What Level of Hearing Loss Requires a Hearing Aid?

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A woman looking at a pair of hearing aids in her hands, wondering what level of hearing loss requires a hearing aid?

Think back to the last time you had to ask someone to repeat themselves. Maybe there was a great deal of background noise. Maybe they were speaking too softly.

Or maybe you are suffering from mild to moderate hearing loss.

Many people struggle with the same questions once they begin to notice a decline in their hearing. “Am I losing my hearing? What level of hearing loss requires a hearing aid? How effective are hearing aids? Do I need a hearing aid for mild hearing loss? Can mild hearing loss be corrected?”

The answers may surprise you! Hearing loss isn’t limited to extreme cases. A recent study found that over 700,000 New Zealanders are affected by hearing loss.

If you feel you might be one of those people, read on to find out if a hearing aid can help you.

Causes of Hearing Loss

Despite what you might think, old age is not the only reason a person experiences hearing loss. Sensorineural, conductive, and mixed hearing loss have a variety of causes.

Sensorineural hearing loss (SNHL) represents about 9 in 10 cases of reported hearing loss. Age-related hearing loss (presbycusis) is the most common form of SNHL, and noise-induced hearing loss is the second.

The second most common type of hearing loss is called conductive. This is when something physically blocks or damages the ear and keeps sound from reaching the inner ear.

Ever had a bad ear infection and had to suffer through muffled underwater sounds till it got better? That’s a good example of conductive hearing loss. A few others include water blocking your ear, Eustachian tube dysfunction, or just too much wax in there.

Conductive hearing loss isn’t usually permanent. It often gets better once you address the underlying problem. It’s often hard to figure out what that problem is without consulting a general practitioner or an audiologist.

Finally, you may be suffering from mixed hearing loss. This is when sensorineural and conductive hearing loss happens at the same time. Again, getting your hearing tested will be the first step in figuring out what’s causing the problem.

How Hearing Loss is Measured

When you have a hearing test, your hearing ability is measured in “levels” from mild to profound. Each level is categorised by a range – or level – of decibels concerning human hearing and speech frequencies.

Measuring Decibels and Perceived Volume

Decibels represent sound intensity or amplitude. The higher the number of decibels, the louder a sound is. Decibels are measured on a logarithmic scale which is different to a linear scale.

A linear scale is more relatable for most people as we often encounter it in our daily lives. An example of a linear scale is a ruler measuring distance. The markings on a ruler are of equal distance to one another, making them linear.

A logarithmic scale is not linear and represents exponents (or powers) of a base number. You might remember exponents from maths class in school. An example is 5 to the power of 2, where 5 is the number and 2 is the exponent explaining how many times to use the number in a multiplication. In which case it is 5 x 5 = 25.

In the case of decibels (dB), for every 10-dB rise, there is a 10-fold increase in sound intensity, and we perceive this as being 2-times louder in volume.

The below table shows the logarithmic scale in more detail.

Decibels, Perceived Volume and Sound Intensity

Source ExampleDecibels
(Intensity Level)
Increase in Sound Intensity
(No. of Times Greater Than TOH)
Percieved Volume
Increase
Daily Exposure
Limit
Threshold of hearing (TOH)0 dB--
Rustling leaves10 dB10 times the sound intensity2 times as loudUnlimited
Whisper at 1 m distance20 dB100 (10 x 10)4 (2 x 2)Unlimited
Whisper face to face30 dB1,000 (10 x 10 x 10)8 (2 x 2 x 2)Unlimited
Library40 dB10,00016Unlimited
Quiet office50 dB100,00032Unlimited
Normal conversation60 dB1,000,00064Unlimited
Vacuum cleaner70 dB10,000,000128Unlimited
Heavy traffic noise80 dB100,000,00025625 hours
Petrol lawn mower90 dB1,000,000,0005122.5 hours
Car horn100 dB10,000,000,000102415 minutes
Live rock music110 dB100,000,000,000204830 seconds
Petrol chainsaw120 dB1,000,000,000,00040969 seconds

A normal face-to-face conversation is about 60 dB. The siren from an ambulance is about 120dB, and it’s unsafe to listen to up close for longer than 9 seconds.

