Relationships between extended high frequency hearing, cognition, and speech-in-noise performance

Abstract

Impaired speech-in-noise performance is a primary patient complaint in audiology clinics, and in addition to standard frequency (SF; 0.25–8 kHz) sensitivity, age, and cognition, recent work as focused on the association of extended high frequency (EHF, > 8 kHz) sensitivity with this degraded performance. Despite this accepted relationship, clinical utility of EHFs is limited because there is not a universally accepted cutoff value for normal vs. impaired sensitivity. The objective of the current study was to analyze the relationship between EHF sensitivity, SF sensitivity, cognition, and age with speech in-noise performance, as measured by the Words-in-Noise (WIN) test. The SF audiometry, EHF audiometry, and speechin-noise assessments were measured in 605 listeners between the years 2015 and 2024. Pure tone average (PTA) for both the SF (PTA SF : 0.5, 1, 2, & 4 kHz) and EHF (PTA EHF : 9, 10, 12.5, & 14 kHz) were calculated for each participant. A normal hearing (NH) group was defined by having a PTA SF ≤ 20 dB HL ( N = 700 ears) and a hearing loss group (HL) had a PTA SF > 20 dB HL ( N = 505 ears). Cognition was also measured via the Montreal Cognitive Assessment (MoCA) in 524 of the participants. PTA SF and PTA EHF were both found to be associated with WIN performance across all participants. However, when we analyzed solely participants with NH, PTA EHF explained more variance in WIN thresholds than PTA SF . Data were further assessed to determine functional cutoffs. The NH participants were broken into 5-dB-HL bins to determine cutoff values for WIN performance, and significant cutoffs were found at a PTA SF > 10 dB HL and a PTA EHF > 35 dB HL. The EHF PTA , MoCA scores, and age each had a significant effect on WIN threshold, but EHF PTA was found to be a stronger predictor, despite limited EHF spectral information in the WIN stimuli. These findings are consistent with previous literature and support the clinical relevance of EHF sensitivity. EHF threshold measurements may provide valuable information, given their association with speech-in-noise deficits, a common patient complaint.