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.

Background/Objectives: This study examined how different types of language activities in educational settings predict language ability in preschoolers with cochlear implants (CIs) versus normal-hearing (NH) peers. Predictor variables included two dimensions of language activities (language learning activities: shared reading, word games, and story retelling; daily communication activities: routine conversations and free play talk), as well as auditory utilization status (awareness of sounds, perception of speech sounds, and attentive listening to teachers/peers), learning attentional state, and family socioeconomic status (SERS). The outcome variable was language ability, measured with the Mandarin Clinical Evaluation of Language for Preschoolers’ Core Scale (MCELP-CS), and control variables included age and, for the CI group only, age of implantation. Methods: Participants included 189 CI (mean age = 4.53 years, SD = 0.83) and 210 NH preschoolers (mean age = 4.64 years, SD = 0.83). All predictor and control variables were collected via teacher-reported questionnaires (self-compiled by the research team). Statistical analyses used hierarchical regression with separate models for each group. Results: For the CI group, after controlling for age and age of implantation, engagement in language learning activities emerged as the most stable and independent predictor of language ability. Auditory utilization status was another significant predictor, and its inclusion substantially increased the model’s R2. For the NH group, language ability was primarily predicted by age-related maturation, with language learning activities showing additional predictive value, while daily communication activities and learning attentional state contributed very little. Conclusions: Findings suggest that for educational rehabilitation of CI preschoolers: increasing engagement in language learning activities in classrooms may be more beneficial than relying on daily conversation or merely improving attention alone; meanwhile, auditory utilization skills should also be fostered synergistically. Importantly, language intervention models designed for NH preschoolers cannot be directly transferred to CI preschoolers.

Objective In this study, we aimed to compare open-set environmental sound perception performance and response patterns across four groups—hearing aid (HA) users, cochlear implant (CI) users, young normal-hearing adults, and older normal-hearing adults—and to examine background factors associated with environmental sound perception in the HA and CI groups. Methods Ninety participants were included: 21 HA users, 22 CI users, 24 young normal-hearing adults, and 23 older normal-hearing adults. Environmental sound perception was assessed using an open-set identification task with 36 environmental sounds presented in the sound field. Responses were classified as Perfect correct, Similar correct, Incorrect, or Unclassifiable. In the HA and CI groups, associations between environmental sound perception and individual background factors were examined. Results Environmental sound perception differed significantly across the four groups, with performance highest in the young normal-hearing group, followed by the older normal-hearing group, HA group, and CI group. Response patterns also differed significantly across groups. Compared with normal-hearing participants, HA and CI users showed higher proportions of Incorrect and Unclassifiable responses. In the HA group, sentence-level speech perception was the only significant predictor of environmental sound perception. In the CI group, no significant predictor was identified. Conclusions Adults with hearing loss, including both HA and CI users, showed poorer open-set environmental sound perception than normal-hearing adults. The hearing-loss groups showed reduced exact identification and increased Incorrect and Unclassifiable responses, suggesting that open-set environmental sound perception difficulties were reflected in altered response patterns, particularly misidentification and difficulty providing a classifiable sound-source label. In HA users, environmental sound perception was associated with sentence-level speech perception, whereas no significant predictor was identified in CI users. These findings suggest that open-set assessment may provide useful information about real-world auditory function in adults with hearing loss that is not fully captured by conventional audiological measures.

