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Hidden Hearing Loss: A 10-Year Journey

Research Findings

A decade after the discovery of cochlear synaptopathy, or ‘hidden hearing loss,’ scientists uncover a new potential cause.

It’s not uncommon for people to have hearing difficulties, particularly in noisy environments. For years, patients have come to clinics complaining of such difficulties and clinicians have questioned the efficacy of an audiogram, a commonly used hearing exam. As they suspected with some types of hearing loss, more could be happening in the inner ear than an audiogram can measure.

In 2009, a team of investigators led by Sharon G. Kujawa, PhD, and M. Charles Liberman, PhD, of the Eaton-Peabody Laboratories (EPL) at Massachusetts Eye and Ear, uncovered a new type of inner ear damage that could explain these poorly understood, but common, hearing complaints.

In a study published in the Journal of Neuroscience, they described that with age or noise exposure, the neural synapses responsible for the communication between the ear and the brain can disappear and decrease the reliability of the auditory information sent to the brain.

“This finding changed the landscape of how we look at patients with hearing loss,” said Dr. Kujawa. “Conventional wisdom suggests that sensorineural hearing loss is largely attributed to the loss of hair cells, but this study indicated something different.”

Dr. Kujawa and Dr. Liberman showed that noise and aging first damage the synapses, which connect the hair cells to the nerve fibers and ultimately, carry neural signals to the brain. This hearing damage is now known as cochlear synaptopathy. Since hair cell function is what audiograms measure, this synaptic loss is typically undocumented, inspiring the popular term ‘hidden hearing loss.’

Dr. Charles Liberman and Dr. Sharon Kujawa.

A decade of discoveries

This year marks the 10-year anniversary of the discovery of hidden hearing loss at Mass. Eye and Ear. Throughout this past decade, investigators around the world have aimed to uncover the prevalence, diagnosis and functional consequences of the condition.

Dr. Kujawa and Dr. Liberman noted that over the past 10 years, EPL investigators have demonstrated cochlear synaptopathy in many animals as well as aging humans. They’ve also developed techniques based on gene therapy and drug delivery that can protect the ear against noise exposure or even regenerate the neural connections after damage.

One of the most recent discoveries of this team came from the work of Stéphane F. Maison, PhD, who has found a connection between cochlear synaptopathy and sound deprivation. His findings suggest that ear infections and conditions that cause chronic conductive hearing loss may lead to nerve damage if left untreated.

Noise exposure, ‘normal’ aging, and use of ototoxic drugs have also been identified as causes of hidden hearing loss. This study, however, is the first to suggest that underuse of the ear might also have similar damaging effects.

“Our results suggest that chronic sound deprivation can lead to speech recognition difficulties consistent with cochlear synaptopathy,” said Dr. Maison. “The findings are especially important considering that children with asymmetric hearing loss have higher rates of academic, social and behavioral difficulties.”

People with hearing loss in one ear are often reluctant to seek treatment as they still can rely on their better ear. This study suggests that, in absence of treatment, speech perception may worsen in time.

Dr. Maison recommends that clinicians consider providing amplification in the management of unilateral conductive hearing loss.

Looking toward the next 10 years

Ten years after the landmark discovery of cochlear synaptopathy, investigators are getting closer to understanding what hidden hearing loss is, what causes it, and how to identify it in patients.

EPL researchers hope to improve the sensitivity and specificity of hearing tests in order to identify hidden hearing loss and define how this condition evolves in time.

“Although much work remains to be done, including the challenge of accurately diagnosing the degree of neural degeneration in human ears, the development of cures for this key aspect of hearing impairment is now a real possibility,” said Dr. Liberman.

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  1. Avatar

    Michael Moore

    I lost a great deal of my hearing after being given drugs to counter meningitis when I was one year old and have one or two hearing aids since that time.
    I have always felt that it was not the lack of sound was my problem but the differentiation of that sound.
    Until I read this very interesting article I was led to believe it was the non existence of the hair follicles that prevented me from hearing.
    As you can appreciate this new discovery fills me with great hope that maybe in the not too distant future a therapy will become available to correct this problem.
    I am now 65 years old and can hope it is not too far away as I would love to be able to sing opera at Carnegie Hall before I go.

  2. Avatar

    Donna Kos

    Had a hearing test at B+W Hospital in 2023. Said my hearing was o.k. However I often hear a different word than what is actually being said. I am 74 years old. Should l have another hearing test?

  3. Avatar

    Arthur Chen

    Is this related to sudden deafness, which struck my wife a few years ago?

  4. Avatar

    John Anthony Lock

    I am a Mass Eye and Ear patient that we have not found a good solution for my hearing loss. If there is a test and possible experimental solution based on your research I would be very very interested in trying it. I realize that your research is still in the experimental stage but if you need any patients to experiment on please let me know.

  5. Avatar

    Julie Tirinnanzi

    I have chronic sinusitis much of which is caused by asthma drugs. Is it possible this is causing my hearing loss Also I have a long history of ear infections which started as a child. Is it possible that I need a course of antibiotics ?

    • Avatar

      Ryan Jaslow

      Julie, thanks for reading. These are questions best answered by your doctor.

  6. Avatar

    Chandrakant Patel

    Thanks to the doctor who pioneered and came with a logical conclusion of the invisible trouble of hearing loss some people faces but cannot explain as to why it is happening can have some reason to believe and hopefully look for some remedy of disparity dilemma person like me facing. My fiancée does not believe me at all. She thinks, I am just ignoring her when she is talking and look for excuses when I cannot repeat what she said to me a minute ago. I am 82 years old blaming myself for hearing trouble. I had been diagnosed with specificity about my trouble in INDIA while I was there. At the time they were preparing me for hearing aid, with or without equipment, I had trouble of hearing during test. When I said about my trouble nobody believed me. I hope the new research will also find the cure for it soon.