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Distinguishing Between Auditory Processing Deficit and Hearing Loss Related Speech Discrimination Impairment

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How can you tell the difference between a problem with auditory processing as opposed to difficulty understanding speech when using hearing aids due to hearing loss and limitations of speech in noise? I am very concerned that, in many environments, I can hear sound, which is sometimes overwhelming despite various adjustments; however, I can’t pick out speech. I don’t know if it’s related to the , which is relatively new although a few years old now, or if there is a neurological (e.g. brain damage from a fall or undiagnosed auditory processing deficit which may or may not be associated with a learning disability (I was only diagnosed with visual perceptual/spatial/motor/math LD). I am now officially a senior citizen, and I know that one’s senses tend to decline, but what I find disconcerting is that even when the hearing aids produce both volume and clarity, it’s as if there is a synaptic gap between reception of sound and interpretation of the message. Is this common with hearing loss, especially as we age?

You don’t get an auditory processing disorder diagnosis when you have hearing loss in part just because of how we categorize things, but also in part because by virtue of having hearing loss you already automatically have an auditory processing disorder. Hearing loss is caused by changes (damage) to the ear, but changes to the ear over time result in changes to the auditory centres in the brain.

The brain uses two ears to localize things in space and to analyze the sound scene. It is very normal for someone who is working with only one ear to have dramatic difficulties in background noise often above and beyond someone with a bilateral hearing loss that may be technically “worse” but which is symmetrical. Modern hearing aids, even at the premium level, regularly cannot provide a sufficient increase in the signal to noise ratio to support someone who is only working with one ear. Often someone with one deaf ear and one typically-hearing ear will seem like they have no hearing loss at all in a quiet situation, but as soon as there is background noise their ability to understand conversation falls apart.

Absolutely aging impacts our cognitive reserves and can make listening more difficult for anyone. Aging also regularly comes with a whole host of other health problems and chronic pains, big and small, that tax your mental reserves. But what you are describing can also simply be explained by single-sided deafness.

The will give you better auditory access to your bad side so that you aren’t constantly craning your head around to hear someone on that side, but it typically won’t do enough to support you in background noise. technology (e.g. Roger On) will be more effective in background noise if it is something that you can learn to use effectively. Aside from that, you’re looking for strategies to manage and mitigate background sound and support clear communication, which I’m sure this community probably has a lot of ideas about.

Thank you for explaining this phenomenon, Neville. I was really worried and upset today by the experience (a coffee hour social for the residents in a senior’s housing complex which couldn’t have been set up more disastrously for people who are hard of hearing. Carpet, high ceiling, two long rows of fabric armchairs with a fireplace along the wall at the end of the room, side conversations. Analyzing the situation now in the context that you presented, it’s really not surprising. It’s reassuring that, in this case, auditory processing difficulty is part of the hearing loss package rather than another disability in and of itself (which, of course, exists in other contexts). I appreciate your description of how the and one-sided deafness works.

In my experience, senior’s housing complexes, retirement homes, etc. often have really awful listening environment despite often having a majority population of people who are hard of hearing.

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