Hearing Aid Noise Reduction Lowers the Sustained Listening Effort During Continuous Speech in Noise-A Combined Pupillometry and EEG Study

Salience-Dependent Disruption of Sustained Auditory Attention Can Be Inferred from Evoked Pupil Responses and Neural Tracking of Task-Irrelevant Sounds

Stimulus-driven attention allows us to react to relevant stimuli (and imminent danger!) outside our current focus of attention. But irrelevant stimuli can also disrupt attention, for example, during listening to speech. The degree to which sound captures attention is called salience, which can be estimated by existing, behaviorally validated, computational models (Huang and Elhilali, 2017). Here we examined whether neurophysiological responses to task-irrelevant sounds indicate the degree of distraction during a sustained-listening task and how much this depends on individual hearing thresholds. Forty-seven Danish-speaking adults (28/19 female/male; mean age, 60.1; SD, 15.9 years) with heterogenous hearing thresholds (PTA; mean, 25.5; SD, 18.0 db HL) listened to continuous speech while 1-s-long, task-irrelevant natural sounds (distractors) of varying computed salience were presented at unpredictable times and locations. Eye tracking and electroencephalography were used to estimate pupil response and neural tracking, respectively. The task-irrelevant sounds evoked a consistent pupil response (PR), distractor-tracking (DT), and a drop of target-tracking (ΔTT), and statistical modeling of these three measures within subjects showed that all three are enhanced for sounds with higher computed salience. Participants with larger PR showed a stronger drop in target tracking (ΔTT) and performed worse in target speech comprehension. We conclude that distraction can be inferred from neurophysiological responses to task-irrelevant stimuli. These results are a first step toward neurophysiological assessment of attention dynamics during continuous listening, with potential applications in hearing care diagnostics.

Relationship Between Working Memory, Compression, and Beamformers in Ideal Conditions

OBJECTIVES

Previous research has shown that speech recognition with different wide dynamic range compression (WDRC) time-constants (fast-acting or Fast and slow-acting or Slow) is associated with individual working memory ability, especially in adverse listening conditions. Until recently, much of this research has been limited to omnidirectional hearing aid settings and colocated speech and noise, whereas most hearing aids are fit with directional processing that may improve the listening environment in spatially separated conditions and interact with WDRC processing. The primary objective of this study was to determine whether there is an association between individual working memory ability and speech recognition in noise with different WDRC time-constants, with and without microphone directionality (binaural beamformer or Beam versus omnidirectional or Omni) in a spatial condition ideal for the beamformer (speech at 0 , noise at 180 ). The hypothesis was that the relationship between speech recognition ability and different WDRC time-constants would depend on working memory in the Omni mode, whereas the relationship would diminish in the Beam mode. The study also examined whether this relationship is different from the effects of working memory on speech recognition with WDRC time-constants previously studied in colocated conditions.

DESIGN

Twenty-one listeners with bilateral mild to moderately severe sensorineural hearing loss repeated low-context sentences mixed with four-talker babble, presented across 0 to 10 dB signal to noise ratio (SNR) in colocated (0 ) and spatially separated (180 ) conditions. A wearable hearing aid customized to the listener's hearing level was used to present four signal processing combinations which combined microphone mode (Beam or Omni) and WDRC time-constants (Fast or Slow). Individual working memory ability was measured using the reading span test. A signal distortion metric was used to quantify cumulative temporal envelope distortion from background noise and the hearing aid processing for each listener. In a secondary analysis, the role of working memory in the relationship between cumulative signal distortion and speech recognition was examined in the spatially separated condition.

RESULTS

Signal distortion was greater with Fast WDRC compared with Slow WDRC, regardless of the microphone mode or spatial condition. As expected, Beam reduced signal distortion and improved speech recognition over Omni, especially at poorer SNRs. Contrary to the hypothesis, speech recognition with different WDRC time-constants did not depend on working memory in Beam or Omni (in the spatially separated condition). However, there was a significant interaction between working memory and cumulative signal distortion, such that speech recognition increased at a faster rate with lower distortion for an individual with better working memory. In Omni, the effect of working memory on speech recognition in different spatial conditions (colocated versus spatially separated) was inconclusive.

CONCLUSIONS

The findings highlight the benefit of binaural beamformers for all listeners, especially at poorer signal to noise ratios for target speech from the front and noise behind the listener. Individuals with better working memory are more likely to benefit from reduced signal distortions than individuals with poorer working memory in these conditions. There was no clear evidence for benefit or detriment in speech recognition with Fast versus Slow WDRC, regardless of individual working memory.

Improving Tracking of Selective Attention in Hearing Aid Users: The Role of Noise Reduction and Nonlinearity Compensation

Hearing impairment (HI) disrupts social interaction by hindering the ability to follow conversations in noisy environments. While hearing aids (HAs) with noise reduction (NR) partially address this, the "cocktail-party problem" persists, where individuals struggle to attend to specific voices amidst background noise. This study investigated how NR and an advanced signal processing method for compensating for nonlinearities in Electroencephalography (EEG) signals can improve neural speech processing in HI listeners. Participants wore HAs with NR, either activated or deactivated, while focusing on target speech amidst competing masker speech and background noise. Analysis focused on temporal response functions to assess neural tracking of relevant target and masker speech. Results revealed enhanced neural responses (N1 and P2) to target speech, particularly in frontal and central scalp regions, when NR was activated. Additionally, a novel method compensated for nonlinearities in EEG data, leading to improved signal-to-noise ratio (SNR) and potentially revealing more precise neural tracking of relevant speech. This effect was most prominent in the left-frontal scalp region. Importantly, NR activation significantly improved the effectiveness of this method, leading to stronger responses and reduced variance in EEG data and potentially revealing more precise neural tracking of relevant speech. This study provides valuable insights into the neural mechanisms underlying NR benefits and introduces a promising EEG analysis approach sensitive to NR effects, paving the way for potential improvements in HAs.

A qualitative study of the role of hearing aid use and physical fit accessories in a sample of older adults

OBJECTIVE

The purpose of the study was to qualitatively describe the experiences of hearing aid and physical fit accessories use during physical activity and exercise participation in a sample of older adults with hearing loss.

DESIGN

A prospective qualitative research design was employed with the use of focus groups with older adult participants who were fitted with hearing aids and physical fit accessories.

STUDY SAMPLE

Twelve older adults with hearing loss (six experienced and six new hearing aid users, age range 64 - 88 years) were recruited in this study.

