What’s a Hearing Number and Why You Should Know Yours

Do you know how well you hear, how much hearing you have right now, how it has changed over time, and what steps you might consider in response to it? If you don't, you're not alone.

A mere 9% of adults are aware of what constitutes a “typical” hearing level, and only 27% are likely to have their hearing evaluated. In contrast, the majority of people know the status of their blood pressure and cholesterol. A 2022 study suggests that roughly 85% of adults know the standard blood pressure ranges and around 52% are knowledgeable about normal cholesterol levels.

Yet, when you ask most people about how well they hear, you'll either get a vague answer...or silence.

Why understanding and monitoring your hearing health is important

Our hearing enables us to interact and engage with the world around us and connect with loved ones. When our hearing levels change, we may struggle to communicate effectively and confidently, which can negatively affect our mental health and we may start to feel socially isolated. Numerous research studies have linked untreated hearing loss to a greater risk for loneliness, depression, and dementia. Hearing loss is also associated with a wide range of chronic diseases and illnesses, along with reduced quality of life and even economic status.

Clearly, our hearing has a huge impact on our health, yet many of us do not know much about our hearing and how it changes as we age. With approximately 15% of American adults (37.5 million) aged 18+ reporting some trouble hearing, it is important that we see hearing healthcare as an integral part of our overall health and wellness—and something that can have significant consequences if left untreated.

Yet, data from the MarkeTrak 2022 study reveals that people tend to wait an average of 4 years from the moment they first notice a hearing loss before seeking treatment. Additionally, only 34% of individuals with hearing impairments opt for hearing aids.

The “Know Your Hearing Number” Campaign: Changing the way we talk and think about our hearing

Throughout other health disciplines, there have long been common health metrics—numbers that mean something to people—that can be used to track any changes. But, when it comes to hearing, there hasn’t been a consistent or universal way to measure and talk about it like there is for other measures of health and wellness…until recently.

In September 2022, Johns Hopkins Cochlear Center for Hearing and Public Health launched the “Know Your Hearing Number” campaign. The goal of this campaign is to work with public health entities and industries in this space to standardize the way hearing is reported and encourage people to be aware of their Hearing Number as a basic health metric and take responsibility for their hearing. This campaign coincided with the US Food & Drug Administration releasing its regulations for over-the-counter (OTC) hearing aids.

Frank Lin, MD, PhD, Director of the Cochlear Center for Hearing and Public Health at Johns Hopkins Bloomberg School of Public Health and co-creator of the Hearing Number campaign, told an audience at the 2023 Academy of Doctors of Audiology (ADA) Conference that most people now get their hearing screened at birth, followed by a screening at about age 7, then they may not get their hearing checked again until around the time of their Welcome to Medicare exam—or when their spouse is pleading with them to get it checked. Clearly, this is not consistent with good healthcare policy for people ages 13 through the adult lifespan.

Lin says apps and audio tech manufacturers now refer to hearing loss in different ways with different metrics. As a public health issue, he believes a standard number is needed that reflects hearing ability—with an emphasis on hearing protection and conservation—that is universal, accessible, actionable, and clinically meaningful.

What is a Hearing Number?

The campaign from Johns Hopkins presents the Hearing Number as a simple metric to get a snapshot of our hearing at the time it is assessed. Technically speaking, it is a four-frequency pure-tone average (PTA4) of an individual's hearing thresholds. This means it is an average of your hearing ability at the four pitches (500, 1000, 2000, and 4000 Hz) that largely determine how well you perceive speech. This makes the Hearing Number a rough estimate of how loud speech needs to be before you can reliably hear it.

Notably, the Consumer Technology Association (CTA) just released a new standard using the Hearing Number as its method for reporting consumer hearing, and this should help standardize the metric across various consumer-facing apps. Consumer technology companies will adopt this standard as a reference for incorporating and applying the Hearing Number in their products, ensuring at least some consistency when educating and informing consumers about their hearing.

Understanding your Hearing Number

Depending on the testing equipment, a Hearing Number typically ranges from 0-100. Each person has two Hearing Numbers: one for each ear. The higher your Hearing Number, the louder the sounds need to be for you to hear them.

The Hearing Number cannot be lowered or improved, and there is no “perfect score.” Children generally have a Hearing Number less than 10, which means they can hear very soft sounds. As we age, the parts of the inner ear that detect sound commonly experience wear and tear leading to hearing loss. As our hearing gets worse, sounds must be louder for you to hear them, and this is reflected in an increase in the Hearing Number.

