J Am Acad Audiol 25:859-868 (2014)

The Impact of Different Background Noises: Effects

on Cognitive Performance and Perceived Disturbance
in Employees with Aided Hearing Impairment
and Normal Hearing
DOI: 10.3766/jaaa.25.9.8

Hakan Hua*t
Magnus Emilsson*f
Kim Kahari:j:
Stephen Widen*§
Claes Moller*§**
Bjorn Lyxell*f

Abstract

Background: Health care professionals frequently meet employees with hearing impairment (HI) who
experience difficulties at work. There are indications that the majority of these difficulties might be related
to the presence of background noise. Moreover, research has also shown that high-level noise has a
more detrimental effect on cognitive performance and self-rated disturbance in individuals with HI than
low-level noise.

Purpose: The purpose of this study was to examine the impact of different types of background noise on
cognitive performance and perceived disturbance (PD) in employees with aided HI and normal hearing.

Research Design: A mixed factorial design was conducted to examine the effect of noise in four exper­
imental conditions.

Study Sample: A total of 40 participants (21 men and 19 women) were recruited to take part in the study.
The study sample consisted of employees with HI (n = 20) and normal hearing (n = 20). The group with
Hi had a mild-moderate sensorineural HI, and they were all frequent hearing-aid users.

Intervention: The current study was conducted by using four general work-related tasks (mental arith­
metic, orthographic decoding, phonological decoding, and serial recall) in four different background con­
ditions: (1) quiet, (2) office noise at 56 dBA, (3) daycare noise at 73.5 dBA, and (4) traffic noise at 72.5
dBA. Reaction time and the proportion of correct answers in the working tasks were used as outcome
measures of cognitive performance. The Borg CR-10 scale was used to assess PD.

Data Collection and Analysis: Data collection occurred on two separate sessions, completed within
4 wk of each other. All tasks and experimental conditions were used in a counterbalanced order.
Two-way analysis of variance with repeated measures was performed to analyze the results. To examine
interaction effects, pairwise f-tests were used. Pearson correlation coefficients between reaction time
and proportion of correct answers, and cognitive performance and PD were also calculated to examine
the possible correlation between the different variables.

Results: No significant between-group or within-group differences in cognitive performance were

observed across the four background conditions. Ratings of PD showed that both groups rated PD
according to noise level, where higher noise level generated a higher PD. The present findings also dem­
onstrated that the group with HI was more disturbed by higher than lower levels of noise (i.e., traffic and
daycare setting compared with office setting). This pattern was observed consistently throughout four

"Linnaeus Centre HEAD, Swedish Institute for Disability Research, Linkoping University, Linkoping, Sweden; d epartm ent of Behavioural Sciences
and Learning, Linkoping University, Linkoping, Sweden; d epartm ent of Audiology, Sahlgrenska Academy, Gothenburg University, Gothenburg,
Sweden; §School of Health and Medical Sciences, Orebro University, Orebro, Sweden; **Audiological Research Centre, Orebro University Hospital,
Orebro, Sweden
Hakan Hua, Linkoping University, Department of Behavioral Sciences, SE-581 83 LINKOPING, Sweden; E-mail: huahakan@aol.com

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Journal o f the American Academy o f Audiology/Volume 25, Number 9, 2014

working tasks where the group with HI reported a significantly greater PD in the daycare and traffic set­
tings compared with office noise.

Conclusions: The present results demonstrate that background noise does not impair cognitive per­
formance in nonauditory tasks in employees with HI and normal hearing, but that PD is affected to a
greater extent in employees with HI during higher levels of background noise exposure. In addition, this
study also supports previous studies regarding the detrimental effects that high-level noise has on
employees with HI. Therefore, we emphasize the need of both self-rated and cognitive measurements
in hearing care and occupational health services for both employees with normal hearing and HI.

Key Words: Cognitive performance, labor market, hearing impairment, noise, perceived disturbance, work

Abbreviations: ANOVA = analysis of variance; HA = hearing aid; HI = hearing impairment; PD =

perceived disturbance; PTA = pure-tone average; RT = reaction time

IN T R O D U C T I O N effects on cognitive performance (Knez and Hygge,

2002; Schlittmeier et al, 2008; Ebissou et al, 2013).
earing ability is an im portant factor at the In a study by Schlittmeier et al (2008), three experi­

