Listening effort and fatigue: what exactly are we measuring? A British Society of Audiology Cognition in Hearing Special Interest Group 'white paper'.

OBJECTIVE There is growing interest in the concepts of listening effort and fatigue associated with hearing loss. However, the theoretical underpinnings and clinical meaning of these concepts are unclear. This lack of clarity reflects both the relative immaturity of the field and the fact that research studies investigating listening effort and fatigue have used a variety of methodologies including self-report, behavioural, and physiological measures. DESIGN This discussion paper provides working definitions for listening effort and listening-related fatigue. Using these definitions as a framework, methodologies to assess these constructs are reviewed. RESULTS Although each technique attempts to characterize the same construct (i.e. the clinical presentation of listening effort and fatigue), different assumptions are often made about the nature of these phenomena and their behavioural and physiological manifestations. CONCLUSION We suggest that researchers consider these assumptions when interpreting their data and, where possible, make predictions based on current theoretical knowledge to add to our understanding of the underlying mechanisms of listening effort and listening-related fatigue. FOREWORD Following recent interest in the cognitive involvement in hearing, the British Society of Audiology (BSA) established a Special Interest Group on Cognition in Hearing in May 2013. In an exploratory group meeting, the ambiguity surrounding listening effort and fatigue was discussed. To address this problem, the group decided to develop a 'white paper' on listening effort and fatigue. This is a discussion document followed by an international set of commentaries from leading researchers in the field. An approach was made to the editor of the International Journal of Audiology who agreed to this suggestion. This paper, and the associated commentaries that follow, are the result.