Efficacy of individual computer-based auditory training for people with hearing loss: a systematic review of the evidence

Auditory training involves active listening to auditory stimuli and aims to improve performance in auditory tasks. As such, auditory training is a potential intervention for the management of people with hearing loss. Objective This systematic review (PROSPERO 2011: CRD42011001406) evaluated the published evidence-base for the efficacy of individual computer-based auditory training to improve speech intelligibility, cognition and communication abilities in adults with hearing loss, with or without hearing aids or cochlear implants. Methods A systematic search of eight databases and key journals identified 229 articles published since 1996, 13 of which met the inclusion criteria. Data were independently extracted and reviewed by the two authors. Study quality was assessed using ten pre-defined scientific and intervention-specific measures. Results Auditory training resulted in improved performance for trained tasks in 9/10 articles that reported on-task outcomes. Although significant generalisation of learning was shown to untrained measures of speech intelligibility (11/13 articles), cognition (1/1 articles) and self-reported hearing abilities (1/2 articles), improvements were small and not robust. Where reported, compliance with computer-based auditory training was high, and retention of learning was shown at post-training follow-ups. Published evidence was of very-low to moderate study quality. Conclusions Our findings demonstrate that published evidence for the efficacy of individual computer-based auditory training for adults with hearing loss is not robust and therefore cannot be reliably used to guide intervention at this time. We identify a need for high-quality evidence to further examine the efficacy of computer-based auditory training for people with hearing loss

Assessing the benefits of auditory training to real-world listening: identifying appropriate and sensitive outcomes

Auditory training is an intervention that aims to improve auditory performance and help alleviate the difficulties associated with hearing loss. To be an effective intervention, any task-specific learning needs to transfer to functional benefits in real-world listening. The present study aimed to identify optimal outcome measures to assess the benefits of auditory training for people with hearing loss. Thirty existing hearing-aid users with mild-moderate sensorineural hearing loss trained on a phoneme discrimination in noise task. Complex measures of listening and cognition were assessed pre- and post-training. Functional benefits to everyday listening were examined using a dual-task of listening and memory and an adaptive two-competing talker task. There was significant on-task learning for the trained task (p < .001), and significant transfer of learning to improvements in competing speech (p < .05) and dual-task performance (p < .01). For the dual-task, improvements were shown for a challenging listening condition (0 dB SNR), with no improvements where the task was either too easy (in quiet) or too difficult (-4 dB SNR). Findings suggest that for listening abilities, the development of complex cognitive skills may be more important than the refinement of sensory processing. Outcome measures should be sensitive to the functional benefits of auditory training and set at an appropriately challenging level

How does auditory training work? Joined up thinking and listening

Auditory training aims to compensate for degradation in the auditory signal and is offered as an intervention to help alleviate the most common complaint in people with hearing loss, understanding speech in a background noise. Yet there remain many unanswered questions. This article reviews some of the key pieces of evidence that assess the evidence for whether, and how, auditory training benefits adults with hearing loss. The evidence supports that improvements occur on the trained task; however, transfer of that learning to generalized real-world benefit is much less robust. For more than a decade, there has been an increasing awareness of the role that cognition plays in listening. But more recently in the auditory training literature, there has been an increased focus on assessing how cognitive performance relevant for listening may improve with training. We argue that this is specifically the case for measures that index executive processes, such as monitoring, attention switching, and updating of working memory, all of which are required for successful listening and communication in challenging or adverse listening conditions. We propose combined auditory-cognitive training approaches, where training interventions develop cognition embedded within auditory tasks, which are most likely to offer generalized benefits to the real-world listening abilities of people with hearing loss

Assessing the benefits of auditory training to real-world listening: identifying appropriate and sensitive outcomes

Auditory training is an intervention that aims to improve auditory performance and help alleviate the difficulties associated with hearing loss. To be an effective intervention, any task-specific learning needs to transfer to functional benefits in real-world listening. The present study aimed to identify optimal outcome measures to assess the benefits of auditory training for people with hearing loss. Thirty existing hearing-aid users with mild-moderate sensorineural hearing loss trained on a phoneme discrimination in noise task. Complex measures of listening and cognition were assessed pre- and post-training. Functional benefits to everyday listening were examined using a dual-task of listening and memory and an adaptive two-competing talker task. There was significant on-task learning for the trained task (p < .001), and significant transfer of learning to improvements in competing speech (p < .05) and dual-task performance (p < .01). For the dual-task, improvements were shown for a challenging listening condition (0 dB SNR), with no improvements where the task was either too easy (in quiet) or too difficult (-4 dB SNR). Findings suggest that for listening abilities, the development of complex cognitive skills may be more important than the refinement of sensory processing. Outcome measures should be sensitive to the functional benefits of auditory training and set at an appropriately challenging level

Working memory training for adult hearing aid users: study protocol for a double-blind randomized active controlled trial

