Effect of Contralateral Noise on Speech Intelligibility

In patients with strong asymmetric hearing loss, standard clinical practice involves testing speech intelligibility in the ear with the higher hearing threshold by simultaneously presenting noise to the other ear. However, psychoacoustic and functional magnetic resonance imaging (fMRI) studies indicate that this approach may be problematic as contralateral noise has a disruptive effect on task processing. Furthermore, fMRI studies have revealed that the effect of contralateral noise on brain activity depends on the lateralization of task processing. The effect of contralateral noise is stronger when task-relevant stimuli are presented ipsilaterally to the hemisphere that is processing the task. In the present study, we tested the effect of four different levels of contralateral noise on speech intelligibility using the Oldenburg sentence test (OLSA). Cortical lateralization of speech processing was assessed upfront by using a visual speech test with fMRI. Contralateral OLSA noise of 65 or 80 dB SPL significantly reduced word intelligibility irrespective of which ear the speech was presented to. In participants with left-lateralized speech processing, 50 dB SPL contralateral OLSA noise led to a significant reduction in speech intelligibility when speech was presented to the left ear, i.e. when speech was presented ipsilaterally to the hemisphere that is mainly processing speech. Thus, contralateral noise, as used in standard clinical practice, not only prevents listeners from using the information in the better-hearing ear but may also have the unintended effect of hampering central processing of speech.