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We will be provided with an authorization token (please note: passwords are not shared with us) and will sync your accounts for you. The editor and reviewers' affiliations are the latest provided on their Loop research profiles and may not reflect their situation at time of review. Introduction : Speech recognition in adverse listening conditions becomes more difficult as we age, particularly for individuals with age-related hearing loss (ARHL). Results : Significant improvements on all trained conditions were observed in both ARHL and normal-hearing groups over the course of training.
Conclusions : ARHL did not preclude auditory perceptual learning but there was little generalization to untrained conditions.
Speech processing involves not only the perception and identification of individual speech sounds and words, but also the integration of successively heard words, phrases, and sentences to achieve a coherent and accurate representation of the meaning of the message being communicated.
Lower level processes are compromised to a greater extent in older-adults with ARHL group than in normal-hearing older adults.
Auditory training for the purpose of hearing rehabilitation involves active listening to auditory stimuli and aims to improve the ability of participants to comply with the demands of non-optimal listening environments (Boothroyd, 2007; Henderson Sabes and Sweetow, 2007). We focused on adults with mild-to-moderate sensorineural hearing loss who were experiencing hearing difficulties, but had not yet sought intervention for their hearing loss, as well as on normal-hearing adults.
A total of 56 participants (35 females) met the inclusion criteria reported above and their data is included in the analyses reported in this manuscript. The study used a randomized, controlled, quasi-crossover design similar in concept to Ferguson et al.
PDF access policyFull text access is free in HTML pages; however the journal allows PDF access only to subscribers. Lise Obeling, Torben PoulsenPMID:12689507The audiograms of fifty-seven musicians from four Danish symphony orchestras were determined in connection with an interview about their working experience. Mariola Sliwinska-Kowalska, Piotr Kotylo, Beata HendlerPMID:12689508It has been suggested that otoacoustic emissions, particularly transient-evoked otoacoustic emissions (TEOAE), might be more sensitive in assessment of changes to the cochlea caused by noise than pure-tone audiometry (PTA). Anjali Desai, David Reed, Alex Cheyne, Scott Richards, Deepak PrasherPMID:12689509Otoacoustic emissions and contra-lateral sound activated efferent suppression of emissions were examined to determine whether they provide any early indication of auditory damage from exposure to noise. Is there a gender difference in coping, perceived disability and handicap in patients with noise-induced hearing loss? Lillemor HallbergPMID:12689510Gender differences in coping strategies and self-rated disability and handicap were explored in individuals with noise-induced hearing loss. This means that you will not need to remember your user name and password in the future and you will be able to login with the account you choose to sync, with the click of a button. This page doesn't support Internet Explorer 6, 7 and 8.Please upgrade your browser or activate Google Chrome Frame to improve your experience. Whether these difficulties can be eased with training remains debated, because it is not clear whether the outcomes are sufficiently general to be of use outside of the training context. The study design was a cross over design with three groups (immediate-training, delayed-training, and no-training group). Normal hearing participants learned more than participants with ARHL in the speech-in-noise condition, but showed similar patterns of learning in the other conditions. We suggest that most training-related changes occurred at higher level task-specific cognitive processes in both groups.
Specifically, older adults often experience considerable difficulties when listening to speech in the presence of background noise, to competing speech signals or to rapid speech (Pichora-Fuller et al., 1995).
Therefore, attempts are being made to supplement the rehabilitation process with patient-centered education, counseling, and auditory training, which were hypothesized to help listeners compensate for degradation in the auditory signal and improve communication (Sweetow and Sabes, 2006). In this process distinct (but interactive) neural networks process both the acoustic structure and the meaning of speech. According to the Ease of Language Understanding Model (ELU), incoming speech is initially processed automatically and a phonological representation of the signal is created. For example, older adults with presbycusis required more favorable signal-to-noise ratios (SNRs) to benefit from the ability to predict sentence-final words from sentence context than older adults with normal hearing, even though the magnitude of the context effect was similar in the two groups (Pichora-Fuller et al., 1995).
Home-based auditory training programs were developed to allow adults with hearing loss to engage in perceptual learning, which in turn may lead to better speech understanding and improved communication ability (Sweetow and Sabes, 2007). On-task learning following auditory training in older adults with ARHL is usually robust, however generalization of learning to untrained tasks or stimuli that were not experienced directly during training does not always occur, or is very small (see Henshaw and Ferguson, 2013 for a similar use of the terms). They found that training changed the neural processing of speech sounds and promoted cognitive and perceptual skills. Passages on a wide array of topics were presented in degraded form (noise or time-compression) or in parallel to a competing talker. To the best of our knowledge, the present study is one of the first studies to conduct home-based training research in everyday listening situations; in fact it is the first of its kind in relation to Hebrew speakers. Participants were recruited from the Institute for Audiology and Clinical Neurophysiology at the Interdisciplinary Clinical Center at the University of Haifa, from the Hearing and Speech Center at the Rambam Health Care Campus and through advertisements at the University and Rambam.


