Active listening modulates the spatial hearing experience: a multicentric study.

Although flexible and portable virtual reality technologies have simplified measuring participants' perception of acoustic space, their clinical adoption remains limited, often lacking ecological fidelity. In clinical practice, participants are typically instructed to remain still when testing sound localization, whereas head movements are crucial in daily life. Additionally, assessing spatial hearing extends beyond measuring accuracy to include meta-cognitive evaluations like perceived effort and confidence, which are rarely adopted. Our study hypothesized that allowing head movement during sound localization, compared to a static head condition, would reduce perceived listening effort and enhance confidence in normal hearing participants. Conducted across three audiology and otology hospital services in Northern Italy, the study involved personnel inexperienced with our VR equipment. This also tested the feasibility and usability of our VR approach in clinical settings. Results showed that head movements reduced subjective effort but did not significantly affect perceived confidence. However, during the active condition, participants reporting higher confidence exhibited less head movement and explored the space less. Similarly, those with less head movement reported lower listening effort. These findings underscore the importance of allowing natural posture to capture the full extent of spatial hearing capabilities and the value of including metacognitive evaluations in assessing performance. Our use of affordable, off-the-shelf VR equipment effectively measured spatial hearing in clinical settings, providing a flexible alternative to current static systems. This approach highlights the potential for more dynamic and comprehensive assessments in clinical audiology.