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• Arras, Tine; Boudewyns, An; Dhooge, Ingeborg; Zarowski, Andrzej; Philips, Birgit & Desloovere, Christian [Show all 8 contributors for this article] (2026). Longitudinal Developmental Outcomes of Children With Prelingual Single-Sided Deafness With and Without a Cochlear Implant and Recommendations for Follow-Up. Ear and Hearing. ISSN 0196-0202. 47(1), p. 4–19. doi: 10.1097/AUD.0000000000001724. Full text in Research Archive
• Humbeeck, Nathan Van; Wilderode, Mira Van; Wieringen, Astrid van & Krampe, Ralf T. (2025). Concurrent listening impairs compensatory postural control mechanisms in middle and late adulthood. PLOS ONE. 20(4). doi: 10.1371/journal.pone.0321828. Full text in Research Archive Show summary

  Multitasking involving sensorimotor functions has been shown to affect older more than young adults but little is known about whether related challenges already emerge in middle adulthood. Here we compare 21 younger (18–30 years of age), 23 middle-aged (45–65 years of age) and 19 older participants (66–81 years of age) who listened to and memorized spoken words while they tried to maintain a stable posture on a force platform. The number of words in the listening task was adjusted to individual single-task levels and cognitive control demands were manipulated by presenting words from either the same or switching target speakers. Postural control demands were varied by manipulating proprioceptive reliability (stable stance or sway-referencing). Young adults’ listening and postural control remained unaffected by concurrent performances. During multitasking middle-aged and older adults maintained single-task levels in listening, however, their postural stability declined significantly. Stabilogram diffusion analysis identified efficiency and timing of long-term corrective mechanisms as the key processes affected by multitasking. We argue that middle-aged adults can maintain young-adult levels of postural stability under ideal conditions by cognitive compensation for sensorimotor decline, a process breaking down during multitasking. Our findings illustrate that multitasking in ecologically relevant listening and postural control settings presents a significant challenge as early as middle adulthood.

• Wilderode, Mira Van; Humbeeck, Nathan Van; Krampe, Ralf T. & Wieringen, Astrid van (2025). Enhancing Speech Perception in Noise Through Home-Based Competing Talker Training. Ear and Hearing. ISSN 0196-0202. 46(4), p. 856–870. doi: 10.1097/AUD.0000000000001631. Full text in Research Archive Show summary

  Objectives: This study aimed to evaluate the effectiveness of a competing talker training paradigm (2TT-Flemish). The primary objectives were the assessment of on-task learning and the transfer to untrained tasks. Design: A total of 60 participants (54–84 years, mean age = 69.4) with speech-in-noise problems participated in the study. The study used a randomized controlled design with three groups: an immediate training group, a delayed training group, and an active control group. The immediate training group trained from the very beginning, while delayed training started after 4 weeks. The active control group listened to audiobooks for the first 4 weeks. All participants underwent 4 weeks of competing talker training. Outcome measures included speech perception in noise, analytical tasks (modulation detection and phoneme perception in noise), and inhibitory control. In addition, a listening-posture dual task assessed whether training freed up cognitive resources for a concurrently performed task. Finally, we assessed whether training induced self-reported benefits regarding hearing, listening effort, communication strategies, emotional consequences, knowledge, and acceptance of hearing loss. Outcome measures were assessed every 4 weeks over a 12-week period. The present study aimed to investigate the effectiveness of competing talker training in a stratified randomized controlled trial. Results: Overall compliance to the training was good and increased with age. We observed on-task improvements during the 4 weeks of training in all groups. Results showed generalization toward speech-in-noise perception, persisting for at least 4 weeks after the end of training. No transfer toward more analytical tasks or inhibitory control was observed. Initial dual-task costs in postural control were reliably reduced after competing talker training suggesting a link between improved listening skills and cognitive resource allocation in multitask settings. Our results show that listeners report better knowledge about their hearing after training. Conclusions: After training with the 2TT-Flemish, results showed on-task improvements and generalization toward speech-in-noise. Improvements did not generalize toward basic analytical tasks. Results suggest that competing talker training enables listeners to free up cognitive resources, which can be used for another concurrent task.

