by Neil Bauman, Ph.D.
February 18, 2017
A young lady wrote,
I have a 30 dB hearing loss in my left ear although I still have 100% word recognition. However, my right ear has an 80 dB hearing loss, but only 8% word recognition. My doctor told me that due to this, my right ear is not eligible for a hearing aid. She said even if I hear speech in my right ear, it will be highly unrecognizable and distorted. Is this true?
Does this mean I have severe hearing loss in my right ear and normal hearing in my left?
In crowds, with a lot of background noise, I feel like I can’t hear anything. Also if a phone rings or a baby cries, I can sort of hear it, but I cannot possibly find where the sound is coming from. I was wondering if you knew why this was.
A 30 dB hearing loss is a mild loss. Don’t let the term “mild” fool you. You still miss a significant amount of quiet sounds, although you will still hear louder sounds.
An 80 dB hearing loss is, like you already know, a severe loss. This means you don’t hear much with that ear—only loud sounds. However, you can still hear a “lot”. I have an 80 dB loss in both ears and I still think I hear a “lot”, but I know I miss ever so much more than I hear. Thus, to answer your second question. You have a mild hearing loss in one ear and a severe hearing loss in the other.
Therefore, in order to correct your lack of hearing, you need hearing aids to amplify sounds so you can hear them. Most people only think you need more volume to hear. This is only one aspect of hearing loss.
The second aspect of hearing loss is how much you understand of what you hear—what audiologists call speech discrimination or word recognition. If you have 100% word recognition, you understand everything you hear. 80% word recognition means you understand 4 out of every 5 words you hear. This is still quite good as your brain often can fill in the missing words from the context of the sentence, unless you happen to miss a key word. Then you may miss the meaning of the entire sentence.
Your bad ear only understands 8% of what it hears. This is very poor discrimination. Basically, that ear just gives you gibberish. You’ll only understand every twelfth word. So if you hear someone talking, you’d hear something like this.
“Gibberish, gibberish, gibberish, gibberish, gibberish, gibberish, gibberish, gibberish, gibberish, gibberish, gibberish, gibberish, car, gibberish, gibberish, gibberish, gibberish, gibberish, gibberish, gibberish, gibberish, gibberish, gibberish, gibberish, gibberish, dishes.”
Not very edifying is it?
If you wear a hearing aid in that ear, all you’d hear is louder gibberish for the most part with an English word thrown in now and again. Wearing a hearing aid won’t magically make this gibberish into English. Thus, what your doctor said is true.
However, if you are a good speechreader, even with only 8% discrimination, you could still understand a lot more of speech than your level of discrimination would indicate. You will get the cadence of speech via your hearing aid (and the odd word you understand) and this will help you immensely with your speechreading accuracy. Your brain will put together what you hear with what you see (speechread) and surprise—you’ll find you understand quite a bit.
Having said that, you will likely find that if you wear hearing aids in both ears, all the gibberish your bad ear hears and sends to your brain will overpower the good sounds from your better ear. This makes it much harder for your brain to separate the good sounds from the gibberish. The result will be that you won’t understand as much as you would if you only wore a hearing aid in your better ear. Besides, you’ll feel much more tired and cranky as the day wears on.
If you find that this is your case, then you should only wear a hearing aid in your better ear, especially when you are in relatively quiet places.
Now let’s look at why you have so much difficulty understanding speech in noisy places. In order to extract speech from background noise, you basically tell your brain to listen to just the sounds coming from one person’s mouth. In order to do that, your brain has to focus on the sounds coming from that specific location. And in order to do that, your brain needs two separate sound signals of that person talking.
As an analogy, think of the difference between a flat (2D) picture and a 3D picture. In the former—you see the various objects as though they were all the same distance from you (the speech is all inter-tangled with the background noise). You can instantly see this effect by shutting one eye (or ear).
However, if you want to see this same picture in 3D, you need both eyes (ears), each sending a slightly different set of signals to your brain. The result, is that your brain triangulates (focuses) on the person you are wanting to see (hear), and he suddenly stands out from the background.
Since your bad ear can’t hear that person talking, only your better ear sends that sound signal to your brain. Thus your brain doesn’t have the critical information it needs to make that person’s voice “pop” out of the background racket. Essentially, you are only hearing in 2D, not 3D. This makes extracting speech from background racket almost impossible.
If you wore a hearing aid in your bad ear in such cases would just make everything even worse, because now your brain would have to contend with an enormous amount of gibberish as well.
Furthermore, the reason you can’t tell the direction from which sounds are coming is also related to your lack of binaural hearing. You see, in order to locate the source of sounds, a baby crying, the phone ringing, etc., you also need two working ears. Your brain uses the slight difference in the volume of the sounds reaching each ear and the tiny difference in time these sounds reach each ear, to figure out from which direction the sound is coming.
