Aided and Unaided Speech Perception by Older Hearing Impaired Listeners

Abstract

The most common complaint of older hearing impaired (OHI) listeners is difficulty understanding speech in the presence of noise. However, tests of consonant-identification and sentence reception threshold (SeRT) provide different perspectives on the magnitude of impairment. Here we quantified speech perception difficulties in 24 OHI listeners in unaided and aided conditions by analyzing (1) consonant-identification thresholds and consonant confusions for 20 onset and 20 coda consonants in consonant-vowel-consonant (CVC) syllables presented at consonant-specific signal-to-noise (SNR) levels, and (2) SeRTs obtained with the Quick Speech in Noise Test (QSIN) and the Hearing in Noise Test (HINT). Compared to older normal hearing (ONH) listeners, nearly all unaided OHI listeners showed abnormal consonant-identification thresholds, abnormal consonant confusions, and reduced psychometric function slopes. Average elevations in consonant-identification thresholds exceeded 35 dB, correlated strongly with impairments in mid-frequency hearing, and were greater for hard-to-identify consonants. Advanced digital hearing aids (HAs) improved average consonant-identification thresholds by more than 17 dB, with significant HA benefit seen in 83% of OHI listeners. HAs partially normalized consonant-identification thresholds, reduced abnormal consonant confusions, and increased the slope of psychometric functions. Unaided OHI listeners showed much smaller elevations in SeRTs (mean 6.9 dB) than in consonant-identification thresholds and SeRTs in unaided listening conditions correlated strongly (r = 0.91) with identification thresholds of easily identified consonants. HAs produced minimal SeRT benefit (2.0 dB), with only 38% of OHI listeners showing significant improvement. HA benefit on SeRTs was accurately predicted (r = 0.86) by HA benefit on easily identified consonants. Consonant-identification tests can accurately predict sentence processing deficits and HA benefit in OHI listeners.

Quality of life after intervention with a cochlear implant or hearing aid

“…Hearing aids (HA) and cochlear implants (CI) are the most common devices used for the treatment of hearing loss. Although these interventions result in improvements in speech perception and even disease‐specific quality of life, the impact on generic health‐related quality of life is unclear …”

“…10,11 Hearing aids (HA) and cochlear implants (CI) are the most common devices used for the treatment of hearing loss. Although these interventions result in improvements in speech perception 12,13 and even disease-specific quality of life, the impact on generic health-related quality of life is unclear. [14][15][16][17][18] Health-related quality of life is a broad multidimensional concept that includes both physical and mental well-being.…”

Speech Perception in Older Hearing Impaired Listeners: Benefits of Perceptual Training

“…Older hearing impaired (OHI) listeners exhibit deficits in consonant identification [ 1 – 5 ] that contribute to problems in understanding connected speech, including sentences. Hearing aids (HAs) improve consonant identification in OHI listeners [ 6 ], with the magnitude of HA benefit on consonant identification correlating with improvements in sentence reception thresholds (SeRTs) [ 7 , 8 ]. However, aided OHI listeners continue to show large deficits in consonant identification in comparison to older listeners with normal hearing (ONH), particularly for harder-to-identify consonants [ 7 ].…”

“…Hearing aids (HAs) improve consonant identification in OHI listeners [ 6 ], with the magnitude of HA benefit on consonant identification correlating with improvements in sentence reception thresholds (SeRTs) [ 7 , 8 ]. However, aided OHI listeners continue to show large deficits in consonant identification in comparison to older listeners with normal hearing (ONH), particularly for harder-to-identify consonants [ 7 ]. For example, when tested with large consonant sets aided OHI listeners with mild to moderately severe hearing losses identify only 60–75% of consonants even in quiet [ 9 , 10 ].…”

“…Consonants convey the majority of information in conversational speech, and consonant thresholds show large elevations in OHI listeners, even in aided listening conditions [ 7 ]. When high-frequency hearing is partially restored by HAs, consonant identification improves and consonant-cue weightings are partially normalized [ 7 ]. However, HAs produce smaller improvements in consonant identification than might be expected based on improvements of audibility [ 11 ].…”