The Complex Relationship between Hearing & Understanding

What is the difference between hearing and understanding? How are the two related?


  • Hearing vs. Understanding
  • Communication Hygiene
  • Active Listening Strategies
  • Communicating Through A Mask

Hearing vs. Understanding

Many people who experience hearing loss are not fully aware of the source of the problem until long after it has begun. This is mostly due to a misunderstanding of what hearing loss actually means. Often, hearing loss is not simply a general reduction in sound, like a stereo being turned down to a lower volume. In fact, rather than following this type of linear model, hearing loss tends to involve different facets of sound for different individuals.

People who get their hearing tested for the first time will often say that they can hear but have trouble understanding. This is because hearing loss tends to reduce one’s ability to hear specific frequencies of sound rather than all of them, and particularly those in the higher register. In everyday
conversation, this can create a lot of problems. For instance, a person may have no problem identifying vowel sounds (A, E, I, O, and U), which exist at a lower frequency, but have great difficulty differentiating many consonant sounds that are at a much higher frequency. The vowel sounds indicate that speech is present and provide the building blocks for sound to become language, but it is the consonants that give that speech meaning and structure. A person experiencing hearing loss in the higher frequencies, commonly known as “sloping” hearing loss, may have no trouble hearing the main sounds of speech, but struggle to identify words that are differentiated by high frequency consonant sounds. Words like “grow” and “flow” or “blue” and “clue” become more difficult to discern when the consonant sounds are less distinguishable, forcing the brain to work overtime using context clues and visual cues to fill in the blanks of understanding. This problem is made worse by higher pitched voices, competing background noise,
or a lack of corroborative visual information. 

While scheduling a hearing test and, if recommended, being fitted for a hearing aid is typically the first step toward improving one’s hearing, its primary function is to increase the levels of sound that the ear can hear in a very sophisticated way that also aids in better speech understanding. This is critical to provide the listener with the basic tools (the sounds themselves) to hear, but is only half the battle when it comes to achieving effective communication. The rest of the work occurs in the brain, not the ears. This is why it is important to train your brain on HOW to listen so that sound can be interpreted into information (see “Communication Hygiene” and “Active Listening Strategies”).

Hearing loss can take many forms and affect many sensory and cognitive processes beyond just the ears, therefore it is important to be aware of the warning signs so that hearing loss can be accurately diagnosed and treated. A hearing test can identify the exact pitches of sound not being heard, and
hearing aids can focus on those specific pitches, filling in the auditory blanks and providing a broader bandwidth of sound for the brain to interpret. This, coupled with active listening strategies and proper communication hygiene, eases the cognitive strain that can eventually lead to mental decline, and provides the brain with the full scope of auditory information with which to work.
Victory, Joy. “I Can Hear, Just Not Clearly”. 2019
Bricker, Sarah. “Hearing vs. Understanding”. 2016.

Communication Hygiene

Conversation is a two way street. In order to achieve meaningful communication with someone, each party must be able to clearly express themselves, be heard, and feel understood by the other person. This requires active engagement from both speaker and listener to ensure information is being conveyed accurately. When speaking with someone who is hearing impaired, this two-way effort is even more critical. While it is important that people who are hearing impaired employ active listening strategies to maximize their ability to absorb all of the information being conveyed in a conversation, it is equally important for the speaker to meet them halfway and be conscious of their own communication techniques. Here are
a few tips for maintaining good communication hygiene when speaking with someone who is hearing impaired.

Be Seen
• Be aware of noise and lighting around you. Choose to have the conversation in areas with less background noise, and position yourself so that the source of light is behind the listener, not in their eyes. This is of particular importance in public spaces such as cafes or restaurants.
• Face the listener and maintain appropriate eye contact to increase the visibility and conveyance of nonverbal communication cues.
Give Cues
• Support your speech with facial expressions and body language to provide context when you are speaking.
• When appropriate, say the person’s name at the start of a conversation or when in a larger group. This will signal the listener to focus their attention and avoid falling behind at the start of a new topic.
Be Aware
• Pay attention to the listener and their reactions. If they appear confused, politely ask leading questions to ensure they have heard and understood what you are saying, or simply ask the listener if they need further clarification.
• Pay attention to your own voice and communication style. Make a conscious effort to speak slowly, clearly, and succinctly.
• If you must repeat yourself, try simplifying and rephrasing the information that was missed, maintaining a natural speaking cadence, rather than shouting the same phrase at an increasing volume.
Be Helpful
• Avoid speaking rapidly and changing the subject abruptly.
• Repeat questions and key facts as the conversation progresses to reinforce the topic being discussed.
• Avoid eating, chewing, or touching your face while speaking. These actions can make your speech more difficult to understand and can block the listener’s ability to lip read or pick up nonverbal cues.
Be Patient
• In order to ensure a conversation is easy to follow, take turns speaking and avoid interruptions and overlapping speech.
• Don’t shout or exaggerate mouth movements. Oftentimes shouting will distort the sound of speech, and exaggerating mouth movements can disrupt the natural cadence of speech, making it less predictable and harder to understand.

If one takes the time and effort to employ these strategies when participating in conversations with someone that is hearing impaired (or anyone for that matter), it will help create a clearer and more rewarding environment in which to communicate.
Newton VE, Shah SR. Improving communication with patients with a hearing impairment. Community Eye Health. 2013;26(81):6-7.

Active Listening Strategies

If you are experiencing hearing loss, conversation with acquaintances and loved ones alike can become difficult and frustrating.
These six active listening strategies, used in conjunction with hearing aids, can help bridge the gap between speaker and listener and
reestablish a more positive and rewarding communication environment.

Position yourself for success
• Sit close to the person with whom you are conversing and face them when they are speaking.
• Obtain a vantage point where you can easily see the speaker’s lips, facial expressions, and body language.
• If one ear is better than the other, position that ear toward whoever is speaking.

Eliminate Distractions
• Reduce or eliminate background interference.
• Turn down or off stereos, televisions, fans or other noisy appliances.
• In public spaces such as restaurants and bars, look to sit in quieter areas with good lighting, so that you can hear and see the speaker more clearly.

Be open about your hearing loss
• Let the speaker know about your hearing loss — this allows them to work with you and better accommodate your needs.
• Tension is exhausting and can significantly reduce your ability to read speech and fully engage with a conversation. Try to relax and have a sense of humor instead of becoming frustrated, it will make it easier for both speaker and listener to work together.

• Don’t be afraid to ask someone to repeat themselves, rather than simply nodding and pretending to hear.
• If something is difficult to understand, ask the speaker to clarify specifically the part of the speech with which you had trouble. This will keep you engaged with the topic being discussed and prevent feeling gradually more and more lost in a conversation.

Repeat back
• One of the ways people affirm their engagement with someone speaking is by repeating back bits of information back to them, thus conveying an understanding and retention of what is being said. This can also be used as a tool for clarifying speech, as it can indicate to the speaker what is being understood and may help them to identify and reiterate anything the listener may have missed.

• Listening requires focus and concentration in order to fully engage with a conversation.
• Be aware or ask about the topic being discussed. This will allow you to focus on the thoughts or ideas being expressed rather than attempting to decipher every word.
• Engaging in the subject of a conversation can enable the listener to better understand the core concepts being discussed, which in turn can help fill in any blanks the listener may have missed, using environmental and context clues.

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