Training-induced changes in the processing of sound in patients with sensorineural hearing loss and its impact on quality of life

背景和理由：听力损失影响着英国超过1000万人，老年人的风险更大。听力损失的负面影响是深远的，包括社会孤立，抑郁和痴呆症的风险增加。在英国，听力损失最常见的原因是内耳的变化，即老年性聋，最常见的报告困难是与他人交谈，特别是在餐馆等背景噪音中。这种抱怨有两个组成部分：第一，声音的水平降低，第二，个人努力区分声音之间的距离很近。后一种能力被称为对声音的时间处理。鉴于语音的快速转换，这种技能对于理解即使是简单的话语也是至关重要的，但在嘈杂的环境中是必不可少的。治疗方案主要是助听器，尽管技术进步，但在这些环境中仍然存在局限性。最近，有令人鼓舞的报道，对听力障碍患者进行时间处理任务的培训。然而，这种改善在多大程度上转移到“真实的世界”中的言语感知改善，从而消除听力损失的负面社会影响，仍不清楚。我们提出了一个时间处理的训练研究，其目的如下：（1）在传统纯音测试之外的更广泛的背景下（例如，通过使用噪声测试中的语音，详细的解剖扫描和生活质量测量），评估听力损伤的后果。(2)研究听觉训练对言语感知和心理健康的益处。(3)根据培训前的测试结果和培训后这些测试的改善幅度，预测谁会从培训中受益。方法：我们将招募轻度/中度听力损失的参与者（<60岁，以尽量减少混淆，例如认知下降）。参与者（n=50）将被随机分配到由Posit Science（大脑健康）主办的两个在线培训计划之一，为期数周。一组将参加听觉计划，包括各种旨在提高时间处理速度的愉快任务，另一组将参加视觉训练计划，作为主动控制条件。之所以提出这一特别的培训方案，是因为它以前取得了令人鼓舞的成果，研究人员可以在线跟踪方案的执行情况。在培训前后，将对参与者进行一系列心理物理和定性评估。

Context and rationale: Hearing loss affects over 10 million people in the UK, with older individuals being at greater risk. The negative effects of hearing loss are far reaching, and include social isolation, depression and increased risk of dementia. The social and economic costs are therefore significant.The most common cause of hearing loss in the UK is changes in the inner ear, known as presbyacusis, with the most commonly reported difficulty being conversations with others, particularly in background noise such as restaurants. This complaint has two components: first, levels of sound are reduced and second, individuals struggle differentiating between sounds spaced close together. The latter ability is known as temporal processing of sounds. Given the rapid transitions of speech, this skill is vital for understanding even the simple utterances but is essential in noisy envionments. Treatment options are primarily hearing aids which, despite technological advances, still have limitations in these environments.Recently, there have been encouraging reports of training individuals with hearing impairment on temporal processing tasks. However, to what extent this improvement transfers to speech perception improvements in the "real world", and thereby alleviates the negative social impact of hearing loss, remains unclear. We propose a training study on temporal processing with the following aims:(1) characterise the consequences of hearing impairment in a wider context beyond traditional pure-tone testing (e.g. by using speech in noise tests, detailed anatomical scans and quality of life measures).(2) examine the benefits of auditory training on the perception of speech and mental well-being.(3) predict who benefits from training based on the combination of test results before training and magnitude of improvement on these tests after training. Methodology: We will recruit participants with mild/moderate hearing loss (<60 years of age to minimise confounds from, e.g. cognitive decline). Participants (n=50) will be randomly assigned to one of two online training programmes for several weeks hosted by Posit Science (Brain Fitness). One group will take part in the auditory programme, consisting of a variety of enjoyable tasks aimed at improving temporal processing speeds, and another group will take part in a visual training programme, as an active control condition. This particular training programme is proposed as it has previously led to encouraging results and adherence to the programme can be followed online by the researcher. Participants will be assessed on a range of psychophysical and qualitative measures before and after training.