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BACKGROUND: Recent work using the Threshold Equalizing Noise (TEN) test as a gold standard suggests that the presence of cochlear dead regions in persons with moderate-to-severe hearing loss may be quite common. In addition, previous data suggest that certain characteristics of hearing loss, such as severe-profound high-frequency hearing loss or steeply sloping configurations may be more commonly associated with positive TEN findings. These findings, however, are based largely on studies including a relatively small number of participants and/or participants that were included based on specific audiometric criteria (e.g., the presence of severe high-frequency hearing loss). Likewise, results from many of these studies are limited to the frequency regions of 500-4000 Hz. There has been less work that has systematically evaluated the relationship between audiometric characteristics and TEN test findings, particularly in the frequency regions above 4000 Hz, on a large number of individuals with a wide range of hearing losses and hearing loss configurations. PURPOSE: The purpose of this study was to further examine the effects of audiometric characteristics such as degree and slope of hearing loss on the rate of positive, negative, and inconclusive findings on the TEN test over a wide frequency range (250-8000 Hz). Given that the functional impact of positive findings (i.e., findings suggestive of a dead region) may vary with the extent of potential damage, we were also interested in determining the relative occurrence of 'patchy' versus contiguous positive findings on the TEN. RESEARCH DESIGN: Fifty-nine adults (117 ears) with a wide range of SNHL participated. To examine results over a wide frequency range (250-8000 Hz), the TEN (SPL), rather than the TEN (HL), was utilized. Thresholds, in both ears, were measured in quiet and in the TEN (SPL). Results were categorized as positive (suggestive of a dead region), negative (not suggestive of a dead region), or inconclusive. RESULTS: Consistent with past research, positive TEN (SPL) results were more common when hearing losses exceeded 60 dB HL; however, there was not a systematic increase in positive results with increases in threshold. In contrast to previous work, however, positive test results among individuals with milder hearing losses (< 60 dB HL) were not uncommon, suggesting a potential for false positive results. In regard to audiometric slope, also consistent with past research, slope of hearing loss was an inadequate predictor of TEN (SPL) results. Negative results (not suggestive of a dead region) were less common in participants with steeply sloping losses while positive test findings were unaffected by hearing loss slope. Although a large proportion of participants had positive results on the TEN (SPL), for most participants, these positive findings occurred in isolated (i.e., one or two frequencies) rather than in contiguous frequency regions. CONCLUSIONS: The relatively large number of inconclusive results and the potential for false positive results makes interpreting the functional impact of TEN (SPL) results difficult, particularly when positive results are in the high (> 4000 Hz) frequencies. In addition, although a large proportion (84%) of study participants had positive findings on the TEN (SPL), the functional impact of these findings is not clear as, in the majority of cases, positive findings occurred at only one or two test frequencies. [ABSTRACT FROM AUTHOR]

BACKGROUND: While there have been many studies of real-world preferred hearing aid gain, few data are available from participants using hearing aids with today's special features activated. Moreover, only limited data have been collected regarding preferred gain for individuals using trainable hearing aids. PURPOSE: To determine whether real-world preferred hearing aid gain with trainable modern hearing aids is in agreement with previous work in this area, and to determine whether the starting programmed gain setting influences preferred gain outcome. RESEARCH DESIGN: An experimental crossover study. Participants were randomly assigned to one of two treatment groups. Following initial treatment, each subject crossed to the opposite group and experienced that treatment. STUDY SAMPLE: Twenty-two adults with downward sloping sensorineural hearing loss served as participants (mean age 64.5; 16 males, 6 females). All were experienced users of bilateral amplification. INTERVENTION: Using a crossover design, participants were fitted to two different prescriptive gain conditions: VC (volume control) start-up 6 dB above NAL-NL1 (National Acoustic Laboratories-Non-linear 1) target or VC start-up 6 dB below NAL-NL1 target. The hearing aids were used in a 10 to 14 day field trial for each condition, and using the VC, the participants could 'train' the overall hearing aid gain to their preferred level. During the field trial, daily hearing aid use was logged, as well as the listening situations experienced by the listeners based on the hearing instrument's acoustic scene analysis. The participants completed a questionnaire at the start and end of each field trial in which they rated loudness perceptions and their satisfaction with aided loudness levels. RESULTS: Because several participants potentially experienced floor or ceiling effects for the range of trainable gain, the majority of the statistical analysis was conducted using 12 of the 22 participants. For both VC-start conditions, the trained preferred gain differed significantly from the NAL-NL1 prescriptive targets. More importantly, the initial start-up gain significantly influenced the trained gain; the mean preferred gain for the +6 dB start condition was approximately 9 dB higher than the preferred gain for the -6 dB start condition, and this difference was statistically significant (p < .001). Partial eta squared (n2) = 0.919, which is a large effect size. Deviation from the NAL-NL1 target was not significantly influenced by the time spent in different listening environments, amount of hearing aid use during the trial period, or amount of hearing loss. Questionnaire data showed more appropriate ratings for loudness and higher satisfaction with loudness for the 6 dB below target VC-start condition. CONCLUSIONS: When trainable hearing aids are used, the initial programmed gain of hearing instruments can influence preferred gain in the real world. [ABSTRACT FROM AUTHOR]

