The Effect of Background Noise and Music on Speech Recognition Performance of Individuals with Normal Hearing and Hearing Loss


  • Eun Yeon Kim

    Department of Speech Language Pathology, Graduate School of Interdisciplinary Therapy, Myongji University, Seoul, 03674, Korea

  • Sang Eun Lee

    Department of Music Therapy, Graduate School of Interdisciplinary Therapy, Myongji University, Seoul, 03674, Korea

  • Hye Yoon Seol

    Department of Communication Disorders, Ewha Womans University, Seoul, 03760, Korea

Received: 11 April 2024 | Revised: 2 May 2024 | Accepted: 15 May 2024 | Published Online: 20 June 2024


This study explores speech recognition characteristics in background noise and music between normal hearing (NH) listeners, hearing aid (HA) users and cochlear implant (CI) users.Sixty individuals participated in the study: 20 with NH, 20 HA users, and 20 CI users. HA and CI users had a Categories of Auditory Performance score of 6 and open set sentence recognition of 85% or higher. They had been using the devices for at least one year. Babble noise (BN), piano solo (PS), piano + violin (PV), and piano + chorus (PC) were presented at +5- and +10 dB signal-to-noise ratio (SNR). The participants were asked to listen and repeat words and sentences from the Korean Standard Sentence List for Adults. At +5- and +10 dB SNRs, CI users performed worse than those with NH on word and sentence recognition in BN, PS, PV, and PC. HA users outperformed CI users in all conditions. Those with NH showed better sentence recognition than HA users across all conditions at +5 dB SNR and better word recognition in PV and BN at +5 dB SNR and in PC at +10 dB SNR. Correlational analysis revealed that the percentage of life with hearing loss before CI was not correlated with sentence and word recognition across all conditions in both SNRs. Statistically significant negative correlations were observed between the duration of deafness and sentence and word recognition in some conditions. Despite individuals with HL performing well on clinical tests, background music can still interfere with communication for those using hearing devices. To accurately evaluate individuals’ communication abilities clinical tools that include background music need to be developed. Studies using different types of music could help develop and standardize such tools for assessing speech and language abilities in individuals with hearing loss.


Hearing loss; Audiology; Rehabilitation


Agelfors, E., 1996. A comparison between patients using cochlear implants and hearing aids. Part I: Results on speech tests. Quarterly Progress and Status Report. 37(1), 63–76.

Anne, S., Lieu, J.E.C., Cohen, M.S., 2017. Speech and language consequences of unilateral hearing loss: a systematic review. Otolaryngol-Head and Neck Surgury. 157(4), 572–579. DOI:

Bernhard, N., Gauger, U., Romo Ventura, E., et al., 2021. Duration of deafness impacts auditory performance after cochlear implantation: a meta-analysis. Laryngoscope Investigative Otolaryngol. 6(2), 291–301. DOI:

Brandt, A., Gebrian, M., Slevc, L.R., 2012. Music and early language acquisition. Frontier Psychol. 3, 327. DOI:

Bruns, L., Mürbe, D., Hahne, A., 2016. Understanding music with cochlear implants. Scientific Reports. 6(1), 32026. DOI:

Ching, T.Y., Crowe, K., Martin, V., et al., 2010. Language development and everyday functioning of children with hearing loss assessed at 3 years of age. International Journal of Speech-Language Pathology. 12(2), 124–131. DOI:

Cho, Y.S., Park, S.Y., Seol, H.Y., et al., 2019. Clinical performance evaluation of a personal sound amplification product vs a basic hearing aid and a premium hearing aid. JAMA Otolaryngol-Head and Neck Surgury. 145(6), 516-522. DOI:

Cunningham, L.L., Tucci, D.L., 2017. Hearing loss in adults. New England Journal of Medicine. 377(25), 2465–2473. DOI:

Davis, A., McMahon, C.M., Pichora-Fuller, K.M., et al., 2016. Aging and hearing health: the life-course approach. The Gerontologist. 56(Suppl_2), S256–S267. DOI:

Denes, P.B., Pinson E.N., 2016. The Speech Chain: The Physics And Biology Of Spoken Language [Internet]. Available from: (cited 2024 Mar 8).

