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What is Hidden Hearing Loss?: The causes, risks, symptoms and treatments

Kimberley Bradshaw - Head of Marketing
Written By:
Kimberley Bradshaw

Head of Online Medical Content

Paul Harrison - Audiology Expert at Hearing Aid UK
Medically Reviewed By:
Paul Harrison

Audiology Expert

Updated: 29th July 2025
Updated and medically reviewed: 29th July 2025 in: Hearing Loss Awareness
What is Hidden Hearing Loss?

What is Hidden Hearing Loss?

The causes, risks, symptoms and treatments

 

Overview

Hidden hearing loss makes it hard to understand speech in noisy places, even if a standard hearing test shows normal results. It’s caused by damage to the nerve connections in the ear, not the ear itself. Common causes include noise exposure, ageing, and certain medications.

While it doesn’t show up on regular tests, support is available through advanced hearing aids, training, and lifestyle strategies. Early help can improve communication and quality of life.

 

An instant decrease in hearing

You’re in a busy cafe with friends, the background music is soft, people are chatting, and coffee machines hiss away.

You lean in to hear the conversation, but something feels a bit off. Everyone else in your group seems to follow the conversation easily, yet you're struggling to pick out what’s being said. 

However, your recent hearing test came back "normal", so what's going on?  If this seems all too familiar, it could be a sign of something known as hidden hearing loss.

Hidden hearing loss refers to difficulty understanding speech in noisy environments, even when your standard hearing test (audiogram) appears normal. It’s called hidden because it doesn’t show up in routine hearing checks. 

These tests only measure how soft a sound needs to be before you can hear it. They don’t assess how well your brain processes complex sounds like conversation in a noisy room.

 

How is hidden hearing loss different from the other types?

Most types of hearing loss involve damage to the hair cells in the inner ear, which help detect sound vibrations. But in hidden hearing loss, the problem lies in the connections between those hair cells and the auditory nerve.

These connections, called synapses, are important for passing sound information to your brain.

When they’re damaged, the brain doesn’t receive all the signals it needs, especially in busy, noisy environments.  In short, you can hear a pin drop in a quiet room, but throw in background chatter and you’re lost.

Related reading:  Types of hearing aids

 

What causes hidden hearing loss?

There isn’t one clear-cut cause, but several causes could be:

  • Noise exposure:  Long-term exposure to loud sounds, even if not loud enough to damage hearing thresholds, can harm the nerve connections in the ear.
  • Ageing:  Even with “normal” hearing, the brain’s ability to process sound can decline with age.
  • Genetics:  Some people may be more susceptible to nerve or synaptic damage.
  • Ototoxic drugs:  Certain medications that affect hearing may play a role.

 

Some real-life examples of hidden hearing loss

In the office:  Working in a busy office and often attending meetings, you might notice that you are nodding along more than usual, pretending you've heard what was said. 

In the moment, you might have thought you were tired or stressed, but then it keeps happening, especially in group conversations. 

Socialising:  You might be partaking in your local pub quiz night, and everyone is enjoying it, but you can't follow the questions being read out. You might blame the acoustics and not your hearing.

These experiences are common among people with hidden hearing loss. It can affect anyone – young professionals, musicians, teachers, and retirees alike.

 

Why doesn't it show up on a hearing test?

Standard hearing tests measure how well you hear tones in quiet settings. They don’t evaluate how you process speech in noisy conditions, which is where the difficulty lies for those with hidden hearing loss. 

Specialised tests like speech-in-noise tests or auditory brainstem response (ABR) tests can provide more insight.

Unfortunately, these aren’t always readily available through standard NHS pathways, but private hearing care providers, like us, offer them as standard.

 

What can I do about it?

While there’s no magic fix, there are a few strategies and technologies that can help:

  • Hearing aids:  Modern hearing aids, especially those with directional microphones and noise reduction features, can improve clarity in noisy environments, even for those without traditional hearing loss.
  • Auditory training:  This involves exercises designed to improve the brain’s ability to process sound and speech. Think of it as a workout for your ears and brain.
  • Communication strategies:  Simple changes like reducing background noise, facing the person you’re speaking to, and asking others to speak clearly, not necessarily louder, can make a world of difference.
  • Custom hearing protection:  For people exposed to regular noise – musicians, construction workers, bar staff – custom earplugs can help prevent further synaptic damage.

 

Why early detection matters

If you’re frequently asking people to repeat themselves, feeling more fatigued in social settings, or avoiding noisy environments altogether, it’s worth speaking to a hearing care professional.

