Am I hard of hearing?

Defining what it means to be deaf, hard of hearing, and part of the Deaf community.

The 3 key takeaways

  • There are differences in the definitions of hard of hearing, deaf, and Deaf – Some terms are medically-based, while others reflect culture and identity.
  • A person’s diagnosis might be different from how they identify themselves – How someone describes their own hearing or deafness is up to them. Some people might not want to use any labels at all.
  • Hard of Hearing (HOH) is the preferred term over hearing-impaired — Hearing impaired is an outdated term that many believe unfairly focuses on what people can’t do rather than what they can do.

Deaf. Deafened. Hard of hearing. People use plenty of terms to describe hearing loss, a medical condition that affects approximately 13% of adults over 18. There are significant differences between what it means to be Deaf, hard of hearing, or to have hearing loss. Understanding these terms is important in order to appreciate how people might identify with their hearing abilities.

The different types of hearing loss

Just as no two individuals are alike, the same goes for hearing loss. The type and cause of hearing loss is an important medical classification of hearing loss, but it might also influence how people identify themselves.

While some people have hearing loss present at birth or a very young age, some hearing loss occurs later in life. Hearing loss can also be stable or progressive. Let us review the types of hearing loss.

Sensorineural hearing loss

Almost always permanent, this type of hearing loss is associated with damage to the inner ear or hearing nerve. Sensorineural hearing loss is most commonly caused by aging and noise exposure, but it can also be congenital (present at birth), hereditary, or a result of ototoxic medications.

Conductive hearing loss

This type of hearing loss occurs when there is a problem with sound traveling through your middle ear to the inner ear. Conductive hearing losses can be present at birth due to anatomical differences, or may be the result of ear infections or ear trauma. Some conductive hearing losses can be fixed through medical treatment, but others are permanent.

Mixed hearing loss

This type of hearing loss is a combination of permanent inner ear damage as well as hearing loss caused by mechanical problems in the middle ear. Mixed hearing loss may also be either permanent or temporary, depending on the cause.

The different levels of hearing loss

Hearing loss is not only defined by the type of loss, but also how severe it is. Your hearing thresholds, or the softest sounds you can hear, are measured in a unit of loudness called decibels (dB).

The lower the number, the better the hearing. Thresholds are plotted on a graph called an audiogram. Often, people have a range of hearing loss, for example: mild to severe. The severity of hearing loss is an important component in understanding the definition of hard of hearing versus deaf.

 

Hearing loss severity Decible level
Mild 26-40
Moderate 41-55
Moderately-severe 56-70
Severe 71-90
Profound 91+

What does it mean to be hard of hearing?

“Hard of hearing” is a term used to describe people who have different degrees of hearing loss, from mild to severe. Hard of hearing usually implies that there is a degree of residual hearing allowing them to benefit from amplification and communicate using spoken language.

People who call themselves hard of hearing usually have persistent hearing loss, rather than those experiencing hearing loss temporarily due to a medical condition such as an ear infection.

People can become hard of hearing in a number of ways. They can be born with hearing loss or it can develop over time. In the past, people may have referred to this as being “hearing impaired”.

Now, “hearing impaired” is seen as a negative term that suggests there is something wrong with the individual, and many choose to not identify this way.

Hard of hearing vs. deaf

While hard of hearing indicates a range of hearing loss, the term ‘deaf’ is used to describe profound hearing loss. People who are deaf may wear hearing aids, but they might use them for sound awareness rather than a primary goal of spoken communication.

People who are deaf may also wear cochlear implants or choose to forgo technology altogether. People can be born deaf or become deaf later in life. Someone who was born hearing and becomes deaf later in life might refer to themselves as “late deafened”.

Deaf vs. deaf

There is a difference between the term deaf and Deaf (with a capital d). Lowercase deaf refers to the medical condition of hearing loss. When you see uppercase Deaf, this refers to the culture and community of people who use sign language. In the United States, American Sign Language (ASL) is a visual language complete with its own grammar and rules.

Other countries have their own sign languages. Some in the Deaf community may exclusively communicate through ASL, while some might lip read, use spoken language, or a combination of the two.

The Deaf community does not see their condition as a disability or something that needs to be fixed. Many, especially if born deaf, might not consider themselves to even have a hearing loss.

The Deaf community is diverse and every individual has the right to choose how they identify themselves, despite how the medical field may label their hearing.

Diagnosing hearing loss

In the United States and most developed countries, newborns receive their first hearing screening at just a few days old. This allows hearing loss to be identified early in order to get infants and their parents access to services and technology as soon as possible.

Newborns who do not pass their hearing screening are seen for a full evaluation with an audiologist as soon as possible. This type of testing is called an auditory brainstem response (ABR) and evaluates how the inner ear and pathways to the brain are functioning, all while the baby sleeps.

