1. Aging, Hearing Loss and Amplification: Beyond the Audiogram
Donald J. Schum, PhD
Vice President, Audiology & Professional Relations
Oticon, Inc.

2. Audiological Perspective Cognitive Perspective
The Elderly
Audiological Perspective
Cognitive Perspective

3. Audiological Perspective Cognitive Perspective
The Elderly
Audiological Perspective
Cognitive Perspective

4. Our Core Approach:
Full Audibility

5. UCL
100
UCL
Speech
Range
dB SPL
HTL
HTL

6. UCL
100
UCL
Speech
Range
dB SPL
HTL
HTL

7. Sensorineural Hearing Loss
Yost & Nielsen, 1985

8. 120
100 80 60 40 20
UCL
HTL

9. 120
100 80 60 40 20
UCL
OHC Loss
OHC & IHC Loss
HTL

10. What else has to go right?
Yost & Nielsen, 1985
What else has to go right?

11. Types of Presbyacusis (Schuknecht, 1974)
Sensory
Metabolic
Mechanical
Neural

12. WRS Quiet at 70 dB HL R: 76% L: 68%
Mr. G
81 yr old Male
Gradually progressive loss
WRS Quiet at 70 dB HL R: 76% L: 68%

13. Seminars in Hearing, 2001

15. Schneider & Pichora-Fuller, 2001

16. Arthur et al., 1971

17. Dubno & Ahlstrom, 2001

18. First Conclusion: Effects of SNHL on periphery potentially more complex than hair cell loss

19. Audiological Perspective Cognitive Perspective
The Elderly
Audiological Perspective
Cognitive Perspective

20. How good is the brain?

21. Streaming Examples Mixed Same Voice (Female) Mixed Same Voice (Male)
Mixed Different Voices

22. How does the brain get the job done?

23. The brain strives to organize

24. Bregman, 1981

25. Bregman, 1981

26. Kubovy & Van Valkenburg, 2001
Localization helps to take stimulation in early perception and group into specific auditory streams Spatial organization puts all of these streams in relation to one another, allowing for conscious decisions as to what to pay attention to and what to ignore
Kubovy & Van Valkenburg, 2001

27. Normal Aging Which Skills Are Affected? motor skills
sensory sensitivity & acuity
short term memory
sensory-motor reaction time
processing & decision speed
selective attention
Which Skills are Retained?
Long-term memory (recall)
intelligence
linguistic skills

28. Normal Aging Loss of efficient processing of information
Neurological Slowing All neurological events takes longer to happen

29. Average Driving Speed 0 10 20 30 40 50 Mile Per Hour Chu, 1994
Mile Per Hour
Young Middle Elderly
Chu, 1994

30. Real-time Speech Understanding
More than word recognition
The ability to extract meaningful information from on-going conversation
On-going, real-time
Normally effortless
. . .listening to another talker is an “externally paced task”
Welford, 1983

31. Sensorineural Hearing Loss
Loss of the ability to organize sound

32. Complex Environments Multiple talkers Movement
Stable, non-speech sources
Unstable, non-speech sources
Distractions
Shifting focus
A little bit of everything

33. Normal Aging Which Skills Are Affected? motor skills
sensory sensitivity & acuity
short term memory
sensory-motor reaction time
processing & decision speed
selective attention
Which Skills are Retained?
Long-term memory (recall)
intelligence
linguistic skills

34. Neural Slowing

35. Real-time Speech Understanding
More than word recognition
The ability to extract meaningful information from on-going conversation
On-going, real-time
Normally effortless
Externally Paced

36. Multiple Cue Speech Processing
Word
Frequency
Acoustic Information
Stress
Pattern
Phonemic
Cues
Gesture
Sentence
Structure
Situational
Cues
Speech Understanding

37. Natural Voice Separation & Tracking:
Fundamental Frequency
Harmonic Structure
Supra-segmentals
Visual Cues
Linguistics
Loudness
Location
Timbre
Rate
etc.

