Analysis of Factors Influencing Auditory Temporal Resolution Based on Mandarin

doi:10.21203/rs.3.rs-4878878/v1

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Analysis of Factors Influencing Auditory Temporal Resolution Based on Mandarin

https://doi.org/10.21203/rs.3.rs-4878878/v1

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Objective:

This study examines the correlation between the temporal resolution of the auditory system and speech recognition in noise based on Mandarin. It also explores the impact of various factors on the temporal resolution abilities in the elderly.

Methods:

A total of 170 participants were included in this research. The control group consisted of 30 young individuals with normal hearing thresholds, while the experimental group comprised 30 elderly individuals aged 60 and above with mild to moderately severe hearing loss and 20 elderly individuals who wore hearing aids. Tests conducted included the Gaps in Noise (GIN) test for auditory temporal resolution and the Mandarin Quick Speech-in-Noise test (M-QuickSIN), from which Gap Detection Threshold (GDT) scores and SNR loss scores were derived. Statistical analysis was performed using SPSS 25.0.

Results:

The differences between GDT and M-QuickSIN scores were statistically significant (p < 0.05) in the moderate and moderately severe hearing loss and hearing aid wearing elderly groups. Significant statistical differences in GDT were also observed between the normal hearing young group and the normal hearing elderly group, as well as between the normal hearing elderly group and the elderly with moderate to moderately severe hearing loss (P < 0.05). Notably, significant differences in GDT before and after the use of hearing aids were observed in the same elderly individuals (P < 0.001).

Conclusion:

Increasing age, degree of hearing loss, and M-QuickSIN scores significantly influence GDT outcomes. Long-term use of hearing aids decreases GDT and enhances speech recognition capabilities in noise. When subjects are unable to perform speech audiometry clinically, the GIN test should be considered for diagnostic reference.

Health sciences/Diseases/Neurological disorders

Biological sciences/Neuroscience

Health sciences/Medical research

GDT

Mandarinquickspeech-in-noise test

Temporal resolution

Signal to noise loss

Hearing loss is one of the common manifestations of physical deterioration in older adults, which can lead to impaired speech communication in life, especially in noisy environments [1, 2]. Although the mechanisms underlying speech comprehension difficulties in the elderly are not fully understood, increasing evidence suggests that the temporal resolution of the auditory system is closely linked to vocal communication in both animals and humans [3, 4]. Viemeister et al. noted, "Changes in the timing of sound signals are fundamental to the transmission of speech and other acoustic signals" [5]. The loss of temporal cues can lead to speech comprehension disorders, so the temporal characteristics of the acoustic signal are particularly important for the processing and transmission of auditory information, which may contribute to speech comprehension disorders in older adults [6, 7].

Auditory system temporal resolution testing assesses the ability to discern the shortest silent interval in a sequence of continuous sounds. Auditory temporal information can be divided into fine structure, periodicity, and temporal envelopes. Common testing methods include GDT tests, modulation detection tests, and forward masking tests. In GDT tests, the amplitude of the sound frequency changes over time, such as inserting a silent gap in a tone, equivalent to turning the sound source off and then on. This transient change may be detected by the participant due to frequency spread or splatter, affecting the accuracy of the test. The above phenomenon can be avoided by inserting a silent interval into a continuous noise in the GIN test. This paper utilizes the GIN test module from the Angel Speech Training software version 5.08.02 developed by the Hausser Research Institute, which assesses the ability to distinguish the shortest interval between two noises. Due to its language-independence and simple operation, it is suitable for a diverse population [8, 9].

2.1 Research Material

2.1.1 Research subject

Experimental group: elderly group, male and female, age ≥ 60 years old [10, 11], 30 cases in the group with normal hearing thresholds (Group B), 30 cases in the group with mild hearing loss (Group C), 30 cases in the group with moderate hearing loss (Group D), 30 cases in the group with moderately severe hearing loss (Group E), and 20 cases in the group wearing hearing aids (Group F) were selected respectively.

Control group (Group A): hearing threshold normal group, male and female, age between 18 and 35 years old, 30 cases. The hearing grading standards of both groups were referred to the 2021 new version of WHO hearing grading standards [12].

