by Neil Bauman, Ph.D.
A man wrote:
My question is about hearing aid effectiveness. I notice that some people talk about having hearing aids but still having problems hearing. At the price that hearing aids go for, while I don’t expect to have Superman’s hearing, I thought I would be getting rid of the mumbles. I would expect issues such as background noise, certain sounds amplified that you don’t want to hear etc, but I do expect to understand what people are saying at a conversational level, even on the phone. Why are people having problems understanding conversational speech?
That is a good question. Let me explain. You need to realize that when hearing loss occurs, a number of things happen.
First, obviously, there is a hearing loss. If this was all that happened, then hearing aids could easily fix this problem by providing exactly the right amount of amplification at each frequency to make up for the hearing loss.
But this is not all that happens. Coupled with hearing loss is a decrease in the ability to discriminate between similar sounds. Thus speech, even when at a comfortably loud level, sounds “fuzzy” or “muddy”. You hear people talking, but just can’t quite understand what they are saying. Amplifying this just makes louder “fuzzy”. It does little to make it clearer.
It’s analogous to wearing glasses. If your glasses are ground wrong (fuzzy) you see everything fuzzy. But if your glasses are ground correctly, you expect to see clearly. But this does not always happen because the “fuzzy” may be in the lens of your eye. The light passes clearly though your glasses, but then gets “messed up” as it passes through your “fuzzy” lens.
This is exactly what happens with hearing. The amplified sounds may pass clearly through your hearing aids–but then they hit the “fuzzy” cochlea and you hear distorted speech. This is not the fault of the hearing aids, but of a damaged auditory system.
This is why we call hearing aids “hearing aids“—they are aids to better hearing, not the cure for poor hearing.
The worse your discrimination scores, the less you can expect hearing aids alone to help you. For example, with my hearing aids, my discrimination is approximately 62% or so. This means that out of every 100 words spoken, and when amplified properly for my hearing loss, I still don’t understand 38 of them. That is why I always speechread at the same time—to fill in the “fuzzy” words.
Understanding Speech Problems is mine type of problem uhm how should i start, uhm im 16 years old and i can hear people what they say my hearing is good BUT here the thing i cant understand, man im 16 years old and i have spoken my countries language nearly my whole life, this is a fact also 2 years ago i was reading on a train suddenly i could understand everything poeple was saying but 2-3 weeks later i coould understand nothing oo please whats the problem . i can explain more if you send me a answer on this please, how to listen what to listen for should i listen for the Beginnings of a word?? or should i hear and then see pictures in my head for understanding, also that way with the picture stuff it works BUT i having problem listening to facts.please help meee
Hi Sonny Boy:
If you have problems understanding speech, the first thing I’d do is go to an audiologist and have a complete audiological evaluation which includes hearing testing. From what you say, it seems you likely have a high-frequency hearing loss.
The most common reason for having trouble understanding speech when you can hear speech, is that you have a high frequency hearing loss.
You see, most of the “intelligence” of speech lies in the higher frequencies, while most of the volume of speech lies in the lower frequencies. Thus if you have a high-frequency loss (very common as a result of noise damage), you hear people talking (because you hear the low-frequency sounds well), but you can’t understand what they are saying (because you don’t hear the high-frequency sounds well anymore).
I have same problem as sonny boy above mention.. i went to ENT specialist and i recoverd a lot of my hearing but i still have problem in comprehending what people say though i hear everything.. the ENT Specialist said my nerves are weak.. i want to ask if hearing aid can resolve my problem? what is the solution of my problem? please do answer i will be thankfull to you..
How can I learn to “speech read”?
I have been wearing starkey hearing aids for 2 years paid 2 months paycheck they will not tell you your hearingm will not be helped with them they wait till warrenty goes out then says sorry your hearing is gone to far that they cannot help with out inplant . why are they only worried about money
Hi Joseph:
I don’t understand what your beef is. When you purchase hearing aids, you have 30 days to try them out. During that time you can tell whether they are helping you or not. If they’re not, give them back and get your money back.
If they are, then what’s the problem? Two years later when the warranty runs out, and if your hearing is now profound, there is a good chance that your hearing has dropped so much that hearing aids cannot help you any more.
At that point, your option is to get a cochlear implant or not.
If you are buying hearing aids and have a history of losing more hearing each year, then I make sure I purchase hearing aids that have much more power than I require at the moment–so as my hearing drops, the aids can be turned up and I can still hear.
You do not want to purchase aids that just have enough power for you now–as they’ll soon reach their capacity as your hearing drops and then be useless. Then you’ll have to purchase more powerful ones at double the expense. If that’s your beef, I can certainly understand.
Regards
Neil
The best response ever. In simple words, explained what we want to know and what to expect when wearing aids. The first time I was fitted, I took 5 months to understand people talking. I was very confused! I changed my aids recently and it´s been a better transition. Docs and dispensers should transmit this realistic impression to patients, always! Thanks a lot.
