Hidden Hearing Loss: Learn the Signs. Take Action.
November 15, 2021

Hidden Hearing Loss: Learn the Signs. Take Action.

A man is taking a picture of a family at a dinner table.

Do you feel like you hear fine, but you struggle to understand speech when there is a competing of background noise, like at a large family gathering? You could have hidden hearing loss.

More than 65.5 million americans have hearing loss and more than 30 million americans have tinnitus

"With a hidden hearing loss, the brain is still able to process simple sounds resulting in the appearance of 'normal hearing,' but more difficult sounds like conversational speech can be harder for the brain to process."
-- Ali Carmichael, Au.D.

“A person’s sense of hearing connects them to the world around them and helps them stay

engaged with the people, places and events in their lives,” said Dr. Megan Johnson,

audiologist and owner of Johnson Audiology. “Yet many people discount their hearing,

ignoring the signs that something is amiss with their inner ear and waiting years to address

it. I see it every day in my practice; people who tell me they have been struggling in different

listening environments for 10 years or more. It disturbs me that people put off seeking

helping because of embarrassment, or fear or misunderstanding, especially now in an era

when help for hearing issues is so advanced and accessible.” Dr. Johnson continued, “Part

of Johnson Audiology’s mission is to bring education about hearing and hearing loss to the

forefront, teach people how important your sense of hearing is and smash the stigma that

some feel in regards to their hearing issues. Hearing loss is widespread; yet treatment is

right around the corner at your nearest audiologist. People don’t have to live with untreated

hearing loss anymore!”


How widespread is hearing loss?

Dr. Ali Carmichael, one of the 12 audiologists that makes up the team of hearing

professionals at Johnson Audiology, said, “More than 20% of the United States population

is affected by various types and degrees of hearing loss. That’s more than 65.5 million

people! Additionally, tinnitus, which is a constant or intermittent ringing, buzzing, or hissing

in the ears, affects more 30 million Americans.” Recent research has come out that states

that up to 13 million Americans without any degree of hearing loss also experience some

form of tinnitus. Through medical conditions, noise exposure, genetic conditions, or the

processes of aging, hearing loss can occur gradually or suddenly at any stage of life. The

inner ear, or cochlea, is composed of thousands of small hair-like fibers responsible for

sending hearing signals to the brain. One of the leading causes of hearing loss in people

under the age of 40 is due to noise exposure, which can cause major damage to the inner

ear leading to hearing loss and tinnitus.


What is hidden hearing loss?

Dr. Johnson said, “For most people with hearing issues, a basic hearing test, also called an

audiogram, reveals, in a very obvious way, the type and severity of a person’s hearing loss.”

Sometimes damage done to the inner ear, either by noise exposure or auto-immune

disorders, is not so transparent though. Dr. Johnson mentioned that in some cases

“damage can create a ‘hidden hearing loss’ where the hearing test shows normal hearing,

but tinnitus or difficulty hearing in a noisy environment is still a concern.” This damage

causes an incomplete signal being sent to the brain, which can lead to a familiar hearing

complaint where a person knows that something is being said but cannot understand the

actual words. The repeated noise exposure causes a breakdown of the hearing system in a

way that is not detectable by a standard hearing test; however, the damage can cause

enough inner hair fibers to be destroyed, which leads to the sensation of tinnitus but with a

lack of detectable hearing loss. Dr. Carmichael said, “With a hidden hearing loss, the brain

is still able to process simple sounds resulting in the appearance of ‘normal hearing,’ but

more difficult sounds like conversational speech can be harder for the brain to process. As a

result, communication often fails.” Long-term exposure to noise, even in small amounts, has

been shown to be one of the leading causes of hidden hearing loss and tinnitus.


Why is hidden hearing loss something to be concerned about?

The frustration a person feels when dealing with hidden hearing loss and tinnitus can lead

to social isolation and a decrease in social interactions. Also, because hidden hearing loss

is more difficult to diagnose, it may be overlooked, a person’s complaints and struggles

minimized, and their frustration grows. A university-trained audiologist is the professional

most equipped and skilled to recognize when a person might be struggling with hidden

hearing loss and to initiate the expanded testing that is necessary for diagnosis. A standard

hearing test with additional noise testing can help to identify the degree of difficulty a person

is having in noisy situations. Speech in noise testing, which includes repeating sentences as

the volume of background noise increases, can be done to help determine the amount of

difficulty someone is experiencing when processing sound with background noise present.

