JMIR Publications

ABSTRACT

Background:

Auditory-cognitive training (ACT) combines auditory and cognitive exercises to improve listening and cognition in individuals with hearing difficulties, yet lacks standardized implementation and consistent evidence.

Objective:

This mixed evidence synthesis aimed to map ACT’s implementation characteristics and summarize its reported short-term and maintenance effects on trained and non-trained cognitive and auditory outcomes, including hearing functioning in daily life.

Methods:

We carried out a systematic search including Embase, Cochrane Library, PubMed, and APA PsycNet from inception to January 15, 2026. Studies evaluating integrated auditory–cognitive training interventions in older adults were included, covering RCTs, quasi-experimental, and pre–post intervention designs, with 12 articles included. Meta-analysis was restricted to RCTs with sufficient available data.

Results:

Results showed that ACT yields significant short-term improvements in speech-in-noise (SIN) recognition (SMD = −0.25, 95% CI: −0.47 to −0.04, p = 0.02) and memory (SMD = 1.02, 95% CI: 0.53 to 1.51, p < 0.001). The SIN improvement (0.25 dB) is modest and below clinical meaningfulness. Effects on pure-tone audiometry, subjective hearing function, attention, working memory, executive function, and global cognition were limited and nonsignificant. Current evidence is limited by unstandardized training dosage/duration, limited linguistic generalizability across non-English languages, and insufficient assessment of patient-reported real-life listening outcomes.

Conclusions:

ACT produces consistent short-term improvements in speech-in-noise recognition and memory-related functions. Integrated auditory-cognitive training. Future research should focus on standardized training protocols, real-life hearing assessments, multilingual tool adaptation, and long-term outcome monitoring to advance the clinical application and generalizability of ACT.