Published investigations (n = 29) in which a dual-task experimental paradigm was employed to measure listening effort during speech understanding in younger and older adults were reviewed. A summary of the main findings reported in the articles is provided with respect to the participants’ age-group and hearing status. Effects of different signal characteristics, such as the test modality, on dual-task outcomes are evaluated, and associations with cognitive abilities and self-report measures of listening effort are described. Then, several procedural issues associated with the use of dual-task experiment paradigms are discussed. Finally, some issues that warrant future research are addressed. The review revealed large variability in the dual-task experimental paradigms that have been used to measure the listening effort expended during speech understanding. The differences in experimental procedures used across studies make it difficult to draw firm conclusions concerning the optimal choice of dual-task paradigm or the sensitivity of specific paradigms to different types of experimental manipulations. In general, the analysis confirmed that dual-task paradigms have been used successfully to measure differences in effort under different experimental conditions, in both younger and older adults. Several research questions that warrant further investigation in order to better understand and characterize the intricacies of dual-task paradigms were identified.

The ability to recognize masked speech, commonly measured with a speech reception threshold (SRT) test, is associated with cognitive processing abilities. Two cognitive factors frequently assessed in speech recognition research are the capacity of working memory (WM), measured by means of a reading span (Rspan) or listening span (Lspan) test, and the ability to read masked text (linguistic closure), measured by the text reception threshold (TRT). The current article provides a review of recent hearing research that examined the relationship of TRT and WM span to SRTs in various maskers. Furthermore, modality differences in WM capacity assessed with the Rspan compared to the Lspan test were examined and related to speech recognition abilities in an experimental study with young adults with normal hearing (NH). Span scores were strongly associated with each other, but were higher in the auditory modality. The results of the reviewed studies suggest that TRT and WM span are related to each other, but differ in their relationships with SRT performance. In NH adults of middle age or older, both TRT and Rspan were associated with SRTs in speech maskers, whereas TRT better predicted speech recognition in fluctuating nonspeech maskers. The associations with SRTs in steady-state noise were inconclusive for both measures. WM span was positively related to benefit from contextual information in speech recognition, but better TRTs related to less interference from unrelated cues. Data for individuals with impaired hearing are limited, but larger WM span seems to give a general advantage in various listening situations.

Results: SRTs and TRTs were well associated, also when controlling for age. Correlations for the SRTSTAT were generally lower than for the SRTMOD. The cognitive tests were correlated to the SRTs only when age was not controlled for. Age and the TRTs were the only significant predictors of SRTMOD. SRTSTAT was predicted by level of education and some of the TRT versions.Conclusions: TRTs and SRTs are robustly associated, nearly independent of age. The association between SRTs and RSpan is largely age dependent. The TRT test and the RSpan test measure different nonauditory components of linguistic processing relevant for speech perception in noise.

With increasing age, the risk of developing chronic health conditions also increases, and many older people suffer from multiple co-existing health conditions, i.e., multimorbidity. One common health condition at older age is hearing loss (HL). The current article reflects on the implications for audiological care, when HL is one of several health conditions in a multimorbidity. An overview of health conditions often co-existing with HL, so called comorbidities, is provided, including indications for the strength of the associations. The overview is based on a literature study examining cohort studies that were published in the years 2010-2018 and examined associations of hearing loss with other health conditions, namely Visual impairment, Mobility restrictions, Cognitive impairment, Psychosocial health problems, Diabetes, Cardiovascular diseases, Stroke, Arthritis, and Cancer. This selection was based on previous publications on common chronic health conditions at older age and comorbidities of hearing loss. For all of these health conditions, it was found that prevalence is larger in people with a HL and several longitudinal studies also found increased incident rates in people with a HL. The examined publications provide little information on how hearing loss should be managed in the clinical care of its comorbidities and vice versa. The current article discusses several options for adaptations of current care. Nonetheless, solutions for an integrated audiology care model targeting HL in a multimorbidity are still lacking and should be subject to future research.

