Cognitive compensation of speech perception in hearing loss: How and to what degree can it be achieved?
In daily life, speech is often degraded due to environmental factors, but its perception can be enhanced using cognitive mechanisms. Such compensation not only relies on increased cognitive processing (listening effort), but also makes use of context, linguistic knowledge and constraints. In hearing impairment, the speech signal is additionally and intrinsically degraded due to loss of audibility and/or suprathreshold deficiencies. In cochlear implants, the signal transmitted is spectro-temporally degraded. Hence, it has not been clear if hearing-impaired individuals and hearing-device users can as successfully use the cognitive compensation mechanisms, due to the interactive effects of these degradations with aging and hearing device front-end processing. The speech intelligibility tests are not capable of characterizing the cognitive compensation mechanisms. In our research, reviewed here, we have employed new approaches (phonemic restoration, dual-task paradigm, eye tracking, verbal response times) to answer this research question. Our results have shown that there is a fine balance between the speech degradations and their top-down compensation. This can be broken in advanced degrees of hearing impairment or due to inadequate device settings. With degraded speech, sentential context can still be used. Yet, this may come at the cost of delayed processing, likely drawing on more cognitive resources then timely integration of semantic information by normal-hearing listeners. Aging does not always have to have a negative effect; long-term linguistic and lexical knowledge may be successfully employed to achieve compensation. These findings indicate that new measures of cognitive processes need to be developed and used in clinics and device development, to comprehensively capture speech comprehension abilities and to improve diagnostic and rehabilitation procedures and tools.
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