RESULTS

The barriers to hearing at physical activity and exercise environments were related to reverberation, loud music, and instructor's location and position relative to exercise members, whereas facilitators were aided hearing, the instructor projecting their voice and demonstrating the moves. The most preferred physical fit accessories were the retention lock and the corded and cordless hearing aid sleeves. The least preferred accessories were the hearing aid-to-glasses connector and stick'n stay tape.

CONCLUSIONS

Individual differences and needs were factored into different perspectives on hearing aid and physical fit accessory use, emphasising patient-centered approach when coaching and counselling on device use for physical activity and exercise.

Development of measures to assess listening-related effort and fatigue in daily life among hearing aid users: protocol for a quantitative field trial

INTRODUCTION

Individuals with hearing loss and hearing aid users report higher levels of listening effort and fatigue in daily life compared with those with normal hearing. However, there is a lack of objective measures to evaluate these experiences in real-world settings. Recent studies have found that higher sound pressure levels (SPL) and lower signal-to-noise ratios (SNR) are linked to increased heart rate and decreased heart rate variability, reflecting the greater effort required to process auditory information. This study aims to establish physiological and acoustic predictors of self-reported listening effort and fatigue in daily life. Additionally, the moderating effects of cognitive abilities, personality traits, stress, fatigue, suprathreshold abilities, noise annoyance, lifestyle and health on the development of listening effort and fatigue will be investigated.

METHODS AND ANALYSIS

A 4-week field trial will be conducted, in which physiological responses will be continuously recorded using Empatica Embrace Plus wristbands. Ambient acoustics will be captured every 20 s via the participants' (n=60) personal hearing aids, and the participants will provide self-reported momentary assessments through a mobile app throughout the day. Questionnaires will be used to assess personality traits, fatigue, stress and noise annoyance, and gather relevant background information. Cognitive and suprathreshold abilities will also be evaluated. Associations between physiological responses, ambient acoustics and momentary assessments, as well as the potential influence of participant characteristics, will be analysed using multilevel regression models and time-series analyses.

ETHICS AND DISSEMINATION

Informed consent will be obtained from all participants. The study has been exempted from ethical application by the Science Ethics Committee for the Capital Region of Denmark (journal no. F-23028367). Results will be presented at conferences and submitted for publication in peer-reviewed journals.

Cortical encoding of phonetic onsets of both attended and ignored speech in hearing impaired individuals

Hearing impairment alters the sound input received by the human auditory system, reducing speech comprehension in noisy multi-talker auditory scenes. Despite such difficulties, neural signals were shown to encode the attended speech envelope more reliably than the envelope of ignored sounds, reflecting the intention of listeners with hearing impairment (HI). This result raises an important question: What speech-processing stage could reflect the difficulty in attentional selection, if not envelope tracking? Here, we use scalp electroencephalography (EEG) to test the hypothesis that the neural encoding of phonological information (i.e., phonetic boundaries and phonological categories) is affected by HI. In a cocktail-party scenario, such phonological difficulty might be reflected in an overrepresentation of phonological information for both attended and ignored speech sounds, with detrimental effects on the ability to effectively focus on the speaker of interest. To investigate this question, we carried out a re-analysis of an existing dataset where EEG signals were recorded as participants with HI, fitted with hearing aids, attended to one speaker (target) while ignoring a competing speaker (masker) and spatialised multi-talker background noise. Multivariate temporal response function (TRF) analyses indicated a stronger phonological information encoding for target than masker speech streams. Follow-up analyses aimed at disentangling the encoding of phonological categories and phonetic boundaries (phoneme onsets) revealed that neural signals encoded the phoneme onsets for both target and masker streams, in contrast with previously published findings with normal hearing (NH) participants and in line with our hypothesis that speech comprehension difficulties emerge due to a robust phonological encoding of both target and masker. Finally, the neural encoding of phoneme-onsets was stronger for the masker speech, pointing to a possible neural basis for the higher distractibility experienced by individuals with HI.

Neural correlates of listening to nonnative-accented speech in multi-talker background noise

We examined the neural correlates underlying the semantic processing of native- and nonnative-accented sentences, presented in quiet or embedded in multi-talker noise. Implementing a semantic violation paradigm, 36 English monolingual young adults listened to American-accented (native) and Chinese-accented (nonnative) English sentences with or without semantic anomalies, presented in quiet or embedded in multi-talker noise, while EEG was recorded. After hearing each sentence, participants verbally repeated the sentence, which was coded and scored as an offline comprehension accuracy measure. In line with earlier behavioral studies, the negative impact of background noise on sentence repetition accuracy was higher for nonnative-accented than for native-accented sentences. At the neural level, the N400 effect for semantic anomaly was larger for native-accented than for nonnative-accented sentences, and was also larger for sentences presented in quiet than in noise, indicating impaired lexical-semantic access when listening to nonnative-accented speech or sentences embedded in noise. No semantic N400 effect was observed for nonnative-accented sentences presented in noise. Furthermore, the frequency of neural oscillations in the alpha frequency band (an index of online cognitive listening effort) was higher when listening to sentences in noise versus in quiet, but no difference was observed across the accent conditions. Semantic anomalies presented in background noise also elicited higher theta activity, whereas processing nonnative-accented anomalies was associated with decreased theta activity. Taken together, we found that listening to nonnative accents or background noise is associated with processing challenges during online semantic access, leading to decreased comprehension accuracy. However, the underlying cognitive mechanism (e.g., associated listening efforts) might manifest differently across accented speech processing and speech in noise processing.

Using Alpha-Band Power to Evaluate Hearing Aid Directionality Based on Multistream Architecture

PURPOSE

The aim of the study was to evaluate whether behavioral speech-in-noise (SiN) benefits of hearing aid directivity based on multistream architecture (MSA) might result in reduced electroencephalographic activity in the alpha-band, as is often associated with task difficulty.

METHOD

A single-blind within-subject design was used in this study. Thirteen older adults (Mage = 73.5 years, range: 62-82 years, six women) with sensorineural hearing loss participated in the study. Participants wearing study hearing aids first performed an adaptive sentence-level SiN test in an MSA-enabled condition (i.e., MSA-ON) to determine the signal-to-noise ratios (SNRs) corresponding to speech reception thresholds for 50% correct performance (i.e., SRT-50s). Participants were then tested at their individualized SNRs with target sentences alternating on each trial between two loudspeakers positioned in the front at 0° and -30° azimuth, such as to simulate turn-taking between two talkers seated across from the listener. Electroencephalographic activity was recorded as participants performed this SiN test in two hearing aid conditions: MSA-OFF and MSA-ON.

