Ten-year association between change in speech-in-noise recognition and falls due to balance problems: a longitudinal cohort study.

BACKGROUND: This study examined the relationship between speech-in-noise recognition and incident/recurrent falls due to balance problems ten years later (RQ-1); 10-year change in speech-in-noise recognition and falls (RQ-2a), as well as the role of dizziness in this relationship (RQ-2b). The association between hearing aid use and falls was also examined (RQ-3). METHODS: Data was collected from the Netherlands Longitudinal Study on Hearing between 2006 and December 2022. Participants completed an online survey and digits-in-noise test every five years. For this study, data was divided into two 10-year follow-up time intervals: T0 (baseline) to T2 (10-year follow-up), and T1 (5-years) to T3 (15-years). For all RQs, participants aged ≥ 40 years at baseline, without congenital hearing loss, and non-CI users were eligible (n = 592). Additionally, for RQ-3 participants with a speech reception threshold in noise (SRTn) ≥ -5.5 dB signal-to-noise ratio were included (n = 422). Analyses used survey variables on hearing, dizziness, falls due to balance problems, chronic health conditions, and psychosocial health. Logistic regressions using General Estimating Equations were conducted to assess all RQs. RESULTS: Among individuals with obesity, those with poor baseline SRTn had a higher odds of incident falls ten years later (odds ratio (OR):14.7, 95% confidence interval (CI) [2.12, 103]). A 10-year worsening of SRTn was significantly associated with a higher odds of recurrent (OR: 2.20, 95% CI [1.03, 4.71]) but not incident falls. No interaction was found between dizziness and change in SRTn. Hearing aid use (no use/ < 2 years use vs. ≥ 2 years) was not significantly associated with incident nor recurrent falls. Although there was a significant interaction with sex for this association, the effect of hearing aid use on incident/recurrent falls was not statistically significant among males nor females. CONCLUSIONS: A longitudinal association between the deterioration in SRTn and recurrent falls due to balance problems after 10 years was confirmed in this study. This result stresses the importance of identifying declines in hearing earlier and justifies including hearing ability assessments within fall risk prevention programs. Mixed results of hearing aid use on fall risk warrant further investigation into the temporality of this association and possible differences between men and women.

Promoting hearing and cognitive health in audiologic rehabilitation for the well-being of older adults.

OBJECTIVE: With our aging population, an increasing number of older adults with hearing loss have cognitive decline. Hearing care practitioners have an important role in supporting healthy aging and should be knowledgeable about cognitive decline and associated management strategies to maximize successful hearing intervention. METHODS: A review of current research and expert opinion. RESULTS: This article outlines the association between hearing loss and cognitive decline/dementia, hypothesized mechanisms underlying this, and considers current research into the effects of hearing intervention on cognitive decline. Cognition into old age, cognitive impairment, dementia, and how to recognize cognitive decline that is not part of normal aging are described. Screening of older asymptomatic adults for cognitive decline and practical suggestions for the delivery of person-centered hearing care are discussed. Holistic management goals, personhood, and person-centered care in hearing care management are considered for older adults with normal cognitive aging through to dementia. A case study illustrates important skills and potential management methods. Prevention strategies for managing hearing and cognitive health and function through to older age, and strategies to maximize successful hearing aid use are provided. CONCLUSION: This article provides evidence-based recommendations for hearing care professionals supporting older clients to maximize well-being through the cognitive trajectory.

Cohort profile: Netherlands Longitudinal Study on Hearing (NL-SH).

