Objective The objective of this study was to determine whether listening difficulties (LiD), defined as difficulties in understanding speech in noisy environments despite normal hearing, reflect cross-modal attentional limits under visual load in adults.Design This cross-sectional study used a dual-task paradigm (1-back visual plus visual-audio digit-matching) that required focused visual attention while monitoring auditory stimuli. Errors and reaction times were analysed.Study Sample Twenty adults with listening difficulties and 20 adult controls with normal hearing were enrolled.Results The participants with LiD performed significantly worse than the controls in the 1-back visual (U = 88.5, p = 0.002) and visual-audio matching tasks (U = 38.0, p < 0.001), with a larger effect size observed for the latter. The receiver operating characteristic analysis showed high discriminative accuracy for the visual-audio matching task (cut-off = 6 errors, sensitivity = 85%, specificity = 90%). The median reaction times did not differ (U = 149.0, p = 0.17), although they increased with errors (LiD: r(18)=0.79, p < 0.001; controls: r(18)=0.45, p = 0.05).Conclusions The participants with LiD demonstrated limited cross-modal attentional capacity under visual load, which disproportionately disrupted auditory monitoring. The dual-task paradigm may serve as a sensitive tool for clinical differentiation of LiD and underscores the importance of evaluating cognitive contributions to LiD.
Obuchi et al. (2026) studied this question.