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Year : 2021  |  Volume : 27  |  Issue : 1  |  Page : 30-35

Speech intelligibility enhancement in elderly with high-frequency hearing loss through visual speech perception

Department of Electronics and Communication, J. K. Institute of Applied Physics and Technology, University of Allahabad, Prayagraj, Uttar Pradesh, India

Date of Submission22-Sep-2019
Date of Decision22-Mar-2020
Date of Acceptance06-Apr-2020
Date of Web Publication26-Oct-2021

Correspondence Address:
Mr. Himanshu Chaurasiya
Department of Electronics and Communication, J. K. Institute of Applied Physics and Technology, University of Allahabad, Prayagraj 211 002, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/indianjotol.INDIANJOTOL_46_20

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Background: Pathological and physiological disabilities of human auditory receptors reduce speech intelligibility under hearing loss (HL) at high frequencies. Objectives: The objective of the study is to investigate the speech-intelligibility-enhancement (SIE) in elderly with high-frequency HL (HFHL) through visual-speech-perception (VSP). The hypothesis is that the VSP of spondee words (two-syllable words with equal stress on both syllables) is properly recognized and reproduced with HFHL. Also; to decide the statistical relevance of the precise significant difference in speech discrimination (SD) with VSP on the subjected ear. Methods: Observational and descriptive studies of SIE with VSP on 12 elderly listeners (24 clear ears; without wax impaction) with progressive and bilateral HFHL were examined. The entire experimental records were checked for distribution with normal (Gaussian) using the Shapiro–Wilk's and paired Student's t-test (parametric test) had the 5% (0.05) significance level (α). Results: We analyzed, improved, and better performance in SIE with HFHL through VSP. The statistical P (probability) measure was calculated nothing, i.e., 0 (P < 0.05). Therefore, investigators strongly and carefully discarded the null hypothesis consideration. There was some significant value of statistical variation also exists with VSP. Moreover, with the help of the confidence-interval analysis, the same conclusion was achieved. Conclusions: In this study, it is concluded that the elderly-individuals of this experiment, whose mother tongue and official language is Hindi and English, respectively, they demonstrate the SIE with HFHL through VSP. This investigation also helps to improve the hearing sensitivity to some extent with VSP.

Keywords: High-frequency hearing loss, speech discrimination, speech-intelligibility-enhancement

How to cite this article:
Chaurasiya H. Speech intelligibility enhancement in elderly with high-frequency hearing loss through visual speech perception. Indian J Otol 2021;27:30-5

How to cite this URL:
Chaurasiya H. Speech intelligibility enhancement in elderly with high-frequency hearing loss through visual speech perception. Indian J Otol [serial online] 2021 [cited 2023 Feb 5];27:30-5. Available from: https://www.indianjotol.org/text.asp?2021/27/1/30/329098

  Introduction Top

The hearing sensitivity with high-frequency hearing loss (HFHL) survives with speech intelligibility enhancement (SIE). According to the World Health Organization, 466 million individual (over 5% of the world's population) suffer with hearing impairment.[1] The HFHL is one of them, who start affecting roughly, >25% of individual with 50 years or older, this type of disease manifests itself. With this HFHL, in order to enhance the speech intelligibility in elderly, the perception technique is used which is called as visual speech perception (VSP).[2] In this SIE, equal stress two-syllable spondee words are recognized with the increased complexity between the localization of speech sound and its associated discrimination.[3] The health conditions across the lifespan of young individuals with hearing impairment have also recently drawn attention.[4]

The visual/audio (V/A) speech perception, thus the V/A phenomenon of the lip/speech-reading is synchronized with a visible information and articulation from a speaking face. The existing literature proposes that each and every level of the unit configuration of psycholinguistic speech (e.g., words, syllables, and phonemes) is visible.[5] The speech articulators (e.g., speaker's lip, speaker's jaw, speaker's tong, and speaker's face) have a very important role in VSP. The utterance of speech unit as VSP in HFHL is a very careful observation.

However, if the VSP is different to the speech unit sounds, observation of the audio speech unit may be affected. For example, the demonstration of the/lu-do/sound (audio) with visual/ju-do/(speaker's face uttering the/ju-do/sound), resulting in different visual stimuli, often results in perception of the demonstrated/lu/sound instead of/ju/sound. This effect of altered VSP is well known as the McGurk effect.[6]

The loss of hearing acuteness or HFHL etiology is multi-factorial including age, slow-progressive, bilateral-symmetrical, and sensory-neural. Men are impacted more at high frequencies.[7] It is also known as age-related/sensorineural HL in elderly.[8] HFHL can be classified into six various types: Strial (metabolic), neural, cochlear conductive, sensory, intermediate, and mixed as shown in [Figure 1].
Figure 1: A classification of high-frequency hearing loss

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Strial (metabolic)

Strial, is the abnormality related to loss of blood supply of the inner ear cochlea (atrophy of the unique structure striavascularis) with a flat audiometric curve because of the intact inner ear cochlea is exaggerated.[9] This maintains the conservation of speech discrimination (SD), metabolic health of cochlea along with chemical and bio-electric balance.

