How to Know If You Have Mild-to-Moderate Hearing Loss (and Why It's Important!)

Have you noticed it's difficult following conversations in restaurants? Do your loved ones seem to mumble when they speak? If this sounds familiar, you may be experiencing mild or moderate hearing loss, which can greatly impact your daily life. Fortunately, addressing it early can improve your overall quality of life and well-being while helping you stay connected to loved ones. And you now have numerous options, including over-the-counter (OTC) hearing aids specifically designed for people with perceived mild-to-moderate hearing loss and other hearing solutions.

Here, we offer a guide to recognizing key signs of mild or moderate hearing loss. We'll also explore treatment and management options and share expert advice and experiences from members of an online hearing loss support group.

Understanding Mild-to-Moderate Hearing Loss

The “gold standard” test an audiologist uses to assess hearing is pure-tone audiometry—the familiar beep test that measures how well you can hear sounds at various frequencies (pure-tones). The test is summarized in an audiogram, a graph that displays the softest sound, in decibels (dB), that you can hear at each frequency tested. These hearing thresholds are then averaged at the four most important frequencies for speech reception to get your overall hearing level in decibels (dB HL)—also known as your hearing number.

The audiogram is very useful for understanding your hearing status. The most important regions for hearing speech are between 500 Hz and 4,000 Hz, and sensorineural hearing loss (the most common type of hearing loss) usually first becomes noticeable in the high frequencies, as shown here. In terms of loudness, people usually converse at about 55-60 dB—but the ability to understand speech can change dramatically in the presence of background noise.

The woman's audiogram below shows normal to mild hearing loss until about 2-3 kHz, then dips into moderate and severe hearing loss in the higher frequencies. It's quite possible she is missing some higher-frequency sounds and consonants like /k/, /p/, /f/, /th/, and /s/, and her brain must work harder to "fill in the blanks" during conversations, especially in noisy listening environments.

Here’s how mild and moderate hearing losses are typically defined in a hearing clinic, according to the American Speech Hearing Language Association (ASHA):

• Mild Hearing Loss: Hearing thresholds between 26 to 40 dB HL.
• Moderate Hearing Loss: Hearing thresholds between 41 to 55 dB HL.

Anything below 26 dB HL is usually defined as “normal hearing” or slight hearing loss (16-25 dB); anything over 55 dB HL is defined as moderately-severe (56-70 dB HL), severe (71-90 dB HL), or profound (91+ dB HL). OTC hearing aids are designed only for hearing losses of 55 dB or less, so you'll likely receive diminishing benefits from them as your hearing loss approaches or exceeds that level.

Note that different organizations, including the World Health Organization (WHO), may have slightly different values for each hearing loss category. Additionally, while extremely useful, the audiogram only provides a narrow snapshot of hearing ability. Hearing involves the outer, middle, and inner ear, the nervous system, and different brain regions. This is why two people with the exact same audiogram can have completely different challenges when hearing in noise or other situations.

Additionally, as many as 26 million adults may have what is considered “hidden hearing loss,” which is “normal” hearing, while still struggling to understand speech. Because there are many possible causes of hearing loss, HearingTracker always recommends that people get a comprehensive audiological exam rather than a basic hearing screening, particularly when first investigating a potential hearing loss.¹

How many people have mild-to-moderate hearing loss?

Mild-to-moderate hearing loss affects a significant portion (37.1 million) of the U.S. population and about 1 in 5 people aged 50 to 70. According to the National Institutes of Health (NIH), approximately 15% of American adults (37.5 million) 18 years or older report some trouble hearing. As you might expect, the likelihood of experiencing hearing loss increases as people get older.

Audiologist-researcher Larry Humes, PhD, analyzed nine years of data from the National Health and Nutrition Examination Survey (NHANES) to estimate the number of people who might benefit from over-the-counter (OTC) hearing aids.² Using the description "a little or moderate trouble hearing" as a proxy for mild-to-moderate hearing loss, Dr. Hume's data shows that about one-fifth (21.2%) of US adults (49.5 million) may have mild-to-moderate hearing loss, with most falling within the 50 to 69 age range.