H workplace for understanding speech and iden­

tifying environmental sounds. Health care
professionals frequently meet employees with hearing
impairment (HI) who experience difficulties at work.
Researchers have reported disadvantages in both physi­
cal and psychosocial work conditions, increased sick leave
due to distress, and worse health among employees with
HI compared with their normal-hearing peers (Ringdahl
and Grimby, 2000; Danermark and Gellerstedt, 2004;
Kramer et al, 2006). There are indications th at the
majority of the negative effects of noise might be related
to the presence of background noise at work (Danermark
and Gellerstedt, 2004; Hua et al, 2013). Previous re­
search has mainly focused on field studies with self-
reported ratings of different working conditions and
not so much on laboratory studies with controlled con­
ditions and behavioral measures of cognitive perfor­
mance. In the present study, we examine the impact
of different types of background noise on cognitive per­
formance and perceived disturbance (PD) in employees
with aided HI and normal hearing.
Noise annoyance is a fundamental concept in the area
of environmental effects of sound. It is perceived as a
negative aspect of environmental conditions, but its
meanings are quite broad and diverse. Noise annoyance
is a multifaceted concept covering the effects of noise on
behavior, such as PD or interference with intended activi­
ties (Guski et al, 1999). Guski (1997) further states that
the term annoyance can be used interchangeably with
subjective experiences, such as disturbing or irritating.
Intelligible competing speech is usually considered a neg­
ative feature of the work environment, and the degree
of intelligibility of competing speech has been found
to correlate positively with self-rating scales on PD.
As Venetjoki et al (2006) have demonstrated in a group
of normal-hearing participants, the more intelligible
the competing speech is, the higher self-rating scales
of PD. Also, research on normal-hearing participants
has demonstrated th at competing speech has negative
ments tested the impact of low background speech
(35 dBA) of both good and poor intelligibility, in compar­
ison to quiet and highly intelligible speech not lowered
in level (55 dBA). Mental arithmetic, verbal short-term
memory, and verbal-logical reasoning were used as
measurements of cognitive performance, and self-rating
scales of PD were also reported by the participants after
completing each task in each experimental condition.
The results showed that the performance was signifi­
cantly impaired by highly intelligible competing speech
(55 dBA) on the short-term memory and mental arith­
metic tasks, but not in verbal-logical reasoning. However,
ratings of PD were consistent over all three experiments
where quiet was rated least disturbing, and low back­
ground speech with poor speech intelligibility was rated
less disturbing than good and highly intelligible speech
in 35 and 55 dBA, respectively.
Although such self-rated assessments and cognitive
measures clearly speak in favor of reducing high-level
noise in the workplace for employees with normal hear­
ing, very little empirical evidence exists regarding cor­
responding performance effects for employees with HI
in the labor market. Moreover, although the negative
effects of background noise on speech understanding
of persons with HI are well documented (Van Tasell,
1993; Humes, 2002), most studies concerning individu­
als with HI focus mainly on processing of listening tasks
and listening effort in noise (Larsby et al, 2005; Zekveld
et al, 2011; Jahncke and Halin, 2012; Rudner et al,
2012). In a study by Larsby et al (2005), different speech
noises were found to interfere with cognitive processing
in individuals with HI and normal hearing. Four study
groups were included in their study, and the sample
consisted of both young/elderly participants with nor­
mal sensitivity for pure tones and young/elderly partic­
ipants with HI. Cognitive tests of speech understanding
and self-rated effort were administered, respectively, in
four background conditions: quiet and three types of
speech or speech-like noise. The results demonstrated

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 E ffects of N oise on C ognitive P erfo rm a n ce a n d PD/Hua et al
th at the presence of noise compared with quiet had a
negative effect on accuracy, speed of performance in
the speech-processing tasks, and self-rated effort for
the group with HI compared with the group with nor­
mal hearing.
As stated earlier, few studies have examined the im­
pact of different background noises on cognitive per­
formance and PD among employees with HI, and it is
not clear whether the negative effects of background
noise also apply to nonauditory tasks for individuals
with HI. Jahncke and Halin (2012) have previously
investigated whether open-plan office noise affects non­
auditory performance and stress, and whether these
effects differ between individuals with HI and normal
hearing. Twenty hearing-im paired and 18 norm al­
hearing participants took part in their study, and cog­
nitive performance, reported fatigue, and physiological
stress were measured during work in a simulated open-
plan office consisting of low and high noise levels at
30 and 60 dBA, respectively. The results showed that
there was indeed a decreased performance in the group
with HI for nonauditory tasks th a t involved recall of
semantic information in high-level office noise. Partici­
pants with HI also reported higher levels of fatigue
and tended to have higher stress hormone levels during
high noise exposure compared with the low noise level.
Taken together, the presence of high-level noise could
have a detrimental effect on cognitive performance, and
sparse literature exists on work performance involving
nonauditory tasks and rated disturbance among em­
ployees with HI. Furthermore, few studies have com­
pared the impact of different work-related settings
consisting of both low- and high-level noise in this study
population. Therefore, the aim of this study was to com­
pare the cognitive performance and PD between three
types of background noise varying in temporal and
spectral characteristics: simulating an office, daycare,
and traffic setting in comparison to a quiet condition,
in employees with aided HI and normal hearing.
METHODS
Participants
To estimate the required study sample for the current
study, The G*Power 3.1.7 power analysis package was
used. Data for estimation were based on our previous
study using a general working task described by Hua
et al (2013). Assuming that the results will show an
effect size of 0.9 (a = 0.05) between the two groups in
noise, it was estimated th at a minimum of 16 partici­
pants in each group were needed to reach statistical sig­
nificance with a power greater than 0.8. A total of
40 participants (21 men and 19 women) were recruited
to take part in the study and consisted of employees
with HI (n = 20) and normal hearing (n = 20). The indi­
viduals in the present study were participants in a
larger research project about individuals with HI in the
labor market, and were the same individuals as reported
by Hua et al (2013). The hearing-impaired participants
were recruited from the Department of Audiology, Orebro
University Hospital, Sweden. They were selected based
on the following criteria: 18-65 yr old, mild-moderate
binaural sensorineural hearing loss, history of aural
rehabilitation, and experienced hearing-aid (HA) users
(>3 mo). Exclusion criteria were retirement, long-term
sick leave, m oderate-severe tin n itu s, hyperacusis,
psychiatric illnesses, dyslexia, and/or other significant
diseases/disabilities. The two study groups were matched
according to age and educational level, and did not dif­
fer significantly (p > 0.05). The study was approved
by the Regional Ethics Committee in Uppsala (Dnr:
2010/072), and informed consent was obtained from
all participants.
A udiological Tests
Air- and bone-conduction thresholds were measured
using standard audiological procedures in a sound-treated
booth, and pure-tone averages (PTAs) were calculated
for 0.5,1, 2, and 4 kHz for each ear. As part of the audio-
logical assessment, speech recognition in noise was
obtained for each participant and ear using standardized
recordings of the Swedish phonemically balanced word
lists (Magnusson, 1995). Each list was composed of 50
monosyllabic words for recognition scoring and was pre­
sented with a carrier phrase produced by a male speaker
with a Swedish native accent. The participants were
instructed to repeat the word that followed the carrier
phrase, and performance was scored as a proportion of
correctly identified words. Table 1 gives the demographic
information of the participants.
Working Tasks
A rith m etic Task
The arithmetic task, in which participants were
asked to solve addition problems, was a modified version
of a task used by Duverne and Lemaire (2004). On each
trial, one number and two to-be-added numbers (e.g., 16
and 9 + 5) were presented adjacently to each other on the
computer screen. The task was to indicate, by means of a
key press, which one was the larger of the two (i.e., the
single number or the sum of the two to-be-added num ­
bers). The addition problems remained on the screen
until a response had been given, or until 30 sec had
passed. Level of difficulty was manipulated by using
single-digit operands in the easy condition (e.g., 9 + 5)
and three-digit operands in the difficult condition (e.g.,
588 + 192). To encourage exhaustive calculations in the
easy task, the difference between the sum of the operands
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Journal of the American Academy of Audiology/Volume 25, Number 9, 2014

