Mechanisms of Listening Effort in Individuals with Hearing Loss
Abstract
Background and Aim: Listening effort refers to the cognitive resources required to understand speech, particularly in challenging listening environments. Individuals with hearing loss experience increased listening effort due to auditory deficits, affecting their communication and cognitive load. Understanding the mechanisms behind listening effort is essential for developing effective hearing interventions. This study aims to explore the mechanisms of listening effort in individuals with hearing impairments.
Material and Methods: A narrative review was conducted using specific keywords in Google Scholar (as a search engine) and the research databases Web of Science, Scopus, and PubMed. Relevant articles were selected based on their alignment with the focus on the mechanisms of listening effort in individuals with hearing loss.
Results: Hearing loss triggers compensatory cognitive strategies, engaging prefrontal regions and working memory to process degraded auditory signals. Neural adaptations, including cross-modal plasticity and reliance on top-down processing, further elevate mental workload. Degraded temporal processing and attentional demands in noisy environments exacerbate effort, often leading to fatigue.
Conclusion: Understanding these mechanisms informs interventions such as adaptive hearing technologies, cognitive training to optimize resource allocation, and personalized communication strategies. Integrating neurophysiological insights into clinical practice can reduce cognitive fatigue and enhance real-world communication outcomes.
Amiri M, Mohammadi M, Razavi SZ, Abdollahi H, Mobarakeh ZIP. Normative Data for Speech-in-Noise Perception Test in Young Adults with Normal Hearing: Gender and Ear Laterality Effects. Audit Vestib Res. 2022; https://doi.org/10.18502/avr.v32i1.11323
2. Gagne J-P, Besser J, Lemke U. Behavioral assessment of listening effort using a dual-task paradigm: A review. Trends Hear. 2017;21:2331216516687287. https://doi.org/10.1177/2331216516687287
3. Pichora-Fuller MK, Kramer SE, Eckert MA, Edwards B, Hornsby BWY, Humes LE, et al. Hearing impairment and cognitive energy: The framework for understanding effortful listening (FUEL). Ear Hear. 2016;37:5S-27S. https://doi.org/10.1097/AUD.0000000000000312
4. Rönnberg J, Rudner M, Foo C, Lunner T. Cognition counts: A working memory system for ease of language understanding (ELU). Int J Audiol. 2008;47(sup2):S99–105. https://doi.org/10.1080/14992020802301167
5. Rönnberg J, Lunner T, Zekveld A, Sörqvist P, Danielsson H, Lyxell B, et al. The Ease of Language Understanding (ELU) model: Theoretical, empirical, and clinical advances. Front Syst Neurosci. 2013;7:31. https://doi.org/10.3389/fnsys.2013.00031
6. Humes LE, Roberts L. Speech-recognition difficulties of the hearing-impaired elderly: The contributions of audibility. J Speech, Lang Hear Res. 1990;33(4):726–35. https://doi.org/10.1044/jshr.3304.726
7. McCoy SL, Tun PA, Cox LC, Colangelo M, Stewart RA, Wingfield A. Hearing loss and perceptual effort: Downstream effects on older adults’ memory for speech. Q J Exp Psychol Sect A. 2005;58(1):22–33. https://doi.org/10.1080/02724980443000151
8. Hällgren M, Larsby B, Lyxell B, Arlinger S. Speech understanding in quiet and noise, with and without hearing aids: Comprensión del lenguaje en silencio y con ruido, con y sin auxiliares auditivos. Int J Audiol. 2005;44(10):574–83. https://doi.org/10.1080/14992020500190011
9. Plomp R. A signal-to-noise ratio model for the speech-reception threshold of the hearing impaired. J Speech, Lang Hear Res. 1986;29(2):146–54. https://doi.org/10.1044/jshr.2902.146
10. Hopkins K, Moore BCJ, Stone MA. Effects of moderate cochlear hearing loss on the ability to benefit from temporal fine structure information in speech. J Acoust Soc Am. 2008;123(2):1140–53. https://doi.org/10.1121/1.2824018