Measurements of sound levels and noise dose were performed during rehearsal and during concerts in the four orchestras with the measurement equipment placed in various instrument groups.
The aim of the study was to compare temporary threshold shifts with the changes in TEOAE following a six-hour exposure to industrial noise at the intensity of 85-97 dB (A).
Three groups were studied: noise exposed workers (n=50, mean age 42 years), patients with Meniere's disease (n=24, mean age 48 years) and normal subjects (n=24, mean age 41 years).
The study group consisted of 60 male and 33 female patients, consecutively presenting at the hearing clinics in two hospitals in the western part of Sweden.
The aim of the current study was to compare training-induced learning and generalization between normal-hearing older adults and those with ARHL. Trained participants received 13 sessions of home-based auditory training over the course of 4 weeks. Greater pre- to post-test changes were observed in trained than in untrained listeners on all trained conditions. However, these were enhanced by high quality perceptual representations in the normal-hearing group. Because these conditions are present in everyday situations, many older-adults find it difficult to understand speech in everyday life.
The end result, mapping sounds to meaning, relies on matching the output from acoustic and phonetic analyses with stored lexical representations (Davis and Johnsrude, 2007; Hickok and Poeppel, 2007). This example also suggests that hearing impairment does not necessarily interfere with the ability to engage top-down processes to support listening.
In the latter program, listeners train on speech recognition in passages on a wide variety of topics, in conditions such as competing speakers, time-compressed speech and speech-in-noise, that mimics the challenges of real-world listening.
In one of these studies (Anderson et al., 2013a), participants improved in both physiological (brainstem timing) as well as perceptual assessments (speech-in-noise perception, short-term memory and speech processing) following 40 sessions of computerized home-based auditory training.
Listeners had to answer content-related questions and the level of acoustic difficulty was adapted based on their responses.
Recruitment criteria included age 60–72 years, normal-hearing or hearing impairment with no neurologic disorders and Hebrew as a first language. Mean air conduction hearing thresholds across ears and participants are plotted for all Normal-Hearing (NH) and Age-Related Hearing Loss (ARHL) participants. The average audiogram showed a decrease at higher frequencies similar to an age-related hearing loss. All subjects underwent routine pure tone audiometry, tympanometry and otoacoustic emission testing. The females were older and had worse average hearing thresholds over the low frequencies (0.5, 1 and 2 kHz) in the better ear than the males. Three adverse listening conditions were targeted: (1) Speech-in-noise, (2) time compressed speech, and (3) competing speakers, and the outcomes of training were compared between normal and ARHL groups.
In addition, the ability of trained listeners from the ARHL group to discriminate minimally different pseudowords in noise also improved with training.
In contrast, some training-related changes have also occurred at the level of phonemic representations in the ARHL group, consistent with an interaction between bottom-up and top-down processes. Studies with older adults have shown that even participants with normal pure-tone and speech perception thresholds often report that listening in everyday life has become effortful (Schneider et al., 2002).
In addition training outcomes also depend on the trained task (Amitay et al., 2006), suggesting that plasticity is also mediated by cognitive task-specific mechanisms rather than by only the sensory attributes of the trained stimuli. Burk and colleagues examined the effect of word-based auditory training and focused on word-recognition abilities within a background noise with varied words and talkers. The overall goal of such ecological training approaches is to improve sensory function, and engage higher level processes that support sensory processing (Schneider and Pichora-Fuller, 2000). Moreover, perceptual learning studies usually ask if learning simple auditory skills can generalize to more complex ones. Exclusions from the study were on the basis of audiometric results of asymmetric or conductive hearing loss (n = 4), being an existing hearing aid user (n = 5), unwillingness to participate in post-test sessions (n = 4), inability to control a computer mouse (n = 2).
Participants with ARHL had symmetrical mild to moderate hearing loss with hearing thresholds ≤60 dBHL through 8000 Hz, and did not use hearing aids either in the past or at the time of the study. Subgroups of participants underwent auditory training between different test sessions such that overall, participants served as their own untrained controls. Each audiogram was corrected for the age of the person by means of the median from ISO 7029 and the average audiogram from these age-corrected individual audiograms showed no signs of hearing loss. As a number of studies have shown that with hearing threshold better than 30 dB HL, emissions are almost always present and are generally absent with hearing loss greater than 30 dB HL, subjects in this study were sub grouped into these two categories in order to examine the incidence of emissions. ARHL is estimated to affect more than 25% of the population aged 60 or more and its incidence is expected to increase with the aging of the population (Roth et al., 2011). Thus, the current study specifically asks whether a home-based auditory training approach that mimics the challenges of real-world listening can improve speech perception in normal-hearing and in hearing impaired older adults, and whether the patterns of learning and generalization are influenced by the presence of a hearing impairment.


