Improvements in naturalistic speech-in-noise comprehension in middle-aged and older adults after 3 weeks of computer-based speechreading training.

Problems in understanding speech in noisy environments are characteristic for age-related hearing loss. Since hearing aids do not mitigate these communication problems in every case, potential alternatives in a clinical rehabilitation plan need to be explored. This study investigates whether a computer-based speechreading training improves audiovisual speech perception in noise in a sample of middle-aged and older adults (N = 62, 47-83 years) with 32 participants completing a speechreading training and 30 participants of an active control group completing a foreign language training. Before and after training participants performed a speech-in-noise task mimicking real-life communication settings with participants being required to answer a speaker's questions. Using generalized linear mixed-effects models we found a significant improvement in audiovisual speech perception in noise in the speechreading training group. This is of great relevance as these results highlight the potential of a low-cost and easy-to-implement intervention for a profound and widespread problem as speech-in-noise comprehension impairment.

The neuroanatomical hallmarks of chronic tinnitus in comorbidity with pure-tone hearing loss.

Tinnitus is one of the main hearing impairments often associated with pure-tone hearing loss, and typically manifested in the perception of phantom sounds. Nevertheless, tinnitus has traditionally been studied in isolation without necessarily considering auditory ghosting and hearing loss as part of the same syndrome. Hence, in the present neuroanatomical study, we attempted to pave the way toward a better understanding of the tinnitus syndrome, and compared two groups of almost perfectly matched individuals with (TIHL) and without (NTHL) pure-tone tinnitus, but both characterized by pure-tone hearing loss. The two groups were homogenized in terms of sample size, age, gender, handedness, education, and hearing loss. Furthermore, since the assessment of pure-tone hearing thresholds alone is not sufficient to describe the full spectrum of hearing abilities, the two groups were also harmonized for supra-threshold hearing estimates which were collected using temporal compression, frequency selectivity und speech-in-noise tasks. Regions-of-interest (ROI) analyses based on key brain structures identified in previous neuroimaging studies showed that the TIHL group exhibited increased cortical volume (CV) and surface area (CSA) of the right supramarginal gyrus and posterior planum temporale (PT) as well as CSA of the left middle-anterior part of the superior temporal sulcus (STS). The TIHL group also demonstrated larger volumes of the left amygdala and of the left head and body of the hippocampus. Notably, vertex-wise multiple linear regression analyses additionally brought to light that CSA of a specific cluster, which was located in the left middle-anterior part of the STS and overlapped with the one found to be significant in the between-group analyses, was positively associated with tinnitus distress level. Furthermore, distress also positively correlated with CSA of gray matter vertices in the right dorsal prefrontal cortex and the right posterior STS, whereas tinnitus duration was positively associated with CSA and CV of the right angular gyrus (AG) and posterior part of the STS. These results provide new insights into the critical gray matter architecture of the tinnitus syndrome matrix responsible for the emergence, maintenance and distress of auditory phantom sensations.

Different neuroanatomical correlates for temporal and spectral supra-threshold auditory tasks and speech in noise recognition in older adults with hearing impairment.

Varying degrees of pure-tone hearing loss in older adults are differentially associated with cortical volume (CV) and thickness (CT) within and outside of the auditory pathway. This study addressed the question to what degree supra-threshold auditory performance (i.e., temporal compression and frequency selectivity) as well as speech in noise (SiN) recognition are associated with neurostructural correlates in a sample of 59 healthy older adults with mild to moderate pure-tone hearing loss. Using surface-based morphometry on T1-weighted MRI images, CT, CV, and surface area (CSA) of several regions-of-interest were obtained. The results showed distinct neurostructural patterns for the different tasks in terms of involved regions as well as morphometric parameters. While pure-tone averages (PTAs) positively correlated with CT in a right hemisphere superior temporal sulcus and gyrus cluster, supra-threshold auditory perception additionally extended significantly to CV and CT in left and right superior temporal clusters including Heschl's gyrus and sulcus, the planum polare and temporale. For SiN recognition, we found significant correlations with an auditory-related CT cluster and furthermore with language-related areas in the prefrontal cortex. Taken together, our results show that different auditory abilities are differently associated with cortical morphology in older adults with hearing impairment. Still, a common pattern is that greater PTAs and poorer supra-threshold auditory performance as well as poorer SiN recognition are all related to cortical thinning and volume loss but not to changes in CSA. These results support the hypothesis that mostly CT undergoes alterations in the context of auditory decline, while CSA remains stable.

