Hidden Hearing Loss


by Dr. Ronna Fisher Au.D. FAAA

“How is your dad?” Jeremy asked his boss sitting across the table at a recent dinner party. “He died,” said his partner.  “That’s great.  Tell him I said hello.”

Jeremy knew something was wrong from the stricken look on everyone’s face.  When his wife leaned over and whispered, “He said his father died.”  Jeremy wanted to crawl under the table and disappear.  He thought his boss said, “He’s fine.”

Jeremy called his doctor the next morning to get his hearing checked.  He was only 42, but this was not the first time Jeremy had misunderstood.  He was having more trouble hearing in court, making out what his wife said from another room and sometimes even when he was in the same room.

He was surprised when the doctor told him the tests were normal and his hearing was fine.  “You just need to pay more attention,” his doctor said.

Jeremy’s struggle to understand in everyday listening situations is not uncommon.   Studies over the last 10 years show that changes and deterioration of auditory processing in the brain begins at age 40.  These changes are not detectable on a hearing test.


Hearing vs understanding.  They are not the same.

Hearing is about loudness.  If your hearing goes down, you just make the sound louder, right?


As any wearer of hearing aids knows, making them louder does not make them clearer.  Turning up the volume does not mean you are going to understand any better.

Understanding is about processing.  Your brain has to sort out, filter and make sense of all the sounds it receives.  How does it do that?  What does your brain need so you can understand clearly?

  • •  Temporal Processing – the rate at which we can process auditory information. The ability to follow rapid changes in speech, music and other sounds.

    Have you ever thought that kids talk too fast? They are on their third sentence and you are still processing the first one.  Kids do not talk any faster than they always did.  Your temporal processing has slowed down.

    The slower your temporal processing, the more time you will need to understand what someone is saying.

  • •  Working Memory – the mental sticky note we use to temporarily store and use information. Often used synonymously with short-term memory, working memory is critical for learning, reasoning and decision-making.

    When you have difficulty understanding, your brain has to concentrate more and listen harder.  You brain is so intensely focused on trying to understand, that it does not have the resources to transfer the information to your memory.  Therefore, even if you “get it” your brain cannot store it.

  • •  Auditory Distraction – irrelevant sounds that break through your attention and focus and impairs your cognitive function.

    In order to participate in a conversation, especially in a difficult listening environment, your brain has to separate all of the incoming sounds and focus on one of them.

    Beginning at around age 40, the brain cannot filter out distracting information as well as it used to.  The ability to encode and retrieve words severely erodes in “background babble.”


While you cannot change Mother Nature, there are a few things you can do to help you understand more clearly

  • •  If you can, turn off the TV, Radio, Music and any other distracting sounds
  • •  Eyes help make up for what the ears miss. Try to face and look at the person with whom you are speaking
  • •  In restaurants, try to sit in a booth or a table where you are facing the wall and the noise is behind you.
  • •  Hearing aids and PSAP’s (Personal Sound Amplifying Products). The solution for most people with a hearing problem, attention deficit disorder, or focus issues, is usually to make the signal (speech) louder than the noise or distraction.  Amplifying the speech, even when hearing tests are normal, allows for easier listening and less distractions.

Increasingly, hearing aids and the lower cost counterparts, PSAP’s (which are not intended to correct hearing but make sound louder) are being fit and worn to use in those distracting and difficult situations or anytime when understanding clearly is a problem.

Photo of Hearing Health Center audiologist ronna staff

Dr. Ronna Fisher, Au.D., FAAA, Founder and President of Hearing Health Center

Dr. Fisher received her doctoral degree in Audiology from the Pennsylvania College of Optometry. She is a fellow of the American Academy of Audiology, has earned the Certificate of Clinical Competence from the American Speech-Language and Hearing Association, and is an active member of the Academy of Dispensing Audiologists, American Tinnitus Association, and the Illinois Academy of Audiology.


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