Neural (biological)

Neural, is the abnormality related to loss of nerve fibers and neural elements (degeneration of the auditory neurons and sensory nerve spiral ganglia) by a long way of 2,100 primary auditory neurons is vanished every decade (of 35,000).[10] This type of HL begins before time in life, but not perceptible until senior/elder age because the operative pure tone average (hearing assessments) is not affected in anticipation of about 90% of auditory function neurons are disappeared. At this time, SD reveals severe decrease.

Cochlear/conductive (mechanical)

Cochlear is the abnormality related to loss of perceived intensity (energy perceived by the cochlea travels through a unit area viewed as perpendicular to the course of transmission of waves) through gradual thickening and minor amount of stiffening of the elastic basilar membrane. Here, SD is average.


Sensory is the abnormality related to loss of functional outer hair cells (acoustical preamplifier) in the organ of Corti (sensory receptor in the inner ear cochlea that originates enough bio-electric nerve impulses from neuron in response to the transduction of sound vibrations). It shows the abrupt downward sloping curve in the context of pure tone high-frequency (about 4 kHz; the right side of the audiogram), pointing to a particular inadequacy in the transduction process of high-frequency auditory sensation. This loss reveals SD (normal) often conserves.[11]


On the subject of 25% of all cases of HFHL illustrate none of the above characteristics and are classified as indeterminate.


The above types of combinations of losses refer to them to any individual cases which do not separate into a specific type is termed as the mixed.[12]

Studies show that the hearing (auditory system) phenomenon involves the conduction of waves of sound with integration and the complex interplay of several mechanisms.[13] Cochlear sensory receptors (hair cells) have systematically declined with age.[14],[15] Bone conduction does not play a significant role due to the impedance mismatch.[16] While the reported prevalence of hearing threshold among elders increases by approximately 1 dB per year with a bent to further loss with increasing age.[17],[18]

HFHL, also called presbycusis, who has a major impact associated with cognitive deficits, or/and possibly exacerbating anxiety-depressive condition.[19] According to the literature, the cause of reduced hearing sensitivity of speech sound in HFHL is still unpredictable. To some extent, possible outcomes of collective hazards[20],[21] are also responsible that are depicted in [Figure 2].
Figure 2: The collective hazards

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In the present study, the investigators hypothesize that the VSP of spondee words (two-syllable words with equal stress on both syllables) is properly recognized and reproduced with HFHL. In such a way that the response of the listeners articulated those spondee words served well with VSP. Further, HFHL listeners performed SIE on spoken word with VSP in such a way that the spondee words articulated by the listeners were better recognized. The objective of this article was projected to investigate how VSP enhances the phonetically balanced disyllabic phoneme speech intelligibility in HFHL and statistically decided the precise significant difference in SD between VSP and without VSP.

  Series, Materials and Methods Top

A study design and location

This was an observational and descriptive study with elderly listeners in ENT-related departments for 11 months (July 2016–May 2017). In HFHL, according to the literature, subjectively normal hearing with normal hearing sensitivity at the voice frequencies (250 Hz–2 KHz) and better describe the audio logical selection of the patients. Here, the conventional frequency audiometric technique was used.

Ethical approval for this study (research ethics committee health centre no.: 235/RES/16) was granted by the institutional ethics committee of University of Allahabad, Prayagraj, UP, India, on 08 March 2016.

Participant samples

The participant (with HFHL) group aged 60 years and above had been sent to the department of audiology for examination. With this, informed consents were provisionally signed with listeners who had granted permission to contribute in the hearing research. We utilized an appropriate sample of 12 listeners (24 clear ears; without wax impaction). Listeners having co-morbidities such as hypertension, ringing-tinnitus, systemic diseases such as diabetes mellitus and psychiatric disorders that could interfere with language were excluded.

Data sources and collection techniques

Before starting test, each listener was given short instruction of duration of 10–20 min. With many HFHL listeners, a PT (pure tone) audiometric test was repeated prior to data collection. This was done at this stage because of their better performance achievement. The experimental data were collected with the help of digital computer. The trials of vocal audiograms with and without VSP were performed by male announcer (same audiologist), and the course of action was carried out with the awareness of the listeners. The processed input was presented in a soundproof booth.

