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. 2026 Feb 6;21(1):1–6. doi: 10.26599/JOTO.2026.9540045

Listening performance in background noise and subjective hearing: a comparison among young adults, older adults, and adults with listening difficulties

Yayoi Yamamoto 1,*, Yuka Sasame 2, Chie Obuchi 3
PMCID: PMC12945654  PMID: 41766845

Abstract

Objective

To investigate subjective and objective listening abilities in noise in young adults, older adults with normal hearing, and adults with listening difficulties (LiD).

Methods

This study examined 20 young adults, 20 older adults with normal hearing, and 20 adults with LiD. All participants underwent pure-tone audiometry and the Hearing in Noise Test－Japanese version (HINT-J) and completed the Speech, Spatial and Qualities of Hearing Scale (SSQ).

Results

All groups had normal hearing thresholds (125－8,000 Hz). Older adults with normal hearing performed worse on the HINT-J than young adults, while adults with LiD reported greater subjective LiD on the SSQ. No significant correlations were found between HINT-J and SSQ scores with any group. Significant differences were found between groups in terms of both the HINT-J (χ2(2)=17.9, p<0.01) and SSQ (χ2(2)=38.7, p<0.01).

Conclusion

Despite normal audiometric thresholds, older adults with normal hearing and adults with LiD experience distinct LiD in noisy environments, highlighting the need for comprehensive assessment beyond traditional audiometry. Future research should focus on developing more sensitive diagnostic tools.

Keywords: Listening difficulties, Older adults, Questionnaire, Cognitive function

1. Introduction

Pure-tone audiometry is commonly used to assess hearing. Hearing levels obtained via audiometry are important indicators for diagnosing hearing loss, determining its severity and selecting appropriate hearing aids. However, listening difficulties (LiD) are not solely determined by hearing level. Some people experience discrepancies between objective audiometric results and their subjective listening perceptions. One such example is LiD that is characterized by symptoms such as difficulty listening in noisy environments despite normal hearing.

The prevalence of LiD is not well established. However, a study in the United States found that 12.0% of individuals with normal hearing thresholds self-reported experiencing LiD. The prevalence of LiD in the entire cohort was therefore 2.9% (Tremblay et al., 2015). LiD involves central nervous system processing of auditory information processing and is associated with problems in sound source localization, lateralization, and auditory discrimination. Diagnosis is defined by the presence of one or more of the following: impaired sound source localization, lateralization, auditory discrimination, auditory pattern recognition, temporal processing of auditory information, perception of competing speech, or perception of distorted speech (Moore, 2018).

Cognitive function has been suggested as a background factor for hearing difficulties in LiD, despite the absence of peripheral hearing problems (Moore et al., 2010). The relationship between LiD and developmental disorders has been extensively studied. Some studies noted relationships between various listening problems and developmental disorders(Obuchi et al., 2024). For example, both children and adults with autism spectrum disorders exhibit auditory processing difficulties (Schafer et al., 2020) and attention deficit hyperactivity disorder, and most children referred for hearing assessment report concomitant LiD symptoms (Bench et al., 2020).

Among cognitive functions, attention has been reported to be related to hearing comprehension. For example, listening to speech in noisy conditions requires separating the noise from the target speech and directing attention accordingly. This is called selective attention, or the cocktail party phenomenon (Cherry, 1953). Different aspects of attentional function exist, such as distributive and sustained attention; a reduction in these functions may contribute to hearing difficulties in individuals with LiD.

Similarly, older adults experience difficulty hearing speech in noise. The Working Group on Speech Understanding and Aging (1988) proposed that peripheral, central, and cognitive factors contribute to this difficulty (Working Group on Speech Understanding and Aging, 1988). For example, older adults exhibit significantly reduced performance on dichotic listening tests, which require attention to separate stimuli presented to the left and right ears (Martin and Jerger, 2005; Passow et al., 2012). Furthermore, even after controlling for age and hearing ability, dichotic listening performance was significantly lower in patients with Alzheimer's disease than in those without cognitive problems (Bouma and Gootjes, 2011). Listening ability in older adults is related to a combination of factors, including declines in both peripheral and central auditory functions (such as attention and memory) due to aging (Humes et al., 2012). In addition to peripheral problems, cognitive function and other factors significantly impact listening ability in older adults.

