A language-independent hearing screening self-test at school-entry.

The usage of a tablet-based language-independent self-test involving the recognition of ecological sounds in background noise, the Sound Ear Check, was investigated. The results of 692 children, aged between 5 and 9 years and 4 months, recruited in seven different countries, were used to analyze the validity and the cultural independence of test. Three different test procedures, namely a monaural adaptive procedure, a procedure presenting the sounds dichotically in diotic noise, and a procedure presenting all the sounds with a fixed signal-to-noise ratio and a stopping rule were studied. Results showed high sensitivity and specificity of all three procedures to detect conductive, sensorineural and mixed hearing loss > 30 dB HL. Additionally, the data collected from different countries were consistent, and there were no clinically relevant differences observed between countries. Therefore, the Sound Ear Check can offer an international hearing screening test for young children at school entry, solving the current lack of hearing screening services on a global scale.

Is current data sufficient to infer that hearing aids contribute to postural control and balance in older adults? A systematic review.

BACKGROUND: Balance and postural control are related to hearing and hearing loss, but whether they can be improved with hearing-aid use in older adults is not clear. We systematically reviewed controlled studies in which balance and hearing were tested in experienced older hearing aid users to determine the potential effects of hearing-aid use on balance. DESIGN: The review was pre-registered in PROSPERO and performed in accordance with PRISMA. The question, inclusion and exclusion criteria were defined using the Population, Intervention, Control, Outcomes and Study design (PICOS) framework. Older adults with hearing loss with no experience with hearing aids, or balance tests conducted without hearing aids in hearing aid users served as controls. SUMMARY: 803 studies were screened, 8 of which met the inclusion and exclusion criteria and were included in the final review. Five of the eight studies found a significant correlation between the use of hearing aids and the outcomes of the balance tests. The quality of the studies was limited or moderate. KEY MESSAGES: The role of hearing aids in balance and postural control is unclear because of the quality of the papers and the sparse reporting of hearing status and hearing aids quality of fitting and use.

Price reductions in hearing aids and access to audiologists, Israel.

Problem: Hearing rehabilitation with hearing aids is a complex process which requires professional expertise and the involvement of audiologists or hearing-care specialists. Professional care, however, requires extra resources, making it tempting to rely solely on technology and reduce the role of professional counselling. Approach: To reduce the out-of-pocket share for adults needing hearing rehabilitation, in 2011 the Israeli government tripled the subsidy for adult hearing aids by converting 3 years of subsidies into a triennial, enlarged fund. Regulations for providing hearing rehabilitation and a set of rules for tenders for the supply of hearing aids were issued. Local setting: Auditory diagnosis and rehabilitation are included in the Israeli national health insurance system. Before 2011, the annual government-funded subsidy for hearing aids was negligible; hearing aids were expensive and bought mostly with patients' own resources. Relevant changes: A series of tenders for companies to supply hearing aids, aiming to control public and individual expenses, resulted in a large reduction in prices, which in turn raised the demand for hearing aids and increased public expenditure. As the price of hearing aids fell markedly, hearing rehabilitation is approaching a point of becoming limited to supplying hearing devices, while reducing the importance placed on professional elements of the rehabilitation course. Lessons learnt: Lowering out-of-pocket costs for patients should not be the only consideration in hearing rehabilitation. Our goal should be to control public expenditure but also provide affordable hearing aids with sufficient intervention of hearing-care specialists, to ensure access to advanced technologies and proper professional care.

Rapid but specific perceptual learning partially explains individual differences in the recognition of challenging speech.

Perceptual learning for speech, defined as long-lasting changes in speech recognition following exposure or practice occurs under many challenging listening conditions. However, this learning is also highly specific to the conditions in which it occurred, such that its function in adult speech recognition is not clear. We used a time-compressed speech task to assess learning following either brief exposure (rapid learning) or additional training (training-induced learning). Both types of learning were robust and long-lasting. Individual differences in rapid learning explained unique variance in recognizing natural-fast speech and speech-in-noise with no additional contribution for training-induced learning (Experiment 1). Rapid learning was stimulus specific (Experiment 2), as in previous studies on training-induced learning. We suggest that rapid learning is key for understanding the role of perceptual learning in online speech recognition whereas longer training could provide additional opportunities to consolidate and stabilize learning.

Speech Perception in Older Adults: An Interplay of Hearing, Cognition, and Learning?