PURPOSE: The Netherlands Longitudinal Study on Hearing (NL-SH) was set up to examine associations of hearing ability with psychosocial, work and health outcomes in working age adults. PARTICIPANTS: Inclusion started in 2006 and is ongoing. Currently the sample comprises 2800 adults with normal and impaired hearing, aged 18-70 years at inclusion. Five-year follow-up started in 2011, 10-year follow-up in 2016 and 15-year follow-up in 2021. All measurements are web-based. Participants perform a speech-in-noise recognition test to measure hearing ability and fill out questionnaires about their hearing status, hearing aid use, self-reported hearing disability and coping, work status and work-related outcomes (work performance, need for recovery), physical and psychosocial health (depression, anxiety, distress, somatisation, loneliness), healthcare usage, lifestyle (smoking, alcohol), and technology use. FINDINGS TO DATE: The NL-SH has shown the vast implications of reduced hearing ability for the quality of life and health of working-age adults. A selection of results published in 27 papers is presented. Age-related deterioration of hearing ability accelerates after the age of 50 years. Having a history of smoking is associated with a faster decline in hearing ability, but this relationship is not found for other cardiovascular risk factors. Poorer hearing ability is associated with increased distress, somatisation, depression and loneliness. Adults with impaired hearing ability are more likely to be unemployed or unfit for work, and need more time to recuperate from work effort. FUTURE PLANS: Participant data will be linked to a national database to enable research on the association between hearing ability and mortality. Linking to environmental exposure data will facilitate insight in relations between environmental factors, hearing ability and psychosocial outcomes. The unique breadth of the NL-SH data will also allow for further research on other functional problems, for instance, hearing ability and fall risk. TRIAL REGISTRATION NUMBER: NL12015.029.06.

The Longitudinal Relationship Between Speech Recognition in Noise, Need for Recovery After Work, Job Demand, and Job Control Over a Period of 5 Years.

OBJECTIVE: Hearing impairment may lead to an increased need to recover from fatigue and distress after a day of work. Also, hearing impairment may negatively affect the balance between workload and control over it (job demand and job control). The uptake of hearing solutions may have a positive effect on these outcomes. We aimed to assess the longitudinal relationship between change in speech recognition in noise and changes in need for recovery after work and job demand and job control, and the influence of hearing solutions on these relationships over a period of 5 years. Research questions (RQs) were as follows: (1) Is a 5-year change in speech recognition in noise associated with a change in need for recovery after work over that same 5-year period?; (2) Is a 5-year change in speech recognition in noise associated with a change in job demand and job control over that same 5-year period?; (3) What is the effect of hearing solution uptake in the 5-year period on the change in these outcomes in that same 5-year period? METHOD: Data of the Netherlands Longitudinal Study on Hearing, collected between 2006 and January 2019, were divided into two 5-year follow-up intervals: T0 (baseline) to T1 (5-year follow-up) and T1 (5-year follow-up) to T2 (10-year follow-up). An online digit-triplet in noise test was used to assess speech recognition in noise. Online questionnaires on demographic, socioeconomic, and work-related characteristics were administered. For RQ1-RQ2, the study sample included adults working ≥12 hours per week, with at least two consecutive measurements (n = 783). For RQ3, employees who had not yet obtained hearing solutions at baseline, but who would be eligible based on a speech reception threshold in noise ≥ -5.5 dB signal-to-noise ratio (SNR), were included (n = 147). Longitudinal linear regression analyses using mixed models were performed to assess RQ1-RQ3. RESULTS: After adjusting for baseline values, 5-year change in speech recognition in noise showed a statistically significant association with 5-year change in need for recovery. A worsening of 1 dB SNR in speech recognition in noise in an individual was associated with an increase of 0.72 units in need for recovery (scale range 0 to 100). A 5-year change in speech recognition in noise was not significantly associated with a 5-year change in job demand or job control. The uptake of hearing solutions in the 5-year period did not have a significant effect on change in need for recovery in that same 5-year period. CONCLUSION: The significant longitudinal association between 5-year worsening in speech recognition in noise and increase in need for recovery over the same time period strengthens the evidence for the importance of early detection of a worsening in speech recognition in noise to identify employees with an increase in need for recovery. The absence of an effect of the uptake of a hearing solution on need for recovery indicates that additional alternative interventions may be needed to foster beneficial use of hearing solutions as well as to mitigate the increased need for recovery in case of worsening speech recognition in noise.

Uptake of Hearing Aids and Hearing Assistive Technology in a Working Population: Longitudinal Analyses of The Netherlands Longitudinal Study on Hearing.

