Abstract
<title>Abstract</title> <p>Background Extended high-frequency hearing loss (EHFHL) can occur despite normal conventional audiometric thresholds and has been associated with speech perception difficulties in noise. However, limited research has examined its combined influence with age on auditory-cognitive abilities such as auditory memory and sequencing. Evaluating these effects may help identify early functional auditory changes not detected by routine audiological assessment. Objective To examine the independent and combined effects of age and extended high-frequency hearing loss (EHFHL) on auditory memory, auditory sequencing and speech perception in noise (SPIN). Method 80 Marathi-speaking adults with normal conventional audiograms were allocated to four equal groups by age (young: 20–39 years; middle-aged: 40–60 years) and EHFHL status. Outcomes were assessed using the Auditory Memory and Sequencing Test in Marathi (AMST-M), the Speech Perception in Noise test in Marathi (PSIN-M). Non-parametric group comparisons (Mann–Whitney U), effect size, correlation analysis and multiple linear regression using age and extended high-frequency pure-tone average (EHFPTA) as continuous predictors were performed. Results Among adults without EHFHL, age significantly affected auditory memory only (p = 0.001, r = 0.362). Among adults with EHFHL, age significantly affected auditory memory, sequencing, and SPIN (all p < 0.001), with large effect sizes (r = 0.573–0.668). EHFHL had no significant effect in young adults, but in middle-aged adults, it was associated with significantly poorer performance across all three outcomes (p ≤ 0.05), with large effects on auditory memory (r = 0.582) and SPIN (r = 0.751). Regression models explained the variance in auditory memory, sequencing and SPIN. Age was the stronger predictor of auditory memory (β = −0.456) and sequencing (β = −0.316), while EHFPTA was the stronger predictor of SPIN (β = −0.446). Conclusions These findings highlight the additive effect of age and EHFHL on auditory-cognitive function and underscore the clinical importance of EHF audiometry in adults with normal conventional thresholds.</p>