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.

The P300 Auditory Evoked Potential: A Physiological Measure of the Engagement of Cognitive Systems Contributing to Listening Effort?

OBJECTIVES: This study aimed to explore the potential of the P300 (P3b) as a physiological measure of the engagement of cognitive systems contributing to listening effort. DESIGN: Nineteen right-handed young adults (mean age: 24.79 years) and 20 right-handed older adults (mean age: 58.90 years) with age-appropriate hearing were included. The P300 was recorded at Fz, Cz, and Pz using a two-stimulus oddball paradigm with the Flemish monosyllabic numbers "one" and "three" as standard and deviant stimuli, respectively. This oddball paradigm was conducted in three listening conditions, varying in listening demand: one quiet and two noisy listening conditions (+4 and -2 dB signal to noise ratio [SNR]). At each listening condition, physiological, behavioral, and subjective tests of listening effort were administered. P300 amplitude and latency served as a potential physiological measure of the engagement of cognitive systems contributing to listening effort. In addition, the mean reaction time to respond to the deviant stimuli was used as a behavioral listening effort measurement. Last, subjective listening effort was administered through a visual analog scale. To assess the effects of listening condition and age group on each of these measures, linear mixed models were conducted. Correlation coefficients were calculated to determine the relationship between the physiological, behavioral, and subjective measures. RESULTS: P300 amplitude and latency, mean reaction time, and subjective scores significantly increased as the listening condition became more taxing. Moreover, a significant group effect was found for all physiological, behavioral, and subjective measures, favoring young adults. Last, no clear relationships between the physiological, behavioral, and subjective measures were found. CONCLUSIONS: The P300 was considered a physiological measure of the engagement of cognitive systems contributing to listening effort. Because advancing age is associated with hearing loss and cognitive decline, more research is needed on the effects of all these variables on the P300 to further explore its usefulness as a listening effort measurement for research and clinical purposes.

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 Views and Experience of Audiologists Working in Flemish Hearing Aid Centers Concerning Cognition Within Audiological Practice.

PURPOSE: This study aimed to get insight into the views and experience of audiologists, employed in Flemish hearing aid centers, concerning cognition within audiological practice. METHOD: An online 49-item questionnaire was developed and subdivided into five categories: (a) work setting, (b) practical experience regarding hearing aid fitting linked to cognition, (c) knowledge regarding the auditory-cognitive perspective of speech understanding, (d) willingness and guidelines to implement cognitive measures within audiological practice, and (e) demographics. Respondents were surveyed during January and February 2021. RESULTS: One hundred twenty-nine audiologists working in Flemish hearing aid centers responded to the entire questionnaire and showed a mean work experience of 8.0 years. Results revealed that cognition was taken into account, especially within the anamnesis interview and general communication strategy, whereas only a minority took cognition into account when actually fitting hearing aids. Knowledge and experience did not determine whether or not respondents took cognition into account. A willingness to implement cognitive measures in a time-efficient manner in audiological practice was observed among respondents. CONCLUSION: Evidence-based guidelines regarding hearing aid fitting based on an individual's auditory-cognitive profile are needed to improve the quality of hearing rehabilitation. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19593388.

Investigation of the Relation Between Tinnitus, Cognition, and the Amount of Listening Effort.

PURPOSE: This study aimed to investigate the effect of chronic tinnitus on measures of listening effort and cognitive performance, as well as the relation between cognitive performance and the amount of listening effort obtained by those measures. METHOD: Thirteen normal-hearing young adults with chronic tinnitus were matched with a control group. First, behavioral listening effort was measured using a dual-task paradigm in various favorable and unfavorable listening conditions. Furthermore, verbal working memory, processing speed, selective attention, and cognitive flexibility and inhibition were evaluated. RESULTS: A significant and nonsignificant trend toward more listening effort in the tinnitus group was, respectively, found for the quiet listening condition and the condition with a signal-to-noise ratio of +2 dB. No significant differences in cognitive performances were found between the groups, nor were there significant relationships between the cognitive factors and listening effort scores for either the control or tinnitus group. CONCLUSIONS: Listening effort was increased in the tinnitus group. Although no clear differences in cognitive performance could be found between the tinnitus group and their controls, a trend could be seen whereby selective attention deficits in the subjects with tinnitus may be an important factor that affects the amount of listening effort.

