Hearing-impaired Participants Research Articles

Subjective hearing loss is not associated with an increased risk of Alzheimer's disease dementia

Hearing loss is a risk-factor for dementia but the reasons for this are unclear. Subjective hearing loss is related to increased future dementia risk, however, this metric has not been previously examined with cognitive, neuroimaging and biochemical measures that are relevant to Alzheimer's disease. We assessed Cognitively Normal and Mild Cognitively Impaired participants from the Alzheimer's Disease Neuroimaging Initiative with subjective hearing loss to examine if they had faster decline in episodic memory scores, hippocampal volume and greater pTau positivity. The likelihood of a dementia diagnosis in hearing impaired participants over a 5-year period was also assessed. There were no statistically significant differences between the hearing subgroups over a 5-year period nor were there in conversions to a dementia diagnosis. Objective hearing loss metrics may provide a more reliable link between hearing loss and dementia risk.

Behavioural evidence for enhanced olfactory and trigeminal perception in congenital hearing loss.

Sensory deprivation, especially hearing loss (HL), offers a valuable model for studying neuroplasticity in the human brain and adaptive behaviours that support the daily lives of those with limited or absent sensory input. The study of olfactory function is particularly important as it is an understudied aspect of sensory deprivation. This study aimed to compare the effects of congenital HL on olfactory capacity by using psychophysical tasks. Methodological concerns from previous studies regarding the onset of HL and cognitive assessments were addressed. We recruited 11 individuals with severe-to-profound sensorineural HL (SNHL) since birth and 11 age- and sex-matched typical hearing non-signers. We used standardized neuropsychological tests to assess typical cognition among participants with SNHL. We evaluated olfactory functions by assessing olfactory detection threshold, odour discrimination and odour identification. Hearing-impaired participants outperformed their typical hearing counterparts in olfactory tasks. We further evaluated the accuracy and response time in identifying and localizing odours to disentangle olfactory sensitivity from trigeminal system sensitivity. Participants with SNHL demonstrated higher sensitivity to both the identification and localization tasks. These findings suggest that congenital SNHL is associated with enhanced higher-level olfactory processing and increased trigeminal sensitivity.

A spectro-temporal modulation test for predicting speech reception in hearing-impaired listeners with hearing aids

Spectro-temporal modulation (STM) detection sensitivity has been shown to be associated with speech-in-noise reception in hearing-impaired (HI) individuals. Based on previous research, a recent study [Zaar, Simonsen, Dau, and Laugesen (2023). Hear Res 427:108650] introduced an STM test paradigm with audibility compensation, employing STM stimulus variants using noise and complex tones as carrier signals. The study demonstrated that the test was suitable for the target population of elderly individuals with moderate-to-severe hearing loss and showed promising predictions of speech-reception thresholds (SRTs) measured in a realistic set up with spatially distributed speech and noise maskers and linear audibility compensation. The present study further investigated the suggested STM test with respect to (i) test-retest variability for the most promising STM stimulus variants, (ii) its predictive power with respect to realistic speech-in-noise reception with non-linear hearing-aid amplification, (iii) its connection to effects of directionality and noise reduction (DIR+NR) hearing-aid processing, and (iv) its relation to DIR+NR preference. Thirty elderly HI participants were tested in a combined laboratory and field study, collecting STM thresholds with a complex-tone based and a noise-based STM stimulus design, SRTs with spatially distributed speech and noise maskers using hearing aids with non-linear amplification and two different levels of DIR+NR, as well as subjective reports and preference ratings obtained in two field periods with the two DIR+NR hearing-aid settings. The results indicate that the noise-carrier based STM test variant (i) showed optimal test-retest properties, (ii) yielded a highly significant correlation with SRTs (R2=0.61) exceeding and complementing the predictive power of the audiogram, (iii) yielded significant correlation (R2=0.51) with the DIR+NR-induced SRT benefit, and (iv) did not provide significant correlation with subjective preference for DIR+NR settings in the field. Overall, the suggested STM test represents a valuable tool for diagnosing speech-reception problems that remain when hearing-aid amplification has been provided and the resulting need for and benefit from DIR+NR hearing-aid processing.

