Hearing aid technology has improved dramatically in the last decade, especially in the ability to adaptively respond to dynamic aspects of background noise. Despite these advancements, however, hearing aid users continue to report difficulty hearing in background noise and having trouble adjusting to amplified sound quality. These difficulties may arise in part from current approaches to hearing aid fittings, which largely focus on increased audibility and management of environmental noise. These approaches do not take into account the fact that sound is processed all along the auditory system from the cochlea to the auditory cortex. Older adults represent the largest group of hearing aid wearers; yet older adults are known to have deficits in temporal resolution in the central auditory system. Here we review evidence that supports the use of the auditory brainstem response to complex sounds (cABR) in the assessment of hearing-in-noise difficulties and auditory training efficacy in older adults. 1. Introduction In recent years, scientists and clinicians have become increasingly aware of the role of cognition in successful management of hearing loss, particularly in older adults. While it is often said that “we hear with our brain, not just with our ears,” the focus of the typical hearing aid fitting continues to be one of providing audibility. Despite evidence of age-related deficits in temporal processing [1–6], abilities beyond the cochlea are seldom measured. Moreover, when auditory processing is assessed, behavioral measures may be affected by reduced cognitive abilities in the domains of attention and memory [7, 8]; for example, an individual with poor memory will struggle to repeat back long sentences in noise. The assessment and management of hearing loss in older adults would be enhanced by an objective measure of speech processing. The auditory brainstem response (ABR) provides such an objective measure of auditory function; its uses have included evaluation of hearing thresholds in infants, children, and individuals who are difficult to test, assessment of auditory neuropathy, and screening for retrocochlear function [9]. Traditionally, the ABR has used short, simple stimuli, such as pure tones and tone bursts, but the ABR has also been recorded to complex tones, speech, and music for more than three decades, with the ABR’s frequency following response (FFR) reflecting the temporal discharge of auditory neurons in the upper midbrain [10, 11]. Here, we review the role of the ABR to complex sounds (cABR) in assessment and documentation of
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