Poor Speech Recognition Research Articles

Speech-in-Noise and Dichotic Auditory Training Students With Autism Spectrum Disorder.

Individuals diagnosed with autism spectrum disorder (ASD) often exhibit auditory processing issues, including poor speech recognition in background noise and dichotic processing (integration of different stimuli presented to the two ears). Auditory training could mitigate these auditory difficulties. However, few auditory training programs have been designed to target specific listening deficits for students with ASD. The present study summarizes the development of an innovative, one-on-one, clinician-developed speech-in-noise (SIN) training program that has not been previously described and an existing dichotic auditory training program to address common auditory processing deficits in students with ASD. Twenty verbal students with ASD, ages 7-17 years, completed a one-on-one, clinician-developed SIN training program and a commercially available dichotic training program 2-3 times a week (30-45 min per session) for 12 weeks. Maximum and minimum training levels from the SIN and dichotic training programs were analyzed statistically to document changes in training level over the training period. Analyses of the pre- and posttraining data revealed significant improvements in training level for both the SIN and dichotic training programs. Overall, the proposed SIN training resulted in significant improvements in training level and may be used along with dichotic training to improve some of the most common auditory processing issues documented in verbal individuals with ASD requiring minimal support. Both types of auditory training may be implemented in one-on-one therapy in clinics and in the schools.

Experienced Adult Cochlear Implant Users Show Improved Speech Recognition When Target Fitting Parameters Are Applied.

The aim of the present study was to investigate whether prediction models built by de Graaff et al. (2020) can be used to improve speech recognition in experienced adult postlingual implanted Cochlear CI users. de Graaff et al. (2020) found relationships between elevated aided thresholds and a not optimal electrical dynamic range (<50 CL or >60 CL), and poorer speech recognition in quiet and in noise. The primary hypothesis of the present study was that speech recognition improves both in quiet and in noise when the sound processor is refitted to match targets derived from the prediction models from de Graaff et al. (2020). A second hypothesis was that subjectively, most of the CI users would find the new setting too loud because of an increase in C levels, and therefore, prefer the old settings. A within-participant repeated measures design with 18 adult Cochlear CI users was used. T- and C-levels were changed to "optimized settings," as predicted by the model of de Graaff et al. (2020). Aided thresholds, speech recognition in quiet, and speech recognition in noise were measured with the old settings and after a 4-week acclimatization period with the optimized settings. Subjective benefit was measured using the Device Oriented Subjective Outcome Scale questionnaire. The mean electrical dynamic range changed from 41.1 (SD = 6.6) CL to 48.6 (SD = 3.0) CL. No significant change in aided thresholds was measured. Speech recognition improved for 16 out of 18 participants and remained stable for 2 participants. Average speech recognition scores in quiet significantly improved by 4.9% (SD = 3.8%). No significant change for speech recognition in noise was found. A significant improvement in subjective benefit was found for one of the Device Oriented Subjective Outcome subscales (speech cues) between the old and optimized settings. All participants chose to keep the optimized settings at the end of the study. We were able to improve speech recognition in quiet by optimizing the electrical dynamic range of experienced adult CI users, according to the prediction models built by de Graaff et al. (2020). There was no significant change in aided thresholds nor in speech recognition in noise. The findings of the present study suggest that improved performance for speech recognition in quiet in adult Cochlear CI users can be achieved by setting the dynamic range as close as possible to values between 50 and 60 CL when the volume level is at 10.

Spatial release from masking with simulated hybrid cochlear implant speech

Spatial release from masking (SRM) is the improvement in speech intelligibility when the masking signals are spatially separated from the target signal. Cochlear implant (CI) users utilizing electric-only (E-Only) stimulation had poorer speech recognition than CI users utilizing electric-acoustic stimulation (EAS). Previous research investigating SRM on hybrid CI users big spatial separations (±90°) between the target and the maskers which were unrealistic in conversational settings. Here, we present SRM data using natural speech, simulated CI speech, and simulated EAS speech from young, normal hearing listeners for smaller, yet realistic, spatial separations between the target and the maskers. An eight-channel noise-excited vocoder was used to simulate cochlear implant processing and low-frequency filtering was used to simulate residual low-frequency hearing. Five spatial configurations were used: (colocated (target and the two maskers presented from 0° azimuth) and one of four spatially separated conditions (target at 0°, symmetrical maskers at ± 5°, ± 10°, ±15°, or ±30°). Initial analysis of the data revealed that the listeners had significantly poorer speech identification thresholds for the simulated CI speech when compared to EAS speech. The individual variability and the relationship between the speech identification thresholds in the three conditions will be discussed.