Comparison of Powered Toothbrushes and Manual Toothbrushes in Removing Dental Plaque among Children with hearing Disabilities: A Randomized Pilot Study

OBJECTIVE: This study aimed to compare the the effectiveness of plaque removal between manual and powered toothbrushes in hearing impaired children. Maintaining a good quality of life requires optimal levels of oral hygiene. In differently abled subjects, manual dexterity may be slightly compromised, which is why powered toothbrushes were initially designed to help overcome the slight deficit. METHODOLOGY: A parallel arm, randomized study was conducted. Twenty two congenitally hearing-impaired participants aged eighteen to twenty two of age were recruited from National Special Education Centre for Hearing Impaired Children,Islamabad. They were randomly divided into two groups of eleven participants. Plaque levels were evaluated on the first day and plaque removal effectiveness of powered toothbrushes compared with manual toothbrush was checked on the eighth day. Plaque scores were evaluated using the simplified Oral Hygiene Index and Turesky's Modification of Quigley Hein Plaque Index. RESULTS: No significant difference of Mean score in effectiveness of plaque removal between manual and powered toothbrushes was seen. CONCLUSIONS: Manual and powered toothbrushes are equally effective at plaque . More studies highlighting cost effectiveness and patient's perception regarding ease of use are required to confirm results. KEYWORDS: Differently abled patients, manual toothbrushes, electric toothbrushes, oral hygiene.

Exploring level- and spectrum-based music mixing transforms for hearing-impaired listeners.

Multitrack mixing is an essential practice in modern music production. Research on automatic-mixing paradigms, however, has mostly tested samples of trained, normal hearing (NH) participants. The goal of the present study was to explore mixing paradigms for hearing-impaired (HI) listeners. In two experiments, the mixing preferences of NH and HI listeners with respect to the parameters of lead-to-accompaniment level ratio (LAR) and the low to high frequency spectral energy balance were investigated. Furthermore, preferences of transformed equalization (EQ-transform) were assessed, achieved by linearly extrapolating between the power spectrum of individual tracks and a reference spectrum. Multitrack excerpts of popular music were used as stimuli. Results from experiment 1 indicate that HI participants preferred an elevated LAR compared to NH participants but did not suggest distinct preferences regarding spectral balancing or EQ-transform. Results from experiment 2 showed that bilateral hearing aid (HA) disuse among the HI participants yielded higher LAR values, stronger weighting of higher frequencies, as well as sparser EQ-transform settings compared to a condition with HA use. Overall, these results suggest that adjusting multitrack mixes may be a valuable way for making music more accessible for HI listeners.

Impact of hearing impairment and cochlear implantation on productivity and social well-being in a professionally active but severely hearing-impaired group: protocol of the ‘Hear again, work again’ longitudinal prospective cohort study

IntroductionSevere hearing loss is a sensory deficit with considerable impact on the patient’s daily life and on society. Previous research has established occupational obstacles in professionally active patients with hearing...

Development and validation of the Montreal cognitive assessment for people with hearing impairment (MoCA-H).

Hearing impairment is common among older adults and affects cognitive assessments for identification of dementia which rely on good hearing function. We developed and validated a version of the Montreal Cognitive Assessment (MoCA) for people with hearing impairment. We adapted existing MoCA 8.1 items for people with hearing impairment by presenting instructions and stimuli in written rather than spoken format. One Attention domain and two Language domain items required substitution by alternative items. Three and four candidate items respectively were constructed and field-tested along with the items adapted to written form. We used a combination of individual item analysis and item substitution to select the set of alternative items to be included in the final form of the MoCA-H in place of the excluded original items. We then evaluated the performance and reliability of the final tool, including making any required adjustments for demographic factors. One hundred and fifty-nine hearing-impaired participants, including 76 with normal cognition and 83 with dementia, completed the adapted version of the MoCA. A further 97 participants with normal hearing completed the standard MoCA as well as the novel items developed for the MoCA-H to assess score equivalence between the existing and alternative MoCA items and for independence from hearing impairment. Twenty-eight participants were retested between 2-4 weeks after initial testing. After the selection of optimal item set, the final MoCA-H had an area under the curve of 0.973 (95% CI 0.952-0.994). At a cut-point of 24 points or less sensitivity and specificity for dementia was 92.8% and 90.8%, respectively. The intraclass correlation for test-retest reliability was 0.92 (95%CI 0.78-0.97). The MoCA-H is a sensitive and reliable means of identifying dementia among adults with acquired hearing impairment.

