Types and Degrees of Hearing Loss

Two people can have the same audiogram and have completely different problems. One has fluid behind the eardrum that a physician can treat. The other has permanent inner ear damage that hearing aids can help with but nobody can reverse. Same numbers on the chart, different diagnosis, different path forward.

That is why a hearing evaluation asks two separate questions: how much hearing is missing, and where in the ear the breakdown is happening. This page covers both.

The three types of hearing loss

Conductive hearing loss

Sound is having trouble getting from the outside world into the inner ear. The inner ear itself is usually fine. Something in the ear canal or middle ear is blocking or dampening the signal.

Common causes include impacted earwax, fluid behind the eardrum, ear infections, a perforated eardrum, otosclerosis, and less often a growth or bone abnormality. Sound tends to feel muffled or plugged rather than distorted, and people often say their own voice sounds strange inside their head.

The important part: conductive loss is frequently medically or surgically treatable. If testing shows a conductive component, we refer to a physician or ENT before anyone starts talking about hearing aids. Fixing the cause is the better answer when fixing the cause is possible.

Sensorineural hearing loss

This is the common one in adults. The hair cells inside the cochlea, or occasionally the auditory nerve, are damaged. Sound reaches the inner ear fine. The inner ear cannot process it cleanly.

Aging and noise exposure account for most cases. Genetics, certain medications, head injury, diabetes, and disease processes contribute in others. It is almost always permanent, because those hair cells do not grow back.

What makes sensorineural loss distinctive is clarity. It is not just quieter. It is fuzzier. Turning up the volume makes sound louder without making words clearer, which is the frustration that drives most people to finally get tested. Hearing aids are the primary tool here, and they work well when they are fit and verified properly.

Mixed hearing loss

Both at once. There is permanent inner ear damage plus something conductive layered on top, such as long-standing noise damage in someone who also has an ear infection or a wax blockage.

Mixed loss usually gets managed in two steps. Treat the conductive part medically, retest, then address whatever sensorineural loss remains.

A note on auditory processing

A smaller group of people have normal or near-normal hearing thresholds and still struggle badly to understand speech, especially in noise. The ears are picking up sound; the brain is having trouble sorting it. This is not classic hearing loss and it does not always respond to hearing aids the same way. It is worth naming because these patients often get told their hearing is fine and sent home with no explanation for a very real problem.

Degrees of hearing loss

Degree describes severity. It is measured in decibels hearing level, or dB HL, and it refers to the softest sound you can detect at each pitch. Higher numbers mean more hearing loss, which trips people up at first.

These are the ranges most clinics in the United States use:

• Normal (up to 25 dB HL):Everyday conversation is comfortable in most settings.
• Mild (26 to 40 dB HL):Soft speech and distant voices get missed. Noisy rooms take effort. Many people at this stage insist their hearing is fine, and in quiet, it nearly is.
• Moderate (41 to 55 dB HL):Normal conversation is genuinely difficult without help. The TV goes up. Repeating becomes routine.
• Moderately severe (56 to 70 dB HL):Speech has to be loud to be followed at all. Group settings and phone calls become very hard.
• Severe (71 to 90 dB HL):Ordinary conversation is inaudible. Communication depends on amplification, visual cues, or both.
• Profound (91 dB HL and above):Even shouted speech may not be understood. Powerful hearing aids or cochlear implant evaluation come into the discussion.

Degree is rarely uniform across pitches. It is very common to sit in the normal range for low tones and drop into moderate or severe in the highs. That specific pattern has its own page: high-frequency hearing loss.

Configuration: the shape of the loss

Beyond type and degree, the pattern across pitches matters for how a hearing aid should be programmed.

• Sloping:Good in the low pitches, worse as pitch rises. The most common adult pattern.
• Flat:Similar loss at every pitch.
• Rising:Worse in the low pitches, better in the highs. Less common.
• Notched:A dip in one region, classically around 4000 Hz, often a fingerprint of noise exposure.
• Precipitous:Near-normal lows falling off a cliff in the highs.

Loss can also be bilateral (both ears), unilateral (one ear), symmetrical, or asymmetrical. A meaningful difference between the two ears is a finding we do not ignore, and it is covered under one-sided hearing loss.

Why word recognition matters more than the numbers

Two patients arrive with identical moderate sensorineural losses. One repeats 92 percent of test words back correctly. The other manages 58 percent.

Their audiograms look the same. Their outcomes will not be. Word recognition scoring measures how much usable information survives the trip through a damaged inner ear, and it adds important information about likely hearing-aid benefit beyond tone thresholds alone.

This is one reason we do not fit hearing aids off a screening or an online test. Thresholds tell us how much to amplify. Word scores tell us what is realistic to expect afterward, and setting honest expectations up front is most of what makes a fitting successful.

Getting your own answers

A comprehensive evaluation identifies type, degree, configuration, and word recognition in a single visit, and you leave understanding what each of those means for you specifically.

Hearing Aid Factory Outlet is located inside Sugarloaf Mills at 5900 Sugarloaf Parkway in Lawrenceville and serves hearing-aid patients from Gwinnett County and communities throughout the Atlanta area. We are open seven days a week. Schedule an evaluation or call (404) 786-6416.

Related reading: signs of hearing loss, age-related hearing loss, and our hearing testing services.