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

Pienkowski, Martin

doi: 10.1097/AUD.0000000000000388

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.

George S. Osborne College of Audiology, Salus University, Elkins Park, Pennsylvania, USA.

The author has no conflicts of interest to disclose.

Received April 19, 2016; accepted September 30, 2016.

Address for correspondence: Martin Pienkowski, George S. Osborne College of Audiology, Salus University, 8360 Old York Road, Elkins Park, PA 19027, USA. E-mail:

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