Diseases, G.B.D., Injuries, C., 2020. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. The Lancet. 396(10258), 1204–1222. DOI:

Eby, T.L., Arteaga, A.A., Spankovich, C., 2020. Otologic and audiologic considerations for Covid-19. Otolaryngol-Head and Neck Surgury. 163(1), 110–111. DOI:

Fernald A., 1992. Human maternal vocalizations to in-fants as biologically relevant signals. In: Barkow, J.H., Cosmides, L., Tooby, J. (Eds.). The adapted mind: Evolutionary psychology and the generation of culture. Oxford University Press, USA. pp 391-394.

Flynn, M., Dowell, R., Clark, G., 1996. Speech perception of hearing aid users versus cochlear implantees. The Journal of the Acoustical Society of America. 100(4), 261–265. DOI:

Friederici, A.D., 2006. The neural basis of language development and its impairment. Neuron. 52(6), 941–952. DOI:

Halliday, L.F., Tuomainen, O., Rosen, S., 2017. Language development and impairment in children with mild to moderate sensorineural hearing loss. Journal of Speech, Language, and Hearing Research. 60(6), 1551–1567. DOI:

Helvik, A.-S., Jacobsen, G., Svebak, S., et al., 2007. Hearing impairment, sense of humour and communication strategies. Scandinavian Journal of Disability Research. 9(1), 1–13. DOI:

Jung, K.H., Cho, Y.S., Cho, J.K., et al., 2010. Clinical assessment of music perception in Korean cochlear implant listeners. Acta Oto-laryngol. 130(6), 716–723. DOI:

Kaandorp, M.W., Smits, C., Merkus, P., et al., 2015. Assessing speech recognition abilities with digits in noise in cochlear implant and hearing aid users. International Journal of Audiology. 54(1), 48–57. DOI:

Ketterer, M.C., Haussler, S.M., Hildenbrand, T., et al., 2020. Binaural hearing rehabilitation improves speech perception, quality of life, tinnitus distress, and psychological comorbidities. Otology and Neurotology. 41(5), e563–e574. DOI:

Kramer, S.E., 2008. Hearing impairment, work, and vocational enablement. International Journal of Audiology. 47(Suppl 2), S124–S130. DOI:

Laske, R.D., Veraguth, D., Dillier, N., et al., 2009. Subjective and objective results after bilateral cochlear implantation in adults. Otology and Neurotology. 30(3), 313–318. DOI:

Lesiuk, T., 2005. The effect of music listening on work performance. Psychology of Music. 33(2), 173–191. DOI:

Lieu, J.E., Kenna, M., Anne, S., et al., 2020. Hearing loss in children: a review. JAMA. 324(21), 2195–2205. DOI:

Looi, V., Gfeller, K., Driscoll, V., 2012. Music Appreciation and training for cochlear implant recipients: a review. Seminars in Hearing. 33(4), 307–334. DOI:

Mansutti, I., Achil, I., Rosa Gastaldo, C., et al., 2023. Individuals with hearing impairment/deafness during the Covid-19 pandemic: a rapid review on communication challenges and strategies. Journal of Clinical Nursing. 32(15–16), 4454–4472. DOI:

McDaid, D., Park, A.L., Chadha, S., 2021. Estimating the global costs of hearing loss.

International Journal of Audiology. 60(3), 162–170. DOI:

McMullen, E., Saffran, J.R., 2004. Music and language: a developmental comparison. Music Perception. 21(3), 289–311.


Meilijson, S., Spitzer, J.B., 2015. The language performance of hearing aid and cochlear implant adult users: a pragmatic approach. Journal of Interactional Research in Communication Disorders. 6(2), 237. DOI:

Møller, A.R., 2012. Hearing: anatomy, physiology, and disorders of the auditory system. Plural Publishing: San Diego.

Mondelli, M.F.C.G., de Souza, P.J.S., 2012. Quality of life in elderly adults before and after hearing aid fitting. Brazilian Journal of Otorhinolaryngology. 78(3), 49–56.

