Accurately recognizing the emotional prosody of others is crucial for effective social interactions, yet this ability notably declines as individuals age, particularly in individuals with age-related hearing loss. To further understand how aging and hearing loss affect older adults' recognition patterns and to investigate potential contributors, the present study recruited 32 older adults with normal hearing, 26 older adults with age-related hearing loss, 30 younger adults with simulated hearing loss, and 30 younger adults with normal hearing to identify vocal emotions portrayed in semantically neutral Chinese words. Accuracy was analyzed using generalized linear mixed-effects models to assess the impact of aging and hearing loss. Multiple linear regression explored the contributions of age, low- and high-frequency hearing sensitivity, cognitive scores, and education level. The influence of Mandarin lexical tones on emotional prosody perception was also investigated. Results showed older adults with hearing loss had the lowest accuracy, followed by older adults with normal hearing. Younger adults with simulated hearing loss outperformed both older groups but lagged behind younger adults with normal hearing. Happiness and fear were particularly challenging emotions for individuals with hearing loss. Flat and rising tones enhanced happiness recognition, while falling tones improved sadness recognition. High-frequency hearing loss, cognitive scores, and years of education are significant contributors to older adults' performance. These findings reveal that older age and hearing loss are associated with reduced sensitivity to emotional prosody. Furthermore, the pattern of emotional prosody perception appears to differ across emotions and is related to individual differences in sensory, cognitive, and social factors. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Hearing loss can compromise U.S. Army aviators' performance, safety, and situational awareness, resulting in increasing mental workload and listening effort. This study evaluated simulated hearing loss on performance and cognitive workload among Army aviators. A mixed-effects linear regression study design was used. A total of 21 aviators underwent clinical audiological testing and simulated flight performance assessments. Simulated hearing loss and workload were manipulated to investigate their effects on speech recognition, flight performance, and subjective workload. Flight simulator routes included normal hearing and simulated hearing loss conditions for both high and low workloads. Task load questionnaires were administered for subjective workload assessments and compared across conditions. Speech recognition scores decreased with increasing levels of hearing loss. In-flight speech intelligibility declined in high workload conditions, with a 26% decrease for mild hearing loss and a 40% decrease for severe hearing loss. High workload conditions degraded flight performance and response times to a secondary task which was exacerbated by simulated hearing loss. Workload scores validated increased workload with simulated hearing loss. No significant findings were observed on the hearing assessment. Findings suggest hearing loss negatively impacts speech recognition and flight performance, especially under high workloads. These results support the importance of addressing hearing loss in aviators. Further research is needed to determine if the clinically adapted Modified Rhyme Test can reflect the impact of hearing loss on aviator performance. Noetzel J, Henry P, Mackie R, Cave K, Stefanson JR, Hale JK, Andres K, Jones H. Simulated hearing loss on speech recognition, flight performance, and workload in aviators. Aerosp Med Hum Perform. 2025; 96(4):269-278.

Objective measures of auditory capacity in the hearing loss population are crucial for cross-checking behavioral measures. Mismatch negativity (MMN) is an auditory event-related potential component indexing automatic change detection and reflecting speech discrimination performance. MMN can potentially serve as an objective measure of speech discrimination. This study examined whether the audibility of stimuli modulates MMN to Mandarin lexical tone contrasts by analyzing hearing loss simulation (HLS) in adults with normal hearing. The configurations of HLS were the between-subjects variable, with the sloping HLS simulating high-frequency hearing loss (more severe hearing loss at frequencies > 1000 Hz) and the rising HLS simulating low-frequency hearing loss. An AX discrimination task was used to measure the lexical tone discrimination by calculating d'. A multideviant oddball paradigm with large (high-level vs. low-dipping tones, T1-T3) and small (high-rising vs. low-dipping tones, T2-T3) deviant contrasts was employed to examine whether deviant size affects MMN sensitivity to stimuli's audibility. The results showed that the T1-T3 change elicited MMN in the sloping and rising HLS groups. The T2-T3 change elicited MMN in the sloping HLS group but a positive mismatch response in the rising HLS group. Furthermore, regression analysis indicates that more negative mismatch responses to T2-T3 predict better performance in discriminating T2-T3 contrasts. MMN to the T2-T3 change is sensitive to reduced audibility at frequencies lower than 1000 Hz. This suggests that MMN has the potential to serve as an objective assessment for evaluating lexical tone discrimination in people with hearing loss.

