Characteristics of environmental sound perception in individuals with hearing loss: Associations with background factors.

OBJECTIVE: In this study, we aimed to compare open-set environmental sound perception performance and response patterns across four groups-hearing aid (HA) users, cochlear implant (CI) users, young normal-hearing adults, and older normal-hearing adults-and to examine background factors associated with environmental sound perception in the HA and CI groups. METHODS: Ninety participants were included: 21 HA users, 22 CI users, 24 young normal-hearing adults, and 23 older normal-hearing adults. Environmental sound perception was assessed using an open-set identification task with 36 environmental sounds presented in the sound field. Responses were classified as Perfect correct, Similar correct, Incorrect, or Unclassifiable. In the HA and CI groups, associations between environmental sound perception and individual background factors were examined. RESULTS: Environmental sound perception differed significantly across the four groups, with performance highest in the young normal-hearing group, followed by the older normal-hearing group, HA group, and CI group. Response patterns also differed significantly across groups. Compared with normal-hearing participants, HA and CI users showed higher proportions of Incorrect and Unclassifiable responses. In the HA group, sentence-level speech perception was the only significant predictor of environmental sound perception. In the CI group, no significant predictor was identified. CONCLUSIONS: Adults with hearing loss, including both HA and CI users, showed poorer open-set environmental sound perception than normal-hearing adults. The hearing-loss groups showed reduced exact identification and increased Incorrect and Unclassifiable responses, suggesting that open-set environmental sound perception difficulties were reflected in altered response patterns, particularly misidentification and difficulty providing a classifiable sound-source label. In HA users, environmental sound perception was associated with sentence-level speech perception, whereas no significant predictor was identified in CI users. These findings suggest that open-set assessment may provide useful information about real-world auditory function in adults with hearing loss that is not fully captured by conventional audiological measures.