Why You Can’t Hear in Some Situations

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Hidden hearing loss (HHL), a type of auditory disorder, is hearing loss that can’t be detected through standard hearing tests such as a speech-in-noise (SIN) test. Unlike other types of hearing loss, HHL happens when there is a defect in your cochlea, a bone in the inner ear. Factors such as old age, exposure to loud noise, and taking certain drugs can increase your risk of developing HHL.

Read more to learn about the tests that can detect hidden hearing loss, signs that show it, and ways to manage it. 

Signs You Need a Hearing Test

Verywell / Theresa Chiechi

What Is Hidden Hearing Loss?

Hidden hearing loss doesn't present in the same way as other types of hearing loss. It is often more difficult to diagnose, as it isn't caught during a standard speech-in-noise (SIN) test. During a SIN test, a variety of voices are played over background noise. The listener is assessed to determine if they can differentiate between useful (speech) and irrelevant (background) noise.

Oftentimes, those with HHL cannot be diagnosed with a standard audiogram (a commonly used hearing test). Their hearing will usually appear unaffected on this type of test.

Why does this occur? In terms of ear anatomy, sound waves travel from the middle ear to the inner ear, causing vibrations in the hair cells. These send impulses to the brain for interpretation. In those with HHL, the auditory nerve cells (cochlear nerve) used to interpret the sounds are damaged.

Signs of Hidden Hearing Loss

The signs and symptoms of hidden hearing loss may include:

  • You have a strong feeling that you can’t hear properly even after your hearing tests reads normal.  
  • You prefer quiet environments.
  • You find it difficult to focus in noisy places.
  • You often misinterpret what people say.


One of the major causes of hearing loss is noise. Long exposure to noisy environments can increase the risk of developing hidden hearing loss. Age is also a common contributor. As you get older, your nerve synapses—which help in transporting sound waves to the brain—reduce. Over time, this can affect the way you hear.

Also, a 2017 report showed that malfunction with cells that make myelin, the protective layer around neurons in the central nervous system, can cause hidden hearing loss. Certain disorders like Guillain-Barré syndrome and multiple sclerosis can attack myelin.

The cause of hidden hearing loss can often be attributed to your brain rather than your ears. The signals may be passing through your middle ear to your inner ears perfectly, but your brain may not receive these signals for proper interpretation. 

Diagnosing Hidden Hearing Loss

Not all tests can show that you may be experiencing hidden hearing loss. Tests that may help with diagnosis include:

  • Extended high-frequency pure-tone audiograms: These specialized audiograms measure the gentlest sound you can hear at a high frequency.
  • Otoacoustic emissions (OAE) tests: These tests are used to assess the function of the cochlea. They measure the sounds that come off the hair cells when they vibrate.
  • Otoscopy: This procedure checks the ear anatomy and determines if there are any physical issues.
  • Tympanometry: This is a test to evaluate the middle ear—specifically a structure called the tympanic membrane—to see if it responds appropriately to pressure changes.
  • Acoustic reflexes: This test assesses how well your middle ear responds to a loud sound.
  • Auditory brain stem response (ABR) test: This is also known as brain stem auditory evoked response (BAER) and auditory evoked potential (AEP). During this test, electrodes attached to the head track brain waves that occur when sounds are heard. This is a noninvasive and highly accurate test.


Researchers are working to find ways to regrow the neuron synapses that have worn out, contributing to hidden hearing loss. People with little or mild hearing loss use hearing aids that have speech-in-noise adjustments. The hearing aids use their in-built microphones to pick up signals in front of you and lower the ones around you. 

It can help to find a healthcare provider who is an expert in handling patients with hidden hearing loss. They will know the right devices or mobile applications you need to aid your hearing based on your individual situation. 


Hidden hearing loss is a type of hearing loss that can’t be detected by some hearing tests. It is a result of disconnection in sound transmission between your inner ear and brain.

Avoiding excessive exposure to noise can help prevent cases of hidden hearing loss. Watch for signs that could hint at a hidden hearing loss disorder, such as difficulty communicating with those around you or trouble focusing in noisy environments.

Don’t hesitate to visit your healthcare provider if you are having difficulty hearing. They can recommend specific devices or mobile apps that can assist you with your hearing. 

A Word From Verywell

Living with hidden hearing loss may not be easy, but it can be managed. Certain drugs are being reviewed to see if the lost synapses could be regrown to cure hidden hearing loss. In the meantime, connecting with in-person or online support groups can help you maintain your mental health and give you a sense of community. You’re not alone in this journey.

Frequently Asked Questions

  • Is hearing loss considered a disability?

    Generally, hearing loss is not considered a disability unless it prevents you from working or completing certain daily activities. 

  • How can you tell if hearing loss is permanent or temporary?

    If the hearing loss occurs after an ear infection or due to excess earwax then it is likely temporary hearing loss. However, if your hearing is not regained, then it could be a permanent hearing loss. Always consult with an auditory healthcare professional so they can give you a definitive diagnosis.

  • What is the minimum VA rating to qualify for hearing loss?

    The minimum VA (Veteran Affairs) rating for mild to moderate hearing loss is from 0% to 10%. Severe hearing loss has a VA rating ranging from 30% to 50%.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Cunningham LL, Tucci DL. Hearing loss in adults. N Engl J Med. 2017;377(25):2465-2473.

  3. Wan G, Corfas G. Transient auditory nerve demyelination as a new mechanism for hidden hearing loss. Nature Communications. 2017;8(14487).

  4. Tyler RS, Perreau A, Mancini PC. Consequences of hidden tinnitus and hearing loss. The Hearing Journal. 2020;73(8):8-9 doi:10.1097/01.HJ.0000695808.51418.5d

  5. Stepko B. Why you may have sudden hearing loss in noisy settings. AARP.

  6. Avraham O, Feng R, Ewan EE, Rustenhoven J, Zhao G, Cavalli V. Profiling sensory neuron microenvironment after peripheral and central axon injury reveals key pathways for neural repairElife. 2021;10:e68457. doi:10.7554/eLife.68457

By Margaret Etudo
Margaret Etudo is a health writing expert with extensive experience in simplifying complex health-based information for the public on topics, like respiratory health, mental health and sexual health.