Prevalence and Characteristics of Veterans with Severe Hearing Loss: A Descriptive Study.

Hearing loss is common among Veterans, and extensive hearing care resources are prioritized within the Veterans Administration (VA). Severe hearing loss poses unique communication challenges with speech understanding that may not be overcome with amplification. We analyzed data from the VA Audiometric Repository between 2005 and 2017 and the relationship between hearing loss severity with speech recognition scores. We hypothesized that a significant subset of Veterans with severe or worse hearing loss would have poor unaided speech perception outcomes even with adequate audibility. Sociodemographic characteristics and comorbidities were compiled using electronic medical records as was self-report measures of hearing disability. We identified a cohort of 137,500 unique Veterans with 232,789 audiograms demonstrating bilateral severe or worse hearing loss (four-frequency PTA > 70 dB HL). The median (IQR; range) age of Veterans at their first audiogram with severe or worse hearing loss was 81 years (74 to 87; 21-90+), and a majority were male (136,087 [99%]) and non-Hispanic white (107,798 [78.4%]). Among those with bilateral severe or worse hearing loss, 41,901 (30.5%) also had poor speech recognition scores (<50% words), with greater hearing loss severity correlating with worse speech perception. We observed variability in speech perception abilities in those with moderate-severe and greater levels of hearing loss who may derive limited benefit from amplification. Veterans with communication challenges may warrant alternative approaches and treatment strategies such as cochlear implants to support communication needs.

The association between electrode impedance and short-term outcomes in cochlear implant recipients of slim modiolar and slim straight electrode arrays

Objectives Electrode impedance measurements from cochlear implants (CI) reflect the status of the electrode array as well as the surrounding cochlear environment, and could provide a clinical index of functional changes with the CI. The goals of this study were to examine (1) the impact of electrode array type on electrode impedance, and (2) the relationship between electrode impedance and short-term hearing preservation and speech recognition outcomes. Methods Retrospective study of 115 adult hearing preservation CI recipients of a slim modiolar or slim straight array. Common ground electrode impedances, pre- and post-operative hearing thresholds and CNC word recognition scores were retrieved. Results Electrode impedances were significantly higher for recipients of the straight electrode array. Within individuals, electrode impedances were stable after the first week post-activation. However, increased standard deviation of electrode impedances was associated with greater loss of low frequency hearing at initial activation, and with poorer speech recognition at 6 months post-implantation. Conclusions Results demonstrate that electrode impedances depend on the type of implanted array. Findings also suggest that there may be a role for the variability in electrode impedance across electrodes as an indicator of changes in the intracochlear environment that contribute to outcomes with a CI.

Speed of Information Processing and Verbal Working Memory in Children and Adolescents With Cochlear Implants.

Verbal working memory delays are found in many deaf children with cochlear implants compared with normal-hearing peers, but the factors contributing to these delays are not well understood. This study investigated differences between cochlear implant users and normal-hearing peers in memory scanning speed during a challenging verbal working memory task. To better understand variability in verbal working memory capacity within each sample, associations between memory scanning speed, speech recognition, and language were also investigated. Twenty-five prelingually deaf, early implanted children (age, 8-17 yr) with cochlear implants and 25 normal-hearing peers completed the Wechsler Intelligence Scale for Children, Fifth Edition, Letter-Number Sequencing (LNS) working memory task. Timing measures were made for response latency and average pause duration between letters/numbers recalled during the task. Participants also completed measures of speech recognition, vocabulary, and language comprehension. Children with cochlear implants had longer pause durations than normal-hearing peers during three-span LNS sequences, but the groups did not differ in response latencies or in pause durations during two-span LNS sequences. In the sample of cochlear implant users, poorer speech recognition was correlated with longer pause durations during two-span sequences, whereas poorer vocabulary and weaker language comprehension were correlated with longer response latencies during two-span sequences. Response latencies and pause durations were unrelated to language in the normal-hearing sample. Children with cochlear implants have slower verbal working memory scanning speed than children with normal hearing. More robust phonological-lexical representations of language in memory may facilitate faster memory scanning speed and better working memory in cochlear implant users.