11. Hagerman B. Clinical measurements of speech reception threshold in noise. Scand Audiol. 1984;13(1):57–63. https://doi.org/10.3109/01050398409076258
12. Shinn-Cunningham BG, Best V. Selective attention in normal and impaired hearing. Trends Amplif. 2008;12(4):283–99. https://doi.org/10.1177/1084713808325306
13. Weinstein BE, Ventry IM. Hearing impairment and social isolation in the elderly. J Speech, Lang Hear Res. 1982;25(4):593–9. https://doi.org/10.1044/jshr.2504.593
14. Demorest ME, Erdman SA. Scale composition and item analysis of the Communication Profile for the Hearing Impaired. J Speech, Lang Hear Res. 1986;29(4):515–35. https://doi.org/10.1044/jshr.2904.535
15. Strawbridge WJ, Wallhagen MI, Shema SJ, Kaplan GA. Negative consequences of hearing impairment in old age: a longitudinal analysis. Gerontologist. 2000;40(3):320–6. https://doi.org/10.1093/geront/40.3.320
16. Ohlenforst B, Zekveld AA, Jansma EP, Wang Y, Naylor G, Lorens A, et al. Effects of hearing impairment and hearing aid amplification on listening effort: A systematic review. Ear Hear. 2017;38(3):267. https://doi.org/10.1097/AUD.0000000000000396
17. Wingfield A, Tun PA, McCoy SL. Hearing loss in older adulthood: What it is and how it interacts with cognitive performance. Curr Dir Psychol Sci. 2005;14(3):144–8. https://doi.org/10.1111/j.0963-7214.2005.00356.x
18. Pichora-Fuller MK. Perceptual effort and apparent cognitive decline: Implications for audiologic rehabilitation. In: Seminars in Hearing. Copyright© 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New …; 2006. p. 284–93. https://doi.org/10.1055/s-2006-954855
19. Mahalawy T, Emara AA, Hussein AB, Lasheen RM. Listening Effort in Patients with Sensorineural Hearing Loss using Cochlear Implant. Egypt J Ear, Nose, Throat Allied Sci. 2024;25(25):1–9. https://doi.org/10.21608/ejentas.2022.140669.1516
20. Mallard M, Van Engen KJ. Speech intelligibility and listening effort: A dual-task paradigm for accented speech perception. J Acoust Soc Am. 2023;153(3_supplement):A169–A169. https://doi.org/10.1121/10.0018546
21. Sardone R, Battista P, Panza F, Lozupone M, Griseta C, Castellana F, et al. The age-related central auditory processing disorder: silent impairment of the cognitive ear. Front Neurosci. 2019;13:619. https://doi.org/10.3389/fnins.2019.00619
22. Janse E, Ernestus M. The roles of bottom-up and top-down information in the recognition of reduced speech: Evidence from listeners with normal and impaired hearing. J Phon. 2011;39(3):330–43. https://doi.org/10.1016/j.wocn.2011.03.005
23. Moore BCJ. Cochlear hearing loss: physiological, psychological and technical issues. John Wiley & Sons; 2007. (Book)
24. MC K. I can hear what people say, but I can’t understand them. Hear Rev. 1997;4:8–14.
25. Peelle JE, Wingfield A. The neural consequences of age-related hearing loss. Trends Neurosci. 2016;39(7):486–97. https://doi.org/10.1016/j.tins.2016.05.001
26. Alloway TP, Copello E. Working memory: The what, the why, and the how. Educ Dev Psychol. 2013;30(2):105–18. (Internet)
27. Akeroyd MA. Are individual differences in speech reception related to individual differences in cognitive ability? A survey of twenty experimental studies with normal and hearing-impaired adults. Int J Audiol. 2008;47(sup2):S53–71. https://doi.org/10.1080/14992020802301142
28. Pichora‐Fuller MK, Schneider BA, Daneman M. How young and old adults listen to and remember speech in noise. J Acoust Soc Am. 1995;97(1):593–608. https://doi.org/10.1121/1.412282
29. Manini B, Vinogradova V, Woll B, Cameron D, Eimer M, Cardin V. Sensory experience modulates the reorganisation of temporal auditory regions for executive processing. bioRxiv. 2021;2002–21. https://doi.org/10.1101/2021.02.08.430248
