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Birgitta Larsby

*
Mathias Ha ¨ llgren*
Bjo ¨ rn Lyxell
$
Stig Arlinger*
*Division of Technical Audiology,
Department of Neuroscience and
Locomotion, Sweden
$
Department of Behavioural Sciences,
Linko¨ ping University, Linko¨ ping,
Sweden
Key Words
Speech processing
Cognitive tests
Perceived effort
Hearing
Age
Noise
Audio-visual contribution
Original Article
International Journal of Audiology 2005; 44:131Á/143
Cognitive performance and perceived effort in
speech processing tasks: Effects of different
noise backgrounds in normal-hearing and
hearing-impaired subjects
Desempen˜ o cognitivo y percepcio´ n del esfuerzo en
tareas de procesamiento del lenguaje: Efectos de las
diferentes condiciones de fondo en sujetos normales e
hipoacu´ sicos
Abstract
Cognitive tests of speech understanding were adminis-
tered (presented as text, or in auditory or audiovisual
modality) and perceived effort was rated. This was done
in four background conditions: in silence, and in three
types of noise (S/N//10 dB) varying in temporal
structure and meaningfulness. Four groups of 12 subjects
each (young/elderly with normal hearing and young/
elderly with hearing impairment) participated. The pre-
sence of noise had a negative effect on accuracy and speed
of performance in the speech processing tasks, and
resulted in higher scores of perceived effort, even when
the stimuli were presented as text. Differences in perfor-
mance between noise conditions existed. In the subjective
scores, the noise with temporal variations, but without
meaningful content, was the most disruptive of the three
noise conditions. In the objective scores, the hearing-
impaired subjects showed poorer results in noise with
temporal variations. The elderly subjects were more
distracted by noise with temporal variations, and espe-
cially by noise with meaningful content. In noise, all
subjects, particularly those with impaired hearing, were
more dependent upon visual cues than in the quiet
condition.
Sumario
Se realizaron pruebas cognitivas sobre la comprensio´ n del
lenguaje, presentadas como texto, o en una modalidad
auditiva o audiovisual, y se obtuvieron puntuaciones de
la percepcio´ n del esfuerzo, tanto en silencio como en tres
tipos de ruido (S/N//10 dB), variando la estructura
temporal y el significado. Participaron cuatro grupos de
12 sujetos cada uno, integrados por jo´venes/ancianos con
audicio´n normal y jo´venes/ancianos con trastorno audi-
tivo. La presencia de ruido tuvo un efecto negativo sobre
la exactitud y la velocidad de desempen˜ o en las tareas de
procesamiento del habla, y generaron puntuaciones ma´s
altos en la percepcio´ n del esfuerzo, au´ n cuando los
estı ´mulos fueron presentados como texto. Existio´ difer-
encia en el desempen˜ o entre las condiciones ruidosas. En
las puntuaciones subjetivas, el ruido con variaciones
temporales pero sin contenido significativo fue la ma´s
perturbante de las tres condiciones ruidosas. En las
puntuaciones objetivas, los sujetos hipoacu´ sicos mostrar-
on resultados ma´s pobres en ruidos con variaciones
temporales. Los sujetos ancianos se distrajeron ma´s con
ruidos con variaciones temporales, y especialmente con
ruidos con contenido significativo. Con ruido, todos los
sujetos, particularmente aquellos con trastornos auditi-
vos, fueron ma´s dependientes de las claves visuales, que en
condicio´ n silenciosa.
In the complex process of speech understanding, the listener
depends on peripheral hearing, as well as on central auditory
and cognitive functions. Several studies have shown the im-
portance of cognitive skills in speech processing tasks (Lyxell
et al, 2003; Pichora-Fuller, 2003; Lunner, 2003). Working
memory capacity, speed of verbal information processing, and
phonological skills are cognitive components that are critical.
For speech processing in noise, these cognitive functions are
likely to be especially important since the noise partly masks the
speech signal.
The effect of noise on cognitive performance has been studied
earlier. For example, several studies assessing effects on short
term memory performance, showed loss of efficiency in serial
recall tasks when noise was presented to the test subjects (Jones,
1999; Macken et al, 1999; Tremblay et al, 2000; Murphy et al,
2000). Negative effects of noise on working memory capacity,
(i.e. the ability to simultaneously store and process information
over a short period of time) have also been reported (e.g.,
Pichora-Fuller et al, 1995). Our own studies of normal-hearing
and hearing-impaired subjects have shown that processing
of information is slower in noisy environments (Ha¨llgren et al,
2001b). Long-term memory performance and learning of
new material also suffers during noise exposure, even if
identification of speech sounds is as effective with as without
noise (Surprenant, 1999; Evans & Bullinger, 1998). Listening to
speech in noise requires more cognitive resources, and puts
higher demands on topÁ/down driven processing to restore the
distorted sensory signal. It is thus likely that listening in noise
ISSN 1499-2027 print/ISSN 1708-8186 online
DOI: 10.1080/14992020500057244
# 2005 British Society of Audiology, International
Society of Audiology, and Nordic Audiological Society
Birgitta Larsby
Department of Neuroscience and Locomotion Division of Technical Audiology,
University Hospital, S-581 85 Linko¨ ping, Sweden
E-mail birgitta.larsby@inr.liu.se
Received:
January 19, 2004
Accepted:
May 24, 2004
requires more effort (Pichora-Fuller et al, 1995). The degree of
perceived effort required in performing various tasks in noise is a
measure that is important to consider when assessing the effect
of noise on auditory comprehension.
The disturbing sounds that we are exposed to in everyday life
are rarely random noise, but very often interfere with human
speech. Speech is special in many respects. It provides context
and conveys a meaningful message. It is thus likely that it
interferes more with a speech processing task than noise without
meaning. Studies have shown (Tun et al, 2002) that older people
especially have problems ignoring a competing signal with
context. Liberman & Mattingly (1985) have argued that speech
perception cannot entirely be explained by principles that apply
to sounds in general. According to Fodor (1983), it must also be
seen as a manifestation of biologically inborn and specialized
structures or modules that prevent listeners from hearing
speech as sounds in general. Several studies have shown
that the temporal characteristics of the masker significantly
affect the degree of speech interference, both in normal-hearing
and hearing-impaired subjects (e.g., Bacon et al, 1998; Gustafs-
son & Arlinger, 1994; Bronkhorst & Plomp, 1992; Hygge et al,
1992).
