"Hearing Loss" vs "Hearing Impairment"

The most common complaint of those with a hearing deficit is not "I can't HEAR sounds" but rather, "I hear the SOUNDS , but I don't understand the WORDS, especially in noisy places." Conventionally fitted aids don't solve the problem. Difficulty understanding conversations persists.

Dr. Gil Magilen makes a clear distinction between "hearing loss", the loss of audibility of sound, and "hearing impairment", loss of the abilities to understand WORDS and to clearly separate the speaker from surrounding noise.

The root of the problem individuals face is not their "hearing loss" per se; it is their brain's difficulty in turning sound into meaningful words. Hearing WORDS requires three indispensable components: audibility of sound, neural processing and cognitive processing.

When sounds are made audible they become available to be processed into words. The neural processing transforms the sound into information that can be used by the brain to make words. The cognitive processing puts the correct word to the sound that was spoken. The end result is the experience of "hearing words".

When a person acquires a loss of audibility for soft sounds, it creates a challenge to the cognitive processing of the brain to make up for the loss of information.

The hearing-impaired experience great difficulty with speech spoken quickly even when it is spoken loudly. The words seem to blur and run together, making it difficult to separate the speech stream into meaningful words. Understanding words is far more complex than hearing sound.

There are other factors affecting the ability of the hearing-impaired to understand spoken material. The pitch of the speaker's voice, acoustic reflections from walls, background noise and topic familiarity can all significantly impact speech comprehension. The hearing-impaired often require face-to-face communication in which the movement of the lips, jaw and mouth aid in the process of decoding the spoken message. However, this cognitive, sensory integration demands considerable mental effort and may leave the listener exhausted.

The likelihood of hearing impairment increases as a person ages. It is far more common among those over 70 than among the young or middle-aged. Compounding the hearing problem is the challenge of recalling words from memory. Hearing and memory work together to decode spoken language. When one or the other (or both) fails to function properly, difficulty in comprehension often results, making it difficult to follow or participate in ongoing conversations.