Struggling with Conversations? It’s About More Than Just Your Ears
Hearing aids are essential for people with hearing loss – they amplify sounds, making them audible again. But hearing is more than just detecting sound, it’s about understanding speech. Unfortunately, hearing aids alone often fall short because they do not fully restore the brain’s ability to process and interpret speech – especially in challenging environments (e.g., noise, rapid speech, competing talkers)1, and they don’t retrain the brain to process sound effectively.
This is where auditory training (AT) comes in. Research shows that combining hearing aids with structured listening exercises leads to better speech comprehension, improved noise tolerance, and long-term brain plasticity.2, 3
In this article, we’ll explore:
- Why hearing aids alone aren’t enough
- How auditory training helps the brain hear better & its proven benefits
- Practical ways to incorporate AT into hearing rehabilitation
Hearing Aids Amplify, But the Brain Must Still Decode
Hearing aids restore audibility, but they don’t fix auditory processing – the brain’s ability to interpret speech4.
When hearing loss goes untreated for years, the brain’s auditory pathways weaken, becoming inefficient in processing speech, particularly in noise5. Auditory damage or trauma from noise exposure, accidents or age-related deterioration, leads to auditory deprivation that results in auditory processing degradation6.
If the brain has been deprived of clear signals and mishearing sounds (sometimes for many years), simply amplifying sound doesn’t automatically restore any neural distortions and fix speech comprehension7. Hearing aids can provide sound input, but if the brain cannot discriminate sounds effectively, speech understanding remains poor. Even with hearing aids, a person can still confuse words like ‘ship’ vs. ‘chip’, struggle to understand fast talkers and follow group conversations, and misses entirely or mishears words in noise because the brain has lost sharpness in decoding speech8. Additionally, a person with untreated hearing loss for prolonged years may struggle even with well-fitted hearing aids, because their brain has adapted to filling in the gaps incorrectly.
Research studies have found that hearing aids alone do not restore normal hearing – auditory training is needed to fill the gap3.
✅ Hearing aids provide the sound, but auditory training trains the brain to understand it.
Auditory Training Helps the Brain Listen Better
Auditory training (AT) can be described as teaching the brain to listen through active engagement with sounds. AT is structured listening practice that rewires the brain to process speech more efficiently. Research shows structured, clinician-guided AT leads to greater improvements than informal listening practice alone11.
| Scenario | Why Hearing Aids Alone Is Insufficient | How Auditory Training Helps |
|---|---|---|
| Speech in Noise | Hearing aids amplify noise along with speech | Trains the brain to focus on speech and suppress background noise |
| Rapid Speech | Limitations in hearing aid processing | Helps the brain process rapid speech |
| Multiple Talkers | Hearing aids cannot fully isolate one speaker | Enhances selective attention and segregation skill |
| Speech Discrimination | Hearing aids fail to address distortions in auditory system | Improves ability to tell similar sounds apart (e.g. 'bat' vs 'pat') |
| Auditory Skills | Hearing aids do not actively train the auditory systems | Improves working memory, attention and communication |
✅ Auditory training doesn’t just help you hear – it helps you understand.
Hearing Aids + Auditory Training = Best Results
AT rewires the brain for better speech decoding and induces long-term neural plasticity. Studies have shown that hearing aid users who engaged in auditory training have improved speech understanding in noisy environments15.
✅ Hearing aids and Auditory training leads to the best long-term hearing outcomes.
Get Started with Auditory Training
Clinician-guided auditory training has been proven to be most beneficial and provide the most listening and communication improvement11. Our audiologist can provide structured programs appropriate for your needs, and app-based recommendations that are suitable. Auditory processing assessment is recommended to best individualise any auditory training programs for your specific needs.
Alternatively, you can start with the following active listening practice. Take your time, and only move on to the next level of difficulty once you are managing the current level comfortably. Remember to relax and breathe – overwhelm and stress impacts our ability to learn.
Level 1: Listen to an audiobook, whilst following along with the written book.
Level 2: Listen to the audiobook without any visual cues.
Level 3: Listen to the audiobook, with some instrumental music in the background. For extra challenge, increase the volume of the music over time.
Level 4: Listen to the audiobook, with talk-back radio playing in the background. For extra challenge, increase the volume of the music over time.
