A significant challenge faced by people who use cochlear implants—and anyone with hearing loss—is understanding speech in noisy places.  Cochlear implant technology offers options to help CI users cope with the challenges of listening in noise including directional microphones, dedicated maps/programs, streaming options, and assistive listening devices. However, more than these technology advances may be needed in certain listening situations regularly encountered.

We live in a noisy world. Some noise may be addressable, both technologically and perceptually, while noise encountered in other situations may be more difficult. For example, the noise of an air conditioner is typically constant in its nature and volume. It may be easier to understand speech in the presence of noise from an air conditioner than in the presence of noise from people talking—even if the two noise sources are of equal volume level.

Noise and Speech Levels (sometimes referenced as the Signal to Noise Ratio)
Noise level is a key variable affecting one’s ability to understand speech.  An individual with hearing loss is particularly impacted by the noise level relative to the volume of speech that the listener is attempting to hear.  The smaller the difference between noise and speech levels, the harder it is to understand speech in noise.  People with normal hearing may be able understand speech in the presence of noise that is equal to (or in some instances even greater than) the volume of the speech signal.  Most CI users need the speech level to exceed the noise level by at least 10 decibels to understand speech.

How to improve the speech to noise ratio?

Improving the ratio between speech and noise may be accomplished by distancing oneself from the noise source and/or getting closer to the speech source. This is not always possible. Sometimes, we must stand next to the noise source (for example, when washing dishes). Sometimes, noise is coming from multiple directions and it's impossible to distance ourselves from it (for example, when sitting at a table in the middle of a restaurant).

Understanding and analyzing noisy situations can help improve coping in them
The more hearing care professionals AND people with hearing loss thoughtfully analyze the acoustic environment, the better we are able to explain the problems to others, who may then know how to meet the needs of someone with hearing loss.

One way someone with hearing loss can raise awareness about the challenges that noisy environments create for them and better explain their communication needs is to explore the specifics of the intensity (or loudness) of the noise they are encountering. For that, I encourage someone to download a sound level meter app(decibel meter/noise meter) and use it to experiment and learn about the acoustic environment at home, at work, and wherever someone regularly spends time. I find that people are often surprised to discover how much noise exists in seemingly quiet environments. For example, the noise generated by the large flame on my gas stove is 45 decibels. The refrigerator generates noise which can reach an intensity of 52 decibels.  The dishwasher generates noise of 55 decibels and the water stream in the kitchen faucet creates noise 70 decibels of noise. Of course, one can be cognizant of such noise when replacing appliances. 

Speech intensity for a normal conversation range between 55 and 60 decibels with loud speech reaching 70 decibels. This means that while you are washing dishes, it may well be impossible to understand speech—even if the person speaking is standing immediately next to you.

When standing next to the stove cooking and conversing with another person, the speech will be stronger than the gas flame noise by about 10-15 decibels. If there are no additional noises and you have good speech perception skills, you may understand them without much effort. However, as the speaker moves away from you, the speech intensity will decrease, making it more difficult to understand speech. The speech intensity you hear when you six feet from the stove will may be equal to the noise intensity (or even be weaker than the speaker) so speech understanding will become a real challenge.

Knowing the average speech level and the (measured) noise level in different situations can reflect your difficulty understanding a conversation. You can explain to family members and friends that any noise of the same or higher intensity than 60 decibels (the average speech intensity in a normal conversation), or even 50 decibels, significantly affects your ability to understand speech without speech reading. Therefore, if needed, they should position themselves so that you have easy access to their faces. The same applies to talking to you from a distance greater than 3-4 feet in a non-quiet environment.

Understanding the implications of basic acoustics in everyday situations can avoid misunderstanding and discomfort.  

Basic facts you should keep in mind:

• Knowing the noise levels in the car (about 65 decibels) can demonstrate to people why they should not call you while driving, especially while using the car's speaker option. In addition, being aware of the noise level while driving with you can encourage use of your assistive listening device

• Measuring noise intensity in different restaurants can help you make informed choices for the quiet options.  Restaurant noise can vary depending on table location, so you can ask in advance to sit at a corner table or a table away from known noise (such as the bar). 
  

Measuring noise levels in the environment can help you:

• Distance yourself from noise sources and reduce controllable noises
• Know when to use technology to improve understanding of speech in noise including ensuring noise reduction programs on your processor are optimized for listening in noisy situations and you are making use of suitable assistive listening devices.
• Explain to others the challenges you face in noisy environments to help them communicate with you more constructively, suitably, and considerately.
  A better understanding of the acoustic conditions will allow you to manage everyday situations to reduce the adverse effects of noise and help you enjoy better communication with less effort.