Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. <zdoi; 10.1097/AUD.0000000000000634> 0196/0202/2018/XXXX-00/0 • Ear & Hearing • Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved • Printed in the U.S.A. 1 Objectives: In this article, we explore two manipulations of “meaning response,” intended to either “impart” meaning to participants through the manipulation of a few words in the test instructions or to “invite” meaning by making the participant feel involved in the setting of their preferred sound. Design: In experiment 1, 59 adults with normal hearing were randomly assigned to one of the two groups. Group 1 was told “this hearing in noise test (HINT) you are about to do is really hard,” while the second group was told “this HINT test is really easy.” In experiment 2, 59 nor- mal-hearing adults were randomly assigned to one of two groups. Every participant was played a highly distorted sound file and given 5 mystery sliders on a computer to move as often and as much as they wished until the sound was “best” to them. They were then told we applied their settings to a new file and they needed to rate their sound settings on this new file against either (1) another participant in the study, or (2) an expert audiologist. In fact, we played them the same sound file twice. Results: In experiment 1, those who were told the test was hard per- formed significantly better than the easy group. In experiment 2, a sig- nificant preference was found in the group when comparing “my setting” to “another participant.” No significant difference was found in the group comparing “my setting” to the “expert.” Conclusions: Imparting or inviting meaning into the context of audio- logical outcome measurement can alter outcomes even in the absence of any additional technology or treatment. These findings lend support to a growing body of research about the many nonauditory factors including motivation, effort, and task demands that can impact performance in our clinics and laboratories. Key words: Meaning, Expectations, Hearing, Placebo, Audiology. (Ear & Hearing 2018;XX;00–00) INTRODUCTION “Meaning responses” can be defned as a change in perfor- mance, outcome, and/or preference that is governed by factors that are not necessarily related to the treatment of interest (i.e., motiva- tion, effort, task demands, the surrounding context in which you fnd yourself, personal beliefs and biases, the narrative you tell yourself about experiences, etc.; Moerman & Jonas, 2002). Meaning in Health Care Treatment in health care is largely considered a means of counteracting the pathology of a disease often through the use of pharmacological approaches, therapy, and/or surgery. However, treatment rarely happens in isolation without the direct involve- ment of a clinician and the context and situational infuences that are available in the treatment environment (Naylor et al., 2015). There is a large body of literature that shows meaning responses can have a substantial infuence on physiological and psychological performance (for a thorough review of mean- ing responses see Moerman and Jonas (2002)). The authors defne meaning response as “the physiologic or psychological effects of meaning in the origins or treatment of illness; mean- ing responses elicited after the use of inert or sham treatment can be called the ‘placebo effect’ when they are desirable and the ‘nocebo effect’ when they are undesirable.” The magnitude of these meaning responses can be as minor as liking the outft that the physician wears when treating you (stethoscope and lab coat; Blumhagen, 1979), all the way to achieving the same out- come with sham surgery (an incision with no actual surgery for knee repair; Sihvonen et al., 2013). The color of pills is known to have an effect even when the pills themselves are inert (i.e., red pills are known to create a stimulant effect, whereas blue pills create a depressive effect [Blackwell et al., 1972; Shapira, McClelland, Griffths, Newell, 1970]). Taking 2 inert pills can have a larger meaning than taking only 1 inert pill (Moerman, 2000), and the name recognition of the pill can infuence its effectiveness (i.e., familiar brand named pills are more effective than unfamiliar named pills; Branthwaite, & Cooper, 1981). In sports medicine, the same 10-week exercise program designed to target aerobic improvements worked for 2 groups equally well. However, one of the groups was told that the 10-week program would also enhance their psychological well-being. The group that was told the additional information showed an improvement in both aerobic capacity (like group 1) but also an improvement in psychological well-being (Desharnais et al., 1993). Even in cultural anthropology, beliefs, and perceptions have been found to infuence mortality rate. Chinese individuals born in “unlucky” years die 7% earlier than Chinese individuals born in “lucky” years even if they were raised in the same coun- try (United States) with the same access to health care (Phil- lips et al., 1993). As the authors point out, people seem to die younger because of Chinese ideas, not Chinese genes. Meaning in Audiology If outcome changes can be found in the absence of treat- ment, it is likely that there are a number of cognitive (nonau- ditory) factors that vary in a meaningful way for people that subsequently have an impact on their performance. A recent consensus workshop was convened and a special issue of Ear and Hearing was devoted to the ideas generated at that con- ference (Pichora-Fuller et al., 2016). The authors developed a framework for understanding the complex relationships between nonauditory factors, for example, motivation/arousal and task demands, that may have a direct impact on effort and Changing Hearing Performance and Sound Preference With Words and Expectations: Meaning Responses in Audiology William E. Hodgetts, 1,2 Daniel Aalto, 1,2 Amberley Ostevik, 1 and Jacqueline Cummine 1 1 Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada; and 2 Institute for Reconstructive Sciences in Medicine, Edmonton, Alberta, Canada.