Why You Struggle to Hear in Noisy Situations | Cognitive Load

You know that feeling when you can hear someone talking, but the words won’t land, especially once you sit down in a loud restaurant? I’m Blaise Delfino, and I’m breaking down why that frustration is real and why it’s usually not about “turning it up.” Hearing sound is one thing. Understanding speech is a fast, demanding brain process that depends on timing, consonants, context, attention, and memory while you fight background noise and reverberation. 

We get practical about why restaurants expose hearing problems so quickly, why people start saying “everyone mumbles,” and how high-frequency hearing loss often steals the softer consonants that make speech crisp. That missing clarity can push you into lip reading, guessing, and constant repair work, which ramps up cognitive load and auditory fatigue. If you’ve been leaving dinners drained, skipping invitations, or feeling tense before you even walk into a busy room, you’re not alone, and it’s not a character flaw. 

I also address a big myth floating around online: hearing loss does not cause dementia, and fear-based marketing helps no one. What matters is taking action with the right tools: a comprehensive hearing evaluation, speech-in-noise testing, and professional fitting with real ear measurements. We talk about how modern hearing aids have changed with adaptive directionality, smarter noise management, and machine learning, plus when a remote microphone can improve speech understanding in noise. 

If you want clearer conversations and less listening effort, subscribe, share this with a friend who says “everyone mumbles,” and leave a review so more people can find trustworthy hearing healthcare guidance.

Visit our website and take our quick online hearing screener. 

And if you're ready to take the next step, our online hearing care provider locator can help you find a trusted hearing care professional near you. Taking that first step can make a meaningful difference, helping you stay connecting to the people and moments that matter most. 