RESULTS

Neural oscillations in the alpha-band were significantly reduced over centroparietal electrode sites when listeners performed SiN testing in MSA-ON versus MSA-OFF conditions. Alpha-band power was also observed to increase significantly over the course of 60 test trials, possibly indicative of listener fatigue. Reductions in alpha-band power were not significantly related to likewise improvements in SiN performance.

CONCLUSIONS

Hearing aid directivity based on the MSA algorithm resulted in significantly lower neural activity associated with listening task difficulty in a simulated multitalker situation. Although these results align with the behavioral SiN improvements associated with MSA, magnitudes of change in alpha-band power did not correlate with the degree of behavioral benefit at the level of individual listeners. Measuring neural oscillations in the alpha-band might be useful for evaluating and gaining greater insight into the impact of hearing aid processing on listening effort in challenging acoustic environments.

Evaluating aperiodic and periodic neural activity as markers of listening effort in speech perception

Listening effort (LE) is critical to understanding speech perception in acoustically challenging environments. EEG alpha power has emerged as a potential neural correlate of LE. However, the magnitude and direction of the relationship between acoustic challenge and alpha power has been inconsistent in the literature. In the current study, a secondary data analysis of Silcox and Payne (2021), we examine the broadband 1/f-like exponent and offset of the EEG power spectrum as measures of aperiodic neural activity during effortful speech perception and the influence of this aperiodic activity on reliable estimation of periodic (i.e., alpha) neural activity. EEG was continuously recorded during sentence listening and the broadband (1-40 Hz) EEG power spectrum was computed for each participant for quiet and noise trials separately. Using the specparam algorithm, we decomposed the power spectrum into both aperiodic and periodic components and found that broadband aperiodic activity was sensitive to background noise during speech perception and additionally impacted the measurement of noise-induced changes on alpha oscillations. We discuss the implications of these results for the LE and neural speech processing literatures.

A Multimodal Approach to Measuring Listening Effort: A Systematic Review on the Effects of Auditory Task Demand on Physiological Measures and Their Relationship

OBJECTIVES

Listening effort involves the mental effort required to perceive an auditory stimulus, for example in noisy environments. Prolonged increased listening effort, for example due to impaired hearing ability, may increase risk of health complications. It is therefore important to identify valid and sensitive measures of listening effort. Physiological measures have been shown to be sensitive to auditory task demand manipulations and are considered to reflect changes in listening effort. Such measures include pupil dilation, alpha power, skin conductance level, and heart rate variability. The aim of the current systematic review was to provide an overview of studies to listening effort that used multiple physiological measures. The two main questions were: (1) what is the effect of changes in auditory task demand on simultaneously acquired physiological measures from various modalities? and (2) what is the relationship between the responses in these physiological measures?

DESIGN

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, relevant articles were sought in PubMed, PsycInfo, and Web of Science and by examining the references of included articles. Search iterations with different combinations of psychophysiological measures were performed in conjunction with listening effort-related search terms. Quality was assessed using the Appraisal Tool for Cross-Sectional Studies.

RESULTS

A total of 297 articles were identified from three databases, of which 27 were included. One additional article was identified from reference lists. Of the total 28 included articles, 16 included an analysis regarding the relationship between the physiological measures. The overall quality of the included studies was reasonable.

CONCLUSIONS

The included studies showed that most of the physiological measures either show no effect to auditory task demand manipulations or a consistent effect in the expected direction. For example, pupil dilation increased, pre-ejection period decreased, and skin conductance level increased with increasing auditory task demand. Most of the relationships between the responses of these physiological measures were nonsignificant or weak. The physiological measures varied in their sensitivity to auditory task demand manipulations. One of the identified knowledge gaps was that the included studies mostly used tasks with high-performance levels, resulting in an underrepresentation of the physiological changes at lower performance levels. This makes it difficult to capture how the physiological responses behave across the full psychometric curve. Our results support the Framework for Understanding Effortful Listening and the need for a multimodal approach to listening effort. We furthermore discuss focus points for future studies.

Changes in Listening Effort Through Pupil Response After Atresioplasty in Children With Congenital Aural Atresia

OBJECTIVES

This study aimed to determine whether the improvement of hearing by surgical treatment alleviates cognitive demands through pupil response in patients with unilateral congenital aural atresia (CAA).

DESIGN

A prospective study was performed on patients with unilateral CAA who were scheduled to undergo primary atresioplasty between November 2017 and May 2020. Pure-tone audiometry, auditory digit span test, Korean Speech Perception in Noise test, pupil measurement during speech tests, and questionnaires (Sound-Spatial-Qualities of Hearing Scale; subjective listening effort rating) were performed before and 6 months after surgery.

RESULTS

Of 30 consecutive patients who initially enrolled, only 18 patients (12 males and 6 females) were included in the analysis. When the improvement of the air-bone gap and interaural difference of air conduction within 30 dB was defined as a successful hearing outcome, successful hearing improvement was achieved in 50% of the 18 patients. In pupil measurement, the success group had a significantly smaller mean pupil dilation response than the nonsuccess group at 0 and -3 dB signal to noise ratio (SNR) (all p < 0.01). In addition, significant differences were identified between the two groups for peak dilation and peak latency at all noise levels (all p < 0.01). When analyzing the change in pupil response before and after surgery, the difference in relative mean pupil dilation in the success group was significantly greater than that in the nonsuccess group at -3 dB SNR ( p = 0.02). In addition, the success group showed a significantly greater change in peak latency than the nonsuccess group at the -3 dB SNR ( p < 0.01). The difference in peak dilation tended to be greater in the success group than in the nonsuccess group, but the difference was not statistically significant.

CONCLUSIONS

Patients with unilateral CAA who achieved surgically improved hearing had a smaller pupil dilation response than those who did not. These results suggest that successful hearing outcomes after surgery in patients with unilateral CAA may reduce the cognitive effort required to understand speech under difficult listening conditions.

