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How does hearing loss affect cognition?

This is a Fellowship awarded to Dr Emma Holmes at University College London in 2019. 


Many people with hearing loss struggle to listen in noisy places, which may cause them to avoid social situations. For example, they may avoid busy places like restaurants or pubs, or have difficulty participating in conversations around the dinner table with family and friends.

These difficulties have been linked to social isolation, depression and dementia. Although hearing aids can make it easier for people to understand speech in quiet places, users generally still struggle in noisy places. Currently, we do not fully understand what causes these difficulties or how people with hearing loss might overcome them. 

When hearing tests are administered in the clinic, they focus on identifying problems at the ear. However, our brains play an important role in interpreting what we hear, and so hearing loss may also affect how the brain processes sounds. It could be that problems with processing sounds in the brain may underlie why people with hearing loss find noisy places particularly difficult.  

1 way in which people try to improve their listening in noisy places is to anticipate ‘where to listen’ – for example, we often predict who will speak next by looking around us. This helps us to better understand speech in these situations, and it is accompanied by measurable changes in brain activity. 


Emma will establish how processes in the brain help people to understand speech in noisy places, and measure how these processes are affected by hearing loss. She’ll simulate real-life scenarios in a hearing lab, using a speech-in-noise task that gives clues to help participants to anticipate ‘where to listen’ (to the left or to the right). She’s has already shown that this test can detect differences in attention between children with normal hearing and children with hearing loss. 

There are 2 strands to Emma’s research.

Strand 1

Emma will develop a computational model for ‘active listening’. This model will include the cognitive processes that:

  • enable people to anticipate ‘where to listen’
  • establish the best strategies that people use to direct their attention to the correct place to listen
  • and simulate what happens to these processes when someone has hearing loss.

Strand 2

Emma will test how differences in hearing thresholds relate to processes that people use to prepare ‘where to listen’. She’ll measure speech intelligibility and brain activity when older and younger adults deploy these attentional processes. 


This project could significantly advance our knowledge of how hearing loss affects the brain processes related to hearing and attention.

The results could help clinicians to better understand why people with hearing loss find it particularly difficult to listen in noisy places and may help researchers to develop clinical tests to inform diagnosis.

Such tests could allow clinicians to predict how well each patient will understand speech in noisy places, and whether that patient would benefit from specific interventions (e.g. training or hearing aids).

The work could also inspire new treatments to help people with hearing loss, such as training apps that improve speech understanding or the next generation of hearing aids that mimic typical hearing brain processes.

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