Many studies have reported that hearing-impaired persons
suffer from additional problems with speech understanding in
noise (e.g., Festen & Plomp, 1990; Hygge et al, 1992). Hearing-
impaired listeners need a better signal-to-noise ratio than
normal-hearing subjects to reach the same degree of speech
recognition. For example, Festen & Plomp (1990) repor-
ted a difference in speech recognition thresholds between
normal-hearing and hearing-impaired subjects that varied
from 4 dB in steady-state noise, to 10 dB for a single interfering
voice.
Cognitive functions are correlated with the ability to recognize
speech in noise (Lunner, 2003; Gatehouse et al, 2003). Some
cognitive skills important for speech understanding, such as
working memory capacity, speed of verbal information proces-
sing, selective attention, and phonological skills, decline with
increasing age in the later part of life (Ro¨ nnberg, 1990;
Wingfield, 1996; Ha¨llgren et al, 2001a; Ha¨llgren et al, 2001b;
Lindenberger, 2001). Thus the elderly person, especially the
elderly hearing-impaired person, has problems in meeting the
extra demands on cognitive processing imposed by the environ-
ment (CHABA, 1988). An elderly person may need a 5 dB more
favourable signal-to-noise ratio than a young person with a
comparable degree of hearing loss (Gustafsson & Arlinger,
1994).
A common complaint among hearing-impaired people is the
great effort required in order to be able to recognize speech in
noisy environments. Thus, in order to obtain a more complete
description of the negative effects of noise on speech recognition,
the assessment should include not only speech recognition
performance but also a measure of perceived degree of effort
to reach this performance.
The purpose of this study was to examine how different speech
or speech-like background noises, differing in temporal or
contextual characteristics, interfere with cognitive processes
important for speech understanding in normal-hearing, hear-
ing-impaired, young and elderly adult subjects. The effects were
measured in terms of these dependent variables: perceived effort,
accuracy, and processing speed.
Methods
Subjects
Four groups, each with 12 subjects, participated in the study:
. Young normal-hearing subjects (YNH), aged 22Á/37 years
(mean/29.5, SD/4.5) and with hearing threshold levels
5/20 dB HL in the range of 250Á/4000 Hz (Figure 1).
. Elderly subjects with hearing better than normal for their age
(ENH), aged 66Á/75 years (mean/69.0, SD/3.2). This group
was chosen from a randomly selected unscreened population
of subjects where audiometric data were available. From a
total of 35 subjects in the age range 65Á/75 years, the 12
subjects with the best PTA (mean of 500, 1000 and 2000 Hz)
values were selected for this study (Figure 1).
. Young hearing-impaired subjects (YHI), aged 25Á/38 years
(mean/30.3, SD/4.4), with sensorineural hearing losses of
mild-to-moderate degree, and with audiograms that match
those of the elderly hearing-impaired group as closely as
possible (Figure 1).
. Elderly hearing-impaired subjects (EHI), aged 67Á/73 years
(mean/70.7, SD/1.7) with gradually sloping, sensorineural
hearing losses of mild-to-moderate degree (Figure 1).
All participating subjects had normal or corrected vision, by
self report.
The subjects were paid a small amount (approx. 10t) for their
participation.
Test methods
A cognitive, text based, test battery for evaluation of skills
important for speech understanding has previously been devel-
oped (Ausmeel, 1988). This test battery has been modified and
further developed to present the stimuli not only as text on a
computer screen but also in the auditory or audiovisual
modalities (SVIPS-Speech and Visual Information Processing
System, Ha¨llgren et al, 2001b). The SVIPS test battery allows us
to assess both accuracy (percent correct answers) and processing
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Figure 1. Mean hearing threshold levels (9/1 SD) for the
participating groups for right and left ears, respectively.
132 International Journal of Audiology, Volume 44 Number 3
speed, providing a detailed picture of the involvement of the
individual’s cognitive skills in processing of spoken stimuli. The
SVIPS tests are summarized below.
Tests of verbal information-processing
. Semantic decision-making. The subject’s task was to decide
whether a word belonged to a certain pre-defined semantic
category or not (cf. Shoben, 1982). The four categories, each
comprising eight items, were ‘‘colours’’, ‘‘occupations’’, ‘‘dis-
eases’’, and ‘‘parts of the body’’.
. Lexical decision-making. The subject’s task was to judge
whether a combination of three letters was a real word or a
non-word. Half of the items were real words and the other
half were not (30 items in total). The real words used in the
present test were all familiar Swedish words according to
Alle´n (1970).
. Name matching. The subject’s task was to judge whether two
presented letters were the same (e.g., AÁ/A) or not (AÁ/B). Ten
test items were presented.
Modalities of presentation
The tests were presented in three different modalities:
a. In a text-based version, the stimuli were presented as text on
a computer screen.
b. In an auditory version, the stimuli were presented acousti-
cally, via a frontally located loudspeaker at a distance of
approximately 1 m in a sound field.
c. In an audiovisual version, the stimuli were presented
acoustically via a loudspeaker, and simultaneously the face
of the speaker was visible on a computer screen, located
immediately below the loudspeaker.
Rating perceived effort during listening
Immediately after each test, the subjects were asked to rate the
degree of perceived effort during performance of the tasks, in all
background noise conditions in the different modalities. A
version of Borg’s CR-10 scale (Borg, 1990) was used. This scale
was primarily developed for registration of perception of
exertion in physical work but has also been used in the field of
hearing research to score ‘‘the perceived normal sound level at
work’’ for rock/jazz musicians (Ka¨ha¨ri, 2002). This scale is a
combination of ratio and category scaling where verbal expres-
sions and numbers are used congruently on a scale ranging from
0 (none at all) to 10 (extremely great). If the experience was
larger, the subject was allowed to use greater numbers. The
subject was given the scale on a sheet of paper, and asked to
indicate a number corresponding to the degree of effort
perceived during the listening task.
Background conditions
All tests were performed in the following four background
conditions (Figure 2):
1. ICRA noise. These are artificial multi-band random noise
signals with speech-like spectral and temporal characteristics
(Dreschler et al, 2001). The noise was included with the
intention of having characteristics of ordinary speech except
for meaningful content. Test signal 4 on the ICRA CD,
corresponding to one female voice speaking at normal vocal
output, was used in this study.
