Hidden Hearing Loss in Older Adults

Hidden Hearing Loss in Older Adults: Mechanisms of Speech-in-noise Perception Deficits and Associated Central Compensation

The goal of this observational study is to investigate whether speech-in-noise perception deficits in older adults aged 60 years or older with objectively normal hearing thresholds are due to impaired ability of processing temporal cues in speech signals. The study further aims to examine whether cognitive and cortical mechanisms provide compensatory support for speech perception in challenging listening environments.

Study Overview

• Status: Recruiting
• Conditions: Hidden Hearing Loss

Detailed Description

This observational study aims to investigate the peripheral auditory mechanisms underlying speech-in-noise perception deficits in older adults with hidden hearing loss, as well as the potential central compensatory mechanisms involved. The study will recruit community-dwelling adults aged 60 years and older who has objectively normal hearing thresholds on pure-tone audiometry but self-report difficulties understanding speech in noisy or complex listening environments.

The investigators hypothesize that speech-in-noise perception deficits in these individuals are associated with impaired ability of processing temporal cues in speech signals under challenging listening conditions. The investigators further hypothesize that cortical mechanisms involved in speech-in-noise processing may be recruited to facilitate speech understanding, although the extent of such compensation in the aging brain may vary across individuals.

The study will collect demographic, lifestyle, and health-related information. Participants will undergo comprehensive audiological assessments, neurophysiological testing, behavioral evaluations, and neuroimaging examinations. These measures will be used to characterize the ability of the peripheral auditory system to process temporal acoustic information and to investigate potential central compensatory mechanisms associated with speech perception in complex listening environments.

• Study Type: Observational
• Enrollment (Estimated): 200

Contacts and Locations

• Study Contact: Name: Rong Tian; Phone Number: 86+13718339118; Email: rongtian_7@163.com

Study Locations

• China
  • Shanghai Municipality
    • Shanghai, Shanghai Municipality, China, 200011
      • Recruiting
      • Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai, China
      • Contact: Rong Tian; Phone Number: 86+13718339118; Email: rongtian_7@163.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Community-dwelling adults aged 60 years and older residing in Shanghai, who has objectively normal hearing thresholds on pure-tone audiometry but self-report difficulties understanding speech in noisy or complex listening environments.

Description

Inclusion Criteria:

1. Aged 60 years or older;
2. Bilateral pure-tone average hearing thresholds across 0.5, 1, 2, and 4 kHz ≤ 25 dB HL;
3. Self-reported hearing difficulties identified during previous hearing screening;
4. Fluent in Mandarin Chinese;
5. No history of otologic disease, ear trauma, ototoxic medication history, or long-term noise exposure;
6. No known neurological or psychiatric disorders, or other major medical conditions that may affect nervous system function.

Exclusion Criteria:

1. Unable to comply with or complete the study assessments;
2. Mini-Mental State Examination (MMSE) score < 24 during previous health screening;
3. Refuse to participate in the study

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
older adults with hidden hearing loss; adults aged 60 years and older who has objectively normal hearing thresholds on pure-tone audiometry but self-report difficulties understanding speech in noisy or complex listening environments.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Conventional pure-tone audiometry (PTA) with extended high-frequency (0.25-16 kHz)	This measure reflects the overall audibility of the individual. Together with the other measures listed under the primary outcome measure, it provides a comprehensive assessment of participants' peripheral auditory function.	Participants will complete all study assessments within one month of enrollment.
Gap Detection Test (GDT)	This behavioral test assesses an individual's ability to detect brief silent gaps in an auditory signal, reflecting temporal resolution within the auditory system	Participants will complete all study assessments within one month of enrollment.
Distortion Product Otoacoustic Emissions (DPOAEs)	This objective measure evaluates cochlear outer hair cell. Together with the other measures listed under the primary outcome measure, it provides a comprehensive assessment of participants' peripheral auditory function.	Participants will complete all study assessments within one month of enrollment.
Electrocochleography	This objective measure assesses cochlear and auditory nerve function. Together with the other measures listed under the primary outcome measure, it provides a comprehensive assessment of participants' peripheral auditory function.	Participants will complete all study assessments within one month of enrollment.
Auditory Brainstem Response (ABR)	This objective measure assesses auditory nerve and brainstem function. Together with the other measures listed under the primary outcome measure, it provides a comprehensive assessment of participants' peripheral auditory function.	Participants will complete all study assessments within one month of enrollment.
Frequency-Following Response (FFR)	This objective measure assesses the neural encoding of sound by recording phase-locked neural responses to auditory stimuli. It reflects the ability of the auditory system to encode and resolve temporal information.	Participants will complete all study assessments within one month of enrollment.
Central neural activity during Memory task measured by fMRI		Participants will complete all study assessments within one month of enrollment
Central neural activity during listening task measured by fMRI		Participants will complete all study assessments within one month of enrollment.

Secondary Outcome Measures

Outcome Measure	Time Frame
Depressive symptoms assessed using the Patient Health Questionnaire-9 (PHQ-9)	Participants will complete all study assessments within one month of enrollment
Anxiety symptoms assessed using the Generalized Anxiety Disorder-7 (GAD-7)	Participants will complete all study assessments within one month of enrollment.
Cognitive function assessed using Digit Span test.	Participants will complete all study assessments within one month of enrollment.

Collaborators and Investigators

• Sponsor: Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University

Study record dates

Study Major Dates

• Study Start (Estimated): June 15, 2026
• Primary Completion (Estimated): May 1, 2027
• Study Completion (Estimated): May 30, 2027

Study Registration Dates

• First Submitted: June 3, 2026
• First Submitted That Met QC Criteria: June 9, 2026
• First Posted (Actual): June 12, 2026

Study Record Updates

• Last Update Posted (Actual): June 12, 2026
• Last Update Submitted That Met QC Criteria: June 9, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Cochlear Synaptopathy; Age-related Hearing Loss
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Otorhinolaryngologic Diseases; Sensation Disorders; Ear Diseases; Hearing Loss; Hearing Disorders; Hearing Loss, Sensorineural; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Hearing Loss, Hidden; Presbycusis
• Other Study ID Numbers: SH9H-2026-T21-2

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: IPD used in the results publication will be shared.
• IPD Sharing Time Frame: IPD and supporting information will be available for 5 years following publication.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No