My Hearing Test is Normal. Why Do I Still Struggle to Hear?
You had a hearing test, and the results came back normal. So why do you still find yourself asking people to repeat themselves, struggling to follow conversations in restaurants or missing parts of conversations when several people are talking? It can be frustrating when your hearing test says everything looks normal but your everyday experience tells you something feels different.
The important thing to know is that a standard hearing test does not measure every aspect of how you listen in everyday life. A hearing test can tell us a lot about how well you detect different sounds, but listening in the real world involves much more than hearing tones in a quiet room.
Difficulty understanding speech in background noise, following fast conversations or separating one voice from several others can sometimes occur even when hearing thresholds are normal or near normal.
In this article, we’ll look at why this can happen, what a normal hearing test actually tells you and what you can do if you’re still having trouble hearing.
Key Takeaways
- A normal hearing test does not always mean you will have no difficulty hearing in everyday situations.
- Standard hearing tests primarily measure how softly you can hear different pitches in controlled conditions.
- Background noise, multiple speakers, distance and room acoustics can make speech much harder to understand.
- Speech-in-noise testing can provide additional information about how you understand speech in more challenging listening situations.
- There are several possible reasons for difficulty hearing even when a standard hearing test looks normal.
- If you are struggling to hear, your everyday listening concerns are worth discussing with a hearing care professional.
In this article
- What Does a Normal Hearing Test Actually Tell You?
- Why Is It Harder to Hear in Noisy Places?
- Why Can’t I Understand People Even Though I Can Hear Them?
- What if I Have Normal Hearing but Still Struggle With Conversations?
- What Can You Do If Your Hearing Test is Normal but You Still Struggle?
- When Should You Get Your Hearing Tested Again?
- Next Steps
What Does a Normal Hearing Test Actually Tell You?
A standard hearing test usually measures your hearing sensitivity at different pitches. You listen for sounds through headphones or insert earphones and respond when you hear them.
The results are recorded on an audiogram and help determine whether there is a measurable hearing loss, as well as its type and degree. This is an important part of understanding your hearing, but it is still a controlled test.
In everyday life, you’re rarely listening to one simple sound in a quiet room. You may be trying to follow your spouse while the television is on, understand a friend at a busy restaurant or listen to someone speaking from across a room.
These situations require your auditory system to do more than simply detect sound. That’s why someone can have normal hearing thresholds and still report real difficulty understanding speech, particularly in challenging listening environments. Research has documented this experience in people with normal or near-normal audiograms.
Why Is It Harder to Hear in Noisy Places?
Background noise is one of the most common reasons people struggle even when their hearing test is normal. Think about being at a restaurant. There may be conversations happening around you, dishes and cutlery making noise, music playing in the background and people moving around the room.
Your brain has to pick out the voice you want to hear while filtering out everything else. This is very different from sitting in a quiet room and listening for a tone through headphones.
Speech-in-noise testing can help assess how well someone understands speech when background noise is present. The results can sometimes provide information that a hearing test performed in quiet does not.
If noisy environments are where you notice the biggest problem, it’s worth telling your hearing care professional exactly what those situations are like for you.
Having trouble following conversations in noisy places?
Even if your hearing test results are normal, there may be more to understand about your listening difficulties. Our hearing care professionals can discuss your concerns and help you explore the next steps.
Why Can’t I Understand People Even Though I Can Hear Them?
Hearing and understanding are related, but they are not exactly the same thing. You may be able to hear that someone is talking without being able to clearly make out every word.
For example, you might hear a friend speaking across the table but find that their words become difficult to understand when other people are talking. You may describe speech as sounding muffled or like everyone is mumbling.
This can be especially noticeable when:
- There is background noise
- Several people are talking at the same time
- Someone is speaking quickly
- You cannot see the speaker’s face
- The speaker is farther away
- You are in a large or echoey room
- You are tired after a long day of listening
These are all examples of situations that can place greater demands on listening than a quiet hearing test does.
What If I Have Normal Hearing but Still Struggle with Conversations?
If your hearing test is normal but you’re consistently having trouble with conversations, that does not mean your concerns should simply be dismissed. There are several possible reasons for the difference between your test results and your everyday experience.
