Hearing loss

The sounds of nature, conversations with friends and family, and concerts—our ears play a significant role in how much we enjoy these activities. Our ears are also a natural warning system, able to detect oncoming traffic, register a home intrusion and alert us of any potential danger.

The famous quote, “You don’t know what you’ve got until it’s gone”, is an excellent daily reminder not to take these wonderfully complex organs for granted. But it’s not always easy to admit that our hearing is not what it used to be. Many people wait several years after noticing the first signs of hearing loss before seeking help.

Hearing aids can drastically improve your health and quality of life. Read on to discover the causes of hearing loss and difficulties, or click on the links above to learn more about different types of hearing loss, hearing tests and your general hearing health.

Table of Contents
  • Hearing Loss
  • Types of hearing loss
  • Hearing test

Hearing loss and your quality of life

What causes hearing loss?

It’s a well-known fact that too much noise can be harmful to our ears. Whether on the street, at a concert, at home or work, the world can be a loud place. When played at high volume, music on headphones or earbuds can increase the likelihood of hearing damage. Hearing loss can also just be a natural function of aging.

Other factors may include head injury, disease, infection, trauma, stress, diet, and even certain medications. In the case of medical treatment, it’s not necessarily the drug itself, but the amount. For example,an overdose of painkillers can result in permanent damage. Genetics can be a culprit too.

Hearing difficulties fall into three categories: sound conduction, sensorineural, or combined.

Sound conduction difficulties reduce, or block, the sound waves entering the inner ear.
Sensorineural difficulties involve a pathological change of the inner ear or auditory nerve. Sometimes, the auditory nerve does not send the received signal to the brain accurately.

When is the right time to seek help?

Look out for these signs:

  • Difficulty following a conversation with two or more people at once
  • Difficulty understanding what people are saying in loud environments, such as busy shops or restaurants
  • Others sound like they’re mumbling
  • You have to listen to the TV at high volume
  • Ringing in the ear
  • Group conversations are exhausting

Types of Hearing Loss

The medical community has identified three types of hearing loss: conductive, sensorineural, and combined. Hearing loss affects your quality of life, health and social interactions, and how you treat it depends on its severity:

Hearing Test

Better hearing begins with a test

The signs of hearing loss are usually subtle and develop over time. If people around you always complain that your TV is too loud, or if you struggle to follow conversations in a noisy environment, especially in group discussions, you will need a hearing test. Only a licensed hearing care professional (ear-nose-throat specialist, audiologist or any hearing aid acoustician) can use the proper techniques and equipment to yield accurate data. Based on your results, they’ll then recommend the correct treatment. In the case of tinnitus, they will also perform a test to evaluate your hearing.

Take the first step with hear.com

A conversation with us will help put you on the path to better hearing—before you see an audiologist. Sign up for a free consultation, and one of our hearing aid experts will talk to you about your hearing situation, needs and lifestyle, and equip you with relevant information on hearing loss and treatments. After the consultation, you’ll be prepared to visit one of our partner providers near you. They’ll measure your hearing loss and suggest suitable hearing aids. It’s life-changing!

Types of hearing tests

Audiometry exams can help diagnose your type and degree of hearing loss. A hearing care professional will perform either a subjective hearing test, objective hearing test, or a combination of the two. Most of the time, it will require you to sit in a soundproof room with headphones or earphones on, connected to an audiometer. The specialist will transmit sounds to your ears and record your responses on an audiogram.

Subjective hearing test

This type of hearing test requires you to cooperate. During a subjective hearing test, the specialist will play sounds or words and ask you to make a gesture in response to these sounds.

Pure-tone audiometry

A pure-tone or air-conduction test measures how well your outer and middle ear process sounds and finds the softest sounds you can hear. Wearing headphones or earphones, you will listen to “pure” tones at different volumes, and signal once you hear each tone. If the exam reveals hearing difficulty, a bone-conduction test (which transmits sounds through the skull to the inner ear via a device, without any interference from the outer or middle ear) can help to differentiate between conductive and sensorineural hearing loss.

Speech audiometry

By repeating two-syllable words while a tone gradually decreases to lower levels, this test will indicate the level at which you can hear and understand certain sounds. It may also include a word-recognition exam, where the specialist will ask you to repeat certain words. To test comprehension, you will listen to one-syllable words at a comfortable listening level and repeat what you hear.

Objective hearing test

Typically performed on newborns and infants, this type of test does not require you to cooperate. Objective hearing tests can help identify damage to the inner ear and assess your quality of hearing.

Otoacoustic emission (OAE) test

This hearing evaluation can reveal damage to the inner ear (cochlea). A specialist inserts a small device into the ear canal and measures if outer hair cells in the inner ear vibrate in response to the sounds. If nothing comes back, it may point to hearing loss.

Auditory brainstem response (ABR)

Electrodes attached to the head measures how hearing nerves respond to sounds in a specific frequency range. A computer will record the results.

Acoustic reflex test

This test helps to establish the severity of a hearing loss. It uses sounds to determine if the middle-ear muscles contract when stimulated.


A tympanometry exam allows specialists to diagnose problems in the middle ear and any disorders linked to hearing loss. A probe sends loud sounds into the ear canal to measure movements of the eardrum as the air pressure changes.


Produced by an audiometer, an audiogram is a graph that demonstrates your hearing threshold (the softest sound you can hear) at different frequencies (or pitches) in each ear. The audiogram’s ready-made form lists pitch horizontally (frequency ranging from low to high in Hertz, Hz) and volume vertically (from soft to loud in decibel, dB). It shows the sounds you can hear normally and the sounds that are missing.

How to read an audiogram

The top of the graph indicates normal hearing. The further down you go, the more challenging it may be for you to hear and understand certain sounds. For example, consonant sounds (t, s, f, th, k, sh, ch) are higher pitched and spoken more softly than vowels. If you’re missing sounds in the higher ranges, it means you can hear it, but can’t understand it (it sounds like mumbling). Some specialists will use the left side of the graph (volume in dB) to measure the severity of your hearing loss.

Air and bone conduction

In air conduction tests, headphones allow sound to travel from the outer to the inner ear, and in bone conduction tests, a device placed behind the ear transmits sound vibrations through the skull. When tones are poorly recognised via air but well recognised via bone conduction, the expert will refer to this as a conductive hearing loss. It can be because of a foreign body in the auditory canal, a middle ear effusion or an issue with sound transfer from the eardrum to the ossicles (three small bones in the middle ear). These causes are often treatable, but if not, hearing aids may be a good option.

In the case of a sensorineural hearing loss, you have trouble hearing high frequencies. The hearing curve on the audiogram will run parallel for both bone and air conduction, whereas the individual threshold will be well above the standard hearing threshold. This range requires higher volumes until the hearing threshold can be determined (common in people with age-related hearing loss). While medication and surgery don’t usually bring relief, wearing hearing aids can alleviate a loss of inner ear function.