Izazovi odraslih korisnika slušne amplifikacije tokom pandemije Covid-19

Introduction. The Covid-19 pandemic has considerably affected many aspects of human life, especially healthcare and social services. The contacts of elderly people with family and friends, as well as their social activities, have been drastically reduced due to fear of contagious diseases with potentially serious consequences. Preventive measures of physical distancing and obligatory protective masks have brought additional challenges for hearing-impaired persons because of the decreased intensity and muffled quality of speech signals as well as the lack of visual cues because of the face masks. Objective. The study aimed to identify the challenges that adult hearing aid users faced during the Covid-19 pandemic. Methods. A special questionnaire was developed for the purpose of this study with a 3-point Likert type of scale. Results. The results of the study have shown that effective communication with other people during the pandemic was a great challenge for hearing-impaired participants. They pointed out the use of face masks and avoidance of communication with other people due to the fear of misunderstanding others. The participants noticed some changes in listening with hearing aids as well as mood swings and compliance to hearing aids. Most of the participants were satisfied with the access to hearing aids, fitting, and repair services, but none of them had access to rehabilitation and advisory support. Conclusion. The Covid-19 pandemic revealed the need for developing a network for alternative methods and approaches in surdology to provide advisory and rehabilitation services for hearing-impaired people as well as technical support for hearing aid users. That would be the way to provide ongoing support for hearing aid users, not only in extreme situations, such as the pandemic, but to increase the accessibility of those services in everyday life for all users.

ASSOCIATIONS OF AUDIOMETRIC HEARING, BRAIN MRI, AND COGNITIVE PERFORMANCE WITH SPEECH-IN-NOISE PERFORMANCE

Abstract Speech-in-noise performance is fundamental to daily communications and comprehensive characterization is needed. We studied 590 dementia-free participants aged 70-84 years, including 428 hearing-impaired participants from the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study baseline (2018-19), which is a randomized controlled trial partially nested within the Atherosclerosis Risk in Communities (ARIC) Study, and 162 normal-hearing ARIC Visit 6/7 (2016-17/2018-19) participants. The Quick Speech-in-Noise (QuickSIN) test was used to measure speech-in-noise performance. Predictors included (1) Four-frequency better-ear pure-tone average (PTA); (2) Magnetic resonance imaging (MRI) measures (total and lobar volumes, diffusion tensor imaging, white matter hyperintensities); (3) Global and domain-specific (language, memory, executive function) cognitive performance. All predictors were standardized to Z-scores. We used multivariable-adjusted linear regression, adjusting for demographic and disease covariates. PTA and cognitive performance, but not MRI measures, were independently associated with speech-in-noise performance, with PTA explaining the largest variance, indicating the promising role of hearing aids.

Vehicle noise: comparison of loudness ratings in the field and the laboratory

Objective Distorted loudness perception is one of the main complaints of hearing aid users. Measuring loudness perception in the clinic as experienced in everyday listening situations is important for loudness-based hearing aid fitting. Little research has been done comparing loudness perception in the field and in the laboratory. Design Participants rated the loudness in the field and in the laboratory of 36 driving actions. The field measurements were recorded with a 360° camera and a tetrahedral microphone. The recorded stimuli, which are openly accessible, were presented in three conditions in the laboratory: 360° video recordings with a head-mounted display, video recordings with a desktop monitor and audio-only. Study samples Thirteen normal-hearing participants and 18 hearing-impaired participants with hearing aids. Results The driving actions were rated as louder in the laboratory than in the field for the condition with a desktop monitor and for the audio-only condition. The less realistic a laboratory condition was, the more likely it was for a participant to rate a driving action as louder. The field–laboratory loudness differences were bigger for louder sounds. Conclusion The results of this experiment indicate the importance of increasing realism and immersion when measuring loudness in the clinic.

