Speaker
Description
Animal studies suggest that the earliest consequences of loud noise exposure may be audiometrically unapparent, or “hidden,” to conventional threshold‑based tests. In humans, difficulty understanding speech in noise (SiN) has been widely hypothesised as a primary functional consequence of such hidden hearing damage, leading to the view that objective SiN tests—such as the digit‑triplet test (DTT)—may serve as integrated markers of auditory peripheral integrity across both subclinical and overt stages. Here, we critically evaluate this assumption by characterising the inter-relationships among multiple hearing measures (DTTs, tinnitus, hearing-aid use, and self-reported hearing difficulty) and their dependence on key risk factors (age and lifetime noise exposure) in a large (N = 14,917) population-based sample from the UK Biobank (UKBB) imaging study. Descriptive analyses showed that, compared with self‑reported hearing measures and tinnitus, DTT performance was more sensitive to age and less sensitive to lifetime noise exposure. Path analysis suggested that the weak association between noise exposure—particularly leisure exposure to loud music—and DTTs may, at least in part, be due to a moderating effect of cognitive effort. Factor analysis indicated that the UKBB hearing measures are influenced by two primary causal drivers: one loading on DTTs and hearing aid use, consistent with clinically overt hearing damage, and a second loading on tinnitus and self-reported hearing difficulty, suggestive of a distinct subclinical damage dimension. Together, these findings challenge the interpretation of digit triplet SiN performance as a unified marker of hidden and overt auditory damage.