You May Have Difficulty Hearing in Noise
Some people with normal or near-normal hearing thresholds have particular difficulty understanding speech when background noise is present. One study looking at this group found that noisy environments, including restaurants, were a common source of difficulty.
Your Hearing Test May Not Have Tested Every Listening Situation
Traditional hearing tests are useful for measuring hearing sensitivity, but they do not recreate every situation you encounter throughout the day. Depending on your concerns, additional testing may provide more information. This can include speech testing in noise or other assessments of how you process and understand sounds.
Your Ears May Not Be the Only Part of the Picture
Listening involves the entire auditory system, including how the brain processes incoming sounds. Some people have difficulty processing speech when there are competing sounds, multiple speakers or other challenging listening conditions. Auditory processing difficulties can have several possible causes and require careful assessment rather than being assumed based on one symptom.
You May Have What Is Sometimes Called “Hidden Hearing Loss”
You may have come across the term hidden hearing loss online. The term is used to describe certain auditory difficulties that may not show up on a standard pure-tone hearing test. ASHA notes that cochlear synaptopathy, sometimes referred to as hidden hearing loss, is not identified through standard pure-tone audiometry and may be associated with difficulty understanding speech in noise.
However, hidden hearing loss is an area that is still being researched, and having trouble hearing in noise with a normal audiogram does not automatically mean that you have hidden hearing loss. The important takeaway is that your listening difficulty can be real even when your standard hearing test looks normal.
Your Hearing Test Is Just One Piece of the Picture
Understanding your hearing results can help you make sense of what you’re experiencing in everyday life. If conversations are still difficult, your hearing care professional can help you understand what your results mean and whether additional testing may be worth exploring.
What Can You Do If Your Hearing Test is Normal but You Still Struggle?
Start by describing exactly what you’re experiencing. Instead of simply saying, “I can’t hear,” think about when the problem happens. Is it mainly in restaurants? At family gatherings? In the car? When someone speaks from another room? When several people are talking? On the phone?
These details can help your hearing care professional understand what your standard hearing test may not fully explain. Depending on your symptoms and history, a more comprehensive hearing assessment may include additional speech testing, including testing in background noise. It can also be helpful to bring up any other symptoms you have noticed, such as tinnitus, a feeling of muffled hearing or a noticeable difference between your ears.
The goal is not simply to put a label on the problem. It is to understand where and when you’re having difficulty and what may help.
When Should You Get Your Hearing Tested Again?
If your hearing concerns continue, it may be worth having your hearing reassessed, particularly if it has been some time since your last test or your symptoms have changed. You should also let your hearing care professional know if your hearing difficulty is new, sudden, noticeably worse in one ear or accompanied by other concerning symptoms. In some situations, further medical assessment may be appropriate.
Even if your hearing continues to measure within the normal range, keeping track of your hearing over time can provide a useful baseline and help identify changes later.
Next Steps
A normal hearing test is good news, but it doesn’t necessarily answer every question about how you hear in everyday life. If you’re still struggling to follow conversations, especially in noisy or busy environments, talk to a hearing care professional about what you’re experiencing. Your real-world listening concerns are an important part of understanding your hearing.
At Hearing Solutions, we can look beyond your basic hearing thresholds and talk about the situations where you’re having the most difficulty. Depending on your needs, your assessment may include additional speech testing and a discussion about your listening challenges. If you’re having trouble hearing even though your last hearing test was normal, book a hearing assessment with Hearing Solutions and tell us what you’re experiencing.
References:
National Library of Medicine (3, Sep 2020). Discovering the Unmet Needs of People With Difficulties Understanding Speech in Noise and a Normal or Near-Normal Audiogram. https://pubmed.ncbi.nlm.nih.gov/32463705/
American Academy of Audiology (n.d.). Hidden Hearing Loss. https://www.audiology.org/consumers-and-patients/hearing-and-balance/hidden-hearing-loss/
American Speech-Language-Hearing Association (n.d.). Hearing Loss in Adults. https://www.asha.org/practice-portal/clinical-topics/hearing-loss