Design, Manufacture, and Acceptance Evaluation of APO: A Lip-syncing Social Robot Developed for Lip-reading Training Programs.

Lack of educational facilities for the burgeoning world population, financial barriers, and the growing tendency in favor of inclusive education have all helped channel a general inclination toward using various educational assistive technologies, e.g., socially assistive robots. Employing social robots in diverse educational scenarios could enhance learners’ achievements by motivating them and sustaining their level of engagement. This study is devoted to manufacturing and investigating the acceptance of a novel social robot named APO, designed to improve hearing-impaired individuals’ lip-reading skills through an educational game. To accomplish the robot’s objective, we proposed and implemented a lip-syncing system on the APO social robot. The proposed robot’s potential with regard to its primary goals, tutoring and practicing lip-reading, was examined through two main experiments. The first experiment was dedicated to evaluating the clarity of the utterances articulated by the robot. The evaluation was quantified by comparing the robot’s articulation of words with a video of a human teacher lip-syncing the same words. In this inspection, due to the adults’ advanced skill in lip-reading compared to children, twenty-one adult participants were asked to identify the words lip-synced in the two scenarios (the articulation of the robot and the video recorded from the human teacher). Subsequently, the number of words that participants correctly recognized from the robot and the human teacher articulations was considered a metric to evaluate the caliber of the designed lip-syncing system. The outcome of this experiment revealed that no significant differences were observed between the participants’ recognition of the robot and the human tutor’s articulation of multisyllabic words. Following the validation of the proposed articulatory system, the acceptance of the robot by a group of hearing-impaired participants, eighteen adults and sixteen children, was scrutinized in the second experiment. The adults and the children were asked to fill in two standard questionnaires, UTAUT and SAM, respectively. Our findings revealed that the robot acquired higher scores than the lip-syncing video in most of the questionnaires’ items, which could be interpreted as a greater intention of utilizing the APO robot as an assistive technology for lip-reading instruction among adults and children.

Cognitive control strategies in hearing impairment: a study with the AX–CPT

Objective The present study investigated the impact of hearing impairment on the implementation of proactive and reactive cognitive control strategies across the ageing process. Methods 31 hearing-impaired (HI) individuals with one cochlear implant and 41 normal-hearing (NH) listeners of different ages performed the AX–CPT, a well-validated task to measure proactive and reactive cognitive control strategies. Data from both accuracy and response times (RTs) were analysed by mixed effect models that considered trial type, group, age and their interactions. Results Both accuracy and RT analyses showed significant interactions between trial type, group and age. Specifically, with ageing, the NH group had lower performance on AY and BX trials (i.e. the most conflicting trial types of the AX–CPT associated with proactive and reactive control). Conversely, HI participants yielded higher performance on the same trial types at older ages. However, for the HI group only, the accuracy benefits observed for AY and BX trials were coupled with an age-related RT increase on both trial types (i.e. speed accuracy trade-off). Conclusion The present findings show a different utilisation of cognitive control strategies in HI participants as compared to NH listeners, at both younger and older ages.

Spatial hearing in middle-aged and older adults with a hearing aid: Does noise type matter?

Purpose: The present study aimed to identify the overall patterns of spatial hearing in a sample population of the geriatric population wearing a hearing aid in an actual clinical setting and to investigate while paying attention to aging and the effects of spatial separation on informational masking (IM) of target speech of common types of noise in everyday life.Methods: Nine participants (mean age: 68.9 ± 9.6) wearing hearing aids participated. The spatial hearing abilities of the participants were assessed by measuring their speech reception threshold (SRT) and spatial release from masking (SRM), using speech-like (SLN) and steady-state (SSN) noise-maskers.Results: The study results identified a trend in the decrease in SRT in all noise conditions with increasing azimuth angles. The larger the target/masker spatial separation, the larger the SRM became in all noise conditions. Results revealed that geriatric hearing-impaired participants experienced a comparable amount of SRM from IM in SLN concerning SSN.Conclusions: Given these findings, the spatial separation did not have the same effects on the IM of target speech by SLN in the geriatric population wearing a hearing aid as it did in the general hearing-impaired population at younger ages. It can be inferred from these findings that the extent to which informational maskers can compromise the spatial hearing abilities of geriatric hearing-impaired listeners may depend on their age and the severity of spatial hearing loss being imposed on them.

