Right-Ear Advantage for Speech-in-Noise Recognition in Patients with Nonlateralized Tinnitus and Normal Hearing Sensitivity

  • Yihsin Tai
  • Fatima T. Husain
Research Article


Despite having normal hearing sensitivity, patients with chronic tinnitus may experience more difficulty recognizing speech in adverse listening conditions as compared to controls. However, the association between the characteristics of tinnitus (severity and loudness) and speech recognition remains unclear. In this study, the Quick Speech-in-Noise test (QuickSIN) was conducted monaurally on 14 patients with bilateral tinnitus and 14 age- and hearing-matched adults to determine the relation between tinnitus characteristics and speech understanding. Further, Tinnitus Handicap Inventory (THI), tinnitus loudness magnitude estimation, and loudness matching were obtained to better characterize the perceptual and psychological aspects of tinnitus. The patients reported low THI scores, with most participants in the slight handicap category. Significant between-group differences in speech-in-noise performance were only found at the 5-dB signal-to-noise ratio (SNR) condition. The tinnitus group performed significantly worse in the left ear than in the right ear, even though bilateral tinnitus percept and symmetrical thresholds were reported in all patients. This between-ear difference is likely influenced by a right-ear advantage for speech sounds, as factors related to testing order and fatigue were ruled out. Additionally, significant correlations found between SNR loss in the left ear and tinnitus loudness matching suggest that perceptual factors related to tinnitus had an effect on speech-in-noise performance, pointing to a possible interaction between peripheral and cognitive factors in chronic tinnitus. Further studies, that take into account both hearing and cognitive abilities of patients, are needed to better parse out the effect of tinnitus in the absence of hearing impairment.


signal-to-noise ratio loss QuickSIN left-ear disadvantage bilateral tinnitus 



The authors would like to thank Anthony Tsao for assisting with data collection and Dr. Sa Shen for providing advice on aspects of the statistical analysis. We are deeply grateful to Dr. Richard Tyler for his insightful comments on earlier versions of this manuscript.

