Noise Tolerance and Speech-in-Noise Performance under Binaural Listening in Young Normal-Hearing and Older Hearing-Impaired Adults
,
Abstract
Background and Aim: Age-Related Hearing Loss (ARHL) impairs speech understanding in noise. Acceptable Noise Level (ANL) reflects noise tolerance and predicts hearing-aid outcomes, while Speech-in-Noise (SIN) ability is indexed by Signal-to-Noise Ratio required for 50% correct recognition (SNR-50). Their relationship under binaural listening remains unclear. This study examined binaural ANL and SIN performance in young normal-hearing and older hearing-impaired adults to determine their association and identify audiometric predictors.
Methods: Sixty-nine adults participated: 37 young normal-hearing (18–30 years) and 32 older adults with ARHL (60–80 years). Binaural ANL was measured using Persian continuous discourse with 12-talker babble. SIN performance was assessed binaurally using a monosyllabic word test, with SNR-50 estimated by the Spearman-Kärber method. Group comparisons, correlations, and regression analyses examined age effects and audiometric predictors.
Results: Older adults showed higher most comfortable levels and ANL values, indicating reduced noise tolerance, and poorer SIN performance with higher SNR-50 and greater variability. Binaural ANL was not associated with SNR-50 in either group. In older adults, SIN performance was predicted by high-frequency thresholds and hearing loss severity, whereas ANL was not a significant predictor.
Conclusion: Under binaural conditions, noise tolerance and speech intelligibility are dissociable. In older adults, SIN ability was predicted by high-frequency hearing sensitivity and overall hearing loss severity, whereas ANL was not a significant predictor, underscoring the importance of multidimensional auditory assessment in clinical practice.
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17. Nabelek AK, Tucker FM, Letowski TR. Toleration of background noises: relationship with patterns of hearing aid use by elderly persons. J Speech Hear Res. 1991;34(3):679-85.
18. Nilsson M, Soli SD, Sullivan JA. 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):1085-99. [DOI:10.1121/1.408469]
19. Bavandi A, Ashrafi M, Mohammadzadeh A. A Descriptive Study on the Effect of Music on Speech-in-Noise Perception in Binaural and Monaural Hearing Aid Users. Indian J Otolaryngol Head Neck Surg. 2024;76(6):5176-82. [DOI:10.1007/s12070-024-04929-9]
20. Nabelek AK, Freyaldenhoven MC, Tampas JW, Burchfiel SB, Muenchen RA. Acceptable noise level as a predictor of hearing aid use. J Am Acad Audiol. 2006;17(9):626-39. [DOI:10.3766/jaaa.17.9.2]
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22. Kim JH, Lee JH, Lee HK. Advantages of binaural amplification to acceptable noise level of directional hearing aid users. Clin Exp Otorhinolaryngol. 2014;7(2):94-101. [DOI:10.3342/ceo.2014.7.2.94]
23. Best V, Gallun FJ, Carlile S, Shinn-Cunningham BG. Binaural interference and auditory grouping. J Acoust Soc Am. 2007;121(2):1070-6. [DOI:10.1121/1.2407738]
24. Emsaki G, Molavi H, Chitsaz A, Movahed Abtahi M, Asgari K. [Psychometric properties of the Montreal Cognitive Assessment (MoCA) in Parkinson's disease patients in Isfahan]. J Isfahan Med Sch. 2011;29(158):1606-15. Persian.
25. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695-9. [DOI:10.1111/j.1532-5415.2005.53221.x]
26. Ahmadi A, Fatahi J, Keshani A, Jalilvand H, Modarresi Y, Jalaie S. [Developing and evaluating the reliability of acceptable noise level test in Persian language]. J Rehab Med. 2015;4(2):109-17. Persian.