The Effects of Light Level and Signal-to-Noise Ratio on the Task-Evoked Pupil Response in a Speech-in-Noise Task

PURPOSE

There is increasing interest in the measurement of cognitive effort during listening tasks, for both research and clinical purposes. Quantification of task-evoked pupil responses (TEPRs) is a psychophysiological method that can be used to study cognitive effort. However, light level during cognitively demanding listening tasks may affect TEPRs, complicating interpretation of listening-related changes. The objective of this study was to examine the effects of light level on TEPRs during effortful listening across a range of signal-to-noise ratios (SNRs).

METHOD

Thirty-six adults without hearing loss were asked to repeat target sentences presented in background babble noise while their pupil diameter was recorded. Light level and SNRs were manipulated in a 4 × 4 repeated-measures design. Repeated-measures analyses of variance were used to measure the effects.

RESULTS

Peak and mean dilation were typically larger in more adverse SNR conditions (except for SNR -6 dB) and smaller in higher light levels. Differences in mean and peak dilation between SNR conditions were larger in dim light than in brighter light.

CONCLUSIONS

Brighter light conditions make TEPRs less sensitive to variations in listening effort across levels of SNR. Therefore, light level must be considered and reported in detail to ensure sensitivity of TEPRs and for comparisons of findings across different studies. It is recommended that TEPR testing be conducted in relatively low light conditions, considering both background illumination and screen luminance.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25676538.

Investigation of the behavior of tinnitus patients under varying listening conditions with simultaneous electroencephalography and pupillometry

OBJECTIVE

This study aims to control all hearing thresholds, including extended high frequencies (EHFs), presents stimuli of varying difficulty levels, and measures electroencephalography (EEG) and pupillometry responses to determine whether listening difficulty in tinnitus patients is effort or fatigue-related.

METHODS

Twenty-one chronic tinnitus patients and 26 matched healthy controls having normal pure-tone averages with symmetrical hearing thresholds were included. Subjects were evaluated with 0.125-20 kHz pure-tone audiometry, Montreal Cognitive Assessment Test (MoCA), Tinnitus Handicap Inventory (THI), EEG, and pupillometry.

RESULTS

Pupil dilatation and EEG alpha power during the "encoding" phase of the presented sentence in tinnitus patients were less in all listening conditions (p < .05). Also, there was no statistically significant relationship between EEG and pupillometry components for all listening conditions and THI or MoCA (p > .05).

CONCLUSION

EEG and pupillometry results under various listening conditions indicate potential listening effort in tinnitus patients even if all frequencies, including EHFs, are controlled. Also, we suggest that pupillometry should be interpreted with caution in autonomic nervous system-related conditions such as tinnitus.

Input-related demands: vocoded sentences evoke different pupillometrics and subjective listening effort than sentences in speech-shaped noise

OBJECTIVES

The Framework for Effortful Listening (FUEL) suggests five input-related demands can alter listening effort: source, transmission, listener, message and context factors. We hypothesised that vocoded sentences represented a source factor degradation and sentences in speech-shaped noise represented a transmission factor degradation. We used pupillometry and a subjective scale to examine our hypothesis.

DESIGN

Participants listened to vocoded sentences and sentences in speech-shaped noise at several difficulty levels designed to produce similar word recognition abilities; they also listened to unprocessed sentences. Within-participant pupillometrics and subjective listening effort were analysed. Post-hoc analyses were performed to examine if word recognition accuracy differentially influenced pupil responses.

STUDY SAMPLES

Twenty young adults with normal hearing.

RESULTS

Baseline pupil diameter was significantly smaller, peak pupil dilation was significantly larger, peak pupil dilation latency was significantly shorter, and subjective listening effort was significantly greater for the vocoded sentences than the sentences-in-noise. Word recognition ability also affected pupillometrics, but only for the vocoded sentences.

CONCLUSIONS

Our findings suggest that source factor degradations result in greater listening effort than transmission factor degradations. Future research should address how clinical interventions tailored towards different input-related demands may lead to reduced listening effort and improve patient outcomes.

Evaluating Real-World Benefits of Hearing Aids With Deep Neural Network-Based Noise Reduction: An Ecological Momentary Assessment Study

PURPOSE

Noise reduction technologies in hearing aids provide benefits under controlled conditions. However, differences in their real-life effectiveness are not established. We propose that a deep neural network (DNN)-based noise reduction system trained on naturalistic sound environments will provide different real-life benefits compared to traditional systems.

METHOD

Real-life listening experiences collected with Ecological Momentary Assessments (EMAs) of participants who used two premium models of hearing aid are compared. One hearing aid model (HA1) used traditional noise reduction; the other hearing aid model (HA2) used DNN-based noise reduction. Participants reported listening experiences several times a day while ambient SPL, SNR, and hearing aid volume adjustments were recorded. Forty experienced hearing aid users completed a total of 3,614 EMAs and recorded 6,812 hr of sound data across two 14-day wear periods.

RESULTS

Linear mixed-effects analysis document that participants' assessments of ambient noisiness were positively associated with SPL and negatively associated with SNR but were not otherwise affected by hearing aid model. Likewise, mean satisfaction with the two models did not differ. However, individual satisfaction ratings for HA1 were dependent on ambient SNR, which was not the case for HA2.

CONCLUSIONS

Hearing aids with DNN-based noise reduction resulted in consistent sound satisfaction regardless of the level of background noise compared to hearing aids implementing noise reduction based on traditional statistical models. While the two hearing aid models also differed on other parameters (e.g., shape), these differences are unlikely to explain the difference in how background noise impacts sound satisfaction with the aids.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25114526.

Reliability and generalizability of neural speech tracking in younger and older adults

Neural tracking of spoken speech is considered a potential clinical biomarker for speech-processing difficulties, but the reliability of neural speech tracking is unclear. Here, younger and older adults listened to stories in two sessions while electroencephalography was recorded to investigate the reliability and generalizability of neural speech tracking. Speech tracking amplitude was larger for older than younger adults, consistent with an age-related loss of inhibition. The reliability of neural speech tracking was moderate (ICC ∼0.5-0.75) and tended to be higher for older adults. However, reliability was lower for speech tracking than for neural responses to noise bursts (ICC >0.8), which we used as a benchmark for maximum reliability. Neural speech tracking generalized moderately across different stories (ICC ∼0.5-0.6), which appeared greatest for audiobook-like stories spoken by the same person. Hence, a variety of stories could possibly be used for clinical assessments. Overall, the current data are important for developing a biomarker of speech processing but suggest that further work is needed to increase the reliability to meet clinical standards.