Older adults with age-related hearing loss exhibit substantial individual differences in speech perception in adverse listening conditions. We propose that the ability to rapidly adapt to changes in the auditory environment (i.e., perceptual learning) is among the processes contributing to these individual differences, in addition to the cognitive and sensory processes that were explored in the past. Seventy older adults with age-related hearing loss participated in this study. We assessed the relative contribution of hearing acuity, cognitive factors (working memory, vocabulary, and selective attention), rapid perceptual learning of time-compressed speech, and hearing aid use to the perception of speech presented at a natural fast rate (fast speech), speech embedded in babble noise (speech in noise), and competing speech (dichotic listening). Speech perception was modeled as a function of the other variables. For fast speech, age [odds ratio (OR) = 0.79], hearing acuity (OR = 0.62), pre-learning (baseline) perception of time-compressed speech (OR = 1.47), and rapid perceptual learning (OR = 1.36) were all significant predictors. For speech in noise, only hearing and pre-learning perception of time-compressed speech were significant predictors (OR = 0.51 and OR = 1.53, respectively). Consistent with previous findings, the severity of hearing loss and auditory processing (as captured by pre-learning perception of time-compressed speech) was strong contributors to individual differences in fast speech and speech in noise perception. Furthermore, older adults with good rapid perceptual learning can use this capacity to partially offset the effects of age and hearing loss on the perception of speech presented at fast conversational rates. Our results highlight the potential contribution of dynamic processes to speech perception.

Plastic changes in speech perception in older adults with hearing impairment following hearing aid use: a systematic review.

OBJECTIVE: Whether hearing aid use in older adults modifies speech perception over time is not clear. To address this question, we systematically reviewed studies in which older first-time hearing aid users and controls were followed over time. DESIGN: The review was pre-registered in PROSPERO and performed in accordance with the statement on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The question, inclusion and exclusion criteria were defined using the Population, Intervention, Control, Outcomes and Study design (PICOS) framework. Studies with no controls, studies in which participants and controls were tested at only one-time point, with no follow-up and no pre-fitting measures, or when outcome measures did not include speech measures, were excluded. STUDY SAMPLE: 6113 studies were screened, out of which 12 studies, published between 1996 and 2021, met the inclusion and exclusion criteria and were included in the final review. RESULTS: 9 of the 12 studies found evidence for amplification-induced auditory plasticity in older adults, expressed in improved speech perception. CONCLUSIONS: The results suggest amplification-induced improvements in speech perception over time, but findings should be interpreted with caution because overall improvements were small, and the studies' quality was moderate.

Rapid Perceptual Learning: A Potential Source of Individual Differences in Speech Perception Under Adverse Conditions?

Challenging listening situations (e.g., when speech is rapid or noisy) result in substantial individual differences in speech perception. We propose that rapid auditory perceptual learning is one of the factors contributing to those individual differences. To explore this proposal, we assessed rapid perceptual learning of time-compressed speech in young adults with normal hearing and in older adults with age-related hearing loss. We also assessed the contribution of this learning as well as that of hearing and cognition (vocabulary, working memory, and selective attention) to the recognition of natural-fast speech (NFS; both groups) and speech in noise (younger adults). In young adults, rapid learning and vocabulary were significant predictors of NFS and speech in noise recognition. In older adults, hearing thresholds, vocabulary, and rapid learning were significant predictors of NFS recognition. In both groups, models that included learning fitted the speech data better than models that did not include learning. Therefore, under adverse conditions, rapid learning may be one of the skills listeners could employ to support speech recognition.

Differences in Working Memory Capacity Affect Online Spoken Word Recognition: Evidence From Eye Movements.

Individual differences in working memory capacity have been gaining recognition as playing an important role in speech comprehension, especially in noisy environments. Using the visual world eye-tracking paradigm, a recent study by Hadar and coworkers found that online spoken word recognition was slowed when listeners were required to retain in memory a list of four spoken digits (high load) compared with only one (low load). In the current study, we recognized that the influence of a digit preload might be greater for individuals who have a more limited memory span. We compared participants with higher and lower memory spans on the time course for spoken word recognition by testing eye-fixations on a named object, relative to fixations on an object whose name shared phonology with the named object. Results show that when a low load was imposed, differences in memory span had no effect on the time course of preferential fixations. However, with a high load, listeners with lower span were delayed by ∼550 ms in discriminating target from sound-sharing competitors, relative to higher span listeners. This follows an assumption that the interference effect of a memory preload is not a fixed value, but rather, its effect is greater for individuals with a smaller memory span. Interestingly, span differences affected the timeline for spoken word recognition in noise, but not offline accuracy. This highlights the significance of using eye-tracking as a measure for online speech processing. Results further emphasize the importance of considering differences in cognitive capacity, even when testing normal hearing young adults.