Speech to noise ratio improvement induces nonlinear parietal phase synchrony in hearing aid users.

ObjectivesComprehension of speech in adverse listening conditions is challenging for hearing-impaired (HI) individuals. Noise reduction (NR) schemes in hearing aids (HAs) have demonstrated the capability to help HI to overcome these challenges. The objective of this study was to investigate the effect of NR processing (inactive, where the NR feature was switched off, vs. active, where the NR feature was switched on) on correlates of listening effort across two different background noise levels [+3 dB signal-to-noise ratio (SNR) and +8 dB SNR] by using a phase synchrony analysis of electroencephalogram (EEG) signals.DesignThe EEG was recorded while 22 HI participants fitted with HAs performed a continuous speech in noise (SiN) task in the presence of background noise and a competing talker. The phase synchrony within eight regions of interest (ROIs) and four conventional EEG bands was computed by using a multivariate phase synchrony measure.ResultsThe results demonstrated that the activation of NR in HAs affects the EEG phase synchrony in the parietal ROI at low SNR differently than that at high SNR. The relationship between conditions of the listening task and phase synchrony in the parietal ROI was nonlinear.ConclusionWe showed that the activation of NR schemes in HAs can non-linearly reduce correlates of listening effort as estimated by EEG-based phase synchrony. We contend that investigation of the phase synchrony within ROIs can reflect the effects of HAs in HI individuals in ecological listening conditions.

Modulation masking produced by a low-frequency pure tone

An intense low-frequency tone can affect the perception of amplitude modulation (AM) applied to a high-frequency carrier. Here, thresholds for detecting AM of a 3000-Hz carrier were measured in the presence of a 50-Hz pure tone at 91 dB SPL. When the carrier was presented at 20 dB sensation level (SL), the thresholds were higher than in the absence of the 50-Hz tone, increased when the AM frequency was increased from 20 to 100 Hz, and did not show a maximum near 50 Hz, as would be expected if the effect of the 50-Hz tone resulted from modulation detection interference. When the AM frequency was fixed at 50 Hz, the AM detection thresholds showed a minimum when the phase of the AM was 90° ahead of the phase of the 50-Hz tone (denoted Δφ = 90°) and a maximum for Δφ = 270°. To assess the role of the outer hair cells (OHCs), AM detection thresholds were measured as a function of Δφ using SLs of 20 and 50 dB for normal-hearing participants and 20 dB for hearing-impaired participants. It was assumed that the latter would have impaired OHC function. The pattern of the results was similar across SLs and groups: AM detection thresholds were 8–10 dB lower for Δφ = 90° than for Δφ = 270° in all cases. This suggests that the OHCs do not play a large role in these effects and supports the idea that the low-frequency tone biases the responses of inner hair cells tuned to high frequencies.

Emotion Elicitation through Vibrotactile Stimulation as an Alternative for Deaf and Hard of Hearing People: An EEG Study

Despite technological and accessibility advances, the performing arts and their cultural offerings remain inaccessible to many people. By using vibrotactile stimulation as an alternative channel, we explored a different way to enhance emotional processes produced while watching audiovisual media and, thus, elicit a greater emotional reaction in hearing-impaired people. We recorded the brain activity of 35 participants with normal hearing and 8 participants with severe and total hearing loss. The results showed activation in the same areas both in participants with normal hearing while watching a video, and in hearing-impaired participants while watching the same video with synchronized soft vibrotactile stimulation in both hands, based on a proprietary stimulation glove. These brain areas (bilateral middle frontal orbitofrontal, bilateral superior frontal gyrus, and left cingulum) have been reported as emotional and attentional areas. We conclude that vibrotactile stimulation can elicit the appropriate cortex activation while watching audiovisual media.

Comparing In-ear EOG for Eye-Movement Estimation With Eye-Tracking: Accuracy, Calibration, and Speech Comprehension.