Attention Mobilization as a Modulator of Listening Effort: Evidence From Pupillometry

Listening to speech in noise can require substantial mental effort, even among younger normal-hearing adults. The task-evoked pupil response (TEPR) has been shown to track the increased effort exerted to recognize words or sentences in increasing noise. However, few studies have examined the trajectory of listening effort across longer, more natural, stretches of speech, or the extent to which expectations about upcoming listening difficulty modulate the TEPR. Seventeen younger normal-hearing adults listened to 60-s-long audiobook passages, repeated three times in a row, at two different signal-to-noise ratios (SNRs) while pupil size was recorded. There was a significant interaction between SNR, repetition, and baseline pupil size on sustained listening effort. At lower baseline pupil sizes, potentially reflecting lower attention mobilization, TEPRs were more sustained in the harder SNR condition, particularly when attention mobilization remained low by the third presentation. At intermediate baseline pupil sizes, differences between conditions were largely absent, suggesting these listeners had optimally mobilized their attention for both SNRs. Lastly, at higher baseline pupil sizes, potentially reflecting overmobilization of attention, the effect of SNR was initially reversed for the second and third presentations: participants initially appeared to disengage in the harder SNR condition, resulting in reduced TEPRs that recovered in the second half of the story. Together, these findings suggest that the unfolding of listening effort over time depends critically on the extent to which individuals have successfully mobilized their attention in anticipation of difficult listening conditions.

Hearing Aid Delay Effects on Neural Phase Locking

OBJECTIVES

This study was designed to examine the effects of hearing aid delay on the neural representation of the temporal envelope. It was hypothesized that the comb-filter effect would disrupt neural phase locking, and that shorter hearing aid delays would minimize this effect.

DESIGN

Twenty-one participants, ages 50 years and older, with bilateral mild-to-moderate sensorineural hearing loss were recruited through print advertisements in local senior newspapers. They were fitted with three different sets of hearing aids with average processing delays that ranged from 0.5 to 7 msec. Envelope-following responses (EFRs) were recorded to a 50-msec /da/ syllable presented through a speaker placed 1 meter in front of the participants while they wore the three sets of hearing aids with open tips. Phase-locking factor (PLF) and stimulus-to-response (STR) correlations were calculated from these recordings.

RESULTS

Recordings obtained while wearing hearing aids with a 0.5-msec processing delay showed higher PLF and STR correlations compared with those with either 5-msec or 7-msec delays. No differences were noted between recordings of hearing aids with 5-msec and 7-msec delays. The degree of difference between hearing aids was greater for individuals who had milder degrees of hearing loss.

CONCLUSIONS

Hearing aid processing delays disrupt phase locking due to mixing of processed and unprocessed sounds in the ear canal when using open domes. Given previous work showing that better phase locking correlates with better speech-in-noise performance, consideration should be given to reducing hearing aid processing delay in the design of hearing aid algorithms.

An Exploratory Study of the Effect of Tinnitus on Listening Effort Using EEG and Pupillometry

OBJECTIVE

Previous behavioral studies on listening effort in tinnitus patients did not consider extended high-frequency hearing thresholds and had conflicting results. This inconsistency may be related that listening effort is not evaluated by the central nervous system (CNS) and autonomic nervous system (ANS), which are directly related to tinnitus pathophysiology. This study matches hearing thresholds at all frequencies, including the extended high-frequency and reduces hearing loss to objectively evaluate listening effort over the CNS and ANS simultaneously in tinnitus patients.

STUDY DESIGN

Case-control study.

SETTING

University hospital.

METHODS

Sixteen chronic tinnitus patients and 23 matched healthy controls having normal pure-tone averages with symmetrical hearing thresholds were included. Subjects were evaluated with 0.125 to 20 kHz pure-tone audiometry, Montreal Cognitive Assessment Test (MoCA), Tinnitus Handicap Inventory (THI), Visual Analog Scale (VAS), electroencephalography (EEG), and pupillometry.

RESULTS

Pupil dilation and EEG alpha band in the "coding" phase of the sentence presented in tinnitus patients was less than in the control group (p < .05). VAS score was higher in the tinnitus group (p < .01). Also, there was no statistically significant relationship between EEG and pupillometry components and THI or MoCA (p > .05).

CONCLUSION

This study suggests that tinnitus patients may need to make an extra effort to listen. Also, pupillometry may not be sufficiently reliable to assess listening effort in ANS-related pathologies. Considering the possible listening difficulties in tinnitus patients, reducing the listening difficulties, especially in noisy environments, can be added to the goals of tinnitus therapy protocols.

The Effects of Noise and Simulated Conductive Hearing Loss on Physiological Response Measures During Interactive Conversations

PURPOSE

The purpose of this work was to study the effects of background noise and hearing attenuation associated with earplugs on three physiological measures, assumed to be markers of effort investment and arousal, during interactive communication.

METHOD

Twelve pairs of older people (average age of 63.2 years) with age-adjusted normal hearing took part in a face-to-face communication to solve a Diapix task. Communication was held in different levels of babble noise (0, 60, and 70 dBA) and with two levels of hearing attenuation (0 and 25 dB) in quiet. The physiological measures obtained included pupil size, heart rate variability, and skin conductance. In addition, subjective ratings of perceived communication success, frustration, and effort were obtained.

RESULTS

Ratings of perceived success, frustration, and effort confirmed that communication was more difficult in noise and with approximately 25-dB hearing attenuation and suggested that the implemented levels of noise and hearing attenuation resulted in comparable communication difficulties. Background noise at 70 dBA and hearing attenuation both led to an initial increase in pupil size (associated with effort), but only the effect of the background noise was sustained throughout the conversation. The 25-dB hearing attenuation led to a significant decrease of the high-frequency power of heart rate variability and a significant increase of skin conductance level, measured as the average z value of the electrodermal activity amplitude.

CONCLUSION

This study demonstrated that several physiological measures appear to be viable indicators of changing communication conditions, with pupillometry and cardiovascular as well as electrodermal measures potentially being markers of communication difficulty.

