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Two women (one with hearing loss) talking at beach

You might think that hearing loss is readily identifiable in your hearing test results, and often, it is. However, it’s a lesser-known fact that when individuals report having hearing issues, they sometimes have normal audiograms.

Practitioners often see patients reporting hearing problems (they’re sometimes even accompanied by a family member or partner who confirm their communication issues), however, when it comes to conducting a hearing test, the patient's pure tone audiometry shows hearing thresholds within normal limits


What is Hidden Hearing Loss?

Hidden hearing loss refers to those patients with dysfunction affecting the cochlear nerve synapse associated with noise exposure. Sufferers have an auditory disability but rather deceivingly, a normal pure tone hearing threshold. For the elderly, the audiogram might even reveal a modest deficit in hearing thresholds that is still incompatible with the severity of the patient's complaints.

If you’re told that your hearing is “normal” (but you are obviously experiencing difficulties) this will not provide you with any comfort and can be incredibly frustrating to hear from a medical professional. Clearly, your hearing isn’t as good as it used to be from a subjective perspective, and you still want to find a solution to your troubles.

What Causes Hidden Hearing Loss?

Before hearing loss even affects the hair cells of the ears (the tell-tale hearing loss sign that is looked for in a standard hearing test), the fibers located in the auditory nerves are damaged. A function of these auditory nerves is to connect to your hair cells, allowing you to hear in noisy environments, and working in harmony to filter out unnecessary background noise. When the auditory nerves are damaged it is difficult to hear in these noisy environments.

The reason this form of damage results in what is referred to as “hidden” hearing loss, is that it doesn’t appear on an audiogram, simply due to the conditions in which the test is carried out. The audiologist plays low-volume frequencies played in a quiet room which doesn’t actually test the response of the auditory nerve fibers. The patient’s results come back as “normal” because they haven’t been sufficiently tested to flag the cause of their hearing difficulties.

Just like with other and perhaps more obvious forms of hearing loss, hidden hearing loss is often caused by repeated exposure to loud noise. Interestingly, it appears to be quite common amongst young people which some researchers are attributing to their greater tendency to listen to loud music through headphones and to attend live concerts.

What are the Symptoms of Hidden Hearing Loss?

Hidden hearing loss is sometimes difficult for the sufferer to even notice because you can normally hear perfectly well in quieter environments. When there are loud background noises and it suddenly becomes difficult to hear something like a conversation happening right in front of you, this is a sign that you may have hidden hearing loss. If this happens again and again, hidden hearing loss may well be the culprit.

If You Suspect You Have Hearing Loss

If you’re struggling to hear speech and noise around you, it’s extremely important that you don’t wait to see a specialist. Not only can hearing loss be symptomatic of certain diseases and underlying health conditions, if left untreated, hearing loss can lead to other health problems such as balance issues and dementia.

An audiologist will be able to give you a medical examination, hearing test, and work with you to figure out the best treatment for your individual case. 

How Do I Know if I Have Hidden Hearing Loss?

If you go to an audiologist with hearing difficulties, they will usually conduct a simple hearing test to see whether your audiogram reveals your hearing thresholds are within normal limits. 

A decade or so ago, if you passed a hearing test, an audiologist would probably conclude that you had normal hearing and leave it at that. 

Now, if your results are within normal limits, your practitioner should understand the legitimacy of your complaints and conduct a comprehensive evaluation of your hearing, including specific tests that measure how your ears and your brain process sound. This is necessary to get to the bottom of your problems as it may be the case that you have hidden hearing loss.

It might be reassuring for you to hear that as James W. Hall highlights in Hidden Hearing Loss: An Audiologist's Perspective, “In a typical audiology clinic population, pure tone audiometry is normal for about five to seven percent of patients with self-perceived hearing difficulties”. Now that the healthcare profession is aware of this fact, your hidden hearing loss should be diagnosable. 

How to Treat Hidden Hearing Loss?

As we’ve already mentioned, hidden hearing loss doesn’t impact the ears in the typical way that occurs in ordinary hearing loss. As a result, hearing aids aren’t usually very helpful. 

Although it can be difficult, if you know you have hidden hearing loss you should limit your exposure to noisy environments as much as possible. This will be unavoidable to some extent, however, it’s better to organize certain things like one-on-one catch-ups in a quiet place where you’ll be able to hear your friends.

New medications might eventually be able to repair the damaged auditory nerve fibers, thus reversing hidden hearing loss. Still, these may not be available for a long time, and it’s best to focus on how you can effectively plan your life around the limitations of your hearing loss.

Can I use a Personal Sound Amplification Product (PSAP)?

To aid your hearing in noisy places you might consider the use of a personal sound amplifying product (PSAP), as these can help amplify speech in hard-to-hear environments. Sound amplifiers are very different devices in comparison to hearing aids. They are designed simply to boost environmental sounds and should not be used as a hearing aid replacement.

However, in the case of hidden hearing loss (as hearing aids are unlikely to help you), a specially designed sound amplifier can be an affordable and accessible hearing asset. You should always check with your physician before using a PSAP to aid your hearing. This is particularly important when you have hidden hearing loss as this is still a form of hearing loss, which PSAPs are not intended to treat. Your hearing loss is unique, and a PSAP may not be a suitable treatment for you.

If your doctor says it is safe for you to use a PSAP, this can provide you with hearing benefits. Although in the past hearing amplifiers could merely amplify background noise and nothing more, advanced earbuds such as Olive Union’s Olive Smart Ear can provide you with personalized sound enhancement. The Olive Smart Ear boasts 16 channels, a dynamic range of 96dB, and personalization capabilities. This gives you fantastic sound clarity and allows you to filter out disturbing noise.

To read more about hearing loss, see our other blog articles here. 

The information in this guide has been written using the following reliable sources:

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