Sensorineural hearing loss affects a significant portion of the global population, with its prevalence projected to rise sharply in the coming years. Most cases involve the degeneration of hair cells and spiral ganglion neurons within the inner ear, and current therapeutic options for hearing rehabilitation offer limited efficacy with variable outcomes among patients. This systematic review evaluates the existing evidence on stem cell therapy as an intervention for hearing loss, focusing on its impact on hearing restoration, quality of life, and safety. A thorough search of electronic databases and clinical trial registries identified randomized and quasi-randomized studies on this topic. Eight studies met the inclusion criteria, investigating various types of stem cells such as embryonic, umbilical cord, and inner ear cells administered intravenously or directly into the inner ear. Most studies used animal models to simulate hearing loss, while one was conducted in humans. Findings on hearing improvement were mixed, with some studies reporting significant improvements in hearing thresholds and others showing no effect. The safety of stem cell therapy was assessed in a single human study, which noted no significant adverse effects. While the results indicate potential therapeutic value, further human studies with standardized protocols and larger sample sizes are necessary to clarify the safety and effectiveness of stem cell therapy for sensorineural hearing loss.

Several studies outline a future scenario of longer working lives and later retirement, meaning that there could be a large number of elderly workers in offices. Add to this the natural effect of hearing loss due to ageing (presbycusis; which usually presents after the 5th decade of life) and you have an open door to questions regarding the acoustic comfort of this group. In a first study, it was shown that the effect of intelligible speech on performance in a serial recall task is similar for listeners with normal hearing and presbycusis. The aim of this new experiment is to assess whether any differences might occur when people are involved in a more ecologically valid task (long exposure to noise - 3 h/condition - and similar tasks to those performed in open-plan offices). Given the validation of a hearing loss simulator in previous studies, this one will be used to reproduce the group of people with mild hearing loss (onset of presbycusis). Therefore, the same group of people (32 participants) with normal hearing will perform the experiment under two listening conditions, with and without the simulator. Each listening condition will have two noise conditions, irrelevant speech, each with a different intelligibility level.

Spectral weighting functions for sound localization were measured in participants with bilateral mild sloping to moderately severe, high-frequency sensorineural hearing loss (SNHL) and compared to normal hearing (NH) participants with and without simulated SNHL. Each participant group localized three types of complex tones, comprised of seven frequency components spatially jittered and presented from the horizontal frontal field. A threshold-elevating noise masker was implemented in the free field to simulate SNHL for participants with NH. On average, participants with SNHL and NH (in quiet and simulated SNHL) placed the greatest perceptual weight on components within the interaural time difference "dominance region," found previously to peak around 800 Hz [Folkerts and Stecker, J. Acoust. Soc. Am. 151, 3409-3425 (2022)]. In addition to the peak at 800 Hz, both participant groups (including NH participants in quiet) placed near equal weight on 400 Hz, resulting in a broadened "peak" in the dominance region, most likely due to the reduction of audibility to higher frequency components. However, individual weighting strategies were more variable across participants with SNHL than participants with NH. Localization performance was reduced for participants with SNHL but not for NH participants with simulated hearing loss when compared to NH participants in quiet.

The importance of simulating patient behavior for medical assessment training has grown in recent decades due to the increasing variety of simulation tools, including standardized/simulated patients, humanoid and android robot-patients. Yet, there is still a need for improvement of current android robot-patients to accurately simulate patient behavior, among which taking into account their hearing loss is of particular importance. This paper is the first to consider hearing loss simulation in an android robot-patient and its results provide valuable insights for future developments. For this purpose, an open-source dataset of audio data and audiograms from human listeners was used to simulate the effect of hearing loss on an automatic speech recognition (ASR) system. The performance of the system was evaluated in terms of both word error rate (WER) and word information preserved (WIP). Comparing different ASR models commonly used in robotics, it appears that the model size alone is insufficient to predict ASR performance in presence of simulated hearing loss. However, though absolute values of WER and WIP do not predict the intelligibility for human listeners, they do highly correlate with it and thus could be used, for example, to compare the performance of hearing aid algorithms.

Better communication with older people requires not only improving speech intelligibility but also understanding how well emotions can be conveyed and the effect of age and hearing loss (HL) on emotion perception. In this paper, emotion discrimination experiments were conducted using a vocal morphing method and an HL simulator in young normal hearing (YNH) and older participants. Speech sounds were morphed to represent intermediate emotions between all combinations of happiness, sadness, and anger. Discrimination performance was compared when the YNH listened to normal sounds, when the same YNH listened to HL simulated sounds, and when older people listened to the same normal sounds. The results showed that there was no significant difference between discrimination with and without HL simulation, suggesting that peripheral HL may not affect emotion perception. The discrimination performance of the older participants was significantly worse only for the anger-happiness pair than for the other emotion pairs and for the YNH. It was also found that the difficulty increases with age, not just with hearing level.