Table 1. Demographic Data for the Two Study Groups S eria l R ecall
Group Men/Women Mean (SD)
Normal Hearing (n = 20) 11/9
In the serial recall task, eight digits were presented
Age (yr) 40.5 (14.0) visually on the computer screen in each trial. The digits
PTA right ear 5.2 (6.3) were presented one at a time for 350 msec and were sep­
PTA left ear 7.0 (7.2) arated by an interstim ulus interval of 400 msec. After
Speech recognition in 84.1 (6.5) the presentation of the final digit, participants were
noise right ear (%) asked to type in (in a dialog box appearing on the
Speech recognition in noise 80.7 (4.1) screen) each of the eight digits in the order of presenta­
left ear (%) tion. Participants were instructed to always write down
Hearing Impaired (n = 20) 10/10
eight digits recalled in their correct position. In each
Age (yr) 48.0 (12.0)
condition, there were 10 trials. The outcome measure
PTA right ear 36.5 (6.0)
was the proportion of correct responses.
PTA left ear 36.0 (7.0)
Speech recognition in noise 62.3 (17.0)
right ear (%)
R ating of PD
Speech recognition in noise 61.2 (16.9)
left ear (%) After each working task was completed in each of the
four background conditions, the participants were imme­
diately instructed to rate how disturbing they found the
and the single number was never larger than ±2 (e.g.,
noise to be, using the Borg CR-10 scale (Borg, 1990). This
16 and 9 + 5), and in the difficult task, the single num ­
scale is a combination of ratio and category scaling where
ber was always approximately 1% (or 5-10 in absolute
numbers) from the sum of the operands. In all four con­ verbal expressions and numbers are used congruently
ditions, the same 16 easy and 16 difficult arithmetic on a scale ranging from 0 (no PD at all) to 10 (extremely
problems were used. To minimize recognition of prob­ great). An “absolute maximum” is located outside the
number scale to avoid a ceiling effect. The scale was
lems across conditions, four unique randomized orders,
given on a sheet of paper next to the computer to help
with easy and difficult problems interspersed, were
used. the participants with the ratings, and they were ins­
tructed to first choose the verbal expression th at best
O rth ographic D ecoding described their experience and then type in the number
corresponding to the degree of disturbance perceived for
In the orthographic decoding task, participants were each of the four conditions. One question was asked for
presented with two strings of letters at a time. The task each level of difficulty of the arithmetic task. The Borg
was to indicate, by means of a key press, which string CR-10 scale was chosen as a measurement of disturb­
constituted a correctly spelled Swedish word. The letter ance because it has been shown to be sensitive enough
strings remained on the screen until a response had to identify differences between different background
been given, or until 10 sec had passed. Four lists with conditions in previous studies in individuals with HI
different stimuli were used in the four conditions. Each and normal hearing (c.f. Hallgren et al, 2005; Larsby
list consisted of 24-25 trials. et al, 2005). Although this scale was originally devel­
oped to measure perceived effort, it is also a general
P h on ological D ecoding and common tool for measuring intensity of experiences
(Borg, 2008). This includes PD of different types of
In the phonological decoding task, participants were noise, and the scale has previously been used in several
presented with two strings of letters (real words versus investigations for this specific purpose (Ljungberg et al,
nonwords) at a time. The task was to indicate, by means 2004; Ljungberg and Neely, 2007).
of a key press, which string sounded like a proper Swedish
word. The letter strings remained on the computer Background Conditions
screen until a response had been given, or until 10 sec
had passed. Four lists with different stimuli were used All of the working tasks and measures of PD were
in the four experimental conditions. Each list consisted performed in the following four background conditions,
of 19 trials. each simulating a typical workplace setting with differ­
The outcome measures in the arithmetic, ortho­ ent sound level:
graphic decoding, and phonological decoding task was
mean reaction time (RT) (based on correct and incorrect 1. Quiet setting. No noise was simulated in this condition.
responses as well as omissions) and the proportion of 2. Office setting. The office noise used in the experiment
correct responses. Trials in all three tasks were separa­ was recorded in an office area, or more specifically in
ted by an interstim ulus interval of 500 msec. the reception/call center room, at Orebro University.

