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Purpose: A relevant aspect of listening is the effort required during speech processing, which can be assessed by pupillometry. Here, we assessed the pupil dilation response of normal-hearing (NH) and hard of hearing (HH) individuals during listening to clear sentences and masked or degraded sentences. We combined this assessment with functional magnetic resonance imaging (fMRI) to investigate the neural correlates of the pupil dilation response., Method: Seventeen NH participants ( M age = 45 years) who were individually matched in age and educational level. Participants repeated sentences that were presented clearly, that were distorted, or that were masked. The sentence intelligibility level of masked and distorted sentences was 50% correct. Silent baseline trials were presented as well. Performance measures, pupil dilation responses, and fMRI data were acquired.M age = 45 years) who were individually matched in age and educational level. Participants repeated sentences that were presented clearly, that were distorted, or that were masked. The sentence intelligibility level of masked and distorted sentences was 50% correct. Silent baseline trials were presented as well. Performance measures, pupil dilation responses, and fMRI data were acquired., Results: HH individuals had overall poorer speech reception than the NH participants, but not for noise-vocoded speech. In addition, an interaction effect was observed with smaller pupil dilation responses in HH than in NH listeners for the degraded speech conditions. Hearing impairment was associated with higher activation across conditions in the left superior temporal gyrus, as compared to the silent baseline. However, the region of interest analysis indicated lower activation during degraded speech relative to clear speech in bilateral frontal regions and the insular cortex, for HH compared to NH listeners. Hearing impairment was also associated with a weaker relation between the pupil response and activation in the right inferior frontal gyrus. Overall, degraded speech evoked higher frontal activation than clear speech., Conclusion: Brain areas associated with attentional and cognitive-control processes may be increasingly recruited when speech is degraded and are related to the pupil dilation response, but this relationship is weaker in HH listeners., Supplemental Material: https://doi.org/10.23641/asha.27162135.

In daily life, both acoustic factors and social context can affect listening effort investment. In laboratory settings, information about listening effort has been deduced from pupil and cardiovascular responses independently. The extent to which these measures can jointly predict listening-related factors is unknown. Here we combined pupil and cardiovascular features to predict acoustic and contextual aspects of speech perception. Data were collected from 29 adults (mean  =  64.6 years, SD  =  9.2) with hearing loss. Participants performed a speech perception task at two individualized signal-to-noise ratios (corresponding to 50% and 80% of sentences correct) and in two social contexts (the presence and absence of two observers). Seven features were extracted per trial: baseline pupil size, peak pupil dilation, mean pupil dilation, interbeat interval, blood volume pulse amplitude, pre-ejection period and pulse arrival time. These features were used to train k-nearest neighbor classifiers to predict task demand, social context and sentence accuracy. The k-fold cross validation on the group-level data revealed above-chance classification accuracies: task demand, 64.4%; social context, 78.3%; and sentence accuracy, 55.1%. However, classification accuracies diminished when the classifiers were trained and tested on data from different participants. Individually trained classifiers (one per participant) performed better than group-level classifiers: 71.7% (SD  =  10.2) for task demand, 88.0% (SD  =  7.5) for social context, and 60.0% (SD  =  13.1) for sentence accuracy. We demonstrated that classifiers trained on group-level physiological data to predict aspects of speech perception generalized poorly to novel participants. Individually calibrated classifiers hold more promise for future applications., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Daily communication may be effortful due to poor acoustic quality. In addition, memory demands can induce effort, especially for long or complex sentences. In the current study, we tested the impact of memory task demands and speech-to-noise ratio on the time-specific components of effort allocation during speech identification in noise. Thirty normally hearing adults (15 females, mean age 42.2 years) participated. In an established auditory memory test, listeners had to listen to a list of seven sentences in noise, and repeat the sentence-final word after presentation, and, if instructed, recall the repeated words. We tested the effects of speech-to-noise ratio (SNR; -4 dB, +1 dB) and recall (Recall; Yes, No), on the time-specific components of pupil responses, trial baseline pupil size, and their dynamics (change) along the list. We found three components in the pupil responses (early, middle, and late). While the additional memory task (recall versus no recall) lowered all components' values, SNR (-4 dB versus +1 dB SNR) increased the middle and late component values. Increasing memory demands (Recall) progressively increased trial baseline and steepened decrease of the late component's values. Trial baseline increased most steeply in the condition of +1 dB SNR with recall. The findings suggest that adding a recall to the auditory task alters effort allocation for listening. Listeners are dynamically re-allocating effort from listening to memorizing under changing memory and acoustic demands. The pupil baseline and the time-specific components of pupil responses provide a comprehensive picture of the interplay of SNR and recall on effort.