38. Use of Context by the Elderly (Schum & Matthews, 1992)
High Context:
“The watchdog gave a warning growl”
Low Context Score
High Context Score
Scores below the line:
Poor use of Contextual Cues
Low Context
“John was talking about the growl”

39. Schum & Matthews, 1992

40. Two-channel Monitoring (Schum, 1994)
Difficulty of Primary Task
Reaction Time
Primary Task:
“John was talking about the growl”
Secondary Task:
Acknowledge screen color change

41. Schum, 1994

42. Schum, 1994

43. Do cognitive declines affect basic speech understanding?

45. Relationship between cognitive abilities
and speech understanding in noise
S/N
Memory Span (% correct)
Lunner, 2003

46. Relationship between cognitive abilities
and speech understanding in noise
S/N
Lexical Decision Speed (ms.)
Lunner, 2003

47. Does that mean a hearing aid will not be useful for the elderly patient?

49. Relationship between cognitive abilities and hearing aid benefit
Speech Understanding (% correct)
U A U A U A U A
Low/Low Low/High High/Low High/High
Cognitive Performance (2 measures)
Davis, 2003

50. Is measuring speech understanding telling us all we need to know?

51. Real-time Speech Understanding
More than word recognition
The ability to extract meaningful information from on-going conversation
On-going, real-time
Normally effortless
. . .listening to another talker is an “externally paced task”
Welford, 1983

52. Hearing is not independent of the rest of the nervous system
Second Conclusion:
Hearing is not independent of the
rest of the nervous system

53. Compensation Strategies:
We don’t change hearing . . .
We change sound

54. Multiple Cue Speech Processing
Word
Frequency
Acoustic Information
Stress
Pattern
Phonemic
Cues
Gesture
Sentence
Structure
Situational
Cues
Speech Understanding

55. Compensation Strategies
Patient Education & Realistic Expectations

56. Compensation Strategies
Patient Education & Realistic Expectations
Excellent Speech Processing (preserve information)

57. Fast Acting Slow Acting
Minimizes both long term & short term variations
Minimizes only long term variations
Amplitude
Time
Time

58. Fast Acting Slow Acting
Amplitude
Time
Time

59. Slow Acting Frequency (Hz.) dB HL UCL 125 250 500 1000 2000 4000 8000 20
Slow
Acting 40
dB HL 60 80
100
UCL
120 25

60. Slow Acting Frequency (Hz.) dB HL UCL 125 250 500 1000 2000 4000 8000 20
Slow
Acting 40
dB HL 60 80
100
UCL
120 25

62. Compensation Strategies
Patient Education & Realistic Expectations
Excellent Speech Processing (preserve information)
Signal-to-Noise ratio improvement

63. Compensation Strategies
Patient Education & Realistic Expectations
Excellent Speech Processing (preserve information)
Signal-to-Noise ratio improvement
Fully Automatic Design

64. Compensation Strategies
Patient Education & Realistic Expectations
Excellent Speech Processing (preserve information)
Signal-to-Noise ratio improvement
Fully Automatic Design
Pacing & complexity of message

65. Seminars in Hearing, 2001

67. Wingfield & Tun, 2001

68. Compensation Strategies
Patient Education & Realistic Expectations
Excellent Speech Processing (preserve information)
Signal-to-Noise ratio improvement
Fully Automatic Design
Pacing & complexity of message
Clear Speech

69. Clear Speech: Research History
Picheny, Braida, & Durlach: Mid 1980’s
coined the term, contrasted to “conversational style speech”
documented acoustic changes
documented intelligibility improvement

70. Acoustic Changes Effect? Slower rate of speech
More frequent and longer pauses
Longer phoneme durations (consonants & vowels)
More released word-final stops
Greater differentiation of vowels
Improved Consonant/Vowel ratio
Effect?

71. Acoustic Changes Effect? 15-20% WR improvement Slower rate of speech
More frequent and longer pauses
Longer phoneme durations (consonants & vowels)
More released word-final stops
Greater differentiation of vowels
Improved Consonant/Vowel ratio
Effect?
15-20% WR improvement

72. “Tuborg is a famous Danish beer. So is Carlsberg.”
Conversational Clear
Slower Rate
Higher Level
More & Longer Pauses

73. consonants (improved C/V)
“So is Carlsberg.”
Conversational Clear
Longer, more intense
consonants (improved C/V)

75. 2: Can it be maintained in continuous discourse?
1: Does the effect last? Yes, at least a month or longer after training.
2: Can it be maintained in continuous discourse?

78. Training in Clear Speech

79. Communication Tips vs. Training

84. Clear Speech Training Explain Importance Define/describe Clear Speech
Demonstration & Practice
Demonstrate reductions
Demonstrate emphasis of key words
Demonstrates phrasing
Continuous Discourse
Other Communication Tactics

85. Compensation Strategies
Patient Education & Realistic Expectations
Excellent Speech Processing (preserve information)
Signal-to-Noise ratio improvement
Fully Automatic Design
Pacing & complexity of message
Clear Speech
Follow-up Programs

86. Third Conclusion: Compensation to relieve the processing burden

87. Providing Amplification to the Aging Auditory System
Donald J. Schum, PhD
Vice President, Audiology & Professional Relations
Oticon, Inc.