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 Effects of N oise on C ognitive Perform ance and PD/Hua et al
This space consists of three booths with two desks in
each booth. This condition included a recording of
intelligible speech of normal level of the receptionist
answering phone calls.
3. Daycare setting. The daycare noise was recorded in a
daycare environment in Orebro. Recording took
place in the children’s playroom before the morning
assembly where the children played freely. The num­
ber of children in the playroom varied between 8 and
12 during the recording. In the middle of the room,
there was an open-space area covered by a large car­
pet. In one corner was a life-size toy castle, and in
another corner was playground decorated like a
small kitchen and, next to it, a couple of tables
and a few chairs. This condition introduced intelli­
gible speech at normal to high levels and consisted
of the children talking, screaming, and shouting
every now and then.
4. Traffic setting. The traffic noise used in the experi­
ment was recorded at a crossroads in Orebro during
morning traffic. The traffic noise consisted of sounds
from cars and trucks driving past the recording loca­
tion at a normal to high level. No intelligible speech
was introduced in this condition.
The three types of background noise were recorded
by a microphone using Ambisonics surround sound
technique. From the original recordings, approximately
15-19 min of each noise was extracted, edited, and
reproduced in an anechoic chamber (5.5 X 5.5 X 4.5
m). Six loudspeakers spaced 60° in a circle were used
to reproduce the noise. The participants were seated
in the center of the loudspeaker array with a computer
performing the working tasks and rating of PD. To
ensure a realistic noise levels, the sound was repro­
duced with an equivalent A-weighted sound pressure
level of 56.6 dBA, 73.5 dBA, and 72.5 dBA for the office,
daycare, and traffic noise, respectively, matching the
level of the original recording locations. The final output
of the noise was also looped so th at it played continu­
ously until the working tasks were completed by each
participant.
Procedure
Data collection occurred on two separate sessions.
Sessions were completed within 4 wk of each other,
and each session lasted roughly 1.5-2.5 hr. Because
the data are based on a larger project, several other
tasks and tests were included in the project in a coun­
terbalanced order, meaning th at the four work-related
tasks and the four experimental conditions could be per­
formed either in the first and/or second session. How­
ever, the audiological tests were always performed in
the first session before the participants performed the
required working tasks in the anechoic chamber. The
group with HI always wore their HAs during all work­
ing tasks.
Statistical A nalysis
The SPSS software (version 19) was used for statistical
analysis. To control for normal distribution, raw scores of
the outcome measures and PD were plotted. This showed
that RT and PD were normally distributed, and the pro­
portion of correct responses showed a positive skew in
performance. Because the distribution of the partici­
pants’ responses showed a positive skew, data were
log transformed to obtain a more homogeneous error var­
iance. To analyze for significant differences, a general lin­
ear model mixed two-way analysis of variance (ANOVA)
was performed with four within-subject factors (PD in four
environmental conditions) and one between-subject factor
(group). To examine interaction effects, pairwise /-tests
were used. Pearson correlation coefficients between RT
and accuracy of cognitive measures, and cognitive per­
formance and self-rated disturbance were also calculated
to examine the possible correlation between the different
variables. All tests were conducted at a 5% significance
level.
RESULTS
C ognitive Perform ance
As evident from Table 2, both groups obtained high
levels of performance and responded rapidly in the dif­
ferent working tasks across all background conditions.
No large performance differences were observed among
the four background conditions. As expected, the diffi­
cult arithmetic task also generated a slightly lower per­
formance level compared with the easy task for both
groups (80-89% versus 92-97%), and serial recall showed
a performance score at approximately 60-70%. A mixed
two-way ANOVA conducted on the mean scores obtained
for each working task showed no significant main effect
of condition or group, and no significant interaction
between condition and group (p > 0.05) (Table 3).
PD
The average PD rating obtained for each task in the
four conditions is summarized in Table 4. In the follow­
ing results, only significant comparisons are discussed.
Generally, it seems as if the participants rated PD
according to noise level across all tasks, where the quiet
and office conditions were rated relatively low (0.3-3.8
points), and the daycare and traffic noise were rated higher
(2.0-5.5 points). A mixed two-way ANOVA was conducted
on the mean scores of each task, and this showed a signifi­
cant main effect of condition (p = 0.001), but no significant
main effect between groups (p > 0.05) (Table 5). An
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J o u rn a l o f th e A m erica n A cad em y o f A u d iology /Volume 25, Number 9, 2014

Table 2. Mean Performance and SD in the Four Background Conditions for the Hearing-Impaired and Normal-Hearing
Groups
Quiet Office Daycare Traffic
Working Task Group Mean (SD) Mean (SD) Mean (SD) Mean (SD)
Arithm etic task perform ance - easy (%) NH 97 (4) 97 (5) 96 (5) 95 (11)
HI 93 (22) 94 (22) 94 (22) 92 (22)
Arithm etic task perform ance - difficult (%) NH 88 (10) 89 (10) 88 (7) 86 (15)
HI 82 (25) 80 (21) 81 (23) 80 (22)
O rthographic de co ding perform ance (%) NH 99 (2) 98 (2) 98 (3) 98 (2)
HI 98 (3) 9 9 (1 ) 97 (4) 99 (2)
Phonological decoding perform ance (%) NH 97 (5) 98 (4) 95 (5) 97 (4)
HI 94 (6) 93 (7) 94 (8) 92 (8)
Serial recall (%) NH 66 (14) 66 (14) 61 (18) 67 (15)
HI 62 (19) 58 (22) 61 (18) 60 (20)
Arithm etic task RT -E a sy (msec) NH 2705 (736) 2605 (729) 2597 (757) 2 5 8 2(9 2 1 )
HI 2553 (1089) 2695 (1224) 2631 (1282) 2 5 6 6(9 0 9 )
Arithm etic task RT -D iffic u lt (msec) NH 9209 (3575) 8737 (3916) 8 8 4 5(4 2 2 7 ) 8767 (3035)
HI 8341 (2859) 8997 (3735) 8871 (3291) 8 6 5 8(3 1 7 1 )
O rthographic decodingR T (msec) NH 1040 (244) 1044 (218) 1083 (228) 1028 (244)
HI 1185 (336) 1215 (297) 1177 (216) 1203 (327)
Phonological decodingR T (msec) NH 2031 (495) 2338 (553) 2401 (589) 2 2 6 5(5 0 2 )
HI 2756 (761) 2751 (889) 2784 (1054) 2703 (645)