OBJECTIVE: To identify predictors of the 5-year uptake of hearing aids (HAs) and hearing assistive technology (HAT) in a sample of Dutch employees eligible for HAs and/or HAT. The potential predictors included demographic factors (age, sex, marital status, and living situation), education, hearing factors (ability to recognize speech in noise and self-reported hearing disability), distress, self-efficacy, and work-related factors (job demand, job control, and need for recovery). DESIGN: Five-year follow-up data of the Netherlands Longitudinal Study on Hearing (NL-SH) collected until January 2019 were included. An online digit-triplet in noise test, the National Hearing Test (NHT), was used to assess speech-recognition-in-noise ability. In addition, online questionnaires on demographic, socioeconomic, self-reported hearing disability, health, and work-related characteristics were administered. Adults who worked over 12 hours per week, who had not yet taken up HAs or HAT, but who would be eligible for HAs/HAT based on their NHT score (insufficient or poor hearing ability), were included in the study. The 5-year uptake of HAs/HAT was defined as a dichotomous variable of self-reported HA/HAT use reported 5 years later. Generalized Estimating Equations analyses were performed to analyze the associations between potential predicting factors and the 5-year uptake of HAs/HAT, taking into account the repeated measurements of the predicting factors and the 5-year uptake of HAs/HAT. RESULTS: Data of 218 participants were included. The cumulative incidence of the 5-year uptake of HAs/HAT was 15 to 33%, of which 52 employees took up HAs and 11 employees took up HAT. Married participants had increased odds for 5-year uptake of HAs/HAT compared with unmarried participants (odds ratio [OR] = 2.13, 95% confidence interval [CI] = 1.05 to 4.35). Higher self-reported hearing disability (per one unit, scale range 0 to 74) was associated with increased odds for 5-year uptake of HAs/HAT (OR = 1.05, 95% CI = 1.03 to 1.07). Job demand showed a significant interaction with sex (p = 0.002), and therefore, stratified analyses were performed. In male participants, participants with higher job demand scores (per one unit, scale range 12 to 48) had increased odds for 5-year uptake of HAs/HAT (OR = 1.18, 95% CI = 1.05 to 1.35). No difference was seen in females. CONCLUSION: This study confirms that factors predicting the uptake of HAs/HAT in the general or older populations, including marital status and self-reported hearing disability, also extend to the working population. The identification of job demand as a predictor of the uptake of HAs/HAT (in males only) was a novel finding. It demonstrates the importance of considering work-related factors in aural rehabilitation.

Self-reported hearing handicap in adults aged 55 to 81 years is modulated by hearing abilities, frailty, mental health, and willingness to use hearing aids.

OBJECTIVE: The aim of this study was to predict outcomes of the HHI questionnaire (Hearing Handicap Inventory) using individual variables beyond pure-tone hearing thresholds. DESIGN: An extensive health-related test battery was applied including a general anamnesis, questionnaires, audiological measures, examination of visual acuity, balance, and cognition, as well as tactile- and motor skills. Based on the self-assessment of health variables and different sensory and cognitive performance measures, a frailty index was calculated to describe the health status of the participants. A stepwise linear regression analysis was conducted to predict HHI scores. STUDY SAMPLE: A mixed sample (N = 212) of 55- to 81-year-old, participants with different hearing and aiding status completed the test battery. RESULTS: The regression analysis showed statistically significant contributions of pure-tone hearing thresholds, speech recognition in noise, age, frailty, mental health, and the willingness to use hearing aids on HHIE outcomes. CONCLUSIONS: Self-reported hearing handicap assessed with the HHI questionnaire reflects various individual variables additionally to pure-tone hearing loss and speech recognition in noise. It is necessary to be aware of the influences of age and health-related variables on HHI scores when using it in research as well as in clinical settings.

The Effect of Hearing Aid Use on Cognition in Older Adults: Can We Delay Decline or Even Improve Cognitive Function?

