Objectives: Adults with hearing loss (HL) may experience stigma, which can reduce help-seeking and may contribute to social isolation and psychological distress. Perceptions of HL and hearing devices vary across cultural contexts, underscoring the importance of examining cultural influences on stigma. The primary aim of this cross-sectional, online survey study was to examine differences in public stigma (negative societal beliefs regarding HL and hearing devices), self-stigma (internalization of these beliefs), and affiliate stigma (stigma experienced by individuals associated with someone with HL, such as family members, referred to as “affiliates”) across ethnic groups living in the United Kingdom. The secondary aim was to explore whether acculturation indicators (e.g., duration of stay in the United Kingdom, generational status determined using participants’ and their parents’ country of birth, and languages spoken at home) were associated with stigma perceptions. It was hypothesized that stigma perceptions would vary across (1) ethnic groups and (2) acculturation indicators. Design: Participants completed an online survey assessing stigma related to HL and hearing devices using validated questionnaires. The survey was designed to include individuals with and without HL, as well as affiliates. All items were rated on 5-point Likert scales ranging from “strongly disagree” to “strongly agree.” The final sample comprised 385 individuals: 256 with self-reported HL, 107 without HL, and 22 who were unsure. Participants were grouped into three ethnic categories, with 164 identifying as Black, 100 as South Asian, and 121 as White. Hierarchical regression analyses were used to examine whether ethnicity and acculturation indicators predicted public, self-, and affiliate stigma while controlling for covariates (age, gender, education level, hearing status). Results: Ethnicity was a significant predictor of public stigma, with South Asian ( β = 9.97, p < 0.001) and Black ( β = 4.03, p = 0.001) participants having higher stigma scores than White participants. A similar pattern was observed for self-stigma, with higher scores among Black ( β = 8.71, p < 0.001) and South Asian ( β = 6.28, p = 0.017) participants. Generational status also predicted stigma. Compared with second-generation participants, immigrants and first-generation participants reported lower public stigma ( β = −6.98, p = 0.004; β = −4.05, p = 0.039) and self-stigma ( β = −6.97, p < 0.001; β = −5.63, p = 0.011). Affiliate stigma was not associated with ethnicity or acculturation indicators (all p > 0.05). Conclusions: Ethnicity and generational status were key predictors of public and self-stigma, highlighting the role of sociocultural context in shaping perceptions of HL and hearing aid use. This suggests that a uniform approach to addressing stigma may be inadequate, as experiences of stigma may differ across cultural and generational contexts. Future qualitative work is needed to better understand lived experiences of stigma within and between ethnic groups to ground the development of culturally responsive stigma-reduction interventions and patient education materials, with implications for both translational research and clinical practice.
Objectives: Understanding speech in noise and reverberation requires the integration of auditory, language, and cognitive abilities. Many children experience listening difficulties in such environments which, if persistent, can affect long-term academic outcomes. However, relative contributions of underlying processes remain poorly understood. This study investigated how nonspeech auditory processing, language and cognitive abilities contribute to phoneme identification and sentence understanding in noise in a representative sample of school-aged children. Design: The study included 221 primary school children aged 6 to 11 yr (88 boys, 133 girls), all with normal peripheral hearing. Participants completed measures of nonspeech auditory processing, phoneme identification, and sentence understanding in noise and reverberation, as well as language ability, attention, nonverbal intelligence, and memory. Using structural equation modeling enabled us to consider the influence of multiple predictors simultaneously. Results: A complex pattern of relationships emerged. Bottom-up nonspeech auditory processing supported phoneme identification, which in turn supported sentence understanding in noise. Language ability had a direct top-down influence on sentence understanding. Memory and intelligence contributed indirectly through their influence on language. Minimal associations were observed between cognition and nonspeech auditory processing, supporting a conceptual distinction between auditory and higher-level processes. Conclusions: The results show that bottom-up and top-down abilities make distinct contributions to listening and identify direct and indirect pathways underlying children’s listening in adverse conditions. Auditory processing contributed to phoneme perception, which in turn supported sentence understanding in noise. Language abilities exerted a strong independent influence to sentence understanding in noise, while nonverbal intelligence and memory affected performance only indirectly through language.