interaction effect between condition and hearing was also ceived the daycare noise to be more disturbing than the
noted in all working tasks (p < 0.05), except in phonolog­ office noise in the serial recall task (t = 2.5, p = 0.003).
ical decoding (p = 0.06). Post hoc analysis revealed that
both groups reported th a t the three noise conditions C o rrelation s b e tw e e n C o g n itiv e P erform an ce
were significantly more disturbing than the quiet condi­ an d PD
tion (t = 5.2, p < 0.05) in all tasks, and that the group with
HI perceived the daycare and traffic noise to be more dis­ A series of Pearson product-moment correlation coeffi­
turbing than the office noise (t, = 5.3, p < 0.04). Further­ cient tests were used in order to examine whether the dif­
more, between-group differences were observed where the ferent outcome measures correlated with each other. As
hearing-impaired group reported a significantly higher there was no significant between-group difference in cog­
PD (t = 1.3—3.6, p = 0.001) in the daycare and traffic con­ nitive performance, but in self-rated PD, correlation ana­
dition compared with the normal-hearing group in the lyses were calculated separately for each group. However,
arithmetic tasks, orthographic decoding, and serial recall no significant correlations were observed between RT and
task. Although the group with normal hearing rated all the proportion of correct answers, and cognitive perfor­
three noise conditions quite similar consistently through­ mance and PD in the different conditions and work-related
out all tasks, post hoc analysis revealed that they per­ tasks (p > 0.05).
Table 3. Analysis of Cognitive Performance for All Working Tasks
Main effect Interaction effect between
F of condition F condition & hearing F Main effect of hearing
W orking task (df = 3,114) p-value ( t i p 2) (df = 3,114) p-value ( t i p 2 ) (df = 1,38) p-value (rip 2)
Arithm etic task 1.1 .34 (.03) 0.3 .80 (.01) 2.4 .13 (.06)
perform ance - easy
Arithm etic task 0.5 .67 (.01) 0.4 .73 (.01) 0.9 .33 (.03)
perform ance - difficult
O rtographic decoding 2.3 .08 (.06) 0.8 .51 (.02) 0.1 .93 (.00)
perform ance
Phonological decoding 0.5 .71 (.01) 0.8 .52 (.02) 1.9 .19 (.01)
perform ance
Serial recall 0.8 .50 (.02) 1.7 .17 (.01) 1.8 .18 (0 3 )
Arithm etic task RT - easy 0.3 .86 (.01) 0.8 .51 (.02) 0.4 .52 (.01)
Arithm etic task RT - difficult 0.3 .99 (.00) 0.6 .62 (.02) 0.1 .71 (.00)
O rtographic de co ding RT 1.9 .90 (.01) 0.8 .51 (.02) 3.6 .07 (.08)
Phonological de co ding RT 1.9 .14 (.05) 1.6 .19 (.04) 2.1 .17 (.04)

864
 Effects of N oise on C ognitive Performance and PD/Hua et al

Table 4. Mean Score of PD and SD in the Four Background Conditions for the Hearing-Impaired and Normal-Hearing
Groups
Q u ie t O ffice D a yca re Traffic
W o rkin g Task G ro u p M ean (SD) M ean (SD) M ean (SD) M ean (SD )

A rith m e tic ta s k - e a s y NH 0 .7 (1.3) 2 .8 (1.7) 2 .9 ( 1 5 ) 3 .0 (1.9)

HI 0 .3 (0.6) 2.5 (1.8) 4.2 (4.8) 4.1 (2.0)
A rith m e tic ta s k - d iffic u lt NH 1.0 (1.9) 3 .8 (1.7) 3.8 (1.8) 3 .9 (2.1)
HI 0 .4 (0.8) 3 .2 (1.9) 4 .8 (2.3) 5 .0 (2.1)
O rth o g ra p h ic d e c o d in g NH 0 .3 (0.8) 1 7 (1 .1 ) 2 .0 (1.1) 2.0 (1.4)
HI 0 .2 (0.5) 1 .7 (1 9 ) 2 .8 (2.5) 3 .4 (2.7)
P h o n o lo g ic a l d e c o d in g NH 0 .5 (1.0) 2 .3 (1.0) 2 .8 (1.4) 2.9 (1.7)
HI 0 .3 (0.7) 2 .2 (2.1) 3.7 (2.5) 4 .0 (2 .5 )
S erial recall NH 0 .6 (1.0) 3 .8 (1.5) 4 .6 (2.3) 3 .7 (2.0)
HI 0 .3 (0.8) 3 .6 (2.0) 5 .0 (2.6) 5.5 (2.7)

N o te : HI = h e a rin g im p a ire d ; NH = norm a l he a rin g .

