Larry E. Humes

Central Presbycusis: A Review and Evaluation of the Evidence

BACKGROUND The authors reviewed the evidence regarding the existence of age-related declines in central auditory processes and the consequences of any such declines for everyday communication. PURPOSE This report summarizes the review process and presents its findings. DATA COLLECTION AND ANALYSIS The authors reviewed 165 articles germane to central presbycusis. Of the 165 articles, 132 articles with a focus on human behavioral measures for either speech or nonspeech stimuli were selected for further analysis. RESULTS For 76 smaller-scale studies of speech understanding in older adults reviewed, the following findings emerged: (1) the three most commonly studied behavioral measures were speech in competition, temporally distorted speech, and binaural speech perception (especially dichotic listening); (2) for speech in competition and temporally degraded speech, hearing loss proved to have a significant negative effect on performance in most of the laboratory studies; (3) significant negative effects of age, unconfounded by hearing loss, were observed in most of the studies of speech in competing speech, time-compressed speech, and binaural speech perception; and (4) the influence of cognitive processing on speech understanding has been examined much less frequently, but when included, significant positive associations with speech understanding were observed. For 36 smaller-scale studies of the perception of nonspeech stimuli by older adults reviewed, the following findings emerged: (1) the three most frequently studied behavioral measures were gap detection, temporal discrimination, and temporal-order discrimination or identification; (2) hearing loss was seldom a significant factor; and (3) negative effects of age were almost always observed. For 18 studies reviewed that made use of test batteries and medium-to-large sample sizes, the following findings emerged: (1) all studies included speech-based measures of auditory processing; (2) 4 of the 18 studies included nonspeech stimuli; (3) for the speech-based measures, monaural speech in a competing-speech background, dichotic speech, and monaural time-compressed speech were investigated most frequently; (4) the most frequently used tests were the Synthetic Sentence Identification (SSI) test with Ipsilateral Competing Message (ICM), the Dichotic Sentence Identification (DSI) test, and time-compressed speech; (5) many of these studies using speech-based measures reported significant effects of age, but most of these studies were confounded by declines in hearing, cognition, or both; (6) for nonspeech auditory-processing measures, the focus was on measures of temporal processing in all four studies; (7) effects of cognition on nonspeech measures of auditory processing have been studied less frequently, with mixed results, whereas the effects of hearing loss on performance were minimal due to judicious selection of stimuli; and (8) there is a paucity of observational studies using test batteries and longitudinal designs. CONCLUSIONS Based on this review of the scientific literature, there is insufficient evidence to confirm the existence of central presbycusis as an isolated entity. On the other hand, recent evidence has been accumulating in support of the existence of central presbycusis as a multifactorial condition that involves age- and/or disease-related changes in the auditory system and in the brain. Moreover, there is a clear need for additional research in this area.

Factors underlying the speech-recognition performance of elderly hearing-aid wearers

This paper reports the aided and unaided speech-recognition scores from a group of 171 elderly hearing-aid wearers. All hearing-aid wearers were fit with identical instruments (linear Class-D amplifiers with output-limiting compression) and evaluated with a standard protocol. In addition to including multiple measures of speech recognition, an extensive set of physiological and perceptual measures of auditory function, as well as general measures of cognitive function, were completed prior to the hearing-aid fitting. Comparison of the results from this study to available norms suggested that this group of participants was fairly typical or representative for their hearing loss and age. Approaches to the prediction of general speech-recognition performance that were examined included methods based on an acoustical index, the Speech Intelligibility Index (SII), and others based on linear-regression statistical analysis. The latter approach proved to be the most successful, accounting for about two-thirds of the variance in speech-recognition performance, with the primary predictive factors being measures of hearing loss and cognitive function.

Auditory measures of selective and divided attention in young and older adults using single-talker competition

In this study, two experiments were conducted on auditory selective and divided attention in which the listening task involved the identification of words in sentences spoken by one talker while a second talker produced a very similar competing sentence. Ten young normal-hearing (YNH) and 13 elderly hearing-impaired (EHI) listeners participated in each experiment. The type of attention cue used was the main difference between experiments. Across both experiments, several consistent trends were observed. First, in eight of the nine divided-attention tasks across both experiments, the EHI subjects performed significantly worse than the YNH subjects. By comparison, significant differences in performance between age groups were only observed on three of the nine selective-attention tasks. Finally, there were consistent individual differences in performance across both experiments. Correlational analyses performed on the data from the 13 older adults suggested that the individual differences in performance were associated with individual differences in memory (digit span). Among the elderly, differences in age or differences in hearing loss did not contribute to the individual differences observed in either experiment.

