Why can I not hear very well in background noise?

The primary complaint of people with hearing loss and the primary complaint of people wearing hearing aids is speech understanding in noise.

There are two main causes as to why it is difficult to hear in background noise

1) Hearing loss

A common type of hearing loss is a high-frequency sensorineural hearing loss, which is a permanent loss of high pitch sounds. Below is a classic example of a high- frequency hearing loss, as shown in red circles. The dark grey region above the red line is an area where it is inaudible to the person. The lighter region below the line represents the audible area. The consonants, which gives clarity in speech are mainly located in the inaudible, dark grey region. The vowels that convey volume are located in the audible, lighter grey region. The problem with background noise is that it mainly consists of low pitch sounds which mask the speech in the audible area.

Hence a person with this hearing loss is losing both speech volume an clarity in background noise

2. Brain Hearing

The ear is simply a microphone to the brain. The brain is where hearing and understanding of speech takes place.

Two factors that may affect speech understanding at the brain level are

1. The damage in hearing might cause distortion of the speech signal, so the brain does not receive a clear enough sound to be able to understand.

2. The brain itself may have trouble separating speech from noise. So if the signal is not clean enough, the brain cannot make sense of the speech.

Recent research by Petersen et al. (2016) explains the second point.

In quiet environments, the speech sound of interest is present in isolation. The acoustic information is clear and well-defined, largely because it has no competition. Therefore, understanding speech is generally effortless.

In noisy environments (restaurants, bars, cocktail parties, etc) the primary speech sound is acoustically mixed with multiple secondary speech sounds (i.e., background noise) at the ears. To solve this dilemma, the brain attempts to organize and prioritize sounds present in the sound scene by focusing on the primary speech sounds while ignoring all others, i.e. secondary sounds. For listeners with more significant hearing loss, there is no significant difference in the encoding of the two speech signals, thus indicating that people with hearing loss, are less able to ignore the disturbing secondary speech (i.e., background noise).

How can Hearing aids help?

Hearing aids cannot change how the cochlea or the brain work, but hearing aids can change the sound that enters the ears. Hearing aids attempt to reduce disturbing background noise to support the brain’s ability to organize complex sounds and thereby better focus on the primary speech sound. Many hearing aids do this with directionality microphones and algorithms that filter out excess background noise. ( Click here to see the latest hearing aid technologies)

Reference

Petersen, E.A., Wöstmann, M., Obleser, J., Lunner, T., (2016) “Neural tracking of attended versus ignored speech is differentially affected by hearing loss”, Journal of Neurophysiology

Queen Elizabeth II spotted with hearing aids

The 93-year-old Queen Elizabeth II was photographed —for the first time ever, —wearing a hearing aid.

The Queen is wearing a Signia Silk completely-in-the-canal (CIC) hearing aid.

It appears that the CIC is not optimally positioned in the Queen’s ear, leading to suggestions by hearing care professionals that she could benefit from counseling on a better insertion technique.

Sudden sensorineural hearing loss

Sudden sensorineural hearing loss (SSHL) is defined as a rapid- onset subjective sensation of hearing impairment, resulting in 30 dB loss at three or more frequencies .

The majority are unilateral hearing loss , and they may occur with tinnitus and vertigo or dizziness. The most effective treatment is oral and/or intra-tympanic injections of steroids. If a person presents for treatment within 2 weeks of the onset of symptoms, the chance of a full or partial recovery of hearing is much improved.  

What to do!

1. See an audiologist for a hearing assessment ASAP to confirm diagnosis of sudden sensorineural hearing loss (SSHL) versus conductive loss.
2.See your GP/ ENT specialist to start on oral steroids, typically Prednisone .

3. Evaluate for retrocochlear pathology by MRI.
4. See an ENT specialist for intratympanic steroid therapy when incomplete recovery from sudden SNHL .
4. Follow-up audiometric evaluation at the conclusion of treatment.
5. Audiologic rehabilitation for patients who have residual hearing loss and/or tinnitus who may benefit from treatment.

Hearing loss and Diabetes

The relationship between hearing loss and diabetes has long been debated. Recent research now concludes that hearing loss is more prevalent in adults with diabetes even when the major factors known to affect hearing, such as age, race, ethnicity, income level, noise exposure , and use of certain medications have been accounted for.

One research study included data from participants ranging in age from 20 to 69. Important information they found:

• People with diabetes were 2x more likely to have hearing loss than people without.

• People who are pre-diabetic are 30% more likely to have hearing loss.

How does diabetes cause hearing loss?

Diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. Diabetes may lead to hearing loss by damaging the nerves and blood vessels of the inner ear, the researchers suggest.

High blood sugars may damage the very small blood vessels that support and feed the inner ear. This is similar to how high blood sugars can affect vision and kidney function. The blood vessel system that feeds the ear is very similar to the systems that support the eyes and kidneys. As this system is damaged, hearing is compromised.

Fight back

Diabetes may play a role in hearing loss, but you can fight back by helping reduce your overall risk of hearing impairment. Some prevention tips:

• Manage your diabetes if you have the disease, using strategies created with your medical doctor.

• Reduce exposure to excess noise, one of the most preventable causes of hearing loss.

• Eat a balanced, nutritious diet, which contributes to better ear functioning.

• Avoid tobacco use, a risk factor for cancer, hearing loss, and many other problems.

• Stay physically active, reduce blood sugar level.

• Regular hearing check monitor your hearing.

Why you feel so tired after a conversation

(Fig. 1, Kral et al., 2016)

Hearing and listening are not the same. We may use the wording interchangeably, but in terms of underlying processes, the two differ. Listening is defined as hearing with intention and attention (Kiessling et al., 2003). Listening thus involves both auditory and cognitive processing. Therefore, mechanisms such as attention, working memory and speed of processing are relevant themes when exploring the topic of listening. Listening begins peripherally, but it actually involves a mosaic of different cognitive functions working together in order to achieve fast and efficient perception of sounds. This ensemble of cognitive functions is called the listening connectome (Fig. 1, Kral et al., 2016).

Listening effort

Listening effort can be described as mental exertion required to attend to and understand an acoustic input.

The diagram below explains two different pathways how we understand acoustic inputs

First, in a quiet environment, the auditory signal is clear and can easily be recognized and understood. This is a fast process that requires low cognitive effort.

Second is in a more difficult , complex situations( or when the hearing threshold gets worse). Auditory signal is degraded and is difficult to recognize. Instead of instant recognition, the distorted input signal is compared to already stored information in the memory before understanding is possible. This requires a lot of effort and leads to fatigue.

Everyone has finite amount of cognitive resources. Cognitive resources can be used to compensate for the hearing difficulties. The greater the hearing problem, the more effort is required to listen and understand, hence feels fatigued quicker.

References

Kiessling J, Pichora-Fuller MK, Gatehouse S, et al. (2003). Candidature for and delivery of audiological services: Special needs of older people. Int J Audiol, 42(Suppl 2), S92–S101.

Kral A, Kronenberger WG, Pisoni DB, et al. (2016). Neurocognitive factors in sensory restoration of early deafness: a connectome model. Lancet Neurol, 15, 610-621.

Chocolate and Wine can protect your hearing

A sweet way to protect your hearing

Dark chocolate contains numerous antioxidant and high level of zinc, which boosts the immune system and prevents potential infections in the body.

Since ear infections can cause hearing loss, dark chocolate may help protect against ear infections and prevent from hearing loss

The relationship between cardiovascular health and hearing is strong and has been confirmed by a sizeable number of investigators.

Heart disease, hypertension, or any other restriction of blood supply to the peripheral and central auditory system can reflect itself in terms of audiometry, communication and can be progressive in nature.

Dark chocolate with at least 70 percent cocoa content has also been shown to be good for the cardiovascular system. One observational study found that eating chocolate five or more times per week lowered the risk of cardiovascular disease by 57 percent. Since poor heart health is linked to hearing loss, anything to improve your cardiovascular system can be helpful to your hearing health.

Cheers to your ears

If you prefer to sip some wine over eating chocolate, you may still be doing something good for your hearing. It’s long been suggested that a glass of red wine per day can be part of a healthy lifestyle. Just like chocolate, the antioxidants in red wine can help protect against cardiovascular disease, and in turn, hearing loss. But drinking red wine may actually go a step further and prevent hearing loss more directly.

A compound found in the skin of red grapes, resveratrol, has been found to protect against noise-induced hearing loss, as well as cognitive decline. A 2013 study by the Henry Ford Hospital found that rats given resveratrol and exposed to loud noises recovered their hearing more quickly, and showed a reduced amount of hearing loss and cognitive decline, compared to those not given the substance.

Everything in moderation

While small indulgences in dark chocolate and red wine may be beneficial to your hearing and health, too much can be a bad thing. Chocolate is often high in sugar and fat, so eating large amounts can lead to serious health issues, and consuming too much alcohol can be dangerous for many reasons. However, in moderation, chocolate and wine can be a healthy part of your diet and good for your hearing.