Here's a breakdown by age group of the people with self-reported mild-to-moderate hearing loss in the study:

You can see that the percentage of mild-to-moderate hearing loss goes down after age 59 because people’s hearing levels gradually progress into the more severe hearing loss categories.

Interestingly, the data also showed how often certain health problems occur in people with different levels of hearing loss. Health issues including smoking, high blood pressure, and diabetes were found to be risk factors, increasing the likelihood of developing hearing problems. (For more information, see my article Chronic Illness and Hearing Loss: What You Need to Know.)

How Can You Tell If You Have Mild-to-Moderate Hearing Loss?

Often, it’s family members or close friends who first notice you are missing parts of conversations. While some people with mild or moderate hearing loss may be acutely aware of their difficulties, others might not realize the extent of their hearing issues until pointed out by those around them.

Hearing loss usually develops gradually and can vary significantly from person to person, making it easy to overlook. “My ex-husband said I was always asking him to look at me and not mumble and I should get checked so I did,” Kelli, who has moderate hearing loss, told HearingTracker.

Symptoms of mild to moderate hearing loss: "I can hear what people say, but I can't understand them."

People with mild or moderate hearing loss often describe a lack of clarity in what they hear, making it challenging to understand conversations. A typical complaint is, "I can hear what people say, but I can't understand them.”³

This issue can be particularly pronounced in noisy environments or when multiple people are talking at once. “Patients will typically complain of difficulty hearing in all but ideal environments,” says Dr. Ruth Reisman, AuD, MBA, Brooklyn College professor, and Urban Hearing co-owner.

Bethany was in her early 30s when she realized her hearing difficulties. “I noticed that I was the one turning the volume up on the TV from what I had been saying to the kids was loud enough,” she recalls.

If your hearing loss is age-related, known as presbycusis, you might first notice that high-pitched sounds are difficult to hear. You may find it harder to understand women's and children's voices compared to lower-pitched ones. Additionally, you might notice a reduced ability to hear environmental sounds, such as birdsong and car blinkers.

Using online hearing tests and audiograms

While HearingTracker always advises getting a thorough hearing exam from an audiologist, an online hearing test can give you a helpful snapshot of your hearing ability. These tests are often free, and anyone with a pair of headphones can test their hearing this way, making them a convenient and accessible tool to help you determine whether you might have a hearing loss.

Popular options for online hearing tests include Mimi, SonicCloud, and uHear. Follow the test's setup instructions carefully, including any volume calibration steps, and take the test in a quiet environment. While these tests are useful for initial screening, they should not replace a professional evaluation. Be sure to follow up with a hearing care professional for a thorough assessment.

You should also take the Consumer Ear Disease Risk Assessment (CEDRA) test. This questionnaire, created by the Mayo Clinic and Northwestern University, helps rule out conditions or diseases that might be affecting your hearing.

Get an Audiological Exam

As mentioned above, the most reliable method for diagnosing hearing loss is a comprehensive audiological exam conducted by a hearing care professional. The evaluation is crucial for precise diagnosis and effective treatment. It typically includes a thorough examination of your ear canal, pure-tone audiometry, speech audiometry to evaluate how well you understand speech at different volumes both in quiet and in noise, and tympanometry to check the movement of your eardrums and detect potential issues in the middle ear.

The hearing provider may also conduct other tests to understand how different parts of your auditory system are functioning. In this way, a comprehensive audiological examination is different from a simple hearing screening which, as the name implies, is intended to tell you if you have a hearing problem. These screenings are generally limited to questions about your hearing health, an ear canal inspection, and pure-tone audiometry.¹

If you haven’t had your hearing examined for a long time, we recommend you get a comprehensive audiological exam. This way, you’ll have a detailed record of your hearing status that you can compare to later tests and keep for your health records. Whether you get a comprehensive exam or just a screening, ask for a copy of your audiogram after your hearing test for your records; they can come in handy should you decide to try a self-fitting OTC hearing aid (see details below).

What Can You Do If You Have Mild-to-Moderate Hearing Loss?

If you have a mild-to-moderate hearing loss, you can take several practical steps to improve your hearing.

