Auditory Aging and Vulnerability of Short‑Term and Episodic Memory in Middle‑Aged Adults: A Narrative Review

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.2026.117650.3510

Abstract

Background:

Age-related auditory decline extends beyond pure-tone threshold elevation. In middle adulthood, subtle subclinical auditory processing changes—particularly under challenging listening environments like speech-in-noise—increase listening effort and cognitive load, potentially compromising memory performance even when conventional pure-tone thresholds remain within clinically normal limits.

Objective:

This narrative review synthesizes current evidence linking auditory aging, listening effort, cognitive load, and memory performance, focusing specifically 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 used to integrate behavioral, cognitive, and neurophysiological evidence published mainly after 2000. Studies examining central auditory processing, effortful listening, memory function, and related neural markers were systematically synthesized, highlighting middle age as a critical yet underexplored window.

Results:

Evidence indicates that subtle auditory processing alterations in midlife significantly elevate cognitive load during speech perception. To maintain comprehension, individuals recruit compensatory cognitive strategies, reallocating attentional and working memory resources toward sensory decoding. Although this adaptive mechanism preserves immediate speech understanding, it imposes a hidden cognitive cost: reduced efficiency in memory encoding and subsequent retrieval, particularly affecting episodic representations.

Conclusion:

Middle adulthood constitutes a crucial developmental window for examining the mechanisms linking auditory aging with cognitive vulnerability. Integrating audiological, cognitive, and neuroscientific perspectives reveals the inadequacy of standard threshold-based hearing assessments, emphasizing the necessity of evaluating listening effort and memory. This comprehensive framework enables early identification of cognitive vulnerability and promotes proactive, prevention-oriented audiological interventions.

Keywords

Main Subjects

References

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The Scientific Journal of Rehabilitation Medicine

Articles in Press, Accepted Manuscript
Available Online from 04 October 2026

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History

  • Receive Date: 02 October 2026
  • Revise Date: 04 October 2026
  • Accept Date: 04 October 2026
  • First Publish Date: 04 October 2026

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