Objective This systematic review aimed to clarify the current status of environmental sound perception in individuals with hearing loss using hearing aids and/or cochlear implants, and to identify effective support methods. Methods We systematically reviewed articles on environmental sound perception in individuals with hearing loss published between 1995 and June 22, 2025. Four databases (PubMed, Scopus, Google Scholar, and the Cochrane Library) were searched, and these searches were supplemented by a manual review of a prior systematic review on environmental sound perception in cochlear implant users and its reference list. Using PICOS criteria, we organized the evidence regarding the current status of environmental sound perception, associated factors, and the effects of interventions aimed at improvement. Risk of bias and levels of evidence were also assessed. Results Of 2609 records, 15 peer-reviewed original articles were included. In environmental sound identification tasks, individuals with hearing loss generally showed poorer performance than normal-hearing listeners; however, performance among individuals with hearing loss varied widely across studies depending on task format, the presence of contextual scenes, scoring methods, and device-related performance differences. Associations with background factors showed consistent correlations with speech perception performance and cognitive function, whereas findings for age and hearing thresholds were inconsistent. Acoustic characteristics, particularly frequency and temporal information, as well as categorical characteristics such as human sounds and non-verbal human vocalizations also influenced performance. Improvements in environmental sound identification associated with hearing aids and cochlear implant use alone were modest, whereas a training-based intervention study reported improved performance in environmental sound identification. Conclusions This systematic review indicates that environmental sound perception in individuals with hearing loss is generally poorer than that in normal-hearing listeners, although these difficulties may be restricted to specific stages of perception. Environmental sound perception is also influenced by individual background factors, device-related differences, and the acoustic and categorical characteristics of environmental sounds. Preliminary evidence from a single study suggests that training may improve environmental sound identification; however, further controlled studies are needed to confirm its efficacy and generalizability. These findings provide foundational knowledge to guide auditory rehabilitation.

OBJECTIVE:The objective of this study was to determine whether listening difficulties (LiD), defined as difficulties in understanding speech in noisy environments despite normal hearing, reflect cross-modal attentional limits under visual load in adults. DESIGN:This cross-sectional study used a dual-task paradigm (1-back visual plus visual-audio digit-matching) that required focused visual attention while monitoring auditory stimuli. Errors and reaction times were analysed. STUDY SAMPLE:Twenty adults with listening difficulties and 20 adult controls with normal hearing were enrolled. RESULTS:The participants with LiD performed significantly worse than the controls in the 1-back visual (U = 88.5, p = 0.002) and visual-audio matching tasks (U = 38.0, p < 0.001), with a larger effect size observed for the latter. The receiver operating characteristic analysis showed high discriminative accuracy for the visual-audio matching task (cut-off = 6 errors, sensitivity = 85%, specificity = 90%). The median reaction times did not differ (U = 149.0, p = 0.17), although they increased with errors (LiD: r(18)=0.79, p < 0.001; controls: r(18)=0.45, p = 0.05). CONCLUSIONS:The participants with LiD demonstrated limited cross-modal attentional capacity under visual load, which disproportionately disrupted auditory monitoring. The dual-task paradigm may serve as a sensitive tool for clinical differentiation of LiD and underscores the importance of evaluating cognitive contributions to LiD.

Background/Objectives: The dichotic listening test (DLT) is widely used to assess auditory attention and hemispheric language lateralization, with the right-ear advantage (REA) representing a robust behavioral phenomenon. Although the REA is often attributed to structural asymmetries in auditory pathways and left-hemisphere dominance for speech processing, the neural mechanisms by which selective attention modulates this asymmetry remain unclear. This study examined how directed auditory attention influences the REA and its neural correlates using magnetoencephalography (MEG)-based auditory steady-state responses (ASSRs). Methods: Fifteen right-handed participants performed directed-attention dichotic listening tasks during MEG recording. One participant was excluded from MEG analyses due to excessive noise contamination, resulting in 14 participants included in neural analyses. Participants attended to either the left or right ear throughout each session and reported the perceived stimulus from the attended ear. Dichotic speech stimuli were amplitude-modulated at 35 Hz and 45 Hz for frequency tagging. ASSR amplitudes were extracted from the left and right auditory cortices and analyzed in relation to behavioral accuracy using correlation analyses and analysis of covariance (ANCOVA). Results: Behavioral accuracy was significantly higher during right-ear attention than left-ear attention, indicating a residual REA. ASSR amplitudes tended to be higher during left-ear attention. Importantly, during left-ear attention, ASSR amplitude in the left auditory cortex showed a significant positive correlation with behavioral accuracy, whereas no such association was observed during right-ear attention. Conclusions: These findings indicate that the REA reflects a dynamic interaction between structural auditory asymmetry and top-down attentional control, with successful left-ear listening relying on compensatory recruitment of the left auditory cortex.

