The Impact of Age, Sex, and Hearing Thresholds on Speech Recognition in Quiet and Noise

PURPOSE: Audiologic assessment is crucial for managing hearing loss across the lifespan. Routine evaluations typically include pure-tone audiometry and word recognition in quiet (WRQ), the clinical standard for over 60 years. More recently, speech-in-noise tests such as the Quick Speech-in-Noise Test (QuickSIN) have been adopted. This study investigated the effects of age, sex, and hearing sensitivity on WRQ and QuickSIN performance in a large clinical cohort. METHOD: Data from 9,042 patients (17,414 ears; aged 18-90 years) who underwent audiometric assessment at the Stanford Ear Institute were analyzed. All completed pure-tone audiometry, WRQ, and monaural QuickSIN. Analyses focused on individuals with hearing loss (9,373 ears) and those with normal hearing (4,277 ears), using stepwise linear regression. In a subset of normal-hearing individuals (1,095 ears), perceived auditory disability was also assessed using the 12-item Speech, Spatial, and Qualities of Hearing Scale (SSQ12). RESULTS: In the hearing-loss cohort, high-frequency pure-tone average (HFPTA) predicted both WRQ and QuickSIN performance. Sex also contributed, with females performing better on QuickSIN but worse on WRQ. After adjusting for HFPTA and sex, age affected QuickSIN but not WRQ. In the normal-hearing group, hearing sensitivity had no effect on WRQ, but thresholds at 2000 and 4000 Hz influenced QuickSIN. Sex predicted QuickSIN performance, with males performing better. After accounting for thresholds, age was associated with both WRQ and QuickSIN. QuickSIN, but not WRQ, predicted perceived auditory disability on the SSQ12. CONCLUSIONS: After accounting for hearing sensitivity, age showed minimal effects on speech performance in normal-hearing and hearing-loss groups, explaining less than 1% of WRQ variance and < 0.5 dB on QuickSIN. These findings suggest age has limited impact on speech recognition once hearing thresholds are considered. Small but consistent sex effects aligned with prior work. For WRQ, ceiling effects may mask age-related changes, while for QuickSIN, the small effect may be driven by additional peripheral or central auditory factors.