Improving Interpretation of Hearing- Related Patient Reported Outcomes for Bilingual Adults

PROJECT SUMMARY/ABSTRACT
In the Audiology clinic, decision making is guided by evidence-based research supporting best practices, with
integration of multiple data sources including both objective test results and subjective patient reports in order
to inform recommendations and interventions. There is no one-size-fits-all approach to clinical care, rather
each patient must be holistically considered as an individual. This is particularly relevant for patients who are
members of minoritized populations, such as bilingual language users, who account for 21% of the population
of United States residents aged 5+.
There is evidence that bilingual speakers, even those who are highly proficient in both of their languages, show
performance deficits on speech-based measures, particularly when tested in the presence of background
noise. However, language history is not routinely queried by many clinicians, and standardized objective
patient reported outcome measurement tools aren’t written to take language history and usage into
consideration. This is especially important for the aging population, where both peripheral hearing loss and
central changes in cognitive capacity can combine to result in challenges with spoken communication,
especially in background noise. Preliminary work has shown that bilingual adults, even those who are currently
English dominant, show accelerated age-related declines in objective measures of suprathreshold auditory
function. It is important to know if these declines are reflected in subjective patient reports, and if the current
patient-reported outcome measures used in the audiology clinic can accurately capture changes in
communication ability in non-monolingual adults.
In this proposal, both objective and subjective measures of speech-in-noise recognition will be collected in a
large population of monolingual and bilingual active-duty service members, along with demographic
information including detailed language history questions, with the goal of identifying which gradient features of
bilingualism interact with age to impact objective and subjective SiN performance in bilingual adults across a
wide age range (Aim 1). Normative reference equations for speech-in-noise scores based on language and
demographic factors will be developed for use with bilingual adults (Aim 2). This research will also examine the
impact of task instructions on responses to patient-reported outcome measures of speech-in-noise
understanding (Aim 2) in order to determine the appropriate administration and interpretation of subjective
clinical measures with bilingual patients. The long term goal of the proposed project is to ensure that findings
regarding objective and subjective speech-in-noise measures used in the Audiology clinic are generalizable
across bilinguals who vary in terms of language background, age, and hearing status.

Grant Number: 5R21DC021516-02
NIH Institute/Center: NIH
Principal Investigator: Rebecca Bieber