Hearing in background noise is one of the most common concerns expressed by audiology patients, and often a chief motivator for getting hearing aids. It is understandable then, that when wearing hearing aids, one would hope and expect to hear well in noisy places and crowds, such as at a restaurant or a large family gathering. Imagine then, how disappointing it would be, to discover that after obtaining hearing aids (an expensive investment if acquired through the private sector!), you are still struggling to hear and understand people in these situations. In the worst-case scenario, some people even feel like they hear even more poorly in noise with their hearing aids in, than without them—often finding that the background noise is just even louder than before, but that speech and conversations remain unclear and difficult to decipher.
On a more positive note, it is important to stress that when fitted properly, hearing aids can and should improve your hearing in background noise. However, this will only be to a certain degree. Everyone, whether they have a hearing loss or not, will find it more difficult to hear people in a noisy place. This will be even more so, of course, if you have a hearing loss, and this can be the case even with hearing aids in your ears. Let’s take a deeper look at why this might be the case.
The Acoustics of Speech and Noise
In most age-related hearing losses, high pitch (or more scientifically speaking, “high frequency”) sounds are usually more severely affected than low pitch (or “low frequency”) sounds. Our ability to hear low frequency sounds consequently affects our sense of “loudness”, whereas high frequency sounds affect our sense of “clarity”. For many people with hearing loss, they may have quite good low frequency hearing, but poorer high frequency hearing. This means that it’s not so much that things aren’t “loud enough” for the person, but rather that they’re not “clear enough”.
When looking at the frequencies that contribute to speech-related sounds, low frequencies help us hear the vowels, while high frequencies helps us hear the consonants. The consonants are really what give the meaning to speech sounds. For example, did someone say “fix” or “six”? Those subtle, crucial differences can be severely affected by a high frequency hearing loss.
Additionally, background noise tends to be a low pitched sound. The clarity and definition of speech in a conversation is a high pitched sound. Therefore, if your low frequency hearing is better than your high frequency hearing, you can hear all the background noise well, but not the conversation! Furthermore, there are other variables that can confound the problem even more, such as poor room acoustics (for example, highly reverberant, “echoey” places will make hearing much more challenging), and your own positioning within a noisy place (for example, is the background noise behind you or in front of you?).
The Physiology of Hearing Loss
Hearing loss, particularly when it affects the inner ear (usually associated with ageing and noise exposure), not only affects how loud things are for you, but also how clear things are. Some of this clarity can indeed be improved with the use of hearing aids, but the sound is still travelling through a damaged auditory system, which hearing aids can’t entirely compensate for.
Hearing is a complex sense that relies on both the ears, as well as the pathways from the hearing nerve to the brain. The brain then needs to process the sounds that have been delivered from the hearing nerve. When there is wear and tear on the inner ear (such as from ageing), this can cause sounds travelling from the inner ear to the hearing nerve to be “distorted”. This distorted sound is then sent to the brain for further processing, where the brain must then make sense of what the ears have just heard.
You can see then, where our problem might lie. A hearing aid would be picking up sounds from the environment, sending this sound through the damaged inner ear, which then distorts the sound before it is processed by the brain. Modern hearing aids are engineered to help work with the brain’s natural processing of sound and can help improve the clarity of what one is hearing—whether that’s in a quiet place, or a noisy one. However, because the sound is still being distorted to at least some degree, one may still struggle somewhat with the clarity of what they are hearing.
The Ability to Recognise and Understand Speech
In audiology, we often talk about “speech understanding” or “speech recognition”. This is essentially the ability to understand what is being said, when it is loud enough for you to hear, based on your degree of hearing loss. In other words, do you still have trouble making sense of speech, even when it is loud enough for you to hear? Many people don’t realise that hearing and understanding can be two very different things. As described above, a damaged inner ear creates distortion, which can then cause speech understanding to deteriorate.
As hearing loss further declines, and as a person’s age increases, speech understanding abilities tend to decrease. This means that even when using hearing aids, someone may still struggle, to a degree, to make sense of what is being said. This will be even more challenging in background noise, as the brain then has the additional task of filtering out the speech from the surrounding noise. There are other factors that can contribute to this difficulty as well, such as one’s memory and overall cognitive processing abilities, which can naturally slow down with age.
