Audiometric, Perceptual and Subjective Cognitive Assessment of Hearing Loss in Adults with Hearing-Related Complaints

Background: Pure-tone audiometry (PTA) does not fully capture functional hearing difficulties. This study examined relationships between audiometric thresholds, self-reported hearing quality (SSQ12), and cognitive screening in patients with auditory complaints, as well as the association of other factors such as age and noise exposure with these measures. Methods: Data from 178 patients complaining about subjective hearing loss (mean age 55 ± 17.4 years; 43.3% male), including PTA and SSQ12, were analyzed. A subgroup of 60 patients aged ≥ 60 years also completed the Subjective Cognitive Decline Questionnaire (MiCog/SuCog). Associations were assessed via bivariate correlation and multiple linear regression analyses. Results: Age was independently associated with higher PTA4 thresholds in both ears (right: B = 0.60 dB HL per year, 95% CI 0.47-0.73; left: B = 0.61 dB HL per year, 95% CI 0.48-0.74; p < 0.001). SSQ12 scores correlated with PTA (right ear ρ = -0.532) and age (ρ = -0.283; both p < 0.001) and were lower in noise-exposed participants after adjusting for PTA, age, sex and tinnitus (B = -1.005, 95% CI -1.565 to -0.446, p < 0.001). In the cognitive subgroup, right-ear PTA showed an unadjusted correlation with MiCog (ρ = 0.332, p = 0.010); in the adjusted model, neither PTA nor any other predictor was independently associated with MiCog (PTA: B = 0.095, 95% CI -0.075 to 0.264, p = 0.266). No significant association was found between MiCog and the SSQ12 total score (Pearson r = -0.166, p = 0.204; Spearman ρ = -0.241, p = 0.064). Conclusions: Audiometric thresholds, self-reported hearing quality, and cognitive screening capture partially distinct, interrelated dimensions of auditory function. Self-reported measures revealed noise-related difficulties undetected by audiometry. These findings support incorporating patient- and informant-reported outcomes alongside audiometry to support a more comprehensive, patient-centered approach to hearing and cognitive care.