“The hearing number concept isn't necessarily all new,” says Nicholas S. Reed, AuD, PhD, a researcher and assistant professor in the Department of Epidemiology at Johns Hopkins who frequently works with Dr. Lin on research. “This four-frequency PTA is the same as the measures used in the vast majority of epidemiologic studies calculating the prevalence of hearing loss or associating hearing loss with various outcomes, including hearing loss and cognitive decline among older adults. That's because this same four-frequency PTA has been previously recommended by the World Health Organization for categorizing hearing loss. However, what the Hearing Number campaign adds is moving away from the traditional categories.”

These traditional categories alongside the corresponding hearing numbers are as follows:

• Normal is a Hearing number less than 20
• Mild is a Hearing Number of 20 to 34
• Moderate is a Hearing Number of 35 to 49
• Moderately severe is a Hearing Number of 50 to 64
• Severe is a Hearing Number of 65 to 79

Drs. Lin and Reed hope that establishing a Hearing Number will help increase conversation around hearing, motivate people to care more about and monitor their hearing health, and empower people with hearing loss to adopt communication strategies and hearing technologies that can help improve their hearing and overall quality of life.

“We believe that moving away from broad categorizations of hearing loss as either a binary label—like 'hearing loss' or 'normal hearing'—or using nebulous words—like normal, mild, moderate, or severe—would be preferable because these categories don't really give consumers a practical indication of their hearing status,” says Reed. “Instead, we should move towards a more discrete number that characterizes a person's hearing ability, rather than just hearing loss. We need to give people a Hearing Number that moves on an easy-to-understand scale. This is important in a few ways.

“First,” Reed explains, “it standardizes the consumer-facing metric for hearing which can reduce confusion.

“Second, it empowers and helps people understand hearing and gives them a discrete anchor point to see how their hearing changes over time, as opposed to some of the labels that don't offer much insight or remain stagnant over the course of someone's life. For example, an individual could have 'mild' hearing loss for 30 years, but during that period their Hearing Number might change from 21 to 34 [a borderline moderate hearing loss]. Only by using the Hearing Number metric will that change be clear and meaningful.

“Third, it can offer some basic guidance on when to start using different strategies for addressing hearing loss or when to see a professional by providing a scale that shows change in hearing well before someone might notice it subjectively.

“Fourth, given all the research about hearing loss and various aging outcomes, I do think it is important that the Hearing Number uses the same metric as many of those studies and can help us link hearing to our overall health,” says Reed.

How do I get my Hearing Number?

Since the Hearing Number metric isn't necessarily new, you can technically get it anywhere you receive a pure-tone audiometry test, whether it is by a hearing care professional, a portable audiometer such as Shoebox or HearX, or from a validated smartphone or computer app.

The Mimi and SonicCloud apps are particularly helpful if you have an Apple phone or tablet: just visit the website or app and you can get your Hearing Number in 5-10 minutes. With Mimi, you take the "Pure Tone Threshold Test" and get your Hearing Number at the bottom of your audiogram. With SonicCloud, you take the test then import the results into the Apple Health app; your Hearing Number will be displayed at the bottom of the "Audiogram" section.

You can also calculate your hearing number from any audiogram by following the instructions below in the example calculation from the Hearing Number website:

Again, shown above, the Hearing Number is a simple average of the volume (in decibels) at which you hear four of the frequencies that are most important for speech understanding: 500, 1000, 2000, and 4000 Hz.

How can I use my Hearing Number to help me improve my hearing?

The Hearing Number can be used as a guide for early decisions, like when to see an audiologist and when various communication strategies or technology may help.

“That number is incredibly empowering,” said Dr. Lin during a seminar about over-the-counter (OTC) hearing aids at the Consumer Electronics Show (CES) in January 2023. “So, by knowing that number, it lets people like me—or anyone who has a Hearing Number—figure out which technologies you can uptake; it lets you know something about your life course and where your hearing’s changing.“

Reed explains: “Moreover, if we can standardize the consumer-facing metric and increase awareness of differences in hearing (not just hearing loss), we could increase awareness of apps that customize the sound for our specific hearing levels, and this could lead to more comfort with hearing technology across the population. A long-term ramification may be things like increasing adoption of hearing technologies like hearing aids before someone waits too long.”

The following infographic from the Hearing Number campaign shows how we can use our hearing number to discover helpful, widely recommended hearing strategies:

If your Hearing Number is between 10 and 60, an OTC device could be appropriate for you. For larger numbers, a prescription hearing aid may be needed, or even a cochlear implant. As the infographic shows, there is an overlap of prescription hearing aids with both cochlear implants and OTC devices. Since everyone’s hearing loss experience is unique, a device that works for one person may not work for someone else, even if they have the same Hearing Number.

