Katrien Kestens

Purpose: In light of concerns about the traditional dual-task approach for behavioral listening effort, this study explored a novel dual-task interference (DTI)–based method in adults with and without hearing loss (HL). Method: Fifty-two normal-hearing individuals and 52 with HL were matched for age, sex, and education ( M age overall = 67.38 years). The dual-task paradigm combined a primary speech understanding task under five listening conditions with a secondary visual memory task. Dual-task effects (DTEs; performance change from baseline to dual-task) were calculated for both tasks. Linear mixed models assessed the effects of listening condition and hearing group on both DTEs. To explore individual task prioritization strategies, interference patterns were derived by plotting both DTEs, and Fisher's exact tests were used to examine associations between interference patterns and hearing groups across listening conditions. Results: Linear mixed models revealed significantly higher DTE values for the primary task at +4 dB SNR compared to +8 dB SNR, and higher secondary-task DTE values at 0 and −4 dB SNR compared to the other conditions. No significant effects of hearing group or interactions were found. Fisher's exact tests showed no significant group differences in DTI patterns. Conclusions: The DTI approach highlights individual DTI patterns, suggesting dynamic resource allocation and task prioritization under competing demands. These findings provide additional insight into the current use of dual-task paradigms for listening effort and support a broader interpretation of their role, including their potential for individualized counseling.

Purpose: The benefits of digital signal-processing features, such as noise reduction (NR) and frequency compression (FC), differ among individuals. This study aimed to explore the impact of deactivating NR and FC on hearing aid (HA) benefit, acknowledging the complexity of interindividual variability. Method: Thirty-two first-time HA users were assigned to three groups: a control group with no feature changes ( n = 10, mean age [MA] = 68.40 years), an NR-off group ( n = 11, MA = 65.82 years), and an FC-off group ( n = 11, MA = 66.82 years). Two test sessions were separated by about 4 weeks of acclimatization. Session 1 included baseline assessments (cognition, speech understanding, subjective measures) using initial HA settings, followed by immediate speech understanding reassessment after group allocation. In Session 2, speech understanding and subjective outcomes were reassessed. Wilcoxon signed-ranks and Kruskal–Wallis tests examined within-group and between-groups differences. Results: No significant effects of NR or FC on speech understanding or subjective measures were observed, but small trends emerged. Subjective improvements were most consistent in the control group. Tentative minor trends in subjective ratings suggested FC deactivation may be associated with declines in auditory–visual and psychosocial functioning and improvements in cognitive functioning, listening effort, and fatigue. Conclusions: Exploratory patterns suggest FC may impact subjective outcomes differently, despite no significant effects being found. The findings further critically reflect the complexity of evaluating cognition-related HA benefit and emphasize the need for multidimensional research to guide individualized HA fitting. Supplemental Material: https://doi.org/10.23641/asha.31141591

Purpose: This study aimed to assess the magnitude and direction of dual-task interference in a listening effort dual-task paradigm in individuals with severe-to-profound hearing loss before and in the short- and long-term after cochlear implantation. Design: The study sample consisted of 26 adult candidates for cochlear implantation with severe-to-profound hearing loss. The dual-task paradigm consisted of a primary speech understanding task, conducted in a quiet condition, and a favorable and unfavorable noise condition on the one hand and a secondary visual memory task on the other hand. The dual-task effect for both tasks and the derived patterns of dual-task interference were determined. Participants were evaluated at four test moments: before cochlear implantation and at 3 months, 6 months, and 12 months after implantation. Results: Across all listening conditions, a shift was observed from patterns of dual-task interference with worse and stable scores for the primary speech understanding task in the dual-task condition compared to the baseline condition before implantation, toward patterns in which stable or better scores were obtained, respectively, for the primary task in the dual-task condition after implantation. This indicates that more attention could be allocated to the primary speech understanding task during the dual-task condition after implantation, implying a decreased listening effort. Conclusions: A decreased listening effort was found after cochlear implantation. This study provides additional insights into the evolution of dual-task interference after cochlear implantation. It highlights the importance of interpreting both the primary and secondary tasks using a dual-task paradigm in the assessment of listening effort.

Purpose: The purpose of the current study was to assess dual-task interference (i.e., changes between the dual-task and baseline condition) in a listening effort dual-task paradigm in normal-hearing (NH) adults, hearing aid (HA) users, and cochlear implant (CI) users. Method: Three groups of 31 participants were included: (a) NH adults, (b) HA users, and (c) CI users. The dual-task paradigm consisted of a primary speech understanding task in a quiet condition, and a favorable and unfavorable noise condition, and a secondary visual memory task. Dual-task interference was calculated for both tasks, and participants were classified based on their patterns of interference. Descriptive analyses were established and differences between the three groups were examined. Results: The descriptive results showed varying patterns of dual-task interference between the three listening conditions. Most participants showed the pattern of visual memory interference (i.e., worse results for the secondary task in the dual-task condition and no difference for the primary task) in the quiet condition, whereas the pattern of speech understanding priority trade-off (i.e., worse results for the secondary task in the dual-task condition and better results for the primary task) was most prominent in the unfavorable noise condition. Particularly, in HA and CI users, this shift was seen. However, the patterns of dual-task interference were not statistically different between the three groups. Conclusions: Results of this study may provide additional insight into the interpretation of dual-task paradigms for measuring listening effort in diverse participant groups. It highlights the importance of considering both the primary and secondary tasks for accurate interpretation of results. Supplemental Material: https://doi.org/10.23641/asha.26409088

