How can I have normal hearing levels and still struggle to hear?

This information tries to explain why certain listening situations are difficult for people even if they do not have a hearing loss.

Many people with normal hearing report having difficulty hearing in settings where there is a lot of background noise. As the world we live in is generally a very noisy place this can cause a lot of problems with everyday listening.

Due to COVID 19 lifestyles may have changed drastically for a lot of people. People have been shielding, unable to see family and friends so limiting the amount of face to face communication. The government encouraged home working where possible so companies took this on by equipping staff to do their jobs remotely.

There has been little to no socialising allowed, no meetings of large groups and gyms, restaurants and pubs closed for long periods of time. This has resulted in people often working in much quieter environments with very little background sound and no other exposure to more challenging listening situations which they would normally have been in. The auditory system is like a muscle, it needs to be active and challenged to keep it working well. As the situation changes and life begins to return to normality people may find that moving back into noisier work and social situations may prove very challenging with regards to getting their skills at listening in noise back.

People often work in open plan offices; call centres or busy environments like hospitals, classrooms or factories. In open plan offices the use of acoustic screens can make communication very difficult, as visual clues such as lip reading are not available. The screens also affect the clarity of speech as they affect the transmission of high frequency sounds which are often the consonant sounds in speech, (e.g. ‘sh’ ‘f’ ‘t’) that often start and end words, which give it clarity and meaning. The acoustics of the room can be poor if they have high ceilings and bare surfaces. There can be a lot of competing conversations, phone calls, machine noise etc. Trying to hear above the noise can become very stressful for some people.

Effect of stress

Stress and anxiety can have an adverse effect on our ability to hear. The most common thing reported by people suffering from anxiety is having difficulty focusing on conversation or sounds. This reduced ability to pay attention can mean you may not be able to focus on everything someone is saying while they are talking to you. However this does not mean you are not hearing but instead your brain is not able to process it. In order to combat this, any anxiety issues need to be addressed as when we are calm we are much more able to process information so it makes sense. People with busy lifestyles often find it difficult to relax at home when they feel there are other things they could be doing. Attending a class like tai chi, yoga or pilates can often be useful in learning relaxation techniques away from other distractions. Mindfulness is another technique which uses meditation to help people focus on and enjoy the moment, rather than worrying about the past or future problems which they may have no control over.

Avoidance

When hearing becomes difficult in background noise some people naturally try to avoid noisy situations. However this can be unhelpful. Noisy situations also tend to be the more social occasions like parties, restaurants and family gatherings. Avoiding them can start to affect your quality of life. Not only does the anxiety about struggling to hear in noise increase but also it has been shown that the more practice the auditory system gets at listening, the more we are able to pick out the correct information from the sounds around us. Studies have shown that the more practice at listening we get the better we get at picking things up correctly. This demonstrates the importance of not withdrawing from difficult listening situations but rather to keep challenging our auditory system and hopefully strengthening its ability to cope, just like exercising a muscle.

Listening and attention

Our auditory systems try to naturally filter out important sounds from noise and so help us decide what we need to pay attention to. However there is a difference between hearing and listening. Hearing is quite passive, we can hear the wind outside; fridge humming or clock ticking, it is involuntary and effortless and often sounds don’t register unless something draws you attention to them. Listening requires more active attention, focus from your mind along with increased auditory processing, which is the system by which the brain decodes messages received via the auditory nerves to make sense of what it is we are listening to and deciding what importance to place on the sound.

Listening requires your attention but we do have a limited capacity for this. When there is a lot of noise and activity going on around us it can result in our capacity for attention being overloaded with too many different stimuli. This can make holding a conversation difficult as we tend to hear the noise but are unable to make any sense out of the speech. In a crowded room where you are paying attention to one person you tend not to be actively listening to other conversations around you, but you do have an unconscious awareness of them. If, for example, you heard your name mentioned then it would automatically refocus your attention to whoever has said it.

People often feel they have a hearing problem because of difficulty in certain listening situations. For example if they are watching TV and their partner speaks to them they do not always catch what they are saying. However this is quite normal. If your attention is on one thing by the time it has switched to something else vital information will have been missed which would have made the speech make sense. This can easily be remedied by the person simply having your attention before speaking or by them turning off the TV before speaking.

Another factor which can affect your ability to hear is how tired you are as it requires a lot of effort and concentration to pick up speech from noise.

Environment

Think about the place where you spend the most of your time. Is it especially quiet with little distraction? Or do you live alone or are not keen on having the TV or radio on in the background?

If you spend the majority of the day in a quiet place then there is little to challenge the auditory system. If then you go out socially to noisy restaurants or pubs then suddenly your ears have a lot more to cope with and can get out of practice at filtering out unimportant sounds in order to focus on speech.

Many people complain that they used to be able to hear much better in those noisy situations and are confused as to why that has changed. Studies suggest that our capacity for filtering out irrelevant information does deteriorate with age, so even if your hearing levels remain within normal range it still may not be as good as when you were 20. Ageing also decreases the amount of control which we have over unimportant sounds, meaning we lose some of our ability to filter out background noise. Age seems to increase the amount of time needed for the brain to make sense of the sounds around us. It has been suggested that speech intelligibility is limited by our ability to focus on one thing and filter out competing conversations. This can mean in group situations, where there is more than one person talking, it is hard to focus on one conversation without being distracted.

Listening and communication techniques

Various listening techniques and communication tactics can help. In open plan workplaces try to sit with your back to the wall so that you only have sound coming at you from one direction. Try to reduce distractions, in restaurants try to sit in a corner away from the door or the bar where you have people constantly walking past you. Pick places with quieter background music playing and good lighting so you can clearly see the person who is speaking. Make people aware that you are struggling to hear. It makes a big difference if people are facing you when they are talking as visual clues are very important to help hearing. If people talk while looking down, from behind a newspaper, walking away or speaking to you from another room it will also increase the difficulty of listening so don’t be afraid to ask people to change how they are communicating with you. You also have to work at listening. People can fall into a habit of letting their friend or partner listen for them then just ask them later what was being talked about.

Be realistic

It is really important try to remember that everyone can struggle to hear in background noise some people just seem to cope with this better than others. Try to maintain realistic expectations about what you will be able to hear in difficult situations and try to implement listening strategies to help make the situation easier for you rather than just avoiding it altogether.