Hearing loss is a modifiable risk factor for dementia in older adults. Whether hearing aid use can delay the onset of cognitive decline is unknown. Participants in this study (aged 62-82 years) were assessed before and 18 months after hearing aid fitting on hearing, cognitive function, speech perception, quality of life, physical activity, loneliness, isolation, mood, and medical health. At baseline, multiple linear regression showed hearing loss and age predicted significantly poorer executive function performance, while tertiary education predicted significantly higher executive function and visual learning performance. At 18 months after hearing aid fitting, speech perception in quiet, self-reported listening disability and quality of life had significantly improved. Group mean scores across the cognitive test battery showed no significant decline, and executive function significantly improved. Reliable Change Index scores also showed either clinically significant improvement or stability in executive function for 97.3% of participants, and for females for working memory, visual attention and visual learning. Relative stability and clinically and statistically significant improvement in cognition were seen in this participant group after 18 months of hearing aid use, suggesting that treatment of hearing loss with hearing aids may delay cognitive decline. Given the small sample size, further follow up is required.

10-Year Follow-Up Results of The Netherlands Longitudinal Study on Hearing: Trends of Longitudinal Change in Speech Recognition in Noise.

OBJECTIVES: Previous findings of longitudinal cohort studies indicate that acceleration in age-related hearing decline may occur. Five-year follow-up data of the Netherlands Longitudinal Study on Hearing (NL-SH) showed that around the age of 50 years, the decline in speech recognition in noise accelerates compared with the change in hearing in younger participants. Other longitudinal studies confirm an accelerated loss in speech recognition in noise but mostly use older age groups as a reference. In the present study, we determined the change in speech recognition in noise over a period of 10 years in participants aged 18 to 70 years at baseline. We additionally investigated the effects of age, sex, educational level, history of tobacco smoking, and alcohol use on the decline of speech recognition in noise. DESIGN: Baseline (T0), 5-year (T1), and 10-year (T2) follow-up data of the NL-SH collected until May 2017 were included. The NL-SH is a web-based prospective cohort study which started in 2006. Central to the NL-SH is the National Hearing test (NHT) which was administered to the participants at all three measurement rounds. The NHT uses three-digit sequences which are presented in a background of stationary noise. The listener is asked to enter the digits using the computer keyboard. The outcome of the NHT is the speech reception threshold in noise (SRT) (i.e., the signal to noise ratio where a listener recognizes 50% of the digit triplets correctly). In addition to the NHT, participants completed online questionnaires on demographic, lifestyle, and health-related characteristics at T0, T1, and T2. A linear mixed model was used for the analysis of longitudinal changes in SRT. RESULTS: Data of 1349 participants were included. At the start of the study, the mean age of the participants was 45 years (SD 13 years) and 61% of the participants were categorized as having good hearing ability in noise. SRTs significantly increased (worsened) over 10 years (p < 0.001). After adjustment for age, sex, and a history of tobacco smoking, the mean decline over 10 years was 0.89 dB signal to noise ratio. The decline in speech recognition in noise was significantly larger in groups aged 51 to 60 and 61 to 70 years compared with younger age groups (18 to 30, 31 to 40, and 41 to 50 years) (p < 0.001). Speech recognition in noise in participants with a history of smoking declined significantly faster during the 10-year follow-up interval (p = 0.003). Sex, educational level, and alcohol use did not appear to influence the decline of speech recognition in noise. CONCLUSIONS: This study indicated that speech recognition in noise declines significantly over a 10-year follow-up period in adults aged 18 to 70 years at baseline. It is the first longitudinal study with a 10-year follow-up to reveal that the increased rate of decline in speech recognition ability in noise already starts at the age of 50 years. Having a history of tobacco smoking increases the decline of speech recognition in noise. Hearing health care professionals should be aware of an accelerated decline of speech recognition in noise in adults aged 50 years and over.

The Circle of Care for Older Adults With Hearing Loss and Comorbidities: A Case Study of a Geriatric Audiology Clinic.

