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

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

Characteristics of auditory processing disorder in primary school-aged children

The aims of this research were to identify and compare auditory processing, speech intelligibility, cognitive, listening, language and communication abilities in (i) typically developing, mainstream school (MS) children (n = 122) for direct comparison with (ii) children presenting to clinical services with auditory processing disorder (APD) (n = 19) or specific language impairment (SLI) (n = 22), and in (iii) a large population sample (n = 1469) who were categorised by their functional listening and communication abilities according to parental report rather than clinical diagnosis. All had normal hearing sensitivity. The clinically referred APD and SLI groups shared many behavioural characteristics across the broad range of measures. Both clinical groups significantly underperformed compared to the MS children, and the APD and SLI groups were virtually indistinguishable. This suggests diagnosis was based more on the referral route than on the actual differences. There was little association of auditory processing deficits with listening or language problems in either the clinical or the population sample after accounting for nonverbal IQ. The only exceptions were backward masking and frequency discrimination, the AP tests with the highest cognitive load. Poor general cognitive abilities were evident in those children with listening or language problems. These results suggest that top-down processing influences listening and language more than bottom-up sensory processing. It is argued that the term APD is a misnomer and should be renamed listening impairment. The co-occurrence of APD, or listening impairment, with both language impairment and autistic behaviours in the clinical and population samples suggests that APD is not a discrete and categorical disorder. Instead, APD as it is currently conceptualised, is dimensional, positioned more towards the language than the autistic extreme. Children with listening impairment who attend Audiology or ENT clinics should be screened for functional everyday measures of language and autistic behaviours to ensure appropriate onward referrals

Making Sense of Listening: The IMAP Test Battery

The ability to hear is only the first step towards making sense of the range of information contained in an auditory signal. Of equal importance are the abilities to extract and use the information encoded in the auditory signal. We refer to these as listening skills (or auditory processing AP). Deficits in these skills are associated with delayed language and literacy development, though the nature of the relevant deficits and their causal connection with these delays is hotly debated

Characteristics of auditory processing disorder in primary school-aged children

The aims of this research were to identify and compare auditory processing, speech intelligibility, cognitive, listening, language and communication abilities in (i) typically developing, mainstream school (MS) children (n = 122) for direct comparison with (ii) children presenting to clinical services with auditory processing disorder (APD) (n = 19) or specific language impairment (SLI) (n = 22), and in (iii) a large population sample (n = 1469) who were categorised by their functional listening and communication abilities according to parental report rather than clinical diagnosis. All had normal hearing sensitivity. The clinically referred APD and SLI groups shared many behavioural characteristics across the broad range of measures. Both clinical groups significantly underperformed compared to the MS children, and the APD and SLI groups were virtually indistinguishable. This suggests diagnosis was based more on the referral route than on the actual differences. There was little association of auditory processing deficits with listening or language problems in either the clinical or the population sample after accounting for nonverbal IQ. The only exceptions were backward masking and frequency discrimination, the AP tests with the highest cognitive load. Poor general cognitive abilities were evident in those children with listening or language problems. These results suggest that top-down processing influences listening and language more than bottom-up sensory processing. It is argued that the term APD is a misnomer and should be renamed listening impairment. The co-occurrence of APD, or listening impairment, with both language impairment and autistic behaviours in the clinical and population samples suggests that APD is not a discrete and categorical disorder. Instead, APD as it is currently conceptualised, is dimensional, positioned more towards the language than the autistic extreme. Children with listening impairment who attend Audiology or ENT clinics should be screened for functional everyday measures of language and autistic behaviours to ensure appropriate onward referrals

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