Environmental sounds matter too
Reviewed by Yovina Khiroya-Morjaria

Individuals with auditory neuropathy spectrum disorder (ANSD) frequently report major listening difficulties despite hearing thresholds that may not fully explain their functional impairment. Most audiological assessment batteries focus heavily on speech perception, yet this paper argues that environmental sound perception (ESP) may also play a crucial role in day-to-day hearing ability. The authors evaluated 42 individuals with ANSD using speech identification scores (SIS), an environmental sound perception test and the Speech, Spatial, and Qualities of Hearing Scale (SSQ). Participants demonstrated markedly reduced SSQ scores across all domains, particularly in speech understanding within complex listening environments. The most interesting finding was that ESP showed a significant independent relationship with self-perceived hearing ability and was a stronger predictor of overall SSQ performance than speech identification scores alone. This reinforces the idea that successful listening extends beyond understanding speech and includes interpreting warning sounds, environmental cues and broader auditory scene analysis. The discussion around real-world consequences, including safety concerns in traffic and social withdrawal from difficulty identifying nonverbal sounds, was particularly valuable clinically. This study highlights an often-overlooked aspect of auditory rehabilitation in ANSD and supports incorporating environmental sound testing into routine assessment and rehabilitation planning. While larger studies and exploration of speech-in-noise measures would strengthen the evidence further, the paper offers a practical and clinically relevant perspective on functional hearing difficulties in this population.

Does environmental sound perception contribute to self-perceived hearing abilities in auditory neuropathy spectrum disorder?
Sasidharan M, Bhat RJ, Mohan KM, Ramadas V.
HEAR BALANCE COMMUN
2026;24(1):7–16.