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Purpose: The purpose of this study was to examine if classroom noise levels and perceived listening difficulty were related to fatigue reported by children with and without hearing loss., Method: Measures of classroom noise and reports of classroom listening difficulty were obtained from 79 children (ages 6-12 years) at two time points on two different school days. Forty-four children had mild to moderately severe hearing loss in at least one ear. Multiple regression analyses were conducted to evaluate if measured noise levels, perceived listening difficulty, hearing status, language abilities, or grade level would predict self-reported fatigue ratings measured using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale., Results: Higher perceived listening difficulty was the only predictor variable that was associated with greater self-reported fatigue., Conclusions: Measured classroom noise levels showed no systematic relationship with fatigue ratings, suggesting that actual classroom noise levels do not contribute to increased reports of subjective fatigue. Instead, perceived challenges with listening appears to be an important factor for consideration in future work examining listening-related fatigue in children with and without hearing loss.

Purpose: Children with hearing loss (CHL) are considered at risk for listening-related fatigue and its negative consequences. We collected data via focus groups and interviews from three stakeholder groups-CHL, their parents, and teachers/school professionals-in order to define the construct of listening-related fatigue from the perspective of CHL and key stakeholders. This is an important first step in our long-term goal to construct and validate a measure (i.e., scale) of listening-related fatigue for the pediatric population, with a focus on CHL. This article provides an overview of the data gathering process, analysis of qualitative reports, and the development of a theoretical framework for understanding the experience of listening-related fatigue in CHL., Method: We conducted focus groups and interviews in school-age children exhibiting bilateral, moderate-to-profound hearing loss ( n = 43), their parents ( n = 17), and school professionals who work with CHL ( n = 28). The discussions were audio-recorded, transcribed, and coded using a hierarchical coding system. Qualitative analysis was conducted using an iterative inductive-deductive approach., Results: We identified primary themes from the focus group/interview discussions to develop a theoretical framework of listening-related fatigue in CHL. The framework demonstrates the complex interaction among situational determinants that impact fatigue, symptoms or manifestations of fatigue, and the utilization of, and barriers to, coping strategies to reduce listening-related fatigue., Conclusions: Participant discussion suggests that listening-related fatigue is a significant problem for many, but not all, CHL. Qualitative data obtained from these stakeholder groups help define the construct and provide a framework for better understanding listening-related fatigue in children.

There is mounting evidence to support the premise that children with hearing loss (CHL) are at increased risk for listening-related fatigue and its associated sequelae. This article provides an overview of the construct of listening-related fatigue in CHL, its importance, possible academic and psychosocial consequences, and recommendations for the identification and management of fatigue associated with pediatric hearing loss., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: Adults with hearing loss (AHL) often report feeling fatigued after being in situations that require prolonged listening, an experience referred to as listening-related fatigue. We conducted focus groups to identify key domains and constructs of listening-related fatigue. Our goal was to create a theoretical framework for understanding listening-related fatigue that could guide the development of a reliable and valid assessment tool., Design: Eight focus group discussions were conducted using a moderator's guide. Discussions were recorded, transcribed, coded, and analysed to identify common themes related to listening-related fatigue. A hierarchical coding manual was developed iteratively as new themes and subcategories were identified during the analysis process., Study Sample: Forty-three adults (11 males; aged 20 to 77 years) with varying degrees of hearing loss participated in the focus groups. Participants included primarily hearing aid users ( n  = 34), hearing aid candidates ( n  = 6), and a small group of cochlear implant users ( n  = 3)., Results: Qualitative analyses revealed the multidimensional nature of listening-related fatigue for AHL, including physical, mental, emotional, and social domains. These varied experiences were influenced by the external (acoustic/environmental) characteristics of the listening situation, the internal state of the listener (cognitive/motivational), and coping strategies implemented to modify the listening experience. The use of amplification had both positive and negative effects on listening-related fatigue., Conclusions: For some AHL, the consequences of listening-related fatigue can be significant, negatively impacting their quality of life. Data from these focus groups provides a framework for understanding the experience of listening-related fatigue among AHL. This is a critical first step in the development of a tool for measuring listening-related fatigue in this at-risk group.

Objectives: Increased listening effort in school-age children with hearing loss (CHL) could compromise learning and academic achievement. Identifying a sensitive behavioral measure of listening effort for this group could have both clinical and research value. This study examined the effects of signal-to-noise ratio (SNR), hearing loss, and personal amplification on 2 commonly used behavioral measures of listening effort: dual-task visual response times (visual RTs) and verbal response times (verbal RTs)., Design: A total of 82 children (aged 6-13 years) took part in this study; 37 children with normal hearing (CNH) and 45 CHL. All children performed a dual-task paradigm from which both measures of listening effort (dual-task visual RT and verbal RT) were derived. The primary task was word recognition in multi-talker babble in three individually selected SNR conditions: Easy, Moderate, and Hard. The secondary task was a visual monitoring task. Listening effort during the dual-task was quantified as the change in secondary task RT from baseline (single-task visual RT) to the dual-task condition. Listening effort based on verbal RT was quantified as the time elapsed from the onset of the auditory stimulus to the onset of the verbal response when performing the primary (word recognition) task in isolation. CHL completed the task aided and/or unaided to examine the effect of amplification on listening effort., Results: Verbal RTs were generally slower in the more challenging SNR conditions. However, there was no effect of SNR on dual-task visual RT. Overall, verbal RTs were significantly slower in CHL versus CNH. No group difference in dual-task visual RTs was found between CNH and CHL. No effect of amplification was found on either dual-task visual RTs or verbal RTs., Conclusions: This study compared dual-task visual RT and verbal RT measures of listening effort in the child population. Overall, verbal RTs appear more sensitive than dual-task visual RTs to the negative effects of SNR and hearing loss. The current findings extend the literature on listening effort in the pediatric population by demonstrating that, even for speech that is accurately recognized, school-age CHL show a greater processing speed decrement than their normal-hearing counterparts, a decrement that could have a negative impact on learning and academic achievement in the classroom.

