An Augmented Reality Audio-Motor Training Game for Improving Speech-in-Noise Perception: Single-Arm Pilot Feasibility Study.

Background: Difficulty understanding speech in noisy environments is a primary challenge of hearing impairment, inadequately addressed by hearing aids alone. While auditory training can enhance selective attention and speech perception, current digital programs face poor user adherence and lack realistic 3D spatial audio. Objective: This pilot study evaluated the feasibility, usability, and preliminary efficacy of ARIA (Augmented Reality Immersive Auditory training), a handheld mobile intervention that provides gamified at-home auditory training to middle-aged adults via earbud-delivered spatial audio. Methods: In this single-arm, pre-post-follow-up pilot study, 11 adults (mean age 53.0, SD 3.0 y) with functional hearing not requiring amplification completed a 4-week at-home training program using ARIA on provided devices (iPhone 14 Pro, AirPods Pro 2). Speech-in-noise perception was assessed via the Korean Matrix Sentence Test at baseline, 4 weeks, and 8 weeks at 3 signal-to-noise ratios (SNRs; 0 dB, -6 dB, and -9 dB, respectively). Feasibility, usability (System Usability Scale), user experience (Player Experience of Need Satisfaction), in-game performance, and qualitative feedback were collected. Results: Protocol completion was 100% (11/11), demonstrating technical feasibility. Exploratory efficacy analyses revealed statistically significant speech-in-noise improvements posttraining across all conditions (0 dB: t10=3.43, P=.02; -6 dB: t10=5.34, P<.001; -9 dB: t10=4.34, P=.004). Gains were maintained at the 8-week follow-up. In-game localization improvements correlated significantly with speech perception gains at -6 dB SNR (ρ=0.639; P=.03) and -9 dB SNR (ρ=0.612; P=.045). User experience showed mixed results: the mean System Usability Scale score was 70.2 (SD 19.6; range 47.5-92.5), reflecting substantial individual differences in usability perception. While 72% (n=8) reported difficulties with the augmented reality (AR) environmental setup, 63% reported genuine mastery-driven engagement with core gameplay. Thematic analysis revealed a dissociation between peripheral usability challenges (setup friction, "homework" characterization due to protocol structure) and successful engagement with the training paradigm itself. Conclusions: This pilot demonstrated the feasibility of AR-based audio-motor training for at-home delivery and revealed encouraging preliminary efficacy signals, warranting progression to controlled efficacy trials. Formative findings identified specific usability refinements needed for broader implementation, particularly streamlining AR setup while preserving the core gameplay elements that successfully fostered competence and engagement. These insights provide clear guidance for platform optimization and randomized controlled trial design.