Purpose Older adults seeking audiologic rehabilitation often present with medical comorbidities, yet these realities of practice are poorly understood. Study aims were to examine (a) the frequency of identification of selected comorbidities in clients of a geriatric audiology clinic, (b) the influence of comorbidities on audiology practice, and (c) the effect of comorbidities on rehabilitation outcomes. Method The records of 135 clients ( M age = 86 years) were examined. Information about comorbidities came from audiology charts (physical paper files) and hospital electronic health records (EHRs). Data about rehabilitation recommendations and outcomes came from the charts. Focus groups with audiologists probed their views of how comorbidities influenced their practice. Results The frequency of identification was 68% for visual, 50% for cognitive, and 42% for manual dexterity issues; 84% had more than one comorbidity. Also noted were hypertension (43%), falls (33%), diabetes (13%), and depression (16%). Integrating information from the audiology chart and EHR provided a more complete understanding of comorbidities. Information about hearing in the EHR included logs of outpatient audiology visits (75% of 135 cases), audiologists' care notes for inpatients and long-term care residents (25%), and entries by other health professionals (60%). Modifications to audiology practice were common and varied depending on comorbidity. High rates of success were achieved regardless of comorbidities. Conclusions In this clinic, successful outcomes were achieved by modifying audiology practice for clients with comorbidities. Increased interprofessional communication among clinicians in the circle of care could improve care planning and outcomes for older adults with hearing loss.

Longitudinal Relationships Between Decline in Speech-in-Noise Recognition Ability and Cognitive Functioning: The Longitudinal Aging Study Amsterdam.

Purpose Various directional hypotheses for the observed links between aging, hearing, and cognition have been proposed: (a) cognitive load on perception hypothesis, (b) information degradation hypothesis, (c) sensory deprivation hypothesis, and (d) common cause hypothesis. Supporting evidence for all 4 hypotheses has been reported. No studies have modeled the corresponding 4 causal pathways into 1 single model, which would be required to evidence that multiple directional hypotheses apply. The aim of the current study was to tease out which pathways apply for 5 different cognitive measures. Method Data from 1,029 respondents of the Longitudinal Aging Study Amsterdam were used spanning a maximum follow-up of 7 years (3 measurements). Speech-in-noise recognition ability (digit triplet speech-in-noise test) was included as a measure of auditory function. Cognitive measures included global cognitive functioning, fluid intelligence, information processing speed, and verbal memory (immediate recall and retention). Bivariate dual change score modeling was used to model the causal pathways between hearing, cognition, and baseline age. Results For information processing speed, global cognitive functioning, fluid intelligence, and memory-immediate recall, all pathways except for the sensory deprivation pathway were supported. For memory-retention, only the common cause and the sensory deprivation pathways were supported. Conclusions Causal pathways corresponding to all 4 hypotheses were supported. Support for the common cause hypothesis, the information degradation hypothesis, and the cognitive load on perception hypotheses was found for 4 of 5 cognitive measures. This was unexpected in some cases (e.g., support for the information degradation pathway for cognitive measures that do not rely on auditory stimuli). The sensory deprivation pathway that emerged for memory-retention might point toward processes related to early stages of dementia. In summary, the results show that the links between decline in auditory function, cognition, and aging are complex and most likely are captured by pathways belonging to various directional hypotheses.

Verbal Response Times as a Potential Indicator of Cognitive Load During Conventional Speech Audiometry With Matrix Sentences.

This study examined verbal response times-that is, the duration from stimulus offset to voice onset-as a potential measure of cognitive load during conventional testing of speech-in-noise understanding. Response times were compared with a measure of perceived effort as assessed by listening effort scaling. Three listener groups differing in age and hearing status participated in the study. Testing was done at two target intelligibility levels (80%, 95%) and with two noise types (stationary and fluctuating). Verbal response times reflected effects of intelligibility level, noise type, and listener group. Response times were shorter for 95% compared with 80% target intelligibility, shorter for fluctuating compared with stationary noise, and shorter for young listeners compared with older listeners. Responses were also faster for the older listeners with near normal hearing compared with the older hearing-aid users. In contrast, subjective listening effort scaling predominantly revealed effects of target intelligibility level but did not show consistent noise-type or listener-group effects. These findings show that verbal response times and effort scalings tap into different domains of listening effort. Verbal response times can be easily assessed during conventional speech audiometry and have the potential to show effects beyond performance measures and subjective effort estimates.

