"I used to think that I wasn’t able to understand some people because they weren’t speaking clearly, or sometimes because I wasn’t focusing on what they were saying. I didn't realize that my difficulty was often due to background noise. I didn't realize how noisy the world is.”

A dear patient of mine recently shared the above comment with me. After so many years of encountering this issue, I decided to write about it.

Understanding the Impact of Noise

How do you solve the problem of noise? Is it not obvious for people with cochlear implants (CIs) how to organize their acoustic environment to reduce the impact of noise on their ability to understand spoken communication? Why don’t family members and friends take care to reduce noise and be more considerate? Why is it not enough to note that CI users (or anyone with hearing loss) has considerably more difficulty hearing in noise than people with typical hearing and that to understand speech, the signal must be significantly louder than noise in the environment? Why don’t people understand that noise causes those with significant hearing loss to be tired and impatient and that they generally prefer to be in a quiet environment?  

What is Considered “Noise” is Subjective

Noise is subjective. What is perceived as noise by people using CIs may not be considered noise by people with typical hearing. For that reason, those not bothered by environmental sounds may not know to mitigate sounds to enhance CI users' communication. The Wikipedia entry defines noise as "an unwanted sound considered unpleasant, loud, or disruptive to hearing."

Noise can cause discomfort to people with CIs (as well as those using hearing aids). It may be challenging for CI users to separate the sounds they wish to hear from background noise. Therefore, they may perceive any sound that does not belong to the auditory stimulus they wish to focus on as disruptive noise. Compared to typically hearing people, CI users are likely to experience many more sounds in various situations as noise.

People with typical hearing often enjoy having a conversation sitting in the park, surrounded by the sounds of water flowing, birds chirping, and children playing. CI recipients in the same situation may find holding a conversation in the same situation to be a struggle. While people with typical hearing may experience a particular situation as pleasant, their CI user friends might experience the same situation as noisy and stressful. The gap between the two groups' experiences can be so significant that people with typical hearing may have no idea that their CI user friends' situation is so challenging.

Noise at Home

These gaps may also reflect various situations at home. For example, while getting ready for a family dinner the following could contribute to noise in the listening environment:

• TV located 16 feet from the dining table playing at a low volume
• Microwave on
• Refrigerator running (seems just a little noisy but contributes)
• Someone at the sink is washing dishes

Given the above scenario, many people with typical hearing would sit down at the dinner table oblivious to the noise and not even bother to turn off the TV. People with CIs might well feel surrounded by unbearable noise. In many instances, a CI user would not be able to manage a conversation and they might also be confused because they are struggling to hear as well as being unable to identify the source(s) of the various noise contributors.

There are people with typical hearing who have a higher sensitivity to noise than the general population. Still, they—unlike many CI recipients—would be able to locate the noise sources and quiet them (or at least complain about them).  Someone without significant hearing loss might say, for example: "The noise of your neighbor’s lawn mower is driving me crazy!”  And then someone might close the window.

What can we do?

People with typical hearing should ask about listening difficulties and listen to their CI user friends' complaints about disturbing and disruptive sounds. They should understand that these sounds are not something that people with CIs can "live with;" they should not say but “this is noise.” When communicating with people with CIs, those with typical hearing should adopt acoustic standards based on their CI user friends' judgment. At the same time, CI users should explore their daily acoustic environments, to maximize their skills in recognizing sounds that interfere with their communication and manage them.

How can we do it?

People with typical hearing: Ask your CI user friends about their acoustic experience.

• Do you find this location too noisy?
• Would you prefer to look for a quieter place?
• Listen to, and respect, any comments

People with typical hearing can listen to the "silence”

• What sounds do you hear?
• Where do these sounds come from?
• Is it possible to diminish the sounds you hear? Is it possible to remove them completely?
• Is it possible to keep away the noise sources away from where the conversation is taking place?
• Should you move the group and chat in a quieter place?

People with CIs:  Try to listen carefully to the noise in the environment.

• Stand near different appliances and learn to recognize the noise they produce
• Ask friends with typical hearing about sounds that you hear but cannot identify
• At home, close windows and doors when there are noise disruptions from outside or from another room in the house
• While having a conversation, chose a location that is as far away from from noise sources as possible

Concluding Thoughts

When communicating with CI recipients, people with typical hearing should be sensitive to how sounds in the environment may impact others and thereby develop a concept of “noise” that is sensitive to their CI friends’ needs. Collaborating with friends and family to create comfortable communication environments may be challenging for everyone as those with typical hearing may not understand the noise problems being encountered nor how to address them while the CI user may not be able to accurately identify why they are having a problem. Collaborative exploration and mutual efforts may help reduce communication gaps and achieve better communication for all.