Age, Hearing, and the Perceptual Learning of Rapid Speech.

The effects of aging and age-related hearing loss on the ability to learn degraded speech are not well understood. This study was designed to compare the perceptual learning of time-compressed speech and its generalization to natural-fast speech across young adults with normal hearing, older adults with normal hearing, and older adults with age-related hearing loss. Early learning (following brief exposure to time-compressed speech) and later learning (following further training) were compared across groups. Age and age-related hearing loss were both associated with declines in early learning. Although the two groups of older adults improved during the training session, when compared to untrained control groups (matched for age and hearing), learning was weaker in older than in young adults. Especially, the transfer of learning to untrained time-compressed sentences was reduced in both groups of older adults. Transfer of learning to natural-fast speech occurred regardless of age and hearing, but it was limited to sentences encountered during training. Findings are discussed within the framework of dynamic models of speech perception and learning. Based on this framework, we tentatively suggest that age-related declines in learning may stem from age differences in the use of high- and low-level speech cues. These age differences result in weaker early learning in older adults, which may further contribute to the difficulty to perceive speech in daily conversational settings in this population.

The Association between Hearing Loss, Postural Control, and Mobility in Older Adults: A Systematic Review.

BACKGROUND: Degraded hearing in older adults has been associated with reduced postural control and higher risk of falls. Both hearing loss (HL) and falls have dramatic effects on older persons' quality of life (QoL). A large body of research explored the comorbidity between the two domains. PURPOSE: The aim of the current review is to describe the comorbidity between HL and objective measures of postural control, to offer potential mechanisms underlying this relationship, and to discuss the clinical implications of this comorbidity. DATA COLLECTION AND ANALYSIS: PubMed and Google Scholar were systematically searched for articles published in English up until October 15, 2015, using combinations of the following strings and search words: for hearing: Hearing loss, "Hearing loss," hearing, presbycusis; for postural control: postural control, gait, postural balance, fall, walking; and for age: elderly, older adults. RESULTS: Of 211 screened articles, 7 were included in the systematic review. A significant, positive association between HL and several objective measures of postural control was found in all seven studies, even after controlling for major covariates. Severity of hearing impairment was connected to higher prevalence of difficulties in walking and falls. Physiological, cognitive, and behavioral processes that may influence auditory system and postural control were suggested as potential explanations for the association between HL and postural control. CONCLUSIONS: There is evidence for the independent relationship between HL and objective measures of postural control in the elderly. However, a more comprehensive understanding of the mechanisms underlying this relationship is yet to be elucidated. Concurrent diagnosis, treatment, and rehabilitation of these two modalities may reduce falls and increase QoL in older adults.

Hearing Aid-Induced Plasticity in the Auditory System of Older Adults: Evidence From Speech Perception.

PURPOSE: We tested whether using hearing aids can improve unaided performance in speech perception tasks in older adults with hearing impairment. METHOD: Unaided performance was evaluated in dichotic listening and speech-in-noise tests in 47 older adults with hearing impairment; 36 participants in 3 study groups were tested before hearing aid fitting and after 4, 8, and 14 weeks of hearing-aid use. The remaining 11 participants served as a control group and were similarly evaluated but were not fitted with hearing aids. Three protocols were compared in the study groups: amplification for the nondominant ear, amplification for the dominant ear, and bilateral amplification. Subsequently, after 4 weeks, all participants were afforded bilateral amplification. RESULTS: In the study groups, unaided dichotic listening scores improved significantly in the nondominant ear by 8 weeks and onward. Significant improvements were also observed for unaided speech identification in noise, with some gains apparent after 4 weeks of hearing-aid use. No gains were observed in the control group. CONCLUSIONS: Using hearing aids for a relatively short period can induce changes in the way older adults process auditory inputs in perceptual tasks such as speech identification in noise and dichotic listening. These changes suggest that the central auditory system of older adults retains the potential for behaviorally relevant plasticity.

How difficult is difficult? Speech perception in noise in the elderly hearing impaired.

