One of the most common things that I hear from patients is: "I can hear people talking, but can't understand what they are saying". In reality, the issue is usually not that people have forgotten how to speak clearly. This complaint is one of the classic early signs of hearing loss and hearing difficulties.

Hearing And Understanding Are Two Different Things

When we talk about 'hearing', this is the detection of sound - whereas 'understanding' is the processing of speech. You may still hear that somebody is talking, but the difficulty is identifying the individual speech sounds that actually make the words clear.

Imagine you need to read a sentence, but some of the letters have been removed. You can likely still read the sentence, but understanding it becomes much more difficult.

Why Do People Sound Like They're Mumbling?

Some of the most common types of hearing loss: age-related hearing loss and noise-related hearing loss, often affects the higher pitches first. Many speech sounds that create clarity are actually high-pitched, for example; S, F, TH, SH and CH. Vowels on the other hand, are usually louder and easier to hear, so you may find yourself thinking "I can hear the voice, but can't make out the words".

Why Are Restaurants And Cafes Especially So Difficult?

Now, when we are talking about restaurants and cafes, all of a sudden we are introducing background noise, possible reverberation, multiple conversations, and potentially more distance from the person speaking. Here, the challenge isn't hearing sounds - there will be plenty of this. The challenge is separating the speech you want to hear from all the competing sounds around it. These same high-pitched speech sounds mentioned above are also often presented softly - they're usually not voiced. Try this for yourself, saying sounds such as S, F, TH, SH & CH. Your vocal cords do not vibrate when you make these sounds. Some of these sounds are also likely getting drowned out by some of the background noise around you - not making it any easier, particularly if you also have a hearing loss in those same pitches.

What About The TV?

Struggling to understand speech often also translates to watching TV. You may find that you need the subtitles on or you need the TV volume turned up, which can often bother others in the house (or even neighbours!). Its not uncommon that I will hear people tell me they are hearing the TV but missing the volume, or that their family is complaining about the TV volume.

Is It Always Hearing Loss?

As with anything, there is always nuance. It is very common that it is related to hearing loss, however, let's also consider other potential factors. Perhaps there is a something in your ears temporarily causing a hearing loss - for example, ear wax buildup or an ear infection. But sometimes we also might need to consider that speech understanding abilities can vary, and if there are any potential cognitive factors at play. Needless to say, a diagnostic hearing assessment with an audiologist will be able to help narrow down the cause.

Can Hearing Aids Help?

Hearing aids can certainly improve access to speech sounds. Amplification of the pitches where the hearing loss is occurring will help boost access to these sounds which may help you better distinguish them. In addition to amplification, modern hearing technology can also help in background noise by 'cleaning' up the noise and leaving the clear speech for you to hear easier.

However, it's also important to note that hearing aids do not restore normal hearing. When a permanent hearing loss exists, there has been some degree of damage done to the inner ear and/or auditory nerve. Hearing aids can certainly improve things - there is no doubt about that, but they do not 'cure' hearing loss.

How Do We Measure Speech Understanding?

We perform a full diagnostic hearing assessment. You may think of this as the test we all know about: "press the button when you hear the tones". However, in a complete diagnostic assessment there is actually much more to it. There is a whole component of speech testing included - both in quiet and in background noise. This gives us an idea of how well you can understand and distinguish different speech sounds in different types of environments. Moreover, when you get your hearing aids fitted, the hearing aid fitting is also verified using more speech tests. There are several types of verified speech tests, but the most relevant and useful test for your specific hearing loss and needs will be clinically decided and evaluated by the audiologist.

When Should You Have Your Hearing Checked?

Hearing loss is often slow and gradual, so the signs and symptoms can be subtle to begin with. Often, its our family or loved ones who might notice first!

Some examples of early signs and symptoms include (but not limited to):

• People seem to mumble

• Difficulty in group situations

• Trouble understanding in restaurants or cafes

• Needing repetitions

• Leaning in to hear someone

• Increasing TV volume or reliance on subtitles

• Ringing or buzzing sounds in the ears

• Withdrawing from social situations

• Family notices changes

If you experience any of these or have any other concerns with your ear or hearing health, it is recommended to have a full diagnostic hearing assessment with an audiologist.

Take Home Message

If people seem to mumbling more than they used to, the issue may not be that they are suddenly speaking less clearly. Hearing speech and understanding speech are two completely different processes. Difficulty understanding speech, particularly in the presence of background noise, is one of the most common early signs of hearing loss. A comprehensive, diagnostic hearing assessment with an audiologist can help identify the cause and determine the most appropriate management options. One of the biggest misconceptions is that hearing loss simply makes everything quieter. In reality, many people experience hearing loss as a loss of clarity, rather than a loss of volume.

Written by Daniel Gerace, Clinical Audiologist and Owner of Solo Audiology and Hearing.