Moon, I.-J., Jo, M., Kim, G.-Y., et al., 2022. How does a face mask impact speech perception? Healthcare. 10(9), 1709. DOI:

Moon, I.J., Kim, E.Y., Jeong, J.O., et al., 2012. The influence of various factors on the performance of repetition tests in adults with cochlear implants. European Archives of Oto-Rhino-Laryngology. 269(3), 739–745. DOI:

Nasresfahani, A., Dasdar, S., Kianfar, N., et al., 2022. Music appreciation of cochlear implant users versus Normal hearing individuals. Iranian Journal of Otorhinolaryngology. 34(122), 171. DOI:

Nikolopoulos, T.P., Archbold, S.M., O’Donoghue, G.M., 1999. The development of auditory perception in children following cochlear implantation. International Journal of Pediatric Otorhinolaryngology. 49 (Suppl. 1), S189–191. DOI:

Philips, B., Vinck, B., De Vel, E., Maes, L., D’haenens, W., Keppler, H., Dhooge, I., 2012. Characteristics and determinants of music appreciation in adult CI users. European Archives of Oto-Rhino-Laryngology. 269, 813–821. DOI: 10.1007/s00405-011-1718-4

Prather, J. F., 2013. Auditory signal processing in communication: perception and performance of vocal sounds. Hearing Research. 305, 144–155. DOI:

Ramus, F., Nespor, M., Mehler, J., 1999. Correlates of linguistic rhythm in the speech signal. Cognition. 73(3), 265–292. DOI:

Riley, P.E., Ruhl, D.S., Camacho, M., et al., 2018. Music appreciation after cochlear implantation in adult patients: a systematic review. Otolaryngology–Head and Neck Surgery. 158(6), 1002–1010. DOI:

Seol, H.Y., Jo, M., Yun, H., et al., 2023. Comparison of speech recognition performance with and without a face mask between a basic and a premium hearing aid in hearing-impaired listeners. American Journal of Otolaryngology. 44(5), 103929. DOI:

Seol, H.Y., Kim, G.Y., Kang, S., Jo, M., et al., 2021. Clinical Comparison of a hearing aid, a personal sound amplification product, and a wearable augmented reality device. Clinical and Experimental Otorhinolaryngology. 14(3), 359–361. DOI:

Seol, H.Y., Moon, I.J., 2022. Hearables as a gateway to hearing health care. Clinical and Experimental Otorhinolaryngology. 15(2), 127–134. DOI:

Siedliecki, S. L., Good, M., 2006. Effect of music on power, pain, depression and disability. Journal of Advanced Nursing. 54(5), 553–562. DOI:

Stelmachowicz, P.G., Pittman, A.L., Hoover, B.M., et al., 2004. The importance of high-frequency audibility in the speech and language development of children with hearing loss. JAMA Otolaryngology-Head and Neck Surgery. 130(5), 556–562. DOI:

Stephens, S.D., Jaworski, A., Lewis, P., et al., 1999. An analysis of the communication tactics used by hearing-impaired adults. British Journal of Audiology. 33(1), 17–27. DOI:

Temperley, D., 2022. Music and language. Annual Review of Linguistics. 8, 153–170. DOI:

Thiessen, E.D., Hill, E.A., Saffran, J.R., 2005. Infant-directed speech facilitates word segmentation. Infancy. 7(1), 53–71. DOI:

Trainor, L., Trehub, S., 1998. Singing to infants: lullabies and playsongs. Advances in Infancy Research. 12, 43–78.

Tye-Murray, N., 1992. Preparing for communication interactions: the value of anticipatory strategies for adults with hearing impairment. Journal of Speech and Hearing Research. 35(2), 430–435. DOI:

Wagner-Hartl, V., Grossi, N.R., Kallus, K.W., 2018. Impact of age and hearing impairment on work performance during long working hours. International Journal of Environmental Research and Public Health. 15(1), 98. DOI:

Wermke, K., Leising, D., Stellzig-Eisenhauer, A., 2007. Relation of melody complexity in infants' cries to language outcome in the second year of life: a longitudinal study. Clinical Linguistics and Phonetics. 21(11–12), 961–973. DOI:

Wilson, B.S., Tucci, D.L., Merson, M.H., et al., 2017. Global hearing health care: new findings and perspectives. The Lancet. 390(10111), 2503–2515. DOI:

Wilson, J., Hickson, L., Worrall, L., 1998. Use of communication strategies by adults with hearing impairment. Asia Pacific Journal of Speech, Language and Hearing. 3(1), 29–42.DOI:

World Health Organization [Internet]. Global Costs of Unaddressed Hearing Loss and Cost-Effectiveness of Interventions. Available from: (cited 2024 Mar 8).