Have you heard the noise around APD? With a flurry of interest around noise-cancellation and APD, Dale Hewitt offers his take on the evidence and theory.
When and why did this question first arise?
An article was published by BBC News (16 Feb 2025): Are noise-cancelling headphones to blame for young people’s hearing problems? [1]. In this, several UK National Health Service (NHS) audiologists expressed their concern that the overuse of noise-cancelling headphones is a possible cause of auditory processing disorder (APD). Patients who have difficulty understanding speech in noisy environments but have normal hearing thresholds are usually diagnosed with APD – they have a listening problem but not a hearing problem.
The audiologists’ concern stems from an apparent increase in the number of young adults who are being diagnosed with APD. They suspect that the overuse of noise-cancelling headphones is negatively impacting the ability to segregate speech from background noise. It is still only a hypothesis, but these audiologists feel there is enough concern for the possible link to be investigated.
Broadly similar articles were published by The Guardian (22 Feb 2025): Are noise-cancelling headphones impairing our hearing skills? [2], by ENT & Audiology News (26 Feb 2025): Are noise-cancelling headphones a cause for concern? [3] and by McGill University - Office for Science and Society (28 Feb 2025): Harm from Noise-Cancelling Headphones? More Questions than Answers [4].
I have previously worked as a UK NHS audiologist (for over 10 years) and was interested in what these articles had to say. Having read and digested them, I couldn’t help but conclude that they had opened a whole can of worms…
Neuroplasticity
The developing auditory areas of the brain are neuroplastic (they can change structure and function) and the post-development auditory areas remain neuroplastic (albeit to a lesser degree) throughout the human lifetime [5]. This means that the auditory system is primed to mature normally, but is at risk of reorganising abnormally [6]. An understanding of this neuroplasticity informs audiologists in their rehabilitation of patients provided with hearing aids and cochlear implants, and this neuroplasticity underpins the auditory training (AT) exercises given to APD patients (and to patients fitted with cochlear implants). AT sessions for APD patients typically last around 30 minutes each day and continue for several weeks [7]. Most are evidence-supported interventions and are known to induce neuroplasticity.
"Auditory system neuroplasticity means that we need to look again at multiple aspects of APD patient management"
When we wear noise-cancelling headphones, the background noise of the outside world is much reduced. All of the sounds we hear with the headphones, for example music or an audiobook, are not perceived like real-world sounds arriving from different directions and distances, but as sounds that seem to emanate from inside the head [8]. It logically follows that a likely consequence of the auditory system neuroplasticity is that the overuse use of noise-cancelling headphones will interfere with the normal development of auditory skills (which continue to develop into the teenage years), or result in the loss of the mature auditory skills through abnormal reorganisation (in the case of adults). Sophie, 25 years old and diagnosed with APD (see the BBC and ENT & Audiology News articles mentioned previously [1,3]), had a history of wearing her noise-cancelling headphones for up to five hours a day whenever she found herself in a noisy environment. Similarly, many individuals wear them when they use noisy public transport to commute. If this daily use of headphones, such as with Sophie, adds up to five hours, this is in the order of 10x the time APD patients spend (per day) completing a typical corrective AT session.
The perception of an auditory scene requires many different auditory skills, including [9]:
a) sound localisation involving the processing of:
- the sound level differences between the two ears.
- the sound arrival time differences between the two ears.
- the spectral distortions introduced by the head and external ears (which are unique to an individual and vary with the sound source location and age).
b) the ability to deal effectively with sound reflection / reverberation
- by limiting the response to the first-arriving sound: the sound that travels directly from the source to the ears.
- by ignoring any reflected sound: the sound that arrives milliseconds later (than the direct source) and from multiple directions.
Through neuroplasticity, the overuse of noise-cancelling headphones may well train / retrain auditory perception to be good at listening to sounds through the headphones (which seem to emanate from inside the head) and poor at listening to real-world sounds (which are acoustically more complex and usually include background noises from multiple directions). It should be noted that, if this is the case, similar outcomes are to be expected with the overuse of many different kinds of headphones (and earphones), not just those with noise-cancelling.
Moving forward
As a consequence of the neuroplasticity of the human auditory system, the overuse of noise-cancelling headphones will likely result in problems with listening to speech in noise (APD). Research will enable the definition of what overuse means and any effects of age.
"It logically follows that a likely consequence of the auditory system neuroplasticity is that the overuse use of noise-cancelling headphones will interfere with the normal development of auditory skills"
Auditory system neuroplasticity means that we need to look again at multiple aspects of APD patient management. For example, with regards to APD rehabilitation, the current recommendation that acoustic modifications should be made to classrooms / offices (to, as much as possible, reduce noise and reverberation) comes into question, as does the recommendation to provide devices / technologies designed to reduce background noise and reverberation. With regards to the efficacy of APD auditory training rehabilitation, the use of virtual reality (VR) sounds and background noises offer the potential to assist with:
- the problematic development of auditory skills (in the case of children).
- the re-establishment of the mature auditory skills lost through abnormal re-organisation (in the case of adults).
Such VR technologies can be used to closely mimic real-life situations and provide greater ecological validity [10,11,12].
References
1. Karpel H. Are noise-cancelling headphones to blame for young people’s hearing problems? BBC News 2025.
https://www.bbc.co.uk/news/articles/cgkjvr7x5x6o
2. Sample I. Are noise-cancelling headphones impairing our hearing skills? Some audiologists are beginning to worry. The Guardian 2025.
https://www.theguardian.com/science/2025/
feb/22/filter-trouble-why-audiologists-worry-noise
-cancelling-headphones-may-impair-hearing-skills
3. Are noise-cancelling headphones a cause for concern? ENT & Audiology News 2025
https://www.entandaudiologynews.com/
news/post/are-noise-cancelling-headphones
-a-cause-for-concern
4. Jarry J. Harm from Noise-Cancelling Headphones? More Questions than Answers. McGill Office for Science and Society 2025.
https://www.mcgill.ca/oss/article/medical
-technology-did-you-know/harm-noise-cancelling
-headphones-more-questions-answers
5. Dahmen JC, King AJ. Learning to hear: plasticity of auditory cortical processing. Curr Opin Neurobiol 2007;17(4):456–64.
6. Cardon G, Campbell J, Sharma A. Plasticity in the Developing Auditory Cortex: Evidence from Children with Sensorineural Hearing Loss and Auditory Neuropathy Spectrum Disorder. J Am Acad Audiol 2012;23(6):396–495.
7. Weihing J, Chermak GD, Musiek FE. Auditory Training for Central Auditory Processing Disorder. Semin Hear 2015;36(4):199–215.
8. Lieberman A, Schroeder J, Amir O. A voice inside my head: The psychological and behavioral consequences of auditory technologies. Behav Hum Decis Process 2022;170:104133.
9. Litovsky R. Development of the auditory system. Handb Clin Neurol 2015;129:55–72.
10. Patou F. Can the audiology clinic benefit from advances in virtual reality? ENT & Audiology News 2022;30(6).
https://www.entandaudiologynews.com/features/
audiology-features/post/can-the-audiology-clinic
-benefit-from-advances-in-virtual-reality
11. Serafin S, Adjorlu A, Percy-Smith LM. A Review of Virtual Reality for Individuals with Hearing Impairments. Multimodal Technol Interact 2023;7(4):36.
12. Eriksholm Workshop. Ecological Validity. Ear Hear 2020;41:1S-146S.
[All links last accessed May 2025].
Declaration of competing interests: None declared.