The purpose of the current study was to evaluate the consistency and reliability of user adjustments to hearing aid gain and the resulting effects on speech understanding. Sixteen bilaterally aided individuals with hearing loss adjusted their hearing aid gain to optimize listening comfort and speech clarity while listening to speech in quiet and noisy backgrounds. Following these adjustments, participants readjusted their aids to optimize clarity and comfort while listening to speech in quiet. These final gain settings were recorded and compared to those provided by NAL-NL1 prescriptive targets. In addition, speech understanding was tested with the hearing aids set at target and user gain settings. Performance differences between the gain settings were then assessed. Study results revealed that although some listeners preferred more or less gain than prescribed, on average, user and prescribed gain settings were similar in both ears. Some individuals, however, made gain adjustments between ears resulting in 'gain mismatches.' These 'mismatches' were often inconsistent across trials suggesting that these adjustments were unreliable. Speech testing results, however, showed no significant difference across the different gain settings suggesting that the gain deviations introduced in this study were not large enough to significantly affect speech understanding. [ABSTRACT FROM AUTHOR]

Speech understanding in noise is affected by both the energetic and informational masking components of the background noise. In addition, when the background noise is everyday speech, the relative contributions of the energetic and informational masking components to the overall difficulties in understanding speech are unclear. This study estimated informational masking effects, in conversational speech settings, on the speech understanding of persons with and without hearing loss. The benefits and limitations of amplification in settings containing both informational and energetic masking components were also explored. Speech recognition was assessed in the presence of two types of maskers (speech and noise) that varied in the amount of informational masking they were expected to produce. Persons with hearing loss were tested both unaided and aided. Study results suggest that background noise, consisting of individual talkers, results in both informational and energetic masking. In addition, the benefits of amplification are limited when the background noise contains both informational and energetic masking components. [ABSTRACT FROM AUTHOR]

This brief report discusses the affect of digital noise reduction (DNR) processing on aided speech recognition and sound quality measures in 14 adults fitted with a commercial hearing aid. Measures of speech recognition and sound quality were obtained in two different speech-in-noise conditions (71 dBA speech, +6 dB SNR and 75 dBA speech, +1 dB SNR). The results revealed that the presence or absence of DNR processing did not impact speech recognition in noise (either positively or negatively). Paired comparisons of sound quality for the same speech in noise signals, however, revealed a strong preference for DNR processing. These data suggest that at least one implementation of DNR processing is capable of providing improved sound quality, for speech in noise, in the absence of improved speech recognition. [ABSTRACT FROM AUTHOR]

The effect of feedback reduction (FBR) systems on sound quality recorded from two commercially available hearing aids was evaluated using paired comparison judgments by 16 participants with mild to severe sloping hearing loss. These comparisons were made with the FBR systems on and off without audible feedback and while attempting to control for differences in gain and clinical fitting factors. Wilcoxon signed rank test analyses showed that the participants were unable to differentiate between signals that had been recorded with the FBR systems on and off within the same hearing aid. However, significant between-instrument differences in sound quality were identified. The results support the activation of the FFT-phase cancellation FBR systems evaluated herein without concern for a noticeable degradation of sound quality. [ABSTRACT FROM AUTHOR]