The complaint of difficulty hearing in noise is similar between patients with LiD and older adults. As mentioned, attentional function is involved in listening in noise; however, several hypotheses address the relationship between the two. An early hypothesis is filter theory (Broadbent, 1958), which proposes a filter at the beginning of information processing, allowing only attended information to pass through and be processed. Marginal capacity theory (Kahneman, 1973) posits that the brain has limited processing resources. Therefore, to use these resources effectively, they are allocated only to necessary information. In auditory scene analysis, which has recently attracted attention, forming a sound pulse by linking components likely originating from the same sound source is crucial, using frequency and spatial information as cues. Listening in noise involves detecting the relevant sound pulse in a mixture of sounds, directing attention to that pulse, and suppressing other unwanted pulses to achieve sound pulse bifurcation (Bregman, 1990).

In any case, listening to words in a noisy environment requires focusing attention on the necessary sounds within a mixture of sounds. In everyday life, people are exposed to various sound environments during communication. Conversational situations often occur in noisy settings, for example, conversations in restaurants, conversations with colleagues amidst the sounds of work, or classroom discussions. Therefore, difficulty hearing in noise significantly impacts social life, including relationships, work, and studies. However, hearing quality may vary depending on underlying factors. These findings indicate the importance of understanding where the background to the hearing difficulty lies, whether it stems from attentional issues, as in individuals with LiD, or from multiple factors related to aging, as in older adults. When a person is judged to have normal hearing on a standard hearing test, the challenge lies in capturing the subjective quality of hearing difficulty, which is not numerically expressed. Therefore, this study administered sentence listening tests under noise environments and questionnaires to healthy young adults, healthy older adults, and individuals with LiD to investigate differences in listening comprehension from both objective and subjective perspectives.

2. Materials and Methods

2.1. Participants

This study included a total of 20 older adults with normal hearing, 20 adults with LiD, and 20 young adults with normal hearing (Table 1). The mean age of older adults was 71.6 years (age range 66-76; SD±3.2 years; 8 men, 12 women), with a mean threshold of 14.2 dB HL (SD±6.3) in the right ear and 14.9 dB HL (SD±5.8) in the left ear. All thresholds from 500 to 4,000 Hz were below 25 dB HL. These participants were recruited from senior community centers. Older adults were administered the Mini-Mental State Examination, and their scores were ≥27 points and cognitive function was normal. Individuals with unilateral hearing loss or ear disease were excluded. The mean age of adults with LiD was 21.2 years (age range: 17-28; SD±3.2 years; 5 men, 15 women) and mean hearing thresholds were 4.6 dB HL (SD±5.2) in the right ear and 2.9 dB HL (SD±4.4) in the left ear. The differential diagnoses of LiD symptoms were conducted using both a subjective questionnaire and auditory processing tests. All participants with LiD showed cut-off scores of ≤109 on the questionnaire for LiD (Obuchi and Kaga, 2020) and scored lower than normal-hearing participants in at least one listening test (e.g., dichotic listening test). They also exhibited normal otoacoustic emissions. Given their ability to attend a regular university, we assumed that they had no problems with basic cognitive screening tests. The mean age of young adults with normal hearing was 20.8 years (age range: 20-21 SD±0.4 years; 7 men, 13 women) and mean hearing thresholds were 2.0 dB HL(SD±3.2) in the right ear and 1.2 dB HL(SD±3.1) in the left ear.

Table 1. Participants’ information.

