Sensorineural hearing loss among children at risk: A 16-year audiological records review in a tertiary referral center.

OBJECTIVES: Hearing loss (HL) constitutes an increasing worldwide health problem. Neonatal hearing screening improved early detection and management to alleviate HL detriments on the person and society. Still, HL in childhood, beyond infancy, is under-investigated, especially in developing countries. This study aimed to explore the prevalence of HL in childhood amongst Jordanian children with HL risk factors and investigate the associated risk factors. METHODS: Retrospective cross-sectional review of audiological records in a tertiary public and teaching hospital. The data of 1307 children aged 0-15 years who underwent audiological assessment from 2000 to 2016 were included. A review of diagnostic audiological and medical records was conducted to investigate the prevalence of sensorineural HL in high-risk (HR) children and the most contributing risk factors. RESULTS: Descriptive statistical analysis showed that the prevalence of sensorineural HL was 29.2% in the study sample. The HL was bilateral in 95% and mild to moderate HL in 73%. The mean age at the diagnosis was around 4.5 years. The most common risk factors were parental concern about their child's hearing, ototoxic drug use, and developmental and speech delay. The Chi-squared test showed that parental concern and ototoxic drug use were associated with an increased probability of having HL. CONCLUSION: The prevalence of HL amongst at-risk children in Jordan is relatively high, and the diagnosis is delayed. The results highlight the importance of implementing a hearing screening program in at-risk children. This needs to start from birth and include a serial follow-up to detect cases of delayed-onset HL.

Insights into perceived listening difficulties post COVID-19 infection: no measurable hearing difficulty on clinical tests despite increased self-reported listening effort.

Objective: The aim was to use a battery of clinic-based auditory assessment procedures to compare participants with and without self-reported hearing difficulties following a confirmed COVID-19 infection. A further aim was to compare the groups on self-reported measures of listening effort and fatigue. Methods: There were 25 participants in each group (age range 20-59 years, 80% females). Participants were recruited after a minimum of 4 weeks of testing positive. Hearing assessment involved tympanometry, acoustic reflex thresholds, pure-tone audiometry (PTA; 0.25-14 kHz), and distortion product otoacoustic emissions (DPOAEs; 0.5-10 kHz). Listening effort was assessed using the Arabic version of the Effort Assessment Scale (EAS-A) and fatigue was assessed using the Arabic version of the Fatigue Assessment Scale (FAS-A). Results: There was no difference between groups on any measure except for greater self-reported listening effort in the perceived hearing difficulty group (p = 0.01). Conclusion: The only difference between groups was self-reported listening effort. This could be due to a subclinical auditory deficit following COVID-19, increased listening effort due to the impact of COVID-19 on cognitive processes, or a psychosomatic response/health anxiety.

Establishing the reliability and the validity of the Arabic translated versions of the Effort Assessment Scale and the Fatigue Assessment Scale.

OBJECTIVE: The aim was to establish the reliability and the validity of Arabic translated versions of the Fatigue Assessment Scale (FAS) and the Effort Assessment Scale (EAS). DESIGN: The FAS and the EAS were translated from the original English following a recommended six-step approach for translating hearing-related questionnaires for different languages. The reliability of the scales was investigated using Cronbach's alpha, item-total correlation, and inter-item correlation. Construct validity was investigated using factor analysis and the hypothesis testing method. STUDY SAMPLE: The translated scales were completed by 146 participants from Jordan and Saudi Arabia (age range 19-86 years old, 39% male). Participants' hearing level ranged from normal to profound. RESULTS: Item 3 in the translated FAS was removed to improve the scale's construct validity. The translated version of the EAS was found to be as reliable and valid as the original EAS. CONCLUSIONS: The availability of standardised versions of the FAS and the EAS provides a quick and easy method for improving hearing rehabilitation in Arabic-speaking countries where audiology services can often be costly and not necessarily accessible to all individuals.

Associations between pre-stimulus alpha power, hearing level and performance in a digits-in-noise task.