Objectives: Active listening in everyday settings is challenging and requires substantial mental effort, particularly in noisy settings. In some cases, effortful listening can lead to significant listening-related fatigue and negatively affect quality of life. However, our understanding of factors that affect the severity of fatigue is limited. Hearing aids and cochlear implants (CIs) can improve speech understanding and thus, potentially, reduce listening effort and fatigue. Some research supports this idea for adult hearing aid users with mild-to-moderate hearing loss, but similar work in CI users is very limited. This study examined (1) longitudinal changes in listening-related fatigue in new and established CI users, and (2) relationships between demographic and audiologic factors and preimplantation and postimplantation listening-related fatigue., Design: Participants included an experimental group of 48 adult CI candidates receiving either a unilateral implant (n = 46) or simultaneous, bilateral implants (n = 2) and a control group of 96 experienced (>12 months experience) adult CI users (50 unilateral, 46 bilateral). Listening-related fatigue was evaluated using the 40-item version of the Vanderbilt Fatigue Scale for Adults. Experimental group ratings were obtained before implantation and again at 0.5-, 1-, 2-, 3-, 6-, and 12-month(s) postactivation. Control group participants completed the scale twice-upon study entry and approximately 3 months later. Additional measures, including a social isolation and disconnectedness questionnaire, hearing handicap inventory, and the Effort Assessment Scale, were also administered at multiple time points. The role of these measures and select demographic and audiologic factors on preimplant and postimplant fatigue ratings were examined., Results: Adult CI candidates reported significantly more fatigue, greater self-perceived hearing handicap, greater listening effort, and more social isolation than experienced adult CI users. However, significant reductions in fatigue and effort were observed within 2 weeks postimplantation. By 3 months, there were no significant differences in fatigue, effort, hearing handicap, or social isolation between new CI recipients and experienced CI users. Secondary analyses revealed that age at onset of hearing loss (before or after 2 years of age) and subjective hearing handicap contributed significantly to the variance of preimplantation fatigue ratings (those with higher handicap reported higher fatigue). In contrast, variance in postimplantation fatigue ratings was not affected by age of hearing loss onset but was affected by gender (females reported more fatigue than males) and subjective ratings of effort, handicap, and isolation (those reporting more effort, handicap, and isolation reported more fatigue)., Conclusions: Listening-related fatigue is a significant problem for many CI candidates, as well as for many experienced unilateral and bilateral CI users. Receipt of a CI significantly reduced listening-related fatigue (as well as listening effort, hearing handicap, and social isolation) as soon as 2 weeks post-CI activation. However, the magnitude of fatigue-related issues for both CI candidates and experienced CI users varies widely. Audiologic factors, such as hearing loss severity and aided speech recognition, were not predictive of individual differences in listening-related fatigue. In contrast, strong associations were observed between perceived hearing handicap and listening-related fatigue in all groups suggesting fatigue-related issues may be a component of perceived hearing handicap., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Listening-related fatigue (LRF) is a prominent topic of research interest. The purpose of this study is to investigate the reliability and validity of the Turkish version of the 40-item Vanderbilt Fatigue Scale for Adults (TR-VFS-A-40)., Method: This study included 317 adults with no hearing loss and 260 adults with hearing loss in the study group, totaling 577 adults aged 18-75 years. While 31 adults in the study group did not use any hearing technology, there were 96 hearing aid users and 123 cochlear implant (CI) users. A subset of 80 CI users completed the TR-VFS-A-40 a second time, 2 weeks later, to assess test-retest reliability. Intraclass correlation coefficients were used to assess test-retest reliability. Cronbach's alpha was used to evaluate internal consistency. To examine construct validity, a confirmatory factor analysis (CFA) was performed. For concurrent validity analysis, the Checklist Individual Strength (CIS) and TR-VFS-A-40 scores were analyzed using the Spearman correlation test., Results: Cronbach's alpha values were excellent for the total scale of .987 and the cognitive, emotional, physical, and social subscales (.953, .954, .955, and .946, respectively). Analyses of concurrent validity revealed strong and significant correlations between CIS and TR-VFS-A-40 scores, indicating a good concurrent validity. The CFA determined that the construct validity of the TR-VFS-A-40 was satisfactory., Conclusion: The TR-VFS-A-40 is a valid and reliable measure of LRF., Supplemental Material: https://doi.org/10.23641/asha.25457752.