Mumps is the most common disease for children, which causes hearing loss in all auditory systems. WHO initiated compulsory vaccination for children who are at age of 12 months to 12 years, since 1967. Children must take two doses of vaccination for mumps. The dynamics of the system describing the mumps transmission is studied in this work. The main aim is to elucidate the nonlinear behavior of the system which can provide insights into the long-term effects of Mumps infection on auditory function. As the fractional-order derivative preserves the impact of system memory, we employ the Caputo fractional derivative as the dynamical system describing modeling to simulate hearing loss in children brought on by the mumps virus. The boundedness existence of the solution and stability analysis of the dynamical system are derived in the framework. The result is derived using a well-known numerical method to capture the corresponding consequences and predict the future consequence of the dynamical system associated with parameters. To testify to the importance of the generalizing classical model with a fractional operator, we plot 2D graphs. This study helps to researcher beginners to understand the essential and fundamental tools while investigating real-world problems.

Background and ObjectivesLocalization of a sound source in the horizontal plane depends on the listener’s interaural comparison of arrival time and level. Hearing loss (HL) can reduce access to these binaural cues, possibly disrupting the localization and memory of spatial information. Thus, this study aimed to investigate the horizontal sound localization performance and the spatial short-term memory in listeners with actual and simulated HL.Subjects and MethodsSeventeen listeners with bilateral symmetric HL and 17 listeners with normal hearing (NH) participated in the study. The hearing thresholds of NH listeners were elevated by a spectrally shaped masking noise for the simulations of unilateral hearing loss (UHL) and bilateral hearing loss (BHL). The localization accuracy and errors as well as the spatial short-term memory span were measured in the free field using a set of 11 loudspeakers arrayed over a 150° arc.ResultsThe localization abilities and spatial short-term memory span did not significantly differ between actual BHL listeners and BHL-simulated NH listeners. Overall, the localization performance with the UHL simulation was approximately twofold worse than that with the BHL simulation, and the hearing asymmetry led to a detrimental effect on spatial memory. The mean localization score as a function of stimulus location in the UHL simulation was less than 30% even for the front (0° azimuth) stimuli and much worse on the side closer to the simulated ear. In the UHL simulation, the localization responses were biased toward the side of the intact ear even when sounds were coming from the front.ConclusionsHearing asymmetry induced by the UHL simulation substantially disrupted the localization performance and recall abilities of spatial positions encoded and stored in the memory, due to fewer chances to learn strategies to improve localization. The marked effect of hearing asymmetry on sound localization highlights the need for clinical assessments of spatial hearing in addition to conventional hearing tests.

Abstract If there is sound in the ear canal, you can measure it with a probe microphone in the ear. The following are a few examples of how you might use your real-ear probe microphone measures beyond verifying hearing aid fittings, signal processing, and function of features. A process to simulate hearing loss to educate and support family members and patients is described.

The goal of this work is to extend the use of physiological measures of listening effort to interactive conversation. The initial work here investigates variations in head movement, eye gaze, and pupil dilation around conversational state changes during task-based conversations. Here, conversational state changes are defined as the points in time at which speakers start and stop talking. Windows around each of these types of state changes are analyzed for systematic differences of these parameters, which could be indicative of changes in attention and/or differences in speech production versus perception. Additionally, we calculate state change response functions, derived from a multivariate regression that maps from the state changes to the measured parameters and extracted features. The predictive power of these functions is explored, alongside comparisons of various considerations in their derivations. Our findings, based on data collected from 12 sets of interactive conversations taking place in varying levels of noise and simulated hearing loss, offer insight into how physiological responses during complex interactions can be measured and interpreted to infer when and where effort is directed throughout conversation.