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Transcript

Welcome And Sponsor Thanks

Blaise M. Delfino, M.S. - HIS 0:06

Welcome back to the Hearing Matters Podcast, where we explore hearing technology, communication science, and the people and ideas shaping the future of hearing health care and hearing loss around the world. Before we kick things off, a special thank you to our partners. Care Credit. Here today to help more people here tomorrow. Inventis. Inventis is innovation. Blueprint Solutions. Clinic management made easy for hearing care professionals. Now with Blueprint AI. And Fader Plugs, the world's first custom adjustable earplug. Welcome back to another episode of the Hearing Matters Podcast. I'm your founder and host, Laise Delfino, and as a friendly reminder, this podcast is separate from my work at Starkey. Now let's get into the conversation. Have you ever said this before? I can hear people talking. I just can't understand what they're saying. Or maybe this one. Everyone mumbles. Or how about this? I'm fine one-on-one, but restaurants are just impossible. If that sounds familiar, you are not alone. And more importantly, you're not imagining it because one of the biggest misconceptions in hearing healthcare is this. People think hearing loss is only about volume, but I am here to tell you that it is not. Sometimes the real issue isn't hearing sound, it's understanding speech, especially in noise, especially in restaurants where we gather socially with friends and family, especially in groups, and especially when your brain is just overloaded. Today I'm gonna break down one of the most common complaints that people have and that hearing care professionals hear in the clinic. Why can I hear but not understand? So we're gonna be talking about why restaurants expose hearing problems so quickly. You know, why people think everyone else is mumbling, what cognitive load even has to do with hearing, and how modern hearing technology has changed dramatically. We'll also throw in there what you can do if this sounds like you. So I'll share this from a perspective most people can't. As a former private practice owner, as someone who studied speech language pathology, and as someone who has worked with countless patients who said the exact same thing. I hear people, I just can't understand them. Really excited for this episode. Welcome to the Hearing Matters podcast. So we're gonna dive in. Hearing sound versus understanding speech. Now, I want to start with a truth that surprises many people. Hearing sound and understanding speech are just not the same thing. You can hear dishes clanking, your favorite music playing, doors closing, people talking, but still struggle to understand the words being said. Why is this? And that's the million-dollar question. Because speech understanding is far more complex than simply detecting sound. Our brain is incredible. I mean, what it is able to do. I'm just as I get older, I am just so interested in the brain and how it works and processes, and I could go off on a tangent there, but your brain has to rapidly process pitch timing, consonants, vowels, speech cues, all of these competing voices, background noise if you're in a restaurant, memory context, and visual cues. And that's all in real time. Humans are absolutely incredible. The fact that we're able to do all of that at the same time, and this becomes especially hard in noisy environments, and that is why people say I do okay in a quiet room, but then I fall apart in a restaurant. And I heard this on a daily basis when I was practicing full time because restaurants remove your margin for error. There's noise, there's movement all around you, unless you ask to be seated, you know, in the corner. There's multiple speakers, you've got distance, and I don't want to go into the proximity effect, but you've got distance, you've got reverberation, which is so annoying. And unfortunately, too many restaurants today do not take into account, nor do they invest in acoustic panels, which are relatively cheap. And then you're also competing with different conversations going on at the same time, and now your brain has to work over time. There was a colleague of mine, and I really appreciated it, I believe it was before the holiday season, and he wrote a LinkedIn article about auditory fatigue. And I I loved it because even if you present with normal hearing, if you're in an environment where there's just so much noise going on, and you have one communication partner you're talking to, but you have to drown out the background noise, especially during the holidays or an event, there's so much noise going on. Even if you have normal hearing, you might feel fatigued. That's called auditory fatigue. Now, put hearing loss on top of that. That's why it's so important that we understand what our patients are going through. Yes, you do fine in a quiet room because there's nothing competing. Right now, I'm recording this podcast episode in a quiet room because if I recorded it with multiple speakers in here, I don't care how well you have it treated acoustically, the microphone's going to pick that up even with a noise gate. So auditory fatigue is real. Now, why do people think that everyone mumbles? One of the most common statements I heard from patients was, everyone mumbles now. It's not me. I just think as you know, this new generation, they just mumble. It's like they're talking with marbles in their mouth. I mean, I heard it all. And I always understood where that frustration came from because to them, it feels true, but most of the time, the world didn't suddenly start mumbling. What changed really was access to speech clarity, especially consonants. Now, whenever I would show patients the audiogram in the clinic, I would never bore them with the minutia of the audiogram. However, I would always show them the consonant and vowels on the audiogram, especially if they had a sensor-neural high-frequency