Dislike Cocktail Parties? Might Be a Clue to Undiagnosed Hearing Loss

When the invitation arrives, the negotiation begins. My husband loves the season of holiday gatherings and cocktail parties. Not me; I'm ready to send my polite regrets. I don't like cocktail parties. It's hard to hear above the roar and din of a crowded, low-lit room. I miss a lot of straining and tire of asking other guests to repeat the punchier lines of their charming banter.

Pamela Weinstein began to struggle similarly at age 35, realizing she would rather spend an intimate dinner with friends in the quiet of her Pine Brook, New Jersey home than snag a coveted table at the hottest new restaurant. 

"I find that when everybody is talking at once with all the chatter and cleaning up of glassware, I can't zero in on the conversation," she says. "Sometimes I get so anxious, I have to leave the room."

This condition is known as the "cocktail party problem," to be solved by a certain kind of hearing that requires the ability to discriminate a single voice among a chorus of voices. Hearing in noisy environments can be challenging, especially when sounds from multiple directions are present simultaneously. 

The party guest who appears bored in conversation, whose eyes dart around the room, or who seems to be eavesdropping on nearby conversations may be a cocktail party hearing sufferer.

Screening out noise distraction is essential to understand speech. To mimic the human ability to recognize a relevant speaker in background noise, Google Research invested millions into its AI deep-learning algorithms to make videoconferencing and interactive listening on its devices possible. 

As adults age, they can experience a decline in noise-in-noise hearing. Trouble with this type of hearing can be an early sign of certain forms of hearing loss that can go undetected on standard hearing evaluations. Research is needed to detect these deficits better and to understand which adults are most at risk.

Normal-hearing individuals can significantly differ in the ability to perceive one conversationalist's voice by parsing sounds in a noisy social environment. When studying cocktail party listening skills among members from large families, Samuel Mathias, Ph. D., a Harvard geneticist collaborating with scientists at the University of Texas, found comprehensive individual-to-individual variation in ability. 

He noted genes could explain about half the differences in the human capacity to decipher conversations in background noise. Understanding how hearing loss relates to genetics unlocks new avenues to study why some experience early decline or are more likely to suffer damage from factors like drugs or noise overexposure. 

"Age-related hearing loss, though treatable with hearing aids and cochlear implants, is currently irreversible," Mathias points out. "Genetics may allow us to predict who will develop age-related hearing loss earlier in life before these irreversible effects occur."

Hearing tests are designed to assess thresholds, the softest tonal sound detected in quiet. Individuals who complain of hearing difficulty can have normal tests despite struggling with speech intelligibility against background noise. 

This hearing loss cannot be overcome by increasing sound volume and doesn't alter hearing thresholds until extreme. As the condition often goes undiagnosed on audiology testing in quiet, it has been dubbed "hidden hearing loss."

Aging makes the ear vulnerable to a loss of connections between its sensory inner hair cells, which transduce sound into electrical impulses, and the auditory-nerve fibers involved in the brain's auditory processing. These hair cells convert sound like a microphone converts voice into electrical signals. 

Degradation of the nautilus-shaped cochlea's nerve fibers in the inner ear leads to perceptual difficulties like those involved in hidden hearing loss.

Floor seats bring ticket holders thrillingly up close to the artist, and the ear ringing and sound-dampening experienced afterward improve as concert-goers exit the venue; however, these "high dose" noise exposures can lead to lasting effects. 

Noise overexposure is increasingly understood to predispose to hearing loss through cochlear nerve degeneration, which is also linked to other issues, including tinnitus (ringing in the ears) and hyperacusis (sensitivity to loud noise.) 

OSHA considers noise exposure above 85 decibels averaged over eight working hours as safe; however, these sound exposure limits do not thoroughly account for the risk of promoting hidden hearing loss.

"The most susceptible fibers to noise and aging are those most important for coding speech information in noise, for example, having a conversation in a restaurant," explains Stéphane Maison, Ph.D. of the Massachusetts Eye and Ear Infirmary (MEII) in Boston. 

Until recently, the extent of cochlear nerve loss could be assessed in humans only through complex testing. Maison, an audiologist with a team at the Eaton-Peabody Lab, successfully developed a model to predict the health of nerve fibers essential to "cocktail party" hearing based on word recognition. 

"Adding a speech-in-noise test to standard audiometric evaluations is likely to provide important information about cochlear nerve damage," says Maison. Routine testing of hearing in background noise improves the detection of hidden hearing loss by simulating real-life challenges and helps to identify those who can benefit from assistive devices.

The researchers were awarded a five-year $12.5 million research grant from the National Institute of Health (NIH) to expand their understanding of hidden hearing loss. More nuanced testing will permit a better definition of the impacts of stressors like occupational and neighborhood noise — think jackhammers, leaf blowers and urban traffic. 

Other exposures commonly suspected to insult hearing but poorly understood include loud music from clubs, in-ear listening devices and certain drugs like chemotherapeutic agents.

For "cocktail party problem" sufferers, there is no present antidote, but hosts can help by turning down the music and turning up the lighting. This will allow partygoers to recognize visual cues from speakers with whom they're making conversation. 

Alternatively, hosts can consider providing a quiet side room as an oasis where guests can engage in the festivities with less competing sound. If you contend with hearing loss, try positioning yourself with your back facing the noise, say the bar in a restaurant or the center of the dance floor, and your conversation partner toward the room's periphery. 

This strategy will help you to focus and, if you wear a hearing aid already, position the directional microphone on your device toward the speaker in front of you, helping with clarity and speech recognition. 

Remote microphone systems and FM or frequency modulation wireless devices to use alone or with hearing aids allow listeners to isolate the sounds that interest them most as they have built-in technology to adaptively attenuate background noise.

Ellen Kornmehl Dr. Ellen Kornmehl, MD, is a radiation oncology specialist in Boston, MA, and has over 34 years of experience in the medical field. She graduated from Yale University in 1988. Read More