Tehran University of Medical Sciences Auditory and Vestibular Research 2423-480X 0 0 2026 04 29 1529 1529 Vishal Kooknoor JSS Institute of Speech and Hearing Sanjana Singh S Department of Audiology, JSS Institute of Speech and Hearing Impana L Kikkeri Department of Audiology, JSS Institute of Speech and Hearing 2025 12 20 2026 04 29 Background and Aim: The contributions of auditory and cognitive factors to speech perception in noise in the elderly are well studied; however, the roles of adaptive mechanisms, such as Rapid Adaptation (RA) and Perceptual Learning Ability (PLA), are less well explored. This study examined the relative contributions of RA, PLA, auditory processing and cognitive abilities towards speech perception in noise in the elderly. Methods: Seventy-eight participants aged 60–75 years were divided into three groups: elderly with normal hearing (ENH), elderly with hearing impairment (EHI), and elderly with hearing aid (EHA). Auditory processing, cognitive abilities, and speech perception in noise were assessed. RA was quantified as the learning slope during exposure to time-compressed speech, and PLA was measured as retained improvement from pre- to post-training after a 2–4-day interval. Results: Significant group differences were observed across auditory processing, cognitive measures, baseline speech perception, RA, and PLA. RA differentiated normal-hearing participants from hearing-impaired participants but did not differentiate between hearing-impaired participants. PLA emerged as the strongest predictor of speech perception in noise in the hearing-impaired groups, accounting for substantial variance beyond auditory and cognitive factors, whereas auditory measures predominated in the normal-hearing group. Conclusion: RA and PLA make distinct contributions to speech perception in noise among elderly listeners. Adaptive mechanisms were not influenced by the hearing aid use, highlighting the need for rehabilitation approaches that incorporate targeted perceptual learning–based auditory training along with amplification. https://avr.tums.ac.ir/index.php/avr/article/view/1529