What Is Hidden Hearing Loss?

You have your hearing checked but are told it’s normal. Still, you seem to be missing words in conversations and crowded areas. Do you have hidden hearing loss?

Many of us lose hearing ability as we age. Restaurants seem noisier than ever before. Everyone seems to be mumbling. Other people can follow conversations, 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 your ear. But you can also struggle to hear because of damage to synapses in your 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 crosses 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.

Researchers know, for example, that mice can lose half of their synapses in areas related to hearing when they are subjected to a noise as loud as a lawn mower for two hours. 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 their ear, sometimes after food poisoning, the flu, or hepatitis.

To identify hidden hearing loss, Massachusetts Eye and Ear, a teaching hospital, developed two tests. One measures electrical signals from the surface of your ear, and another 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.

In the research, it turned out that some volunteers could follow a conversation against a noisy background better than others who had normal audiograms.

If you can’t follow a conversation, 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 in workplaces. 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. Audiologists can help you determine the best solution for you.

Current hearing aids have settings for “speech in noise.” Tiny microphones within the aids focus on the signal in front of you, while the aids lower 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.

You could use a mobile app to caption the words spoken during meetings. 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 is to avoid noise.

It’s true that restaurants have become noisier, with less carpeting, which can absorb sound, and bigger bars. The phone app SoundPrint lists quiet restaurants in several cities. Founder Gregory Scott Faber, who suffered permanent hearing loss from meningitis as a baby, co-authored a study of 2,376 Manhattan restaurants, 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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