hearing loss. Again, we're talking about patients thinking that everyone mumbles now and understanding where that frustration came from. But again, most of the time the world didn't suddenly start mumbling. Hearing loss is oftentimes gradual. So it happened slowly over time. And again, what changed was access to that speech clarity, especially those consonants. So consonants carry much of the intelligibility of speech. Think about sounds like S for Sam, F for Frank, T H for Thimble, T for Tumble, K for cat, and then P for pizza. When those softer, high frequency sounds become harder to hear, speech starts to get a little blurry. You may hear the voice, but the message becomes fuzzy. So cat and cap, fit and sit, three and free can become confusing. And I'm I'm chuckling a little bit here because there were so many times in the clinic, and my patients would always laugh with me too. You know, the husband might say, Oh, I thought she said this or that. And they would chuckle along together because this was usually after I fit the patient with the in-office demos. And I always appreciated and welcomed that humor because addressing hearing loss is not an easy thing to do. So if we can have some laughs and just show them that there is hope and that we can with technology enhance their hearing, I always appreciated that. That can all again become very confusing. And that's when people begin relying heavily on lip reading, facial expressions, guessing from context, asking their communication partner to repeat themselves, huh? What did you say? What was that? Or they're pretending to understand, and that takes effort and a lot of effort. And when we talk about lip reading, I would always watch my patient's eyes. I would always say to our team, when we have new patients come in, they're not necessarily listening with their ears, they're listening with their eyes. And at first, I'd be like, Blaze, what are you talking about? And I would say, No, seriously, when you have a patient walk in and you start talking to them in an average conversational voice, terms of volume, watch where their eyes go. And oftentimes it would go right to the lips because that can close in any and all those speech cues. And then when you talk about facial expressions, this is where I saw a lot of patients really break down in those noisy situations if a crowd starts to laugh. And do they miss the punchline of the joke? And then, you know, maybe they're laughing, but is that a joke that they would actually laugh at? And it's all those social cues. And of course, patients, they don't necessarily want to ask their communication partner to repeat themselves, especially if it's a familiar communication partner, because chances are maybe that communication partner's been like, I've had enough of it. And then what you're doing is you're conditioning your spouse or your friend who presents with hearing loss not to ask you any more questions. So it's like, then they're going to socially withdraw. There is that snowball effect. So when patients start to rely on the lip reading, the facial expressions, and pretending to understand, that is taking effort and that is adding on to that cognitive load. But then as a result of that, can also result in social isolation and social withdrawal. And then that is that snowball effect. So I really want to now lean into cognitive load, which is absolutely the hidden exhaustion. And this is without a doubt, one of the most overlooked parts of hearing difficulty, and that's cognitive load. Now, you might see online today there's so much being shared about comorbidities linked to untruded hearing loss, cognitive decline being linked to untreated hearing loss. And I want you to hear it from me, Hearing Matters Podcast. We are the trusted source in hearing healthcare. Hearing loss does not cause dementia. So I don't want you to be marketed to with fear-based messaging that if you don't address your hearing loss, today you're going to get dementia. I'm going to encourage you, please go see a licensed hearing healthcare professional. And if you do present with hearing loss, please address your hearing. But I just have to get that out there. Now, cognitive load. As I said earlier in this episode, we live in an age of constant stimulation. Emails, texts, notifications, deadlines, schedules, stress. And that can be a lot. Even if you're a hearing aid user and you're retired, you still are going to experience the stressors of just everyday life. So all of these stressors, these constant you know, stimulants we're experiencing on a day-to-day basis, then we walk into a restaurant or a family gathering or even a business meeting and expect our brain to just effortly decode speech and chaos. For someone with untreated hearing loss, that can be exhausting because the brain is constantly trying to compensate. And what do I mean by that? It's filling in those missing words, guessing what was said. It's, you know, repairing the gaps in conversation and trying to track who is speaking, filtering background noise, holding on to earlier parts of the sentence while you know trying to understand the ending, all of that uses working memory, it uses attention, and it uses mental bandwidth. So instead of just like naturally enjoying the moment, being where our feet are, being present, your brain is doing labor, it's an overdrive. And many people don't realize that. They may just think, well, I'm just tired after dinner, I lose patience faster, or you know, I don't enjoy social settings anymore. I'd rather stay home. But more times than not, it's not the people, it's the listening effort. Again, going back to patients listening with their eyes before wearing hearing technology. And even while they're wearing technology, they still might look at lips because it's a learned behavior and maybe it just allows them to better understand and grasp a concept, which is totally fine, whatever works for you from a communication standpoint, especially