Speech Perception in Noise in Individuals With Tinnitus: Top-Down and Bottom-Up Processes

Objectives: To evaluate speech-in-noise and spatial listening performance in patients with tinnitus by examining the potential contributions of top-down and bottom-up processes. Design: Thirty-one patients with tinnitus and 31 age-matched controls without tinnitus (participants with normal hearing), aged 18 to 60 years, underwent audiological evaluation. All participants completed the Listening in Spatialized Noise–Universal Test to assess speech-in-noise performance under different spatial conditions and cognitive tests (Serial Digit Learning and Stroop) to assess attention and memory. Results: Hearing thresholds did not differ significantly between groups ( p > 0.05), although a significant main effect of frequency was observed ( p < 0.001). Participants with tinnitus demonstrated poorer speech-in-noise performance than controls across both colocated and spatially separated listening conditions [ F (1,60) = 12.53, p = 0.001], whereas spatial advantage ( t = 1.08, p = 0.28) and cognitive performance (all p > 0.05) were comparable between groups. Conclusions: Patients with tinnitus demonstrated poorer speech-in-noise performance than controls in both spatially separated and colocated listening conditions. Spatial advantage and cognitive test performance were comparable between groups, suggesting that the between-group difference in speech-in-noise performance was evident across both listening conditions rather than being limited to spatial cue utilization.