The sole purpose of your outer ear is to collect sound. It sends the sound down your ear canal to your eardrum. The eardrum starts to vibrate which causes the 3 bones (the 3 smallest bones in your body) in your middle ear to vibrate. The vibrations are transferred to your inner ear where millions of tiny hair cells respond and send the information to your brain. Your brain then processes and makes sense of the information it received.

Any time there is a change in hearing clarity and understanding, there is a hearing health problem.

When certain sounds are missing, your brain is not getting all of the stimulation it needs to process and make sense of the sounds it’s receiving.

There are two types of hearing problems. One is medically or surgically treatable. One is treatable with sound and hearing devices customized for you.

• A Conductive hearing problem is when the sound cannot get from the outer ear to the inner ear. Some examples are: wax blocking the ear canal, a hole in the eardrum, fluid in the middle ear (fluid in the middle ear is the number one reason for pediatric visits), one of the tiny bones in the middle ear gets stuck and cannot move. Most Conductive hearing problems can be corrected medically or surgically. However, conductive hearing problems comprise only 5% of all hearing issues.

• A Sensori-neural hearing problem is any problem that originates in the inner ear and/or auditory nerve. 95% of all hearing issues are sensori-neural and are not medically or surgically treatable. The number one cause of sensori-neural hearing problems is exposure to noise. Common, everyday noises (traffic, appliances, music in exercise classes, etc) are loud enough to damage or kill the tiny hair cells in the inner ear that respond to sound. When these hair cells are damaged or destroyed, the inner ear is only sending partial information to your brain resulting in a lack of clarity and understanding.

The only treatment for sensori-neural hearing problems is using some type of hearing device to correct the deficit.

Hearing problems can affect anyone at any age. It is naturally more common as we get older because we’ve exposed our ears to more noise throughout our lifetime. Interestingly, since the advent of personal listening systems (iPods, MP3 players), nearly as many teenagers have hearing problems as 60 year olds!

• One third of those between ages 40-49 have some degree of decreased hearing
• Every other person over the age of 50 experiences difficulty hearing clearly in certain situations
• One half of those over 70 have a significant hearing problem
• People wait much too long to have a hearing checkup and get treatment

Because you’re not deaf and can actually hear okay, sometimes it’s difficult to know if there’s really a problem. Remember, most people with hearing problems hear fine; they just don’t understand…the voices aren’t clear. That’s why it takes so long to recognize that you really have a significant hearing issue, even though your spouse, kids, and friends have been telling you for years.

• You know someone is talking, but you don’t understand what they’re saying.
• You accuse your spouse, kids, co-workers, or friends of mumbling. You hear fine…they just don’t speak clearly.
• You have no difficulty understanding when you are in a quiet room with one person, facing one another.
• You have trouble understanding some people in a group (4 or more).
• You have difficulty understanding someone from another room.
• It is especially hard to understand what people are saying when there’s a lot of background noise.
• You don’t always hear the movie, play, pastor/rabbi clearly. You miss the punch line of the joke.
• You prefer the TV louder than those watching with you.
• Find yourself saying, “what?” “Huh?” “Pardon me?” “Could you repeat that?”

Two or more YES answers indicate a possible hearing deficit. Early detection and treatment is essential to preserve brain processing. You should have a baseline hearing checkup.

“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.

SO WHAT HAPPENS WHEN YOU TURN 40?

Hearing vs understanding.  They are not the same.

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

Wrong!

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.”

WHAT CAN YOU DO?

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.

• Beck DL. (2015) Invisible Hearing Loss American Academy of Audiology Web site.
• Fullgrabe C, Moore BCJ, Stone MA. (2015) Age-group Differences in Speech Identification Despite Matched Audiometrically Normal Hearing: Contributions from Auditory Temporal Processing and Cognition. Frontiers.
• Grose GH, Mamo SK, Buss E, Hall JW. (2015) Temporal Processing Deficits in Middle Age. American Journal of Audiology 24:91.
• Helfer KS, Vargo M. (2009) Speech Recognition and Temporal Processing in Middle-Aged Women. Journal of the American Academy of Audiology20(4):264-271.
• Baycrest Centre for Geriatric Care.
• bit.ly/bg-babble