The increase in sound intensity or the extra energy it takes to produce the sound from 60 dB, and 120 dB is 1-million times! And you would perceive the volume increase as being 64 times louder.

All of this might sound a little complicated, but don’t worry, it sometimes confuses the best of us! The important things to remember are:

  1. The scale is not linear but logarithmic. For example, the difference between the perceived volume and sound intensity between 40 dB and 50 dB is not the same as between 50 dB and 60dB.
  2. Sound intensity is the energy required to create a given level of sound. And the perceived volume increase is the level at which a person hears or interprets the difference in the volume of the resulting sound.

Levels of Hearing Loss

The lowest level of hearing loss is “mild“. Mild hearing loss indicates people have difficulty hearing speech below 26 to 40 dB.

Mild loss is particularly noticeable when someone is talking while not facing you or talking to a child who speaks softly (and in the higher frequencies).

One might think that mild means it has little to no effect on a person’s daily life, but listening fatigue, falling behind at school or work, and feelings of isolation aren’t mild at all.

In childhood, it’s easier to notice when someone can’t hear the teacher in class. As a person enters adulthood, hearing loss is often just brushed off as something that happens to us as we get older. There’s growing evidence to suggest doing something sooner rather than later is a good idea.

One level up is “moderate” hearing loss. A person with hearing loss in this range has trouble hearing speech softer than 41 to 55 dB. You might realise you can’t hear the phone ringing or have trouble understanding someone when they’re talking at an average volume in the presence of background noise.

Moderately severe” hearing loss is the next level, where hearing normal conversation is a real struggle. Any conversation under 56 to 70 dB is not loud enough to be heard.

Remember, a normal face-to-face conversation takes place at about 60 dB.

You can’t hear conversational speech with “severe” hearing loss, and the threshold is 71 to 90 dB.

Profound” hearing loss caps off the spectrum, meaning the inability to hear speech under 91 or more decibels.

When you have a full diagnostic hearing test, your hearing ability is mapped on an audiogram, which provides you with your level of hearing loss.

What is an Audiogram?

An audiogram is the result of a pure-tone hearing test to measure hearing sensitivity. The audiogram plots sound you can hear at different frequencies (pitch) and decibels (volume).

Frequency is a measure in hertz (Hz). Humans with normal hearing can hear sounds between 20 Hz and 20,000 Hz.

An audiogram will describe hearing sensitivity from normal to profound loss.

The stylised audiogram below plots normal hearing and all levels of a sloping hearing loss concerning:

  • a speech banana
  • face to face conversational speech between two adults
  • the frequency of various letters when spoken
  • the volume and frequency of multiple sounds like a bird singing and a band playing.
Stylised audiogram of normal to severe sloping loss
Stylised audiogram of normal to severe sloping loss

A speech banana is not a delicious snack for audiologists, but the audible region of phonemes or various human speech sounds is plotted on an audiogram. You can see how isolated sounds from speech cover a wide range of frequencies and volumes.

Try this out for yourself! Phonetically sound out some parts of speech:

  • eɪ – which is in words like, say or eight
  • tʃ – such as in, check or church
  • ɔɪ – for example, boy or join.

Notice the difference in both volume (how loud it sounds) and frequency (how deep or high pitched it sounds).

People with normal hearing can hear all the frequencies at all the volumes on an audiogram.

People with mild hearing loss fail to hear the sounds above the pink line, such as birds chirping and leaves blowing in the wind.

Even with a mild loss, there is potentially a reduction in speech comprehension. Depending on the severity of mild hearing loss, you may also fail to hear sounds above the green line, including some speech sounds in the speech banana. This loss of ability to hear speech might be unnoticeable as people often alter their behaviour to compensate.

With a moderate hearing loss, the level begins at the green line and depending on the severity; it can reach the blue line. The blue line is where face to face conversational speech at an average volume starts to become difficult to hear.

Can you start to see the pattern forming? For example, the lower threshold for the mild hearing loss level is the pink line, and the upper limit is the green line.