In hearing research, pupillometry is an established method of studying listening effort. The focus of this study was to evaluate several pupil measures extracted from the Task-Evoked Pupil Responses (TEPRs) in speech-in-noise test. A range of analysis approaches was applied to extract these pupil measures, namely (a) pupil peak dilation (PPD); (b) mean pupil dilation (MPD); (c) index of pupillary activity; (d) growth curve analysis (GCA); and (e) principal component analysis (PCA). The effect of signal-to-noise ratio (SNR; Data Set A: -20 dB, -10 dB, +5 dB SNR) and luminance (Data Set B: 0.1 cd/m 2 , 360 cd/m 2 ) on the TEPRs were investigated. Data Sets A and B were recorded during a speech-in-noise test and included TEPRs from 33 and 27 normal-hearing native Dutch speakers, respectively. The main results were as follows: (a) A significant effect of SNR was revealed for all pupil measures extracted in the time domain (PPD, MPD, GCA, PCA); (b) Two time series analysis approaches (GCA, PCA) provided modeled temporal profiles of TEPRs (GCA); and time windows spanning subtasks performed in a speech-in-noise test (PCA); and (c) All pupil measures revealed a significant effect of luminance. In conclusion, multiple pupil measures showed similar effects of SNR, suggesting that effort may be reflected in multiple aspects of TEPR. Moreover, a direct analysis of the pupil time course seems to provide a more holistic view of TEPRs, yet further research is needed to understand and interpret its measures. Further research is also required to find pupil measures less sensitive to changes in luminance.

Purpose The pupil dilation response is sensitive not only to auditory task demand but also to cognitive conflict. Conflict is induced by incompatible trials in auditory Stroop tasks in which participants have to identify the presentation location (left or right ear) of the words "left" or "right." Previous studies demonstrated that the compatibility effect is reduced if the trial is preceded by another incompatible trial (conflict adaptation). Here, we investigated the influence of hearing status on cognitive conflict and conflict adaptation in an auditory Stroop task. Method Two age-matched groups consisting of 32 normal-hearing participants ( M age = 52 years, age range: 23-64 years) performed an auditory Stroop task. We assessed the effects of hearing status and stimulus compatibility on reaction times (RTs) and pupil dilation responses. We furthermore analyzed the Pearson correlation coefficients between age, degree of hearing loss, and the compatibility effects on the RT and pupil response data across all participants. Results As expected, the RTs were longer and pupil dilation was larger for incompatible relative to compatible trials. Furthermore, these effects were reduced for trials following incompatible (as compared to compatible) trials (conflict adaptation). No general effect of hearing status was observed, but the correlations suggested that higher age and a larger degree of hearing loss were associated with more interference of current incompatibility on RTs. Conclusions Conflict processing and adaptation effects were observed on the RTs and pupil dilation responses in an auditory Stroop task. No general effects of hearing status were observed, but the correlations suggested that higher age and a greater degree of hearing loss were related to reduced conflict processing ability. The current study underlines the relevance of taking into account cognitive control and conflict adaptation processes.M age = 52 years, age range: 23-64 years) performed an auditory Stroop task. We assessed the effects of hearing status and stimulus compatibility on reaction times (RTs) and pupil dilation responses. We furthermore analyzed the Pearson correlation coefficients between age, degree of hearing loss, and the compatibility effects on the RT and pupil response data across all participants. Results As expected, the RTs were longer and pupil dilation was larger for incompatible relative to compatible trials. Furthermore, these effects were reduced for trials following incompatible (as compared to compatible) trials (conflict adaptation). No general effect of hearing status was observed, but the correlations suggested that higher age and a larger degree of hearing loss were associated with more interference of current incompatibility on RTs. Conclusions Conflict processing and adaptation effects were observed on the RTs and pupil dilation responses in an auditory Stroop task. No general effects of hearing status were observed, but the correlations suggested that higher age and a greater degree of hearing loss were related to reduced conflict processing ability. The current study underlines the relevance of taking into account cognitive control and conflict adaptation processes.

