White and Gold or Blue and Black: Perception is Key

White and Gold or Blue and Black: Perception is Key

imageThis past week, you couldn’t open any social media site without seeing “the dress”. Everyone was talking about whether “the dress” was white/gold or blue/black. Everywhere I turned, I saw people asking others and opening up web searches about the topic. Amongst my friends, we even searched for articles written by ophthalmologists (as they must really understand this phenomenon). The dress was definitely either white/gold or blue/black. It certainly wasn’t a dress that changed colors. But something about the way that one’s eyes processed what was seen allowed for perception to be different.

So what does this have to do with hearing loss? With photos and articles going viral, and widespread controversy about visual differences and visual perception. It got me to thinking about the parallel to how those with hearing loss deal with issues of speech perception on a daily basis.

Once a hearing loss has been diagnosed, the audiologist can fit the child or adult who has hearing loss with appropriate technology. But, what is considered to be an appropriate fit? How can we determine if the technology provides optimal benefit?

It all comes down to speech perception. Speech perception is the ability of the brain to perceive and make sense of the sounds of language. The audiogram does not tell the whole story. It is how the brain perceives speech that counts. In this day and age, there are technologies that allow for most children and adults to have excellent speech perception. This means access to speech at the top of the speech banana. Jane Madell, a well known audiologist in the field, has suggested a change in the terminology from “speech banana” to “speech string bean” (Madell, 2011), believing that access at the bottom of the “speech banana” is not enough. She suggests the need for children to have access to soft speech and, thus, incidental language in order to optimally benefit from technology.

When a parent’s goal is for a child to be mainstreamed and function to his/her maximum listening and language potential, we need to be sure that maximum aided benefit is attained. This means ensuring that…

  • Aided thresholds are towards top of the “speech banana” binaurally.
  • Speech perception is excellent at conversational levels.
  • Speech perception is very good with soft speech.
  • Speech perception is good to very good in the presence of noise.

How can we guarantee this?

  • Make sure your audiologist tests both unaided and aided hearing for each ear.
  • Make sure your audiologist tests speech perception in quiet, noise and soft levels of speech.
  • Make sure you work with a therapist who specializes in working with children with hearing loss and understands how to maximize auditory benefit and how to provide useful information to the audiologists that program hearing aids and cochlear implants.
  • Make sure technology is fit to maximize hearing in all of the above conditions.


Madell 2011, Pediatric Amplification: Using Speech Perception to Achieve Best Outcomes


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