by Neil Bauman, Ph.D.
A man asked:
Is anything that can be done about poor discrimination (word recognition) besides learning techniques for coping with it? I have worn hearing aids for many years but have never received a plain answer to that question.
There’s really not all that much that can be done for poor discrimination besides learning how to best cope with it. Here are some things that may help though.
1. Poor discrimination is often the result of not being able to hear the higher frequencies well, or at all, since most of the “intelligence” in speech resides in the higher frequencies. If you can still hear the high frequencies somewhat, then having hearing aids and/or assistive devices that are specifically adjusted to amplify these higher frequencies to your optimal level will help. So will using high-fidelity sound equipment. The better the quality of the sound, the better we can understand it—even with our poor hearing.
If you cannot hear the high frequencies at all, then using a frequency-transposition hearing aid may help you by shifting sounds down to the frequency range you can still hear. Some people have good success with these special hearing aids. There are a couple of companies that make these hearing aids. Perhaps the best known is the Sonovation line of ImpaCt frequency transposition hearing aids, but most Widex hearing aids now also have this feature. Widex calls it the “Audibility Extender”.
2. Amplification technology can only go so far. When it can’t help anymore, then getting cochlear implants will very often remarkably help improve your discrimination (and hearing too of course). When hearing aids can no longer significantly help you, this is the next logical step to take.
3. As far as coping strategies go, speechreading used in conjunction with your hearing aids can also remarkably improve discrimination. Studies have shown that when used with hearing aids, speechreading can push your discrimination back up around the 80% level. Finally, if all else fails—use real time captioning—then your discrimination is essentially back to 100% (assuming, of course, that your captionist can hear the speaker accurately).
I have just finished reading several pages of your posts and I can say you are a gifted writer. I have found myself sitting here for the last two hours reading. I plan to order 2 of your books shortly.
My comment to this post is that USF in Florida has a program they use for hearing aid/cohlear implant training to build up your word recognition. I have been using this for a few months and found that it is helping my patients, especially with concentration skills.
Also Phonak has a new aid out called the Naida which has Sound Recover(freq transposition) and I have had amazing results from this aid. Check out my website and you can read some of the stories about them.
Thank you for such good information on your site, keep up the good work.
I have cookie bite hearing loss. My last test my hearing had not gone down, but my speech discrimination has. My audiologist wants me to see a specialist. When I asked him if he used the same level tone as before, he said he use a comfortable setting. I hate to spend money for a specialist–but the setting he has for my hearing aids now echo and I cannot understand people as well–been wearing phonic hearing aids for 2 yrs (speaker goes in ear.
Hi Linda:
When your audiologist tests you for word recognition (or speech discrimination) the results can vary depending whether it is a man or woman saying the words, whether it is live or recorded, and whether the volume is set the same.
For example, in my case, my discrimination scores change a lot depending whether the volume is set at a “low” comfortable level or a “high” comfortable level.
Therefore, you are right to be concerned if your hearing hasn’t changed, and your discrimination scores did unless the level was the same as before, and the other factors I mentioned are the same too.
Now, when it comes to hearing aids and discrimination, there are ever so many possibilities for setting your hearing aids (tens of thousands of possible combinations) so it takes time and skill to get it just right so you have the best possible discrimination.
From what you describe, I wouldn’t be at all surprised if your hearing aids are not set to best maximize your discrimination.
Regards
Neil
Thanks, my son thinks the same!!! Nice to have a place to ask questions!!!
I just read your comments on speech discrimination advise. They were very helpful. I have a question and I hope you can help me. My mother is 94 years old and has begun to loose speech discrimination abilities. She hates her hearing aid saying it does not help her to hear or understand what people are saying. When we speak to her at a normal level of sound she understands and hears what we are saying but the words have to be directed to her face. We live in Mexico and very recently heard news that a new computerized hearing aid is now available in the market to help old people with this condition. Can you help us identify if this is so? If it is the case can you recommend someone who can help her with her condition? Thank you!!!!
I have recently been told that the hearing discrimination test was poor therefore no hearing aids would help this problem.. I have tried 2 different top of the line hearing aids and found them to be of no benefit.
Is this where I stop and just accept the problem?
It’s very frustrating.
Hi Bonnie:
What does poor mean? What were your discrimination scores for each ear?
It is true that the poorer your discrimination is, the less hearing aids help you, but that does not mean they are of no help. I know people with very poor discrimination that do well wearing hearing aids and using speechreading at the same time.
How bad is your hearing? If you have poor discrimination scores and profound hearing loss, then you probably will find that getting a cochlear implant will give you ever so much better hearing. If you have just a mild loss and poor discrimination, that is a different story.
