Sophia E. Kramer

The Association of Hearing Impairment and Chronic Diseases with Psychosocial Health Status in Older Age

Objectives:This study examines the association of hearing impairment and chronic diseases (diabetes mellitus, lung disease, cardiac disease, stroke, cancer, peripheral artery disease, osteoarthritis, rheumatoid arthritis) with psychosocial status (depression, self-efficacy, mastery, loneliness, social network size) in older persons. Methods:The sample consists of 3,107 persons (55 to 85 years) participating in the Longitudinal Aging Study Amsterdam. MANOVA, adjusted for covariates, was used to test the effect of hearing impairment on the combined outcomes. The association of hearing impairment and chronic diseases with psychosocial status was studied using multivariate regression analyses. Results:Hearing impaired elderly report significantly more depressive symptoms, lower self-efficacy and mastery, more feelings of loneliness, and a smaller social network than normally hearing peers. Whereas chronic diseases show significant associations with some outcomes, hearing impairment is significantly associated with all psychosocial variables. Discussion:The findings emphasize the negative effect of hearing impairment on quality of life.

Factors Influencing Help Seeking, Hearing Aid Uptake, Hearing Aid Use and Satisfaction With Hearing Aids: A Review of the Literature

Objectives: This descriptive summary of the literature provides an overview of the available studies (published between January 1980 and January 2009) on correlates of help-seeking behavior for hearing loss, hearing-aid uptake, hearing-aid use, and satisfaction with the device. Methods: Publications were identified by structured searches in Pubmed and Cinahl and by inspecting the reference lists of relevant articles. The articles covered different stages that a person with hearing impairment may go through: prior to hearing aid fitting, the period covering the fitting and the period post hearing aid fitting. Inclusion of articles occurred according to strict inclusion and exclusion criteria. Data were extracted by two independent researchers. Thirty-nine papers were included that identified 31 factors examined in relation to the four outcome measures. These covered personal factors (e.g., source of motivation, expectation, attitude), demographic factors (e.g., age, gender) and external factors (e.g., cost, counseling). Only two studies covered the actual fitting process. There was only one factor positively affecting all four outcome variables. This was self-reported hearing disability. The vast majority of studies showed no relationship of age and gender with any of the outcome domains. Discussion and conclusion: Whereas research of the last 28 years yielded valuable information regarding relevant and irrelevant factors in hearing aid health care, there are still many relevant issues that have never been investigated in controlled studies. These are discussed.

Optimal Outcome Measures, Research Priorities, and International Cooperation

&NA; The participants in the Eriksholm Workshop on “Measuring Outcomes in Audiological Rehabilitation Using Hearing Aids” debated three issues that are reported in this article. First, it was agreed that the characteristics of an optimal outcome measure vary as a function of the purpose of the measurement. Potential characteristics of outcome self‐report tools for four common goals of outcome measurement are briefly presented to illustrate this point. Second, 10 important research priorities in outcome measurement were identified and ranked. They are presented with brief discussion of the top five. Third, the concept of generating a brief universally applicable outcome measure was endorsed. This brief data set is intended to supplement existing outcome measures and to promote data combination and comparison across different social, cultural, and health‐care delivery systems. A set of seven core items is proposed for further study.

Cognitive load during speech perception in noise: the influence of age, hearing loss, and cognition on the pupil response.

Objectives: The aim of the present study was to evaluate the influence of age, hearing loss, and cognitive ability on the cognitive processing load during listening to speech presented in noise. Cognitive load was assessed by means of pupillometry (i.e., examination of pupil dilation), supplemented with subjective ratings. Design: Two groups of subjects participated: 38 middle-aged participants (mean age = 55 yrs) with normal hearing and 36 middle-aged participants (mean age = 61 yrs) with hearing loss. Using three Speech Reception Threshold (SRT) in stationary noise tests, we estimated the speech-to-noise ratios (SNRs) required for the correct repetition of 50%, 71%, or 84% of the sentences (SRT50%, SRT71%, and SRT84%, respectively). We examined the pupil response during listening: the peak amplitude, the peak latency, the mean dilation, and the pupil response duration. For each condition, participants rated the experienced listening effort and estimated their performance level. Participants also performed the Text Reception Threshold (TRT) test, a test of processing speed, and a word vocabulary test. Data were compared with previously published data from young participants with normal hearing. Results: Hearing loss was related to relatively poor SRTs, and higher speech intelligibility was associated with lower effort and higher performance ratings. For listeners with normal hearing, increasing age was associated with poorer TRTs and slower processing speed but with larger word vocabulary. A multivariate repeated-measures analysis of variance indicated main effects of group and SNR and an interaction effect between these factors on the pupil response. The peak latency was relatively short and the mean dilation was relatively small at low intelligibility levels for the middle-aged groups, whereas the reverse was observed for high intelligibility levels. The decrease in the pupil response as a function of increasing SNR was relatively small for the listeners with hearing loss. Spearman correlation coefficients indicated that the cognitive load was larger in listeners with better TRT performances as reflected by a longer peak latency (normal-hearing participants, SRT50% condition) and a larger peak amplitude and longer response duration (hearing-impaired participants, SRT50% and SRT84% conditions). Also, a larger word vocabulary was related to longer response duration in the SRT84% condition for the participants with normal hearing. Conclusions: The pupil response systematically increased with decreasing speech intelligibility. Ageing and hearing loss were related to less release from effort when increasing the intelligibility of speech in noise. In difficult listening conditions, these factors may induce cognitive overload relatively early or they may be associated with relatively shallow speech processing. More research is needed to elucidate the underlying mechanisms explaining these results. Better TRTs and larger word vocabulary were related to higher mental processing load across speech intelligibility levels. This indicates that utilizing linguistic ability to improve speech perception is associated with increased listening load.

