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It takes the average person with hearing loss 5 to 7 years before getting a professional diagnosis, notwithstanding the fact that the warning signs of hearing loss are clear to others. But are those with hearing loss merely too stubborn to get help? No, actually, and for a handful of different reasons.

Perhaps you know someone with hearing loss who either denies the difficulties or declines to seek out professional help, and even though this is without a doubt frustrating, it is very possible that the indications of hearing loss are much more clear to you than they are to them.

Here are the reasons why:

1. Hearing loss is gradual

In most scenarios, hearing loss unfolds so little-by-little that the affected individual simply doesn’t notice the change. While you would notice an quick change from normal hearing to a 25 decibel hearing loss (characterized as moderate hearing loss), you wouldn’t perceive the minor change of a 1-2 decibel loss.

So a slow loss of 1-2 decibels over the course of 10-20 years, while causing a 20-40 total decibel loss, is not going to be noticeable at any given moment in time for those impacted. That’s why friends and family members are almost always the first to detect hearing loss.

2. Hearing loss is often partial (high-frequency only)

The majority of hearing loss cases are classified as high-frequency hearing loss, which means that the affected person can still hear low-frequency background sounds normally. Even though speech, which is a high-frequency sound, is strenuous for those with hearing loss to follow, other sounds can usually be heard normally. This is why it’s not uncommon for those with hearing loss to claim, “my hearing is fine, everyone else mumbles.”

3. Hearing loss is not attended to by the family doctor

People struggling with hearing loss can attain a false sense of well-being after their yearly physical. It’s common to hear people state “if I had hearing loss, my doctor would have told me.”

This is of course not true because only 14% of physicians regularly test for hearing loss during the course of the annual checkup. Not to mention that the principal symptom for most cases of hearing loss — trouble following speech in the presence of background noise — will not present itself in a quiet office atmosphere.

4. The burden of hearing loss can be shared or passed on to others

How do you treat hearing loss when there’s no cure? The solution is simple: amplify sounds. The issue is, although hearing aids are the most effective at amplifying sounds, they are not the only way to achieve it — which people with hearing loss promptly identify.

Those with hearing loss oftentimes crank up the volume on everything, to the detriment of those around them. Television sets and radios are played excessively loud and people are made to either shout or repeat themselves. The individual with hearing loss can manage just fine with this approach, but only by transferring the burden to friends, family members, and co-workers.

5. Hearing loss is pain-free and invisible

Hearing loss is predominately subjective: it cannot be diagnosed by visible assessment and it generally is not accompanied by any pain or discomfort. If people with hearing loss do not recognize a problem, largely due to the reasons above, then they probably won’t take action.

The only method to correctly diagnose hearing loss is through audiometry, which will calculate the specific decibel level hearing loss at multiple sound frequencies. This is the only method to objectively determine whether hearing loss is present, but the difficult part is needless to say getting to that point.

How to approach those with hearing loss

Hopefully, this essay has manufactured some empathy. It is always frustrating when someone with hearing loss refuses to acknowledge the problem, but keep in mind, they may legitimately not comprehend the magnitude of the problem. Rather than commanding that they get their hearing examined, a more effective strategy may be to educate them on the characteristics of hearing loss that make the condition essentially invisible.

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