• Borre, Elien Van den; Wieringen, Astrid van; Denys, Sam & Wouters, Jan (2025). The digit triplet test for school-age hearing screening: comparing languages, school grades and scoring methods in a large sample. International Journal of Audiology. ISSN 1499-2027. doi: 10.1080/14992027.2024.2440027. Full text in Research Archive Show summary

  To investigate the reliability of a bilingual school-age hearing screening in four school grades based on the Digit Triplet Test (DTT) in two languages and to investigate three calculation methods for referral values in their ability to detect hearing losses and avoid false-positive results. Design and study sample 3255 children, aged between 10 and 17 years old, were tested during a systematic hearing screening program in a bilingual, French-German area in Belgium. French speaking children were tested with a French DTT, German children were tested with a German DTT. The SRT-values, their stability and measurement error were investigated per grade and language. The number of false-positive results was studied for three referral methods, using additional audiometric data of 71 children. Results Our data showed that reliable results with high stability and a small measurement error can be obtained in only around two minutes per ear. Differences between languages are minimal and grade-specific referral values were necessary. A referral method considering the lowest SNRs in the adaptive staircase reduces the number of false-positive results substantially. Conclusion The DTT versions of different languages can be used reliably in a bilingual school-age hearing screening program when grade-specific, alternative referral methods are implemented.

• Porto, Lyan; Wouters, Jan & Wieringen, Astrid van (2025). Sentence intelligibility in noise in children: development of the LIST-k. International Journal of Audiology. ISSN 1499-2027. doi: 10.1080/14992027.2025.2461151. Full text in Research Archive Show summary

  Objective The goal was to develop a new set of male and female sentence materials in the Dutch language suitable for use in assessments of speech intelligibility in noise in children. Design A subset of the LIST sentences, a Flemish-Dutch language sentence intelligibility test, was selected for its suitability and appropriateness for children. This subset was grouped into new lists, which were then validated with speech-shaped noise. Study sample Fifty-four typically hearing children between 8 and 12 years old and 12 typically hearing adults participated. Results Children obtained an average SRT of −6.4 (± 0.8) dB SNR across all female lists, and −5.8 (± 0.8) dB SNR across all male lists. Furthermore, an age effect was observed, with performance improving with age. Lists were shown to be equivalent within each set. Conclusion The two sets of sentences developed and evaluated in noise here, one consisting of 280 sentences/recordings by a male speaker, and one consisting of 210 sentences/recordings by a female speaker are suitable for children aged 8 to 12 years old. Reference data for three age groups are provided.

• Adalilar, Irem; Gransier, Robin; Wouters, Jan & Wieringen, Astrid van (2025). Response strength and latencies of auditory steady-state responses from age six. International Journal of Audiology. ISSN 1499-2027. 64(7), p. 735–744. doi: 10.1080/14992027.2024.2419998. Full text in Research Archive Show summary

  Auditory-steady state responses (ASSRs) to stimuli modulated by different frequencies may differ between children and adults. These differences in response characteristics or latency may reflect developmental changes. This study investigates age-related differences in response strength, latencies, and hemispheric laterality indices of ASSRs for different modulation frequencies. Multi-channel EEG was used to measure ASSRs to broadband noise, modulated at either 40 or 80 Hz, presented at 70 dB SPL to the left, right, or both ears. This study involved 18 adults (20-26 years) and 17 children divided into two age groups: younger children (6-10 years) and older children (11-14 years). Advancing age was associated with increased response strength and prolonged latencies for 40-Hz ASSRs, with significant differences observed between adults and younger children. No significant age-related differences were noted for 80-Hz ASSRs. Laterality analysis indicated a right-hemisphere tendency for 40-Hz ASSRs in older children and 80-Hz ASSRs in younger children, respectively. The study indicates the development of 40-Hz ASSRs with increasing response strength and prolonged latencies. The results of children with normal hearing are important for further research on children with hearing impairment.

• Denys, Sam; Barry, Johanna; Moore, David R.; Verhaert, Nicolas & Wieringen, Astrid van (2024). A Multi-Sample Comparison and Rasch Analysis of the Evaluation of Children's Listening and Processing Skills Questionnaire. Ear and Hearing. ISSN 0196-0202. 45(5), p. 1202–1215. doi: 10.1097/AUD.0000000000001509. Full text in Research Archive Show summary