Pupil response as an indication of effortful listening: the influence of sentence intelligibility.

Objectives: The aim of this study was to evaluate the influence of sentence intelligibility on the pupil dilation response during listening. Task-induced pupil-dilation reflects explicit effortful processing load. Therefore, pupillometry can be used to examine the listening effort during speech perception in difficult listening conditions. We expected to find increasing pupil dilation as a function of decreasing speech intelligibility. Design: Thirty-eight young participants (mean age = 23 yrs, SD = 3.2 yrs) with normal hearing were included. They performed three speech reception threshold (SRT) tests in which they listened to sentences in stationary noise. A one-up-one-down, two-up-one-down, or four-up-one-down adaptive procedure was applied, resulting in the correct rehearsal of 50, 71, or 84% of the sentences (SRT50%, SRT71%, and SRT84%, respectively). We examined the peak dilation amplitude, the latency of the peak dilation amplitude, and the mean pupil dilation during the processing of the speech in each of these conditions. The peak dilation amplitude and mean pupil dilation were calculated relative to the baseline pupil diameter during listening to noise alone. For each SRT condition, participants rated the experienced listening effort and estimated their performance level. Results: The signal to noise ratios (SNRs) in the SRT50%, SRT71%, and SRT84% conditions increased as a function of the speech intelligibility level. The subjective effort ratings decreased, and the estimated performance increased with increasing speech intelligibility level. Repeated measures analyses of variance indicated that peak dilation amplitude and mean pupil dilation were higher in the SRT50% condition as compared with the SRT71% and SRT84% conditions. The peak dilation amplitude, mean pupil dilation, and peak latency increased with decreasing SNR of the speech in noise, but no effect of noise level by itself on the baseline pupil diameter was observed. Irrespective of SNR, the pupil response was higher for incorrectly repeated sentences than for correctly repeated sentences. The analyses also indicated condition-order effects on the peak dilation amplitude and mean pupil dilatation: the pupil response was higher in the first SRT test than in the second and third tests. Within the first and third test, the baseline pupil diameter and the mean pupil dilation decreased as a function of the sentence number within the test. Spearman correlation coefficients showed no relations among the SNRs at the SRTs, subjective ratings, and the pupil response. Conclusions: The peak dilation amplitude, peak latency, and mean pupil dilation systematically increase with decreasing speech intelligibility. These results support that listening effort, as indicated by the pupil response, increases with decreasing speech intelligibility. This study indicates that pupillometry can be used to examine how listeners reach a certain performance level. Application of this technique to study listening effort can yield valuable insight into the processing resources required across listening conditions and into the factors related to interindividual differences in speech perception in noise.

Occupational performance: Comparing normally-hearing and hearing-impaired employees using the Amsterdam Checklist for Hearing and Work

This study compares the occupational performance of employees with and without hearing impairment, and aims to identify occupational difficulties specifically related to hearing loss. The Amsterdam Checklist for Hearing and Work was administered to 150 hearing-impaired employees and 60 normally-hearing colleagues. A multivariate analysis of variance was performed to test group effects, and to examine differences between means. Factors predicting sick-leave were identified by regression analyses. A significant group effect (p < 0.01) was found. Hearing-impaired employees differed from normally-hearing colleagues in their perception of ‘environmental noise’, ‘job control’ and the ‘necessity to use hearing activities’ at work. Also, sick-leave due to distress occurred significantly more often in the hearing impaired group (p < 0.05). ‘Hearing impairment’, ‘job demand’, and the requirement to ‘recognize/distinguish between sounds’ were the strongest risk-factors for stress related sick-leave. The importance of hearing functions besides speech communication is discussed. Implications for rehabilitation are suggested. In future research, hearing loss should be considered as a risk factor for fatigue and mental distress which may lead to sick-leave. Sumario Este estudio compara el desempeño ocupacional de empleados con y sin trastorno auditivo y busca identificar dificultades laborales específicamente relacionadas con la hipoacusia. Se administró el Listado de Amsterdam para Audición y Trabajo a 150 trabajadores con trastornos auditivo y a 60 colegas normo-oyentes. Se realizó un análisis multivariado de varianza para evaluar efectos de grupo y para examinar diferencias entre las medias. Se identificaron los factores para predecir incapacidades por enfermedad por medio de análisis de regresión. Se encontró un significativo efecto de grupo (p < 0.01. Los trabajadores hipoacúsicos fueron diferentes de los normo-oyentes en su percepción del “ruido ambiental”, del “control laboral” y de la “necesidad de utilizar actividades auditivas” en el trabajo. También, las incapacidades debidas a tensión ocurrieron significativamente más a menudo en el grupo de hipoacúsicos (p < 0.05). Los “trastornos auditivos”, las “demandas del trabajo” y el requisito de “reconocer/distinguir sonidos” fueron los factores de riesgo más importantes para las incapacidades relacionadas con el estrés. Se discute la importancia de las funciones auditivas más allá de la comunicación por lenguaje. Se sugieren las implicaciones para la rehabilitación. En investigaciones futuras, la hipoacusia debe ser considerada como un factor de riesgo para fatiga y tensión mental que pueden conducir a incapacidades por enfermedad.