2.1.2 Inclusion Criteria

Participants must be able to communicate in Mandarin without cognitive impairments, possess a Type A tympanogram at 226Hz [13], and score ≥ 26 on the Montreal Cognitive Assessment (MoCA) [14]. Both the normal-hearing young and elderly groups show no otological diseases, with pure tone audiometry thresholds < 20 dB HL at all tested frequencies. Results from the Distortion Product Otoacoustic Emissions test indicate "pass" for both ears. The hearing-impaired elderly group includes individuals with post-lingual bilateral sensorineural hearing loss for over a year. The hearing aid group consisted of patients with moderate to severe hearing loss who had been wearing hearing aids in both ears for more than 3 months.

2.1.3 Exclusion Criteria

(1) Individuals with other otological diseases such as tinnitus or vertigo.

(2) Individuals with a history of psychiatric or neurological diseases, or with brainstem or brain pathological damage.

(3) Individuals scoring < 26 on the MoCA test.

(4) Individuals who are physically unwell or mentally unable to participate fully in the tests.

(5) Individuals whose 226Hz tympanogram does not classify as Type A.

2.1.4 Ethical Consideration

The relevant tests involved in this study have been approved by the Ethics Committee of the First Affiliated Hospital of Ningbo University, with the approval to conduct this project under project number 2021-R116. After approval, verbal informed consent was obtained from the subjects and no information about individual subjects was involved in the study process. All experiments in this research were performed in accordance with relevant guidelines and performed in accordance with the Declaration of Helsinki.

2.2 Research Method

2.2.1 Experimental Environment

The acoustic conductance impedance test was conducted outside the soundproof room, and the instrument was manually calibrated before each day's test. Pure tone audiometry, M-QuickSIN tests, hearing aid threshold tests, and distortion product otoacoustic emissions tests are all conducted within a soundproof booth, which meets the required standards with a background noise level of ≤ 30 dB SPL (A). For the M-QuickSIN test and hearing aid threshold assessments, two speakers are positioned at 45 degrees to the left and right of the subject's sagittal plane, 1.5 meters away from the center point of the head's vertical line, and at the same height as the subject's ears.

2.2.2 M-QuickSIN Test

The test material was chosen from the M-QuickSIN test word list independently developed by Zhang Hua's team [15], which contains 11 groups of standard word lists, 6 sentences in each group, 5 keywords in each sentence, and the keywords can be one word or one word (two, three or four words), and one word list was randomly selected for each test. During the test, subjects repeat the words they hear from the speakers. Each key word correctly repeated scores 1 point; a full correct response earns 1 point. Any errors in a key word or additional or missing characters result in a score of 0. The final score is calculated using the M-Quick SIN formula (SNR loss = 25.5 - number of correct words), where a lower SNR loss score indicates more key words correctly identified, as shown in Table 1.

Table 1

Examples of the M-QuickSIN test word list
Sentence	Test Value	SNR	Score
It is anticipated that he will refuse to submit another urine sample.	{anticipated} {will} {refuse to} {submit} {urine sample}	+ 20	5
We have never left our dog at home when going out.	{We} {have never} {left} {dog} {going out}	+ 15	5
Your translation of "My Past and Thoughts" is a significant piece of work.	{translation} {Past}{} {significant} {piece of work}	+ 10	4
Do you think we can sell it to him in bulk?	{Do you think} {can}{bulk}{sell} {}	+ 5	4
My relative is the one who lost five thousand yuan.	{lost} {five thousand} {yuan} {My} {relative}	0	5
The arrogant and proud driver absconded with two hundred yuan.	{} {proud} {} {} {}	-5	1
SNR loss = 24.5- the number of correctly answered words

2.2.3 GDT Test

The Gaps in Noise (GIN) test, part of the auditory discrimination module from the Angel Speech Training software version 5.08.02 developed by Hausser Research Institute, administers sounds at 25 dB above the average hearing threshold (500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz pure tone averages) to the subjects. The formal test involves 30 sets of noises, each containing three sounds with one including a silent gap ranging from a few milliseconds to several tens of milliseconds. The other two sounds contain no gaps. After playback, subjects select the noise containing the gap. Correct identification leads to a reduction in the subsequent GIN gap size, while incorrect responses result in an increase. This process repeats for 30 rounds, with the GDT recorded at the conclusion of the test.

2.3 Statistical Methods

Statistical analyses were performed using SPSS 25.0. Normality was tested using the 1-sample Kolmogorov-Smirnov test. Data that followed a normal distribution were analyzed for homogeneity of variance using One-Way ANOVA, and multiple mean comparisons between groups were conducted using LSD, with P < 0.05 indicating statistical significance.

Table 2 provides descriptive statistical data for the hearing thresholds of all study subjects. Smaller values indicate better hearing thresholds. Table 2 reveals that the left and right ear thresholds for each experimental group are closely aligned, showing no significant difference (P < 0.05).

