Already Gone Though undetectable with testing, hearing decline begins when we’re in our 40s and 50s. What causes this change, and how can clinicians advise clients who notice the difference and struggle with it in everyday listening situations? Features
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Features  |   June 01, 2015
Already Gone
Author Notes
  • Janet Koehnke, PhD, CCC-A, is professor and chair of the Department of Communication Sciences and Disorders at Montclair State University in Montclair, New Jersey. She is an affiliate of ASHA Special Interest Group 10, Issues in Higher Education. koehnkej@mail.montclair.edu
    Janet Koehnke, PhD, CCC-A, is professor and chair of the Department of Communication Sciences and Disorders at Montclair State University in Montclair, New Jersey. She is an affiliate of ASHA Special Interest Group 10, Issues in Higher Education. koehnkej@mail.montclair.edu×
  • Jennifer Lister, PhD, CCC-A, is professor and chair of the Department of Communication Sciences and Disorders at the University of South Florida in Tampa. She is an affiliate of SIG 6, Hearing and Hearing Disorders: Research and Diagnostics. jlister@usf.edu
    Jennifer Lister, PhD, CCC-A, is professor and chair of the Department of Communication Sciences and Disorders at the University of South Florida in Tampa. She is an affiliate of SIG 6, Hearing and Hearing Disorders: Research and Diagnostics. jlister@usf.edu×
  • Ilse Wambacq, PhD, is associate professor in the Department of Communication Sciences and Disorders at Montclair State University in Montclair, New Jersey. iwambacq@runbox.com
    Ilse Wambacq, PhD, is associate professor in the Department of Communication Sciences and Disorders at Montclair State University in Montclair, New Jersey. iwambacq@runbox.com×
Article Information
Hearing & Speech Perception / Features
Features   |   June 01, 2015
Already Gone
The ASHA Leader, June 2015, Vol. 20, 38-42. doi:10.1044/leader.FTR1.20062015.38
The ASHA Leader, June 2015, Vol. 20, 38-42. doi:10.1044/leader.FTR1.20062015.38
Forty-two-year-old Kelly comes to see you because she is having trouble understanding her friends in social situations, like outings to restaurants or clubs. She knows her hearing is normal and says she seems to have this problem only in situations where there are multiple conversations, background noise or music. Kelly is concerned because she’s now avoiding social events with challenging listening environments.
Sound familiar? It’s not uncommon for us, as audiologists, to see people in their 40s and 50s who complain of difficulty understanding speech in noisy environments. Yet when we conduct a complete audiometric evaluation on these clients, we often find normal pure-tone and speech thresholds and excellent word recognition in quiet. So what is the source of these clients’ hearing challenges?
A growing number of studies suggest that while clients’ hearing may be normal, their complex auditory processing at a central level is not what it was when they were in their 20s and 30s (see sources below). Some of the explanations for these declines include impaired temporal processing and binaural/spatial processing, which are thought to be mediated, at least in part, at the level of the auditory brainstem. In addition, there is clear evidence for age-related changes in cognitive processing in middle-aged people.
How do these changes affect the ability to understand speech in degraded listening conditions, locate sound sources, and, in general, communicate in everyday listening situations? Not surprisingly, research suggests there is not a simple answer to this question (see sources below). Nonetheless, certain auditory-processing challenges likely contribute to these hearing difficulties. Though typically not a debilitating decline, it is one audiologists and speech-language pathologists need to watch for in middle-aged clients, so that they can offer support, as needed.
Typical decline
Temporal processing, or the ability to follow rapid changes in speech, music and other sound, declines sharply with age, beginning in the early 40s, research indicates. These declines appear to happen independently of hearing loss and are more apparent for complex, speech-like stimuli than for simple sounds.
The extensive work of researcher Sandra Gordon-Salant and colleagues reveals clear effects of aging on deficits in judgments about speech rhythm and emphasis. Further, in a study published in Hearing Research in 2010, Larry Humes and colleagues conducted a study of middle-aged adults in which they controlled the influence of hearing loss by presenting low-pass filtered sounds at a high level. Despite the controls, middle-aged adults had significantly poorer temporal processing than young adults. The researchers identified cognition and age as the predictors of temporal processing.
These changes in temporal processing—which affect speech understanding—will undoubtedly affect everyday communication. As clinicians, therefore, we should be aware that listeners may “miss” some rapidly occurring cues (for example, “What did you say?” versus “Where did you stay?”), especially in conversational situations where there is noise, music or other competing conversations. Other research suggests that, by the time people are in their 40s or 50s, many have a harder time determining where sounds are coming from, especially if there is background noise or reverberation (echoes) in the environment.

