Associations of Word Recognition in Noise with Perceived Hearing Handicap and Quality of Life in Older Adults with Sensorineural Hearing Loss

Abstract

Background/Objectives: Pure-tone audiometry and word recognition scores (WRS) obtained in quiet may not fully reflect everyday hearing difficulties. This study examined how WRS across different listening conditions relate to perceived hearing handicap and quality of life in older adults with sensorineural hearing loss, and whether they explain perceived handicap beyond demographic and audiological variables. Methods: Seventy-nine older adults with sensorineural hearing loss were included. WRS were assessed in quiet and at +10 dB and 0 dB signal-to-noise ratios (SNRs) using ipsilateral speech noise. Perceived hearing handicap and quality of life were evaluated using the Turkish Hearing Handicap Inventory for the Elderly (HHIE) and World Health Organization Quality of Life-Older Adults Module (WHOQOL-OLD), respectively. Listening conditions were compared using Friedman and Bonferroni-corrected Wilcoxon tests. Associations were examined with Spearman correlations, and hierarchical regression assessed the independent contribution of WRS after adjustment for age, pure-tone average, hearing loss duration, and tinnitus. Results: WRS decreased from 88% in quiet to 72% at +10 dB SNR and 32% at 0 dB SNR (p < 0.001). Lower WRS was associated with greater hearing handicap, most strongly at 0 dB SNR (r = −0.491, p < 0.001), while no significant association was observed with overall quality of life. Both speech-in-noise conditions explained a similar amount of additional variance in HHIE total scores beyond demographic and audiological variables (+10 dB SNR, ΔR2 = 0.037, p = 0.054; 0 dB SNR, ΔR2 = 0.042, p = 0.039). Conclusions: Word recognition in noise reflected perceived hearing handicap better than performance in quiet. Speech recognition in noise may complement hearing-specific self-report measures in evaluating everyday hearing difficulties.