It really helps if you give me all the information I need so I can figure out what will best help you.
Cordially,
Neil
Hello, I have been struggling with hearing loss in my right ear for the last two-theee years. My most recent hearing assessment suggested that my speech discrimination score has dropped from 80% in my right ear to lower than 40% in the past 6 months. (My left ear is at 96%). I’m concerned with the rapidity of the drop, and am beginning a 30 day trial of a very high-end hearing aid (haven’t used hearing aids before now) but feel confused about whether a hearing aid will really be helpful. Is my brain unable to understand speech? Is it a case of “use it or lose it?” The right ear has moderate to severe loss, and is extremely sensitive to loud “sharp” sounds, so I’m
Not confident about how amplified sounds are going to feel.
Hi Emily:
Your discrimination is dropping alarmingly fast. Have your doctors figured out why? I’m wondering if you’ve had a MRI or CT scan to check whether you have an acoustic neuroma growing on your auditory nerve. This is what I’d do first.
High-end hearing aids basically just have more bells and whistles than less expensive hearing aids, but they all have the same basic core–amplifying sounds. They do not (and cannot) compensate for poor discrimination. It’s sort of like polishing the inside of a window so you can see more clearly when it is the outside that is dirty.
If you are sensitive to “sharp” sounds, you’ll have to have the compression set by frequency so that such sounds will not recruit. This is not always possible due to limitations of the hearing aid–but it can certainly help. When my hearing aids can’t “fix” it, I just take them off. If you “screw down” the compression too much, it will make your discrimination even worse, but if you don’t, the sharp sounds will “blow the top of your head off”. Thus, there is a fine line to tread in getting the best compromise.
If the hearing aid doesn’t help you significantly, then be sure to turn it in and get your money back within the 30 day trial period. Don’t even go over by 1 day or you will have just bought it. Some places are very picky about this.
Cordially,
Neil
Thank you, and yes, I’ve had an MRI to rule out tumour possibilities. At this point we are thinking Ménière’s disease, and are still trying to sort out all of the intricacies for daily life.
The hearing aid trial will let me explore the sound and whether I can tolerate the amplification of all the sounds of my daily life (I teach kindergarten! So my work environment is not a particularly quiet one!)
I guess what I wonder is if increased stimulation will improve my discrimination? Or once it’s gone, is it never coming back?
I’d be more inclined to work hard to learn to live with the hearing aid if it can help my brain regain discrimination, than if it’s a lost cause.
Hi Emily:
If you are thinking you have Meniere’s disease, then I’d strongly suggest you read my comprehensive article on how to get rid of Meniere’s. You can read it at http://hearinglosshelp.com/blog/atlas-adjustments-alleviate-menieres-disease/ . Your doctor has probably not heard of this, so he will never suggest it, but it works.
I doubt that wearing a hearing aid will help with your discrimination. Whether it is permanent or not depends on excactly what is causing it.
Cordially,
Neil
Hi
I lost my hearing in right ear since 8 month ago
and my SDS test is 68%
use of 6 depo-medrol injection during 3 weeks didn’t answer and my MRI was not problem.
I use hearing ads (Phonak) from 2 month ago but I think that’s not solve my problem!! sometimes I have tinnitus in right ear and that is problem to hearing clearly!!
my doctor changed my hearing ads setting but I think my SDS is poor yet!!
Thank you
Hi Hossain:
Hearing aids do not change your SDS–speech discrimination score. You SDS is the result of your damaged ears and there is basically nothing that is going to change that.
Cordially,
Neil
Hi Dr Neil,
My discrimination score is poor. It is 40% of left ear and 45% of right ear, I have bilateral severe hearing loss. It’s been long that I am unable to hear clear. It frustrates me a lot, as hearing aids are not clearing me speech , I am now thinking of cochlear implant. Is it right decision ?
Please reply. Thanks.
Hi Nitin:
Since your discrimination scores are poor–40% or less is considered poor–if you want a cochlear implant go for it. It’s your decision, not mine.
Just remember, cochlear implants are not perfect. They will not give you perfect hearing, but almost everyone I know that has a cochlear implant says the same thing, and that is, “If I had to do it over again, I do it in a heartbeat”.
That shows just how many people there are out there that our ever so happy they got their cochlear implants and love them in spite of their shortcomings.