27. Mahdavi ME, Rabiei A. Psychometric function characteristics of Persian consonant vowel-consonant words. Aud Vestib Res. 2021;30(1):50-5. [DOI:10.18502/avr.v30i1.5311]
28. Wu YH, Stangl E, Pang C, Zhang X. The effect of audiovisual and binaural listening on the acceptable noise level (ANL): establishing an ANL conceptual model. J Am Acad Audiol. 2014;25(2):141-53. [DOI:10.3766/jaaa.25.2.3]
29. Hogan CA, Turner CW. High-frequency audibility: benefits for hearing-impaired listeners. J Acoust Soc Am. 1998;104(1):432-41. [DOI:10.1121/1.423247]
30. Sato H, Morimoto M, Ota R. Acceptable range of speech level in noisy sound fields for young adults and elderly persons. J Acoust Soc Am. 2011;130(3):1411-9. [DOI:10.1121/1.3609122]
31. Motlagh Zadeh L, Silbert NH, Sternasty K, Swanepoel W, Hunter LL, Moore DR. Extended high-frequency hearing enhances speech perception in noise. Proc Natl Acad Sci U S A. 2019;116(47):23753-9. [DOI:10.1073/pnas.1903315116]
32. Gordon-Hickey S, Morlas H. Speech Recognition at the Acceptable Noise Level. J Am Acad Audiol. 2015;26(5):443-50. [DOI:10.3766/jaaa.14079]
33. Nasiri E, Jalilvand H, Mahdavi ME, Koravand A. Auditory Recognition of Words-in-Noise in Normal Hearing and Mild-to-Severe Sensorineural Hearing Loss with Different Configurations. Aud Vestib Res. 2024;33(2):110-7. [DOI:10.18502/avr.v33i2.14813]
34. Smith ML, Winn MB, Fitzgerald MB. A Large-Scale Study of the Relationship Between Degree and Type of Hearing Loss and Recognition of Speech in Quiet and Noise. Ear Hear. 2024;45(4):915-28. [DOI:10.1097/AUD.0000000000001484]
35. Davis A, McMahon CM, Pichora-Fuller KM, Russ S, Lin F, Olusanya BO, et al. Aging and Hearing Health: The Life-course Approach. Gerontologist. 2016;56 Suppl 2(Suppl 2):S256-67. [DOI:10.1093/geront/gnw033]
36. Taghavi SMR, Mohammadkhani G, Jalilvand H. Speech intelligibility index: a literature review. Aud Vestib Res. 2022;31(3):148-57. [DOI:10.18502/avr.v31i3.9861]
37. Fatemi N, Mahdavi ME, Jalilvand H, Baghban AA. Hearing Aid Outcome Measures and Auditory Processing in Elderly Users of Binaural Amplification. Aud Vestib Res. 2025,34(2):169-77. [DOI:10.18502/avr.v34i2.18060]
2. World Health Organization. Ageing and health. Geneva: World Health Organization; 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
3. Sharma RK, Lalwani AK, Golub JS. Prevalence and Severity of Hearing Loss in the Older Old Population. JAMA Otolaryngol Head Neck Surg. 2020;146(8):762-3. [DOI:10.1001/jamaoto.2020.0900]
4. Yamasoba T, Lin FR, Someya S, Kashio A, Sakamoto T, Kondo K. Current concepts in age-related hearing loss: epidemiology and mechanistic pathways. Hear Res. 2013;303:30-8. [DOI:10.1016/j.heares.2013.01.021]
5. Rahne T, Wagner TM, Kopsch AC, Plontke SK, Wagner L. Influence of Age on Speech Recognition in Noise and Hearing Effort in Listeners with Age-Related Hearing Loss. J Clin Med. 2023;12(19):6133. [DOI:10.3390/jcm12196133]
6. Mick P, Kawachi I, Lin FR. The association between hearing loss and social isolation in older adults. Otolaryngol Head Neck Surg. 2014;150(3):378-84. [DOI:10.1177/0194599813518021]
7. Vermeire K, Knoop A, Boel C, Auwers S, Schenus L, Talaveron-Rodriguez M, et al. Speech Recognition in Noise by Younger and Older Adults: Effects of Age, Hearing Loss, and Temporal Resolution. Ann Otol Rhinol Laryngol. 2016;125(4):297-302. [DOI:10.1177/0003489415611424]