Dr. Johnson urged, “When visiting your audiologist, it is important to relay all symptoms

related to your hearing and balance. This will help your audiologist pick the correct tests and

formulate an appropriate treatment plan.” Important symptoms to relay if hidden hearing

loss may be a concern include:


·often hearing speech incorrectly

·feeling like you are struggling when listening in environments when background noise is

loud but you understand people well in quiet situations

·constant tinnitus, or

·feeling distracted, or even anxious, in difficult listening environments.


Advancements in technology make the difference

Dr. Carmichael said, “Treatment for hidden hearing loss continues to develop, and research

has shown that around 60% of patients with tinnitus say they experience some relief from

their symptoms while wearing hearing aids.” It also has been proven that the improvements

in directional microphones of hearing aids have helped to overcome communication

breakdowns in noisy situations. The advances in noise reduction in hearing aids have

developed to help overcome the volume of noise and help to focus attention towards the

important conversations with loved ones.

Dr. Johnson said, “Over the course of my 19-year

career as an audiologist, I have seen such advancements in technology. It’s these

advancements that have made the detection and treatment of hidden hearing loss possible.

It can be a real game changer for people.”

Knowledge about the structure and workings of the inner ear continues to progress, and a

better understanding of how damage to the inner ear creates different types and degrees of

hearing loss continues to develop. Additionally, hearing technology and treatment for

hearing loss is advancing by leaps and bounds. “At no other time in history have we been

more informed and more equipped to help people with all types of hearing loss,” said Dr.

Carmichael. “Take control of your hearing loss. Take action today.”