Objectives: Listening-related fatigue can be a significant problem for adults who struggle to hear and understand, particularly adults with hearing loss. However, valid, sensitive, and clinically useful measures for listening-related fatigue do not currently exist. The purpose of this study was to develop and validate a brief clinical tool for measuring listening-related fatigue in adults., Design: The clinical scale was derived from the 40-item version of the Vanderbilt Fatigue Scale for Adults (VFS-A-40), an existing, reliable, and valid research tool for measuring listening-related fatigue. The study consisted of two phases. Phase 1 ( N = 580) and Phase 2 ( N = 607) participants consisted of convenience samples of adults recruited via online advertisements, clinical records review, and a pool of prior research participants. In Phase 1, results from item response theory (IRT) analyses of VFS-A-40 items were used to identify high-quality items for the brief (10-item) clinical scale: the VFS-A-10. In Phase 2, the characteristics and quality of the VFS-A-10 were evaluated in a separate sample of respondents. Dimensionality was evaluated using exploratory factor analyses (EFAs) and item quality and characteristics were evaluated using IRT. VFS-A-10 reliability and validity were assessed in multiple ways. IRT reliability analysis was used to examine VFS-A-10 measurement fidelity. In addition, test-retest reliability was assessed in a subset of Phase 2 participants ( n = 145) who completed the VFS-A-10 a second time approximately one month after their initial measure (range 5 to 90 days). IRT differential item functioning (DIF) was used to assess item bias across different age, gender, and hearing loss subgroups. Convergent construct validity was evaluated by comparing VFS-A-10 responses to two other generic fatigue scales and a measure of hearing disability. Known-groups validity was assessed by comparing VFS-A-10 scores between adults with and without self-reported hearing loss., Results: EFA suggested a unidimensional structure for the VFS-A-10. IRT analyses confirmed all test items were high quality. IRT reliability analysis revealed good measurement fidelity over a wide range of fatigue severities. Test-retest reliability was excellent ( rs = 0.88, collapsed across participants). IRT DIF analyses confirmed the VFS-A-10 provided a valid measure of listening-related fatigue regardless of respondent age, gender, or hearing status. An examination of associations between VFS-A-10 scores and generic fatigue/vigor measures revealed only weak-to-moderate correlations (Spearman's correlation coefficient, rs = -0.36 to 0.57). Stronger associations were seen between VFS-A-10 scores and a measure of perceived hearing difficulties ( rs = 0.79 to 0.81) providing evidence of convergent construct validity. In addition, the VFS-A-10 was more sensitive to fatigue associated with self-reported hearing difficulties than generic measures. It was also more sensitive than generic measures to variations in fatigue as a function of degree of hearing impairment., Conclusions: These findings suggest that the VFS-A-10 is a reliable, valid, and sensitive tool for measuring listening-related fatigue in adults. Its brevity, high sensitivity, and good reliability make it appropriate for clinical use. The scale will be useful for identifying those most affected by listening-related fatigue and for assessing benefits of interventions designed to reduce its negative effects., Competing Interests: The authors have no conflict of interest to report., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Mixed historical data on how listening effort is affected by reverberation and listener-to-speaker distance challenge existing models of listening effort. This study investigated the effects of reverberation and listener-to-speaker distance on behavioral and subjective measures of listening effort: (a) when listening at a fixed signal-to-noise ratio (SNR) and (b) at SNRs that were manipulated so that word recognition would be comparable across different reverberation times and listening distances. It was expected that increased reverberation would increase listening effort but only when listening outside critical distance., Method: Nineteen adults (21-40 years) with no hearing loss completed a dual-task paradigm. The primary task was word recognition and the secondary task was timed word categorization; response times indexed behavioral listening effort. Additionally, participants provided subjective ratings in each condition. Testing was completed at two reverberation levels (moderate and high, RT 30 = 469 and 1,223 ms, respectively) and at two listener-to-speaker distances (inside and outside critical distance for the test room, 1.25 and 4 m, respectively)., Results: Increased reverberation and listening distances worsened word recognition performance and both behavioral and subjective listening effort. The effect of reverberation was exacerbated when listeners were outside critical distance. Subjective experience of listening effort persisted even when word recognition was comparable across conditions., Conclusions: Longer reverberation times or listening outside the room's critical distance negatively affected behavioral and subjective listening effort. This study extends understanding of listening effort in reverberant rooms by highlighting the effect of listener's position relative to the room's critical distance.