with cues. Now, I do want to touch upon the boardroom here and being in a business meeting. I had a patient who was an executive and he traveled a lot, and he really struggled with accepting that he presented with hearing loss because his biggest thing was this. When I'm in a boardroom and I'm working on a big deal or closing a big deal, I don't want others to see my hearing aids and view it as a sign of weakness. And that hit me. And I was like, wow, I feel that. So what we did is I really worked on reframing, and again, this is where my background in speech language pathology, working with patients, pulling from that counseling aspect and listening twice as much as I speak, and I really wanted to sit with him and unpack that a bit. I was able to reframe that and show him that the hearing aids were going to empower him. And I did talk about untreated hearing loss being linked to lost US earnings. And I didn't share that to be like, well, if I share with him that if he doesn't get these hearing aids, it's going to affect how many deals he closes. Not by any means, but statistics show untreated hearing loss is linked to lost U.S. earnings. And what do I mean by that? This gentleman could have been in a boardroom and maybe he missed a cue or misunderstood something and went back to the proposal and added an extra zero when there shouldn't have been an extra zero at the I'm just making that up. But either way, you see where I'm going with this, where communication, not only just in the boardroom, but even with family, you know, there were so many times where I would have patients come in thinking that they're just tired after dinner or they just lose patience faster, but they're just tired. I mean, when they wake up, right when they wake up, they have to work so hard to understand what is being said. So we're talking about listening effort, we're talking about people beginning to withdraw, and they may start declining invitations. Maybe they'll become quieter, they'll avoid restaurants. I've even seen patients stop participating the way that they used to, you know, with family gatherings. Now I want to go one level deeper. When communication becomes repeatedly stressful, frustrating, and you know, even embarrassing, the body's gonna remember that. Your nervous system will start anticipating difficulty. You walk into a loud room already tense because you know what you need to do from a compensatory standpoint. So you're already bracing, you're already wondering if you're even able to keep up. That can create stress signals. It will then increase frustration, it will shorten your patience, and it can really make someone feel mentally drained even before the night's over. And this is why hearing challenges are never just about ears, they affect energy, confidence, smooth relationships. And I want to slow down here because there's also something hopeful here. The brain's adaptable. So there's a term called neuroplasticity. So when people are properly fit with hearing technology and support it appropriately, many will begin to notice less listening effort, less fatigue, they experience more confidence in social situations, they're participating more in family conversations or even in community outreach events, and just overall they're experiencing more joy in life. When the brain starts to receive clearer sound, it doesn't have to work as hard to decode life. That was good. I want to say that again. When when the brain receives clearer sound, it doesn't have to work as hard to decode life. Again, we talked about what we're doing on a constant basis, especially when we're talking to someone, you're talking about pitch, timing, short-term memory, even tapping into your working memory and then competing with all that background noise. Man, that's hard. And again, we're talking about cognitive load. Even the anticipation prior to being fit with hearing technology, if you do present with untreated hearing loss, I can I can see how stressful that could be, for sure. Now, I want to dive into with some of my learnings from speech language pathology. So my background studying speech language pathology absolutely shaped how I approached hearing care. Communication in general is more than our hearing thresholds. And what do I mean by that? Well, hearing thresholds, when you go to the hearing care professional, when they test you, they conduct pure tone testing, and they're gonna show you on your audiogram what your hearing thresholds are. Communication is more than pure tone audiometry. Communication is the exchange of ideas. It's confidence, articulation, behavior, relationships, and its psychology. We talk so much about the psychology of the hearing impaired, but my fear is that we're really not tapping as deep as we can into the psychology of the hearing impaired. And I'm a huge fan of Eric Erickson's psychosocial stages of development. And the age demographic that we mostly see being fit with hearing technology oftentimes are going through that generativity versus stagnation stage. So I don't want to go deep dive, but again, my background and speech path, I love tapping into the communication aspect, the language aspect, the psychological aspect. When patients came in, I was not only thinking about their hearing levels, I was always thinking about how they described their struggles. You know, what emotions were underneath the complaint? Well, Mr. Smith, how does that make you feel? Well, it kind of makes me sad, Blaze. And no, I'm not a psychologist. I'm just I'm a human as well. And I wanted to ask those human questions. I was thinking about how the patient's denial was showing up. So we know that denial isn't linear. So acceptance, you could go back to bargaining. Elizabeth Kubler-Ross, you know, she introduced the stages of grief. And they're not linear. You don't just go from bargaining to acceptance, it could go back and forth. I was also thinking about what communication habits had formed.

