Arizona Hearing Center November 2019

2627 North Third Street, Ste. 100, Phoenix, AZ 85004 | 14418 West Meeker Blvd., Bldg B, Ste. 102, Sun City West, AZ 85375


602-277-4327 |

‘I Only Have Hearing Loss When …’

The Myth of Situational Hearing Loss

Hearing, for all intents and purposes, doesn’t work in a vacuum. What we experience as the sensation of listening is actually the result of three distinct processes working simultaneously. Imagine a triangle where one corner is the auditory process of hearing, the hard biology if you will. In the other two corners, you’ll find speech reading and context. Speech reading comprises all of the visual cues that magnify our sense of hearing, from lip reading to gesticulations to facial animations. Context includes the situation a conversation happens in and the words and sentences that precede and follow a given set of sounds. Language and communication, as most people experience them, require all three of these to function properly. Because all three of these work in concert, we have a lifetime of experience associating each corner of the triangle with the other two. When one of them falters, we use the other two to prop them up. Sometimes, we do this compensating tactic consciously. If we’re on the phone, for example, we can’t rely on speech reading. Understanding that something is lost when we aren’t able to see the person we’re speaking to, we tend to focus more on the person. The reason the buffoon who nearly wanders into traffic while talking on the phone is a cliché is because we

tend to ignore what’s around us to make it easier to hear what’s coming through the speaker. In other situations, our compensation process kicks in without us realizing it. One such situation is the early stages of hearing loss. We’re able to compensate the gradual diminishing of one corner of the triangle, the physiological process of hearing, with the strength of the other two. The way this compensation manifests itself in many patients is with the sense that they only have hearing loss in certain situations. You’ve probably heard a patient make this exact argument or a spouse attest to its veracity. The bottom line, though, is that while it may only hamper communication in certain situations, their hearing loss is present all the time. It’s an empirical phenomenon, not a situational one. If you think about the situations when a patient will argue that their hearing loss shows up, almost all of them demonstrate a restriction on one of the other parts of the triangle, as well. In the car, you have to focus on the road, making speech reading impossible. At a party with new people, you’re less attuned to body language and speech patterns. If you miss the first two sentences of a piece of conversation, especially if it doesn’t include the usual Dale Carnegie small

talk, it becomes a lot harder to keep up. When you couple these scenarios with failing hearing, it’s easy to see why hearing loss feels situational even when it’s not. How does somebody gain too much weight? One ounce at a time. You don’t go to sleep at 200 pounds and wake up the next week at 500. Hearing loss works the same way, but it’s much more insidious, in a sense. As your hearing begins to fail, you don’t have an easily memorable reference point for what normal looks or feels like. Your ears don’t get tight like your waistband. Your brain wants you to be able to communicate and understand, and it will allow you to do that long after demonstrable hearing loss is present. When a patient says they only have hearing loss in certain situations, what they really mean is they're in the early stages of hearing loss. They may not know it, but they’ve actually given you the perfect chance to intervene early, before they start to feel the effects of hearing loss all the time.

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