Background/Objectives: Individuals with listening difficulties (LiD) report problems understanding speech despite normal hearing sensitivity. This study investigated how speech characteristics (clarity, speaking rate, and loudness) influence subjective speech understanding in adults with LiD under quiet and noisy conditions, compared with individuals with normal hearing (NH) and those who are hard of hearing (HH). Methods: A questionnaire-based survey assessed perceived speech intelligibility across 12 listening conditions created by combining two environments (quiet and noisy) and six speaking styles. Participants included 77 adults with LiD (50 LiD without developmental disorders [DD] and 27 LiD and DD), 30 adults with NH, and 26 individuals with HH. Ratings were analyzed using analysis of variance and correlation analyses. Results: Both the LiD and HH groups demonstrated significantly reduced speech understanding in noisy environments when the speaking style was suboptimal, compared with the NH group. In contrast, the LiD group uniquely reported difficulties even under quiet conditions with clear, slow, and loud speech. Loud speech in quiet conditions was not consistently beneficial, particularly in the LiD and DD group, possibly reflecting auditory hypersensitivity. Conclusions: Listening difficulties in the LiD group are influenced by environmental and speaker-related factors and cannot be addressed solely by conventional strategies used for hearing loss. Although individualized communication approaches may be required, further investigation, including experimental studies, is necessary to validate this interpretation.

Context:People with listening difficulties (LiD) experience difficulty listening despite having no issues with hearing tests. Hearing is a sense, and can, therefore, be influenced by sensory characteristics. LiD symptoms may be related to the sensory characteristics in children with autism spectrum disorder (ASD); however, their influence on LiD is unclear.Aims:The aim of this study was to investigate the effects of sensory characteristics on children with LiD.Settings and Design:This was a cross-sectional study comparing the sensory characteristics of children with LiD.Subjects and Methods:Eleven, 16, and 41 children with LiD, LiD/ASD, and ASD without LiD, respectively, were enrolled. The Japanese version of the Sensory Profile includes six sections (auditory, visual, vestibular saturation, tactile, multisensory, and oral) and four quadrants (low registration, sensation seeking, sensory sensitivity, and sensory avoidance) to assess sensory characteristics. The results for each participant group were compared and statistically analyzed.Statistical Analysis Used:Kruskal-Wallis and Dwass-Steel-Critchlow-Fligner tests were used to compare performance between groups, while the Friedman test was used to compare scores within each group.Results:The ASD/LiD and ASD groups had all high section cores, while the LiD group had high auditory and multisensory scores. All three groups scored high on passive behavioral responses (low registration and sensory sensitivity), but active responses differed. LiD and ASD scored high in sensory avoidance and sensation seeking, respectively.Conclusions:Atypical auditory and multisensory perceptions may affect LiD symptoms. Furthermore, the difference between the sensory quadrant scores for children with LiD and ASD indicates differences in sensory characteristics.

Auditory temporal resolution plays a critical role in the everyday experience of listening to complex acoustic patterns. The two most commonly-used methods for assessing auditory temporal resolution are gap detection and amplitude modulation (AM) detection. In an attempt to develop a standardized clinical test of auditory temporal resolution, we used Zippy Estimation by Sequential Testing (ZEST), a Bayesian threshold estimation procedure, to measure gap and AM detection thresholds. ZEST is considered to be one of the most efficient threshold estimation methods and is more efficient than standard transformed up-down procedures. We conducted simulations and experiments, in which we measured gap and AM detection thresholds using ZEST in two stages. In the first stage, we tried to identify ZEST parameters that would yield efficient and precise threshold measurements. The results showed that with appropriate sets of parameter values it was possible to complete the threshold measurements within 20 trials with reasonable precision. In the second stage, we used bimodal distributions consisting of the threshold distributions of normal-hearing and hearing-impaired participants, which were obtained in the first stage, as the initial probability density functions for ZEST. The use of these bimodal distributions further speeded up the threshold measurements.

