Screening and treatment of functional hearing difficulties in virtual reality

The growing number of individuals reporting functional hearing difficulties (FHDs) despite having normal audiometric thresholds reveals critical gaps in how auditory processing is currently assessed and treated. Conventional audiometric assessments and rehabilitation protocols often fail to detect and treat these deficits, highlighting the need for more ecologically valid methods. This dissertation explores virtual reality (VR) as a tool for screening and treating FHDs. By effectively integrating spatial audio with visual and sensorimotor cues, VR can harness multisensory integration, enhancing realism and ecological validity, thereby offering the potential to improve both diagnostic accuracy and rehabilitation outcomes. A central question addressed here is whether behavioral responses to virtual stimuli mirror those elicited in real-world settings—a current key barrier to clinical adoption. To this end, this work systematically evaluates the effects of virtualization on well-established functional hearing measures, examining how multisensory integration in VR influences auditory perception, particularly in spatial hearing tasks, and whether findings from traditional clinical and laboratory contexts can be replicated in state-of-the-art virtual acoustic environments. In addition, this thesis explores whether VR-based auditory training can lead to measurable improvements in functional hearing performance. Altogether, it explores potential alternatives to current screening and rehabilitation methods through accessible, portable, and innovative solutions that are evaluated from both perceptual and technical perspectives. These findings contribute to the growing body of evidence supporting multisensory approaches in audiology and pave the way for the integration of VR into future hearing healthcare.