Hidden Hearing Loss: Why You Hear the Sounds but Can’t Understand

By Temma Ehrenfeld @temmaehrenfeld
November 18, 2020

You have your hearing checked but are told it’s normal. Still, you seem to be missing words in conversations and can’t focus on what someone is saying in a crowded area. Why?

Many of us lose hearing ability as we age. Restaurants seem noisier than ever before. Everyone seems to be mumbling. Other people can follow the conversation but you can’t.

Even more frustrating, you can see an audiologist to test your hearing, but you’re told that it’s normal.

In fact, about 10 percent of patients who visited the audiology clinic at Massachusetts Eye and Ear over 16 years had a normal audiogram, according to a one study.

That’s because audiograms identify problems within the ear. But you can also struggle to hear because of damage to synapses in the brain. As you age, the problem reveals itself when you have trouble understanding speech in noisy situations.


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What is hidden hearing loss?

When you hear, movement in tiny hair cells within your ear cross synapses to reach the main nerve for hearing. Audiograms will catch damage to the hair cells or the nerve. If you have hidden hearing loss, you may have lost some of the synapses. The most common cause would be noise pollution.

We know, for example, that when mice are subjected to a noise as loud as a lawn mower for two hours they can lose half of their synapses in areas related to hearing. Even exposure to low-level noise over many years could damage synapses.

People with certain autoimmune disorders can also suffer from damage to nerve cells near the ear, sometimes after food poisoning, the flu, or hepatitis.

To identify hidden hearing loss, Massachusetts Eye and Ear developed two tests, one that measures electrical signals from the surface of the ear and another that measures changes in your pupils while you listen to speech in a noisy place. Your pupils reflect how hard it is to perform the task.

It turned out that even in volunteers with normal audiograms, some could follow a conversation against a noisy background much more easily than others.

If you’re the one who can’t follow, it’s easy to feel left out. You might decide that you’re not a sociable person without realizing why.

How can you prevent hidden hearing loss?

If you work in a noisy environment, wear ear plugs. Speak to your employer about minimizing noise, as required by law. If you decide to bring a worker’s comp complaint for damaged hearing, do it sooner rather than later, especially if you’re middle-aged. Your employer may argue that your trouble is entirely caused by age.

What you can do

There’s no cure for hidden hearing loss, but you can minimize its impact. The first step is to get a baseline hearing test. Current hearing aids have settings for “speech in noise.” Tiny microphones within the aid focus on the signal in front of you, while the aid lowers the volume of sound in other directions. But it’s unusual to wear a hearing aid unless you have at least some ordinary hearing loss. And don’t overpay for your hearing aids: Before you buy check out Costco or online alternatives.

Audiologists can also help you by telling you about a variety of options for people with hearing trouble, including a mobile app that can caption the words in a meeting, for example. You can try using amplifiers available at theaters, although you might find that they make everything too loud.

You can train yourself to distinguish speech more easily from noise, using exercise programs available on a home computer or phone. You might check out the Angel Sound app, which is based on a computer program.

The best solution: avoid noise. It’s absolutely true that restaurants have become noisier, with less carpeting and bigger bars. The phone app SoundPrint lists quiet restaurants in 11 cities. Founder Gregory Scott Faber, who suffered permanent hearing loss from meningitis as a baby co-authored a study of 2,376 Manhattan restaurants from 2015 to 2017 using the app, concluding that “approximately 31 percent of mainstream restaurants and 60 percent of all bars have sound levels during peak days and hours that are potentially dangerous to the hearing health of their patrons, and, even more importantly, to their employees.”

Restaurants are quietest at 5 p.m. Stay far from the bar or a table with drinkers. Ask the waiter if it’s possible to turn down music.

At lectures, arrive early and sit in the front.

The biggest danger is that you’ll withdraw from social situations. Don’t be shy about telling people you have a hearing issue. You’ll hardly be alone.


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November 18, 2020

Reviewed By:  

Janet O'Dell, RN