Some people hear well in quiet places but struggle to follow conversations in noisy settings like restaurants or family gatherings — even after passing a hearing test. If this has happened to you, there may be more going on. Here’s what to know.

What is hidden hearing loss? 

Hidden hearing loss is when you have trouble hearing even though your test results look normal. It’s referred to as “hidden” because the problem doesn’t show up on regular tests. 

Most hearing tests check how well you hear tones in a quiet room. But everyday life isn’t quiet, it’s full of sounds and noise. People with hidden hearing loss can often hear sounds but can’t understand what others say when there’s background noise.  

Experts think hidden hearing loss happens when parts of the inner ear get damaged. Tiny cells in the cochlea (the part of the ear that sends sound to your brain) may stop working properly. When that happens, your brain doesn’t get a clear message and voices may sound fuzzy or unclear.*

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Why is it often missed on hearing exams? 

Standard hearing tests don’t always show the whole picture. They check whether you can hear tones at different pitches and volumes,  not how well you understand speech in everyday situations. 

People with hidden hearing loss often “pass” these tests because they can still hear the tones. The difficulty shows up in noisy environments, when the brain has to separate speech from background sound.  

Some providers use special tests that add background noise, such as speech-in-noise tests, to look for this problem. But there isn’t one official test for hidden hearing loss yet. 

What causes hidden hearing loss?  

One of the main causes is long-term exposure to loud noise. Loud concerts, sporting events, construction work or listening to headphones at high volume can damage the tiny nerve fibers that carry sound from your ear to your brain. 

Aging can also play a role. Over time, those same nerve connections can weaken. Some medicines such as certain cancer drugs may also affect hearing. 

In some cases, hidden hearing loss may be linked to other health issues, such as: 

• Autoimmune conditions, which can damage the coating around nerves 
• Chronic ear infections or hearing loss in one ear, which may reduce sound signals to the brain 
• Tinnitus (ringing or buzzing in the ears), which can be a sign of nerve damage 

No matter the cause, the result is similar: The ear and brain don’t work together as smoothly as they should, which can make everyday listening harder. 

Take advantage of your hearing benefit 

Your plan covers one routine hearing exam each year with an in-network provider.   

You also get hearing aid coverage with a copay of $XXX–$XXX (per ear, per year (two hearing aids every year) through NationsHearing®. Plus, one hearing aid fitting and evaluation.

You can schedule your hearing exam or hearing aid appointment with a NationsHearing provider. Just call 1-877-225-0137 (TTY: 711). Representatives are available from 8 AM to 8 PM local time, 7 days a week, excluding holidays.

What are the symptoms? 

Hidden hearing loss can sneak up slowly. You might notice: 

• Trouble following group conversations or phone calls 
• Feeling worn out from trying to listen 
• Speech sounding muffled or unclear 
• Turning up the TV or asking people to repeat themselves 
• Ringing in your ears  

If these sound familiar, have your doctor check your hearing again. Even if your last hearing test looked normal.

How can you manage hidden hearing loss?

An audiologist can help you find ways to make listening easier and manage hidden hearing loss. 

Some people benefit from hearing aids or assistive listening devices that make speech clearer. These tools can help you focus on voices, especially in busy or noisy places. 

Communication tips can also help. Try: 

• Moving closer to the person you’re talking to  
• Turning off background noise, like the TV or music  
• Asking people to face you when they speak  
• Using visual cues, like lip reading or gestures  

A hearing specialist can test how well you understand speech in noise and help find options that fit your lifestyle.

Ways to protect your hearing 

Protect your ears whenever you’re in a loud environment — concerts, fireworks, sports games or even when mowing the lawn. 

Simple steps can help: 

• Wear earplugs or earmuffs designed for noise protection 
• Set volume limits on personal devices 
• Take listening breaks when sounds feel too loud 
• Walk away from loud speakers when possible 

Even if your hearing seems fine now, protecting it can help prevent problems later. 

If you often ask people to repeat themselves or have trouble following conversations in noisy places, it may help to talk with a hearing specialist. 

They can look beyond standard hearing tests to see how well your ears and brain work together. Getting help early can make it easier to hear and enjoy conversations again. 

*FOR HEARING LOSS: American Academy of Audiology. Hidden Hearing Loss. October 14, 2025. Accessed March 9, 2026. 

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area. Participating health care providers are independent contractors and are neither agents nor employees of Allina Health | Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change.

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