Background: One in ten people aged between 55 to 74 years have a significant hearing impairment in their better hearing ear (as defined by audiometric hearing thresholds). However, it is becoming increasingly clear that the challenges faced by older listeners cannot be explained by the audiogram alone. The ability for people with hearing loss to use cognition to support speech perception allows for compensation of the degraded auditory input. This in turn offers promise for new cognitive-based rehabilitative interventions. Working memory is known to be highly associated with language comprehension and recent evidence has shown significant generalization of learning from trained working memory tasks to improvements in sentence-repetition skills of children with severe to profound hearing loss. This evidence offers support for further investigation into the potential benefits of working memory training to improve speech perception abilities in other hearing impaired populations. Methods/Design: This is a double-blind randomized active controlled trial aiming to assess whether a program of working memory training results in improvements in untrained measures of cognition, speech perception and self-reported hearing abilities in adult hearing aid users (aged 50 to 74 years) with mild-to-moderate hearing loss, compared with an active control group who receive a placebo version of the working memory training program. Discussion: The present study aims to generate high-quality preliminary evidence for the efficacy of working memory training for adults with mild-to-moderate sensorineural hearing loss who are existing hearing aid users. This trial addresses a number of gaps in the published literature assessing training interventions for people with hearing loss, and in the general literature surrounding working memory training, such as the inclusion of an active control group, participant and tester blinding, and increased transparency in reporting

Computer and internet interventions to optimize listening and learning for people with hearing loss: accessibility, use, and adherence

Purpose: The aim of this research forum article was to examine accessibility, use, and adherence to computerized and online interventions for people with hearing loss. Method: Four intervention studies of people with hearing loss were examined: 2 auditory training studies, 1 working memory training study, and 1 study of multimedia educational support. Results: A small proportion (approximately 15%) of participants had never used a computer, which may be a barrier to the accessibility of computer and Internet based interventions. Computer competence was not a factor in intervention use or adherence. Computer skills and Internet access influenced participant preference for the delivery method of the multimedia educational support program. Conclusions: It is important to be aware of current barriers to computer and Internet-delivered interventions for people with hearing loss. However, there is a clear need to develop and future-proof hearing-related applications for online delivery

Applying theories of health behaviour and change to hearing health research: time for a new approach

Objective: In recent years, there has been an increase in the application of behavioural models, such as social cognition models, to the promotion of hearing health. Despite this, there exists a well-developed body of literature that suggests such models may fail to consistently explain reliable amounts of variability in human behaviours. Design: This paper provides a summary of this research across selected models of health-related behaviour, outlining the current state of the evidence. Results: Recent work in the field of behaviour change is presented together with commentary on the design and reporting of behaviour change interventions. Conclusions: We propose that attempts to use unreliable models to explain and predict hearing health behaviours should now be replaced by work which integrates the latest in behaviour change science, such as the Behaviour Change Wheel and Theoretical Domains Framework

Benefits of phoneme discrimination training in a randomized controlled trial of 50- to 74-year-olds with mild hearing loss

Objectives: The aims of this study were to (i) evaluate the efficacy of phoneme discrimination training for hearing and cognitive abilities of adults aged 50 to 74 years with mild sensorineural hearing loss who were not users of hearing aids, and to (ii) determine participant compliance with a self-administered, computer-delivered, home- and game-based auditory training program. Design: This study was a randomized controlled trial with repeated measures and crossover design. Participants were trained and tested over an 8- to 12-week period. One group (Immediate Training) trained during weeks 1 and 4. A second waitlist group (Delayed Training) did no training during weeks 1 and 4, but then trained during weeks 5 and 8. On-task (phoneme discrimination) and transferable outcome measures (speech perception, cognition, self-report of hearing disability) for both groups were obtained during weeks 0, 4, and 8, and for the Delayed Training group only at week 12. Results: Robust phoneme discrimination learning was found for both groups, with the largest improvements in threshold shown for those with the poorest initial thresholds. Between weeks 1 and 4, the Immediate Training group showed moderate, significant improvements on self-report of hearing disability, divided attention, and working memory, specifically for conditions or situations that were more complex and therefore more challenging. Training did not result in consistent improvements in speech perception in noise. There was no evidence of any test-retest effects between weeks 1 and 4 for the Delayed Training group. Retention of benefit at 4 weeks post-training was shown for phoneme discrimination, divided attention, working memory, and self-report of hearing disability. Improved divided attention and reduced self-reported hearing difficulties were highly correlated. Conclusions: It was observed that phoneme discrimination training benefits some but not all people with mild hearing loss. Evidence presented here, together with that of other studies that used different training stimuli, suggests that auditory training may facilitate cognitive skills that index executive function and the self-perception of hearing difficulty in challenging situations. The development of cognitive skills may be more important than the development of sensory skills for improving communication and speech perception in everyday life. However, improvements were modest. Outcome measures need to be appropriately challenging to be sensitive to the effects of the relatively small amount of training performed

Using the CLOX drawing task to educate the public of the effects of hearing loss

We describe a task used to educate the public on the importance of hearing and the experience of hearing loss. During an open day at Nottingham University, participants were presented with verbal instructions (with or without a background masker) and asked to draw the image of a clock face as accurately as possible. Poorest performance was observed when the instructions were presented with a background masker. We suggest that the task could be applied effectively by healthcare professionals who aim to educate younger individuals of the difficulties associated with hearing loss