8. Füllgrabe C, Moore BC, Stone MA. Age-group differences in speech identification despite matched audiometrically normal hearing: contributions from auditory temporal processing and cognition. Front Aging Neurosci. 2015;6:347. [DOI:10.3389/fnagi.2014.00347]
9. Lesica NA. Why Do Hearing Aids Fail to Restore Normal Auditory Perception? Trends Neurosci. 2018;41(4):174-85. [DOI:10.1016/j.tins.2018.01.008]
10. Jayakody DMP, Friedland PL, Martins RN, Sohrabi HR. Impact of Aging on the Auditory System and Related Cognitive Functions: A Narrative Review. Front Neurosci. 2018;12:125. [DOI:10.3389/fnins.2018.00125]
11. Parthasarathy A, Kujawa SG. Synaptopathy in the Aging Cochlea: Characterizing Early-Neural Deficits in Auditory Temporal Envelope Processing. J Neurosci. 2018;38(32):7108-19. [DOI:10.1523/JNEUROSCI.3240-17.2018]
12. Ng CW, Recanzone GH. Age-Related Changes in Temporal Processing of Rapidly-Presented Sound Sequences in the Macaque Auditory Cortex. Cereb Cortex. 20181;28(11):3775-96. [DOI:10.1093/cercor/bhx240]
13. Peelle JE, Wingfield A. The Neural Consequences of Age-Related Hearing Loss. Trends Neurosci. 2016;39(7):486-97. [DOI:10.1016/j.tins.2016.05.001]
14. Yancey CM, Barrett ME, Gordon-Salant S, Brungart DS. Binaural advantages in a real-world environment on speech intelligibility, response time, and subjective listening difficulty. JASA Express Lett. 2021;1(1):014406. [DOI:10.1121/10.0003193]
15. Kartal A, Konukseven O. Age-related altering temporal processing and binaural interaction functions in normal hearing individuals: Observational and cross-sectional study. Auris Nasus Larynx. 2021;48(4):615-21. [DOI:10.1016/j.anl.2020.11.015]
16. Ashrafi M, Baghban AA. Dynamic Spatial Auditory Processing in the Elderly. Indian J Otolaryngol Head Neck Surg. 2024;76(4):3031-6. [DOI:10.1007/s12070-024-04581-3]
17. Nabelek AK, Tucker FM, Letowski TR. Toleration of background noises: relationship with patterns of hearing aid use by elderly persons. J Speech Hear Res. 1991;34(3):679-85.
18. Nilsson M, Soli SD, Sullivan JA. 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):1085-99. [DOI:10.1121/1.408469]
19. Bavandi A, Ashrafi M, Mohammadzadeh A. A Descriptive Study on the Effect of Music on Speech-in-Noise Perception in Binaural and Monaural Hearing Aid Users. Indian J Otolaryngol Head Neck Surg. 2024;76(6):5176-82. [DOI:10.1007/s12070-024-04929-9]
20. Nabelek AK, Freyaldenhoven MC, Tampas JW, Burchfiel SB, Muenchen RA. Acceptable noise level as a predictor of hearing aid use. J Am Acad Audiol. 2006;17(9):626-39. [DOI:10.3766/jaaa.17.9.2]
21. Shetty HN, Raju S, Singh SS. The relationship between age, acceptable noise level, and listening effort in middle-aged and older-aged individuals. J Otol. 2023;18(4):220-9. [DOI:10.1016/j.joto.2023.09.004]
22. Kim JH, Lee JH, Lee HK. Advantages of binaural amplification to acceptable noise level of directional hearing aid users. Clin Exp Otorhinolaryngol. 2014;7(2):94-101. [DOI:10.3342/ceo.2014.7.2.94]
23. Best V, Gallun FJ, Carlile S, Shinn-Cunningham BG. Binaural interference and auditory grouping. J Acoust Soc Am. 2007;121(2):1070-6. [DOI:10.1121/1.2407738]
24. Emsaki G, Molavi H, Chitsaz A, Movahed Abtahi M, Asgari K. [Psychometric properties of the Montreal Cognitive Assessment (MoCA) in Parkinson's disease patients in Isfahan]. J Isfahan Med Sch. 2011;29(158):1606-15. Persian.
25. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695-9. [DOI:10.1111/j.1532-5415.2005.53221.x]
26. Ahmadi A, Fatahi J, Keshani A, Jalilvand H, Modarresi Y, Jalaie S. [Developing and evaluating the reliability of acceptable noise level test in Persian language]. J Rehab Med. 2015;4(2):109-17. Persian.
27. Mahdavi ME, Rabiei A. Psychometric function characteristics of Persian consonant vowel-consonant words. Aud Vestib Res. 2021;30(1):50-5. [DOI:10.18502/avr.v30i1.5311]
28. Wu YH, Stangl E, Pang C, Zhang X. The effect of audiovisual and binaural listening on the acceptable noise level (ANL): establishing an ANL conceptual model. J Am Acad Audiol. 2014;25(2):141-53. [DOI:10.3766/jaaa.25.2.3]
29. Hogan CA, Turner CW. High-frequency audibility: benefits for hearing-impaired listeners. J Acoust Soc Am. 1998;104(1):432-41. [DOI:10.1121/1.423247]
30. Sato H, Morimoto M, Ota R. Acceptable range of speech level in noisy sound fields for young adults and elderly persons. J Acoust Soc Am. 2011;130(3):1411-9. [DOI:10.1121/1.3609122]
31. Motlagh Zadeh L, Silbert NH, Sternasty K, Swanepoel W, Hunter LL, Moore DR. Extended high-frequency hearing enhances speech perception in noise. Proc Natl Acad Sci U S A. 2019;116(47):23753-9. [DOI:10.1073/pnas.1903315116]
32. Gordon-Hickey S, Morlas H. Speech Recognition at the Acceptable Noise Level. J Am Acad Audiol. 2015;26(5):443-50. [DOI:10.3766/jaaa.14079]
33. Nasiri E, Jalilvand H, Mahdavi ME, Koravand A. Auditory Recognition of Words-in-Noise in Normal Hearing and Mild-to-Severe Sensorineural Hearing Loss with Different Configurations. Aud Vestib Res. 2024;33(2):110-7. [DOI:10.18502/avr.v33i2.14813]
34. Smith ML, Winn MB, Fitzgerald MB. A Large-Scale Study of the Relationship Between Degree and Type of Hearing Loss and Recognition of Speech in Quiet and Noise. Ear Hear. 2024;45(4):915-28. [DOI:10.1097/AUD.0000000000001484]
35. Davis A, McMahon CM, Pichora-Fuller KM, Russ S, Lin F, Olusanya BO, et al. Aging and Hearing Health: The Life-course Approach. Gerontologist. 2016;56 Suppl 2(Suppl 2):S256-67. [DOI:10.1093/geront/gnw033]
36. Taghavi SMR, Mohammadkhani G, Jalilvand H. Speech intelligibility index: a literature review. Aud Vestib Res. 2022;31(3):148-57. [DOI:10.18502/avr.v31i3.9861]
37. Fatemi N, Mahdavi ME, Jalilvand H, Baghban AA. Hearing Aid Outcome Measures and Auditory Processing in Elderly Users of Binaural Amplification. Aud Vestib Res. 2025,34(2):169-77. [DOI:10.18502/avr.v34i2.18060]
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How to Cite
1.
Nazmi Z, Jalilvand H, Mahdavi ME, Akbarzadeh Baghban A. Noise Tolerance and Speech-in-Noise Performance under Binaural Listening in Young Normal-Hearing and Older Hearing-Impaired Adults. Aud Vestib Res. 2026;.
