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I think I have hearing loss because I can't tell where sounds are coming from

Kimberley Bradshaw - Head of Marketing
Written By:
Kimberley Bradshaw

Head of Online Medical Content

Updated: 16th July 2025
Updated and medically reviewed: 16th July 2025 in: Hearing Loss Awareness
I can't tell where sounds are coming from

Spatial Hearing Loss

When you can hear sounds but can't tell where they're coming from anymore

Overview    |    What is spatial hearing loss?    |    How does sound localisation work?    |    Symptoms    |    Causes    |    Treatment    |    What to do next    |    Summary

 

Overview

Spatial hearing loss means you can hear sounds but struggle to tell where they're coming from. This can affect daily life, safety, and social situations, even if your overall hearing seems fine. Causes include hearing loss in one ear, brain processing issues, or ageing.

Treatment options like directional hearing aids, auditory training, and simple communication strategies can help. If you're finding it harder to locate sounds, a hearing assessment is recommended.

 

I struggle with the direction of sounds

Many people associate hearing loss with difficulty detecting sounds or understanding speech. However, there's another type of hearing challenge that often goes unrecognised, which is being unable to determine where sounds are coming from.

This condition, known as spatial hearing loss or auditory localisation disorder, can significantly impact daily life even when hearing sensitivity remains normal.

 

What is spatial hearing loss?

This refers to difficulty localising sounds in your environment. People with this condition can often hear sounds clearly but struggle to identify their direction or distance.

This means you might hear a car horn but be unable to determine which direction the vehicle is approaching from, or hear someone calling your name in a crowded room without knowing where to look.

Unlike traditional hearing loss, which affects the ability to detect sounds, spatial hearing loss specifically impacts how the brain processes directional audio information. This can occur on its own or alongside other hearing problems.

 

How sound localisation works

Understanding spatial hearing requires knowing how our auditory system normally processes directional information. When a sound occurs, several things help us determine its location.  When any part of this system fails, spatial hearing becomes compromised.  Such as:

  • Interaural time differences: Sounds reach the ear closest to the source slightly earlier than the far ear. This time difference, measured in microseconds, provides important directional information.
  • Interaural level differences: Your head acts as a natural barrier, creating subtle volume differences between ears. Sounds are typically louder in the ear closer to the source.
  • Spectral cues: Your outer ear or pinna naturally filters sound frequencies differently based on direction, creating unique acoustic signatures for various locations.
  • Binaural processing: Your brain combines information from both ears to create a three-dimensional sound map of your environment.

 

Common symptoms of this type of hearing loss

People with spatial hearing loss may experience:

  • Difficulty locating ringing phones, alarms, or other electronic devices
  • Inability to determine which direction traffic is coming from
  • Trouble following conversations in noisy environments
  • Feeling disoriented in crowded spaces
  • Needing to rely heavily on visual cues during conversations
  • Experiencing anxiety in unfamiliar acoustic environments
  • Difficulty separating speech from background noise

 

Common symptoms of spatial hearing loss

 

Causes of spatial hearing loss

Several factors can contribute to spatial hearing problems:

  • Hearing loss in one ear:  Unilateral hearing loss eliminates the ability to compare sounds between ears, making localisation difficult.
  • Auditory processing disorders:  Central auditory processing problems can affect how the brain interprets spatial information, even when hearing sensitivity is normal.
  • Neurological conditions:  Stroke, traumatic brain injury, or other neurological issues can damage brain areas responsible for sound localisation.
  • Age-related changes:  Natural ageing can affect both hearing sensitivity and spatial processing abilities.
  • Ear infections or blockages:  Temporary conditions that affect one ear more than the other can disrupt spatial hearing.
  • Certain medications:  Some drugs can affect inner ear function or auditory processing.

 

Impact on daily life

Spatial hearing loss affects more than just sound localisation. It can impact safety, as it is difficult to determine vehicle direction while walking or driving, which poses safety risks. 

Social interactions are also challenging when you can't identify who's speaking in group settings, and jobs requiring good spatial awareness may become more difficult.

Constant spatial confusion can create anxiety and social withdrawal, and make independence limited with simple tasks like finding a ringing phone or responding to someone calling your name become complicated.

Related reading:  How does hearing loss affect everyday life?

 

Diagnosis and testing

If you suspect spatial hearing problems, you would need to consult an audiologist who will perform various diagnostic tests, such as:

A comprehensive hearing evaluation, speech-in-noise testing, sound localisation assessments, auditory processing disorder testing and a medical evaluation to rule out underlying conditions.

 

Treatments

Treatment approaches vary depending on the underlying cause:

Hearing aids:  For those with accompanying hearing loss, modern hearing aids with directional microphones can help with spatial processing.

Auditory training:  Specialised therapy can help improve sound localisation skills through targeted exercises.

Environmental modifications:  Reducing background noise and improving lighting can make social situations more manageable.

