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Speech perception in noise in the elderly: the effect of text type Lee, Grace May 1995

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SPEECH PERCEPTION IN NOISE IN T H E E L D E R L Y : T H E EFFECT OF T E X T T Y P E by G R A C E M A Y L E E B . A . , The University of British Columbia, 1991 A THESIS SUBMITTED IN P A R T I A L F U L F I L L M E N T OF T H E REQUIREMENTS FOR T H E D E G R E E OF M A S T E R OF SCIENCE in T H E F A C U L T Y OF G R A D U A T E STUDIES (School of Audiology and Speech Sciences) We accept this thesis as conforming to the required standard T H E UNIVERSITY OF BRITISH C O L U M B I A April 1995 ® Grace May Lee, 1995 In presenting t h i s thesis i n p a r t i a l f u l f i l l m e n t of the requirements for an advanced degree at the University of B r i t i s h Columbia, I agree that the Library s h a l l make i t f r e e l y a v a i l a b l e for reference and study. I further agree that permission for extensive copying of t h i s thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It i s understood that copying or pu b l i c a t i o n of t h i s thesis for f i n a n c i a l gain s h a l l not be allowed without my written permission. Department of fMiolo^ ^foefcXK £ti€flCC£, The University of B r i t i s h Columbia Vancouver, Canada 11 ABSTRACT The purpose of the present study was to examine how age-related changes in hearing and cognition contribute to the poor speech perception performance in noise observed in elderly listeners. Passages of two different text types were presented in +6, 0, and -6 dB signal-to-noise conditions to eight normal-hearing elderly listeners. Highly structured narratives and less structured descriptions were presented in a clause-by-clause fashion using a modified tracking procedure. Subjects repeated what they heard verbatim. The number and types of errors were analyzed. It was found that elderly listeners made more errors as listening conditions became less favourable. Moreover, elderly subjects made more errors for descriptions than for narratives. It seems that the subjects were able to benefit from the supportive context, which was available to a greater extent in the narratives than in the descriptions, in order to compensate for the degraded auditory signal. These results were then compared to a previous study that examined the speech perception performance of younger, normal-hearing adults in the same conditions. It was found that elderly listeners performed more poorly than younger adult listeners as noise increased, regardless of text type. This finding is likely due to age-related declines in auditory processing abilities. Importantly, there were no age differences in the utilization of supportive context, suggesting that elderly listeners take advantage of text structure to the same extent as do young listeners. i i i T A B L E OF CONTENTS Page A B S T R A C T i i T A B L E OF CONTENTS i i i LIST OF T A B L E S viii LIST OF FIGURES ix A C K N O W L E D G E M E N T xi DEDICATION xii Chapter 1 REVIEW OF T H E L I T E R A T U R E 1 Introduction 1 Hearing impairment, handicap, and disability 1 Disability of understanding speech in noise 2 Auditory Changes 5 Pure-tone thresholds 5 Frequency selectivity 7 Temporal processing 10 Binaural processing 16 Cognitive Changes 19 Processing of speech 21 Working memory 22 Inferential reasoning 23 Rationale Null hypotheses iv 25 30 Chapter 2 METHODS 31 Subjects 31 Materials 31 Procedure 32 Screening 32 Text-in-noise experiment 33 Coding 35 Error types 35 Units of utterance affected by error 37 Multiple error codings for one utterance 38 Linguistic level analysis 39 Chapter 3 RESULTS 43 Effect of S:N condition and text type on mean number 43 of errors Effect of S:N condition and text type on mean number 45 of errors for five error types Units of Utterance affected by error types 'deletion' 48 and 'substitution' V - Units of utterance affected by error type 48 'deletion' in narratives - Units of utterance affected by error type 50 'deletion' in descriptions - Units of utterance affected by error type 50 'substitution' Linguistic level analysis for substitution errors 53 - Partial auditory match - semantic level 53 - Partial auditory match - syntactic level 54 - No auditory match - semantic level 54 - No auditory match - syntactic level 57 - Preservation of syntactic and semantic 57 information Effect of S:N condition and text type on comprehension 59 scores Age differences in the effect of text type on speech perception 59 - Effect of S:N, text type and age on mean number of errors 61 Comparison of results by ease of listening 64 Chapter 4 DISCUSSION 68 Effect of S:N condition and text type 68 vi Effect of S:N condition and text type for five error types 69 Deletion errors 70 Substitution errors 70 a) Preservation of auditory information 70 b) Preservation of semantic and syntactic 71 information Comprehension results 71 Comparison of results between the two age groups 73 Comparison of results by common S:N ratio 74 Comparison of results by ease of listening 76 Summary and future directions 78 Implications for aural rehabilitation 80 REFERENCES 82 APPENDICES 92 Appendix A - Subject profiles 92 Appendix B - Passages 93 Appendix C - Readability, word, and syllable counts for each text 105 Appendix D - Hearing and language history 106 Appendix E - Subject thresholds - right ear (dB HL) 107 Appendix F - Transcriptions of subjects' responses 108 Appendix G - Comprehension Questions 203 vii Appendix H - M i l l Hi l l vocabulary test 215 Appendix I - Hearing handicap inventory for the elderly 216 Appendix J - Comprehension scores and ease of listening ratings 217 vii i LIST OF TABLES Table 1: Target-response matrix for substitution errors 52 Table 2: Frequency of substitution pairings in descending order 52 I X LIST OF FIGURES Figure 1: Mean number of errors per subject as a function of signal-to-noise 44 condition and text type. Figure 2: Mean number of errors per subject as a function of signal-to-noise 46 condition and the five error types. Figure 3: Mean number of errors per subject as a function of text type and 47 the five error types. Figure 4: Number of deletion errors as a function of signal-to-noise condition 49 and unit of utterance (narrative discourse condition). Figure 5: Number of deletion errors as a function of signal-to-noise condition 51 and unit of utterance (description discourse condition). Figure 6: Percentage of substitution errors that partially matched the 55 target auditorily as a function of signal-to-noise condition and degree of semantic match (+6 dB: N = 85; 0 dB: N = 142; -6 dB: N=209). N = total errors in that S:N condition. Figure 7: Percentage of substitution errors that partially matched the 55 target auditorily as a function of signal-to-noise condition and degree of syntactic match (+6 dB: N = 85; 0 dB: N=142; -6 dB: N=209). N = total errors in that S:N condition. Figure 8: Percentage of substitution errors that did not match the target 56 auditorily as a function of signal-to-noise condition and degree of semantic match (+6 dB: N = 85; 0 dB: N = 142; -6 dB: N=209). N = total errors in that S:N condition. Figure 9: Percentage of substitution errors that did not match the target 56 auditorily as a function of signal-to-noise condition and degree of syntactic match (+6 dB: N = 85; 0 dB: N = 142; -6 dB: N=209). N = total errors in that S:N condition. Figure 10: Number of substitution errors (partial auditory match) that 58 preserved both semantic and syntactic, only syntactic, only semantic, or neither level of information. Figure 11: Number of substitution errors (no auditory match) that preserved 58 both semantic and syntactic, only syntactic, only semantic or X neither level of information. Figure 12: Comprehension questionnaire scores (in %) as a function of 60 signal-to-noise ratio and text type. Figure 13: Mean number of errors per subject as a function of signal-to-noise 62 condition and text type for young subjects (from Howarth, 1992). Figure 14: Mean number of errors per subject as a function of signal-to-noise 63 condition and text type for young subjects (from Howarth, 1992) and old subjects (present study). Figure 15: Mean number of errors per subject in as a function of 'listening ease,' 66 text type and age. xi A C K N O W L E D G E M E N T I would like to express my sincere thanks - to Kathy Fuller: for her research expertise, her incredible support and guidance, and most of all, her ability to stay calm even at the eleventh hour - to John Gilbert: for his encouragement and support - to Carolyn Johnson: for her encouragement, support, and excellent cooking at the thesis meetings - to my family, especially my parents, for their patience, understanding, and 'space' - to my fellow classmates: "IT IS FINISHED!" - to my thesis subjects: for their enthusiasm - and finally, to my pilot subject/typist/chauffeur/fiance, Sion Shyng, who stayed up with me all those late nights. Without his love and constant support, I know this thesis would not have been possible. xii To my grandmother C H A P T E R ONE REVIEW OF T H E L I T E R A T U R E 1 Introduction Hearing impairment, handicap and disability Age-related decline in hearing, referred to as presbycusis, is a common health problem in the elderly. According to the data collected by Statistics Canada in the 1986 census and the 1986 post-censual survey, 3.7% of the Canadian population report that their hearing is impaired to some degree (Schein, 1992). Of this hearing-impaired group, 83.2% are 65 years of age or over. Within the hearing-impaired elderly population, 67.3% state that they have partial difficulty hearing in both one-to-one conversations and in groups (Schein, 1992). A n individual's hearing loss can be described in at least three ways: in terms of impairment, disability, or handicap. Hearing impairment refers to "any loss or abnormality of psychological, physiological or anatomical structure or function" (World Health Organization (WHO), 1980, cited in Stephens & Hetu, 1991). Impairment is a deviation from the norm and can be measured in a laboratory or clinic. Hearing disability, however, refers to "any restriction or lack of ability (resulting from the impairment) to perform an activity in a manner considered normal for a human being" (WHO, 1980, cited in Stephens & Hetu, 1991). This refers to the auditory difficulties experienced by the listener (e.g. difficulty perceiving speech and as a result, difficulty understanding spoken language in noisy environments). A final term, handicap, refers to the disadvantage for the individual (resulting from the impairment or disability) that limits or prevents the fulfilment of a role that is normal 2 for the individual (depending on what might be expected, given the person's age, sex, social and cultural values) (WHO, 1980 cited Stephens & Hetu, 1991). This last concept recognizes that there are effects of the hearing loss on the social status of the individual, (e.g. the negative stigma of being hearing impaired). Standard audiometric testing by an audiologist assesses a person's degree of hearing impairment, and from the results, rehabilitative measures can be developed in an attempt to reduce the restrictions imposed by the disability. Counselling services, support groups, and compensatory strategies are all ways that may help to reduce handicap. Disability of perceiving speech in noise One of the most frequent complaints of the elderly is that they experience trouble perceiving speech in typical noisy environments (for a review, see Committee on Hearing, Bioacoustics, and Biomechanics [CHABA], 1988). This disability is often exacerbated by the combined effects of noise (e.g. Duquesnoy & Plomp, 1980) and reverberation (e.g. Harris & Reitz, 1985; Heifer & Wilber, 1990; NabelSk & Robinson, 1982). Longitudinal studies of presbycusics have shown that the perception of everyday speech declines significantly with age for listening in non-optimal conditions (Bergman et al., 1976). This change is observed as early as the fourth decade of life and accelerates sharply after the seventh decade of life (e.g. Bergman et al., 1976; Bergman, 1980; Willott, 1991). Furthermore, unlike their younger counterparts, presbycusics who perform similarly in quiet on speech perception tasks may differ considerably from each other in their performance in noise (e.g. Duquesnoy, 1983a). This variation in performance among the elderly depending on whether the condition is quiet 3 or noisy differs from the pattern seen for young subjects (e.g. Harris & Reitz, 1985; Nabelek & Robinson, 1982). Standard audiometric assessments commonly reveal an elevation of audiometric thresholds in persons over sixty-five years of age (for a review, see Willott, 1991). This decline in thresholds may be a contributing factor to the disability experienced by elderly persons when they hear speech in noisy environments. However, elderly listeners who are assessed as having clinically normal audiometric thresholds (see later section, Pure-tone thresholds, for a definition of normal hearing for elderly persons) also report having greater difficulty in noise than young normal-hearing adults (e.g. Bergman, 1971; C H A B A , 1988). In studies examining the effects of age on speech perception in noise and in reverberant conditions, normal-hearing elderly subjects obtained poorer scores than normal-hearing younger individuals on speech discrimination tests (e.g. Harris & Reitz, 1985; Heifer & Wilber, 1990; Nabelek & Robinson, 1982). On the other hand, in quiet conditions with non-degraded speech stimuli, elderly subjects with relatively normal hearing perform similarly to young normal-hearing adults (e.g. Bergman 1971, 1980). Overall, evidence from the literature on age differences suggests that there are no significant effects of age on hearing in optimal listening conditions (for a review, see Willott, 1991). In view of these findings, it seems unlikely that threshold loss alone can account for the poorer speech perception ability demonstrated by elderly individuals in noise. The discrepancy between the degree of hearing disability predicted by the standard pure-tone audiogram and the degree of hearing disability that is actually reported by elderly persons in their difficult daily experiences strongly suggests the need for new approaches to 4 the assessment of hearing. Rehabilitative measures will remain inadequate in successfully reducing the negative effects of the impairment as long as they are based solely on traditional clinical tests. Factors other than threshold loss, such as auditory changes not observable through standard audiometric testing need to be addressed in order to better appreciate the difficulty in understanding speech in noise that is experienced by both normal-hearing and hearing-impaired elderly persons. In addition to age-related changes in audition, age-related cognitive changes should also be considered as other factors that might contribute to the deterioration of speech perception in the elderly. When we listen to spoken language, not only do we perceive and identify the sounds through our auditory system, but cognitive processes must also act on the input for us to achieve language comprehension. Age-related differences in cognition, such as working memory capacity and inferential reasoning abilities must also be considered (for a review, see Cohen, 1987; CHABA, 1988). Three explanations, the multiple distortion hypothesis, the central auditory nervous system (CANS) hypothesis and the cognitive-component hypothesis have been postulated to explain why older listeners have more difficulty perceiving speech in noisy situations than do younger listeners (CHABA, 1988). The multiple distortion hypothesis attributes the disability in noise to peripheral auditory deficits such as abnormal thresholds. The CANS hypothesis assumes that declines in the CANS from aging, resulting in deficits in binaural processing, for example, will affect speech perception in noise. Finally, the cognitive-component hypothesis assumes that the ability to process information entering any sensory channel is reduced (CHABA, 1988). . 5 In view of these hypotheses, the following sections will examine how age-related changes in auditive (peripheral and central processes) and cognitive factors may contribute to an elderly listener's disability in perceiving speech in noise. Auditory Changes Age-related declines in auditory processing can occur at both the periphery (processes occurring in external, middle, inner ear and perhaps the VHIth cranial nerve) and in the central auditory system (processes occurring more central than the level of VHIth cranial nerve). The resulting hearing impairment not only includes an elevation in the level of sound at the threshold level, but also an impairment in abilities to process sound presented at suprathreshold levels (CHABA, 1988). Age-related changes in threshold measures, specifically pure-tone thresholds, and in supra-threshold measures, specifically frequency selectivity, temporal resolution, and binaural processing, will be examined. Pure-Tone Thresholds The most commonly observed characteristic of presbycusis is an elevation in audiometric pure-tone thresholds. A review by Willott (1991) of the relationship between pure-tone thresholds and age showed that this elevation in auditory thresholds can begin as early as the third or fourth decade in life and that it increases rapidly with advancing age, especially in the sixth decade of life. Schuknecht (1974, cited in Willott, 1991) categorized presbycusis into four different types according to audiometric configuration and postmortem histopathologic studies of 6 presbycusics: sensory, neural, strial, and mechanical or cochlear conductive. Sensory presbycusis is associated with pathology of the Organ of Corti and is characterized by steeply sloping high frequency sensori-neural hearing loss. Neural presbycusis, pathology of the spiral ganglion cells and their processes, is associated with some loss of high frequency sensitivity and a decrease in speech discrimination ability that is poorer than what the corresponding pure-tone audiogram would predict. Strial presbycusis concerns pathology in the stria vascularis and is associated with a flat audiometric pattern. Finally, mechanical or cochlear conductive presbycusis is related to pathology in the basilar membrane, the spiral ligament, and other structures related to cochlear mechanics. This type of presbycusis is associated with a gradually sloping high frequency loss. To date, however, Schuknecht's scheme has been widely viewed as too simplistic because it appears to have been based mainly on case study information (for reviews see Marshall, 1981; Willott, 1991). Moreover, more than one type of anatomical degeneration may occur concurrently, and as a result, not all presbycusic profiles can fit distinctly into one of the four categories. In addition, the mechanical or cochlear conductive category remains theoretical to date, with empirical evidence yet to be found to support the existence of this type of presbycusis (Willott, 1991). In more recent reviews of presbycusis by Olsho, Harkins, and Lenhardt (1985) and Willott (1991), no single universal configuration of age-related hearing loss is identified, although it is widely agreed that the loss is usually bilateral and symmetrical in nature. Audiometric profiles of presbycusics can range from relatively flat losses across the frequencies to the well-documented and frequently observed high-frequency losses above 2000 7 Hz (Willott, 1991). The extent of this loss is usually more pronounced in males (e.g. Corso, 1963; Harbert, Young, & Menduke, 1966). The degree of hearing loss in elderly individuals will vary, but almost all persons will have some degree of impairment, even if the individual is classified clinically as having 'normal hearing.' 