Prescription and OTC hearing aids

“Hearing aids, whether over the counter (OTC) or prescription [from a professional], are options for this population as well as a formal or informal aural rehabilitation program,” explains Reisman. Research indicates that hearing aid users benefit from reduced fatigue and mental stress related to communication, along with improved self-esteem, social interactions and less loneliness, and better overall quality of life.

Gabriella explained how getting hearing aids helped her regain confidence: “A year of unhelpful people, depression, and anxiety—until an awesome audiologist put me onto Widex hearing aids to support my individual needs and give me the courage to go out again.”

OTC hearing aids are designed for adults with mild-to-moderate hearing loss, offering a quicker and more affordable solution compared to prescription aids. These devices can be purchased directly from stores or online without a medical exam, prescription, or professional fitting.

Like prescription hearing aids, OTC hearing aids come in various styles, including:

• Receiver-In-Canal (RIC): Small and discreet, with the receiver located in the ear canal and connected via a wire to the rest of the device behind the ear, offering a natural sound quality.
• Behind-the-Ear (BTE): The receiver is within the main body of the device, which sits behind the ear, and a tube directs sound into an earpiece in the ear canal.
• In-the-Ear (ITE): Fits inside the ear canal and is less visible. These can include full- and half-shell ITEs and In-the-Canal (ITC) styles.
• Completely-in-Canal (CIC): As the name implies, CICs are inserted into the ear canal and are almost invisible. Invisible-in-Canal (IIC) styles are even smaller and inserted more deeply.
• Earbud style: Look just like standard earbuds typically used to play music.

OTC hearing aids are also separated into two important classes: “preset” and “self-fitting” devices. A preset or wear-and-go device usually comes with either 1-4 program settings that you select, as well as a volume control. A self-fitting device usually includes a hearing test or a method for entering your audiogram into an app or the device's software. This means self-fitting OTC aids can be better tailored for your unique hearing loss.

While OTC hearing aids can treat mild-to-moderate hearing loss, prescription hearing aids offer a higher level of customization, along with personalized service and guided counseling on using the devices. Good hearing providers use best practices that include techniques like real-ear measurements (REMs) to fine-tune devices with greater precision than self-fitting OTC devices.

OTC hearing aids are designed to fit a broad range of adult ears and typically do not include custom ear impressions that provide a personalized fit and better sound quality. They are not intended for children or more severe hearing loss. Additionally, if you have uniquely shaped ear canals or specific fitting needs, consult a hearing care professional who can guide you on the proper fit and settings.

New Apple AirPods Pro 2 software

Apple AirPods Pro 2 are wireless earbuds that sport features that mimic hearing aids, such as Transparency mode and Active Noise Cancellation. These settings help you control environmental noise, making conversations easier in noisy places. More recently, the FDA cleared Apple's Hearing Features software as an OTC "software as a medical device" (i.e., the software is the medical device feature, not the AirPods). With this clearance, you can use Apple's software to take a hearing test and modify the acoustics of the AirPods Pro 2 earbuds for your own hearing profile or audiogram.

Coming soon: Hearing Glasses

Yes, you read that correctly—glasses that help you hear (and see, if you have prescription lenses)! Hearing glasses, like the upcoming Nuance Audio hearing glasses from global optical giant EssilorLuxottica, may revolutionize hearing technology. Nuance Audio glasses are designed for people who struggle to hear in noisy environments, particularly those with mild-to-moderate hearing loss.

The glasses use acoustic beamforming to focus on specific sounds, such as conversations, while cutting out background noise. You simply look at the source of the sound—such as the person you're speaking to—and the directional microphone focuses on this sound, amplifying it through the glasses' stems, which are integrated with an air-conduction OTC hearing aid system. Another advantage is that you get the benefits of a sophisticated amplifier while people won’t be able to spot that you’re wearing a hearing aid; the “open ear” technology doesn't require hardware either in the ear or over the ear like traditional hearing aids.

Tested by HearingTracker's Founder and Audiologist Abram Bailey, the glasses allowed him to hear better in a busy restaurant. “Wherever I looked, I could hear,” he said. “It was like some kind of weird eavesdropping superpower.”

At this writing, these glasses are not yet available in the United States. Stay tuned for updates!

