Abstract
This study examined whether a gamified and personalized auditory-cognitive training (ACT) program could improve naturalistic speech-in-noise (SIN) comprehension in older adults with mild-to-moderate hearing loss. In a randomized controlled trial, 54 older participants with hearing loss were assigned to four weeks of ACT or an active control condition. SIN comprehension was assessed using conversational sentences embedded in cafeteria noise. Complementary measures assessed working memory, selective attention, phonological short-term memory, divided attention, speech intelligibility, subjective hearing ratings, and subjective listening effort. Participants completing ACT demonstrated significant improvements in SIN comprehension, with partial cognitive gains, which remained at follow-up. Active controls showed no improvements. SIN intelligibility did not change in either group, indicating a dissociation between low-level fidelity and higher-order comprehension. No changes emerged in subjective hearing reports. These findings underline ACT's potential for supporting SIN comprehension in older adults with hearing loss, offering a promising complement to traditional auditory rehabilitation.