Mean age (years) Mean hearing level (dB HL) Speech perception (%)
Right Left Right Left
Young adults (n=20) 21.0 (±0.3） 4.6 (±5.2) 2.9 (±4.4) 97.2 (±3.0) 96.7 (±2.3)
Older adults (n=20) 71.6 (±3.2) 14.2 (±6.3) 14.9 (±5.8) 89.4 (±15.2) 91.4 (±6.6)
Adults with LiD (n=20) 20.8 (±0.4) 2.0 (±3.2) 1.2 (±3.1) 97 (±2.9) 97(±2.9)
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Both adults with LiD and young adults with normal hearing had normal otoscopic examinations performed by otolaryngologists, no history of long-term music listening or exposure to loud noise and thresholds <25 dB HL on extended high-frequency audiometry. It was not implemented for older adults. As extended high-frequency hearing declines after the age of 30 years and difficulty hearing is reliably observable among older adults (Wang et al., 2021), audiometric testing was limited to 8000 Hz. This study was approved by the Ethics Committee of the International University of Health and Welfare in Chiba Prefecture of Japan (reference number: #2020-Io-32; ethical approval date: 26 July 2020) and performed in accordance with the guidelines of the Declaration of Helsinki. The study was also conducted within the ethics review approval period. All participants provided informed consent and received a briefing prior to the study’s commencement.

2.2. Tests

2.2.1. Objective listening assessment: Hearing in Noise Test-Japanese (HINT-J)

The HINT-J is a test for listening to sentences in noisy environments and has been developed in several languages, including Japanese (Nilsson et al., 1994). The HINT-J simulates hearing situations similar to those in daily life and is often used to assess hearing in individuals with hearing impairment. The tests were conducted in a soundproof room. The noise used was a broadband noise for masking word sounds, with a spectrum close to the long-time average spectrum of the word sound.

The HINT-J software was installed on a laptop computer (Dell) and the test sentences were presented through a loudspeaker via an audiometer (AA-H1, RION). The list consisted of 20 sentences with 5–7 keywords. The test was performed in the noise-front condition, where noise and sentences were presented simultaneously through a loudspeaker located 1 m in front of the participants with instructions to repeat the sentences. If the correct sentence was repeated, the next sentence was displayed at a lower volume; however, if the wrong sentence was repeated, the next sentence was displayed at a higher volume. The noise level was fixed at 65 dB, and the sound pressure level of the sentences was changed adaptively according to the participants’ responses. Reception Thresholds for Sentences (RTS) heard with a probability of 50% were calculated, alongside the signal-to-noise ratio.

2.2.2. Subjective hearing assessment: Speech, Spatial and Quality of Hearing Scale (SSQ)

The SSQ is a self-administered 11-step scale designed to assess listening in people with hearing difficulties, consisting of questions about speech, spatial, and quality of hearing (Noble, 2010). In this study, a shortened version of the SSQ was used to assess psychosocial reactions to LiD (Noble et al., 2013). In Japan, the questionnaire has been reported to be useful for screening patients, providing valuable insights for understanding the listening characteristics of adults with LiD (Obuchi et al., 2023).

The questionnaire assessed four aspects of hearing: listening, spatial perception, hearing quality, and psychological aspects. For the first three aspects, participants rated their experiences on a scale from 0 (not at all understandable) to 10 (completely understandable). The first domain, speech listening (questions 1–4), included items related to listening in noise and multiple speech streams. For example, “You are listening to someone talking to you while at the same time trying to follow the news on TV. Can you follow what both people say?” The second domain, spatial perception (questions 5–8), addressed localization, distance, and movement of sounds. For example: “You are outside. A dog barks loudly. Can you tell immediately where it is without having to look?” The third domain, hearing quality (questions 9–12), covered sound segregation, sound identification, and listening effort. For example, “Do you concentrate very much when listening to someone or something?” The sum of all question scores constituted the overall SSQ score, with lower scores indicating greater subjective LiD.

2.3. Statistics

The RTS of the HINT-J and SSQ scores were compared among the three groups to clarify their differences using the Kruskal–Wallis test. Moreover, Scheffe’s multiple comparison test was used to examine whether there were significant differences between which groups. The Shapiro-Wilk test indicated that some of the data were not normally distributed; therefore, the non-parametric Kruskal–Wallis was used for data analyses. The relationship between the HINT-J and SSQ scores in each group was analyzed using Spearman's rank correlation coefficient to determine whether subjective perception of LiD correlated with objective listening performance in noise. Additionally, mean SSQ scores were calculated for each of the 12 questions, and score trends across the groups were analyzed. All statistical analyses were performed using Bell’s curve in Excel version 2.00 (Social Survey Research Information Co, Ltd, Tokyo, Japan).