Communication strategies:  Learning to use visual cues and positioning yourself strategically in conversations.

 

When to seek help

Consult a healthcare professional if you experience:

  • Persistent difficulty locating sounds
  • Increased anxiety in noisy environments
  • Safety concerns related to spatial awareness
  • Social isolation due to communication challenges
  • Sudden onset of spatial hearing problems

 

What to do next

While it can be frustrating and disorienting, many people successfully adapt through proper diagnosis, treatment, and coping strategies.

Understanding that hearing loss encompasses more than just volume detection is important for both people experiencing these challenges and the healthcare professionals who treat them.

If you suspect you have spatial hearing difficulties, don't hesitate to seek professional evaluation. With proper support and adaptation strategies, it's possible to maintain quality of life and continue participating fully in personal, social, and professional activities.

We can support your hearing healthcare locally, with an audiologist you can trust in your area offering either in-clinic or home visit appointments, at no cost.

 

Summary

Spatial hearing loss is the inability to locate where sounds are coming from, even when hearing remains otherwise normal. It can affect safety, cause confusion in social settings, and lead to anxiety. Common causes include one-sided hearing loss, ageing, or neurological issues.

Diagnosis involves specialised testing, and treatment may include hearing aids, auditory training, and environmental adjustments. Early support can help manage symptoms and maintain independence and quality of life.

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I struggle to figure out where sounds are coming from

Do I have hearing loss?

If you're experiencing difficulty locating sounds in your daily life, you're not alone. Consider speaking with an audiologist who can help identify the underlying cause and explore treatment options tailored to your specific needs.

Spatial hearing challenges are a legitimate medical concern that deserves proper attention and care.  Taking this step can help you regain confidence in navigating your acoustic environment and improve your overall quality of life.

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Written by Kimberley Bradshaw

Meet Kimberley Bradshaw, Head of Online Medical Content

Kimberley Bradshaw started her love of content creation, as a freelancer for many well-established medical brands.  She has written about hearing healthcare for several UK and US online health and wellness publications since.  Connect with Kimberley on LinkedIn.

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FAQs

What is the best hearing aid model for me?

In general, any audiologist will always recommend to you the hearing aid model that best suits your needs. Here is a useful checklist to make sure that is the case.

  • Audiologist's level of knowledge: The audiologist you have seen will hopefully have a wide knowledge of all available hearing aids; however, some will only be familiar with a small number of brands and, therefore, may not really be in a position to know which model is the best for you. It is OK to challenge their recommendation and ask them to justify why this particular brand is the one for you.
  • Do research: Read about the hearing aid that was recommended. Does it seem like it will suit your lifestyle? Does it have more or fewer features than you need? 
  • Be aware of sales targets: Many high street retailers have specific tie-ins to a particular manufacturer/brand. The hearing aid they have suggested may still be the correct one for you, but do your research so that you know why they might have recommended it.
Do I need one hearing aid or two?

If you have significant hearing loss in both ears, you should be wearing two hearing aids. Here are the audiological reasons why:

Localisation: The brain decodes information from both ears and compares and contrasts them. By analysing the minuscule time delays as well as the difference in the loudness of each sound reaching the ears, the person is able to accurately locate a sound source. 

Simply put, if you have better hearing on one side than the other, you can't accurately tell what direction sounds are coming from.

Less amplification is required: A phenomenon known as “binaural summation” means that the hearing aids can be set at a lower and more natural volume setting than if you wore only one hearing aid.

Head shadow effect: High frequencies, the part of your hearing that gives clarity and meaning to speech sounds, cannot bend around your head. Only low frequencies can. Therefore, if someone is talking on your unaided side, you are likely to hear that they are speaking, but be unable to tell what they have said.

Noise reduction: The brain has its own built-in noise reduction, which is only really effective when it is receiving information from both ears. If only one ear is aided, even with the best hearing aid in the world, it will be difficult for you to hear in background noise as your brain is trying to retain all of the sounds (including background noise) rather than filtering them out.

Sound quality: We are designed to hear in stereo. Only hearing from one side sounds a lot less natural to us.

Fancy some further reading on this topic?  You can read about why two hearing aids are better than one in our article, hearing aids for Both Ears, here

What are the benefits of rechargeable hearing aids?

For most people, the main benefit of a rechargeable hearing aid is simple convenience. We are used to plugging in our phones and other devices overnight for them to charge up.  Here are some other pros and cons:

For anybody with poor dexterity or issues with their fingers, having a rechargeable aid makes a huge difference, as normal hearing aid batteries are quite small and some people find them fiddly to change.

One downside is that if you forget to charge your hearing aid, then it is a problem that can't be instantly fixed. For most, a 30-minute charge will get you at least two or three hours of hearing, but if you are the type of person who is likely to forget to plug them in regularly, then you're probably better off with standard batteries.

