![]() Speech in noise performance is associated with cognition, and the role of cognition becomes increasingly important as the complexity of the listening task increases ( Heinrich et al., 2015). ![]() The role of cognition becomes more apparent when communicating in adverse conditions, such as when listening to speech in fluctuating background noise or competing talkers ( Akeroyd, 2008 Humes and Dubno, 2010). This is particularly evident for older listeners ( Gordon-Salant, 2014 Moore et al., 2014). Furthermore, there is mounting evidence that non-sensory factors such as cognition, motivation, and context, play an important role in both listening to speech (one-way interaction process) and communication (bi-directional interaction Kiessling et al., 2003 Pichora-Fuller and Singh, 2006 Rudner et al., 2011). It is widely accepted that understanding speech in background noise is the most common problem for people with hearing loss ( Vermiglio et al., 2012 Humes et al., 2013), as characterized by the typical statement “I can hear but I cannot understand what is being said.” In addition to a loss of hearing sensitivity, there may be additional deficits of temporal and spectral processing that contribute to listening difficulties ( Hopkins and Moore, 2011). Listening and Communication in Adverse Conditions We propose that combined auditory-cognitive training approaches, where cognitive enhancement is embedded within auditory tasks, are most likely to offer generalized benefits to the real-world listening abilities of adults with hearing loss. For WM training, lack of far-transfer to untrained outcomes suggests no generalized benefits to real-world listening abilities. Furthermore, outcome measures should be sensitive to the functional benefits of AT. ![]() This suggests that for AT related benefits, the development of complex cognitive skills may be more important than the refinement of sensory processing. AT resulted in generalized improvements in measures of self-reported hearing, competing speech, and complex cognitive tasks that all index executive functions. A series of three high-quality training studies are discussed, which include, (i) a randomized controlled trial (RCT) of phoneme discrimination in quiet that trained adults with mild hearing loss ( n = 44), (ii) a repeated measures study that trained phoneme discrimination in noise in hearing aid (HA) users ( n = 30), and (iii) a double-blind RCT that directly trained working memory (WM) in HA users ( n = 57).
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