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Review
. Mar/Apr 2017;38(2):135-148.
doi: 10.1097/AUD.0000000000000388.

On the Etiology of Listening Difficulties in Noise Despite Clinically Normal Audiograms

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Free PMC article
Review

On the Etiology of Listening Difficulties in Noise Despite Clinically Normal Audiograms

Martin Pienkowski. Ear Hear. .
Free PMC article

Abstract

Many people with difficulties following conversations in noisy settings have "clinically normal" audiograms, that is, tone thresholds better than 20 dB HL from 0.1 to 8 kHz. This review summarizes the possible causes of such difficulties, and examines established as well as promising new psychoacoustic and electrophysiologic approaches to differentiate between them. Deficits at the level of the auditory periphery are possible even if thresholds remain around 0 dB HL, and become probable when they reach 10 to 20 dB HL. Extending the audiogram beyond 8 kHz can identify early signs of noise-induced trauma to the vulnerable basal turn of the cochlea, and might point to "hidden" losses at lower frequencies that could compromise speech reception in noise. Listening difficulties can also be a consequence of impaired central auditory processing, resulting from lesions affecting the auditory brainstem or cortex, or from abnormal patterns of sound input during developmental sensitive periods and even in adulthood. Such auditory processing disorders should be distinguished from (cognitive) linguistic deficits, and from problems with attention or working memory that may not be specific to the auditory modality. Improved diagnosis of the causes of listening difficulties in noise should lead to better treatment outcomes, by optimizing auditory training procedures to the specific deficits of individual patients, for example.

Keywords: Auditory development and plasticity; Auditory processing disorder; Hidden hearing loss; Speech intelligibility in noise.

Conflict of interest statement

The author has no conflicts of interest to disclose.

Figures

Fig. 1.
Fig. 1.
Audiograms (top) and DPgrams (bottom; i.e., distortion product otoacoustic emission amplitudes vs. primary tone frequency) in a child with a brainstem tumor who underwent chemotherapy that included the ototoxic drug cisplatin. Adapted from Figure 7–4 in Otoacoustic Emissions: Principles, Procedures, and Protocols. San Diego, CA: Plural Publishing; 2011.
Fig. 2.
Fig. 2.
Previously unpublished extended audiogram of a young adult amateur musician, recorded in our University clinic, showing elevated thresholds only above 10 kHz. This person had a chronic, bilateral, hissing tinnitus, which she reliably pitch-matched to narrowband noise with a center frequency of 9 kHz, near the edge of the hearing loss.
Fig. 3.
Fig. 3.
An intuitive guide to differentiating deficits in linguistic and auditory processing. Adapted from Richard (2013).
Fig. 4.
Fig. 4.
Subtests of the LiSN-S test. See text for explanation. Adapted from Figure 2 in J Am Acad Audiol, 2012;23, 97–105. LiSN-S, listening in spatialized noise-sentences.

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