Effect of Tinnitus on Listening Effort in Patients

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Effect of Tinnitus on Listening Effort in Patients of Sudden Sensorineural Hearing Loss 李典憲

Effect of Tinnitus on Listening Effort in Patients of Sudden Sensorineural Hearing Loss 李典憲 1, 2 蔡明憲 3 黃啟原 1, 2 1台北榮民總醫院 耳鼻喉頭頸部耳科 2國立陽明大學 耳鼻喉科 3國立臺北護理健康大學語言治療與聽力學系 台灣耳鼻喉科醫學會 第 105屆學術演講會 The 105 th Scientific Conference of the Taiwan Otolaryngological Society

Background • Listening effort is defined as the cognitive resources necessary to understand speech.

Background • Listening effort is defined as the cognitive resources necessary to understand speech. • Limited resource capacity theory. • When listening effort is increased, fewer cognitive resources are available. Kahneman, 1973 Picou et al. , 2013

Limited resource capacity theory Kahneman, 1973 Background noise Hearing loss Tinnitus Listening effort Cognitive

Limited resource capacity theory Kahneman, 1973 Background noise Hearing loss Tinnitus Listening effort Cognitive resources Rehearsal Recall Comprehension 3

Literature Review Background noise Listening effort Hearing loss Tinnitus Desjardins & Doherty, 2013; Mc.

Literature Review Background noise Listening effort Hearing loss Tinnitus Desjardins & Doherty, 2013; Mc. Coy et al. , 2005; P. Rabbitt, 1991; P. M. Rabbitt, 1968; Wightman & Kistler, 2005 Hicks & Tharpe, 2002 Desjardins & Doherty, 2014; Hornsby, 2013; Lewis et al. , 2016; Ohlenforst, Zekveld, Jansma, et al. , 2017; Picou et al. , 2013 Degeest et al. , 2017 Josefine Juul Jensen et al. , 2018 4

Clinical Issues Tinnitus Single-sided hearing Background noise SSNHL

Clinical Issues Tinnitus Single-sided hearing Background noise SSNHL

Aim • What is the effect of tinnitus on listening effort in SSNHL patients?

Aim • What is the effect of tinnitus on listening effort in SSNHL patients? Ø Single-sided hearing Ø Under background noise or not 6

Material and Method • • Criteria of SSNHL Healthy contralateral ear: AC within 25

Material and Method • • Criteria of SSNHL Healthy contralateral ear: AC within 25 d. B Age: 16 – 65 y/o Exclusion: Inflammatory diseases of the ear, acoustic neuroma, or neurocognitive disorder • Pure tone audiometry, SRT, tympanometry • Tinnitus handicap inventory (THI) • Listening effort: Dual-task paradigm 7

Dual-task paradigm TVGH Audiometric Test Room ① Speech-recognition task Noise(-) or Noise(+) 1 m

Dual-task paradigm TVGH Audiometric Test Room ① Speech-recognition task Noise(-) or Noise(+) 1 m 1 m 2 9 ② Visual reaction time task 0. 45 m Reaction time Mask the deaf ear Listening effort 8

Study Design & Results Prospective Study Unilateral sudden hearing loss with tinnitus Criteria: SSNHL

Study Design & Results Prospective Study Unilateral sudden hearing loss with tinnitus Criteria: SSNHL Admission T 0 Evaluation: PTA, SRT, THI & dual task (n=22) Exclusion: n= 1, Acoustic neuroma Loss of F/U n= 3, F/U(1 M) T 1 Evaluation: PTA, SRT, THI & dual task (n=18 ) 9

Results: Demographics SSNHL (n=21) Gender (M/F) 11/10 (52%/48%) Age (mean ± SD) 48. 1

Results: Demographics SSNHL (n=21) Gender (M/F) 11/10 (52%/48%) Age (mean ± SD) 48. 1 ± 17. 1 Affected side (R/L) 8/13 (38%/62%) 10

Results: Audiometric Findings IV steroid treatment Pure tone audiometry AC 1 0. 5, 1

Results: Audiometric Findings IV steroid treatment Pure tone audiometry AC 1 0. 5, 1 , 2 , 4 k-ave Hz (d. B) AC 2 0. 5, 1 , 2 , 4, 8 k-ave Hz (d. B) Speech recognition threshold (d. B) T 0 T 1 P value AC 1 62. 1 42. 2 *0. 002 AC 2 63. 8 44. 1 *0. 001 AC 1 17. 4 18. 6 0. 350 AC 2 20. 1 21. 2 0. 335 Affected side 62. 9 37. 3 *0. 001 Healthy side 15. 1 15. 8 0. 651 Affected side Healthy side 11

Results: Severity of Tinnitus & Dual task IV steroid treatment T 0 T 1

Results: Severity of Tinnitus & Dual task IV steroid treatment T 0 T 1 P value 52. 7 34. 4 *<0. 001 Noise(-) 292. 8 266. 1 *0. 037 Noise(+) 315. 2 277. 1 *0. 028 Tinnitus handicap inventory Dual task – Reaction time(ms) 12

Results: Tinnitus & Reaction time

Results: Tinnitus & Reaction time

Results: ΔTHI & ΔRT 14

Results: ΔTHI & ΔRT 14

Results: Background noise T 0 T 1 15

Results: Background noise T 0 T 1 15

Discussion • Tinnitus impairs cognitive efficiency. • In patients with SSNHL Hallam et al.

Discussion • Tinnitus impairs cognitive efficiency. • In patients with SSNHL Hallam et al. , 2004 ØNo correlation between the tinnitus severity and listening effort ØCompatible with recent studies Hearing-impaired people (Josefine et al. , 2018) Normal-Hearing Young Adults (Degeest et al. , 2017) 16

Discussion • Patients with unilateral hearing loss have poor speech recognition under background Feuerstein,

Discussion • Patients with unilateral hearing loss have poor speech recognition under background Feuerstein, 1992 noise. • Background noise increased listening effort of patients with SSNHL ØCompatible with previous studies Normal-Hearing people (Desjardins & Doherty, 2013) Hearing-impaired children(Dawna Lewis et al. , 2016) 17

Conclusion • No correlation between the tinnitus severity and listening effort in SSNHL patients

Conclusion • No correlation between the tinnitus severity and listening effort in SSNHL patients with single-sided hearing. • Background noise increases the listening effort in SSNHL patients with single-sided hearing. 18

Thank You 台北榮民總醫院 李典憲 (dslee@vghtpe. gov. tw)

Thank You 台北榮民總醫院 李典憲 (dslee@vghtpe. gov. tw)

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Future Work • A larger series of assessment and systemic validation. ØCompared with healthy

Future Work • A larger series of assessment and systemic validation. ØCompared with healthy control group • Explore other factors for listening effort in paitents with SSNHL ØAge, motivation, learning effect 21

Dual-task paradigm 22

Dual-task paradigm 22

Discussion Auditory system Distorted speech signal (Tyler et al. , 2006) Listening effort Tinnitus

Discussion Auditory system Distorted speech signal (Tyler et al. , 2006) Listening effort Tinnitus Emotional distress Negativity & Anxiety (Hallam et al. , 1984; Hoekstra, Wesdorp, & van Zanten, 2014) 23

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