3. Results

The relationship between the HINT-J SRTs and the total SSQ score is shown in Fig. 1. All 20 young adults had SSQ scores of ≥80, whereas all 20 (100%) participants with LiD and 4 of the 20 (20%) older adults had scores <80. The low SSQ scores of adults of LiD were particularly significant. No significant correlations existed between the HINT-J SRTs and SSQ scores in any group: young adults (r=0.1, n.s.), older adults (r=-0.2, n.s.), and adults with LiD (r=-0.1, n.s.) (Fig. 1). Analysis of covariance also revealed that age was associated with HINT-J performance (F=5.2, p<0.05) but not with SSQ total scores (F=0.5, n.s.).

Figure 1.

Figure 1

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Relationship between HINT-J and SSQ total score.

*SSQ, Speech, Spatial and Qualities of Hearing Scale; RTS, Reception Thresholds for Sentences; LiD, Listening difficulties

The HINT-J SRTs for each group are shown in Fig. 2. The mean HINT-J SRT was -3.1 dB (SD, 1.4) for young adults, -1.4 dB (SD, 2.0) for adults with LiD, and -0.5 dB (SD, 1.9) for older adults. A significant difference was observed between the groups (χ2(2)=13.7, p<0.01), and post-hoc analysis using Scheffe’s multiple comparison test showed a significant difference between young and older adults (p<0.01).

Figure 2.

Figure 2

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HINT-J scores in each participant group.

The SSQ scores for each participant group are shown in Fig. 3. The mean SSQ scores were 100.7 (SD, 9.9) for young adults, and 90.7 (SD, 12.0) for older adults, and 57.9 (SD, 12.2) for adults with LiD. A significant difference existed between the groups (χ2(2)=30.2, p<0.01), and post-hoc analysis using Scheffe’s multiple comparison test showed a significant difference between young adults and adults with LiD (p<0.01).

Figure 3.

Figure 3

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SSQ scores in each participant group.

For the SSQ, the effect size was d=1.85 (large); for HINT, the effect size was d=-0.76 (medium).

The mean SSQ scores for each question were compared across the three groups (Table 2). Significant differences were observed for all items except for questions 7, 8, 10, and 11. The largest score difference between the groups was for question 4(χ2＝39.8, p<0.001), followed by question 3(χ2＝35.8, p<0.001). Question 4 pertained to speech-in-noise, and question 3 pertained to speech-in-speech. Adults with LiD had the lowest mean SSQ score for all questions except for question 10 (sound identification).

Table 2. Mean and standard deviation of each item in the questionnaire for young adults, older adults, and adults with LiD.

Question items Young adults
(n=20)		 Older adults
(n=20)		 Adults with LiD
(n=20)		 p-value
1 9.20 (±1.00) 8.40 (±2.03) 4.70 (±2.15) p <0.001**
2 6.95 (±2.28) 7.05 (±1.98) 12.15 (±1.87) p < 0.001**
3 8.60 (±1.53) 7.10 (±2.22) 3.00 (±1.58) p < 0.001**
4 9.05 (±1.19) 6.80 (±2.26) 3.05 (±1.43) p < 0.001**
5 8.40 (±1.18) 6.25 (±2.07) 4.15 (±2.25) p < 0.001**
6 8.00 (±2.02) 7.40 (±2.08) 5.15 (±3.15) p < 0.05*
7 7.65 (±1.98) 7.40 (±1.50) 5.85 (±2.71) n.s.
8 8.75 (±1.16) 7.90 (±1.74) 6.95 (±2.62) n.s.
9 8.60 (±1.42) 6.30 (±2.63) 4.70 (±2.07) p < 0.001**
10 7.05 (±2.45) 7.45 (±1.84) 6.65 (±3.03) n.s.
11 8.70 (±1.45) 8.45 (±1.50) 6.95 (±2.64) n.s.
12 7.95 (±1.50) 7.30 (±1.92) 3.00 (±2.42) p < 0.001**
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4. Discussion