'Normal hearing' for young individuals is defined as thresholds of 25 dB H L or better from 250 Hz to 8000 Hz inclusive. For elderly individuals however, this is not a suitable norm, as very few elderly individuals will meet this criteria (for reviews, see Olsho et al., 1985; Willott, 1991). Such reviews of many studies of pure-tone thresholds in elderly subjects suggest that age-adjusted norms need to be applied. Most research studies set the criterion for 'normal hearing' in the elderly to be thresholds between 0 to 25 dB H L from 250 Hz up to at least 2000 or 3000 Hz (Willott, 1991). However, it remains at issue as to whether or not age specific norms defined in terms of absolute sensitivity are appropriate to characterize the hearing abilities of elderly individuals. As discussed earlier, even elderly persons classified as having clinically normal audiograms also report having trouble perceiving speech in typical noisy environments, a disability that is not usually reported by normal-hearing young listeners. Frequency selectivity A listener's ability to separate the components of a complex sound such as speech depends on the frequency-resolving power of the basilar membrane (for further information, see Moore, 1989). Without good ability to analyze the frequency components of complex sounds, the ability to discriminate speech at levels well above threshold is impaired. This frequency-resolving power of the ear is referred to as frequency selectivity, and is often 8 demonstrated and measured using masking studies. The extent to which a signal can still be detected in the presence of a masker defines the limits of the frequency selectivity of the inner ear (for further information, see Moore, 1989). One of the most important masking experiments for quantifying frequency selectivity was conducted by Fletcher (1940, cited in Moore, 1989). In his experiment, Fletcher (1940) measured the threshold of a sinusoidal signal as a function of the bandwidth of a noise masker. As the bandwidth of the masker was increased, the threshold of the signal increased (i.e., it became more difficult to hear the signal). This increase in threshold eventually plateaued, such that with further increases in the bandwidth of the noise masker there was no further increase in the threshold of the signal. Fletcher (1940) concluded from these results that the auditory system behaved analogously to a set of what are now called 'auditory filters.' Each 'auditory filter' could be characterized as having a particular bandwidth centred on a particular frequency. When a signal in noise is detected by the auditory system, one of the 'auditory filters' passes the signal with minimal loss and filters out noise components with remote spectral characteristics. In Fletcher's (1940) experiment, increasing the bandwidth of the noise was presumed to result in more noise passing through the auditory filter. But once the noise masker's bandwidth became greater than the width of the auditory filter's bandwidth, it was presumed that further increases in the noise masker's bandwidth did not result in more noise passing through the filter. The threshold of the signal was assumed to plateau at this point. The bandwidth of the noise masker at which the threshold of the signal did not increase further was used to estimate the 'critical bandwidth' of the auditory filter. Subsequent studies revealed that the bandwidth of auditory filters varies with centre frequency; specifically, 9 narrower bandwidths are found for decreasing centre frequencies (for a discussion, see Moore, 1989). Patterson, Nimmo-Smith, Weber, and Milroy (1982) examined changes in frequency selectivity with age. Their notched-noise experiment followed the same principles as Fletcher's masking experiment but used a modified masking paradigm. The masker was a broadband noise with a sharp-edged 'notch' that was centred on the signal frequency. The signal frequency was fixed and the listener's threshold for the signal was measured as a function of notch width (i.e., the width of the notch was varied and threshold was determined for each notch width). The bandwidth of the auditory filters of normal-hearing young and elderly listeners were measured at three signal frequencies (500, 2000 and 4000 Hz). The bandwidths of the filters were compared across the two age groups. Patterson et al. (1982) concluded that the critical bandwidth of the auditory filter broadens with age. In contrast to the study by Patterson et al. (1982), more recent studies show that impaired frequency selectivity in elderly listeners can be attributed mainly to age-related cochlear loss, rather than to age itself (e.g. Peters & Moore, 1992; Peters, Moore, & Pillsbury, 1992; Sommers & Humes, 1993). Peters and Moore (1992) measured the auditory filters of young and elderly subjects who were matched for degree of hearing impairment. Their results did not show any clear differences in the filter characteristics of the two age groups. The apparent age-related decrease in frequency selectivity was determined to be related to the hearing loss itself, given that their findings indicate that the filters broadened with increasing loss; therefore, poorer absolute thresholds are associated with poorer frequency resolution. These findings agree with those of Sommers & Humes (1993) who 10 noted that there were no significant differences between the bandwidths of the auditory filters at 2000 Hz in their normal-hearing young and elderly listeners. Age per se, therefore, does not appear to influence a listener's frequency selectivity (Peters & Moore, 1992; Peters et al., 1992). In general, these findings are consistent with the results from studies examining the relationship between frequency selectivity and losses resulting from damage to the cochlea (e.g. noise-induced hearing loss, ototoxic loss, Meniere's Disease) (for a review, see Moore, 1989). Such studies conclude that poorer frequency resolution is frequently observed in cochlear losses. It would appear that declines in auditory frequency selectivity contribute to the greater difficulty in perceiving speech in noise that is experienced by presbycusics, even if it is not a factor that affects the performance of elderly listeners who have no measurable sensorineural hearing loss. Having deficits in the frequency resolving power of the auditory system leads to a greater susceptibility to masking by interfering background noise (Moore, 1989). Furthermore, reduced frequency selectivity impairs the ability of the listener to analyze complex signals into their spectral components, thereby leading to a greater likelihood that the listener will experience difficulty in distinguishing speech sounds (Moore, 1989). Temporal resolution When a listener listens to complex sounds such as speech or music, much of the information is not only derived from the spectral properties of the stimulus, but also from modulations in frequency and amplitude that occur over time. The temporal analysis abilities of the auditory system have been measured in studies of temporal summation, temporal 11 integration, and gap detection (for a review, see Moore, 1989). The aspect of temporal processing most extensively studied in hearing-impaired individuals is gap detection. Importantly, it has been found that the ability to detect gaps in speech is correlated with speech perception performance (e.g. Tyler, Summerfield, Wood, & Fernandes, 1982). Gap detection experiments require the listener to detect a silent interval or gap between pure tones, or in broadband or bandlimited noise. The duration of the gap is slowly decreased and the subject must determine at which point the pair of signals, separated by a gap, are perceived as a single acoustic event (i.e., when the gap is no longer detected). The gap detection threshold is measured by finding the duration of the gap that the subject is just able to detect. In normal-hearing listeners, smaller gaps can be detected for higher signal frequencies; below 4000 Hz, gap detection becomes progressively poorer (i.e., gap detection thresholds become larger) as the signal frequency becomes lower (Fitzgibbons & Gordon-Salant, 1987; Florentine & Buus, 1983; Moore, 1989). To account for this finding, one theory states that the on/off effect of a signal, caused by the presentation of a gap between a pair of signals, results in a 'ringing' in the auditory filter. This ringing might partially fill in a gap, making it more difficult to detect the gap. Filters with longer response times will have more ringing. Longer response times are associated with narrower bandwidths. Therefore, since the auditory filters responsible for the analysis of low signal frequencies have narrower bandwidths, more ringing will occur in the low-frequency auditory filters, such that poorer gap detection is predicted for low-frequency sounds (Moore, 1989; Moore & Glasberg, 1988). While this theory will explain why gap detection thresholds become increasingly larger 12 for low signal frequencies for normal-hearing subjects, it would follow that listeners with cochlear hearing loss should have better gap detection thresholds than normals since the auditory filter bandwidths of hearing-impaired listeners are broadened (see previous section on frequency selectivity). This is clearly not the case, given that many studies have shown that listeners with sensorineural hearing loss frequently have larger gap detection thresholds than normal-hearing listeners (Florentine & Buus, 1984; Fitzgibbons & Gordon-Salant, 1987; Moore & Glasberg, 1988). For example, Florentine and Buus (1984) compared the gap detection thresholds of normal-hearing subjects, hearing-impaired subjects (who had high-frequency hearing losses) and normal subjects with simulated impairments. Impairments were simulated using spectrally-shaped masking noises to yield masked thresholds similar to the quiet thresholds of the hearing-impaired listeners. Gap detection thresholds were obtained by measuring the duration of a brief temporal gap in a broadband noise signal. Their results revealed larger gap detection thresholds with the simulated and real losses. To account for this, Florentine and Buus (1984) suggested that because the listeners with the simulated and real hearing losses could not hear the high frequency part of the noise, only the auditory filters that pass lower frequencies were stimulated. This agrees with the explanation presented by Fitzgibbons and Gordon-Salant (1987) that much of the data for broadband signals heard by listeners with high-frequency impairments appear to reflect the deterioration in gap detection ability associated with low-pass signal filtering. In other words, because the hearing-impaired listeners could not hear the high frequency components in the broadband noise, the situation became much like a low-pass filtering condition, where only lower signal frequencies are presented. The hearing-impaired listeners behaved much the same way as normal listeners did 13 with lower signal frequencies, insofar as larger gap thresholds are measured with lower signal frequencies. Fitzgibbons and Gordon-Salant (1987) also examined gap detection ability in normal-hearing subjects and subjects with high-frequency losses (above 2 kHz). Their findings also revealed larger gap detection thresholds in the hearing-impaired listeners compared to the normal-hearing listeners. However, larger than normal gap detection thresholds were also observed for the hearing-impaired subjects for low signal frequencies, where hearing was normal. Fitzgibbons and Gordon-Salant (1987) cannot provide a clear explanation for this diminished temporal resolution in normal sensitivity regions. Their results suggest that pure-tone sensitivity loss does not appear to be a prerequisite for abnormal temporal resolution. Moore and Glasberg (1988) postulated that the broadband stimuli used in many gap detection threshold studies, including those by Florentine and Buus (1984) and Fitzgibbons and Gordon-Salant (1987), influenced the measured thresholds. Moore and Glasberg (1988) measured gap detection thresholds in normal-hearing, hearing-impaired and electrically-stimulated listeners (listeners with implanted extracochlear devices) using two types of signal stimuli: broadband noise and sinusoidal signals. The sinusoidal signals were interrupted pure tones. Because spectral splatter is observed when tones are rapidly switched on and off, notched masking noise was used to mask the unwanted frequency components of the splatter. With broadband noise stimuli, Moore and Glasberg (1988) obtained gap thresholds with similar patterns to previous studies in which broadband stimuli were employed, where the thresholds were larger for the impaired ears when comparisons between the subjects were made at equal sound pressure level (SPL). Differences between the subjects decreased slightly 14 when they were compared for stimuli presented at equal sensation level (SL). The implanted ears had even larger gap detection thresholds than either of the other two subject groups. However, gap detection thresholds for the sinusoidal stimuli were similar for the normal and impaired ears. At equal SL, gap detection thresholds were often smaller for the impaired ears. Moore and Glasberg (1988) postulated that at equal SLs, the stimuli were louder for the impaired ears because of the reduced dynamic range (recruitment) typically observed in cochlear hearing losses. Because the levels were perceptually louder, and hence the impaired ears heard the signal better, the gap detection thresholds were smaller than for normals. In addition, Moore and Glasberg (1988) found that gap detection thresholds for the sinusoidal stimuli for the implant subjects were comparable to those of the normal and hearing-impaired subject groups. More importantly, when using sinusoidal stimuli, gap detection thresholds did not vary markedly across centre frequencies. The discrepancy observed between the findings obtained using broadband and sinusoidal stimuli may be explained in terms of the fluctuations in broadband stimuli. Dips in the temporal envelope of a broadband stimuli can be confused with the presented gaps. The result is that listeners will required a bigger gap in the noise to avoid confusions between the target gap and dips in the noise. In conclusion, Moore and Glasberg (1988) suggested that the temporal resolution of the auditory system is not necessarily adversely affected by the degree of cochlear hearing loss, and that there does not appear to be any correlation between gap detection threshold and signal frequency when sinusoidal signals are used. To investigate age differences in the ability of listeners to detect gaps, Schneider, 15 Pichora-Fuller, Kowalchuk and Lamb (1994) measured gap detection thresholds in young and elderly normal-hearing listeners using 2-kHz tone pips.that were shaped by a Gaussian envelope. Moore and Glasberg (1988) had used interrupted pure tones and employed a spectrally shaped noise masker to mask the spectral splatter caused by the abrupt on/off presentations of the pure tones. However, auditory adaptation to the noise could occur prior to the presentation of the gap, thereby resulting in less sensitivity to the gap (Schneider et al., 1994). To avoid the potential problem of adaptation, Gaussian-shaped tone pips were used instead. By using Gaussian-shaped tone pips, it was possible to control spectral splatter while preserving frequency-specificity. Hearing-impaired listeners were not used in this study to ensure that the results obtained would be a function of age per se, rather than being simply a function of sensorineural hearing loss. Results from the study indicate that the gap detection thresholds of the old subjects were more variable and twice as large as the gap thresholds of the young subjects. Moreover, this effect held true regardless of the level of presentation. Because both age groups had normal hearing, no correlation was found between the gap thresholds and the pure-tone thresholds of the subjects, a result consistent with Moore and Glasberg's finding that temporal processing is not necessarily the result of sensorineural hearing loss. Age-related differences in temporal resolution may account for some of the speech perception difficulty experienced by the elderly. Tyler et al. (1982) found a correlation between gap detection ability and the perception of speech sounds for subjects where age was not controlled. Synthetic speech samples with altered temporal properties were presented to normal-hearing and hearing-impaired subjects. The temporal properties of speech can be 16 altered by either compressing the speech so that the speech rate is increased, resulting in pitch changes to the signal, or, conversely, by expanding speech, resulting in a slower rate of speech or by digitally dropping out gaps in the speech signal or by varying other parameters such as voice onset time. Tyler et al. (1982) found that hearing-impaired listeners showed poorer discrimination of the temporally altered speech syllables than did the normal-hearing listeners. In studies examining age differences in temporal resolution, old subjects showed poorer speech perception performance with temporally altered speech than did young subjects (Willott, 1991). Binaural processing Deficits in some areas of the central auditory system will impair binaural processing abilities. Two aspects of binaural hearing that are affected by lesions in the central auditory nervous system (CANS) are that of binaural synthesis and binaural separation (for a review see Rousch, 1985). Binaural separation requires the CANS to compare binaural time cues. Dichotic listening tests, which present different stimuli or portions of stimuli to each ear, are frequently used to measure age differences in binaural separation. One such test is the Staggered Spondaic Word Test (SSW) originally developed by Katz (1962, cited in Willott, 1991). Two spondees1 are presented, with the first syllable of the first spondee presented to one ear with no competing signal and with the second syllable overlapped such that it co-A spondee is a two-syllable word (having common usage in the language) pronounced with equal stress on both syllables (Hirsh et al., 1952, cited in Martin, 1986) 17 occurs with the first syllable of the second spondee which is presented to the other ear. The final syllable of the second spondee is presented with no competing signal. This can be pictured as: one ear: HOTDOG the other ear: COWBOY ==========> time The listener is asked to repeat both words. Studies on age differences in binaural separation tests show an overall decline in performance with age. This poorer performance can be attributed to deficits in the CANS; however, declines in general cognitive factors such as attention and memory should also be considered (Rousch, 1985). Binaural synthesis concerns two