2. Hagerman’s noise (HN). This is a computer generated noise
using digital samples of Hagerman’s original 5 word
sentences read by a female speaker (Hagerman, 1982). The
noise is slightly amplitude-modulated to simulate the ampli-
tude variations in speech babble (Hagerman 2002: 1982).
3. Speech. The voice of a female speaker reading a continuous
story from the novel ‘Nils Holgerssons underbara resa
genom Sverige’ (The Wonderful Adventures of Nils) by
Selma Lagerlo¨ f.
4. No noise.
Test procedure
The subject was seated in a sound-isolated chamber. The tests
were performed with an application developed for PC, with a
screen-card for two screens connected to the same computer.
This allowed the experimenter to control the tests from outside
the chamber. The equipment in the test room included a
computer screen, a loudspeaker, and response buttons. The
Figure 2. Waveforms of the three noise distracters.
Cognitive performance and perceived effort
in speech processing tasks: Effects of differ-
ent noise backgrounds in normal-hearing
and hearing-impaired subjects
Larsby/Ha ¨ llgren/Lyxell/Arlinger 133
subject pressed predefined response buttons for ‘‘yes’’ and for
‘‘no’’. The participants were informed that reaction times were
measured, and instructed to press the response button as soon as
possible. Reaction time was recorded automatically by the
computer. The acoustic signal was generated by the soundcard,
and fed via an audiometer to the loudspeaker in front of the
subject at a distance of one meter. The sound level of the stimuli
was 75 dB SPL (C-weighted equivalent level) as standard, but
was adjusted to a higher level if practice stimuli, taken from the
SVIPS tests, were not correctly repeated. The aim was to present
the test items at a level which provided optimum speech
recognition in quiet. All tests were carried out without hearing
aids, although all subjects in the hearing-impaired groups were
experienced hearing aid users. The visual information was
presented via a computer monitor located one meter in front
of the subject just below the loudspeaker. The text (font Arial)
was 12 mm high and centred on the screen. The speaker’s face
was 70 mm high.
The auditory and audiovisual stimuli were presented as
digitized movies (MPEG-format) showing the speaker’s face
and shoulders. The test items were preceded by two seconds of
silence and followed by four seconds of silence.
The tests were performed in two sessions of about 90 minutes
each, with at least one week in between. At the first session,
pure-tone audiometry (125Á/8000 Hz) was performed, followed
by the SVIPS battery for two out of the four noise conditions
(ICRA, HN, Speech and No noise). At the second session, the
SVIPS battery for the remaining two noise conditions was
performed. The order between the four noise conditions was
balanced between the subjects. All noises were equalized to the
same C-weighted equivalent level. A signal-to-noise ratio of /10
dB was used in the auditory and audiovisual modalities. The
same noise level was used in the text modality. The order in
which the text, auditory, and audiovisual versions were per-
formed, was balanced between the subjects and was the same for
each subject at the four noise conditions. The only difference
between the auditory and the audiovisual condition was that
the face was visible in the audiovisual condition. Therefore,
the stimuli were balanced across these test-conditions; that is,
half of the stimuli were presented in the auditory condition for
half of the subjects, and in the audiovisual condition for the
other half of the subjects, and vice versa. The order of the SVIPS
tests was the same in all modalities and for all subjects, namely
semantic decision-making, lexical decision-making, and name
matching.
In each modality and noise condition, after completing
the SVIPS tests, the subject was asked to rate the degree of
perceived effort by giving a numerical value on the Borg
scale corresponding to the perceived effort during the listening
task.
Statistics
Pure-tone hearing threshold levels were entered into an ANOVA
to evaluate differences between subject groups. ANOVA was
carried out with test results in the SVIPS tests (accuracy or
average reaction time for each subject and test) as dependent
variables. Only interactions including background condition are
considered in the Results and Discussion sections. Since ceiling
effects were present in accuracy measurements, an arcsin-
transformation was carried out to avoid dependence between
means and standard deviations. The transformed values were
used in the ANOVA, while the raw scores are shown in the
figures. ANOVA was also carried out with the perceived effort
ratings as dependent variables. A p-level of 0.05 was considered
statistically significant throughout. P-levels smaller than 0.001
are listed as pB/0.001, and for p-values above 0.001 exact
p-values are used.
Results
In the results section, the hearing threshold levels for the four
participating groups are analysed and compared first. Then, the
interference of noise with target stimuli presented in text
modality is given as a reference. The effect of noise on auditory
and audiovisual modalities is divided into two different analyses.
First, the general effects of noise are analysed by comparing
the no-noise condition with the mean of the different
noise conditions. Secondly, the differences between the noises
are presented in an analysis without the no-noise condition.
The effort perceived by the subjects to perform the tests, in
all background conditions and modalities, are presented last
in the results section. Mean values and standard deviations in
the various cognitive tests for all participating groups, in all
modalities and background conditions are presented in Table 1.
Perceived effort data for the cognitive tests taken together are
presented in Table 2.
Hearing thresholds
The average hearing threshold levels for the four groups are
presented in Figure 1. A four-way ANOVA was performed,
with age groups (young, elderly) and hearing status (normal-
hearing, hearing-impaired) as between-group factors; audio-
metric frequency (125, 250, 500, 1000, 2000, 3000, 4000, 6000
and 8000 Hz) and ear (left, right) as within-subject factors;
and hearing threshold level as the dependent variable. There
were significant main effects of age (pB/0.001), hearing status
(pB/0.001), and frequency (pB/0.001). The interaction between
age group and hearing status was significant (p/0.003) and post
hoc analysis showed that normal-hearing groups (young, elderly)
differed significantly in hearing threshold levels (pB/0.001),
while hearing-impaired groups (young, elderly) did not.
Text modality
A three-way ANOVAwas performed for each cognitive test with
age group (young, elderly) and hearing status (normal-hearing,
hearing-impaired) as between-group factors, background condi-
tion (ICRA, HN, Speech and No noise) as within-subject factor,
and percent correct answers and reaction time as dependent
variables, respectively.
ACCURACY
Results from ANOVA in the text modality with correct answers
as the dependent variable, showed only one significant main
effect, namely an effect of age in the semantic test (p/0.006).
