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Research Article
Volume 13 Issue 3 - February 2018
DOI: 10.19080/GJO.2018.13.555862
Glob J Otolaryngol
Copyright © All rights are reserved by Rinu Annie Roy
Rinu Annie Roy*
Masters in Clinical Audiology and Hearing Therapy, School of Advanced Education Research and Accreditation, University of Isabel 1, Spain
Submission: January 22, 2017; Published: February 15, 2018
*Corresponding author: Masters in Clinical Audiology and Hearing Therapy, School of Advanced Education Research and Accreditation, University of
Isabel 1, Spain, Email:
Glob J Otolaryngol 13(3): GJO.MS.ID.555862 (2018) 001
Introduction
Auditory working memory (AWM) is the process of keeping
sounds in mind for short periods of time when the sounds are
no longer present in the environment. The auditory feedback
loop is the process of self-monitoring and correcting one’s own
speech. Auditory feedback is very important for the attainment
Hearing is simply the act of perceiving sound by the ear. Hearing
is a passive bodily process that occurs at subconscious level for
a person with normal hearing. Listening, however, is something
that we consciously choose to do. Hearing is essentially a passive
bottom up driven process, whereas listening is a top down
process that requires attention, many repetitions of stimuli, and
tremendous cognitive coordination and effort. Hearing is a sense
and listening is a learned skill.
To process sound effectively, the brain must receive maximal
auditory information, to simultaneously receive, store, and
process acoustic information, this phenomenon also referred
to as working memory (WM). Short-term memory (STM) may
memorize a few or many items. WM involves more of cognitive
processing of the same information.
WM refers to a brain system that provides temporary storage
and manipulation of the necessary information for complex
cognitive tasks such as language comprehension, learning, and
reasoning. WM requires simultaneous storage and processing
working memory capacity (WMC) as the cognitive ability that
allows one to keep information within easy cerebral reach while
Global Journal of
Otolaryngology
ISSN 2474-7556
Abstract
Working memory has a crucial role in one’s effective communication, especially for the speech and language comprehension. The purpose
of this study is to compare the auditory working memory capacity (AWMC) in normal hearing adults and adults with mild to moderate hearing
loss using digit span tasks from WAIS- IV. This paper attempts to increase the audiologist’s knowledge about the relationship between AWMC
and mild to moderate hearing loss in adults by comparing AWMC with respect to type, laterality and duration of hearing loss. This paper also
examines current literature on auditory working memory (AWM) and provides a brief overview about working memory associated with various
(control group) and other 20 were having mild to moderate hearing loss (experimental group). The results show that the AWMC of individuals
with mild to moderate hearing loss is poor when compared to individuals with normal hearing. The poor AWMC in conductive and mixed hearing
importance of assessing AWM in audiology clinical setting.
Keywords: Auditory working memory; Auditory working memory capacity; Mild to moderate hearing loss; Conductive hearing loss; Mixed
Abbreviations: AWM: Auditory Working Memory; AWMC: Auditory Working Memory Capacity; AWM: Adults with Normal/Mild-Moderate
Auditory Working Memory: A Comparison Study in
Adults with Normal Hearing and Mild to Moderate
Hearing Loss
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Global Journal of Otolaryngology
How to cite this article: Rinu Annie Roy. Auditory Working Memory: A Comparison Study in Adults with Normal Hearing and Mild to Moderate Hearing Loss. Glob
J Oto 2018; 13(3): 555862. DOI: 10.19080/GJO.2018.13.555862
simultaneously processing it. WM is so important that it may be
the basis for general intelligence and reasoning, according to
The WM, serves as an interface between perception, long-
physical absence of the sensory input, a representation of the
information can be maintained and manipulated over a period of
resources constituting WM are limited with regard to the load
of information that can be maintained i.e., memory load, as well
as to the duration of how long information can be maintained
i.e., memory decay. These constraints are inherently linked to
the limited amount of attention that can be allocated to the to-
be-remembered information (Gazzaley and Nobre, 2012). When
limitations are exceeded, performance declines due to a lack of
attention resources (Norman and Bobrow [6]).
The memory load refers to the number of items to be
held in WM. Miller (1956) proposed that WMC in humans is
approximately seven units of data, plus or minus two, and
described this as the magical number seven. He claimed that
the information-processing capacity of young adults is around
seven elements which he called «chunks», regardless whether
the elements are digits, letters, words, or other units. Later, this
number has been revised to four chunks by Cowan (2001). In
2005, Cowan explains that to make precise predictions about
how well working memory operate, one have to measure
strategies like rehearsal and grouping and that is how one can
observe a capacity limit of 3 to 5 separate items. In the case
of auditory working memory, the acoustic degradation i.e.,
environmental noise, competing talkers or auditory degradation
i.e., the lack of precision in neural encoding that accompanies
sensorineural hearing loss (Bernstein and Oxenham, 2006;
Humes and Roberts, 1990) will lead to increase memory load
Rudner et al., 2011).
