“There is a difference between hearing aids and glasses. Hearing aids only 'help' if there is usable hearing remaining in the ear. They do not 'correct' hearing the way glasses correct vision. People with profound hearing loss may have no hearing at all; they therefore cannot use hearing aids and must consider other solutions, such as cochlear implants.” - Drew Sutton, MD, Board-Certified Otolaryngologist
For many, hearing loss is simply part of getting older; for others, it seems to appear out of nowhere, with little warning. Hearing loss is multifactorial and spans a wide range of severity.
Beyond normal hearing, hearing loss ranges from mild to severe. Among the different types of hearing loss are conductive hearing loss, sensorineural hearing loss, and profound hearing loss. Affected individuals typically have damage to the structures of the cochlea or the auditory nerve.
As we already know, hearing loss can be caused by noise exposure. Other common causes include ear infections, head trauma, certain medications, tinnitus, viral infections, and diseases like meningitis.
While some people with hearing impairment perceive soft sounds almost at a normal level, others need amplification or hearing aids as soon as they are in noise. Depending on the type of hearing loss or hearing impairment you have, amplification may specifically target low or high frequencies. It helps restore some audibility.
Many people approach hearing loss as an all-or-nothing situation: either you have severe hearing loss, or your hearing is perfectly intact. In reality, hearing loss exists on a spectrum, with varying degrees of auditory acuity, which can even vary depending on the pitch of sounds.
If you or a loved one suffers from hearing impairment, you may have already heard the term "profound hearing loss." While it seems obvious that profound hearing loss corresponds to deeply impaired hearing, the term actually refers to a very specific diagnosis based on numerous tests.
Here is a more detailed look at what exactly profound hearing loss is, how hearing loss is judged to be profound, and an overview of what you can do about hearing impairment.
How is hearing loss tested?
Hearing loss can affect all ages (infants, young children, teenagers, adults) and, although older people account for a proportionally higher number of cases, the truth is that it can affect you at any point in your life.
In the past, hearing loss often went unnoticed during childhood, leading many students to perform poorly in school due to not hearing properly. Over the past few decades, local communities have begun to mandate school hearing screenings to identify hearing loss as early as possible.
Regardless of age, hearing tests are fundamentally the same and are an excellent way to better understand your hearing acuity and any weaknesses it may have. A standard hearing evaluation may include pure-tone audiometry, tympanometry, and bone conduction testing.
The combination of these examinations allows the audiologist to measure the extent of hearing loss and identify the most likely type of hearing loss.
Here's a more detailed look at the different components of a hearing evaluation and what they can reveal.
Pure-tone audiometry
If you have never had your hearing tested, or if you haven't since childhood, you are probably not familiar with an audiogram. An audiogram is the graphical representation of pure-tone audiometry: it tells you about your hearing acuity at different sound pitches.
Pure-tone audiometry begins with you sitting in a quiet room, often soundproofed. You wear headphones, and the audiologist plays a sound at a given intensity and pitch.
The audiologist will most likely ask you to raise your hand on the side where you hear the sound. If a sound is played but not heard, they will increase the intensity and repeat until you perceive it.
At the end of the test, your hearing level for the right and left ear appears on the audiogram. This usually indicates the degrees of hearing loss directly on the graph, to help you understand the quality of your hearing. The more decibels it takes to hear a given frequency, the more severe the hearing loss.
Tympanometry
Unlike pure-tone audiometry, tympanometry is an examination that does not require the person to make any listening effort. Tympanometry essentially assesses the proper functioning of your middle ear.
It relies on a device that varies the pressure in the ear canal while emitting a sound. The proportion of sound reflected versus absorbed by the middle and inner ear allows clinicians to determine if the middle ear is functioning as it should.
The result of a tympanometry is called a tympanogram, and it is a little less intuitive to interpret. The examination generally produces a pyramid-shaped curve, which is then compared to the reference tympanogram.
This test helps determine if the hearing loss is conductive or sensorineural. If the test shows a normally functioning middle ear while hearing loss is detected, this points to a sensorineural origin.
Bone Conduction
The bone conduction test assesses your ability to hear sounds transmitted through your skull. The vibrator is placed on the skull region behind the ear, called the mastoid. The device then emits vibrations of varying frequencies and intensities, which are conducted through the bone and interpreted as sound by the cochlea.
A bone conduction test is conducted similarly to pure-tone audiometry and can also result in an audiogram, which is then compared to the reference. It is used because it bypasses the middle ear and exclusively evaluates the functioning of the sensorineural components of hearing, such as the cochlea.
What is profound hearing loss and how is it defined?
Once the general outline of a hearing evaluation is understood, it becomes much easier to grasp what exactly is meant by profound hearing loss. According to the CDC, profound hearing loss is characterized by the inability to hear speech: affected individuals only perceive very loud sounds.
More specifically, people with profound hearing loss are unable to hear sounds below 91 decibels. Above 91 decibels, for example, are lawnmowers, ambulance sirens, or a concert. Profound hearing loss can affect one or both ears and can result from sensorineural, conductive, or mixed damage.
Profound hearing loss is equivalent to functional deafness. Completely deaf people may have no auditory sensation, but those with profound hearing loss hear nothing below the sound level of a leaf blower.
People with profound hearing loss or profound deafness most often rely on sign language or visual cues (such as lip-reading) whenever there is noise or speech.
What you can do about hearing loss
Living with impaired hearing can be challenging, and it's frustrating to constantly have to ask people to repeat themselves. Thanks to modern medicine and technology, people with hearing impairments have several tools to reduce the impact of low auditory acuity on daily life.
Here is an overview of the different ways to address hearing loss. Receiving a diagnosis of hearing impairment can be daunting: knowing your options and available tools makes the news a little easier to accept.
Hearing aids
Hearing aids are small devices that amplify the intensity of sounds in your environment to bring them to your perception threshold. They achieve this through a microphone, an amplifier, and a speaker. The microphone picks up the sound your ear would normally hear, then sends it to the amplifier, where the pitch remains the same but the intensity increases. The signal is then transmitted to the speaker, which reproduces the sound very close to the eardrum.
People with mild to moderate hearing loss are good candidates for hearing aids, as they generally retain the ability to distinguish pitch differences and simply need sounds to be a little louder. Hearing aids for moderate hearing loss can significantly improve your understanding of what people around you are saying.
Hearing aids come in many forms and can incorporate several additional features. The CLARIA EV3, for example, comes in a very compact format and integrates the Clear Sound + function. This function isolates speech in the environment and amplifies it while simultaneously reducing ambient background noise. The result: clear speech, much easier to hear.
Implants
Profound sensorineural hearing loss and deafness are hearing impairments that can benefit from an implant.