The pupil dilation response is sensitive both to listening effort and the emotional significance of a task. We aimed to assess the influence of evaluative feedback on the pupil dilation response using a speech reception threshold (SRT) task. Besides the pupil dilation response, we acquired subjective ratings and two physiological biomarkers sensitive to stress: cortisol and alpha-amylase levels as determined in saliva samples. We included 34 participants with normal hearing (mean age = 52 years, age range 25-67 years) and 29 age-matched participants with mild-to-moderate hearing loss (mean age = 52 years, age range 23-64 years). Half of the participants performed a standard SRT test without feedback, and the other half performed an SRT test in which they did receive feedback and were urged to perform better. The SRT conditions targeted 50% and 71% correct reception of the sentences. Pupil size was recorded and saliva samples were obtained and participants rated their experience of the task. Participants with hearing loss performed more poorly on the SRT test than participants with normal hearing participants receiving feedback had better SRTs in the 71% intelligibility condition and higher peak pupil dilation in both intelligibility conditions than participants who did not receive feedback, irrespective of hearing status. Saliva cortisol level and alpha-amylase activity reflected the usual diurnal patterns but showed no effects of hearing status or feedback. Finally, participants who received feedback experienced more difficulties than those who did not receive feedback, irrespective of hearing status. This study underlines the importance of taking into account the influence of task instructions and feedback in a speech perception task as these factors may influence the experienced difficulties, listening effort, and task performance., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objectives: Speech understanding may be cognitively demanding, but it can be enhanced when semantically related text cues precede auditory sentences. The present study aimed to determine whether (a) providing text cues reduces pupil dilation, a measure of cognitive load, during listening to sentences, (b) repeating the sentences aloud affects recall accuracy and pupil dilation during recall of cue words, and (c) semantic relatedness between cues and sentences affects recall accuracy and pupil dilation during recall of cue words., Design: Sentence repetition following text cues and recall of the text cues were tested. Twenty-six participants (mean age, 22 years) with normal hearing listened to masked sentences. On each trial, a set of four-word cues was presented visually as text preceding the auditory presentation of a sentence whose meaning was either related or unrelated to the cues. On each trial, participants first read the cue words, then listened to a sentence. Following this they spoke aloud either the cue words or the sentence, according to instruction, and finally on all trials orally recalled the cues. Peak pupil dilation was measured throughout listening and recall on each trial. Additionally, participants completed a test measuring the ability to perceive degraded verbal text information and three working memory tests (a reading span test, a size-comparison span test, and a test of memory updating)., Results: Cue words that were semantically related to the sentence facilitated sentence repetition but did not reduce pupil dilation. Recall was poorer and there were more intrusion errors when the cue words were related to the sentences. Recall was also poorer when sentences were repeated aloud. Both behavioral effects were associated with greater pupil dilation. Larger reading span capacity and smaller size-comparison span were associated with larger peak pupil dilation during listening. Furthermore, larger reading span and greater memory updating ability were both associated with better cue recall overall., Conclusions: Although sentence-related word cues facilitate sentence repetition, our results indicate that they do not reduce cognitive load during listening in noise with a concurrent memory load. As expected, higher working memory capacity was associated with better recall of the cues. Unexpectedly, however, semantic relatedness with the sentence reduced word cue recall accuracy and increased intrusion errors, suggesting an effect of semantic confusion. Further, speaking the sentence aloud also reduced word cue recall accuracy, probably due to articulatory suppression. Importantly, imposing a memory load during listening to sentences resulted in the absence of formerly established strong effects of speech intelligibility on the pupil dilation response. This nullified intelligibility effect demonstrates that the pupil dilation response to a cognitive (memory) task can completely overshadow the effect of perceptual factors on the pupil dilation response. This highlights the importance of taking cognitive task load into account during auditory testing.