When your brain only has one signal coming in, it doesn’t have the critical time delays and volume differences to triangulate the direction of the incoming sound. The result is that you just hear the sound, but don’t have a clue where it is coming from.
In such situations, you may gain some benefit from wearing two hearing aids. When you wear two hearing aids, as long as both of your ears can pick up the same sound, then your brain has the sound delays and volume differences it needs to calculate direction. Thus, you may find you have your directionality back.
Some people in your situation do wear two hearing aids when out and about so they can hear the direction from which warning sounds are coming—for example, a siren, horn honking, person shouting a warning, etc.
This can work quite well since you don’t have to understand speech in these situations, you just have to hear the sound. Note: this is only going to work when the background noise isn’t so loud that it buries the sound you want to hear.
To summarize:
- In quiet situations, wear a hearing aid in your better ear and not one in your worse ear. This will let you hear the best without amplifying the gibberish your worse ear hears.
- In noisy situations, you may find that even wearing a hearing aid in your better ear doesn’t help, so you may want to take it off and see if you hear and understand better without it.
- When out and about, you may find that wearing two hearing aids will help you identify the direction of warning sounds, but they won’t aid in understanding speech.
- Finally, in all situations, use your eyes. Your eyes are now also your “ears”. Speechread all the time and your brain will put together what your eyes see and what your better ear hears. The result is that you will understand speech much better than you otherwise would. After all, that’s exactly what you want.
Thank you so much for your answer! The explanation of why my directionality is poor and why background noise agitates me, was so eye-opening! I guess I never really considered ears being a pair. I know that sounds dull, but I thought they would work separately like arms, I suppose. Continuing on, my doctor said a Cros hearing aid might benefit me, as they work as a receiver and transmitter to send signals to my better ear. However, I wonder if this would worsen the effect of me being unable to locate sound.
Also, I am only 19, and I was wondering if you knew how much hearing I would lose as I age. I mean, comparatively to a hearing individual. I always fear that I will become very very HoH and unable to function properly. However, I am pretty fluent in ASL, so I guess there is a way around everything. I just guess I’m asking if their is an average decay rate to hearing. Like perhaps “normal” for a 60 year old would be 20 decibels, or something. So, if that was the case, my hearing might get about 15 decibels worse in each ear.
Thank you, Thank you, Thank you!
Hi Sabrina:
Your ears work in pairs–just like arms. Just try taking the lid off a jar with one arm. Yes, they can work independently just like arms–but so much of what they do is done in pairs–just like arms.
Yes, a CROS (actually you need a Bi-CROS aid) can help you, especially if you often have someone talking to you from your deaf side. Or you can arrange things so that people have to talk to you from your better side. E.g. have your friends walk on your good side, sit on your good side, etc. And you need to sit on the side of the classroom/church/meeting room so your bad ear is to the wall and your better ear is facing/hearing into the room. This will make a big difference too.
A CROS/Bi-CROS aid won’t help you locate sound, but it won’t make it worse either.
What caused your sudden hearing loss? Also, what caused the 30 dB loss in your better ear? If you are abusing your ears by taking drugs, or exposing them to loud sounds, your hearing will drop much faster than if you are protecting your ears from loud sounds, etc. There are “average” curves that show how fast people lose their hearing as they age. The good news is that women lose hearing slower than men by about 10 years. This means a man at 50 will have the same hearing loss a woman at 60 might have.
Hearing loss generally slopes down in the higher frequencies as you age. This means your low frequecy hearing doesn’t drop much at all, but your high frequency hearing drops about 20 dB per decade from 50 on up at 8000 Hz. Remember, these are average figures. You could be completely different.
These curves don’t show much hearing loss until you reach 50 or so, then you’ll see that the high-frequency hearing begins to drop and gets progressively worse as you age from there.
Being fluent in ASL is great, but since few people are, who are you going to talk to? You will find that learning to speechread will help you more in the hearing world. I have been speechreading since the day I was born. It has been my prime means of communication all these years.
Cordially,
Neil
Also, I’d like to add that my Audiologist said I was one of the poorest patients she ever had dealing with word recognition. She was convinced that I didn’t get lower because I just ended up guessing right occasionally. (I received an 8%) So, I guess I’m asking if having a very poor word recognition score is uncommon?
Hi Sabrina:
Well, if you guessed right, you just guessed right two times. Each word right accounts for 4%.
But she is right. You have extremely low discrimination for an 80 dB loss. My loss in both of my ears is about 80 dB too, but I have around 80% discrimination. I’d say your level of discrimination is not very common at all for your degree of hearing loss.