Prevalence of Hearing Loss in Young People

The natural aging process is a cause of hearing loss common to us all – called presbycusis. As a result, many people think hearing loss is a disease for older people. However, this isn’t the case.

Young people are arguably increasingly susceptible to hearing loss in a world where its estimated noise pollution doubles or triples every 30 years. The use of smartphones, earbuds, and headphones is no doubt taking a toll.

A study on the social and economic costs of hearing loss in New Zealand found that many younger people were affected. 21,480 out of 600,144 people with mild hearing loss were between the ages of 0 and 20.

This prevalence isn’t confined to one country; the World Health Organization (WHO) reports that 34 million children worldwide suffer from hearing impairment.

Babies and young children are most at risk from complications at birth, genetic causes, certain diseases, recurring or chronic ear infections, medical treatment with particular drugs, and exposure to excessive noise.

The WHO also reports 1.1 billion young people aged between 12–35 years are at risk of hearing loss from exposure to noise in recreational settings. For example, excessive use of headphones and earbuds, going to loud concerts and bars or playing music in a band are all scenarios where damage to your hearing is a distinct possibility.

The point is, your age is not the deciding factor on whether or not you have a hearing loss. To be sure, go and get a hearing test.

You can start with an online test and then graduate to an in-person hearing screening. Both are free (at least at Ear Health) and only take a few minutes of your time.

Depending on the hearing screening results, you might require a full diagnostic hearing test which takes about an hour to complete and costs about $90. You will receive documentation about your hearing ability at the end of the full diagnostic test, including an audiogram.

Upgrading From “In-The-Drawer” Hearing Aids

A common form of listening device is the ITD, or “in-the-drawer” style. This model features outdated technology that causes users to experience annoying feedback whistles, improper fitting, and a hearing experience that doesn’t meet their individual needs. As a result, the user threw them in a drawer and resigned to the idea that hearing aids don’t work for them.

ITD hearing aids lead some people to believe they must settle for a lower quality of life. So how can this problem be addressed?

Back in 1999, MarkeTrak V surveyed hearing aid users. The survey asked people to write a letter detailing whether they wore their hearing aids and, if they didn’t, explain what they saw as the problem. More than 16% of users said they had decided not to use their hearing aids at all, citing not only whistling feedback but improper fit and high cost as the reasons.

Compare that to a 2019 MarkeTrak10 survey that found 79% of hearing aid users wore them daily, along with other significant improvements in satisfaction rates. These improvements include digital microchip technology that amplifies sounds according to a user’s unique hearing prescription.

Other advancements in the last 20 years include Bluetooth capability, smartphone apps, remote controls, rechargeable batteries, feedback (whistling) elimination and wind noise reduction.

In terms of technology, hearing aids have advanced significantly, and they are much less likely to end up in your sock drawer.

Aesthetically, they are also more appealing, with smaller components, and even high-powered hearing aids are now small and discreet.

Do You Need a Hearing Aid for Mild Hearing Loss?

The truth is that even people with mild hearing loss are candidates for a hearing aid. The same study that found statistics on how many young people are affected also showed that those with mild hearing loss were in the overwhelming majority. Over 600,000 out of 880,350 overall cases in New Zealand alone reported mild hearing loss.

Treating the problem with a hearing aid while still in the mild range will help you maintain your quality of life and stay engaged in social situations.

Early intervention has many potential health benefits, including:

  1. Improved relationships through maintaining or improving intimacy, communication and independence.
  2. Enhanced career prospects by being able to sustain communication ability in a broad range of workplace scenarios.
  3. Keeping the mind stimulated and possibly decreasing the risk of cognitive decline, brain shrinkage and dementia.
  4. Minimising the risk of depression and other mental illnesses that may result from the isolation, loneliness and stress experienced with untreated hearing loss.

So if you’ve been finding yourself wondering why people won’t stop muttering or have been noticing that some words aren’t coming through clear, don’t hesitate to discuss with one of our audiologists. We can help you address the issue now before it becomes an even bigger problem.

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