Moreover, cognitive processes such as working memory, selective attention, and the speed at which information can be processed also affect speech understanding (Pichora-Fuller and Singh, 2006).
Such training on perceptual distinctions assumes that by resolving lower level sensory issues through training, listening and communication should improve in a bottom-up manner.
Whole sentences are expected to provide top-down lexical feedback in the perceptual learning process (Davis et al., 2005). In the current study, generalization to untrained speech tasks was examined in normal-hearing older adults and those with ARHL. The audiograms were also compared to the expected audiograms from ISO 1999, which takes account of the number of years at work, the number of playing hours per week, and the average sound level in the orchestra for the instrument group. Both, PTA and TEOAE showed significant reduction due to noise exposure, but no correlation between temporary threshold shifts and decreases in either the overall TOAE level or the level of otoacoustic emission in the frequency bands was found.
Absence of emissions in subjects with mean hearing thresholds better than 30 dB HL varied from 0% in normal controls, 8% in patients with Meniere's disease and a significantly high 56% in noise exposed workers despite similar mean hearing thresholds for all groups. The patients responded to the Communication Strategies Scale, CSS, measuring "maladaptive behaviour", "verbal strategies" and "nonĀ­verbal strategies" and the Hearing Disability and Handicaps Scale, HDHS, which is composed of four factorially derived subscales: "speech perception", "non-speech sounds", "interpersonal distress" and "threat to the self-image". Outcome measures included tests on all of the trained conditions as well as on a series of untrained conditions designed to assess the transfer of learning to other speech and non-speech conditions. While it has been shown that ARHL is the major cause of these speech perception difficulties, research has shown that cognitive functions such as memory and attention also affect these difficulties (Pichora-Fuller, 2008; Humes and Dubno, 2010).
A similar conclusion was reached in an MRI study that found higher correlation between the volume of frontal areas and speech in noise perception in older adults compared to normal-hearing young adults (Wong et al., 2010). Sweetow and Sabes (2006) tested older adult hearing-aid users on trained and untrained measures of speech-in-noise. We also ask whether training on complex sounds generalizes to simple acoustic tasks, by testing participants on non-verbal auditory discrimination tasks.
In almost all cases the measured audiograms looked better than the predictions from ISO 1999. The mean transient emission levels for the noise exposed workers was significantly lower than the controls and Meniere's groups.
Despite this compensatory engagement of higher-level brain areas, older adults experience disproportionate difficulties in understanding speech in ecological conditions that include suboptimal noise conditions and fast talkers. They reported significant on-task learning effects but only small effects of generalization and only in one of the two untrained tasks with sentences stimuli. Finally, training on whole sentences is expected to motivate participants and promote compliance with the training regimen.
The aims of the current study were (1) to examine the efficacy of a home-based auditory training scheme in improving speech perception abilities among normal-hearing older adults and among hearing impaired non-aided older adults.
It may be concluded from this investigation that musicians cannot be expected to get pronounced audiometric hearing losses from playing in a symphony orchestra. This study may recommend this measurement as a method of evaluation for TTS conditions for hearing conservation programme purposes, in addition to pure-tone audiometry.
This study clearly indicates that in the noise-exposed group there is sub clinical and sub audiometric damage to the outer hair cells responsible for generation of otoacoustic emissions. Despite differences in pure-tone audiometry, there were no significant differences between gender in perceived disability or handicap. Therefore, successful auditory training in this population should foster an effective balance between bottom-up, signal-based processes, and top-down knowledge-based processes (Pichora-Fuller and Levitt, 2012).
All participants received standardized cognitive tests taken from the Wechsler Abbreviated Scale of Intelligence (WASI, Similarities, and Block Design) and the Digit span memory subtest from the Wechsler Intelligence Test (Wechsler, 1997) and showed age normal cognitive function. As shown in Figure 2, training occurred between times t1 and t2 for the immediate-training participants and between times t2 and t3 for the delayed-training participants, and the retention period occurred between times t2 and t3 for immediate-training participants.
It should be noted, though, that the data material is limited, and that the subjects have not been selected in a systematically or representative way. Of those with normal otoacoustic emissions, the efferent suppression was absent in 60% of noise exposed workers but in only 3.8% of control subjects implying that the efferent control may also be affected in a significant proportion despite normal hearing thresholds and emissions. The women used "maladaptive behaviour" and "verbal strategies" significantly more often than the men. This is in agreement with results of an interview-study of women with NIHL, showing that the perceived emotional temperature in a specific situation guided the choice of coping strategy.
The gender difference in coping could also be related to, and explained by, the conversational goal (transactional or interactional).



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