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Traditional Testing for Hearing Loss

For those suffering hearing loss, the type of hearing loss you may have depends on what part or parts of your ear are damaged. Testing by an audiologist can indicate which type you have. Hearing loss may be measured by using different tests and is traditionally diagnosed using an audiogram, which is the gold standard of hearing tests.

However, traditional testing for hearing may miss an important type of hearing loss. People as young as middle age report trouble hearing conversations, especially in noisy environments. This hearing difficulty is a cause for concern, prompting them to have their hearing tested. However, these patients do not have trouble hearing sounds in quiet places, even soft whispers. When they are given traditional hearing tests, such as an audiogram, the results return as inconclusive. This confusing deficiency in hearing is referred to as hidden hearing loss.

What is Hidden Hearing Loss?

Hidden hearing loss is a widely underdiagnosed form of hearing loss. Traditional hearing tests do identify this specific type of deficiency in the ear. This inconclusiveness can be very frustrating for people whose social, professional and academic lives are being affected by the inability to hear conversation. This condition may pose problems in environments that have lots of background noise, such as bars, restaurants, a school lecture hall and the office. 

As with other forms of hearing loss, people may develop social anxiety and depression. Research shows that hearing loss sufferers withdraw from other people and social events. That is why it is important to recognize this hidden condition, understand why it happens and how it can be helped.

Hidden hearing loss is not detectable with a traditional audiogram because the cause differs from other forms of hearing loss. Hidden hearing loss is thought to occur in relation to aging like other forms of hearing loss, but may also form in much younger people and children. Possible causes include damage from listening to headphones with the volume up too loud, attending loud concerts and working in consistently loud environments. Even exposure to low-level noise for extended periods may contribute to hidden hearing loss.

What is the Difference Between Hidden Hearing Loss and Other Types of Hearing Loss?

In the typical hearing mechanism, the soundwaves vibrate hair cells in the inner ear that send information to the vestibulocochlear nerve. To get there, the information must pass over synapses that link nerve cells. These nerve cells then send information to the brain.

Traditional hearing loss affects the nerves or the hair cells in the inner ear. In hidden hearing loss, the synapses in the ear are affected. The affected synapses are sending incomplete information to the nerve cells and thus to the brain. This is why following a conversation for those with this form of hearing loss may be so difficult. The condition may also be referred to as cochlear synaptopathy which references the neuropathy (nerve damage) of cochlear nerve synapses. 
Other research has shown that cells involved in the production of myelin may also be a part of the problem. However, aging and noise pollution are thought to be the primary contributing factors in hidden hearing loss. 


Diagnosing hidden hearing loss may prove to be much harder than other forms of hearing loss. When audiograms and speech recognition tests come back normal while the patient is still certain they are experiencing hearing deficiencies, more tests are necessary. This is where misdiagnosis may occur, especially in young children who may not be able to explain their symptoms as effectively.

Experimental tools are being used to pinpoint patients with hidden hearing loss. One method involves tracking pupil dilation of a patient while following conversation with and without background noise. Another involves the use of electrical signals and taking measurements from the ear canal that show the ability to decipher fluctuation in sound waves. 

Although there is no specified hidden hearing loss test, a combination of tests and the commitment from your audiologist at Sonora Hearing Care will help get you to the root of your hearing loss.


There is hope for the development of medication that will help prompt patient’s neurons to grow new synapses, but at this time it has not yet been developed. While the treatment for hidden hearing loss is still in its early stages, Sonora Hearing Care will be able to assist you in determining what assistive hearing devices will work best for you. 

If you believe you are experiencing hidden hearing loss, please visit our website for information on scheduling a hearing test and further care with our committed team.