Baddeley and Hitch [7] introduced the multi-component
model of WM by revising the picture of STM provided by the
Multi-Store Model (Atkinson and Shiffrin [8]). According to
their function and the type of information they process and
manipulate. This study proposes that every component of WM
has a limited capacity.
The components are,
(a) The central executive: The central executive is the
most important component of the model. It is responsible
for monitoring and coordinating the function of the slave
systems and relates them to long term memory. It consists of
two sub systems, the phonological loop and the visuospatial
sketch pad.
(b) The phonological loop: The phonological loop deals
with the spoken and written material. It consists of two parts;
the phonological store (that is linked to speech perception
information in speech based form for 1-2 seconds) and the
articulatory control process (that is linked to articulation
used to rehearse and store verbal information from the
phonological store).
(c) The Visuospatial sketch pad: The visuospatial sketch
pad deals with visual and spatial information.
(d) The episodic buffer: In 2000, Baddeley added an
additional component called the episodic buffer. It links
information across the long-term memory and the other
components of WM.
It is relevant here to discuss about the difference between
STM and WM as both are terms that have been frequently
mentioned in the above paragraphs. The central executive region,
located in the prefrontal cortex, seems to play a fundamental role
in both STM and WM. Short term memory refers to a cognitive
system that is used for holding sensory events, movements, and
cognitive information, such as digits, words, names, or other
items for a brief period of time (Kolb and Wishaw, 2009). The
term WM became popular through the WM model of Baddeley
maintenance and controlled manipulation of a limited amount of
information before recall. Many studies support the concurrence
of both STM and WM (Gathercole and Alloway [9]; Nadel and
Hardt, [10]) but it is also claimed that the term WM has replaced
the older term STM (Gray [11])
AWM is the process of actively maintaining sounds in
memory over short periods of time (Kumar et al [12]). Baddeley
[13] suggests that auditory short-term memory extends up to 5
or 10 seconds. The functioning of WM via the central executive
system is suggested to be strongly dependent on the frontal lobes
(Baddeley, 1996). Studies on nonhuman primates (Goldman-
subjects (Braver et al.,1997; Carlson et al., 1998; Martinkauppi
et al., 2000) also indicate the importance of the prefrontal
cortex in WM processing. The functional magnetic resonance
imaging study in human by Kumar et al. (2016), demonstrates
maintenance of single tones in memory is associated with
activation in auditory cortex. In addition, sustained activation
was observed in hippocampus and inferior frontal gyrus.
Multivoxel pattern analysis showed that patterns of activity in
auditory cortex and left inferior frontal gyrus distinguished the
tone that was maintained in memory. Functional connectivity
during maintenance was demonstrated between auditory cortex
and both the hippocampus and inferior frontal cortex. The AWM
in auditory cortex by projections from higher-order areas,
including the hippocampus and frontal cortex (Kumar et al [12]).
WM appears to predict performance on a wide variety of
How to cite this article: Rinu Annie Roy. Auditory Working Memory: A Comparison Study in Adults with Normal Hearing and Mild to Moderate Hearing Loss. Glob
J Oto 2018; 13(3): 555862. DOI: 10.19080/GJO.2018.13.555862
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Global Journal of Otolaryngology
role in understanding speech, because listeners must decode the
incoming speech signal while relating the information to stored
knowledge and anticipating the speech that is forthcoming
Akeroyd [18]). While listening to conversations, individuals
must continually store and update auditory information that is
spoken in real time. Therefore, a preserved WM is considered
in WM are often observed (Brebion [19]) and are thought to be
Craik [21] proposed that WM would appear to be an
important factor in persons with hearing loss relative to speech
understanding. When the audibility of the speech signal is
reduced due to hearing loss, then more WM resources may need
to be assigned when listeners are trying to comprehend the
impoverished incoming speech signal (Foo et al., 2007; Rudner
et al, 2011; Besser et al., 2013). Whenever listening becomes
challenging, particularly in noisy environments, resources
typically allocated to storage are actually used to process the
ability.
audiogram. The degree of hearing loss is usually described by
at speech frequencies, which are 500Hz, 1000Hz and 2000Hz.
dB HL as Normal hearing; 16 to 25dB HL as Slight hearing loss;
hearing loss; 56 to 70dB HL as Moderately severe hearing loss;
hearing loss.
hearing faint sounds or distant speech even in quiet situations
hearing soft consonant sounds making words seem incomplete.
Noisy environments make hearing more challenging. They miss
experienced will depend upon the background noise level,
or speaker is not in line of vision. There will be high chances to
miss unstressed words and consonants, especially when a high
frequency hearing loss is present (Anderson and Matkin [22]).
to engage in conversational speech only at close distance (Stach,
2010). Hard and soft consonant sounds become inaudible
background noise. They understand conversational speech at
a distance of 3-5 feet, if sentence structure and vocabulary are
[22]).
The extent to which the hearing problems cause a
communication disorder depends on a number of auditory
factors, including: degree of sensitivity loss, audiometric
individual patient factors like age of onset of loss, whether the
loss was sudden or gradual, and communication demands on the
patient, that are interrelated to these auditory factors (Stach,
2010).