unknown 23:52

Right.

Smarter Hearing Aids Plus Real Results

Hearing Test Steps And Closing

Blaise M. Delfino, M.S. - HIS 23:53

And that's why I always asked familiar communication partners to come with the patient to the office because I was always interested. Well, he's really reading my lips recently, and within the past three to five years, that really increased. So I'd always want to know what communications have. So I'd always want to know what communication habits had formed and really what trust needed to be built. Sometimes people were not resistant to hearing aids. They were grieving the change. They were afraid. Maybe they heard a friend say, Well, you know, hearing aids don't work. I hate mine, they whistle all the time. They were worried they were declining. So counseling mattered. And every hearing care professional, it is our duty, it is in our scope to counsel our patients throughout the hearing health care journey. And this is really important. If you notice that a patient does present with increased anxiety or depression because of their hearing loss, please make the appropriate referral. So counseling mattered. Open-ended questions mattered, motivational interviewing mattered. Listening twice as much as I spoke was so important. And then once trust was built, everything changed. Now we live, as I said, in the most connected era socially that we've ever lived in. I mean, again, emails, texts, calls, going to different events. We also live in the technology age, and technology has just improved dramatically throughout the years. So I want to talk technology. Many people compare today's hearing aids to devices from years ago. And I think that's a mistake because earlier generations they often relied heavily on traditional microphones. So, meaning they focused mostly on what was in front of you. Now that helped in some settings, but if conversation shifted around a table, like let's say someone to the left or the right of you, performance would often drop. Now, you could, as a hearing care professional, within the fitting software, open the microphones wider, which would go to more of an omnidirectional polar pattern, but then more background noise rushed in. So today, modern technology is dramatically different, dramatically improved. It's improved so much since I started in private practice in 2017. We now have systems that are using uh machine learning, deep neural networks, adaptive directionality, smarter noise management. So we can tell the difference between speech and non-speech and faster environmental analysis. I mean, it's incredible. Now, why is this all important? We'll get into that as it relates to cognitive load, but today's devices can better prioritize speech while they're managing noise in real time. So they're faster, they're smarter, they're more natural. My goodness, patients fit today, they say, wow, that's that just sounds so natural. That's so important. And of course, today's technology is a lot more responsive. And when they are professionally fit and verified, the results can be life-changing. Now, I want to share a story that I'll never forget. There was a patient who came to us. She was already wearing hearing aids from another provider, but she still struggled, especially in conversations with her husband, one-on-one conversations with her husband, right? We re-evaluated everything. We fit her with the latest and greatest technology, custom power molds, conducted real measurements, and we discussed adding what is called a remote microphone to improve the signal-to-noise ratio. And something beautiful happened. Not only did her speech and articulation improve, because she could better hear her own voice again, but her husband was absolutely thrilled. And why is that? Because they could actually go out to dinner and talk again. I mean, think about that. Things maybe that normal hearing individuals just take for granted. She couldn't just hear, but she could now reconnect with her husband. After years together, they literally regained something deeply valuable, which is what I talk a lot about on this podcast. It's the shared moments, it's the conversation, it's the ease of just walking in a park and being able to make a comment about how beautiful this flower smell or how amazing the sun feels. It's the presence, it's feeling connected. That's what this work is all about. It's not about the devices, it is all about people. So I really appreciate your time today, and we're nearing the end, but what do you do if this sounds like you? So if you've been saying that everyone around you is mumbling, restaurants are just impossible, I'll start making more dinners at home. I hear, but I don't necessarily understand, or I'm exhausted in groups, please don't ignore it. Please start with a comprehensive hearing evaluation. And one way to kickstart the process is if you visit our website, Hearing Matters Podcast.com, we do have an online hearing screener. Now, screening very and vastly different from a comprehensive audiological evaluation, which I recommend that you do. But here's what you could do visit HearingMatters Podcast.com, take the online hearing screener as a baseline, bring those results to your local hearing care professional. Also on our website, we have a provider locator. So if you need to find a local hearing care professional near you, visit our online hearing provider locator. You put in your zip code, and there will be hearing care professionals around you, and you can select which one is most convenient, read reviews, all of that. So again, start with that hearing screening on hearingmatterspodcast.com, then schedule your comprehensive hearing evaluation. Real assessment, explore how you function with speech, especially in noise. So when you do visit your hearing care professional, even prior to making the appointment, just double check that they do conduct speech and noise testing and relay or measurement. Because we do not listen to life in pure tones. Meaning, when you hear those beeps, that's not how we hear in real life. We listen to life through human conversation, human connected speech. And if treatment is recommended, please know this. Addressing hearing is not giving in. It's actually leveling up and investing in your relationships. You're going to experience increased confidence, energy, and just overall quality of life. And please know it is a journey. It's not a sprint. So, my closing takeaway today, first and foremost, thanks so much for hanging out with us today. This is an episode very near and dear to my heart, and I hope to release more on cognitive load, cognition as it relates to untruded hearing loss. Why can you hear but not understand? Hearing is not just ears, it's brain, it's attention, it's memory, it's clarity, it's environment, and its connection. And the good news, because there is good news here, there are answers and there are solutions. There's hope. If this episode resonated with you, please share it with someone who always says everyone mumbles. I'm Blaze Delfino, host of the Hearing Matters podcast. Until next time, hear life story.