  Objectives: Assessing listening difficulties and associated complaints can be challenging. Often, measures of peripheral auditory functions are within normal ranges, making clinicians feel unsure about proper management strategies. The range and nature of observed or experienced difficulties might be better captured using a qualitative measure. The Evaluation of Children’s Listening and Processing Skills (ECLiPS) questionnaire was designed to broadly profile the auditory and cognitive problems often present in children with listening difficulties. This 38-item questionnaire was initially standardized in British children aged 6 to 11 years, was subsequently modified for use with North-American children, and was recently translated into Flemish–Dutch. This study aimed to compare typical scores of the Flemish version with the UK and US versions, and to evaluate and compare its psychometric quality based on Rasch analysis. Design: We selected 112 Flemish children aged 6 to 11 years with verified normal hearing and typical development, and asked two caregivers of every child to fill out the ECLiPS. Data from two comparator samples were analyzed, including responses for 71 North-American children and 650 British children. Typical values for ECLiPS factors and aggregates were determined as a function of age and gender, and meaningful differences across samples were analyzed. Rasch analyses were performed to evaluate whether ECLiPS response categories work as intended, and whether item scores fit a linear equal interval measurement scale that works the same way for everyone. Item and person metrics were derived, including separation and reliability indices. We investigated whether items function similarly across linguistically and culturally different samples. Results: ECLiPS scores were relatively invariant to age. Girls obtained higher scores compared with boys, mainly for items related to memory and attention, and pragmatic and social skills. Across ECLiPS versions, the most pronounced differences were found for items probing social skills. With respect to its psychometric quality, ECLiPS response categories work as intended, and ECLiPS items were found to fit the Rasch measurement scale. Cultural differences in responses were noted for some items, belonging to different factors. Item separation and reliability indices generally pointed toward sufficient variation in item difficulty. In general, person separation (and reliability) metrics, quantifying the instrument’s ability to distinguish between poor and strong performers (in a reproducible manner), were low. This is expected from samples of typically developing children with homogeneous and high levels of listening ability. Conclusions: Across the languages assessed here, the ECLiPS caregiver questionnaire was verified to be a psychometrically valid qualitative measure to assess listening and processing skills, which can be used to support the assessment and management of elementary school children referred with LiD.

• Wilderode, Mira Van; Humbeeck, Nathan Van; Krampe, Ralf & Wieringen, Astrid van (2024). Speech-Identification During Standing as a Multitasking Challenge for Young, Middle-Aged and Older Adults. Trends in Hearing (Trends). 28. doi: 10.1177/23312165241260621. Full text in Research Archive Show summary

  While listening, we commonly participate in simultaneous activities. For instance, at receptions people often stand while engaging in conversation. It is known that listening and postural control are associated with each other. Previous studies focused on the interplay of listening and postural control when the speech identification task had rather high cognitive control demands. This study aimed to determine whether listening and postural control interact when the speech identification task requires minimal cognitive control, i.e., when words are presented without background noise, or a large memory load. This study included 22 young adults, 27 middle-aged adults, and 21 older adults. Participants performed a speech identification task (auditory single task), a postural control task (posture single task) and combined postural control and speech identification tasks (dual task) to assess the effects of multitasking. The difficulty levels of the listening and postural control tasks were manipulated by altering the level of the words (25 or 30 dB SPL) and the mobility of the platform (stable or moving). The sound level was increased for adults with a hearing impairment. In the dual-task, listening performance decreased, especially for middle-aged and older adults, while postural control improved. These results suggest that even when cognitive control demands for listening are minimal, interaction with postural control occurs. Correlational analysis revealed that hearing loss was a better predictor than age of speech identification and postural control.

• Humbeeck, Nathan Van; Wilderode, Mira Van; Kliegl, Reinhold; Wieringen, Astrid van & Krampe, Ralf T. (2024). Multitasking across the lifespan in different task contexts. Scientific Reports. 14(1). doi: 10.1038/s41598-024-61859-w. Full text in Research Archive Show summary

  We assessed lifespan development of multitasking in a sample of 187 individuals aged 8–82 years. Participants performed a visuo-spatial working memory (VSWM) task together with either postural control or reaction time (RT) tasks. Using criterion-referenced testing we individually adjusted difficulty levels for the VSWM task to control for single-task differences. Age-differences in single-task performances followed U-shaped patterns with young adults outperforming children and older adults. Multitasking manipulations yielded robust performance decrements in VSWM, postural control and RT tasks. Presumably due to our adjustment of VSWM challenges, costs in this task were small and similar across age groups suggesting that age-differential costs found in earlier studies largely reflected differences already present during single-task performance. Age-differences in multitasking costs for concurrent tasks depended on specific combinations. For VSWM and RT task combinations increases in RT were the smallest for children but pronounced in adults highlighting the role of cognitive control processes. Stabilogram diffusion analysis of postural control demonstrated that long-term control mechanisms were affected by concurrent VSWM demands. This interference was pronounced in older adults supporting concepts of compensation or increased cognitive involvement in sensorimotor processes at older age. Our study demonstrates how a lifespan approach can delineate the explanatory scope of models of human multitasking.