It has been suggested that a lack of auditory input from
an untreated hearing loss could negatively affect the neural
networks involved in certain cognitive abilities (Sekuler and
Blake (1987); Belin et al. [23]; Wong et al. (2010)). It has
also been suggested that even mild hearing loss could lead
to a decline in cognitive performance because the cognitive
resources normally used for higher-level comprehension, like
storing auditory information into memory, must be used by the
individual to accurately decode and perceive the speech signal
abilities including, concentration, memory and planning skills o f
began the study with hearing loss (severe enough to interfere
normal hearing to see their cognitive abilities diminish. The
researchers suggest that, hearing loss seemed to speed up age
related cognitive decline. The people with mild, moderate and
times more likely to develop dementia (Lin et al. [15]). A few
studies have suggested that WM could be a predictor of overall
[25], Lunner and Sundewall-Thoren [26]). Ronnberg, Rudner,
Lunner, and Zekveld [27] suggests that, the persons with higher
WM scores perform better with faster signal processing speeds
than persons with lower WM scores. However, another study by
Cox and Xu (2010) reported that WM might be a more important
factor for persons with lower WM than persons with high WM.
Amblyaudia is a new diagnostic category within Auditory
deprived it causes the other ear to compensate and leads to
weaknesses in the listener’s binaural processing of auditory
who experience temporary hearing loss, most commonly
from ear infections, are at an increased risk of developing
Characteristics of amblyaudia include speech comprehension
skills, and inattention studies point to asymmetrical auditory
004
Global Journal of Otolaryngology
How to cite this article: Rinu Annie Roy. Auditory Working Memory: A Comparison Study in Adults with Normal Hearing and Mild to Moderate Hearing Loss. Glob
J Oto 2018; 13(3): 555862. DOI: 10.19080/GJO.2018.13.555862
input as the cause (Musiek and Weihing, 2011). Asymmetrical
auditory input during periods of auditory development in
children, leads to disruption in normal auditory development
and results in neural impairment, which affects acoustic
processing. Hearing loss is the primary disruption that leads to
asymmetrical auditory input. The hearing loss associated with
Lamminen and Houlihan, [29]).
deprivation effect may occur in adults when one ear regularly
receives auditory input but the other ear is deprived of adequate
auditory stimulation for a period of time. It is observed as a
reduction in the speech recognition ability of the under stimulated
ear. The auditory deprivation effect occurs in the unaided ear
of patients with a bilateral sensorineural hearing loss who use
unaided ear effect has been repeatedly corroborated (Gelfand et
Emmer, 1990; Silverman, 1989; Silverman and Silman 1990;
Auditory deprivation effects also occur for the poorer ears of
patients with asymmetric sensorineural hearing loss (Silverman
and Emmer, 1993), and an analogous phenomenon effect has
been reported in patients with Meniere’s disease (Hood [30]).
The auditory deprivation effect is not limited to adults. Gelfand
and Silman (1993) states that children with bilateral moderate
sensorineural hearing loss developed an auditory deprivation
were reported by Hattori (1993) for children with severe
bilateral losses. The precipitating factors for the unaided ear
leading to the conclusion that the amount of hearing loss plays
a major role in the onset of the unaided ear effect through
protracted auditory deprivation (Hurley, [31]). According to Lin
et al. (2013), adults with untreated hearing loss tend to develop
sooner than those with normal hearing. Those with a hearing
thinking abilities when compared to their counterparts without
hearing loss (Lin, et al. 2013).
Literature shows the affected WM associated with several
speech, language and communication disorders in adults. Few
characterized by a variety of persistent behavioral symptoms
including inattention, hyperactivity, and impulsivity (American
(2008) proposed that the hyperactivity and behavioral
with visuospatial working memory (Westerberg, Hirvikoski,
Oosterlaan, Sergeant, and Buitelaar’s (2005) meta-analytic
as inhibition and set shifting, as well as in non-executive
functioning areas such as fast word reading and color naming
areas such as verbal and visual memory, and divided attention
Schoelin and Engel, 2005). Schweitzer, Hanford and Medoff
(2006), assessed differences in WM functioning between normal
type), using sub-tests from the Wechsler Adult Intelligence
the normal group on WM tests requiring rapid processing and
groups and the normal group varied depending on the measure
and the gender of the participants. Gender differences in
performance were evident on some measures of WM, regardless
of group, with males performing better than females.
processing of information in the auditory modality. Moore
that cannot be explained by tests of peripheral auditory
function. American speech and hearing association (2005)
reports that auditory processing disorders may lead to or be
and communication functions. Although auditory processing
language impairment, and learning disability), it is not the
of performance on a battery of auditory tests, which may
include electrophysiologic as well as behavioral procedures,
administered under acoustically controlled conditions (Jirsa
consistently lower scores than typically developing subjects in
lateralization and WM capacity measures (Moossavi, Mehrkian,
How to cite this article: Rinu Annie Roy. Auditory Working Memory: A Comparison Study in Adults with Normal Hearing and Mild to Moderate Hearing Loss. Glob
J Oto 2018; 13(3): 555862. DOI: 10.19080/GJO.2018.13.555862
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Global Journal of Otolaryngology
Kennett and Levisee (2015), observed various changes in
speed of information (sensory and mental) processing with
advancing age (Salthouse, 1996). This reduction in the speed of
information processing along with reduction in cognitive skills is
Fuller 2003). Speech understanding especially in adverse or
challenging environments has been related to listener’s WM
capacity (Akeroyd [18]; Holt and Lotto, 2008; Tun, Benichov
with bilateral symmetrical ranged from mild to moderate
sensorineural hearing loss in the high frequency due to aging
and those with hearing loss. According to the correlation test
both genders and all of the studied subjects. They suggested that,
effect on auditory verbal memory.
