Have you ever misheard a word or phrase in conversation and felt confused? Language is made of many individual speech sounds called “phonemes.” Some examples of phonemes would be the s, f, th, and sh sounds. Many phonemes sound very much alike and can easily cause word confusion, especially with hearing loss. While this can be harmless or even funny, it can also be frustrating or embarrassing.
Imagine having an entire conversation talking about your mom, when really, someone asked “what’s going on.” Let’s talk about why it’s important to hear the difference, and what to do if you can’t understand conversation.
Hearing and understanding are not the same. Hearing is simply perceiving sound, while understanding requires your brain to actively process what you hear. This takes more focus and effort than simply detecting a sound. Think about how we often ask someone to pause what they’re doing before we share something important—because divided attention makes listening and comprehension harder.
For speech to be understood, it must travel through the middle ear, inner ear, and auditory nerve before being processed by the brain. Any disruption along the way, such as background noise, can make comprehension difficult. For example, parents often struggle to follow a phone conversation when their kids are making noise in the background.
Many people describe the experience of being able to hear sounds clearly but not understanding the words being spoken. This situation often raises questions like: “Why can’t I understand what someone is saying?” or “I can hear fine, but I can’t make sense of the words.”
This difficulty can be linked to several possible conditions. In adults, one of the most discussed causes is Auditory Processing Disorder (APD), sometimes referred to as “auditory dyslexia,” because the brain struggles to interpret sounds— similar to how dyslexia affects written language. Adults with APD may benefit from an auditory processing disorder test to confirm diagnosis and explore treatment options.
Other possible explanations include aphasia, a language disorder often caused by brain injury or stroke; hidden hearing loss, which may not show up on a standard hearing test; and neurological conditions such as Auditory Neuropathy.
The good news is that there are treatment options for auditory processing disorders in adults as well as strategies to manage related conditions. Below are the most common reasons why you may hear but not fully understand speech.
Auditory Processing Disorder affects how the brain interprets sounds, even when hearing is normal. Adults with APD can hear speech but struggle to organize, or interpret it correctly. Key signs include:
This common form of hearing loss makes it harder to detect high-pitched sounds, such as consonants, which are crucial for word clarity. As a result, words like “chair”, “hair”, and “share” may sound nearly identical. Symptoms include:
Hidden hearing loss occurs when someone has normal hearing on standard tests but still struggles to understand speech, especially in noisy places. This is often linked to damage in the auditory nerve fibers (cochlear synaptopathy). Causes include loud noise exposure, certain medications, or ageing. Symptoms include:
Aphasia is a language disorder that affects the ability to understand or use words. It is usually caused by stroke, head injury, or neurological conditions. Unlike hearing loss, aphasia is about language processing, not sound detection. Signs include:
In adults with ADHD, inattention can disrupt listening skills. Even when hearing is normal, sustaining focus on longer or complex conversations can be challenging. Signs include:
In ANSD, the inner ear detects sound, but signals are not transmitted properly to the brain. This leads to inconsistent hearing and poor speech understanding, even with normal hearing tests. Symptoms include:
Our ears naturally age with time, and there are some sounds adults can’t hear. By age 25, adults may miss out on certain high-frequency sounds only kids can hear, according to Scientific American.* While this type of change isn’t a cause for concern, if you can hear but can’t understand words on a regular basis, your hearing health might need attention.
But there are numerous other ways that you can find yourself misunderstanding words. Oronyms, for example, are a series of words that sounds very similar to another phrase that has a different meaning. Some oronym examples are “night rain” and “night train,” or “that’s tough” and “that stuff.” These types of mix-ups aren’t necessarily hearing related—they typically result from confusion about the context or conversation in general.
On the other hand, if someone says “can you bring me a copy?” and you hear them say “can you bring me a coffee?” this would be a sign that you’re mishearing speech and sound itself. If this specific situation happened in the workplace, you might end up asking someone if they wanted cream and sugar, instead of printing out the document they requested. Situations like this can certainly lend themselves to humor, but may also be a signal to get your hearing tested. You can learn more about the mechanics of missing certain sounds in our blog post “Why Am I Hearing Words Incorrectly?”
