Listening-Based Communication Ability in Adults With Hearing Loss: A Scoping Review of Existing Measures

Enhancing Cochlear Implant Outcomes across Age Groups: The Interplay of Forward Focus and Advanced Combination Encoder Coding Strategies in Noisy Conditions

Background: Hearing in noise is challenging for cochlear implant users and requires significant listening effort. This study investigated the influence of ForwardFocus and number of maxima of the Advanced Combination Encoder (ACE) strategy, as well as age, on speech recognition threshold and listening effort in noise. Methods: A total of 33 cochlear implant recipients were included (age ≤ 40 years: n = 15, >40 years: n = 18). The Oldenburg Sentence Test was used to measure 50% speech recognition thresholds (SRT50) in fluctuating and stationary noise. Speech was presented frontally, while three frontal or rear noise sources were used, and the number of ACE maxima varied between 8 and 12. Results: ForwardFocus significantly improved the SRT50 when noise was presented from the back, independent of subject age. The use of 12 maxima further improved the SRT50 when ForwardFocus was activated and when noise and speech were presented frontally. Listening effort was significantly worse in the older age group compared to the younger age group and was reduced by ForwardFocus but not by increasing the number of ACE maxima. Conclusion: Forward Focus can improve speech recognition in noisy environments and reduce listening effort, especially in older cochlear implant users.

Effects of entropy in real-world noise on speech perception in listeners with normal hearing and hearing lossa)

Hearing aids show more benefit in traditional laboratory speech-in-noise tests than in real-world noisy environments. Real-world noise comprises a large range of acoustic properties that vary randomly and rapidly between and within environments, making quantifying real-world noise and using it in experiments and clinical tests challenging. One approach is to use acoustic features and statistics to quantify acoustic properties of real-world noise and control for them or measure their relationship to listening performance. In this study, the complexity of real-world noise from different environments was quantified using entropy in both the time- and frequency-domains. A distribution of noise segments from low to high entropy were extracted. Using a trial-by-trial design, listeners with normal hearing and hearing loss (in aided and unaided conditions) repeated back sentences embedded in these noise segments. Entropy significantly affected speech perception, with a larger effect of entropy in the time-domain than the frequency-domain, a larger effect for listeners with normal hearing than for listeners with hearing loss, and a larger effect for listeners with hearing loss in the aided than unaided condition. Speech perception also differed between most environment types. Combining entropy with the environment type improved predictions of speech perception above the environment type alone.

Perceived listening ability and hearing loss: Systematic review and qualitative meta-synthesis

BACKGROUND

Hearing loss (HL) can affect communication in complex ways. Understanding how adults with HL reflect on and conceptualise the way they listen (metacognition) is required if interventions, and the outcome measures used to evaluate them, are to address barriers to functional communication arising from HL.

OBJECTIVES

This study describes how adults with HL experience and report the processes, behaviours, and components of listening, as presented in published studies.

DESIGN

Systematic review and meta-synthesis of qualitative studies.

METHODS

Systematic searches identified English-language, peer-reviewed journal articles reporting the results of qualitative or mixed-methods studies of adults' with HL perceived listening abilities. Medline, PsychInfo, Web of Science, Embase, and Google Scholar were searched from inception to November 2021. Handsearching reference lists of included studies identified additional studies for inclusion. The Critical Appraisal Skills Programme (CASP) qualitative checklist was used to appraise studies' methodological quality. Data from included studies were analysed using thematic meta-synthesis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Confidence in the Evidence from Reviews of QUALitative (CERQual) approach assessed confidence in the review findings. Two reviewers independently completed all screening and quality appraisal. Thematic meta-synthesis and GRADE CERQual assessment was completed by one reviewer and confirmed by a second reviewer. Discrepancies were resolved through discussion.

RESULTS

Data from 46 studies were included in the review. Thematic meta-synthesis identified six descriptive themes: 1) perceived listening ability; 2) external modifiers; 3) psychosocial impacts of hearing loss; 4) communication partner perspectives; 5) self-efficacy for listening; and 6) cognitive load. GRADE CERQual ratings for descriptive themes ranged from low to moderate confidence. Descriptive themes were related by analytic themes of liminality and reciprocity.

CONCLUSIONS

Adults with HL provide in-depth accounts of components and processes of listening, with studies reporting both cognitive and affective experiences consistent with theoretical models of metacognition. The findings will inform content generation for a hearing-specific patient-reported outcome measure of perceived listening ability in everyday communication.