Hearing Loss: A guide to prevention and treatment

• How we hear
  • The journey of sound
• When hearing loss occurs
  • Kinds of hearing loss
  • Causes of hearing loss
• Testing for hearing loss
  • The medical exam
  • The audiological evaluation
• Progress in hearing technology
  • Hearing aids then and now
  • Before you buy
  • Choosing a hearing aid dispenser
  • Choosing a hearing aid style
  • Choosing hearing aid circuitry
  • One hearing aid or two?
  • Fitting a hearing aid
  • Adjusting to a hearing aid
• Surgery for hearing loss
  • Implantable bone-conducting hearing aids
  • Fully implantable ossicle stimulator
  • Cochlear implant
  • Auditory brainstem implant
  • Middle ear implant
  • Other surgeries
• Coping with hearing loss
• Preventing hearing loss
• Glossary
• Resources
  • Books
  • Organizations

Everyone has had this experience: someone is talking to you, and you can hear the words loudly but not clearly. The problem is especially common when you’re trying to have a conversation in a noisy room. But with age, many people have this problem even in quiet settings. The words are loud, but they sound garbled.

A speech discrimination test assesses how well you understand words. For this test, the audiologist has you listen to words through the headphones at a decibel level louder than your speech reception threshold, so you won’t have any problem with the volume of the speech. This test uses one-syllable words with vowels and consonants that are distributed similarly to those of words used in ordinary conversations—words such as jar, this, and box. The audiologist asks you to repeat the words you hear. Successfully repeating 90% or more of them is considered excellent.

Although it doesn’t mean your hearing is good, a high score on the speech discrimination test is good news. It means that you stand to benefit the most from a hearing aid, because boosting the volume of words will help you understand them better. In other words, your problem is mainly volume, which a hearing aid can fix. If you understand only a low percentage of the words, simply turning up the volume with a hearing aid is unlikely to help you hear any more clearly.

The main cause of difficulty with word discrimination is inner-ear hair cell or nerve degeneration. If your trouble understanding words is modest, a hearing aid may help to some degree, but it will not cure the problem. You’ll still need to use visual cues, such as lip reading, to help you understand what a person is saying. The more severe your problem is with word discrimination, the more limited your benefit from using a hearing aid.