Trouble Hearing in Background Noise

The restaurant test is how most people find out. Everyone else at the table is having a perfectly normal evening. You are catching maybe half of it, watching faces, nodding at things you did not hear, and leaving with a headache.

Difficulty in background noise is usually the first real-world consequence of hearing loss, and it typically shows up years before anyone has trouble in a quiet room. It is also the complaint people are most likely to dismiss, because noisy rooms are hard for everyone.

They are. They are not this hard.

What a normal ear does that yours may not

Separating a voice from surrounding noise is one of the more impressive things the auditory system does, and it depends on several mechanisms working together.

Two ears compared against each other. Your brain analyzes the small differences in timing and intensity between what each ear receives, and uses that to separate sources coming from different directions. This binaural comparison is an important part of hearing in noise, and it can be reduced when hearing is unequal between the ears or only one impaired ear is aided.

High-frequency detail. Consonants are what let you tell one word from a similar one, and they are the first casualties in noise since they are soft to begin with.

Timing resolution. Speech contains brief gaps, and a healthy auditory system catches fragments of the target voice during momentary dips in the background noise. Damaged inner ears lose this ability, which researchers call listening in the dips.

Damage any of these and noise stops being an inconvenience and becomes a wall.

Why your audiogram may look fine

This is the frustrating part, and it is a common experience. Someone struggles badly in restaurants, gets tested, is told their hearing is within normal limits, and leaves with no explanation.

Standard tone testing happens in a silent booth with one sound at a time. That measures detection, which is a much easier task than separating a voice from six competing conversations. People can have essentially normal thresholds and still perform poorly the moment noise is introduced.

Contributing factors that a routine audiogram will not reveal:

• Early high-frequency loss above the frequencies many screenings test
• Cochlear synaptopathy, sometimes called hidden hearing loss, where connections between hair cells and the auditory nerve are damaged while thresholds remain normal
• Poor word recognition despite reasonable thresholds
• Auditory processing difficulty, where the ears deliver clean signal and the brain struggles to sort it
• Any asymmetry between the ears, which undermines the comparison the brain relies on

If you have been told your hearing is normal and you still cannot function in a restaurant, ask specifically for speech-in-noise testing. It measures the thing you are actually complaining about.

Speech-in-noise testing

Rather than presenting words in silence, this test presents sentences against competing background noise and progressively adjusts the difficulty to find the point where you can still follow about half of what is said.

The result is expressed as how much extra signal you need compared to a person with normal hearing. Someone might need speech to be 8 dB louder than the noise to keep up, where a normal-hearing listener manages at 0 dB. That number is concrete, it explains the daily experience, and it directly informs what technology is likely to help.

It is also the test that vindicates people who have been told nothing is wrong. See speech-in-noise testing for more.

What actually helps

Two aided ears, not one

If both ears have aidable hearing loss, treating both often provides a more balanced input than treating only one. The recommendation still depends on hearing levels, speech understanding, comfort, medical history and the person’s actual goals.

Directional microphones

Modern hearing aids use multiple microphones to emphasize sound arriving from in front while reducing sound from behind and the sides. In a restaurant, that means the person across from you gets priority over the table behind you. This is one of the clearest, most reliable benefits current technology provides for noise.

Some higher technology tiers use more adaptive directional processing, but the benefit depends on the room, the fitting and the person’s hearing. More expensive does not automatically mean better for every listener. The approach also differs by brand: Phonak’s AutoSense OS automatically classifies your environment and adjusts directionality in real time, Signia’s RealTime Conversation Enhancement is built specifically to track multiple speakers as a group shifts and moves, and Starkey’s Edge Mode+ lets you manually trigger an on-demand speech-focus boost through the My Starkey app when the automatic setting is not quite enough. We go through what separates the tiers on our hearing aid packages and technology levels page.

Remote microphones

For many people, this is the biggest single improvement available, and it is underused.

A small microphone clips to your conversation partner or sits on the table, and streams their voice directly to your hearing aids. It bypasses the room entirely. Distance and background noise stop mattering. For restaurants, meetings, lectures and car rides, this can provide a larger improvement than changing a hearing-aid program alone.

Their cost and compatibility vary, and they are frequently overlooked. If noise is your primary complaint, ask whether one is appropriate for your devices and daily situations. See hearing aid accessories.

Noise reduction, with realistic expectations

Hearing-aid noise reduction can reduce listening effort and make some noisy environments more comfortable. On its own, it usually helps comfort more than speech understanding when the competing sound is other people talking.

Worth having. Not the solution by itself. Anyone promising that noise reduction alone will fix restaurants is overselling.

Strategies that cost nothing

• Pick the restaurant. Carpet, upholstery, tablecloths, and separated tables beat hard surfaces and open ceilings. Go earlier when it is quieter.
• Sit with your back to the room and against a wall or in a booth, so noise comes from behind where directional microphones handle it best.
• Face the person speaking. Visual cues contribute more than most people realize, and in noise the difference is substantial.
• Take the middle seat at a long table instead of the end.
• Tell people. “I hear better when I can see you” is one sentence and it changes how others speak to you.
• Ask for a rephrase rather than a repeat. Different words are often easier to catch than the same ones louder.

Get the right test

If restaurants and gatherings have become work, that is worth investigating whether or not you have been told your hearing is fine. A full evaluation including word recognition and speech-in-noise testing will identify what is happening and what will help.

Hearing Aid Factory Outlet is located inside Sugarloaf Mills at 5900 Sugarloaf Parkway in Lawrenceville and serves hearing-aid patients from Gwinnett County and communities throughout the Atlanta area. We are open seven days a week. Schedule an evaluation or call (404) 786-6416.