Impact of a clinical decision support system on paediatric drug dose prescribing: a randomised within-subject simulation trial.

BACKGROUND: Drug dosing errors are among the most frequent causes of preventable harm in paediatrics. Due to the complexity of paediatric pharmacotherapy and the working conditions in healthcare, it is not surprising that human factor is a well-described source of error. Thus, a clinical decision support system (CDSS) that supports healthcare professionals (HCP) during the dose prescribing step provides a promising strategy for error prevention. METHODS: The aim of the trial was to simulate the dose derivation step during the prescribing process. HCPs were asked to derive dosages for 18 hypothetical patient cases. We compared the CDSS PEDeDose, which provides a built-in dose calculator to the Summary of Product Characteristics (SmPC) used together with a pocket calculator in a randomised within-subject trial. We assessed the number of dose calculation errors and the time needed for calculation. Additionally, the effect of PEDeDose without using the built-in calculator but with a pocket calculator instead was assessed. RESULTS: A total of 52 HCPs participated in the trial. The OR for an erroneous dosage using the CDSS as compared with the SmPC with pocket calculator was 0.08 (95% CI 0.02 to 0.36, p<0.001). Thus, the odds of an error were 12 times higher while using the SmPC. Furthermore, there was a 45% (95% CI 39% to 51%, p<0.001) time reduction when the dosage was derived using the CDSS. The exploratory analysis revealed that using only PEDeDose but without the built-in calculator did not substantially reduce errors. CONCLUSION: Our results provide robust evidence that the use of the CDSS is safer and more efficient than manual dose derivation in paediatrics. Interestingly, only consulting a dosing database was not sufficient to substantially reduce errors. We are confident the CDSS PEDeDose ensures a higher safety and speeds up the prescribing process in practice.

Better speech-in-noise comprehension is associated with enhanced neural speech tracking in older adults with hearing impairment.

The alignment between low-frequency activity in the brain and slow acoustic modulations in the speech signal depicts a core principle in present theories of speech perception-a process referred to as 'neural speech tracking'. While most older adults, particularly those with highly prevalent age-related hearing loss, have difficulties with speech perception and comprehension, the impact of hearing loss on neural speech tracking is still unclear. In this study we investigated the effects of pure-tone hearing loss and different types of background noise on the neural tracking response in a large sample of older adults (N = 101). Furthermore, we examined whether the neural tracking response was predictive for speech comprehension. For this purpose, we obtained scalp EEG from our participants who had varying degrees of pure-tone hearing loss (7.5-59.6 dB HL for .5-8 kHz pure tones) while they listened to sentences in quiet, pink and multi-talker babble noise. Speech tracking was quantified by computing the cross-correlation between the EEG signal and the amplitude envelope of the sentences heard. A higher degree of pure-tone hearing loss was associated with greater neural speech tracking (i.e., greater cross-correlation). Additionally, neural speech tracking showed a positive association with speech comprehension. This relationship was modulated by the degree of pure-tone hearing loss with hearing-impaired participants benefitting more from greater neural speech tracking. Our results highlight the potential of neural speech tracking as an objective measure of speech comprehension and as a possible target mechanism for clinical interventions such as neurofeedback. Furthermore, the interaction between speech tracking and pure-tone hearing loss suggests a compensatory mechanism by which the hearing-impaired rely more on slow amplitude modulations in the speech signal.