We examined subjective LiD and abilities in noisy conditions in young adults, older adults, and adults with LiD. All participants had normal hearing between 125 and 8,000 Hz; however, older adults tended to score lower on the HINT-J than the other groups, while adults with LiD tended to score lower on the SSQ than the other groups. Statistically significant differences were found in both cases. In other words, older adults experience difficulty listening to speech in noisy environments even with normal hearing thresholds. Adults with LiD experienced more severe subjective LiD in everyday life than the other groups. This suggests that the nature of subjective LiD differ between older adults and those with LiD, even in the absence of measurable hearing loss. The SSQ results indicate that adults with LiD particularly experience difficulty in selectively directing attention only to the speech that one wants to hear, especially in noisy conditions. Normally, individuals can allocate attentional resources to relevant sounds amidst a variety of voices, successfully allocating attentional resources on a moment-to-moment basis. However, this allocation is likely to be difficult for adults with LiD, which may cause LiD. However, in a set task situation such as HINT-J, accurate listening is possible. This implies that, unlike dysfunction of attention itself, there may be problems with the successful use of attention functions.

The difference in LiD may be explained by the distinct underlying causes of auditory processing problems in each group. Adults with LiD are reported to have attentional weakness (Petley et al., 2021) experiencing difficulty attending to speech in unexpected contexts and directions in everyday life. However, they often perform well in test situations, which provide cues and reminders that prepare them to listen and attend to the test sounds. Therefore, their attentional weaknesses may not result in clearly diminished performance on objective auditory tests. The HINT-J is an important test that can assess objective listening performance in the presence of noise. However, the questionnaire results reveal subjective listening in everyday life. Objective and subjective assessments may not be equivalent. Both assessments are required to assess symptoms for adults with LiD.

In addition, in everyday life, there are many situations in which people can’t

concentrate solely on listening, such as listening while multitasking or hearing the necessary sounds in the presence of multiple speech sounds. As described in auditory scene analysis (Bregman, 1990), humans hear a variety of sounds by sifting through multiple sounds according to similar attributes. The results for question item 9 in SSQ, ‘When you hear two or more sounds, do they sound like one mixed sound?’ revealed low scores for adults with LiD. When speech messages that they have to listen to are presented with a mixture of sounds, it is difficult for them to sift out the speech items clearly, one by one. Hence, this may contribute to the difficulty of listening in noisy situations. The detection rate of LiD symptoms using auditory processing tests is lower in adults with LiD than in children with LiD (Moore, 2012). Some adults with LiD may exhibit normal performance on auditory processing tests despite experiencing significant LiD in daily life.　Therefore, assessing attentional weaknesses and demonstrating their impact on auditory test results is important. Recent studies have reported that adults with LiD perform poorly on objective tests that simulate complex everyday listening situations and incorporate dual tasks requiring multiple attentional controls (Kawase et al., 2022; Obuchi et al., 2023). This highlights the need to develop test batteries that can objectively and appropriately assess LiD symptoms.

Although the older adults’ hearing thresholds from 500 to 4,000 Hz were within 25 dB HL, they performed poorly on the HINT-J. While this may not be problematic in quiet environments, it can significantly impact listening in noise. Even older adults with hearing impairments have worse speech perception in noise, older adults with normal hearing or mild hearing loss exhibit poorer speech perception in noise than younger adults (Dubno et al., 1984). Age-related changes beyond hearing thresholds contribute to speech-listening abilities in noise (Gordon-Salant and Fitzgibbons, 1993).

The HINT-J requires listening to and repeating sentences in noise; therefore, performance is affected by factors such as attention and working memory. Age-related decline in these functions may significantly reduce HINT-J scores in older adults.

While SSQ scores have been reported to differ significantly between older adults with hearing loss and younger adults specifically for speech listening (Humes et al., 2013), this study found no significant differences between older and younger adults. This suggests that the fact that the older adults in this study had clinically normal hearing may have influenced the results.　Additionally, age-appropriate hearing loss is often overlooked in older adults. It is important to recognize that even when subjective complaints of hearing loss are minimal, the actual impact on listening ability can exceed what standard audiological tests indicate.

This study has some limitations. First, cognitive assessment of adults with LiD could not be conducted. Therefore, more comprehensive tests of attention and working memory could reveal the relationship with subjective LiD.

