In our research, we recognize that traditional hearing-aid evaluations primarily rely on speech intelligibility tests, which measure word recognition in controlled environments.

However, real-world communication is far more complex, involving turn-taking, participation, backchanneling (e.g., “mmm,” “uh-huh”), as well as gestures and head movement.

Hearing loss often disrupts conversational flow, affecting speech levels, timing, and non-verbal cues.

Background noise further compounds these challenges, making it harder for individuals with hearing impairment to follow and participate in group discussions.

If hearing aids are to support meaningful communication, we need to assess them in realistic conversation scenarios.

Our findings highlight how hearing loss, noise, and hearing aids shape conversational behavior:

• Turn-taking and speaking time – We found that individuals with hearing loss (HI) speak for longer, take more time to respond, and struggle with consistent timing of their turns, particularly in noisy environments.

• Conversational fluency with hearing aids – Our research shows that aided HI participants initiate turns faster and with reduced variability and increase their articulation rates compared to when unaided, making their speech patterns more like normal-hearing (NH) participants.

• Increased communication effort in noise – All speakers raise their voice and slow their speech rate in noisy conditions, however, HI participants face greater communication difficulties, resulting in less precise timing of turns. Compared to the HI interlocutor, the NH speaker raises their voice level more in noise, to accommodate for the difficulty experienced by their conversation partner.

• Backchanneling behavior and engagement – NH participants use short verbal cues (“mmm,” “yeah”) to signal engagement, while HI individuals reduce these cues in noise, likely due to the backchannels disrupting the auditory signal and causing increased listening effort.

• Balancing participation in group conversations – Our findings suggest that HI participants speak more to maintain control and avoid listening, while NH participants adjust their speech and backchanneling strategies to compensate.

These results indicate that traditional hearing-aid evaluations do not fully capture real-world conversational success and that new assessment methods are necessary to reflect the demands of everyday communication.