5SThe Fifth Eriksholm Workshop on "Hearing Impairment and Cognitive Energy" was convened to develop a consensus among interdisciplinary experts about what is known on the topic, gaps in knowledge, the use of terminology, priorities for future research, and implications for practice. The general term cognitive energy was chosen to facilitate the broadest possible discussion of the topic. It goes back to Titchener (1908) who described the effects of attention on perception; he used the term psychic energy for the notion that limited mental resources can be flexibly allocated among perceptual and mental activities. The workshop focused on three main areas: (1) theories, models, concepts, definitions, and frameworks; (2) methods and measures; and (3) knowledge translation. We defined effort as the deliberate allocation of mental resources to overcome obstacles in goal pursuit when carrying out a task, with listening effort applying more specifically when tasks involve listening. We adapted Kahneman's seminal (1973) Capacity Model of Attention to listening and proposed a heuristically useful Framework for Understanding Effortful Listening (FUEL). Our FUEL incorporates the well-known relationship between cognitive demand and the supply of cognitive capacity that is the foundation of cognitive theories of attention. Our FUEL also incorporates a motivation dimension based on complementary theories of motivational intensity, adaptive gain control, and optimal performance, fatigue, and pleasure. Using a three-dimensional illustration, we highlight how listening effort depends not only on hearing difficulties and task demands but also on the listener's motivation to expend mental effort in the challenging situations of everyday life.

As perception improved, N1-P2 amplitude increased. These changes in waveform morphology are thought to reflect increases in neural synchrony as well as strengthened neural connections associated with improved speech perception. These findings suggest that the N1-P2 complex may have clinical applications as an objective physiologic correlate of speech-sound representation associated with speech-sound training.

Sensory abilities decline with age. More than 5% of the world's population, approximately 360 million people, have disabling hearing loss. In adults, disabling hearing loss is defined by thresholds greater than 40 dBHL in the better hearing ear.Hearing disability is an important issue in geriatric medicine because it is associated with numerous health issues, including accelerated cognitive decline, depression, increased risk of dementia, poorer balance, falls, hospitalizations, and early mortality. There are also social implications, such as reduced communication function, social isolation, loss of autonomy, impaired driving ability, and financial decline. Furthermore, the onset of hearing loss is gradual and subtle, first affecting the detection of high-pitched sounds and with difficulty understanding speech in noisy but not in quiet environments. Consequently, delays in recognizing and seeking help for hearing difficulties are common. Age-related hearing loss has no known cure, and technologies (hearing aids, cochlear implants, and assistive devices) improve thresholds but do not restore hearing to normal. Therefore, health care for persons with hearing loss and people within their communication circles requires education and counseling (e.g., increasing knowledge, changing attitudes, and reducing stigma), behavior change (e.g., adapting communication strategies), and environmental modifications (e.g., reducing noise). In this article, we consider the causes, consequences, and magnitude of hearing loss from a life-course perspective. We examine the concept of "hearing health," how to achieve it, and implications for policy and practice.

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Behavioral perceptual abilities and neurophysiologic changes observed after listening training can generalize to other stimuli not used in the training paradigm, thereby demonstrating behavioral “transfer of learning” and plasticity in underlying physiologic processes. Nine normal-hearing monolingual English-speaking adults were trained to identify a prevoiced labial stop sound (one that is not used phonemically in the English language). After training, the subjects were asked to discriminate and identify a prevoiced alveolar stop. Mismatch negativity cortical evoked responses (MMN) were recorded to both labial and alveolar stimuli before and after training. Behavioral performance and MMNs also were evaluated in an age-matched control group that did not receive training. Listening training improved the experimental group’s ability to discriminate and identify an unfamiliar VOT contrast. That enhanced ability transferred from one place of articulation (labial) to another (alveolar). The behavioral training effects were reflected in the MMN, which showed an increase in duration and area when elicited by the training stimuli as well as a decrease in onset latency when elicited by the transfer stimuli. Interestingly, changes in the MMN were largest over the left hemisphere. The results demonstrate that training can generalize to listening situations beyond those used in training sessions, and that the preattentive central neurophysiology underlying perceptual learning are altered through auditory training.

Speech-evoked auditory event-related potentials (ERPs) provide insight into the neural mechanisms underlying speech processing. For this reason, ERPs are of great value to hearing scientists and audiologists. This article will provide an overview of ERPs frequently used to examine the processing of speech and other sound stimuli. These ERPs include the P1-N1-P2 complex, acoustic change complex, mismatch negativity, and P3 responses. In addition, we focus on the application of these speech-evoked potentials for the assessment of (1) the effects of hearing loss on the neural encoding of speech allowing for behavioral detection and discrimination; (2) improvements in the neural processing of speech with amplification (hearing aids, cochlear implants); and (3) the impact of auditory training on the neural processing of speech. Studies in these three areas are reviewed and implications for audiologists are discussed.

A passively elicited cortical potential that reflects the brain's discrimination of small acoustic contrasts was measured in response to two slightly different speech stimuli in adult human subjects. Behavioral training in the discrimination of those speech stimuli resulted in a significant change in the duration and magnitude of the cortical potential. The results demonstrate that listening training can change the neurophysiologic responses of the central auditory system to just-perceptible differences in speech.

Older adults often have difficulty understanding speech in a noisy environment or with multiple speakers. In such situations, binaural hearing improves the signal-to-noise ratio. How does this binaural advantage change with increasing age? Using magnetoencephalography, we recorded cortical activity evoked by changes in interaural phase differences of amplitude-modulated tones. These responses occurred for frequencies up to 1225 Hz in young subjects but only up to 940 Hz in middle-aged and 760 Hz in older adults. Behavioral thresholds also decreased with increasing age but were more variable, likely because some older adults make effective use of compensatory mechanisms. The reduced frequency range for binaural hearing became significant in middle age, before decline in hearing sensation and the morphology of cortical responses, which became apparent only in the older subjects. This study provides evidence from human physiological data for the early onset of biological aging in binaural hearing.