Cochlear Implant Rehabilitation for Adults
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Listening Effort and Fatigue: Part 1

Posted By Naama Tsach, PhD, Tuesday, October 23, 2018

Today we will talk about the fatigue associated with listening effort. Listening involves both auditory and cognitive processing. We hear with our ears but we listen with our brains and consequently people whose auditory input is of a lesser quality may expend more mental effort to listen. The fatigue may be described as a feeling of being tired, exhausted or having low energy or a low motivation to listen.

Fatigue associated with listening effort is reported by many people with hearing loss including those using cochlear implants. Statements such as these are not uncommon from people with hearing loss of all ages.

• I feel that my brain is working nonstop and it takes a lot of energy for me to listen.
• I am bursting with auditory stimuli that I cannot filter.
• My brain needs to process what I am hearing faster than it used to do before.

Such comments are more common with CI recipients who used hearing aids for many years (when they could have benefited more from cochlear implants) and also from those adults who had significant hearing loss at birth or early childhood and were implanted later in life.

People with hearing loss may refer to communication conditions as stress inducing situations since they require significant listening efforts and can potentially involve communication breakdowns and misunderstanding.

What kind of listening effort may be required of people who are deaf and hard of hearing? Why do CI users report fatigue associated with listening?

People with hearing loss may perform complicated auditory processing in order to understand speech because of imperfect auditory perception. They may work hard to: localize sound, identify who is speaking, distinguish speech from background sounds, and recognize speech sounds as well as cues for emphasis and intonation. They may rely upon visual information for speech reading to supplement what they are receiving auditory. In many real-life situations, accessibility to visual cues may be restricted due to imperfect lighting conditions, difficulty in localizing the speaker and other factors.

Consequently auditory and visual cues might not be sufficient and people with hearing loss may need to rely upon previous knowledge regarding a conversation. They may also draw upon their linguistic knowledge (e.g., Is this word likely to be a noun?) and on other kinds of supporting clues. If all of this isn’t difficult enough, they may need to process the spoken information rapidly—based upon the speaker's pace of speech or to stop the speaker to ensure they understood what was said. They also need to remember everything they heard already and use different cognitive and language skills to fill in the whole meaning.

People who have never experienced typical hearing, as well as older adults who had typical hearing in the past, may experience greater difficulties with recalling auditory input and this also contributes to their effort to communicate effectively. Since auditory memory skills are imperfect, the individual with hearing loss must put a great deal of effort into understanding speech—even when they can recognize single words

Consequently, fatigue can be an inevitable consequence of listening with hearing loss. What fatigue in adult CI recipients? How can we manage fatigue and improve quality of life for adults post CI? We’ll talk about it soon, on our next post.

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The mission of the American Cochlear Implant (ACI) Alliance is to advance access to the gift of hearing provided by cochlear implantation through research, advocacy and awareness.