Page 18 - Winter Issue 2018
P. 18

Age-Related Hearing Loss
mounted on a pair of eyeglasses to track the direction of the tive effort, such as pupillometry (a measure of pupil size and
listener’s gaze (Kidd et al., 2013), which may indicate the reactivity), may be a more sensitive assessment of training
listener’s focus of attention. The information regarding the benefits than measures of speech recognition alone. Kuchin-
direction of gaze is then used to maximize the directionality sky et al. (2016) found that twenty 90-minute sessions that
of a multimicrophone array. trained word recognition in noise resulted in pupillometry
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The idea of “brain-controlled” hearing aids is certainly ap- C anges a re ec ii . a .ecreaSe In cogm V‘? e or  lm
_ _ _ _ proved word recognition in 29 older adults with hearing loss.
pealing. Nevertheless, the ability to benefit from this strat- . . . .
_ _ _ _ _ _ _ Many questions remain unanswered regarding the potential
egy is still limited by the ability of the auditory system to . . . . .
_ _ _ _ for training to improve speech understanding in older adults.
accurately process the amplified signal. As mentioned in _ . .
_ _ _ _ _ Studies are underway to assess the benefits of training that
The Audiological Evaluation, aging and hearing loss can . . .
_ _ _ _ target age-related temporal processing deficits and auditory-
disrupt the processing of the timing and frequency aspects . . . . .
_ _ _ cognitive interactions in older adults. A better understand-
of speech. The potential for neuroplastic changes in the ag- . . . . .
_ _ ing of training strategies that engender neuroplastic changes
ing auditory system has not yet been fully explored. There . .
_ _ _ _ _ in older adults should lead to better outcomes and improved
is some evidence that the use of hearing aids over time . . . . .
_ _ _ communication and social function in older adults.
may improve the neural processing of speech signals, and
that changes in cortical processing relate to improvements
_ _ _ _ _ Summary
in cognitive function (Karawani et al., 2018), but more re- . .
_ _ _ _ _ Age-related hearing loss has many potential consequences
search 1S needed to explore the limits of neuroplasticity. . . . . . .
for the quality of life, including social withdrawal and pos-
outcomes may be improved if hearing aid use is supplement. sible loss of cognitive function. It is therefore important to
ed with auditory training. But evidence for the potential ben- provide timely audiological assessment and management to
efits of auditory training to provide long-term improvement indiVid11alS Wh0 aPPeaf t0 be having ditnC11ltY hearing and
of perception and neural function has been mixed. A large. understanding speech. Nevertheless, aging brings additional
scale randomized control trial was conducted to evaluate the challenges to identifying the source of speech-understand-
effects of supplementing hearing aid use with 10 hours of au- ing problems, including disruptions in the transmission or
ditory training with Listening and Communication Enhance. processing of speech stimuli that can occur at all levels of the
ment Training (LACE) in 279 veterans and found that LACE auditory system and the brain. Age-related cognitive decline
training did not result in better outcomes than those obtained may also contribute to speech-understanding problems-
with standard.of.care hearing aid intervention alone (saun. Therefore, it is imperative to identify and manage hearing
ders et al_, 2015). Another study assessed the effects of 40 loss to minimize the impact of cognitive decline. These dis-
hours of auditory-based cognitive training in 29 older adults 1‘1lPti0nS inaY limit the benefit that Can be Obtained from
with and without hearing loss and found that the training im. hearing aid amplification and auditory training. Research
proved performance on the QuickSIN and also reduced exag- iS ongoing t0 0PtiIniZe hearing aid technology using neural
geration of the speech envelope in older adults with hearing feedback regarding the listener’s focus of attention. The de-
loss (Anderson et al_, 2013b). Although the Anderson et al_ velopment of effective auditory training programs may also
study suggests that a sufficient number of hours of training improve hearing aid outcomes. Improved assessment and
may engender neuroplastic changes, the improvement in management Pr°t°e°i5 Sneuld irnPr°Ve the abiiitY °r elder
perception was relatively small and would not be considered adults (including Your grandmother) t0 maintain a neaitnYs
clinically significant. It is possible that a behavioral measure aCtiVe Soeial lite de5Pite nearing i055-
of perception obtained in a laboratory setting does not cap-
ture training-related improvements that are experienced in nefereneee
realtlife Settings" Older adults with_heari.ng1O_SS expend more Anderson, S., Parbery-Clark, A., White-Schwoch, T., and Kraus, N. (2013a).
effort to understand Speech! especially in noisy Settings An Auditory brainstem response to complex sounds predicts self-reported
individual who expends considerable effort to understand speech-in-noise performance. Iournal of Speech, Language, and Hearing
what is said will not be able to maintain that level of effort Resmrrl‘ 55(1)’ 3143-
. Anderson, S., White-Schwoch, T., Choi, H. I., and Kraus, N. (2013b). Train-
over the long term. When effort cannot be sustained, speech . . . . .
mg changes processing of speech cues in older adults with hearing loss.
perception may decrease and the individual begins to with- Frontiers in Systems Neuroscience 7(97), 1.9. https://doi.org/10.3389/fn-
draw from the conversation. An objective measure of cogni- sys-2013-00091
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