What Does It Mean to Have “Normal” Hearing?

The definitions of normality and abnormality are socially defined, and sometimes they can seem like arbitrary distinctions. Take for instance, the difference between people who are neurotypical and neurodivergent. Depending on the type of testing being done, some people will be incorrectly placed in the wrong category, leading to serious effects for service provision. For instance, for many years girls were underdiagnosed for autism. Something about gender expectations made tasters less likely to diagnose girls on the spectrum, meaning that they did not have access to the educational service they needed. 

A similar conundrum faces the definition of normal and impaired hearing. How did we arrive at the decision that 20 decibels is the threshold between no hearing loss and mild hearing loss? In fact, the decision to diagnose a person with hearing loss is much more complex and requires a nexus of several different measures and factors to be effective. One of these factors can be the experience of the individual and the desire for assistance, as well. Let’s look at some of the ways the hearing health community has defined hearing loss, as well as what you can do to make sure that you and your loved ones are getting the care you need. 

Early Definitions of “Normal”

One of the first moments in the history of hearing loss diagnosis came at the 1933 World’s Fair. Researchers wanted a large sample of people, so they tested thousands at this event. The test was simple. They played tones for the participants at increasingly quiet levels and then asked them at what point they were no longer able to hear. They then took the average of these thousands of reports and used that number as “audiometric zero.” It turned out that most of the people tested at the 1933 World’s Fair could not hear sounds quieter than 20 decibels, so that threshold was used to mark the definition for hearing loss. Those who needed sound to be louder than 20 decibels were said to have hearing loss from that time forward. Although this simple test was the first moment in the long history of diagnosing hearing loss, you can imagine how much has changed. 

Recent Innovations in Diagnosis

Although this simple test is a good starting point, innovations in testing ability and shifting population statistics have made the conversation more nuanced since that time. In the first place, we are able to produce sounds in many different frequency ranges and with complex timbral spectra, or combinations of frequencies. Speech audiometry is another technique that measures the ability to hear not only a pure tone but also to understand speech. Other tests capture other dynamics of hearing ability, as well. The number of frequency bands used in the diagnosis makes a difference, and some have called out the World Health Organization for using four frequency bands to make their determination, when in fact age makes the greatest difference in hearing ability. The decision to diagnose hearing loss with a marker that is relative to age or as a basic standard across the lifespan is a serious consideration, and hearing health professionals can each weigh in with their thoughts on the decision.

Despite the variety of methods to determine the meaning of hearing loss, hearing health professionals agree that getting assistance sooner than later is the key to ongoing wellbeing after the onset of hearing loss. Not only can assistance maintain the ability to communicate with others, but it can stave off other conditions such as cognitive decline and mental health concerns. Defining the threshold of hearing loss is a complex assessment left to hearing health professionals, and they will also want to know in what contexts hearing is more or less difficult for you. 

Each experience of hearing loss is different, and it takes expertise to understand not only how to diagnose hearing loss but also what kind of assistance to recommend. With the wide range of hearing assistive devices available, recommendations by a trained hearing health professional will be the best way to navigate the sea of possibilities. Though the fine line between normal and impaired hearing is highly contextual, your hearing health professional can adjudicate this context with your best interest in mind.