Face mask use in healthcare settings: effects on communication, cognition, listening effort and strategies for amelioration

Aim To investigate mask use and the difficulties it may pose during communication in healthcare settings. Methods A survey utilizing a series of Likert scales was administered. Mask use challenges between clinicians and their patients were examined in the domains of communication, listening effort, cognition, and rehabilitation. Results Across 243 participants, mask use significantly increased listening effort, with hearing loss having an additive effect on listening effort. Listening effort was also significantly associated with more trouble understanding conversation, decreased interest in conversation, more difficulty connecting with patients, changes in cognition for both providers and patients, and changes in the clinical efficiency of providers. Hearing loss had an additive effect for trouble understanding conversations and changes in clinical efficiency. Conclusion These results provide information about the clinical strain introduced from mask use in healthcare settings. Overall, results show that in healthcare settings there is increased cognitive load and listening effort for both patients and providers, as well as changes in clinical efficiency for providers when utilizing masks. These effects are often greater with hearing loss. Results showed that patients reported written and visual instructions would be most beneficial to include in appointments among the other rehabilitative strategies which are discussed.

Task-Induced Mental Fatigue and Motivation Influence Listening Effort as Measured by the Pupil Dilation in a Speech-in-Noise Task

Objectives: Listening effort and fatigue are common complaints among individuals with hearing impairment (HI); however, the underlying mechanisms, and relationships between listening effort and fatigue are not well understood. Recent quantitative research suggests that the peak pupil dilation (PPD), which is commonly measured concurrent to the performance of a speech-in-noise task as an index of listening effort, may be informative of daily-life fatigue, but it remains unknown whether the same is true for task-induce fatigue. As fatigue effects are known to manifest differently depending on motivation, the main aim of the present study was to experimentally investigate the interactive effects of task-induced fatigue and motivation on the PPD. Design: In a pre-/post- fatigue within-subject design, 18 participants with normal hearing (NH) engaged in a 98-trial-long speech-in-noise task (i.e., a load sequence, approximately 40 min. long), which either excluded or included additional memory demands (light vs. heavy load sequence). Before and after the load sequence, baseline pupil diameter (BPD) and PPD were measured during shorter probe blocks of speech-in-noise tasks. In these probe blocks, if participants correctly repeated more than 60% of the keywords, they could win vouchers of either 20 or 160 Danish krones worth (low incentive vs. high incentive). After each probe block, participants reported their invested effort, tendency for quitting, and perceived performance. Results: The BPD in anticipation of listening declined from pre- to post-load sequence, suggesting an overall decrease in arousal, but the decline did not scale with the magnitude of the load sequence, nor with the amount of monetary incentive. Overall, there was larger pre- to post-load sequence decline in PPD when the load sequence was heavy and when the monetary incentives were low. Post-hoc analyses showed that the decline in PPD was only significant in the heavy-load sequence-low reward condition. The speech-in-noise task performance, self-reported effort, and self-reported tendency to quit listening did not change with the experimental conditions. Conclusions This is the first study to investigate the influence of task-induced fatigue on BPD and PPD. Whereas BPD was not sensitive to the magnitude of previous load sequence and monetary incentives, the decline in PPD from pre- to post- load sequence was significant after the heavy load sequence when the offered monetary incentives were low. This result supports the understanding that fatigue and motivation interactively influence listening effort.

Interdisciplinary Approaches to the Study of Listening Effort in Young Children with Cochlear Implants

Very early bilateral implantation is thought to significantly reduce the attentional effort required to acquire spoken language, and consequently offer a profound improvement in quality of life. Despite the early intervention, however, auditory and communicative outcomes in children with cochlear implants remain poorer than in hearing children. The distorted auditory input via the cochlear implants requires more auditory attention resulting in increased listening effort and fatigue. Listening effort and fatigue may critically affect attention to speech, and in turn language processing, which may help to explain the variation in language and communication abilities. However, measuring attention to speech and listening effort is demanding in infants and very young children. Three objective techniques for measuring listening effort are presented in this paper that may address the challenges of testing very young and/or uncooperative children with cochlear implants: pupillometry, electroencephalography, and functional near-infrared spectroscopy. We review the studies of listening effort that used these techniques in paediatric populations with hearing loss, and discuss potential benefits of the systematic evaluation of listening effort in these populations.

Listening Effort in Cochlear Implant Users: The Effect of Speech Intelligibility, Noise Reduction Processing, and Working Memory Capacity on the Pupil Dilation Response

Purpose: This study aimed to evaluate the effect of speech recognition performance, working memory capacity (WMC), and a noise reduction algorithm (NRA) on listening effort as measured with pupillometry in cochlear implant (CI) users while listening to speech in noise. Method: Speech recognition and pupil responses (peak dilation, peak latency, and release of dilation) were measured during a speech recognition task at three speech-to-noise ratios (SNRs) with an NRA in both on and off conditions. WMC was measured with a reading span task. Twenty experienced CI users participated in this study. Results: With increasing SNR and speech recognition performance, (a) the peak pupil dilation decreased by only a small amount, (b) the peak latency decreased, and (c) the release of dilation after the sentences increased. The NRA had no effect on speech recognition in noise or on the peak or latency values of the pupil response but caused less release of dilation after the end of the sentences. A lower reading span score was associated with higher peak pupil dilation but was not associated with peak latency, release of dilation, or speech recognition in noise. Conclusions: In CI users, speech perception is effortful, even at higher speech recognition scores and high SNRs, indicating that CI users are in a chronic state of increased effort in communication situations. The application of a clinically used NRA did not improve speech perception, nor did it reduce listening effort. Participants with a relatively low WMC exerted relatively more listening effort but did not have better speech reception thresholds in noise.

Speech perception and hearing effort using a new active middle ear implant audio processor

Purpose The Vibrant Soundbridge (VSB) was introduced in 1996, and the fourth generation of the audio processor recently released. This clinical study evaluates the audiological performance and subjective satisfaction of the new SAMBA 2 audio processor compared to its predecessor, SAMBA. Method Fifteen VSB users tested both audio processors for approximately 3 weeks. Air conduction and bone conduction thresholds and unaided and aided sound field thresholds were measured with both devices. Speech performance in quiet (Freiburg monosyllables) and noise (OLSA) was evaluated as well as subjective listening effort (ACALES) and questionnaire outcomes (SSQ12 and APSQ). In addition, data from 16 subjects with normal hearing were gathered on sound field tests and ACALES. Results Both audio processors showed substantial improvement compared to the unaided condition. The SAMBA and SAMBA 2 had comparable performance in sound filed thresholds, while the SAMBA 2 was significantly better in speech in quiet, speech in noise, reduced listening effort, and improved subjective satisfaction compared with the SAMBA. Conclusion The SAMBA 2 audio processor, compared to its predecessor SAMBA, offers improved performance throughout the parameters investigated in this study. Patients with a VSB implant would benefit from an upgrade to SAMBA 2.