Background: Tramadol is a centrally acting opioid with an analgesic effect. Prolonged chronic pain management with tramadol and tramadol misuse may cause opioid use disorder attributed to tramadol (OUD-T). Evidence from pathophysiologic mechanisms of OUD-T raised the probability for central auditory processing abnormalities. Objectives: To our knowledge, no available studies evaluate the underlying pathology. Consequently, this study was designed to evaluate speech recognition, auditory temporal processing, auditory neurocognitive function in these patients. Materials and Methods: This work comprised a study group of 19 males with OUD-T and a control group of 19 participants, both with an age range of 20-40 years. All participants were subjected to (1) basic audiological evaluation, (2) psychoacoustic central auditory tests to assess auditory figure ground (speech intelligibility in noise) and temporal processing (Gaps-In-Noise and pitch pattern sequence), and (3) P300 neurocognitive potential. Results: OUD-T showed statistical significant depressed scores of speech in noise and pitch pattern sequence tests in comparison to the control group. In addition a statistically significant elevated GIN test approximate threshold and depressed total score was present in OUD-T. As regards P300, there was statistically significant difference between the control and the study group in latency and amplitude. Conclusion: These findings emphasize the importance of speech in noise, temporal processing, and neurocognitive evaluation in adults with opioid use disorder attributed to tramadol.Keywords: Auditory figure-ground, gaps-in-noise test, opioid use disorder attributed to tramadol, P300, pitch pattern sequence, temporal auditory processing