OBJECTIVE: Baseline electroencephalography (EEG) alpha power, i.e. that measured prior to stimulus presentation, is a potential objective predictor of task performance. Here we assessed the predictive power of EEG alpha on performance accuracy in a digits-in-noise recognition task, factoring in hearing thresholds and age. DESIGN: EEG alpha power, recorded while participants listened to target digits presented in a noise background, was analysed during two different baseline periods: i) a pre-stimulus baseline (pre-STIM) free from any acoustic stimulus, and ii) a pre-target baseline (pre-TARG) recorded in background noise only. STUDY SAMPLE: Eighty-five participants with either normal hearing or aided hearing impairment (age range: 55-85 years old, 42 male). RESULTS: Hierarchical multiple regression analyses indicated that i) lower hearing thresholds and, to a lesser extent, higher pre-STIM alpha power were associated with improved performance accuracy ii) alpha power in pre-STIM and pre-TARG were highly correlated across individuals but pre-TARG alpha power was not a significant predictor of performance accuracy. CONCLUSION: Investigations of baseline EEG alpha power as a predictor of speech-in-noise performance accuracy should control for associations between hearing thresholds and measures of EEG baseline periods.

Dimensions of self-reported listening effort and fatigue on a digits-in-noise task, and association with baseline pupil size and performance accuracy.

OBJECTIVE: Pupillometry is sensitive to cognitive resource allocation and has been used as a potential measure of listening-related effort and fatigue. We investigated associations between peak pupil diameter, pre-stimulus pupil diameter, performance on a listening task, and the dimensionality of self-reported outcomes (task-related listening effort and fatigue). DESIGN: Pupillometry was recorded while participants performed a speech-in-noise task. Participants rated their experience of listening effort and fatigue using the NASA-Task Load Index (NASA-TLX) and the Visual Analogue Scale of Fatigue (VAS-F), respectively. The dimensionality of the NASA-TLX and the VAS-F was investigated using factor analysis. STUDY SAMPLE: 82 participants with either normal hearing or aided hearing impairment (age range: 55-85 years old, 43 male). RESULTS: Hierarchal linear regression analyses suggested that pre-stimulus pupil diameter predicts a dimension of self-reported fatigue, which we interpreted as tiredness/drowsiness, and listening task performance when controlling for hearing level and age: Larger pre-stimulus pupil diameter was associated with less tiredness/drowsiness and better task performance. CONCLUSION: Pre-stimulus pupil diameter is a potential index of listening fatigue associated with speech processing in challenging listening conditions. To our knowledge, this is the first investigation of the associations between pre-stimulus pupil diameter and self-reported ratings of listening effort and fatigue.

Measures of Listening Effort Are Multidimensional.

OBJECTIVES: Listening effort can be defined as the cognitive resources required to perform a listening task. The literature on listening effort is as confusing as it is voluminous: measures of listening effort rarely correlate with each other and sometimes result in contradictory findings. Here, we directly compared simultaneously recorded multimodal measures of listening effort. After establishing the reliability of the measures, we investigated validity by quantifying correlations between measures and then grouping-related measures through factor analysis. DESIGN: One hundred and sixteen participants with audiometric thresholds ranging from normal to severe hearing loss took part in the study (age range: 55 to 85 years old, 50.3% male). We simultaneously measured pupil size, electroencephalographic alpha power, skin conductance, and self-report listening effort. One self-report measure of fatigue was also included. The signal to noise ratio (SNR) was adjusted at 71% criterion performance using sequences of 3 digits. The main listening task involved correct recall of a random digit from a sequence of six presented at a SNR where performance was around 82 to 93%. Test-retest reliability of the measures was established by retesting 30 participants 7 days after the initial session. RESULTS: With the exception of skin conductance and the self-report measure of fatigue, interclass correlation coefficients (ICC) revealed good test-retest reliability (minimum ICC: 0.71). Weak or nonsignificant correlations were identified between measures. Factor analysis, using only the reliable measures, revealed four underlying dimensions: factor 1 included SNR, hearing level, baseline alpha power, and performance accuracy; factor 2 included pupillometry; factor 3 included alpha power (during speech presentation and during retention); factor 4 included self-reported listening effort and baseline alpha power. CONCLUSIONS: The good ICC suggests that poor test reliability is not the reason for the lack of correlation between measures. We have demonstrated that measures traditionally used as indicators of listening effort tap into multiple underlying dimensions. We therefore propose that there is no "gold standard" measure of listening effort and that different measures of listening effort should not be used interchangeably. When choosing method(s) to measure listening effort, the nature of the task and aspects of increased listening demands that are of interest should be taken into account. The findings of this study provide a framework for understanding and interpreting listening effort measures.

