What Is Hidden Hearing Loss and What You Can Do About It

Losing your hearing can happen immediately due to an accident or illness, or more commonly, just over time.

When hearing loss happens gradually, it can be harder to notice the subtle changes in your hearing that indicate a loss. 

Even more difficult is diagnosing someone with a hidden hearing loss.

These types of hearing impairments require additional testing and a dedicated team of trained professionals to help determine your level of impairment. 

Let’s discuss how hearing works, which parts of the ear are affected by hidden hearing loss, and what you can do to hear better.

How Does Hearing Work?

The ear has three parts.

  1. Outer Ear. The outer ear consists of the part you can see, called the pinna, and the ear canal.
  2. Middle Ear. The middle ear contains your eardrum, and three small bones called the malleus, incus, and stapes.
  3. Inner Ear. The inner ear contains a snail-shaped structure called the cochlea, the semicircular canals, and the auditory nerve.

Your hearing functionality also depends on the brainstem and brain, which means that the brain, too, is a part of the body that helps you hear. 

The Hearing Process

Sound occurs in waves. Sound waves are collected by the outer ear and sent down the ear canal, where they vibrate against the eardrum.

The eardrum vibrates the three bones of the inner ear and amplifies the sound, sending it into the cochlea. 

Inside the fluid-filled cochlea, the basilar membrane divides the structure in half. On top of the basilar membrane, tiny hairs begin to move with the vibration of the fluid in the cochlea.

These cells interact with neurons.

Together with the semicircular canals, they change the sound waves into electrical signals, which go to the auditory nerve. 

The auditory nerve delivers the electrical signals to the brain, which interprets what we hear as sound.

Thus, to be able to hear properly, there are many structures in both the ears and in the brain that must be in working order.

Hearing loss may occur if a part of the ear or brain becomes damaged. 

What Is Hidden Hearing Loss?

Most hearing loss is diagnosed through a simple test that a doctor or audiologist can administer.

However, hidden hearing loss is a loss of hearing that isn’t diagnosable through normal auditory testing methods. 

Normally, an audiologist will administer an audiogram test when someone suspects they’ve lost a portion of their hearing.

The audiogram usually shows the same results for a person with hidden hearing loss as someone with normal hearing.

In past decades, this led to confusion, and the condition was even suspected of having psychogenic causes.

Thankfully, hidden hearing loss is now recognized as a physiological impairment, and new testing methods can help a healthcare professional determine if someone’s hearing loss is hidden.

Symptoms of Hidden Hearing Loss

A person with a hidden hearing loss usually complains of not being able to hear the conversation when there is competing background noise

In addition, a person with hidden hearing loss may experience tinnitus, the sound of ringing or buzzing in the ears.

They may also feel like there is something lodged in their ear or experience a feeling of fullness in the ear. 

How Is Hidden Hearing Loss Diagnosed?

Because hidden hearing loss can’t be diagnosed with standard testing, another test is usually needed to determine your level of hearing loss.

Specialists will use a test that involves understanding speech in noise and asking questions about your hearing loss symptoms. 

Your audiologist may also order other diagnostic tests and scans to ensure there are no other issues that could be causing your loss of hearing. 

Causes of Hidden Hearing Loss

Like any type of hearing loss, there can be numerous reasons your hearing is declining.

These include:

  • Long-term exposure to loud noise (considered over 70 decibels)
  • Short-term or impulse exposure to extremely loud noise (like gunshots or fireworks)
  • Age-related hearing loss called presbycusis
  • Some diseases or infections
  • Side-effects from medications

No matter the cause, the underlying damaged structures in a person with hidden hearing loss may be the hair cells.

These hair cells connect with neurons in the inner ear and transmit electrical signals into the semicircular canals. 

A Communication Breakdown

Hearing can be lost when the hair cells lose the ability to communicate with the neurons.

These synapses (the communication between hair cells and neurons) are important for clear hearing, especially when conversing in a noisy environment.

Specific synapses are needed inside the cochlea to help filter background noise and help you focus on speech.

In a person with hidden hearing loss, these synapses are lost for several reasons.

What Can I Do About Hidden Hearing Loss?

If you’ve received a diagnosis of hidden hearing loss, your healthcare provider can help you understand your options for hearing more clearly.

Because hearing loss can have a profound impact on your quality of life and your successful communication with others, it’s important to find a solution that works.

Hearing Aids

Hearing aids can help a person with hidden hearing loss hear better.

Open-fit hearing aids are small, have a barely visible design, and sit inside the ear canal. 

Hearing aids have a microphone for picking up sound, an amplifier for increasing the sound waves, and a speaker for delivering the sound waves to the cochlea. 

FM Systems

Frequency modulation systems can help someone filter out background noise in an environment with competing sounds.

These can be used alone or in connection with hearing aids and are considered a type of assistive listening device. 

Assistive Listening Devices

Assistive listening devices (ALDs) can help block background noise and amplify sound.

These may be in the form of headsets, earbuds, or other inner-ear devices. They may also be handheld devices that translate speech to text, such as a teletypewriter or TTY device.

Lip Reading

Although it may sound low-tech, reading lips is a preferred method of communication for many people with hearing loss.

Deciphering words without hearing aids can be very important to some people with hearing impairment. Learning to read lips allows them to participate in the conversation without a hearing aid or other device.


If you have a hidden hearing loss, ensuring the remainder of your hearing is protected is vital.

You can protect your hearing by limiting your exposure to loud noise and protecting your ears when you’re around loud noise. You can do this by wearing protective, over-the-ear headphones or specialized earbuds. 

Living With Hidden Hearing Loss

Living a full life with a hidden hearing loss is completely possible with the right tools to help you communicate effectively.

Through special testing, your doctor can determine your level of hearing loss and suggest treatment methods to keep you focused on conversations that matter. 

For more information on hearing loss and tips to keep your hearing protected, check out the USA Rx blog. You’ll find tips for keeping well and information about hearing health. 

References, Studies and Sources:

What is hidden hearing loss? | Ohio State Medical Center 

Hidden hearing loss – See diagnosis, causes and treatment | Hear It 

Second Cause of Hidden Hearing Loss Identified | UOFM Health 

author avatar
Angel Rivera Physician
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