Hearing loss is associated with increased risk of falling, but little is known about how hearing impairment might affect mobility. Here, we report preliminary results from an ongoing experimental study investigating dynamic properties of gait while walking with and without impaired hearing. Young- and middle-aged adult participants with self-reported normal hearing completed four walking tasks, 2 indoors, 2 outdoors, each conducted with and without a simulated hearing loss. In the impaired condition, participants wore an insert earplug in one ear combined with binaural, circumaural noise-damping headphones. We quantified gait parameters using data from inertial measurement units (IMUs) affixed to participants’ ankles and waist, allowing participants to walk farther than in typical gait assessments. Parameters included standard gait metrics, such as limb acceleration as well as a novel spatiotemporal index quantifying variability in step patterns. Data have been collected from 13 of 30 projected participants. Analysis will focus on how temporal-spatial gait parameters and variability differ between indoor and outdoor walking with and without hearing impairment. We expect gait parameters to reflect a more variable and potentially less mobile walking strategy in the outdoor condition and with impaired hearing due to increased cognitive load and/or reduced spatial awareness in those conditions.

Recent research has found that practicing speech-language pathologists report feeling underprepared to provide services for individuals with hearing loss. At the same time, graduate SLP programs report that students have fewer training opportunities with low-incidence populations. This study examines learning outcomes for a cohort of graduate SLP students using a novel application of an immersive, augmented reality, hearing loss simulation. Results show encouraging outcomes for the simulation experience’s effects on empathy, knowledge, and clinical skills. This simulation offers a unique way to provide training related to auditory rehabilitation in SLP.

In today’s dynamic and interconnected world, emotional response to music is an experience that connects people across cultures. Regardless of cultural background, the music listening experience is impeded for people facing hearing loss. Hearing loss is quite prevalent, yet little is known about how those with impaired hearing experience emotions in response to music. This project’s objective was to understand cross-cultural emotional responses to music and how they are altered under hearing-impaired conditions. We studied emotions expressed by people from two different countries after listening to world music and investigated how these emotions varied under simulated hearing loss. We first hypothesized that emotions elicited by music would be similar across people from the U.S. and India. We next hypothesized that emotions found to be elicited similarly across cultures would continue to be experienced when listening to music under simulated hearing loss conditions. In this study, we surveyed 984 participants from the two countries, asking them to identify the emotions elicited by 100 world music clips. We then repeated the survey with an additional 886 participants using clips in which the music was modified to simulate hearing loss. Our results indicated that, of the 20 emotions studied, 8 were prominently positively correlated across both countries. Furthermore, we found that these emotions differed from the emotions correlated across the two countries under simulated hearing loss, potentially providing new insight into how hearing loss affects emotional perceptions of music. The conclusions have implications in audiology, psychology, and for the music industry as it relates to hearing loss.

Purpose: Hearing loss simulation (HLS) has been recommended for clinical teaching and counseling of patients and their families, so that they can experience hearing impairment. However, few validated procedures for simulating hearing loss are available to instructors and practicing clinicians. The aim of this study was to assess the accuracy of the Immersive Hearing Loss and Prosthesis Simulator (I-HeLPS) on reducing hearing sensitivity and word recognition to determine its adequacy for educational and clinical use. Method: Thirty-seven young adults with normal hearing completed hearing threshold and word recognition testing under normal and simulated hearing losses. The accuracy of the nominal hearing threshold settings within the I-HeLPS software was assessed with behavioral detection of frequency-modulated pure tones presented in a calibrated sound field, while listeners wore I-HeLPS headphones. The impact of the HLSs on speech perception was measured using the California Consonant Test. Hearing thresholds, word identification accuracy, and sound confusions were compared across listening conditions. Results: Hearing thresholds increased systematically with worse simulated hearing loss. Performance on the California Consonant Test worsened, and the number of phoneme confusions increased with simulated hearing loss severity. Most of the confusions were place confusions with near neighbors and manner confusions increased as a function of increasing severity of simulated hearing loss. Conclusions: The I-HeLPS accurately elevated hearing thresholds with increasing HLS severity and impacted word recognition in a manner consistent with sensorineural hearing loss. The simulations were considered reasonable for educational and clinical purposes. Supplemental Material: https://doi.org/10.23641/asha.24520966

Hearing loss can render an aviator more susceptible to the adverse effects of degraded communication signals and consequently lead to an increased allocation of mental resources to hear (referred to as listening effort). Army aviation hearing standards, which are primarily based on pure tone and speech recognition test scores in quiet environments, do not necessarily predict the functional impact of hearing loss. The Army has recently adopted a new Military Operational Hearing Test (MOHT) to assess the functional impact of hearing loss. The current study aimed to validate the MOHT, specifically for aviators, and measure subjective workload, task performance, and physiological workload across different simulated hearing loss conditions in both clinical and flight simulator settings. Participants were Army aviators with normal hearing thresholds and underwent clinical testing using the MOHT for normal and hearing loss conditions. In addition to audiometric data, flight performance data were collected from pilots operating a full-motion UH-60 Black Hawk flight simulator for different levels of workloads and compared across the different hearing loss conditions. Subjective and physiological measurements of cognitive workload during simulated flight were also collected. Findings from this study will be leveraged in developing future protocols for aeromedical standards and evaluating hearing loss mitigation strategies using various headset technologies.

