There is a hierarchy to hearing and understanding. We must be able to accomplish all levels of this hierarchy in order to have optimal hearing. When any one level is having difficulty, it can make an individual feel lost or left out of the conversation.
The first step for hearing is detection. This is the ability to hear sounds (even very soft sounds) within a normal range. Without the ability to detect sound, we cannot move up to higher levels of the hierarchy. Detection is what a standard hearing test measures. A standard hearing test assess if you can hear soft sounds within a normal range and if you cannot hear the soft sounds within normal range, this is when a hearing loss is diagnosed and hearing aids will likely be recommended. Properly fit hearing aids will allow you to have improved detection or access to soft sounds that you are not hearing without the hearing aid. Sometimes an individual will have normal detection and still have subjective hearing difficulty. Sometimes an individual with hearing loss (abnormal detection) will treat their hearing loss with hearing aids and continue to have significant difficulty with speech understanding. It is these continued difficulties beyond detection that may indicate auditory processing concerns at higher levels of the hearing hierarchy.
The next level of our hearing hierarchy is discrimination. Discrimination is the ability to perceive similarities or differences between two or more speech stimuli or sounds. For example, is an individual able to hear the difference between /t/ and /s/. Can an individual discriminate the word “keys” from “peas.” For some this discrimination becomes very difficult and an individual may feel that they are guessing often because they cannot hear the differences between speech sounds which alters the overall meaning of what is said.
Moving up the hierarchy is identification. Identification is the ability to label what is heard. This may include repeating singular words or knowing what is making a particular sound (such as the microwave beeping). In order to have accurate identification for speech an individual must be able to interpret parts of speech patterns such as duration, loudness, pitch, rhythm, stress, and/or intonation. Additionally individuals need to interpret parts of speech such as vowels/consonants, initial sounds, varying syllables, and familiar expressions. In order to have ideal identification an individual must have detection and discrimination.
The last level of our hearing hierarchy is comprehension. Comprehension is the ability to understand meaning, participate in conversation, follow directions, and summarize what is heard. Comprehension requires detection, discrimination, and identification skills. Comprehension additionally requires a auditory memory to retain what is said and respond appropriately. It is this level of hierarchy that allows us to listen in noise, sequence multistep directions or multipart stories.
Often times when visiting the audiologist, an individual notices a decline at the level of comprehension. Difficulties reported may include difficulty hearing in background noise (such as restaurants) or following stories spoken by their loved ones. The audiologist will first assess, diagnose, and treat detection concerns (hearing loss). For some, resolving detection will improve the higher levels of hearing hierarchy. For others, a continued difficulty with comprehension remains. This is where auditory training may be beneficial. Auditory training is designed to address weaknesses beyond detection. Auditory training includes exercises to build up weaknesses in discrimination, identification, and comprehension. Good candidates for auditory training include those who have treated their hearing loss (such as use of hearing aids or cochlear implants), those who are not meeting their hearing goals with treatment of hearing loss, and those who are motivated to improve their overall hearing and comprehension.
Auditory training can be very beneficial and improve hearing ability. It is similar to physical therapy following a knee replacement- while some individuals may be doing well following surgery others may need additional exercises in order to achieve their goals. To determine if auditory training is right for you or determine the best auditory training to meet your needs and goals talk to your audiologist!
