The communication difficulties in a patient with sensorineural hearing loss will typically occur at the same time - but with varying degrees.
Loss of sensitivity
With loss of sensitivity you have difficulties hearing soft speech. Soft sounds have to be made louder in order to be heard, and turning up the television or speaking a bit louder may compensate for a mild loss of sensitivity.
Loss of high frequencies
Hearing-impaired people have problems hearing high frequency consonants such as s, t, f, p, k and combinations of consonants such as th and sh, all of which can make it very difficult for hearing-impaired people to understand a conversation.
Discrimination loss make it difficult for them to understand speech in noisy surroundings. They may do well in quiet one-to-one situations, but will have problems with their hearing in cases where there is background noise. The noise 'masks' or covers speech sounds.