A Clinical Paradigm for Listening Effort Assessment in Middle-Aged Listeners

Abstract

Listening effort (LE) has been known to characterize speech recognition in noise regardless of hearing sensitivity and age. Whereas the behavioral measure of dual-task paradigm effectively manifests the cognitive cost that listeners exert when processing speech in background noise, there is no consensus as to a clinical procedure that might best express LE. In order to assess the cognitive load underlying speech recognition in noise and promote counselling for coping strategies, a feasible clinical paradigm is warranted. The ecological validity of such a paradigm might best be demonstrated in middle-aged adults, exhibiting intact hearing sensitivity on one hand, however, experiencing difficulties in degraded listening conditions, unaware of the implicated cognitive cost of speech recognition in noise. To this end, we constructed a dual-task paradigm that consists of a primary task of sentences-in-noise recognition and a secondary task of simple visual colored-shape matching. Research objective was to develop a clinical paradigm for the assessment of LE in middle-aged adults. Participants were 17 middle-aged adults (mean age of 52.81 years) and 23 young adults (mean age of 24.90 years). All participants had normal hearing according to age. Speech stimuli consisted of the Hebrew Matrix sentences in noise test. SRTn was obtained for 80% correct identification. Visual stimuli were colored geometric shapes. Outcome measures were obtained initially for each task separately, to establish performance ability, and then obtained simultaneously. Reaction time and accuracy in the secondary task were the defined metrics for LE. Results: LE was indicated for both groups, however, was more pronounced in the middle-aged, manifested in the visual accuracy and reaction time metrics. Both groups maintained the 80% correct recognition-in-noise in the dual-task, however, the middle-aged group necessitated a better SNR of 1.4dB than the normal hearing group. Moreover, the middle-aged group was taxed in a greater prolongation of reaction time, in order to uphold the correct recognition. Conclusion: a dual-task paradigm consisting of sentences-in-noise primary task combined with a simple secondary task successfully showed different manifestations of LE in middle-aged adults compared to young adults, thus approximating the use of such a paradigm in a clinical setting.

Keywords: a clinical paradigm; cognitive cost; dual-task paradigm; listening effort; middle- aged adults.

FIGURE 1

Mean (± sd) air conduction thresholds for the young and middle-aged groups.

FIGURE 2

in panel (A), mean (± se) of SRTn 80% sentence recognition of young (white) and MA (gray) groups, in the single task. Note that the MA group needed a more positive SNR than the young group, even when the primary task was performed singly. In panel (B) distribution of correct sentence recognition for the young (white) and MA (gray), in the dual-task, performed at the individual SNR, obtained when tested singly. Lower and upper box boundaries represent the 25th-75th percentiles, lower and upper error bars represent 10th and 90th percentiles, respectively. The horizontal line inside the box represents the median and the X – the mean. Note the larger distribution of the MA results, albeit almost similar median and mean scores.

FIGURE 3

Mean (± se) of visual task accuracy in the single (solid) and dual (pattern) tasks for Young (white) and MA (gray) groups.

FIGURE 4

Mean (± se) of visual reaction time in the single (solid) and dual (pattern) tasks for Young (white) and MA (gray) groups.