Effective communication is more than recognizing words—it involves turn-taking, engagement, and having a good conversational flow.

Traditional hearing-aid evaluations focus on speech intelligibility, but real-world conversations require precise timing, vocal effort, and cognitive processing to ensure a smooth interaction with your conversation partner(s).

We conducted multiple studies analyzing how hearing impairment, noise, and hearing-aid use shape real-world conversations. Our research included:

• One-on-one conversations using structured spot-the-difference tasks (DiapixDK) to assess turn-taking timing and adaptation strategies.

• Three-person (triadic) conversations to examine how hearing-impaired (HI) individuals engage and maintain participation in group settings.

• Group conversations evaluate the perceived realism and conversation success.

• Realistic conversational scenarios – creating and testing various methods to spark conversations in laboratory settings, ensuring they reflected natural social interactions.

By integrating natural conversations into a controlled experimental design, we examined speech levels, turn-taking timing, speaking time distribution, and perceived communication success to understand how individuals adapt their communication strategies to different challenges.

Unaided HI individuals take longer to initiate turns and show more variability in timing, suggesting difficulty in predicting when to speak.

Normal-hearing (NH) partners compensate for the impaired hearing experienced by the conversation partner by raising their voice, even more so than the HI talkers themselves.

Hearing aid use normalized speech levels and improves turn-taking precision, making conversational exchanges smoother and improving the conversational flow.

However, background noise increases cognitive effort for all speakers, leading to longer response times, louder speech, and reduced conversational flow.

Our findings reinforce that conversations are affected not only be speech clarity (speech level), but also on how people respond, emphasizing the need for hearing-aid evaluations that incorporate conversational dynamics as key measures.

Future research should focus on:

• Developing new outcome measures that assess turn-taking, engagement, and listening effort beyond traditional speech tests.

• Investigating non-verbal communication cues, such as gaze direction and body movement, to better understand how individuals navigate complex conversations.

• Exploring adaptive hearing-aid features that dynamically adjust to real-time conversational needs and user behavior.

• Refining ecologically valid testing environments, integrating natural noise, group discussions, and real-world social interactions.