Characterizing Music Engagement and Reward in Individuals Across a Spectrum of Hearing Loss and Rehabilitation

OBJECTIVE: Hearing aids (HAs) and cochlear implants (CIs) improve speech perception for individuals with hearing loss (HL), yet their impact on music outcomes remains unclear. We examined music perception, engagement, and reward in a large cohort of individuals across various hearing conditions. STUDY DESIGN: Cross-sectional survey. SETTING: Tertiary academic medical center and community. METHODS: Adults (≥18 years) including normal hearing (NH) individuals, unaided individuals with HL, HA users, and CI users were assessed using the Barcelona Music Reward Questionnaire (BMRQ), Goldsmiths Musical Sophistication Index perceptual abilities subscale (GMSI-PA), and music engagement items. ANOVA/ANCOVA was used to assess group differences, adjusting for age, gender, race, education, and musical training. RESULTS: Among 201 participants (NH = 30, unaided HL = 23, HA = 84, CI = 64; 55.2% female; mean age 61.3), hearing status was associated with perceptual abilities; in particular, CI users had lower perceptual abilities than other groups (CI adjusted mean = 33.1 vs 38.6-42.9 for NH, unaided HL, HA; all P < .01). However, non-perceptual factors, including musical training and age, were stronger determinants of engagement and reward than hearing condition. A 1-SD increase in musical training (10.1 points) was associated with a 3.1-point increase in GMSI-PA, 21.7 additional listening days/year, 32.3 additional participation days/year, and 3.1-point increase in BMRQ. CONCLUSION: Poorer hearing status was associated with reduced music perception but not engagement or reward, even among CI users. Non-perceptual factors like musical training and age may play a stronger role in explaining individual differences, highlighting the role of modifiable behavioral factors in enhancing music reward for individuals with HL.