Second, we did not examine other potential contributing factors to LiD. Mental health conditions and developmental disorders may be related to these symptoms; therefore, future research should investigate these traits in adults with LiD to better understand the causes of their difficulties. Lastly, while this study included older adults, their social circumstances and living environment may differ from those of the relatively young adults with LiD. Future research should investigate trends in young adults with hearing loss while controlling for age.

5. Conclusions

We examined the subjective and objective listening abilities in young adults, older adults, and adults with LiD and found that older adults performed the worst on the HINT-J, while adults with LiD reported more subjective LiD on the SSQ. There is a discrepancy between subjective and objective assessment. The study findings indicate the importance of understanding the factors behind LiD and suggest the need for a comprehensive assessment that goes beyond conventional listening tests.

Acknowledgements

We gratefully thank all participants in this study.

Acknowledgments

Informed consent

All participants provided informed consent and received a briefing prior to the study’s commencement.

Conflict of interest

The authors declare no conflicts of interest.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Ethical approval

This study was approved by the Ethics Committee of the International University of Health and Welfare in Chiba Prefecture of Japan (reference number: #2020-Io-32).

Funding Statement

This work was supported by the Japan Society for the Promotion of Science(JSPS) Grants in Aids for Scientific Research(KAKENHI) [grant number 21K20238].