By Jan Hollingsworth July 22, 2025
Wondering about that ringing in your ears? Join us for a free community event where our audiologists will discuss tinnitus—what causes it, how it can affect you, and real solutions. Whether you are new to it or have lived with it for years, come learn and ask questions in a relaxed setting. Space is limited! Reserve your spot today! Date: Friday, August 16, 2025 Time: 10 am to 11 am Location: Johnson Audiology's Chattanooga office location at 6830 Lee Highway RSVP to 423-710-1432 or submit the form below.
By Jan Hollingsworth June 4, 2025
Like anything new in life, adjusting to hearing aids can take time and perseverance to achieve the best results. Yet many people are too quick to give up, not allowing the brain the chance to relearn how to hear or not giving themselves the opportunity to become accustomed to the use and maintenance of their devices. “We meet so many people who wait—who convince themselves their hearing is not ‘bad enough’ or that they can just get by. But untreated hearing loss quietly steals moments, connection, and joy. At Johnson Audiology, we understand the fear, the frustration, and the doubt. That is why we offer more than hearing aids—we offer compassion, answers, and a partner you can trust. You don’t have to do this alone. Let us help you hear your life again,” says Dr. Megan Johnson, audiologist and owner of Johnson Audiology. “Hearing aids should never be an experience where a person is fit with devices and then they never see their hearing care provider again. To ensure patient success, Johnson Audiology seeks to be a lifelong partner on a person’s journey to healthy hearing, someone who is there at every turn,” says Dr. Megan Johnson, audiologist and owner of Johnson Audiology. What are the most common reasons why people give up on hearing aids and why is it important to stick with it? Reasons why people might give up on hearing aids An adjustment period It is your brain that hears, not your ears. The ears transmit sound to the brain where it is interpreted. Dr. Johnson explains, “When a person’s brain has not been stimulated by sound because of hearing loss and then sound is restored with hearing aids, it can take some getting used to. For some people, it takes more than one appointment to get them up to full sound prescription, stair stepping up gradually to let the brain adjust. The brain’s capacity to do this is called neural plasticity .” Research by the University of Colorado Boulder’s Hearing Epidemiology and Research Diagnostic Laboratory has revealed that what the brain can experience impacts within weeks rather than years when hearing loss reaches a certain level. Dr. Johnson says, “The brain’s temporal lobe is where much of hearing and sound interpretation happens. Electroencephalogram (EEG), which is a medical test that measures the electrical activity of the brain, shows that in the presence of hearing loss, the brain will recruit areas assigned to other tasks—like vision—to compensate. The trouble is that this extra cognitive load can tax those areas. However, after treatment with hearing aids, brain recruitment is shown to reverse, partially or fully.” The adjustment period for hearing aids tends to be more seamless for those who have not been without sound for years and years. Dr. Johnson says, “I always encourage people to get their hearing checked when they first notice they are struggling. Sooner is always better.” An investment in quality of life People often make an investment in their health and well-being—for example, purchasing glasses, getting a knee replacement, straightening their teeth—and yet many relegate hearing to the backburner because of cost. Dr. Johnson says, “I’ve seen many patients struggle with hearing aids after buying inferior products in an attempt to save money. Without the guidance of a hearing care provider, even the best device can quickly become ineffective and frustrating.” Dr. Johnson encourages making hearing a priority and budgeting for your hearing health. Perceived benefits and ease of use Getting in the routine of putting hearing aids in each day and being diligent about regular cleaning and maintenance might be a challenge that some face and which deters them from being successful with their aids. “At Johnson Audiology, we offer a plan for regular in-office cleaning and maintenance, easing the task of upkeep for patients. Plus, our offices have dedicated walk-in hours that do not require an appointment. We are here to answer questions, make hearing aid adjustments, and much more as we seek to help people safeguard their investment in hearing technology and make the process easy and convenient.” Family attitudes and support When it comes to hearing aids, having a support system can be crucial to success. “In my 20 years as an audiologist, I have seen the immense benefits when a person’s family members show patience and support during the adjustment period with new hearing aids,” said Dr. Johnson. What about patients who do not have that familial encouragement? Dr. Johnson says, “We are your support system. That’s where our caring and professional audiologists, audiology assistants, and patient care coordinators can lend a helping hand. Success with hearing aids is our goal for every patient, so we promise to be there every step of the way.” Why is healthy hearing so important Hearing loss is a family affair The positive impact of treating hearing loss is often manifested most significantly through improved relationships with family and friends. Hearing loss leads to miscommunication. It can also cause mounting frustration as family members must constantly repeat every sentence. Dr. Johnson comments, “Living with the TV blaring can put a strain on others living in the same household. Untreated hearing loss can quietly tear at the fabric of your relationships. When words go unheard and conversations fade, love and connection start to suffer, and that pain is felt by all involved.” Healthy hearing can help the brain stay sharp and pliable For many years, researchers at Johns Hopkins University have been studying the relationship between hearing loss and dementia. While there is still much left to discover, increasingly scientists recognize healthy hearing as a key factor in maintaining a healthy brain and potentially decelerating the risk of dementia, like Alzheimer’s disease. Dr. Johnson says, “It seems logical that when certain areas of the brain are not stimulated by sound, they atrophy. In fact, research suggests an actual reduction in the physical size of the brain, especially in areas where sound processing and memory take place.” She goes on to say that “while there are many risk factors that individuals cannot control about the effects of aging on the brain, hearing is definitely one that can and should be addressed.” Healthy hearing keeps a person engaged in life Humans are social beings. Since hearing loss can impair effective communication, it is not difficult to understand how it also could lead to social isolation, which can cause increased anxiety and depression. “Conversely, addressing hearing loss can keep a person engaged in life and connected to family and friends,” Dr. Johnson says. Falls and other health risks The ears have two main functions. Hearing is one that most of us learn as youngsters, but the ears also play a major role in helping a person maintain their balance and knowing where their body is in space. “The fluid, or endolymph, in the ear’s semicircular canals is what helps a person do things like stand up from a seated position without falling, walk a straight line, and not run into a door frame when turning a corner into a room,” says Dr. Johnson. In the presence of hearing loss, the reduction in acoustic signals impairs a person’s ability to process spatial information and can mean a higher risk for falling. In turn, falling can lead to broken bones and other injuries and a cascading effect of hospital stays and loss of independence. If you have been unsuccessful with hearing aids in the past, call Johnson Audiology, a hearing health clinic comprised of caring and professional staff. The team can bring a range of options to the table to help people hear better, including hearing aids from all six of the major manufacturers, custom fit products, cochlear implants, and Lyric, the world’s only extended wear hearing aid. Call your office of choice today or schedule online.