Already Gone

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The ASHA Leader, June 2015, Vol. 20, 38-42. doi:10.1044/leader.FTR1.20062015.38

Though undetectable with testing, hearing decline begins when we’re in our 40s and 50s. What causes this change, and how can clinicians advise clients who notice the difference and struggle with it in everyday listening situations?

Janet Koehnke, PhD, CCC-A; Jennifer Lister, PhD, CCC-A; Ilse Wambacq, PhD

Forty-two-year-old Kelly comes to see you because she is having trouble understanding her friends in social situations, like outings to restaurants or clubs. She knows her hearing is normal and says she seems to have this problem only in situations where there are multiple conversations, background noise or music. Kelly is concerned because she’s now avoiding social events with challenging listening environments.

Sound familiar? It’s not uncommon for us, as audiologists, to see people in their 40s and 50s who complain of difficulty understanding speech in noisy environments. Yet when we conduct a complete audiometric evaluation on these clients, we often find normal pure-tone and speech thresholds and excellent word recognition in quiet. So what is the source of these clients’ hearing challenges?

A growing number of studies suggest that while clients’ hearing may be normal, their complex auditory processing at a central level is not what it was when they were in their 20s and 30s (see sources below). Some of the explanations for these declines include impaired temporal processing and binaural/spatial processing, which are thought to be mediated, at least in part, at the level of the auditory brainstem. In addition, there is clear evidence for age-related changes in cognitive processing in middle-aged people.

How do these changes affect the ability to understand speech in degraded listening conditions, locate sound sources, and, in general, communicate in everyday listening situations? Not surprisingly, research suggests there is not a simple answer to this question (see sources below). Nonetheless, certain auditory-processing challenges likely contribute to these hearing difficulties. Though typically not a debilitating decline, it is one audiologists and speech-language pathologists need to watch for in middle-aged clients, so that they can offer support, as needed.

See full article here.