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Pure-Tone Audiometry Fails to Predict Real-World Speech-in-Noise Perception: Insights From a Multi-Talker Spatial Attention Paradigm

Poster Session A - Saturday, March 7, 3:00 – 5:00 pm, Fairview/Kitsilano Ballrooms

Nina E. Wade^1,2 (ninawadeucla@g.ucla.edu), Brett M. Bormann^1,3, Daniel C. Comstock¹, Kelsey Mankel^1,4,5, Soukhin Das^1,6, Hilary Brodie⁷, Doron Sagiv⁷, Lee M. Miller^1,7,8; ¹Center for Mind and Brain, University of California, Davis, ²Fielding School of Public Health, University of California, Los Angeles, ³Neuroscience Graduate Group, University of California, Davis, ⁴Institute for Intelligent Systems, University of Memphis, ⁵School of Communication Sciences & Disorders, University of Memphis, ⁶Psychology Graduate Group, University of California, Davis, ⁷Department of Otolaryngology | Head and Neck Surgery, University of California,Davis, ⁸Neurobiology, Physiology and Behavior, University of California, Davis

Traditional audiology assessments often fail to explain why individuals with “normal” hearing struggle to understand speech in noise. Standard measures like pure-tone averages (PTA) primarily assess peripheral sensitivity, overlooking cognitive and perceptual demands of everyday listening, and contributing to this diagnostic gap known as hidden hearing loss. We investigated whether conventional audiological metrics predict speech-in-noise (SIN) performance in 116 Veterans (ages 20–70) with hearing ranging from normal to mild–moderate loss. Participants completed PTA, self-reported hearing ability (Speech, Spatial, and Qualities of Hearing Scale; SSQ), and a novel multi-talker spatial attention task in single- and dual-talker conditions with sound separated by space. Participants pressed the spacebar when they heard a naturally embedded color word in the target story, and we extracted word hit accuracy and reaction time as measures of their speech and SIN perception. Regression analyses evaluated relationships among traditional and novel measures. Results showed that performance on the novel task correlated with validated SIN assessments, confirming its ecological validity. However, PTA did not predict perception in both quiet and noisy listening environments, underscoring its limited utility for assessing functional hearing. Interestingly, the SIN condition of our novel task predicted PTA, suggesting it may be more sensitive to individual differences in perception across listening conditions. These findings demonstrate that pure tone thresholds provide limited insight into real-world listening ability, especially under complex auditory conditions. Incorporating SIN and attention-based tasks into clinical assessments may enhance detection of functional hearing deficits and better reflect the multifaceted, dynamic nature of speech perception.

Topic Area: PERCEPTION & ACTION: Audition