For older children and adults, hearing loss is diagnosed with an audiologist through conventional testing, usually in a sound-treated booth. The audiologist will conduct tests to evaluate different parts of your ear and will review the results with you.

Once hearing loss is identified, the audiologist will talk to you about your treatment options and refer you to any other specialists, if needed.

Treatment options for hearing loss

Treatment of hearing loss will depend on the type and severity of the loss. Some hearing losses may require referral to n ear, nose, and throat provider, while others can get started on their treatment plans right away.

Over-the-counter hearing aids

In October 2022, the FDA finalized a category of over-the-counter (OTC) hearing aids. OTC hearing aids were created as a way for people to get access to affordable hearing devices, but they are not for everyone. OTC hearing aids are only meant for adults with mild to moderate hearing loss; children and adults with more severe losses will still need to seek traditional hearing care through an audiologist.

OTC hearing aids are lower in cost and do not require a hearing test to be fit. However, it is in your best interest to get a diagnostic hearing evaluation to make sure you are a good candidate and medical conditions that could be treated are not missed.

There are many OTC hearing aids to choose from. Devices can be purchased in retail stores, through an audiologist’s office, or even online. If you need help narrowing down your options take a look at our many OTC hearing aid reviews.

Prescription hearing aids

A downside to OTC hearing aids is that they usually do not come with any in-person professional services. Many OTC hearing aids are fit remotely through an app.
If you are someone who prefers to see a provider face-to-face or if your hearing loss does not make you a candidate for OTCs, you can get prescription hearing aids, which are traditional hearing aids set to your unique hearing loss.

Prescription hearing aids are designed for all ages and all hearing losses. They can only be fit by a hearing care professional such as an audiologist or a hearing instrument specialist. The provider will help you select from brands and styles that are appropriate for your needs and then program them using specialized computer software.

Depending on your loss, you could be fit with a hearing aid in one or both ears. If you have one hearing ear and one ear with no usable hearing, there is even a device called a CROS. This device can transfer sounds picked up on the side of your bad ear and send it to your good one.

Middle ear implants and bone conduction hearing aids

There are alternative options for people who cannot wear a traditional on-ear hearing aid. Middle ear implants work by sending sounds picked up from an external device (the processor) to an implant that is placed in the middle ear.

The implant itself vibrates the ossicles, also called the middle ear bones. Middle ear implants are available for most types and severities of hearing loss. It is an excellent option for people with severe allergies, anatomy differences, or those who have chronic ear infections.

Bone conduction hearing aids work in a similar fashion to middle ear implants, however unlike middle ear implants they can be implanted with surgery or worn with a headband or stuck on with adhesive.

Bone conduction hearing aids can be worn for the same reasons as a middle ear implant, however they are typically used for people with conductive or mixed hearing loss.

Cochlear implants

People who are deaf or have significant hearing loss with limited benefit from hearing aids may be candidates for a cochlear implant. A cochlear implant is a device that bypasses the severely damaged inner ear to transfer sound to the hearing nerve and brain.

Cochlear implants used to be reserved only for people born deaf, but over the years the candidacy has changed. Research has shown that a wider range of people can benefit from this technology.

Deaf and hard of hearing are terms people use to describe their medical diagnosis of hearing loss. The biggest difference in the definition of hard of hearing versus deaf is in the degree of hearing loss.

However, Deaf does not only mean lack of hearing, but also has cultural significance for the community of people who use American Sign Language. How you identify with your hearing loss, how you treat it, and how you choose to communicate, are all personal choices. When you are navigating the healthcare system, make sure you have providers who respect and understand your needs.

Frequently asked questions

What percentage of hearing loss is legally deaf?

Unlike “legally blind” which is a clearly-defined term, “legally deaf” is not used with hearing loss. Since a percentage does not accurately describe hearing ability, a rating of severity is used instead. Individual states might, however, define the amount of hearing loss necessary to be considered for disability services.

I am hard of hearing. Should I learn ASL?

Knowing ASL is a great skill to have, especially if you identify or plan to get involved in the Deaf community. There are hard of hearing people that choose to learn ASL in case they lose their residual hearing. Ultimately, whether or not you choose to learn ASL depends on what your communication goals are.

Is hearing loss a disability?

It depends on how you feel! Some may personally consider hearing loss to be a disability and it might be included as a disability under state laws. However, there are plenty of people, especially in the Deaf community, who do not believe hearing loss is either a loss or a disability.

I have no hearing in one ear. Am I deaf?

If you have hearing in your other ear, you wouldn’t be considered completely deaf, but you could say you have single-sided deafness and that you are deaf in one ear. There are plenty of options available to treat single-sided deafness, including special devices such as the CROS or BiCROS.

Is sign language the same in the United States as it is in the UK?

No. British Sign Language is an entirely different language than American Sign Language. In fact, there is no universal sign language and most countries have their own sign language.