Eye Tracking-Based Evaluation of Auditory Spatial Attention in a Virtual Auditory Environment: Protocol for Development of a New Approach and Preliminary Validation.

Background: Auditory spatial attention (ASA) can be impaired in clinical populations and affects everyday activities, yet it remains understudied and lacks practical assessment tools for clinical use. However, recent technological advances have enabled the development of auditory virtual environments capable of engaging attentional networks while remaining compatible with clinical implementation and supporting the collection of objective physiological measures. Objective: This study aimed to address the lack of clinically applicable ASA assessments by developing a new assessment (phase 1) and supporting its future implementation in clinical practice through preliminary validation and user experience evaluation (phase 2). Methods: In phase 1, the assessment was developed through a multidisciplinary research committee involving clinicians and researchers, and was refined through pilot testing with 17 healthy participants. It uses an immersive auditory virtual environment and combines eye tracking, head tracking, and pupillometry. Phase 2 will consist of two successive studies: (1) 15 expert clinicians (neuropsychologists or speech therapists) will evaluate face and content validity, and user experience, and (2) 80 healthy adults will provide additional sources of validity evidence and user experience data. Participants will complete 5 steps of an ASA task, alternating habituation and measurement blocks, using either gaze orientation or head orientation as the response modality. Vocal targets will be presented with or without background sound in a dynamic binaural environment. Results: Study 1 will provide preliminary validity evidence based on face and content, together with user experience outcomes, including usability, satisfaction, and intention to use. Recruitment of participants began in November 2025 and was completed in January 2026. Data analysis is in progress, and the corresponding manuscript is expected to be submitted for publication during the winter of 2026-2027. Study 2 will provide preliminary validity evidence based on precision, face and content, response processes, internal structure, and fairness, together with user experience outcomes, including usability, satisfaction, and sense of presence. Recruitment of participants began in March 2026 and is expected to be completed in October 2026. As of July 2026, 48 participants had been enrolled. Completion of data analysis and submission of the corresponding manuscript are expected in winter 2027-2028. Conclusions: This validation study represents the first step toward developing a clinically applicable tool for assessing ASA. By combining immersive auditory technology with clinically feasible hardware, the proposed approach aims to provide a rapid and ecologically valid evaluation of ASA. Future studies will focus on formal psychometric validation, patient testing, and the development of normative data.