Most of us know someone personally who experiences a hearing loss to some degree. My mother experiences a profound hearing loss in one ear. Growing up, I frequently found myself working as a second set of ears for her in social situations, crowded rooms, and places with lots of excess noise. I worked as her communication partner to ensure that she didn’t miss anything important. You too may have an older family member and find yourself changing your speech rate or volume so they can hear you better.

Hearing loss can occur at any time, from infancy to adulthood, and can have profound effects on communication. Hearing is crucial for speech and language development, and even a slight hearing loss can impact development.

According to the National Institute on Deafness and Other Communication Disorders, approximately 2-3 out of 1,000 children in the United States are born with a detectable hearing loss, and approximately 15% of adults over the age of 18 reports some difficulty hearing. Loss of hearing occurs due to problems with the outer ear, the middle ear, or the inner ear. For children, it may be identified at birth through newborn hearing screenings, or later due to difficulty developing language. As adults, we can experience hearing loss as a result of continued exposure to loud noises, aging, or progressive disorders. An audiologist can determine if an individual is experiencing hearing loss, and make a treatment plan. 

Hearing loss can be described by the type, degree, and configuration. Type refers to where the hearing loss occurs in the ear, degree refers to how loud sounds need to be for you to hear them, and configuration describes the extent of hearing loss at each frequency. 

Types of Hearing Loss

Conductive Hearing Loss

Conductive hearing loss occurs when sound cannot get through the outer and middle ear into the inner ear. With conductive hearing loss, soft sounds may be hard to hear and louder sounds may be muffled. Thankfully, medicine or surgery can often fix this type of loss.

Conductive hearing loss can be caused in a variety of ways including:

  • Fluid in your middle ear
  • Ear infection – also known as otitis media
  • Ear wax
  • A hole in your eardrum
  • Swimmer’s ear – also called external otitis 
  • An object stuck in your ear canal
  • Benign tumors
  • Malformation of the outer or middle ear

Sensorineural Hearing Loss

Sensorineural hearing loss is the result of damage to the inner ear. This can also be the result of damage to the nerve pathways from your inner ear to your brain. With this type of loss, soft sounds will be hard to hear and loud sounds may be unclear or muffled. 

Cause of sensorineural hearing loss include: 

  • Illness
  • Aging
  • A blow to the head
  • Genetic factors or hearing loss that runs in the family
  • A problem in the way the inner ear is formed
  • Loud noises or explosions
  • Drugs that are toxic to hearing (ototoxic drugs)

Mixed Hearing Loss

Mixed hearing loss is a result of problems in your outer or middle ear and your inner ear. Anything that causes a sensorineural hearing loss or conductive hearing loss can cause a mixed hearing loss.

Degree of Hearing Loss

The degree of hearing loss describes how loud sounds need to be for you to hear them. Decibels describe loudness, and are abbreviated as dB; dB HL describes hearing loss in decibels.

Degree of hearing lossDecibel range
Normal-10 to 15 dB HL
Slight16 to 25 dB HL
Mild26 to 40 dB HL
Moderate41 to 55 dB HL
Moderately Severe56 to 60 dB HL
Severe71 to 90 dB HL
Profound91+ dB HL

If sounds need to be 20 dB or greater for you to hear them, then you have slight hearing loss. If sounds need to be 30 dB or greater for you to hear them, then you have mild hearing loss. An example of a 20 dB sound is whispering from 5 feet away, and an example of a 30 dB sound is whispering nearby.

Configuration of Hearing Loss

The configuration of hearing loss describes the extent of hearing loss at each frequency. Some examples to describe the configuration of hearing loss are below.

