Do You Have 20/20 Hearing?

The term “hearing loss” is an awkward and imprecise way to describe a complex concept. When I mention to people that I have hearing loss, sometimes they assume I do not hear any sounds at all and use sign language to communicate. Other times the opposite occurs, and because I wear hearing aids, they expect me to hear things perfectly. For most of us with hearing loss, the truth lies somewhere in the middle. We hear well in some situations but struggle in others. It can be confusing for people who have not experienced it themselves.

These contradictions also make it tricky to explain our hearing loss to others. It is hard to know what words to use, or how to describe how hard of hearing we actually are. The current characterizations of “mild” or “profound” hearing loss leave a lot to the imagination; and for people with hearing loss, the descriptions don’t often ring true. How can we call hearing loss mild if it disrupts communication? It certainly doesn’t feel mild when it cuts us off from friends, family or co-workers. I’ve often wondered if there is a better way.

What is a hearing number?

One suggestion was offered this October, when several hearing loss companies and non-profits teamed up to launch a new public health campaign known as Hearing 20/20. In it, they put forth a new and objective measure for hearing. Similar to the well-known 20/20 standard used to represent typical vision, this program suggests we use a 20/20 metric for typical hearing too. They call this a hearing number and assert that we should all know ours, just like most people know their measurement of vision.

In vision, the numbers refer to distance measured in feet. The top number is your distance from an eye chart and the bottom number is the distance at which a person with normal eyesight can read the same line. A person with 20/20 vision can see what an average person can see on an eye chart from 20 feet away. If you have 20/30 vision, your vision is worse than average. From 20 feet away, you see what most people can see at 30 feet. The metric 20/20 does not represent perfect vision, but instead average vision.

For hearing, the numbers refer to loudness measured in decibels (dBs). The metric 20/20 refers to your ability to hear unaided sounds at 20 dBs in both ears. Just like 20/20 vision, 20/20 hearing does not mean you have perfect hearing, but that it is normal or average.

Would a hearing number work?

I like the idea of creating a more objective measurement of hearing loss that is easier to understand and to communicate to others. It might also incentivize people to have their hearing tested, if there was a way to quantify it more clearly. I believe that is the primary goal of the Hearing 20/20 campaign.

But hearing is more complicated than vision, which may make this method overly simplistic for most people with hearing loss. Imagine if a person has 20/20 hearing in certain pitches, but 60/60 hearing in others. Would they receive a measurement for each set of tones, or would the numbers be averaged? Does the averaged 40/40 hearing accurately reflect the challenges this person would experience in real-world communication? What would the standard be for a referral to an audiologist or for an audiologist’s treatment plan?

There are more questions than answers, but the program highlights two important things. Hearing care is critical to overall health, and it should be monitored more regularly and completely. This is an important message for primary care doctors as well as patients. Secondly, we need to find a more succinct and meaningful way to describe hearing loss to make it more understandable for those who have it, as well as their communication partners. I am glad to see the work on this front is beginning.