Hearing Handicap and Speech Recognition Correlate With Self-Reported Listening Effort and Fatigue.

OBJECTIVES: To investigate the correlations between hearing handicap, speech recognition, listening effort, and fatigue. DESIGN: Eighty-four adults with hearing loss (65 to 85 years) completed three self-report questionnaires: the Fatigue Assessment Scale, the Effort Assessment Scale, and the Hearing Handicap Inventory for Elderly. Audiometric assessment included pure-tone audiometry and speech recognition in noise. RESULTS: There was a significant positive correlation between handicap and fatigue (r = 0.39, p < 0.05) and handicap and effort (r = 0.73, p < 0.05). There were significant (but lower) correlations between speech recognition and fatigue (r = 0.22, p < 0.05) or effort (r = 0.32, p< 0.05). There was no significant correlation between hearing level and fatigue or effort. CONCLUSIONS: Hearing handicap and speech recognition both correlate with self-reported listening effort and fatigue, which is consistent with a model of listening effort and fatigue where perceived difficulty is related to sustained effort and fatigue for unrewarding tasks over which the listener has low control. A clinical implication is that encouraging clients to recognize and focus on the pleasure and positive experiences of listening may result in greater satisfaction and benefit from hearing aid use.

Self-Reported Listening-Related Effort and Fatigue in Hearing-Impaired Adults.

OBJECTIVE: Hearing loss may increase listening-related effort and fatigue due to the increased mental exertion required to attend to, and understand, an auditory message. Because there have been few attempts to quantify self-reported effort and fatigue in listeners with hearing loss, that was the aim of the present study. DESIGN: Participants included three groups of hearing-impaired adults: (1) hearing aid users (HA, n = 50; 31 male, 19 female; age range = 55 to 85 years); (2) cochlear implant users (CI, n = 50; 26 male, 24 female; age range = 55 to 80 years); and (3) single sided deafness (SSD, n = 50; 30 male, 20 female; age range = 58 to 80 years). There was also a control group of adults who passed a hearing screen at 30 dB HL at the frequencies: 500, 1000, 2000, and 4000 Hz in both ears (n = 50; 22 male, 28 female; age range = 55 to 78 years). The fatigue assessment scale (FAS) was used to quantify fatigue. The FAS is a generic standardized self-report scale consisting of 10 items that are scored using a five-point Likert scale. An effort assessment scale (EAS), developed for the present study, consisted of six questions with responses provided on a visual analog scale that ranges from 0 to 10. RESULTS: All hearing-impaired groups reported significantly increased effort and fatigue compared to the control group. The median fatigue score for the control group was 14 and around 22 for the three hearing-impaired groups. The median effort score for the control group was 20 and around 70 for the three hearing-impaired groups. There was no significant difference in mean effort or fatigue between the three groups of hearing-impaired adults. There was a weak positive correlation between fatigue and effort scores (r = 0.40, p < 0.05). The proportion of participants with extreme fatigue (scores above the 95th percentile of the control group) was 22, 10, and 22%, for the HA, CI, and SSD groups, respectively. The proportion of those with extreme effort was 46, 54, and 52%, for the HA, CI, and SSD groups, respectively. Results of factor analysis using the individual questions from both questionnaires indicated that the questions loaded into two factors: a "fatigue" factor for all of the FAS questions and an "effort" factor for all of the EAS questions. CONCLUSION: Hearing-impaired individuals report high levels of listening effort and fatigue in everyday life. The similarity in listening-related effort and fatigue between the different hearing-impaired groups suggests that these aspects of listening experience are not predicted by the severity of hearing impairment. Factor analysis suggests that the FAS and the EAS assess two distinct dimensions. The low correlation between FAS and EAS means that fatigue cannot be reliably predicted from self-reported effort in individual listeners.