BACKGROUND: Perception of speech in the presence of competing multitalker noise is difficult for most individuals with sensory hearing loss, and in particular, for the elderly hearing impaired. Elderly people frequently report that these difficulties are poorly compensated for by hearing aids, albeit the algorithms and technologies aiming to improve speech perception in noise. The aim of the current study was therefore to assess competing speech signals processing by measuring the amount of signal to noise ratio (SNR) loss experienced by elderly hearing impaired individuals and their performance in dichotic listening tests. METHODS: Speech in multitalker babble noise and dichotic listening were assessed in older hearing impaired individuals and in young normal-hearing adults. RESULTS: The average dichotic scores in the elderly group were substantially and significantly lower compared with the scores of the younger group with a significant right ear advantage (higher accuracy in reporting words arriving at the right ear than words arriving at the left ear) in the elderly group. Speech identification in noise in the older group was significantly poorer than in the younger group (SNR loss: 10 dB). CONCLUSIONS: The poor performance in the elderly hearing impaired group highlights the difficulties faced by hearing impaired older adults in demanding listening environments. Our results suggest that it may be unreasonable to expect that elderly hearing impaired individuals may fully understand speech in multitalker environments even when hearing aids are used.

Rapid adaptation to time-compressed speech in young and older adults.

BACKGROUND: The ability of human listeners to comprehend rapid speech improves quickly with experience, a process known as adaptation. Whether inefficient adaptation to rapid speech partially accounts for the marked difficulties of older listeners with rapid speech is not clear. METHODS: Two conditions of adaptation to time-compressed speech were used. A baseline condition intended to test the hypothesis that adaptation is different in older and younger listeners, and an interference condition in which sentences compressed to two different rates were interleaved. Identification accuracy was compared between two time points (before and after adaptation) and between older and younger listeners. RESULTS: The effects of adaptation did not differ between younger and older listeners in either adaptation condition. CONCLUSIONS: It seems that once initial performance differences are taken into account, rapid adaptation to time-compressed speech is as effective and as immune to interference by competing speech rates in younger and older adults.

Better together: reduced compliance after sequential versus simultaneous bilateral hearing aids fitting.

PURPOSE: The purpose of this study was to determine the effects of sequential versus simultaneous bilateral hearing aids fitting on patient compliance. METHOD: Thirty-six older adults with hearing impairment participated in this study. Twelve were fitted with bilateral hearing aids simultaneously. The remaining participants were fitted sequentially: One hearing aid (to the left or to the right ear) was used initially; 1 month later, the other ear was also fitted with a hearing aid for bilateral use. Self-reports on usefulness and compliance were elicited after the first and second months of hearing aid use. In addition, the number of hours the hearing aids were used was extracted from the data loggings of each device. RESULTS: Simultaneous fitting resulted in high levels of compliance and consistent usage throughout the study period. Sequential fitting resulted in abrupt reduction in compliance and hours of use once the second hearing aid was added, both in the clinical scoring and in the data loggings. CONCLUSIONS: Simultaneous fitting of bilateral hearing aids results in better compliance compared with sequential fitting. The addition of a second hearing aid after a relatively short period of monaural use may lead to inconsistent use of both hearing aids.

Semi-structured listening experience (listening training) in hearing aid fitting: influence on dichotic listening.

PURPOSE: In this study, the authors tested whether training with amplified, clear speech in regular room acoustics would result in larger perceptual gains of auditory processing in elderly hearing aid users. METHOD: Elderly participants with hearing impairment (N = 36, ages 64­88) were fitted with bilateral hearing aids and were randomly assigned to 2 unequal groups. Study group participants were provided with 7 sessions (1 month) of individual listening training during which a free conversation was conducted, with the aim of stimulating the amplified ears with verbal auditory input. The control group participants were fitted with hearing aids without training. Auditory processing changes were assessed through the use of dichotic listening tasks. RESULTS: During hearing aid use, dichotic listening scores­tested without the hearing aids­improved in both groups, mainly in the non-dominant ears. The overall dichotic performance was significantly higher in the study group, and the main effect of auditory training was manifested in the scores of the dominant ear. CONCLUSIONS: Hearing aid use may improve auditory processing performance as tested in unaided conditions. Listening training has an additional beneficial effect on the dominant ear­that is, the ear with the lesser potential for improvement. Listening training in elderly adults presumably enhanced the acclimatization process by better recruiting the potential for auditory plasticity and improving attention recruitment.