Listening effort has been recognized as an important dimension of everyday listening, especially with regard to the comprehension of spoken language. At constant levels of comprehension performance, the level of effort exerted and perceived during listening can differ considerably across listeners and situations. In this article, listening effort is used as an umbrella term for two different types of effort that can arise during listening. One of these types is processing effort, which is used to denote the utilization of "extra" mental processing resources in listening conditions that are adverse for an individual. A conceptual description is introduced how processing effort could be defined in terms of situational influences, the listener's auditory and cognitive resources, and the listener's personal state. Also, the proposed relationship between processing effort and subjectively perceived listening effort is discussed. Notably, previous research has shown that the availability of mental resources, as well as the ability to use them efficiently, changes over the course of adult aging. These common age-related changes in cognitive abilities and their neurocognitive organization are discussed in the context of the presented concept, especially regarding situations in which listening effort may be increased for older people.

LiSN-S outcomes were poorer for adults aged 65 years or older, even those with good audiograms, compared with younger adults and also compared with people up to the age of 60 years from a previous study. In the present study, regardless of the types of cues, auditory and cognitive interactions were reflected by the combined influences on LiSN-S outcomes of high-frequency hearing acuity and measures of linguistic and cognitive processing. The data also suggest a hierarchy in the deployment of processing resources, which would account for the observed shift from linguistic abilities in the younger group to general cognitive abilities in the older group.

Objectives: Auditory training (AT), which is active listening to various auditory stimuli, aims to improve auditory skills. There is evidence that AT can be used as a tool in auditory rehabilitation to improve speech perception and other auditory cognitive skills in individuals with hearing impairment. The present state-of-the-art review examines the effect of AT on communication abilities in individuals with hearing impairment. In particular, transfer of AT effects on performance in untrained speech perception tasks was evaluated. Design: PubMed, Medline, and Web of Science databases were searched using combinations of key words with restriction to the publication date from December 2012 until December 2018. The participant, intervention, control, outcome, and study design criteria were used for the inclusion of articles. Only studies comparing effects in an intervention group to a control group were considered. The target group included individuals with a mild to moderately severe hearing impairment, with and without hearing-aid experience. Out of 265 article abstracts reviewed, 16 met the predefined criteria and were taken for review. Results: The majority of studies that were included in this state of- the-art review report at least one outcome measure that shows an improvement in non-trained tasks after a period of intense AT. However, observed shortcomings are that a comparison between studies remains difficult as training benefits were assessed with various outcome measures. Also, the sustainability of training benefits was not investigated sufficiently. Conclusions: Recent evidence suggests that intensive auditory (-cognitive) training protocols are a valid tool to improve auditory communication skills. Individuals with hearing impairment seem to benefit the most using a combination of sensory rehabilitation with hearing aids and AT to enhance auditory rehabilitation. Long term benefits of AT are still not consistently observed and should be in the focus of future research.

This study examined verbal response times-that is, the duration from stimulus offset to voice onset-as a potential measure of cognitive load during conventional testing of speech-in-noise understanding. Response times were compared with a measure of perceived effort as assessed by listening effort scaling. Three listener groups differing in age and hearing status participated in the study. Testing was done at two target intelligibility levels (80%, 95%) and with two noise types (stationary and fluctuating). Verbal response times reflected effects of intelligibility level, noise type, and listener group. Response times were shorter for 95% compared with 80% target intelligibility, shorter for fluctuating compared with stationary noise, and shorter for young listeners compared with older listeners. Responses were also faster for the older listeners with near normal hearing compared with the older hearing-aid users. In contrast, subjective listening effort scaling predominantly revealed effects of target intelligibility level but did not show consistent noise-type or listener-group effects. These findings show that verbal response times and effort scalings tap into different domains of listening effort. Verbal response times can be easily assessed during conventional speech audiometry and have the potential to show effects beyond performance measures and subjective effort estimates.