A Clinical Paradigm for Listening Effort Assessment in Middle-Aged Listeners

Abstract

Listening effort (LE) has been known to characterize speech recognition in noise regardless of hearing sensitivity and age. Whereas the behavioral measure of dual-task paradigm effectively manifests the cognitive cost that listeners exert when processing speech in background noise, there is no consensus as to a clinical procedure that might best express LE. In order to assess the cognitive load underlying speech recognition in noise and promote counselling for coping strategies, a feasible clinical paradigm is warranted. The ecological validity of such a paradigm might best be demonstrated in middle-aged adults, exhibiting intact hearing sensitivity on one hand, however, experiencing difficulties in degraded listening conditions, unaware of the implicated cognitive cost of speech recognition in noise. To this end, we constructed a dual-task paradigm that consists of a primary task of sentences-in-noise recognition and a secondary task of simple visual colored-shape matching. Research objective was to develop a clinical paradigm for the assessment of LE in middle-aged adults. Participants were 17 middle-aged adults (mean age of 52.81 years) and 23 young adults (mean age of 24.90 years). All participants had normal hearing according to age. Speech stimuli consisted of the Hebrew Matrix sentences in noise test. SRTn was obtained for 80% correct identification. Visual stimuli were colored geometric shapes. Outcome measures were obtained initially for each task separately, to establish performance ability, and then obtained simultaneously. Reaction time and accuracy in the secondary task were the defined metrics for LE. Results: LE was indicated for both groups, however, was more pronounced in the middle-aged, manifested in the visual accuracy and reaction time metrics. Both groups maintained the 80% correct recognition-in-noise in the dual-task, however, the middle-aged group necessitated a better SNR of 1.4dB than the normal hearing group. Moreover, the middle-aged group was taxed in a greater prolongation of reaction time, in order to uphold the correct recognition. Conclusion: a dual-task paradigm consisting of sentences-in-noise primary task combined with a simple secondary task successfully showed different manifestations of LE in middle-aged adults compared to young adults, thus approximating the use of such a paradigm in a clinical setting.

The Involvement of Listening Effort in Explaining Bilingual Listening Under Adverse Listening Conditions

“…In addition to pupillometry, various other physiological techniques have been suggested to capture differences in effort. For example, changes in cardiac responses (e.g., Mackersie & Calderon-Moultrie, 2016; Mackersie & Cones, 2011; Seeman & Sims, 2015), hormonal activity (e.g., Jahncke & Halin, 2012), or skin conductance responses (e.g., Mackersie & Calderon-Moultrie, 2016; Mackersie & Cones, 2011; Seeman & Sims, 2015), were attributed to changes in effort. In addition, changes in the synchronization of alpha and theta oscillations during electroencephalogram (EEG) recordings (Deng et al, 2019; Miles et al, 2017; Obleser et al, 2012; Wisniewski, 2017; Wisniewski et al, 2018), changes in the topography, latency, or amplitude of event-related potentials (ERPs) (e.g., Bertoli & Bodmer, 2016; Kyong et al, 2020; Obleser & Kotz, 2011; Ullsperger et al, 1988), or recruitment of additional brain areas in neuroimaging studies (e.g., Eckert et al, 2016; Peelle, 2018; White & Langdon, 2021; Wild et al, 2012) were found to be associated with the difficulty of the task and were interpreted to reflect changes in effort.…”

“…For instance, Alhanbali et al (2019) showed non-significant or weak correlations between pupillometry, skin conductance, EEG alpha power, and subjective ratings measures, suggesting that these measures may tap into slightly different components of the effort construct. In addition, different effort measures may not be equally sensitive to the demands of a task and to methodological manipulations (Seeman & Sims, 2015; Strand et al, 2018). For instance, Seeman and Sims (2015) showed that the sensitivity to changes in task complexity and signal-to-noise ratios (SNRs) differed across listening effort measures.…”

“…In addition, different effort measures may not be equally sensitive to the demands of a task and to methodological manipulations (Seeman & Sims, 2015; Strand et al, 2018). For instance, Seeman and Sims (2015) showed that the sensitivity to changes in task complexity and signal-to-noise ratios (SNRs) differed across listening effort measures. In their study, physiological heart rate variability was greater for increased task complexity and poorer SNRs, skin conductance measure was elevated for greater task complexity only, and dual-task measure increased for stimuli presented at more challenging SNRs.…”

“…To date, there is no agreement on what the concept of listening effort encompasses, and the dimensions of the effort construct are still under-specified (Alhanbali et al, 2019; Francis & Love, 2020; Strand et al, 2020). Furthermore, there is no consensus regarding the measure that might best express listening effort (Neeman et al, 2022). Thus, until more information is available about the different dimensions of this construct and the overlapping systems it is composed of, it may be advisable to include multiple measures rather than relying on one as a sole indicator (Strand et al, 2020).…”

Listening efficiency in adult cochlear-implant users compared with normally-hearing controls at ecologically relevant signal-to-noise ratios

“…Previous research has considered (dual-task) behavioral measures to be effective assessments of listening effort (Gatehouse and Gordon, 1990;Deary, 1994;Hällgren et al, 2001;Larsby et al, 2005;Houben et al, 2013). Their use has even been proposed in clinical settings (Gosselin and Gagné, 2010;Kaplan Neeman et al, 2022). Nonetheless, as with other listening effort assessments, measures of accuracy and RT need to be taken into account in combination since it is known that listening effort can still be experienced even when intelligibility performance is at or near ceiling (Houben et al, 2013;Pals et al, 2020;Winn and Teece, 2022).…”