Hearing impairment and cognitive energy: the Framework for Understanding Effortful Listening (FUEL)

The Fifth Eriksholm Workshop on “Hearing Impairment and Cognitive Energy” was convened to develop a consensus among interdisciplinary experts about what is known on the topic, gaps in knowledge, the use of terminology, priorities for future research, and implications for practice. The general term cognitive energy was chosen to facilitate the broadest possible discussion of the topic. It goes back to Titchener (1908) who described the effects of attention on perception; he used the term psychic energy for the notion that limited mental resources can be flexibly allocated among perceptual and mental activities. The workshop focused on three main areas: (1) theories, models, concepts, definitions, and frameworks; (2) methods and measures; and (3) knowledge translation. We defined effort as the deliberate allocation of mental resources to overcome obstacles in goal pursuit when carrying out a task, with listening effort applying more specifically when tasks involve listening. We adapted Kahneman’s seminal (1973) Capacity Model of Attention to listening and proposed a heuristically useful Framework for Understanding Effortful Listening (FUEL). Our FUEL incorporates the well-known relationship between cognitive demand and the supply of cognitive capacity that is the foundation of cognitive theories of attention. Our FUEL also incorporates a motivation dimension based on complementary theories of motivational intensity, adaptive gain control, and optimal performance, fatigue, and pleasure. Using a three-dimensional illustration, we highlight how listening effort depends not only on hearing difficulties and task demands but also on the listener’s motivation to expend mental effort in the challenging situations of everyday life.

Models of the additivity of masking

Three models of masking additivity are reviewed, which are referred to as the high-compression model [M. J. Penner, J. Acoust. Soc. Am. 67, 608-616 (1980); M. J. Penner and R. M. Shiffrin, J. Acoust. Soc. Am. 67, 617-627 (1980)], the power-law model [R. A. Lutfi, J. Acoust. Soc. Am. 73, 262-267 (1983); 80, 422-428 (1986)], and the modified power-law model with compressed internal noise [Humes et al., J. Acoust. Soc. Am. 83, 188-202 (1988)]. While the high-compression model was derived from data for two or more nonsimultaneous maskers and the power-law model was derived from data for two or more simultaneous maskers, the modified power-law model can be applied to both cases. The modified power-law model assumes that the threshold in quiet is equivalent to a masked threshold resulting from an internal noise that is continually present. Additional assumptions concern the interaction of two maskers prior to the addition of the masking effects. Most of the data on the additivity of masking are well described by the modified power-law model, regardless of the nature of the maskers. Thus the model provides a good description of data for combined simultaneous maskers and combined nonsimultaneous maskers, a task heretofore requiring the use of at least two separate and independently developed models.

Factors Affecting Speech Understanding in Older Adults

This chapter reviews various factors that affect the speech-understanding abilities of older adults. Before proceeding to the identification of several such factors, however, it is important to clearly define what is meant by “speech understanding.” This term is used to refer to either the open-set recognition or the closed-set identification of nonsense syllables, words, or sentences by human listeners. Many years ago, Miller et al. (1951) demonstrated that the distinction between open-set recognition and closed-set identification blurs as the set size for closed-set identification increases. When words were used as the speech material, Miller et al. (1951) demonstrated that the closed-set speech-identification performance of young normal-hearing listeners progressively approached that of open-set speech recognition as the set size doubled in successive steps from 2 to 256 words. Clopper et al. (2006) have also demonstrated that lexical factors (e.g., word frequency and acoustic-phonetic similarity) impacting word identification and word recognition are very similar when the set size is reasonably large for the closed-set identification task and the alternatives in the response are reasonably confusable with the stimulus item. Thus the processes of closed-set speech identification and open-set speech recognition are considered to be very similar and both are referred to here as measures of “speech understanding.”

A review of past research on changes in hearing aid benefit over time.

&NA; Hearing aid benefit refers to a relative change in performance on a particular measure between aided and unaided listening conditions. A number of studies in recent years have investigated the hypothesis that hearing aid benefit increases over time after the initial fitting of the aid. Both objective (speech recognition) and subjective (questionnaire) measures have been used to measure hearing aid benefit. Some studies have reported a positive increase over time in group mean benefit, and some have reported no change in benefit, whereas none have reported a group mean negative change in benefit. However, individual subjects in these studies can show changes in benefit in either a positive or negative direction. The variability across subjects in each study has been large in comparison with the observed amount of benefit increase. In this review of the literature, it is argued that the studies present essentially similar results and the range of values across subjects in the various studies shows considerable overlap. Although there does appear to be a tendency for hearing aid benefit to increase over time, there are other, much stronger, factors influencing changes in hearing aid benefit that make it impossible at present to predict which patients will show a reliable increase (or decrease) in hearing aid benefit over time. (Ear & Hearing 1996;17;14S‐28S)

Effect of training on word-recognition performance in noise for young normal-hearing and older hearing-impaired listeners.

