Auditory, Visual, and Cognitive Abilities in Normal-Hearing Adults, Hearing Aid Users, and Cochlear Implant Users.

OBJECTIVES: Speech understanding is considered a bimodal and bidirectional process, whereby visual information (i.e., speechreading) and also cognitive functions (i.e., top-down processes) are involved. Therefore, the purpose of the present study is twofold: (1) to investigate the auditory (A), visual (V), and cognitive (C) abilities in normal-hearing individuals, hearing aid (HA) users, and cochlear implant (CI) users, and (2) to determine an auditory, visual, cognitive (AVC)-profile providing a comprehensive overview of a person's speech processing abilities, containing a broader variety of factors involved in speech understanding. DESIGN: Three matched groups of subjects participated in this study: (1) 31 normal-hearing adults (mean age = 58.76), (2) 31 adults with moderate to severe hearing loss using HAs (mean age = 59.31), (3) 31 adults with a severe to profound hearing loss using a CI (mean age = 58.86). The audiological assessments consisted of pure-tone audiometry, speech audiometry in quiet and in noise. For evaluation of the (audio-) visual speech processing abilities, the Test for (Audio) Visual Speech perception was used. The cognitive test battery consisted of the letter-number sequencing task, the letter detection test, and an auditory Stroop test, measuring working memory and processing speed, selective attention, and cognitive flexibility and inhibition, respectively. Differences between the three groups were examined using a one-way analysis of variance or Kruskal-Wallis test, depending on the normality of the variables. Furthermore, a principal component analysis was conducted to determine the AVC-profile. RESULTS: Normal-hearing individuals scored better for both auditory, and cognitive abilities compared to HA users and CI users, listening in a best aided condition. No significant differences were found for speech understanding in a visual condition, despite a larger audiovisual gain for the HA users and CI users. Furthermore, an AVC-profile was composed based on the different auditory, visual, and cognitive assessments. On the basis of that profile, it is possible to determine one comprehensive score for auditory, visual, and cognitive functioning. In the future, these scores could be used in auditory rehabilitation to determine specific strengths and weaknesses per individual patient for the different abilities related to the process of speech understanding in daily life. CONCLUSIONS: It is suggested to evaluate individuals with hearing loss from a broader perspective, considering more than only the typical auditory abilities. Also, cognitive and visual abilities are important to take into account to have a more complete overview of the speech understanding abilities in daily life.

The effect of age on the hearing-related quality of life in normal-hearing adults.

INTRODUCTION: Recently, a new holistic Patient Reported Outcome Measure (PROM) to assess hearing-related quality of life was developed, named the hearing-related quality of life questionnaire for Auditory-VIsual, COgnitive and Psychosocial functioning (hAVICOP). The purpose of the current study was to evaluate if the hAVICOP is sufficiently sensitive to detect an age effect in the hearing-related quality of life. METHODS: One-hundred thirteen normal-hearing participants (mean age: 42.13; range: 19 to 69 years) filled in the entire hAVICOP questionnaire online through the Research Electronic Data Capture surface. The hAVICOP consists of 27 statements, across three major subdomains (auditory-visual, cognitive, and psychosocial functioning), which have to be rated on a visual analogue scale ranging from 0 (rarely to never) to 100 (almost always). Mean scores were calculated for each subdomain separately as well as combined within a total score; the worse one's hearing-related quality of life, the lower the score. Linear regression models were run to predict the hAVICOP total as well as the three subdomain scores from age and sex. RESULTS: A significant main effect of age was observed for the total hAVICOP and all three subdomain scores, indicating a decrease in hearing-related quality of life with increasing age. For none of the analyses, a significant sex effect was found. CONCLUSION: The hAVICOP is sufficiently sensitive to detect an age effect in the hearing-related quality of life within a large group of normal-hearing adults, emphasizing its clinical utility. This age effect on the hearing-related quality of life might be related to the interplay of age-related changes in the bottom-up and top-down processes involved during speech processing.

Development of the hearing-related quality of life questionnaire for auditory-visual, cognitive and psychosocial functioning (hAVICOP).

INTRODUCTION: There is a need for a validated and standardized self-assessment instrument to assess the subjective effect of hearing aid (HA) use and/or cochlear implantation (CI) on different aspects of functioning in daily life. The aim of this study was to develop a new holistic Patient Reported Outcome Measure (PROM) to assess hearing-related quality of life. The new PROM is titled the hearing-related quality of life questionnaire for Auditory-VIsual, COgnitive and Psychosocial functioning (hAVICOP). METHODS: A conceptual framework was set up and test items were prepared per domain. Preliminary testing involved a semi-structured interview-based assessment in normal-hearing and hearing-impaired adults and an expert panel. For the further psychometric evaluation, a new sample of 15 adult HA users, 20 adult CI users and 20 normal-hearing adults filled in the refined version of the hAVICOP, the Speech, Spatial and Qualities of Hearing Scale, the Nijmegen Cochlear Implant Questionnaire and the TNO-AZL Questionnaire for Adult's Health-Related Quality of Life. Based on these results, a factor analysis was conducted and internal consistency, discriminant validity and concurrent construct validity were determined. RESULTS: The final version of the hAVICOP consists of three domains for hearing-related quality of life: (1) auditory-visual functioning, (2) cognitive functioning, and (3) psychosocial functioning. A sufficient internal consistency was found, and discriminant validity and concurrent construct validity were good. CONCLUSIONS: A new PROM to assess hearing-related quality of life was developed, named the hAVICOP. In the future the validity and reliability should be examined further.

The Effects of Age, Gender and Test Stimuli on Visual Speech Perception: A Preliminary Study.

INTRODUCTION: To the best of our knowledge, there is a lack of reliable, validated, and standardized (Dutch) measuring instruments to document visual speech perception in a structured way. This study aimed to: (1) evaluate the effects of age, gender, and the used word list on visual speech perception examined by a first version of the Dutch Test for (Audio-)Visual Speech Perception on word level (TAUVIS-words) and (2) assess the internal reliability of the TAUVIS-words. METHODS: Thirty-nine normal-hearing adults divided into the following 3 age categories were included: (1) younger adults, age 18-39 years; (2) middle-aged adults, age 40-59 years; and (3) older adults, age >60 years. The TAUVIS-words consist of 4 word lists, i.e., 2 monosyllabic word lists (MS 1 and MS 2) and 2 polysyllabic word lists (PS 1 and PS 2). A first exploration of the effects of age, gender, and test stimuli (i.e., the used word list) on visual speech perception was conducted using the TAUVIS-words. A mixed-design analysis of variance (ANOVA) was conducted to analyze the results statistically. Lastly, the internal reliability of the TAUVIS-words was assessed by calculating the Chronbach α. RESULTS: The results revealed a significant effect of the used list. More specifically, the score for MS 1 was significantly better compared to that for PS 2, and the score for PS 1 was significantly better compared to that for PS 2. Furthermore, a significant main effect of gender was found. Women scored significantly better compared to men. The effect of age was not significant. The TAUVIS-word lists were found to have good internal reliability. CONCLUSION: This study was a first exploration of the effects of age, gender, and test stimuli on visual speech perception using the TAUVIS-words. Further research is necessary to optimize and validate the TAUVIS-words, making use of a larger study sample.