Difficulties arising in everyday speech communication often result from the acoustical environment, which may contain interfering background noise or competing speakers. Thus, listening and understanding speech in noise can be exhausting. Two experiments are presented in the current study that further explored the impact of masker type and Signal-to-Noise Ratio (SNR) on listening effort by means of pupillometry. In both studies, pupillary responses of participants were measured while performing the Danish Hearing in Noise Test (HINT; Nielsen and Dau, 2011). The first experiment aimed to replicate and extend earlier observed effects of noise type and semantic interference on listening effort (Koelewijn et al., 2012). The impact of three different masker types, i.e. a fluctuating noise, a 1-talker masker and a 4-talker masker on listening effort was examined at a fixed speech intelligibility. In a second experiment, effects of SNR on listening effort were examined while presenting the HINT sentences across a broad range of fixed SNRs corresponding to intelligibility scores ranging from 100% to 0% correct performance. A peak pupil dilation (PPD) was calculated and a Growth Curve Analysis (GCA) was performed to examine listening effort involved in speech recognition as a function of SNR. The results of two experiments showed that the pupil dilation response is highly affected by both masker type and SNR when performing the HINT. The PPD was highest, suggesting the highest level of effort, for speech recognition in the presence of the 1-talker masker in comparison to the 4-talker babble and the fluctuating noise masker. However, the disrupting effect of one competing talker disappeared for intelligibly levels around 50%. Furthermore, it was demonstrated that the pupillary response strongly varied as a function of SNRs. Listening effort was highest for intermediate SNRs with performance accuracies ranging between 30% and 70% correct. GCA revealed time-dependent effects of the SNR on the pupillary response that were not reflected in the PPD., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Listening to speech in noise can be effortful but when motivated people seem to be more persevering. Previous research showed effects of monetary reward on autonomic responses like cardiovascular reactivity and pupil dilation while participants processed auditory information. The current study examined the effects of monetary reward on the processing of speech in noise and related listening effort as reflected by the pupil dilation response. Twenty-four participants (median age 21 yrs) performed two speech reception threshold (SRT) tasks, one tracking 50% correct (hard) and one tracking 85% correct (easy), both of which they listened to and repeated sentences uttered by a female talker. The sentences were presented with a single male talker or, in a control condition, in quiet. Participants were told that they could earn a high (5 euros) or low (0.20 euro) reward when repeating 70% or more of the sentences correctly. Conditions were presented in a blocked fashion and during each trial, pupil diameter was recorded. At the end of each block, participants rated the effort they had experienced, their performance, and their tendency to quit listening. Additionally, participants performed a working memory capacity task and filled in a need-for-recovery questionnaire as these tap into factors that influence the pupil dilation response. The results showed no effect of reward on speech perception performance as reflected by the SRT. The peak pupil dilation showed a significantly larger response for high than for low reward, for the easy and hard conditions, but not the control condition. Higher need for recovery was associated with a higher subjective tendency to quit listening. Consistent with the Framework for Understanding Effortful Listening, we conclude that listening effort as reflected by the peak pupil dilation is sensitive to the amount of monetary reward., (Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.)

Recent studies have shown that activating the noise reduction scheme in hearing aids results in a smaller peak pupil dilation (PPD), indicating reduced listening effort, at 50% and 95% correct sentence recognition with a 4-talker masker. The objective of this study was to measure the effect of the noise reduction scheme (on or off) on PPD and sentence recognition across a wide range of signal-to-noise ratios (SNRs) from +16 dB to -12 dB and two masker types (4-talker and stationary noise). Relatively low PPDs were observed at very low (-12 dB) and very high (+16 dB to +8 dB) SNRs presumably due to 'giving up' and 'easy listening', respectively. The maximum PPD was observed with SNRs at approximately 50% correct sentence recognition. Sentence recognition with both masker types was significantly improved by the noise reduction scheme, which corresponds to the shift in performance from SNR function at approximately 5 dB toward a lower SNR. This intelligibility effect was accompanied by a corresponding effect on the PPD, shifting the peak by approximately 4 dB toward a lower SNR. In addition, with the 4-talker masker, when the noise reduction scheme was active, the PPD was smaller overall than that when the scheme was inactive. We conclude that with the 4-talker masker, noise reduction scheme processing provides a listening effort benefit in addition to any effect associated with improved intelligibility. Thus, the effect of the noise reduction scheme on listening effort incorporates more than can be explained by intelligibility alone, emphasizing the potential importance of measuring listening effort in addition to traditional speech reception measures., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: People with hearing impairment are likely to experience higher levels of fatigue because of effortful listening in daily communication. This hearing-related fatigue might not only constrain their work performance but also result in withdrawal from major social roles. Therefore, it is important to understand the relationships between fatigue, listening effort, and hearing impairment by examining the evidence from both subjective and objective measurements. The aim of the present study was to investigate these relationships by assessing subjectively measured daily-life fatigue (self-report questionnaires) and objectively measured listening effort (pupillometry) in both normally hearing and hearing-impaired participants., Design: Twenty-seven normally hearing and 19 age-matched participants with hearing impairment were included in this study. Two self-report fatigue questionnaires Need For Recovery and Checklist Individual Strength were given to the participants before the test session to evaluate the subjectively measured daily fatigue. Participants were asked to perform a speech reception threshold test with single-talker masker targeting a 50% correct response criterion. The pupil diameter was recorded during the speech processing, and we used peak pupil dilation (PPD) as the main outcome measure of the pupillometry., Results: No correlation was found between subjectively measured fatigue and hearing acuity, nor was a group difference found between the normally hearing and the hearing-impaired participants on the fatigue scores. A significant negative correlation was found between self-reported fatigue and PPD. A similar correlation was also found between Speech Intelligibility Index required for 50% correct and PPD. Multiple regression analysis showed that factors representing "hearing acuity" and "self-reported fatigue" had equal and independent associations with the PPD during the speech in noise test. Less fatigue and better hearing acuity were associated with a larger pupil dilation., Conclusions: To the best of our knowledge, this is the first study to investigate the relationship between a subjective measure of daily-life fatigue and an objective measure of pupil dilation, as an indicator of listening effort. These findings help to provide an empirical link between pupil responses, as observed in the laboratory, and daily-life fatigue.

