Different patterns of perceptual learning on spectral modulation detection between older hearing-impaired and younger normal-hearing adults

Rate Discrimination Training May Partially Restore Temporal Processing Abilities from Age-Related Deficits

The ability to understand speech in complex environments depends on the brain's ability to preserve the precise timing characteristics of the speech signal. Age-related declines in temporal processing may contribute to the older adult's experience of communication difficulty in challenging listening conditions. This study's purpose was to evaluate the effects of rate discrimination training on auditory temporal processing. A double-blind, randomized control design assigned 77 young normal-hearing, older normal-hearing, and older hearing-impaired listeners to one of two treatment groups: experimental (rate discrimination for 100- and 300-Hz pulse trains) and active control (tone detection in noise). All listeners were evaluated during pre- and post-training sessions using perceptual rate discrimination of 100-, 200-, 300-, and 400-Hz band-limited pulse trains and auditory steady-state responses (ASSRs) to the same stimuli. Training generalization was evaluated using several temporal processing measures and sentence recognition tests that included time-compressed and reverberant speech stimuli. Results demonstrated a session × training group interaction for perceptual and ASSR testing to the trained frequencies (100 and 300 Hz), driven by greater improvements in the training group than in the active control group. Further, post-test rate discrimination of the older listeners reached levels that were equivalent to those of the younger listeners at pre-test. Generalization was observed in significant improvement in rate discrimination of untrained frequencies (200 and 400 Hz) and in correlations between performance changes in rate discrimination and sentence recognition of reverberant speech. Further, non-auditory inhibition/attention performance predicted training-related improvement in rate discrimination. Overall, the results demonstrate the potential for auditory training to partially restore temporal processing in older listeners and highlight the role of cognitive function in these gains.

Methodological Considerations for Auditory Training Interventions for Adults With Hearing Loss: A Rapid Review

Purpose The aim of this study was to evaluate literature on auditory training published since 2013. Method A rapid review or a streamlined approach to systematically identify and summarize relevant studies was performed. Selected health sciences databases were searched using a search strategy developed with the PICO (population, intervention, comparison, and outcome) framework. Studies eligible for inclusion had older adult participants with hearing loss and utilized technology-based auditory training in laboratory or home settings. Results The study quality of most studies was found to be low to moderate, with concentrations between low and moderate. Major issues were related to study design and reporting, such as the need for blinding and a control group, larger sample sizes, and a follow-up for long-term outcomes of auditory training interventions. Wide variability in training approaches, participant backgrounds (e.g., audiograms, hearing aid use), and outcome measures are also noted. Conclusions Evidence on the effectiveness of auditory training is mixed. Future research should include high-quality randomized controlled trials with representative populations; follow-up periods to study long-term effects; and exploration of behavioral, electrophysiological, and self-reported outcome measures. Recommendations for study designs and methodologies are also discussed.

Auditory Training for Adult Cochlear Implant Users: A Survey and Cost Analysis Study

OBJECTIVES

The aims of this study were as follows: (a) to describe audiologists' practices toward auditory training (AT) for adult cochlear implant (CI) users with a postlingual hearing loss; and (b) to assess the cost of different AT methods for clients and service providers in comparison with no AT delivery.

DESIGN

A survey was distributed to approximately 230 Australian CI audiologists to investigate the range, magnitude, and rationale of AT practices adopted as part of rehabilitation services with adult CI users. The cost of these different AT practices was then estimated from the perspectives of both clients and service providers, and compared against no AT delivery.

RESULTS

Seventy-eight audiologists responded to at least one section of the survey (16% to 33% response rate), of which 85.5% reported that they viewed AT as a necessary component of rehabilitation. Home-based and face-to-face were the methods most frequently adopted to deliver AT. Methods used during training, such as stimuli type, feedback, and encouragement for training adherence, varied across respondents. The cost analysis indicated that home-based training resulted in the lowest program costs, whereas face-to-face AT (when delivered independently from routine appointments) was the method with highest cost for clients and service providers.

CONCLUSIONS

The type of AT, recommended frequency of sessions, and overall duration of programs varied widely across respondents. Costs incurred by clients depended mainly on whether the AT was home-based or clinician-led (i.e., face-to-face, group-based), program fees, and travel arrangements made by clients, as well as clinicians' wages and the method chosen to deliver AT.

A Randomized Control Trial: Supplementing Hearing Aid Use with Listening and Communication Enhancement (LACE) Auditory Training

OBJECTIVE

To examine the effectiveness of the Listening and Communication Enhancement (LACE) program as a supplement to standard-of-care hearing aid intervention in a Veteran population.

