[2] Unofficial guide to your hearing - I can hear people talking, but I can't understand them.
Muffled hearing vs. Distorted hearing
Alright. Let’s talk about THE MOST COMMON complaint from my patients: Clarity.
I was thinking a lot of what I should discuss after the first post, but I could not decide, and just today, I had several of these complain. When you can hear other people, but cannot understand them, we need to clarify what you are experiencing. Is it muffled? Or is it distorted?
Muffled Hearing: Missing the “High Notes”
If you experience muffled hearing, it is likely from high frequency hearing loss from your ears. Muffled sensation = missing details, brightness, and sharpness. In other words: missing high frequencies. When you have high-frequency loss, details like “s” in plural words, the difference between “pool” and “cool”, and sibilant sounds that give just a bit of clarity to each word and sentence start to go away. During the pandemic, everybody was wearing mask, and that spiked patient visits. Chief complaint? muffled hearing. Meaning? Wearing a mask acted as a high frequency filter (to be exact, a low-pass filter that lets low frequency to pass through but cuts off the highs).
A Quick Rule for Family Members: Stop Talking from the Other Room!
That is for patients. Alright, to those who are around the patient who is experiencing high frequency loss, please, please face them when you talk and stay in the same room. High frequency is directional. The volume of the high frequency is preserved at the max level when the sound source, your mouth is pointing to the patient’s face. If you turn away, all of those precious high frequency information is projected away from the patient. Also, when you talk from the other room, the patient is not likely to hear or understand you drastically because of the inverse-square law. Basically, every time the distance the sound has to travel doubles, the strength of the sound drops exponentially. To deliver same clarity to the patient from six feet away as you would from three feet away, you have to make your voice 4 times louder because the distance between you and the patient has doubled. Inconvenient, I know. But it is your loved one, or at least someone you care.
Anyways, if the muffled hearing is an issue, then the solution could be simple. Get a hearing test, and get an intervention. It could be middle ear effusion which can be managed with medication or procedure, or it could be sensorineural hearing loss that can be managed with hearing aids. Yes, high frequency can be caused from fluid in your ear and earwax as well.
Distorted Hearing: A Processing Problem
Now, let’s talk about the distortion. This is more complicated than muffled hearing because it is not about the perception, it is about processing what has been perceived. This phenomenon is quite rare. A condition that can cause this could be a tumor (like I said, it is rare.)
Lot of patients actually confuse this with muffled hearing. Here is the distinction between actual distortion and pseudo distortion. If you can understand someone when he/she talks to you at a closer distance or louder volume, you don’t have distortion. You have muffled hearing.
What you would experience with the actual distortion is even when sounds are presented to you at a louder level, specifically speech signal, you won’t be able to understand what it is being said. So your perception of sound is not impaired. “PROCESSING what you can hear” is impaired. This presents a very difficult management situation for clinicians. Even if we fit the patient with hearing aids, it won’t always help them; hearing aids are essentially highly sophisticated amplification devices that can be customized to each hearing profile, but they cannot fix the what is happening beyond the perception. Some patients do experience some improvements in their distortion with hearing aids, but not by too much. This leads us to consider cochlear implant. However, most of the cochlear implant requires severe sensorineural hearing loss to be considered as a candidate; some institutions require 70 dB HL in pure tone average level.
The Golden Rule for Communication with This Type of Patient.
Unfortunately, when things are truly distorted, the communication strategies such as facing the speaker, conversing in a noise-free environment, using visual cues, staying in one context at a time and etc, should be implemented. Oh, and also, when the patient asks you to repeat what you said, please repeat what you said EXACTLY WORD BY WORD. Paraphrasing may actually confuse them.
For the next post, I’ll scratch the question everybody has, but not going to ask doctors: why do we have you get tested by you, when we can do it online or phone app. And the reason why it requires your response unlike to image scans.
Any questions and comments, just put it down below. If you have any updates regarding this issue, let me know, so that I can update this post.
