An ear exam can help diagnose hearing problems, but doesn’t tell us much about listening.

A mother takes her four-year-old to the pediatrician, reporting that she’s worried about the girl’s hearing. The doctor runs through a battery of tests, checks in the girl’s ears to be sure everything looks good, and makes notes in the child’s folder. Then, the doctor takes the mother by the arm. They move together to the far end of the room, behind the girl. The doctor whispers in a low voice to the concerned parent, “Everything looks fine. But, she’s been through a lot of tests today. You might want to take her for ice cream after this as a reward.” The daughter jerks her head around, a huge grin on her face, “Oh, please, Mommy! I love ice cream!” The doctor, speaking now at a regular volume, reports, “As I said, I don’t think there’s any problem with her hearing, but she may not always be choosing to listen.”

This mother-daughter interaction is not uncommon. People choose when they want to listen, but hearing is biological. It is something many do without even trying. It is a physiological response to sound waves moving through the air at up to 760 miles per hour. First, we receive the sound in our ears. The wave of sound causes our eardrums to vibrate, which engages our brain to begin processing. The sound is then transformed into nerve impulses so that we can perceive the sound in our brains. Our auditory cortex recognizes a sound has been heard and begins to process the sound by matching it to previously encountered sounds in a process known as auditory association.^[1] Hearing has kept our species alive for centuries. When you are asleep but wake in a panic having heard a noise downstairs, an age-old, self-preservation response engages. You were asleep. You weren’t listening for the noise—unless perhaps you are a parent of a teenager out past curfew—but you hear it. Hearing is unintentional, whereas listening (by contrast) requires you to pay conscious attention. Our bodies hear, but we need to employ intentional effort to truly listen.