Following a conversation in background noise is a necessary task in many common social settings, and yet, many individuals struggle to hear in noise. Older adults commonly report greater difficulty perceiving speech in noise than their audiograms would predict. Even many young adults with normal hearing thresholds experience challenges understanding speech when noise is present. Audiometric pure tone thresholds and measures of subcortical auditory processing, such as auditory brainstem responses, are well-established clinical measures that can help determine why a patient might have trouble hearing in noise. Cognitive components and adaptation to difficult listening environments also play a large role in real-world auditory perception, but are factors that are difficult to incorporate into clinical assessment. This presentation will describe research on the factors that contribute to accurate speech-in-noise perception in adults of all ages as well as the implications for clinical practice. The respective roles of cochlear function, auditory neural responses, and cognitive processing in speech-in-noise perception performance of young and older adults will be explored. Approaches for audiological assessments that may more holistically reflect everyday hearing ability will also be discussed.

Learning Objectives:

1. Explain the role of cognitive processing in speech-in-noise perception
2. Describe how auditory brainstem function impacts the ability to hear in noise
3. Demonstrate an understanding of the differences between young and older adults in the factors that influence their speech-in-noise understanding