Speech Reception Threshold of 85 dB HL: Severe to Profound Hearing Loss
An SRT of 85 dB HL indicates severe sensorineural hearing loss that renders the ear functionally non-serviceable, meaning traditional hearing aids will provide minimal to no benefit, and cochlear implantation should be strongly considered as the primary treatment option. 1, 2
Understanding the Severity
An SRT of 85 dB HL falls within the severe hearing loss category (71-90 dB HL), approaching profound loss (>90 dB HL). 2
At this threshold, the patient requires sounds to be amplified to 85 decibels—roughly equivalent to heavy traffic or a loud alarm—just to understand 50% of simple speech material. 3, 4
This level of hearing loss is classified as "non-serviceable" by the American Academy of Otolaryngology-Head and Neck Surgery, meaning the ear would not benefit from conventional hearing amplification in most circumstances. 5
Critical Diagnostic Steps
Before proceeding with treatment, you must confirm this is truly sensorineural hearing loss and rule out treatable causes:
Obtain complete audiometry including air conduction, bone conduction thresholds, speech audiometry, and tympanometry to exclude any conductive component. 1, 2
If the hearing loss is asymmetric (≥15 dB difference at 2 or more frequencies compared to the other ear), MRI of the internal auditory canals with gadolinium is mandatory to rule out vestibular schwannoma or other retrocochlear pathology. 5, 6
If the hearing loss developed suddenly (within 72 hours), this is an otologic emergency requiring immediate oral corticosteroids without waiting for imaging. 5, 6
Treatment Algorithm
For Sudden Onset (<2 weeks):
- Initiate oral corticosteroids immediately if within 2 weeks of symptom onset. 1, 6
- Consider intratympanic steroid therapy for treatment failures or patients presenting 2-6 weeks after onset. 6
For Established Severe Hearing Loss:
Cochlear implantation is the primary treatment recommendation for severe to profound bilateral hearing loss when hearing aids provide insufficient benefit. 1
Traditional hearing aids are unlikely to restore functional hearing at this severity level, as they cannot adequately compensate for the profound loss of cochlear function. 5, 1
For unilateral severe loss with better hearing in the contralateral ear, CROS (Contralateral Routing of Signal) or BiCROS hearing aid systems should be considered. 6
Immediate Counseling Priorities
Address the profound impact on quality of life, including:
Communication barriers: The patient will have extreme difficulty understanding conversation even in quiet environments, and speech-in-noise performance will be severely compromised. 5, 1, 3
Safety concerns: Inability to hear warning signals, alarms, approaching vehicles, or emergency announcements. 5, 1
Social isolation and cognitive impact: Untreated severe hearing loss is associated with increased risk of cognitive decline and depression. 5, 1
86% of adults with unilateral sudden sensorineural hearing loss report significant hearing handicap, and 56% with tinnitus experience handicap on validated inventories. 6
Common Pitfalls to Avoid
Do not delay audiologic rehabilitation—auditory deprivation leads to poorer outcomes even after intervention. 1, 6
Do not assume bilateral symmetric severe loss is simply age-related; evaluate for autoimmune disease, Lyme disease, syphilis, and ototoxic medication exposure. 6
Do not rely solely on hearing aids at this severity level—they will not restore serviceable hearing and may delay appropriate cochlear implant evaluation. 5, 1
Follow-Up Protocol
Obtain follow-up audiometry at the conclusion of any treatment and within 6 months to assess for progression. 1, 6
Refer to audiology immediately for comprehensive rehabilitation planning, including cochlear implant candidacy evaluation. 1, 6
Connect the patient with support resources such as the Hearing Loss Association of America. 6