Jane Auriemmo, Au.D., CCC-A
Approximately 48 million Americans have hearing loss. Most frequently, the problem is a result of damage in the inner ear resulting in “sensorineural hearing loss.” While most of the time these listeners achieve great benefit from hearing aids or cochlear implants, they often continue to struggle in adverse environments. Challenging settings include noisy restaurants or bars, reverberant rooms and certain outdoor locations. Individuals with sensorineural hearing loss are at a disadvantage in noisy environments, even with today’s advanced hearing aid technology.
“Hidden hearing loss" results in difficulties hearing in noisy environments
If we can detect sounds at normal levels, our hearing is normal. But is it? Sometimes there is damage in the connections between the inner ear and the hearing nerve. Since it doesn’t show up on our standard hearing tests, it is known as “hidden hearing loss.” Listeners exposed to excessively loud noise are particularly susceptible. While the hearing test results are normal, these listeners often have trouble hearing in background noise.
Central auditory system changes in listeners with normal hearing
Individuals who hear normally but have difficulty listening in noisy environments sometimes have central auditory processing disorders (CAPD). In these cases, the cause of the difficulty may not lie in the ear itself. Instead, the problem involves the auditory pathways that carry information from the ear to the brain. Most people associate the term “auditory processing disorder” with children. However, CAPD is not just a potential problem for children. In fact, the prevalence of CAPD in adults is actually higher! There are many potential reasons an adult may have auditory pathway weaknesses, but by far the most common involves changes in the auditory pathways as a result of normal aging. These changes can result in listening difficulty in challenging environments, such as restaurants and group gatherings.
Interestingly, complaints about difficulty hearing in noise from listeners of all ages have increased recently. In the past several months, Covid-19 restrictions have loosened. People have resumed group social activities such as visiting restaurants and bars. A plausible explanation is the long absence of auditory stimulation and “rusty” auditory processing. The brain is out of practice after an extended period of only quiet, controlled listening environments. If this is the case, problems should resolve thanks to the amazing capability of brain “plasticity.”
Multiplicative effects
Listeners may have more than one of these problems. For example, an individual with sensorineural hearing loss may also experience changes in the central auditory pathways due to aging. This would result in even greater challenges listening in noise.
When difficulties arise, take action. Here are my better hearing tips:
1. Have your hearing tested!
Your audiologist will determine whether or not your hearing is normal. She can also measure how well you understand speech in noise and will be able to determine if your performance is where it should be. If you are interested in CAPD testing, ask your audiologist if you are a candidate for this assessment. Contact CHC.
2. Discuss hearing technology with your audiologist
If you are a hearing aid user, talk to your audiologist about an assistive device. Accessories such as remote microphones or FM systems may help in some settings.
3. Try these tips for better hearing in restaurants
Choose the venue when you can. Try an internet search. You can enter “quiet restaurants” in your browser for a local list.
Scope out a restaurant in advance, make suggestions in advance of a group gathering. Look for restaurants with low ceilings, wall décor, curtains and table cloths. This can help reduce reverberation and distortion of sound.
Sit with your back to a wall or window if possible, so that there is less noise from behind.
Choose a booth if you are in a casual restaurant or diner.
Avoid sitting near a noisy kitchen or bar area.
Position yourself so that you can see the speakers’ faces.
Ambience is nice, but avoid dark rooms where visual cues will be obscured. Watching facial cues and gestures are even more critical when the message isn’t perfectly clear.
Think ahead about who you’re gathering with and what topics of conversation might come up. You studied for school, you prepare for work. Take some time to prepare for your fun night out. You’ll be ready for some of the vocabulary that might spill out over the course of your meal.
Make use of context. Stay alert and connected to the topic. If you hear only part of a sentence, use context to help figure out the part you missed.
Avoid “faking it.” Listeners get into trouble when they nod “yes” to everything they don’t hear. Ask the speaker to repeat if you don’t understand something.
Take out that smart phone. If you are comfortable doing so, leave your smart phone out on the table with a live speech-to-text app running. It will provide a written transcription for you to peek at when needed. An example is Google Live Transcribe.
Help other diners seeking food and quiet conversation. You can use your smartphones to make sound level measurements and enter the information into a shared database to help others seeking quiet venues. Check out the SoundPrint app.
I hope this information is helpful and that you or a loved one can apply some of the suggestions I've made to help you hear better in noisy settings. Don't hesitate to contact me at jauriemmo@chchearing.org if you have any questions you'd like me to address. The CHC Audiology Team is here to help you hear and live better!