Temporal processing, or the ability to follow rapid changes in speech, music and other sound, declines sharply with age, beginning in the early 40s.

Auditory distraction
To successfully participate in a conversation in a difficult listening environment, the listener has to separate incoming sounds into distinct conversations and focus on one of them. This process is referred to as auditory stream segregation. People may start struggling with auditory stream segregation as early as middle age (see sources below).
Although the precise reasons for these difficulties are not clearly understood, they may include changes in hearing status (even if acuity is still within the normal range), central auditory function, or cognitive function, including memory, attention and processing speed. Our and others’ research reveals early signs of changes in brain processing of binaural information in middle-aged adults with normal hearing.
Background noise is another hearing detractor because it interferes with tasks requiring working memory—which is integral to language processing and which already declines with age. For example, to participate successfully in a conversation, a person needs to store incoming words and to process and integrate them with prior words in a sentence. In a study published just this year in the Journal of the American Academy of Audiology, Michelle Neidleman and colleagues found that background babble appears to negatively affect middle-aged adults’ ability to encode and retrieve words using working memory.

Background noise is another hearing detractor because it interferes with tasks requiring working memory—which is integral to language processing and which already declines with age.

Hearing help
In cases where normal, age-related decline in hearing brings clients to our offices, what can we recommend? The strategies we suggest to listeners—some of them intuitive—include:
  • Silence any noise sources, such as radio or television, that interfere with your understanding of another’s speech.

  • Position yourself and your conversation partners to optimally see and hear one another.

  • Ask conversation partners to speak more loudly and clearly.

  • If other conversations are happening around you, try to move to a new location. Separating will help focus your attention on the auditory stream of interest, which becomes more challenging when other streams compete with it.