Purpose: Growing evidence suggests that fatigue associated with listening difficulties is particularly problematic for children with hearing loss (CHL). However, sensitive, reliable, and valid measures of listening-related fatigue do not exist. To address this gap, this article describes the development, psychometric evaluation, and preliminary validation of a suite of scales designed to assess listening-related fatigue in CHL: the pediatric versions of the Vanderbilt Fatigue Scale (VFS-Peds)., Method: Test development employed best practices, including operationalizing the construct of listening-related fatigue from the perspective of target respondents (i.e., children, their parents, and teachers). Test items were developed based on input from these groups. Dimensionality was evaluated using exploratory factor analyses (EFAs). Item response theory (IRT) and differential item functioning (DIF) analyses were used to identify high-quality items, which were further evaluated and refined to create the final versions of the VFS-Peds., Results: The VFS-Peds is appropriate for use with children aged 6-17 years and consists of child self-report (VFS-C), parent proxy-report (VFS-P), and teacher proxy-report (VFS-T) scales. EFA of child self-report and teacher proxy data suggested that listening-related fatigue was unidimensional in nature. In contrast, parent data suggested a multidimensional construct, composed of mental (cognitive, social, and emotional) and physical domains. IRT analyses suggested that items were of good quality, with high information and good discriminability. DIF analyses revealed the scales provided a comparable measure of fatigue regardless of the child's gender, age, or hearing status. Test information was acceptable over a wide range of fatigue severities and all scales yielded acceptable reliability and validity., Conclusions: This article describes the development, psychometric evaluation, and validation of the VFS-Peds. Results suggest that the VFS-Peds provide a sensitive, reliable, and valid measure of listening-related fatigue in children that may be appropriate for clinical use. Such scales could be used to identify those children most affected by listening-related fatigue, and given their apparent sensitivity, the scales may also be useful for examining the effectiveness of potential interventions targeting listening-related fatigue in children., Supplemental Material: https://doi.org/10.23641/asha.19836154.

Purpose: The purpose of this study was to evaluate the impact of file compression on clinically measured word recognition scores obtained using the Northwestern University Test Number Six (NU-6; Auditec recording) materials., Method: Participants were 86 adults ( N = 170 ears; M age = 65.5). The 25 most difficult words from each of four NU-6 test lists were used to measure word recognition. Two lists were compressed using a freely available Advanced Audio Coding compression algorithm and two were not. Word recognition was measured in each ear using one compressed file and one uncompressed file. Percent correct scores were calculated in each test condition and log transformed for analyses. Clinically meaningful differences between uncompressed and compressed scores were examined using 95% critical difference ranges. The effects of file compression on word recognition scores were examined in the context of multiple potential confounding effects, including age and degree of hearing loss, using linear mixed-effects models (LMMs)., Results: Differences between compressed and uncompressed scores in a given ear exceeded the 95% critical difference range in about 7% of cases, approximating the 5% of expected cases occurring due to chance. Likewise, LMM results revealed no significant effect of file compression on clinically measured NU-6 word recognition scores and no significant interactions between compression effects and age or degree of hearing loss., Conclusions: While the original uncompressed audio files are clearly the most appropriate stimuli for clinical purposes, our study results suggest that file compression, even at an aggressive 64 kilobits per second, does not have a statistically significant, or clinically meaningful, effect on word recognition scores when measured using these Auditec materials.

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.

Listening-related fatigue is a potentially serious negative consequence of an aging auditory and cognitive system. However, the impact of age on listening-related fatigue and the factors underpinning any such effect remain unexplored. Using data from a large sample of adults ( N = 281), we conducted a conditional process analysis to examine potential mediators and moderators of age-related changes in listening-related fatigue. Mediation analyses revealed opposing effects of age on listening-related fatigue: Older adults with greater perceived hearing impairment tended to report increased listening-related fatigue. However, aging was otherwise associated with decreased listening-related fatigue via reductions in both mood disturbance and sensory-processing sensitivity. Results suggested that the effect of auditory attention ability on listening-related fatigue was moderated by sensory-processing sensitivity; for individuals with high sensory-processing sensitivity, better auditory attention ability was associated with increased fatigue. These findings shed light on the perceptual, cognitive, and psychological factors underlying age-related changes in listening-related fatigue.

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.)

