Many of us have had the experience: Someone we know, who quite obviously has difficulty hearing, says with complete sincerity: “I don’t have any problems hearing!” With wide-eyed expression, we find their response, well…amazing.
So, to answer the question of why their perception is so far off from everyone else’s, a hearing care professional named Cutis Alcock, from Exeter, England, has provided the following five reasons why the person with hearing loss is such a poor identifier of their own loss:
You can’t perceive what doesn’t exist. This theory is based on the concept studied in human and animal behavior called umwelt, which states that our perception is shaped by our senses. For those with hearing loss, if a sound falls outside of our own hearing range, that sound ceases to exist, and it is no longer part of their reality. The person with hearing loss doesn’t believe that they can’t hear sounds. Rather, in their mind, the sounds don’t even exist!
A comment from someone who supports this theory: “My wife has exceptionally good hearing!” No, she doesn’t. There is no such thing. Her hearing is just better than yours — possibly in the normal range, possibly with some hearing loss as well, but better than yours. It is certainly not “exceptional.”
Sound is an ever-changing target. Sound changes continuously. Sometimes it is louder, sometimes softer. Television is a good example of fluctuating loudness. The person who is shy or has poor speech patterns may be hard to understand for everyone, which is another example. Background noise does interfere with hearing speech. As we age, we have more lifetime experiences of fluctuating loudness, which makes it easier for one to think that outside factors, not personal hearing loss, is the reason behind not hearing.
It is easy to believe that if one doesn’t hear then another system is the cause for missed speech. Since understanding comes from integration of auditory, visual, cognitive, and social cues, one can easily blame another system for the lack of hearing: “I wasn’t paying attention.” “You weren’t facing me when you talked to me.”
Hearing loss is generally gradual, making it nearly impossible to recall what a sound sounded like many months or several years prior. In order to believe that one has a decline in hearing, one must have an immediate comparison between two different sound samples. It’s the contrast between the two sounds that is identifiable. For example, the comparison of what normal hearing sounds like and what their hearing loss sounds like. Small, one-decibel changes are not perceivable.
This is why I regularly have the patient listen to a sound sample of normal hearing, then turn off the sound sample and have them listen using their own ears. The contrast is easy to identify, even for the doubting patient. Hearing loss simulation software allows the accompanying loved one to hear the same contrast as it relates to the hearing-impaired person.
Finally, the vast majority of hearing losses are high frequency, not low frequency. High-frequency hearing loss, if still in the mild to moderate range, reduces clarity of speech much more than loudness of speech. Therefore, the person with the mild to moderate high-frequency hearing loss can hear speech, but they cannot clearly understand speech. This reinforces their perception that they don’t have hearing loss; they believe that the speech delivered to their ears simply isn’t clear enough. It is more evidence to the person with hearing loss that the trouble lies in external factors.
Given the above reasons why it is difficult to self-identify hearing loss, belief will come in the form of the audiologist conducting a diagnostic hearing test and, if hearing loss is present, providing the person with a sound sample of normal hearing compared to the same sound sample as they are hearing it with hearing loss. Simply telling the person that they have hearing loss, without hearing testing, creates further unbelief.
Sharon Macner, Au.D. Doctor of Audiology, Champlain Valley Audiology, PLLC Plattsburgh, NY Alcock, C. It’s not denial. It’s observation. Hearing Review 2015:16-20.