Sound comes to you through your ears, but it’s your brain that makes those sounds meaningful to you.
If you have hearing loss, hearing aids and other devices will amplify sounds to make it easier to hear. However, your brain may still be struggling to interpret what you’re hearing, especially if you have age-related hearing loss.
Boosting ‘brain hearing’ skills
Researchers have looked for ways to boost our brain-hearing skills—usually called “auditory training.” So far, the results haven’t inspired professionals to routinely suggest it. But the digital universe is bringing us more options.
Like a video game
The latest trend: training that feels like a video game, so fun you’d play “even if it weren’t good for you,” noted Nancy Tye-Murray, an audiologist and professor at Washington University in St. Louis who specializes in auditory training. As you play, your brain releases dopamine “because it’s engaged in a pleasant activity and dopamine promotes perceptual learning,” she told Healthy Hearing.
Auditory training for mild hearing loss is emerging field
Auditory training is sometimes called “aural rehabilitation” or “hearing exercises.” It is currently best-known among cochlear-implant patients and commonly used to help children with cochlear implants as well as those diagnosed with other auditory problems, such as auditory processing disorder.
New hearing-aid users, anyone with milder age-related hearing loss—or adults with “hidden hearing loss” who don’t need hearing aids yet have trouble understanding speech—may be candidates as well, but it is not ordinarily recommended to them. “Research on auditory training for adults with mild-to-moderate hearing loss is still in its infancy,” Larry Humes, an audiologist and professor emeritus at Indiana University in Bloomington told Healthy Hearing.
Can I do auditory training at home?
Yes! If you hear the term “aural rehabilitation” you might think of various “rehab” programs that require supervision. This is exercise you can do with a computer or phone app.
Improving working memory, auditory processing speed and auditory attention
What could you expect? Just like a physical therapist might give you exercises to strengthen key muscles, an auditory training program targets key skills, such as working memory and auditory processing speed.
To understand a conversation, we need to tap our working memory, the short-term memory that holds onto words and their context. Declines in working memory can drag down speech understanding in older people, research suggests.
Auditory training may also focus on your auditory processing speed. Older people often have trouble keeping up. The average person speaks approximately 150 words per minute, but there is a big range: from 120 words to 180 words. For many of us, our auditory processing speed drops steadily as we age.
To hear speech, we sometimes need to pick it out against background noise—for example, in a noisy restaurant—a skill called auditory attention. Auditory training aims to improve your ability to filter out distractions.
How do I know if auditory training could help me?
Is hearing hard for you? Even if you don’t have hearing loss, you may still struggle to hear—because of cognitive changes, not ear changes.
“Most older adults have good speech comprehension, if it’s quiet and they have good hearing,” said Jonathan Peele, a neuroscientist at Washington University in St. Louis studying how the brain understands speech. Many people simply endure their hearing loss, but if you’re struggling in restaurants or even in quiet spots, don’t underestimate your effort. You might pick up enough words to get by, but if you had to work hard to catch them you might find them harder to remember. You may also misunderstand complex sentences, Peele notes.
That extra effort is measurable even in the young, Peele has found. “There’s increasing evidence that young adults also have to work harder when they have worse hearing, even if it’s not hearing ‘loss’,” he said.
Hearing aids not quite cutting it?
If you’ve worked with an audiologist to get used to your hearing aids but still have trouble or lack confidence you’ll be able to hear in settings you encounter in your life, auditory training could be worth a try.
Some signs you’re working too hard to hear even when wearing hearing aids: avoiding noisy restaurants, asking family members to repeat themselves and feeling fatigued after a conversation. Auditory training can help with these tasks.
What evidence is there that auditory training can work?
People definitely can improve their performance on hearing tests.
In one study, older volunteers who wore hearing aids practiced for three and a half hours a week with a program designed to challenge their ability to understand speech against background noise. After eight weeks (35 hours of practice) they could correctly identify 25% more words in spoken sentences—even with a din in the background.
Even without hearing loss, people vary greatly in their ability to focus on one sound rather than another. Trained musicians are better at it, and researchers have found that people can improve their performance with only two hours of training.
Multi-tasker alert!: Other research has found that training can make accurate hearing less demanding, making volunteers better at another task they performed at the same time.
It’s possible that you’d benefit most if you had a tailor-made program using your primary companion’s voice. When 10 couples tried this—using a 6-week computerized auditory training program developed by Tye-Murray’s team—seven of the hearing-impaired volunteers said they had an easier time afterward hearing their spouse. One implication: you might ask your audiologist to check your comprehension with your primary companion speaking.
If you like computer games (but maybe kick yourself for “wasting time”) what if your game boosted your hearing? In a study Tye-Murray led with 93 hearing-impaired adults who completed 12 lessons designed to feel like games, a large majority said they had improved at least one aspect of hearing and many enjoyed the program.
Limitations of auditory training
Now the bad news.
The main downsides: the time you spend training may not pay off in real-life situations or the training could be a bore.
When a research team at Indiana University tested a 5-week at-home program on 13 older hearing-aid users with mild-to-moderate hearing loss, they improved their test scores. They also held onto those improvements when they were tested 8 months later. But most of them didn’t choose to continue training on their own and didn’t feel the program helped them. This study, published in 2019, is the most recent. “It is hoped that research will identify the keys to effective and practical auditory training solutions for these individuals in the near future,” study author Humes told Healthy Hearing.
Earlier, a larger study with veterans tested them 6 months after they completed an auditory training program known as Listening and Communication Enhancement (LACE) in various formats. Overall, the program didn’t help them, though most of them trained diligently. People who had especially bad performance in the beginning saw more improvement.
How much does it cost?
A variety of low-cost apps are available, listed here. Some computerized programs cost $15 to $24.99 a month. They are generally not covered by insurance. Tye-Murray has started a company with a full-service program called Amptify, with fun games, a personal coach, a daily interactive curriculum and coach-led online groups for social support. That costs $49 a month and should be available in spring 2021. The company’s research suggests the benefits last at least three months—so as with any exercises, you may need to keep them up.
Bottom line: If you’re committed to better hearing and you enjoy computer games, auditory training may be useful to you.