Clearly, there are many possible explanations for increasing difficulties with hearing in middle age. Although we cannot easily pinpoint which of the changes underlies the problems some clients experience, we can at least explain to them what we know about normal auditory decline. This information may ease some of their concerns.
As audiologists and SLPs treating these clients, we should be attuned to age-related changes and ready to recommend listening strategies. These strategies may help Kelly and others like her decrease their communication difficulties. Such guidance from us is essential to helping these clients to actively participate in their world.
Sources
Davis, T. T., & Jerger, J. (2014). The effect of middle age on the late positive component of the Auditory Event-Related Potential. Journal of the American Academy of Audiology, 25(2), 199–209. DOI:10.3766/jaaa.25.2.8 [Article] [PubMed]
Davis, T. T., & Jerger, J. (2014). The effect of middle age on the late positive component of the Auditory Event-Related Potential. Journal of the American Academy of Audiology, 25(2), 199–209. DOI:10.3766/jaaa.25.2.8 [Article] [PubMed]×
Fitzgibbons, P., & Gordon-Salant, S. (2010). Age-related differences in discrimination of temporal intervals in accented tone sequences. Hearing Research, 264, 41–47. DOI: 10.1016/j.heares.2009.11.00. [Article] [PubMed]
Fitzgibbons, P., & Gordon-Salant, S. (2010). Age-related differences in discrimination of temporal intervals in accented tone sequences. Hearing Research, 264, 41–47. DOI: 10.1016/j.heares.2009.11.00. [Article] [PubMed]×
Gordon-Salant, S., Fitzgibbons, P., & Yeni-Komshian, G. H. (2011). Auditory temporal processing and aging: Implications for speech understanding of older people. Audiology Research, 1, 9–15.
Gordon-Salant, S., Fitzgibbons, P., & Yeni-Komshian, G. H. (2011). Auditory temporal processing and aging: Implications for speech understanding of older people. Audiology Research, 1, 9–15.×
Grose, J., Hall, J. W., & Buss, E. (2006). Temporal processing deficits in the pre-senescent auditory system. Journal of the Acoustical Society of America, 119(4), 2305–2315. [Article] [PubMed]
Grose, J., Hall, J. W., & Buss, E. (2006). Temporal processing deficits in the pre-senescent auditory system. Journal of the Acoustical Society of America, 119(4), 2305–2315. [Article] [PubMed]×
Helfer, K., & Vargo, M. (2009). Speech recognition and temporal processing in middle-aged women. Journal of the American Academy of Audiology, 20, 264–271. [Article] [PubMed]
Helfer, K., & Vargo, M. (2009). Speech recognition and temporal processing in middle-aged women. Journal of the American Academy of Audiology, 20, 264–271. [Article] [PubMed]×
Humes, L., Kewley-Port, D., Fogerty, D., & Kinney, D. (2010). Measures of hearing threshold and temporal processing across the adult lifespan. Hearing Research, 264, 30–40. [Article] [PubMed]
Humes, L., Kewley-Port, D., Fogerty, D., & Kinney, D. (2010). Measures of hearing threshold and temporal processing across the adult lifespan. Hearing Research, 264, 30–40. [Article] [PubMed]×
Koehnke, J., & Besing, J. (2001). The effects of aging on binaural and spatial hearing. Seminars in Hearing, 22(3), 241–253. [Article]
Koehnke, J., & Besing, J. (2001). The effects of aging on binaural and spatial hearing. Seminars in Hearing, 22(3), 241–253. [Article] ×
Koehnke, J., Besing, J., Zheng, Y., Cooper, D., Ferise, A., & Wambacq, I. (October, 2011). Effects of noise, reverberation, and age on virtual localization. Poster presented at the Conference on Aging and Speech Communication, Bloomington, IN.
Koehnke, J., Besing, J., Zheng, Y., Cooper, D., Ferise, A., & Wambacq, I. (October, 2011). Effects of noise, reverberation, and age on virtual localization. Poster presented at the Conference on Aging and Speech Communication, Bloomington, IN.×
Krause, J. C., & Braida, L. D. (2002). Investigating alternative forms of clear speech: The effects of speaking rate and speaking mode on intelligibility. Journal of the Acoustical Society of America, 112(5), 2165–2172. [Article] [PubMed]
Krause, J. C., & Braida, L. D. (2002). Investigating alternative forms of clear speech: The effects of speaking rate and speaking mode on intelligibility. Journal of the Acoustical Society of America, 112(5), 2165–2172. [Article] [PubMed]×
Lister, J., Besing, J., & Koehnke, J. (2002). Effects of age and frequency disparity on gap discrimination. Journal of the Acoustical Society of America, 111(6), 2793–2800. [Article] [PubMed]
Lister, J., Besing, J., & Koehnke, J. (2002). Effects of age and frequency disparity on gap discrimination. Journal of the Acoustical Society of America, 111(6), 2793–2800. [Article] [PubMed]×
Neidleman, M., Wambacq, I., Besing, J., Spitzer, J., Koehnke, J. (2015). The effect of background babble on working memory in young and middle-aged adults. Journal of the American Academy of Audiology, 26(3), 220–228. [Article] [PubMed]
Neidleman, M., Wambacq, I., Besing, J., Spitzer, J., Koehnke, J. (2015). The effect of background babble on working memory in young and middle-aged adults. Journal of the American Academy of Audiology, 26(3), 220–228. [Article] [PubMed]×
Wambacq, I. J. A., Koehnke, J., & Besing, J. (2010). Concurrent sound segregation across the adult life-span. Perspectives on Hearing & Hearing Disorders: Research & Diagnostics, 46–53.
Wambacq, I. J. A., Koehnke, J., & Besing, J. (2010). Concurrent sound segregation across the adult life-span. Perspectives on Hearing & Hearing Disorders: Research & Diagnostics, 46–53.×
Wambacq, I., Koehnke, J., Besing, J., Romei, L., DePierro, A., & Cooper, D. (2009). Processing interaural cues in sound segregation by young and middle-aged brains. Journal of the American Academy of Audiology, 20(7), 453–458. [PubMed]
Wambacq, I., Koehnke, J., Besing, J., Romei, L., DePierro, A., & Cooper, D. (2009). Processing interaural cues in sound segregation by young and middle-aged brains. Journal of the American Academy of Audiology, 20(7), 453–458. [PubMed]×
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June 2015
Volume 20, Issue 6