Listening Effort Measured Using a Dual-task Paradigm in Adults With Different Amounts of Noise Exposure.

OBJECTIVES: Excessive noise levels can result in hearing damage and/or hearing-related symptoms, thereby leading to impaired communication and, eventually a decrease in the quality of life. Moreover, in daily practice, subjects often indicate that listening in noisy situations is a challenging and often exhausting experience, even in the absence of a clinically significant hearing loss. Hence, a person's perceived difficulty of the listening situation will also be important to consider. It has been suggested that beyond the peripheral factors, there are some central cognitive correlates of speech understanding that are essential for communication abilities. The aim of the present study was to evaluate the effect of the amount of noise exposure on hearing as measured by pure-tone audiometry and otoacoustic emissions (OAEs) on the one hand and listening effort measured using a dual-task paradigm on the other hand. DESIGN: The study included 152 adults between 18 and 40 years of age. First, participants completed a self-administered questionnaire regarding the amount of noise exposure. Second, hearing status was evaluated using pure-tone audiometry and transient evoked OAEs (TEOAEs) as well as distortion product OAEs (DPOAEs). Finally, listening effort was evaluated using a dual-task paradigm, which consisted of a primary speech-recognition task in different listening conditions and a secondary visual memory task that were performed both separately and simultaneously. Based on the quartiles of their subjective estimation of noise exposure, the participants were categorized into a group with low noise exposure (lower quartile), moderate noise exposure (two middle quartiles), and high noise exposure (upper quartile). RESULTS: There was no significant difference in hearing thresholds between the participants with low, moderate, and high noise exposure for each frequency of the pure-tone audiometry. In contrast, more absent TEOAEs and DPOAEs were found in the high noise exposed group. Regarding the primary speech-recognition task of the dual-task paradigm, no significant difference in speech recognition was found between the different groups of noise exposure. For the amount of listening effort, it was found that across all listening conditions subjects with high noise exposure expend significantly more listening effort compared with subjects with low and moderate noise exposure. CONCLUSIONS: This study is a first exploration of the effects of different amounts of noise exposure on listening effort showing that, listening effort is increased in subjects with high noise exposure compared with subjects with low and medium noise exposure. The most plausible hypothesis pertains to an effect of noise exposure on the peripheral and central auditory system, or a combination of effects on both the auditory system and the high-level cognitive functions necessary for speech understanding in the subjects with high levels of noise exposure. As such, a test for listening effort would be useful as part of a comprehensive test battery within the assessment of subjects exposed to noise.

Visual and Verbal Working Memory and Processing Speed Across the Adult Lifespan: The Effect of Age, Sex, Educational Level, Awakeness, and Hearing Sensitivity.

Objective: To strengthen future methodological choices regarding the measurement of cognition within the field of audiology, the current study aimed to examine the effect of, among other things, hearing sensitivity on the backward corsi tapping task (i.e., visual working memory and processing speed) and the letter-number sequencing task (i.e., verbal working memory and processing speed). Design and Study Sample: The backward corsi tapping task and the letter-number sequencing task were administered to 184 participants, aged between 18 and 69 years. The effect of age, sex, educational level, awakeness, and hearing sensitivity on verbal and visual working memory and processing speed was assessed using stepwise multiple regression analyses. Results: For all outcome variables, a decrease in performance was observed with increasing age. For visual and verbal working memory, males outperformed females, whereas no clear sex effect was observed for visual and verbal processing speed. Hearing sensitivity had only a significant impact on visual processing speed. Conclusion: The importance to evaluate cognitive construct validity within audiological research was highlighted. Further research should focus on investigating the associations between speech understanding on the one hand and the backward corsi tapping task and letter-number sequencing task on the other hand.

The Effect of Cognition on the Aided Benefit in Terms of Speech Understanding and Listening Effort Obtained With Digital Hearing Aids: A Systematic Review.