Are you surprised to hear this? Longitudinal spectral speech exposure in older compared to middle-aged normal hearing adults.

Cognitive abilities such as attention or working memory can support older adults during speech perception. However, cognitive abilities as well as speech perception decline with age, leading to the expenditure of effort during speech processing. This longitudinal study therefore investigated age-related differences in electrophysiological processes during speech discrimination and assessed the extent of enhancement to such cognitive auditory processes through repeated auditory exposure. For that purpose, accuracy and reaction time were compared between 13 older adults (62-76 years) and 15 middle-aged (28-52 years) controls in an active oddball paradigm which was administered at three consecutive measurement time points at an interval of 2 wk, while EEG was recorded. As a standard stimulus, the nonsense syllable /'a:ʃa/was used, while the nonsense syllable /'a:sa/ and a morphing between /'a:ʃa/ and /'a:sa/ served as deviants. N2b and P3b ERP responses were evaluated as a function of age, deviant, and measurement time point using a data-driven topographical microstate analysis. From middle age to old age, age-related decline in attentive perception (as reflected in the N2b-related microstates) and in memory updating and attentional processes (as reflected in the P3b-related microstates) was found, as indicated by both lower neural responses and later onsets of the respective cortical networks, and in age-related changes in frontal activation during attentional stimulus processing. Importantly, N2b- and P3b-related microstates changed as a function of repeated stimulus exposure in both groups. This research therefore suggests that experience with auditory stimuli can support auditory neurocognitive processes in normal hearing adults into advanced age.

The impact of hearing aids and age-related hearing loss on auditory plasticity across three months - An electrical neuroimaging study.

The present study investigates behavioral and electrophysiological auditory and cognitive-related plasticity in three groups of healthy older adults (60-77 years). Group 1 was moderately hearing-impaired, experienced hearing aid users, and fitted with new hearing aids using non-linear frequency compression (NLFC on); Group 2, also moderately hearing-impaired, used the same type of hearing aids but NLFC was switched off during the entire period of study duration (NLFC off); Group 3 represented individuals with age-appropriate hearing (NHO) as controls, who were not different in IQ, gender, or age from Group 1 and 2. At five measurement time points (M1-M5) across three months, a series of active oddball tasks were administered while EEG was recorded. The stimuli comprised syllables consisting of naturally high-pitched fricatives (/sh/, /s/, and /f/), which are hard to distinguish for individuals with presbycusis. By applying a data-driven microstate approach to obtain global field power (GFP) as a measure of processing effort, the modulations of perceptual (P50, N1, P2) and cognitive-related (N2b, P3b) auditory evoked potentials were calculated and subsequently related to behavioral changes (accuracy and reaction time) across time. All groups improved their performance across time, but NHO showed consistently higher accuracy and faster reaction times than the hearing-impaired groups, especially under difficult conditions. Electrophysiological results complemented this finding by demonstrating longer latencies in the P50 and the N1 peak in hearing aid users. Furthermore, the GFP of cognitive-related evoked potentials decreased from M1 to M2 in the NHO group, while a comparable decrease in the hearing-impaired group was only evident at M5. After twelve weeks of hearing aid use of eight hours each day, we found a significantly lower GFP in the P3b of the group with NLFC on as compared to the group with NLFC off. These findings suggest higher processing effort, as evidenced by higher GFP, in hearing-impaired individuals when compared to those with normal hearing, although the hearing-impaired show a decrease of processing effort after repeated stimulus exposure. In addition, our findings indicate that the acclimatization to a new hearing aid algorithm may take several weeks.

Behavioral Assessment of Listening Effort Using a Dual-Task Paradigm.