disorder, as a single diagnosis to describe all of these conditions
is dyslexia, which affects a complex range of abilities related to
which affects writing abilities, dyscalculia, which affects the
application of mathematical operations, and visual-spatial
organization problems (Berninger and May, 2011). Nonverbal
demonstrate adequate verbal expression, vocabulary or reading
such as problem-solving, visual-spatial tasks and reading body
language or recognizing social cues (Handler and Fierson, 2011).
and Siegel, 2001; Torgesen, 1985). In adult readers with
It has been suggested that impaired AWM skills may be one
and WM in 75 children and adults with learning disabilities
and 86 normally achieving children and adults shows that, for
both ability groups, the factor analysis indicated that STM and
WM loaded on different factors, and the regressions and partial
correlations showed that these different factors accounted for
separate variance in reading comprehension and mathematics.
Both STM and WM are important in understanding reading
comprehension and mathematics performance in children and
adults with learning disabilities; however, WM is more important
for children and adults without learning disabilities.
A research needs to be connected with work already done
to attain an overall relevance and purpose. The studies related
to AWM have stimulated enormous research activity in recent
years throughout the world. The following paragraphs contain a
summary of literature related to AWM in various combinations.
Millman and Mattys [32], conducted a study to assess the
relationship between speech perception in modulated maskers
and components of auditory verbal working memory (AVWM)
over a range of signal to noise rations. They measured speech
in noise and AVWM in 30 listeners (age range 31-67years) with
normal hearing. AVWM was estimated using forward digit recall,
backward digit recall, and non-word repetition. Their results
show that speech perception in modulated maskers was related
to individual differences in the phonological component of
WM (as assessed by non-word repetition) but only in the least
favorable signal to noise ration. The executive component of WM
(as assessed by backward digit) was not predictive of speech
perception in any condition. They concluded that, the listeners
with greater phonological WMC are better able to correctly
identify sentences in modulated noise backgrounds.
measures of auditory short-term memory (ASTM) to provide
a clinical measure of intrusion in tinnitus. They studied the
response function for 6 normal listeners on a delayed pitch
discrimination task were contrasted in three conditions
designed to manipulate attention in the presence and absence
of simulated tinnitus: (1) no tinnitus, (2) ignore tinnitus, and
(3) attend tinnitus. The result of their study highlight that the
delayed pitch discrimination functions were more variable in
the presence of simulated tinnitus when listeners were asked to
divide attention between the primary task and the amplitude of
the tinnitus tone. This study indicates that the changes in the
variability of ASTM may provide a novel means of quantifying
the level of intrusion associated with the tinnitus percept during
listening.
A comparison study of auditory and visual working memory
functioning. The sample included 268 post-secondary students,
006
Global Journal of Otolaryngology
How to cite this article: Rinu Annie Roy. Auditory Working Memory: A Comparison Study in Adults with Normal Hearing and Mild to Moderate Hearing Loss. Glob
J Oto 2018; 13(3): 555862. DOI: 10.19080/GJO.2018.13.555862
diagnoses, and 60 individuals without either of these disorders
comprise a clinical group. The study found that, there was no
difference between auditory and visual WM functioning in
the individuals with a learning disability demonstrated weaker
groups.
Miller et al. [35] investigated the relationship between WM
and speech recognition in noise with different noise types as
well as in the presence of visual cues among adults with hearing
loss. They did the study on 76 adults with bilateral, mild to
moderately severe sensorineural hearing loss (mean age: 69
years). They used a cross sectional design and took 2 measures
of WM: a reading span measure, and Word Auditory Recognition
Speech recognition was measured with the Multi-Model Lexical
Sentence Test for Adults (Krik et al., 2012) in steady state noise
the testing in the unaided conditions. The results showed that,
predictors of the Multi-Model Lexical Sentence Test outcomes.
Fullgrabe and Rosen [36], studied the importance of
WM in speech in noise processing for listeners with normal
hearing thresholds. To assess, they surveyed published and
unpublished studies in which the Reading Span test was
administered in conjunction with a measure of speech in noise
audiological and hearing research. Their study revealed that, for
young listeners with audiometrically normal hearing, individual
variation in WMC are estimated to account for, on average, less
listener.