Factors Associated With the Development of Tinnitus and With the Degree of Annoyance Caused by Newly Developed Tinnitus.

Objectives:Tinnitus is highly prevalent, but only a few risk factors for developing tinnitus are known and little is known about factors associated with the degree of annoyance of new-onset tinnitus. Longitudinal analysis can reveal risk factors associated with the development of tinnitus and might lead to targeted prevention. The aim of this study is twofold. (1) To identify risk factors that are longitudinally associated with the odds of developing tinnitus 5 years later. (2) To identify factors that are cross-sectionally associated with tinnitus annoyance in adults with new-onset tinnitus.Methods:Baseline, 5-year, and 10-year follow-up data of participants in the Netherlands Longitudinal Study on Hearing (NL-SH) were used. The NL-SH is a web-based prospective cohort study, which started in 2006 and includes both normal hearing and hearing-impaired adults aged 18 to 70 years at baseline. The NL-SH uses an online digit-triplet speech-in-noise test to asses speech recognition ability in noise, and online questionnaires on various aspects of life. At follow-up, participants are asked (1) if they suffer from tinnitus and (2) to rate tinnitus annoyance on a 0 to 100 numeric rating scale. We investigated whether demographic (age, sex, living arrangement, educational level), lifestyle (history of tobacco smoking, alcohol use), health (asthma, severe heart disease, hypertension, history of stroke, osteoarthritis, rheumatoid arthritis, epilepsy, multiple sclerosis, and migraine), hearing (speech recognition ability in noise, hyperacusis, and occupational noise exposure), and psychological variables (distress, somatization, depression, and anxiety) were potential risk factors for new-onset tinnitus, or associated with annoyance caused by new-onset tinnitus. Generalized estimating equations were used to longitudinally analyze the association between potential risk factors and new-onset tinnitus measured 5 years later. A multivariable association model was constructed using a forward selection procedure with p < 0.05 for model entry. Linear regression analysis was used to cross-sectionally analyze the association between potential factors and tinnitus annoyance in new-onset tinnitus. For this purpose, a multivariable association model was constructed using a forward selection procedure with p <0.05 for model entry.Results:In total, 734 participants without tinnitus at baseline were included, from which 137 participants reported to suffer from new-onset tinnitus 5 or 10 years later. Risk factors for new-onset tinnitus were history of smoking (odds ratio 1.5, 95% confidence interval [CI] 1.0 to 2.2, p = 0.027) and higher levels of somatization (odds ratio 2.0, 95% CI 1.2 to 3.3, overall p = 0.024). Factors associated with the degree of tinnitus annoyance were increased levels of anxiety (β = 11.6, 95% CI 2.3-20.8, overall p = 0.035) and poor speech recognition ability in noise (β = 13.5, 95% CI, 4.4 to 22.6, overall p = 0.014).Conclusions:Higher levels of somatization and a history of smoking were found to be risk factors for new-onset tinnitus 5 years later. Anxiety and poor speech recognition ability in noise were associated with higher degrees of tinnitus annoyance in new-onset tinnitus. Somatization deserves to be addressed in future research and clinical practice as it might provide part of a model for the development of chronic tinnitus.

Afferent Loss, GABA, and Central Gain in Older Adults: Associations with Speech Recognition in Noise.

