Speech recognition in background noise: An evidence-based review

Audiologists who work with the older adult population frequently hear, “I can understand you fine in your office, but when I am in the ‘real world’ I really struggle.” Audiologists are well aware that communication does not always occur in quiet settings such as an office or sound booth, but instead often occurs in the presence of background noise. As people age, pathological changes along the entire auditory pathway contribute to sensorineural hearing loss and make speech understanding in background noise increasingly difficult. Within the profession of audiology, tradition has dictated that: a) speech testing is performed in quiet, and b) hearing aids are utilized as the main, if not sole, rehabilitative strategy for sensorineural hearing loss. However, what is tradition is not always what is best practice. This paper serves to review the evidence which emphasizes the need for speech testing in the presence of background noise, as well as the need for a rehabilitation plan beyond the hearing aid fitting. A review of the senescent changes to the auditory system will also be discussed