Audiogram or perceived hearing difficulty?

In today’s world of audiology, there is a reliance on the audiogram because it is seen to be objective.

An audiogram is a graph that shows the results of a hearing test. It will show how loud sounds need to be at different frequencies for you to hear them. The audiogram shows the type, degree, and configuration of hearing loss.

A key problem with reliance on the pure-tone audiogram for help with hearing aids is the frequently observed mismatch with a person’s self-perceived hearing loss. Often the mismatch between audiometric and self-report measures of hearing difficulties has been couched in terms of the self-report measure either underestimating or overestimating the true hearing loss. But it is accepted now that the audiogram does not provide a comprehensive picture of hearing function and self-report measures were needed to supplement it.

When reviewing the literature on self-reported or perceived hearing loss it is quickly apparent that there is no consensus as to how this should be measured and summarised.

Even for the audiogram, heated scholarly exchanges have been going on for many years about whether they effectively capture the severity of a hearing problem.

Recent research has found that individuals with “normal hearing” could have self-reported hearing difficulties that ranged from minimal to substantial.

Within the context of the WHO International Classification of Health and Functioning (WHO-ICF; WHO, 2001), pure-tone audiometry tapped into only the “bodily impairment” domain of healthy function whereas well-conceived self-report measures can tap all three domains defined by the WHO model – bodily impairment, activity limitations, and participation restrictions, and possibly some of the contextual factors that modulate each domain. As a result, a strong association between the narrow audiometric measure of hearing loss and the broad self-report measure of hearing difficulty would not be expected.

It is important to better understand the association between audiometric definitions of hearing impairment and self-report measures of perceived hearing difficulty. Of particular interest is the association of each of these measures with the eventual uptake of assistance from devices, such as hearing devices. Several studies and reviews have identified self-reported hearing difficulty as the key factor leading to hearing-aid acquisition.

Furthermore, many older adults with slight amounts of pure-tone hearing loss – “normal” hearing – seek hearing aids and obtain benefits. These individuals are already well motivated as they have perceived hearing needs that compromise their auditory wellness.

This article was taken from U.S. Population Data on Hearing Loss, Trouble Hearing, and Hearing-Device Use in Adults: National Health and Nutrition Examination Survey, 2011–12, 2015–16, and 2017–20. This report had the following objectives. To provide: (1) updated estimates of the prevalence of audiometric hearing loss and perceived hearing difficulty among U.S. adults; (2) updated estimates of the prevalence of use of hearing aids and ALDs in U.S. adults; (3) estimates of the unmet HHC needs of U.S. adults. In addition, variables affecting audiometric hearing loss, perceived hearing difficulty, and device uptake were examined.