Interplay of age, speech perception in noise, standard and extended high-frequency hearing, and cochlear synaptopathy in individuals with normal audiograms

Older adults often complain about having difficulty understanding speech in noise, despite clinically normal hearing (D-SiN-NH). Two otopathologies known to decline with age and that are not reflected in the conventional audiogram are extended high-frequency (EHF) hearing impairment and cochlear synaptopathy (CS), both hypothesized to be responsible for D-SiN-NH....

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✦ The floor

Discussion

Signed responses from readers of the wire.

✦ Clinical Takeaway ✦

Extended high-frequency audiometry and cochlear synaptopathy measures may help explain speech-in-noise difficulties in patients with normal standard audiograms, but routine clinical adoption requires further validation before practice change is warranted.

✦ Why It Matters ✦

This study advances understanding of why patients with clinically normal audiograms still report hearing difficulties, potentially reshaping how audiologists evaluate and counsel this population.

✦ Key Points ✦

01Targets adults with normal conventional audiograms who nonetheless experience hearing difficulties.
02Examines the role of cochlear synaptopathy (hidden nerve damage) alongside age-related factors.
03Includes extended high-frequency (EHF) hearing measures beyond the standard audiogram range.
04Speech-in-noise perception is a core outcome, reflecting real-world hearing challenges.
05Published in Hearing Research, a peer-reviewed audiology journal.

✦ Claims & Evidence ✦

ClaimEvidenceSupport

Age, speech-in-noise perception, extended high-frequency hearing, and cochlear synaptopathy are interrelated in adults with normal audiograms.

studypartially supported

Cochlear synaptopathy contributes to hearing difficulties in individuals who pass standard audiometric screening.

studypartially supported

✦ Research metadata ✦

PMID: 42284997
DOI: 10.1016/j.heares.2026.109706.
Journal: Hearing Research
Publication type: research_article
Evidence level: 2b
Population: Adults with clinically normal audiograms
Intervention: Assessment of age, extended high-frequency hearing, and cochlear synaptopathy measures

Primary outcomes

Speech-in-noise perception; Extended high-frequency hearing thresholds; Cochlear synaptopathy markers

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