Previous research has shown the effects of task demands on pupil responses in both normal hearing (NH) and hearing impaired (HI) adults. One consistent finding is that HI listeners have smaller pupil dilations at low levels of speech recognition performance (≤50%). This study aimed to examine the pupil dilation in adults with a normal pure-tone audiogram who experience serious difficulties when processing speech-in-noise. Hence, 20 adults, aged 26 to 62 years, with traumatic brain injury (TBI) or cerebrovascular accident (CVA) but with a normal audiogram participated. Their pupil size was recorded while they listened to sentences masked by fluctuating noise or interfering speech at 50% and 84% intelligibility. In each condition, participants rated their perceived performance, effort, and task persistence. In addition, participants performed the text reception threshold task-a visual sentence completion task-that measured language-related processing. Data were compared with those of age-matched NH and HI participants with no neurological problems obtained in earlier studies using the same setup and design. The TBI group had the same pure-tone audiogram and text reception threshold scores as the NH listeners, yet their speech reception thresholds were significantly worse. Although the pupil dilation responses on average did not differ between groups, self-rated effort scores were highest in the TBI group. Results of a correlation analyses showed that TBI participants with worse speech reception thresholds had a smaller pupil response. We speculate that increased distractibility or fatigue affected the ability of TBI participants to allocate effort during speech perception in noise.

In recent years, the fields of Audiology and Cognitive Sciences have seen a burgeoning of research focusing on the assessment of the effort required during listening. Among approaches to this question, the pupil dilation response has shown to be an informative nonvolitional indicator of cognitive processing during listening. Currently, pupillometry is applied in laboratories throughout the world to assess how listening effort is influenced by various relevant factors, such as hearing loss, signal processing algorithms, cochlear implant rehabilitation, cognitive abilities, language competency, and daily-life hearing disability. The aim of this special issue is to provide an overview of the state of the art in research applying pupillometry, guidance for those considering embarking on pupillometry studies, and to illustrate the diverse ways in which it can be used to answer-and raise-pertinent research questions.

The measurement of cognitive resource allocation during listening, or listening effort, provides valuable insight in the factors influencing auditory processing. In recent years, many studies inside and outside the field of hearing science have measured the pupil response evoked by auditory stimuli. The aim of the current review was to provide an exhaustive overview of these studies. The 146 studies included in this review originated from multiple domains, including hearing science and linguistics, but the review also covers research into motivation, memory, and emotion. The present review provides a unique overview of these studies and is organized according to the components of the Framework for Understanding Effortful Listening. A summary table presents the sample characteristics, an outline of the study design, stimuli, the pupil parameters analyzed, and the main findings of each study. The results indicate that the pupil response is sensitive to various task manipulations as well as interindividual differences. Many of the findings have been replicated. Frequent interactions between the independent factors affecting the pupil response have been reported, which indicates complex processes underlying cognitive resource allocation. This complexity should be taken into account in future studies that should focus more on interindividual differences, also including older participants. This review facilitates the careful design of new studies by indicating the factors that should be controlled for. In conclusion, measuring the pupil dilation response to auditory stimuli has been demonstrated to be sensitive method applicable to numerous research questions. The sensitivity of the measure calls for carefully designed stimuli.