Objectives: Individuals who are being considered for cochlear implantation are assessed with tests of speech understanding to estimate hearing aid adequacy and, thus, cochlear implant (CI) candidacy. Lower scores suggest a CI may provide benefit, and specific thresholds (e.g., <60% correct responses) are established as criteria for CI. The influence of cognition on speech understanding is not considered in most CI clinics or in candidacy criteria, despite a scientific literature describing its importance for speech understanding when the signal is ambiguous (e.g., due to hearing loss or background noise). It is unclear if there is an upper limit of hearing loss (e.g., as determined by pure-tone threshold average [PTA]) beyond which the afferent signal does not provide enough information to facilitate cognitive processing for speech understanding. The objectives of the study were to determine, among adults presenting for CI candidacy assessment, the degree to which measures of executive function and memory are associated with performance on common tests of speech understanding used in CI clinics, and whether associations are larger in patients with lower (better) PTA. Design: Adult participants presenting for CI candidacy assessment at a tertiary referral center were recruited. An existing dementia diagnosis was an exclusion criterion. Participants underwent routine CI candidacy assessments. Cognition was assessed using the Brief Visuospatial Memory Test-Revised, the Mental Alternation Test, the Animal Fluency Test, semantic fluency tests, and the Stroop test. Tests of speech understanding included the AzBio sentence test (in noise and quiet) and the consonant-nucleus-consonant word test (in quiet). Associations between cognition and speech understanding were determined using multivariable linear regression, adjusting for age, sex, deafness duration, and PTA. Multiplicative interaction terms were used to test for interactions between cognitive variables and PTA. Results: There were 64 participants in total (PTA range 70 to 120+ dB HL). Multivariable regression results were as follows: Mental Alternation Test was associated with AzBio sentence-in-noise performance for individuals with PTA <92 dB HL and with AzBio sentence-in-quiet performance for individuals with PTA <87 dB HL. Brief Visuospatial Memory Test-Revised was associated with consonant-nucleus-consonant for individuals with PTA <100 dB HL (all associations in the expected direction). Conclusions: Measures of memory and executive function were positively associated with speech understanding among potential CI candidates with better hearing (i.e., PTA <87 to 100 dB HL, depending on the speech test). The results suggest that speech understanding scores are a function of both the adequacy of the afferent signal and cognitive processing among CI candidates with better PTA.
Objectives: Children with mild bilateral hearing loss (CHL), defined as having thresholds between 20 and 40 dB HL, experience difficulties conversing in adverse acoustic conditions with background noise, despite having near-normal speech perception in quiet. Mixed evidence of hearing aid benefit among CHL has led to guidelines that emphasize individualized management, making it challenging for clinicians to suggest intervention options. The overarching goal of this study was to investigate the influence of suprathreshold neural processing on speech perception in noise and how it is influenced by amplification. We focused primarily on auditory temporal and spectral processing, the two main predictors of speech perception in noise among adults with hearing loss. Design: In 11 neurotypical CHL (6- to 14-yr-old) and 28 age-matched neurotypical children with normal hearing (CNH), the signal to noise ratio required to achieve 70% accuracy on a speech perception in noise task was tracked using a spatial release from masking paradigm. Across three conditions, target words were presented from a front loudspeaker (0°), while noise (2-talker babble) was presented either from the same front loudspeaker or from the left or right loudspeaker (±45° azimuth), with a copy of the noise being presented from the front loudspeaker 3-msec later from the lead noise to simulate spatial separation between the target words and noise. Neural sensitivity to spectral and temporal modulations was assessed objectively using functional near-infrared spectroscopy (fNIRS). The fNIRS responses were recorded in the bilateral frontotemporal area, when children listened to broadband noise that was unprocessed (reference), amplitude-modulated at 4 Hz, or spectrally modulated with spectral ripple noise. Results: CNH and CHL, whether unaided or aided, benefited similarly from the spatial separation between noise and target speech. Aiding neither enhanced nor deteriorated the benefit of spatial release from masking. fNIRS measures in aided CHL showed increased cortical activation to the temporal and spectral modulations in the temporal cortex (TC) compared to both unaided conditions and CNH. Higher aided than unaided cortical activity in the TC likely reflects enhanced sensitivity to speech-relevant acoustic features with amplification. Further, in CHL, lower cortical activity to temporal modulation in the right frontotemporal cortex and higher activity to spectral modulation in the left TC were associated with lower signal to noise ratio required to achieve 70% accuracy. The associations likely reflect region-specific and cue-specific contributions to speech perception in noise among CHL. No associations were found in CNH. Conclusions: Our study highlights the value of hearing aid fitting in improving speech-in-noise outcomes in CHL. While behavioral benefits may be subtle or inconsistent, cortical data revealed enhancement in auditory processing with amplification, particularly in the TC. Our findings suggest that suprathreshold neural processing underlies the variation in speech perception in noise among CHL.
Objectives: This study proposes a new method for detecting cortical responses to formant frequency changes using the auditory change complex (ACC). These can be used as a proxy for discrimination performance between spectral characteristics of vowels. Design: We generated two sets of vowel-like stimuli, each of which contained four sinusoids with carrier frequencies chosen to correspond to the first three formants of the vowels/u/ and/i/, respectively. During EEG recordings, the second formant ( F 2) frequency changed in different step sizes to evoke an ACC response. We collected responses for both a hearing-impaired group (10 participants) and a control group with normal hearing (9 participants) and furthermore compared these to a behavioral measure of formant frequency discrimination. Results: The size of the change in the frequency of the F 2 formant, as well as the presence of hearing impairment, significantly affected the ACC response. Larger frequency changes produced larger ACC response amplitudes, specifically for the/u/ stimuli with more lower-frequency content. Responses tended to be lower overall for the hearing-impaired participants. Moreover, the ACC magnitude was correlated with behavioral formant discrimination thresholds. Conclusions: Taken altogether, these results lend support to the use of an ACC paradigm to assess frequency discrimination abilities objectively with speech-like stimuli. This study shows reliable responses as well as correlation with behavioral discrimination, which highlight the paradigm’s potential suitability for clinical purposes.
