I always pass free hearing screenings, but really think I have a hearing loss. Is this possible?

Yes! This is very possible. A free hearing screening can vary by practitioner, but it often consists of a pass/fail screening at a certain level at just four frequencies. A complete audiological evaluation typically includes about 10 frequencies from 250-8,000 Hz. Just because you have normal hearing between 500-4,000 Hz does not automatically mean you have normal hearing sensitivity outside of that small range. A screening also does not include speech testing. A complete exam should look at speech discrimination abilities in quiet and in noise and is not included in a free screen. 

This is a great question, one that we often encounter in our clinic. A hearing screening or puretone audiogram alone doesn't give us enough information to work with. A complete hearing health history and further diagnostic measures are warranted to give us a more complete picture. There is also interesting research looking into cochlear synaptopathy or hidden hearing loss that better explains how our patients have normal audiograms but diffuse complaints regarding their hearing. Here are some links to research articles that explain this in greater detail -  

• Perceptual Consequences of “Hidden” Hearing Loss
• Toward a Diagnostic Test for Hidden Hearing Loss

Absolutely. It depends on the criteria of pass/fail for the clinician that you saw. Also, there is no such thing as "normal" hearing - we have a range of hearing that we consider to be optimal and often say someone's hearing is "within normal limits" or "within the normal range." Someone could come in for a test and be at the lower end of normal and we would then say that they are within the normal range - if this person used to be at the top end of normal then that would be a HUGE drop in their hearing and they would likely feel like their hearing has changed. If your brain had be accustomed to having really good hearing, then a drop in hearing (even still being within the normal range) can cause you to struggle more than you used to. This is why it is so important to have a baseline test of your hearing so we have something to gauge later on to see if your hearing did change. I would recommend you have a full diagnostic evaluation completed to get a complete picture of your hearing. 

As others have said, a hearing screening usually isn't very comprehensive and cannot detect issues such as auditory neuropathy or central auditory processing disorder.  A screening is generally only a pass / fail test at 4-6 puretones and just takes a few minutes, whereas a comprehensive hearing evaluation involves a broader range of frequencies (8 - 12), speech reception thresholds, word recognition testing at conversational speech level and at your most comfortable listening level, speech-in-noise testing, uncomfortable listening level, and bone conduction testing.  Diagnostic tests for tympanometry, acoustic reflex thresholds, threshold decay testing, otoacoustic emissions testing, and brainstem response testing are additional tests that can be completed for patients showing additional symptoms.  An entire test battery along these lines can take 30 - 60 minutes and would need to be administered by a licensed audiologist.

In addition, research (as cited by others in this thread) does suggest the possibility of "Hidden Hearing Loss", where someone shows no clear signs of hearing loss but perceives it to be the case.  In these cases, trial amplification with hearing aids can prove beneficial, but only on a trial bases to determine potential benefit and should not be a "go-to" solution.  In most cases, trial amplification for someone who has effectively normal hearing usually does not measure up to the cost/benefit ratio.  

Passing a hearing screening does not always equate with our perception of hearing.   I highly recommend that you schedule an appointment to see an Audiologist who can verify your concerns and provide a treatment plan.

You may be suffering from hidden hearing loss. Ask the Audiologist to do Word Recognition of speech in noise testing. In some cases, technology can be beneficial, even when there is little or no hearing loss detected by the hearing screening.

Absolutely! Most audiologists and hearing health professionals only screening hearing at the frequencies of 250-8,000 Hz. However, in our office, we also check for hearing levels at 9,000-20,000 Hz. In addition, one needs to remember that the ears simply transmit the neural impulses to the brain. The brain does the processing. Our clinic also specializes in assessments for auditory information processing disorders. What is auditory information processing? In the words of Jack Katz, Ph.D., "auditory processing is what the brain does with what it hears". The brain is the computer of the body and is responsible for pulling in the information it receives, putting the pieces of the puzzle together and forming (executing) a response to that information. An auditory information processing battery is a series of tests that examines different ways in which the brain processes auditory information coming through the ears. Here's another thing, the act of listening requires attention. There are many things can distract us and prevent us from fully paying attention and listening to the information we hear. I would recommend you start with a comprehensive hearing test, testing the organ of hearing at 250-20,000 Hz, including speech understanding tests in quiet vs. background noise, before looking into a complete auditory information processing test battery.

Yes, it is entirely possible. I won't get into the limitations of screenings since that has already been addressed. My recommendation is to schedule an appointment with an audiologist to have a full hearing evaluation. They will be able to determine your hearing profile and advise you on next steps.