Level 5: Listen to an unfamiliar audiobook, with background noise (songs with lyrics, talk-back radio, etc.).
✅ Auditory training provides long-term benefits.
‘Hearing’ Is Much More Than Detection—It’s About Understanding
Hearing aids are a critical first step, but they’re only part of the solution. To truly communicate effectively, the brain must relearn how to process speech – and that’s where auditory training comes in.
“Hearing is about the ears (peripheral auditory system), but listening is about the brain (central auditory system). Train both for the best results.”
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REFERENCES:
- Shinn-Cunningham, B. G., & Best, V. (2008). Selective attention in normal and impaired hearing. Trends in amplification, 12(4), 283–299. https://doi.org/10.1177/1084713808325306
- Sweetow, R. W., & Sabes, J. H. (2006). The need for and development of an adaptive Listening and Communication Enhancement Program.Journal of the American Academy of Audiology.
- Olson, A. (2015). Options for Auditory Training for Adults with Hearing Loss. Seminars in Hearing, 36(04), 284–295. https://doi.org/10.1055/s-0035-1564461
- An, Y. H., Sub Lee, E., Hyun Kim, D., Sik Oh, H., Ho Won, J., & Joon Shim, H. (2022). Long-Term Effects of Hearing Aid Use on Auditory Spectral Discrimination and Temporal Envelope Sensitivity and Speech Perception in Noise. The journal of international advanced otology, 18(1), 43–50. https://doi.org/10.5152/iao.2022.21228
- Sharma, A., Glick, H., Campbell, J., Torres, J., Dorman, M., & Zeitler, D. M. (2016). Cortical Plasticity and Reorganization in Pediatric Single-sided Deafness Pre- and Postcochlear Implantation. Otology & Neurotology, 37(2), e26–e34. https://doi.org/10.1097/mao.0000000000000904
- Windle, R., Dillon, H., & Heinrich, A. (2023). A review of auditory processing and cognitive change during normal ageing, and the implications for setting hearing aids for older adults. Frontiers in Neurology, 14. https://doi.org/10.3389/fneur.2023.1122420
- Lesica, N. A. (2018). Why Do Hearing Aids Fail to Restore Normal Auditory Perception? Trends in Neurosciences, 41(4), 174–185. https://doi.org/10.1016/j.tins.2018.01.008
- Henshaw, H., McCormack, A., & Ferguson, M. A. (2015). Intrinsic and extrinsic motivation is associated with computer-based auditory training uptake, engagement, and adherence for people with hearing loss. Frontiers in Psychology, 6. https://doi.org/10.3389/fpsyg.2015.01067
- Stropahl, M., Besser, J., & Launer, S. (2020). Auditory Training Supports Auditory Rehabilitation. Ear and Hearing, 41(4), 697-704. https://doi.org/10.1097/aud.0000000000000806
- Gfeller, K., Driscoll, V., & Looi, V. (2012). Music Appreciation and Training for Cochlear Implant Recipients: A Review. Seminars in Hearing, 33(04), 307–334. https://doi.org/10.1055/s-0032-1329222
- Gil, D., & Iorio, M. C. M. (2010). Formal auditory training in adult hearing aid users. Clinics, 65(2), 165–174. https://doi.org/10.1590/s1807-59322010000200008
- Gallun, F. J., & Best, V. (2020). Age-Related Changes in Segregation of Sound Sources. Springer Handbook of Auditory Research, 143–171. https://doi.org/10.1007/978-3-030-49367-7_7
- Henshaw, H., McCormack, A., & Ferguson, M. A. (2015). Intrinsic and extrinsic motivation is associated with computer-based auditory training uptake, engagement, and adherence for people with hearing loss. Frontiers in Psychology, 6. https://doi.org/10.3389/fpsyg.2015.01067
- Ferguson, M. A., & Henshaw, H. (2015). Auditory training can improve working memory, attention, and communication in adverse conditions for adults with hearing loss. Frontiers in Psychology, 6(556). https://doi.org/10.3389/fpsyg.2015.00556
- de Miranda, E. C., Gil, D., & Iório, M. C. M. (2008). Formal auditory training in elderly hearing aid users. Brazilian Journal of Otorhinolaryngology, 74(6), 919–925. https://doi.org/10.1016/s1808-8694(15)30154-3.