This presentation details and evaluates a method for estimating the attended speaker during a two-person conversation by means of in-ear electro-oculography (EOG). Twenty-five hearing-impaired participants were fitted with molds equipped with EOG electrodes (in-ear EOG) and wore eye-tracking glasses while watching a video of two life-size people in a dialog solving a Diapix task. The dialogue was directionally presented and together with background noise in the frontal hemisphere at 60 dB SPL. During three conditions of steering (none, in-ear EOG, conventional eye-tracking), participants' comprehension was periodically measured using multiple-choice questions. Based on eye movement detection by in-ear EOG or conventional eye-tracking, the estimated attended speaker was amplified by 6 dB. In the in-ear EOG condition, the estimate was based on one selected channel pair of electrodes out of 36 possible electrodes. A novel calibration procedure introducing three different metrics was used to select the measurement channel. The in-ear EOG attended speaker estimates were compared to those of the eye-tracker. Across participants, the mean accuracy of in-ear EOG estimation of the attended speaker was 68%, ranging from 50 to 89%. Based on offline simulation, it was established that higher scoring metrics obtained for a channel with the calibration procedure were significantly associated with better data quality. Results showed a statistically significant improvement in comprehension of about 10% in both steering conditions relative to the no-steering condition. Comprehension in the two steering conditions was not significantly different. Further, better comprehension obtained under the in-ear EOG condition was significantly correlated with more accurate estimation of the attended speaker. In conclusion, this study shows promising results in the use of in-ear EOG for visual attention estimation with potential for applicability in hearing assistive devices.

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.

Hearing aid delay in open-fit devices – coloration-pitch discrimination in normal-hearing and hearing-impaired

Objective The delay in digital hearing aids is known to cause distortions due to the mixing of the delayed hearing aid sound with the undelayed direct sound. The most apparent delay-based distortion is a pitch sensation referred to as coloration-pitch. This study investigated coloration-pitch discrimination at the lower end of typical hearing aid delays and aimed at establishing thresholds where a large change in coloration-pitch is just perceptible. Design Simulations were verified against a reference hearing aid for numerous conditions of delay, insertion gain and incident direction. The simulations were used in a psycho-acoustics experiment in which coloration-pitch discrimination thresholds were measured as a function of hearing aid delay and gain. Participants discriminated between coloration-pitches produced by delay changes of 12%. Insertion gains compensating for mild to moderate hearing losses were used. Study Sample Nine normal-hearing and twelve hearing-impaired participants with mild to moderate hearing loss participated. Results The simulations accurately reflected the acoustics of the open-fit hearing aid. Discrimination thresholds were between 0.3 ms and 1 ms depending on insertion gain and hearing status. Conclusions High sensitivity for changes in coloration-pitch was found for delays >1 ms. For shorter delays participants were increasingly insensitive to changes in coloration-pitch.

The Effects of Hearing-Aid Amplification and Noise on Conversational Dynamics Between Normal-Hearing and Hearing-Impaired Talkers.

There is a long-standing tradition to assess hearing-aid benefits using lab-based speech intelligibility tests. Towards a more everyday-like scenario, the current study investigated the effects of hearing-aid amplification and noise on face-to-face communication between two conversational partners. Eleven pairs, consisting of a younger normal-hearing (NH) and an older hearing-impaired (HI) participant, solved spot-the-difference tasks while their conversations were recorded. In a two-block randomized design, the tasks were solved in quiet or noise, both with and without the HI participant receiving hearing-aid amplification with active occlusion cancellation. In the presence of 70 dB SPL babble noise, participants had fewer, slower, and less well-timed turn-starts, while speaking louder with longer inter-pausal units (IPUs, stretches of continuous speech surrounded by silence) and reducing their articulation rates. All these changes are indicative of increased communication effort. The timing of turn-starts by the HI participants exhibited more variability than that of their NH conversational partners. In the presence of background noise, the timing of turn-starts by the HI participants became even more variable, and their NH partners spoke louder. When the HI participants were provided with hearing-aid amplification, their timing of turn-starts became faster, they increased their articulation rate, and they produced shorter IPUs, all indicating reduced communication effort. In conclusion, measures of the conversational dynamics showed that background noise increased the communication effort, especially for the HI participants, and that providing hearing-aid amplification caused the HI participant to behave more like their NH conversational partner, especially in quiet situations.