Research tools

The audio logical examinations were conducted in ISO 8253 and 389 certified soundproof test room with the help of a calibrated (ANSI S3.6-1996) Madsen orbiter 922 dual-channel electronics audiometer, noise excluding audio headset ME70, TDH 39 ear/headphone receiver enclosed in Mx-41/AR ear cushions, and bone vibrator/conductor B-71 at the hospital ENT. The scientific and statistic research tools used for this study are MATLAB 2017a and IBM SPSS 23.0, respectively.

Statistical techniques

The present research study precedes the checks for the diligence of the statistical tests normality (the data should be normally distributed) and covariance homogeneity (homoscedasticity). To evaluate the effect of VSP on SD (ability to understand speech), we planned to choose parametric or nonparametric tests. Parametric tests accept that records in different groups have the same standard deviation (homoscedastic attributes). The significance (statistical) certification of the outcomes using hypothetical analysis paired Student's t-test offers a P = 0.05 (5%) with 95% confidence interval.

Data analysis

As a metric for auditory, we measured the speech reception threshold (SRT) with and without VSP. All the listeners (who had listened continuously for <5 min per disyllabic words with high sensitivity headphone) underwent PT Audiometry vocal (speech) audiogram with SRT ≥40 dB. Type A or As tympanogram (Jerger classification) tracing, acoustic reflex, and oral communication ability were analyzed. Disyllabic speech spectrograms were compared also.

  Results Top

The age of the analyzed 12 (24 ears) elderly participants in this study oscillated from 58 to 81 years. Clinically without wax impaction, they belonged to a mean ± standard deviation of 69.0 ± 7.1 years, which comprised 75.0% males (M:F = 3:1). The main sociodemographic characteristics of the examined HFHL group are listed in [Table 1].
Table 1: The high frequency hearing loss subjected listener's sociodemographic profile

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The SRT values evaluated in dB HL were recorded for both with and without VSP. Here, obtained SRT values result us to two specimens of the same listeners: One with VSP and other without VSP. Statistically, it was associated with quantitative and paired data. Moreover, the recorded SRT values were further quantitatively analyzed.

The SRT intensity difference is tabulated on the average of 26.3 ± 4.66 (20–35). While collate the average of the consequences, it had been seen that the listeners showed better results with VSP. Improvement of the SRT and the data associated with VSP shows a positive correlation in between with an average drop of 26.3 dB.

As far as, the applicability condition is concerned, the goodness-of-fit or Kolmogorov–Smirnov test (with lilliefors significance correction) tries to determine whether the two of the datasets (sample size ≤50) differed significantly. Furthermore, the Shapiro–Wilk sample normality test was also performed. The main experimental SRT values (from the descriptive analysis of the examined group) and the above stated test results are listed in [Table 2].
Table 2: The descriptive analysis and sample normality test results

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In the Shapiro–Wilk normality test, the numerical quantity of statistically calculated P = 0.897 (≥0.05). Hence, consequently, the null hypothesis (H0) rejection was not possible at all. Thereby, we come to an end, that a normally-distributed-data were achieved through SRT-difference-data and the paired t-test. Here, the paired t-test was employed for verification purpose.

The HL in elderly-individuals with audiometer frequencies, SRT values with their difference, the identical decision of the variation in the sample-data-display (box plots) and mean HL dB with frequency in kHz for different age class were shown as part A, B, C, and D in [Figure 3] respectively.
Figure 3: The hearing loss in elderly-individuals and speech reception threshold values with their difference. (a) Result of hearing loss in dB with frequency in kHz. (b) Result of speech reception threshold values in dB with age class. (c) The variation in the sample data display (box plots). (d) Result of mean HL in dB with frequency in kHz for different age class

Click here to view

We bring forwarded H0 for the verifiable drive and make a check for the statistical t-test pairs. We take-in, the assumption that the value of μ0 equal to 0 (this means that, no difference was allowed between with and without VSP). As in result, the two-tailed significance verification (using a paired samples t-test) had been achieved. These verifications are shown in [Table 3]. In which, the SPSS simulated P value was found to be zero (<0.05). Hence, H0 was rejected and thereby the Ha (alternate hypothesis) was essentially accepted.
Table 3: Two-tailed significance verification (using a paired samples t-test)

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Thus, as a sequence of the acceptance, the result showed a significant difference (statistically) in SD between with and without VSP. The confidence interval estimate, computed from the observed data (with RH0 that is the exclusion of zero) also shows a parallel conclusion.