Who people hear noise and who people understand words ?
I am curious to hear your opinion on SSID 98 decible as a qualifying impairment, And what do you think that 80 would be a fair standard or even 75?
I’m asking because while I believe and know that most individuals can work with hearing aids at these levels and worse, I know that. Some can not and that hearings aids don’t benefit everybody.
I have bilateral sensinueral hearing loss. My last exam I had 78 decible in my left ear and a 65/in my right. I dropped 30 decible since my last exam. I know my hearing has gotten much worse as even with the hearing aids I have extreme difficulty understanding people.
Ive been discriminated from employers and it has all brought on depression anxiety and fear. I know I’m not alone.
Personally I feel that the the way SSID determines whether a person is capable of working solely on an arbitrary number is wrong. Especially when people are working longer, have paid into it and (correct me if I’m wrong) but more people are at risk for hearing loss than any other disability.
My father worked from the time he was 13 yrs old. He worked 3 jobs for more than 30 years and had to work until he was 70 doing manual labor (6months before he died) because his hearing loss was so severe he couldn’t understand 3 feet away…but it didn’t fit the SSID standards.
I feel that there are and will be more people in this situation. So I apologize for the length of this but I am very passionate about this issue and would love any info you would like to share with me. Thank you
S
Hi Jean:
I don’t understand what you are talking about regarding a 98 dB hearing loss as qualifying for SSDI.
Here are the rules as I understand them.
“Most people that receive disability benefits do so because they meet one of the SSA’s disability listings in the Blue Book. Hearing loss applicants can qualify under two different listings:
Hearing Loss (2.10) – which requires:
An average hearing threshold of 60 to 90 decibels or greater in the better ear, dependent upon the testing method
OR
A word recognition score of 40 percent or lower in the better ear
Hearing Loss with a Cochlear Implant (2.11)– which automatically qualifies medically for disability benefits for at least one year after surgery.”
The range of average hearing loss is from 60 to 90 dB. depending on your situation. And it sure helps if you have poor discrimination (less than 40%) at the same time.
Since your average hearing loss in your better ear is 65 dB and you have trouble understanding people (some degree of discrimination), it’s possible you may qualify under the above rules. I think in your case a lot will depend on your degree of discrimination. Hearing loss by itself shouldn’t be a reason for getting SSDI. My hearing loss average is more like 80 dB in both ears and I’ve never considered SSDI. My discrimination is above 70%.
Cordially,
Neil
Hi Neil,
I have a question/dilemma I hope you can help with.
I can not afford hearing aids. I don’t have insurance. I heard that Starkey had a program but that you have to pay 100.00 per ear application fee and don’t get it back if you aren’t chosen. Is this true?
Also do you know of any other programs out there? I have one now that is 7 yrs old. It is on its way out and needs a transmitter but the company no longer makes these hearing aids.
I’m grateful for any info you can give me. Thank you.
Jean
Hi Jean:
As far as I know, your information on Starkey is true. If you can’t afford the application fee, what good is giving away free hearing aids. The people that really need them can’t apply.
There are other solutions. One is to get your hearing aids from MD Hearing Aid. These are good quality aids and they come at a most reasonable price. For example, their top line of aids are only $349.99 each or a pair for $649.99. You can see them at https://www.mdhearingaid.com/shop/mdhearingaid-air/.
Cordially,
Neil
Hi Neil
I have a little problem I don’t understand. I have had hearing tests and been told that my hearing is better than average for my age..yet I am still experiencing problems understanding the start of a conversation on the telephone. The noise is there but it makes no senses sounds all muzzed up, I get people to repeat themselves a few times until I get it or use other words that I do recognise to formulate the conversation this can sometimes lead to problems – agreeing to stuff I don’t agree with. This problem has only started in the last few years. I am now 49
Hi Philippa:
When they add “for your age”, negates what they just said previously. So many times I have people tell me that they hear normally for their age. That is just a fancy way of saying they have a hearing loss. Audiologists and others mix up “normal” which would be perfect hearing and “common” which would fit in with “for your age”.
Whenever you deviate from the “perfect” hearing (0 dB), then you have some degree of hearing loss–typically in the high frequencies. And when you no longer hear the high frequencies well, you begin to have trouble understanding speech to some degree.
Your problem with the phone is that you have some degree of hearing loss (maybe not much, but it is there) and when you hear a new voice, it takes time for your brain to understand their speech patterns.
I encounter this all the time. A person phones and unless they have no accent and speak clearly for my ears, initially I have a lot of trouble understanding them. But as times goes by, my brain begins to get used to their speech patterns and I begin to understand more and more of what they say. After I have been talking with them for an hour, I understand them pretty well–not at all like I heard them at the beginning of the call.
