Speech in noise: hearing loss, neurocognitive disorders, aging, traumatic brain injury and more

Abstract

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.

Amplification for adults with hearing difficulty, speech in noise problems - and normal thresholds

“…The research literature reveals many studies have reported patients' complaints of HDs in the presence of normal thresholds in 10 to 50% of their subjects, especially in older persons (e.g., Saunders and Haggard, 3 ; Gates et al, 4 Chia et al, 5 Hannula et al, 6 Tremblay et al, 7 Spankovich et al 8 ) Clearly, HDs and SIN problems are not limited to abnormal audiometric thresholds. According to Beck, Larsen, and Bush, 9 people with hearing thresholds WNLs may have supra-threshold auditory deficits due to or associated with any of the following: central presbycusis, auditory disability with normal hearing, obscure auditory dysfunction (OAD), King-Kopetzky Syndrome, auditory dysacusis, auditory processing disorders (APDs), idiopathic discriminatory dysfunction, hidden hearing loss (HHL), cochlear synaptopathy (CS), tinnitus, neurocognitive disorders, dyslexia, attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), traumatic brain injury (TBI), spatial hearing disorders (SHDs), aging, dementia, cognitive decline, presbycusis (sensory, neural, synaptic, auditory fiber, and/or central causes), noise-induced hearing loss (NIHL), mild cognitive impairment (MCI), receptive aphasia, and Alzheimer's Disease among others.…”

“…Hearing aids, particularly those coupled to RMs, can help these individuals, even in the presence of thresholds WNL. 9,34 Many blast-exposed veterans complain of difficulty understanding SIN, rapid speech, and following instructions, often disproportionately to their peripheral hearing sensitivity. 35 FM and RM systems using Bluetooth are effective interventions for blast-exposed veterans with normal or near-normal hearing sensitivity, but HDs.…”

“…These tools may soon be shown to serve a neuroprotective role against cognitive decline associated with hearing loss and some neurocognitive disorders. 9,37…”

Examining the Use and Benefits of Low-/Mild-Gain Hearing Aids in Service Members with Normal Hearing Thresholds and Self-Reported Hearing Difficulties

“…Published studies have suggested several possible interventions for patients with abnormal auditory abilities, including compensatory strategies, counseling, and auditory training [ 13 ]. Several studies suggest that technologies that increase the signal-to-noise ratio (SNR), such as low- (or mild-) gain hearing aids (LGHAs), with or without the use of remote microphones, can provide significant benefits to those with SHDs and NHTs [ 14 , 15 , 16 , 17 ]. Anecdotal results from military audiologists have reported positive results from the use of LGHAs (i.e., self-reported satisfaction and use through data logging), and many military clinics have started routinely prescribing LGHAs to patients who present with SHDs and NHTs.…”

Understanding Hearing Health: A Cross-Sectional Study of Determinants in a Metropolitan Area

“…Although the causes of hearing loss are well-established, the existing literature indicates that adopting behaviors to safeguard hearing health is challenging for individuals [ 2 , 14 ]. As reported, 46.7% of American adults aged 18 years and older have reported some degree of hearing difficulty [ 15 ].…”