Published investigations ( n = 29) in which a dual-task experimental paradigm was employed to measure listening effort during speech understanding in younger and older adults were reviewed. A summary of the main findings reported in the articles is provided with respect to the participants' age-group and hearing status. Effects of different signal characteristics, such as the test modality, on dual-task outcomes are evaluated, and associations with cognitive abilities and self-report measures of listening effort are described. Then, several procedural issues associated with the use of dual-task experiment paradigms are discussed. Finally, some issues that warrant future research are addressed. The review revealed large variability in the dual-task experimental paradigms that have been used to measure the listening effort expended during speech understanding. The differences in experimental procedures used across studies make it difficult to draw firm conclusions concerning the optimal choice of dual-task paradigm or the sensitivity of specific paradigms to different types of experimental manipulations. In general, the analysis confirmed that dual-task paradigms have been used successfully to measure differences in effort under different experimental conditions, in both younger and older adults. Several research questions that warrant further investigation in order to better understand and characterize the intricacies of dual-task paradigms were identified.

Longitudinal auditory learning facilitates auditory cognition as revealed by microstate analysis.

The current study investigates cognitive processes as reflected in late auditory-evoked potentials as a function of longitudinal auditory learning. A normal hearing adult sample (n=15) performed an active oddball task at three consecutive time points (TPs) arranged at two week intervals, and during which EEG was recorded. The stimuli comprised of syllables consisting of a natural fricative (/sh/,/s/,/f/) embedded between two /a/ sounds, as well as morphed transitions of the two syllables that served as deviants. Perceptual and cognitive modulations as reflected in the onset and the mean global field power (GFP) of N2b- and P3b-related microstates across four weeks were investigated. We found that the onset of P3b-like microstates, but not N2b-like microstates decreased across TPs, more strongly for difficult deviants leading to similar onsets for difficult and easy stimuli after repeated exposure. The mean GFP of all N2b-like and P3b-like microstates increased more in spectrally strong deviants compared to weak deviants, leading to a distinctive activation for each stimulus after learning. Our results indicate that longitudinal training of auditory-related cognitive mechanisms such as stimulus categorization, attention and memory updating processes are an indispensable part of successful auditory learning. This suggests that future studies should focus on the potential benefits of cognitive processes in auditory training.

Change in Psychosocial Health Status Over 5 Years in Relation to Adults' Hearing Ability in Noise.

OBJECTIVES: The aim of this study was to establish the longitudinal relationship between hearing ability in noise and psychosocial health outcomes (i.e., loneliness, anxiety, depression, distress, and somatization) in adults aged 18 to 70 years. An additional objective was to determine whether a change in hearing ability in noise over a period of 5 years was associated with a change in psychosocial functioning. Subgroup effects for a range of factors were investigated. DESIGN: Longitudinal data of the web-based Netherlands Longitudinal Study on Hearing (NL-SH) (N = 508) were analyzed. The ability to recognize speech in noise (i.e., the speech-reception-threshold [SRTn]) was measured with an online digit triplet test at baseline and at 5-year follow-up. Psychosocial health status was assessed by online questionnaires. Multiple linear regression analyses and longitudinal statistical analyses (i.e., generalized estimating equations) were performed. RESULTS: Poorer SRTn was associated longitudinally with more feelings of emotional and social loneliness. For participants with a high educational level, the longitudinal association between SRTn and social loneliness was significant. Changes in hearing ability and loneliness appeared significantly associated only for specific subgroups: those with stable pattern of hearing aid nonuse (increased emotional and social loneliness), who entered matrimony (increased social loneliness), and low educational level (less emotional loneliness). No significant longitudinal associations were found between hearing ability and anxiety, depression, distress, or somatization. CONCLUSIONS: Hearing ability in noise was longitudinally associated with loneliness. Decline in hearing ability in noise was related to increase in loneliness for specific subgroups of participants. One of these subgroups included participants whose hearing deteriorated over 5 years, but who continued to report nonuse of hearing aids. This is an important and alarming finding that needs further investigation.

Hearing Impairment and Cognitive Energy: The Framework for Understanding Effortful Listening (FUEL).

