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I have also noticed that as one ages, understanding speech in noisy environments with multiple speakers becomes more difficult even with a normal hearing test, especially in non-musicians.
Why is that?
When it comes to understanding speech, normal brain processing is required to interpret the sound the ear picks up.
Speech and non-speech sounds are basically noise. What makes speech special is that there is meaning embedded within the sound. The ear's job is to just pick up sound no matter what the sound is. But it is the brain that takes in all the sound picked up by the ear, processes the sound, and than gives meaning by interpreting sound due to speech. Otherwise sound is just sound without any inherent meaning to it.
With age, not only does memory start to diminish, but also the brain's ability to process sounds start to diminish as well leading to not so much "hearing loss" per se, but "understanding loss."
That's why hearing aids can only help so much in this situation... hearing aids amplify ALL sounds as it is not able to distinguish between "speech" sounds vs other types of sounds. The brain STILL has to process all the sounds being picked up and give meaning to any speech sounds that may be present.
So why do musicians with or without hearing loss able to "understand" so much better than non-musicians in noisy environments?
It's because musicians have over years strengthened the auditory pathways and brain circuits to isolate melodies and pitches from one another. A violinist in an orchestra can literally hear individual sounds made from other instruments in the orchestra effortlessly.
A non-musician may be able to appreciate the orchestral music as a whole, but would have trouble humming/singing back the sound produced ONLY by the viola section, for example.
So how can a non-musician learn to understand better in noisy environments whether hearing loss is present or not? It's what I call hearing music therapy. This type of treatment is being investigated more aggressively now. NPR even did a story on this type of music therapy to help with hearing loss early in 2017.
For those patients who may benefit from this type of hearing therapy, I suggest the following:
1) Join a chorus (typically, a church choir)
2) Listen to classical music and pick one instrument to follow the sound it makes throughout the entire song ignoring all else. Start with trios before moving on to quartets, than string orchestras, than full symphonic orchestras. I usually suggest Mozart, Bernstein, or Copland as starting points.
3) Spend at least 30-60 minutes a day performing this activity (even if it is in a car going to and from work)
When doing such music therapy, it should not be a passive activity. One has to ACTIVELY listen and work at it regularly, otherwise, improvement will not be expected to occur.
'Like Brain Boot Camp': Using Music To Ease Hearing Loss. NPR 5/31/17
Hearing and music in dementia. Handb Clin Neurol. 2015; 129: 667–687.
Auditory Reserve and the Legacy of Auditory Experience. Brain Sci. 2014 Dec; 4(4): 575–593.