Types and Degrees of Hearing Loss

Hearing loss is more common than most people realize. And it can affect anyone at any time
in their life.

If you think you or a loved one may have hearing loss, or if youve recently been diagnosed,
you likely have questions.

Below is some basic information to help you better understand the several types and degrees
of hearing loss.

As you seek to understand what a hearing loss may mean to you or a loved one, we strongly
encourage you to reach out to a hearing healthcare provider for a comprehensive hearing
evaluation and information specific to your situation. Going to a hearing care professional
helps ensure that you receive a proper diagnosis of the cause, type, and severity of hearing
loss you may have.

Importantly, a hearing care professional can make appropriate recommendations for

addressing your individual hearing needs.

As you learn more, we hope youll be inspired by the tremendous progress that has been
made in the treatment of hearing loss in recent years, including the many advances in
research and hearing aid technologies.

Theres a lot to feel positive about. In fact, BHI research shows again and again that quality
of life often improves in many ways when people address their hearing loss.

Conversely, a growing body of research suggests that leaving hearing loss unaddressed may
have negative consequences linked to other health and quality-of-life issues down the road.

So, we applaud you in your efforts to understand and address hearing losswhether for
yourself or a loved one.

If you have not yet had a professional hearing examination, we invite you to take BHIs
confidential, online hearing check. It will help you determine if you need a comprehensive
hearing test by a hearing healthcare provider. The BHI Hearing Check prompts you through a
series of simple questions in just a few quick minutes.

We hope you find the information below helpful. And congratulations on taking that
important next step!

(For an explanation of how people hear, please visit our webpage: How We Hear.)

Types of hearing loss

Below is a brief explanation of each of the three basic types of hearing loss: 1) sensorineural,
2) conductive, and 3) mixed.
Sensorineural Hearing Loss

The vast majority of people with hearing loss have sensorineural hearing loss. This occurs
when there is a problem with the sensory (hair cells) and/or neural structures (nerves) in the
inner ear (cochlea). Most often, sensorineural hearing loss involves damage to the tiny hair
cells that are activated by sound waves to vibrate and release chemical messengers that
stimulate the auditory nerve. The auditory nerve is made up of many nerve fibers that then
carry signals to the brain that are interpreted as sound. While sensorineural hearing loss
usually involves damage to the tiny hair cells, it also can result from damage to the auditory
nerve.

A sensorineural hearing loss reduces the intensity of sound. But a sensorineural hearing loss
also can distort what is heardeven when the sounds are loud enough. That is why people
with sensorineural hearing loss often struggle to hear words clearlyparticularly certain
spoken consonant sounds and when in noisy environments.

Most sensorineural hearing loss cannot be reversed with medical treatment and is typically
described as an irreversible, permanent condition. Nevertheless, research into a cure
continues.

The good news is that once any underlying medical conditions have been ruled out or
addressed, most people with sensorineural hearing loss can benefit from hearing aids.

Ninety-one percent of people who purchased hearing aids in the last year say theyre
satisfied, in fact. And 90 percent say theyd recommend getting hearing aids to family
members and friends.

Some of the potential causes of sensorineural hearing loss include:

Exposure to loud noise

Aging

Medicines that damage the ear (ototoxic)

Illnesses, such as meningitis, measles and certain autoimmune disorders, among

others

Geneticsthat is, hearing loss runs in the family

Trauma to the head

Structural malformation of the inner ear

Conductive Hearing Loss

Conductive hearing loss is mechanical in nature. That means that somethinga physical
condition or diseaseis stopping sound from being conducted from the outer or middle ear to
the inner ear, where nerves are stimulated to carry sound to the brain.
Often, the cause of conductive hearing loss can be identified and treated. Medical treatment
of conductive hearing loss often allows for partial or complete improvement in hearing. Then,
hearing aids are usually helpful in compensating for any remaining hearing loss.

Potential causes of conductive hearing loss include:

Wax buildup

Fluid in the middle ear due to colds or allergies

Fluid in the middle ear due to poor eustachian tube function (The eustachian tube
drains fluid from the middle ear and ventilates it to regulate air pressure there.)

Ear infection

A foreign object lodged in the ear

A ruptured eardrum (also called a perforated eardrum or a tympanic membrane

perforation), which means there is a tear in the membrane that separates the outer ear
from the inner ear

Structural malformation of parts of the ear

Trauma to the ear

In rare cases, tumors

Mixed Hearing Loss

A mixed hearing loss means there is a sensorineural hearing loss along with a conductive
hearing loss component. In addition to some irreversible hearing loss caused by a problem
with the inner ear, there also is an issue with the middle ear, which makes the hearing loss
worse. But it may be possible to successfully treat the conductive hearing loss, as explained
above. The individual also may benefit from hearing aids to help manage the sensorineural
hearing loss.

What about presbycusis, noise-induced hearing loss, and tinnitus?

Presbycusis

Presbycusis (pronounced prez-bi-ky-ss) simply means age-related hearing loss. Typically,

presbycusis comes on gradually and equally in both ears. In most cases, its the result of
changes in the ear that happen as people get older.

Often, presbycusis involves damage to the inner ear, making it a sensorineural hearing loss.
Cardiovascular disease, diabetes, other health conditions common with aging, and ototoxic
medications that can damage the inner ear all can contribute to presbycusis.

Noise-induced Hearing Loss

Noise-induced hearing loss is a type of sensorineural hearing loss. Its caused by damage to
the delicate hair cells in the inner ear that vibrate in response to sound waves. When these
hair cells vibrate, they trigger the auditory nerve to send signals to the brain that it interprets
as sound. Just as we can overload an electrical circuit, we can overload these hair cells with
too much noise or sounds that are too loud. The hair cells that enable us to clearly hear
higher-frequency sounds tend to go first.