Funding Information

The study was supported in part by the Department of Defense, award number W81XWH-15-2-0032 (PI: Husain) and a Center for Wounded Veterans in Higher Education (UIUC) seed grant (PI: Husain).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. Akeroyd MA (2008) Are individual differences in speech reception related to individual differences in cognitive ability? A survey of twenty experimental studies with normal and hearing-impaired adults. Int J Audiol 47(sup2):S53–S71. CrossRefPubMedGoogle Scholar
  2. American National Standards Institute (1999) Maximum permissible ambient noise levels for audiometric test roomsGoogle Scholar
  3. American National Standards Institute (2010) Specification for audiometersGoogle Scholar
  4. Anderson S, Kraus N (2010) Objective neural indices of speech-in-noise perception. Trends Amplif 14(2):73–83. CrossRefPubMedPubMedCentralGoogle Scholar
  5. Andersson G, Westin V (2008) Understanding tinnitus distress: introducing the concepts of moderators and mediators. Int J Audiol 47(sup2):S106–S111. CrossRefPubMedGoogle Scholar
  6. Arlinger S, Lunner T, Lyxell B, Pichora-Fuller MK (2009) The emergence of cognitive hearing science. Scand J Psychol 50(5):371–384. CrossRefPubMedGoogle Scholar
  7. Basile CE, Fournier P, Hutchins S, Hebert S (2013) Psychoacoustic assessment to improve tinnitus diagnosis. PLoS One 8:28–41Google Scholar
  8. Bidelman GM, Bhagat SP (2015) Right-ear advantage drives the link between olivocochlear efferent “antimasking” and speech-in-noise listening benefits. Neuroreport 26(8):483–487. CrossRefPubMedGoogle Scholar
  9. Bidelman GM, Howell M (2016) Functional changes in inter- and intra-hemispheric cortical processing underlying degraded speech perception. NeuroImage 124(Pt A):581–590. CrossRefPubMedGoogle Scholar
  10. CHABA (1988) Speech understanding and aging. J Acoust Soc of Am 83(3):859–895. CrossRefGoogle Scholar
  11. Cuny C, Chéry-Croze S, Bougeant JC, Koenig O (2004a) Investigation of functional hemispheric asymmetry of language in tinnitus sufferers. Neuropsychology 18(2):384–392. CrossRefPubMedGoogle Scholar
  12. Cuny C, Norena A, El Massioui F, Chery-Croze S (2004b) Reduced attention shift in response to auditory changes in subjects with tinnitus. Audiol Neurotol 9:294–302, 5, doi:
  13. Davis A, El Rafaie A (2000) Epidemiology of tinnitus. In: Tyler RS (ed) Tinnitus handbook. Singular, San Diego, pp 1–24Google Scholar
  14. Degeest S, Keppler H, Corthals P (2017) The effect of tinnitus on listening effort in normal-hearing young adults: a preliminary study. J Speech Lang Hear Res 60(4):1036–1045. CrossRefPubMedGoogle Scholar
  15. Ellis RJ, Molander P, Ronnberg J, Lyxell B, Andersson G, Lunner T (2016) Predicting speech-in-noise recognition from performance on the trail making test: results from a large-scale internet study. Ear Hear 37(1):73–79. CrossRefPubMedGoogle Scholar
  16. Figueiredo RR, Azevedo AAD, Oliveira PDM (2009) Correlation analysis of the visual-analogue scale and the Tinnitus Handicap Inventory in tinnitus patients. Braz J Otorhinolaryngol 75(1):76–79. CrossRefPubMedGoogle Scholar
  17. Gilles A, Schlee W, Rabau S, Wouters K, Fransen E, Van de Heyning P (2016) Decreased speech-in-noise understanding in young adults with tinnitus. Front Neurosci 10:1–14CrossRefGoogle Scholar
  18. Goebel G, Hiller W (1994) The tinnitus questionnaire. A standard instrument for grading the degree of tinnitus. Results of a multicenter study with the tinnitus questionnaire. HNO 42(3):166–172PubMedGoogle Scholar
  19. Hennig TR, Costa MJ, Urnau D, Becker KT, Schuster LC (2011) Recognition of speech of normal-hearing individuals with tinnitus and hyperacusis. Int Arch Otorhinolaryngol 15:21–28Google Scholar
  20. Henry JA, Zaugg TL, Myers PJ, Kendall CJ, Turbin MB (2009) Principles and application of educational counseling used in progressive audiologic tinnitus management. Noise Health 11(42):33–48. CrossRefPubMedGoogle Scholar
  21. Hiller W, Goebel G (2007) When tinnitus loudness and annoyance are discrepant: audiological characteristics and psychological profile. Audiol Neurotol 12(6):391–400. CrossRefGoogle Scholar