Need of the study
For cognitive healthy adults with hearing loss, audiologists
are less concerned with their listening processing as they already
have intact language and cognitive skills. Thus, audiologists
generally provide adequate and appropriate hearing technologies
to make sound more accessible for these individuals. Several
studies suggests that WM plays a key role in understanding
2000; Akeroyd, 2008) and also to predict performance on tasks
about AWM skills in adults and the range of difference in AWM
skills in normal hearing and hearing impaired individuals. The
current study will be a comparison of the AWM in adults with
normal hearing and mild to moderate hearing loss. This study
examines the auditory working memory capacity (AWMC) of
normal hearing adults and adults with mild to moderate hearing
like, type of hearing loss (conductive, mixed and sensorineural),
laterality of hearing loss (unilateral and bilateral) and duration
of hearing loss on the AWMC in adults.
Materials and Methods
Research Objectives
The current study is aimed at exploring the auditory working
memory capacity (AWMC) in normal hearing adults and adults
with mild to moderate hearing loss. In particular, the following
areas of interests were examined:
i. Understand the difference in AWMC in normal hearing
adults and adults with mild to moderate hearing loss.
ii. Understand the differences and similarities in AWMC
with respect to mild to moderate conductive or mixed
hearing loss and mild to moderate sensorineural hearing
loss in adults.
iii. Understand the differences and similarities in AWMC
with respect to unilateral and bilateral mild to moderate
hearing loss in adults.
iv. Understand differences and similarities in AWMC with
respect to duration of the hearing loss in adults.
Subjects
Forty participants between age group of 25-60 years
9 males) were having hearing sensitivity within normal limits
(control group), and other 20 (7 females and 13 males) were
having mild to moderate hearing loss (experimental group). In
the experimental group, 11 individuals were diagnosed with
conductive and mixed hearing loss and 9 with sensorineural
hearing loss. Bilateral hearing loss were observed in 8 and
grouped in to three, (1) duration of hearing loss less than 1 year,
that was noted in 9 individuals, (2) duration of hearing loss 1
to 5 years were reported in 7 individuals and (3) duration of
Inclusion criteria
1. 20 participants were adults with normal hearing with
tympanogram.
2. 20 participants were adults with mild to moderate
hearing loss, with fair to good speech discrimination scores.
language.
How to cite this article: Rinu Annie Roy. Auditory Working Memory: A Comparison Study in Adults with Normal Hearing and Mild to Moderate Hearing Loss. Glob
J Oto 2018; 13(3): 555862. DOI: 10.19080/GJO.2018.13.555862
007
Global Journal of Otolaryngology
25- 60 years.
Exclusion criteria
1. Adults with current complaint of tinnitus, vertigo and
otalgia were excluded.
2. Adults with any neurogenic or psychogenic disorder
were excluded.
3. Adults with poor speech discrimination scores.
profound hearing loss.
5. Adults with a sudden onset of hearing loss.
Procedure
All the tests were done in a double walled acoustically
treated room with a single walled control room. All the
participants were seated comfortably and instructed well before
the administration of each tests. An Equinox 2.0 Interacoustics
clinical diagnostic audiometer and a Titan Interacoustics
clinical diagnostic tympanometer, calibrated to meet current
1. Tympanometry
3. Speech Audiometry
Case history: An important starting point of any audiological
evaluation is case history. It provides necessary information
about the nature of auditory complaints, including whether it is
one ear or both, whether it is acute or chronic, and the duration of
the problem (Stach, 1998). All the participants were undergoing
a brief case history prior to the audiological evaluations, which
was focused to gather information about duration of hearing
problem, family history, history of noise exposure, history of
ototoxicity, presence of tinnitus, nature of hearing loss, ears
of dizziness and any other medical history.
Tympanometry: Tympanometry is a test of middle ear
functioning. It records the compliance of the tympanic
membrane to changing air pressures, indicating how effectively
sound is transmitted into the middle ear. Tympanometry
of the eardrum, or any other kind of middle ear abnormalities.
The result is graphically represented, called tympanograms.
A typical tympanometry result indicates the ear canal volume
(ml). Impedance testing is crucial in distinguishing a conductive
loss from a sensorineural hearing loss.
All the participants were seated comfortably and instructed
to remain as still as possible (avoid any unnecessary movement
and avoid speaking or swallowing after the probe has been
inserted) during the test. Tympanograms were obtained using
a 226-Hz probe tone.
All the subjects in the control group got A- type tympanogram,
which suggests normal middle ear function. The participants in
the experimental group showed different types of tympanograms.
Nine of them got A- type tympanogram, suggestive of normal
middle ear function, which was accompanied with sensorineural
hearing loss in the pure tone audiogram. C, Cs and B type
tympanogram that suggests some kind of middle ear dysfunction
were obtained for 11 participants. C and Cs-type was noted in
3 and 2 participants respectively and B- type was obtained for
6 participants, those were accompanied with conductive and
mixed hearing loss in the pure tone audiogram.
Pure Tone Audiometry:
measurement of an individual’s hearing sensitivity for calibrated
pure tones. It determines the faintest tones an individual can
manual air-conduction (AC) measurements at 250, 500, 1000,
at 3000 Hz as needed. Also, when required appropriate masking
is used.