important issues: binaural fusion and binaural masking level differences (Rousch, 1985). The former refers to a listener's ability to synthesize dichotically presented components of a word or syllable. For example, band-passed filtered spondees are presented dichotically to a listener, with a high-pass filtered version of the spondee presented to one ear while a low-pass filtered version of the spondee is presented to the opposite ear. The listener is required to binaurally fuse the two stimuli and identify the spondee. In studies examining age differences in binaural fusion, elderly subjects essentially performed like young subjects. Moreover, elderly individuals showed better performance in binaural conditions than in monaural conditions, indicating that binaural fusion persists even in old age (for a review, see Willott, 1991). Binaural masking level differences (MLD) is an extensively studied aspect of binaural processing (for reviews, see Durlach, Thompson, & Colburn, 1981; Olsho et al., 1980; 18 Rousch, 1985). M L D s are observed when dichotic presentations of a signal plus its masker yield lower thresholds than do diotic presentations of a signal and masker. In a binaural masking level difference task, a signal and masker are presented to both ears, with the level of the signal being adjusted so that it is barely audible to the listener. If the signal only is turned off at one ear, the signal still being presented to the other ear becomes even more audible. The threshold for the signal in the diotic listening situation where signal and masker are the same at both ears (M 0S 0) is elevated compared to the threshold of the signal in the dichotic listening situation, where the signal occurs at one ear and the masker at both (M 0 S m ) . In other dichotic situations, for example, the M0S„ condition where the signal and masker are presented to both ears but the signal is 180° out of phase at the two ears, thresholds for the signal are also lower than they are in the diotic (M 0S b) condition. Such findings indicate that masked signals are better detected with the binaural system when interaural difference cues are present but different for signal and masker. Pichora-Fuller and Schneider (1991) examined age differences in M L D s . They observed that normal-hearing elderly and young subjects had similar thresholds in the diotic conditions. However, thresholds for the elderly listeners in dichotic conditions were elevated compared to those of the young listeners. Moreover, age differences were found in two dichotic conditions, SnN0 (noise is diotic but signal is presented 180° out of phase at the two ears) and in the SJM m (both signal and masker were antiphasic and the noise was also interaurally time delayed) (Pichora-Fuller & Schneider, 1991, 1992). These age differences were attributed to declines in temporal processing. Since binaural processing is sensitive to interaural time cues, any loss in temporal processing could lead to reduced M L D s . Temporal 19 variability or 'jitter' in the binaural system's process of realigning left and right ear inputs to analyze interaural time cues is hypothesized to be greater in the elderly, consistent with there being poorer time resolution in the binaural system. Poorer binaural processing in the elderly may contribute to the poor ability to understanding speech heard in noise that is reported by older listeners. In noisy environments, listeners demonstrate a reduced ability to perform the binaural analysis needed to separate the target speech from the competing speech. Cognitive Changes While there is much information in the literature on the influence of auditive factors,' there is a paucity of research that examines how cognitive changes might interact with auditory changes to affect speech perception and language comprehension in the elderly (for reviews, see C H A B A , 1988; Willott, 1991; van Rooij & Plomp, 1989). A better understanding of the relative contributions of cognitive and auditive factors to speech perception might hold important implications for the diagnosis and rehabilitation of hearing loss. As shown earlier, age differences in speech perception in noise can be accounted for to a large extent by auditive factors alone, such as deficits in threshold sensitivity, frequency selectivity, temporal processing, and binaural hearing. However, there is evidence that age-related cognitive differences (such as changes in memory and rate of processing) might also play a secondary role in the deterioration of speech perception in the elderly (e.g. van Rooij & Plomp, 1989; 1990; 1992; Pichora-Fuller etal., 1995). To assess the relative contributions of auditive and cognitive factors to speech 20 perception in the elderly, van Rooij and Plomp (1989; 1990) developed a test battery that measured the performance of normal-hearing young and elderly listeners on a variety of tasks. Auditive tests measured the pure-tone sensitivity, frequency selectivity and temporal resolution of the subjects. Cognitive tests evaluated memory performance, processing speed, and divided attention ability. Speech perception tests measured a listener's ability to identify phonemes, spondees, and words in sentences. Their findings indicated that poorer speech perception observed in the elderly is largely attributed to auditive factors. However, cognitive deficits due to reduced mental efficiency, as evidenced by slower rates of processing and reduced memory capacity also contributed significantly to the variability in speech perception ability that was measured in the elderly. Nevertheless, cognitive factors accounted for less of the variance in performance than did auditive factors (van Rooij & Plomp, 1990; 1992). The reasons for the lack of a strong correlation between cognitive factors and speech perception may be due to the low face validity of the speech perception tests. Even though most standard clinical tests employ the type of speech perception tests used in van Rooij & Plomp's (1989) test battery, these tests are not ecologically valid in so far as they do not represent the everyday speech an elderly listener struggles to hear in a typical noisy environment. The lack of face validity of such tests suggests the need for better ways to assess speech perception. Furthermore, speech perception tests do not measure comprehension of spoken language. Correct perception of the speech signal is important but it is not the only factor necessary for the comprehension of spoken language. When we listen to spoken language, not only do we obtain information from the auditory signal, but we also obtain information from non-auditory information such as context to achieve comprehension. We shall return to this point later in 21 this review. Processing of Speech Before understanding how cognitive changes could affect comprehension of spoken language in the elderly, it is important to first understand how speech is processed. In ideal listening environments where the speech signal is clearly presented, listening requires little effort and processing is largely automatic. However, should the conditions deteriorate, and the listener be required to apply greater mental effort in order the perceive the speech signal and comprehend the spoken message, swift and complex interactions of 'bottom-up' and 'top-down' (higher-level) processes are required (for a review, see Brown & Yule, 1989; Cohen, 1987; Marslen-Wilson & Tyler, 1981). Bottom-up processing involves the processing of the acoustic signal by the ear and the auditory nervous system. Two main operations occur during bottom-up processing: 1) auditory analysis of the waveform, and 2) identification of phonemes and words. Top-down processing involves the imposition of syntactic and phonological rule structure on the incoming signal. During top-down processing, numerous operations occur: 1) identification of the meaning of words; 2) parsing of the grammatical structure of sentences; 3) integration of meaning across different parts of a sentence and across different sentences; 4) identification of the mood and intentions of the speaker; 5) comparison of spoken information to previously acquired knowledge on same topic; 6) extraction of the logical inferences and the underlying implications of what has been explicitly stated (Cohen, 1987). Bottom-up processes are necessary for the perception of speech even in effortless listening conditions in which processing is largely automatic. The role of higher-level top-down 22 processes, however, is less important in effortless listening conditions. On the other hand, in less-than-ideal listening environments in which listening requires greater effort, bottom-up processes begin to fail. The interaction of top-down and bottom-up processes is necessary in order to disambiguate degraded auditory signals. Declines in cognitive processing seem likely to affect the comprehension of spoken language. Even if bottom-up processes are intact, in that an individual is able to detect and identify the sound patterns of speech, comprehension can be impaired if the listener is unable to use world knowledge and contextual information to achieve a coherent interpretation of the input (CHABA, 1988). If the bottom-up processes, (i.e. detection and identification of phonemes and words) are impaired, then top-down processes could be used to infer what has been said by calling on linguistic, and nonlinguistic contextual and permanent knowledge (CHABA, 1988). This is especially important in situations where a listener fails to hear the input completely, whether due to hearing loss or because the speech signal is degraded. Top-down processes must be used to "fill in" the information lost during bottom-up processing. In the following sections of this review, I will examine how declines in cognitive factors that are important in the comprehension of spoken language, specifically deficits in working memory capacity and in inferential reasoning, can contribute to the difficulty that elderly persons report when they try to understand speech heard in noise. Working Memory Spoken language is transmitted in a rapidly varying acoustic signal. Processing of the information carried by a signal presented in an adverse listening condition requires swift 23 interaction between bottom-up and top-down processes. As the degraded speech signal is detected and subjected to bottom-up perceptual processes, top-down processes also begin to act on the signal. For the bottom-up and top-down operations to interact and work together to arrive at an interpretation of an incoming signal, a storage or work space must be present where operations on the signal can be carried out. The space where the incoming information is maintained and manipulated is called working memory (Daneman & Carpenter, 1980). Working memory capacity varies across individuals and is dictated by how efficiently processing and storage functions operate together (Daneman & Carpenter, 1980). It is hypothesized that individuals who process information efficiently will have more working memory capacity for storage functions, whereas individuals who may have less efficient and slower processing systems will be left with functionally smaller storage capacity. Thus, for elderly individuals, an overall, less efficient processing system may contribute to a reduced working memory storage capacity (Cohen, 1987). Inferential reasoning Because of slower rates of information processing and reduced memory storage capacity, it is suggested that elderly listeners have less time and working memory space to carry out the higher levels of processing required for comprehension. It is quite common to observe an elderly person having a difficult time grasping what has been said to her, especially in difficult listening environments (such as- a noisy place) where the detection and identification of the signal is impaired (Cohen, 1979). While such difficulties might be attributed to hearing loss or lapses of attention, age-related deficits at the higher stages of 24 language comprehension, specifically inferential reasoning, may also be affecting ability to comprehend spoken language. Cohen (1979) assessed the abilities of elderly individuals to pull together different facts and draw correct inferences from these facts. Inferential reasoning can an important part of comprehension, as the true meaning carried by the incoming signal may not be explicitly stated. Moreover, if the information to be received is affected by hearing loss or input is degraded, then inferential reasoning abilities, involved in the top-down processing of language, may be required to make up for what was not heard. Cohen (1979) had subjects listen to short messages that recounted everyday events (e.g. going to work, walking the dog). The messages were presented at either fast or slow speech rates and contained complex or simple facts. Subjects were later questioned on the facts of the messages (subjects responded orally). Questions were either simple ones that requested verbatim answers drawn from the explicit information given in the message or complex questions that required the subjects to draw implicit information out from what was explicitly stated. Her findings suggest that there was an age-related deficit in inferential reasoning aspects of language comprehension. The process of constructing inferences from the presented information was omitted or inefficiently performed (Cohen, 1979). Cohen concluded that elderly individuals have a reduced ability to perform simultaneously the task of registering the surface meaning of a sentence and the task of carrying out further processes required to make inferences (Cohen, 1979; 1981). Similar findings were found in studies by Belmore (1981) and Ti l l and Walsh (1980). Cohen (1981) postulated three different factors that may contribute to the elderly 25 person's difficulty in drawing inferences. The first is a reduced processing capacity due to a slowing down of rate of information processing. When the rate of input (of the incoming speech signal) exceeds the rate at which the processing of the signal can be carried out, inference construction operations are reduced or even omitted. This is supported by Cohen's (1979) finding that older subjects showed deficits (i.e. made more errors) in answering inference questions when the rate of input was faster. On the other hand, verbatim questions were unaffected by speech rate. Another factor affecting inferential reasoning in old age is an impairment in the ability to recall information, which is tied to the memory capacity of the individual. While listening to an incoming signal, an elderly individual may forget some of the facts previously heard and hence inferences are less likely to be correctly constructed (Cohen, 1981). This is a plausible explanation because all necessary facts must be available for inferences to be constructed (Cohen, 1981; Taub, 1979). If this is the case, then age-related deficits in inference making should disappear when the task does not rely on memory (CHABA, 1988; Cohen, 1981). Finally, impaired reasoning ability may also be a factor in inferential reasoning deficits. Age-related deficits in the ability to reason and understand the relationship between the facts presented contribute to poorer inference construction and overall poor language comprehension (Cohen, 1981; Dixon, Simon, Nowak, & Hultsch, 1982; Til l & Walsh, 1980). Rationale for the present study We have examined so far the various auditive and cognitive factors that may influence an elderly person's ability to perceive speech and comprehend language in noise. A better 26 understanding of these factors has important implications for diagnostic and rehabilitative audio logy. Currently, standard diagnostic testing is routinely used to measure the hearing impairment of an individual in quiet, ideal conditions. For example, tests employing monosyllables require the listener to repeat back well articulated words presented in quiet surroundings. However, it has been known for some time that these tests lack ecological validity, in that the materials used, the tasks themselves and the testing environment do not represent the daily listening situations of individuals (CHABA, 1988). In an everyday listening situation, an individual is subjected to rapidly articulated connected discourse in less-than-ideal conditions, usually in a noisy environment, such as a restaurant, classroom or office. Standard clinical tests do not predict well what an individual truly experiences when listening to speech in noise. As stated earlier, the extent of an elderly individual's hearing disability is not well predicted by the pure-tone audiogram. Despite the lack of ecological validity of the pure-tone audiometric results, however, the most commonly prescribed solution of choice for poor speech perception is a hearing aid, the fitting of which is based mainly on results from pure-tone tests conducted in quiet. Because the fittings are only based on tests of low face validity, this may be why patients often report dissatisfaction with hearing aids. In fact, the 1986 post-censual survey reports that only 30.3% of hearing-impaired Canadians use technical aids. Of this group, 88.9% use hearing aids (Schein, 1992). Many reasons are cited in the literature for why hearing-impaired people do not wear aids; reasons range from not wanting to accept the stigma associated with having a hearing aid to not being able to bear the cost of purchasing 27 an aid (McCarthy, 1993). However, one prevailing reason is that many people find that hearing aids produce too much auditory confusion, especially in noisy environments (McCarthy, 1993). Plomp (1978) demonstrated that although hearing aids may improve speech perception in quiet listening conditions, mostly because they compensate for the elevation of thresholds that characterizes the loss, hearing aids are of limited benefit in noise. The distortion provided by both the internal noise of the aids and by the degraded speech relayed in less-than-ideal listening situations restricts the benefit a hearing aid may provide (Plomp, 1978). While hearing aids can certainly assist overall speech perception, hearing aids alone are not enough to adequately improve an elderly listener's perception of speech in noise. To obtain better rehabilitation measures though, one must have better approaches to the assessment of hearing disability. Assessments which apply knowledge of the interaction between cognitive and auditive factors might lead to the development of better tests of hearing disability and, in turn, more effective aural rehabilitation programs. Such tools may not only be used to evaluate the contributions of auditive factors by manipulating the signal properties but they may also be used to evaluate the contributions of cognitive factors by manipulating the contextual information provided by the signal. The contextual structure of discourse can serve as an important source of information for speech perception and language comprehension. Age differences in perception and comprehension are less evident when the spoken material contains supportive context (Cohen, 1987). If the information presented is well structured, predictable and high in contextual cues, then language comprehension is facilitated. In fact, different text types have been shown to have different effects on recall and comprehension. Individuals are better able to recall 28 information from a narrative passage, which is highly structured and predictable, over an expository passage, which is less structured and less predictable (Graesser, Hauft-Smith, Cohen, & Pyles, 1989; Tun 1989). For example, old and young subjects who had to immediately recall the content of a passage that they had just read showed better recall for narratives than for expository passages, although for both types of passages, the old subjects recalled less than the young subjects (Tun, 1989). Tests using the Speech Perception in Noise Test (SPIN) (Bilger, Nuetzel, Rabinowitz, Rzeczkowski, 1984; Kalikow, Stevens, & Elliot, 1977), revealed age differences in the effect of context on speech perception. The SPIN test consists of eight lists of 50 sentences; where half of the sentences provide a supportive context for the sentence-final target word and the other half do not. These materials have been presented in varying degrees of signal-to-noise ratio. Studies observing age differences in scores obtained using the SPIN materials showed that age differences were greater in noisy conditions than in quiet conditions and that both young and old subjects took advantage of contextual information to identify words in noise (Kalikow et al, 1977; Hutchinson, 1989), with some old subjects being more effective at taking advantage of contextual information than the young (Pichora-Fuller, Schneider, & Daneman, 1995). Such findings indicate that when listening conditions are less favourable, elderly individuals benefit considerably from sentence context to facilitate the identification of words in noise. To compensate for failing sensory abilities then, whether a listener has a hearing loss or whether the quality of the speech signal is poor, elderly subjects may rely more than young subjects on top-down processes to facilitate speech perception and spoken language comprehension (CHABA, 1988). 