DESIGN

A multisite randomized controlled trial was conducted to compare outcomes following standard-of-care hearing aid intervention supplemented with (1) LACE training using the 10-session DVD format, (2) LACE training using the 20-session computer-based format, (3) placebo auditory training (AT) consisting of actively listening to 10 hr of digitized books on a computer, and (4) educational counseling-the control group. The study involved 3 VA sites and enrolled 279 veterans. Both new and experienced hearing aid users participated to determine if outcomes differed as a function of hearing aid user status. Data for five behavioral and two self-report measures were collected during three research visits: baseline, immediately following the intervention period, and at 6 months postintervention. The five behavioral measures were selected to determine whether the perceptual and cognitive skills targeted in LACE training generalized to untrained tasks that required similar underlying skills. The two self-report measures were completed to determine whether the training resulted in a lessening of activity limitations and participation restrictions. Outcomes were obtained from 263 participants immediately following the intervention period and from 243 participants 6 months postintervention. Analyses of covariance comparing performance on each outcome measure separately were conducted using intervention and hearing aid user status as between-subject factors, visit as a within-subject factor, and baseline performance as a covariate.

RESULTS

No statistically significant main effects or interactions were found for the use of LACE on any outcome measure.

CONCLUSIONS

Findings from this randomized controlled trial show that LACE training does not result in improved outcomes over standard-of-care hearing aid intervention alone. Potential benefits of AT may be different than those assessed by the performance and self-report measures utilized here. Individual differences not assessed in this study should be examined to evaluate whether AT with LACE has any benefits for particular individuals. Clinically, these findings suggest that audiologists may want to temper the expectations of their patients who embark on LACE training.

Examination of Individual Differences in Outcomes From a Randomized Controlled Clinical Trial Comparing Formal and Informal Individual Auditory Training Programs

PURPOSE

The purpose of this study was to determine if patient characteristics or clinical variables could predict who benefits from individual auditory training.

METHOD

A retrospective series of analyses were performed using a data set from a large, multisite, randomized controlled clinical trial that compared the treatment effects of at-home auditory training programs in bilateral hearing aid users. The treatment arms were (a) use of the 20-day computerized Listening and Communication Enhancement program, (b) use of the 10-day digital versatile disc Listening and Communication Enhancement program, (c) use of a placebo "books-on-tape" training, and (d) educational counseling (active control). Multiple linear regression models using data from 263 participants were conducted to determine if patient and clinical variables predicted short-term improvement on word-recognition-in-noise abilities, self-reported hearing handicap, and self-reported hearing problems.

RESULTS

Baseline performance significantly predicted performance on each variable, explaining 11%-17% of the variance in improvement. The treatment arm failed to emerge as a significant predictor with other clinical variables explaining less than 9% of the variance.

CONCLUSION

These results suggest that hearing aid users who have poorer aided word-recognition-in-noise scores and greater residual activity limitations and participation restrictions will show the largest improvement in these areas.

Enhancing speech learning by combining task practice with periods of stimulus exposure without practice

Language acquisition typically involves periods when the learner speaks and listens to the new language, and others when the learner is exposed to the language without consciously speaking or listening to it. Adaptation to variants of a native language occurs under similar conditions. Here, speech learning by adults was assessed following a training regimen that mimicked this common situation of language immersion without continuous active language processing. Experiment 1 focused on the acquisition of a novel phonetic category along the voice-onset-time continuum, while Experiment 2 focused on adaptation to foreign-accented speech. The critical training regimens of each experiment involved alternation between periods of practice with the task of phonetic classification (Experiment 1) or sentence recognition (Experiment 2) and periods of stimulus exposure without practice. These practice and exposure periods yielded little to no improvement separately, but alternation between them generated as much or more improvement as did practicing during every period. Practice appears to serve as a catalyst that enables stimulus exposures encountered both during and outside of the practice periods to contribute to quite distinct cases of speech learning. It follows that practice-plus-exposure combinations may tap a general learning mechanism that facilitates language acquisition and speech processing.

Comparing auditory filter bandwidths, spectral ripple modulation detection, spectral ripple discrimination, and speech recognition: Normal and impaired hearing

Some listeners with hearing loss show poor speech recognition scores in spite of using amplification that optimizes audibility. Beyond audibility, studies have suggested that suprathreshold abilities such as spectral and temporal processing may explain differences in amplified speech recognition scores. A variety of different methods has been used to measure spectral processing. However, the relationship between spectral processing and speech recognition is still inconclusive. This study evaluated the relationship between spectral processing and speech recognition in listeners with normal hearing and with hearing loss. Narrowband spectral resolution was assessed using auditory filter bandwidths estimated from simultaneous notched-noise masking. Broadband spectral processing was measured using the spectral ripple discrimination (SRD) task and the spectral ripple depth detection (SMD) task. Three different measures were used to assess unamplified and amplified speech recognition in quiet and noise. Stepwise multiple linear regression revealed that SMD at 2.0 cycles per octave (cpo) significantly predicted speech scores for amplified and unamplified speech in quiet and noise. Commonality analyses revealed that SMD at 2.0 cpo combined with SRD and equivalent rectangular bandwidth measures to explain most of the variance captured by the regression model. Results suggest that SMD and SRD may be promising clinical tools for diagnostic evaluation and predicting amplification outcomes.

