Sometimes, individuals can have hearing test results that are normal and still experience difficulties in hearing, particularly when it comes to speech and conversations. This condition may indicate a situation known as hidden hearing loss. In these circumstances, the ears can detect sound; however, there are problems with sound signals making it through the nervous system. This means that instead of conventional hearing loss, there is a diminished ability to process auditory information.
What is Hidden Hearing Loss?
The concept that patients may have normal hearing thresholds while experiencing difficulties with listening skills is a relatively recent focus in both research and clinical practice. As a result, some individuals in this situation may find that they possess normal hearing and that no further action is required. Unfortunately, those who present with normal audiograms receive brief discussions and insufficient follow-up. However, an increasing number of audiologists are beginning to address this issue by integrating a more comprehensive understanding of auditory perception and listening processes.
While there are no established guidelines to diagnose hidden hearing loss, some symptoms to look out for include:
• Having a sense of hearing loss after passing a hearing test
• Requiring quiet settings for conversations
• Consistently hearing people incorrectly
• Easily distracted or unable to focus in noisy surroundings
A Different Kind of Hearing Loss
When auditory function is working properly, sound waves initiate movement in the hair cells located within the inner ears. These tiny hairs convert sounds into signals transmitted to the auditory nerve. These signals need to traverse synapses, the critical junctions between nerve cells. Hidden hearing loss is characterized by hearing difficulties that affect an individual’s ability to listen and comprehend despite appearing normal on standard hearing assessments. This type of hearing impairment can significantly impact communication and overall quality of life, highlighting the need for increased understanding of its implications.
Synaptic Theory
Researchers propose that certain instances of hidden hearing loss may be attributed to the malfunctioning of auditory synapses. This condition results in incomplete transmission of sound to the brain, leading to a loss of critical signals needed for interpreting sound. Clinically, this phenomenon is called “cochlear synaptopathy.” The synapse theory represents a burgeoning area of research, primarily derived from studies conducted with animals. Continued investigation is essential to understand this complex issue further.
Some people may have multiple issues that can lead to hearing loss. Other conditions affect listening ability, including:
• Traumatic brain injuries
• Autoimmune diseases that destroy nerve tissue
• Extremely mild hearing loss
• Comprehensive high-frequency hearing loss
• Auditory and acoustic processing disorders
• Drug-related hearing loss, known as ototoxicity
The Need for Comprehensive Testing
If you have received a standard hearing test that showed no signs of hearing loss, it is important to remain optimistic. Comprehensive testing could help develop a clearer understanding of your hearing health. It may be beneficial to seek a second opinion or consult with other healthcare providers who specialize in hearing-related issues.
Doctors can incorporate additional tests into the standard hearing test battery used by audiologists and ear-nose-throat specialists. These supplementary evaluations can help identify hidden hearing loss’s underlying causes while ruling out other potential contributors.
• Speech-in-noise tests (SIN)
• Auditory brainstem response tests (ABR)
• Acoustic reflexology tests
• Comprehensive high-frequency audiometry tests
• Diagnostic otoacoustic emissions tests
Locating the right audiologist is not impossible. The limited typical diagnostic tool set can make identifying the root cause of suspected synapse issues challenging. Nonetheless, patients can and should receive assistance. It is essential to seek an audiologist who acknowledges the reality of these difficulties and is committed to providing appropriate interventions, accommodations, strategies, and support to help manage the challenges facing patients. If you have concerns regarding potential hidden hearing loss, we encourage you to contact us for a consultation with one of our specialists.