For people with hearing difficulties, following a conversation in a noisy environment requires substantial cognitive processing, which is often perceived as effortful. Recent studies with normal hearing (NH) listeners showed that the pupil dilation response, a measure of cognitive processing load, is affected by 'attention related' processes. How these processes affect the pupil dilation response for hearing impaired (HI) listeners remains unknown. Therefore, the current study investigated the effect of auditory attention on various pupil response parameters for 15 NH adults (median age 51 yrs.) and 15 adults with mild to moderate sensorineural hearing loss (median age 52 yrs.). Both groups listened to two different sentences presented simultaneously, one to each ear and partially masked by stationary noise. Participants had to repeat either both sentences or only one, for which they had to divide or focus attention, respectively. When repeating one sentence, the target sentence location (left or right) was either randomized or blocked across trials, which in the latter case allowed for a better spatial focus of attention. The speech-to-noise ratio was adjusted to yield about 50% sentences correct for each task and condition. NH participants had lower ('better') speech reception thresholds (SRT) than HI participants. The pupil measures showed no between-group effects, with the exception of a shorter peak latency for HI participants, which indicated a shorter processing time. Both groups showed higher SRTs and a larger pupil dilation response when two sentences were processed instead of one. Additionally, SRTs were higher and dilation responses were larger for both groups when the target location was randomized instead of fixed. We conclude that although HI participants could cope with less noise than the NH group, their ability to focus attention on a single talker, thereby improving SRTs and lowering cognitive processing load, was preserved. Shorter peak latencies could indicate that HI listeners adapt their listening strategy by not processing some information, which reduces processing time and thereby listening effort., (Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.)

Previous research has reported effects of masker type and signal-to-noise ratio (SNR) on listening effort, as indicated by the peak pupil dilation (PPD) relative to baseline during speech recognition. At about 50% correct sentence recognition performance, increasing SNRs generally results in declining PPDs, indicating reduced effort. However, the decline in PPD over SNRs has been observed to be less pronounced for hearing-impaired (HI) compared to normal-hearing (NH) listeners. The presence of a competing talker during speech recognition generally resulted in larger PPDs as compared to the presence of a fluctuating or stationary background noise. The aim of the present study was to examine the interplay between hearing-status, a broad range of SNRs corresponding to sentence recognition performance varying from 0 to 100% correct, and different masker types (stationary noise and single-talker masker) on the PPD during speech perception. Twenty-five HI and 32 age-matched NH participants listened to sentences across a broad range of SNRs, masked with speech from a single talker (-25 dB to +15 dB SNR) or with stationary noise (-12 dB to +16 dB). Correct sentence recognition scores and pupil responses were recorded during stimulus presentation. With a stationary masker, NH listeners show maximum PPD across a relatively narrow range of low SNRs, while HI listeners show relatively large PPD across a wide range of ecological SNRs. With the single-talker masker, maximum PPD was observed in the mid-range of SNRs around 50% correct sentence recognition performance, while smaller PPDs were observed at lower and higher SNRs. Mixed-model ANOVAs revealed significant interactions between hearing-status and SNR on the PPD for both masker types. Our data show a different pattern of PPDs across SNRs between groups, which indicates that listening and the allocation of effort during listening in daily life environments may be different for NH and HI listeners., (Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.)

Pupillometry is one method that has been used to measure processing load expended during speech understanding. Notably, speech perception (in noise) tasks can evoke a pupil response. It is not known if there is concurrent activation of the sympathetic nervous system as indexed by salivary cortisol and chromogranin A (CgA) and whether such activation differs between normally hearing (NH) and hard-of-hearing (HH) adults. Ten NH and 10 adults with mild-to-moderate hearing loss (mean age 52 years) participated. Two speech perception tests were administered in random order: one in quiet targeting 100% correct performance and one in noise targeting 50% correct performance. Pupil responses and salivary samples for cortisol and CgA analyses were collected four times: before testing, after the two speech perception tests, and at the end of the session. Participants rated their perceived accuracy, effort, and motivation. Effects were examined using repeated-measures analyses of variance. Correlations between outcomes were calculated. HH listeners had smaller peak pupil dilations (PPDs) than NH listeners in the speech in noise condition only. No group or condition effects were observed for the cortisol data, but HH listeners tended to have higher cortisol levels across conditions. CgA levels were larger at the pretesting time than at the three other test times. Hearing impairment did not affect CgA. Self-rated motivation correlated most often with cortisol or PPD values. The three physiological indicators of cognitive load and stress (PPD, cortisol, and CgA) are not equally affected by speech testing or hearing impairment. Each of them seem to capture a different dimension of sympathetic nervous system activity.