Table 2

Average hearing thresholds of all study subjects
Group	Average Hearing Threshold for One Ear (dB HL)	Average Hearing Threshold for Both Ears (dB HL)
Left Ear of Group A	5.21 ± 2.65	4.86 ± 2.78
Right Ear of Group A	4.51 ± 2.90	4.86 ± 2.78
Left Ear of Group B	13.96 ± 3.64	13.27 ± 3.92
Right Ear of Group B	12.58 ± 4.13	13.27 ± 3.92
Left Ear of Group C	28.34 ± 4.52	27.57 ± 4.40
Right Ear of Group C	26.79 ± 4.20	27.57 ± 4.40
Left Ear of Group D	43.46 ± 4.10	42.85 ± 4.43
Right Ear of Group D	42.25 ± 4.74	42.85 ± 4.43
Left Ear of Group A	55.11 ± 3.61	57.48 ± 3.72
Right Ear of Group A	53.86 ± 3.77	57.48 ± 3.72
Left Ear of Group F Before Wearing Hearing Aids	57.88 ± 7.27	57.19 ± 7.33
Right Ear of Group F Before Wearing Hearing Aids	56.50 ± 7.52	57.19 ± 7.33
Left Ear of Group F After Wearing Hearing Aids	35.38 ± 5.00	36.31 ± 4.98
Right Ear of Group F After Wearing Hearing Aids	37.25 ± 4.89	36.31 ± 4.98

Figures 1 and 2 depict the GDT and M-QuickSIN scores for all study subjects, respectively.

In Table 3, the correlation between GDT and M-QuickSIN SNR loss score is explored for Groups A-F, along with the overall correlation between groups. Groups A, B, and C exhibit P-values greater than 0.05, indicating no significant correlation between the two measures. However, Groups D, E, and F demonstrate a significant correlation with P-values less than 0.05. This suggests that the association between GDT and M-QuickSIN SNR loss scores is primarily linked to the degree of hearing loss and is more pronounced in populations with moderate to severe hearing impairment. Poor temporal resolution may contribute to the decline in speech recognition in noise.

Table 3

Correlation between GDT and M-QuickSIN SNR loss scores for each group
Groups	GDT (ms)	M-Quick SIN SNR loss score (dB)	r Value	P-value
Groups A	3.65 ± 0.81	0.26 ± 1.81	0.287	0.124
Groups B	5.87 ± 1.53	1.67 ± 2.70	0.235	0.210
Groups C	5.76 ± 1.33	2.67 ± 2.26	-0.707	0.714
Groups D	11.15 ± 2.91	5.72 ± 1.35	0.856	<0.001
Groups E	11.57 ± 2.71	7.67 ± 1.68	0.514	<0.004
F before wearing hearing aids	15.54 ± 4.23	9.95 ± 2.01	0.719	<0.001
F After wearing hearing aids	10.08 ± 3.53	5.85 ± 1.39	0.888	<0.001
Overall correlation between groups	8.70 ± 4.51	4.50 ± 3.68	0.825	<0.001

Table 4 illustrates the GDT for Groups A, B, and F. Group A shows significantly better (P < 0.05) thresholds, suggesting that age is one of the contributing factors to differences in GDT.

Table 4

Comparison of GDT between young and older individuals with normal hearing, as well as older individuals after wearing hearing aids.
Group	Groups A and B		Groups A and F
GDT (ms)	3.65 ± 0.81	5.87 ± 1.53	3.65 ± 0.81	10.08 ± 3.53
P-value	<0.001		<0.001

In Table 5, the GDT for Group B is compared to that of Groups C, D, and E. The results indicate that Group B exhibits similar thresholds to Group C, with no significant difference (P > 0.05) and significantly better (P < 0.05) thresholds than Groups D and E. This implies that a certain degree of hearing impairment is one of the factors leading to differences in GDT, with more severe hearing loss resulting in poorer GDT.

Table 5

Comparison of GDT between older individuals with normal hearing and those with mild, moderate, and moderately severe hearing loss.
Group	Groups B
Group	Groups C	Groups D	Groups F
GDT (ms)	5.76 ± 1.33	11.15 ± 2.91	11.57 ± 2.71
P-value	0.863	<0.001	<0.001

Table 6 highlights the GDT for Group F before and after wearing hearing aids, compared to Groups B, C, D, and E. All individuals using hearing aids are elderly individuals experiencing moderate to severe hearing loss. Although hearing aids cannot restore the hearing of these individuals to normal levels, they generally enhance their hearing to a level comparable to participants with moderate hearing loss.