30. Glick H, Sharma A. Cross-modal plasticity in developmental and age-related hearing loss: Clinical implications. Hear Res. 2017;343:191–201. https://doi.org/10.1016/j.heares.2016.08.012
31. Lomber SG, Meredith MA, Kral A. Cross-modal plasticity in specific auditory cortices underlies visual compensations in the deaf. Nat Neurosci. 2010;13(11):1421–7. https://doi.org/10.1038/nn.2653
32. Francis AL, Love J. Listening effort: Are we measuring cognition or affect, or both? Wiley Interdiscip Rev Cogn Sci. 2020;11(1):e1514. https://doi.org/10.1002/wcs.1514
33. Pichora-Fuller MK, Singh G. Effects of age on auditory and cognitive processing: implications for hearing aid fitting and audiologic rehabilitation. Trends Amplif. 2006;10(1):29–59. https://doi.org/10.1177/108471380601000103
34. Winn MB, Teece KH. Listening effort is not the same as speech intelligibility score. Trends Hear. 2021;25:23312165211027690. https://doi.org/10.1177/23312165211027688
35. Peelle JE. Listening effort: How the cognitive consequences of acoustic challenge are reflected in brain and behavior. Ear Hear. 2018;39(2):204. https://doi.org/10.1097/AUD.0000000000000494
36. Wingfield A, Tun PA, Koh CK, Rosen MJ. Regaining lost time: adult aging and the effect of time restoration on recall of time-compressed speech. Psychol Aging. 1999;14(3):380. https://doi.org/10.1037/0882-7974.14.3.380
37. Peelle JE, Johnsrude I, Davis MH. Hierarchical processing for speech in human auditory cortex and beyond. Front Hum Neurosci. 2010;4:1735. https://doi.org/10.3389/fnhum.2010.00051
38. Davis MH, Johnsrude IS. Hearing speech sounds: top-down influences on the interface between audition and speech perception. Hear Res. 2007;229(1–2):132–47. https://doi.org/10.1016/j.heares.2007.01.014
39. Vaden KI, Kuchinsky SE, Cute SL, Ahlstrom JB, Dubno JR, Eckert MA. The cingulo-opercular network provides word-recognition benefit. J Neurosci. 2013;33(48):18979–86. https://doi.org/10.1523/JNEUROSCI.1417-13.2013
40. Wild CJ, Yusuf A, Wilson DE, Peelle JE, Davis MH, Johnsrude IS. Effortful listening: the processing of degraded speech depends critically on attention. J Neurosci. 2012;32(40):14010–21. https://doi.org/10.1523/JNEUROSCI.1528-12.2012
41. Erb J, Henry MJ, Eisner F, Obleser J. The brain dynamics of rapid perceptual adaptation to adverse listening conditions. J Neurosci. 2013;33(26):10688–97. https://doi.org/10.1523/JNEUROSCI.4596-12.2013
42. Eckert MA, Menon V, Walczak A, Ahlstrom J, Denslow S, Horwitz A, et al. At the heart of the ventral attention system: the right anterior insula. Hum Brain Mapp. 2009;30(8):2530–41. https://doi.org/10.1002/hbm.20688
43. Duncan J. The multiple-demand (MD) system of the primate brain: mental programs for intelligent behaviour. Trends Cogn Sci. 2010;14(4):172–9. https://doi.org/10.1016/j.tics.2010.01.004
44. Wingfield A, Grossman M. Language and the aging brain: patterns of neural compensation revealed by functional brain imaging. J Neurophysiol. 2006;96(6):2830–9. https://doi.org/10.1152/jn.00628.2006
45. Pouyandeh MH, Hoseinabadi R. Factors influencing the hearing aids use and satisfaction: a review study. Journal of Modern Rehabilitation. 2019;13(3):137-. https://doi.org/10.32598/JMR.13.3.137
2. Gagne J-P, Besser J, Lemke U. Behavioral assessment of listening effort using a dual-task paradigm: A review. Trends Hear. 2017;21:2331216516687287. https://doi.org/10.1177/2331216516687287
3. Pichora-Fuller MK, Kramer SE, Eckert MA, Edwards B, Hornsby BWY, Humes LE, et al. Hearing impairment and cognitive energy: The framework for understanding effortful listening (FUEL). Ear Hear. 2016;37:5S-27S. https://doi.org/10.1097/AUD.0000000000000312
4. Rönnberg J, Rudner M, Foo C, Lunner T. Cognition counts: A working memory system for ease of language understanding (ELU). Int J Audiol. 2008;47(sup2):S99–105. https://doi.org/10.1080/14992020802301167