  22. Hiscock M, Kinsbourne M (2011) Attention and the right-ear advantage: what is the connection? Brain Cogn 76(2):263–275. CrossRefPubMedGoogle Scholar
  23. Hoekstra CEL, Wesdorp FM, van Zanten GA (2014) Socio-demographic, health, and tinnitus related variables affecting tinnitus severity. Ear Hear 35(5):544–554. CrossRefPubMedGoogle Scholar
  24. Huang CY, Lee HH, Chung KC, Chen HC, Shen YJ, Wu JL (2007) Relationships among speech perception, self-rated tinnitus loudness and disability in tinnitus patients with normal pure-tone thresholds of hearing. ORL 69(1):25–29. CrossRefPubMedGoogle Scholar
  25. Jain C, Sahoo JP (2014) The effect of tinnitus on some psychoacoustical abilities in individuals with normal hearing sensitivity. Int Tinnitus J 19(1):28–35. CrossRefPubMedGoogle Scholar
  26. Jastreboff PJ (1990) Phantom auditory perception (tinnitus): mechanisms of generation and perception. Neurosci Res 8(4):221–254. CrossRefPubMedGoogle Scholar
  27. Jerger J, Chmiel R, Allen J, Wilson A (1994) Effects of age and gender on dichotic sentence identification. Ear Hear 15(4):274–286. CrossRefPubMedGoogle Scholar
  28. Kam ACS, Keith RW (2010) Aging effect on dichotic listening of Cantonese. Int J Audiol 49(9):651–656. CrossRefPubMedGoogle Scholar
  29. Killion MC, Niquette PA, Gudmundsen GI, Revit LJ, Banerjee S (2004) Development of a quick speech-in-noise test for measuring signal-to-noise ratio loss in normal-hearing and hearing-impaired listeners. J Acoust Soc Am 116(4):2395–2405. CrossRefPubMedGoogle Scholar
  30. Kimura D (2011) From ear to brain. Brain Cogn 76(2):214–217. CrossRefPubMedGoogle Scholar
  31. Kuk FK, Tyler RS, Russell D, Jordan H (1990) The psychometric properties of the Tinnitus Handicap Questionnaire. Ear Hear 11(6):434–445. CrossRefPubMedGoogle Scholar
  32. McArdle RA, Wilson RH (2006) Homogeneity of the 18 QuickSIN lists. J Am Acad Audiol 17(3):157–167. CrossRefPubMedGoogle Scholar
  33. McArdle RA, Wilson RH, Burks CA (2005) Speech recognition in multitalker babble using digits, words, and sentences. J Am Acad Audiol 16(9):726–739. CrossRefPubMedGoogle Scholar
  34. McCormack A, Edmondson-Jones M, Somerset S, Hall D (2016) A systematic review of the reporting of tinnitus prevalence and severity. Hear Res 337:70–79. CrossRefPubMedGoogle Scholar
  35. McKenna L, Handscomb L, Hoare DJ, Hall DA (2014) A scientific cognitive-behavioral model of tinnitus: novel conceptualizations of tinnitus distress. Front Neurol 5:196. CrossRefPubMedPubMedCentralGoogle Scholar
  36. Meikle MB, Henry JA, Griest SE, Stewart BJ, Abrams HB, McArdle R, Myers PJ, Newman CW, Sandridge S, Turk DC, Folmer RL, Frederick EJ, House JW, Jacobson GP, Kinney SE, Martin WH, Nagler SM, Reich GE, Searchfield G, Sweetow R, Vernon JA (2012) The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus. Ear Hear 33(2):153–176. CrossRefPubMedGoogle Scholar
  37. Moller AR (2007) Tinnitus: presence and future. Prog Brain Res 166:3–16. CrossRefPubMedGoogle Scholar
  38. Moon IJ, Won JH, Kang HW, Kim DH, An YH, Shim HJ (2015) Influence of tinnitus on auditory spectral and temporal resolution and speech perception in tinnitus patients. J Neurosci 35(42):14260–14269. CrossRefPubMedGoogle Scholar
  39. Newman CW, Jacobson GP, Spitzer JB (1996) Development of the tinnitus handicap inventory. Arch Otolaryngol Head Neck Surg 122(2):143–148. CrossRefPubMedGoogle Scholar
  40. Nilsson M, Soli SD, Sullivan JA (1994) Development of the hearing in noise test for the measurement of speech reception thresholds in quiet and in noise. J Acoust Soc Am 95(2):1085–1099. CrossRefPubMedGoogle Scholar
  41. Norena AJ (2015) Revisiting the cochlear and central mechanisms of tinnitus and therapeutic approaches. Audiol Neurotol 20(1):53–59. CrossRefGoogle Scholar
  42. Pichora-Fuller MK (2003) Cognitive aging and auditory information processing. Int J Audiol 42:S26–S32CrossRefGoogle Scholar