  Discussion Top

Listeners who have suffered from HFHL performed better SIE on spoken word with VSP. In such a way that the spondee words (two-syllable words with equal stress on both syllables) which were articulated by the listeners were better recognized by them. The SIE increased with VSP from the human voice utterances. This increment happens when it connected through an uninterrupted speech segment of the speech signal (di-syllabic word segment) stream and increase the SD of the distinctive sound unit (phonemes) of that. Individuals can control this type of situation in their day-to-day life. Specially, at that time, when they speak to those listeners who have already suffered from auditory impairments of HFHL or any other hearing disabilities.

The aged-hearing-sensitivity with HFHL survives with SIE. There are no such investigations found concerning the importance of social alertness of VSP effect on Indian individuals who have suffered from HFHL. Those who should tell directly that the SIE could possible in elderly with HFHL through VSP. In view of the fact, no such investigations also have been executed with Indians whose mother tongue is Hindi, and the official language is English.

This study investigates that the listeners who suffered from HFHL had skipped some phonemes within the words without VSP. As, an evidence, the worse performance of the reproduced speech (phoneme) intelligibility of the spoken words had to be seen. The importance of the study in the strengthening of the old age hearing sensitivity further allow go head to the eminent VSP.

Given the significance of the results obtained, the all aspects of this study were coined important. Here, the specimen volume limitation had existed. This happened only because of the number of rejections exist in the experiment. The enhancement in the statistical data (a likelihood function which is a significant parameter of the outcomes) was feasible with some extra earmark specimens. Here, with a positive correlation the increase in SRT level (an imminent loss of SD) had been achieved with VSP. The results of this research work may be in queue with other studies related to auditory range impairment. Nevertheless, is to say that proposed route of this research was related with geriatric HFHL.

Currently, >460 million individuals (over 4.9% of the world's population) are suffering from hearing impairment. Approximately 33% of the individuals over 65 years of age class are generally influenced by this HFHL (auditory loss). The pervasiveness of HFHL in this age cluster is most noteworthy in South Asia, Asia Pacific, and sub-Saharan Africa. Although here considering the causes of hearing with prevalence was used to it for quantifying the hearing hindrance. Moreover, a deviation in the proficiencies with threshold parameter was also indicated here.[22]

Although in the present article, we also indicated possible outcomes of collective hazards (extrinsic and intrinsic). Such hazards are risky. Noise, ototoxic, and diet are extrinsic hazards that are responsible for the reduced hearing sensitivity. While, on the other hand, the intrinsic hazards include aging, genetics, health comorbidities, hereditary, hormonal, immunologic disorders, metabolic syndrome, stress, and vascular.

In this study, the comorbidities can be a great hazard also linked to the functional incapacity to their health which independently, reduces longevity.[23] The individual's education stage also seems to be important with a positive impact on HFHL listener's life. The investigation found the HL was present in both the gender.[24]

Nevertheless, in the literature, there is no such experiment with especially Indian language listeners that, indicate the SIE (with increasing hearing sensitivity) with HFHL through VSP.

Auditory impairment at higher frequencies can greatly affect the speech (phoneme) intelligibility. The SIE in elderly with HFHL through VSP had been achieved. Here, the uses of phonetically balanced disyllabic words were used as spondee words. These words were properly recognized and reproduced with HFHL through VSP. This finding can be elucidated by the routine practice of VSP on listeners having HFHL in order to enhance speech intelligibility.

  Conclusions Top

In this study, it is concluded that, the elderly-individuals of this experiment, whose mother tongue and official language is Hindi and English respectively, they demonstrate the SIE with HFHL through VSP. This investigation also helps to improve the hearing sensitivity to some extent with VSP.

More evidence-based studies are needed in the direction of SIE with HFHL through VSP to the sensitivity of auditory disability of the elderly-individuals.

Hence, also it would be significant to branch out the SIE (word recognition) with HFHL in this direction.

In general, the VSP significance is remarkable for geriatric care. The elderly-auditory-rehabilitation could also be improved to some extent without the smart electronic assistive listening device or hearing aid.

Future aspects

VSP with phoneme recognition will definitely enhance the speech intelligibility in old age individuals. Furthermore, the most geriatric health care is devoted to those over 65 years of age, one who known with regard to their special health care with hearing aids. The above research findings could greatly help to prevent to some extent the extensive use of hearing aids or other assistive listening devices in the future.


We would like to express our sincere and deepest gratitude to Dr. Rajesh Srivastava for motivating the work in audiology included in this study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Figure 1], [Figure 2], [Figure 3]

  [Table 1], [Table 2], [Table 3]


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