Assistive Listening Devices

For people with mild-to-moderate hearing loss, assistive listening devices (ALDs) can give a helpful communication boost. ALDs work by amplifying sound and reducing background noise to enhance a person’s hearing experience. These devices can be especially helpful in difficult listening situations, such as in large spaces, noisy surroundings, or when there's a considerable distance between the speaker and the listener.

There are numerous ALDs to explore, here are just a few:

Speech-enhancement apps

Speech-enhancement Smartphone apps typically work by using your smartphone's microphone to capture environmental sounds. These sounds are processed using algorithms to filter out background noise, improving speech clarity and making it easier to understand conversation. The adjusted sound is sent to your headphones or earbuds, where you can customize settings such as volume, listening modes (like speech enhancement or noise reduction), and fine-tune options based on your hearing profile. The HeardThat app works with both Bluetooth earbuds or your hearing aids, and other apps such as Sound Amplifier (Android), Sound Amplifier (iOS), and Live Listen (iOS) work with a pair of headphones or earbuds.

Captioning apps and glasses

Captioning apps, also known as speech-to-text or transcription apps, convert spoken conversations into real-time text, allowing you to read dialogue directly on your smartphone. Some examples include Google Live Transcribe and Notification, NALscribe, Transkriptor, and Ava.

Though transcription apps are becoming increasingly accurate and hearing aid wearer, Randy, is a big fan of them, he also embraces the occasional errors. He told HearingTracker, “The transcription flaws are what helps with socialization. The mistakes the apps make are hilarious at times. I share those with the person/people I’m with. What happens is WE laugh together. I am therefore part of the conversation.”

An evolving class of products is augmented reality (AR) live-captioning glasses. Although captioning glasses have been around for a few years now, initial prototypes were aesthetically “chunky.” Increasingly, they are becoming more lightweight, and some even boast new innovative features beyond captioning. This means they can be worn for a whole host of different situations, such as conversations, the cinema, theater, lectures, meetings, or when you’re at home watching TV.

Hearables and PSAPs

Hearables and personal sound amplification products (PSAPs) are small, portable gadgets designed to enhance hearing by amplifying sound directly into the user's ears. Unlike OTC hearing aids, they have not been cleared by the FDA to compensate for hearing loss; however, many can be exceptionally useful for situational listening (e.g., lectures, restaurants, etc.). They generally include a microphone, amplifier, and headphones or earbuds, which capture and amplify nearby sounds, making it easier to hear speech in noisy environments.

PSAPs are easy to use and often relatively inexpensive. Frequently, they come with adjustable volume controls and sometimes basic tone adjustments. Examples of PSAPs include the Williams Sound Pocketalker Ultra, Behear SMARTO, and the ZOWEETEK Portable Mini Voice Amplifier.

Hearing loops and telecoils

If you have an OTC or prescription hearing aid with a telecoil (T-coil), you can take advantage of hearing loops. These induction loops send electromagnetic signals directly to your hearing aid, filtering out background noise for clear audio straight to your hearing aid. The system consists of a cable loop around a space like a theatre, house of worship, or meeting room. A microphone picks up sound and the loop transmits it as a signal to your telecoil.

Communication Strategies for People with Mild-to-Moderate Hearing Loss

Through the years, I've learned that having a few tricks up your sleeve can greatly reduce the stress of the communication challenges that come with hearing loss. Here are some go-to strategies:

• Tell people you have hearing loss: Being open about your hearing loss can improve communication and reduce embarrassment. “I’ve found that letting people I meet know right away that I have hearing loss is a lot less embarrassing than struggling and flailing at trying to catch their every word. Most people are gracious about it,” explains Bethany.
• Face the speaker: Position yourself to see the speaker’s face. Ask them to speak clearly and use visual cues to aid understanding. “I always tell people I am wearing hearing aids and to talk to my face,” explains Gabriella, who has moderate hearing loss.
• Reduce background noise: Choose quiet environments and turn off distractions like the TV. Opt for rooms with soft surfaces (e.g., carpets, blinds), which are easier to hear in than those with hard surfaces (like kitchens or bathrooms).
• Ask for repetition: Don't hesitate to ask people to repeat or rephrase if you didn't catch what they said.
• Consider your seating position: In restaurants or meetings, sit where you can face the speaker and with your back to the wall or in a corner or booth to minimize background noise.
• Self-advocate: Ask for what you need, such as having people get your attention before speaking, speak one at a time, and repeat or write things down when necessary. “I am confident enough to ask for a change of table/chair position in a restaurant. I also explain to both friends and colleagues if I cannot hear conversations. My hearing loss does not embarrass me,” shares hearing aid wearer, Juliet.
• Get enough rest: Listening with hearing loss requires extra effort. Ensure you’re well-rested before important meetings or social events to stay sharp and focused.