5. Rönnberg J, Lunner T, Zekveld A, Sörqvist P, Danielsson H, Lyxell B, et al. The Ease of Language Understanding (ELU) model: Theoretical, empirical, and clinical advances. Front Syst Neurosci. 2013;7:31. https://doi.org/10.3389/fnsys.2013.00031
6. Humes LE, Roberts L. Speech-recognition difficulties of the hearing-impaired elderly: The contributions of audibility. J Speech, Lang Hear Res. 1990;33(4):726–35. https://doi.org/10.1044/jshr.3304.726
7. McCoy SL, Tun PA, Cox LC, Colangelo M, Stewart RA, Wingfield A. Hearing loss and perceptual effort: Downstream effects on older adults’ memory for speech. Q J Exp Psychol Sect A. 2005;58(1):22–33. https://doi.org/10.1080/02724980443000151
8. Hällgren M, Larsby B, Lyxell B, Arlinger S. Speech understanding in quiet and noise, with and without hearing aids: Comprensión del lenguaje en silencio y con ruido, con y sin auxiliares auditivos. Int J Audiol. 2005;44(10):574–83. https://doi.org/10.1080/14992020500190011
9. Plomp R. A signal-to-noise ratio model for the speech-reception threshold of the hearing impaired. J Speech, Lang Hear Res. 1986;29(2):146–54. https://doi.org/10.1044/jshr.2902.146
10. Hopkins K, Moore BCJ, Stone MA. Effects of moderate cochlear hearing loss on the ability to benefit from temporal fine structure information in speech. J Acoust Soc Am. 2008;123(2):1140–53. https://doi.org/10.1121/1.2824018
11. Hagerman B. Clinical measurements of speech reception threshold in noise. Scand Audiol. 1984;13(1):57–63. https://doi.org/10.3109/01050398409076258
12. Shinn-Cunningham BG, Best V. Selective attention in normal and impaired hearing. Trends Amplif. 2008;12(4):283–99. https://doi.org/10.1177/1084713808325306
13. Weinstein BE, Ventry IM. Hearing impairment and social isolation in the elderly. J Speech, Lang Hear Res. 1982;25(4):593–9. https://doi.org/10.1044/jshr.2504.593
14. Demorest ME, Erdman SA. Scale composition and item analysis of the Communication Profile for the Hearing Impaired. J Speech, Lang Hear Res. 1986;29(4):515–35. https://doi.org/10.1044/jshr.2904.535
15. Strawbridge WJ, Wallhagen MI, Shema SJ, Kaplan GA. Negative consequences of hearing impairment in old age: a longitudinal analysis. Gerontologist. 2000;40(3):320–6. https://doi.org/10.1093/geront/40.3.320
16. Ohlenforst B, Zekveld AA, Jansma EP, Wang Y, Naylor G, Lorens A, et al. Effects of hearing impairment and hearing aid amplification on listening effort: A systematic review. Ear Hear. 2017;38(3):267. https://doi.org/10.1097/AUD.0000000000000396
17. Wingfield A, Tun PA, McCoy SL. Hearing loss in older adulthood: What it is and how it interacts with cognitive performance. Curr Dir Psychol Sci. 2005;14(3):144–8. https://doi.org/10.1111/j.0963-7214.2005.00356.x
18. Pichora-Fuller MK. Perceptual effort and apparent cognitive decline: Implications for audiologic rehabilitation. In: Seminars in Hearing. Copyright© 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New …; 2006. p. 284–93. https://doi.org/10.1055/s-2006-954855
19. Mahalawy T, Emara AA, Hussein AB, Lasheen RM. Listening Effort in Patients with Sensorineural Hearing Loss using Cochlear Implant. Egypt J Ear, Nose, Throat Allied Sci. 2024;25(25):1–9. https://doi.org/10.21608/ejentas.2022.140669.1516
20. Mallard M, Van Engen KJ. Speech intelligibility and listening effort: A dual-task paradigm for accented speech perception. J Acoust Soc Am. 2023;153(3_supplement):A169–A169. https://doi.org/10.1121/10.0018546
21. Sardone R, Battista P, Panza F, Lozupone M, Griseta C, Castellana F, et al. The age-related central auditory processing disorder: silent impairment of the cognitive ear. Front Neurosci. 2019;13:619. https://doi.org/10.3389/fnins.2019.00619
22. Janse E, Ernestus M. The roles of bottom-up and top-down information in the recognition of reduced speech: Evidence from listeners with normal and impaired hearing. J Phon. 2011;39(3):330–43. https://doi.org/10.1016/j.wocn.2011.03.005