The diagnostic audiometer used for the study was Equinox
ANSI S3.6-2010. The AC thresholds were estimated by using a
bone vibrator (B-72).
Appropriate verbal instructions were given to all the
participants prior to the AC, BC and masking measurements. The
participants were instructed to indicate the faintest tone that
heard by pressing and releasing the signal switch.
Westlake down-up procedure. When a difference of 20 dB
or more exists between the threshold values at any two
adjacent octave frequencies from 500 to 2000 Hz, interoctave
measurements were made. After the threshold estimation in all
the frequencies, a pure-tone average was calculated in each ear
by taking the average of hearing thresholds at 500, 1000, and
2000, which was considered to determine the degree of hearing
loss. The air-bone gap was also noted to determine the type of
hearing loss.
Speech Audiometry: Speech audiometry refers to procedures
that use speech stimuli to assess auditory function (Konkle
and Rintelmann, 1983). The participants in this study
underwent 3 speech audiometry tasks, speech recognition
comfortable loudness level (MCL). The speech stimuli were
008
Global Journal of Otolaryngology
How to cite this article: Rinu Annie Roy. Auditory Working Memory: A Comparison Study in Adults with Normal Hearing and Mild to Moderate Hearing Loss. Glob
J Oto 2018; 13(3): 555862. DOI: 10.19080/GJO.2018.13.555862
with calibrated (ANSI S3.6-2010) Equinox 2.0 Interacoustics
diagnostic audiometer. All the speech stimuli were presented
live via VU meter monitor, with voice intensity was balanced at
0dB and without lip reading.
Speech recognition threshold is the minimum intensity
at which the speech stimuli can be understood. The threshold
are properly repeated. All the participants were instructed to
repeat the words as they heard. The stimuli used were Spondee
descending method (Tillman, 1973) was used in this study to
obtain the SRT.
Speech discrimination scores is a procedure of establishing
the percentage of correctly perceived phonetically balanced
monosyllabic words or consonant vowel combination presented
speech discrimination ability of an individual. Carhart (1965)
recommended the use of monosyllabic words for discrimination
test since they are meaningful to the patient and are non-
well to repeat the words as they heard. The stimuli used in the
study was NU 6-word list (from Gelfand, 2001), which were
and represented in percentage. All the participants scored above
skills.
Most comfortable loudness level is the hearing level at
which, an individual experiences speech stimulus to be most
prefers to listen to speech material. The speech stimuli used
here was live cold running speech. The rainbow passage. The
participants were instructed to rate the level at which listening
is found to be most comfortable. Several trials were completed
numerical digits and are tasked to recall the sequence correctly,
with increasingly longer sequences being tested in each trial.
The participant’s auditory memory span is the longest number of
tasks can be given forwards or backwards, once the sequence is
presented, the participant is asked to either recall the sequence
tasks are the most commonly used test for AWM span, partially
because performance on a digit-span task cannot be affected by
factors such as semantics, frequency of appearance in daily life,
complexity, etc (Jones, Gary; Macken, Bill, [38]).
Verbal / auditory working memory is also thought to be one
of the elements underlying intelligence thus, the digit span task
is a common component of many IQ tests, including the widely
used Wechsler Adult Intelligence Scale (WAIS) (Schroeder, et.al,
2011; Heinly et.al, 2005). In the present study the digit span task
was taken from WAIS-IV. The tasks given for the participants
from 2 digits to 9 digits. There are 8 items with each item consist
of two trials. The examiner needs to administer both the trials
even if the listener passes trail 1. The digit strings will increase
in length with each trial.
In the present study the digits were presented through a
S3.6-2010) Equinox 2.0 Interacoustics diagnostic audiometer.
The mode of presentation was live via VU meter monitor,
with voice intensity was balanced at 0dB.In case of unilateral
hearing loss the stimuli were presented in the affected ear and
stimuli were presented binaurally for bilateral hearing loss. The
presentation level was at the level of participant’s MCL. Each
trial verbatim was read at the rate of one digit per second, in an
even monotone without any variation in the pitch of voice. The
task was discontinued after obtained scores of 0 on both trials
of an item.
All the participants were seated comfortably in an
acoustically treated room and instructed to listen carefully and
that won’t be scored. The scoring will start from item 1 and like
The study followed the same procedures that mentioned above
were instructed to listen carefully and repeat the heard numbers
backwards, or in the reverse order.
Scoring of digit span tasks:
correct response was scored as 1 point and incorrect response or
no response as 0 point. The item score is the sum of the scores on
score will be 8 points.
Method of statistical analysis
The data emerging from study was coded for computer
analysis. Quantitative analysis was carried out using the
used to analyze the data obtained at baseline and on the clinical
and socio-demographic variables, including frequencies, mean
How to cite this article: Rinu Annie Roy. Auditory Working Memory: A Comparison Study in Adults with Normal Hearing and Mild to Moderate Hearing Loss. Glob
J Oto 2018; 13(3): 555862. DOI: 10.19080/GJO.2018.13.555862
009
Global Journal of Otolaryngology
analyzed using independent sample t-test, since it compares the
mean differences between two independent groups on a given
variable. One-way analysis of variance (ANOVA), which compares
the mean of three or more groups based on a independent
the experimental group. The difference between the groups on
categorical variable gender was analyzed using Chi-Square test,
since it determines the association between two categorical
variables, and the quantitative variable age was analyzed using
as 0.05.