Deficits in auditory nerve (AN) function for older adults reduce afferent input to the cortex. The extent to which the cortex in older adults adapts to this loss of afferent input and the mechanisms underlying this adaptation are not well understood. We took a neural systems approach measuring AN and cortical evoked responses within 50 older and 27 younger human adults (59 female) to estimate central gain or increased cortical activity despite reduced AN activity. Relative to younger adults, older adults' AN response amplitudes were smaller, but cortical responses were not. We used the relationship between AN and cortical response amplitudes in younger adults to predict cortical response amplitudes for older adults from their AN responses. Central gain in older adults was thus defined as the difference between their observed cortical responses and those predicted from the parameter estimates of younger adults. In older adults, decreased afferent input contributed to lower cortical GABA levels, greater central gain, and poorer speech recognition in noise (SIN). These effects on SIN occur in addition to, and independent from, effects attributed to elevated hearing thresholds. Our results are consistent with animal models of central gain and suggest that reduced AN afferent input in some older adults may result in changes in cortical encoding and inhibitory neurotransmission, which contribute to reduced SIN. An advancement in our understanding of the changes that occur throughout the auditory system in response to the gradual loss of input with increasing age may provide potential therapeutic targets for intervention.SIGNIFICANCE STATEMENT Age-related hearing loss is one of the most common chronic conditions of aging, yet little is known about how the cortex adapts to this loss of sensory input. We measured AN and cortical responses to the same stimulus in younger and older adults. In older adults we found hyperexcitability in cortical activity relative to concomitant declines in afferent input that are consistent with central gain. Lower levels of cortical GABA, an inhibitory neurotransmitter, were associated with greater central gain, which predicted poorer SIN. The results suggest that the cortex in older adults may adapt to attenuated sensory input by reducing inhibition to amplify the cortical response, but this amplification may lead to poorer SIN.

Remote-Microphone Benefit in Noise and Reverberation for Children Who are Hard of Hearing.

Remote-microphone (RM) systems are designed to reduce the impact of poor acoustics on speech understanding. However, there is limited research examining the effects of adding reverberation to noise on speech understanding when using hearing aids (HAs) and RM systems. Given the significant challenges posed by environments with poor acoustics for children who are hard of hearing, we evaluated the ability of a novel RM system to address the effects of noise and reverberation. We assessed the effect of a recently developed RM system on aided speech perception of children who were hard of hearing in noise and reverberation and how their performance compared to peers who are not hard of hearing (i.e., who have hearing thresholds no greater than 15 dB HL). The effect of aided speech audibility on sentence recognition when using an RM system also was assessed. Twenty-two children with mild to severe hearing loss and 17 children who were not hard of hearing (i.e., with hearing thresholds no greater than 15 dB HL) (7-18 years) participated. An adaptive procedure was used to determine the signal-to-noise ratio for 50 and 95% correct sentence recognition in noise and noise plus reverberation (RT 300 ms). Linear mixed models were used to examine the effect of listening conditions on speech recognition with RMs for both groups of children and the effects of aided audibility on performance across all listening conditions for children who were hard of hearing. Children who were hard of hearing had poorer speech recognition for HAs alone than for HAs plus RM. Regardless of hearing status, children had poorer speech recognition in noise plus reverberation than in noise alone. Children who were hard of hearing had poorer speech recognition than peers with thresholds no greater than 15 dB HL when using HAs alone but comparable or better speech recognition with HAs plus RM. Children with better-aided audibility with the HAs showed better speech recognition with the HAs alone and with HAs plus RM. Providing HAs that maximize speech audibility and coupling them with RM systems has the potential to improve communication access and outcomes for children who are hard of hearing in environments with noise and reverberation.

Does age-related hearing loss deteriorate attentional resources?