The young group showed better performance (mean/97.9%)
than the elderly group (mean/94,3%). The only signifi-
cant interaction was between background condition and age
in the lexical test (p/0.007). Planned comparisons showed that
in the elderly group there was a significant decline in perfor-
mance in the ICRA noise compared to the other background
134 International Journal of Audiology, Volume 44 Number 3
Table 1. Mean values and standard deviations of accuracy and reaction time for the four subject groups in the different cognitive tests
Accuracy (%) Reaction time (ms)
Young NH Young HI Elderly NH Elderly HI Young NH Young HI Elderly NH Elderly HI
mean S.D. mean S.D. mean S.D. mean S.D. mean S.D. mean S.D. mean S.D. mean S.D.
no noise 91.8 5.6 91.9 8.0 92.2 5.3 90.5 8.2 673 88 782 143 826 186 967 169
Text
ICRA 92.8 7.5 93.9 7.9 89.8 5.7 84.4 20.7 749 149 763 130 794 168 929 172
HN 90.9 4.8 91.3 7.9 93.0 3.9 91.4 6.5 670 110 785 169 810 162 903 145
speech 91.8 5.0 89.6 13.0 93.1 4.5 88.7 8.2 691 103 779 196 847 151 920 115
no noise 91.2 4.8 69.6 15.4 92.8 7.1 67.7 14.2 1222 111 1769 290 1375 153 1742 157
Lexical
Auditory
ICRA 88.5 7.5 60.3 15.0 78.4 10.8 56.5 11.1 1378 144 1887 340 1493 114 1746 353
test
HN 77.9 6.4 65.2 11.6 76.8 8.4 55.5 7.5 1300 165 1688 247 1444 205 1804 166
speech 81.7 8.5 61.0 10.4 79.5 9.6 53.9 17.4 1265 125 1764 247 1535 144 1660 264
no noise 87.8 4.5 80.6 6.5 91.3 3.6 78.9 10.6 1298 123 1688 200 1481 147 1734 157
Audiovisual
ICRA 84.3 5.5 75.0 8.7 82.9 7.2 73.5 10.2 1400 176 1735 293 1573 88 1824 143
HN 90.7 5.1 74.8 9.6 88.7 8.5 65.7 12.8 1471 150 1755 246 1620 172 1882 154
speech 88.4 5.5 76.3 13.0 87.4 7.2 69.5 13.9 1471 151 1803 197 1695 139 1811 257
no noise 97.6 4.3 98.7 2.1 97.2 2.8 94.5 12.2 573 72 648 126 706 107 791 116
Text
ICRA 97.4 2.6 98.0 2.7 95.7 5.6 92.2 11.6 629 137 696 148 701 78 759 85
HN 98.5 2.0 97.6 2.5 96.9 3.6 92.7 8.6 585 91 645 102 726 94 746 84
speech 97.4 6.3 97.9 3.3 95.6 4.9 87.1 13.7 559 65 656 126 725 90 830 156
no noise 99.5 1.8 92.6 4.3 99.3 1.9 86.1 14.4 991 121 1408 320 1148 79 1393 211
Semantic
Auditory
ICRA 97.3 3.4 87.6 10.1 96.3 5.2 77.5 21.4 1145 137 1627 418 1248 102 1660 292
test
HN 95.3 6.2 85.5 7.1 91.9 5.5 80.2 14.1 1082 152 1500 333 1180 106 1513 157
speech 94.7 5.9 82.8 9.1 88.7 6.1 73.2 15.3 1048 139 1591 378 1236 77 1594 239
no noise 96.5 4.0 94.6 5.0 93.3 5.6 84.5 17.0 1107 136 1441 274 1246 90 1525 297
Audiovisual
ICRA 95.8 4.3 90.5 8.1 89.0 6.8 80.7 19.3 1216 137 1528 244 1309 106 1497 196
HN 96.8 3.0 94.4 6.9 96.8 3.9 86.6 16.2 1217 130 1493 264 1364 85 1529 138
speech 98.5 2.0 93.3 6.5 94.2 4.8 79.2 22.5 1205 142 1510 258 1402 77 1553 112
no noise 95.0 6.7 95.0 6.7 95.8 5.1 89.6 14.7 544 84 610 125 631 101 760 184
Text
ICRA 99.2 2.9 96.4 5.0 97.5 4.5 93.5 8.2 566 86 581 88 642 114 706 133
HN 95.8 6.7 96.7 8.9 95.8 5.1 95.5 6.9 540 99 626 119 641 123 717 126
speech 98.3 3.9 96.7 6.5 95.0 6.7 90.3 14.7 542 82 583 95 666 99 712 96
no noise 98.2 4.3 83.4 13.2 94.8 8.3 73.5 15.3 1634 107 1967 244 1742 83 1971 246
Name
Auditory
ICRA 89.1 3.0 60.5 19.8 82.6 11.1 62.7 23.0 1725 82 1979 202 1808 101 1996 300
matching HN 93.3 6.5 78.8 17.9 85.8 5.1 77.5 17.8 1607 151 1795 130 1663 102 1850 153
test speech 90.0 10.4 79.0 11.4 84.6 11.2 71.2 18.5 1588 98 1975 227 1714 89 1848 226
no noise 100.0 0.0 90.1 17.1 97.5 6.2 94.4 13.5 1674 94 1892 175 1753 74 1867 191
Audiovisual
ICRA 96.7 6.5 86.0 12.7 94.2 6.7 83.2 15.9 1761 148 1925 184 1808 89 1903 100
HN 89.5 8.1 86.8 11.7 90.3 7.3 73.4 23.8 1810 104 2073 206 1925 95 2049 362
speech 89.7 6.4 82.6 13.5 86.9 11.7 78.3 16.2 1781 110 2061 183 1959 122 2050 287
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conditions together (p/0.046). This was not seen in the younger
group.
REACTION TIME
With reaction time as the dependent variable, there were
significant main effects of both age group and hearing status
in the lexical and the semantic tests, but only of age group in the
name matching test. The elderly subjects showed longer reaction
times than the young subjects (18.3% difference, averaged over
all tests, hearing-status groups and background conditions). The
hearing-impaired subjects showed longer reaction times than the
normal-hearing subjects (11.2% difference, averaged over the
lexical and semantic tests, age group and background condi-
tions). There were no significant interactions in the lexical and
name matching tests, but in the semantic test there was
an interaction between background condition and age group
(p/0.001), see Figure 3 showing that the effect of background
condition was different for the two age groups.