Results
The study was done to understand the nature of AWM in
adults with normal hearing and adults with mild to moderate
the participants. The data were analyzed across the two groups
(adults with normal hearing and adults with mild to moderate
hearing loss) and also across three categories in the hearing
loss group (type of hearing loss, laterality of hearing loss, and
duration of hearing loss).
The socio-demographic data such as age and gender of the
experimental group and control group were analyzed using
t-test and Chi-square test. The results are shown below in Table
1. The table indicates the mean value and standard deviation of
Table 1: Socio-demographic data of experimental and control group (Age using t-test, gender using Chi-Square test).
Variable Experimental Group
(N= 20)
Control Group
(N= 20) ‘t’ value Significance (2 tailed)
Age
Mean ±*SD Mean ±SD
10.77 10.15 0.33
*N NChi Square Value
Gender Male 13
7
9
11
1.62
Female
Table 2: Description of clinical variables in experimental group.
Variable Experimenta Group (N= 20) *N
Laterality of Unilateral 12
hearing Loss Bilateral 8
Duration of
hearing loss
Less than one year 9
7
More than 5 years
Type of hearing
loss
Conductive 7
Mixed
Sensorineural 9
*N- Frequency
Table 3: Comparison of the Experimental group and the Control Group on the DSF, LDSF, DSB, and LDSB. (t-test).
Variable Experimental group (N= 20) Control group (N= 20) t value Significance
(Two tailed)
Mean ± *SD Mean ± SD
DSF 6.75 1.16 9.15 -5.83 p <0.001
LDSF 0.67 6.75 0.91 -7.51 p <0.001
DSB 6.30 1.08 8.35 0.81 -6.78 p <0.001
LDSB 3.65 0.93 5.05 0.39 -6.18 p <0.001
*SD – Standard Deviation
0010
Global Journal of Otolaryngology
How to cite this article: Rinu Annie Roy. Auditory Working Memory: A Comparison Study in Adults with Normal Hearing and Mild to Moderate Hearing Loss. Glob
J Oto 2018; 13(3): 555862. DOI: 10.19080/GJO.2018.13.555862
Table 4: Comparison of the study variables DSF, LDSF, DSB, and LDSB with respect to type of hearing loss. (One-way ANOVA).
Variable
Conductive (N= 7) Mixed (N= 4) Sensorineural (N= 9)
f value Significance
Mean ± *SD Mean ± SD Mean ± SD
DSF 6.70 1.11 6.25 1.50 7.00 1.11 11.32 p <0.001
LDSF 0.75 0.95 5.00 0.50 18.29 p <0.001
DSB 6.00 0.57 5.50 0.57 6.88 1.26 20.39 p <0.001
LDSB 0.78 3.00 0.00 1.05 18.17 p <0.001
Table 5: Comparison of the study variables DSF, LDSF, DSB, and LDSB with respect to laterality of hearing loss (t-test).
Variable Unilateral hearing loss (N= 12) Bilateral hearing
Loss (N= 8) t value Significance
(Two tailed)
Mean ± *SD Mean ± SD
DSF 6.83 1.19 6.63 1.19 0.38 0.71
LDSF 0.79 0.53 0.60
DSB 6.25 1.06 6.38 1.19 0.25 0.81
LDSB 3.58 1.19 3.75 0.38 0.71
*SD – Standard Deviation
Table 6: Comparison of the study variables DSF, LDSF, DSB, and LDSB with respect to duration of hearing loss (One-way ANOVA).
Variable Less than one year (N= 9) One to five years (N=7) More than 5 years (N=4) f value Significance
Mean ± *SD Mean ± SD Mean ± SD
DSF 7.10 1.05 6.70 1.30 6.00 0.8 1.79 0.20
LDSF 5.10 0.78 0.57 0.27
DSB 1.23 6.10 0.89 6.25 1.25 0.50 0.62
LDSB 3.60 1.00 3.70 0.90 3.50 1.00 0.52 0.61
*SD – Standard Deviation
The table also shows the frequency of male and female
gender across the two groups. In experimental group the
frequency of male and female was 13 and 7, and in the control
group it was 9, and 11, respectively. The chi-square value was
Table 2 shows the description of clinical variables in
experimental group, such as laterality of hearing loss (unilateral
and bilateral), duration of hearing loss (less than 1-year,
1- 5 years and more than 5 years) and type of hearing loss
(conductive, mixed and sensorineural), in terms of frequency.