Introduction Understanding how listeners execute a dual-task paradigm for listening effort would provide a benchmark for future studies and clinical implementations. Therefore, this study aimed to examine the impact of instructions on the prioritization strategy employed by individuals during a dual-task paradigm for listening effort by assessing dual-task interference. Methods The dual-task paradigm consisted of a primary speech understanding task in different listening conditions and a secondary visual memory task, both performed separately (baseline) and simultaneously (dual-task). Twenty-three normal-hearing participants (mean age: 36.8 years; 14 females) were directed to prioritize the primary speech understanding task in the dual-task condition, whereas another twenty-three (matched for age, gender, and education level) received no specific instructions regarding task priority. Both groups performed the dual-task paradigm twice (mean interval: 14.8 days). Dual-task interference was assessed by plotting the dual-task effect of the primary and secondary task against each other. Participants were classified based on their patterns of interference. Results The prioritizing group had more participants who achieved stable or better scores on the primary task in the dual-task condition compared to baseline. However, there was considerable variability in the prioritizing strategy employed at the individual level across listening conditions and test moments, regardless the given prioritization instructions. Conclusion Providing prioritization instructions was insufficient to ensure that an individual will mainly focus on the primary task and will stick to this strategy across listening conditions and test moments. These results raised certain reservations about the current usage of dual-task paradigms for listening effort.

Objectives: This study aimed to explore the potential of the P300 (P3b) as a physiological measure of the engagement of cognitive systems contributing to listening effort. Design: Nineteen right-handed young adults (mean age: 24.79 years) and 20 right-handed older adults (mean age: 58.90 years) with age-appropriate hearing were included. The P300 was recorded at Fz, Cz, and Pz using a two-stimulus oddball paradigm with the Flemish monosyllabic numbers “one” and “three” as standard and deviant stimuli, respectively. This oddball paradigm was conducted in three listening conditions, varying in listening demand: one quiet and two noisy listening conditions (+4 and −2 dB signal to noise ratio [SNR]). At each listening condition, physiological, behavioral, and subjective tests of listening effort were administered. P300 amplitude and latency served as a potential physiological measure of the engagement of cognitive systems contributing to listening effort. In addition, the mean reaction time to respond to the deviant stimuli was used as a behavioral listening effort measurement. Last, subjective listening effort was administered through a visual analog scale. To assess the effects of listening condition and age group on each of these measures, linear mixed models were conducted. Correlation coefficients were calculated to determine the relationship between the physiological, behavioral, and subjective measures. Results: P300 amplitude and latency, mean reaction time, and subjective scores significantly increased as the listening condition became more taxing. Moreover, a significant group effect was found for all physiological, behavioral, and subjective measures, favoring young adults. Last, no clear relationships between the physiological, behavioral, and subjective measures were found. Conclusions: The P300 was considered a physiological measure of the engagement of cognitive systems contributing to listening effort. Because advancing age is associated with hearing loss and cognitive decline, more research is needed on the effects of all these variables on the P300 to further explore its usefulness as a listening effort measurement for research and clinical purposes.

Purpose: This study aimed to get insight into the views and experience of audiologists, employed in Flemish hearing aid centers, concerning cognition within audiological practice. Method: An online 49-item questionnaire was developed and subdivided into five categories: (a) work setting, (b) practical experience regarding hearing aid fitting linked to cognition, (c) knowledge regarding the auditory–cognitive perspective of speech understanding, (d) willingness and guidelines to implement cognitive measures within audiological practice, and (e) demographics. Respondents were surveyed during January and February 2021. Results: One hundred twenty-nine audiologists working in Flemish hearing aid centers responded to the entire questionnaire and showed a mean work experience of 8.0 years. Results revealed that cognition was taken into account, especially within the anamnesis interview and general communication strategy, whereas only a minority took cognition into account when actually fitting hearing aids. Knowledge and experience did not determine whether or not respondents took cognition into account. A willingness to implement cognitive measures in a time-efficient manner in audiological practice was observed among respondents. Conclusion: Evidence-based guidelines regarding hearing aid fitting based on an individual's auditory–cognitive profile are needed to improve the quality of hearing rehabilitation. Supplemental Material: https://doi.org/10.23641/asha.19593388