References

  1. Bench, J., Jacobs, K., Furlonger, B. On differentiating auditory processing disorder (APD) from attention deficit disorder (ADD): An illustrative example using the Cattell-Horn-Carroll (CHC) model of cognitive abilities. Int. J. Audiol. 2020;59(3):224–229. doi: 10.1080/14992027.2019.1682199. [DOI] [PubMed] [Google Scholar]
  2. Bouma, A., Gootjes, L. Effects of attention on dichotic listening in elderly and patients with dementia of the Alzheimer type. Brain Cogn. 2011;76(2):286–293. doi: 10.1016/j.bandc.2011.02.008. [DOI] [PubMed] [Google Scholar]
  3. Bregman, A.S., 1990. Auditory Scene Analysis. The Perceptual Organization of Sound. Cambridge: MIT Press.
  4. Broadbent, D.E., 1958. Perception and Communication. London: Pergamon Press.
  5. Cherry, E.C. Some experiments on the recognition of speech, with one and with two ears. J. Acoust. Soc. Am. 1953;25(5):975–979. doi: 10.1121/1.1907229. [DOI] [Google Scholar]
  6. Dubno, J.R., Dirks, D.D., Morgan, D.E. Effects of age and mild hearing loss on speech recognition in noise. J. Acoust. Soc. Am. 1984;76(1):87–96. doi: 10.1121/1.2019841. [DOI] [PubMed] [Google Scholar]
  7. Gordon-Salant, S., Fitzgibbons, P.J. Temporal factors and speech recognition performance in young and elderly listeners. J. Speech Lang. Hear. Res. 1993;36(6):1276–1285. doi: 10.1044/jshr.3606.1276. [DOI] [PubMed] [Google Scholar]
  8. Humes, L.E., Dubno, J.R., Gordon-Salant, S., et al. Central presbycusis: A review and evaluation of the evidence. J. Am. Acad. Audiol. 2012;23(8):635–666. doi: 10.3766/jaaa.23.8.5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Humes, L.E., Kidd, G.R., Lentz, J.J. Auditory and cognitive factors underlying individual differences in aided speech-understanding among older adults. Front. Syst. Neurosci. 2013;7:55. doi: 10.3389/fnsys.2013.00055. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Kahneman, D., 1973. Attention and Effort. Englewood Cliffs: Prentice-Hall, 339–340.
  11. Kawase, T., Teraoka, R., Obuchi, C., et al. Temporal and directional cue effects on the cocktail party problem for patients with listening difficulties without clinical hearing loss. Ear Hear. 2022;43(6):1740–1751. doi: 10.1097/AUD.0000000000001247. [DOI] [PubMed] [Google Scholar]
  12. Martin, J.S., Jerger, J.F., 2005. Some effects of aging on central auditory processing. J. Rehabil. Res. Dev. 42(4 Suppl 2), 25–44. [DOI] [PubMed]
  13. Moore, D.R., Ferguson, M.A., Edmondson-Jones, A.M., et al. Nature of auditory processing disorder in children. Pediatrics. 2010;126(2):e382–e390. doi: 10.1542/peds.2009-2826. [DOI] [PubMed] [Google Scholar]
  14. Moore, D.R. Listening difficulties in children: Bottom-up and top-down contributions. J. Commun. Disord. 2012;45(6):411–418. doi: 10.1016/j.jcomdis.2012.06.006. [DOI] [PubMed] [Google Scholar]
  15. Moore, D.R. Guest editorial: Auditory processing disorder. Ear Hear. 2018;39(4):617–620. doi: 10.1097/AUD.0000000000000582. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Nilsson, M., Soli, S.D., Sullivan, J.A. Development of the Hearing in Noise Test for the measurement of speech reception thresholds in quiet and in noise. J. Acoust. Soc. Am. 1994;95(2):1085–1099. doi: 10.1121/1.408469. [DOI] [PubMed] [Google Scholar]
  17. Noble, W. Assessing binaural hearing: Results using the speech, spatial and qualities of hearing scale. J. Am. Acad. Audiol. 2010;21(9):568–574. doi: 10.3766/jaaa.21.9.2. [DOI] [PubMed] [Google Scholar]
  18. Noble, W., Jensen, N.S., Naylor, G., et al. A short form of the Speech, Spatial and Qualities of Hearing scale suitable for clinical use: The SSQ12. Int. J. Audiol. 2013;52(6):409–412. doi: 10.3109/14992027.2013.781278. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Obuchi, C., Kaga, K. Development of a questionnaire to assess listening difficulties in adults with auditory processing disorder. Hear. Balance Commun. 2020;18(1):29–35. doi: 10.1080/21695717.2019.1663055. [DOI] [Google Scholar]
  20. Obuchi, C., Kawase, T., Kaga, K., et al. Auditory attention ability under dichotic dual-task situation in adults with listening difficulties. Audiol. Neurotol. 2023;28(3):175–182. doi: 10.1159/000528050. [DOI] [PubMed] [Google Scholar]
  21. Obuchi, C., Kawase, T., Sasame, Y., et al. Traits of developmental disorders in adults with listening difficulties without diagnosis of autism spectrum disorder and/or attention-deficit/hyperactivity disorder. J. Clin. Med. 2024a;13(20):6281. doi: 10.3390/jcm13206281. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Passow, S., Westerhausen, R., Wartenburger, I., et al. Human aging compromises attentional control of auditory perception. Psychol. Aging. 2012;27(1):99–105. doi: 10.1037/a0025667. [DOI] [PubMed] [Google Scholar]
  23. Petley, L., Hunter, L.L., Motlagh Zadeh, L., et al. Listening difficulties in children with normal audiograms: Relation to hearing and cognition. Ear Hear. 2021;42(6):1640–1655. doi: 10.1097/AUD.0000000000001076. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Schafer, E.C., Mathews, L., Gopal, K., et al. Behavioral auditory processing in Children and Young Adults with autism Spectrum Disorder. J. Am. Acad. Audiol. 2020;31(9):680–689. doi: 10.1055/s-0040-1717138. [DOI] [PubMed] [Google Scholar]
  25. Tremblay, K.L., Pinto, A., Fischer, M.E., et al. Self-reported hearing difficulties among adults with normal audiograms: The beaver dam offspring study. Ear Hear. 2015;36(6):e290–e299. doi: 10.1097/AUD.0000000000000195. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Wang, M.M., Ai, Y., Han, Y.C., et al. Extended high-frequency audiometry in healthy adults with different age groups. J. Otolaryngol. Head Neck Surg. 2021;50(1):52. doi: 10.1186/s40463-021-00534-w. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Working Group on Speech Understanding and Aging Speech understanding and aging. J. Acoust. Soc. Am. 1988;83(3):859–895. doi: 10.17226/20619. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Articles from Journal of Otology are provided here courtesy of Chinese PLA General Hospital

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