D IS C U S S IO N normal hearing, who rated all three noise conditions

n the present study, we examined the impact of dif­
I ferent types of background noise on cognitive per­
formance and PD among some employees with aided
HI and some with normal hearing sensitivity. Summa­
rizing the findings, the current results demonstrate
th at both groups scored relatively high in accuracy
and fast in RT in the different working tasks across
all conditions. No significant between- or within-group
differences in cognitive performance were observed across
the four background conditions. Ratings of PD, on the
other hand, showed th a t both groups seemed to rate
PD according to noise level, where higher noise level
generated a higher PD. Generally, the lowest PD was
observed in the quiet condition, and both groups rated
PD of the three noise conditions significantly higher
than the quiet condition. Interestingly, the present find­
ings also indicate th at the group with HI was more dis­
turbed by higher than lower levels of noise (i.e., traffic
and daycare setting compared with the office setting).
This pattern was observed consistently throughout four
working tasks where the group with HI reported a sig­
nificantly higher PD in the daycare and traffic settings
compared with the office noise. In addition, this effect of
the high-level noise was not observed in the group with
equally similar in each working task, with the exception
of reported PD between the daycare and office settings
in the serial recall task. Lastly, correlation analyses
were performed separately for each group between RT
and accuracy of the cognitive measures, and between
cognitive performance and ratings of PD. However, no
significant correlations were observed between these dif­
ferent outcome measures.
The nonsignificant differences in cognitive perform­
ance of the working tasks displayed an expected pattern
because there was no indication as to why the hearing-
impaired group would perform significantly more poorly
than the group with normal hearing (c.f. Hallgren et al,
2001). Firstly, both groups were relatively young and
healthy with the main difference between the groups
being mild-moderate aided HI. Secondly, the two
groups were initially well matched in age and educa­
tional level, and all participants were controlled for
physical/psychological diseases/disabilities before incep­
tion of the study. Previous studies have shown, however,
that performances are usually poorer in the group with
HI when background noise is present (Hygge et al, 1992;
Larsby et al, 2005). The difference between the current
study and previous studies conducted on individuals
with HI is that nonauditory working tasks were used.

Table 5. Analysis of PD for All Working Tasks

M ain e ffe c t In te ra ctio n e ffe c t b e tw e e n
F o f c o n d itio n F c o n d itio n & h e a rin g F M ain e ffe c t o f h e a rin g
W o rkin g ta s k (d f = 3 ,1 1 4 ) p -v a lu e (n p 2) (d f = 3 ,1 1 4 ) p -v a lu e (iqp2) (d f = 1,38) p -v a lu e ( t ip 2)

A rith m e tic 3 7 .4 .001 (.50) 4.0 .005 (.09) 0.2 .6 (.03)

ta s k - easy
A rith m e tic 3 8.5 .001 (.55) 3.8 .01 (.09) 0.3 .6 (.01)
ta s k - d iffic u lt
O rto g ra p h ic 3 0 .2 .001 (.4 4 ) 3.2 .02 (.08) 1.3 .3 (.03)
d e c o d in g
P h o n o lo g ica l 3 5 .2 .001 (.48) 2.5 .06 (.06) 0.9 .3 (.01)
d e c o d in g
S erial recall 70.2 .001 (.65) 4.2 .007 (.10) 0.6 .4 (.02)

