Lost in a Sea of Sound: How Tinnitus Amplifies Restaurant Noise
As if the ringing weren’t enough to deal with, many people with tinnitus also complain that it is challenging for them to follow a conversation in background noise. This interruption in the ability to socialize and easily communicate can be devastating to the person and their loved ones. Unfortunately, when someone is not able to follow along with what family and loved ones are saying at the dinner table, too many people default to ‘then why bother even being there’.
The feelings of isolation, depression, fear, loneliness, embarrassment, frustration, and anxiety that are associated with tinnitus and hearing loss are real and are very well documented. Perhaps you only need to look in the mirror or at a loved one to realize how real these emotions are. The ability to follow a conversation when multiple people are speaking or with other competing sounds (when the TV is on in the background, running water from the sink) is a natural cognitive (brain) ability that we take for granted until it begins to break down and interfere with communication with others. As we age, for many in their 40s and 50s, subtle changes in the ears yield significant differences in the ability to hear in these ‘complex’ listening environments, including noisy restaurants, etc. Most often, this difficulty is noticed long before the official diagnosis of hearing loss.
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Tiny ‘hair cells’ in our ears that process sound and connect our ears to the brain become damaged and die off with age, and they do not come back. As a result, our ears will have difficulty noticing fine differences in sounds. For example, the subtle differences between the ‘s’ and ‘sh’ sounds become undetectable to the listener, making words like ‘see’ and ‘she’ harder to understand and distinguish. This difficulty with clarity is why so many people with early tinnitus and hearing loss say, ‘can you repeat that?’ and not, ‘can you please say that louder?’. Clarity and volume are not the same, and the loss of clarity impacts your life 5-10 years before you need sounds to be louder. This is one of the first signs that tinnitus is also impacting your ability to hear.
Once the vast neural network that connects the ears to the brain becomes damaged, the unseen changes in the brain can be devastating. A recent report from Johns Hopkins found that people with hearing loss and tinnitus can also have significant cerebral atrophy. They noted that people could lose up to 40% of their total brain volume – and the only common factor in the research subjects was damage to the auditory system. While this may seem odd, it makes a lot more sense when you consider that we hear with our brains, not our ears! This damage to the brain can become progressively worse with age if left untreated.
Cerebral atrophy is a hallmark feature of dementia; thus, tinnitus and hearing loss are closely tied to a person’s future risk of developing cognitive decline and dementia.
Listening to others is otherwise effortless when we live without tinnitus and with normal hearing. However, when living with tinnitus - the ability to hear in complex listening environments (such as noisy restaurants), will require significant effort and tax the brain. The brain has four unique hearing capabilities, including:
- Localization – the ability to determine where sounds are coming from.
- Recognition – the ability to recognize words and understand conversation.
- Focus – tuning in to what is important (somebody speaking to you), especially in noisy rooms or restaurants.
- Separation – segregating out what you want to hear from what you don’t want to hear.
Each of these tasks relies on a vast and robust neural network of information coming from the ears. Thus, each of these is negatively affected when tinnitus and hearing loss wreak havoc on the ear-to-brain neural networks.
With tinnitus and hearing loss, the damage to your ears and brain is not reversible; however, with treatment, the goal is to slow down the progression of the disorder and preserve neural integrity.
The medical treatment of tinnitus and hearing loss is custom prescribed to address the needs of each patient by restoring clarity, supporting the four cognitive tasks mentioned above, allowing them to maintain high-quality communication with others – even in the noisiest restaurants - reduce the risk of cognitive decline and reduce tinnitus.
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