The Effects of Hearing Aids and Cognitive Training on Dual-Task Listening-while-Balancing Performance in Normal-hearing Adults and Older Adult Hearing Aid Users
Year: 2025
Type: dissertation
Study design: Clinical Trial
Abstract: Age-related hearing loss increases the risk of mobility problems and falls, potentially due to reduced access to spatial auditory cues and/or greater listening effort that taxes the cognitive resources that are shared with maintaining balance. However, it remains unclear whether interventions that enhance spatial hearing or reduce cognitive load, such as hearing aids or cognitive training, can also improve balance, especially under complex, realistic conditions. This thesis explored whether (a) hearing aids improve balance by enhancing spatial sound access and/or reducing cognitive load, and (b) cognitive training improves cognitive processing to support balance during simultaneously performed listening and postural tasks. Chapter 2 investigated whether hearing aids improve balance under ecologically valid, dual-task conditions (listening-while-balancing) using a virtual reality (VR) environment in older adults with and without hearing loss (aids on/off). Results showed, that at lower task demands (i.e., low listening load, eyes open, standing on firm surface) older adults with hearing loss demonstrated higher dual-task costs compared to those with normal hearing. However, despite improving listening accuracy, hearing aids did not remarkably improve postural stability. Chapter 3 explored whether cognitive training could improve cognitive processing in middle-aged and older adults with normal hearing and older adults with hearing loss (aided), thereby improving dual-task (auditory-cognitive + balancing) performance in a realistic VR environment. A randomized controlled trial was conducted using an established 12-week, at-home executive function (EF) training program. In terms of auditory-cognitive task performance, older adults with the poorest hearing and cognition benefited the most from EF training, suggesting that those who had the most to gain experienced the greatest improvement. For balance outcomes, performance improved after EF training, but only for older adults with better hearing. This suggests that once hearing loss is too severe, any training-related improvements in cognitive processing may not be sufficient to better manage balance-related outcomes. The findings from this thesis suggest that while hearing and cognitive interventions may support mobility and cognition in older adults, their effectiveness is likely influenced by a combination of factors such as task difficulty and severity of hearing loss, highlighting the importance of early intervention across the adult lifespan.
Source: TSpace (University of Toronto)
Author: Mohanathas, Niroshica
Institution: University of Toronto
Language: English
Field: Health Professions
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7139330399