Cordially,
Neil
Hi Sabrina:
Well, if you guessed right, you just guessed right two times. Each word right accounts for 4%.
But she is right. You have extremely low discrimination for an 80 dB loss. My loss in both of my ears is about 80 dB too, but I have around 80% discrimination. I’d say your level of discrimination is not very common at all for your degree of hearing loss.
Cordially,
Neil
I do not abuse drugs, I lost my hearing over night at age 15. My doctors believe it was due to an untreated case of labyrinthitis. I have a very low immune system, and have had ear infections all of my life. I remember my hearing being around 15 decibels before I fell sick with extreme vertigo. (On a side note, I do not have Meniere’s disease because I stopped having vertigo the first week of being sick) So, that means my hearing wasn’t all that well to begin with. Originally, doctors believed I must’ve hit my head to acquire that much hearing loss so quickly. However, I live a very quiet life at school, church, and my job. I attend a Deaf church of about 45 individuals: that’s who I talk to.
Thanks!
The way you talk to people is extremely bad. You freak people out with no reason. There is no reason to tell someone that all he hears is gibberish. There is no reason freaking young people out when they get tinnitus. I see how you talk to them making them feel guilt and I get sad. You are not helping anyone. You’ re just making a career out of being hard of hearing.
Hi Jim:
When a person has a discrimination score of 8%, that means that all they hear is gibberish 11 times then catch one word, then 11 more gibberishes and another word–that is, on the average.
It seems you want me to lie and tell people untruths. To me it seems that you are in denial and don’t like hearing the truth. So you blame me rather than accepting the truth. Notice that the lady whose questions I was answering was very thankful for my reply. She ended her comments with “Thank you, thank you, thank you”.
You are so freaked out about hearing loss and tinnitus, I can just assume that you wrecked your ears and are now in the anger stage of grieving and are taking it out on everybody else. And instead of being grateful for all the help I freely give people, you feel you have to attack me to try to make yourself feel better. But I’ll bet you feel worse now, not better.
Keep working through the grieving process and eventually you’ll come to the acceptance stage and find yourself on an even keel again.
Cordially,
Neil
Dr. Neil,
In your case of having 80% speech discrimination, and Sabrina’s case of having only 8% why is it that you two both have the same 80dB loss yet your discrimination is so much better than hers? What causes the difference? Thanks!
Hi Jan:
I think a lot of it depends on exactly what pitches of sound you hear or don’t hear. For example, if you don’t hear the high-frequency component of speech, but hear the lower tones, you can easily hear people talking, but not understand what they say. That would give you poor discrimination.
On the other hand, if you heard the higher-frequency speech sounds, but not the lower ones, you’d understand much more of speech (as long as it was loud enough for you to hear).
Since speech discrimination is tested at your most comfortable loudness level, a person with a reverse-slope loss (low-frequency loss) would have a definite advantage in speech discrimination as opposed to a person who only hear lower-frequency sounds.
Since I have the rare reverse slope loss, and if your daughter has a ski-slope loss, that could account for the enormous difference in our speech discrimination–even though we have apppoximately the same overall hearing loss.
Another possible cause may be how many outer hair cells are dead. Since the outer hair cells greatly help with clarity of speech, if most of them are dead (especially in the higher frequencies), then you’d have poorer speech discrimination than if most of them were still alive.
Cordially,
Neil
Hi, me too my right ear was totally deaf as in doesnt hear anything..and i felt shy if somebody sitting beside me talking to me on my right side..so which one better to use for my right ear..
Hi Frinalyn:
Since you are totally deaf in your right ear, no hearing aid is going to help you significantly. Your best bet is to get a CROS aid. This is a special kind of aid that takes the sound from your deaf side and sends it to your good ear. That way you can hear people sitting on your deaf side quite well.
What you do is wear what looks like a hearing aid on your deaf side, but it is really just a microphone to pick up the sound from your deaf side and a miniature transmitter to transmit it to your good ear. On your left side you also wear what looks like a hearing aid, but it is really a miniature receiver and amplifier that feeds the sound from your deaf side into your good ear.
if your good ear has a hearing loss, then you need a biCROS aid rather than a CROS aid. The only difference is that a biCROS aid is both a CROS aid for your deaf side and a hearing aid for your better ear. Thus a biCROS aid amplifies sounds from both sides of your head, not just from your deaf side.
Cordially,
Neil
Hi Doctor,
My dad has hearing loss in both ears (right 55 dB HL, left – 85 dBHL). However, he has Cholesteatoma in his left ear and is prone to secretions from that ear. Antibiotics didn’t help, and the ENT doctor said that given my dad is in his seventies, an operation might be a bit risky, and told us to let it be. He said my dad can use hearing aid in his right ear, and he can’t use it in his left ear due to secretions.