ABSTRACT Recent work suggests that age-related hearing loss (HL) is a possible risk factor for cognitive decline in older adults. Resulting poor speech recognition negatively impacts cognitive, social and emotional functioning and may relate to dementia. However, little is known about the consequences of hearing loss on other non-linguistic domains of cognition. The aim of this study was to investigate the role of HL on covert orienting of attention, selective attention and executive control. We compared older adults with and without mild to moderate hearing loss (26–60 dB) performing (1) a spatial cueing task with uninformative central cues (social vs. nonsocial cues), (2) a flanker task and (3) a neuropsychological assessment of attention. The results showed that overall response times and flanker interference effects were comparable across groups. However, in spatial cueing of attention using social and nonsocial cues, hearing impaired individuals were characterized by reduced validity effects, though no additional group differences were found between social and nonsocial cues. Hearing impaired individuals also demonstrated diminished performance on the Montreal Cognitive Assessment (MoCA) and on tasks requiring divided attention and flexibility. This work indicates that while response speed and response inhibition appear to be preserved following mild-to-moderate acquired hearing loss, orienting of attention, divided attention and the ability to flexibly allocate attentional resources are more deteriorated in older adults with HL. This work suggests that hearing loss might exacerbate the detrimental influences of aging on visual attention.

Susceptibility to signal distortion in older listeners with hearing loss

Older adults show significant individual variability in hearing aid benefit. Our recent work has identified factors contributing to this individual variability including age, degree of hearing loss, and working memory. Specifically, older adults with greater hearing loss and poorer working memory are disadvantaged (poorer speech recognition) by signal distortions arising from adverse listening conditions and aggressive hearing aid signal processing settings. In this presentation, we focus on the range of signal distortions (quantified by a cepstral correlation metric) due to hearing aid signal processing such as amplitude compression, frequency lowering, and digital noise reduction, combined with different amounts and types of background noise. Across studies, we characterized individual susceptibility to signal distortions with a comprehensive set of conditions ranging from laboratory simulations to realistic listening conditions. Earlier studies considered omnidirectional settings and co-located speech and noise conditions, whereas recent work has focused on clinically realistic conditions such as wearable hearing aids, microphone directionality, and spatially-separated speech and multi-talker babble. We will discuss the clinical implications of these findings, particularly the impact on customizing hearing aid fittings to maximize benefit for older individuals. [Work is funded by NIDCD.]

Self-Adjustment of Hearing Aid Amplification for Lower Speech Levels: Independent Ratings, Paired Comparisons, and Speech Recognition.

Self-adjustment of hearing aid amplification enables wearers to customize the hearing aid output to match their preferences and could become an important tool for programming direct-to-consumer devices for people with mild-to-moderate hearing loss. One risk is that user-selected settings may provide inadequate audibility. This study assessed that risk by quantifying relationships between self-adjusted settings, subjective preferences, and speech recognition performance using speech at low levels in quiet, where achieving high speech audibility requires sufficient amplification. Fifteen people with symmetric, mild-to-moderate sensorineural hearing loss self-adjusted hearing aid amplification while listening to speech in quiet at 45, 55, and 65 dBA. After self-adjustment, 11 participants made blinded ratings of their self-adjusted fit, their NAL-NL2 prescriptive fit, and experimenter-created fits with reduced gain. Participants completed blinded paired comparisons and sentence recognition assessments using these settings. The gain of self-adjusted fits showed a large range of variability between participants. On average, self-adjusted gain was similar to NAL-NL2 prescribed gain for input signals of 55 dBA and slightly greater than prescribed gain for 45-dBA signals. Speech recognition scores for NAL-NL2 fits were consistently high, and differences in speech recognition results were strongly correlated with the overall preferences obtained from paired comparisons. Self-adjusted fits are highly variable between individuals for low-audibility conditions. Nonetheless, self-adjusted fits are at least as satisfactory as NAL-NL2 fits, and listeners tend to disfavor settings that result in poorer speech recognition. The findings argue against concerns that self-adjustment will result in inadequate audibility compared to prescribed settings.

Personal Characteristics Associated with Ecological Momentary Assessment Compliance in Adult Cochlear Implant Candidates and Users.