  43. Probst T, Pryss R, Langguth B, Schlee W (2016) Emotional states as mediators between tinnitus loudness and tinnitus distress in daily life: results from the “TrackYourTinnitus” application. Sci Rep 6(1).
  44. Ronnberg N, Stenfelt S, Rudner M (2011) Testing listening effort for speech comprehension using the individuals’ cognitive spare capacity. Audiol Res 1(1S).
  45. Roup CM (2011) Dichotic word recognition in noise and the right-ear advantage. J Speech Lang Hear Res 54(1):292–297. CrossRefPubMedGoogle Scholar
  46. Roup CM, Wiley TL, Wilson RH (2006) Dichotic word recognition in young and older adults. J Am Acad Audiol 17(4):230–240. CrossRefPubMedGoogle Scholar
  47. Rudner M, Lunner T (2014) Cognitive spare capacity and speech communication: a narrative overview. Biomed Res Int 2014:1–10. CrossRefGoogle Scholar
  48. Ryu IS, Ahn JH, Lim HW, Joo KY, Chung JW (2012) Evaluation of masking effects on speech perception in patients with unilateral chronic tinnitus using the hearing in noise test. Otol Neurotol 33(9):1472–1476. CrossRefPubMedGoogle Scholar
  49. Searchfield GD (2014) Tinnitus what and where: an ecological framework. Front Neurol 5:271. CrossRefPubMedPubMedCentralGoogle Scholar
  50. Tadros SF, Frisina ST, Mapes F, Kim SH, Frisina DR, Frisina RD (2005) Loss of peripheral right-ear advantage in age-related hearing loss. Audiol Neurootol 10(1):44–52. CrossRefPubMedGoogle Scholar
  51. Theodoroff SM, Folmer RL (2013) Repetitive transcranial magnetic stimulation as a treatment for chronic tinnitus: a critical review. Otol Neurotol 34(2):199–208. CrossRefPubMedGoogle Scholar
  52. Tillman TW, Carhart R (1966) An expanded test for speech discrimination utilizing CNC monosyllabic words: Northwestern University Auditory Test No. 6. Northwestern University Auditory Research Lab, Evanston, ILGoogle Scholar
  53. Tyler RS (2000) Psychological management of tinnitus. In: Tyler RS (ed) Tinnitus handbook. Singular, San Diego, pp 263–279Google Scholar
  54. Tyler RS, Baker LJ (1983) Difficulties experienced by tinnitus sufferers. J Speech Hear Disord 48(2):150–154. CrossRefPubMedGoogle Scholar
  55. Tyler RS, Ji H, Perreau A, Witt S, Noble W, Coelho C (2014) Development and validation of the tinnitus primary function questionnaire. Am J Audiol 23(3):260–272. CrossRefPubMedGoogle Scholar
  56. Vielsmeier V, Kreuzer PM, Haubner F, Steffens T, Semmler PRO, Kleinjung T, Schlee W, Langguth B, Schecklmann M (2016) Speech comprehension difficulties in chronic tinnitus and its relation to hyperacusis. Front Aging Neurosci 8:1–8CrossRefGoogle Scholar
  57. Walden TC, Walden BE (2004) Predicting success with hearing aids in everyday living. J Am Acad Audiol 15(5):342–352. CrossRefPubMedGoogle Scholar
  58. Wayne RV, Johnsrude IS (2015) A review of causal mechanisms underlying the link between age-related hearing loss and cognitive decline. Ageing Res Rev 23(Pt B):154–166. CrossRefPubMedGoogle Scholar
  59. Wilson RH (2003) Development of a speech-in-multitalker-babble paradigm to assess word-recognition performance. J Am Acad Audiol 14(9):453–470PubMedGoogle Scholar
  60. Wilson RH, McArdle RA, Smith SL (2007) An evaluation of the BKB-SIN, HINT, QuickSIN, and WIN materials on listeners with normal hearing and listeners with hearing loss. J Speech Lang Hear Res 50(4):844–856. CrossRefPubMedGoogle Scholar
  61. Wong PC, Ettlinger M, Sheppard JP, Gunasekera GM, Dhar S (2010) Neuroanatomical characteristics and speech perception in noise in older adults. Ear Hear 31(4):471–479. CrossRefPubMedPubMedCentralGoogle Scholar
  62. Yund EW, Woods DL (2010) Content and procedural learning in repeated sentence tests of speech perception. Ear Hear 31(6):769–778. CrossRefPubMedGoogle Scholar

Copyright information

© Association for Research in Otolaryngology 2017

Authors and Affiliations

  1. 1.Department of Speech and Hearing ScienceUniversity of Illinois at Urbana-ChampaignChampaignUSA
  2. 2.Neuroscience ProgramUniversity of Illinois at Urbana-ChampaignChampaignUSA
  3. 3.Beckman Institute for Advanced Science and TechnologyUniversity of Illinois at Urbana-ChampaignChampaignUSA

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