Hidden hearing loss can affect quality of life and even lead to increased stress, isolation, or cognitive strain over time.  Early support means you can stay engaged in the conversations and environments that matter most.

 

Summary

Hidden hearing loss is a condition where individuals struggle to hear in noisy environments despite having normal results on standard hearing tests. It’s caused by damage to the nerve connections between the inner ear and the brain, affecting how sound is processed.

Common causes include noise exposure, ageing, genetics, and certain medications. Though not detectable through typical tests, specialised assessments and modern solutions—like advanced hearing aids and auditory training—can help manage symptoms and improve daily communication.

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Unlike most national retailers we are not owned by any manufacturer, this means we can offer the full choice of all makes and models of hearing aids

You've been told your hearing is fine, but still struggling to hear?

Hidden hearing loss is a condition where people struggle to hear and understand speech, particularly in noisy environments, despite having normal results on standard hearing tests.

This occurs because while they can detect sounds, the brain has difficulty processing them.  Key points include:

  • Standard hearing tests may not detect it.
  • Early diagnosis is important.
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Written by Kimberley Bradshaw

Meet Kimberley Bradshaw, Head of Online Medical Content

Kimberley Bradshaw started her love of content creation, as a freelancer for many well-established medical brands.  She has written about hearing healthcare for several UK and US online health and wellness publications since.  Connect with Kimberley on LinkedIn.

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Common FAQs about hearing aids and hearing loss

What is the best hearing aid model for me?

In general, any audiologist will always recommend to you the hearing aid model that best suits your needs. Here is a useful checklist to make sure that is the case.

  • Audiologist's level of knowledge: The audiologist you have seen will hopefully have a wide knowledge of all available hearing aids; however, some will only be familiar with a small number of brands and, therefore, may not really be in a position to know which model is the best for you. It is OK to challenge their recommendation and ask them to justify why this particular brand is the one for you.
  • Do research: Read about the hearing aid that was recommended. Does it seem like it will suit your lifestyle? Does it have more or fewer features than you need? 
  • Be aware of sales targets: Many high street retailers have specific tie-ins to a particular manufacturer/brand. The hearing aid they have suggested may still be the correct one for you, but do your research so that you know why they might have recommended it.
Do I need one hearing aid or two?

If you have significant hearing loss in both ears, you should be wearing two hearing aids. Here are the audiological reasons why:

Localisation: The brain decodes information from both ears and compares and contrasts them. By analysing the minuscule time delays as well as the difference in the loudness of each sound reaching the ears, the person is able to accurately locate a sound source. 

Simply put, if you have better hearing on one side than the other, you can't accurately tell what direction sounds are coming from.

Less amplification is required: A phenomenon known as “binaural summation” means that the hearing aids can be set at a lower and more natural volume setting than if you wore only one hearing aid.

Head shadow effect: High frequencies, the part of your hearing that gives clarity and meaning to speech sounds, cannot bend around your head. Only low frequencies can. Therefore, if someone is talking on your unaided side, you are likely to hear that they are speaking, but be unable to tell what they have said.

Noise reduction: The brain has its own built-in noise reduction, which is only really effective when it is receiving information from both ears. If only one ear is aided, even with the best hearing aid in the world, it will be difficult for you to hear in background noise as your brain is trying to retain all of the sounds (including background noise) rather than filtering them out.

Sound quality: We are designed to hear in stereo. Only hearing from one side sounds a lot less natural to us.

Fancy some further reading on this topic?  You can read about why two hearing aids are better than one in our article, hearing aids for Both Ears, here

What are the benefits of rechargeable hearing aids?

For most people, the main benefit of a rechargeable hearing aid is simple convenience. We are used to plugging in our phones and other devices overnight for them to charge up.  Here are some other pros and cons:

For anybody with poor dexterity or issues with their fingers, having a rechargeable aid makes a huge difference, as normal hearing aid batteries are quite small and some people find them fiddly to change.

One downside is that if you forget to charge your hearing aid, then it is a problem that can't be instantly fixed. For most, a 30-minute charge will get you at least two or three hours of hearing, but if you are the type of person who is likely to forget to plug them in regularly, then you're probably better off with standard batteries.

Rechargeable aids are also a little bit bigger and are only available in Behind-the-Ear models.

Finally, just like with a mobile phone, the amount of charge you get on day one is not going to be the same as you get a few years down the line. Be sure to ask what the policy is with the manufacturer's warranty when it comes to replacing the battery.

