In this article, we explore and report the prevalence of speech in noise difficulties across multiple patient populations and reveal and speculate on management of the same. Speech in Noise problems is commonly associated with sensorineural hearing loss. The inability to understand speech in noise is often associated with, and attributed to, sensorineural hearing loss. However, some 12-15% of adults with normal hearing thresholds (i.e., pure tones) have difficulty hearing and struggle to understand speech in noise. Many of these same symptoms are present in people with neurocognitive disorders, advanced age, traumatic brain injury and more. As such, we recommend speech in noise testing on all adults who report these same difficulties. Further, once speech in noise difficulty has been objectively identified and quantified, an appropriate goal would be to improve the patient's speech in noise ability through aural rehabilitation, as well as modern technological advances.