Objective: People with hearing loss often encounter difficulties in hearing under adverse conditions, such as listening in the presence of noise. Listening effort is an indicator used to assess listening difficulties in daily life. Although many studies on listening effort have been conducted in recent years, there is a notable gap in the exploration of how task load influences listening effort in young adults. This study compared the effects of background noise and memory load on task performance and subjective listening effort in young adults with and without hearing loss. Methods: The study included a group of 8 adults with hearing loss (mean age: 24.1 +/- 6.0 years) and a group of 16 individuals with normal hearing (mean age: 27.9 +/- 4.9 years). A number memorizing task was conducted, involving two types of auditory digits (either three or seven digits) presented under multi-talker babble noise conditions of signal-to-noise ratio of-5 dB [SN-5 dB] or SN +5 dB. Participants determined whether the number presented in the encoding interval matched the one presented in the retrieval interval. Subsequently, they were asked to complete a questionnaire using a Visual Analog Scale (VAS) to assess their subjective listening effort. Percentage of correct responses, reaction times, and VAS ratings were compared between adults with and without hearing loss. Results: Our results showed significant differences between the two groups in the percentage of correct responses and the reaction time under the SN-5 dB conditions, regardless of the memory load. Under the SN +5 dB conditions, a significant difference was found only in the percentage of correct responses for seven digits. In the normal hearing group, the percentage of correct responses and VAS ratings tended to decrease as the memory load increased, even under the same noise condition. Conversely, in the hearing loss group, a consistent trend could not be identified in the effects of noise and memory load on the percentage of correct responses and VAS ratings. Conclusion: These results suggest that in conditions of high noise load, young adults with hearing loss show a higher tendency for listening effort to be affected by other loads. We confirmed that for some participants with hearing loss, the task exceeded a certain level of difficulty in the SN-5 dB and seven digits condition, leading to a change in their motivation and strategy used. Future research should examine ways to control for participants' motivations.

Background: A short and easy questionnaire is needed to identify symptoms of listening difficulties (LiD) at an early stage. This study aimed to evaluate the utility of such a questionnaire for adolescents with and without LiD. Methods: We included adolescents with and without LiD and adults without LiD in this study. We utilized a questionnaire designed for individuals with LiD, which combined the Speech, Spatial, and Quality of Hearing scales (SSQ)-12 and four additional psychological items. From this, we selected three items that exhibited the largest differences between adolescents with and without LiD. We subsequently examined the relationship between the total scores of all items and the three selected items to develop the short questionnaire. Results: The responses of adolescents to the questionnaire were consistent with those of adults. The total scores from the three selected items exhibited a strong correlation with the overall questionnaire score for adolescents both with and without LiD, indicating their potential for identifying LiD symptoms. Conclusions: The wide implementation of the short questionnaire developed in this study could lead to the early detection of potential LiD symptoms and timely intervention.

要旨 : 本研究では, 難聴学齢児は皮肉の文脈が明示された場合, 皮肉発話をどのように解釈するのかを明らかにすることを目的とする。難聴児18名および聴児157名に対し, 皮肉発話の意図を問う自由記述課題を実施した。その結果, 軽度~重度難聴の補聴器および人工内耳装用学齢児で言語発達が良好な児は, 文脈情報が明示された場合, 聴児と同様に皮肉発話の否定的感情を理解することが可能であることが明らかとなった。しかし, 聴児とは質的に異なる解答をする難聴児が一部存在し, これらの質的な差異が実際のコミュニケーション場面における皮肉理解にどのような影響を及ぼすのか検討する必要性が示唆された。また, 皮肉理解の成績と聴覚機能, 語彙力には相関が認められなかった。このため, 皮肉理解の獲得については, 日常の会話経験や養育者の皮肉使用, 友人関係など, 聴覚機能や言語力にその他の要因を加えて広く検討していくことが今後の課題であるといえる。