What can the pure‐tone audiogram tell us about a patient's SNR loss?

Although most of us know that you can’t use a patient’s audiogram to predict the amount of trouble he or she will have hearing in noise, many of us still enjoy guessing. In other words, many of us look at an audiogram and estimate the degree of signal-to-noise ratio (SNR) loss that our patient will have,1,2 and then act on our guess as if it were reality, i.e., as if we knew from our guess what difficulty the patient will have hearing in noise. This article looks at hair cell microphotographs taken by Dunn and by Harrison, at histological evidence obtained by Schuknecht on 44 human ears,3 and at direct experimental evidence on the relationship between SNR loss and audiometric loss. All evidence suggests our guessing game won’t (and probably can’t) work very well.