Profound Hearing Loss: What Is It?
November 01, 2021

“There is a difference between hearing aids and eyeglasses. Hearing aids “aid” if and only if there is any usable hearing in the ear. They do not “correct” hearing like eyeglasses correct vision. Those with profound hearing loss may not have any hearing at all and therefore cannot use hearing aids and may need to consider other options such as a cochlear implant.”   - Drew Sutton, MD, Board-Certified Otolaryngologist

Hearing loss is just a part of getting older for many people, while for others, it can seem to come out of the left field without much warning. Hearing loss is multifactorial and comes in a wide range of severities. 

Aside from normal hearing, hearing loss ranges from mild hearing loss to severe hearing loss. A few different types of hearing loss include conductive hearing loss, sensorineural hearing loss, and profound hearing loss. People with hearing loss typically have damage to the structures of their cochlea or auditory nerve.

As we already know, hearing loss can be caused by noise exposure. In addition, some of the other common causes of hearing loss include ear infections, head injuries, specific medications, Tinnitus, viral infections,  and illnesses like meningitis. 

While some people with hearing loss may recognize soft sounds almost at a normal level, others will need amplification or hearing aids when around noise exposure. Depending on the type of hearing loss or hearing damage you may have, the amplification could be specifically for lower frequencies or high frequencies. Amplification can help restore some audibility. 

Many people equate hearing loss with an all or nothing mentality in that you are either extremely hard of hearing or have fully intact hearing. In reality, hearing loss is on a spectrum in which you can have varying degrees of auditory acuity, and that acuity can even vary based upon pitch.

If you or a loved one has a hearing impairment, you may have heard the term profound hearing loss used. While it may seem obvious that profound hearing loss is when hearing is profoundly lost, in reality, the term refers to a very specific diagnosis and involves many tests. 

Below is a closer look at what exactly profound hearing loss is, how a hearing loss is deemed profound, as well as a closer look at the things you can do to help a hearing impairment.

How Is Hearing Loss Tested?

Hearing loss can affect people of all ages (infants, young children, teens, adults), and while the elderly tend to disproportionately have more cases of hearing loss, the truth is that it can affect you at any age. 

In the distant past, hearing loss was something that was typically missed during childhood and resulted in many individuals performing poorly in school due to a hard time hearing. In the past few decades, local governments have begun to mandate hearing screenings in schools to help identify hearing loss sooner rather than later. 

No matter the age, hearing tests are fundamentally the same and are a great way to better understand your auditory acuity and where it may be falling short. A standard hearing test may consist of a pure-tone test, a tympanometry screening, and a bone conduction test to assess hearing. 

Combining these tests can allow an audiologist to understand the extent of hearing loss and what the most likely type of hearing loss is at play. 

Below is a closer look at the components of a hearing test and what they help to identify.

Pure Tone Test

If you have never gone to get your hearing tested or haven't gotten them checked since you were a child, you are most likely unfamiliar with an audiogram. An audiogram is a graphical representation of a pure-tone test, and it provides you with information about your hearing acuity at a variety of different pitches. 

A pure tone test begins by getting you into a quiet and often noise isolated room. You will have headphones on in the room, and the audiologist will play a tone at a specific intensity and pitch. 

The audiologist will most likely ask you to raise your hand on the same side that the tone is heard. If a tone is played and not heard, the audiologist will increase the intensity and try again until you can perceive it. 

When the test is done, you will see your level of hearing in both your right and left ear on the audiogram. Typically the audiogram will have the degrees of hearing loss present on the graph to help you determine how good your hearing is. The more decibels needed to hear a specific frequency of sound, the more severe the hearing loss. 


Unlike the pure pitch test, tympanometry is a hearing test that doesn’t require the individual to try and hear at all. A tympanometry test is essentially testing how well your middle ear works. 

This is accomplished by a device that modulates pressure in the ear canal and plays a tone. Based upon how much of the tone is reflected vs. absorbed by the middle and inner ear can help clinicians to determine if the middle ear is working as it should. 

The results of a tympanometry test are called a tympanogram, and they are a little less easy to understand intuitively. The test will typically output a pyramid-like graph which is then compared to the standard tympanogram.

This test is utilized to help determine whether hearing loss is conductive or sensorineural. If the test shows normal middle ear function and hearing loss is detected, it is likely to point to sensorineural. 