Listening-related fatigue can be a significant burden for adults with hearing loss (AHL), and potentially those with other health or language-related issues (e.g., multiple sclerosis, traumatic brain injury, second language learners) who must allocate substantial cognitive resources to the process of listening. The 40-item Vanderbilt Fatigue Scale for Adults (VFS-A-40) was designed to measure listening-related fatigue in such populations. This article describes the development, and psychometric properties, of the VFS-A-40. Initial qualitative analyses in AHL suggested listening-related fatigue was multidimensional, with physical, mental, emotional, and social domains. However, exploratory factor analyses revealed a unidimensional structure. Item and test characteristics were evaluated using Item Response Theory (IRT). Results confirmed that all test items were of high quality. IRT analyses revealed high marginal reliability and an analysis of test-retest scores revealed adequate reliability. In addition, an analysis of differential item functioning provided evidence of good construct validity across age, gender, and hearing loss groups. In sum, the VFS-A-40 is a reliable and valid tool for quantifying listening-related fatigue in adults. We believe the VFS-A-40 will be useful for identifying those most at risk for severe listening-related fatigue and for assessing interventions to reduce its negative effects. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Hearing loss can disrupt emotional responses to sound. However, the impact of stimulus modality (multisensory versus unisensory) on this disruption, and the underlying mechanisms responsible, are unclear. The purposes of this project were to evaluate the effects of stimulus modality and filtering on emotional responses to non-speech stimuli. It was hypothesized that low- and high-pass filtering would result in less extreme ratings, but only for unisensory stimuli. Twenty-four adults (22- 34 years old; 12 male) with normal hearing participated. Participants made ratings of valence and arousal in response to pleasant, neutral, and unpleasant non-speech sounds and/or pictures. Each participant completed ratings of five stimulus modalities: auditory-only, visual-only, auditory-visual, filtered auditory-only, and filtered auditory-visual. Half of the participants rated low-pass filtered stimuli (800 Hz cutoff), and half of the participants rated high-pass filtered stimuli (2000 Hz cutoff). Combining auditory and visual modalities resulted in more extreme (more pleasant and more unpleasant) ratings of valence in response to pleasant and unpleasant stimuli. In addition, low- and high-pass filtering of sounds resulted in less extreme ratings of valence (less pleasant and less unpleasant) and arousal (less exciting) in response to both auditory-only and auditory-visual stimuli. These results suggest that changes in audible spectral information are partially responsible for the noted changes in emotional responses to sound that accompany hearing loss. The findings also suggest the effects of hearing loss will generalize to multisensory stimuli if the stimuli include sound, although further work is warranted to confirm this in listeners with hearing loss., (Copyright © 2020. Published by Elsevier B.V.)

Objective: Well-being is influenced by the activities we undertake. Hearing loss may reduce well-being directly through increased listening-related fatigue due to cognitive and emotional strain in challenging situations. Hearing loss and hearing device use may also indirectly impact fatigue and well-being by altering the frequency and type of daily-life activities. This review examines the available literature to help understand the relationships., Design: We provide (i) a summary of the extant literature regarding hearing loss, hearing device use and fatigue in adults, as well as regarding fatigue and daily-life activity (work, social and physical) and (ii) a systematic search and narrative review of the relationships between hearing loss, hearing device use and activity., Study Sample: The systematic search resulted in 66 eligible texts., Results: Data examining well-being in persons with hearing loss are limited. Our literature review suggests that well-being can be related directly and indirectly to hearing loss, hearing device use, activity level and listening-related fatigue., Conclusions: Variations and interactions between hearing loss, hearing device use, fatigue and activity levels can be expected to impact well-being in persons with hearing loss in direct and indirect ways. Future research linking hearing and daily-life fatigue should take account of activity levels.

Objectives: The objective of this study was to characterize the acoustics of the home environment of young children with hearing loss. Specifically, we aimed to quantify the range of speech levels, noise levels, and signal-to-noise ratios (SNRs) encountered by children with hearing loss in their homes., Design: Nine families participated in the study. The children with hearing loss in these families were between 2 and 5 years of age. Acoustic recordings were made in the children's homes over one weekend (Saturday and Sunday) using Language ENvironmental Analysis (LENA) recorders. These recordings were analyzed using LENA's proprietary software to determine the range of speech and noise levels in the child's home. A custom Matlab program analyzed the LENA output to estimate the SNRs in the children's homes., Results: The average SNR encountered by children with hearing loss in our sample was approximately +7.9 dB SNR. It is important to note that our analyses revealed that approximately 84% of the SNRs experienced by these children with hearing loss were below the +15 dB SNR recommended by the American Speech-Language Hearing Association. Averaged across families, speech and noise levels were 70.1 and 62.2 C-weighted decibels, respectively., Conclusions: These data show that, for much of the time, young children with hearing loss are forced to listen under suboptimal conditions in their home environments. This has important implications as listening under these conditions could negatively affect learning opportunities for young children with hearing loss. To mitigate these potential negative effects, the use of assistive listening devices that improve the SNR (e.g., remote microphone systems) should be considered for use at home by young children with hearing loss.

A classic paradigm used to quantify the perceptual weighting of binaural spatial cues requires a listener to adjust the value of one cue, while the complementary cue is held constant. Adjustments are made until the auditory percept appears centered in the head, and the values of both cues are recorded as a trading relation (TR), most commonly in μs interaural time difference per dB interaural level difference. Interestingly, existing literature has shown that TRs differ according to the cue being adjusted. The current study investigated whether cue-specific adaptation, which might arise due to the continuous, alternating presentation of signals during adjustment tasks, could account for this poorly understood phenomenon. Three experiments measured TRs via adjustment and via lateralization of single targets in virtual reality (VR). Targets were 500 Hz pure tones preceded by silence or by adapting trains that held one of the cues constant. VR removed visual anchors and provided an intuitive response technique during lateralization. The pattern of results suggests that adaptation can account for cue-dependent TRs. In addition, VR seems to be a viable tool for psychophysical tasks.

