Suggestions for optimizing reliability with the synthetic sentence identification test

The Psychometric Properties of the Persian Version of the Hearing Handicap Inventory Screening Scale (HHIE-S) among Older Adults

BACKGROUND

There is a great need for a valid hearing loss measurement tool in the Persian language to help identify hearing handicaps and potential communicational difficulties among Persian-speaking older adults. The present study aimed to validate and adapt the original English version of the Hearing Handicap Inventory for the Elderly (HHIE) into the Persian language.

METHODS

A tool development study was designed and data were collected from August to November 2019 in Tabriz, Iran among the older adults aged 60 years and above whose hearing loss had been confirmed by audiometry. The construct validity was assessed using Confirmatory Factor Analysis (CFA). The reliability of the tool was calculated by internal consistency and test-retest reliability. The statistical analysis was performed using SPSS 26.0 (SPSS and STATA 14).

RESULTS

The CFA was conducted to examine the construct validity of the HHIE-S. According to the results, the model fit indices were acceptable (TLI = 0.93, CFI = 0.97, RMSEA = 0.07 (90% CI: 0.04 to 0.10), and SRMR = 0.03). Cronbach's alpha coefficient (0.85) and the test-retest reliability score (0.73) indicated good internal consistency.

CONCLUSION

The results showed that HHIE-S is a valid and reliable tool for assessing hearing handicaps among Persian-speaking and Iranian older adults.

Auditory and cognitive factors underlying individual differences in aided speech-understanding among older adults

This study was designed to address individual differences in aided speech understanding among a relatively large group of older adults. The group of older adults consisted of 98 adults (50 female and 48 male) ranging in age from 60 to 86 (mean = 69.2). Hearing loss was typical for this age group and about 90% had not worn hearing aids. All subjects completed a battery of tests, including cognitive (6 measures), psychophysical (17 measures), and speech-understanding (9 measures), as well as the Speech, Spatial, and Qualities of Hearing (SSQ) self-report scale. Most of the speech-understanding measures made use of competing speech and the non-speech psychophysical measures were designed to tap phenomena thought to be relevant for the perception of speech in competing speech (e.g., stream segregation, modulation-detection interference). All measures of speech understanding were administered with spectral shaping applied to the speech stimuli to fully restore audibility through at least 4000 Hz. The measures used were demonstrated to be reliable in older adults and, when compared to a reference group of 28 young normal-hearing adults, age-group differences were observed on many of the measures. Principal-components factor analysis was applied successfully to reduce the number of independent and dependent (speech understanding) measures for a multiple-regression analysis. Doing so yielded one global cognitive-processing factor and five non-speech psychoacoustic factors (hearing loss, dichotic signal detection, multi-burst masking, stream segregation, and modulation detection) as potential predictors. To this set of six potential predictor variables were added subject age, Environmental Sound Identification (ESI), and performance on the text-recognition-threshold (TRT) task (a visual analog of interrupted speech recognition). These variables were used to successfully predict one global aided speech-understanding factor, accounting for about 60% of the variance.

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.

Central auditory dysfunction as a harbinger of Alzheimer dementia

OBJECTIVE

To confirm that central auditory dysfunction (CAD) may be a precursor to the onset of Alzheimer dementia (AD).

DESIGN

Cohort study.

SETTING

Research study center.

PARTICIPANTS

Two hundred seventy-four volunteers from a dementia surveillance cohort were followed up for as long as 4 years after undergoing complete audiometric assessment. Twenty-one received a consensus diagnosis of AD after a hearing test.

INTERVENTION

The following 3 central auditory tests were performed: the Dichotic Sentence Identification, the Dichotic Digits, and the Synthetic Sentence Identification With Ipsilateral Competing Message.

MAIN OUTCOME MEASURES

A new diagnosis of AD using the National Institute of Neurological and Communicative Diseases and Stroke-Alzheimer Disease and Related Disorders Association criteria at a consensus conference.

RESULTS

The mean scores on each CAD test were significantly poorer in the incident dementia group. Cox proportional hazards models with age as the time scale were used to estimate the hazard ratio for incident dementia based on CAD test results. After adjusting for educational level, the hazard ratio for incident dementia in people with severe CAD based on a Dichotic Sentence Identification in free report mode of less than 50% was 9.9 (95% confidence interval, 3.6-26.7).

CONCLUSIONS

Central auditory dysfunction is a precursor to AD. We recommend evaluation with CAD tests in older adults who report hearing difficulty. Those with severe CAD should receive a modified rehabilitation program and be considered for referral for neurologic evaluation.

Executive dysfunction and presbycusis in older persons with and without memory loss and dementia

OBJECTIVE

To determine the relation of age-related auditory processing dysfunction and executive functioning.

BACKGROUND

Central auditory dysfunction is common in Alzheimer dementia, but the mechanism is not established.

METHOD

A total of 313 volunteers from the Adult Changes in Thought surveillance cohort with adequate peripheral hearing were included in the study. Outcome measures such as (1) peripheral audition; (2) auditory-evoked potentials; (3) central auditory tests (Synthetic Sentence Identification with Ipsilateral Competing Message, Dichotic Sentence Identification, Dichotic Digits); (4) Executive Functioning: Trail Making; Clock Drawing, Stroop Color and Word, and subtests from the Cognitive Abilities Screening Instrument were used to measuring the mental concentration. A composite executive functioning score was created using item response theory.

RESULTS

The composite executive functioning score was significantly associated with each central auditory measure, explaining 8% to 21% of the variance. Trails B test was most strongly associated with the auditory outcomes, explaining 8% to 14% of the variance. The relation between executive functioning and central auditory function was still significant when participants diagnosed with memory impairment or dementia were excluded.

CONCLUSIONS

In elderly persons, reduced executive functioning is associated with central auditory processing, but not with primary auditory function. This suggests that central presbycusis and executive dysfunction may result from similar neurodegenerative processes.

Practice and list effects on the synthetic sentence identification test in young and elderly listeners

A high prevalence of central auditory processing disorders (CAPD) has been reported in the elderly based on scores for the Synthetic Sentence Identification Test (SSI). This study examined practice effects and list differences on the Auditec version of the SSI with an ipsilateral competing message in 30 young and 20 elderly participants. Results for the younger participants suggested that a minimum of one practice list should be used with the SSI, whereas results for the elderly participants suggested that a minimum of three practice lists should be used. The binomial model of A. R. Thornton and M. J. M. Raffin (1978) was suggested for use in determining the required number of lists needed to obtain reliable SSI performance. Significant list differences were found with the Auditec version of the SSI. It was recommended to use only Lists A, C, D, E, G, and I for consistent results across lists. Practice effects and list differences should be accounted for when using the SSI for the assessment of CAPD in elderly and young listeners.