According to the above table the frequency of unilateral and
bilateral hearing loss are 12, and 8 respectively. The frequency
of the duration of the hearing loss shows 9 in the less than
group. The frequency of the conductive mixed and sensorineural
The Table 3 shows the comparison of experimental and
above table depicts the mean and standard deviation values of the
scores obtained by the participants in experimental and control
shows the higher mean and standard deviation values compared
mixed and sensorineural hearing loss were done using one-way
value obtained across all the study variables were less than 0.05,
with respect to the type of hearing loss. The mean values show
that the sensor neural hearing loss scored higher compared to
conductive and mixed hearing loss, whereas the conductive and
mixed hearing loss scored almost same across all the tasks.
unilateral and bilateral hearing losses were obtained by using
independent sample t-test. The mean and standard deviation
values obtained by unilateral and bilateral hearing loss groups,
were obtained as 0.38, 0.53, 0.25 and 0.38 respectively. The two-
How to cite this article: Rinu Annie Roy. Auditory Working Memory: A Comparison Study in Adults with Normal Hearing and Mild to Moderate Hearing Loss. Glob
J Oto 2018; 13(3): 555862. DOI: 10.19080/GJO.2018.13.555862
0011
Global Journal of Otolaryngology
the duration of the hearing loss i.e., less than 1 year, 1-5 years,
and more than 5 years. The above Table 6 shows the mean and
Discussion
difference in AWMC in normal hearing adults and adults
with mild to moderate hearing loss. The results in the Table
among the adults with normal hearing and adults with mild
to moderate hearing loss. The mean values indicate that the
adults with normal hearing showed higher scores across all the
impairment when compared to their counterparts without
hearing loss. Several previous studies by Tun et al. (2009);
current study results indicating poor AWM (which is a cognitive
hearing loss by comparison with normal hearing adults.
The second objective of the study was to understand the
relationship of AWMC with type of hearing loss (conductive,
mixed and sensorineural hearing loss). The results show that
capacity in between the 3 groups, the conductive, mixed and
the conductive and mixed hearing loss group performed poorer
compared to sensorineural hearing loss group, which shows that,
conductive and mixed hearing loss in adults is also a prominent
hearing loss. Currently, there is no information regarding the
co relation between conductive/mixed hearing loss and AWMC
in adults. But several previous studies indicate the auditory
loss. Auditory temporal processing determines understanding
of speech, appreciation of music, being able to localize a sound
source, and to listen to a person in a noisy crowd (Eggermont,
cortex synapses and spikes, and this may contribute to auditory
hearing loss. Bayat et.al (2017) also reported reduced auditory
temporal processing ability in adults with conductive hearing
loss compared to normal hearing subjects.
The third and fourth objective of the study was to compare
the AWMC of adults in terms of laterality and duration of the
difference in the AWMC with respect to unilateral and bilateral
hearing loss (Table 5). The AWMC comparison with respect to
duration of hearing loss that shows in Table 6 also indicates no
current study the laterality of hearing loss and the duration of
There are limitations of the current study that warrant
further research. First, the relatively small sample size in the
experimental group limited the power of the current analysis
to detect relationships among variables like laterality of
hearing loss and duration of hearing loss, while its likely that
Secondly this study couldn’t do the alternative cognitive
AWMC, such as cognition, mental status, academic background,
etc. Also, the stimulus used in study to measure the AWMC was
digit span tasks, which consist of only numbers. Finally, even
though the age range in the current study covers young adults
to older adults, the study couldn’t group participants according
support a growing body of literature indicating that the
AWMC, which is an important cognitive function that is crucial
moderate hearing loss when compared to normal hearing adults.
The study gains the attention towards the co relation of AWMC
and the type of hearing loss, which concludes that conductive
and mixed hearing loss can also lead to poor AWMC in adults
with mild to moderate hearing loss [76-85] Appendix.
Conclusion
Hearing impairment is a prevalent and a universal health
concern that have a great impact on a person’s quality of life,
both physically and emotionally. Several studies suggest that WM
is important in individuals with hearing loss relative to speech
understanding (Craik (2007; Foo et al., 2007; Rudner et al, 2011;
Besser et al., 2013). The present study results indicate the AWMC
of individuals with mild to moderate hearing loss is poor when
compared to individuals with normal hearing. It may contribute
0012
Global Journal of Otolaryngology
How to cite this article: Rinu Annie Roy. Auditory Working Memory: A Comparison Study in Adults with Normal Hearing and Mild to Moderate Hearing Loss. Glob
J Oto 2018; 13(3): 555862. DOI: 10.19080/GJO.2018.13.555862
in processing complex or lengthy discourse than their normal
hearing peers (Foo et al., 2007; Rudner et al, 2011; Besser et al.,
2013). The poorer AWMC in conductive and mixed hearing loss
group when compared to sensorineural hearing loss group, also
gains the attention that the individuals with conductive/ mixed
Ferfuson and Henshaw (2015), proposes that an integrated
of training for people with hearing loss in terms to improve the
speech understanding in adverse conditions. Few studies have
suggested that WM could be a predictor of overall success with
and Sundewall-Thoren, 2007).
that the Audiologists may seek ways to assess AWM in the clinical
setting. Future studies should use more consistent materials and
methodological approaches to illuminate a better understanding
regarding the possible associations between AWM and hearing
loss in more ecologically relevant conditions.
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DOI:
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