Although noise-induced hearing loss is largely preventable, its a significant societal problem
due to so much noise in the world around us.

Any sounds at or above 85 decibels for a prolonged period of time can be unsafe to a persons
hearing. (The intensity of sound is measured in decibels.) To put that in perspective, most
heavy city traffic and school cafeterias are at about 85 decibels, and fireworks are in the 140-
to-165 decibels range, according to Its A Noisy Planet. Its also important to realize that
something like the single bang of a firecracker at close range can permanently damage
hearing in an instant.

Because noise-induced hearing loss is so common, attributing gradual hearing loss over time
strictly to aging can be somewhat misleading. In middle-aged and older people, its often
difficult to distinguish what percentage of a sensorineural hearing loss is attributable to aging
and what percentage is the result of repeated exposure to noise.

About 40 million U.S. adults aged 20 to 69 years have noise-induced hearing loss, according
to the Centers for Disease Control and Prevention (CDC). And nearly 50 percent of 12 to 35-
year-olds are exposed to unsafe levels of sound from the use of personal audio devices, based
on data analyzed by the World Health Organization (WHO). Around 40 percent of 12 to 35-
year-olds are exposed to potentially damaging levels of sound at entertainment venues.

Tinnitus

Often called ringing in the ears, tinnitus is the perception of a sound in a persons ears or
head that has no external source. Many people with tinnitus experience a ringing, humming,
buzzing, or chirping sound. Others even perceive singing or music. Experts believe that
neural hyperactivity leads to this perception of sound.

Usually, tinnitus is the by-product of noise exposure, although it can be caused by other
things as well. Tinnitus is almost always accompanied by hearing loss and is considered a
symptom of hearing loss.

Many people can manage the annoyance associated with tinnitus with hearing aids. A good
number of high-tech hearing aids now include integrated sound therapy specifically
designed to offer relief from tinnitus.

Unfortunately, teenagers are increasingly experiencing tinnitus, according to a study

published in Scientific Reports.

Degrees of hearing loss

When someone is professionally diagnosed with hearing loss, typically theyre told how
significant the hearing loss is. The degree of hearing loss can range from mild to
profound, but the question for most people is, What does that mean for me?

Below is a brief explanation of the degrees of hearing loss. Generally, the more serious the
hearing loss, the harder it is for the person to hear quiet sounds, which would be at a lower
decibel level.

Mild

Mild is the most common and under-diagnosed degree of hearing loss.

People with mild hearing loss usually can hear sounds louder than 40 decibels, but may have
some difficulty hearing sounds below 40 decibels.

Heres how that translates into real life: The humming of a refrigerator is about 40 decibels; a
whisper is about 30 decibels; rustling leaves are about 20 decibels; and the sound of normal
breathing is about 10 decibels.

So, someone with mild hearing loss may have minimal or no issues in quiet, one-on-one
settings, or with only a couple of people. But they tend to have difficulty hearing softer
sounds, especially in noisier environments, at a distance, in larger-group settings, or over the
phone.

For instance, someone with mild hearing loss may only notice that they have trouble making
out the conversation in certain situationslike in a noisy restaurant or when there is
background music. Or, they may have trouble with certain wordstypically with consonant
sounds. They may hear the word, but they may strain to distinguish it clearly or think
something else that sounds similar was said. For example, someone with mild hearing loss
may think the speaker said hurt when it was shirt, or fun when it was sun, and so on.

When hearing loss is related to noise exposure and aging, people tend to lose their ability to
hear higher frequency sounds firstlike consonants in speech, which are higher pitched and
softer in volume than vowels. This is challenging because consonants contribute much more
than vowels to our understanding of speech.

People with mild hearing loss also may need to work harder to follow the conversation when
a women or child is talking. They also may miss very high-pitched sounds, like higher-
pitched birds or alarms.

The bottom line is that someone with unaddressed mild hearing loss may need to put more
cognitive effort (higher levels of concentration) into following conversations in certain
situations than they realize. The cumulative strain, especially for individuals with active
professional, social, and civic lifestyles, can be significant and draining.

Moderate

People with moderate hearing loss have trouble hearing sounds below 40 decibels, but also
many sounds in the 41 to 60 decibels range. Normal conversation, for example, is between 50
and 65 decibels. A quiet office is about 50 to 60 decibels.
By the time someone has moderate hearing loss, the person often strains to keep up with
conversation in most settings without the use of hearing aids or other assistive listening
devices.

Severe

People with severe hearing loss have difficulty hearing most sounds below 61 decibels and
many between 61 and 80 decibels. Sounds in the 61 to 80 decibels range include a vacuum
cleaner or hair dryer (about 70 decibels) and a garbage disposal (80 decibels).

In day-to-day life, that means that someone with untreated severe hearing loss would have
trouble following most conversations. They likely would have difficulty even hearing loud
speech without amplification, such as hearing aids.

Profound

Someone with profound hearing loss can only hear very loud soundsthose above 81
decibels. A lawn mower and food blender are between about 85 and 90 decibels. A
motorcycle, at about 25 feet away, is 88 decibels.

A person with a profound hearing loss probably would not hear any speech and only very
loud sounds. They most often have difficulty hearing and following conversation even with
hearing aids and often rely on lip-reading and/or sign language.

We strongly encourage people struggling with hearing loss to see a hearing healthcare
professional. Addressing hearing loss can have a tremendously positive impact on a persons
everyday life