From Audiogram to Real-World Performance: How Hearing Aids Improve Communication

It seems like each and every day I explain to a patient who has hearing loss, how hearing aids can help their communication ability. So I did a little extra research so I can answer this question for you in a way that makes sense.

So how do hearing aids help communication? Hearing aids amplify sound to restore speech sounds and cues that would not be heard by someone that has a hearing loss. Hearing aids also attempt to make the sound easier to be understood by using directional microphones and noise reduction, all while maintaining the auditory clues the brain needs.

There is a lot packed into that last paragraph and so I will try to unfold it so that there are clear expectations of what hearing aids can and cannot do to resolve your hearing loss.

The fundamental Way Hearing Aids Help Is By Providing Amplification

When an audiologist assesses hearing loss they do so in various ways. The main way that people think of a hearing test is by listening to very faint or soft beeps and by either raising your hand or pushing a button when you hear one of those beeps. With this test, an audiogram is made. It tells what is the minimum level of hearing at any given frequency.

The information from this audiogram is imported into the hearing aids and a prescription for the hearing loss is calculated. The prescription is based on a ton of research on how much volume people need to hear to the best of their ability.

Remember that the research looks for the average from a very large group of people. So, when an audiologist initially sets up the hearing aids for your hearing loss we are very confident that the hearing aids are in the right ballpark range of how you should be hearing. But no person is perfectly average and so it takes some fine-tuning appointments to ensure the hearing aids are set to the optimal level.

Hearing aids are designed to give you the speech clues that you need to understand speech. Hearing aids are not designed to restore your hearing ability back to normal. As an over-simplified way of thinking about hearing aid prescriptions, they give you back about 50% of what you lost.

For example, if you had a 60dB hearing loss at 3000Hz. A hearing aid prescription gives you back 30dB in the 3000Hz range. A hearing threshold of 60 dB is a moderately-severe hearing loss. After the hearing aid provides 30dB of amplification, the hearing loss would remain in the mild range.

Now that was an over-simplified example because hearing aid prescriptions are actually quite complex. They apply different amounts of gain to soft, medium, and loud sounds and also apply compression to each level. But the example illustrates that we are not trying to get your hearing back to normal levels.

The reason why we do not get your hearing back to normal is that any click, hiss, or footstep would seem overwhelming to you after not hearing them for so long. Instead, the focus is put on speech understanding.

The Second Part Of A Hearing Test Is Word Recognition Ability

When you take a hearing exam, the second part of it is when you repeat a long list of words. This score is reported as a percentage and represents how well you can understand speech in the perfect environment.

Think about this, the exam takes place in a soundproof hearing booth where the words are played at a loud enough level for your hearing loss. There are no distractions, and no background noise and the task has your full attention. The score that you get out of that test, shows the best that you can realistically expect to do with the best hearing aids on the market.

If you only got 60% of those words correctly, it means that even with hearing aids, you are going to struggle significantly to understand what is being heard, even in a quiet environment. Hearing aids only have the ability to make speech louder but not necessarily more clear.

No matter how good of a hearing aid you have and how much processing it does. It still plays the sound into your damaged ear. And if your ear distorts the sound, the brain has a very difficult job making sense of it.

Hearing Exam Results Are Not Real-World Performance

Often, patients who do well in the hearing test complain that the test is not like the real world. The world has a lot of background noise, and distractions, and you may or may not be paying attention to a certain speaker. It is most certainly much more difficult than repeating words while in a very quiet hearing test.

Audiologists know the hearing exam is not like the real world and it is not intended to be. The word recognition test shows the best speech understanding you can get in the ideal environment (think of this as your best ability).

This is essential to understanding your hearing loss and setting realistic expectations for how much a hearing aid will improve your communication.

Hearing Aids Improve Communication With Processing Sound To Make Signal More Understandable

Premium-level hearing aids are applying vast amounts of technology to help you understand to the best of your ability (as discussed above). People with hearing loss tend to struggle more when there are multiple speakers at the same time and when there is background noise.

All of the advanced features in hearing aids attempt to clean up the signal presented to the user. They help to get the user closer to what they can hear while they are in a quiet environment. I will not discuss here how each advanced feature works but just that the goal is to help the user use the least amount of effort to hear the maximum possible.

Hearing Aids Help With Communication By Allow Others to Know You Have A Hearing Loss

When a person sees that you are wearing hearing aids, they should naturally speak slower and articulate more than they typically would. This is an important aspect of hearing.

Hearing aid users will understand much better when the speaker slows the rate of speech down and articulates more. It is also helpful if the speaker is directly in front of the listener so that facial cues can also be seen.