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Precise auditory diagnostic is essential for characterizing functional deficits in age-related hearing loss. Using an extensive clinical test battery, including pure-tone audiometry, suprathreshold psychoacoustics measures (speech recognition in noise, tone-in-noise, loudness scaling), electrophysiological and vestibular measures, we profiled individuals with untimely age-related hearing loss (uARHL, ≥40 years) and age-matched normal-hearing controls. This diagnostics-centered approach aligns with current efforts in the bilateral PRESAGE project (The PREciSion audiology for AGE-related hearing loss, Institut d’Audition, Paris and Universität Oldenburg) and complements broader initiatives to improve clinical audiology through deep phenotyping.

Age-related changes in the control group followed expected patterns, with gradually elevated thresholds and typical loudness recruitment at higher levels. In contrast, listeners with uARHL showed age-inappropriate deterioration, most prominently in suprathreshold domains. Speech-in-noise testing revealed substantially elevated speech recognition thresholds and reduced masking release from fluctuating noise, while tone-in-noise thresholds were elevated at 2 kHz. Although average pure-tone thresholds accounted for some of the variance, large interindividual differences remained even among participants with comparable audibility and age. Loudness scaling further indicated elevated loudness functions at low levels, reflecting reduced sensitivity, in addition to steeper loudness growth at higher levels in both groups.

These results demonstrate that suprathreshold diagnostics capture functional impairments that pure-tone audiometry alone cannot reveal. This is particularly important in light of increasing evidence, as highlighted in the contribution by Kollmeier et al. at the current congress, that genetic abnormalities are not limited to severe or implant-relevant hearing loss but also occur in mild to moderate forms. Parallel genetic analyses within PRESAGE show heterogeneous, predominantly monogenetic findings, underscoring the need to integrate auditory phenotyping with scalable genotyping approaches.

Overall, this work lays the foundation for the establishment of a sensitive test battery capable of detecting early functional changes in uARHL and supporting future genotype–phenotype analyses.