Context: Although the pupil light reflex has been widely used as a clinical diagnostic tool for autonomic nervous system dysfunction, there is no systematic review available to summarize the evidence that the pupil light reflex is a sensitive method to detect parasympathetic dysfunction. Meanwhile, the relationship between parasympathetic functioning and hearing impairment is relatively unknown., Objectives: To 1) review the evidence for the pupil light reflex being a sensitive method to evaluate parasympathetic dysfunction, 2) review the evidence relating hearing impairment and parasympathetic activity and 3) seek evidence of possible connections between hearing impairment and the pupil light reflex., Methods: Literature searches were performed in five electronic databases. All selected articles were categorized into three sections: pupil light reflex and parasympathetic dysfunction, hearing impairment and parasympathetic activity, pupil light reflex and hearing impairment., Results: Thirty-eight articles were included in this review. Among them, 36 articles addressed the pupil light reflex and parasympathetic dysfunction. We summarized the information in these data according to different types of parasympathetic-related diseases. Most of the studies showed a difference on at least one pupil light reflex parameter between patients and healthy controls. Two articles discussed the relationship between hearing impairment and parasympathetic activity. Both studies reported a reduced parasympathetic activity in the hearing impaired groups. The searches identified no results for pupil light reflex and hearing impairment., Discussion and Conclusions: As the first systematic review of the evidence, our findings suggest that the pupil light reflex is a sensitive tool to assess the presence of parasympathetic dysfunction. Maximum constriction velocity and relative constriction amplitude appear to be the most sensitive parameters. There are only two studies investigating the relationship between parasympathetic activity and hearing impairment, hence further research is needed. The pupil light reflex could be a candidate measurement tool to achieve this goal.

Recent studies have shown that prior knowledge about where, when, and who is going to talk improves speech intelligibility. How related attentional processes affect cognitive processing load has not been investigated yet. In the current study, three experiments investigated how the pupil dilation response is affected by prior knowledge of target speech location, target speech onset, and who is going to talk. A total of 56 young adults with normal hearing participated. They had to reproduce a target sentence presented to one ear while ignoring a distracting sentence simultaneously presented to the other ear. The two sentences were independently masked by fluctuating noise. Target location (left or right ear), speech onset, and talker variability were manipulated in separate experiments by keeping these features either fixed during an entire block or randomized over trials. Pupil responses were recorded during listening and performance was scored after recall. The results showed an improvement in performance when the location of the target speech was fixed instead of randomized. Additionally, location uncertainty increased the pupil dilation response, which suggests that prior knowledge of location reduces cognitive load. Interestingly, the observed pupil responses for each condition were consistent with subjective reports of listening effort. We conclude that communicating in a dynamic environment like a cocktail party (where participants in competing conversations move unpredictably) requires substantial listening effort because of the demands placed on attentional processes., (Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.)

