cs.CLOct 28, 2026

Do Audio LLMs HEAR Pain? Tracing Acoustic Evidence from Speech to Language Reasoning

Authors: Wenqi Li, Xiangjue Dong, Sulaiman Vesal

Organizations: Microsoft

Abstract

Large audio language models (LALMs) can process speech directly, but it remains unclear how well they use the non-lexical acoustic information that speech carries. We study this question through pain, using TAME-Pain, which contains pain-neutral Harvard sentences and spoken pain ratings recorded at different self-reported pain levels. We introduce HEAR, a four-stage diagnostic framework that traces pain-related information from the speech signal to the model's prediction, and apply it to seven closed-source and open-weight LALMs. On the Harvard sentences, where pain can only be inferred from the voice, all models perform at chance level, and same-speaker references or few-shot examples improve balanced accuracy by no more than six points. On the spoken ratings, the same models reach 87.5-99.7% balanced accuracy. Layer-wise probing of open-weight LALMs shows that pain can be decoded from early audio representations (74.1% balanced accuracy for binary prediction and 45.0% for three-class severity), but that this information, along with most pain-associated acoustic cues, decreases in deeper layers. In an acoustic perception test, weaker models cannot distinguish even large changes in these cues, whereas stronger models can but still fail to infer pain. Finally, we recover pain-related acoustic cues and directly reinject them as structured text into the prompt, which improves pairwise pain prediction by up to 32 points. These results indicate that current LALMs encode paralinguistic information in early layers that is largely unavailable when the model produces its answer.

Figures & tables

Appendix figures & tables19 assets

Supplementary material from the paper’s appendix.

Appendix

Explore similar work

Mar 19, 2026

How Auditory Knowledge in LLM Backbones Shapes Audio Language Models: A Holistic Evaluation

Large language models (LLMs) have been widely used as knowledge backbones of Large Audio Language Models (LALMs), yet how much auditory knowledge they encode through text-only pre-training and how this affects downstream performance remains unclear. We study this gap by comparing different LLMs under two text-only and one audio-grounded setting: (1) direct probing on AKB-2000, a curated benchmark testing the breadth and depth of auditory knowledge; (2) cascade evaluation, where LLMs reason over text descriptions from an audio captioner; and (3) audio-grounded evaluation, where each LLM is fine-tuned into a Large Audio Language Model (LALM) with an audio encoder. Our findings reveal that auditory knowledge varies substantially across families, and text-only results are strongly correlated with audio performance. Our work provides empirical grounding for a comprehensive understanding of LLMs in audio research.
Mar 6, 2026

Are Audio-Language Models Listening? Audio-Specialist Heads for Adaptive Audio Steering

Multimodal large language models can exhibit text dominance, over-relying on linguistic priors instead of grounding predictions in non-text inputs. One example is large audio-language models (LALMs) where decisive audio evidence can be under-utilized even when it contains important information. To address this issue we use mechanistic interpretability to identify a small set of audio-specialist attention heads whose audio attention yields a ``listening'' signal. We show that this signal increases when audio evidence affects the model's output, providing an indicator of audio engagement under standard prompting. Leveraging this localization, we construct an audio--silence steering direction and apply an inference-time activation intervention to the final representation, amplifying the model's audio effect. To demonstrate the utility of this intervention, we show on MMAU that this improves accuracy by up to +8.0 percentage points on two Qwen-based LALMs, without any parameter updates.
Oct 15, 2026

TRACE: Trustworthy Reasoning from Acoustic Cues and Evidence

We introduce TRACE (Trustworthy Reasoning from Acoustic Cues and Evidence), a benchmark for diagnosing the reliability of large audio-language models (LALMs) by revealing when, and under what acoustic conditions these models behave untrustworthily. Existing benchmarks primarily measure whether a model produces the correct answer, but correctness alone cannot determine whether the answer is grounded in acoustic evidence or instead reflects language and contextual priors. TRACE evaluates model behavior along three complementary dimensions: (1) task performance, whether the answer is correct; (2) evidence alignment, whether the model is attending to the audio regions required to answer the question; and (3) robustness, whether answers and attributed evidence respond coherently to controlled changes such as event order, overlap, signal-to-noise ratio, or background content. TRACE targets temporal ordering, counting, and event existence, three tasks that remain challenging for current models. We synthesize contextually informed acoustic scenes that allow us to test whether models hallucinate events associated with the context but absent from the audio. This synthesis also allows us to obtain a scalable benchmark for which we know the answers by design. For each scene, we create controlled variants in a programmatic way to stress-test model robustness. We introduce attribution-based metrics that quantify model attention at scale on target events and non-target events. Evaluation across five state-of-the-art models shows that current LALMs often detect where relevant sound evidence occurs, but they do not reliably interpret it, integrate it into the answer, or respond to controlled changes in that evidence. Our benchmark also shows that models still struggle the most with ordering and counting questions.