29 To investigate this point further, in the present study I examined the effect of text type on speech perception in noise by elderly individuals over a range of signal-to-noise ratios. Specifically, a study by Howarth (1992) using young normal-hearing subjects was replicated using elderly subjects. Howarth (1992) presented three different text types: narratives, procedures, and descriptions to young normal-hearing listeners at different signal-to-noise ratios. The text types represented a range of contextual structure from the high structure of narratives (stories), to the intermediate structure of procedures (recipes), to the low structure of descriptions (restaurant reviews). Subjects listened to passages of each text type and repeated back verbatim what they heard using a tracking procedure that was a modified version of the one developed by de Fillipo and Scott (1978) (see Methods section). The number and type of errors made by the subjects were analyzed. Howarth (1992) showed that subjects made significantly more errors in less favourable signal-to-noise conditions. Moreover, significantly fewer errors were made when subjects listened to the narratives than when they listened to the descriptions. Howarth (1992) concluded that narrative structures, having higher predictability and structure, support speech perception more than do less predictable discourse structures. Subjects benefit more from context and hence utilize top-down processes when listening conditions become less favourable. Howarth's study was replicated in that elderly subjects performed the same tasks under similar conditions. The responses produced by the elderly subjects were analyzed for errors using the same coding scheme as Howarth's (1992). In addition, the results from the present 30 study were then compared to those obtained by Howarth (1992) to determine if there are any age differences in the effect of context on speech perception. Null Hypotheses The following null hypotheses were tested: 1) There is no significant difference in the number and type of errors observed as the S:N conditions become less favourable. 2) There is no significant difference in the number and type of errors between discourse types. 3) There is no significant difference between elderly and young listeners in the number and type of their errors, regardless of the S:N conditions. 4) There is no significant difference between elderly and young listeners in the number and type of their errors, regardless of text type. 31 C H A P T E R TWO METHODS Subjects Eight elderly subjects, ages 65 to 81, participated in this study. A l l subjects passed a hearing screening test and interview (see following section, Screening, for more information). The participants were all native speakers of English, were retired and in good health (see Appendix A for subject profiles). Materials The stimuli used in Howarth's (1992) study were employed in the present study. The stimuli consisted of six spoken passages of text. The passages were chosen to represent two different text types: narratives and descriptions. Three short stories were used as narrative texts and three restaurant reviews were used as descriptions (see Appendix B for passages). The passages were recorded by Howarth (1992), a female native speaker of English, who read the passages with natural intonation and stress patterns. Howarth (1992) divided the passages into a series of clauses and read them in a clause-by-clause fashion. Previous studies have shown that speakers, when asked to divide passages at places where they thought appropriate, will place these divisions at clause boundaries when given the opportunity (Wingfield, Lahar, & Stine, 1989; Wingfield & Nolan, 1980). However, should a clause boundary create an awkward division in a passage, speakers will place the boundaries at sub-clausal noun and/or verb phrase boundaries instead (Wingfield & Nolan 1980). Thus, 32 Howarth (1992) also divided the passages at noun and/or verb phrase boundaries when a division at a clause boundary resulted in a unit that seemed too long or awkward. Howarth also validated the division of the passages by having a pilot subject divide the passages at points where he judged the boundaries to be natural and appropriate. The divisions selected by the pilot subject closely agreed with the divisions chosen by Howarth (1992). Howarth (1992) recorded the passages using a Madsen Electronics microphone situated in a sound-attenuating booth. Each utterance of a passage was digitally recorded and edited into a separate sound file. Each of these sound files consisted of two channels: the passages were recorded onto the first channel and previously recorded eight-talker babble was re-recorded from an audiotape onto the second channel. Each passage of text was approximately ten minutes in length. The number of words in a given utterance ranged from 1 to 19, with an average length of 42 utterance per passage. Howarth (1992) equated the passages for readability and language level based on Flesch's formula for readability (Flesch 1948). The language level of the passages was determined to be of a Grade seven level, such that any difficulty understanding the passages was not likely to be due to the language level of the materials. The passages were also equated for overall number of syllables (see Appendix C for summary of readability scores, and syllable and word counts for the passages). Procedure Screening Prior to the experiment, subjects were interviewed regarding their hearing, language and health history (see Appendix D for case history form). The hearing status of the subjects 33 was then determined through a hearing screening test using standard audiometric procedures (see Appendix E for subject thresholds). Pure-tone thresholds, speech reception thresholds, speech discrimination scores and babble thresholds were obtained. The criterion for 'normal hearing' was defined as thresholds of 25 dB H L or lower from 250 to 2000 Hz inclusive. This is an acceptable criterion for normal hearing for the elderly population given that many studies have shown that elderly persons demonstrate a decrease in hearing sensitivity particularly in the higher frequencies (see Willott 1992, for a review). This definition of normal hearing for the elderly allows for the commonly observed high-frequency hearing loss. Subjects who passed the hearing screening continued on to the experimental task. Text in Noise Experiment Subjects attended two one-and-a-half hour sessions. In the first session, subjects listened to three passages either of the narrative or description text type. Subjects listened to the three passages of the other discourse type in the second session. Four of the subjects listened to the narratives in the first session, while the other four subjects listened to the descriptions in the first session. In each session, subjects listened to a total of three passages of one discourse type, with each passage presented at one of three signal-to-noise ratios. The chosen signal-to-noise ratios reflected a level of listening difficulty ranging from an 'easy listening condition' to a 'hard listening condition.' Howarth's study (1992) used signal-to-noise ratios of 0, -6, and -12 dB S:N to provide an appropriate range of 'easy', 'medium,' and 'hard' listening conditions for young listeners, respectively. These signal-to-noise levels were determined through a pilot 34 study that showed that young subjects performed nearly perfectly at 0 dB S:N and that they experienced great difficulty at the -12 dB S:N condition (Howarth 1992). However, the pilot study for the present experiment showed that the -6 dB S:N condition was a hard listening condition for an elderly listener, whereas in the +6 dB S:N condition, the pilot subject performed nearly perfectly. The signal-to-noise ratios used in this study were selected to be +6, 0, and -6 dB S:N, which were taken to reflect a range of listening difficulty from easy to hard for elderly listeners. The order of the three passages of each discourse type was randomized across the three signal-to-noise conditions so that the passages were not presented in the same order to different subjects more than once. Subjects began by listening to one passage in the easiest condition (+6 dB S:N) and then proceeded to the medium (0 dB S:N) and then to the hard listening condition (-6 dB S:N). Subjects listened to each passage under TDH-39P earphones in a double-walled sound-attenuating IAC booth. The speech and babble stimuli were presented monaurally to the right ear. The signal was presented at 50 dB above the babble threshold for the right ear. The presentation levels were controlled by a Madsen OB802 audiometer. The delivery of the text materials was monitored and controlled through the NeXT computer, using the same software that had been employed by Howarth (1992). Subjects heard each line of a passage only once and were required to repeat verbatim what they heard. Subjects were given as much time as they needed to repeat back the phrase. They were also allowed to revise their responses during a turn or at any time after or during the presentation of the rest of the passage. Since it is desirable that a subject's response serve 35 as a trigger for the presentation of subsequent speech materials (CHABA 1988), subjects were allowed to pace the speed of presentation by depressing a response button when they were ready for the next line of text. The experimenter recorded the subject's responses onto tape using an audiocassette recorder placed in the booth. Subjects wore a lapel microphone to ensure that their responses were accurately and clearly recorded. The responses were also heard outside the booth by the experimenter, who was able to type the incorrect responses on-line into the NeXT computer (see Appendix F for subject responses). After the completion of each passage, subjects were required to answer ten, four-alternative, multiple-choice questions that pertained to the passage just heard (see Appendix G). Subjects were informed prior to listening to the passages that they would be quizzed on the content of the passages. Half of the questions requested explicit information that had been presented in the passages and the other half of the questions requested implicit information. At the end of the second session, subjects were required to complete a vocabulary test (Raven, 1938) (see Appendix H), a hearing handicap questionnaire (HHIE) (Appendix I), and a reading working memory span test (Daneman & Carpenter, 1980). Coding Following each session, the subjects' responses were transcribed and compared to the target passages. Errors were identified and coded in the following manner. Error Types A n error was defined as any response that did not match the target. Errors were 36 classified into the five categories that were originally defined by Howarth (1992) (the abbreviation in bracket is the coding symbol): 1) Deletion (DEL): any partial or whole omission of a target. Example: Target: It's seven a.m. in Denville. Response: It's seven a.m. in . 2) Substitution (SUB): the target is replaced in whole or in part by a novel response. Example: Target: and crawled up the stairs Response: and ran up the stairs 3) Addition (ADD): the response includes an item not present in the target. Example: Target: this one is a plate licker Response: and this one is a plate licker 4) Exchange (EXC): two items in a target utterance exchange positions. Example: Target: try the sauteed shrimp and crab on noodles 37 Response: try the sauteed crab and shrimp on noodles 5) Revision (REV): subject revises a previous response in the same or a later turn. Example: Target: it starts with rye. bread Response #1: it starts with white bread Response #2 (Revision): it starts with-rye. bread (Even though response #2 is a correct replication of the target, both response #1 and #2 were counted as errors). Units of Utterance Affected by Error Once identified as being one of the above error types, the errors were also analyzed according to which units of the utterance were affected by the error (the abbreviation in bracket is the coding symbol): 1) Lexical item (LX): open-class content words such as nouns, verbs, adjectives, adverbs (Fromkin & Rodman, 1983). 2) Function word (FN): closed-class words serving mainly a grammatical function, e.g. articles, prepositions, conjunctions; also includes pronouns (Fromkin & Rodman, 1983). 3) Bound morpheme (BM): e.g. - 's, -ed, -ing. 4) Phrase (PH): noun phrases, verb phrases, or prepositional phrases. 38 5) Utterance (LN): entire utterance presented in a trial. 6) N i l (NL): a coding category to denote a 'nil response' (see example below). Example: Target: It's seven a.m. in Denville Response: It's seven a.m. in . Coding: Error: Deletion of a lexical item (DEL L X NL) (Errors were coded in the following format: Error, Target, Response. For this example, the error was a deletion, the target was a lexical item, and by definition, the response was nil. The N L coding category is a notation that indicates there was no response.) Multiple Error Codings for One Utterance A response could contain more than one error. If more than one error occurred, then error was coded separately. Example: Target: there's a small restaurant on seventh avenue Response: I know there's a tall restaurant on seventh Coding: 1st Error: Addition of a phrase (ADD N L PH) 2nd Error: Substitution of a lexical item with another lexical item (SUB L X L X ) 3rd Error: Deletion of a lexical item (DEL L X NL) 39 Linguistic Level Analysis Once the error type and the affected part of the utterance were identified, the error was further coded for whether or not the error matched the target at each of three different linguistic levels: auditory, semantic, or syntactic. For each level, the match between the response and the target was coded for 'degree of match'; the response was rated as having matched the target totally, partially, or not at all. 1) Auditory Match: a) Total match (CR): response entirely preserves the phonemic composition of the target. By definition, a correct auditory match would therefore not be an error. b) Partial match (PT): response only partially preserves the phonemic composition of the target. Example: Target: It's seven a.m. in Denville. Response: It's seven a.m. in Denver. c) No match (WG): response does not preserve the phonemic composition of the target at all. Example: Target: and crawled up the stairs Subject Response: and ran up the stairs 40 2) Semantic Match: a) Total match (CR): target and response essentially have the same meaning. Example: Target: he bought a large amethyst Response: he bought a big amethyst b) Partial match (PT): target and response have similar, but not identical meanings. Example: Target: and raced from the company in his personal car Response: and raced from the company in his personal truck c) No match (WG): target and response do not have the same meaning at all. Example: Target: as the cat shot over my shoulder Response: as the rock shot over my shoulder 3) Syntactic match: a) Total match (CR): the syntactic role of the target is preserved in the response. Example: Target: the lunatic, well-dressed business person Response: the lovely, well-dressed business person 41 b) No match (WG): the syntactic role of the target is not preserved in the response. Example: Target: there's a small restaurant on seventh avenue Response: there's a small restaurant I know 'Partial match' was not identified as a degree of match for the syntactic linguistic level. Although Howarth (1992) had employed the 'partial match' degree in her coding scheme, consultation with Howarth prior to the commencement of this study led to the conclusion that the difference between what constituted a partial and no match was difficult to define. It was therefore decided that these two degrees of match would be collapsed into one. The following are examples of how errors were coded by error type and degree of auditory, semantic and syntactic match. Errors were coded in the following format: error, target, response, followed by degree of match for auditory, semantic and syntactic levels. Example 1: Target: It's seven a.m. in Denville Subject Response: It's seven a.m. in . Coding: DEL LX NL WG WG WG Error: Deletion lexical item Degree of Match: Auditory: No match Semantic: No match Syntactic: No match By definition, the response is an omission of the target and hence does not match the target 42 auditorily. Since no semantic nor syntactic information is present, the error does not match the target on these levels either. Example 2: Target: as the cat shot over my shoulder Response: as the rock shot over my shoulder Coding: SUB LX LX WG WG CR Error: Substitution of a lexical item Degree of Match: Auditory: No match Semantic: No match Syntactic: Total match 43 C H A P T E R THREE RESULTS The following sections will examine the effects of signal-to-noise condition, text type, and age on the number of errors and on the type of errors made. Effect of Signal-to-Noise Condition and Text Type on Mean Number of Errors The effect of signal-to-noise ratio and text type on the number of errors was analyzed (see Figure 1). As the listening condition became less favourable, the mean number of errors increased. In addition, fewer errors were made for narratives than for descriptions in the medium (0 dB S:N) and hard (-6 dB) listening conditions. In the easy (+6 dB) condition, however, the mean number of errors was