Bone Conduction

A bone conduction test is a test that assesses your ability to hear tones that are being conducted through your skull. The conduction device is placed on the skull region behind the ear, known as the mastoid process. The device then emits different frequencies and intensities of vibrations conducted through the bone and interpreted as sound by the cochlea. 

A bone conduction test can be done similarly to the pure tone test and can be output as an audiogram to compare to the standard. Bone conduction tests are utilized since they bypass the middle ear and exclusively assess the functioning of the sensorineural aspects of hearing like the cochlea. 

What Is Profound Hearing Loss and How Is It Defined

With a general understanding of a typical hearing test, it is much easier to understand what exactly is meant by profound hearing loss. Per the CDC, profound hearing loss is characterized by an inability to hear any speech, and those with profound hearing loss can only hear very loud sounds. 

More specifically, those with profound hearing loss are unable to hear sounds below 91 decibels. Things over 91 decibels include lawnmowers, ambulance sirens, and a concert. Profound hearing loss can be in one or both ears due to sensorineural, conductive, or mixed hearing loss. 

Profound hearing loss is the same as being functionally deaf. Completely deaf individuals may have no sense of hearing, but the profoundly hearing impaired cannot hear anything below the level of a leaf blower. 

Those with profound hearing loss or profound deafness most likely use sign language or visual cues (like lip-reading) whenever noise or spoken language is present. 

Ways You Can Help Hearing Loss

Having a diminished sense of hearing can be challenging to deal with, and it can be frustrating when you constantly need people to repeat themselves. Thanks to modern medicine and technology, the hearing impaired have several tools at their disposal to help decrease the impact that low auditory acuity can have on everyday life. 

Below is a closer look at the different ways that you can help hearing loss. Getting an impaired hearing diagnosis can be disheartening, and understanding your options and the tools available can make it a little easier to accept. 

Hearing Aids

Hearing aids are small devices that work by amplifying the intensity of sounds in your environment to match your perceivable threshold. Hearing aids accomplish this by having a microphone, amplifier, and speaker. The microphone receives the sound that your ear would normally hear and then sends it through the amplifier where the pitch remains the same but intensity is increased. After the amplifier, the signal is sent to the speaker, where the sound is emitted close to the eardrum. 

Those with mild or moderate hearing loss are good candidates for hearing aids because they typically retain the ability to discern differences in pitch and simply need sounds to be slightly louder. Hearing aids for moderate hearing loss can significantly improve your ability to understand those around you. 

Hearing aids come in many forms and can come with several added features. Audien’s EV3, for example, comes in a small form factor and comes with the added feature of Clear Sound +. The Clear Sound + feature can single out speech in the environment and amplify it while simultaneously reducing ambient background noise. The result is crystal clear speech that is easier to hear. 


Sensorineural associated profound hearing loss and deafness are hearing impairments that can benefit from the use of implants. 

The most common is a cochlear implant, and it is a medical device that essentially bypasses a majority of the ears functioning and provides electrical impulses directly to the cochlea. 

A cochlear implant consists of the implanted device, the electrical lead implanted into the cochlea, and an external means of communication such as the microphone and processor. The microphone receives sounds, the processor determines how to send the information, and it is sent straight to the cochlea. 

While a cochlear implant cannot provide true sound heard with the ear, it can provide individuals with auditory cues that may have not otherwise been possible.


In summary, profound hearing loss is synonymous with being functionally deaf. Without the ability to perceive sounds below 91 DB, those with profound hearing loss will either need to learn how to cope with hearing loss, such as utilizing dictation software, or look into the potential for a cochlear implant. 

For those with milder cases of hearing loss, options like a hearing aid can significantly improve day-to-day life and allow you to not miss out on important conversations and moments with those you love. 



American Academy of Audiology Childhood Hearing Screening Guidelines | CD

Types of Hearing Loss | CDC

What Are Cochlear Implants for Hearing? | NIH

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Drew Sutton M.D.

Drew Sutton, MD is a board-certified otolaryngologist. He has extensive experience and training in sinus and respiratory diseases, ear and skull base surgery, and pulmonary disorders. He has served as a Clinical Instructor at Grady Hospital Emory University for more than 12 years.

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