Ecological momentary assessment (EMA) often places high physical and mental burden on research participants compared with retrospective self-reports. The high burden could result in noncompliance with the EMA sampling scheme protocol. It has been a concern that certain types of participants could be more likely to have low compliance, such as those who have severe hearing loss and poor speech recognition performance, are employed, are not familiar with technologies used to implement EMA (e.g., smartphones), and have poorer cognitive abilities. Noncompliance dependent on personal characteristics could negatively impact the generalizability of EMA research. This article aims to determine personal characteristics associated with EMA compliance in a group of adult cochlear implant (CI) candidates and users. An observational study. Fifty-eight adults who were either scheduled to received CIs or were experienced CI users completed the study. Participants conducted smartphone-based EMA designed to assess an individual's daily auditory ecology for 1 week. EMA compliance was quantified using two metrics: the number of completed surveys and the response rate to the notification delivered by the EMA app. Personal characteristics (i.e., predictors) included age, gender, CI status (candidate or user), employment status (employed or not employed), smartphone ownership, speech recognition performance, social network size, level of depressive symptoms, and neurocognitive abilities. A word recognition test, questionnaires, and a test battery of neurocognitive assessments were used to measure the predictors. We used negative binomial regression and logistic mixed models to determine the factors associated with the number of completed surveys and the response rate, respectively. We hypothesized that, for example, employed participants with poorer speech recognition performance would have lower compliance. Contrary to the hypothesis, word recognition score was negatively associated with the number of completed surveys (p = 0.022). Holding all other variables constant, a 10-point (i.e., 10%) word recognition score decrease was associated with an 11% increase in the number of completed surveys. For the response rate, employment status was the only significant predictor (p < 0.0001). Consistent with our hypothesis, the odds of responding to EMA notifications for those who are not employed are 82% higher than the odds for those who are employed. No other studied personal characteristic was associated with compliance. For CI candidates and users, EMA compliance could be affected by personal characteristics such as speech recognition performance and employment status. Because (1) participants with poorer speech recognition performance do not necessarily have lower compliance and (2) most personal characteristics investigated in the present study (e.g., age, gender, smartphone ownership, and neurocognitive abilities) do not predict compliance, a wide range of participants could successfully conduct smartphone-based EMA.

Metabolic and Sensory Components of Age-Related Hearing Loss.

Age-related hearing loss is a multifactorial condition with effects of aging and environmental exposures that contribute to cochlear pathologies. Metabolic hearing loss involves declines in the endocochlear potential, which broadly reduce cochlear amplification of low-level sounds. Sensory hearing loss involves damage to outer hair cells that may eliminate amplification, especially for high-frequency sounds. A novel approach was developed to estimate the extent of metabolic and sensory components (in dB) for an individual, by combining hearing loss profiles to optimally approximate their hearing thresholds (audiogram). This approach was validated using estimates of metabolic and sensory hearing loss from retrospective datasets including gerbils, cross-sectional and longitudinal audiograms from older adults, a measure of speech recognition in noise, and histopathology case reports. Simulation results showed that well-approximated audiograms can produce accurate metabolic and sensory estimates. Estimates of metabolic and sensory components of age-related hearing loss differentiated gerbils with known strial and/or sensory pathologies based on age and exposures. For older adults, metabolic estimates consistently increased with age and were associated with poorer speech recognition in noise, while sensory estimates were related to sex and noise exposure differences. Histopathology case reports (with audiograms) that described strial and outer hair cell pathology in temporal bones from older donors showed significant differences in metabolic and sensory estimates, respectively. The results support the view that audiograms include information that can be used to estimate the metabolic and sensory components of age-related hearing loss.

Comparing Sound-Field Speech-Auditory Brainstem Response Components between Cochlear Implant Users with Different Speech Recognition in Noise Scores