small for both text types. This description was confirmed by an analysis of variance with there being a significant main effect of signal-to-noise condition, F(2,14)=52.53, p< .01, a significant main effect of text type, F(l,7)=23.84, p< .01, and a significant interaction of signal-to-noise condition and text type, F(2,14)=6.52, p< .05 on the mean number of errors. A Student-Newman-Keuls (S-N-K) test of multiple comparisons confirmed that more errors were made in the medium (0 dB S:N) and hard (-6 dB S:N) conditions than in the easy listening condition (p<.01) for both text types. Moreover, more errors were made for descriptions than for narratives in the medium (0 dB S:N) and hard (-6 dB S:N) conditions (p<.01), but not in the easy (6 dB S:N) listening condition (p> .05). No other significant main effects or interactions were observed. These results are consistent with the subjects' reported differences in 'ease of listening' between the 44 Figure 1: Mean number of errors per subject (error bars show standard errors) as a function of signal-to-noise condition and text type. r 45 narratives and descriptions across the three signal-to-noise conditions. Appendix J shows that for narratives, subjects rated, on average, the +6 dB S:N condition to be 'very easy,' the 0 dB S:N condition to be 'moderately easy,' and the -6 dB S:N to be 'very effortful.' However, for the descriptions, subjects rated, on average, the +6 dB S:N condition to be 'moderately easy,' the 0 dB S:N condition to be 'moderately effortful' and the -6 dB S:N condition to be 'very effortful.' Interestingly, as the results from the HHIE show, most subjects reported having some trouble hearing in difficult listening situations at least some of the time. Effect of S:N and Text Type on Number of Errors for Five Error Types As listening conditions became less favourable, (i.e. as the signal-to-noise ratio decreased), the number of deletion and substitution errors increased as shown in Figure 2. More deletion and substitution errors occurred than any other error type in the medium (0 dB) and hard (-6 dB) listening conditions. Moreover, more deletion errors were made than substitution errors in the hard (-6 dB) listening condition (see Figure 2). In addition, fewer errors of each error type were made for narratives than for descriptions (see Figure 3). Further examination of each error type revealed that the number of errors was not affected by text type except for deletion errors; more deletion errors were made for descriptions than for narratives. A n analysis of variance confirmed this description with there being a significant main effect of signal-to-noise condition, F(2,14)=54.19, p< .01, a significant main effect of error type, F(4,28)=48.99, p<.01, a significant main effect of text type, F(l,7) = 17.61, p<.01, a signficant interaction of text and error type, F(4,28) = 3.81, p<.05, and a significant interaction of signal-to-noise and error type, F(8,56)=29.53, p< .01 on the mean 46 6 0 I ' ' 1 ' ' i * * * * i * * * '• * i * ' * * * Signal-to-Noise (dB) Figure 2: Mean number of errors per subject (error bars show standard errors) as a function of signal-to-noise condition and the five error types. 47 40 35 30 25 20 15 10 5 0 • Deletion • Substitution • Addition El Exchange • Revision Narrative Description Text Type Figure 3: Mean number of errors per subject (error bars show standard errors) as a function of text type and the five error types. 48 number of errors. A S-N-K test of multiple comparisons revealed that significantly more deletion and substitution errors occurred than any other error type (p< .01) in the medium (0 dB S:N) and hard (-6 dB S:N) listening conditions. In addition, the S-N-K test of multiple comparisons confirmed that significantly more deletion errors were made than substitution errors (p< .01) in the hard (-6 dB S:N) listening condition. Furthermore, the mean number of deletion errors per subject was greater for the descriptions than for the narratives (p< .01). For no other error type was there a significant effect of text type on the mean number of errors made. No other significant main effects or interactions were observed. Units of Utterance Affected by Error Types 'Deletion' and 'Substitution' As discussed above, more deletion and substitution errors occurred than any other error type in the medium (0 dB) and hard (-6 dB) listening conditions. These errors affected any one of five units of a given utterance, i.e. lexical item, function word, bound morpheme, phrase or entire utterance spoken in a trial. The following section will examine how deletion and substitution errors affected these units of an utterance. Units of Utterance Affected by Error Type 'Deletion' in Narratives When a subject made a deletion error, any one of five parts of a given utterance were omitted; that is, subjects deleted either a whole utterance, phrase, lexical item, function word, or bound morpheme. The units of the utterance affected in the narrative discourse condition as a function of signal-to-noise are shown in Figure 4. The graph shows that as the listening conditions became less favourable, phrases and whole utterances were deleted more often than 49 Figure 4: Number of deletion errors as a function of signal-to-noise condition and unit of utterance (narrative discourse condition). 50 any other unit of an utterance. Units of Utterance Affected by Error Type 'Deletion' in Descriptions As stated earlier, there were more deletion errors made for descriptions than for narratives. However, as shown in Figure 5, the pattern of deletion errors for the units of an utterance for descriptions was similar to that observed for narratives. As the signal-to-noise condition became less favourable, subjects omitted phrases and whole utterance more often than any other units of an utterance. Thus, while more deletion errors occurred with descriptions than with narratives, the way in which these errors affected the units of an utterance was similar in both discourse conditions. Units of Utterance Affected by Error Type 'Substitution' .. Substitution errors were further analyzed into which units of an utterance underwent substitutions. As the number of substitution errors was not affected by text type, no distinction between discourse conditions will be made here. Table 1 is a Target-Response matrix showing which pairs underwent substitutions. From the matrix, it is observed that subjects most frequently substituted lexical items for other lexical items. Secondly, function words were also frequently substituted by other function words. Phrases were also commonly substituted by other phrases. Table 2 lists the frequency of each possible substitution pairing in descending order. 51 200 L 1 1 1 1 1 ' • • 1 • Signal-to-Noise (dB) Figure 5: Number of deletion errors as a function of signal-to-noise condition and unit of utterance (description discourse condition). Table 1: Target - Response Matrix for Substitution Errors RESPONSE I  L X PH F N B M L N T A R G E T L X PH F N B M L N 183 22 18 31 103 14 0 120 15 0 15 26 Table 2: Frequency of Substitution Pairings in Descending Order L X L X 183 F N F N 120 PH PH 103 P H L X 31 B M B M 26 L X P H 22 L X F N 18 F N B M 15 B M F N 15 PH F N 14 F N PH 8 F N L X 4 B M L X 4 L N L N 4 L N L X 3 L X B M 3 L X L N 0 P H B M 0 PH L N 0 F N L N 0 B M PH 0 B M L N 0 L N PH 0 L N F N 0 L N B M 0 53 Linguistic Level Analysis of Error Type 'Substitution' Substitution errors were coded for whether they matched the target auditorily, semantically, or syntactically. To recap, an error that matched the target auditorily preserved the phonemic composition of the target, and by definition, would not be an error because the subject repeated correctly what was heard. An error that matched the target semantically preserved the meaning of the target. An error that matched the target syntactically preserved the syntactic function of the target. For each of these three linguistic levels, the error was coded as having a total, partial, or no match to the target. Only substitution errors were analyzed in terms of the linguistic level of the error because there was only a significant effect of signal-to-noise ratio for deletion and substitution errors and not for other error types. Deletion errors were not analyzed at this level because any deletion of the target in the subject's response must be coded, by definition, as having no match auditorily, semantically, or syntactically to the target. Linguistic level analyses of the substitution errors were analyzed first as to whether the error was a partial auditory match or no auditory match to the target. (A correct auditory match by definition does not constitute an error). Once it was decided that a substitution was a partial or no auditory match to the target, the error was then coded on the semantic and syntactic levels. Partial Auditory Match — Semantic Level Substitution errors that partially matched the target auditorily were coded according to degree of match on the semantic level. Figure 6 plots the percentage of substitution errors 54 having a total, partial or no semantic match to the target, as a function of the signal-to-noise condition. In all three signal-to-noise conditions, most errors did not match the target semantically. As listening conditions became less favourable, there was an increase in the percentage of errors that did not match the target semantically. Correspondingly, the percentage of substitution errors that partially or totally matched the target semantically decreased as listening conditions became less favourable. In the hard (-6 dB S:N) condition, approximately 70% of all the errors did not match the target semantically. Partial Auditory Match — Syntactic Level The degree of syntactic match for substitution errors that partially matched the target auditorily was analyzed as a function of the signal-to-noise condition (see Figure 7). In the easy (6 dB S:N) listening condition, most of the errors correctly matched the target syntactically. However, as the signal-to-noise ratio became less favourable, the percentage of correct syntactic matches decreased while the percentage of incorrect syntactic matches correspondingly increased. Consequently, in the medium (0 dB S:N) and in the hard (-6 dB S:N) conditions, approximately half of the errors did not match the target syntactically. No Auditory Match — Semantic Level Substitution errors that did not match the target at all auditorily were analyzed for degree of match on the semantic level. Figure 8 plots the percentage of substitution errors that had either a total, partial or no semantic match to the target. A l l errors reported here had no auditory match to the target. In all three signal-to-noise conditions, most errors (>70%) did u o s-u a Ml •*-> C u Ui Figure 6: Figure 7: 100 r 90 ; 80 ; 70 ; 60 ; 50 ; 40 ; 30 ; 20 ; 10 ; 0 i i i i i 1 Total Semantic Match Partial Semantic Match _ No Semantic Match • ' 1 • 1 1 -i—i—• 1 • ' • • • L_ 55 •12 -6 0 6 Signal-to-Noise ( d B ) 12 Percentage of substitution errors that partially matched the target auditorily as a function of signal-to-noise condition and degree of semantic match (+6 dB: N = 85; OdB: N=142; -6 dB: N=209). N = total errors in that S:N condition. 100 I 90 h 5 8 0 1 " <S 70 60 h 50 <u 40 h | 30 h I 20 h & 10 h 0 I I I I I I I I — I I I Total Syntactic Match No Syntactic Match 1 • • • • • 1 •12 -6 0 6 Signal-to-Noise ( d B ) 12 Percentage of substitution errors that partially matched the target auditorily as a function of signal-to-noise condition and degree of syntactic match (+6 dB: N = 85; 0 dB: N = 142; -6 dB: N=209). N = total errors in that S:N condition. C/3 U i o b l b l U o WO 03 c b i a. Figure 8: Figure 9: 100 ; 90 ; 80 • 70 : 60 ; 50 ; 40 ; 30 '-20 ; 10 ; 0 i i i i i i i i i—i i i i T - 1 Total Semantic Match Partial Semantic Match _ No Semantic Match 56 •12 -6 0 6 Signal-to-Noise (dB) 12 Percentage of substitution errors that did not match the target auditorily as a function of signal-to-noise condition and degree of semantic match (+6 dB: N=85; OdB: N = 142; -6 dB: N=209). N = total errors inthatS:N condition. 100 u © Ui Ui W o 01) C Ui 0> 90 80 70 60 50 40 30 20 10 0 • i i i—i—i i i Total Syntactic Match No Syntactic Match I I I I—' 1 1 - I — • ' ' •12 -6 0 6 Signal-to-Noise (dB) 12 Percentage of substitution errors that did not match the target auditorily as a function of signal-to-noise condition and degree of syntactic match (+6 dB: N = 85; 0 dB: N = 142; -6 dB: N=209). N = total errors in that S:N condition. 57 not match the target semantically. Interestingly, as the signal-to-noise conditions became less favourable, the percentage of correct semantic matches increased slightly relative to the incorrect semantic matches. No Auditory Match - Syntactic Level Substitution errors that did not match the target auditorily were plotted according to degree of syntactic match to the target as a function of signal-to-noise ratio (see Figure 9). As the signal-to-noise ratio became less favourable, the percentage of errors that did not match the target syntactically increased. In the hardest listening condition (-6 dB S:N), most of the errors (>70%) did not match the target syntactically. Preservation of Semantic and Syntactic Information To appreciate how the joint preservation of semantic and syntactic information was related to the preservation of syntactic information alone in substitution errors, the errors preserving semantic information totally and partially were collapsed into one category and compared to errors preserving syntactic information alone, to errors preserving both semantic and syntactic information, and to errors that preserved neither level of information. As shown in Figure 10, more errors preserved syntactic information than semantic information. The percentage of errors that preserved neither level of information steadily increased as the signal-to-noise condition became less favourable. However, even in the most adverse listening condition (-6 dB S:N), about one quarter of the errors preserved some degree of syntactic and semantic information. on u a 04DH .5 o > *-CM S o) o e v | £ © z « 225 200 -175 ; 150 -125 100 75 50 25 0 n Partial auditory match Preserved semantic Preserved syntactic Preserved semantic & syntactic Neither preserved 58 •12 -6 0 6 Signal-to-Noise (dB) 12 Figure 10: Number of substitution errors (partial auditory match) that preserved both semantic and syntactic, only syntactic, only semantic, or neither level of information. E o 225 200 I g> 175 | H 150 125 100 75 50 25 <M U © Oil Z © T -EI- NO auditory match Preserved semantic Preserved syntactic Preserved semantic & syntactic Neither preserved 0 -12 -6 0 6 Signal-to-Noise (dB) 12 Figure 11: Number of substitution errors (no auditory match) that preserved both semantic and syntactic, only syntactic, only semantic or neither level of information. 59 For substitution errors that did not match the target auditorily, the preservation of semantic and syntactic information is shown in Figure 11. Again, syntactic information was better preserved overall than semantic information. Moreover, even in the most adverse listening condition, about one quarter of the errors preserved some degree of both syntactic and semantic information. However, more than one third of the errors did not preserve either level of information. Effect of Signal-to-Noise Condition and Text Type on Comprehension Scores As the signal-to-noise condition became less favourable, scores on the comprehension questionnaires became poorer (see Appendix J for scores). However, there was no significant difference between scores for the narrative and description text types (see Figure 12). This description was confirmed by an analysis of variance with there being a significant effect of signal-to-noise condition, F(2,14) = 14.83, p<.01 on the comprehension scores. No significant main effect of text type, F(l>7)=0.0085, p> .05, and no significant interaction of text type and signal-to-noise condition, F(2,14)=2.287, p> .05 on the comprehension scores were observed. A S-N-K test of multiple comparisons revealed that scores were poorer in the hard (-6 dB S:N) listening condition, than in the medium (0 dB) and easy (6 dB) listening conditions (p< .01). Age Differences in the Effect of Text Type on Speech Perception To assess age-related differences in the ability of listeners to understand different text types, the results from the present study were compared to the results from Howarth's (1992) 60 - 1 2 - 6 0 6 1 2 Signal-to-Noise (dB) Figure 12: Comprehension questionnaire scores (in %) as a function of signal-to-noise ratio and text type (error bars show standard errors). 61 study. In her study, young normal-hearing subjects listened to the same speech stimuli in similar listening conditions. The conditions ranged from an easy (0 dB S:N) condition to a hard (-12 dB S:N) condition. Figure 13 shows the results from Howarth's study. The number of errors for each of the two discourse types increased as the signal-to-noise conditions became less favourable. Moreover, fewer errors were made when subjects listened to the narratives than when they listened to the descriptions. This finding was confirmed by an analysis of variance with there being a significant main effect of signal-to-noise condition, F(2,14)=93.1, p<0.01, and a significant main effect of text type, F( 1,7) = 10.7, p<0.05. No other significant main effects or interactions were observed. The performance of the young subjects from Howarth's study (1992) and the performance of elderly subjects who participated in the present study were then compared. Effect of Signal-to-Noise. Text Type, and Age on Mean Number of Errors The effect of signal-to-noise condition and text type on the mean number of errors per subject for both age groups was analyzed and these results are plotted in Figure 14. As listening conditions became less favourable, the mean number of errors increased for both age groups. Moreover, both groups made fewer errors for narratives than for descriptions. With respect to the age effect, in the listening conditions common to both age groups, i.e. 0 dB and -6 dB S:N, elderly subjects made more errors than did young subjects. In addition, elderly subjects made more errors in the -6 dB S:N condition than in the 0 dB S:N condition. However, there was no such difference between the 0 dB and -6 dB S:N condition observed in the performance of the young subjects. Furthermore, elderly subjects made fewer errors 62 80 ~ • 70 r 2? 60 r in • u 50 r ft • in f . 40 f o • u u 30 i W • = 20 r Me 10 r o^-Narrative -D • • Description -18 - 1 2 - 6 0 6 Signal-to-Noise (dB) 12 Figure 13: Mean number of errors per subject (error bars show standard errors) as a function of signal-to-noise condition and text type for young subjects (from Howarth, 1992). 63 -18 -12 -6 0 6 12 18 Signal-to-Noise (dB) Figure 14: Mean number of errors per subject as a function of signal-to-noise condition and text type for young subjects (from Howarth, 1992) and old subjects (present study). This figure is a composite of Figure 1 and Figure 13. 