Written by: Judy Rasin, Audiologist
Hearing care specialists sometimes meet patients who describe difficulty hearing, often especially in noisy or challenging environments, and yet (to our surprise) have normal audiometric findings. Complaints of difficulty understanding speech in noise is expected in our patients with measurable hearing loss, and we approach these patients with recommendations for amplification coupled with enhanced listening strategies and sometimes assistive devices.
Although we have known about “hidden hearing loss” for years (that is, difficulty understanding speech despite normal audiogram), newer technologies are allowing us to offer more proactive solutions.
Imagine a patient coming into the office, and describing hearing difficulty at work meetings and at restaurants. She needs to ask her friends and family for repetition. Hearing is taking extra effort and the energy needed to piece things together is stressful. Fear of mis-hearing may lead to avoiding some previously enjoyable situations. Yet, her audiogram (that box with the graph of hearing sensitivity for a spectrum of pitches for each ear) is within the range considered normal!
In past years I would have reassured the patient that the hearing test is normal, the world is noisy, everyone misses things at times, and to use good strategies to facilitate easier listening. This is still helpful advice for many people. But we audiologists must listen critically and completely to each person’s story. Some people need more help, and we are learning that there are now amplification solutions that are appropriate and helpful even when the audiogram is normal.
In fact, telling someone that their hearing is perfectly normal when they are struggling can be more frustrating than reassuring. (Am I a hypochondriac? inattentive? Is my brain ok? What’s going on??) The physiological theories of why some people have hearing difficulties despite normal audiograms are complex. Our standard threshold tests (the audiogram) simply do not assess these causes adequately.
We have found that for some patients with normal audiograms, use of mild-gain open fit (non-occluding) hearing aids with advanced sound processing capabilities can improve the signal-to-noise ratios, reduce the steady state noise, give an edge to the speech, and make speech more easily accessible.
During this past year we have had at least 3 patients in our practice ranging in age between 16 and 22 years who we fit with wonderful results. Each story is different, and yet each person was highly motivated, and enthusiastic about using technology to enhance hearing ability. The comments had a theme in common: Amplification made the user feel more whole, better in her own skin, more confident and ready to face the world.
Everyone hears most easily in a quiet environment. We hear most accurately when sound is delivered at a favorable signal-to-noise ratio. But we have learned that some people need a boost to best access auditory information, so they can most fully participate in professional, social, and educational activities. Improving the brain’s ability to get the meaning of sound enhances the quality of life. This is a specific solution for some folk who continue to have difficulty even after trying the usual strategies.
At McGuire’s Hearing Centers we think outside the box. We listen hard to hear YOUR story. We know that hearing solutions are not one size fits all. Fitting amplification on patients with normal audiograms is not for everyone. But it is our job to make every effort to help, and that is what we will do for you.