Eye Movements Decrease during Effortful Speech Listening

Hearing impairment affects many older adults but is often diagnosed decades after speech comprehension in noisy situations has become effortful. Accurate assessment of listening effort may thus help diagnose hearing impairment earlier. However, pupillometry-the most used approach to assess listening effort-has limitations that hinder its use in practice. The current study explores a novel way to assess listening effort through eye movements. Building on cognitive and neurophysiological work, we examine the hypothesis that eye movements decrease when speech listening becomes challenging. In three experiments with human participants from both sexes, we demonstrate, consistent with this hypothesis, that fixation duration increases and spatial gaze dispersion decreases with increasing speech masking. Eye movements decreased during effortful speech listening for different visual scenes (free viewing, object tracking) and speech materials (simple sentences, naturalistic stories). In contrast, pupillometry was less sensitive to speech masking during story listening, suggesting pupillometric measures may not be as effective for the assessments of listening effort in naturalistic speech-listening paradigms. Our results reveal a critical link between eye movements and cognitive load, suggesting that neural activity in the brain regions that support the regulation of eye movements, such as frontal eye field and superior colliculus, are modulated when listening is effortful.SIGNIFICANCE STATEMENT Assessment of listening effort is critical for early diagnosis of age-related hearing loss. Pupillometry is most used but has several disadvantages. The current study explores a novel way to assess listening effort through eye movements. We examine the hypothesis that eye movements decrease when speech listening becomes effortful. We demonstrate, consistent with this hypothesis, that fixation duration increases and gaze dispersion decreases with increasing speech masking. Eye movements decreased during effortful speech listening for different visual scenes (free viewing, object tracking) and speech materials (sentences, naturalistic stories). Our results reveal a critical link between eye movements and cognitive load, suggesting that neural activity in brain regions that support the regulation of eye movements are modulated when listening is effortful.

Energetic and informational masking place dissociable demands on listening effort: Evidence from simultaneous electroencephalography and pupillometrya)

The task of processing speech masked by concurrent speech/noise can pose a substantial challenge to listeners. However, performance on such tasks may not directly reflect the amount of listening effort they elicit. Changes in pupil size and neural oscillatory power in the alpha range (8-12 Hz) are prominent neurophysiological signals known to reflect listening effort; however, measurements obtained through these two approaches are rarely correlated, suggesting that they may respond differently depending on the specific cognitive demands (and, by extension, the specific type of effort) elicited by specific tasks. This study aimed to compare changes in pupil size and alpha power elicited by different types of auditory maskers (highly confusable intelligible speech maskers, speech-envelope-modulated speech-shaped noise, and unmodulated speech-shaped noise maskers) in young, normal-hearing listeners. Within each condition, the target-to-masker ratio was set at the participant's individually estimated 75% correct point on the psychometric function. The speech masking condition elicited a significantly greater increase in pupil size than either of the noise masking conditions, whereas the unmodulated noise masking condition elicited a significantly greater increase in alpha oscillatory power than the speech masking condition, suggesting that the effort needed to solve these respective tasks may have different neural origins.

Listening Effort in Tinnitus: A Pilot Study Employing a Light EEG Headset and Skin Conductance Assessment during the Listening to a Continuous Speech Stimulus under Different SNR Conditions

Background noise elicits listening effort. What else is tinnitus if not an endogenous background noise? From such reasoning, we hypothesized the occurrence of increased listening effort in tinnitus patients during listening tasks. Such a hypothesis was tested by investigating some indices of listening effort through electroencephalographic and skin conductance, particularly parietal and frontal alpha and electrodermal activity (EDA). Furthermore, tinnitus distress questionnaires (THI and TQ12-I) were employed. Parietal alpha values were positively correlated to TQ12-I scores, and both were negatively correlated to EDA; Pre-stimulus frontal alpha correlated with the THI score in our pilot study; finally, results showed a general trend of increased frontal alpha activity in the tinnitus group in comparison to the control group. Parietal alpha during the listening to stimuli, positively correlated to the TQ12-I, appears to reflect a higher listening effort in tinnitus patients and the perception of tinnitus symptoms. The negative correlation between both listening effort (parietal alpha) and tinnitus symptoms perception (TQ12-I scores) with EDA levels could be explained by a less responsive sympathetic nervous system to prepare the body to expend increased energy during the "fight or flight" response, due to pauperization of energy from tinnitus perception.

Streamlining experiment design in cognitive hearing science using OpenSesame

Auditory science increasingly builds on concepts and testing paradigms originated in behavioral psychology and cognitive neuroscience - an evolution of which the resulting discipline is now known as cognitive hearing science. Experimental cognitive hearing science paradigms call for hybrid cognitive and psychobehavioral tests such as those relating the attentional system, working memory, and executive functioning to low-level auditory acuity or speech intelligibility. Building complex multi-stimuli experiments can rapidly become time-consuming and error-prone. Platform-based experiment design can help streamline the implementation of cognitive hearing science experimental paradigms, promote the standardization of experiment design practices, and ensure reliability and control. Here, we introduce a set of features for the open-source python-based OpenSesame platform that allows the rapid implementation of custom behavioral and cognitive hearing science tests, including complex multichannel audio stimuli while interfacing with various synchronous inputs/outputs. Our integration includes advanced audio playback capabilities with multiple loudspeakers, an adaptive procedure, compatibility with standard I/Os and their synchronization through implementation of the Lab Streaming Layer protocol. We exemplify the capabilities of this extended OpenSesame platform with an implementation of the three-alternative forced choice amplitude modulation detection test and discuss reliability and performance. The new features are available free of charge from GitHub: https://github.com/elus-om/BRM_OMEXP .

Combining Multiple Psychophysiological Measures of Listening Effort: Challenges and Recommendations

About one-third of all recently published studies on listening effort have used at least one physiological measure, providing evidence of the popularity of such measures in listening effort research. However, the specific measures employed, as well as the rationales used to justify their inclusion, vary greatly between studies, leading to a literature that is fragmented and difficult to integrate. A unified approach that assesses multiple psychophysiological measures justified by a single rationale would be preferable because it would advance our understanding of listening effort. However, such an approach comes with a number of challenges, including the need to develop a clear definition of listening effort that links to specific physiological measures, customized equipment that enables the simultaneous assessment of multiple measures, awareness of problems caused by the different timescales on which the measures operate, and statistical approaches that minimize the risk of type-I error inflation. This article discusses in detail the various obstacles for combining multiple physiological measures in listening effort research and provides recommendations on how to overcome them.

