Personalized and Gamified Auditory-Cognitive Training Improves Naturalistic Speech-In-Noise Comprehension in Older Adults with Hearing Loss

This study examined whether a gamified and personalized auditory-cognitive training (ACT) program could improve naturalistic speech-in-noise (SIN) comprehension in older adults with mild-to-moderate hearing loss. In a randomized controlled trial, 54 participants (ages 65–82) were assigned to either four weeks of ACT or an active control condition involving foreign language training. Pre- and post-training assessments evaluated SIN comprehension using conversational sentences embedded in cafeteria noise, along with standardized measures of working memory, selective attention, phonological short-term memory, divided attention, speech intelligibility, subjective hearing ratings, and perceived listening effort. Participants who completed ACT demonstrated significant improvements in SIN comprehension, with cognitive gains—specifically in working memory, selective attention, and phonological short-term memory—sustained at a two-month follow-up. No such gains were observed in the active control group. However, speech intelligibility, as assessed via standard clinical measures, did not change significantly in either group, indicating a dissociation between low-level fidelity and higher-order comprehension. No significant group differences emerged for subjective hearing ratings or perceived listening effort, although a nonsignificant trend toward reduced listening effort was noted following ACT. These findings suggest that auditory-cognitive training can strengthen cognitive mechanisms supporting real-world communication in older adults with hearing loss, offering a promising complement to traditional auditory rehabilitation.