The association between hearing status and psychosocial health before the age of 70 years: results from an internet-based national survey on hearing

Objective: There is a substantial lack of knowledge of the impact of reduced hearing on psychosocial functioning in adults younger than 70 yr. The aim of this study was to examine the association between hearing status and psychosocial health in adults aged between 18 and 70 yr. Design: This was a cross-sectional cohort study. Baseline data of the National Longitudinal Study on Hearing are analyzed using regression models. The cohort consisted of 1511 participants. Hearing status was determined using the National Hearing test, a recently launched speech-in-noise screening test over the Internet. We assessed self-reported psychosocial health using a set of online questionnaires. Results: Adjusting for confounding variables, significant adverse associations between hearing status and distress, somatization, depression, and loneliness are found. For every decibel signal to noise ratio (dB SNR) reduction of hearing status, both the distress and somatization scores increased by 2% [distress: b = 0.02, 95% confidence interval (CI) = 0.00 to 0.03, p = 0.03; somatization: b = 0.02, 95% CI = 0.01 to 0.04, p < 0.001]. The odds for developing moderate or severe depression increase by 5% for every dB SNR reduction in hearing (odds ratio = 1.05, 95% CI = 1.00 to 1.09, p = 0.03). The odds for developing severe or very severe loneliness significantly increase by 7% for every dB SNR reduction in hearing (odds ratio = 1.07, 95% CI = 1.02 to 1.12, p = 0.004). Different age groups exhibit different associations between hearing status and psychosocial health, with loneliness being an issue particularly in the youngest age group (18 to 30 yr). In the group of middle-aged adults (40 to 50 yr), the number of significant associations is highest. Conclusions: Hearing status is negatively associated with higher distress, depression, somatization, and loneliness in young and middle-aged adults. The associations are different in different age groups. The findings underline the need to seriously address the adverse effects of limited hearing among young and middle-aged adults both in future research and in clinical practice.

Auditory and nonauditory factors affecting speech reception in noise by older listeners

Speech reception thresholds (SRTs) for sentences were determined in stationary and modulated background noise for two age-matched groups of normal-hearing (N = 13) and hearing-impaired listeners (N = 21). Correlations were studied between the SRT in noise and measures of auditory and nonauditory performance, after which stepwise regression analyses were performed within both groups separately. Auditory measures included the pure-tone audiogram and tests of spectral and temporal acuity. Nonauditory factors were assessed by measuring the text reception threshold (TRT), a visual analogue of the SRT, in which partially masked sentences were adaptively presented. Results indicate that, for the normal-hearing group, the variance in speech reception is mainly associated with nonauditory factors, both in stationary and in modulated noise. For the hearing-impaired group, speech reception in stationary noise is mainly related to the audiogram, even when audibility effects are accounted for. In modulated noise, both auditory (temporal acuity) and nonauditory factors (TRT) contribute to explaining interindividual differences in speech reception. Age was not a significant factor in the results. It is concluded that, under some conditions, nonauditory factors are relevant for the perception of speech in noise. Further evaluation of nonauditory factors might enable adapting the expectations from auditory rehabilitation in clinical settings.

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.

A home education program for older adults with hearing impairment and their significant others: A randomized trial evaluating short- and long-term effects

This paper addresses the development and effectiveness of a home education program. The program, designed for hearing-impaired elders and their significant others (SO), deals with communication strategies and speech reading. Participants were randomly assigned to a training group (hearing aid fitting + home education program) or a control group (hearing aid fitting). The training group included 24 hearing-impaired subjects and 24 SOs. Controls were 24 affected individuals and 22 SOs. Questionnaires addressing emotional response, communication strategies and the IOI-HA, IOI-AI and IOI-SO were used. A repeated measures analysis of variance was applied to test group differences between pre, post, and 6-months follow-up measures. Increased awareness of benefits of speech reading and improved interaction with the SO were observed in the training group only (p < 0.05). No group difference on ‘emotional response’ was found. IOI-AI and IOI-SO demonstrated favorable attitudes towards the program. Follow-up measures showed improved quality of life and satisfaction in the training group, while a decrease was observed among the controls (p < 0.05). Some effects differed between first-time and experienced hearing aid users. Addition of services to amplification and involvement of the SO are relevant in aural rehabilitation.