Identifying listeners with hearing loss at risk for exerting extra effort in speech perception

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Project Summary / Abstract Over 460 million people worldwide have hearing loss (HL) that negatively impacts their ability to communicate (WHO, 2020). In the clinic, performance is measured by the percentage of words a listener repeats correctly. However, these scores reflect not only the health of the auditory system but also the listener’s ability to mentally repair misperceptions by using knowledge of the language and context (“cognitive repair”). Standard measures of speech perception cannot detect if a person used cognitive repair or if they accurately heard speech (with no need for repair). Detecting a person’s reliance on cognitive repair is important because while reliance on an extra moment to use context is helpful in the testing booth, it may break down in the real world as the next sentence would be heard before the previous sentence was fully processed. We hypothesize that continual need for cognitive repair is at the heart of what makes listening effortful, and what ultimately leads to increased fatigue (Edwards, 2017), anxiety (Morata et al., 2005), and social withdrawal (Hughes et al., 2018) for people with HL. The aims of this project are to (1) identify listener reliance on cognitive repair, (2) measure the timeline of cognitive repair and its interference with ongoing processing, and (3) measure the relief from effort resulting from advance knowledge of the topic of a sentence. The first aim will result in a clinically feasible test using behavioral measures that identifies when a listener uses cognitive repair. Importantly, this test will better identify patients with HL who use cognitive repair during clinical testing; this finding, can lead to improved individualized patient centered care. The second aim will use a dual-task paradigm to better identify the amount of time needed for cognitive repair after a sentence. During this time the listener would be to susceptible to interference from an upcoming sentence in real-world conversation. The third aim will use pupillometry to measure how listening effort is affected by topic awareness The long-term goals of this project are to improve our understanding of the cognitive repair process and its timeline, as well as to identify listeners who rely on effortful cognitive strategies to compensate for poor hearing. These goals directly address the NIDCD priority of increasing our knowledge of the mechanisms of auditory perception in more real-world conditions and their interaction with cognitive processes for successful communication. These studies will achieve this goal by examining these issues in people who use cochlear implants (neural prosthetic devices that can restore hearing) and people with moderate to moderately severe sensorineural HL. The training program involves extensive instruction in behavioral measures, pupillometry, and advanced statistical analysis relevant to the proposed research. This research will be conducted under the mentorship of leading experts in hearing, listening effort, and physiology at an institution with a strong track record of hearing loss research, where there is also a history of training grants and interdisciplinary collaboration in clinical sensory science.