64 when listening to narratives than when listening to descriptions in the 0 dB and -6 dB S:N listening conditions. In contrast, the performance of the young subjects was equivalent for the two text types in both signal-to-noise conditions. This description was confirmed by an analysis of variance with there being a significant main effect of signal-to-noise ratio, F(l,14) = 34.55, p<.01, a significant main effect of text type, F(l,14) = 34.50, p<.01, a significant main effect of age, F( 1>14) = 81.96, p<.01, a significant interaction between age and signal-to-noise condition, F(l,14) = 17.03, p< .01, and a significant interaction between age and text type F(l,14) = 16.27,p< .01 on the mean number of errors. A S-N-K test of multiple comparisons revealed that elderly subjects made significantly fewer errors for narratives than for descriptions (p< .01), but no such differences were found for the young subjects (p> .05). In addition, a significant interaction of age and signal-to-noise ratio was observed for the elderly (p < .01) but not the young (p > .05) subjects, with the elderly subjects making more errors in the -6 dB S:N condition than in the 0 dB S:N condition. No other significant main effects and interactions were observed. Comparison of Results by Ease of Listening While it is useful to compare the results between the two age groups at the signal-to-noise conditions common to both groups, Howarth's study and the present study employed a different range of signal-to-noise ratios to capture a similar range of perceptual difficulty, i.e. from an easy listening condition to a hard listening condition. To better appreciate and equate the level of difficulty experienced by the subjects in the various listening conditions, the pattern of breakdown observed for the two age groups was compared according to the level 65 of 'listening ease.' Perception was easy for the elderly subjects in the 6 dB S:N condition; it was equally easy for the young subjects in conditions as low as -6 dB S:N. For both age groups, a 6 dB decrease in signal-to-noise rendered listening difficult. The performance of the two age groups in easy vs. difficult listening conditions was thus evaluated. These two conditions, easy and difficult, were realized in the 6 dB and -0 dB S:N conditions for the elderly subjects, and in the -6 dB and -12 dB S:N conditions for the young subjects, respectively. Figure 15 plots the effect of text type and the level of perceptual difficulty on the mean number of errors made by both age groups. When the +6 dB S:N condition for the elderly subjects and the -6 dB S:N condition for the young subjects were equated because they were considered to be of equal perceptual ease, (i.e. an 'easy' listening condition for both age groups), and when the 0 dB S:N condition for the elderly subjects and the -12 dB S:N condition for the young subjects were equated because they were considered to be of equal perceptual ease (i.e. a 'harder' listening condition for both age groups), the results indicate that both age groups made significantly more errors in the harder condition than in the easy listening condition. In addition, both age groups made fewer errors with narratives than with descriptions in the hard listening condition. This description was confirmed by an analysis of variance with there being a significant main effect of perceptual ease/difficulty, F(l,14) = 136.153, p< .01, a significant main effect of text type, F( 1,14) = 16.21, p<.01, and a significant interaction of perceptual ease/difficulty and text type, F(l,14)=6.52, p< .05, on the mean number of errors in both age groups. No other significant main effects or interactions were observed. Interestingly, in comparison to the 66 60 50 b ? 40 M a s« 30 20 r 10r Narrative-young Description-young Narrative-elderly Description-elderly 0 Difficult Easy Ease of Listening Figure 15: Mean number of errors per subject (error bars show standard errors) as a function of 'listening ease,' text type and age. 67 findings shown in Figure 14, the main effect of age and all interactions with age were no longer significant once the listening conditions were equated on perceptual ease for the two age groups. 68 C H A P T E R FOUR DISCUSSION The primary purpose of the present study was to determine how different text types and signal-to-noise conditions affect the ability of elderly listeners to perceive speech in noise. A secondary purpose of the study was to determine if the effects observed for elderly listeners differed from those found previously for young adult listeners. In the present study, elderly subjects listened to either narratives or descriptions, in a range of signal-to-noise conditions that reflected easy (6 dB S:N), medium (0 dB S:N) and hard (-6 dB S:N) listening conditions. The following null hypotheses were tested: 1) there is no significant difference in the number and type of errors made by elderly subjects as the signal-to-noise conditions become less favourable; 2) there is no significant difference in the number and type of errors made by elderly subjects for the two discourse types. Effects of Signal-to-Noise Condition and Text Type There was a significant increase in the number of errors as the signal-to-noise ratio decreased. Not surprisingly, as listening conditions became less favourable, and the amount of perceptible information in the acoustic signal was reduced, elderly subjects made more errors. The effect of signal-to-noise condition on the number of errors suggests that bottom-up perceptual processes were undermined. It is hypothesized that in order to compensate for a lack of perceptible information in the acoustic signal, elderly subjects used text structure to 69 help them 'fill in' what they were not able to perceive accurately. Furthermore, subjects made significantly fewer errors in the narrative conditions than in the description conditions. This suggests that elderly individuals benefit from top-down processes; i.e. they use text structure to aid language comprehension in more difficult listening situations where listening requires more effort. Effects of Signal-to-noise Condition and Text Type for Five Error Types Subsequent to the analysis of the number of errors, errors were further analyzed according to five error types: deletion, substitution, addition, exchange, revision. As the signal-to-noise condition deteriorated, the number of errors for each error type increased, with significantly more deletion and substitution errors occurring than any other error type in the medium (0 dB S:N) and hard (-6 dB S:N) listening conditions. These findings indicate that when elderly subjects did not hear the utterance well in the more difficult listening conditions, they frequently either omitted the items entirely or substituted items to make up for what was misperceived. Presumably other error types were infrequently observed because adding, exchanging or revising an utterance would have required the subject to have heard more of the utterance to begin with. Revision errors occurred the least out of all error types and when subjects performed a revision, the response was counted as an error, regardless of whether the final response was a correct replication of the target or not. For the present study, most revisions did not result in a correct response. 70 Deletion errors Deletion errors were the only error type to show an effect of text type. More deletion errors were made with descriptions than with narratives. It would appear then, that subjects were better able to rely on the supportive context of narratives and hence were not as likely to omit items from narratives as they were to omit items from descriptions. Substitution errors Further examination of the substitution errors by target-response pairings revealed that subjects frequently substituted an item with another item of the same syntactic category. For example, (see Table 2 in the Chapter Three), lexical items were substituted most frequently for other lexical items, function words were substituted mainly by function words, and phrases were frequently substituted for other phrases. Furthermore, these three target-response pairings were the most common of all the substitution pairings that were possible. These findings are in agreement with subsequent analyses of the extent to which syntactic information was preserved in substitution errors. Recall that once errors were identified by error type, they were further coded as to whether the error matched the target at three different linguistic levels: auditorily, semantically, or syntactically. For each level, the match between the error and the target was coded by a 'degree of match,' in which the error was rated as having matched the target totally, partially, or not at all. a) Preservation of auditory information As the signal-to-noise conditions became less favourable, substitution errors that failed 71 to match the target auditorily, whether partially or not at all, increased. This was expected since degraded listening conditions result in a degraded acoustic signal. It is assumed that this degradation made it more difficult for subjects to hear the words that had been spoken. b) Preservation of semantic and syntactic information In most substitution errors that failed to match or only partially matched the target auditorily, semantic information was not usually preserved; however, syntactic information was more often preserved. Even though subjects may not have heard the items in an utterance well, subjects were still able to provide correctly another item that would fill the blank to preserve the syntax of the utterance. These findings suggest that elderly subjects are using language structure to guess the misperceived items. Since language is governed by a limited set of syntactic rules, it would appear that elderly subjects used their knowledge of the rule structure to infer which of all possible items could have been said. They might have applied the 'heuristics' of language to help disambiguate a degraded auditory signal. Alternatively, they might have been guided by other information in the auditory signal obtained by bottom-up perceptual processes. Specifically, suprasegmental information in the auditory signal such as prosody could have influenced the preservation of syntactic information. Comprehension Results After listening to each passage, subjects were given 10 multiple-choice questions that pertained to the passage they had just heard. The scores from the comprehension questionnaire were tabulated and examined. In the easy (6 dB S:N) listening condition, 72 subjects obtained a mean score of 80% on the narrative passages and a mean score of 70% on the descriptives. In the medium (0 dB S:N) listening condition, subjects obtained a mean score of 60% in the narratives and 70% in the descriptions. In the hardest (-6 dB S:N) listening condition, subjects obtained a mean score of 40% on the narratives and 50% on the descriptives. At the harder listening condition, it appears that subjects were performing at near chance levels and may have been guessing at their answers. These findings indicated that as signal-to-noise conditions became less favourable, performance declined on the comprehension questionnaires. This was expected because subjects were not able to extract as much information from the degraded acoustic signal in the less favourable listening conditions. However, scores between the two text types did not differ significantly. This was unexpected because the high predictability structure of the narratives would have been expected to facilitate comprehension of the passage. Subjects had been expected to use the text structure better to infer the parts that they may have missed in a story versus a restaurant review. In Chapter One, it was pointed out that inferential reasoning may be limited by memory deficits. Although the comprehension questionnaire was given immediately after the presentation of the passage, it was still necessary for subjects to recall particular details in order to provide correct answers. Perhaps inability to remember what was said affects all conditions, whether or not the text is highly structured. It was also possible that the questions asked for answers that were too specific. A listener would need a 'good' memory to recall the specifics of a passage, for example, whether the best corned beef dish at Mrs. T's was the omelette, sandwich, pie or salad, or which character, either Jim Moran, his servants, an actor, or the band leader, entered the restaurant first in 'Jewel Prank.' 73 A n analysis of how working memory span correlates with comprehension score and number and type of error needs to be further explored. It is also possible that subjects did have the sufficient memory capacity to store the message, but that they may have stored incorrect information that was obtained from misperceived speech. This would lead subjects to formulate incorrect infererences and hence perform poorly on the comprehension tests. To determine if this is the case, performance on the explicit versus implicit questions needs to be compared. Another reason why an effect of text type was not observed in the comprehension scores may have been that the nature of the tracking task itself did not induce comprehension. Subjects were required to repeat back verbatim what they heard. It is possible that given such a task, subjects merely repeated the information but did not process the information to a level that would have resulted in comprehension or memory for what was comprehended. In essence, subjects could have mainly heard the words, without necessarily having listened to them. The advantage of supportive text would not be fully realized if subjects did not process the information to a deep level of comprehension that would have relied on the use of text structure. Comparison of Results Between the Two Age Groups The findings of the present study were compared to those of Howarth's (1992) study where young subjects performed the same tasks in similar conditions. The following null hypotheses were tested: 3) there is no significant difference between elderly and young listeners in the number 74 and type of their errors, as the S:N conditions become less favourable. 4) there is no significant difference between elderly and young listeners in the number and type of their errors depending on text type. For both age groups, the number of errors increased significantly as signal-to-noise conditions became less favourable. This result suggests that both age groups demonstrated a failure in bottom-up perceptual processing as the acoustic signal became degraded. Both age groups made fewer errors for narratives than for descriptions in the hardest listening conditions, suggesting that both age groups are able to benefit from top-down processes, i.e. they both utilize text structure to advantage when bottom-up processes are stressed. Evidently, elderly subjects perform much like young subjects in the way in which bottom-up and top-down processes interact during comprehension in more difficult listening conditions. Comparison of Results by Common Signal-to-Noise Ratio The results obtained for the two age groups were compared for the signal-to-noise conditions that were common to both groups (0 and -6 dB S:N). Recall that Howarth (1992) had chosen the signal-to-noise ratios of 0, -6, and -12 dB S:N to provide a range of 'easy', 'medium,' and 'hard' listening conditions for young listeners. These signal-to-noise ratios were determined through a pilot study that showed that young subjects performed nearly perfectly in the 0 dB S:N condition and that they experienced great difficulty in the -12 dB S:N condition (Howarth, 1992). However, a pilot study for the present experiment showed that the -6 dB S:N condition provided a hard listening condition for an elderly listener, whereas in a +6 dB S:N condition the pilot subject performed nearly perfectly. The signal-to-75 noise ratios used in this study were therefore, selected to be +6, 0, and -6 dB S:N, which were considered to reflect a range of listening difficulty from easy to hard for elderly listeners. In the signal-to-noise conditions common to both age groups (0 and -6 dB S:N), elderly subjects made significantly more errors than did young subjects. Even though these elderly subjects had normal hearing for their age, they did not perform like young subjects in the signal-to-noise conditions common to both groups. A significant interaction of age and signal-to-noise condition was observed for elderly but not for young subjects. Elderly subjects experienced far greater difficulty than did the young subjects, especially in the 0 dB S:N condition where young subjects had relatively little problem. The elderly made significantly more errors in the -6 dB S:N than in the 0 dB S:N condition. This pattern of breakdown was not observed in the young subjects. A significant interaction of age and signal-to-noise condition was observed for elderly but not for young subjects. Although the elderly subjects were classified as having normal hearing, they were more adversely affected by the degradation of the acoustic signal. Declines in their temporal processing and frequency selectivity abilities are likely to be contributing to their poor performance in noise. To compensate for such failing sensory, bottom-up perceptual processing abilities, unlike the normal-hearing young subjects, the elderly may need to rely more on text structure (derived from top-down processes) to help compensate for the degraded acoustic signal. Despite changes in cognitive processing, elderly subjects were still able to rely on supportive context to disambiguate the auditory signal. Perhaps elderly people, who often experience some degree of difficulty hearing speech in typical everyday environments, are more adept at utilizing supportive context that is highly predictable in nature to assist in 76 their listening comprehension. Young people, however, do not experience a similar failing of their bottom-up perceptual processes in typical everyday environments and hence they may not need to rely as heavily on top-down processing as do elderly people. Elderly subjects have been shown to perform better in a variety of cognitive tasks when greater environmental support is provided (Craik, 1986). These findings are in agreement with the results of other studies where elderly listeners were found to derive more benefit from supportive context than young listeners (e.g. Graesser et al., 1989; Hutchinson, 1989; Kalikow et al., 1977; Pichora-Fulleretal . , 1995; Tun, 1989). Comparison of Results by Ease of Listening In the previous section, I examined the pattern of results for the two age groups in the signal-to-noise conditions that were used to test both groups. When the performance of the two age groups was matched by level of listening ease, however, the main effect of age and all interactions with age disappeared. Comparing performance in the conditions considered to be easy by both groups, (6 dB S:N for the elderly and the -6 dB S:N condition for the young), to performance in the next easiest condition, (in a condition 6 dB poorer than the condition considered to be 'easy'), it was found that performance declined to about the same extent for both age groups. Moreover, a significant interaction of text and listening condition was observed in both groups: fewer errors were made when subjects listened to narratives than when they listened to descriptions. For the 'easy' and ' dB more difficult' conditions, the two age groups demonstrated a similar pattern of breakdown. Elderly subjects did not appear to use narrative structure to any greater 77 extent