Relationships Between Hearing Status, Cognitive Abilities, and Reliance on Visual and Contextual Cues

Micula, Andreea; Holmer, Emil; Ning, Ruijing; Danielsson, Henrik · 2025 · Crossref

DOI: 10.1097/aud.0000000000001596

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Summary

This study investigates how hearing status influences the reliance on visual and contextual cues for speech recognition and how cognitive abilities, specifically working memory and fluid intelligence, modulate this reliance. While it is established that visual and contextual cues facilitate speech understanding in suboptimal listening conditions, it remains unclear whether individuals with hearing loss rely on these cues to a greater extent than those with normal hearing, and which cognitive factors support this compensation. The research aimed to determine if hearing aid (HA) users depend more heavily on visual and contextual information than normal hearing (NH) individuals and to assess the role of working memory and fluid intelligence in this process. The study included 169 participants with NH and 169 HA users with bilateral, symmetrical mild-to-severe sensorineural hearing loss. Speech recognition was measured using the Samuelsson and Rönnberg task, which presented sentences in auditory and audiovisual modalities, with and without contextual cues (a visually presented priming word). The signal-to-noise ratio was individually adjusted to 1 dB below each participant’s 50% correct recognition threshold in the auditory modality. Cognitive abilities were assessed using the Reading Span test for working memory and the Raven test for fluid intelligence. Data were analyzed using linear mixed-effects modeling. Results indicated that both groups significantly benefited from the availability of visual and contextual cues. Although HA users performed significantly worse than NH participants in the auditory-only condition, both groups achieved similar performance levels in the audiovisual condition. This suggests that HA users relied on visual cues to compensate for perceptual deficits, effectively closing the performance gap with NH listeners. Regarding cognitive associations, a significant positive relationship was found between fluid intelligence (Raven test scores) and speech recognition performance, but only for HA users in the audiovisual modality. No significant relationship was observed between working memory capacity (Reading Span scores) and performance for either group. The findings imply that HA users utilize visual cues as a compensatory mechanism to overcome auditory degradation, reaching performance parity with NH individuals when such cues are available. Crucially, fluid intelligence appears to be a key factor in successfully capitalizing on these visual cues for HA users; those with higher fluid intelligence achieved better speech-in-noise recognition by more effectively integrating visual information. In contrast, working memory did not significantly predict cue utilization in this context. These results highlight the importance of fluid intelligence in supporting the compensatory strategies employed by hearing aid users in challenging listening environments.

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