Cordially,
Neil
Hi Dr Neil,
Poor discrimination can be treated if we can hear higher frequencies, since most of intelligence in speech resides in higher frequencies. If we hear higher frequency somewhat poor discrimination problem is solve. Is it correct, I was reading this and think to ask you that if I too hear higher frequencies than I will too hear clear despite my poor discrimination which is 40% of left & 45% of right ear. Please reply dr. I am waiting, I am just about to have cochlear implant. Your reply may change my direction of treatment. I have faith in you. And your replies are important for me. Thanks 🙂
Hi Nitin:
I would say that is generally true–the better you hear the higher frequencies, the better your discrimination tends to be.
Cochlear implants give people much better high-frequency hearing and as their brains adapt to the CI, most people find that their discrimination rises dramatically. I know some people that had essentially 0% discrimination before getting their CIs. After they got used to their CIs, their discrimination rose and is now greater than 90%. That’s a pretty dramatic increase in discrimination, wouldn’t you say?
Not every one does that well, but that is what you could expect.
Cordially,
Neil
Thanks again for quicker valuable reply!
Yes its great from CI if people’s discrimination change from 0% to more than 90 % . And i can understand
CI making big difference.
Actually i have been using CIC hearing aid and I thought if I use bte hearing aid I might be improved on hearing higher frequencies. This year in march I went for new hearing aids & I was advised for bte bilaterally. I took trail for naida v50 for 2 weeks and my response was its good than cic versata but my problem of speech discrimination is not solved. Now I think if I wear phonak naida v50 bte hearing aids and give it some more time say 6 months time to ascertain whether my discrimination improves or not. Will I be wrong in doing or checking this ?
Should I try this?
Or as my discrimination is poor 40 % left & 45% right ear then I should not think as I am thinking for bte and move for CI Bcoz poor discrimination can’t be improved by hearing aids no matter either it is cic or bte or premium hearing aids . Should I understand and accept this that no hearing aids can improve hearing higher frequencies?
Hi Nitin:
While different hearing aids, because of their programming, may give you a bit better discrimination due to letting you hear some high-frequency sounds better, there is only a marginal improvement because of many missing (deaf) hair cells in the cochlea that process the higher-frequency sounds. That’s why, in cases such as yours, going straight to a CI is probably the better alternative.
Cordially,
Neil
Dr. Neil, after all these my queries and other questions asked on this blog one logical, very interesting, and last probably last question from me is to ask ” how long will it take to medicine for cure from sensorineural hearing loss to come in medical science for treatment”. Its very famous question, so I thought to ask you on this blog. Please reply your best answer. So that everyone would be guided correctly because everyone want to know answer to this question. Thanks dr Neil bauman 🙂
Hi Nitin:
I can’t see into the future any better than you can. Thus, I don’t know how long it will take for things like hair cell regeneration to come to pass–if it ever comes to fruition.
Even if it proves useful, there is no guarantee that it will restore hearing to normal–it may just give better hearing, but not normal hearing–just like hearing aids do now.
The current wisdom is that it will be in the next 20 years. Some figure much sooner, but there are still a number of problems to work out before it is ready for public use.
So, don’t hold you breath–but use the best available technology available in order to hear better today.
Cordially,
Neil
Hello, I have cookie bite hearing loss and have recently lost 10 decibels. My pure tone average is 65 in my right ear and 61 in my left. My word discrimination is 68% in my right and 76% in my left. I guess my old hearing aids were not adjusted for my loss and I had been wearing them for some time at the lower volumes. Can my word discrimination come back somewhat now that I am wearing hearing aids better suited for my degree of loss? Did I lose my discrimination because of my additional hearing loss? So depressed. Thank you.
Hi Tara:
If your hearing aids are not adjusted correctly for your specific hearing loss, you can lose some discrimination. But the good news is that when your hearing aids are adjusted properly, or you get better ones, you can regain that lost discrimination.
You’ll not get more than the discrimination testing reveals though. Because discrimination testing is done without hearing aids and at your most comfortable listening level and in total quiet, that gives your best discrimination scores. But hearing aids should give you this same figure in quiet. If it is less, then they are not adjusted properly for your ears.
And of course, the more noise around, the worse your discrimination. But this is one place where hearing aids might actually help you–if they can filter out the noise, you’ll hear speech better than otherwise IF by filtering out the noise, they do not also degrade the speech signal. However, my previous aids also degraded the speech signal so I was not really any further ahead in that respect–but the noise didn’t bother me–so that was the plus.
Cordially,
Neil
hi dr Neil,
dr. I can have answer from audiologist i have here about one question but I want to ask you. when I wear hearing aid on left ear there should be loudness as i have amplified sounds. I have noticed I have less loudness in my left ear than my right ear after wearing hearing aids where my hearing loss is covered by hearing aids. I don’t understand this. why this is ? please reply for sure, and obviously when I am hearing low from left ear then I don’t hear well.
thanks for your time.