ObjectivesMany studies have suggested that cochlear implant (CI) users vary in terms of speech recognition in noise. Studies in this field attribute this variety partly to subcortical auditory processing. Studying speech-Auditory Brainstem Response (speech-ABR) provides good information about speech processing; thus, this work was designed to compare speech-ABR components between two groups of CI users with good and poor speech recognition in noise scores. Materials & MethodsThe present study was conducted on two groups of CI users aged 8-10 years old. The first group (CI-good) consisted of 15 children with prelingual CI who had good speech recognition in noise performance. The second group (CI-poor) was matched with the first group, but they had poor speech recognition in noise performance. The speech-ABR test in a sound-field presentation was performed for all the participants. Results The speech-ABR response showed more delay in C, D, E, F, O latencies in CI-poor than CI-good users (P <0.05), meanwhile no significant difference was observed in initial wave (V(t= -0.293, p= 0.771 and A (t= -1.051, p= 0.307). Analysis in spectral-domain showed a weaker representation of fundamental frequency as well as the first formant and high-frequency component of speech stimuli in the CI users with poor auditory performance.ConclusionsResults revealed that CI users who showed poor auditory performance in noise performance had deficits in encoding the periodic portion of speech signals at the brainstem level. Also, this study could be as physiological evidence for poorer pitch processing in CI users with poor speech recognition in noise performance.

Neural Presbyacusis in Humans Inferred from Age-Related Differences in Auditory Nerve Function and Structure.

A common complaint of older adults is difficulty understanding speech, particularly in challenging listening conditions. Accumulating evidence suggests that these difficulties may reflect a loss and/or dysfunction of auditory nerve (AN) fibers. We used a novel approach to study age-related changes in AN structure and several measures of AN function, including neural synchrony, in 58 older adults and 42 younger adults. AN activity was measured in response to an auditory click (compound action potential; CAP), presented at stimulus levels ranging from 70 to 110 dB pSPL. Poorer AN function was observed for older than younger adults across CAP measures at higher but not lower stimulus levels. Associations across metrics and stimulus levels were consistent with age-related AN disengagement and AN dyssynchrony. High-resolution T2-weighted structural imaging revealed age-related differences in the density of cranial nerve VIII, with lower density in older adults with poorer neural synchrony. Individual differences in neural synchrony were the strongest predictor of speech recognition, such that poorer synchrony predicted poorer recognition of time-compressed speech and poorer speech recognition in noise for both younger and older adults. These results have broad clinical implications and are consistent with an interpretation that age-related atrophy at the level of the AN contributes to poorer neural synchrony and may explain some of the perceptual difficulties of older adults.SIGNIFICANCE STATEMENT Differences in auditory nerve (AN) pathophysiology may contribute to the large variations in hearing and communication abilities of older adults. However, current diagnostics focus largely on the increase in detection thresholds, which is likely because of the absence of indirect measures of AN function in standard clinical test batteries. Using novel metrics of AN function, combined with estimates of AN structure and auditory function, we identified age-related differences across measures that we interpret to represent age-related reductions in AN engagement and poorer neural synchrony. Structure-function associations are consistent with an explanation of AN deficits that arise from age-related atrophy of the AN. Associations between neural synchrony and speech recognition suggest that individual and age-related deficits in neural synchrony contribute to speech recognition deficits.

COVID-19, Face Masks, and Social Interaction: How a Global Pandemic Is Shining a Light on the Importance of Face-to-Face Communication

Purpose The purpose of this article is to discuss the impact of COVID-19 mitigation strategies on face-to-face communication. The article covers three main areas: the effect of face masks and social distancing on aspects of communication, including speech production, speech recognition, and emotion recognition; the effect of face masks on access to visual speech cues; and downstream effects of poor speech recognition on language and cognitive abilities. Conclusions The use of face masks and social distancing are proven mitigation strategies to minimize the spread of COVID-19 and other airborne diseases. However, these strategies may place individuals with hearing, speech, and language disorders at greater risk for communication problems in their daily lives. Practitioners who work directly with these patients should consider these issues when discussing communication strategies with their patients.

Cochlear Synaptopathy: A Primary Factor Affecting Speech Recognition Performance in Presbycusis.