Relationship between perceptual learning in speech and statistical learning in younger and older adults

Within a few sentences, listeners learn to understand severely degraded speech such as noise-vocoded speech. However, individuals vary in the amount of such perceptual learning and it is unclear what underlies these differences. The present study investigates whether perceptual learning in speech relates to statistical learning, as sensitivity to probabilistic information may aid identification of relevant cues in novel speech input. If statistical learning and perceptual learning (partly) draw on the same general mechanisms, then statistical learning in a non-auditory modality using non-linguistic sequences should predict adaptation to degraded speech. In the present study, 73 older adults (aged over 60 years) and 60 younger adults (aged between 18 and 30 years) performed a visual artificial grammar learning task and were presented with 60 meaningful noise-vocoded sentences in an auditory recall task. Within age groups, sentence recognition performance over exposure was analyzed as a function of statistical learning performance, and other variables that may predict learning (i.e., hearing, vocabulary, attention switching control, working memory, and processing speed). Younger and older adults showed similar amounts of perceptual learning, but only younger adults showed significant statistical learning. In older adults, improvement in understanding noise-vocoded speech was constrained by age. In younger adults, amount of adaptation was associated with lexical knowledge and with statistical learning ability. Thus, individual differences in general cognitive abilities explain listeners' variability in adapting to noise-vocoded speech. Results suggest that perceptual and statistical learning share mechanisms of implicit regularity detection, but that the ability to detect statistical regularities is impaired in older adults if visual sequences are presented quickly.

Partial maintenance of auditory-based cognitive training benefits in older adults

The potential for short-term training to improve cognitive and sensory functions in older adults has captured the public's interest. Initial results have been promising. For example, eight weeks of auditory-based cognitive training decreases peak latencies and peak variability in neural responses to speech presented in a background of noise and instills gains in speed of processing, speech-in-noise recognition, and short-term memory in older adults. But while previous studies have demonstrated short-term plasticity in older adults, we must consider the long-term maintenance of training gains. To evaluate training maintenance, we invited participants from an earlier training study to return for follow-up testing six months after the completion of training. We found that improvements in response peak timing to speech in noise and speed of processing were maintained, but the participants did not maintain speech-in-noise recognition or memory gains. Future studies should consider factors that are important for training maintenance, including the nature of the training, compliance with the training schedule, and the need for booster sessions after the completion of primary training.

Decreased ability in the segregation of dynamically changing vowel-analog streams: a factor in the age-related cocktail-party deficit?

Pairs of harmonic complexes with different fundamental frequencies f0 (105 and 189 Hz or 105 and 136 Hz) but identical bandwidth (0.25–3 kHz) were band-pass filtered using a filter having an identical center frequency of 1 kHz. The filter's center frequency was modulated using a triangular wave having a 5-Hz modulation frequency f_mod to obtain a pair of vowel-analog waveforms with dynamically varying single-formant transitions. The target signal S contained a single modulation cycle starting either at a phase of −π/2 (up-down) or π/2 (down-up), whereas the longer distracter N contained several cycles of the modulating triangular wave starting at a random phase. The level at which the target formant's modulating phase could be correctly identified was adaptively determined for several distracter levels and several extents of frequency swing (10–55%) in a group of experienced normal-hearing young and a group of experienced elderly individuals with hearing loss not exceeding one considered moderate. The most important result was that, for the two f0 differences, all distracter levels, and all frequency swing extents tested, elderly listeners needed about 20 dB larger S/N ratios than the young. Results also indicate that identification thresholds of both the elderly and the young listeners are between 4 and 12 dB higher than similarly determined detection thresholds and that, contrary to detection, identification is not a linear function of distracter level. Since formant transitions represent potent cues for speech intelligibility, the large S/N ratios required by the elderly for correct discrimination of single-formant transition dynamics may at least partially explain the well-documented intelligibility loss of speech in babble noise by the elderly.

Conserved mechanisms of vocalization coding in mammalian and songbird auditory midbrain

The ubiquity of social vocalizations among animals provides the opportunity to identify conserved mechanisms of auditory processing that subserve communication. Identifying auditory coding properties that are shared across vocal communicators will provide insight into how human auditory processing leads to speech perception. Here, we compare auditory response properties and neural coding of social vocalizations in auditory midbrain neurons of mammalian and avian vocal communicators. The auditory midbrain is a nexus of auditory processing because it receives and integrates information from multiple parallel pathways and provides the ascending auditory input to the thalamus. The auditory midbrain is also the first region in the ascending auditory system where neurons show complex tuning properties that are correlated with the acoustics of social vocalizations. Single unit studies in mice, bats and zebra finches reveal shared principles of auditory coding including tonotopy, excitatory and inhibitory interactions that shape responses to vocal signals, nonlinear response properties that are important for auditory coding of social vocalizations and modulation tuning. Additionally, single neuron responses in the mouse and songbird midbrain are reliable, selective for specific syllables, and rely on spike timing for neural discrimination of distinct vocalizations. We propose that future research on auditory coding of vocalizations in mouse and songbird midbrain neurons adopt similar experimental and analytical approaches so that conserved principles of vocalization coding may be distinguished from those that are specialized for each species. This article is part of a Special Issue entitled "Communication Sounds and the Brain: New Directions and Perspectives".