Hi Nitin:
I am not clear what you are asking. When you wear a hearing aid in your left ear, you should hear louder sounds as the hearing aid is amplifying them. Is that what is happening?
Now, are you saying that your right ear still hears better than your left ear, even when you are wearing your hearing aid? If so, that is because hearing aids don’t restore hearing to normal–just make it “better” to some degree.
Or are you meaning that when you take your hearing aid off from your left ear after wearing it for some time, now it doesn’t seem to hear as well as your other ear, yet if you never put your hearing aid on, they both sound about the same level? If this is the case, it happens to all of us. If I don’t put my hearing aids on, I hear “normally” for me (very poor hearing to be sure, but normal for me). If I then wear my hearing aids and later take them off, it seems that I hear much worse than my “normal” because of the contrast of how well I hear with hearing aids as opposed to not wearing them. This is just a psychological feeling. The hearing aids haven’t made your ears not hear as well.
Cordially,
Neil
hello Dr. Neil,
this time I am interested to ask you about my left ear tinnitus which is loud enough today for me as I am hearing it to put me ask you a query about it. it is like whistle of pressure cooker (if you ever heard ?) or it may be different thing.
whatever it is, my important question is this that I am thinking to have cochlear implant in my left ear , when I have it done. can my tinnitus recover with cochlear implant surgery? or there is chance tinnitus can remove from my ear or tinnitus loudness may decrease after CI ?
As I am getting, I have read over internet, that tinnitus might recover after CI surgery . Is it true ? please clear me, what should I perceive CI surgery can do to recover my tinnitus in left ear ?
Thanks Dr. 🙂
Hi Nitin:
Numbers of people who have cochlear implants find that when they are turned on their tinnitus goes away during the day while they are wearing their cochlear implants. But the tinnitus can come back at night when they take their CIs off.
Others find that their tinnitus is greatly reduced in volume. So there is a good chance that your tinnitus will be much less after you get a cochlear implant, but there are no guarantees. I’ve also heard of the odd person who has the same or worse tinnitus with their CI.
Note that after the CI surgery and before you are turned on, you may find that your tinnitus gets much worse. This is normal.
Cordially,
Neil
Dear Dr neil,
After 4 months now somebody send me this so I thought to ask u first, please see ahead , I am pasting here –>
Stem Cell Therapy for Hearing Loss in India
The stem cell therapy in India act very much like the hair cells and the sensory cells that normally reside in the inner ear will cure the deafness. We accept the patients only with pure sensorineural hearing loss and not with the conductive hearing loss. The generally treatment protocol for hearing loss includes MSC packets that are injected by IV and LP. The injection and cell types may change slightly depending on the patient’s condition.
When you are submitting your medical information, kindly note that our doctor will request you to view certain documents such as for sensorineural hearing loss you need to send the tuning fork test, pure tone auditory, ABR and ASSR.
Benefits of Stem Cell Therapy for Hearing Loss in India with Tour2India4Health
The stem cell therapy in India can help to improve the symptoms of hearing loss and also restore the sense of hearing. But it is important to remember that the therapy is not a cure. There is also the possibility of minimal to no improvement. Therefore we encourage our patients to keep realistic expectations. Many patients with hearing loss have noticed significant improvement.
Hi Nitin:
Researchers are busy working on stem cell therapy, but in my opinion, it is not ready yet. They haven’t worked out all the bugs yet and who knows what serious negative side effects can surface. Thus, I’d give it a few more years before you jump in.
Notice that they say you may have little or no improvement. Does that sound like a therapy that works? Furthermore, they say it is not a cure for hearing loss. Isn’t that what you want?
If you go ahead, you are going to be a guinea pig and have an uncertain outcome. As I said, personally, I’d wait.
Cordially,
Neil
Dear Dr., Thanks for your quick reply, I am not going ahead with this. As it is uncertain to have cure, this thing don’t make sense to me at all. Actually my most respected dr neil bauman, one of my known healthcare provider at here sent me this. So , I thought to ask you first about your valuable opinion as I perceive you knowledgeable person available to me on earth to ask ear health related questions, and you always helps me, when I need you. I don’t know god exists or not. But I wanna say you that you are gift to me from almighty god. The feeling of connection with you for this important issue of my life is wonderful. Thanks a lot dr for being with me.
Being with a winner makes you a winner, so you makes me a winner !!! 👍