Auditory and audiovisual modalities
NOISE VS. NO NOISE
To study the differences between the no-noise and the noise
conditions (mean of ICRA, HN, and Speech) a four-way
ANOVA was performed with age group (young, elderly) and
hearing status (normal-hearing, hearing-impaired) as between-
group factors, modality (audiovisual, auditory) and background
condition (No noise, Noise) as within-subject factors, and
percent correct answers and reaction time as dependent vari-
ables, respectively.
ACCURACY
When noise was introduced, the average percent correct answers
decreased from 82.4% to 74.6% (mean of ICRA, HN, Speech) in
the lexical test, from 93.2 to 89.3% in the semantic test, and from
93.2 to 83.1% in the name matching test. This main effect of
background condition was significant (pB/0.001) in all cognitive
tests. An interaction was seen between background condition
h c e e p S N H A R C I e s i o n o N
n o i t i d n o c d n u o r g k c a B
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t s e t c i t n a m e S ) 1 0 0 . 0 < p (
g n u o Y
y l r e d l E
Figure 3. Mean reaction times (ms) in the different noise
conditions of the semantic test in the text modality. The
young subjects are represented by circles and the elderly by
squares.
n o i t i d n o c d n u o r g k c a B
e s i o N e s i o n o N
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Figure 4. Mean correct answers (%) in the no-noise and noise
condition for the young (m) and elderly (j) groups in the lexical
test.
Table 2. Mean values and standard deviations of perceived effort for the four subject groups in the cognitive tests
Perceived effort
Young NH Young HI Elderly NH Elderly HI
mean S.D. mean S.D. mean S.D. mean S.D.
no noise 1.66 1.31 1.51 1.75 2.04 1.85 2.28 2.02
Text
ICRA 2.44 2.38 2.78 1.96 2.38 1.91 1.90 1.41
HN 1.73 1.39 2.15 2.03 2.53 2.14 2.54 1.60
speech 2.08 1.60 2.11 2.43 2.38 1.91 2.71 2.10
no noise 2.13 1.54 4.33 2.39 2.56 2.09 4.71 2.29
Auditory
ICRA 4.75 1.70 7.75 3.42 5.18 2.70 8.17 2.41
HN 3.95 2.07 7.00 2.30 4.50 2.80 6.75 2.48
speech 4.08 1.35 7.50 2.85 4.50 2.58 6.42 2.61
no noise 1.59 1.47 3.45 2.14 2.17 1.63 2.92 1.51
Audiovisual
ICRA 4.00 2.02 5.29 2.92 3.43 2.53 5.00 2.39
HN 2.81 1.34 4.71 1.85 3.21 2.75 4.75 2.61
speech 3.58 1.46 4.71 2.78 3.42 2.24 4.88 2.67
136 International Journal of Audiology, Volume 44 Number 3
and age in the lexical test (p/0.006), see Figure 4. When noise
was introduced, the elderly subjects declined more than the
young subjects in performance. Interactions were also seen
between background condition and modality in the lexical and
semantic tests (pB/0.001). Thus, when noise was introduced, the
performance declined more in the auditory than in the audio-
visual modality, as exemplified in Figure 5A.
REACTION TIME
When noise was introduced, the mean reaction time increased
from 1539 to 1625 ms (mean of ICRA, HN, Speech) in the
lexical test (pB/0.001), from 1284 to 1388 ms in the semantic test
(pB/0.001), and from 1813 to 1861 ms in the name matching test
(p/0.011). There was a significant interaction between back-
ground condition and hearing status (p/0.012) in the lexical
test. When introducing noise, the reaction times for the normal-
hearing subjects increased more than for the hearing-impaired
subjects. Interactions were also seen between background
condition and modality in the lexical (p/0.021) and name
matching tests (pB/0.001). When noise was introduced, the
performance thus declined more in the audiovisual than in the
auditory modality, as exemplified in Figure 5B.
Differences between noises
To study the differences in interference between the three noises,
a four-way ANOVA was performed for each cognitive test. Age
group (young, elderly) and hearing status (normal-hearing,
hearing-impaired) were used as between-group factors; modality
(audiovisual, auditory) and noise condition (ICRA, HN, and
Speech) were used as within-subject factors; and percent correct
answers and reaction time were used as dependent variables,
respectively.
ACCURACY
Percent correct answers for main effects are shown in Figure 6,
for the three cognitive tests. Main effects of age group, hearing
status, and modality were seen in all cognitive tests. A main
effect of noise condition was seen in the semantic test only. The
0 6
5 6
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1 0 0 . 0
1 0 0 . 0
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. s . n
. s . n
y t i l a d o M e g A e s i o N g n i r a e H
Figure 6. Significant main effects of age, hearing status,
modality, and noise condition for correct answers in the lexical
("), semantic (j), and name matching test (').
e s i o N e s i o n o N
n o i t i d n o c d n u o r g k c a B
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t s e t l a c i x e L ) 1 0 0 . 0 < p ( t s e t l a c i x e L ) 1 2 0 . 0 = p (
V A
A
V A
A
Figure 5. Mean correct answers (%) in the no-noise and noise condition in the auditory (j) and audiovisual (m) modality (A) in the
lexical test. Corresponding results for the mean reaction times (B).
5 6
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c i t n a m e S ) 1 0 0 . 0 < p (
A R C I
N H
h c e e p S
g n i h c t a m e m a N ) 1 0 0 . 0 < p (
A R C I
N H
h c e e p S
V A
A
Figure 7. Mean correct answers (%) in the semantic and name
matching tests in the different noise conditions in the auditory
(j) and audiovisual (m) modalities.
Cognitive performance and perceived effort
in speech processing tasks: Effects of differ-
ent noise backgrounds in normal-hearing
and hearing-impaired subjects
Larsby/Ha ¨ llgren/Lyxell/Arlinger 137
young groups performed better than the elderly groups, the
normal-hearing subjects performed better than the hearing-
impaired subjects, and the performance was better in the
audiovisual modality than in the auditory. There were significant
interactions between noise condition and modality in the
semantic and name matching tests (pB/0.001). See Figure 7
and the Discussion section for more details.
REACTION TIME
With reaction time as the dependent variable, several main
effects were seen (Figure 8). These were: main effects of age
group in the lexical test, main effects of hearing status in all tests,
main effects of modality in the lexical and name matching tests,
and a main effect of noise condition in the semantic test. The
elderly groups showed longer reaction times than the young
groups, the hearing-impaired groups showed longer reaction
times than the normal-hearing groups, and reaction times were
longer in the audiovisual modality than in the auditory.