than did young subjects in the 'easy' listening condition where performance was near perfect and in conditions 6 dB S:N less where performance was just beginning to break down for both groups. Since age differences in the effect of text structure on the number of errors disappear when conditions are equated for perceptual ease, it would appear that the decreased ability to perceive speech in noise by the elderly as measured using a modified tracking task, is likely the result of declines in auditive factors. Elderly subjects require more favourable signal-to-noise conditions to match the performance level that young subjects are able to achieve in lower signal-to-noise conditions. Because the pattern of breakdown is similar for both age groups when conditions are equated for perceptual ease, there does not appear, therefore, to be a difference in the ability of young and old subjects to take advantage of text structure. Nevertheless, these conclusions are based only on conditions where subjects are performing nearly perfectly or just beginning to break down. It may be that we would observe age differences in the use of context if we were to examine the performance of young and elderly subjects at signal-to-noise conditions further below the levels at which performance just begins to breakdown. To determine if this is the case, performance in noise for young subjects should be examined at a level more comparable to an elderly subject's performance at -12 dB S:N; young subjects should be tested at -18 dB S:N. In this condition, young subjects will likely have much more difficulty hearing. In more difficult listening conditions, young subjects may also need to rely more heavily on top-down processes to disambiguate the auditory signal and they may not be as able as the elderly to do so. 78 Summary and Future Directions The present study attempted to develop a testing scheme that evaluated not only the role of audition, but also the role of cognition, specifically the use of text type, in an elderly individual's speech perception performance in noise. Based on the results of this study, it seems likely that elderly subjects, when compared to young subjects, rely more on top-down processes to compensate for a degraded auditory signal in conditions where listening is difficult for them and requires more effort even though listening appears to remain relatively effortless for young listeners who are experiencing the same signal-to-noise conditions. Further research is required to fully test the hypothesis that elderly subjects do use supportive context to a greater extent than young listeners in a modified tracking exercise presented in a range of signal-to-noise conditions. As stated earlier, this experiment could be administered again for young subjects using conditions that are more difficult. When young and elderly subjects are tested at similar levels of perceptual difficulty, then the nature of age differences may be more clearly observed. In addition, the influence of working memory on the performance in comprehension tests needs to be examined further. The comprehension questions used in this study asked for rather specific answers and as a result, a listener may have needed a 'good' memory to perform well on these tests. As pointed out by C H A B A (1988), the comprehension of spoken language needs to be studied directly rather than via later memory tests. If reduced working memory capacity affects spoken language comprehension as one grows older, then comprehension tests must be controlled for memory demand (CHABA, 1988). Once controlled, perhaps the importance of non-auditory information such as text structure would 79 be more fully realized. Furthermore, other ways to analyze errors should be investigated in order to realize the full extent of the effect of text structure on comprehension. The present study only analyzed the linguistic surface structure of the response errors. Analyses of specific processes that are engaged during comprehension could be undertaken. Discourse analysis might be useful in exploring the relationship between discourse properties and comprehension. Although the modified tracking exercise does not resemble a natural conversation, the responses given in the exercise might prompt insights into how perception, and ultimately comprehension, of the message fails in adverse listening condtions. For example, if the topic was a story is that of a young woman who is afraid of the bogey man, it would seem odd if a subject gave a response that had nothing to do with the topic of the story. Given such occurrences, analyses that investigate aspects of the responses beyond their surface structure, (e.g., topic and sequence of events), should be considered. In addition, different ways to code errors should be investigated. In the current coding scheme, all errors carried equal weight, regardless of whether the error involved a bound morpheme or a whole line of utterance. Thus, a deletion of the whole utterance was counted as one error, but two errors occurring in one utterance were counted as two errors. These errors are inherently different and the present coding scheme does not evaluate this difference. Future administrations of this study should evaluate not only the type of errors that occur, but the number of errors a listener makes on any given utterance, the number of correct utterances vs. incorrect utterances in a given passage, and the number of whole utterance deletions. These kinds of descriptions of the errors may provide greater insight into how and why errors 80 occur and provide a better way of evaluating the effect of text structure on speech perception. Moreover, the revision error should be redefined. In the present coding scheme, any revision was coded as an error, regardless of whether or not the final revised response was correct. Future administrations of this coding scheme should treat revisions that result in a final correct response as correct and not add them to the total number of errors. It should be pointed out that the modified tracking exercise used in this study will pose limits on any conclusions that are drawn from this study. Since everyday listening comprehension does not involve a listener repeating back words verbatim to the speaker, the exercise therefore has limited face validity. On the other hand, by having subjects repeat verbatim what they thought they heard, we gain a window into perception that we would not otherwise have. While the exercise does not fully test the true speech processing abilities of individuals as they are employed in everyday listening environments, the testing environment and the stimuli used in the modified tracking procedure certainly better approximate an individual's everyday listening environment than do traditional tests of speech perception (tests that employ clearly articulated monosyllables in quiet). Implications for aural rehabilitation The results of the present study suggest that elderly individuals are able to benefit from the non-auditory properties of the message to facilitate the comprehension of utterances spoken in noise. 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Perception and Psychophysics. 28(2). 97-102. 92 00 w PC o pi PH H X l-H Q OH U OH W OQ OQ V> -I u w PQ OH Vi o l-H H < Q W X w oo W O < H U w 1—1 OQ oo o CN OQ W < H U O > o l-H CN PQ > PQ o o CO CO CO CO CO o o CO so_ cs CO CO CN r-CN CO CO CN Os 00 oo as 00 Os SO OS o o o o CN OS o o o o oo oo uo oo t-- CN i CN i CN CN o CN o CN CN PH oo SO < o PH oo PH so so PH SO PH CO PH 00 SO 00 OQ 04 OQ U U < v> Vi > Vi U Q o o +1 co oo CN 00 +1 oo oo +1 o\ +1 CN in +1 oo in +1 o r-3 ^ pq •a <u 2 4=1 <L> O —^» <u >H CH •S N O ffi o 2 ! H T—I 4 H o «n u 0 <u g O « , & "k> B l S ^ -t—» O 93 APPENDIX B Text for narrative "Scaredy Cat" 1: when I was small 2: the most frightening place in the world for me was the basement in my own home 3: there were so many places in the basement 4: where a bogey man could hide 5: I believed him to be waiting and watching from the cool dark corners of the room 6: just longing to catch me alone 7: typical of an old-fashioned cellar, the basement had a low ceiling 8: a bulb hanging at the end of the room was the only lighting 9: shadows from haunted old furniture played games with my mind 10: making my imagination run wild 11: a door to the right of the main room led to a small dim laundry room and workshop 12: one day my eldest sister asked me to run downstairs and fetch some clean dish towels 13: as she was busy cleaning the kitchen 14: "well I'm kinda busy right now", I replied 15: as I sat at the table, twiddling my thumbs 16: "oh come on, don't be so lazy" 17: "unless of course you're afraid of the bogey man," she said gleefully 18: to avoid weeks of harassment from my younger sisters 19: I hurriedly assured her 20: that I would be happy to get the towels 21: and bounced down the stairs to the basement 22: the gloomy quiet atmosphere seemed to close in on me 23: as I cautiously stepped into the room 24: my footsteps echoed loudly along with my heart 25: as I walked slowly across the floor 26: the laundry door room whined protestingly 27: a warning of my presence to all who lurked in the shadows 28: the shelves of the clean laundry remained hidden by a black curtain 29: taking a deep breath 30: I drew the curtain to one side 31: and a pair of evil green eyes stared malevolently 32: from within the deep dark recesses of the cupboard 33: a coronary arrest threatened to overtake me 34: as the cat shot over my shoulder and through the open window like a bullet 35: I crawled upstairs, a nervous wreck 36: and told my sister of my fright 37: swearing emphatically that I would never ever go downstairs alone again 38: she was extremely sympathetic ("Scaredy Cat" continued) 39: "oh," she said 40: but you've forgotten the tea towels" 41: Hmmph, sympathetic indeed 95 Text for the narrative "Taxi" 1: it's seven a.m. in Denville 2: and the taxi company has just called a second time 3: to say they can't find my house 4: once again I spell out directions even a blind cabbie could follow 5: only two hours remain until my flight leaves 6: and it's an hour-and-a-half trip to the airport 7: outside the torrential rains are threatening to sweep my little house 8: off the mountain slope on which it teeters 9: a place so far north in denville 10: that city buses lurch past only three times a day 11: the telephone rings again 12: terribly sorry, begins the dispatcher 13: then I realize what's happened 14: flooded with calls the company's maximizing profits by handling only in-city runs 15: I'd heard this happens when the weather gets bad 16: desperately I shout into the phone 17: that I have a plane to catch 18: and I ' l l meet the taxi a few hundred metres away on a bridge over the Clifton River 19: standing over the roaring gale-swelled river 20: horizontal-driven rain drenching my overcoat 21: I gaze up and down the street 22: No taxi 23: finally, struggling with my umbrella and suitcase 24: I begin to hitchhike 25: a pickup truck goes by 26: driver and passenger staring at the well-dressed business person 27: walking backward in the downpour 28: from the other direction a white car approaches, passes 29: and then jams on its brakes 30: a man throws the door open 31: gesturing for me to get in 32: shaking with cold and anger I get inside 33: in the most humble manner the man identifies himself as the dispatcher 34: with whom I've spoken three times this morning 35: to get me to my plane 36: he's abandoned his post 37: and raced from the company in his personal car 38: he apologizes profusely 39: but does not explain why a taxi couldn't pick me up 40: except to say they are very, very busy this morning 41: delivering me to the airport bus 96 ("Taxi" continued) 42: he refuses the money I press into his hand 43: and with more apologies implores me to patronize his company in the future 44: later settling back into my seat as the plane takes off 45: I open the newspaper 46: On the second page my eyes wander to a headline 47: Taxi strike begins this morning in Denville 97 Text for narrative "Jewel Trick" 1: when a trickster named Jim Moran 2: learned that the crown prince of Saudi Arabia was in holly wood for a long visit 3: he decided to pose as the prince one night 4: and see what it was like to be treated as royalty 5: he would wait until the prince was out of town 6: then dress himself in Arab robes 7: and have dinner in a fancy restaurant 8: that was only part of his plan 9: he hired three actors to help him 10: one to pose as his Arab dinner companion 11: the other two as his servants 12: he arranged with a costume company to rent the robes and other clothing they would need 13: then he bought a big batch of glass jewels and a large amethyst 14: an inexpensive gemstone that looks more valuable than it is 15: he stored his so-called precious jewels in a large leather pouch 16: when Moran heard that the prince had left Hollywood for a few days 17: he called an expensive restaurant 18: and reserved a table for that night 19: he also rented a chauffeur driven limosine 20: when they arrived at the restaurant 21: the two servants went inside to make certain 22: that the table was suitable for the prince and his friend 23: after they seated them 24: they stood nearby 25: their table was at the end of the dance floor 26: whenever the dance band played 27: the dancers jostled one another 28: to get a good look at the royal party 29: at one point Moran sent one of his servants 30: to ask the band leader to play this is the life 31: a song that was one of his favorites 32: after the band played the song 33: the prince smiled at the band leader 34: and nodded his approval 35: then he pulled out his pouch of jewels and emptied it onto the tablecloth in front of him 36: as everyone in the restaurant watched 37: he selected the amethyst 38: and then sent it to the band leader as a sign of his appreciation 39: soon after dinner the prince decided to leave 40: his party started across the dance floor toward the door ("Jewel Thief" continued) 41: suddenly the prince's jewel pouch opened 42: and the glass jewels fell to the floor spilling in all directions 43: the servants started to pick them up 44: but the prince said, "leave them" 45: and swept from the room without looking back 46: as the Arabs were seating themselves in the limosine 47: everyone in the restaurant was on hands and knees 48: scrambling for the jewels the prince had left behind 99 Text for description "Ninth Street Cafe" 1: this is a comfortable hole in the wall near the university 2: dim, warm, and almost always full 3: it's become a favorite spot for students 4: with its reasonable prices, pretty good cooking 5: and a menu that's as varied as the choice of music 6: classical is interspersed with jazz and rock-n-roll 7: the regular menu runs to three pages 8: and daily specials are chalked on an overhead blackboard 9: if you're looking for a light meal perhaps a top notch sandwich 10: you're in the right place 11: give this kitchen a couple slices of bread or a burger bun 12: and they're off and running 13: The burgers are made of coarse juicy beef with sprouts, cheese, avocado slices 14: and other good extras dribbling out the side 15: this cafe makes an upscale version of a clubhouse 16: a sandwich which is dipped in egg and fried 17: it's definitely a knife and fork affair 18: as well there is a house special sandwich 19: ham, cheese, tomatoes, mushrooms, onions served open faced 20: this one is a plate licker 21: the soups, which ought to be first rate in a place like this, are ordinary 22: one special had recently been a can of creamed corn 23: which was made smooth 24: and served not quite hot 25: the french onion soup 26: a dark consomme with cubes of bread 27: and lots of fresh onions under a thick layer of baked cheese 28: is a much better deal 29: there's a ceasar salad 30: there's always a ceasar salad 31: but this one involves big juicy ribs of romaine lettuce 32: a rich dressing 33: and a healthy sprinkling of freshly grated parmesan on top 34: it's a better deal than the strips of darkening avocado 35: on either side of defrosted soggy shrimps 36: bathed in a bland cream and celery dressing 37: pasta is available in great variety 38: and you're invited to match any pasta with any six or seven sauces 39: the lasagna is made with fresh spinach and carrots 40: which sounds bizarre but tastes just fine 41: this bistro also offers a selection of heavier-meals ("Ninth Street Cafe" continued) 42: including peppered steak 43: beef stroganoff 44: veal in cream 45: and various species of fish and fowl 46: for dessert have the homemade ice cream 47: the cheesecake 's dry 48: the cafe has an adequate wine list 49: and champagne is available by the glass 50: if you're more thirsty than hungry 51: there's a lounge upstairs 101 Text for description "Mrs. T's" 1: There's a small restaurant on seventh avenue 2: with a large rock in the middle of the room 3: and a free form fireplace that burns real wood on cold evenings 4: Welcome to Mrs. T's 5: a cafe where well fed customers dawdle happily over their coffee 6: while the refills keep coming 7: the chef in this kitchen actually cooks 8: as opposed to those who merely defrost 9: the food is plain here but good 10: for openers there're garlic laced chicken wings 11: smoked salmon with capers 12: and jumbo garlic shrimp 13: with the smoked salmon leading the pack 14: and the garlic wings running a close second 15: the shrimp are just ordinary 16: among the main courses the chicken kiev is large,golden, a little dry outside 17: some would call it extra crispy 18: its a question of semantics 19: but full of parsley and melted butter 20: which spurts nicely when you slice into it 21: the vegetables are likely to be peas with a scoop of mashed potatoes on the side 22: if you like seafood 23: try the sauteed shrimp and crab on noodles 24: its a well put together plate 25: with lots of mushrooms and a gentle white wine sauce that goes well with the seafood 26: the big plus in this restaurant is the homemade corned beef 27: which is rosy and lean and just spicy enough 28: Mrs T's pride and joy 29: made weekly in discrete quantities in this very kitchen 30: and it's good 31: following in the time honored tradition of this city's finest corned beef sources 32: take note of the house special sandwich 33: it starts with rye bread 34: and builds into a great wad of thin-sliced wonderful beef 35: it's a terrific mouthful 36: if you like your beef uncorned 37: there's beef stroganoff 38: or the roast beef dinner 39: the corned beef also shows up in one of several omelettes 40: but the sandwich is its big moment 41: other big moments here include 102 ("Mrs. T's" continued) 42: the honestly homemade pumpkin pie with whipped cream 43: and the classic european cheese cake 44: dense and moist and not too sticky sweet 45: the chocolate cheesecake is a certified diet buster 46: but Mrs. T ain't perfect 47: her ceasar salad is loaded with bacon bits 48: and the dressing doesn't quite make it 49: if you're lusting after the definitive ceasar 50: this won't be it 51: lunch and Sunday brunch are both on Mrs. T's schedule 52: and the restaurant is closed on monday evening 53: there's a short wine list 54: service is friendly and efficient 55: in spite of the fact that one waitress seems to handle it all 103 Text for