The Fifth Eriksholm Workshop on "Hearing Impairment and Cognitive Energy" was convened to develop a consensus among interdisciplinary experts about what is known on the topic, gaps in knowledge, the use of terminology, priorities for future research, and implications for practice. The general term cognitive energy was chosen to facilitate the broadest possible discussion of the topic. It goes back to who described the effects of attention on perception; he used the term psychic energy for the notion that limited mental resources can be flexibly allocated among perceptual and mental activities. The workshop focused on three main areas: (1) theories, models, concepts, definitions, and frameworks; (2) methods and measures; and (3) knowledge translation. We defined effort as the deliberate allocation of mental resources to overcome obstacles in goal pursuit when carrying out a task, with listening effort applying more specifically when tasks involve listening. We adapted Kahneman's seminal (1973) Capacity Model of Attention to listening and proposed a heuristically useful Framework for Understanding Effortful Listening (FUEL). Our FUEL incorporates the well-known relationship between cognitive demand and the supply of cognitive capacity that is the foundation of cognitive theories of attention. Our FUEL also incorporates a motivation dimension based on complementary theories of motivational intensity, adaptive gain control, and optimal performance, fatigue, and pleasure. Using a three-dimensional illustration, we highlight how listening effort depends not only on hearing difficulties and task demands but also on the listener's motivation to expend mental effort in the challenging situations of everyday life.

Cognitive Load and Listening Effort: Concepts and Age-Related Considerations.

Listening effort has been recognized as an important dimension of everyday listening, especially with regard to the comprehension of spoken language. At constant levels of comprehension performance, the level of effort exerted and perceived during listening can differ considerably across listeners and situations. In this article, listening effort is used as an umbrella term for two different types of effort that can arise during listening. One of these types is processing effort, which is used to denote the utilization of "extra" mental processing resources in listening conditions that are adverse for an individual. A conceptual description is introduced how processing effort could be defined in terms of situational influences, the listener's auditory and cognitive resources, and the listener's personal state. Also, the proposed relationship between processing effort and subjectively perceived listening effort is discussed. Notably, previous research has shown that the availability of mental resources, as well as the ability to use them efficiently, changes over the course of adult aging. These common age-related changes in cognitive abilities and their neurocognitive organization are discussed in the context of the presented concept, especially regarding situations in which listening effort may be increased for older people.

Speech perception at positive signal-to-noise ratios using adaptive adjustment of time compression.

Positive signal-to-noise ratios (SNRs) characterize listening situations most relevant for hearing-impaired listeners in daily life and should therefore be considered when evaluating hearing aid algorithms. For this, a speech-in-noise test was developed and evaluated, in which the background noise is presented at fixed positive SNRs and the speech rate (i.e., the time compression of the speech material) is adaptively adjusted. In total, 29 younger and 12 older normal-hearing, as well as 24 older hearing-impaired listeners took part in repeated measurements. Younger normal-hearing and older hearing-impaired listeners conducted one of two adaptive methods which differed in adaptive procedure and step size. Analysis of the measurements with regard to list length and estimation strategy for thresholds resulted in a practical method measuring the time compression for 50% recognition. This method uses time-compression adjustment and step sizes according to Versfeld and Dreschler [(2002). J. Acoust. Soc. Am. 111, 401-408], with sentence scoring, lists of 30 sentences, and a maximum likelihood method for threshold estimation. Evaluation of the procedure showed that older participants obtained higher test-retest reliability compared to younger participants. Depending on the group of listeners, one or two lists are required for training prior to data collection.

Oral communication in individuals with hearing impairment-considerations regarding attentional, cognitive and social resources.

Traditionally, audiology research has focused primarily on hearing and related disorders. In recent years, however, growing interest and insight has developed into the interaction of hearing and cognition. This applies to a person's listening and speech comprehension ability and the neural realization thereof. The present perspective extends this view to oral communication, when two or more people interact in social context. Specifically, the impact of hearing impairment and cognitive changes with age is discussed. In focus are executive functions, a group of top-down processes that guide attention, thought and action according to goals and intentions. The strategic allocation of the limited cognitive processing capacity among concurrent tasks is often effortful, especially under adverse communication conditions and in old age. Working memory, a sub-function extensively discussed in cognitive hearing science, is here put into the context of other executive and cognitive functions required for oral communication and speech comprehension. Finally, taking an ecological view on hearing impairment, activity limitations and participation restrictions are discussed regarding their psycho-social impact and third-party disability.