“I can hear people talking, but I can’t understand what they’re saying,”

If you have ever said this, you are not alone. This phrase is one of the most common complaints people share with us. Even when the volume is loud enough, lack of clarity is often a sign of hearing loss. First, let’s discuss how the hearing system works.

The ear is categorized into three different parts: Outer Ear, Middle Ear, and Inner Ear.

• The Outer Ear: consists of the auricle (the part you see), ear canal, and tympanic membrane (ear drum)
• The Middle Ear: an air-filled space consisting of the Eustachian tube and three tiny bones: malleus (hammer), incus (anvil), and stapes (stirrup)
• The Inner Ear: the cochlea (hearing organ), hearing nerve, and the semicircular canals (part of your balance system). The cochlea is filled with fluid and tiny hair cells. These tiny hair cells are tuned to a specific pitch/frequency. When stimulated, the hair cells send a signal to the hearing nerve. The hearing nerve sends the signal to the brain.

In a typical hearing ear, sound easily travels through these three parts of the ear and is sent to the brain. The brain receives the sound and assigns meaning to it. The brain is responsible for understanding the sounds you hear.

Hearing loss interferes with the delivery of the sound to the brain. There are three types of hearing loss, depending on where in the ear it occurs.

1. Conductive Hearing Loss

• Occurs in the outer and/or middle ear
• Causes can include (not limited to): ear wax, ear infections, hole in the ear drum, missing ear canal, etc.
• Some cases of conductive hearing loss can be corrected medically.
• If the sound is loud enough, a person with this hearing loss can understand very well.
  
  

2. Sensorineural Hearing Loss

• Occurs in the inner ear
• Causes can include (not limited to): genetics, age, environmental factors, illness, ototoxic medications, noise exposure, neuromas, idiopathic (unknown cause)
• Cannot be reversed or “cured” medically. The hair cells and/or hearing nerve are damaged, resulting in the inability to detect sounds at the affected frequencies
• Sound can be loud enough, but a person with sensorineural hearing loss may still have difficulty understanding

3. Mixed Hearing Loss

• Occurs in the outer/middle ear AND inner ear
• Cause: a baseline sensorineural hearing loss also has a conductive hearing loss
• The conductive hearing loss can sometimes be corrected medically, but there is still a sensorineural hearing loss present
• Example: A person with sensorineural hearing loss has ear wax completely blocking their ear canal. This person now has mixed hearing loss until the wax is removed.

Hearing vs. Understanding

There are two parts to hearing: detecting and understanding. Your ears detect sound and deliver the message to your brain. Your brain understands the message. When hearing loss occurs, there is breakdown in the detection, understanding, or both. Certain types of hearing loss affect clarity more than volume.

Can It Get Worse?

The longer hearing loss goes untreated, the harder your brain must work to fill in the missing information. Your hearing nerve becomes less active and inefficient at delivering signals to the brain. Over time, your brain becomes less capable of managing hearing loss, leading to listening fatigue, withdrawal from social situations, and frustration.

How Can an Audiologist Help?

At the Hearing Center of Greater Philadelphia, our goal is to help alleviate the listening fatigue and frustration that often results from untreated hearing loss. As audiologists, we can complete a comprehensive hearing evaluation and provide appropriate treatment recommendations. Sometimes, the treatment recommendation may extend beyond hearing aids. We will educate you on all available options.

If you hear sounds but struggle to understand them, a professional evaluation can be the first step to improved communication.