description "Siggy's Place" 1: the glass trophy case in the entranceway of Siggy's place 2: is a reflection of one man's work 3: chef-owner Siggy Biewald is a familiar face 4: at international culinary salons across europe 5: and the hardware he's collected from them is impressive 6: the case bulges with medals, plaques 7: and various certificates proclaiming his excellence in competition 8: a guest book overflows with rave reviews from grateful customers 9: although the daily fare at Siggy's is not the stuff of international salons 10: this is good homecooking for a reasonable dollar 11: there are three reasons to keep Siggy's in mind 12: one, the Sunday brunch; the best in town for a Sunday meal 13: two, his special menu featuring german dishes 14: and three, in the buffalo business Siggy is a groundbreaker 15: during the summer season when your house overflows with out of towners 16: and you're frantic to find a novel dining experience for them 17: buffalo might be the answer 18: the appetizer of choice is smoked goose breast 19: which is lightly smoked so the strong goosy flavor still comes through 20: the amount of choice in this restaurant is staggering 21: apart from buffalo and german dishes the regular menu includes 22: pork tenderloin, rib-eye beef 23: and skewered beef with papaya and pineapple 24: lamb chops and even a pheasant dish 25: if you're a red meat fan 26: you'll enjoy Siggy's special buffalo menu 27: buffalo chili, buffalo steak with mushrooms, buffalo stew 28: buffalo short ribs, or buffalo bratwurst with sauerkraut 29: there's an item you won't find on many menus 30: the buffalo cheeseburgers are okay 31: but I'd be hard pressed to tell them apart from beef 32: the buffalo stroganoff 33: which Siggy makes with less sour cream and more dill pickle than some cooks would like 34: is a comfortable dish for a big appetite 35: with all of this the menu promises fresh vegetables 36: and sometimes they are 37: other times you get squishy frozen carrots 38: avoid if you can the shrimp crepes 39: which are a soggy effort involving some canned shrimp and some strange gray bits 40: that are in fact oysters in less than good eating condition 41: for dessert ask about the black forest torte ("Siggy's Place" continued) 42: if it's fresh it's wonderful 43: the wine list is short 44: the service is good 45: dinner for two is about thirty-five dollars, complete APPENDIX C 105 (from Howarth, 1992) Readability, word, and syllable counts for each text Narratives Scaredy Cat Taxi Jewel Thief Readability1 70 67 72 number of words number of syllables 351 371 401 502 545 553 Descriptions Ninth Street Cafe Mrs. T's Siggy's Place 69 70 63 373 416 377 533 586 573 A Flesch readability score of 60 to 70 is interpreted as a standard reading score for seventh to eighth graders, (Flesch, 1948). APPENDIX D HEARING A N D L A N G U A G E HISTORY Subject Code: Date: 1. Birthday: (d-m-y) 2. a. What is your first language? b. Do you speak any other language fluently? c. Are you right- or left-handed? Right Left d. How many years did you attend school? e. Geographic locations where you lived as a child: f. Geographic locations where you lived as an adult: 3. a. Do you know how to play a musical instrument? Yes No b. Have you had any training in music? Yes No 4. a. Do people ever complain about your hearing? Yes No b. Have you ever had a hearing test? Yes No c. Do you wear a hearing aid? Yes No 5. Did anyone in your family have a hearing loss before old age? Who? Yes No 6. a. Do you often get colds? Yes No b. Do you have one now? Yes No 7. a. Do you have allergies? Yes No b. Are you bothered by one now? Yes No 8. a. Do you often get ear infections? Yes No b. Do you have one now? Yes No 9. Have you ever had ear surgery? Yes No What kind? 10. Do you have ringing in your ears? Yes No When? Always Sometimes Which ear(s)? Right Left 11. a. What is/was your occupation? Was it extremely noisy at work? Yes No Did you use ear protection? Yes No b. Were you ever in the military? Yes No c. Do you have noisy hobbies? (e.g.loud music, carpentry, ski-doo) Yes No What kind? 12. Do you regularly take any medication? Yes No What kind? 13. Do you have any trouble with your vision? Yes No What kind? 14. Wi l l your participation in the study be affected by a health problem? 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The basement in this story is typically old fashioned because a. it has a high ceiling b. it has a low ceiling c. it has poor sealant d. it has no lighting 2. The sister of the narrator a. is understanding b. is sympathetic c. is also scared of the bogey man d. is a typical sister 3. The narrator goes down into the basement a. because she cares what other people think b. because she knows she is being silly c. because she hates her sisters d. because nobody else will 4. When the narrator goes into the laundry room, what happens? a. the bogey man jumps out at her b. a monster with green eyes attacks her c. a cat jumps out at her d. her sister jumps out at her 5. Our imaginations a. are strange things b. are very creative c. are what makes us human d. are fun to have 204 6. The narrator goes into the basement to get a. bath towels b. flour c. dish soap d. dish towels 7. When returning upstairs the narrator a. runs b. trips c. skips d. crawls 8. At the end of the story a. the narrator has overcome her fears b. still believes in the bogey man c. realizes there's no such thing as a bogey man d. is glad her sister forced her to confront her fears 9. According to the narrator, her basement is a frightening place because a. the bogey man hides there b. its hard to see in the dark c. nobody likes it d. scary creatures hid there 10. The narrator doesn't want to go down to the basement when her sister asks because a. she is too busy b. she is lazy c. she has other things to do d. she is afraid of the bogey man Correct Answers Ouestion Tvpe 1 (b) Explicit 2(d) Implicit 3(a) Implicit 4(c) Explicit 5(b) Implicit 6(d) Explicit 7(d) Explicit 8(b) Implicit 9(a) Explicit 10 (d) Implicit QUESTIONS: WAITING FOR A T A X I 205 For the following questions, select the answer that best applies to the passage you just listened to: 1. The narrator's house a. has been swept off a mountain slope b. teeters on a mountain slope c. has good bus service d. is close to the airport 2. The taxi company in this story is a. trying to maximize profits b. servicing its customers as best it could c. poorly run d. doing its best to cope with the rainy weather 3. The taxi driver a. is a regular full time driver b. is also the owner of the taxi company c. is also a dispatcher d. is a casual part-time driver 4. The narrator decides to hitchhike because a. there's lots of traffic b. she's given up on the taxi company c. its legal d. she's getting wet and cold 5. At the start of the story the narrator is a. anxious b. sleeping c. in a good mood d. crying 6. Which of the following vehicles drives by the narrator? a. a dump truck b. a van c. a motorcycle d. a pickup truck 7. The taxi driver a. makes a lot of money from this drive b. charges only half the fare c. refuses money for his service d. receives a large tip for his service 8. The taxi driver a. wants the narrator to make her plane b. has had a hard time finding the narrator's house c. has risked his life to get the narrator to the airport d. is just learning the city 9. When the story begins it's a. eleven in the morning b. seven in the morning c. noon d. seven in the evening 10. The narrator waits for a taxi outside on a bridge because a. she thinks its the only way she will get a taxi b. she is tired of waiting inside c. she thinks her house is too hard to find d. she can wait for a bus at the same time Correct Answers Ouestion Tvpe 1 (b) Explicit 2(b) Implicit 3(c) Explicit 4(b) Implicit 5(a) Implicit 6(d) Explicit 7(c) Explicit 8(a) Implicit 9(b) Explicit 10 (a) Implicit 207 QUESTIONS: JEWEL P R A N K For the following questions select the answer that best applies to the passage you just listened to: 1. The jewels were stored in: a. a safe b. a pouch c. a purse d. a case 2. At the end of the story the restaurant customers a. were excited b. were upset c. were tired d. were satisfied 3. When the band played "This is the Life" a. Jim Moran was feeling like he was in a dream b. Jim Moran was feeling like a drink c. Jim Moran was feeling like dancing d. Jim Moran was feeling like royalty 4. Jim Moran showed his approval to the band leader a. by nodding his head b. by clapping his hands c. by shaking his hand d. by raising his eyebrows 5. In this story the main character a. waited until the timing was right to go to a fancy restaurant b. wasted no time in making reservations at a fancy restaurant c. bought expensive jewels d. enjoyed eating a fancy restaurants 6. Upon arriving at the restaurant who entered the restaurant first? a. Jim Moran b. the band leader c. one actor d. two servants 7. Jim Moran left the restaurant after a. finding a fly in his soup b. eating his dinner c. the real prince entered the restaurant d. spilling his drink 8. In this story, Jim Moran a. liked to be generous b. liked to hurt people c. like to lie d. liked to have fun 9. Jim Moran was a. a mobster b. an actor c. a trickster d. a prince 10. The band leader a. could not become rich by selling the gemstone he was given b. could make lots of money with the gemstone he was given c. could become famous by selling the gemstone he was given d. was a friend of Jim Moran's Correct Answers Ouestion Tvpe 1(b) Explicit 2(a) Implicit 3(d) Implicit 4(a) Explicit 5(a) Implicit 6(d) Explicit 7(b) Explicit 8(d) Implicit 9(c) Explicit 10 (a) Implicit QUESTIONS: NINTH STREET C A F E 209 For the following questions select the answer that best applies to the passage you just listened to: 1. This restaurant is the place to eat a. nachos b. light meals c. dessert d. french cuisine 2. The dessert menu at this bistro is a. extensive b. limited c. for chocolate lovers d. for cheesecake lovers 3. The ceasar salad at this restaurant a. is like any other ceasar salad b. is worth ordering if you like salads c. is terrible d. is not a traditional ceasar salad 4. The lasagna is made with a. fresh cottage cheese b. fresh ground beef c. fresh carrots and spinach d. fresh pasta 5. This restaurant has a. an extensive menu b. a special kid's menu c. a different menu a night of the week d. all of the above 6. Which of the following was a soup special at this restaurant? 210 a. canned cream of mushroom b. canned cream of corn c. canned cream of asparagus d. canned cream of celery 7. The best choice for dessert is a. the cheese cake b. the chocolate cake c. the berries and cream d. the homemade ice cream 8. If you're craving pasta a. order the spaghetti with garlic b. avoid the pasta menu here c. there's a limited choice here d. you're likely to find something to satisfy your tastebuds 9. This restaurant is near a. a university b. a subway station c. a mall d. a college 10. The burgers in this restaurant a. are tasty b. are ordinary c. are just like those you get at McDonald's d. are made with tofu Correct Answers Ouestion Tvpe 1(b) Explicit 2(b) Implicit 3(b) Implicit 4(c) Explicit 5(a) Implicit 6(b) Explicit 7(d) Explicit 8(d) Implicit 9(a) Explicit 10 (a) Implicit 211 QUESTIONS: MRS. T's C A F E For the following questions select the answer that best applies to the passage you just listened to: 1. Which of the following is an "Opener" at Mrs. T's? a. chicken kiev b. shrimp and crab on noodles c. smoked salmon with capers d. potato skins 2. The efficiency of the restaurant's one waitress is a. revolutionary b. comforting c. terrible d. amazing 3. The best corned beef dish on the menu is a. the omelette b. the sandwich c. the pie d. the salad 4. The house special sandwich is described as a. typical deli food b. too much for one person c. larger than life d. a big moment 5. Mrs. T's is the kind of place where a. you get a good meal for your dollar b. you never feel rushed to leave c. you eat and run d. everything is micro waved 6. The pride and joy of Mrs. T's a. are her children b. is the roast beef c. is the shrimp and crab on noodles d. is the corned beef 7. The restaurant is closed on a. Sundays b. Sunday nights c. Monday nights d. Mondays 8. The pumpkin pie served at Mrs. T's is made a. from scratch b. from a box mix c. at a local bakery d. only in October 9. In the middle of Mrs. T's there's a a. coal stove b. rock c. table d. not something typically made at home 10. The vegetable side dish at Mrs. T's is a. predictable b. always a surprise c. never the same d. not something typically made at home Correct Answers Ouestion Tvpe 1(c) Explicit 2(d) Implicit 3(b) Implicit 4(d) Explicit 5(b) Implicit 6(d) Explicit 7(c) Explicit 8(a) Implicit 9(b) Explicit 10 (a) Implicit 213 QUESTIONS: SIGGY'S R E S T A U R A N T For the following questions select the answer that best applies to the passage you just listened to: 1. The Sunday brunch at Siggy's a. features a buffet b. is a good meal to take your mother to c. is the best deal in town d. starts at eleven in the morning 2. When is the best time to order the black forest torte? a. Soon after it's been baked b. When it's listed as the dessert special c. In the evenings d. When it's served with fresh whipped cream 3. This restaurant will appeal to a. fish eaters b. meat eaters c. vegetarians d. everyone 4. At Siggy's restaurant a. the desserts are the best in town b. the vegetables are always fresh c. the cheeseburgers are outstanding d. the choice of foods is staggering 5. Many of Siggy's customers a. have experienced indigestion b. have come from Europe c. think highly of his cooking d. are chefs 6. This restaurant specializes in a. beef dishes b. buffalo dishes c. seafood dishes d. pork dishes 7. The food at Siggy's is a. good b. terrible c. honest d. excellent 8. Siggy's shrimp crepes are a. made with the freshest of ingredients b. a demonstration of his expertise c. a poor reflection of his abilities d. a typical example of Siggy's fine cooking 9. At the front of Siggy's restaurant is a glass case which displays a. the menu b. a guest book c. medals d. pictures of Siggy with famous chefs 10. According to this restaurant review, Siggy's restaurant a. is reasonably priced b. will put a dent in your wallet c. is known for its blue plate specials d. is typical of eateries Correct Answers Ouestion Tvpe 1(a) Explicit 2(a) Implicit 3(b) Implicit 4(d) Explicit 5(c) Implicit 6(b) Explicit 7(a) Explicit 8(c) Implicit 9(c) Explicit 10 (a) Implicit 215 APPENDIX H M i l l Hi l l Vocabulary Test Name: Date: Sex: _Age:_ Last grade in school: Occupation: In each group of six words below, underline the word which means the same as the word in capital letters above the group, as has been done in the first example. 1. C O N N E C T 8. THRIVE 15. PERPETRATE accident join flourish cry appropriate commit lace bean thrash leap propitiate deface flirt field think blame control pierce 2. PROVIDE 9. PRECISE 16. LIBERTINE harmonize commit natural stupid missionary rescuer hurt supply faulty grand profligate canard annoy divide small exact regicide farrago 3. STUBBORN 10. E L E V A T E 17. QUERULOUS obstinate steady revolve move astringent fearful hopeful hollow raise work petulant curious orderly slack waver disperse inquiring spurious 4. SCHOONER 11. L A V I S H 18. F E C U N D building man selfish unaccountable esculent optative ship singer romantic lawful profound prolific plant scholar praise extravagant sublime salic 5. L IBERTY 12. SURMOUNT 19. A B N E G A T E worry freedom mountain descend contradict decry rich serviette overcome concede renounce execute forest cheerful appease snub belie assemble 6. COURTEOUS 13. BOMBASTIC 20. T R A D U C E dreadful proud pompous democratic challenge attenuate truthful short bickering cautious suspend establish curtsey polite anxious destructive misrepresent conclude 7. R E S E M B L A N C E fondness assemble attendance repose likeness memory 14. ENVISAGE activate surround enfeeble regress 21. T E M E R I T Y contemplate impermanence rashness estrange nervousness stability submissiveness punctuality 216 APPENDIX I T H E UNIVERSITY OF BRITISH C O L U M B I A Project on Speech Understanding in the Elderly Investigator: Grace Lee, M.Sc. candidate Thesis Supervisor: Kathleen Pichora-Fuller, Ph.D H E A R I N G H A N D I C A P I N V E N T O R Y F O R T H E E L D E R L Y (Ventry & Weinstein, 1982) This questionnaire is part of the project on age-related differences in speech understanding in noise. As stated on the consent form for the project, all information gathered, including that obtained in this questionnaire, will be identified by a code known only to the experimenter and your identity will be kept strictly confidential. I am interested in knowing how your hearing affects your everyday life. In the attached questionnaire, you will find a short series of questions about your experiences during everyday listening situations. Knowing which situations cause a person difficulty, we can begin to plan solutions to common problems. Your answers will be confidential. the questions cover a small number of common listening situations. Some questions ask you to judge how well you hear in a certain situation and some questions ask how you feel when you are listening in the situation. For each question, select one of these answers: yes, sometimes, or no It should only take a few minutes to compete the questionnaire. You may fill out the questionnaire at your convenience. Bring the completed questionnaire with you to your next appointment. Be sure to answer all questions. If you have any questions, I will be pleased to provide further information to ensure that you fully understand the nature of the project and what you are being asked to do in completing the Hearing Handicap Inventory questionnaire. 217 Yes Sometimes No 1. Does a hearing problem cause you to feel embarrassed when meeting new people? Yes Sometimes No 2. Does a hearing problem cause you to feel frustrated when talking to members of your family? Yes Sometimes No 3. Do you have difficulty hearing when someone speaks in a whisper? Yes Sometimes No 4. Do you feel handicapped by a hearing problem? Yes Sometimes No 5. Does a hearing problem cause you difficulty when visiting friends, relatives or neighbours? Yes Sometimes No 6. Does a hearing problem cause you to attend religious services less often than you would like? Yes Sometimes No 7. Does a hearing problem cause you to have arguments with family members? Yes Sometimes No 8. Does a hearing problem cause you difficulty when listening to T V or radio? Yes Sometimes No 9. Do you feel that any difficulty with your hearing limits or hampers your personal or social life? Yes Sometimes No 10. Does a hearing problem cause you difficulty when in a restaurant with relatives and friends? 218 X i—i Q Z pq PH PH < SO CD > O * <U bJO Q a + <D H J on 3 W 0) VH so + SO i CD _> *HH OH '£ o o C/0 CU Q so + CL) 0 > cs* VH HH + CN co in as r-in oo CN m co * - H CN 00 00 CN OO cn m CN in CN oo oo CO CN CN oo 00 SO SO m pi m u u < in so co CN SO CN 00 00 00 CN CN CN 00 as so so so co 00 SO 00 00 > oo U X Q +1 in +1 r—I +1 CO l-H +1 in i-H +1 co i—i +1 CN CN +1 in CN +1 J—I +1 r -co +1 Tt <N +1 CN +1 00 > N VH CU > m VH 4-H CU *CU •HH CM VH <U T3 O CO 03 CU -HH CT3 VH (U o co >s co <U <U > CN 03 CU a .a <L) i w I £ . a M HH cd « II * SO 

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