Objective: The objective of this study was to evaluate the effectiveness of a training program for hearing-impaired listeners to improve their speech-recognition performance within a background noise when listening to amplified speech. Both noise-masked young normal-hearing listeners, used to model the performance of elderly hearing-impaired listeners, and a group of elderly hearing-impaired listeners participated in the study. Of particular interest was whether training on an isolated word list presented by a standardized talker can generalize to everyday speech communication across novel talkers. Design: Word-recognition performance was measured for both young normal-hearing (n = 16) and older hearing-impaired (n = 7) adults. Listeners were trained on a set of 75 monosyllabic words spoken by a single female talker over a 9- to 14-day period. Performance for the familiar (trained) talker was measured before and after training in both open-set and closed-set response conditions. Performance on the trained words of the familiar talker were then compared with those same words spoken by three novel talkers and to performance on a second set of untrained words presented by both the familiar and unfamiliar talkers. The hearing-impaired listeners returned 6 mo after their initial training to examine retention of the trained words as well as their ability to transfer any knowledge gained from word training to sentences containing both trained and untrained words. Results: Both young normal-hearing and older hearing-impaired listeners performed significantly better on the word list in which they were trained versus a second untrained list presented by the same talker. Improvements on the untrained words were small but significant, indicating some generalization to novel words. The large increase in performance on the trained words, however, was maintained across novel talkers, pointing to the listener’s greater focus on lexical memorization of the words rather than a focus on talker-specific acoustic characteristics. On return in 6 mo, listeners performed significantly better on the trained words relative to their initial baseline performance. Although the listeners performed significantly better on trained versus untrained words in isolation, once the trained words were embedded in sentences, no improvement in recognition over untrained words within the same sentences was shown. Conclusions: Older hearing-impaired listeners were able to significantly improve their word-recognition abilities through training with one talker and to the same degree as young normal-hearing listeners. The improved performance was maintained across talkers and across time. This might imply that training a listener using a standardized list and talker may still provide benefit when these same words are presented by novel talkers outside the clinic. However, training on isolated words was not sufficient to transfer to fluent speech for the specific sentence materials used within this study. Further investigation is needed regarding approaches to improve a hearing aid user’s speech understanding in everyday communication situations.

Auditory filter shapes in normal‐hearing, noise‐masked normal, and elderly listenersa)

To dissociate the effects of age and hearing impairment on changes in frequency selectivity, auditory filter shapes were measured at 2 kHz in four groups of subjects: (1) normal-hearing young subjects; (2) normal-hearing elderly subjects; (3) elderly hearing-impaired listeners; and (4) young normal-hearing listeners with simulated hearing losses. Filter shapes were derived using a modified version of the notched-noise procedure [Glasberg and Moore, Hear, Res. 47, 103-138 (1990)]. Equivalent rectangular bandwidths (ERBs) of auditory filters were not significantly different in young and elderly subjects with normal 2-kHz hearing. Furthermore, filter widths for young subjects with 20- and 40-dB simulated hearing losses overlapped with those obtained from elderly subjects with corresponding degrees of actual hearing loss. One measure that did show significant differences between actual and simulated hearing losses was the degree of filter asymmetry; auditory filters in hearing-impaired listeners were more asymmetrical than those obtained from noise-masked normal-hearing subjects. The dynamic range of auditory filters, however, was comparable for hearing-impaired and noise-masked listeners. Lastly, post-filter detection efficiency was also similar for young and elderly subjects with equivalent hearing levels. These findings suggest that the reduced frequency selectivity often reported for older listeners can be attributed, primarily, to hearing loss rather than increased age. Implications of the results for speech perception in the elderly and models of hearing impairment are discussed.

Recognition of nonsense syllables by hearing‐impaired listeners and by noise‐masked normal hearers

In the present study, speech-recognition performance was measured in four hearing-impaired subjects and twelve normal hearers. The normal hearers were divided into four groups of three subjects each. Speech-recognition testing for the normal hearers was accomplished in a background of spectrally shaped noise in which the noise was shaped to produce masked thresholds identical to the quiet thresholds of one of the hearing-impaired subjects. The question addressed in this study is whether normal hearers with a hearing loss simulated through a shaped masking noise demonstrate speech-recognition difficulties similar to those of listeners with actual hearing impairment. Regarding overall percent-correct scores, the results indicated that two of the four hearing-impaired subjects performed better than their corresponding subgroup of noise-masked normal hearers, whereas the other two impaired listeners performed like the noise-masked normal listeners. A gross analysis of the types of errors made suggested that subjects with actual and simulated losses frequently made different types of errors.