The further the person’s speech deviates from clear-no accent the longer it takes for my brain to understand them and the harder I have to work to finally understand them.
Do you relate to what I have explained?
Cordially,
Neil
Hi Neil: I have worked for the government for the last twenty years as a Court/Office Clerk. I’ve been wearing hearing aids for the last 9 years as I had to have ear surgery on my left year due to cholesteoma. I now have moderate to severe hearing loss in left and mild loss in right. I have not been able to perform courtroom duties for 5 and a half years. Speech recognition for me is very tough and directional hearing is very embarrassing as I’m only hearing somewhat from my right ear. They want me back in the courtroom it ha hearing assist device. I am so nervous and truly I do not think I am suitable for that setting. Any advice?
Hi Trinda:
What are your discrimination (word recognition) scores? If they are good, then hearing aids and assistive devices should help you. And with some accommodations by your employer, I think you can do a good job in spite of your hearing loss.
There are so many good hearing aids and accessories, as well as assistive devices that something should work for you. You just need the confidence to get back into the courtroom.
What exactly is stopping you from trying again?
Cordially,
Neil
I have a severe-profound hearing loss in the high frequencies. My speech diccrimination score is declining yearly, but my hearing is staying the same. What can I do to stop this downward trend of my SD (from 90s to low 60s). Thank you.
Hi Robin:
Good question. There are a number of things that can cause your discrimination to drop. One thing they relatively recently discovered is what they call the hidden hearing loss. This is damage in the underlying structure in the inner ear such as the spiral ganglion. This damage can continue to progress after whatever caused your hearing loss in the first place.
Another cause can be various ototoxic drugs that can cause all sorts of side effects apart from hearing loss. So if you are on any drugs, one or more of them might be the culprit. If you contact me, I can tell you whether the drugs you are taking are likely culprits.
Cordially,
Neil
I have basic starkey hearing aid which I bought 4 years ago. I cannot understand what people are taking whether I use hearing aid or not. So I do not use it. Do you recommend better hearing aid so I can understand people better.
Hi Nick:
The first thing you want to know is what your word recognition (discrimination) score is without hearing aids on. This testing should have been done when you had your hearing tested. It is done separately for each ear and the result is shown as a percentage.
If you have a high score–say 70% to 100%, then you SHOULD be able to understand people when the sound is loud enough. If you have a poor score–between 0% and 30%, then you don’t understand much speech no matter how loud it is. In between, you’ll understand some speech, but not all of it–so you’ll miss (or misunderstand) a lot.
Once you know where you stand with your word recognition you know roughly what you can expect from your hearing aids. You see, hearing aids do not appreciably increase word recognition. Rather, they make sounds louder and compress sounds so that loud sounds are not too loud and soft sounds are not so soft you can’t hear them.
Thus, if you have poor discrimination, hearing aids are not going to help you all that much–whether they are basic aids or top-line aids. The problem is not the sound coming into your ears (via hearing aids or not) but how your damaged inner ears transmit those sounds to your brain. If your inner ears only send “garbled” speech to your brain, you won’t understand much.
So once you know your discrimination scores, and if you have fairly good discrimination, then its time to zero in on your hearing aids and how they are set. Are they adjusted properly for your hearing loss? The only way you’ll know is if your audiologist or hearing aid dispenser uses real ear testing. Although real ear testing is part of the best practices protocol for audiologists and thus they are supposed to always do it, in actual fact, less that half ever use it. The result is that you have a very high probability that your hearing aids are not fitted properly–and thus you don’t hear (and understand) as well as you should.
So do those two steps and see how it affects your understanding speech.
Cordially,
Neil
Dr Neil, you mentioned poor word discrimination and that hearing aids might not help much in that case. What other options are there to improve that then? I developed a bilateral hearing loss after I had mumps at age 11, now I’m 32 and my hearing has been degrading a lot since then (I even gave up wearing my aids for several years now), is there any research on mumps and hearing loss (I stay at home with my kids so I try to manage without the hearing aids but every year I notice I’m missing more and more)
Hi Camilla:
I’m not aware of anything that can fix poor discrimination as such apart from getting cochlear implants. People with CIs can have dramatic improvements in discrimination–going from near 0% discrimination to 70% and higher. So if you hearing is so bad that hearing aids don’t help much, you should consider being evaluated for cochlear implants.
Using assistive devices in the meantime can help you hear better–but not better than your brain can process the sounds. By this I mean that if you use an ALD that has the microphone at the speaker’s lips, it will capture the high frequency sounds that are lost traveling through air and yet are critical to good discrimination. The microphones on your hearing aids don’t capture these sounds unless you are very close as they “drop out” of the air with increasing distance–making it harder and harder to understand speech the farther you are from the speaker.
Cordially,
Neil