Interactions were seen between noise condition and modality
in the lexical (pB/0.001), semantic (p/0.006), and name
matching test (pB/0.001). See Figure 9 and Discussion section
for more details.
Perceived effort
A four-way design ANOVA was performed with age group
(young, elderly) and hearing status (normal-hearing, hearing-
impaired) as between-group factors; background condition
(ICRA, HN, Speech and No noise) and modality (text, auditory
and audiovisual) as within-subject factors; and the ratings of
perceived effort as the dependent variable.
The significant main effects of the ANOVA analysis are
seen in Figure 10. There were main effects of hearing status
(p/0.009), modality (pB/0.001), and noise condition (pB/
0.001), but not of age (p/0.693). The hearing-impaired subjects
perceived a higher degree of effort than the normal-hearing
subjects. The subjects rated the perceived effort highest in the
auditory modality followed by the audiovisual modality. The
0 0 2 1
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R
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Figure 8. Significant main effects of age, hearing status,
modality, and noise condition for reaction time in the lexical
("), semantic (j), and name matching test (').
0 0 3 1
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0 0 0 2
h c e e p S N H A R C I
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l a c i x e L ) 1 0 0 . 0 < p (
e m a N g n i h c t a m ) 1 0 0 . 0 < p (
c i t n a m e S ) 6 0 0 . 0 = p (
V A
V A
V A
A
A
A
e s i o N
Figure 9. Mean reaction times (ms) in the different cognitive
tests in the different noise conditions for the auditory (A) and
audiovisual (AV) modalities.
0 . 0
0 . 1
0 . 2
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o N V A A t x e T I H H N
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h c e e p S N H A R C I




R
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s
y t i l a d o M g n i r a e H n o i t i d n o c d n u o r g k c a B
9 0 0 . 0 1 0 0 . 0 1 0 0 . 0
Figure 10. Significant main effects of hearing status, modality,
and background condition for perceived effort ratings.
I H H N
g n i r a e H
0
1
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5
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t x e T
y r o t i d u A
l a u s i v o i d u A
Figure 11. Mean ratings of perceived effort for normal-hearing
and hearing-impaired subjects in the text (m), auditory (j), and
audiovisual (") modalities.
138 International Journal of Audiology, Volume 44 Number 3
least effort was perceived in the text modality. The test subjects
reported the lowest effort in the no-noise condition followed by
the Hagerman noise, the Speech background, and finally the
ICRA noise which was hardest to accept.
A significant interaction, as illustrated in Figure 11, was found
between modality and hearing status (pB/0.001). The effect of
modality was different for the normal-hearing and the hearing-
impaired subjects. Planned comparisons showed that the ratings
differed between hearing-status groups in the auditory (pB/
0.001) and audiovisual (p/0.021) modalities, but not in the
text modality (p/0.68).
There was a significant interaction between background
condition and modality (pB/0.001), illustrated in Figure 12.
The effect of noise on perceived effort was largest in the auditory
modality, smaller in the audiovisual modality, and smallest in the
text modality. To further study the differences between the no-
noise and the noise conditions (mean of ICRA, HN, and Speech)
in the text modality, a t-test was performed showing that there
was an effect of background condition (p/0.035). The average
rating was 2.32 in noise, and 1.87 without noise. It is noteworthy
that the negative effect of noise on perceived effort was present
even when stimuli were presented as text.
Discussion
The adverse effects of noise on man are multimodal (Passchier-
Vermeer & Passchier, 2000). There are many occasions when we
are disturbed by noise, which makes it more difficult and
strenuous to process and understand spoken information.
The interfering noise is often speech from other people. This
speech interferes with other spoken messages not only because
of masking, due to its physical characteristics, but also because
it carries a meaningful content. Previous studies have addressed
the effects of various noises on speech recognition, in the form
of signal-to-noise ratios required to reach a predefined level
of performance. This study focuses on effects of interfering
noises with different degrees of speech-like characteristics,
on cognitive abilities critical for speech processing. Except
for speech recognition, the tasks in the present study required
additional processing such as interpreting, categorizing,
and making decisions. The speed of processing was also
investigated.
In challenging listening situations, such as in noise, one has to
rely more on cognitive skills. Going from easy, automatic
sensory-driven processing to more difficult top-down processing
is likely to be strenuous (Pichora-Fuller, 2003; Pichora-Fuller
et al, 1995). The degree of effort one has to exert in difficult
speech understanding tasks when deprived of the full auditory
signal is a dimension that, to our knowledge, has not been
addressed previously. We therefore wanted to supplement the
objective measures of accuracy and speed of performance in the
SVIPS tests, with a subjective measure of the degree of effort
that the individual had to exert when performing the different
tasks. Indeed, this method for scoring perceived effort proved to
be sensitive enough to verify differences between the background
conditions, between hearing-status groups, and between mod-
alities.
Age and peripheral hearing
Both the young and the elderly groups of normal-hearing
and hearing-impaired subjects were properly matched according
to age. It is difficult to find elderly normal-hearing subjects
with the same hearing threshold levels as young subjects
(ISO 7029, 2000). Therefore, the normal-hearing groups
are not perfectly matched. In statistical terms, the hearing-
impaired groups show no significant differences in average
HTL’s (Figure 1). However, the fact that the average HTL’s in
the young hearing-impaired group are 10Á/20 dB better in the
high-frequency range is a confounding factor that cannot be
ignored in reality.
Text modality
PERFORMANCE
The results in accuracy in the text modality show no main effects
of hearing status and only one main effect of age (in the semantic
test), which agrees with previous results (Ha¨llgren et al, 2001b).
The well-known fact that the speed of performance in some
h c e e p S N H A R C I
E S I O N
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(
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I H
H N
Figure 13. Mean correct answers (%) in the different noises for
normal-hearing (j) and hearing-impaired (m) subjects in the
auditory modality.
h c e e p S N H A R C I e s i o n o N
n o i t i d n o c d n u o r g k c a B
0
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t r o f f e d e v i e c r e P ) 1 0 0 . 0 < p (
t x e T
y r o t o i d u A
l a u s i v o i d u A
Figure 12. Mean ratings of perceived effort in the different
background conditions for the text (m), auditory (j), and
audiovisual (") modalities.