Purpose Hearing aids are the primary rehabilitation devices used to compensate for presbycusis, though large intersubject variability in hearing aid benefit has been reported. This systematic review aimed to investigate how intersubject differences in cognition could influence the aided benefit for speech understanding and listening effort with bilateral digital hearing aids. Method Articles were selected through systematic searches in MEDLINE, Embase, Central, and reference lists. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Results The initial search resulted in 1,092 unique hits, of which 16 were included. The effect of cognition on the aided benefit in terms of speech understanding and listening effort was examined in 12 and four studies, respectively. The aided speech and listening effort benefit obtained from hearing aid use in general or from a specific digital feature (i.e., microphone directionality, noise reduction, amplitude compression, and frequency compression) was associated with four cognitive functions (i.e., working memory, processing speed, selective attention, and executive functions). Conclusions Hearing aid users with poorer cognitive functioning derived more aided benefit in terms of speech understanding from hearing aid settings facilitating the matching process between the incoming auditory signal and representations stored in long-term memory. However, since the number of included studies was limited, this trend should be interpreted with caution. Supplemental Material https://doi.org/10.23641/asha.13626509.

An Auditory Stroop Test to Implement in Cognitive Hearing Sciences: Development and Normative Data.

OBJECTIVE: This study developed and gained insight in an auditory Stroop test, implementable in cognitive hearing sciences. METHODS: An auditory Stroop test was developed and performed in 178 participants, aged between 18 and 69 years. This Auditory Stroop test consisted of two tests: Stroop-tones and Stroop-words whereby the pitch of pure-tones and spoken words (i.e., the words high and low) had to be identified by high or low, respectively. An interference score was calculated as a measure of verbal executive functioning. Regression models were conducted to examine the effect of age, sex, education, awakeness, hearing, as well as visual and verbal working memory, and processing speed on the auditory Stroop scores. Normative data were obtained per age decade. RESULTS: Compared to the visual counterparts, the auditory Stroop outcomes were better predicted by verbal working memory and processing speed. A trend was observed showing a decrease in performances with increasing age. No other participant-related variables had a significant relationship with the auditory Stroop test. CONCLUSION: This auditory Stroop test was considered a good test for measuring executive functioning using auditory stimuli. Implementing this auditory Stroop test within cognitive hearing sciences will contribute to unravel the auditory-cognitive perspective of speech understanding.

OBJETIVO: Este estudio desarrolló y alcanzó un claro entendimiento en una prueba auditiva de Stroop, implementable en las ciencias auditivas cognitivas. MÉTODOS: Se desarrolló un test auditivo de Stroop y se aplicó en 178 participantes entre los 18 y los 69 años de edad. Este test auditivo de Stroop constaba dos pruebas, a saber: Stroop-tonos y Stroop-palabras. El tono de los tonos puros y de las palabras habladas (es decir, las palabras alto y bajo) tenían que ser identificadas por alto o bajo, respectivamente. Se calculó una puntuación de interferencia como medida del funcionamiento ejecutivo verbal. Se realizaron modelos de regresión para examinar el efecto de la edad, el sexo, la educación, la vigilia, la audición, así como la memoria de trabajo visual y verbal y la velocidad de procesamiento en todas las puntuaciones auditivas de Stroop. Se obtuvieron datos normativos por década. RESULTADOS: Los resultados del Stroop auditivo podrían predecirse mejor por la memoria de trabajo verbal y la velocidad de procesamiento en comparación con las contrapartes visuales. Se observó una tendencia que mostraba una disminución de los resultados con el aumento de la edad. Ninguna otra variable relacionada con los participantes parecía tener una relación significativa con la prueba auditiva de Stroop. CONCLUSIÓN: Este test auditivo de Stroop se consideró una buena prueba para medir el funcionamiento ejecutivo utilizando estímulos auditivos. La aplicación de esta prueba auditiva de Stroop dentro de las ciencias auditivas cognitivas contribuirá a desentrañar la perspectiva auditivo-cognitiva de la comprensión del habla.