Purpose: The purpose of this study was to examine fatigue associated with sustained and effortful speech-processing in children with mild to moderately severe hearing loss., Method: We used auditory P300 responses, subjective reports, and behavioral indices (response time, lapses of attention) to measure fatigue resulting from sustained speech-processing demands in 34 children with mild to moderately severe hearing loss (M = 10.03 years, SD = 1.93)., Results: Compared to baseline values, children with hearing loss showed increased lapses in attention, longer reaction times, reduced P300 amplitudes, and greater reports of fatigue following the completion of the demanding speech-processing tasks., Conclusions: Similar to children with normal hearing, children with hearing loss demonstrate reductions in attentional processing of speech in noise following sustained speech-processing tasks-a finding consistent with the development of fatigue.

Purpose: Fatigue related to speech processing is an understudied area that may have significant negative effects, especially in children who spend the majority of their school days listening to classroom instruction., Method: This study examined the feasibility of using auditory P300 responses and behavioral indices (lapses of attention and self-report) to measure fatigue resulting from sustained listening demands in 27 children (M = 9.28 years)., Results: Consistent with predictions, increased lapses of attention, longer reaction times, reduced P300 amplitudes to infrequent target stimuli, and self-report of greater fatigue were observed after the completion of a series of demanding listening tasks compared with the baseline values. The event-related potential responses correlated with the behavioral measures of performance., Conclusion: These findings suggest that neural and behavioral responses indexing attention and processing resources show promise as effective markers of fatigue in children.

In this clinical study, 110 patients seen at three different clinical facilities were fit binaurally with linear, in-the-canal (ITC) hearing aids. All patients were new hearing aid users. Each of the hearing aids was equipped with an adjustable control that could be set by one of the audiologists (Audiologist A) at each site to convert it from a linear instrument to an experimental nonlinear one with automatic reduction of low-frquency gain at high input levels (or base increase at low levels, BILL). Both the patient and the audiologist performing the outcome testing at each site (Audiologist B) were blind as to the present setting of the hearing aid. Each participant was enrolled in the study for a total of 12 weeks, with the hearing aid set to either the linear or BILL-processing mode of operation for the first 8 weeks and the opposite setting for a subsequent 4-week period. In summary, this was a prospective, doubleblind, crossover study of 110 new hearing aid users. Outcome measures focused on hearing-aid benefit and included both objective and subjective measures. Objective measures were derived from scores on the Northwestern University Auditory Test NO. 6 (NU-6) and the Connected Speech Test (CST) obtained for all possible combinations of two speech presentation levels (60 and 75 dB SPL) two types of background noise (cafeteria noise and multitalker babble), and two signal-to-noise ratios (+5 and +10 dB). Subjective outcome measures included magnitude estimation of listening effort (MELE), the abbreviated form of the Hearing Aid Performance Inventory (HAPI), and estimations of hearing-aid usage based on daily-use logs kept by the participants. All of these measures were used to evaluate the benefit provided by linear amplification and the benefit resulting from the experimental BILL processing. Participant preferences for the experimental BILL-processing scheme or linear processing were also examined by using a paired-comparison task at the end of the study. Results were analyzed separately for three subgroups of patients (mild, moderate, severe) formed on the basis of their average hearing loss at 500, 1000, 2000, and 4000 Hz. In all three subgroups, significant improvement in performance was observed for linear amplification and for BILL processing when compared to unaided performance. There were no significant differences in aided performance, however, between linear processing and the experimental BILL processing.

The present study consisted of two experiments. Experiment I was directed toward the detection of subtle mid-frequency cochlear dysfunction and the determination of word discrimination in noise for persons with noise-induced hearing loss. The presence of significantly elevated aural-overload thresholds, consistent with the presence of cochlear pathology in regions of normal pure-tone sensitivity, confirmed previous findings obtained with this subject population by other investigators. In addition, a marked reduction in word discrimination was observed in the presence of a background of competing noise. For experiment II, normal hearers listened to consonant-nucleus-consonant monosyllables filtered to match the mean audiometric configuration of the noise-exposed subjects in experiment I. Results showed significantly better performance with these filtered words by the normally hearing subjects than that by the noise-exposed group for unfiltered materials. The results of the second experiment were interpreted as providing further support for the presence of subtle auditory dysfunction in the mid-frequencies despite normal threshold sensitivity in this same frequency region.

Word recognition scores were compared between a younger age group (15 to 35 years) and an older age group (55 to 85 years) exhibiting similar mild sensorineural hearing losses. No differences were found between the two sets of subjects for recognition ability in quiet and only 5% in noise. Contrary to widespread belief, these results revealed no tendency for the older age group to display poorer recognition performance than the younger listeners. The importance of hearing sensitivity as well as age as a factor affecting work recognition is discussed, and comparative data from the literature are presented.

Horizontal sound localization and syllable recognition skills were examined in a group of children with unilateral sensorineural hearing loss and a matched group of normal hearers. The results showed that the unilaterally hearing-impaired children performed more poorly than the normal counterparts in both localization and speech recognition of nonsense syllables. The unilaterally hearing-impaired children had considerable difficulty understanding in a background of noise. The clinical implications of these findings are discussed.