Communication strategies can be helpful for people with all levels of hearing, and these include:

• Standing close to the person you are speaking to and making sure you are facing them
• Avoiding environments with background noise and reverberation (echo)
• Summarizing what you heard the speaker say and asking for clarification

Everyday technologies that can be helpful in aiding communication and understanding include:

• Enabling closed captions on TV shows and movies
• Using internet technologies such as Skype, Google Voice, WhatsApp, and FaceTime to make phone calls, which have better sound quality than traditional phones
• Using apps on your smartphone to customize the sound output of an audio device (e.g., Apple AirPods Pro), making it easier to hear phone calls and listen to music, or even using it during conversations via a transparency mode

A hearing professional can advise you about which hearing technologies will be most helpful and support you in finding the best communication strategies for your everyday needs.

The Hearing Number is a simple snapshot and not the whole picture

It’s evident the Hearing Number has some clear positives and a worthwhile motive driving it, but it should not be viewed as a thorough measure of our hearing health.

“Hearing is very different from individual to individual, and the Hearing Number is a simple snapshot that doesn't capture the full picture,” explains Reed. “While its advantage lies in its common use among researchers and large public health organizations, we also know it isn't a perfect metric. But it isn't supposed to be. The concept is for a consumer-facing common metric to increase understanding, awareness, and comfort with hearing.”

Caveats to the Hearing Number

Thomas Powers, PhD, of Powers Consulting, LLC, and a retired vice president of audiology at global hearing aid manufacturer Siemens and Sivantos (Signia), believes the Hearing Number is a good idea in principle. However, he emphasizes a single number for hearing loss has some limitations because hearing loss isn’t a unidimensional problem.

For example, it's estimated about 26 million American adults with normal audiograms complain about understanding speech or hearing when in noise. Since the Hearing Number is based solely on pure-tone (single-frequency) measures in quiet, it doesn’t give information regarding speech intelligibility in social situations in the presence of competing speech. Only considering pure-tone results means that hidden hearing loss—referring to those with a normal audiogram but who still have hearing difficulty especially in noise—will go undetected. Yet, as noted, the estimated 12% of people with hearing difficulties who have hidden hearing loss will experience significant challenges.

Powers also points out that the Hearing Number doesn't account for potential differences in the slope or configuration of the hearing loss. For example, one person may have a high-frequency hearing loss, reading 30, 40, 50, and 60 dB in the four frequencies most important for understanding speech, and their audiogram will show a sloping downward curve from left to right. Another person may have a “reverse slope hearing loss” that is worse in the low frequencies with a sloping upward curve, reading 60, 50, 40, and 30 dB. In this example, the Hearing Number for both people would be calculated as 45 dB.

“In that instance, these two people have the same Hearing Number,” explains Powers. “But the hearing difficulty that they have is going to be very different in terms of social situations, environments where they struggle, and what they miss. One is going to miss high-frequency sounds and the other is going to miss low-frequency sounds.”

For people taking online hearing tests to determine their Hearing Number, it is important they understand these tests do not provide a comprehensive hearing health assessment. Powers explains that there are certain medical issues that can show up only when you have a full hearing test by a hearing care professional.

For example, you may have impacted wax in the ear, blocking the pathway of sound. This would result in your Hearing Number being artificially higher than it should be. Simply having a professional remove the wax could possibly help relieve any hearing difficulties.

Sudden sensorineural hearing loss (SSNHL) or sudden deafness is a sudden or rapid loss of hearing in one or both ears, which can occur immediately or over a few days. As one of the few real "emergencies of the ear,” SSNHL requires immediate medical attention and, if left untreated, could lead to a greater risk of permanent hearing loss, which might have potentially been recovered. SSNHL can also be an indicator of other serious medical conditions.

These are just a few examples of conditions that are unlikely to be picked up by an online hearing test. Additionally, with online hearing tests, there can be calibration issues with the equipment, meaning test results are not always accurate. “The hope would be that even if their Hearing Number is only slightly elevated, they would go see a hearing professional to give them a full picture of what their hearing is about,” says Powers.

Overall, Powers and other experts in hearing healthcare see the Hearing Number as a way of getting people to start taking control of their hearing health: “It’s certainly a good start on awareness,” he says. "We just need to make sure that it's accurate and comes with good consumer information.”

The Hearing Loss Association of America (HLAA), the largest US advocacy group for people who are hard of hearing, also supports the general idea of creating a consumer-friendly system to track hearing. “Hearing is an often forgotten, but crucial part of overall health and wellness,” comments HLAA Executive Director Barbara Kelley. “Most of us track other health numbers like blood pressure, weight, cholesterol, but have no idea how well we are hearing. Bringing attention to the importance of hearing health and giving consumers the tools to track it, are important steps to tackling the growing public health crisis of hearing loss.”

Do you know your Hearing Number? For more information, visit the Hearing Number website.