865
Journal of the American Academy o f Audiology/Volume 25, Number 9, 2014
Our current findings clearly demonstrate that relatively
young, healthy, and well-matched employees with aided
HI do not differ in performance in visual working tasks
compared with their normal-hearing peers, regardless
of whether or not background noise is present. F urther­
more, previous studies have also reported th at specific
components within the phonological processing system
could be deteriorating, indicating that working tasks
requiring phonological processing could be impaired in
the group with HI (Lyxell et al, 2003). This result is in
contrast with our results because no significant difference
was observed in the phonological decoding tasks; this
m ight be due to the fact th a t the level of HI in pre­
vious studies was more severe-profound (>75 dB HL).
Although the finding of nonsignificant differences in
cognitive performance was somewhat expected for the
current sample, we cannot rule out the possibility th at
the measuring of cognitive performance is important
because previous studies have clearly demonstrated
th at individuals with HI perform lower in certain cir­
cumstances (Hygge et al, 1992; Larsby et al, 2005;
Lyxell et al, 2003). In addition to different study sam­
ples, other reasons for the lack of difference in cognitive
performance m ight be th a t different tasks, noise
conditions, and study designs have been used in these
studies. One could speculate that with different noise
conditions and other types of visual working tasks, or
even a greater difficulty for the current tasks, different
results might have been revealed between groups.
Therefore, we believe that it was a valid choice to include
measures th at consider both objective and subjective
dimensions of the effect of noise in the present study.
Significant differences between and within groups
were observed in PD across the four conditions. Both
groups rated the three noise conditions to be signifi­
cantly more disturbing than the quiet condition, and
this finding is consistent with w hat previous research
has shown among individuals with normal hearing sen­
sitivity (Schlittmeier et al, 2008; Ebissou et al, 2013).
Significant differences were also observed between
groups where the hearing-impaired employees reported
a significantly higher PD than in participants with nor­
mal hearing in the arithmetic easy and difficult task,
and orthographic decoding. No significant interaction
effect was observed between conditions and groups in
phonological decoding. Group differences were noted
in the traffic setting in the serial recall task. Interest­
ingly, these group differences were only observed in the
two conditions with the highest levels (daycare: 73.5
dBA; traffic: 72.5 dBA). Also, no significant differences
were observed between groups in the quiet and office
settings (56.6 dBA), meaning th a t a higher noise level
does indeed disturb employees with aided HI more than
their normal-hearing peers. When looking at the results
within groups, we also observed a similar effect of the
high-level noise conditions in the group with HI where
S 66
PD in these two conditions was rated significantly
higher than the office noise, whereas the normal-hearing
group reported PD equally across all three noise condi­
tions, except in the serial recall task. A similar effect of
high-level noise (60 dBA) has been observed in the
hearing-impaired group in a study by Jahncke and
Halin (2012), where the participants showed higher
self-rated fatigue and tended to have higher stress hor­
mone levels than in the low-level noise (30 dBA). There
might be a couple of explanations for these similar find­
ings in results, according to the authors. Firstly, the
greater sensitivity to a higher level of noise could be
due to recruitment, meaning th at the group with HI
perceived the high-level noises to be louder than what
the normal-hearing group would perceive. Secondly,
HAs were worn by the participants in all working tasks,
which could have distorted incoming noise signals and
consequently generating a higher disturbance for the
group with HI. As the daycare and traffic noise were
around moderate sound levels (70 dBA), one would
believe th at these two conditions were amplified to an
even higher sound level for the group with HI, and thus
a higher PD was reported. In the current study sample,
all participants were fitted with different HAs from dif­
ferent manufacturers, which could have affected the
present results. However, before the study was under­
taken, all participants had their HAs checked by an
audiologist, they were all frequent HA users, and a
majority of the participants were using open-fit HAs
because of mild-moderate HI. This means that regard­
less of the manufacturer, the study sample was relatively
homogeneous in regard to HA use and type, and they
received the required amplification based on their indi­
vidual audiograms. Therefore, the current results should
be generalized on frequent HA users with mild-moderate
HI, and it is possible that different results of PD would
have been observed if the study sample consisted of new
HA users. We further argue that these two reasons are
valid considering that the aided HI was the main differ­
ence between the two groups, and no difference in cogni­
tive performance was observed.
Previous research within the area of PD of noise and
mental performance at work has found th a t background
speech has a detrimental effect on cognitive performance
and PD in normal-hearing participants (Schlittmeier
et al, 2008). Irrelevant speech effect describes the signifi­
cant impairment of mental performance during irrele­
vant speech and some nonspeech sounds (Larsen et al,
2000). In our study, the office and daycare settings were
the only two conditions that included speech, but no
effect of irrelevant speech effect was observed in our
results. This was apparent because no significant differ­
ences were observed between the traffic and daycare
noise within groups. However, it is important to empha­
size that the speech sounds in the office noise were rel­
atively low and took place in a rather quiet office space,
 Effects of N oise on C ognitive Perform ance and PD/Hua et al
and the daycare noise consisted mostly of children talking
and screaming every now and then. Therefore, we do not
believe that this effect could have influenced the results.
As this study used different performance measures
to examine the effects of different types of noise, we
wanted to find out if there was a correlation between
cognitive performance and PD, especially among the
participants with HI. Thus, additional correlation ana­
lyses between variables were performed separately for
each group. No significant correlations were found
between RT and accuracy of the working tasks, and
between cognitive performance and PD. This finding
indicates th at we cannot recommend one particular
robust test to demonstrate the effect th at different types
of background noise may have on individuals. Future
studies developing tests th at can measure both dimen­
sions, as an indicator of people’s perception of disturb­
ance, in a clinical setting would therefore be of interest.
Practical implications of where the present results
are applicable include environments in daycare centers
and inventories where the background noises at the
workplace tend to get high. In a recent study by Sjodin
et al (2012), stress-related health problems among 101
preschool employees with normal hearing were investi­
gated. The adverse effects of noise were analyzed using
validated questionnaires and saliva cortisol samples.
Their results showed th a t stress and energy output
were pronounced and th at 30% of the study sample
experienced burnout syndromes. Therefore, these find­
ings along with the current results could indicate th at a
higher risk for worse health could exist among employ­
ees with HI, and this implication is in agreement with
previous studies conducted on health and quality of life