The impact of having trouble understanding speech will likely affect you as much as—if not more—those around you. Feelings of embarrassment or shame are very real if you experience signs of hearing loss. And in a social situation where you make a mistake and attention is drawn to it, feelings of anxiety can easily be stirred up, even as you try to laugh it off. In the workplace, you might begin to worry about how others perceive your ability to do your job. In your private life, mix-ups can result in frustrations and, eventually, isolation—if you’re concerned about hearing but not understanding, it might lead to you avoiding interactions with other people.
That kind of anxiety and discomfort in coming to terms with hearing loss affects many people, and it’s common to wait as long as 10 years before seeking help. Leaving hearing loss unaddressed can contribute to or compound other physical health concerns, like cognitive decline or difficulty with balance—which can lead to falls. If you withdraw socially because you feel like you can’t fully engage in discussions, or like you’re disrupting the flow of a conversation because you can hear but can’t understand words, might also affect your mental health, causing stress and depression.
If you notice you’re mixing up words and phrases fairly often, it’s a good idea to make an appointment with a professional. A hearing loss speech recognition test is one method used to determine how easily you’re able to pick up on words used in everyday language. The test is conducted by having you listen to a series of words which you then repeat one at a time. If your hearing test shows that you can benefit from hearing aids, using them will allow you to hear everyday sounds and re-engage with your life in a new way.
Imagine going to lunch with a friend or attending a gathering and being able to hear everyone clearly with ease. The benefits of getting fitted for hearing aids extend beyond simply amplifying sound—they create crisp, clear sound with programming that’s personalized for your hearing needs. These tiny devices fill in the gaps or missing sounds your ears don’t naturally pick up, sending a full range of sound to your brain so you can re-engage in conversation.
Spotting problems early makes a real difference. When speech sounds blurred or unclear, identifying whether the cause is hearing loss, auditory processing disorder (APD), or another condition is essential. An early diagnosis means you can access the right tools and support sooner, helping to improve communication, reduce frustration, and enhance everyday life.
Once the cause is identified, a tailored treatment plan can include one or more of the following:
If you feel you can hear but not fully understand, here are some steps to consider:
Early detection is key. Identifying whether blurred speech comes from hearing loss, APD, or another cause allows you to adopt the right strategies—making communication less frustrating and life more manageable.
High-frequency hearing loss is one of the most common types of hearing loss, particularly in adults as they age. It affects the ability to hear sounds in higher ranges, typically above 2,000 Hz, which are essential for understanding speech and appreciating everyday sounds. People with high-frequency hearing loss struggle to hear high-pitched sounds such as birdsong, children’s voices, or consonants like s, f, t, th, and sh. While lower-pitched sounds (like vowels) may remain clear, missing the high-pitched details makes speech sound muffled or blurred, especially in noisy environments.
Several factors can lead to damage in the delicate hair cells of the inner ear that process high-pitched sounds:
Signs can be subtle at first but often include:
If you suspect high-frequency hearing loss, a professional assessment is essential. Steps may include:
While high-frequency hearing loss is usually permanent, several treatments and strategies can significantly improve communication and quality of life:
Left unaddressed, high-frequency hearing loss can affect work, relationships, and emotional well-being. Research also links untreated hearing loss to social isolation, cognitive decline, and dementia risk. Early diagnosis and treatment can make communication far easier and protect long-term health.
Hidden hearing loss (HHL) is a form of hearing difficulty where a person struggles to understand speech—especially in noisy environments—despite having normal results on a standard hearing test (pure-tone audiogram). The condition is thought to arise from damage to the synapses between inner hair cells in the cochlea and the auditory nerve, rather than to the hair cells themselves. Because standard audiograms mainly measure hearing thresholds, they often miss this subtle damage—hence the term “hidden.”
Research points to several possible contributors:
Because the condition is not obvious on standard hearing tests, symptoms often include:
Diagnosing HHL is challenging because it is “invisible” on routine audiograms. More advanced or complementary tests may be used:
Currently, no single “gold standard” clinical test fully confirms HHL, but a combination of history, advanced audiological testing, and symptom assessment helps guide diagnosis.
There is no definitive cure yet, but several strategies may help manage HHL:
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