• Arras, Tine; Boudewyns, An; Dhooge, Ingeborg; Zarowski, Andrzej; Philips, Birgit & Desloovere, Christian [Show all 8 contributors for this article] (2024). Duration of cochlear implant use in children with prelingual single-sided deafness is a predictor of word perception in the CI ear. Hearing Research. ISSN 0378-5955. 450. doi: 10.1016/j.heares.2024.109076. Full text in Research Archive
• Arras, Tine; Rachman, Laura; Wieringen, Astrid van & Başkent, Deniz (2024). Perception of voice cues and speech-in-speech by children with prelingual single-sided deafness and a cochlear implant. Hearing Research. ISSN 0378-5955. 454, p. 1–13. doi: 10.1016/j.heares.2024.109133. Full text in Research Archive Show summary

  Voice cues, such as fundamental frequency (F0) and vocal tract length (VTL), help listeners identify the speaker's gender, perceive the linguistic and emotional prosody, and segregate competing talkers. Postlingually implanted adult cochlear implant (CI) users seem to have difficulty in perceiving and making use of voice cues, especially of VTL. Early implanted child CI users, in contrast, perceive and make use of both voice cues better than CI adults, and in patterns similar to their peers with normal hearing (NH). In our study, we investigated the perception and use of voice cues in children with single-sided deafness (SSD) who received their CI at an early age (SSD+CI), in an attempt to bridge the gap between these two groups. The SSD+CI children have access to bilateral auditory information and often receive their CI at an early age, similar to CI children. They may also have dominant acoustic representations, similar to CI adults who acquired hearing loss at a later age. As such, the current study aimed to investigate the perception and use of voice cues by a group of nine early-implanted children with prelingual SSD. The study consisted of three experiments: F0 and VTL discrimination, voice gender categorization, and speech-in-speech perception. In each experiment, the results of the SSD group are compared to children and adults with CIs (for their CI ear) and with typical hearing (for their NH ear). Overall, the SSD+CI children had poorer VTL detection thresholds with their CI compared to their NH ear, while their F0 perception was similar across ears. Detection thresholds for both F0 and VTL with their CI ear was comparable to those of bilaterally implanted CI children, suggesting that SSD+CI children do not only rely on their NH ear, but actually make use of their CI. SSD+CI children relied more heavily on F0 cues than on VTL cues for voice gender categorization, with cue weighting patterns comparable to those of CI adults. In contrast to CI children, the SSD+CI children showed limited speech perception benefit based on F0 and VTL differences between the target and masker speaker, which again corresponded to the results of CI adults. Altogether, the SSD+CI children make good use of their CI, despite a good-hearing ear, however, the perceptual patterns seem to fall in-between those of CI children and CI adults. Perhaps a combination of childhood neuroplasticity, limited experience with relying only on the CI, and a dominant acoustic representation of voice gender explain these results.

• Borre, Elien Van den; Tufatulin, Gaziz; Zupan, Lea; Urbančič, Nina Božanić; Lavie, Limor & Holube, Inga [Show all 11 contributors for this article] (2024). A language-independent hearing screening self-test at school-entry. Scientific Reports. 14. doi: 10.1038/s41598-024-53026-y. Full text in Research Archive Show summary

  The usage of a tablet-based language-independent self-test involving the recognition of ecological sounds in background noise, the Sound Ear Check, was investigated. The results of 692 children, aged between 5 and 9 years and 4 months, recruited in seven different countries, were used to analyze the validity and the cultural independence of test. Three different test procedures, namely a monaural adaptive procedure, a procedure presenting the sounds dichotically in diotic noise, and a procedure presenting all the sounds with a fixed signal-to-noise ratio and a stopping rule were studied. Results showed high sensitivity and specificity of all three procedures to detect conductive, sensorineural and mixed hearing loss > 30 dB HL. Additionally, the data collected from different countries were consistent, and there were no clinically relevant differences observed between countries. Therefore, the Sound Ear Check can offer an international hearing screening test for young children at school entry, solving the current lack of hearing screening services on a global scale.