Your hearing assessment can help determine and predict some of these challenges, particularly if it includes speech recognition testing. This is where you may be asked to repeat back words that are spoken to you at different loudness levels, along with repeating back sentences in the presence of background noise. Someone who scores poorly on these tests may still have a fair bit of difficulty understanding speech with their hearing aids on—especially in background noise. However, hearing aids will still help you and make your day-to-day life easier—it will just be important to understand their limitations, particularly in the context of the results of your speech recognition tests. Of note, using hearing aids earlier on in the diagnosis of your hearing loss can help keep the brain “exercised”, and ensure that your speech understanding abilities remain sharp. This could be an argument for using a hearing aid even if you only have a mild hearing loss.
Filtering Out the Background Noise
Hearing aids attempt to preserve a “normal” sense of loudness. In other words, soft sounds should sound soft and loud sounds should sound loud. It is also normal to hear background noise, and therefore we don’t want this eliminated entirely when using hearing aids. However, when first wearing hearing aids, the brain can become overwhelmed with sound. Suddenly, you are hearing lots of sounds and noises you haven’t heard before—or at least not in a very long time. The brain then needs to make sense of these sounds, and essentially “relearn” what these sounds are. Papers rustling, footsteps approaching, and dishes clanging can all be quite alarming at first. And because the brain is interpreting these sounds as “unfamiliar”, it places a lot of importance on them, and heightens its focus on these background noises. It can therefore be quite distracting when first using hearing aids and can feel like you’re hearing worse with your hearing aids rather than better.
It is important though not to feel discouraged if this happens, as it can be quite normal to experience this sensation when first wearing hearing aids. Over time, with consistent, full time daily use of your hearing aids, the brain starts to become more adept at learning what sounds are important and need to be focused on (e.g. a conversation), and what sounds are unimportant and can be ignored and put into the background. This does take some time though, and hearing aids do require some patience and perseverance to really start to notice the benefit from them.
Hearing Aids Shouldn’t Only be Worn in Noisy Places
This leads to another important point about hearing aids and background noise. Many people with hearing loss will not notice any difficulty when in quiet, one-to-one conversations. Therefore, they may pursue hearing aids with the intention of solely using them when in more challenging places—like restaurants or social gatherings. The problem with this is that the brain then is only exposed to hearing through a hearing aid in the most difficult of listening environments. The brain becomes oversaturated with auditory information and can’t make sense of what it is listening to. This would understandably be frustrating and discouraging and give someone a sense of hearing poorly with their hearing aids.
To be truly successfully with hearing aids and to get the most benefit from them, I would strongly recommend wearing them in ALL situations. This would be whether you’re home on your own, simply reading a book—or out and about socialising. That’s because there’s lots of little noises going on around you, that are important for the brain to hear and process—and learn to tune out. Be it a tap dripping or a clock ticking, these are sounds that are normal to be able to hear and are critical to help the brain rewire how it processes sound with hearing aids.
What Else Can Be Done to Improve My Hearing in Background Noise?
Hearing aids are designed to automatically recognise when you are in a noisy environment and can adapt their settings accordingly to maximise the benefit you can get from them. However, it can sometimes be helpful to have a special program put into your hearing aids, which you can then manually access and turn on as required. This program, for example, could optimise your hearing aid settings for background noise, helping to further reduce the distractions around you, and focus on the conversation at hand. Your audiologist can set this program up for you and show you how to turn it on and use it.
Some hearing aids also will be able to perform better than others in background noise. Hearing aids are usually available in multiple different “levels” of technology, and more advanced levels will be better at handling background noise than more basic versions. If you tend to be in lots of background noise on a regular basis, then it would be worth considering a higher level of technology for your hearing aids.
Similarly, certain hearing aid models will perform better in background noise than others. The smallest hearing aid options usually won’t be able to perform as well in background noise than larger models. This is because their very small size will limit the technological capabilities of the hearing aid itself.
If you have particularly significant struggles in background noise, it may also be worth considering the use of an accessory in conjunction with your hearing aids. There are different options for this, some being more expensive than others. There are accessories that can help with one-to-one conversations in busy environments (like hearing a friend in a coffee shop), and more advanced devices that can help with the most challenging of situations, like a large business meeting, or a group conversation in a loud restaurant.
Some Final Thoughts
The goal, ultimately, with hearing aids is to make your life easier and more enriching, with overall less strain in making sense of the conversations that you take part in. You should feel that your hearing aids help you, and certainly do not hinder you. It is important though to have realistic expectations about how hearing aids will work for you. They unfortunately can’t eliminate all challenges and it is important to keep in mind that they are an “aid” rather than a complete treatment. A good audiologist can help set these expectations with you, keeping in mind the results of your assessment along with a discussion of your overall difficulties and goals.
If you'd like to learn more about the kind of hearing care we provide for our patients at Finchley Hearing, please explore our website and feel free to get in touch with any questions.
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