Listening But Not Hearing – How Hearing Loss Affects Sound Processing 

July 18 is World Listening Day. To celebrate, I want to discuss the processes that allow us to experience the wonderful sounds around us. Did you know that we don’t listen with our ears? Instead, we hear sounds with our ears and listen with our brains. Our ears are responsible for detecting sound and transmitting the signal to our auditory cortex where the sound is interpreted. Integrity, or proper function of the auditory system, is required for sending the sound to the brain. Once the sound reaches the brain, higher level processing such as attention, working memory, and executive function all play crucial roles in listening and interpreting the sound.

My responsibility as an audiologist is to evaluate the entire auditory system (ear-to-brain) and treat hearing loss that affects sound transmission to the brain. If you have untreated hearing loss you will have difficulty interpreting sounds. Though this problem is often perceived as a lack of listening, it is more likely caused by unintentionally mishearing or misunderstanding due to lack of sound detection.

A variety of reasons cause the appearance of not listen. First, you may not hear what is being said! Oftentimes, you may have trouble hearing from a distance, such as when the speaker is in separate rooms or not facing you or when the speaker is soft spoken. In these situations, you  may not even detect that another person is talking.

Another common occurrence is misinterpreting the message. The word “cat” may be mistaken for the word “hat,” leading to a communication breakdown or misinterpretation of what is being said. This may come across as a lack of listening when, really, you misunderstood. Mishearing the word happens frequently because, if you do not hear every part of the word, your brain must fill in the gaps. Gap-filling is accomplished by using context and visual cues; however, context or the speaker’s face is not always apparent. In these cases, your brain must guess at possible options. For example, if someone at a baseball game says, “Look at their hat!” you could misinterpret this as “look at their bat!” because both “hat” and “bat” make sense in this situation.

Hearing loss is difficult not only for you but also for friends and family. Constant repetition can be very frustrating and feeling as if you are not listening can lead to anger or annoyance. One of the first things I do with you as a new patient is sit down with you and your communication partners to discuss good communication strategies. These strategies help optimize the listening environment and make sure you can hear your partner’s words.

If you, a friend, or relative experience hearing loss, remember mishearing can occur even when listening. It is important to seek out help for hearing problems, to use good communication strategies, and to have patience with one another on the journey to better hearing.