23. Moore BCJ. Cochlear hearing loss: physiological, psychological and technical issues. John Wiley & Sons; 2007. (Book)
24. MC K. I can hear what people say, but I can’t understand them. Hear Rev. 1997;4:8–14.
25. Peelle JE, Wingfield A. The neural consequences of age-related hearing loss. Trends Neurosci. 2016;39(7):486–97. https://doi.org/10.1016/j.tins.2016.05.001
26. Alloway TP, Copello E. Working memory: The what, the why, and the how. Educ Dev Psychol. 2013;30(2):105–18. (Internet)
27. Akeroyd MA. Are individual differences in speech reception related to individual differences in cognitive ability? A survey of twenty experimental studies with normal and hearing-impaired adults. Int J Audiol. 2008;47(sup2):S53–71. https://doi.org/10.1080/14992020802301142
28. Pichora‐Fuller MK, Schneider BA, Daneman M. How young and old adults listen to and remember speech in noise. J Acoust Soc Am. 1995;97(1):593–608. https://doi.org/10.1121/1.412282
29. Manini B, Vinogradova V, Woll B, Cameron D, Eimer M, Cardin V. Sensory experience modulates the reorganisation of temporal auditory regions for executive processing. bioRxiv. 2021;2002–21. https://doi.org/10.1101/2021.02.08.430248
30. Glick H, Sharma A. Cross-modal plasticity in developmental and age-related hearing loss: Clinical implications. Hear Res. 2017;343:191–201. https://doi.org/10.1016/j.heares.2016.08.012
31. Lomber SG, Meredith MA, Kral A. Cross-modal plasticity in specific auditory cortices underlies visual compensations in the deaf. Nat Neurosci. 2010;13(11):1421–7. https://doi.org/10.1038/nn.2653
32. Francis AL, Love J. Listening effort: Are we measuring cognition or affect, or both? Wiley Interdiscip Rev Cogn Sci. 2020;11(1):e1514. https://doi.org/10.1002/wcs.1514
33. Pichora-Fuller MK, Singh G. Effects of age on auditory and cognitive processing: implications for hearing aid fitting and audiologic rehabilitation. Trends Amplif. 2006;10(1):29–59. https://doi.org/10.1177/108471380601000103
34. Winn MB, Teece KH. Listening effort is not the same as speech intelligibility score. Trends Hear. 2021;25:23312165211027690. https://doi.org/10.1177/23312165211027688
35. Peelle JE. Listening effort: How the cognitive consequences of acoustic challenge are reflected in brain and behavior. Ear Hear. 2018;39(2):204. https://doi.org/10.1097/AUD.0000000000000494
36. Wingfield A, Tun PA, Koh CK, Rosen MJ. Regaining lost time: adult aging and the effect of time restoration on recall of time-compressed speech. Psychol Aging. 1999;14(3):380. https://doi.org/10.1037/0882-7974.14.3.380
37. Peelle JE, Johnsrude I, Davis MH. Hierarchical processing for speech in human auditory cortex and beyond. Front Hum Neurosci. 2010;4:1735. https://doi.org/10.3389/fnhum.2010.00051
38. Davis MH, Johnsrude IS. Hearing speech sounds: top-down influences on the interface between audition and speech perception. Hear Res. 2007;229(1–2):132–47. https://doi.org/10.1016/j.heares.2007.01.014
39. Vaden KI, Kuchinsky SE, Cute SL, Ahlstrom JB, Dubno JR, Eckert MA. The cingulo-opercular network provides word-recognition benefit. J Neurosci. 2013;33(48):18979–86. https://doi.org/10.1523/JNEUROSCI.1417-13.2013
40. Wild CJ, Yusuf A, Wilson DE, Peelle JE, Davis MH, Johnsrude IS. Effortful listening: the processing of degraded speech depends critically on attention. J Neurosci. 2012;32(40):14010–21. https://doi.org/10.1523/JNEUROSCI.1528-12.2012
41. Erb J, Henry MJ, Eisner F, Obleser J. The brain dynamics of rapid perceptual adaptation to adverse listening conditions. J Neurosci. 2013;33(26):10688–97. https://doi.org/10.1523/JNEUROSCI.4596-12.2013
42. Eckert MA, Menon V, Walczak A, Ahlstrom J, Denslow S, Horwitz A, et al. At the heart of the ventral attention system: the right anterior insula. Hum Brain Mapp. 2009;30(8):2530–41. https://doi.org/10.1002/hbm.20688
43. Duncan J. The multiple-demand (MD) system of the primate brain: mental programs for intelligent behaviour. Trends Cogn Sci. 2010;14(4):172–9. https://doi.org/10.1016/j.tics.2010.01.004
44. Wingfield A, Grossman M. Language and the aging brain: patterns of neural compensation revealed by functional brain imaging. J Neurophysiol. 2006;96(6):2830–9. https://doi.org/10.1152/jn.00628.2006
45. Pouyandeh MH, Hoseinabadi R. Factors influencing the hearing aids use and satisfaction: a review study. Journal of Modern Rehabilitation. 2019;13(3):137-. https://doi.org/10.32598/JMR.13.3.137
| Issue | Articles in Press | |
| Section | Review Article(s) | |
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| Listening effort hearing loss cognitive load mechanisms | ||
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How to Cite
1.
Iran Pour Mobarakeh Z, Amiri M, Tavanai E, Rahimi V. Mechanisms of Listening Effort in Individuals with Hearing Loss. jmr. 2025;(-).