Rechargeable aids are also a little bit bigger and are only available in Behind-the-Ear models.

Finally, just like with a mobile phone, the amount of charge you get on day one is not going to be the same as you get a few years down the line. Be sure to ask what the policy is with the manufacturer's warranty when it comes to replacing the battery.

Are Behind-the-Ear hearing aids better than In-the-Ear hearing aids?

For most people, the answer is yes. But it's never that simple.

The majority of hearing problems affect the high frequencies a lot more than the low ones. Therefore, open fitting hearing aids sound a lot more natural and ones that block your ears up can make your own voice sound like you are talking with your head in a bucket. Therefore, in-ear aids tend to be less natural.

However, the true answer is we can't tell until we have had a look in your ears to assess the size of your ear canal, and until we have tested your hearing to see which frequencies are being affected.

People with wider ear canals tend to have more flexibility, also there are open fitting modular CIC hearing aids now that do not block your ears.

There is also the age-old rule to consider, that a hearing aid will not help you if it's sat in the drawer gathering dust. If the only hearing aid you would be happy wearing is one that people can't see, then that's what you should get.

Most people can adapt to any type of hearing aid, as long as they know what to expect. Have an honest conversation with your audiologist as to what your needs are.

What are channels, and how many do I need?

Generally speaking, six or more. Unless it's none at all.  The number of channels a hearing aid has is often a simplistic way an audiologist will use to explain why one hearing aid is better than another, but channels are complex, and it is really not that straightforward.  Here are some reasons why:

Hearing aids amplify sounds of different frequencies by different amounts. Most people have lost more high frequencies than low, and therefore need more amplification in the high frequencies. The range of sounds you hear is split into frequency bands or channels, and the hearing aids are set to provide the right amount of hearing at each frequency level.

Less than six channels, and this cannot be done with much accuracy, so six is the magic number. However, a six-channel aid is typically very basic with few other features and is suitable only for hearing a single speaker in a quiet room. The number of channels is not what you should be looking at; it's more the rest of the technology that comes with them.

As a final note, different manufacturers have different approaches. One method is not necessarily better than any other. For example, some manufacturers have as many as 64 channels in their top aids. Most tend to have between 17 and 20. One manufacturer has no channels at all.

What's covered in a manufacturer's warranty?​

Manufacturer's warranties typically last between 2-5 years, depending on the brand and model, and cover defects in materials and workmanship. This includes repairs for component failures, electronic malfunctions, and manufacturing defects, but excludes damage from misuse, accidents, or normal wear. Most manufacturers also include loss and damage insurance for the first year.

We handle all warranty claims on your behalf, liaising with manufacturers and ensuring you get replacement devices quickly when needed. This comprehensive warranty coverage, combined with our lifetime aftercare, gives you complete peace of mind.

How much does the hearing test cost?

Our hearing tests are completely free, whether at our clinics or in your home. Unlike other providers who charge £30-£100 for home visits, we believe hearing healthcare should be accessible without financial barriers. Our comprehensive assessments include examination by a registered audiologist, audiogram results, and personalised recommendations.

All testing, future adjustments, and ongoing support are included at no extra cost. While NHS tests are also free, typical 6-week waiting periods often lead people to seek immediate private testing. We provide prompt, professional assessments that fit your schedule and budget.

Do you offer home visits, and are they included in the price?

Yes, we offer completely free home visits throughout the UK, and this service is included in our prices with no additional charges. Home visits are particularly valuable for people with mobility issues, busy schedules, or those who simply prefer the comfort and convenience of their own environment.

Our audiologists can conduct full hearing tests, fit hearing aids, and provide ongoing support in your home.  This service sets us apart from many providers who either don't offer home visits or charge extra for them.

Why are your hearing aids cheaper than what I'd pay on the high street?

We can offer prices up to 40% lower than high street retailers because of our business model. As a network of 200+ independent audiologists, we don't have the massive overheads of large retail chains - no expensive high street premises, no sales targets pushing audiologists to sell the most expensive options, and no costly marketing campaigns.

However, we maintain the same buying power as the big chains because we purchase on behalf of our entire nationwide network. This means you get access to the same premium hearing aids with professional service, but at genuinely competitive prices.

How long do I have to try the hearing aids before committing to keep them?

We offer a comprehensive 60-day money-back guarantee, which gives you twice the industry standard time to properly assess whether your hearing aids are right for you. This extended period recognises that adjusting to hearing aids takes time, and your brain needs several weeks to adapt to the amplified sounds.

Unlike many providers who offer just 30 days, we believe 60 days gives you the confidence to test your hearing aids in all the situations that matter to you - from quiet conversations at home to busy restaurants and outdoor activities.

Other pages you might like...

Audiology Home Visits - For free in the UK
View Audiology Home Visits - For free in the UK
Best hearing aids available in the UK for 2025
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