PP320 - The Adult Auditory Performance Scale (AAPS): A Way to Assess Listening Difficulty in Adults

Abstract:
The Adult Auditory Performance Scale (AAPS) is a subjective measure of listening difficulty. Unlike other measures, the AAPS assesses listening difficulty in multiple domains which can be divided into easy, noisy, and complex situations. This study investigated the subjective listening difficulty as measured by the AAPS for a large group (N=147) of young adults, as well as a group of middle aged (N=37), and older adults (N=30). Results indicate that middle-aged and older adults reported significantly greater listening difficulty than younger groups. Data also provides normative ranges for easy, complex, and noisy listening situations for each age group.

Summary:
Rationale
Patients who report auditory processing deficits may express difficulty listening in noise, understanding rapid speech, or following instructions. Behavioral and objective auditory measures may not completely explain the complaints of individuals who express auditory processing concerns. Clinicians are left to rely on patient report and subjective qualitative measures. The Adult Auditory Performance Scale (AAPS) was specifically designed to assess auditory performance in a variety of listening situations. Previous research found that the AAPS was sensitive enough to detect differences between adults with and without complaints of hearing difficulty. Domain specific responses have been shown to be associated with speech-in-noise performance, auditory working memory performance, hearing loss, and hearing difficulty following traumatic brain injury. The first normative data published on the AAPS included a smaller sample size. The current study aims to update the normative data in young adults, as well as assess middle-aged and older adult responses on the AAPS. A second aim was to examine the relationship between minimal threshold elevation and responses on the AAPS in young adults.

Methods
Three groups of adults participated, including 147 young adults (18-33 years), 37 middle-aged adults (35-60 years), and 30 older adults (61-89 years). The AAPS is a 36-item questionnaire with six listening domains (quiet, ideal, noise, multiple inputs, auditory memory, and auditory attention). Items are rated from 0 = never to 6 = always, with higher responses indicating greater listening difficulty. Responses on the AAPS were analyzed based on listening situation, including easy (ideal & quiet domains), noise (noise domain), and complex (multiple inputs, auditory memory & auditory attention).

Results
Significant differences in AAPS responses were observed between groups. Specifically, young adults reported the least degree of listening difficulty, whereas the middle-aged and older adults reported significantly greater degrees of listening difficulty. Correlational analysis revealed a significant relationship between the easy listening AAPS domain and pure-tone hearing for the older adult group only. Young adults with subclinical threshold elevation (4-frequency pure-tone average, PTA4) >5 dB HL (n = 70) reported significantly greater listening difficulty on the AAPS than young adults with PTA4’s ≤5 dB HL. Of all participants, 10.9% of young adults, 10.8% of middle-aged adults, and 13.33% of older adults fell two standard deviations outside of the mean for at least one listening situation, most commonly in the noise and complex listening situations.

Conclusions
Results of this investigation suggest that with increasing age, adults experience greater listening difficulty. Pure-tone threshold elevation in the older adult group was associated with poorer responses in the easy listening domain only, suggesting that subjective reports of listening difficulty in complex and noisy listening situations may be driven by other contributors (e.g., working memory). Similarly, subclinical threshold elevation in young adults may contribute to self-perceived hearing difficulty, especially in noise and complex listening conditions. Individuals who fall two standard deviations outside of the mean may be experiencing hearing difficulty not explained by their pure-tone thresholds and need additional counseling.