Purpose Listening-related fatigue is an understudied construct that may contribute to the auditory, educational, and psychosocial problems experienced by children with unilateral hearing loss (UHL). Herein, we present an overview of listening-related fatigue in school-age children with hearing loss (CHL), with a focus on children with UHL. Method Following a review of research examining listening-related fatigue in adults and CHL, we present preliminary findings exploring the effects of unilateral and bilateral hearing loss on listening-related fatigue in children. For these exploratory analyses, we used data collected from our ongoing work developing and validating a tool, the Vanderbilt Fatigue Scale, for measuring listening-related fatigue in children. Presently, we are assessing 3 versions of the fatigue scale-child self-report, parent proxy, and teacher proxy. Using these scales, data have been collected from more than 900 participants. Data from children with unilateral and bilateral hearing loss and for children with no hearing loss are compared with adult Vanderbilt Fatigue Scale data. Results Results of our literature review and exploratory analyses suggest that adults and CHL are at increased risk for listening-related fatigue. Importantly, this increased risk was similar in magnitude regardless of whether the loss was unilateral or bilateral. Subjective ratings, based on child self-report and parent proxy report, were consistent, suggesting that children with unilateral and bilateral hearing loss experienced greater listening-related fatigue than children with no hearing loss. In contrast, results based on teacher proxy report were not sensitive to the effects of hearing loss. Conclusions Children with UHL are at increased risk for listening-related fatigue, and the magnitude of fatigue is similar to that experienced by children with bilateral hearing loss. Problems of listening-related fatigue in school-age CHL may be better identified by CHL themselves and their parents than by teachers and specialists working with the children.

Purpose There is a growing body of literature that suggests a linkage between impaired auditory function, increased listening effort, and fatigue in children and adults with hearing loss. Research suggests this linkage may be associated with hearing loss-related variations in diurnal cortisol levels. Here, we examine variations in cortisol profiles between young adults with and without severe sensorineural hearing loss and examine associations between cortisol and subjective measures of listening effort and fatigue. Method This study used a repeated-measures, matched-pair design. Two groups ( n = 8 per group) of adults enrolled in audiology programs participated, 1 group of adults with hearing loss (AHL) and 1 matched control group without hearing loss. Salivary cortisol samples were collected at 7 time points over a 2-week period and used to quantify physiological stress. Subjective measures of listening effort, stress, and fatigue were also collected to investigate relationships between cortisol levels, perceived stress, and fatigue. Results Subjective ratings revealed that AHL required significantly more effort and concentration on typical auditory tasks than the control group. Likewise, complaints of listening-related fatigue were more frequent and more of a problem in everyday life for AHL compared to the control group. There was a significant association between subjective ratings of listening effort and listening-related fatigue for our AHL, but not for the control group. In contrast, there was no significant difference in cortisol measures between groups, nor were there significant associations between cortisol and any subjective measure. Conclusions Young AHL experience more effortful listening than their normal hearing peers. This increased effort is associated with increased reports of listening-related fatigue. However, diurnal cortisol profiles were not significantly different between groups nor were they associated with these perceived differences.

Background noise and reverberation levels in typical classrooms have negative effects on speech recognition, but their effects on listening effort and fatigue are less well understood. Based on the Framework for Understanding Effortful Listening, noise and reverberation would be expected to increase both listening effort and fatigue. However, previous investigations of the effects of reverberation for adults have resulted in mixed findings. Some discrepancies in the literature might be accounted for by methodological differences; behavioral and subjective indices of listening effort do not often align in adults. The effects of sustained listening on self-reported fatigue in school-aged children are also not well understood. The purposes of this project were to (1) evaluate the effects of noise and reverberation on listening effort in school-aged children using behavioral and subjective measures, (2) compare subjective and behavioral indices of listening effort, and (3) evaluate the effects of reverberation on self-reported fatigue. Twenty typically developing children (10-17 years old) participated. Participants completed dual-task testing in two rooms that varied in terms of reverberation, an audiometric sound booth and a moderately reverberant room. In each room, testing was completed in quiet and in two levels of background noise. Participants provided subjective ratings of listening effort after completing the dual-task in each listening condition. Subjective ratings of fatigue were completed before and after testing in each level of reverberation. Results revealed background noise, not reverberation, increased behavioral and subjective listening effort. Subjective ratings of perceived performance, ease of listening, and desire to control the listening situation revealed a similar pattern of results as word recognition performance, making them poor candidates for providing an indication of behavioral listening effort. However, ratings of time perception were moderately correlated with behavioral listening effort. Finally, sustained listening for approximately 25 min increased self-reported fatigue, although changes in fatigue were comparable in low and moderately reverberant environments. In total, these data offer no evidence that a moderate level of reverberation increases listening effort or fatigue, but the data do support the reduction of background noise in classrooms.