Performance Monitoring and Cognitive Inhibition during a Speech-in-Noise Task in Older Listeners

The goal of this study was to examine the effect of hearing loss on theta and alpha electroencephalography (EEG) frequency power measures of performance monitoring and cognitive inhibition, respectively, during a speech-in-noise task. It was hypothesized that hearing loss would be associated with an increase in the peak power of theta and alpha frequencies toward easier conditions compared to normal hearing adults. The shift would reflect how hearing loss modulates the recruitment of listening effort to easier listening conditions. Nine older adults with normal hearing (ONH) and 10 older adults with hearing loss (OHL) participated in this study. EEG data were collected from all participants while they completed the words-in-noise task. It hypothesized that hearing loss would also have an effect on theta and alpha power. The ONH group showed an inverted U -shape effect of signal-to-noise ratio (SNR), but there were limited effects of SNR on theta or alpha power in the OHL group. The results of the ONH group support the growing body of literature showing effects of listening conditions on alpha and theta power. The null results of listening condition in the OHL group add to a smaller body of literature, suggesting that listening effort research conditions should have near ceiling performance.

Neural signatures of task-related fluctuations in auditory attention and age-related changes

Listening in everyday life requires attention to be deployed dynamically - when listening is expected to be difficult and when relevant information is expected to occur - to conserve mental resources. Conserving mental resources may be particularly important for older adults who often experience difficulties understanding speech. In the current study, we use electro- and magnetoencephalography to investigate the neural and behavioral mechanics of attention regulation during listening and the effects that aging has on these. We first show in younger adults (17-31 years) that neural alpha oscillatory activity indicates when in time attention is deployed (Experiment 1) and that deployment depends on listening difficulty (Experiment 2). Experiment 3 investigated age-related changes in auditory attention regulation. Middle-aged and older adults (54-72 years) show successful attention regulation but appear to utilize timing information differently compared to younger adults (20-33 years). We show a notable age-group dissociation in recruited brain regions. In younger adults, superior parietal cortex underlies alpha power during attention regulation, whereas, in middle-aged and older adults, alpha power emerges from more ventro-lateral areas (posterior temporal cortex). This difference in the sources of alpha activity between age groups only occurred during task performance and was absent during rest (Experiment S1). In sum, our study suggests that middle-aged and older adults employ different neural control strategies compared to younger adults to regulate attention in time under listening challenges.

Neural responses to naturalistic audiovisual speech are related to listening demand in cochlear implant users

There is a weak relationship between clinical and self-reported speech perception outcomes in cochlear implant (CI) listeners. Such poor correspondence may be due to differences in clinical and “real-world” listening environments and stimuli. Speech in the real world is often accompanied by visual cues, background environmental noise, and is generally in a conversational context, all factors that could affect listening demand. Thus, our objectives were to determine if brain responses to naturalistic speech could index speech perception and listening demand in CI users. Accordingly, we recorded high-density electroencephalogram (EEG) while CI users listened/watched a naturalistic stimulus (i.e., the television show, “The Office”). We used continuous EEG to quantify “speech neural tracking” (i.e., TRFs, temporal response functions) to the show’s soundtrack and 8–12 Hz (alpha) brain rhythms commonly related to listening effort. Background noise at three different signal-to-noise ratios (SNRs), +5, +10, and +15 dB were presented to vary the difficulty of following the television show, mimicking a natural noisy environment. The task also included an audio-only (no video) condition. After each condition, participants subjectively rated listening demand and the degree of words and conversations they felt they understood. Fifteen CI users reported progressively higher degrees of listening demand and less words and conversation with increasing background noise. Listening demand and conversation understanding in the audio-only condition was comparable to that of the highest noise condition (+5 dB). Increasing background noise affected speech neural tracking at a group level, in addition to eliciting strong individual differences. Mixed effect modeling showed that listening demand and conversation understanding were correlated to early cortical speech tracking, such that high demand and low conversation understanding occurred with lower amplitude TRFs. In the high noise condition, greater listening demand was negatively correlated to parietal alpha power, where higher demand was related to lower alpha power. No significant correlations were observed between TRF/alpha and clinical speech perception scores. These results are similar to previous findings showing little relationship between clinical speech perception and quality-of-life in CI users. However, physiological responses to complex natural speech may provide an objective measure of aspects of quality-of-life measures like self-perceived listening demand.

Investigating the Provision and Context of Use of Hearing Aid Listening Programs From Real-world Data: Observational Study

BACKGROUND

Listening programs enable hearing aid (HA) users to change device settings for specific listening situations and thereby personalize their listening experience. However, investigations into real-world use of such listening programs to support clinical decisions and evaluate the success of HA treatment are lacking.

OBJECTIVE

We aimed to investigate the provision of listening programs among a large group of in-market HA users and the context in which the programs are typically used.

METHODS

First, we analyzed how many and which programs were provided to 32,336 in-market HA users. Second, we explored 332,271 program selections from 1312 selected users to investigate the sound environments in which specific programs were used and whether such environments reflect the listening intent conveyed by the name of the used program. Our analysis was based on real-world longitudinal data logged by smartphone-connected HAs.

RESULTS

In our sample, 57.71% (18,663/32,336) of the HA users had programs for specific listening situations, which is a higher proportion than previously reported, most likely because of the inclusion criteria. On the basis of association rule mining, we identified a primary additional listening program, Speech in Noise, which is frequent among users and often provided when other additional programs are also provided. We also identified 2 secondary additional programs (Comfort and Music), which are frequent among users who get ≥3 programs and usually provided in combination with Speech in Noise. In addition, 2 programs (TV and Remote Mic) were related to the use of external accessories and not found to be associated with other programs. On average, users selected Speech in Noise, Comfort, and Music in louder, noisier, and less-modulated (all P<.01) environments compared with the environment in which they selected the default program, General. The difference from the sound environment in which they selected General was significantly larger in the minutes following program selection than in the minutes preceding it.

CONCLUSIONS

This study provides a deeper insight into the provision of listening programs on a large scale and demonstrates that additional listening programs are used as intended and according to the sound environment conveyed by the program name.

Speech to noise ratio improvement induces nonlinear parietal phase synchrony in hearing aid users

Objectives

Comprehension of speech in adverse listening conditions is challenging for hearing-impaired (HI) individuals. Noise reduction (NR) schemes in hearing aids (HAs) have demonstrated the capability to help HI to overcome these challenges. The objective of this study was to investigate the effect of NR processing (inactive, where the NR feature was switched off, vs. active, where the NR feature was switched on) on correlates of listening effort across two different background noise levels [+3 dB signal-to-noise ratio (SNR) and +8 dB SNR] by using a phase synchrony analysis of electroencephalogram (EEG) signals.