Cognitive performance and perceived effort
in speech processing tasks: Effects of differ-
ent noise backgrounds in normal-hearing
and hearing-impaired subjects
Larsby/Ha ¨ llgren/Lyxell/Arlinger 139
cognitive functions decline with increasing age (Ro¨ nnberg, 1990;
Tun & Wingfield, 1999; Ha¨llgren et al, 2001b) is also replicated.
However, in this study, there is also a main effect of hearing
status when measuring reaction time, related to longer reaction
times for the hearing-impaired subjects. Different effects of the
various noises are shown by an interaction between noise and
age, where the elderly compared to the young showed a reduced
accuracy in the lexical test in the ICRA noise. In the reaction
time measure, planned comparisons showed a significant inter-
action between age (young, elderly) and noise (Speech, the
average of the noises without meaning, p/0.002). The elderly
need more time for processing in the background condition with
speech (Figure 3). This is in line with Tun et al (2002) who
showed that older adults, but not younger, were impaired more
by meaningful than by non-sense distracters.
PERCEIVED EFFORT
In the perceived effort scores in the text modality, no differences
between the background conditions were seen, but when
comparing no-noise with the mean of the three noises, there
was a significant effect of background condition. Despite the
fact that there was no auditory masking by the noise in the text
modality, the test subjects were affected by the noise and
perceived a higher degree of effort.
Auditory and audiovisual modalities
In the auditory and audiovisual modalities, disturbing noise
leads to both poorer performance and longer reaction times, and
it requires greater effort. This agrees with frequently reported
problems with speech perception and understanding in noise
(e.g., Pichora-Fuller et al, 1995; Ha¨llgren et al, 2001b).
Effect of hearing-status
PERFORMANCE
Hearing-impaired subjects, compared to normal-hearing subject,
have more problems when performing speech understanding
tasks, verified by the significant main effect of hearing status
(Figures 6 and 8). When studying differences between the noises,
there was a significant interaction between noise, modality,
and hearing (p/0.001). In the auditory modality, where there
was no visual input, the difference between hearing-impaired
and normal-hearing subjects was larger in the ICRA and
Speech background noise together, than in the Hagerman noise
(planned comp. p/0.024). That is, the hearing-impaired sub-
jects had more problems in noise with a high degree of temporal
variations (Figure 13). Bronkhorst and Plomp (1992) showed
by varying the number of interfering talkers, that listeners
with hearing loss performed significantly worse than normal-
hearing subjects, with larger differences between the groups
for one talker than for multi-talker babble. Festen & Plomp
(1990) and Hygge et al (1992) showed that the differences in
speech-recognition-threshold between hearing-impaired and
normal-hearing subjects increased, going from steady-state
noise to one interfering voice. It has been suggested by Moore
(1985) that impaired temporal and spectral resolution is a
major source for the problems experienced by hearing-impaired
subjects to understand speech in noise. The response of
the basilar membrane to sound in the healthy cochlea is sharply
tuned, highly non-linear, and compressive. In hearing-impaired
listeners, the response becomes broadly tuned and linear.
Oxenham and Bacon (2003) pointed out that a number of
aspects of temporal processing in hearing-impaired listen-
ers can be explained in terms of this loss of cochlear non-
linearity.
PERCEIVED EFFORT
Hearing-impaired subjects reported a higher degree of perceived
effort than normal-hearing subjects. This complements the
objective measure in the auditory and audiovisual modalities,
where the normal-hearing subjects performed better than the
hearing-impaired subjects. The interaction between hearing
status and modality (Figure 11) shows that the higher degree
of effort perceived by the hearing-impaired subjects was more
pronounced in the auditory modality, in a similar way to the
objective measures.
Since the hearing-impaired subjects in the present study were
experienced hearing aid users, and the testing was performed
without hearing aids, one can argue that some of the difference
between the groups can be due to the unusual test condition for
the hearing-impaired and not to the hearing impairment per se.
From the data in the present study, we can not conclude if, or to
what extent, this has influenced the results.
Effect of age
PERFORMANCE
The elderly group generally made more mistakes than the young
group in noise, and in the lexical test they were also slower
(Figures 6 and 8). In the lexical test, an interaction between
background condition (No noise, Noise) and age (Figure 4)
shows that the elderly subjects have relatively more problems
than the young subjects when noise interferes with the target
signal. This effect remains even when analysed with hearing
threshold level average (PTA4/mean of 500, 1000, 2000 and
4000 Hz) as covariate. It is well known that elderly people
compared to young people have additional difficulties in adverse
listening situations, such as noise (Schneider et al, 2002;
CHABA, 1988). The extra problems in noise for the elderly
subjects appeared in the most difficult test, the lexical test.
In this test, especially in the non-word category, there is
little redundancy in the auditory signal, which puts high
demands on both sensory and cognitive processing. Sommers
(1997) showed that older listeners compared to younger listeners
exhibited larger reductions in identification performance
for lexically difficult items, but not for easy items. In the
present study, the signal-to-noise ratio was /10 dB. At more
difficult signal-to-noise ratios, problems are likely to appear in
the other tests.
PERCEIVED EFFORT
It is noteworthy that the elderly subjects did not report a higher
degree of perceived effort than the young subjects, despite a
difference in the objective measures shown by poorer results and
longer reaction times. Pichora-Fuller (2003) has convincingly
argued that elderly subjects, due to their declining cognitive
ability and speed of processing, more often have to apply greater
effort when trying to understand speech. Such an age effect
might, however, be overridden by the fact that the elderly are less
prone to complain.
140 International Journal of Audiology, Volume 44 Number 3
Effect of visual contribution
PERFORMANCE
In challenging listening situations such as noisy environments,
the visual information contributes more to the performance than
in silence. This is shown by significant interactions between
background condition and modality in the lexical and semantic
test. The improved accuracy is sometimes at the expense of
increased response times. This is illustrated for the lexical test in
Figure 5, as an example. A possible explanation is that
additional visual information gives more accurate answers, but
is also more cognitively demanding, since extra visual informa-
tion has to be interpreted simultaneously or sequentially,
requiring more time. The effect of the visual contribution in
silence seen in the present study, and previously reported by
Ha¨llgren et al (2001b), is further accentuated in noise.