The results of recent animal studies have suggested that cochlear synaptopathy may be an important factor involved in presbycusis. Therefore, here, we aimed to examine whether cochlear synaptopathy frequently exists in patients with presbycusis and to describe the effect of cochlear synaptopathy on speech recognition in noise. Based on the medical history and an audiological examination, 94 elderly patients with bilateral, symmetrical, sensorineural hearing loss were diagnosed as presbycusis. An electrocochleogram, auditory brainstem responses, auditory cortical evoked potentials, and speech audiometry were recorded to access the function of the auditory pathway. First, 65 ears with hearing levels of 41-50 dB HL were grouped based on the summating potential/action potential (SP/AP) ratio, and the amplitudes of AP and SP were compared between the two resulting groups. Second, 188 ears were divided into two groups: the normal SP/AP and abnormal SP/AP groups. The speech recognition abilities in the two groups were compared. Finally, the relationship between abnormal electrocochleogram and poor speech recognition (signal-to-noise ratio loss ≥7 dB) was analyzed in 188 ears. The results of the present study showed: (1) a remarkable reduction in the action potential amplitude was observed in patients with abnormal SP/AP ratios; this suggests that cochlear synaptopathy was involved in presbycusis. (2) There was a large proportion of patients with poor speech recognition in the abnormal SP/AP group. Furthermore, a larger number of cases with abnormal SP/AP ratios were confirmed among patients with presbycusis and poor speech recognition. We concluded that cochlear synaptopathy is not uncommon among elderly individuals who have hearing ability deficits, and it may have a more pronounced effect on ears with declining auditory performance in noisy environments.

İşitme cihazı kullanan çocuklarda gürültüde konuşmayı anlama becerisinin değerlendirilmesi: Preliminer sonuçlar

Assessment of speech perception in noise in children with hearing aids: Preliminary results* Objective: Noisy environments are a part of the daily life of children, just like adults. Children with hearing loss who wear hearing aids are more susceptible to the negative effects of noise than their normal-hearing peers. This study aims to evaluate the speech recognition in noise performance of hearing aid users and compare them with their normal-hearing peers. Material and Method: Five children aged 6-12 years with bilateral moderate to severe symmetrical sensorineural hearing loss and using bilateral behind-the-ear hearing aids were included in the study. 4 different conditions of the Turkish HINT-C were applied, and a speech recognition threshold (SRT) is determined for each condition. Results: Regardless of their age, the SRT needed by children with hearing aids to achieve equal performance with their normal-hearing peers was found to be higher for all test conditions. As seen in children with normal hearing in general, the mean noise front score of the children with hearing loss was higher than the mean noise right and noise left scores. Conclusion: The results of this study revealed that children with bilaterally symmetrical moderate to severe hearing loss achieved poor speech recognition scores in environments similar to the classroom environment, compared to their normal-hearing peers. Our results guided appropriate rehabilitation and follow-up. Keywords: noise, speech recognition in noise, hearing loss, hearing aid, pediatric audiology, HINT, HINT-C

Poor speech recognition, sound localization and reorganization of brain activity in children with unilateral microtia-atresia

Microtia-atresia is a congenital malformation of the external ear, often affecting one side and being associated with severe-to-profound unilateral conductive hearing loss (UCHL). Although the impact of unilateral hearing loss (UHL) on speech recognition, sound localization and brain plasticity has been intensively investigated, less is known about the subjects with unilateral microtia-atresia (UMA). Considering these UMA subjects have hearing loss from birth, we hypothesize it has a great effect on brain organization. A questionnaire on speech recognition and spatial listening ability was administered to 40 subjects with UMA and 40 age- and sex-matched controls. UMA subjects showed poorer speech recognition in laboratory and poorer spatial listening ability. However, cognitive scores determined by the Montreal Cognitive Assessment (MoCA) and Wechsler Intelligence Scale for Children (WISC-IV) did not differ significantly in these two groups. The impact of hearing loss in UMA on brain functional organization was examined by comparing resting-state fMRIs (rs-fMRI) in 27 subjects with right-sided UMA and 27 matched controls. UMA subjects had increased nodal betweenness in visual networks and DMN but decreases in auditory and attention networks. These results indicate that UCHL in UMA causes significant abnormalities in brain organization. The impact of UCHL on cognition should be further examined with a battery of tests that are more challenging and better focused on the cognitive networks identified.