  • Bilateral (in both ears), unilateral (in one ear only)
  • High frequency versus low frequency
  • Symmetrical or asymmetrical – this refers to whether each ear has the same severity and shape in bilateral hearing loss
  • Progressive hearing loss which becomes worse over time or sudden hearing loss, which happens quickly. You should see a doctor if you experience sudden hearing loss. 
  • Fluctuating hearing loss or stable hearing loss – Stable means the hearing loss stays the same over time, whereas fluctuating means it changes over time–sometimes it is better and sometimes it is worse

Speech and Language Development

Hearing is crucial for speech and language development. According to ASHA, hearing loss impacts speech and language development in the following ways. Hearing loss can cause delays in receptive and expressive language. These delays can lead to academic challenges, which often lead to feelings of isolation and poor self-regard. Hearing loss may also have an impact on vocational choices. 

Specific effect on speech and language development may include:

  • Vocabulary: Children with hearing loss often have delays in developing vocabulary. Gaps between the vocabulary of children with hearing loss and their peers increase over time. Children with hearing loss tend to learn more concrete vocabulary first (ex. dog, green, run) and have more difficulty learning abstract vocabulary (ex. jealous, after) or words with multiple meanings (ex. ring, wave). 
  • Sentence Structure: Children with hearing loss often comprehend and create shorter, less complex sentences than their hearing peers. They may have difficulty hearing word endings such as plural -s or past tense -ed, which impacts their use of these grammatical structures. 
  • Speaking: Children with hearing loss may have difficulty hearing softer sounds such as ‘sh’ ‘f’ ‘z’ and ‘s’. Additionally, they may not be able to hear their own voices which can impact their rate, volume, and pitch.  
  • Academic Achievement: The difference in academic progress and achievement when comparing children with hearing loss and their peers gets more significant with time. However, receiving early intervention and appropriate intervention leads to positive outcomes for academic achievement. 
  • Social Functioning: Children with hearing loss often report feeling alone and unhappy in school.

Auditory Processing Disorder 

Some children who don’t have hearing loss, still have difficulty processing what they are hearing. If your child has passed a hearing test/screening, but still has difficulty following directions or appears to have difficulty understanding others, ask an audiologist about Auditory Processing Disorder. This means that the child’s ears detect sounds accurately, but they aren’t correctly interpreting what was said. An audiologist can conduct an evaluation for suspected Auditory Processing Disorder, but a team of individuals may support your child’s treatment plan.


Treatment options for hearing loss vary from person to person. Decisions are impacted by age, type, degree, the cause, and the impact on communication and development, among other factors. Treatment should include monitoring and follow up with an audiologist. The treatment plans will come from a partnership between parents, SLPs, audiologists, or other caregivers and can include school psychologists, teachers, and doctors as well.

Treatment options may include: 

Hearing aid
  • Amplification
    • This includes hearing aids, cochlear implants, FM systems within the classroom.
  • Speech and language therapy
    • Will focus on listening skills, as well as any other speech or language deficits resulting from the hearing loss
    • Includes use of language and understanding of language 
  • Classroom supports, assistive devices, and accommodations 
    • Modified seating within the classroom
    • Use of FM systems 
    • Captioning
  • Decisions about language 
    • American Sign Language (ASL): ASL is a visual-spatial language, expressed using movements primarily of the hands and face. Not all individuals with hearing loss learn sign language. Decisions about language use may include the team of individuals mentioned above and personal to each family and individual. 
    • Auditory Oral: This emphasizes the use of residual hearing through amplification, encourages the use of speechreading and natural gestures, but discourages the use of manual language such as ASL.
    • Auditory Verbal Therapy involves optimizing spoken language acquisition through listening with technology (ex. cochlear implants, hearing aids), but discourages the use of natural gestures, manual language, or speech reading. 
    • Cued Speech: This is a visual communication system that involves the use of lipreading paired with handshapes/cues. These cues help children distinguish between speech sounds that may appear similar while lip-reading such as /p/ and /b/. 
    • Total Communication: This approach to language includes the use of oral and manual language expression. It includes manual signs, amplification, and speech or lip reading. 

Please note that this blog is meant to be informational, and not diagnostic. It is an introduction to hearing loss, which is a broad and complex term. Decisions about treatment and communication around hearing loss are very personal.  If you have concerns about you or a loved one’s hearing, speak to your doctor who can refer you to an audiologist.

Cocoa Berry
Author: Cocoa Berry