PERCEIVED EFFORT
The positive effect of the visual contribution on performance
was also mirrored in the subjective scores where the subjects
experienced less effort in the audiovisual modality. This effect
was most pronounced in noise (Figure 12).
Effects of background condition
PERFORMANCE
The effects of different noises on speech processing and
comprehension tasks are due to masking of the target stimuli,
as well as to distraction of the cognitive decision making. A
significant main effect from noise type (both in accuracy and
reaction time) was seen for the semantic test only (Figures 6 and
8). In the two noises with a high degree of temporal variations
(ICRA and Speech, Figure 2), the performance was poorer
(planned comp. p/0.013) and the reaction times longer
(planned comp. p/0.014) than in the Hagerman noise. These
main effects of noise appeared only in the semantic test, with test
items with a high degree of redundancy. Since the test items are
easy to perceive, it is likely that the worse performance is due to a
higher degree of distraction from the noises with more temporal
variations. Macken et al (1999) pointed out that the distractive
effect from noise on serial recall tasks depends on the temporal
pattern rather than on the content.
Even though this study found main effects of noise only in the
semantic test, there are differential effects of the various noises
on the different hearing-status groups and in the two modalities
(auditory/audiovisual). In the ICRA noise, there is no difference
between the audiovisual and auditory modality; whereas the
audiovisual modality always is more time consuming in the
Hagerman noise and Speech (Figure 9). This pattern is striking
and somewhat surprising. An explanation of the longer reaction
times in the auditory modality for the ICRA noise might be that
this noise is more disruptive, which is also supported by a higher
degree of perceived effort in the ICRA noise. The longer reaction
times seen when processing multiple inputs, that are normally
found in the audiovisual modality, are not seen with the ICRA
noise. This might be explained by the fact that processing is
dominated by one input channel. This theory is supported by the
accuracy results in the semantic test (Figure 13), where there is
no effect of the visual contribution in the ICRA noise. The fact
that the accuracy results in the name matching test in ICRA
noise are very poor in the auditory modality (Figure 7), might be
explained by the combination of difficult background noise and
short test items with low redundancy. However, in the audio-
visual modality the results in the ICRA noise improve drama-
tically. The letters in the name matching test are easy to lip-read;
and therefore it is likely that the subjects rely more on the visual
input signal. Girin et al (2001) showed, in normal-hearing
subjects, that it is possible to identify 20Á/30% of vowels and
consonants with visual input only.
The ICRA noise was intended to have all characteristics of
ordinary speech except the meaningful content. However, the
temporal variations differ from speech in the way that there are
generally fewer silent intervals of longer duration in the ICRA
noise (Dreschler et al, 2001), see Figure 2. This together with the
fact that the ICRA noise was experienced as very disturbing and
highly unrealistic for the test subjects, verified by the high degree
of perceived effort, motivated an analysis without the ICRA noise,
only comparing the Hagerman noise and the Speech background.
In the semantic test, there was a main effect of noise (p/
0.005): the subjects showed better results in the Hagerman noise
than in the Speech background. A significant interaction (p/
0.043) between noise and age shows that the young group
performed equally well in the two noise conditions, while the
elderly performed worse in speech background. The two noises
differ both in acoustical characteristics and in meaning. From
our data, when the ICRA noise is excluded, it is not possible to
separate the relative contribution from these two parameters.
Both models of explanation have been addressed in previous
studies. Snell et al (2002) showed that in adults with normal or
near-normal hearing, speech processing in fluctuating back-
grounds is affected by age and temporal processing. Older
listeners benefit less from listening in the gaps of a competing
voice (Duquesnoy, 1983). Tun et al (2002) showed that elderly
listeners in tests of recall of a target speech, were impaired more
by a meaningful distracter than young subjects. Thus, both
parameters (temporal characteristics and meaningfulness) are
likely to be involved.
PERCEIVED EFFORT
The effect of noise on perceived effort has many similarities with
the performance in SVIPS, both in accuracy and reaction time.
All the three noises included in this study made the tasks more
difficult, resulting in poorer objective performance as well as
higher scores of perceived effort. Differences between the noises
are seen in Figure 12, where the ICRA noise appears as the most
difficult to handle. This is most obvious in the auditory
modality, which agrees with the relatively longer reaction times
in this modality for the ICRA noise (Figure 9).
Assuming that a reported higher degree of effort corresponded
to more energy and concentration devoted to the tasks in the
test, this increased effort was insufficient to compensate for an
increased difficulty as seen in the poorer performance, which
usually correlated with a higher rating of effort.
The present study shows that there are both similarities and
differences between quantitative and subjective data. A measure
of perceived effort has shown to be a valuable tool to
complement the objective measure in the SVIPS tests. A dual
approach gives a more complete picture of the person’s ability
to handle difficult listening situations, such as listening to
speech in noise. It is also likely that hearing aid intervention
Cognitive performance and perceived effort
in speech processing tasks: Effects of differ-
ent noise backgrounds in normal-hearing
and hearing-impaired subjects
Larsby/Ha ¨ llgren/Lyxell/Arlinger 141
would benefit from a multimodal approach. For example,
Humes (1999) pointed out the importance of including a
measure of subjective listening effort when evaluating hearing
aid benefit.
Conclusions
It can be concluded from the present study, that interfering noise
at the relatively favourable signal-to-noise ratio of /10 dB still
has significant negative effects on performance in speech
processing tasks and perceived effort. Major findings in this
study were:
. Hearing-impaired subjects perform worse in noises with
temporal variations (ICRA and Speech), and report a higher
degree of perceived effort than normal-hearing subjects.
. Elderly subjects are more distracted by, and thereby per-
formed worse, in noise with temporal variations, and espe-
cially in noise with meaningful content. Elderly listeners do
not report a higher degree of effort than the young subjects.
. The visual information contributes more to the number of
correct answers in noise, corresponding to a lower degree of
perceived effort in the audiovisual compared to the auditory
modality.
. Performing cognitive processing tasks (SVIPS) in the text
modality, without masking in the auditory canal, still causes
a higher degree of perceived effort in noise than without
noise.
Acknowledgements
Thanks are due to The Swedish Association of Hard of Hearing
People (HRF) for generous support. Thanks are also due to
Inga-Stina Olsson and Lena Gustafsson for their work with the
test material and to Erica Billermark for performing the tests.
We extend a special thanks to all the subjects who participated in
the study.
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