It's a fairly common frustration that audiologists hear from clients/clients' families; “I don't know if they can hear me, or if they are just not paying attention!’ This statement really encapsulates the difference between hearing and listening.
Hearing is the awareness of a sound, it is the simplest task that our hearing system does, and is merely a physiological process. Listening is an interpretive process, and as such is influenced by a vast array of factors.
As audiologists, we do an audiogram, tympanometry, and otoscopy when we do a hearing test. This primarily checks the physiological process. Speech testing is part physiological and part interpretive, so is the one standard assessment we do that gives some insight into the interpretive process of a client. Increasing the complexity of the speech test, by doing a speech-in-noise test, begins to give the audiologist more of an idea about a client's listening ability. Also, we will ask about a client's self-reported communication, where they have trouble, what they notice in different listening situations, what changes or modifications help or don't help, and how are they managing the situations. This will give a more complete picture of a client's communication.
In an initial appointment, while it may not seem necessary, clients will often be asked some health and lifestyle history. These questions can help flesh out other factors which can contribute to challenges with listening. For example, having English as a second language means that the client's mother tongue, and mother accent, is not Aussie English! As such, there is some additional interpretation of speech signals that this person is doing to communicate. It has been observed in the aging population that people revert to the mother tongue as the dominant or more effective communication language, which is thought to be because this is more embedded in the neural pathways of the brain, having been established from birth. If a client is having to do additional processing or cognitive work, it may be that they do this slower or less effectively.
Another example may be a client's vision. Many people have awareness about lip reading and body language but do not realise that a significant portion (some research says 90% others 40-50%) of communication is visual. It may be lip reading, which we all learned as toddlers while we were watching adults' faces intently to learn how to create the shape of the mouth to reproduce the speech! But we also use facial expressions for judging responses, emotions, and reactions( to name a few). In addition to facial expressions, we also have body language, the open engaged position vs a closed crossed arms pose.
General health and known diagnosis can also contribute to cognitive processing. For example, people with chronic pain may be on long-term medication, which as a central nervous system suppressant, can impact cognition. A known neurological condition, like Parkinson's Disease or similar, can also impact how a person is able to interpret what they hear.
Hearing devices definitely improve the quality of the signal that a client receives. It is adjusted to the level that will most help a client, in the various frequencies that we use for most communication. Audiologists also help clients understand how the devices can best be used to improve communication, how to advocate for what they need to perform at their best, and how to change communication habits to better support not only hearing but listening. When families and significant others are included in aural rehabilitation, overall communication and quality of life can be improved.