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.

Child listeners have particular difficulty with speech perception when competing speech noise is present; this challenge is often attributed to their immature top-down processing abilities. The purpose of this study was to determine if the effects of competing speech noise on speech-sound processing vary with age. Cortical auditory evoked potentials (CAEPs) were measured during an active speech-syllable discrimination task in 58 normal-hearing participants (age 7-25 years). Speech syllables were presented in quiet and embedded in competing speech noise (4-talker babble, +15 dB signal-to-noise ratio; SNR). While noise was expected to similarly reduce amplitude and delay latencies of N1 and P2 peaks in all listeners, it was hypothesized that effects of noise on the P3b peak would be inversely related to age due to the maturation of top-down processing abilities throughout childhood. Consistent with previous work, results showed that a +15 dB SNR reduces amplitudes and delays latencies of CAEPs for listeners of all ages, affecting speech-sound processing, delaying stimulus evaluation, and causing a reduction in behavioral speech-sound discrimination. Contrary to expectations, findings suggest that competing speech noise at a +15 dB SNR may have similar effects on various stages of speech-sound processing for listeners of all ages. Future research directions should examine how more difficult listening conditions (poorer SNRs) might affect results across ages., (Copyright © 2019 Elsevier B.V. All rights reserved.)

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.

Despite growing evidence that prolonged episodes of effortful listening can lead to mental fatigue, little work has been done to examine the patterns of brain activation associated with listening over time. In order to gain a better understanding of the nature of listening-related mental fatigue, this study characterized the effects of sustained auditory processing on brain activation in 19 adults with normal hearing. A 50-min, auditory choice paradigm served as the fatiguing task. Mental fatigue was quantified using subjective (self-report) and behavioral (response time and accuracy) measures, as well as event-related potential (ERP) measures indexing motivation (error-related negativity; ERN) and general arousal (N1). Additional electrical neuroimaging analyses were carried out on ERP datasets. Subjective and behavioral results confirmed that participants became fatigued during the auditory task (data from the first 25min compared with the second 25min). ERPs revealed changes in neural activity consistent with decreased arousal (reduced N1 amplitude). Topographical analyses indicated decreased brain activation, without a change in underlying neural network configuration. Regions of decreased brain activation, as estimated via electrical neuroimaging, suggested a decrease in attention to task stimulus-response characteristics (reduced activation in regions associated with the dorsal attention network). The decrease in mean N1 amplitude revealed a significant, positive correlation with subjective report of reduced motivation. These findings support existing cognitive and neurophysiological models that suggest mental fatigue builds over time on task, and affects motivation to influence task performance. Furthermore, this study shows sustained auditory processing can elicit mental fatigue, and that dorsal parietal activity might provide a useful method of measuring its effects., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Purpose: The primary purposes of this study were to examine the effects of hearing loss and respondent type (self- vs. parent-proxy report) on subjective fatigue in children. We also examined associations between child-specific factors and fatigue ratings., Method: Subjective fatigue was assessed using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL-MFS; Varni, Burwinkle, Katz, Meeske, & Dickinson, 2002). We compared self- and parent-proxy ratings from 60 children with hearing loss (CHL) and 43 children with normal hearing (CNH). The children ranged in age from 6 to 12 years., Results: School-age CHL experienced more overall and cognitive fatigue than CNH, although the differences were smaller than previously reported. Parent-proxy report was not strongly associated with child self-report, and parents tended to underestimate their child's fatigue, particularly sleep/rest fatigue. Language ability was also associated with subjective fatigue. For CHL and CNH, as language abilities increased, cognitive fatigue decreased., Conclusions: School-age CHL experience more subjective fatigue than CNH. The poor association between parent-proxy and child reports suggests that the parent-proxy version of the PedsQL-MFS should not be used in isolation when assessing fatigue in school-age children. Future research should examine how language abilities may modulate fatigue and its potential academic consequences in CHL.

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.