Why do some people continue to have difficulty hearing even with a hearing aid?

Why do some people continue to have difficulty hearing even with a hearing aid?
 
As an audiologist, I have the unique opportunity to meet a lot of amplification users.  And I hear a wide range of reports.  Many rave about using amplification and report that acquiring hearing aids is a life changing event that opens up the world to a wide range of sounds and improves communication.  But sometimes I meet people that report that they are reluctant to obtain amplification because they have known friends or a family member that obtained advanced hearing aids but continued to struggle hearing during group activities. 
 
Why is one person a successful hearing aid user while another is not?  What factors contribute to such diverse outcomes?

Many factors contribute to amplification success.  One of the most important variables is how well the brain understands speech.  Degree of hearing loss is also a very important factor.  Several aspects of the auditory system are evaluated during a comprehensive hearing test (also known as an audiogram).  An audiogram not only evaluates the softest sounds that are audible across a frequency range, but also assesses word recognition through speech testing.  Individuals that experience more challenges with speech testing tend to perform poorer with hearing aids than those who perform the test with ease. 

It is important to remember that a hearing aid is an assistive device.  A hearing aid will increase volume and assist with speech understanding, but it cannot repair the damage to the ear that causes the underlying hearing loss.  Investigating restorative solutions is the focus of much research, but current technologies cannot resolve this problem at this time.  A hearing aid will assist in communication and interaction, but some listening situations (particularly noisy restaurants) will still be challenging.

Additionally, a hearing aid must be fit properly to ensure maximum speech understanding.  If the device is not providing adequate volume, an individual may continue to struggle to hear in a variety of listening situations.  The only way to objectively verify that a hearing aid is set appropriately for an individual’s hearing loss is through the use of a Real Ear Probe Measurement.  A Real Ear Probe Measurement involves placing a microphone in an ear with the hearing aid to ensure that the hearing aid is providing appropriate volume for an individual’s hearing loss while making accommodations for the individual’s unique ear canal shape, size and resonance.  Many hearing aids are not fit to the appropriate volume.  Ensure that your audiologist performs this measurement to verify that your device is fit appropriately!

How well one hears with amplification will also depend on the environment.  Some people may hear well in small group settings, but may experience challenges hearing in the presence of background noise.  Many modern hearing aids have advanced features to assist with speech audibility in the presence of background noise, but some people may continue to find hearing in places like restaurants remains challenging.

It is important to remember that while hearing aids are not perfect, they do provide assistance and can facilitate an active social life and ease communication with friends and family.  Significant research is devoted to hearing loss and hearing aids, and devices are constantly improving.  While hearing aids cannot repair damage to an ear, they can improve existing hearing.