showing worse health status in individuals with HI com­
pared with that of their normal-hearing peers (Grimby
and Ringdahl, 2000; Danermark and Gellerstedt,
2004; Kramer et al, 2006; Hua et al, 2013). The current
findings are important because they demonstrate that
although cognitive performance in nonauditory tasks
are not affected in employees with aided HI, higher lev­
els of noise are significantly more disturbing for this
group compared with the group with normal hearing. This
finding could therefore indicate that employees with HI
are more tired at the end of the working day, which
may cause participation restrictions in leisure activities
outside work or even social isolation. If employees with
HI were exposed to high-level noise for a longer period,
this might even be one possible reason for the reduced
physical health status and quality of life in this group.
In addition, no significant correlations were observed
between the different outcome measures. This result sug­
gests that alternative measurement of PD in conjunction
with measures of cognitive performance should be system­
atically used when assessing disturbance of noise in differ­
ent working environments. Therefore, we emphasize the
need of both self-rated and cognitive measurements in
hearing care and occupational health services for both
employees with normal hearing and those with HI.
CONCLUSIONS
he present results demonstrate that background
T noise does not impair cognitive performance in non­
auditory tasks in employees with HI and normal hearing,
but that PD is affected to a higher extent in the group
with HI during higher levels of noise exposure. These
findings should only be generalized to individuals with
aided mild-moderate HI. We argue that self-rated mea­
surements of PD are important and should be used
along with cognitive measurements when assessing noise
annoyance in different working environments. In addition,
this study also supported the results of studies regarding
the detrimental effect that high-level noise has on em­
ployees with HI. Future research within this area should
focus on employees with severe-profound HI, interaction
between different cognitive processes and work perfor­
mance in relationship to different types of background
noise, and the impact on after-work activities.
Acknowledgments. This study would not have been possi­
ble w ithout th e study participants who generously gave th eir
tim e to participate in th e cu rren t study. The authors also
th a n k Jonas Birkelof, Arvid Bjorndal, K ristina Ingvall, Jennie
H jaldahl, Johan n es Olsson, and Tobias A slund who carried
out some of th e tests and recorded the different sound environ­
ments; and G itte Keidser, William G. Beck, and two anonymous
reviewers for providing valuable suggestions on an earlier version
of the manuscript.
REFERENCES
Borg G. (1990) Psychophysical scaling with applications in phys­
ical work and the perception of exertion. Scand J Work Environ
Health 16(Suppl l):55-58.
Borg G. (2008) A general scale to rate symptoms and feelings
related to problems of ergonomic and organizational importance.
G Ital Med Lav Ergon 30(1, Suppl A):A8-A10.
Danerm ark B, Gellerstedt LC. (2004) Psychosocial work environ­
ment, hearing impairment and health. In t J Audiol 43(7):
383-389.
Duverne S, Lemaire P. (2004) Age-related differences in arith­
metic problem-verification strategies. J Gerontol B Psychol Sci
Soc Sci 59(3):P135—P142.
Ebissou A, Chevret P, Parizet E. (2013). Work Performance and
Mental Workload in Multiple Talker Environments. Paper pre­
sented at the Proceedings of Meetings on Acoustics, Acoustical
Society of America, Montreal, Canada, June 2-7.
Grimby A, Ringdahl A. (2000) Does having a job improve the qual­
ity of life among post-lingually deafened Swedish adults with
severe-profound hearing impairment? Br J Audiol 34(3): 187-195.
Guski R. (1997) Psychophysical methods for evaluating sound
quality and assessing acoustic information. Acta Acust United
Acust 83(5):765-774.
857
Journal o f the American Academy of Audiology/Volume 25, Number 9, 2014
Guski R, Felscher-Suhr U, Schuemer R. (1999) The concept of
noise annoyance: How international experts see it. J Sound Vibrat
223(41:513-527.
Hallgren M, Larsby B, Lyxell B, Arlinger S. (2001) Evaluation of a
cognitive test battery in young and elderly normal-hearing and
hearing-impaired persons. J Am Acad Audiol 12(7):357-370.
Hallgren M, Larsby B, Lyxell B, Arlinger S. (2005) Speech under­
standing in quiet and noise, with and without hearing aids. Int J
Audiol 44(101:574-583.
Hua H, Karlsson J, Widen S, Moller C, Lyxell B. (2013) Quality of
life, effort and disturbance perceived in noise: a comparison
between employees with aided hearing impairment and normal
hearing. Int J Audiol 52(9):642-649.
Humes LE. (2002) Factors underlying the speech-recognition per­
formance of elderly hearing-aid wearers. J Acoust Soc Am 112(3 Pt
1):1112-1132.
Hygge S, Ronnberg J, Larsby B, Arlinger S. (1992) Normal-hearing
and hearing-impaired subjects’ ability to just follow conversation in
competing speech, reversed speech, and noise backgrounds.
J Speech Hear Res 35(1):208-215.
Jahncke H, Halin N. (2012) Performance, fatigue and stress in open-
plan offices: the effects of noise and restoration on hearing impaired
and normal hearing individuals. Noise Health 14(60):260-272.
Rnez I, Hygge S. (2002) Irrelevant speech and indoor lighting:
effects on cognitive performance and self-reported affect. Appl
Cogn Psychol 16(6):709—718.
Kramer SE, Kapteyn TS, Houtgast T. (2006) Occupational per­
formance: comparing normally-hearing and hearing-impaired
employees using the Amsterdam Checklist for Hearing and Work.
In t J Audiol 45(9):503-512.
Larsby B, Hallgren M, Lyxell B, Arlinger S. (2005) Cognitive per­
formance and perceived effort in speech processing tasks: effects of
different noise backgrounds in normal-hearing and hearing-
impaired subjects. Int J Audiol 44(3):131-143.
Larsen JD, Baddeley A, Andrade J. (2000) Phonological similarity
and the irrelevant speech effect: implications for models of short­
term verbal memory. Memory 8(3): 145-157.
8B8
Ljungberg J , Neely G, Lundstrom R. (2004) Cognitive performance
and subjective experience during combined exposures to whole-body
vibration and noise. Int Arch Occup Environ Health 77(3):217-221.
Ljungberg JK, Neely G. (2007) Stress, subjective experience and
cognitive performance during exposure to noise and vibration.
J Environ Psychol 27(l):44-54.
Lyxell B, Andersson U, Borg E, Ohlsson IS. (2003) Working-
memory capacity and phonological processing in deafened adults
and individuals with a severe hearing im pairm ent. In t J Audiol
42(Suppl 1):S86-S89.
Magnusson L. (1995) Reliable clinical determination of speech rec­
ognition scores using Swedish PB words in speech-weighted noise.
Scand Audiol 24(4):217-223.
Ringdahl A, Grimby A. (2000) Severe-profound hearin g
im pairm ent and health -related quality of life among post-
lingual deafened Swedish adults. Scand A udiol 29(4):
266-275.
Rudner M, Lunner T, Behrens T, Thoren ES, Ronnberg J. (2012)
Working memory capacity may influence perceived effort during
aided speech recognition in noise. J A m Acad Audiol 23(8):
577-589.
Schlittmeier SJ, Hellbriick J, Thaden R, Vorlander M. (2008) The
impact of background speech varying in intelligibility: effects on
cognitive performance and perceived disturbance. Ergonomics
51(5):719-736.
Sjodin F, Kjellberg A, Knutsson A, Landstrom U, Lindberg L.
(2012) Noise and stress effects on preschool personnel. Noise
Health 14(59): 166-178.
Van Tasell DJ. (1993) Hearing loss, speech, and hearing aids.
J Speech Hear Res 36(2):228-244.
Venetjoki N, Kaarlela-Tuomaala A, Keskinen E, Hongisto V.
(2006) The effect of speech and speech intelligibility on task per­
formance. Ergonomics 49(11):1068-1091.
Zekveld AA, K ram er SE, Festen JM. (2011) Cognitive load dur­
ing speech perception in noise: the influence of age, hearing
loss, and cognition on the pupil response. Ear Hear 32(4):
498-510.
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