Speech Reception Threshold of 65 dB HL: Severe Hearing Impairment
An SRT of 65 dB HL indicates moderately severe to severe sensorineural hearing loss, representing a significant functional impairment where conversational speech at normal levels (60-65 dB SPL) is at or near threshold, meaning the patient can barely detect speech but cannot understand it without substantial amplification. 1
Severity Classification
65 dB HL falls within the moderately severe hearing loss range (56-70 dB HL) according to the American Academy of Otolaryngology-Head and Neck Surgery classification system. 1
This level is approaching severe hearing loss (71-90 dB HL), indicating substantial auditory impairment. 1
For context, normal hearing is defined as ≤20 dB HL, so a 65 dB SRT represents a 45+ dB deficit from normal. 1
Functional Impact
At 65 dB HL, the patient requires speech to be presented at 65 dB just to achieve 50% word recognition—this means normal conversational speech (typically 60-65 dB SPL) is essentially at their detection threshold. 2
The patient will have profound difficulty understanding speech in any background noise, as they lack the signal-to-noise ratio advantage needed for comprehension. 3, 4
Even in quiet environments, speech must be significantly amplified to be understood, not just detected. 5
Clinical Significance and Next Steps
This level of hearing loss requires immediate audiologic intervention and consideration for advanced amplification strategies:
Hearing aids are appropriate as first-line management, though conventional amplification may provide only partial benefit at this severity level. 6
The American Academy of Otolaryngology-Head and Neck Surgery recommends complete audiometric assessment including air and bone conduction thresholds (250-8000 Hz), word recognition scores, and tympanometry to distinguish sensorineural from conductive components. 2, 6
If bilateral and hearing aids provide insufficient benefit, cochlear implantation should be considered, as this severity approaches candidacy criteria for implantation. 6
Critical Diagnostic Considerations
Before finalizing the diagnosis, exclude reversible causes:
Perform otoscopy with cerumen removal—impacted cerumen can elevate SRT and must be excluded before establishing a sensorineural diagnosis. 7
Obtain bone conduction thresholds to rule out conductive overlay; any air-bone gap would indicate a treatable middle ear component. 1
For sudden or rapidly progressive hearing loss to this level, if within 2 weeks of onset, corticosteroids should be offered. 6
MRI of the brain and internal auditory canals is recommended to rule out retrocochlear pathology such as vestibular schwannoma, particularly if asymmetric. 6
Rehabilitation Urgency
Audiologic rehabilitation should be addressed immediately—delay leads to auditory deprivation and poorer outcomes. 6
Counseling must address the profound impact on communication, safety, function, cognition, and quality of life at this severity level. 6
Follow-up audiometric evaluation should be obtained within 6 months to monitor progression and assess amplification benefit. 2, 6