• Porto, Lyan; Wouters, Jan & Wieringen, Astrid van (2023). Speech perception in noise, working memory, and attention in children: A scoping review. Hearing Research. ISSN 0378-5955. 439. doi: 10.1016/j.heares.2023.108883. Full text in Research Archive Show summary

  Purpose Speech perception in noise is an everyday occurrence for adults and children alike. The factors that influence how well individuals cope with noise during spoken communication are not well understood, particularly in the case of children. This article aims to review the available evidence on how working memory and attention play a role in children's speech perception in noise, how characteristics of measures affect results, and how this relationship differs in non-typical populations. Method This article is a scoping review of the literature available on PubMed. Forty articles were included for meeting the inclusion criteria of including children as participants, some measure of speech perception in noise, some measure of attention and/or working memory, and some attempt to establish relationships between the measures. Findings were charted and presented keeping in mind how they relate to the research questions. Results The majority of studies report that attention and especially working memory are involved in speech perception in noise by children. We provide an overview of the impact of certain task characteristics on findings across the literature, as well as how these affect non-typical populations. Conclusion While most of the work reviewed here provides evidence suggesting that working memory and attention are important abilities employed by children in overcoming the difficulties imposed by noise during spoken communication, methodological variability still prevents a clearer picture from emerging.

• Borre, Elien Van den; Wouters, Jan; Verhaert, Nicolas; Boon, Ellen & Wieringen, Astrid van (2023). Measures of Speech Understanding in Noise for Young Children with a Cochlear Implant in Mainstream and Special Education. Trends in Hearing (Trends). 27. doi: 10.1177/23312165231179586. Full text in Research Archive Show summary

  The use of two types of speech-in-noise (SPIN) assessment, namely digits-in-noise self-tests and open-set, monosyllabic word tests, to assess the SPIN understanding performance of children with cochlear implants (CI) in mainstream and special education, was investigated. The tests’ feasibility and reliability and the influence of specific cognitive abilities on their results were studied. The results of 30 children with CIs in mainstream and special education were compared to those of 60 normal-hearing children in elementary school. Results indicate that the digit triplet test (DTT) was feasible for all children tested in this study, as seen by the familiarity of all the digits, the high stability of the test results (<3 dB SNR), and a small measurement error (≤2 dB SNR). Remembering full triplets did not form a problem and results did not show systematic attention loss. For children with CIs, the performance on the DTT was strongly related to the performance on the open-set monosyllabic word-in-noise task. However, small but significant differences were observed in the performance of children with CIs in mainstream and special education on the monosyllabic word test. Both tests showed little influence of cognitive abilities, making them both useful in situations where the bottom-up auditory aspect of SPIN performance needs to be investigated or in situations where sentence-in-noise tests are too challenging.

• Wilderode, Mira Van; Vermaete, Ellen; Francart, Tom; Wouters, Jan & Wieringen, Astrid van (2023). Effectiveness of Auditory Training in Experienced Hearing-Aid Users, and an Exploration of Their Health-Related Quality of Life and Coping Strategies. Trends in Hearing (Trends). 27, p. 1–14. doi: 10.1177/23312165231198380. Full text in Research Archive Show summary

  Hearing aids (HA) are a fundamental component in restoring auditory function; however, they cannot completely alleviate all problems encountered by adults with hearing impairment. The aim of this study is twofold. Firstly, we assess the health-related quality of life and coping strategies of experienced HA users. Secondly, we assess whether HA users can benefit from auditory training. To this end, 40 participants who had worn HAs for more than 6 months participated in this study. Half of the participants received auditory training, while the other half served as a passive control. The training consisted of a personalized training scheme, with outcome measures including speech in noise perception in free-field and via direct streaming to the HA, phoneme identification, cognitive control, and health-related quality of life. Results showed that experienced HA users reported a relatively good quality of life. Health-related quality of life was correlated with aided speech perception in noise, but not with aided pure tone audiometry. Coping strategies were adaptive, leading to improved communication. Participants showed improvements in trained tasks, consonant identification, and speech in noise perception. While both groups yielded improved speech in noise perception at the end, post hoc analysis following a three-way interaction showed a significantly larger pre–post difference for the trained group in the streaming condition. Although training showed some improvements, the study suggests that the training paradigm was not sufficiently challenging for HA users. To optimize daily life listening, we recommend that future training should incorporate more exercises in noise and focus on cognitive control.

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