Can Individual Cognitive Abilities Direct Audiology Treatment?

By Pamela Souza, Tim Schoof, and Jing Shen

This article is a part of the March/April 2017, Volume 29, Number 2, Audiology Today issue.

Imagine you are at a party or at a busy restaurant and you are trying to follow what your conversation partner is telling you. Despite the music, conversations of the other guests, and the sound of clattering dishes in the background, you are able to understand most of the story. You are able to direct your attention to your conversation partner, make use of contextual information, and fill in the gaps of bits of the conversation you may have missed. Of course, it’s important for the auditory system to accurately encode sounds. However, you also need to be able to make sense of the input received. In other words, successful speech perception—especially in challenging environments—relies on cognitive processes to supplement the “bottom-up” auditory information transmitted by the peripheral auditory system.

Cognitive processing is even more important for individuals with hearing loss than for individuals with normal hearing, because auditory information is deficient as a result of cochlear pathology. To compensate for degraded input signals, a listener will need to rely more on cognitive processes to reconstruct the message and fill in the gaps of anything they may have missed. Just as clients vary in terms of their hearing abilities, they differ in terms of their cognitive abilities. And, just as differences in audiometric thresholds can affect treatment success, so can individual differences in cognition. Such differences may partially explain why two clients with the same audiogram respond differently to hearing aid signal processing or vary in their ability to understand speech in complex environments.

Over the past decade, hearing researchers have become increasingly interested in the role of cognition in auditory perception (e.g., Arlinger et al, 2009). Although there is a growing body of research in this area, the standard audiometric evaluation still emphasizes the peripheral auditory system by emphasizing pure-tone air and bone conduction thresholds and speech in quiet. A similar emphasis on peripheral auditory abilities occurs for hearing aids, where the initial hearing aid response is based on the pure-tone audiogram and adjusted according to user feedback (Anderson et al, 2017). While clinicians are interested in more individualized clinical treatment, most are not yet considering cognitive abilities in diagnostic and rehabilitation decisions. Should we be? And if the answer is yes, what do clinicians need to understand about cognition?