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Background: Standard clinical hearing assessments capture performance in controlled conditions and therefore do not fully represent hearing difficulties in complex daily life situations. Understanding how hearing loss affects daily functioning, and how hearing aids ease these challenges, requires methods that assess listening difficulties as they naturally occur. This study introduces a practical approach that integrates the Client Oriented Scale of Improvement (COSI) with Ecological Momentary Assessment (EMA) to characterize everyday listening problems and perceived hearing aid benefits.

Method: Two COSI-adapted EMA questionnaires were developed and deployed using the olMEGA app. In phase one, 20 participants, including normal hearing listeners, hearing aid users, and hearing-impaired individuals without hearing aids, completed the first questionnaire whenever they encountered listening difficulties over one week at home, on the way, at work, and in social settings. Next, hearing-impaired participants without hearing aids were fitted with hearing aids and used them for 5-6 weeks. In phase two, up to five individualized listening situations identified during phase one were selected, and participants revisited them for another week and completed the second questionnaire while using their hearing aids.

Results: Data from the first questionnaire indicated that, compared with normal hearing listeners, hearing-impaired participants reported lower localization ability and speech comprehension and higher concentration difficulty and listening effort. The most selected challenging situations were conversation-based settings, followed by listening to media. Comparison of self-reported responses across the phases showed reductions in perceived impairment, listening effort, and concentration difficulty, and improvements in speech comprehension, localization, and sound pleasantness.

Conclusions: The integration of COSI with EMA yielded a detailed and rich profile of participants‘ everyday listening demands and early benefits experienced by newly fitted participants. This method represents a feasible approach for enhancing the ecological validity of hearing loss evaluation and hearing-aid outcome assessment in real-world environments.