one list, and decreases to 0.68 dB and 0.56 dB for two and three lists, respectively. The average speech recognition thresholds in noise for the Swedish sentences were -3.0 dB signal/noise ratio (SD=1.1 dB). The present study has resulted in a well-defined and internationally comparable set of sentences, which can be used in Swedish audiological rehabilitation and research to measure speech recognition in noise and quiet.