An important aspect of hearing is the degree to which listeners have to deploy effort to understand speech. One promising measure of listening effort is task-evoked pupil dilation. Here, we use functional magnetic resonance imaging (fMRI) to identify the neural correlates of pupil dilation during comprehension of degraded spoken sentences in 17 normal-hearing listeners. Subjects listened to sentences degraded in three different ways: the target female speech was masked by fluctuating noise, by speech from a single male speaker, or the target speech was noise-vocoded. The degree of degradation was individually adapted such that 50% or 84% of the sentences were intelligible. Control conditions included clear speech in quiet, and silent trials. The peak pupil dilation was larger for the 50% compared to the 84% intelligibility condition, and largest for speech masked by the single-talker masker, followed by speech masked by fluctuating noise, and smallest for noise-vocoded speech. Activation in the bilateral superior temporal gyrus (STG) showed the same pattern, with most extensive activation for speech masked by the single-talker masker. Larger peak pupil dilation was associated with more activation in the bilateral STG, bilateral ventral and dorsal anterior cingulate cortex and several frontal brain areas. A subset of the temporal region sensitive to pupil dilation was also sensitive to speech intelligibility and degradation type. These results show that pupil dilation during speech perception in challenging conditions reflects both auditory and cognitive processes that are recruited to cope with degraded speech and the need to segregate target speech from interfering sounds., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Dividing attention over two streams of speech strongly decreases performance compared to focusing on only one. How divided attention affects cognitive processing load as indexed with pupillometry during speech recognition has so far not been investigated. In 12 young adults the pupil response was recorded while they focused on either one or both of two sentences that were presented dichotically and masked by fluctuating noise across a range of signal-to-noise ratios. In line with previous studies, the performance decreases when processing two target sentences instead of one. Additionally, dividing attention to process two sentences caused larger pupil dilation and later peak pupil latency than processing only one. This suggests an effect of attention on cognitive processing load (pupil dilation) during speech processing in noise., (Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.)

The pupil response to speech masked by interfering speech was assessed across an intelligibility range from 0% to 99% correct. In total, 37 participants aged between 18 and 36 years and with normal hearing were included. Pupil dilation was largest at intermediate intelligibility levels, smaller at high intelligibility, and slightly smaller at very difficult levels. Participants who reported that they often gave up listening at low intelligibility levels had smaller pupil dilations in these conditions. Participants who were good at reading masked text had relatively large pupil dilation when intelligibility was low. We conclude that the pupil response is sensitive to processing load, and possibly reflects cognitive overload in difficult conditions. It seems affected by methodological aspects and individual abilities, but does not reflect subjective ratings., (Copyright © 2014 Society for Psychophysiological Research.)

Objectives: The aim of this study was to evaluate the influence of sentence intelligibility on the pupil dilation response during listening. Task-induced pupil-dilation reflects explicit effortful processing load. Therefore, pupillometry can be used to examine the listening effort during speech perception in difficult listening conditions. We expected to find increasing pupil dilation as a function of decreasing speech intelligibility., Design: Thirty-eight young participants (mean age = 23 yrs, SD = 3.2 yrs) with normal hearing were included. They performed three speech reception threshold (SRT) tests in which they listened to sentences in stationary noise. A one-up-one-down, two-up-one-down, or four-up-one-down adaptive procedure was applied, resulting in the correct rehearsal of 50, 71, or 84% of the sentences (SRT(50%), SRT(71%), and SRT(84%), respectively). We examined the peak dilation amplitude, the latency of the peak dilation amplitude, and the mean pupil dilation during the processing of the speech in each of these conditions. The peak dilation amplitude and mean pupil dilation were calculated relative to the baseline pupil diameter during listening to noise alone. For each SRT condition, participants rated the experienced listening effort and estimated their performance level., Results: The signal to noise ratios (SNRs) in the SRT(50%), SRT(71%), and SRT(84%) conditions increased as a function of the speech intelligibility level. The subjective effort ratings decreased, and the estimated performance increased with increasing speech intelligibility level. Repeated measures analyses of variance indicated that peak dilation amplitude and mean pupil dilation were higher in the SRT(50%) condition as compared with the SRT(71%) and SRT(84%) conditions. The peak dilation amplitude, mean pupil dilation, and peak latency increased with decreasing SNR of the speech in noise, but no effect of noise level by itself on the baseline pupil diameter was observed. Irrespective of SNR, the pupil response was higher for incorrectly repeated sentences than for correctly repeated sentences. The analyses also indicated condition-order effects on the peak dilation amplitude and mean pupil dilatation: the pupil response was higher in the first SRT test than in the second and third tests. Within the first and third test, the baseline pupil diameter and the mean pupil dilation decreased as a function of the sentence number within the test. Spearman correlation coefficients showed no relations among the SNRs at the SRTs, subjective ratings, and the pupil response., Conclusions: The peak dilation amplitude, peak latency, and mean pupil dilation systematically increase with decreasing speech intelligibility. These results support that listening effort, as indicated by the pupil response, increases with decreasing speech intelligibility. This study indicates that pupillometry can be used to examine how listeners reach a certain performance level. Application of this technique to study listening effort can yield valuable insight into the processing resources required across listening conditions and into the factors related to interindividual differences in speech perception in noise.