Are Behind-the-Ear hearing aids better than In-the-Ear hearing aids?

For most people, the answer is yes. But it's never that simple.

The majority of hearing problems affect the high frequencies a lot more than the low ones. Therefore, open fitting hearing aids sound a lot more natural and ones that block your ears up can make your own voice sound like you are talking with your head in a bucket. Therefore, in-ear aids tend to be less natural.

However, the true answer is we can't tell until we have had a look in your ears to assess the size of your ear canal, and until we have tested your hearing to see which frequencies are being affected.

People with wider ear canals tend to have more flexibility, also there are open fitting modular CIC hearing aids now that do not block your ears.

There is also the age-old rule to consider, that a hearing aid will not help you if it's sat in the drawer gathering dust. If the only hearing aid you would be happy wearing is one that people can't see, then that's what you should get.

Most people can adapt to any type of hearing aid, as long as they know what to expect. Have an honest conversation with your audiologist as to what your needs are.

What are channels, and how many do I need?

Generally speaking, six or more. Unless it's none at all.  The number of channels a hearing aid has is often a simplistic way an audiologist will use to explain why one hearing aid is better than another, but channels are complex, and it is really not that straightforward.  Here are some reasons why:

Hearing aids amplify sounds of different frequencies by different amounts. Most people have lost more high frequencies than low, and therefore need more amplification in the high frequencies. The range of sounds you hear is split into frequency bands or channels, and the hearing aids are set to provide the right amount of hearing at each frequency level.

Less than six channels, and this cannot be done with much accuracy, so six is the magic number. However, a six-channel aid is typically very basic with few other features and is suitable only for hearing a single speaker in a quiet room. The number of channels is not what you should be looking at; it's more the rest of the technology that comes with them.

As a final note, different manufacturers have different approaches. One method is not necessarily better than any other. For example, some manufacturers have as many as 64 channels in their top aids. Most tend to have between 17 and 20. One manufacturer has no channels at all.

What's covered in a manufacturer's warranty?​

Manufacturer's warranties typically last between 2-5 years, depending on the brand and model, and cover defects in materials and workmanship. This includes repairs for component failures, electronic malfunctions, and manufacturing defects, but excludes damage from misuse, accidents, or normal wear. Most manufacturers also include loss and damage insurance for the first year.

We handle all warranty claims on your behalf, liaising with manufacturers and ensuring you get replacement devices quickly when needed. This comprehensive warranty coverage, combined with our lifetime aftercare, gives you complete peace of mind.

How much does the hearing test cost?

Our hearing tests are completely free, whether at our clinics or in your home. Unlike other providers who charge £30-£100 for home visits, we believe hearing healthcare should be accessible without financial barriers. Our comprehensive assessments include examination by a registered audiologist, audiogram results, and personalised recommendations.

All testing, future adjustments, and ongoing support are included at no extra cost. While NHS tests are also free, typical 6-week waiting periods often lead people to seek immediate private testing. We provide prompt, professional assessments that fit your schedule and budget.

Do you offer home visits, and are they included in the price?

Yes, we offer completely free home visits throughout the UK, and this service is included in our prices with no additional charges. Home visits are particularly valuable for people with mobility issues, busy schedules, or those who simply prefer the comfort and convenience of their own environment.

Our audiologists can conduct full hearing tests, fit hearing aids, and provide ongoing support in your home.  This service sets us apart from many providers who either don't offer home visits or charge extra for them.

Why are your hearing aids cheaper than what I'd pay on the high street?

We can offer prices up to 40% lower than high street retailers because of our business model. As a network of 200+ independent audiologists, we don't have the massive overheads of large retail chains - no expensive high street premises, no sales targets pushing audiologists to sell the most expensive options, and no costly marketing campaigns.

However, we maintain the same buying power as the big chains because we purchase on behalf of our entire nationwide network. This means you get access to the same premium hearing aids with professional service, but at genuinely competitive prices.

How long do I have to try the hearing aids before committing to keep them?

We offer a comprehensive 60-day money-back guarantee, which gives you twice the industry standard time to properly assess whether your hearing aids are right for you. This extended period recognises that adjusting to hearing aids takes time, and your brain needs several weeks to adapt to the amplified sounds.

Unlike many providers who offer just 30 days, we believe 60 days gives you the confidence to test your hearing aids in all the situations that matter to you - from quiet conversations at home to busy restaurants and outdoor activities.

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