BackgroundMost studies on pitch shift provoked by hearing loss have been conducted using pure tones. However, many sounds encountered in everyday life are harmonic complex tones. In the present study, psychoacoustic experiments using complex tones were performed on healthy participants, and the possible mechanisms that cause pitch shift due to hearing loss are discussed.MethodsTwo experiments were performed in this study. In experiment 1, two tones were presented, and the participants were asked to select the tone that was higher in pitch. Partials with frequencies less than 250, 500, 750, or 1,000 Hz were eliminated from the harmonic complex tones and used as test tones to simulate low-tone hearing loss. Each tone pair was constructed such that the tone with a lower fundamental frequency (F0) was higher in terms of the frequency of the lowest partial. Furthermore, partials whose frequencies were greater than 1,300 or 1,600 Hz were also eliminated from these test tones to simulate high-tone hearing loss or modified sounds that patients may hear in everyday life. When a tone with a lower F0 was perceived as higher in pitch, it was considered a pitch shift from the expected tone. In experiment 2, tonal sequences were constructed to create a passage of the song “Lightly Row.” Similar to experiment 1, partials of harmonic complex tones were eliminated from the tones. After listening to these tonal sequences, the participants were asked if the sequences sounded correct based on the melody or off-key.ResultsThe results showed that pitch shifts and the melody sound off-key when lower partials are eliminated from complex tones, especially when a greater number of high-frequency components are eliminated.ConclusionConsidering that these experiments were performed on healthy participants, the results suggest that the pitch shifts from the expected tone when patients with hearing loss hear certain complex tones, regardless of the underlying etiology of the hearing loss.

PurposeMaintaining static balance is a process coordinated by central integration of visual, vestibular and somatosensory information. Whether or not hearing and spatial acoustic information contributes to the maintenance of static postural balance is unclear.MethodsA prospective observational pilot study was performed. Twenty-five normal hearing adults (68% female; 19–31 years) underwent a computerized dynamic posturography test battery including the Sensory Organization Test (SOT), the Motor Control Test (MCT), and the Adaptation Test (ADT). The balance tests were performed two times, in a randomized sequence without or with acute hearing loss. Earplugs (sound insulation 37 dB) or headphones with white noise (sound volume 75 dB) induced the conductive hearing loss. Hence, all participants passed through four sequences of the balance test battery. A repeated-measures analysis of variance (ANOVA) was used to analyze the results.ResultsThe ANOVA revealed no difference for any SOT and ADT subtest without hearing loss and simulated hearing loss (either earplugs or headphones; all p > 0.05). The ANOVA showed no longer latencies with simulated hearing loss compared to no hearing loss in both experiments with one exception: the reaction of the right foot during large forward translation was longer with hearing loss than without hearing loss in both experiments (p = 0.025).ConclusionsOverall, a simulated acute conductive bilateral moderate or severe hearing loss did not disturb the static balance function in normal hearing younger adults in this first small pilot study.

A previous investigation demonstrated differences between younger adult normal-hearing listeners and older adult hearing-impaired listeners in the perceived emotion of clear and conversational speech. Specifically, clear speech sounded angry more often than conversational speech for both groups, but the effect was smaller for the older listeners. These listener groups differed by two confounding factors, age (younger vs. older adults) and hearing status (normal vs. impaired). The objective of the present study was to evaluate the contributions of aging and hearing loss to the reduced perception of anger in older adults with hearing loss. We investigated perceived anger in clear and conversational speech in younger adults with and without a simulated age-related hearing loss, and in older adults with normal hearing. Younger adults with simulated hearing loss performed similarly to normal-hearing peers, while normal-hearing older adults performed similarly to hearing-impaired peers, suggesting that aging was the primary contributor to the decreased anger perception seen in previous work. These findings confirm reduced anger perception for older adults compared to younger adults, though the significant speaking style effect—regardless of age and hearing status—highlights the need to identify methods of producing clear speech that is emotionally neutral or positive.