One other audiologist is however saying that its ok to use hearing aids in both ears.
Is it ok for my dad to use hearing aid in one ear only?
Hi Ravi:
If your dad will hear better with a hearing aid in his left ear, in spite of having a cholesteatoma, then I see nothing wrong with it. However, if the secretions from his left ear are such that they are going to clog up the hearing aid frequently, is not going to really do him any good then. So that would be my main concern.
Cordially,
Neil
Hi,
I started following this thread because I was just diagnosed with SSNHL in my right ear. I can’t remember what my loss was, I do know that it fell in to the moderate to severe loss category, but my WRS was 23%. My left ear has perfectly normal hearing and 100% WRS.
I also have Vertigo along with my loss. I was curious if anyone has experienced this, or knows if the Vertigo goes away? Will a hearing aid help me with my WRS in the bad ear?
I am only 31, and in law school. I am worried about my ability to hear in the courtroom or in meetings and missing important information when I begin practicing.
This is all very new to me, and I still have my follow up appointment from my initial hearing test. But, from what I am reading, it seems that my chances of recovering any hearing is quite low. I wasn’t able to get into the ENT for over 4 weeks from when this first started, so by the time I got there, it had already progressed.
Thanks for any insights anyone can offer!
Hi Brandi:
What caused your SSHL–did your doctor give any ideas? Did you have an active virus in your body, or flu or cold or herpes, etc? From the little you said about it, my guess would be that it was a viral attack on one ear, or possibly a mini stroke in one ear. Since you are pretty young, I doubt that a mini stroke would be the cause.
Since you have vertigo, obviously whatever attacked your hearing mechanism in the cochlea also attacked the other half for your inner ear–your vestibular or balance mechanism, and the result is the vertigo you now experience.
Typically, vertical goes away as your brain learns to ignore the faulty balance signals it’s receiving from your bad ear. Vestibular therapy can help this happen and help you get your balance back to a reasonable level.
With only 23% discrimination, it’s unlikely that a hearing aid is going to significantly help you understand speech in your bad ear. Thus, instead of wearing a hearing aid in your bad ear, you may want to try wearing a CROS aid. Basically this hearing aid takes the sounds coming to your bad ear and sends them to a receiver on your good ear so that you can hear from both sides of your head at the same time with your good ear.
Cordially,
Neil
My husband and I understand now about the gibberish thing. My husband said it’s true that he doesn’t hear all the words when a person is speaking to him. He uses captioning too. He said it was explained very well about why that is. He doesn’t wear hearing aids so maybe now he will, I do. I think that everything I was reading to him made much more clarity about hearing loss, the brain and tinnitus. I was trying to find out about the wearing of one or two hearing aids and that was made clearer too. We appreciated all of this info. Thank you!
A little history about my situation… I think heredity/ menopause/ hormones played a factor in my hearing loss and tinnitus. Then years later a hole was made in my eardrum from a tube that was put in my eardrum. It didn’t come out when it should have (was left in too long) and that caused the hole in my eardrum not to close up. The ENT said that I couldn’t wear my hearing aid due to having the hole in my eardrum. I now found out from a different ENT that I should have been wearing my hearing aid for these past two years even with the hole in my eardrum. Now that caused my word deprivation to be much worse. My brain has suffered from all of this 🙁 And when that ENT surgically closed my eardrum there was still a small hole there. During the surgery I think something must have happened as my hearing loss is worse in that ear. I also think the ENT knows what happened in his office when he placed a cadaver patch in my ear with a tweezer while I sat there and hurtfully poked me as he tried to patch up the small hole that was still there. I think when he poked me with the tweezers that did more damage to my hearing. It is what it is- as my damaged ear needs a molded hearing aid now and the better ear needs a regular hearing aid. I need to have these new hearing aids adjusted better as they aren’t quite right. Also, the arms of my eyeglasses rub on the hearing aids and the length of the receivers isn’t right. All of these issues are making it difficult for me to wear my new hearing aids.
Hi Barbara:
Just because you have a hole in your eardrum does not preclude you from wearing a hearing aid in that ear. Don’t know where you ENT came up with this weird ideas.
Go back to the person who fitted you with the hearing aids and get these issues resolved. It is normal to have to go back several times to address the various issues with new hearing aids. It takes time to figure out what you need adjusted, and skill on the fitters part to make the right adjustments. Sometimes what they think will work makes matters worse so you have to go back yet again.
I’ve been going back to my audiologist for the past 6 months getting things adjusted as best as she can. Nothing is perfect, so you have to find the best compromises and then accept that is the limits of your hearing aids to adapt to your ears.
Cordially,
Neil