Table 6

Comparison of GDT between older individuals wearing hearing aids and those with mild, moderate, and moderately severe hearing loss.
Group	Groups B	Groups F			F before wearing hearing aids
Group	Groups B	Groups C	Groups D	Groups E	F before wearing hearing aids
GDT (ms)	5.87 ± 1.53	5.76 ± 1.33	11.15 ± 2.91	11.57 ± 2.71	15.54 ± 4.23
P-value	<0.001	<0.001	0.144	0.043	<0.001

Numerous scholars at home and abroad [16–20] have confirmed that there is no significant correlation between ear grouping, gender and GDT, Therefore, this study did not specifically explore differences in gender or ears. However, research into the impact of age, varying degrees of hearing loss in the elderly, and the effect of M-QuickSIN on GIN is sparse,which are specifically analyzed in this paper.

4.1 Investigating the correlation between GDT and M-QuickSIN signal-to-noise loss scores in each group

Liberman et al. showed that although only 10–20% of inner hair cells are required to maintain normal hearing thresholds, a slight fiber loss can reduce speech recognition [21]. This study compared the correlation between GDT and M-QuickSIN SNR loss scores across groups A-F, finding a significant correlation especially in individuals with moderate to severe hearing loss. This suggests that the correlation between GDT and SNR loss scores is more apparent in this population, where poorer temporal resolution may lead to diminished speech recognition abilities in noise. For group F, both before and after using hearing aids, there was a notable correlation, and the GDT significantly decreased while M-QuickSIN SNR loss scores significantly improved after using hearing aids, indicating that hearing aids can reduce GDT and enhance speech recognition capabilities. Normal auditory signal transmission involves the collection of sound signals by the pinna of the outer ear, which are then transmitted through the middle ear to the inner ear, where they are analyzed and encoded based on frequency, intensity, and timing to be transformed into comprehensible language. According to a report by the American Speech-Language-Hearing Association (ASHA) auditory temporal resolution is considered a critical component of central auditory processing, playing a key role in speech recognition among individuals with normal hearing, those with hearing loss, individuals with speech disorders, and patients post-cochlear implant surgery. It is also an important of speech perception [22]. Therefore, we believe that temporal resolution capability of the auditory system is one of the significant factors in speech recognition, crucial for the processing and transmission of auditory information.

4.2 Impact of Aging GDT

Research indicates that even among individuals with normal auditory sensitivity, the temporal resolution capacity of the auditory system declines prior to the age of 60 [23, 24]. Studies by Nair et al. [25] comparing the GDT between elderly people with normal hearing and middle-aged adults with normal hearing demonstrate that even those elderly with normal hearing experience an elevated GDT. As shown in Table 4, the GDT in group B are significantly higher than those in group A, illustrating that the elderly exhibit poorer temporal resolution, a finding statistically (P < 0.001) and consistent with the studies by Nair and others [23–28]. This indicates a decline in auditory system temporal resolution with age. According to the spontaneous discharge rate, high spontaneous discharge rate fibers predominantly play a dominant role when the sound intensity is close to the behavioral auditory threshold, and low spontaneous discharge rate fibers are susceptible to noise exposure and aging [29], which affects the temporal coding of the sound envelope at the suprathreshold level [30], resulting in older adults experiencing age-related decreases in the temporal resolution of the auditory system.

4.3 Impact of Degree of Hearing Loss in the Elderly on GDT

Presbycusis, a type of hearing loss caused by aging, typically results in decreased clarity of sounds and reduced speech recognition capabilities [31, 32].After prolonged deafness, the ability of the auditory center to process rapid changes in information decreases due to reduced input of sound information [33]. This paper investigates the differences in GDT among groups B, C, D, and E aged over 60. Table 5 indicates that the GDT between groups B and C are similar and not statistically significant(P = 0.863 > 0.001), suggesting that mild hearing loss has minimal impact on the GDT in the elderly. When comparing the GDT of group B with those of groups D and E, the latter groups display significantly larger thresholds, with a marked statistical significance (P < 0.05). This underscores a close correlation between the GDT and moderate to severe hearing loss, with more severe hearing impairment corresponding to larger GDT. Perceptual and neurophysiological studies indicate that central auditory processing is compromised by hearing loss and aging. Cochlear synaptopathy can disrupt the connection between inner hair cells (IHC) and auditory nerves, leading to dysfunction in low spontaneous rate fibers. The loss of these fibers affects the temporal encoding of sound envelopes and the transmission of sound signals, thereby increasing the GDT [30].

