I have been asked this question, or something along these lines, many times throughout my career. It can be frustrating to notice that your spouse (or friend, or co-worker, or whoever) is able to hear certain environmental sounds, but they don’t seem to be able to hear you! This is a pretty normal occurrence, and it doesn’t even mean the other person is ignoring you! I’ll explain why.

First, there is a big difference between a door slamming and a person talking, in terms of complexity. Speech is probably the most complicated signal that we ask our brains to process. It is infinitely more complex than a door slamming, a dog barking, footsteps, a fan, radio static, etc. It is much easier to hear and recognize all varieties of environmental sounds. Now you know not to take it personally when a person hears a knock at the door but they don’t seem to hear you!

Second, we need to look at the difference between speech detection and speech discrimination. The difference between detection and discrimination is the awareness of someone talking vs. the ability to identify (discriminate) what was actually said. When someone didn’t quite catch all of what you said, there is a shortfall in discrimination, but all you know is that they didn’t hear you. In terms of detection, they did actually hear you, but in terms of understanding what you said, they didn’t. I think this is an important thing to remember and hopefully will reduce frustration in communication. (Incidentally, I once had a patient tell me he could hear the seals barking, and therefore knew he didn’t have hearing loss. I wanted to ask him how he knew what the seals were saying, but I didn’t.) Any number of things can contribute to poor discrimination: excessive background noise; poor acoustics in the room; the person speaking is not facing the person trying to listen; the person trying to listen has hearing loss; the person trying to listen was concentrating on something else when the first person began talking, to name a few.

Third, high frequency hearing loss is very common, particularly as people hit their 40’s and beyond. (In a study of a certain population over time, it was found that what we call "age-related" hearing loss actually begins in our 20’s.) With high frequency hearing loss, even slight high frequency hearing loss, the most important parts of speech, the parts that factor into speech discrimination, are affected. Both vowels and consonants are affected by high frequency hearing loss.

Because speech is so much more complex, for the above-described reasons, it is more difficult to understand speech than to hear a simple environmental sound. If a person can hear a door closing but they can’t hear someone in the room talking, does that mean they need a hearing aid? No, this is not an assumption we can make. It is a good idea, however, to have a hearing evaluation.