If you’re looking for a more in-depth communication survival guide, check out the book “Hear & Beyond: Live Skillfully with Hearing Loss” by hearing health advocates, Shari Eberts and Gael Hannan. It offers practical communication strategies for various listening situations, including relationships, work, and technology. The book encourages the reader to shift their mindset from hearing better to communicating better. Explore their "Hearing Hacks" for valuable tips on navigating challenging listening environments more effectively.

What are the Social and Emotional Impacts of Untreated Hearing Loss?

Numerous research studies have found a link between untreated hearing loss, social isolation, loneliness, and depression. A 2022 study found that untreated hearing loss significantly increases the odds of being emotionally lonely. Since hearing allows us to understand and feel safe in our environment, and make and maintain social connections, it is not surprising that when hearing is compromised, it can impact our relationships and quality of life.

Bethany has experienced varying reactions from friends and family. “Guys with lower voices are the most difficult for me to understand,” she says. “I’ve told my mother many times that she trails off her sentences, and I miss most of what she says but she doesn’t want to 'yell.' So I just try to get the gist of it and look blankly pleasant the rest of it. It’s so frustrating. I’m a nanny/sitter, and the children I work with are great about it! They’re often interested in my hearing aids and don’t mind if I ask for a repeat, or we joke about misheard words. My friends are very kind about it.”

Hearing aid wearer Jill notes some subtle challenges in her everyday life. “I wouldn't say that my hearing loss has had a hugely negative impact on my life or my work relationships,” she explains. “The hardest part about communication is when people speak 'away' from me or in an environment with a lot of background noise. But also, people who are just low-talkers/mumblers in general just make it hard.”

Conversely, Gabriella notes that early on in managing her hearing loss, “The impact socially was huge. I couldn’t go to noisy cafes with wooden floors and high-pitched ceilings.”

Even when loved ones are understanding, living with mild-to-moderate hearing loss can still be difficult, as Tracy explains: “My family is very supportive, so they don't mind me mishearing them or asking them to repeat themselves constantly. But it gets wearing constantly explaining to new people that I need them to repeat things or that I didn't hear them.”

Start Now: Get Hearing Help Sooner Rather Than Later!

Although hearing loss is common, according to the Hearing Loss Association of America, people often wait about 7 years before seeking help. Early treatment is key to avoiding long-term issues with understanding speech and processing sounds.

Reisman explains the importance of addressing hearing loss early to avoid further complications: “Getting amplification sooner helps reduce the sequelae of hearing loss like isolation, auditory deprivation, falls, dementia, etc. The prognosis for maintaining your hearing also improves when you wear hearing devices early on. Most important is the improvement in quality of life,” she told HearingTracker.

Outcomes from the landmark ACHIEVE trial from Johns Hopkins support this. The study found that for older adults at higher risk of cognitive decline, hearing intervention slowed the loss of thinking and memory abilities by 48% over 3 years. This highlights that starting hearing intervention early can be crucial for preserving cognitive function and memory.

Linda’s experience with hearing aids reflects this importance: “I was THRILLED with my hearing aid and how much more speech I could understand without having to turn the volume up so high or keep asking people to repeat themselves. The audiologist who sold me the hearing aid told me that people should always get them sooner than later, and now, after the incredible difference mine has made, I agree with him 100%.”

Addressing mild-to-moderate hearing loss early is vital for maintaining quality of life. Prompt treatment can improve communication, prevent further decline, and reduce feelings of isolation. Reisman adds, “Getting a baseline assessment to know where you stand with your hearing health is a great first step. If you are identified as having hearing loss, you can always ask your provider for a hearing aid trial before committing to the journey. Most patients are amazed when they realize what they've been missing.”