4.4 GDT After Hearing Aid Use

As of 2020, statistics revealed that individuals aged 60 and above in China constituted over 1/6, or approximately 18.7%, of the total population [34]. With advancing age, the prevalence of hearing loss also escalates. Among those aged 65–75, the incidence of hearing loss ranges from 18.7 to 26%, increasing to 34.8–43.6% in individuals aged 75 and above, with over half of those aged 85 and above experiencing hearing loss [35]. Hearing loss significantly impacts the quality of life, prompting those with the means to consider early intervention [36]. Hearing aids are one of the preferred means of rehabilitation for deaf patients to improve hearing sensitivity and speech communication.

This paper's findings demonstrate that after wearing hearing aids, the GDT in the elderly group F were worse than in groups A, B, and C but better than in groups D and E, and notably improved compared to pre-hearing aid levels. This suggests that wearing hearing aids effectively reduces GDT. Potential reasons for this improvement could be attributed to the fact that, following pathological damage to the cochlea in elderly individuals, the auditory center undergoes a process of reconstruction related to auditory "deprivation" when deprived of effective external stimulation for an extended period. However, after prolonged wearing of hearing aids, effective stimulation is reintroduced from the sound signals output by the hearing aids. Through mechanisms like stimulation guidance, there is a transformation in the expression of sound signals in the auditory center, facilitating the retransmission of previously "deprived" auditory signals. This process stimulates the auditory center, thereby leading to a functional reorganization. Research by Sattari et al.Research by Karim et al. [37] shows that hearing aid wearers, after undergoing auditory training based on time processing, experience enhanced speech comprehension and reduced temporal resolution thresholds. While hearing aids may not offer optimal speech recognition for all patients due to individual differences, hearing aids and cochlear implants are the only interventions for improving hearing in the elderly with presbycusis [38]. Therefore, selecting the best hearing aid through multiple assessment pathways and optimizing the fitting and tuning of hearing aids might be beneficial.

This study preliminarily confirms the correlation between GDT and speech recognition abilities, specifically highlighting the impacts of hearing loss and age on the temporal resolution of auditory processing in the elderly, as well as the benefits of long-term hearing aid use. The GDT test serves as a valuable evaluative tool, providing meaningful guidance assessing the rehabilitation effects of hearing devices in later stages. It is important to note that no single hearing test is entirely comprehensive. For the most accurate assessment of hearing and speech recognition capabilities in the elderly, a combination of objective and subjective methods is recommended, along with cross-validation. Regardless, it is still advised that the elderly minimize noise exposure and routinely undergo temporal resolution assessments. Future studies should aim to increase the sample size and refine the categorization by age and degree of hearing loss, thereby reducing individual variations and sample size-related biases to deepen the research into auditory system temporal resolution.

Acknowledgments

This study was supported by the Science and Technology Program of Traditional Chinese Medicine of Zhejiang Province (Itemnumber: 2023ZL648). In addition, we thank all the researchers who helped with this project and Ningbo First Hospital for their support.

Data Availability Statement

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Ethical considerations

This study received from the Medical Ethics Committee and the Clinical Research Management Committee of the First Affiliated Hospital of Ningbo University. (approval number: 2021-R116).

Consent to participate

The data acquisition process for this study utilized verbal forms of informed consent, which was approved by the Medical Ethics Committee and the Clinical Research Management Committee of the First Affiliated Hospital of Ningbo University.

Declaration of conflicting interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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No competing interests reported.

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Analysis of Factors Influencing Auditory Temporal Resolution Based on Mandarin

Status:

Version 1

Abstract

Objective:

Methods:

Results:

Conclusion:

Figures

1 Introduction

2 Research Material and Method

2.1 Research Material

2.1.1 Research subject

2.1.2 Inclusion Criteria

2.1.3 Exclusion Criteria

2.1.4 Ethical Consideration

2.2 Research Method

2.2.1 Experimental Environment

2.2.2 M-QuickSIN Test

2.2.3 GDT Test

2.3 Statistical Methods

3 Results

4 Discussion

4.1 Investigating the correlation between GDT and M-QuickSIN signal-to-noise loss scores in each group

4.2 Impact of Aging GDT

4.3 Impact of Degree of Hearing Loss in the Elderly on GDT

4.4 GDT After Hearing Aid Use

5 Conclusion

Declarations

Ethical considerations

References

Additional Declarations

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