Document Type : Review Article
Authors
1
ENT and Head and Neck Research Center and Department, the Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
2
PhD in Audiology, Associate Professor, Department of Audiology, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3
Department of Performing Arts, College of Fine Arts, University of Tehran, Tehran, Iran
4
Ph.D. Student in Audiology, Department of Audiology ,m School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
10.22037/sjrm.2026.117555.3440
Abstract
Background:
Age-related auditory decline is increasingly recognized as a multidimensional process that extends beyond pure-tone threshold elevation. Subtle changes in auditory processing, particularly under challenging listening conditions such as speech-in-noise, may emerge as early as midlife. These changes often increase listening effort and cognitive load, potentially compromising memory performance even when conventional audiometric measures remain within normal limits.
Objective:
This narrative review aims to synthesize current evidence on the relationship between auditory aging, listening effort, cognitive load, and memory performance, with a specific focus on middle-aged adults. Emphasis is placed on short-term and episodic memory as sensitive cognitive domains reflecting the downstream consequences of effortful listening.
Methods:
A narrative review approach was employed to integrate behavioral, cognitive, and neurophysiological findings published primarily after 2000. Studies addressing auditory processing beyond pure-tone sensitivity, effortful listening, memory function, and associated neural markers were selectively reviewed, with middle adulthood considered a critical yet underexplored period.
Results:
The reviewed evidence suggests that even mild auditory processing changes in midlife can substantially increase cognitive load during speech perception. To maintain adequate speech understanding, individuals increasingly rely on compensatory cognitive mechanisms, reallocating attentional and working memory resources. While such mechanisms support immediate comprehension, they incur a hidden cognitive cost, manifested as reduced efficiency in memory encoding and subsequent recall, particularly for episodic information.
Conclusion:
Middle adulthood represents a critical window for observing the mechanisms linking auditory decline to cognitive vulnerability, rather than merely their clinical consequences. Integrating auditory, cognitive, and neural perspectives highlights the limitations of threshold-based hearing assessment and underscores the importance of evaluating listening effort and memory function. This framework supports earlier identification of cognitive vulnerability and informs more comprehensive, prevention-oriented approaches in audiological practice.
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