Design

The EEG was recorded while 22 HI participants fitted with HAs performed a continuous speech in noise (SiN) task in the presence of background noise and a competing talker. The phase synchrony within eight regions of interest (ROIs) and four conventional EEG bands was computed by using a multivariate phase synchrony measure.

Results

The results demonstrated that the activation of NR in HAs affects the EEG phase synchrony in the parietal ROI at low SNR differently than that at high SNR. The relationship between conditions of the listening task and phase synchrony in the parietal ROI was nonlinear.

Conclusion

We showed that the activation of NR schemes in HAs can non-linearly reduce correlates of listening effort as estimated by EEG-based phase synchrony. We contend that investigation of the phase synchrony within ROIs can reflect the effects of HAs in HI individuals in ecological listening conditions.

Listening Over Time: Single-Trial Tonic and Phasic Oscillatory Alpha-and Theta-Band Indicators of Listening-Related Fatigue

Objectives

Listening effort engages cognitive resources to support speech understanding in adverse listening conditions, and leads to fatigue over the longer term for people with hearing loss. Direct, neural measures of listening-related fatigue have not been developed. Here, event-related or phasic changes in alpha and theta oscillatory power during listening were used as measures of listening effort, and longer-term or tonic changes over the course of the listening task were assessed as measures of listening-related fatigue. In addition, influences of self-reported fatigue and degree of hearing loss on tonic changes in oscillatory power were examined.

Design

Participants were middle-aged adults (age 37–65 years; n = 12) with age-appropriate hearing. Sentences were presented in a background of multi-talker babble at a range of signal-to-noise ratios (SNRs) varying around the 80 percent threshold of individual listeners. Single-trial oscillatory power during both sentence and baseline intervals was analyzed with linear mixed-effect models that included as predictors trial number, SNR, subjective fatigue, and hearing loss.

Results

Alpha and theta power in both sentence presentation and baseline intervals increased as a function of trial, indicating listening-related fatigue. Further, tonic power increases across trials were affected by hearing loss and/or subjective fatigue, particularly in the alpha-band. Phasic changes in alpha and theta power generally tracked with SNR, with decreased alpha power and increased theta power at less favorable SNRs. However, for the alpha-band, the linear effect of SNR emerged only at later trials.

Conclusion

Tonic increases in oscillatory power in alpha- and theta-bands over the course of a listening task may be biomarkers for the development of listening-related fatigue. In addition, alpha-band power as an index of listening-related fatigue may be sensitive to individual differences attributable to level of hearing loss and the subjective experience of listening-related fatigue. Finally, phasic effects of SNR on alpha power emerged only after a period of listening, suggesting that this measure of listening effort could depend on the development of listening-related fatigue.

Relationship between Behavioral and Objective Measures of Sound Intensity in Normal-Hearing Listeners and Hearing-Aid Users: A Pilot Study

Background: For hearing-impaired individuals, hearing aids are clinically fit according to subjective measures of threshold and loudness. The goal of this study was to evaluate objective measures of loudness perception that might benefit hearing aid fitting. Method: Seventeen adult hearing aid users and 17 normal-hearing adults participated in the study. Outcome measures including categorical loudness scaling, cortical auditory evoked potentials (CAEPs), and pupillometry. Stimuli were 1-kHz tone bursts presented at 40, 60, and 80 dBA. Results: Categorical loudness scaling showed that loudness significantly increased with intensity for all participants (p < 0.05). For CAEPs, high intensity was associated with greater P1, N1, and P2 peak amplitude for all listeners (p < 0.05); a significant but small effect of hearing aid amplification was observed. For all participants, pupillometry showed significant effects of high intensity on pupil dilation (p < 0.05); there was no significant effect of hearing aid amplification. A Focused Principal Component analysis revealed significant correlations between subjective loudness and some of the objective measures. Conclusion: The present data suggest that intensity had a significant impact on loudness perception, CAEPs, and pupil response. The correlations suggest that pupillometry and/or CAEPs may be useful in determining comfortable amplification for hearing aids.

Hearing-Aid Directionality Improves Neural Speech Tracking in Older Hearing-Impaired Listeners

In recent years, a growing body of literature has explored the effect of hearing impairment on the neural processing of speech, particularly related to the neural tracking of speech envelopes. However, only limited work has focused on the potential usage of the method for evaluating the effect of hearing aids designed to amplify and process the auditory input provided to hearing-impaired listeners. The current study investigates how directional sound processing in hearing-aids, denoted directionality, affects the neural tracking and encoding of speech in EEG recorded from 11 older hearing-impaired listeners. Behaviorally, the task performance improved when directionality was applied, while subjective ratings of listening effort were not affected. The reconstruction of the to-be-attended speech envelopes improved significantly when applying directionality, as well as when removing the background noise altogether. When inspecting the modelled response of the neural encoding of speech, a faster transition was observed between the early bottom-up response and the later top-down attentional-driven responses when directionality was applied. In summary, hearing-aid directionality affects both the neural speech tracking and neural encoding of to-be-attended speech. This result shows that hearing-aid signal processing impacts the neural processing of sounds and that neural speech tracking is indicative of the benefits associated with applying hearing-aid processing algorithms.

Creating Clarity in Noisy Environments by Using Deep Learning in Hearing Aids

Hearing aids continue to acquire increasingly sophisticated sound-processing features beyond basic amplification. On the one hand, these have the potential to add user benefit and allow for personalization. On the other hand, if such features are to benefit according to their potential, they require clinicians to be acquainted with both the underlying technologies and the specific fitting handles made available by the individual hearing aid manufacturers. Ensuring benefit from hearing aids in typical daily listening environments requires that the hearing aids handle sounds that interfere with communication, generically referred to as “noise.” With this aim, considerable efforts from both academia and industry have led to increasingly advanced algorithms that handle noise, typically using the principles of directional processing and postfiltering. This article provides an overview of the techniques used for noise reduction in modern hearing aids. First, classical techniques are covered as they are used in modern hearing aids. The discussion then shifts to how deep learning, a subfield of artificial intelligence, provides a radically different way of solving the noise problem. Finally, the results of several experiments are used to showcase the benefits of recent algorithmic advances in terms of signal-to-noise ratio, speech intelligibility, selective attention, and listening effort.